脐动脉血气分析对新生儿窒息复苏后发生脑损伤的预测价值

The value of umbilical artery blood gas analysis in predicting brain injury after neonatal asphyxia resuscitation

目的探究脐动脉血气分析对新生儿窒息复苏后发生脑损伤的预测价值。方法选择2020年3月至2022年3月于重庆大学附属涪陵医院和重庆市妇幼保健院分娩并诊断为窒息的164例新生儿作为研究对象,根据复苏后脑损伤发生情况分为非脑损伤组(106例)和脑损伤组(58例)。比较两组患儿的临床资料;多因素Logistic回归分析影响患儿脑损伤的因素;Pearson检验分析脑损伤患儿脐动脉血气指标与其他影响因素间的相关性;受试者操作特征(ROC)曲线分析脐动脉血气指标对患儿脑损伤的预测价值。结果脐带异常、重度窒息、胎儿窘迫、脐动脉血氧分压(PaO_(2))降低、二氧化碳分压(PaCO_(2))升高、pH降低、乳酸升高、剩余碱(BE)升高是导致患儿脑损伤的危险因素(P<0.05),复苏治疗氧浓度为40%是保护因素(P<0.05);脑损伤患儿PaO_(2)、PaCO_(2)、pH、乳酸、BE分别与上述其他影响因素间有明显相关性(P<0.05),且五者单独及联合对患儿脑损伤具有较高的预测价值。结论脐动脉血气指标对新生儿窒息复苏后脑损伤具有较高的预测价值,可为临床早期诊断提供依据。

Objective To explore the predictive value of umbilical artery blood gas analysis on brain injury after neonatal asphyxia resuscitation.Methods 164 newborns born in Chongqing University Fuling Hospital and Chongqing Health Center for Women and Children from March 2020 to March 2022 were selected and diagnosed as asphyxia.According to the occurrence of brain injury after resuscitation,the infants were divided into two groups:Non-brain injury group(n=106)and brain injury group(n=58).The clinical data were compared between the two groups.Multivariate Logistic regression analysis of influencing factors of brain injury in children.Pearson test to analyze the correlation between umbilical artery blood gas index and other influencing factors in children with brain injury.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of umbilical arterial blood gas index in children with brain injury.Results Abnormal umbilical cord,severe asphyxia,fetal distress,decreased partial pressure of oxygen(PaO_(2)),increased partial pressure of carbon dioxide(PaCO_(2)),decreased pH,increased lactate and increased base excess(BE)were risk factors for brain injury,Resuscitation oxygen concentration of 40%was a protective factor(P<0.05).PaO_(2),PaCO_(2),pH,lactic acid and BE were significantly correlated with other factors mentioned above(P<0.05),and the five factors alone and in combination had high predictive value for brain injury in children.Conclusion Umbilical arterial blood gas index has high predictive value for cerebral injury after resuscitation of neonatal asphyxia,which can provide basis for early clinical diagnosis.