Usefulness of the Surgical Apgar Score to Predict the Occurrence of Major Complications in the Early Post-Operative Period of Major Surgeries: Experience of Two Second-Category Hospitals in Cameroon

Objective: The Surgical Apgar Score (SAS) is a tool for intraoperative stratification of the risk of serious complications in the early postoperative period. It varies from 0 to 10 points divided into three risk categories (0 to 4 high, 5 to 7 moderate, 8 to 10 low). The aim of the study was to evaluate its relevance in predicting the appearance of these complications. Material and methods: This descriptive and analytical study was carried out at the “Laquintinie” Hospital in Douala and at the Central Hospital in Yaounde, Cameroon. The main data were collected on a population of patients over 18 years old and recorded on a survey form. They consisted of variables of main interest and exposure variables. Univariate and multivariate statistical analysis using top-down logistic regression models made it possible to evaluate the association of each variable of main interest and each exposure variable. The association was significant at P Results: Of the 88 patients studied, the SAS was 3 hours. In multivariate, this link persisted only and strongly for the SAS OR (IC) 0.1 (0.1 - 0.2) and p = 000. Conclusion: The study found a specific and powerful link between the SAS score < 4 and the occurrence of complications in the early postoperative period, in favor of its relevance in predicting them.

Relationship between age of pregnant women with gestational diabetes mellitus and mode of delivery and neonatal Apgar score

BACKGROUND Gestational diabetes mellitus(GDM)refers to abnormal glucose tolerance during pregnancy,and it is often accompanied by obvious changes in glucose and lipid metabolism,and associated with adverse pregnancy outcomes.The incidence of fetal distress,polyhydramnios,puerperal infection,premature delivery,and macrosomia in pregnant women with GDM are higher than in those without GDM.AIM To analyze the relationship between age of pregnant women with GDM and mode of delivery and neonatal Apgar score.METHODS A total of 583 pregnant women with GDM who delivered in the Department of Obstetrics at our hospital between March 2019 and March 2022 were selected.Among them,377 aged<35 years were selected as the right age group and 206 aged>35 years were selected as the older group.The clinical data of the two groups were collected,and the relationship between age of the pregnant women with GDM and mode of delivery,maternal and neonatal outcomes,and neonatal Apgar score were compared.In the older group,159 women were classed as the adverse outcome group and 47 as the good outcome group according to whether they had adverse maternal and infant outcomes.The related factors of adverse maternal and infant outcomes were analyzed through logistic regression.RESULTS The number of women with assisted pregnancy,≤37 wk gestation,≥2 pregnancies,one or more deliveries,and no pre-pregnancy blood glucose screening in the older group were all higher than those in the right age group(P<0.05).The natural delivery rate in the right age group was 40.85%,which was higher than 22.33%in the older group(P<0.05).The cesarean section rate in the older group was 77.67%,which was higher than 59.15%in the right age group(P<0.05).The older group had a higher incidence of polyhydramnios and postpartum hemorrhage,and lower incidence of fetal distress than the right age group had(P<0.05).There was no significant difference in neonatal weight between the two groups(P>0.05).The right age group had higher Apgar scores at 1 and 5 min than the older group had(P<0.05).Significant differences existed between the poor and good outcome groups in age,education level,pregnancy mode,≤37 wk gestation,number of pregnancies,and premature rupture of membranes(P<0.05).Logistic regression showed that age,education level and premature rupture of membranes were all risk factors affecting the adverse outcomes of mothers and infants(P<0.05).CONCLUSION Delivery mode and Apgar score of pregnant women with GDM are related to age.Older age increases the adverse outcome of mothers and infants.

