脐动脉血气和出生后1 h血气在新生儿窒息诊断中的关系

Relationship Between Umbilical Artery Blood Gas and Blood Gas One Hour after Birth in the Diagnosis of Neonatal Asphyxia

目的探讨脐动脉血气和出生后1 h血气在新生儿窒息诊断中的关系。方法随机选取2018年3月~2019年3月足月生产的窒息新生儿共30例为观察组,同时另随机选取非窒息新生儿30例为对照组,所有患儿于分娩后即刻剪断脐带,在母体端取脐动脉血做样本并立即床边分析血气指标(PH、血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))以及剩余碱(BE)),1 h后行桡动脉血气分析,对比两组患儿最终血气分析结果,并与临床窒息表现相关指标做相关性分析。结果观察组患儿PaCO_(2)明显高于对照组,PaO_(2)、PH值、BE明显低于对照组,差异具有统计学意义(P<0.05)。多因素线性回归分析结果显示:PaCO_(2)与Apgar评分表现出明显相关性、BE与Apgar评分表现出明显相关性。ROC分类曲线分析结果:PH对应的ROC曲线下部面积为(0.736±0.065);PaO_(2)对应的ROC曲线下部面积为(0.934±0.033)。结论脐动脉血气和出生后1小时血气分析与前者单纯分析具有类似诊断效果,而两者共用时,PH、PaO_(2)两项指标可作为特异性诊断指标使用,PH<7.19,PaO_(2)<59.40 mmHg时,考虑存在窒息。

Objective To explore the relationship between umbilical artery blood gas and blood gas one hour after birth in the diagnosis of neonatal asphyxia.Methods Randomly selected from March 2018 to March 2019 in our hospital the asphyxia newborn of term pregnancy were 30 cases as the observation group,while the other not 30 cases of neonatal asphyxia were randomly selected as control group,all the children to cut the umbilical cord immediately after birth,in the mother′s side take umbilical arterial blood analysis of the samples and the bed immediately blood gas index(PH,blood oxygen partial pressure(PaO_(2)),CO_(2) partial pressure(PaCO_(2))and residual alkali(BE)),1 h after radial artery blood gas analysis,compared two groups of children with the final results of blood gas analysis,and make correlation analysis index is associated with clinical asphyxia.Results PaCO_(2) in the observation group was significantly higher than that in the control group,and PaO_(2),PH and BE were significantly lower than that in the control group,with statistically significant differences(P<0.05).Multivariate linear regression analysis showed that PaCO_(2) was significantly correlated with Apgar score,and BE was significantly correlated with Apgar score.Results of ROC classification curve analysis:the area under the ROC curve corresponding to PH was(0.736±0.065).The area under the ROC curve corresponding to PaO_(2) was(0.934±0.033).Conclusions Umbilical artery blood gas analysis and blood gas analysis 1 hour after birth have similar diagnostic effect with the former analysis alone.When the two are Shared,PH and PaO_(2) can be used as specific diagnostic indicators.When PH<7.19 and PaO_(2)<59.40 mmhg,asphyxia is considered.