脐动脉血血气分析联合振幅整合脑电图对新生儿窒息脑损伤的早期诊断价值分析

Analysis of early diagnostic value of umbilical artery blood gas analysis combined with amplitude integrated electroencephalography in neonatal asphyxia brain injury

目的探讨脐动脉血血气分析联合振幅整合脑电图(aEEG),对新生儿窒息脑损伤的早期(生后12 h内)诊断价值。方法选择2020年10月至2021年9月海南省妇女儿童医学中心新生儿重症监护病房收治的80例足月产窒息新生儿为研究对象。根据窒息程度,将其分为轻度窒息组(n=47)和重度窒息组(n=33)。选择同期在该院出生的健康足月产新生儿纳入对照组(n=80)。采用单因素方差分析及LSD-t检验,对3组新生儿脐动脉血血气分析4项指标,包括乳酸、pH值、碳酸氢根(HCO_(3)^(-))及剩余碱浓度,分别进行总体及两两比较;采用独立样本t检验,对aEEG结果轻度异常与重度异常新生儿的智力发育指数(MDI)及精神运动发育指数(PDI)评估结果进行比较;采用χ^(2)检验,对3组新生儿的aEEG检查结果异常率,aEEG结果轻度异常与重度异常新生儿出院后随访1年的生长发育异常率及癫痫发生率等进行比较;采用Spearman相关分析法,对新生儿脐动脉血血气分析4项指标和aEEG检查结果与新生儿窒息程度的相关性进行分析;采用受试者工作特征(ROC)曲线分析,评估窒息新生儿脐动脉血血气分析4项指标和aEEG结果,以及5者联合监测,对窒息新生儿脑损伤的早期预测价值。本研究已通过海南省妇女儿童医学中心伦理委员会批准(审批文号:2021011),患儿家属均知情同意并签署知情同意书。结果①3组新生儿出生时1、5、10 min Apgar评分,脐带、胎位及胎盘异常率,以及母亲羊水量异常、胎膜早破、妊娠期高血压疾病、妊娠期糖尿病、阴道助产及第二产程延长发生率比较,差异均有统计学意义(P<0.05)。②重度窒息组新生儿aEEG结果异常率(93.9%)分别高于轻度窒息组(46.8%)及对照组(0),轻度窒息组该指标高于对照组,并且差异均有统计学意义(χ^(2)=19.26、103.56、45.29,均为P<0.001)。③重度窒息组新生儿脐动脉血乳酸浓度分别高于轻度窒息组及对照组,轻度窒息组该指标高于对照组,并且差异均有统计学意义(P<0.05)。重度窒息组新生儿脐动脉血pH值,HCO 3-与剩余碱浓度,均分别低于轻度窒息组及对照组,轻度窒息组这3项指标均低于对照组,并且差异均有统计学意义(P<0.05)。④Spearman相关分析结果显示,80例窒息新生儿的脐动脉血乳酸浓度及aEEG结果异常程度与新生儿窒息程度,均呈正相关关系(r=0.472、P=0.033,r=0.663、P=0.027),而脐动脉血pH值、HCO 3-浓度、剩余碱浓度与新生儿窒息程度,则均呈负相关关系(r=-0.219、P=0.035,r=-0.335、P=0.042,r=-0.257、P=0.039)。⑤ROC曲线分析结果显示:窒息新生儿aEEG结果与脐动脉血血气分析4项指标联合预测窒息新生儿脑损伤的AUC为0.924(95%CI:0.842~0.964),敏感度和特异度分别为92.6%、89.1%。⑥对53例aEEG结果异常新生儿出院后随访1年的结果显示,aEEG结果为轻度异常患儿的MDI、PDI,均高于aEEG结果为重度异常患儿;其生长发育异常率和癫痫发生率,则均低于aEEG结果为重度异常患儿,并且差异均有统计学意义(P<0.05)。结论脐动脉血血气分析联合aEEG检查结果对新生儿窒息脑损伤早期诊断具有较高临床价值。

