生后72h内动脉血气评估窒息新生儿脑损伤的临床价值

Clinical value of arterial blood gas within 72 h after birth in evaluating neonatal asphyxia induced brain injury

目的探讨新生儿生后72 h内动脉血pH、碱剩余及乳酸水平评估窒息新生儿早期脑损伤的临床价值。方法回顾性分析2015年6月至2016年11月本院新生儿科收治的窒息新生儿，纳入头颅磁共振、视频脑电图、生后12 h内和24～72 h血气分析记录完整的病例。根据头颅磁共振和视频脑电图结果正常/轻度异常和中度/重度异常分为无脑损伤组和脑损伤组，分析两组患儿动脉血pH、碱剩余、乳酸的差异，并应用受试者工作特征曲线分析各项指标评价窒息新生儿脑损伤的价值。结果共纳入符合标准的窒息新生儿63例。头颅磁共振和视频脑电图均正常/轻度异常（无脑损伤组）30例，头颅磁共振和（或）视频脑电图中度/重度异常（脑损伤组）33例。脑损伤组患儿生后12 h内pH低于无脑损伤组[（7.32±0.09）比（7.38±0.08）]，12 h内乳酸和24～72 h乳酸高于无脑损伤组[（7.9±4.2） mmol/L比（4.9±2.4） mmol/L，（3.7±3.2） mmol/L比（2.2±1.1） mmol/L]，差异有统计学意义（P〈0.05）。生后12 h内pH、12 h内乳酸、24～72 h乳酸曲线下面积分别为0.323、0.715、0.643（P＝0.016、0.003、0.051）。生后12 h内乳酸评估脑损伤的临界值为7.5 mmol/L，敏感度为0.46，特异度为0.97。 结论生后72 h内动脉血乳酸水平可用于评估窒息新生儿脑损伤。

ObjectiveTo study the clinical value of neonatal arterial blood pH, base excess and lactate levels within 72 h after birth in assessing early brain injury in asphyxia neonates.MethodFrom June 2015 to November 2016, a retrospective study was performed on the asphyxia newborn admitted to newborn department of Children′s Hospital of Fudan University. The data of brain magnetic resonance imaging （MRI）, video electroenceph alogram （VEEG）, and artery blood gas analysis （within 12 h and 72 h） were all collected. The neonates were assigned into brain injury group （severe or moderate injury） and control group （normal or mild injury） according to MRI and VEEG results. The differences of arterial blood pH, base excess and the level of lactate between the two groups were analyzed and indicators of brain injury were evaluated using ROC curves.ResultA total of 63 cases were included in the study. Thirty patients were in the control group and 33 patients the brain injury group. The pH within 12 h was lower [（7.32±0.09） vs. （7.38±0.08）], and the lactic acid level in 12 h and at 24-72 h were significantly higher in the brain injury group than the control group [（7.9±4.2） mmol/L vs. （4.9±2.4） mmol/L and （3.7±3.2） mmol/L vs. （2.2±1.1） mmol/L]. The differences were statistically significant （P〈0.05）. The areas under the ROC curve of pH, lactate within 12 h and at 24-72 h were 0.323, 0.715, 0.643 （P=0.016, 0.003, 0.051）. The cut-off value of lactic acid within 12 h in assessing of brain injury was 7.5 mmol/L, with the sensitivity of 0.46 and the specificity of 0.97.ConclusionThe artery lactate level within 72 h after birth can be used to evaluate the severity of brain injury in neonatal asphyxia infants.