不同浓度的氧复苏治疗新生儿窒息的临床效果及对新生儿脑损伤的影响

Clinical effects of oxygen resuscitation of different concentrations in treatment of neonatal asphyxia and the effects on neonatal brain injury

目的探讨不同浓度的氧复苏对新生儿窒息的临床效果及对新生儿脑损伤的影响。方法选择2015年10月-2016年12月在该院出生且无脑损伤的窒息新生儿81例,按随机数字表法将患儿分为低氧组、中氧组和高氧组,每组各27例。低氧组患儿给予21%的氧气进行复苏,中氧组患儿给予40%的氧气进行复苏,高氧组患儿给予100%的氧气进行复苏,连续治疗2周。统计3组患儿的临床总有效率,并记录所有患儿开始啼哭时间、建立自主呼吸时间及出生后14 d新生儿神经行为测定(NBNA)评分,同时在出生后1 min、5 min及10 min对新生儿进行Apgar评分及出生后5 min的心率测定。另外对新生儿进行血气分析和统计氧中毒发生率。结果低氧组患儿的临床总有效率为74.07%,中氧组为96.30%,高氧组为85.19%,中氧组明显高于低氧组(P<0.05),其他组内之间比较差异无统计学意义(P>0.05);3组患儿开始啼哭时间、建立自主呼吸时间、NBNA评分及出生5 min的心率之间比较差异有统计学意义(P<0.05)。中氧组患儿的临床症状明显优于其他两组(P<0.05),而低氧组和高氧组患儿各指标之间比较差异无统计学意义(P>0.05);3组患儿出生后1 min后的Apgar评分、pH值及二氧化碳分压(PCO_2)之间比较差异无统计学意义(P>0.05),而出生后5 min和10 min后的Apgar评分及氧分压(PO_2)之间比较差异有统计学意义(P<0.05);中氧组患儿5 min和10 min后的Apgar评分明显高于其他两组(P<0.05),其他两组患儿之间比较差异无统计学意义(P>0.05);高氧组患儿的PO_2明显低于其他两组(P<0.05),其他两组患儿之间比较差异无统计学意义(P>0.05);低氧组和中氧组患儿均未出现氧中毒现象,而高氧组氧中毒现象发生率为3.70%(1/27),组间比较差异无统计学意义(χ~2=2.025,P=0.363)。结论不同氧浓度的临床总有效率比较差异无统计学意义,但是中等氧浓度能够改善窒息新生儿的临床症状,并有效预防足月窒息新生儿脑损伤。

Objective To explore the clinical effects of oxygen resuscitation of different concentrations in treatment of neonatal asphyxia and the effects on neonatal brain injury. Methods A total of 81 asphyxiated neonates without brain injury who were born in the hospital from October 2015 to December 2016 were selected and randomly assigned to low oxygen group,medium oxygen group,and high oxygen group,27 cases in each group. The neonates in low oxygen group,medium oxygen group,and high oxygen group were respectively treated with21%,40%,and 100% oxygen concentrations,all the neonates were continously treated for 2 weeks. The total clinical effective rates in the three groups were calculated statistically,the time of beginning to cry,setting up spontaneous breathing,and neonatal behavioral neurological assessment（ NBNA） scores at 14 days after birth were recorded. At the same time,one-minute,five-minute,and ten-minute neonatal Apgar scores after birth and heart rate within 5 minutes after birth were measured. In addition,blood gas analysis was performed,and the incidence rates of oxygen toxicity were calculated. Results The total clinical effective rates in low oxygen group,medium oxygen group,and high oxygen group were 74. 07%,96. 30%,and 85. 19%,respectively; the total clinical effective rate in medium oxygen group was statistically significantly higher than that in low oxygen group（ P〈0. 05）,while the difference between the other groups was not statistically significant（ P〈0. 05）; there were statistically significantly differences in the time of beginning to cry and spontaneous breathing,NBNA score,and heart rate within 5 minutes after birth among three groups（ P〈0. 05）. The clinical symptoms in medium oxygen group were statistically significantly better than those in the other two groups（ P〈0. 05）,whereas the indexes between low oxygen group and high oxygen group had no statistically significant difference（ P〈0. 05）; one-minute Apgar score after birth,pH value,and partial pressure of carbon dioxide（ PCO_2）among the three groups had no statistically significant difference（ P〈0. 05）,but there were statistically significantly differences in five-minute and ten-minute Apgar scores after birth and PO_2（ P〈0. 05）; five-minute and ten-minute Apgar scores after birth in medium oxygen group were statistically significantly higher than those in the other two groups（ P〈0. 05）,but the scores between the other two groups had no statistically significant difference（ P〈0. 05）; PO_2 in high oxygen group was statistically significantly lower than those in the other two groups（ P〈0. 05）,while the difference between the other two groups had no statistically significant difference（ P〈0. 05）; no oxygen poisoning occurred in low oxygen group and medium oxygen group,while the incidence rate of oxygen toxicity in high oxygen group was 3. 70%（ 1/27）,there was no statistically significant difference in comparison among groups（ χ-2= 2. 025,P = 0. 363）. Conclusion Although the total clinical effective rates of different oxygen concentrations have no statistically significant difference,the medium oxygen concentration can improve the clinical symptoms of asphyxiated neonates and effectively prevent brain injury among full-term asphyxiated neonates.