Predictability of Surgical Apgar Score for postoperative outcomes in hip fractures: A prospective observational study

Objective:To assess the utility and validation of the Surgical Apgar Score(SAS)in predicting postoperative complications of hip fractures.Methods:This prospective observational study included patients who received operations for hip fractures from 1st March 2017 to 30th June 2018 at the Department of Orthopedic Surgery,Liaquat National Hospital and Medical College.Patients were followed at the outpatient department,and complications and mortality were recorded through phone calls.The predictability of SAS for postoperative complications was assessed.Results:SAS≤4 was found as a significant predictor for postoperative pulmonary(P=0.008)and cardiac complications(P=0.042)as well as blood transfusion required to optimize postoperative hemoglobin(P=0.03)in the patients with hip fractures.Conclusions:SAS provides reliable feedback information about patients'postoperative risk during the surgery.Hip fracture patients with scores≤4 should be monitored for major complications both during the hospital admission and after the discharge.

Utility of the Surgical Apgar Score in pancreatic cancer and modification

Objectives:The Surgical Apgar Score(SAS)can predict the incidence of complications in different surgical fields.However,it is rarely studied in pancreatic cancer.The aim of the present study was to assess the predictive value of the SAS in pancreatic ductal adenocarcinoma(PDAC),and then propose a modified SAS which was more suitable for pancreatic cancer patients.Materials and methods:A prospective cohort study of 160 PDAC patients was concluded.The primary endpoint was 30-day major complications.The SAS was calculated as described.The overall discriminatory power of the score was analyzed using receiver operating characteristic curves and the area under the curve(AUC)with respect to major complications or death.Results:It showed a significant predictive value of SAS in major complications or death in PDAC(p=0.020,AUC=0.606),especially in complication of pneumonia(p=0.022)and pleural effusion(p=0.023).In addition,the SAS exert significant predictive value in distal pancreatectomy group,but it has a weak predictive value for pancreaticoduodenectomy group.On multivariable analyses,occurrence of major postoperative complications was associated with lowest mean arterial pressure,estimated blood loss and operative time.Interestingly,as a characteristic of SAS,lowest heart rate was not involved.The modified SAS we proposed including lowest mean arterial pressure,estimated blood loss and operative time increased AUC from 0.606 to 0.743.Conclusions:The SAS can be a simple,rapid scoring system that effectively predicts major postoperative complications.Besides,the modified SAS we proposed in this study,which included lowest mean arterial pressure,estimated blood loss and operative time,exert a better predictive value in PDAC patients.

Surgical apgar score predicts early complication in transfemoral amputees:Retrospective study of 170 major amputations

AIM To assess whether the surgical apgar score(SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery.METHODS This was a single-center,retrospective observational cohort study conducted between January 2013 and April 2015. All patients who had either a primary transtibial amputation(TTA) or transfemoral amputation(TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure(ad modum Persson amputation) performed approximately 10 cm below the knee joint. All TTA procedures were performedwith sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint,performed with anterior/posterior flaps. Trained residents or senior consultants performed the surgical procedures. The SAS is based on intraoperative heart rate,blood pressure and blood loss. Intraoperative parameters of interest were collected by revising electronic health records. The first author of this study calculated the SAS. Data regarding major complications were not revealed to the author until after the calculation of SAS. The SAS results were arranged into four groups(SAS 0-4,SAS 5-6,SAS 7-8 and SAS 9-10). The cohort was then divided into two groups representing low-risk(SAS ≥ 7) and highrisk patients(SAS < 7) using a previously established threshold. The outcome of interest was the occurrence of major complications and death within 30-d of surgery.RESULTS A logistic regression model with SAS 9-10 as a reference showed a significant linear association between lower SAS and more postoperative complications [all patients: OR = 2.00(1.33-3.03),P = 0.001]. This effect was pronounced for TFA [OR = 2.61(1.52-4.47),P < 0.001]. A significant increase was observed for the high-risk group compared to the low-risk group for all patients [OR = 2.80(1.40-5.61),P = 0.004] and for the TFA sub-group [OR = 3.82(1.5-9.42),P = 0.004]. The AUC from the models were estimated as follows: All patients = [0.648(0.562-0.733),P = 0.001],for TFA patients = [0.710(0.606-0.813),P < 0.001] and for TTA patients = [0.472(0.383-0.672),P = 0.528]. This indicates moderate discriminatory power of the SAS in predicting postoperative complications among TFA patients.CONCLUSION SAS provides information regarding the potential development of complications following TFA. The SAS is especially useful when patients are divided into high- and low-risk groups.

