新生儿三重酸碱失衡影响因素及临床分析  

The influencing factors and clinical analysis of triple acid-base disorder in hospital neonate

作　　者：顾昊 卢典 卢屹峰 吴伟玲[1] 郑大同[1] 

机构地区：[1]南京医科大学第二临床医学院,江苏南京210011

出　　处：《东南大学学报（医学版）》2017年第5期698-703,共6页Journal of Southeast University(Medical Science Edition)

摘　　要：目的:了解新生儿三重酸碱失衡(TABD)的影响因素。方法:随机纳入171例患儿,检测动脉血气和血电解质,计算阴离子间隙、潜在HCO-3及HCO-3间隙;依据TABD诊断标准分为单纯酸碱失衡(ABD)组、双重ABD组及TABD组进行研究。结果:171例患儿中TABD组病死率16.67%,高于单纯ABD、双重ABD组(P<0.05)。低碳酸血症型发生率占总TABD的81.48%。窒息或颅内损伤、呼吸窘迫综合征、出血症、感染等基础疾病,缺氧、热卡不足、凝血异常、少尿等合并症,以及治疗差异(机械通气、血液制品、排钾利尿剂、禁食及胃肠减压)均严重影响TABD发生,其作用远高于对单纯及双重ABD组的影响(P<0.01或P<0.05)。结论:在院新生儿TABD高发生率与基础疾病、合并症及治疗有关,且影响预后;低碳酸血症型TABD是新生儿TABD的主要表现形式。Objective： To investigate the influencing factors of triple acid-base imbalance（TABD） in hospitalized neonates.Methods： 171 neonates were randomly selected from the infants admitted to the neonatal ward.All of these were simultaneously subjected to arterial blood gas and blood electrolyte testing,and anion gap,latent HCO-3 and HCO-3 gap values were calculated.According to the TABD criteria,these neonates were diagnosed and divided into three groups： simple ABD group,double ABD group and TABD group.The factors affecting TABD were compared among the groups.Results： Of totally 171 neonates,mortality in the TABD group was 16.67%,much higher than that in the other groups（P〈0.05）.TABD group was significantly higher than other groups in primary disease including asphyxia or intracranial injury,respiratory distress syndrome,hemorrhagic disease and infection of the newborn,and complications including hypoxia,inadequate caloric intake,coagulation dysfunction,oliguria,besides the treatments of mechanical ventilation,blood products,application also included diuretics,fasting and gastrointestinal decompression（P〈0.01 or P〈0.05）.Conclusion： The high incidence of hospitalized neonates with TABD is associated with primary disease,complications and clinical treatment,which affect the prognosis.Hypocapnia is the common symptom of neonatal TABD.

关 键 词：三重酸碱失衡 阴离子间隙 低碳酸血症 新生儿 

分 类 号：R723.12[医药卫生—儿科]