窒息新生儿脐血乳酸值的临床意义(英文)

Clinical Significance of Cord Blood Lactate in Neonates with Asphyxia

目的 Apgar评分和血气分析作为判断新生儿窒息程度和预后的指标有一定的局限性 ,为寻找更具敏感性和特异性的指标 ,该研究探讨脐血乳酸值在新生儿窒息中的临床意义。方法 对 31例足月窒息新生儿(分为轻度窒息组 2 2例和重度窒息组 9例 )和 30例正常新生儿 (对照组 )的脐动脉血进行乳酸测定及微量血液气体分析 ,并在第 1 4天进行新生儿 2 0项行为神经测定 (NBNA)。结果 轻、重度窒息组脐动脉血乳酸值 [(6 .4 2±0 .1 4 )mmol/L ,(1 0 .77± 0 .1 2 )mmol/L]较对照组 [(4 .2 0± 0 .1 5 )mmol/L]显著升高 (P <0 .0 1 ) ,pH值 [(7.1 6±0 .0 7) ,(7.0 4± 0 .0 9) ]较对照组 (7.1 8± 0 .1 1 )明显降低 (P <0 .0 1 ) ;其中重度窒息组的乳酸值高于轻度窒息组 ,pH值低于轻度窒息组 ,差异均有显著性 (P <0 .0 1 )。脐血乳酸值与pH值及第 1 4天NBNA评分呈显著负相关(r =- 0 .76 ,- 0 .85 ,P <0 .0 1 )。结论 脐血乳酸值可作为判断新生儿窒息程度和近期预后的指标。

Objective It is clinically insufficient to assess the severity and prognosis of neonatal asphyxia only according to Apgar score and blood gas measurement. In order to find more sensitive and specific indexes, the clinical significance of cord blood lactate in neonates with asphyxia was studied. Methods The lactate level and the pH value of cord arterial blood were determined in 31 term infants with perinatal asphyxia (further divided into the mild and the severe asphyxia groups) and 30 normal neonates (the control group). At the 14th day after birth, 20 item neonatal behavioral neurological assessment (NBNA) was taken for each subject. Results The levels of cord blood lactate in the mild and severe asphyxia groups [( 6.42 ± 0.14 ) and ( 10.77 ± 0.12 ) mmol/L] were significantly higher than that in the control group [( 4.20 ± 0.15 ) mmol/L](P< 0.01 ). The pH values in the mild and severe asphyxsia groups were markedly lower than that of the control group [( 7.16 ± 0.07 ) vs ( 7.18 ± 0.11 ); ( 7.04 ± 0.09 ) vs ( 7.18 ± 0.11 )](P< 0.01 ). There were significant differences in the lactate level and pH value between the mild and severe asphyxia groups (P< 0.01 ). The lactate level was negatively correlated with the pH value and the score of NBNA (r= -0.76 and -0.85 , respectively, both P< 0.01 ). Conclusions Cord blood lactate may be a useful index in evaluating the severity and short term prognosis in neonates with perinatal asphyxia.