Effect of blood gas analysis in patients with bed rest and blood sampling through the dorsal artery:A meta-analysis

Objective:To systematic evaluation by the dorsalis pedis artery puncture for bed patients blood gas analysis of application effect of impact.Methods:A randomized controlled trial of the effect of arterial blood extraction on blood gas analysis in PubMed,CNKI,Wanfang database and VIP database.After selecting the literature,extracting the data and evaluating the quality of the literature.Meta- analysis was carried out by RevMan 5.3 software.Results:Twelve randomized controlled trials were included and 1696 patients were enrolled.After meta-analysis,the arterial puncture can effectively improve the success of arterial puncture in patients with bed [Z = 5.78,95%CI(1.90,3.66),P<0.001],reduce the occurrence of hematoma [Z = 4.27,95%CI(0.19,0.54),P<0.001],reduce the mistaken into the vein [Z = 4.60,95%CI(0.08,0.36),P<0.001],reduce cyanosis [Z = 2.84,95%CI(0.23,0.81),P<0.008],the difference was statistically significant.Conclusion:Dorsalis pedis artery puncture can improve the success rate of blood gas analysis in bedridden patients,reduce the incidence of hematoma and the incidence of venous leakage,and can be widely used in clinical practice.

Algorithm-based arterial blood sampling recognition increasing safety in point-of-care diagnostics

AIM To detect blood withdrawal for patients with arterial blood pressure monitoring to increase patient safety and provide better sample dating.METHODS Blood pressure information obtained from a patient monitor was fed as a real-time data stream to an experimental medical framework. This framework was connected to an analytical application which observes changes in systolic, diastolic and mean pressure to determine anomalies in the continuous data stream. Detection was based on an increased mean blood pressure caused by the closing of the withdrawal three-way tap and an absence of systolic and diastolic measurements during this manipulation. For evaluation of the proposed algorithm, measured data from animal studies in healthy pigs were used.RESULTS Using this novel approach for processing real-time measurement data of arterial pressure monitoring, the exact time of blood withdrawal could be successfully detected retrospectively and in real-time. The algorithm was able to detect 422 of 434(97%) blood withdrawals for blood gas analysis in the retrospective analysis of 7 study trials. Additionally, 64 sampling events for other procedures like laboratory and activated clotting time analyses were detected. The proposed algorithm achieved a sensitivity of 0.97, a precision of 0.96 and an F1 score of 0.97.CONCLUSION Arterial blood pressure monitoring data can be used toperform an accurate identification of individual blood samplings in order to reduce sample mix-ups and thereby increase patient safety.

A retrospective analysis of the relationship between dermatomyositis-associated interstitial lung disease and disease duration,age,arterial blood gas pH,and serum Cl^(-) levels

Background:Dermatomyositis-associated interstitial lung disease(DM-ILD)represents a severe and insidious complication of dermatomyositis(DM).The study aimed to investigate the association between DM-ILD and arterial blood gas indices,serum ion levels,and the timing of interstitial lung disease onset,with the goal of identifying potential predictors for DM-ILD.Methods:The investigation involved the collection of basic data from 89 patients with DM hospitalized at the Chinese PLA General Hospital between January 2019 and April 2022,and 43 normal control patients hospitalized for physical examinations during the same period.Analyses were conducted to explore the relationship between DM-ILD,arterial blood gas indices,disease duration,and serum ions.A regression model to predict DM-ILD was developed using these indices,and a receiver operating characteristic curve was generated.Results:Significant differences were observed in pH and PaO_(2) between the control group and the disease group(p<0.05).The DM group exhibited higher levels of pH,actual bicarbonate,and base excess(BE)compared with the control group.In contrast,pH and BE levels were lower in the DM-ILD group than in the DM group,with these differences being statistically significant(p<0.05).Interstitial lung disease was correlated with the duration of the disease and pH levels(p<0.05).The cutoff values for age,disease duration,pH,and Cl^(-) were 55.5 years,5.5 years,7.432,and 101.5 mmol/L,respectively.The model demonstrated a prediction sensitivity and specificity for DM-ILD of 0.809 and 0.722,respectively,with an area under the curve of 0.809.Conclusion:Arterial blood gas analysis and serum Cl^(-) levels may assist in predicting DM-ILD.A combined monitoring approach involving arterial blood gas pH,disease duration,age,and serum Cl^(-) levels could enhance the accuracy of DM-ILD predictions and hold significant clinical evaluation potential.

