新生儿窒息后血灌注指数、乳酸、pH和碱剩余值的变化及其临床意义

Changes of blood perfusion index,lactic acid,pH and base excess value after neonatal asphyxia and their clinical significance

目的探讨新生儿窒息后血灌注指数(PI)、乳酸、pH、碱剩余(BE)值的变化及其对新生儿窒息严重程度和器官损害程度的评估价值。方法选择2018年12月至2020年6月新乡市中心医院新生儿重症监护室收治的106例足月窒息患儿为窒息组,选择同期收治的23例肺炎新生儿、17例糖尿病母亲分娩新生儿为对照组。2组患儿入院后抽取动脉血1 mL,应用ABL90FLEX血气分析仪进行血气分析,记录血乳酸、pH和BE值;于入院时及治疗6、24、48 h,应用Masimo Radical-7血氧饱和度检测仪检测PI值。根据1 min Apgar评分将窒息新生儿分为轻度窒息组(n=68)和重度窒息组(n=38);按器官损伤程度将窒息新生儿分为单器官损伤组(n=77)和多器官损伤组(n=29)。比较轻度窒息组、重度窒息组与对照组及单器官损伤组、多器官损伤组与对照组患儿的血PI、乳酸、pH和BE值,采用Pearson相关分析所有患儿血PI与血乳酸、pH、BE值的相关性。结果轻度窒息组和重度窒息组患儿血pH、BE值显著低于对照组,重度窒息组患儿血pH、BE值显著低于轻度窒息组(P<0.05);轻度窒息组和重度窒息组患儿血乳酸值显著高于对照组,重度窒息组患儿血乳酸值显著高于轻度窒息组(P<0.05)。单器官损伤组和多器官损伤组患儿血pH、BE值显著低于对照组,多器官损伤组患儿血pH、BE值显著低于单器官损伤组(P<0.05);单器官损伤组和多器官损伤组患儿血乳酸值显著高于对照组,多器官损伤组患儿血乳酸值显著高于单器官损伤组(P<0.05)。对照组患儿各时间点间血PI值比较差异均无统计意义(P>0.05)。轻度窒息组和重度窒息组患儿治疗6、24、48 h的血PI值显著高于入院时,治疗24、48 h的血PI值显著高于治疗6 h(P<0.05);轻度窒息组和重度窒息组患儿治疗24 h与治疗48 h的血PI值比较差异无统计学意义(P>0.05)。入院时、治疗6 h,轻度窒息组和重度窒息组患儿的血PI值显著低于对照组,重度窒息组患儿的血PI值显著低于轻度窒息组(P<0.05);治疗24、48 h,3组患儿的血PI值比较差异无统计学意义(P>0.05)。单器官损伤组和多器官损伤组患儿治疗6、24、48 h的血PI值显著高于入院时,治疗24、48 h时的血PI值显著高于治疗6 h(P<0.05);单器官损伤组和多器官损伤组患儿治疗24 h与治疗48 h的血PI值比较差异无统计学意义(P>0.05)。入院时、治疗6 h,单器官损伤组和多器官损伤组患儿血PI值显著低于对照组,多器官损伤组患儿血PI值显著低于单器官损伤组(P<0.05);治疗24、48 h,3组患儿的血PI值比较差异无统计学意义(P>0.05)。新生儿血PI值与乳酸值呈负相关(r=-0.762,P=0.000),与血pH、BE值呈正相关(r=0.512、0.593,P=0.000、0.000)。结论血乳酸、pH、BE及PI值可对新生儿窒息后器官损害程度及病情严重程度进行有效评估,且PI值监测无创、操作简便。

Objective To investigate the changes of blood perfusion index(PI),lactic acid,pH and base excess(BE)values of neonates with asphyxia and their value in evaluating the severity and organ damage of neonatal asphyxia.Methods A total of 106 children with neonatal asphyxia admitted to Neonatal Intensive Care Unit of Xinxiang Central Hospital from December 2018 to June 2020 were selected as the asphyxia group,and 23 neonates with pneumonia and 17 neonates with diabetic mothers were selected as the control group.The arterial blood(1 mL)of children in the two groups were collected after admission,and the blood gas analysis was detected by ABL90 FLEX blood gas analyzer,the blood lactic acid,pH and BE value were recorded;at the time of admission and 6,24,48 hours of treatment,the blood PI value of children in the two groups was detected by Masimo Radical-7 blood oxygen saturation detector.The neonates with asphyxia were divided into mild asphyxia group(n=68)and severe asphyxia group(n=38)according to the 1-min Apgar score,and the neonates with asphyxia were divided into single organ injury group(n=77)and multiple organ injury group(n=29)according to the degree of organ injury.The blood PI,lactic acid,pH and BE values of children in the mild asphyxia group,severe asphyxia group and control group,and single organ injury group,multiple organ injury group and control group were compared.Pearson correlation was used to analyze the correlation between blood PI and lactic acid,pH and BE value of all children.Results The blood pH and BE values of children in the mild asphyxia group and severe asphyxia group were significantly lower than those in the control group,the blood pH and BE values of children in the severe asphyxia group were significantly lower than those in the mild asphyxia group(P<0.05);the blood lactic acid value of children in the mild asphyxia group and severe asphyxia group was significantly higher than that in the control group,and the blood lactic acid value of children in the severe asphyxia group was significantly higher than that in the mild asphyxia group(P<0.05).The blood pH and BE values of children in the single organ injury group and multiple organ injury group were significantly lower than those in the control group,and the blood pH and BE values in the multiple organ injury group were significantly lower than those in the single organ injury group(P<0.05);the blood lactic acid value of children in the single organ injury group and multiple organ injury group was significantly higher than that in the control group,and the blood lactic acid value of children in the multiple organ injury group was significantly higher than that in the single organ injury group(P<0.05).There was no significant difference in the blood PI value of children in the control group between different time points(P>0.05).The blood PI value of children in the mild asphyxia group and severe asphyxia group at 6,24 and 48 hours of treatment was significantly higher than that at admission,and the blood PI value at 24 and 48 hours of treatment was significantly higher than that at 6 hours of treatment(P<0.05).There was no significant difference in the blood PI value of children in the mild asphyxia group and severe asphyxia group between 24 hours of treatment and 48 hours of treatment(P>0.05).At admission and 6 hours of treatment,the blood PI value of children in the mild asphyxia group and severe asphyxia group was significantly lower than that in the control group,and the blood PI value of children in the severe asphyxia group was significantly lower than that in the mild asphyxia group(P<0.05);there was no significant difference in the blood PI value of children among the three groups at 24 and 48 hours(P>0.05).At admission and 6 hours of treatment,the blood PI value of children in the single organ injury group and multiple organ injury group was significantly lower than that in the control group,and the blood PI value of children in the multiple organ injury group was significantly lower than that in the single organ injury group(P<0.05);at 24 and 48 hours of treatment,there was no significant difference in the blood PI value of children among the three groups(P>0.05).The blood PI value of neonates was negatively correlated with blood lactic acid value(r=-0.762,P=0.000),ant it was positively correlated with blood pH and BE values(r=0.512,0.593;P=0.000,0.000).Conclusion Blood lactic acid,pH,BE and PI values can effectively evaluate the degree of organ damage and severity of neonatal asphyxia,and PI value monitoring is noninvasive and easy to operate.