窒息复苏后新生儿动脉血气分析对窒息的评估意义  

The significance of arterial blood gas analysis for neonates with asphyxia after resuscitation

作　　者：郭果[1] 祁娇 郭玉婷 张雪峰[1] GUO Guo;QI Jiao;GUO Yu-ting;ZHANG Xue-feng(Department of Neonatology,302 Military Hospital of China,Beijing 100039,China)

机构地区：[1]中国人民解放军第三〇二医院新生儿科,北京100039

出　　处：《发育医学电子杂志》2018年第3期172-175,共4页Journal of Developmental Medicine (Electronic Version)

摘　　要：目的探讨窒息复苏后新生儿的动脉血气分析结果对窒息的评估意义。方法 2012年1月1日至2016年12月31日,在中国人民解放军第三〇二医院新生儿诊疗中心收治的患儿中,纳入116例窒息后复苏患儿,胎龄≥34周,出生体重≥2 500 g,排除先天性出生缺陷及遗传代谢性疾病。所有研究对象均进行动脉血气分析,记录患儿的性别、胎龄、分娩方式、采血时间,1、5及10分钟Apgar评分,以及窒息复苏用药情况。采用独立样本t检验和χ2检验进行统计分析,动脉血p H值和碱剩余(BE)对窒息诊断的敏感度和特异度采用受试者工作特征曲线(ROC)分析。结果轻度窒息组与重度窒息组患儿的采血时间、性别、出生胎龄、出生体重、剖宫产率、产钳助产率比较,差异均无统计学意义(P﹥0.05)。轻度窒息组患儿复苏过程中均未用药;重度窒息组患儿中,11例未用药,其余采用肾上腺素、0.9%氯化钠、碳酸氢钠、纳洛酮等药物治疗。轻度窒息组与重度窒息组的p H值(7.352±0.076与7.177±0.032)、BE值[(-6.4±4.5)与(-15.8±6.4)mmol/L]、HCO3-[(18.7±3.6)与(11.3±4.1)mmol/L]比较,差异均有统计学意义(P值均=0.000)。p H值的ROC曲线下面积为0.842(P=0.000,95%CI为0.733~0.950),BE值的ROC曲线下面积为0.896(P=0.000,95%CI为0.820~0.972)。当p H≤7.27时,敏感度为86.0%,特异度为75.0%;当BE≤-10.6 mmol/L时,敏感度为87.2%,特异度为83.3%,约登指数最大,诊断价值最高。结论窒息复苏后新生儿的动脉血气分析对诊断及评估窒息程度有一定的价值,可以指导复苏后的进一步治疗。Objective To investigate the significance of arterial blood gas analysis for neonates with asphyxia after resuscitation. Methods From January 1 st, 2012 to December 31 st, 2016, 116 cases of neonates with postasphyxial resuscitation, gestational age ≥ 34 weeks, birth weight ≥ 2 500 g, and excluding congenital birth defects and genetic metabolic diseases, were selected from the neonates admitted to the Newborn Clinic of the 302 Military Hospital of China. Arterial blood gas analysis was performed on all subjects. The neonates’ gender, gestational age, mode of delivery, blood sampling time, Apgar score at 1, 5, and 10 minutes, and medication for resuscitation were recorded. Independent sample t-test and χ~2 test were used for statistical analysis. The sensitivity and specificity of arterial blood p H and base excess（BE） for diagnosis of asphyxia were analyzed using receiver operating characteristic（ROC） curves. Results There were no significant difference in blood sampling time, sex, gestational age, birth weight, cesarean section rate, and forceps delivery rate between mild asphyxia group and severe asphyxia group（P ﹥ 0.05）. None of the neonates in the mild asphyxiation group received medication during the resuscitation. In the severe asphyxiation group, 11 neonates did not use medication, and the rest were treated with epinephrine, 0.9% sodium chloride, sodium bicarbonate, naloxone, etc. There were significant difference in p H value（7.352±0.076 vs 7.177±0.032）, BE value [（-6.4±4.5） vs（-15.8±6.4） mmol/L], HCO3-[（18.7±3.6） vs（11.3±4.1） mmol/L] between mild asphyxia group and severe asphyxia group（all P=0.000）. The area under the ROC curve of the p H value was 0.842（P=0.000, 95%CI 0.733-0.950）, and that of the BE value was 0.896（P=0.000, 95%CI 0.820-0.972）. When p H ≤ 7.27, the sensitivity was 86.0% and the specificity was 75.0%; and when BE ≤-10.6 mmol/L, the sensitivity was 87.2%, the specificity was 83.3%. Meanwhile the Youden index was the largest,

关 键 词：新生儿窒息 血气分析 诊断 新生儿复苏 

分 类 号：R722.1[医药卫生—儿科]