围生期窒息对足月新生儿肾功能的影响  

Effect of Perinatal Asphyxia on Kidney Function of Full-Term Newborns

作　　者：张薇[1] 朱光华[1] 裘刚[2] 黄琦薇[2] 何威逊[1] 

机构地区：[1]上海市儿童医院肾脏科,上海200040 [2]上海市儿童医院新生儿科,上海200040

出　　处：《实用儿科临床杂志》2010年第18期1396-1398,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的了解围生期窒息缺氧缺血后对足月新生儿肾功能的影响。方法选取233例围生期窒息足月新生儿。男159例,女74例;孕周37～42+5周;平均出生体质量3 296 g。根据出生时Apgar评分及羊水情况分为重度窒息组37例、轻度窒息组100例及产前窒息组96例。采用肌氨酸氧化酶法测定其血清肌酐(Scr)水平,根据Swatch公式计算内生肌酐清除率(Ccr),与同期收集的100例健康对照组新生儿Scr水平进行比较。结果各窒息组Scr及Ccr水平与健康对照组比较,均有统计学差异;各窒息组之间两两比较,除重度窒息组Ccr与产前窒息组比较有统计学差异,余均无统计学差异。233例中144例Scr超过健康对照组50%以上,达急性肾损伤诊断标准,其中重度窒息组、轻度窒息组、产前窒息组分别为27例、64例、53例。好转129例,好转率89.58%(129/144例),重度窒息组、轻度窒息组、产前窒息组好转率分别为85.19%(23/27例)、89.06%(57/64例)、92.45%(49/53例);死亡1例,因病重放弃治疗14例,预后不良率为10.42%。结论围生期窒息时在缺氧缺血作用下,肾小球滤过率下降,部分患儿虽尚未达急性肾衰竭阶段,但已发生不同程度的急性肾功能异常。应尽早认识急性肾损伤,早期诊断、尽早改善缺氧状态,避免肾功能进一步恶化,降低病死率。Objective To investigate the effect of perinatal asphyxia on kidney function of full-term newborns.Methods Two hundred and thirty-three cases of full-term newborns with perinatal asphyxia（159 cases were male,and 47 cases were female;gestational weeks was 37-42＋5 weeks;average body weight was 3 296 g）,were divided into 3 groups：severe asphyxia group（37 cases）,mild asphyxia group（100 cases）,antepartum asphyxia group（96 cases）,according to their Apgar scores and amniotic fluid conditions.One hundred healthy newborns were selected as healthy control group.All their serum creatinine（Scr） was measured by using sarcosine oxidase method and creatinine clea-rance（Ccr） was estimated by adopting Swatch formula.Results There were significant differences of Scr and Ccr between perinatal asphyxia group and healthy control group.Among perinatal asphyxia groups,there was only a significant difference of Ccr between severe asphyxia group and antepartum asphyxia group,and there was no statistic difference of Ccr and Scrc between severe asphyxia group,mild asphyxia group,and antepartum asphyxia group.Their Scr of 144 cases within 233 newborn infants with perinatal asphyxia exceed 50% compared with that in healthy control group,conforming to acute kidney injury,including 27 cases of severe asphyxia group,64 cases of mild asphyxia group,and 53 cases in antepartum asphyxia group.One hundred and twenty-nine cases improved,improvement rate was 89.58%（129/144 cases）,including 85.19% in severe asphyxia group（23/27 cases）,89.06% in mild asphyxia group（57/64 cases）,92.45% in antepartum asphyxia group（49/53 cases）.One case died,14 cases gave up treatment due to serious pathogenetic condition,unfavourable prognosis rate was 10.42%.Conclusions Once there was perinatal asphyxia,part of full-term newborns,whose glomerular filtration rate was decreased,had acute abnormal renal function in different degrees,even if it was not consistent with the diagnosis of acute renal insufficiency due to anoxia and is

关 键 词：围生期窒息 急性肾损伤 婴儿 新生 

分 类 号：R714.7[医药卫生—妇产科学]