探讨影响新生儿脐血pH值的危险因素  

Risk factors of umbilical cord blood pH value of neonates

作　　者：张惠欣[1] 张月琴[1] 张晓丽[1] 任玮娜[1] 周旭旭 康霜霜 

机构地区：[1]河北医科大学第四医院妇产科,河北石家庄050000

出　　处：《中国妇幼保健》2016年第11期2309-2313,共5页Maternal and Child Health Care of China

基　　金：河北省科技支撑计划(122777149)

摘　　要：目的探讨影响新生儿脐血pH值的危险因素。方法回顾性分析2014年4月-2015年3月,于河北医科大学第四医院东院产科住院的足月、单胎、头位并经阴道分娩的产妇。按照脐动脉血pH值7.20为界分为pH值<7.20组和pH值≥7.20组,对2组产妇的临床资料进行分析,包括年龄、孕周、新生儿体重、新生儿1min Apgar评分、第二产程时间、拨露-娩出时间、头-肩时间(出头后到出肩时间)、分娩方式、分娩体位、羊水性状。结果 1591例产妇符合纳入标准,其第二产程时间、拨露-娩出时间、头-肩时间、脐动脉血pH值的分布情况[中位数(第5百分位数,第95百分位数)]分别为36.0(9.0,115.9)min、20.0(5.0,55.0)min、50.0(10.0,120.0)s、7.25(7.08,7.39),助产率、羊水粪染率、新生儿窒息率分别为4.57%(27/591)、22.00%(130/591)、2.20%(13/591)。22组产妇年龄、孕周、新生儿体重、头-肩时间、羊水粪染率比较,差异均无统计学意义(P>0.05);pH值<7.20组第二产程时间(52.1±36.5)min、拨露-娩出时间(25.8±18.5)min、助产率(8.98%,15/167)、非仰卧位分娩体位(14.37%,24/167)、新生儿1min Apgar评分(9.1±1.0)分、新生儿窒息率(4.79%,8/167),分别与pH值≥7.20组[分别为(41.2±30.0)min、(21.8±20.6)min、(2.83%,12/424)、(27.12%,115/424)、(9.4±0.8)分、(1.18%,5/424)]比较,差异有统计学意义(P值均<0.05)。3Logistic回归分析显示:助产、仰卧位分娩体位、新生儿1min Apgar评分≤7分是脐动脉血pH值<7.20的危险因素。结论第二产程时间、拨露-娩出时间、头-肩时间对新生儿脐血pH值无明显影响,但助产、仰卧位分娩体位、新生儿1min Apgar评分≤7分是影响新生儿酸碱平衡的危险因素。Objective To explore the risk factors of umbilical cord blood pH value of neonates. Methods The hospitalized women undergoing vaginal delivery （full-term, single pregnancy, head position） in the hospital from April 2014 to March 2015 were analyzed retrospectively, then they were divided into pH value〈7.20 group and pH value ≥7.20 group according to umbilical cord blood pH value, the clinical data in the two groups were analyzed, including maternal age, gestational week, neonatal weight, neonatal one-minute Apgar score, the time of the second stage of labor, head visible on vulval gapping-delivery time, head-shoulder time, delivery modes, delivery postures, and the character of amniotic fluid. Results A total of 591 women met the inclusion criteria. The time of the second stage of labor, head visible on vulval gapping-delivery time, head-shoulder time, and umbilical cord blood pH value [ median （ the 5th percentile, the 95th percentile） ] were 36. 0 （9.0, 115.9） minutes, 20. 0 （5.0, 55.0） minutes, 50. 0 （ 10. 0, 120. 0） seconds, 7. 25 （7.08, 7.39） , respectively. The rates of midwifery, meconium-staining amniotic fluid, and neonatal asphyxia were 4. 57% （27/591）, 22. 00% （ 130/591 ）, and 2. 20% （ 13/591 ） , respectively. There was no statistically significant difference in maternal age, gestational week, neonatal weight, headshoulder time, and the rate of meconium-staining amniotic fluid between the two groups （P〉0.05） . The time of the second stage of labor, head visible on vulval gapping-delivery time, the rate of midwifery, non-dorsal position delivery, neonatal one-minute Apgar score, and the rate of neonatal asphyxia in pH value〈7.20 group were （52. 1±36. 5 ） minutes, （25.8±18.5） minutes, 8.98% （15/167）, 14. 37% （24/ 167）, （9. 1±1. ） points, and 4. 79% （8/167）, respectively, compared with pH value≥7. 20 group [ （41.2±30. 0） minutes, （21.8±20. 6） minutes, 83% （212/424）, 27. 12% （115/424）, （9.4±0. 8） points, and

关 键 词：第二产程时间 拨露-娩出时间 头-肩时间 脐血pH值 

分 类 号：R722[医药卫生—儿科]