Correlation between the umbilical artery flow ultrasound parameters of intrauterine fetal distress and fetal ischemic hypoxic damage

Objective: To study the correlation between the umbilical artery flow ultrasound parameters of intrauterine fetal distress and fetal ischemic hypoxic damage. Methods: A total of 158 puerperae who gave birth in our hospital between July 2016 and June 2017 were selected and divided into the intrauterine distress group (Apgar<7 points) and normal pregnancy group (Apgar≥7 points) according to the neonatal Apgar score, the umbilical artery flow ultrasound parameters at 24-30 weeks, 31-36 weeks and 37-41 weeks of gestation were determined, and the umbilical arterial blood gas parameters and oxidative stress molecule levels were determined. Results: At 24-30 weeks, 31-36 weeks and 37-41 weeks of gestation, umbilical arterial RI, PI and S/D of intrauterine distress group were significantly higher than those of normal pregnancy group;umbilical arterial pH and PaO2 of intrauterine distress group were significantly lower than those of normal pregnancy group and negatively correlated with RI, PI and S/D while PaCO2 and lactic acid levels were significantly higher than those of normal pregnancy group and positively correlated with RI, PI and S/D;SOD, GSH-px and CAT levels in umbilical artery of intrauterine distress group were significantly lower than those of normal pregnancy group and negatively correlated with RI, PI and S/D while MDA and 8-OHdG levels were significantly higher than those of normal pregnancy group and positively correlated with RI, PI and S/D. Conclusion: Umbilical artery flow ultrasound characteristics of intrauterine fetal distress are characterized by the increased resistance and decreased blood flow and are correlated with the degree of fetal hypoxia and oxidative stress.

新生儿脐动脉血气分析与1 min Apgar评分相关性的研究

目的探讨新生儿脐动脉血气分析与1 min Apgar评分的相关性。方法以我院分娩的1921例新生儿为样本,行脐动脉血气分析检查的同时进行1 min Apgar评分,并追踪患儿并发症发生率。结果脐动脉血pH值、PO_2与1 min Apgar评分呈正向关联,脐动脉血PCO_2与1 min Apgar评分呈负向关联。脐动脉血pH值、1 min Apgar评分与脏器并发症发生率呈负向关联。结论新生儿窒息的诊断标准中脐动脉血气分析是不可或缺的,是1 min Apgar评分的有效补充,应结合脐动脉血气分析和1 min Apgar评分来综合评估新生儿的预后。

The Clinical Value of Artery Umbilical Cord Blood Gas in Predicting Neonate Condition:A Prospective Cohort Study