The Differences of Cord Blood Troponin I (TnI) Level between Normal and Asphyxiated Infants and Its Correlation with APGAR Score

Asphyxia could increase infant morbidity and mortality. Ante- and intrapartum cardiotocography (CTG) examination could lead to a false positive diagnosis of asphyxia (fetal distress). Troponin I (TnI) is an important factor to the pathogenesis of asphyxia. Cord blood TnI level is increased in infants with fetal cardiac dysfunction, causing pathological CTG and low APGAR score (<7). In the future, TnI is expected to reduce false positive diagnosis of asphyxia caused by CTG. This research was conducted to examine and analyze the differences of cord blood TnI level between normal and asphyxiated infants and to determine the correlation between TnI level and APGAR score. An observational analytical cross sectional study was conducted to a total of 36 patients with asphyxiated infants (18 patients) and normal infants (18 patients). Subjects were selected according to the inclusion and exclusion criteria. Cardiotocography, TnI level, and APGAR score were examined. Umbilical cord blood samples were taken from each subject for the measurement of TnIlevel using a highly sensitive indirect sandwich Enzyme Linked Immunosorbent Assay (ELISA). Statistical analysis was performed by Mann-Whitney and Rank Spearman correlation coefficient test. Cord blood TnI level of asphyxia andnormal groups were 1615.77 ± 1199.98 pg/mL and 819.88 ± 145.82 pg/mLrespectively (p ≤ 0.05). Rank Spearman correlation coefficient between cord blood TnI level and 1’ and 5’ APGAR score was -0.523 (p = 0.026;p ≤ 0.05)and -0.502 respectively (p = 0.034;p ≤ 0.05). There was a statistically significant difference between cord blood TnI level of asphyxia and normal groups;cord blood TnI level of asphyxia group was higher than normal group. Furthermore, negative correlation was observed between cord blood TnI level and APGAR score.

Epidemiology and region-specific risk factors for low Apgar scores in China:a nationwide study

Background Neonatal asphyxia is a serious public health issue.This study aimed to determine the epidemiology and region-specific risk factors for low Apgar scores,an important proxy for neonatal asphyxia,in China from 2015 to 2016.Methods The China Labor and Delivery Survey was a multicenter cross-sectional study including 96 hospitals distributed in 24(out of 34)provinces.Logistic regression analysis was performed to examine the risk factors for a low Apgar score(<7).Correspondence analyses were performed among neonates with low Apgar scores to explore the relationship between risk factors and geographical regions.The population attributable risk percentage(PAR%)was calculated for each region-specific risk factor.Results A total of 72,073 live births,including 320 births with low Apgar scores,were used for the analysis,giving a weighted rate of 3.9/1000 live births.There was a substantial difference in the incidence of low Apgar scores by geographic region,from 2.3/1000 live births in East China to 10.9/1000 live births in Northeast China.Maternal and obstetric factors are the major region-specific risk factors.In Southwest China,hypertensive disorders in pregnancy were more important contributors,with PAR% being 74.47%;in North and Northwest China,pre-pregnancy underweight was a more significant factor,with PAR% of 62.92%;in East China,infants born between 0:00 a.m.and 7:59 a.m.were a key factor,with PAR% of 80.44%.Conclusion Strategies based on region-specific risk factors should be considered to reduce the burden of low Apgar scores in China.

