窒息新生儿窒息生后早期外周动脉血血气分析pH值与振幅整合脑功能的关系  

Relationship between pH value of peripheral arterial blood gas analysis and amplitude integration brain function in early postnatal asphyxia newborns

作　　者：鞠俊 常贺生[1] 秦选光[1] JU Jun;CHANG He-sheng;QIN Xuan-guang(Department of Pediatrics,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院儿科,北京100020

出　　处：《临床和实验医学杂志》2022年第11期1204-1208,共5页Journal of Clinical and Experimental Medicine

基　　金：北京市医院管理中心儿科学科协同发展中心专项经费资助(编号:XTYB201814)。

摘　　要：目的探讨新生儿窒息生后早期外周血pH值与振幅整合脑功能结果的关系。方法回顾性研究2017年1月至2021年9月于首都医科大学附属北京朝阳医院儿科新生儿监护室住院治疗,诊断新生儿窒息的足月儿临床及振幅整合脑功能资料,总病例数78例,其中轻度窒息组52例,重度窒息组26例。根据脐血血气pH值及生后外周动脉血血气pH值将研究病例分为4组:轻度窒息生后2 h内动脉血气分析pH值(PAB-pH)>7.25共36例,轻度窒息PAB-pH<7.25共16例,重度窒息PAB-pH>7.25组共14例,重度窒息PAB-pH<7.25组共12例。评价指标包括aEEG背景活动、睡眠觉醒周期情况以及是否存在惊厥发作。结果重度窒息组aEEG背景活动异常率为61.5%(16/26),显著高于轻度窒息组的26.9%(14/52),两组间差异有统计学意义(P<0.05)。按照生后2 h内动脉血气分析pH值进行分组,pH<7.25组aEEG背景活动异常率为64.3%(18/28),显著高于pH>7.25组[24.0%(12/50)],两组间差异有统计学意义(P<0.05)。4组间aEEG背景活动异常率显著不同,差异有统计学意义(P<0.05)。不论在轻度窒息组,还是重度窒息组,PAB-pH<7.25组的aEEG背景活动异常率均明显高于PAB-pH>7.25组,差异有统计学意义(P<0.05)。重度窒息PAB-pH<7.25组无成熟睡眠觉醒者(包括无睡眠周期及不成熟睡眠周期)为7例(58.3%),其他组在生后72 h内均出现明显睡眠觉醒周期,组间比较差异有统计学意义(P<0.05)。重度窒息PAB-pH<7.25组有2例(16.7%)出现惊厥发作,其他组患儿未监测到惊厥发作,组间比较差异有统计学意义(P<0.05)。结论新生儿窒息足月儿生后2 h动脉血气分析pH值与振幅整合脑功能结果显著相关。应重视生后短时间内动脉血血气分析结果,对于pH值仍小于7.25的患儿,神经系统损伤风险明显增高。Objective To explore the relationship between the pH value of peripheral blood and the results of amplitude integrated brain function in the early stage of neonatal asphyxia.Methods The clinical data of full-term infants with neonatal asphyxia hospitalized in the pediatric neonatal care unit of Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2017 to September 2021 were studied retrospectively.The total number of cases was 78,including 52 cases in the mild asphyxia group and 26 cases in the severe asphyxia group.According to the pH value of umbilical blood gas and the pH value of peripheral arterial blood gas after birth,the study cases were divided into four groups:36 cases of mild asphyxia with arterial blood gas analysis pH value(PAB-pH)>7.25 within 2 hours after birth,16 cases of mild asphyxia with PAB-pH<7.25,14 cases of severe asphyxia with PAB-pH>7.25 and 12 cases of severe asphyxia with PAB-pH<7.25.The evaluation index includes background of aEEG activity,sleep-waking cycle,and convulsion.Results The abnormal rate of aEEG background activity was 61.5%(16/26)in severe asphyxia group,which was higher than that in mild asphyxia group[26.9%(14/52)],the difference was statistically significant(P<0.05).According to the pH values of arterial blood gas analysis within 2 hours after birth,the abnormal rates of aEEG background activity was 64.3%(18/28)in the pH<7.25 group,which was higher than that in the pH>7.25 group[4.0%(12/50)],the difference was statistically significant(P<0.05).The abnormal rate of amplitude integrated brain function background activity was significantly different among the four groups(P<0.01).The abnormal rate of aEEG background activity in PAB-pH<7.25 group was significantly higher than that in PAB-pH>7.25 group,the difference was statistically significant(P<0.05).Seven patients(58.3%)in the group with severe asphyxia with PAB-pH<7.25 had no mature sleep Awakening(including no sleep cycle and immature sleep cycle).Other groups had obvious sleep awakening cycle

关 键 词：新生儿窒息 早期 血气分析pH值 振幅整合脑电图 

分 类 号：R722.12[医药卫生—儿科]