脐动脉血酸中毒预测早期早产儿常见新生儿疾病患病率的价值分析

Value of umbilical cord arterial blood acidosis in predicting the morbidity of early-stage preterm newborns

目的探讨脐动脉血酸中毒预测早发型重度子痫前期(EOSP)及健康孕妇早期早产儿常见新生儿疾病患病率的临床价值。方法选择孕周为29+2～33+6周的212例单胎活产孕妇为研究对象,均以剖宫产终止妊娠。其中EOSP 101例(EOSP组),健康孕妇111例(健康组)。胎儿娩出后30s内抽取脐动脉血1ml行脐动脉血气分析,同时记录新生儿1min Apgar评分、脐动脉血酸中毒(p H<7.15,乳酸≥7.0mmol/L)、新生儿呼吸窘迫综合征(RDS)、动脉导管未闭(PDA)、新生儿颅内出血(ICH)及病理性黄疸等情况。结果总体脐动脉血pH与乳酸呈负相关(r=-0.829,P<0.05),与碱剩余(BE)呈正相关(r=0.738,P<0.05);乳酸与BE呈负相关(r=-0.765,P<0.05)。与健康组相比,EOSP组脐动脉血pH、BE水平较低(P<0.05),乳酸较高(P<0.05),脐动脉血酸中毒发生率较高(P<0.05)。logistic回归分析显示,健康组早产儿脐动脉血酸中毒是低1min Apgar评分、RDS、ICH的影响因素(均P<0.05);EOSP组早产儿脐动脉血酸中毒是低1min Apgar评分的影响因素(P<0.05)。结论 EOSP孕妇早产儿脐动脉血pH、BE较低,乳酸较高,脐动脉血酸中毒与常见新生儿疾病患病率关系不大,而健康孕妇早期早产儿脐动脉血酸中毒与常见新生儿疾病患病率有关。脐动脉血酸中毒预测健康孕妇早期早产儿常见新生儿疾病患病率具有一定的临床价值。

Objective To examine the clinical value of umbilical cord arterial blood gas(UC-ABG) analysis in predicting the morbidity of early-stage preterm newborns. Methods Two hundred and twelve singleton pregnant women and newborns with the gestation age of 29^+2~33^+6w from Wenzhou Central Hospital were recruited in the study. Among them, 101 were pregnant women with severe pre-eclampsia (EOSP)(E group) and 111 were healthy pregnant women (H group). When fetal was delivered, umbilical cord blood was collected within 30 sec for blood gas analysis. The 1min Apgar score was assessed and recorded. The UCB acidosis(pH<7.15, lactate >7.0mmol/L), infants with neonatal respiratory distress syndrome(RDS), patent ductus arteriosus (PDA), intracranial hemorrhage(ICH), pathologic jaundice were also recorded. Results Pearson correlation analysis showed that pH value was negatively correlated with lactic acid content(r=-0.829, P<0.05) and positively correlated with BE value (r=0.738, P<0.05). Lactic acid content was negatively correlated with BE value(r=-0.765, P<0.05). Compared with H group, lower UCB pH and BE value and higher lactic acid content, higher incidence of UCB acidosis were observed in E group(P<0.05). The logistic regression analysis showed that in H group UCB acidosis was associated with low 1min Apgar, RDS and ICH(P<0.05). While in E group, UCB acidosis was only associated with low 1min Apgar score(P<0.05). Conclusion The preterm infants delivered by EOSP women have lower UCB pH, lower BE level and higher lactic acid content compared with those delivered by healthy women. UCB acidosis is not significantly associated with neonatal morbidity in the EOSP pregnancy. However, UCB acidosis is associated with neonatal morbidity in healthy pregnant women. UCB acidosis may has a certain clinical value in predicting the morbidity of early-stage preterm infants in healthy pregnant women.