脐动脉血气指标联合Apgar评分评估新生儿窒息的应用价值

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。

改良衰弱指数联合外科Apgar评分对腹腔镜结直肠癌根治术老年患者术后并发症的预测效能

目的 探讨11项改良衰弱指数(mFI-11)联合外科Apgar评分(SAS)对腹腔镜结直肠癌根治术老年患者发生术后并发症的预测效能。方法 纳入腹腔镜结直肠癌根治术老年(年龄≥65岁)患者481例。术前采用mFI-11完成衰弱评估。根据术中最低平均动脉压、最低心率和估计失血量,计算SAS。比较有术后并发症和无术后并发症患者的临床资料、mFI-11、SAS,分析mFI-11、SAS与术后并发症的关系及其预测价值。结果 mFI-11、SAS、手术时间与术后并发症的发生独立相关(P <0.05),三者预测术后并发症的曲线下面积(AUC)分别为0.805、0.800、0.610,mFI-11联合SAS预测术后并发症的AUC为0.902。结论 在腹腔镜结直肠癌根治术老年患者中,mFI-11、SAS、手术时间与术后并发症的发生显著相关,且mFI-11联合SAS对术后并发症有较高的预测效能,优于单一指标,能够为临床早期识别以及减少并发症的发生提供可靠依据。

基于家庭支持的中介效应探讨妊娠期糖尿病自我管理能力与新生儿出生体质量、Apgar评分的关系

目的基于家庭支持的中介效应探讨妊娠期糖尿病(GDM)自我管理能力与新生儿出生体质量、Apgar评分的关系。方法选取许昌市中心医院2022年4月至2023年4月收治的92例GDM患者,采用GDM专用自我管理能力量表评价其自我管理能力,利用糖尿病专用家庭支持问卷评价其家庭支持情况,且均随访统计新生儿出生体质量、出生1 min Apgar评分。Pearson法分析自我管理能力与家庭支持、新生儿出生体质量、Apgar评分及家庭支持与新生儿出生体质量、Apgar评分的相关性;Mplus8.3软件分析家庭支持在GDM自我管理能力与新生儿出生体质量、Apgar评分间的中介效应,并经Bootstrap法验证。结果患者自我管理能力评分(72.08±13.03)分,家庭支持总分(20.33±4.21),新生儿出生体质量(3308.10±1005.31)g,Apgar评分(8.23±1.69)分;患者自我管理能力总分与家庭支持总分、Apgar评分均呈正相关,差异有统计学意义(P<0.05),与新生儿出生体质量呈负相关,差异有统计学意义(P<0.05);患者家庭支持总分与新生儿出生体质量呈负相关,差异有统计学意义(P<0.05),与Apgar评分呈正相关,差异有统计学意义(P<0.05);患者自我管理能力可影响新生儿出生体质量、Apgar评分,差异均有统计学意义(P<0.05),患者自我管理能力可影响家庭支持,差异有统计学意义(P<0.05),家庭支持在患者自我管理能力与新生儿出生体质量、Apgar评分间呈部分中介效应,差异有统计学意义(P<0.05);自我管理能力对新生儿出生体质量、Apgar评分的直接效应为0.65、0.68,家庭支持对新生儿出生体质量、Apgar评分的间接效应为0.24、0.22,总效应为0.89、0.90。结论GDM自我管理能力待提升、家庭支持水平低,且二者均与新生儿出生体质量、Apgar评分有关,家庭支持在自我管理能力与新生儿出生体质量、Apgar评分间起中介效应。