Objective:To evaluate the predictive ability of neonate condition through the traditional parameters and artery umbilical cord blood gas(aUCBG).Methods:A prospective cohort study was conducted in obstetrics and gynecology department between October 2017 and August 2018 at Tongji Hospital in Wuhan,China,and 360 aUCBG samples were collected.The average age of pregnant women was(29.50±4.42)years,range from 19 to 48 years old.The gestational age range from 28+4 weeks to 41+3 weeks at admission.Logistic regression and area under the curve(AUC)from Receiver operating characteristic curves were used to identify risk factors,such as,premature rupture of membranes(PROM),high blood pressure,premature delivery(PD),low 1-minute Apgar scores(Apgar 1),low 5-minute Apgar scores(Apgar 5),pH,base excess,bicarbonate,neonatal blood sugar(NBS),and so on,to predict neonatal condition and evaluate the predictive ability of traditional and aUCBG parameters.Results:In all cases,PROM,PD,Apgar 1,Apgar 5,pH,base excess,bicarbonate,total carbon dioxide,and neonatal blood sugar were risk factors and were associated with poor condition of neonate.Apgar 1 were an independent risk factor.Combined traditional and aUCBG parameters had higher AUC of 0.895(95%confidence interval(C/):0.830-0.960,P<0.001).In cesarean section subgroup,high blood pressure,PD,and Apgar 1 were risk factors and were associated with poor condition of neonate.Apgar 1 and low pH were the independent risk factors.Combined traditional and aUCBG parameters had highest AUC of 0.940(95%C/:0.886-0.993,P<0.001).In vaginal delivery subgroup,maternal age above 35 years,PROM,PD,Apgar 1,Apgar 5,and male newborn were risk factors and were associated with poor condition of neonate.Maternal age above 35 years was an independent risk factor.Combined traditional and aUCBG parameters had highest AUC of 0.897(95%Cl:0.828-0.965,P<0.001).For pregnant women without comorbidities and complications of pregnancy,aUCBG may not be necessat7.Conclusion:In high-risk pregnancies,especially lower Apgar scores,PD,and maternal age above 35-year old,aUCBG is recommended.Traditional parameters combined with aUCBG might increase the predicting ability of neonate condition.

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。

胎儿大脑中动脉、脐动脉血流指标水平与脐血血气分析结果的相关性分析

目的 分析胎儿大脑中动脉、脐动脉血流指标水平与脐血血气分析结果的相关性。方法 选取90例孕产妇,根据是否出现胎儿窘迫分为对照组(未发生胎儿窘迫,74例)和观察组(发生胎儿窘迫,16例)。于孕产妇孕晚期实施常规超声检查,并在新生儿出生后进行脐血血气分析检测。比较两组胎儿大脑中动脉及脐动脉血流指标[舒张期血流速度(VD)、收缩期血流速度(VS)、搏动指数(PI)、阻力指数(RI)及收缩期峰值血流速度与舒张末期血流速度之比(S/D)]水平,胎儿脐血血气指标[二氧化碳分压(PCO_(2))、氧分压(PO_(2))、碱剩余(BE)、p H值]水平;分析胎儿大脑中动脉及脐动脉血流指标水平与脐血血气指标水平相关性。结果 对照组大脑中动脉VD、VS、PI、RI及S/D分别为(20.17±2.01)cm/s、(68.31±2.39)cm/s、(1.48±0.28)、(0.74±0.18)、(4.45±0.74),脐动脉VD、VS、PI、RI及S/D分别为(16.64±4.25)cm/s、(61.02±4.21)cm/s、(0.74±0.21)、(0.59±0.10)、(3.24±0.72);观察组大脑中动脉VD、VS、PI、RI及S/D分别为(15.04±2.03)cm/s、(66.25±2.37)cm/s、(1.25±0.31)、(0.55±0.14)、(3.22±0.85),脐动脉VD、VS、PI、RI及S/D分别为(12.25±3.89)cm/s、(57.26±4.30)cm/s、(1.02±0.20)、(0.75±0.14)、(2.25±0.64)。与对照组相比,观察组胎儿大脑中动脉VD、VS、PI、RI及S/D更低,脐动脉VD、VS、S/D更低,脐动脉PI、RI更高(P<0.05)。观察组胎儿p H(7.15±0.03)、PO_(2)(23.24±4.29)mm Hg(1 mm Hg=0.133 k Pa)及BE(-7.24±1.41)mmol/L低于对照组的(7.26±0.02)、(28.11±4.36)mm Hg、(-6.01±1.45)mmol/L,PCO_(2)(61.33±2.37)mm Hg高于对照组的(45.35±2.31)mm Hg(P<0.05)。胎儿大脑中动脉VD、VS、PI、RI、SD与脐血p H、PO_(2)、BE呈正相关,与脐血PCO_(2)呈负相关(P<0.05)。胎儿脐动脉VD、VS、SD与p H、PO_(2)、BE呈正相关,与PCO_(2)呈负相关(P<0.05),脐动脉血PI、RI与p H、PO_(2)、BE呈负相关,与PCO_(2)呈正相关(P<0.05)。结论 胎儿大脑中动脉、脐动脉血流指标水平与脐血血气分析结果存在相关性,明确动脉血流指标水平以及脐血血气分析结果可为临床评估胎儿窘迫提供指导。

