新生儿窒息时脐带动脉血气中乳酸和碱剩余值的阈值研究  

Threshold value of lactic acid and buffer excess in umbilical cord arterial blood gas during neonatal asphyxia

作　　者：花少栋 岳丽琴 程黎明 王淑梅 周珍慧 李秋平 封志纯 Hua Shaodong;Yue Liqin;Cheng Liming;Wang Shumei;Zhou Zhenhui;Li Qiuping;Feng Zhichun(Bayi Children′s Hospital,the Seventh Medical Center of Chinese People′s Liberation Army General Hospital,Beijing 100007,China;Beijing New Century Women and Children′s Hospital,Beijing 100102,China)

机构地区：[1]中国人民解放军总医院第七医学中心八一儿童医院,北京100071 [2]北京新世纪妇女儿童医院,100102

出　　处：《中国小儿急救医学》2019年第12期901-906,共6页Chinese Pediatric Emergency Medicine

基　　金：国家自然科学基金(81671504)。

摘　　要：目的研究新生儿脐动脉血气在pH值<7.20时,诊断窒息的相应的乳酸(Lac)及碱剩余(BE)值的界值.方法纳入2017年1月至2019年2月北京新世纪妇女儿童医院住院的2518例产妇,对其围生期一般状况、生产方式进行统计.在新生儿出生后第一声啼哭前采集脐带动脉血,测定血气,研究影响脐动脉血气的围生期因素及pH值<7.2时,脐动脉血气中Lac及BE的界值.采用受试者工作特征曲线分析脐动脉血气中Lac及BE值诊断窒息的价值.结果(1)母亲贫血、无乳链球菌感染、急产、胎盘异常对新生儿脐动脉血气无明显影响.胎膜早破和胎儿宫内窘迫组血气中Lac值高于无胎膜早破及无胎儿宫内窘迫组,BE值低于无胎膜早破及无胎儿宫内窘迫组,差异有统计学意义(P<0.05).分娩方式对新生儿脐动脉血气有影响,剖宫产组Lac值最低[(1.79±1.25)mmol/L],助产组Lac最高[(4.45±1.58)mmol/L];pH值在助产组中最低(7.25±0.07),剖宫产中最高(7.31±0.06);BE值在助产组中最低[-(5.66±2.52)mmol/L],剖宫产组最高[-(2.99±2.28)mmol/L],三组比较差异均有统计学意义(P<0.05).(2)多元线性回归分析结果显示,胎儿娩出方式、胎儿宫内窘迫、胎膜早破、妊娠糖尿病是影响新生儿脐动脉血气中Lac水平的因素;胎儿娩出方式、胎儿宫内窘迫、胎膜早破、胎盘异常是影响新生儿脐动脉血气中BE值的因素.(3)以pH值<7.2诊断为窒息,共199例,绘制新生儿脐动脉血气Lac、BE值诊断窒息的受试者工作特征曲线,当Lac>3.97 mmol/L时,诊断窒息的灵敏度为0.864,特异度为0.791.脐动脉血中BE值≤-6 mmol/L诊断窒息灵敏度为0.613,特异度为0.756.结论新生儿脐动脉血气受诸多因素影响,助产对脐动脉血气影响大,单以pH值<7.2考虑为窒息时,Lac及BE的界值分别为>3.97 mmol/L及≤-6 mmol/L.Objective To study the threshold values of lactic acid(Lac)and buffuer excess(BE)when neonatal umbilical arterial blood gas is at pH<7.20.Methods A total of 2518 pregnant women admitted in Beijing New Century Women and Children′s Hospital from January 2017 to February 2019 were enrolled.The general conditions in perinatal period and labor methods were counted.Umbilical cord arterial blood was immediately collected before the first cry of newborn and was detected on the Abbott I-STAT automatic blood gas analyzer from the United States,and then the umbilical arterial blood gas was measured.We analyzed the perinatal factors affecting umbilical arterial blood gas.We studied the threshold values of Lac and BE for neonal asphyxia by receiver operating characteristic curve.Results(1)Maternal anemia,Streptococcus agalactiae infection,precipitate labour,placenta abnormalities had no significant impact on neonatal umbilical artery blood gas.The Lac value in blood gas was higher in the group of premature rupture of fetal membranes and fetal intrauterine distress.The value of BE was lower in the group with premature rupture of fetal membranes and fetal distress(P<0.05).The Lac value in cesarean section group was the lowest[(1.79±1.25)mmol/L],while that in midwifery group was the highest[(4.45±1.58)mmol/L].pH value was the lowest(7.25±0.07)in the midwifery group and the highest(7.31±0.06)in the cesarean section group.The value of BE was the lowest in the midwifery group[-(5.66±2.52)mmol/L],and the highest in the cesarean section group[-(2.99±2.28)mmol/L],with statistically significant differences among the three groups(P<0.05).(2)Multiple linear regression analysis showed that fetal delivery mode,fetal intrauterine distress,premature rupture of membranes,and gestational diabetes were the factors affecting Lac level in umbilical artery blood gas of newborns.Methods of delivery,intrauterine distress,premature rupture of membranes and placental abnormalities were the factors that affected the BE value of umbilical artery

关 键 词：脐动脉 血气分析 乳酸 碱剩余 新生儿 

分 类 号：R722[医药卫生—儿科]