脐动脉血气指标联合Apgar评分评估新生儿窒息的应用价值

The application value of the umbilical artery blood gas index combined with the Apgar score in the assessment of neonatal asphyxia

目的分析脐动脉血气指标联合Apgar评分应用于评估新生儿窒息的价值。方法选取我院2021年1月至2023年3月收治的157例1min Apgar评分≤7分的新生儿作为研究组,另选同期160例1min Apgar评分≥8分的新生儿作为对照组,采集两组新生儿脐动脉血气指标[血液酸碱度(pH值)、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、碳酸氢根(HCO_(3)^(-))、碱剩余(BE)和二氧化碳结合力(CO_(2)CP)]及脏器损伤的数据,分析Apgar评分和脐动脉血气指标对新生儿脏器损伤的预测效能。结果分析Apgar评分、pH值、PaO_(2)、PaCO_(2)、HCO_(3)^(-)、BE,研究组显著低于对照组(t值介于2.446~8.403之间),重度组显著低于轻度组(t值介于2.937~8.114之间),损伤组显著低于非损伤组(t值介于3.213~9.225之间);分析CO_(2)CP,研究组显著高于对照组(t=5.004),重度组显著高于轻度组(t=4.023),损伤组显著高于非损伤组(t=4.907),差异均有统计意义(P<0.05)。比较三种方法预测新生儿脏器损伤的敏感度、特异度和符合度,Apgar评分明显低于脐动脉血气分析(χ^(2)值分别为1.728、4.146、4.747),Apgar评分明显低于联合评估(χ^(2)值分别为5.722、9.013、10.581),脐动脉血气分析明显低于联合评估(χ^(2)值分别为4.551、3.693、4.384),差异均有统计学意义(P<0.05)。结论脐动脉血气分析联合Apgar评分可有效提高评估窒息新生儿脏器损伤的敏感度、特异度和符合度,有利于降低新生儿窒息误诊率,对评估新生儿预后有重要临床价值。

Objective To investigate the application value of umbilical artery blood gas index combined with Apgar score in the assessment of neonatal asphyxia.Methods A total of 157 neonates with 1min Apgar score≤7 admitted to our hospital from January 2021 to March 2023 were selected as the study group,and another 160 neonates with 1min Apgar score≥8 during the same period were selected as the control group.The data of umbilical artery blood gas indexes[pH value,partial pressure of oxygen in arterial blood(PaO_(2)),partial pressure of carbon dioxide in arterial blood(PaCO_(2)),bicarbonate(HCO_(3)^(-)),buffuer excess(BE)and carbondioxide combining power(CO_(2)CP)]and organ injury were collected in two groups of neonates.The predictive efficacy of Apgar score and umbilical artery blood gas indexes for neonatal organ injury was analysed.Results For Apgar score,pH value,PaO_(2),PaCO_(2),HCO_(3)^(-),BE,the study group was significantly lower than the control group(t=2.446-8.403,respectively),the severe group was significantly lower than the mild group(t=2.937-8.114,respectively),the injury group was significantly lower than the non-injury group(t=3.213-9.225,respectively);for CO_(2)CP,the study group was significantly higher than the control group(t=5.004),the severe group was significantly higher than the mild group(t=4.023),and the injury group was significantly higher than the non-injury group(t=4.907),all the differences were statistically significant(all P<0.05).Comparing the sensitivity,specificity and compliance of the three methods for predicting neonatal organ injury,the Apgar score was significantly lower than that of umbilical artery blood gas analysis(χ^(2)=1.728,4.146 and 4.747,respectively),the Apgar score was significantly lower than that of combined assessment(χ^(2)=5.722,9.013 and 10.581,respectively),and the umbilical artery blood gas analysis was significantly lower than that of combined assessment(χ^(2)=4.551,3.693,and 4.384,respectively),all the differences were statistically significant(all P<0.05).Conclusion Umbilical artery blood gas analysis combined with Apgar score can effectively improve the sensitivity,specificity and conformity of assessing organ damage in asphyxiated neonates,which is conducive to reducing the misdiagnosis rate of neonatal asphyxia,and is of great clinical value in assessing the prognosis of neonates.