脐血血管内皮生长因子水平及血气分析与新生儿视网膜出血相关性研究

目的:探讨脐血血管内皮生长因子(VEGF)水平及血气分析与新生儿视网膜出血(RH)的相关性。方法:选取产科分娩并且行新生儿眼底筛查的596例新生儿。统计新生儿眼底检查结果,根据是否伴有眼底出血分为RH组(230例)和正常对照组(366例),分析VEGF水平及血气分析与新生儿RH的关系。结果:596例新生儿中,RH发生率为38.59%(230/596)。两组患者在产妇年龄、产次、多胎、分娩方式、窒息、产钳助产、胎龄、VEGF、pH值、二氧化碳分压(PaCO_(2))、氧分压(PaO_(2))、碱剩余(BE)值比较,差异有统计学意义(均P<0.05);而在妊娠期糖尿病、妊娠期高血压、贫血、性别、出生体重比较,差异无统计学意义(均P>0.05)。阴道分娩、窒息、产钳助产、VEGF≥251.67pg/ml、pH值<7.32、PaCO_(2)≥52.53mmHg、PaO_(2)<24.37mmHg、BE值<-3.49mmol/L是影响新生儿RH的独立危险因素(均P<0.05)。结论:脐血VEGF水平及血气分析均与KH密切相关。

新生儿脐动脉血血气分析的临床应用研究进展

分娩是一个复杂过程,产程长短、孕妇精神及体力状况、脐带因素(脐带绕颈、脐带扭转、受压等)等均对新生儿造成不同影响。脐动脉血血气分析指标可反映胎儿氧合及酸碱平衡状况,判断宫内、产时缺氧情况,是临床评估新生儿出生状态的常用检测指标。该文综述了脐动脉血血气分析在新生儿窒息、神经系统发育不良和其他系统疾病中的应用价值与研究进展。

脐动脉血气分析与新生儿窒息严重程度的相关性分析

目的:分析脐动脉血气分析与新生儿窒息严重程度的相关性。方法:选取2021年12月—2024年1月于厦门弘爱妇产医院分娩的足月新生儿238例作为研究对象,根据Apgar评分评估新生儿窒息情况,分为正常组、轻度窒息组和重度窒息组。采集新生儿脐动脉血检测pH、氧分压(PO_(2))、二氧化碳分压(PCO_(2))、碱剩余(BE)和乳酸(Lac)水平,比较三组脐动脉血分析指标,分析脐动脉血气分析各项指标与新生儿窒息的相关性。结果:238例新生儿中,无窒息130例,轻度窒息79例,重度窒息29例。三组pH、PO_(2)、BE比较,正常组>轻度窒息组>重度窒息组,三组PCO_(2)、Lac比较,正常组<轻度窒息组<重度窒息组,差异有统计学意义(P<0.05)。pH、PO_(2)、BE与新生儿窒息程度呈负相关(P<0.05),PCO_(2)、Lac与新生儿窒息程度呈正相关(P<0.05)。结论:新生儿脐动脉血气分析可以对新生儿窒息严重程度进行评估,具有一定的临床意义。

