新生儿脐动脉血气特点及酸血症的危险因素——一项观察研究

Characteristics of umbilical artery blood gas in newborns and risk factors for acidemia:an observational study

目的了解新生儿脐动脉血气特点及酸血症发生的危险因素。方法收集2022年12月1—31日贵州中医药大学第一附属医院新生儿脐动脉血气数据,若满足下列任何一项[pH值<7.0,剩余碱(BE)<-12.0 mmol/L,血乳酸(Lac)≥6.0 mmol/L]即被诊断为酸血症。以是否发生酸血症分组,采用多因素Logistics回归方法分析酸血症的危险因素。结果共纳入180例新生儿,其中11例存在酸血症,酸血症发生率为6.1%。酸血症新生儿的Lac≥6.0 mmol/L,而其中pH值<7.0的仅1例,BE<-12 mmol/L的有3例。酸血症新生儿较非酸血症新生儿pH值和BE水平均更低[pH值:7.09(7.08,7.17)比7.29(7.25,7.33),BE(mmol/L):-11.40(-12.55,-8.75)比-2.90(-4.50,-1.10),均P<0.001],血二氧化碳分压(PCO_(2))和Lac水平均更高[PCO_(2)(mmHg;1 mmHg≈0.133 kPa):64.00(59.00,67.50)比51.00(45.00,57.00),Lac(mmol/L):6.50(6.25,7.45)比2.40(1.70,3.70),均P<0.01]。与非酸血症新生儿比较,酸血症新生儿母亲分娩前患有感染性疾病、经阴道分娩率的比例均更高(感染性疾病:27.3%比5.4%,经阴道分娩率:81.8%比34.3%,均P<0.05)。多因素回归分析结果显示,分娩前母亲有感染性疾病[优势比(OR)=6.066,95%可信区间(95%CI)为1.090~29.231,P=0.027]、经阴道分娩(OR=8.205,95%CI为1.984~57.805,P=0.009)均为新生儿酸血症发生的独立危险因素。结论新生儿酸血症以高乳酸血症为主要表现,母亲有感染性疾病和经阴道分娩为新生儿酸血症的独立危险因素。

Objective To understand the characteristics of umbilical artery blood gas in newborns and the risk factors for acidemia.Methods The umbilical artery blood gas data of neonates from the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine from December 1 to 31,2022 were collected.If any of the following conditions[pH value<7.0,base excess(BE)<-12.0 mmol/L,lactic acid(Lac)≥6.0 mmol/L]was met,it was considered to be acidemia.The neonates were grouped based on the occurrence of acidemia,and a multivariate Logistic regression method was used to analyze the risk factors for acidemia.Results A total of 180 newborns were included,of which 11 cases had acidemia,with an incidence of 6.1%.The level of Lac in newborns with acidemia was≥6.0 mmol/L,only 1 case with pH value<7.0 and 3 cases with BE<-12 mmol/L.The newborns with acidemia had lower pH value and BE levels compared to newborns without acidemia[pH value:7.09(7.08,7.17)vs.7.29(7.25,7.33),BE(mmol/L):-11.40(-12.55,-8.75)vs.-2.90(-4.50,-1.10),both P<0.001],and the levels of blood partial pressure of carbon dioxide(PCO_(2))and Lac were both higher[PCO_(2)(mmHg;1 mmHg≈0.133 kPa):64.00(59.00,67.50)vs.51.00(45.00,57.00),Lac(mmol/L):6.50(6.25,7.45)vs.2.40(1.70,3.70),both P<0.01].Compared with the newborns without acidemia,the proportion of acidemia newborns whose mothers suffered from infectious diseases before delivery and the rate of vaginal delivery were higher(infectious diseases:27.3%vs.5.4%,vaginal delivery rate:81.8%vs.34.3%,both P<0.05).Multivariate regression analysis showed that the mother had infectious diseases before delivery[odds ratio(OR)was 6.066,95%confidence interval(95%CI)was 1.090-29.231,P=0.027],and vaginal delivery(OR was 8.205,95%CI was 1.984-57.805,P=0.009)were independent risk factors for neonatal acidemia.Conclusions The main manifestation of neonatal acidemia is hyperlactaemia.The independent risk factors of neonatal acidemia are mother's infectious diseases and vaginal delivery.