驱梅治疗时机对妊娠期梅毒患者妊娠结局、母婴快速血浆反应素试验结果及新生儿Apgar评分和胎传梅毒的影响

目的:探讨不同驱梅治疗时机对妊娠期梅毒患者妊娠结局,母婴快速血浆反应素试验(RPR)结果,新生儿Apgar评分以及胎传梅毒的影响。方法:选择甘肃省第二人民医院与玛曲县人民医院2019年1月至2021年12月收治的100例妊娠期梅毒患者作为研究对象,按照接受驱梅治疗时机的不同分成3组,其中早期组(孕<12周)38例,中期组(孕12~27周)32例,晚期组(孕≥28周)30例。比较3组不良妊娠结局情况、母婴RPR滴度、新生儿出生后1 min和5 min的Apgar评分及新生儿胎传梅毒发病率。结果:早期组、中期组和晚期组的不良妊娠结局发生率分别为7.89%(3/38)、34.38%(11/32)和53.33%(16/30),其中早期组不良妊娠结局发生率显著低于中期组和晚期组(P<0.05)。早期组和中期组妊娠期患者RPR滴度<1∶8的比率均显著高于晚期组(P<0.05);早期组新生儿RPR滴度<1∶8的比率显著高于中期组和晚期组(P<0.05)。早期组新生儿出生后1 min和5 min Apgar评分均显著高于中期组和晚期组(P<0.05);中期组新生儿出生后1 min和5 min Apgar评分均显著高于晚期组(P<0.05)。早期组、中期组及晚期组胎传梅毒发生率分别为0(0/38)、6.25%(2/32)及26.67%(8/30),早期组和中期组胎传梅毒发生率均显著低于晚期组,差异有统计学意义(P<0.05)。结论:妊娠期梅毒患者在孕早期进行驱梅治疗可有效减少不良妊娠结局、降低母婴RPR滴度,并能有效阻断梅毒垂直传播,降低胎传梅毒的发生风险。

紧急宫颈环扎术对宫颈机能不全产妇妊娠结局及新生儿Apgar评分的影响

目的:研究紧急宫颈环扎术对宫颈机能不全产妇妊娠结局及新生儿Apgar评分的影响。方法:回顾性选取2021年1月—2023年9月在赣州市妇幼保健院分娩的80例宫颈机能不全孕妇作为研究对象,根据其是否进行紧急宫颈环扎术分为环扎组(n=40,采用紧急宫颈环扎术治疗)和未环扎组(n=40,采用常规药物治疗)。收集两组临床相关资料,比较两组足月生产率、妊娠结局、新生儿出生不同时间点(1、5、10 min)Apgar评分、出生体重、延长孕周及临床治疗满意程度,记录环扎组手术并发症发生情况。结果:环扎组妊娠32周子宫颈长度长于未环扎组,延长孕周长于未环扎组,差异均有统计学意义(P<0.05)。环扎组足月生产率为50.00%(20/40),高于未环扎组的12.50%(5/40),差异有统计学意义(P<0.05)。环扎组活产率为92.50%(37/40),高于未环扎组的75.00%(30/40),环扎组的孕晚期流产率为7.50%(3/40),低于未环扎组的25.00%(10/40),环扎组自然分娩率为85.00%(34/40),高于未环扎组的57.50%(23/40),差异均有统计学意义(P<0.05)。环扎组新生儿出生1、5、10 min的Apgar评分均高于未环扎组,差异均有统计学意义(P<0.05)。环扎组临床治疗满意度为77.50%(31/40),高于未环扎组的50.00%(20/40),差异有统计学意义(P<0.05)。环扎组40例中有1例发生感染、1例发生子宫颈裂伤,并发症发生率为5.00%(2/40)。结论:紧急宫颈环扎术可有效延长宫颈机能不全孕妇的孕周,降低流产率,提高新生儿Apgar评分,保障母婴健康,且临床治疗满意度较高。