新生儿视网膜出血与脐动脉血气分析变化的相关性研究

目的探讨新生儿视网膜出血(RH)与脐动脉血气指标变化的关系。方法选取2018年5月至2021年12月期间在沧州市人民医院产科出生并行视网膜筛查的596例新生儿,根据新生儿是否视网膜出血分为出血组(n=230)和对照组(n=366),并依据出血程度可分为Ⅰ度组(n=95)、Ⅱ度组(n=75)和Ⅲ度组(n=60)。比较出血组与对照组及Ⅰ度、Ⅱ度、Ⅲ度组新生儿脐动脉血气指标氢离子浓度指数(pH)值、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))及剩余碱(BE)值,并应用Logistic回归模型分析影响RH发生的相关因素,采用受试者工作特征曲线(ROC)分析脐动脉血气指标对RH的预测价值。结果出血组pH值、PaO_(2)及BE值明显低于对照组,PaCO_(2)则高于对照组(P<0.05)。随视网膜出血程度的增加pH值、PaO_(2)及BE值降低,PaCO_(2)水平则升高,差异有统计学意义(P<0.05)。出血组产妇妊娠期糖尿病、妊娠期高血压、阴道分娩、产钳助产、急产、早产儿及新生儿有窒息史占比高于对照组(P<0.05)。多因素Logistic回归分析模型显示,早产儿、产妇妊娠期高血压、产妇阴道分娩、新生儿有窒息史及脐动脉血气中高水平PaCO_(2)及低水平PaO_(2)、BE、pH值均是影响RH的危险因素(P<0.05)。ROC曲线分析显示,pH值、PaO_(2)、PaCO_(2)及BE预测RH发生的AUC分别为0.755、0.719、0.669、0.816,pH值和BE的预测效能高于PaO_(2)和PaCO_(2)(P<0.05)。结论新生儿脐动脉血气指标与RH发生、发展紧密相关,且对RH的筛查具有一定的参考价值,其中pH值和BE筛查价值较高。

新生儿视网膜出血与脐动脉血气分析变化相关性研究

目的:探究新生儿视网膜出血(RH)与脐动脉血气分析变化之间的相关性。方法:回顾性研究。纳入2019-01/2021-12在我院产科出生的足月新生儿312例,根据RetCamⅢ眼底检查结果分为两组:对照组未发生RH的新生儿245例,RH组发生RH新生儿67例,比较两组患儿一般临床资料及脐动脉血气分析指标。根据RH程度分为Ⅰ度组20例,Ⅱ度组29例和Ⅲ度组18例。分析不同RH程度新生儿脐动脉血气分析指标水平,pH值与RH程度间的关系,影响新生儿发生RH因素。结果:RH组与对照组产妇年龄、平均孕周、胎儿性别、胎次、妊娠糖尿病、胎儿出生体质量、羊水情况比较均无差异(均P>0.05),分娩方式、妊娠高血压、产钳助产、新生儿窒息及脐带绕颈均有差异(均P<0.05)。RH组pH值、动脉血氧分压(PaO_(2))及剩余碱(BE)值显著低于对照组(均P<0.01),动脉二氧化碳分压(PaCO_(2))显著高于对照组(P<0.01)。不同程度RH患儿脐动脉血气分析指标有差异(P<0.05),且随着RH程度的增加,pH值、PaO_(2)及BE值逐渐下降(P<0.05),PaCO_(2)逐渐增加(P<0.05)。RH程度与脐动脉血气分析pH值呈负相关(rs=-0.593,P<0.05)。多因素Logistic回归分析结果显示,分娩方式、妊娠高血压、产钳助产、新生儿窒息、脐带绕颈、pH、PaO_(2)、PaCO_(2)及BE均是影响新生儿发生RH的因素。结论:新生儿发生RH与脐动脉血气分析变化密切相关,脐动脉血气分析可用于新生儿RH的诊断。

