新生儿窒息诊断标准改进的临床研究  

Clinical study on improving the diagnostic criteria for neona tal asphyxia

作　　者：陈自励[1] 何锐智[1] 彭倩[1] 郭可瑜[1] 张玉琼[1] 袁惠华[1] 

机构地区：[1]东莞市妇幼保健院新生儿科,广东省523002

出　　处：《中华儿科杂志》2006年第3期167-172,共6页Chinese Journal of Pediatrics

摘　　要：目的探索准确性更高的新生儿窒息的诊断标准。方法连续纳入本院分娩活产婴10376例,检查和登记与窒息有关的5大项目:产前高危因素,系列Apgar评分,脐动脉血气,脏器损伤,低Apgar评分病因的鉴别诊断。统计分析前4项之间的相关性,通过鉴别诊断考察各单项在诊断窒息中的敏感性和特异性以及各项之间的互补性。结果各单项间均呈明显相关(P<0.01或<0.05)但并不完全平行一致。显示各项间可以互相补充,但不能互相取代。高危因素、低Apgar评分、脐动脉血pH<7.00、脏器损伤筛查窒息的敏感性分别为100%、100%、44.44%、100%,特异性分别为17.99%、98.90%、96.05%、99.62%。本组230例低Apgar评分与窒息的符合率仅50.9%,对此230例,低Apgar评分结合脐动脉血pH<7.00评估窒息的敏感性为44.44%,特异性为99.12%;结合脐动脉血pH<7.20的敏感性为100%,特异性为29.20%,加入脏器损伤后特异性提高到65.49%,再通过鉴别诊断排除低Apgar评分的其他病因后,基本消除了误诊。结论目前,新生儿窒息的诊断尚无准确的单一指标,为增加诊断依据和减少误诊,有必要以多项指标的综合诊断标准取代单一的Apgar评分。Objective Diagnosing neonatal asphyxia solely according to Apgar score may lead to misdiagnosis. The aim of this study was to explore new and more accurate diagnostic criteria for neonatal asphyxia. Methods Totally 10 376 live born neonates in our hospital were consecutively enrolled into the study. The following five items related to birth asphyxia, i.e. , antepartum high-risk factors, Apgar scores, umbilical artery blood pH, organ injury, differential diagnosis on the causes of low Apgar score cases were examined and registered. The relationship among the first 4 items were analyzed. By differential diagnosis, the sensitivity and specificity of each index on diagnosing asphyxia and their complementary value on each other were investigated. Results The items correlated well with each other （P 〈 0.01 or 〈 0.05 ） but were not entirely parallel and consistent; they could complement but could not substitute for each other. The sensitivity of antepartum high-risk factors, low Apgar scores, umbilicial artery blood pH 〈 7.00 and organ injury was 100%, 100%, 44.44% and 100%, while the specificity was 17.99%, 98.90%, 96.05% and 96.62%, respectively. Of the 230 low Apgar score cases in this series only 50. 9% coincided with asphyxia. For the 230 cases, when low Apgar score was combined with umbilical artery blood pH 〈 7. 130, the sensitivity and specificity were 41% and 99.1% and when low Apgar score was combined with umbilical artery blood pH 〈7.20, the sensitivity and specificity were 100% and 29.20%, respectively. After organ injury was added, the specificity was increased to 65.49%. When differential diagnosis was further added to exclude the other causes of low Apgar score cases, the misdiagnosis rate was minimized. Conclusion Up to now, no single accurate index for diagnosing neonatal asphyxia is available. In order to increase diagnostic bases and reduce misdiagnosis, the criteria of sole Apgar score should be replaced by multi-index diagnostic criteria. Based on the present study, a set of integrated

关 键 词：窒息 新生儿 诊断 阿普加评分 参考标准 

分 类 号：R722.12[医药卫生—儿科] R719.6[医药卫生—临床医学]