产前诊断胎儿窘迫的新生儿出生后生物化学监测价值的研究

目的 对产前诊断胎儿窘迫的新生儿出生后即刻行脐带血酸碱度及末梢血血氧饱和度检测,探讨不同程度胎儿窘迫导致新生儿缺氧及酸中毒情况.方法 取我院2013年4月15日至2014年11月30日足月临产孕妇150例,分成三组,A组：轻度胎儿窘迫组50例,胎监（CST）及羊水性状轻度异常;B组：重度胎儿窘迫组50例,CST及羊水性状明显异常;C组：正常对照组50例,CST及羊水性状无异常,新生儿出生后用脉搏血氧仪检测末梢血血氧饱和度,用SIEMENSRAPIDLAB248检测仪检测脐动脉血pH值.结果 Apgar评分＞7分有131例,80.15％新生儿脐动脉血pH值≥7.2,17.56％新生儿的血pH值在7.0 ～ 7.2间,2.29％新生儿的血pH值≤7.0; Apgar评分4～7分有16例,62.50％新生儿脐动脉血pH值≥7.2,25.00％新生儿的血pH值在7.0 ～ 7.2间,12.50％新生儿血pH值≤7.0; Apgar评分≤3分的3例新生儿脐动脉血 pH值均≤7.0;表明无窒息新生儿中也有19.85％发生酸中毒（pH＜7.2）;轻度窒息新生儿酸中毒的发生率为37.50％,重度窒息新生儿均有严重酸中毒;Apgar评分与血氧饱和度：Apgar＞7分的血氧饱和度：1分钟为（64.27±12.78）％,5分钟为（92.18±5.89）％,10分钟为（95.34±4.54）％;Apgar评分4～7分的血氧饱和度：1分钟为（59.48±12.07）％,5分钟为（80.47±6.48）％,10分钟为（92.64±6.48）％;Apgar评分≤3分的廊氧饱和度：1分钟为（48.87±14.68）％,5分钟为（76.45±7.28）％,10分钟为（83.74±8.06）％,窒息的新生儿出生1分钟与无窒息新生儿血氧饱和度相比无统计学意义（P＞0.05）,但窒息的新生儿血氧饱和度上升较慢,无窒息与窒息新生儿5分钟、10分钟血氧饱和度差异有统计学意义（P＜0.05）.结论 脐动脉血pH值是一个客观的指标,Apgar评分结合脐动脉血pH＜7.2可提高新生儿窒息诊断的检出率,减少漏诊;连续无创监测血氧饱和度（SPO2）是评价新生儿复苏效果的可靠方法.

Acupuncture in Preterm Babies during Minor Painful Procedures

Objective: To evaluate analgesic effects of acupuncture in preterm neonates during minor painful procedures. Methods: Ten preterm neonates requiring heel prick for blood gas analysis were enrolled in the study, which had a crossover design. Oxygen saturation, systolic and diastolic blood pressure, respiratory rate, heart rate, and crying duration were recorded before and after heel prick. Babies were given expressed breast milk before each procedure. Patients were randomly assigned to receive acupuncture or not, and the groups were crossed over on the following day, so that patients who had received acupuncture received only breast milk, and the previous breast milk only group received both acupuncture and breast milk. The neonatal infant pain scale (NIPS) was used for pain evaluation. Results: Crying duration and NIPS pain scores during heel prick were lower in the neonates who had received acupuncture. Conclusion: Acupuncture is an effective method for the treatment of pain in neonates.