脐动脉血缺血修饰白蛋白联合血气分析对新生儿轻度窒息后心脏损害的预测价值

目的 探讨脐动脉血气分析联合脐动脉血缺血修饰白蛋白(ischemia-modified albumin,IMA)水平检测对新生儿轻度窒息后心脏损害的预测价值。方法 以2022年1月至2023年3月于江苏省阜宁县人民医院分娩的68例轻度窒息新生儿为研究对象,符合方案者65例,根据是否发生心脏损害,分为非心脏损害组(39例)及心脏损害组(26例)。全部研究对象均在分娩现场进行脐动脉血气分析,同时留取脐动脉血,测定IMA、肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)及高敏肌钙蛋白I(high-sensitivity troponin I,hsTnI)水平。应用SPSS 25.0软件对数据进行统计分析,并绘制受试者操作特征(receiver operating characteristic,ROC)曲线。结果 心脏损害组脐动脉血气分析指标[酸碱度(pondus hydrogenii,pH)、氧分压(partial pressure of oxygen,PO_(2))、二氧化碳分压(partial pressure of carbon dioxide,PCO_(2))、剩余碱(base excess,BE)、乳酸]及生物标记物(IMA、CK-MB、hsTnI)均显著高于非心脏损害组(P<0.05)。以心脏损害(否=0,是=1)为因变量,上述指标等为协变量,进行多因素Logistic回归分析。结果显示,pH值、PO_(2)及IMA差异有统计学意义(P<0.05)。IMA与pH值呈中度负相关,与PO_(2)呈弱负相关。用于预测新生儿轻度窒息后心脏损害的脐动脉血气pH值、脐动脉血IMA的ROC曲线下面积(area under curve,AUC)、cut-off值、灵敏度、特异度分别为0.840、7.14、96.20%、64.10%,0.893、79.65、73.10%、89.70%。脐动脉血气pH值及脐动脉血IMA二者联合预测新生儿轻度窒息后心脏损害时,AUC、灵敏度和特异度分别为0.927、76.90%、92.30%,优于单一指标。结论 脐动脉血气pH值联合脐动脉血IMA对新生儿轻度窒息后的心脏损害具有良好的预测价值,且方便、快捷,可考虑作为新生儿轻度窒息后心脏损害的临床早期诊断依据,具有潜在的临床应用价值。

多巴胺对改善剖宫产椎管内麻醉患者血流动力学的临床研究

目的:观察多巴胺(DA)用于剖宫产椎管内麻醉对改善患者血流动力学的影响。方法:选取2021年3月—2022年3月南阳医学高等专科学校附属中医院择期行剖宫产分娩的130例患者作为研究对象。采用抽签法,按1∶1比例将其分为常规组(65例,采用常规椎管内麻醉)和研究组(65例,采用DA辅助椎管内麻醉),比较两组患者术中及术后的血流动力学变化情况、新生儿脐动脉血气及母婴结局。结果:术后,研究组的心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)均低于常规组,血氧饱和度(SPO_(2))高于常规组,差异有统计学意义(t=2.514、2.929、3.474、3.409、2.857,P<0.05);在不同麻醉方案下,研究组新生儿脐动脉血中动脉氧分压(PaO_(2))高于常规组,酸碱值(pH)、动脉二氧化碳分压(PaCO_(2))低于常规组,差异有统计学意义(t=3.779、4.326、3.353,P<0.05);娩出后1 min、5 min、10 min时的Apgar评分高于常规组,差异有统计学意义(t=2.932、3.955、2.472,P<0.05);在不同麻醉方案下,研究组患者术后不良事件发生率低于常规组,差异有统计学意义(χ^(2)=6.432,P<0.05)。结论:采用DA辅助椎管内麻醉可有效维持剖宫产患者术中及术后的血流动力学稳定,对改善新生儿脐动脉血气及预后、降低产妇术后不良事件发生风险均有积极意义。

体位转变配合袋鼠式护理在新生儿肺炎中的应用效果

目的探讨体位转变配合袋鼠式护理在新生儿肺炎中的应用效果。方法选取2019年9月至2022年9月兰陵县人民医院收治的60例肺炎新生儿,按照随机数字表法分为对照组(n=30)和观察组(n=30)。对照组予以常规护理,观察组予以体位转变配合袋鼠式护理。比较两组症状缓解时间、血气分析指标和不良事件总发生率。结果观察组发热、哮鸣音、憋喘及肺部湿啰音缓解时间均短于对照组(P<0.05)。观察组动脉血氧分压、动脉血二氧化碳分压和动脉血氧饱和度水平均优于对照组(P<0.05)。观察组不良事件总发生率低于对照组(P<0.05)。结论体位转变配合袋鼠式护理可辅助缓解肺炎新生儿的临床症状,改善血气分析指标,降低不良事件总发生率,值得临床推广应用。