Objective To investigate the value of umbilical artery blood gas analysis combined with amplitude integrated electroencephalography(aEEG)in the early diagnosis of neonatal asphyxia brain injury(within 12 h after birth).Methods A total of 80 full-term asphyxia neonates admitted to the neonatal intensive care unit of Hainan Women and Children′s Medical Center from October 2020 to September 2021 were selected as the study objects.According to degree of asphyxia,they were divided into mild asphyxia group(n=47)and severe asphyxia group(n=33).Healthy full-term neonates born in the same period and in the same hospital were included in the control group(n=80).Univariate analysis of variance and LSD-t test were used to overall and pairwise compare the four indexes of umbilical artery blood gas analysis,including lactic acid,pH,HCO 3-and residual base concentration,respectively.Independent-samples t test was used to compare the intellectual development index(MDI)and psychomotor development index(PDI)results of newborns between mild abnormality and severe abnormality of aEEG results:Chi-square test was used to compare the abnormal rate of aEEG results among 3 groups,also growth and development abnormal rate and incidence of epilepsy between neonates with mild abnormal aEEG results and those with severe abnormal aEEG results after one year′s follow-up.Spearman correlation analysis was used to analyze the correlation between the four indexes of umbilical artery blood gas analysis and aEEG results and the degree of neonatal asphyxia.Receiver operating characteristic(ROC)curve analysis was used to evaluate the value of four indexes of umbilical artery blood gas analysis and aEEG results,as well as the combination of five factors,in the early prediction of brain injury in neonatal asphyxia.This study has been approved by the Ethics Committee of Hainan Women and Children′s Medical Center(Approval No.2021011),and all families of the children have given informed consent and signed informed consent forms.Results①There were significant differences in Apgar score at 1,5 and 10 min at birth,abnormal rates of umbilical cord,fetal position and placenta,and incidence of maternal abnormal amniotic fluid volume,premature rupture of membranes,hypertensive diseases during pregnancy,gestational diabetes,vaginal midwifery and prolonged second stage of labor among 3 groups(P<0.05).②The abnormal rate of aEEG results in severe asphyxia group(93.9%)was higher than that in mild asphyxia group(46.8%)and control group(0),respectively,and that in mild asphyxia group was higher than that in control group,and the differences were statistically significant(χ^(2)=19.26,103.56,45.29,all with P<0.001).③The concentration of umbilical arterial blood lactic acid in severe asphyxia group was higher than that in mild asphyxia group and control group,respectively,and this index in mild asphyxia group was higher than that in control group,and the differences were statistically significant(P<0.05).The neonatal umbilical arterial blood pH,HCO 3-and residual base concentration in severe asphyxia group were lower than those in mild asphyxia group and control group,respectively,and the three indexes in mild asphyxia group were lower than those in control group,and the differences were statistically significant(P<0.05).④Spearman correlation analysis showed that the concentration of umbilical arterial blood lactic acid and the abnormal degree of aEEG results were positively correlated with the degree of neonatal asphyxia in 80 cases of neonatal asphyxia(r=0.472,P=0.033;r=0.663,P=0.027),While the pH,HCO 3-concentration and residual base concentration of umbilical arterial blood were negatively correlated with the degree of neonatal asphyxia(r=-0.219,P=0.035;r=-0.335,P=0.042;r=-0.257,P=0.039).⑤ROC curve analysis showed that the AUC of neonatal asphyxia brain injury predicted by aEEG results combined with 4 indexes of umbilical artery blood gas analysis was 0.924(95%CI:0.842-0.964),and the sensitivity and specificity were 92.6%and 89.1%,respectively.⑥The results of 1-year follow-up of 53 neonates with aEEG results abnormal after discharge showed that MDI and PDI of children with mild aEEG results abnormal were higher than those with severe aEEG results abnormal,and the rate of growth and development abnormal and incidence of epilepsy were lower than those with severe aEEG results abnormal,and the differences were statistically significant(P<0.05).Conclusions Umbilical artery blood gas analysis combined with aEEG results has high clinical value in early diagnosis of neonatal asphyxia brain injury.