胎心监护重度变异减速、脐血乳酸监测、血气分析联合检测对新生儿窒息预后评估  

Prognostic evaluation of neonatal asphyxia by combined detection of severe variable deceleration of fetal heart monitoring,umbilical blood lactic acid monitoring and blood gas analysis

作　　者：罗敏 叶丽娜 何春梅 LUO Min;YE Li'na;HE Chunmei(Department of Obstetrics,Heyuan Maternal and Child Health Care Hospital,Guangdong,Heyuan 517000,China)

机构地区：[1]广东省河源市妇幼保健院产科,广东河源517000

出　　处：《中国医药科学》2021年第14期85-88,122,共5页China Medicine And Pharmacy

基　　金：广东省河源市社会发展科技计划项目(河科〔2019〕55号-35)。

摘　　要：目的探讨重度变异减速、脐血乳酸监测、血气分析联合检测对新生儿窒息预后评估价值。方法采用回顾性研究,选取河源市妇幼保健院2019年6月至2020年9月收治的60例新生儿窒息患儿为研究对象,根据新生儿出生1 min内的Apgar评分标准将窒息患儿分为轻度窒息组(Apgar 4-7分,30例)与重度窒息组(Apgar 0-3分,30例),另外选取我院同期收治的正常患儿为对照组(Apgar 8-10分,30例),分析不同三组患儿变异减速程度、血乳酸及血气相关指标。随访3个月,根据窒息患儿短期内是否发生不良结局分为预后良好组和预后不良组,单因素和多因素logistic分析窒息患儿发生不良预后的独立影响因素,绘制受试者工作特征(ROC)曲线分析上述指标对窒息患儿预后的评估价值。结果轻度与重度窒息组变异减速程度、血乳酸水平均高于对照组,pH值和BE水平低于对照组(P<0.05),随着窒息严重程度的增加,重度窒息组变异减速程度及血乳酸水平均显著高于轻度窒息组,pH值和BE水平则低于轻度窒息组(P<0.05);单因素显示,预后不良组与预后良好组患儿在变异减速程度、血乳酸、血pH值和BE水平比较,差异均有统计学意义(P<0.05);多因素分析显示,重度变异减速、血乳酸水平>3.33 mmol/L,pH值<7.30和BE水平<-10 mmol/L均是患儿预后不良的独立危险因素(P<0.05);变异减速程度、乳酸及血气指标联合检测的敏感度为84.00%,特异性为87.60%,均大于单项指标检测。结论重度变异减速、血乳酸浓度、血气指标联合检测在窒息患儿预后评估中具有一定的预测价值。Objective To investigate the prognostic value of neonatal asphyxia by combined detection of severe variable deceleration(VD),umbilical blood lactic acid monitoring and blood gas analysis.Methods By retrospective research,a total of 60 cases of neonatal asphyxia admitted to and treated in Heyuan Maternal and Child Health Care Hospital from June 2019 to September 2020 were selected as the research objects.According to the Apgar score within 1 minute after birth,the asphyxia children were divided into the mild asphyxia group(Apgar score=4-7 points,n=30)and the severe asphyxia group(Apgar score=0-3 points,n=30).Meanwhile,normal children admitted to our hospital during the same period were selected as the control group(Apgar score=8-10 points,n=30).The degree of VD,blood lactic acid and blood gas related indices were analyzed among three different groups of children.After 3 months of follow-up,children with asphyxia were divided into the good prognosis group and the poor prognosis group according to whether there were adverse outcomes in a short time.Univariate and multivariate logistic analysis were used to analyze the independent impacting factors of poor prognosis in children with asphyxia.The receiver operating characteristics(ROC)curve was drawn to analyze the evaluation value of the above indices in the prognosis of children with asphyxia.Results The degree of VD and blood lactic acid level in the mild and severe asphyxia groups were all higher than those in the control group,but the pH value and BE level were lower than those in the control group(P<0.05).With the increase of asphyxia severity,the degree of VD and blood lactic acid level in the severe asphyxia group were all significantly higher than those in the mild asphyxia group.The pH value and BE level were lower than those in the mild asphyxia group(P<0.05).Univariate analysis showed that there were statistically significant differences in the degree of VD,blood lactic acid,blood pH value and BE level between the poor prognosis group and the good prognosi

关 键 词：变异减速 乳酸 血气分析 新生儿窒息 

分 类 号：R714.5[医药卫生—妇产科学]