脐动脉血乳酸水平诊断围生儿缺氧的价值  

Study on lactate in cord artery blood used to diagnose the newbores with perinatal hypoxia

作　　者：刘卫[1] 冯秀君[1] 吕响红[1] 綦美花[1] 李健[1] 牟晓峰[1] 杨志斌[1] 

机构地区：[1]青岛大学医学院第二附属医院,山东青岛266042

出　　处：《中国妇幼保健》2008年第1期122-125,共4页Maternal and Child Health Care of China

基　　金：青岛市科技发展计划课题(05-2-NS-43)

摘　　要：目的：通过测定新生儿脐动脉血乳酸水平，探讨乳酸水平在预测围生儿缺氧酸中毒的应用价值。方法：随机选择2005年2月一2006年3月分娩的492例新生儿为对象，依据脐血血气分析及Apgar评分分为两组，对照组427例，观察组65例，应用接受者运行曲线（receiver operation curveROC）分析，对脐血乳酸诊断酸血症（pH〈7．20）、代谢性酸中毒（BE〈-6mmol／L）及新生儿低Apgar评分（1、5min〈7分）进行评价。结果：对照组与观察组新生儿脐动脉血乳酸水平比较差异有统计学意义（P〈0．01）。脐血乳酸诊断酸中毒的ROC曲线下面积（area under curve AUC）为0．941（P〈0．01），以〉3．94mmol／L为界值时，诊断酸中毒其敏感度65．4％，特异度93．3％，诊断符合率88．57％。脐血乳酸预测围生儿结局（酸中毒／低Apgar评分）的AUC为0．838（P〈0．01），以〉3．94mmol／L为诊断界值时，诊断敏感度58．3％，特异度90．9％，符合率88．61％。结论：脐动脉血乳酸水平对产时缺氧酸中毒有较大的诊断价值，尤其适用于产时羊水粪染、不良胎心宫缩图、低Apgar评分等高危新生儿，可筛查高乳酸血症，以判断围生儿预后，指导早期干预。Objective： To present a method to assess efficacy of cord artery blood lactate level measurement in diagnosis of the newberes with perinatal hypoxia. Methods： 492 neonates from February 2005 to March 2006 were divided into two groups, in which there were 427 cases in control group and 65 cases in observing group, according to their umbilical artery blood gas analysis and Apgar score after birth. Umbilical artery blood lactate in the diagnosis of acidosis （pH 〈 7. 20） and low Apgar score after birth （Apgar score below 7 in 1st and 5st minute of life） was evaluated with receiver operation curve （ROC） . Results： The area under ROC curve （AUC） of lactate in cord blood used to diagnose acidosis （ pH 〈 7.20） was 0. 941 （ P 〈 0.01 ） . For the diagnosis of acidosis, a lactate cutoff value higher than 3.94 mmol/L had a sensitivity of 65. 4%, a specificity of 93. 3% and diagnosis coincidence rate of 88. 57%. The AUC of predicting perinatal outcome （acidosis / low Apgar score after birth） was 0. 838 （P 〈 0. 01 ） with a sensitivity of 58.54%, a specificity of 90. 40% and diagnosis coincidence rate of 88. 61%. Condusion： The umbilical artery blood lactate level has a higher predictive value for evaluating the newbores with perinatal hypoxia acidosis, which is especially applicable to the higher risk neonates of intrapartum meconium - staind amniotic fluid, abnormal cardiotocography and low Apgar scores etc, diagnose higher lacticemia and attain the aim of short - term prognosis prediction and early treatment of neonates.

关 键 词：脐动脉血 乳酸 缺氧 酸中毒 围生期 

分 类 号：R72[医药卫生—儿科]