血清HbF、AFP水平及BPS、Apgar评分诊断胎儿母体输血综合征的价值

【目的】探讨孕产妇血清胎儿血红蛋白(HbF)、甲胎蛋白(AFP)联合胎儿生物物理评分(BPS)、阿氏评分(Apgar评分)诊断胎儿母体输血综合征(FMH)的价值。【方法】在本院门诊产检的100例疑似FMH的孕产妇作为研究对象,分娩后检测孕产妇血清HbF、AFP水平,并根据检查结果将孕产妇分为FMH组(13例)和非FMH组(87例)。比较两组孕产妇HbF、AFP水平及BPS、Apgar评分,通过受试者工作特征(ROC)曲线分析HbF、AFP及BPS、Apgar评分预测FMH的价值;多因素分析采取非条件Logistic逐步回归分析。【结果】FMH组患者HbF、AFP水平显著高于非FMH组,BPS、Apgar评分显著低于非FMH组(均P<0.05);经ROC曲线分析显示,HbF、AFP及BPS、Apgar评分可用于发生FMH的预测,曲线下面积分别为0.897、0.810、0.829、0.941,联合诊断曲线下面积为0.980;经多因素Logistic回归分析证实,HbF≤3.712%、AFP≤588.359 ng/mL、BPS≥5.865分、Apgar评分≥5.968分是发生FMH的危险因素。【结论】血清HbF、AFP联合BPS、Apgar评分可用于FMH的早期诊断,且联合检测具有更好的评估效能。

彩色多普勒超声联合血清NSE及5 min Apgar评分对新生儿颅内出血的诊断价值及危险因素分析

目的探讨彩色多普勒超声联合血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)及5 min Apgar评分对新生儿颅内出血(intracranial hemorrhage,ICH)的诊断价值及影响ICH发生的危险因素。方法选取2019年2月至2021年3月承德市中心医院新生儿科收治的存在颅脑损伤危险因素的253例新生儿为研究对象,均接受彩色多普勒超声检查,根据是否存在ICH分为ICH组(n=99)和无ICH组(n=154)。观察并比较两组彩色多普勒超声参数[收缩期峰值流速(peak systolicvelocity,PSV)、阻力指数(resistance index,RI)、舒张末期流速(end diastolic velocity,EDV)]、血清NSE水平、5 min Apgar评分情况,分析血清NSE水平、Apgar评分与彩色多普勒超声参数的相关性及三者联合检测对新生儿ICH的诊断价值,并分析ICH发生的主要影响因素。统计学方法采用独立样本t检验、χ^(2)检验、Pearson相关性分析、Logistic回归分析及受试者操作特征(receiver operating characteristic,ROC)曲线分析。结果ICH组与无ICH组PSV[(6.4±1.2)cm/s与(10.1±1.4)cm/s,t=21.628]、RI(0.6±0.1与0.7±0.1,t=8.144)、EDV[(2.5±0.4)cm/s与(3.1±0.4)cm/s,t=13.216]以及5 min Apgar评分[(6.5±1.7)分与(8.8±1.0)分,t=13.308]比较,ICH组均显著低于无ICH组(P值均<0.001);血清NSE水平显著高于无ICH组[(149.1±10.6)μg/L与(95.2±10.4)μg/L,t=40.015,P<0.001]。ICH组血清NSE水平与彩色多普勒超声参数PSV、RI、EDV呈负相关(r值分为-0.573、-0.520、-0.536,P值均<0.05);5 min Apgar评分与彩色多普勒超声参数PSV、RI、EDV呈正相关(r值分别为0.601、0.529、0.505,P值均<0.05)。ROC曲线结果发现,彩色多普勒超声、血清NSE水平、5 min Apgar评分联合诊断新生儿ICH的曲线下面积(area under the curve,AUC)最大,为0.861。单因素分析显示,与无ICH组比较,ICH组患儿的胎龄更小,出生体质量、5 min Apgar评分更低,出生窒息、应用多巴胺、应用机械通气比例及血清NSE水平更高,差异有统计学意义(P值均<0.05)。多因素Logistic回归分析结果显示,胎龄<32周、出生体质量<1500 g、血清NSE水平>117.95μg/L、5 min Apgar评分<7分是诱发ICH的独立危险因素。结论彩色多普勒超声联合血清NSE及5 min Apgar评分可提高ICH的诊断价值;胎龄<32周、出生体质量<1500 g、血清NSE水平>117.95μg/L、5 min Apgar评分<7分是诱发ICH的独立危险因素。

