云南高原地区健康足月新生儿脉搏血氧饱和度和脐动脉血气值的横断面调查  

Oxygen saturation and umbilical blood gas values for healthy newborns in high lands of Yunnan Province in China:A cross-sectional study

作　　者：中国高原新生儿联盟 泽碧 高瑾[3] 赖银珍 毛辉 秦明彩 张铁松[4] 杨永礼 李杨方[3] 周文浩 刘晓梅[3] 杜琨[3] 无;ZE Bi;GAO Jin;LAI Yinzhen;MAO Hui;QIN Mingcai;ZHANG Tiesong;YANG Yongli;LI Yangfang;ZHOU Wenhao;LIU Xiaomei;DU Kun(Chinese High Altitude Neonatal Medicine Altitude Alliance(CHANMA);Department of Neonatology,Children's Hospital of Fudan University,Shanghai 201102,China;Kunming Children's Hospital Department of Neonatology,Kunming 650103,China;Kunming Children's Hospital Department of Pediatrics,Kunming 650103,China;Department of Pediatrics,Diqing Tibetan Autonomous Prefecture People's Hospital,Shangri-La 674499,China;Department of Obstetrics,Affiliated Hospital of Yunnan University,Kunming 650031,China;Department of Pediatrics,Maternal and Child Health Hospital of Shangri-La,Shangri-La 674499,China;Department of Pediatrics,Maternal and Child Health Hospital of Lijiang,Lijiang 674199,China)

机构地区：[1]不详 [2]复旦大学附属儿科医院新生儿科,海201102 [3]云南省昆明市儿童医院新生儿科,昆明650103 [4]云南省昆明市儿童医院儿科,昆明650103 [5]云南迪庆藏族自治州人民医院儿科,香格里拉674499 [6]云南大学附属医院产科,昆明650031 [7]云南迪庆藏族自治州香格里拉县妇幼保健院儿科,香格里拉674499 [8]云南省丽江市妇幼保健院儿科,丽江674199

出　　处：《中国循证儿科杂志》2022年第6期432-437,共6页Chinese Journal of Evidence Based Pediatrics

基　　金：国家自然科学基金资助项目:82060291;云南省周文浩专家工作站资助项目:2019IC052。

摘　　要：背景对不同高海拔梯度新生儿生后早期氧饱和度(SpO_(2))和脐动脉血气值仍有进一步探索空间,特别是对构建高海拔情况下SpO_(2)和脐动脉血气的正常值有重要意义。目的比较不同高海拔梯度新生儿生后2 h内SpO_(2)和脐动脉血气值的差异。设计横断面调查。方法纳入2022年9月7日至2022年10月10日中国高原新生儿联盟(简称“联盟”)的4家医院连续分娩的胎龄≥37周且<42周的健康足月新生儿。经联盟指定的医护人员采集新生儿基线数据,在统一环境要求、相同标准下检测生后10、~30和~120 min时间段新生儿右手的SpO_(2)值,在新生儿娩出、脐带夹闭后立即行脐动脉血气(pH、乳酸和碱剩余值)检测,并将数据录入联盟数据库。分为海拔2000 m组、海拔2400 m组和海拔3500 m组。以零海拔点SpO_(2)的95%为低氧高危界值参考。主要结局指标生后2 h内SpO_(2)。结果进入联盟数据库229例健康新生儿,海拔2000 m组73例,海拔2400 m组42例,海拔3500 m组114例,3组新生儿性别、胎龄、出生体重及母亲年龄差异均无统计学意义,藏族人群分布差异有统计学意义。总体新生儿人群随时间延长SpO_(2)逐渐上升,海拔2000 m组生后3个延续时段(10、~30和~120 min)SpO_(2)中位数分别为96%、98%和100%,其第25百分位数与零海拔SpO_(2)高危界值分别持平、高2%和高3%;海拔2400 m组生后3个延续时段SpO_(2)中位数分别为88%、90%和94%,其第75百分位数比零海拔SpO_(2)高危界值分别低6%、4%和1%;海拔3500 m组生后3个延续时段SpO_(2)中位数分别为84%、89%和92%,其第75百分位数比零海拔SpO_(2)高危界值分别低5%、5%和1%。脐动脉血气比较,3组不同高海拔组pH值差异均无统计学意义;海拔2400 m组和海拔3500 m组乳酸高于、碱剩余值低于海拔2000 m组,其中海拔2400 m组和海拔3500 m组的剖宫产新生儿乳酸高于、碱剩余值低于海拔2000 m组,差异均有统计学意义。藏族与Background The differences in oxygen saturation in the early postnatal period and umbilical artery blood gas values among different altitude gradients are still needed to be explored,especially for the establishment of normal values of pulse oximetry(SpO_(2))and umbilical artery blood gas at high altitudes.Objective To compare the distribution of SpO_(2)within 2 hours after birth and umbilical artery blood gas analysis in well full-term neonates at different altitudes.Design Cross-sectional study.Methods Healthy full-term neonates who were delivered consecutively in 4 hospitals of the Chinese High Altitude Neonatal Medicine Alliance(CHANMA)from September 7,2022 to October 10,2022 were included.Designated medical staff collected the baseline data of the newborn,and tested the SpO_(2)value of the right hand of the newborn within 10,11 to 30,and 31 to 120 minutes after birth under the same environments with the same standard.Immediately after birth,the umbilical cord was clamped and umbilical arterial blood gas(pH,lactic acid and BE)was detected.The data was recorded in the database of the CHANMA through the computer network.According to the altitude level,they are divided into 2,000 m above sea level group,2,400 m above sea level group and 3,500 m above sea level group.The SpO_(2)value of 95%was taken as the hypoxic high-risk cut-off value for comparison.Main outcome measures SpO_(2)within 2 hours after birth.Results A total of 229 cases were included with 73 cases in the 2,000 m altitude group,42 cases in the 2,400 m altitude group,and 114 cases in the 3,500 m altitude group.There was no significant difference in gender,gestational age,birth weight and mother's age among the three groups.Tibetan distribution was statistically significant.The SpO_(2)of the overall newborn population gradually increased over time.The median SpO_(2)at 2,000 m altitude group was 96%,98%and 100%in three continuous periods after birth(10,11 to 30 and 31 to 120 minutes),and the 25 th quantile was equal to,2%and 3%higher than the hypoxic

关 键 词：高原 新生儿 氧饱和度 脐动脉血气 

分 类 号：R722.1[医药卫生—儿科]