脐动脉血pH值与Apgar评分的相关性及其围产期影响因素和对新生儿早期结局的影响

Umbilical arterial blood pH:correlation with Apgar score,relevant perinatal factors and effects on short-term neonatal outcomes

目的探讨脐动脉血pH值与Apgar评分的相关性及其围产期影响因素和对新生儿早期结局的影响。方法回顾性收集2017年1月至2019年2月于北京大学第三医院产科出生的胎龄≥35周的有脐动脉血气分析结果的单胎新生儿病例(n=7183)。按照新生儿生后1 min Apgar评分是否≤7分,分为低Apgar评分组(n=42)与正常Apgar评分组(n=7141);按照脐动脉血pH值是否<7.2,分为酸中毒组(n=379)与正常pH值组(n=6804)。采用两独立样本t检验、χ2检验、Fisher精确概率法、Pearson相关分析及多因素logistic回归分析脐动脉血pH值与Apgar评分的相关性和围产期合并症/并发症对其的影响,以及酸中毒对新生儿早期结局的影响。结果低Apgar评分组脐动脉血pH值低于正常Apgar评分组(7.19±0.13与7.32±0.07,t=-6.011,P<0.001)。脐动脉血pH值与1 min Apgar评分正相关(r=0.217,P<0.001)。胎儿窘迫是低Apgar评分的独立危险因素(OR=20.553,95%CI:4.380~96.443,P<0.001);胎膜早破是酸中毒的独立危险因素(OR=1.316,95%CI:1.035~1.673,P=0.025)。酸中毒组新生儿低Apgar评分[6.33%(24/379)与0.26%(18/6804),χ2=217.075]、呼吸窘迫[6.60%(25/379)与2.62%(178/6804),χ2=21.205]及颅内出血[1.06%(4/379)与0.04%(3/6804),Fisher精确概率法]的发生率显著高于正常pH值组(P值均<0.001)。结论脐动脉血pH值较低的新生儿发生呼吸窘迫和颅内出血的可能性更大,其对于预测新生儿早期结局也许有意义,因此建议积极开展脐动脉血气分析。

Objective To investigate the relationship of umbilical arterial blood pH with Apgar score and its perinatal influencing factors as well as effects on short-term neonatal outcomes.Methods This study retrospectively collected the clinical data of 7183 singleton newborns who were born at≥35 gestational weeks with umbilical artery blood gas analysis in Peking University Third Hospital from January 2017 to February 2019.All cases were divided into two groups according to their Apgar scores at 1 min:low Apgar group(≤7 scores,n=42)and normal Apgar group(>7 scores,n=7141).Moreover,according to the pH value of umbilical artery blood they were also allocated into acidosis group(pH<7.2,n=379)and normal pH group(pH≥7.2,n=6804).Independent sample t test,Chi-square test,Fisher's exact test,Pearson's correlation analysis and multivariate logistic regression analysis were used to analyze the correlation between umbilical arterial blood pH and Apgar score,effects of perinatal complications on umbilical arterial blood pH,and influences of acidosis on early neonatal outcomes.Results The umbilical arterial blood pH in the low Apgar group was significantly lower than that in the normal Apgar group(7.19±0.13 vs 7.32±0.07,t=-6.011,P<0.001).There was a positive correlation between the umbilical arterial blood pH and Apgar score at 1 min(r=0.217,P<0.001).Fetal distress was an independent risk factor for low Apgar score(OR=20.553,95%CI:4.380-96.443,P<0.001).Premature rupture of membranes was an independent risk factor for acidosis(OR=1.316,95%CI:1.035-1.673,P=0.025).The incidence of low Apgar score[6.33%(24/379)vs 0.26%(18/6804),χ2=217.075],respiratory distress[6.60%(25/379)vs 2.62%(178/6804),χ2=21.205]and intracranial hemorrhage[1.06%(4/379)vs 0.04%(3/6804),Fisher's exact test]was significantly higher in the acidosis group than in the normal pH group(all P<0.001).Conclusions Neonates with lower umbilical arterial blood pH value should be closely monitored after birth as they are more likely to have respiratory distress and intracranial hemorrhage.Umbilical arterial blood pH value may be effective and is recommended in predicting neonatal early outcome.