全身麻醉与蛛网膜下腔麻醉对剖宫产产妇生命体征及新生儿Apgar评分的影响比较

目的 分析比较全身麻醉、蛛网膜下腔麻醉在剖宫产产妇中的应用效果。方法 回顾性分析2022年5月至2023年5月宿迁市妇幼医院收治的150例剖宫产产妇的临床资料,根据麻醉方式不同分为两组,行蛛网膜下腔麻醉的75例剖宫产产妇纳入对照组,行全身麻醉的75例剖宫产产妇纳入观察组。比较两组产妇生命体征、手术时间、新生儿动脉血气分析、新生儿Apgar评分、不良反应。结果 麻醉前(T0),两组心率(HR)、平均动脉压(MAP)比较,差异无统计学意义(P> 0.05);切皮时(T1)、胎儿娩出时(T2),观察组HR、MAP高于对照组,差异有统计学意义(P <0.05);观察组手术时间短于对照组,差异有统计学意义(P <0.05);两组各项动脉血气分析指标,新生儿娩出后1、5 min的Apgar评分及不良反应发生率比较,差异无统计学意义(P> 0.05)。结论 全身麻醉、蛛网膜下腔麻醉均适用于剖宫产手术,但全身麻醉更能够稳定剖宫产产妇的生命体征,缩短手术时间,且对新生儿的动脉血气分析与Apgar评分无显著影响,较为安全可靠,具有一定的应用价值,值得临床借鉴。

丙泊酚诱导全麻剖宫产时血药浓度测定及其对新生儿Apgar评分和神经行为能力的影响

目的:测定丙泊酚诱导全麻剖宫产时产妇静脉血和新生儿脐血中的药物浓度,观察它的麻醉效应和对新生儿Apgar评分及神经行为能力(NBNA)的影响。方法:因特殊情况不宜行硬膜外麻醉剖宫产的足月孕妇30例,用丙泊酚2mg/kg诱导联合琥珀胆碱辅助肌松行全身麻醉剖宫产术(A组),于新生儿娩出时、脐带结扎后分别抽取胎盘侧脐带中脐静脉、脐动脉和母体外周静脉血各5ml,用HPLC-荧光检测法测定血中丙泊酚的浓度,记录产妇术前、意识消失、手术开始、胎儿娩出、手术结束和意识恢复时的脑电双频谱指数(BIS)。另随机选择30例常规硬膜外麻醉剖宫产孕妇(B组),记录并比较两组新生儿娩出后1、5min时的Apgar评分以及新生儿出生后3天和10天的NBNA分值。结果:丙泊酚在母体静脉血中的药物浓度为2.26±0.71μg/ml,在正常麻醉范围内。脐静脉血药浓度为0.83±0.25μg/ml,脐动脉血药浓度为0.78±0.24μg/ml,均低于苏醒浓度。术中产妇生命体征平稳,无意识恢复,术后随访无术中知晓发生。全麻组和硬膜外麻醉组新生儿Apgar评分及NBNA评分均无显著差异(P>0.05)。结论:丙泊酚2mg/kg诱导全麻剖宫产术对新生儿Apgar评分及NBNA评分无明显影响,产妇处于镇静状态。

七氟醚吸入麻醉用于剖宫产对新生儿Apgar评分的影响

目的比较七氟醚吸入麻醉与罗哌卡因腰-硬联合麻醉用于剖宫产术对新生儿Apgar评分的影响,探讨七氟醚用于产科麻醉的可行性。方法76例ASAⅠ或Ⅱ级、择期剖宫产的足月初产妇随机均分为两组:七氟醚组(S组)静注丙泊酚1.5mg/kg,并吸入3.5%(1·3MAC)七氟醚加3L/min氧吸入诱导后,插入喉罩,维持麻醉至胎儿娩出;对照组(R组)L2～3穿刺,蛛网膜下腔给予0.5%罗哌卡因10～15mg,切皮前给予丙泊酚1.5mg/kg。记录两组产妇的ECG、BP、SpO2等生命体征,记录给药至胎儿娩出的时间以及出生后即刻、5-min、10-min的Apgar评分。结果给药至胎儿娩出的时间两组均在5～10min。两组新生儿Apgar评分差异无统计学意义。七氟醚组有3例新生儿Apgar评分≤7分(7.9%);对照组有2例(5.3%)。结论3·5%七氟醚吸入麻醉用于剖宫产对新生儿Apgar评分无明显影响。

