新生儿窒息预后的早期判断

Early judgment of neonatal asphyxia prognosis

目的探究新生儿窒息预后的早期判断。方法选取2019年6月至2020年6月本院新生儿科收治的窒息患儿48例作为研究对象,根据Apgar评分分为研究组(轻度窒息患儿,n=30)与对照组(重度窒息患儿,n=18)。分析新生儿围产期窒息的高危因素;比较两组患儿的脐动脉血气pH和BE水平及出生后3~7 d的头颅磁共振、振幅整合脑电图监测结果。结果新生儿窒息的高危因素为剖宫产(60.42%)、胎膜早破(68.75%)、胎盘异常(50.00%)、羊水异常(64.58%)、脐带异常(54.17%)、胎位异常(62.50%);研究组pH水平、BE负值水平均明显高于对照组(P<0.05);研究组MRI重度异常率明显低于对照组(P<0.05);研究组aEEG大致正常率明显高于对照组(P<0.05),重度异常率明显低于对照组(P<0.05)。结论脐动脉血气分析、头颅MRI分度、aEEG分度有助于评估新生儿窒息的严重程度,联合监测有助于提高诊断新生儿窒息的准确性,并可用于评估新生儿窒息的早期预后情况。

Objective To explore the early judgment of the prognosis of neonatal asphyxia.Methods 48 children with asphyxia admitted to Neonatology Department of our hospital from June 2019 to June 2020 were selected as study subjects.According to Apgar score,they were divided into study group(mild asphyxia children,n=30)and control group(severe asphyxia children,n=18).The high risk factors of neonatal asphyxia were analyzed.The levels of umbilical arterial blood gas pH and BE were compared between the two groups,and the monitoring results of brain MRI and amplitude integrated electroencephalogram 3-7 days after birth were compared between the two groups.Results The high risk factors of neonatal asphyxia were cesarean section(60.42%),premature rupture of membranes(68.75%),placental abnormalities(50.00%),amniotic fluid abnormalities(64.58%),umbilical cord abnormalities(54.17%),and fetal abnormalities(62.50%).The pH level and the negative value of BE of the study group were significantly higher than that of the control group(P<0.05).The children with severe abnormal MRI in the study group was significantly lower than that in the control group(P<0.05);aEEG scores in the study group was significantly higher than those in the control group(P<0.05),and those with severe abnormalities were significantly lower than those in the control group(P<0.05).Conclusion Umbilical artery blood gas analysis,cranial MRI and aEEG are helpful to assess the severity of neonatal asphyxia.Combined monitoring is helpful to improve the diagnostic accuracy of neonatal asphyxia,and can be used to evaluate the early prognosis of neonatal asphyxia.