脐动脉血气分析和Apgar评分评估新生儿窒息的临床探讨

目的探讨脐动脉血气分析及Apgar评分在评估新生儿窒息中的临床意义。方法选择2012年3月～2013年3月广东省肇庆市第二人民医院分娩的84例新生儿作为研究对象，其中34例窒息新生儿为观察组．50例正常新生儿为对照组。分析两组新生儿出生时Apgar评分及脐动脉血血气分析与脏器损伤的关系，脐动脉血pH值与出生1minApgar评分的关系。结果观察组中，pH值〈7．2者占38．2％，对照组中pH值〈7．2者占16．0％，脐动脉血pH值较低的患儿，Apgar评分也较低，同时窒息的发生率较高，差异均有统计学意义（P〈0．05）。结论评估新生儿窒息不能没有血气分析的结果，脐动脉血气分析比Apgar评分对评估新生儿窒息更具客观性，两者结合，能反映胎儿宫内缺氧缺血程度，为临床正确及时诊断新生儿窒息提供可靠的科学依据。

分娩时脐动脉血气分析的临床意义

目的了解分娩时脐动脉血气的临床意义。方法选取2005年3月至2006年12月在北京大学第一医院分娩的产妇810例,临床诊断胎儿窘迫401例,无胎儿窘迫409例,在胎儿娩出后立即行脐动脉血气分析,并追踪新生儿结局,进行分析。结果①胎儿窘迫组中脐血pH值<7.2者49例,占12.2%,而无胎儿窘迫组pH值<7.2者26例,占6.4%。二者间差异有统计学意义(P=0.004);胎儿窘迫组脐血pH均值(7.25±0.24),无胎儿窘迫组脐血pH均值(7.28±0.05),两组差异有统计学意义(P=0.023);②新生儿出生后1minApgar评分>7分者中脐血pH值<7.2占8.3%,而Apgar评分≤7分者中高达34.5%,二者差异有统计学意义(P=0.000);③本研究中新生儿缺氧缺血性脑病(HIE)共18例,Apgar评分≤7分对HIE诊断的敏感性为38.9%,特异性为97.2%,阳性预测值24.1%,阴性预测值98.6%;脐血pH值<7.2对HIE诊断的敏感性55.6%,特异性91.8%,阳性预测值13.3%,阴性预测值98.9%;Apgar评分≤7分和pH值<7.2联合预测HIE的发生,特异性能增加至99.4%,阳性预测值增加至50%,阴性预测值98.4%。结论临床诊断胎儿窘迫者大多数出生时脐血气正常,可能存在过度诊断和治疗现象;血气分析是Apgar评分的补充,二者结合能增加对HIE诊断的特异性和阳性预测值,应结合Apgar评分和脐动脉血气分析来共同评价新生儿预后。

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。

急性等容血液稀释在完全性前置胎盘合并胎盘植入剖宫产手术中的应用

目的探讨急性等容血液稀释(ANH)在完全性前置胎盘合并胎盘植入剖宫产手术中应用的有效性和安全性。方法将52例需剖宫产终止妊娠的完全性前置胎盘合并胎盘植入的产妇随机双盲分为三组:A组在术前进行ANH,B组在术前进行急性高容血液稀释(AHH),C组术前无特殊处理。记录三组产妇术中总出血量、异体血输注例数、术前、术后2h血常规及三组新生儿1、5 min Apgar评分和脐动脉血血气。结果 A、B组产妇急性血液稀释后血气分析差异无统计学意义。A组输注异体血例数明显少于B、C组(P<0.05),术后2 h产妇Hb、Hct、Plt明显高于B、C组(P<0.05),B、C组差异无统计学意义;三组新生儿1、5 min Apgar评分和脐动脉血气分析差异无统计学意义。结论 ANH自体输血对孕妇及胎儿均无不良影响,是一种安全、有效的输血方式。