血气分析对足月儿缺氧后颅内出血的评估价值  

Value of blood gas analysis in evaluating intracranial hemorrhage of term neonates after hypoxia

作　　者：陈慧卿[1] 庄思齐[1] 李易娟[1] 李素萍[1] 

机构地区：[1]中山大学附属第一医院儿科,广州510080

出　　处：《中国实用儿科杂志》2010年第5期388-390,共3页Chinese Journal of Practical Pediatrics

摘　　要：目的评估血气分析对于缺氧相关的足月新生儿颅内出血(ICH)的预测价值。方法以中山大学附属第一医院新生儿科2006年1月至2009年1月住院的274例有围生期缺氧窘迫史的足月新生儿为研究对象,检测脐动脉血及生后1h桡动脉血血气,观察住院期间有无神经系统损害表现,并在生后7d内行头颅MRI或CT检查,判断有无ICH的发生。结果 ICH病例共61例,从ROC曲线分析得出,对足月儿缺氧后ICH有预测价值的血气指标有脐血pH值、BE值及脐血与生后1h动脉血PaCO2差值。按脐血和生后1h动脉pH值分组,各组间ICH发生率差异均有统计学意义(χ2值分别为17.364和5.314,P分别<0.001和=0.023)。按脐血联合生后1h血气pH值分组,ICH的发生率在各组间差异具有统计学意义(χ2=12.948,P<0.001)。剔除71例钳产儿后(剩余203例)进行分析,按脐血pH值分组,组间ICH差异具有统计学意义(χ2=11.844,P=0.003)。按生后1h动脉血pH值分组,组间ICH差异无统计学意义(χ2=0.904,P=0.43)。按脐血联合生后1h血气分组,组间ICH差异具有统计学意义(χ2=14.258,P=0.003)。结论脐血联合生后1h动脉血血气分析有助于预测足月儿缺氧后ICH的发生。Objective To investigate the value of blood gas analysis in evaluating intracranial hemorrhage （ ICH ） of term neonates after hypoxia. Methods A total of 274 full-term neonates with perinatal hypoxia or distress admitted to the First Affiliated Hospital, Sun Yat-Sen University, between January 2006 and January 2009, were studied. Blood gas analysis of umbilical artery, at birth and radial artery at 1 hour after birth were detected. Clinical manifestations of nervous system impairment were observed during hospital stay and cranial CT or MRI was checked within 7 days after birth to estimate ICH. Results Totally 61 cases had ICH. ROC curve analysis showed umbilical blood pH, BE, umbilical and 1 hour postnatal pCO2 difference were valuable index to estimate ICH. Groups divided by umbilical or 1 hour postnatal pH, difference of ICH incidence among groups has statistical significance （ X 2 = 17.364 and 5.314, P 〈 0.001 and = 0.023）. Difference of ICH incidence among groups divided by umbilical and 1 hour postnatal pH had statistical significance （ x 2 = 12.948, P 〈 0.001 ）. Analysis after reject 71 forceps delivery cases, groups divided by umbilical blood pH, difference of ICH incidence among groups had statistical significance （ X 2 = 11.844, P = 0.003 ）. Groups divided by 1 hour postnatal pH, difference of ICH incidence among groups had no statistical significance （ x 2 = 0.904, P = 0.43）. Difference of ICH incidence among groups divided by umbilical and 1 hour postnatal pH had statistical significance （ X2 = 14.258 ,P = 0.003 ）. Conclusion Umbilical cord combined with artery blood gas analysis after birth could be predictive of ICH in term infants after hypoxia.

关 键 词：血气分析 颅内出血 新生儿 缺氧 

分 类 号：R72[医药卫生—儿科]