脐血血气分析联合振幅整合脑电图监测与低Apgar评分患儿近期临床结局关系的研究

Prediction of short term clinical outcomes in low Apgar score neonates using umbilical artery blood gas analysis plus amplitude integrated electroencephalography

目的:探讨脐动脉血气分析联合生后6 h内振幅整合脑电图(amplitude-integrated electroencephalography,aEEG)监测与低Apgar评分患儿早期并发症和近期神经系统预后的关系。方法:采用回顾性队列研究方法,收集厦门市妇幼保健院新生儿重症监护室2020年1月至2022年2月收治的胎龄≥35周、1 min或5 min Apgar评分≤7分新生儿的临床资料,根据生后脐动脉血气分为pH<7.2组和pH≥7.2组,使用独立样本t检验、秩和检验及χ^(2)检验,比较两组中aEEG异常患儿和aEEG正常患儿实验室检查指标、疾病发生情况和随访6月龄时体格生长及神经系统预后情况。结果:共纳入低Apgar评分患儿105例,pH<7.2组73例,其中aEEG异常52例(52/73,71.2%),正常21例;pH≥7.2组32例,其中aEEG异常6例(6/32,18.8%),正常26例。pH<7.2组aEEG异常率高于pH≥7.2组(P<0.001),aEEG异常程度与脐动脉血pH呈负相关(r=-0.463,P<0.001)。pH<7.2组中,aEEG异常患儿肌酸激酶同工酶水平、活化部分凝血活酶时间和缺氧缺血性脑病发生率高于aEEG正常患儿,6月龄时头围小于aEEG正常患儿,差异均有统计学意义(P<0.05);pH≥7.2组中,aEEG异常患儿肌酸激酶同工酶水平、缺氧缺血性脑病和呼吸衰竭发生率高于aEEG正常患儿,6月龄时头围小于aEEG正常患儿,不良神经系统预后发生率高于aEEG正常患儿,差异均有统计学意义(P<0.05)。结论:脐动脉血气分析联合生后6 h内aEEG对预测低Apgar评分患儿早期并发症及近期神经系统预后有一定意义。

Objective To study the predictive values of umbilical artery blood gas analysis(UABG)plus amplitude-integrated electroencephalography(aEEG)monitoring within 6 h after birth for early complications and short term neurological outcomes in low Apgar score neonates.MethodsFrom January 2020 to February 2022,neonates with gestational age(GA)≥35 weeks and 1 min or 5 min Apgar score≤7 admitted to NICU of our hospital were retrospectively reviewed.According to UABG pH values,the neonates were assigned into pH<7.2 group and pH≥7.2 group,and further grouped into abnormal aEEG group and normal aEEG group.The ttest,rank sum test andχ^(2) test were used to compare laboratory results,incidences of diseases,physical growth and neurological prognosis at 6 month of age.ResultsA total of 105 neonates with low Apgar scores were enrolled,including 73 cases in the pH<7.2 group and 32 cases in the pH≥7.2 group.In the pH<7.2 group,52(71.2%)had abnormal aEEG and 21 had normal aEEG.In the pH≥7.2 group,6(18.8%)had abnormal aEEG and 26 had normal aEEG.The incidence of abnormal aEEG in the pH<7.2 group was higher than the pH≥7.2 group(P<0.001).The degree of aEEG abnormality was negatively correlated with UABG pH(r=-0.463,P<0.001).In the pH<7.2 group,the levels of creatine kinase isozymes(CK-MB),activated partial thromboplastin time and the incidence of hypoxic-ischemic encephalopathy(HIE)in neonates with abnormal aEEG were significantly higher than those with normal aEEG,and the head circumference(HC)at 6 month was significantly smaller in neonates with abnormal aEEG(all P<0.05).In the pH≥7.2 group,the level of CK-MB,incidences of HIE and respiratory failure in neonates with abnormal aEEG were higher than those with normal aEEG,HC at 6 month was smaller and the incidence of adverse neurological prognosis was higher in neonates with abnormal aEEG(all P<0.05).ConclusionsUABG plus aEEG monitoring within 6 h after birth shows predictive values for early complications and short term neurological outcomes in low Apgar scores neonates.