新生儿视网膜出血与脐动脉血气分析变化的相关性研究  

A correlation between retinal hemorrhage in neonates and changes in umbilical artery blood gas analysis

作　　者：黄祥訸 杨卫国 王吉云 鲁勃文 闫芳 刘国瑞 HUANG Xianghe;YANG Weiguo;WANG Jiyun;LU Bozwen;YAN Fang;LIU Guorui(The Department of Ophthalmology,Cangzhou People's Hospital,Hebei Cangzhou 061000,China;The Department of Obstetrical,Cangzhou People's Hospital,Hebei Cangzhou 061000,China)

机构地区：[1]沧州市人民医院眼科,河北沧州061000 [2]沧州市人民医院产科,河北沧州061000

出　　处：《中国实验诊断学》2024年第1期1-6,共6页Chinese Journal of Laboratory Diagnosis

基　　金：河北省2021年度医学科学研究课题计划(课题号20211147)。

摘　　要：目的探讨新生儿视网膜出血(RH)与脐动脉血气指标变化的关系。方法选取2018年5月至2021年12月期间在沧州市人民医院产科出生并行视网膜筛查的596例新生儿,根据新生儿是否视网膜出血分为出血组(n=230)和对照组(n=366),并依据出血程度可分为Ⅰ度组(n=95)、Ⅱ度组(n=75)和Ⅲ度组(n=60)。比较出血组与对照组及Ⅰ度、Ⅱ度、Ⅲ度组新生儿脐动脉血气指标氢离子浓度指数(pH)值、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))及剩余碱(BE)值,并应用Logistic回归模型分析影响RH发生的相关因素,采用受试者工作特征曲线(ROC)分析脐动脉血气指标对RH的预测价值。结果出血组pH值、PaO_(2)及BE值明显低于对照组,PaCO_(2)则高于对照组(P<0.05)。随视网膜出血程度的增加pH值、PaO_(2)及BE值降低,PaCO_(2)水平则升高,差异有统计学意义(P<0.05)。出血组产妇妊娠期糖尿病、妊娠期高血压、阴道分娩、产钳助产、急产、早产儿及新生儿有窒息史占比高于对照组(P<0.05)。多因素Logistic回归分析模型显示,早产儿、产妇妊娠期高血压、产妇阴道分娩、新生儿有窒息史及脐动脉血气中高水平PaCO_(2)及低水平PaO_(2)、BE、pH值均是影响RH的危险因素(P<0.05)。ROC曲线分析显示,pH值、PaO_(2)、PaCO_(2)及BE预测RH发生的AUC分别为0.755、0.719、0.669、0.816,pH值和BE的预测效能高于PaO_(2)和PaCO_(2)(P<0.05)。结论新生儿脐动脉血气指标与RH发生、发展紧密相关,且对RH的筛查具有一定的参考价值,其中pH值和BE筛查价值较高。Objective To investigate the relationship between neonatal retinal hemorrhage(RH)and changes in umbilical artery blood gas indexes.Methods 596 newborns born in the obstetrics department of our hospital from May 2018 to December 2021 with retinal screening were selected and divided into bleeding group(n=230)and control group(n=366)according to whether the newborn had retinal hemorrhage,and could be divided into first-degree group(n=95),second-degree group(n=75)and third-degree group(n=60)according to the degree of bleeding.The hydrogen ion concentration index(pH),arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))and residual base(BE)of umbilical artery blood gas indexes,arterial partial pressure of carbon dioxide(PaO_(2))and residual base(BE)values of neonates in the bleeding group and the control group and the I.,Ⅱ.,and Ⅱ.groups were compared,and the relevant factors affecting the occurrence of RH were analyzed by logistic regression model,and the predictive value of umbilical artery blood gas indexes on RH was analyzed by using the subject's working characteristic curve(ROC).Results The pH,PaO,and BE values of the bleeding group were significantly lower than those in the control group,while the PaCOz values were higher than those in the control group(P<0.05).With the increase of the degree of retinal hemorrhage,pH,PaO_(2) and BE decreased,and PaO_(2)levels increased,and the difference was statistically significant(P<0.05).The proportion of maternal diabetes mellitus,gestational hypertension,vaginal delivery,forceps delivery,emergency delivery,premature infants and newborns with a history of asphyxia in the bleeding group was higher than that in the control group(P<o.05).The multivariate logistic regression analysis model showed that preterm infants,maternal hypertension during pregnancy,maternal vaginal delivery,neonatal history of asphyxia,high level of PaCO_(2),low level of PaO_(2),BE and pH in umbilical artery blood gas were all risk factors for RH(P<0.05).R

关 键 词：新生儿 视网膜出血 脐动脉血气分析 相关性 

分 类 号：R722.1[医药卫生—儿科]