重度窒息新生儿5分钟Apgar评分的心率变异性分析

目的探讨重度窒息新生儿5minApgar评分与心率变异性（HRV）的关系。方法入选103例出生后1minApgar评分为0-3分的重度窒息新生儿，根据出生后5minApgar评分分组，〉7分为A组（n=50），≤7分B组（n=53）；同时以40例1、5minApgar评分均〉7分的足月新生儿作为对照组；三组新生儿均于出生后第3天行24h动态心电图检查，并分析其HRV变化。结果B组较对照组及A组HRV时域指标PNN50、rMSSD、SDSD降低，SDNN、SDANN升高，差异均有统计学意义（P〈0．05）；而A组与对照组HRV时域指标差异无统计学意义（P〉0．05）。结论新生儿窒息损伤自主神经功能，5minApgar评分联合HRV时域参数可作为重度窒息新生儿自主神经功能损伤及预后的无创判断指标。

脐动脉血气分析与Apgar评分联合应用临床价值研究

目的探讨脐动脉血气分析与Apgar评分的关系及二者联合应用的临床意义。方法对184例足月新生儿出生即进行脐动脉血气分析、Apgar评分,并追踪新生儿结局。结果宫内窘迫组脐动脉血pH值为(7.25±0.21),无宫内窘迫组pH值为(7.29±0.04)。宫内窘迫组pH<7.2占30.36%,<7.1占23.21%,<7.0占16.07%;无宫内窘迫组pH<7.2占14.06%,<7.1占10.16%,<7.0占5.47%,两组比较差异均有统计学意义(P<0.05)。分别以7.2、7.1、7.0为pH界值,Apgar评分≤7分组中低于pH界值的百分比明显高于Apgar评分>7分组,差异有统计学意义(P<0.05)。Apgar评分≤7分组中pH<7.2敏感性为58.82%,特异性为57.14%;pH<7.1敏感性为55.88%,特异性为73.08%;pH<7.0敏感性为35.29%,特异性为75.00%。pH值越低,缺氧缺血性脑病和高胆红素血症的发病率越高。结论脐动脉血气分析联合Apgar评分能更客观、更灵敏地反映胎儿缺氧、缺血的程度,并对判断新生儿近、远期预后有较大价值。

胎心监护联合脐血血气分析及Apgar评分预测羊水粪染新生儿窒息的临床价值

目的探讨胎心监护联合脐动脉血气分析及Apgar评分对羊水粪染窒息新生儿的预测价值。方法对585例羊水粪染新生儿进行分娩前胎心监护,出生后立即采集脐动脉血进行p H值测定,进行Apgar评分,分析3项指标与脏器损伤的关系,以及三者联合诊断羊水粪染新生儿窒息的灵敏度、特异度及符合率。结果 585例羊水粪染新生儿中共确诊窒息49例,占8.4%。随着p H值、Apgar评分的降低出现脏器损伤的新生儿比例升高(P<0.05),胎心监护异常组的脏器损伤发生率较正常组明显升高(P<0.05)。低Apgar评分(≤7分)联合异常胎心监护、脐动脉血p H值<7诊断羊水粪染新生儿窒息的敏感性为44.9%,特异性为100.0%,符合率为57.1%;低Apgar评分联合脐动脉血p H值<7.2、异常胎心监护诊断窒息的敏感性为83.7%,特异性为78.6%,符合率为82.5%。结论胎心监护联合脐动脉血气分析、Apgar评分可有效地预测评价羊水粪染新生儿窒息,为窒息新生儿及时采取正确的治疗措施提供了可靠的依据。