早产儿脑损伤影响因素分析及早期动脉血气指标的预测价值

Analysis of influencing factors of brain injury in premature infants and predictive value of early arterial blood gas indexes

目的探讨早产儿脑损伤的影响因素及早期动脉血气指标的预测价值。方法选取2017-02—2019-02驻马店市中心医院收治的219例早产儿为研究对象,其中113例脑损伤早产儿为观察组,106例无脑损伤早产儿为对照组。采用头颅磁共振及B超对早产儿进行检查,通过多因素Logistic回归对早产儿脑损伤的影响因素进行分析,收集出生后1 h早产儿的动脉、血气分析结果,对其血气分析中pH值、PaO2、PaCO2、BE值及乳酸与脑损伤的关系进行分析,评估早期血气指标对早产儿脑损伤的预测价值。结果2组早产儿影响因素的单因素分析显示,胎龄<28周、出生体质量<1500 g、分娩方式,孕妇围生期是否发生缺氧、感染以及妊娠并发症并发症比较,差异均有统计学意义(P<0.05);BIPI影响因素的多因素Logistic回归分析显示,胎龄、分娩方式、围生期缺氧、感染以及妊娠并发症均是早产儿发生脑损伤的影响因素。2组动脉血气指标值比较显示,观察组pH值、PaO2、BE值低于对照组,PaCO2及乳酸高于对照组,差异均有统计学意义(P<0.05)。ROC曲线分析显示,pH值、PaO2、PaCO2、BE值以及乳酸诊断BIPI的AUC依次为0.871、0.604、0.710、0.718、0.939,均有一定诊断准确性。pH值诊断的灵敏度、特异度分别为82.1%、78.8%;PaO2为93.4%、45.1%;BE值为100%、53.1%;PaCO2为86.8%、52.2%;乳酸为89.6%、90.3%。结论早期动脉血气pH值、PaO2、PaCO2、BE值及乳酸各指标对BIPI有一定的诊断价值。

Objective To explore the influencing factors of brain injury in preterm infants and the predictive value of early arterial blood gas indicators.Methods A total of 219 premature infants admitted to our hospital from February 2017 to February 2019 were selected as the research subjects,113 premature infants with brain injury were the observation group,and 106 premature infants without brain injury were the control group.Cranial magnetic resonance and B-ultrasound were used to examine premature infants.Multivariate logistic regression was used to analyze the influencing factors of brain injury in premature infants.Arterial and blood gas analysis results of premature infants 1 h after birth were collected,and the pH value in blood gas analysis was collected,PaO2,PaCO2,BE values and the relationship between lactic acid and brain damage,and to evaluate the predictive value of early blood gas indicators for brain damage in preterm infants.Results A univariate analysis of influencing factors in two groups of premature infants,including gestational age<28 weeks,birth weight<1500g,delivery methods,whether pregnant women suffered from hypoxia,infection and complications during pregnancy,the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis of influencing factors of BIPI showed that gestational age,delivery mode,perinatal hypoxia,infection and pregnancy complications were all influencing factors for brain damage in preterm infants.The comparison of arterial blood gas index values between the two groups showed that the pH,PaO2,and BE values of the observation group were lower than those of the control group,and PaCO2 and lactic acid were higher than those of the control group,and the differences were statistically significant(P<0.05).ROC curve analysis showed that pH,PaO2,PaCO2,BE,and AUC of lactic acid for BIPI diagnosis were 0.871,0.604,0.710,0.718,and 0.939 in turn,all of which had certain diagnostic accuracy.The sensitivity and specificity of pH diagnosis were 82.1%and 78.8%;PaO2 was 93.4%and 45.1%;BE values were 100%and 53.1%;PaCO2 was 86.8%and 52.2%;lactic acid was 89.6%and 90.3%.Conclusion Early arterial blood gas pH value,PaO2,PaCO2,BE value and lactic acid have certain diagnostic value for BIPI.