脐动脉血气中乳酸水平在新生儿窒息的应用价值  

Application value of lactic acid level in umbilical artery blood gas in neonatal asphyxia

作　　者：曹珍珍 刘增芳 宋彩虹 贺兆平 CAO Zhenzhen;LIU Zengfang;SONG Caihong;HE Zhaoping(Yulin Hospital,the First Affiliated Hospital of Xi'an Jiaotong University,Yulin 719000,China)

机构地区：[1]西安交通大学第一附属医院榆林医院,陕西榆林719000

出　　处：《临床医学研究与实践》2025年第7期57-61,共5页Clinical Research and Practice

基　　金：榆林市科协青年人才托举计划项目(No.20200223)。

摘　　要：目的探讨脐动脉血气中乳酸水平在新生儿窒息诊断及预后评估中的应用价值。方法选择2020年11月至2022年10月于我院出生的50名正常新生儿作为对照组,将同期新生儿科收治的出生后1 min或5 min Apgar评分≤7分的75例新生儿作为观察组。出生后检测脐动脉的血气值,收集新生儿的临床资料。根据脐动脉血气pH将观察组分为低Apgar评分组(n=26)与窒息组(n=49),比较三组的1 min Apgar评分、脐动脉血乳酸、pH、碱剩余(BE)及器官损害率。根据有无器官损害将观察组分为无器官损害组(n=37)与器官损害组(n=38),比较两组的脐动脉血乳酸、pH、BE。分析脐动脉血乳酸与新生儿出生后1 min Apgar评分、脐动脉血pH及BE的相关性及其对新生儿窒息与窒息后器官损害的预测价值。结果对照组、低Apgar评分组及窒息组的1 min Apgar评分依次降低、器官损害率依次升高,两两比较差异具有统计学意义(P<0.05);对照组、低Apgar评分组及窒息组的脐动脉血乳酸水平依次升高,pH、BE依次降低,其中低Apgar评分组与窒息组、对照组与窒息组比较,差异具有统计学意义(P<0.05)。无器官损害组的脐动脉血乳酸水平低于器官损害组,pH、BE均高于器官损害组,差异具有统计学意义(P<0.05)。脐动脉血乳酸与1 min Apgar评分、脐动脉血pH和BE均呈负相关(P<0.05)。受试者工作特征(ROC)曲线显示,脐动脉血乳酸水平预测新生儿窒息的曲线下面积(AUC)为0.914,cut-off值为5.70 mmol/L,灵敏度为89.80%,特异度为92.30%;预测窒息后器官损害的AUC为0.761,cut-off值为8.25 mmol/L,灵敏度为63.20%,特异度为83.80%。结论脐动脉血乳酸水平可辅助快速判断新生儿窒息及病情严重程度,为临床治疗提供可靠的参考依据。Objective To explore the application value of lactic acid level in umbilical artery blood gas in the diagnosis and prognosis evaluation of neonatal asphyxia.Methods Fifty normal newborns born in our hospital from November 2020 to October 2022 were selected as control group,and 75 newborns with Apgar score≤7 at 1 min or 5 min after birth admitted in the neonatal department during the same period were selected as observation group.The blood gas value of umbilical artery was detected after birth,and the clinical data of newborns were collected.According to the umbilical artery blood gas pH,the observation group was divided into low Apgar score group(n=26)and asphyxia group(n=49),and the 1 min Apgar score,umbilical artery blood lactic acid,pH,base excess(BE)and organ damage rate among the three groups were compared.According to the presence or absence of organ damage,the observation group was divided into non-organ damage group(n=37)and organ damage group(n=38),and the umbilical arterial blood lactic acid,pH and BE of the two groups were compared.The correlation between umbilical artery blood lactic acid and neonatal Apgar score at 1 min after birth,umbilical artery blood pH and BE,and its predictive value of neonatal asphyxia and organ damage after asphyxia were analyzed.Results The 1 min Apgar score of the control group,the low Apgar score group and the asphyxia group decreased in turn,and the organ damage rate increased in turn,the differences between every two groups were statistically significant(P<0.05);the umbilical arterial blood lactate acid level in the control group,the low Apgar score group and the asphyxia group increased in turn,and the pH and BE decreased in turn,and the differences between the low Apgar score group and the asphyxia group,the control group and the asphyxia group were statistically significant(P<0.05).The umbilical arterial blood lactate acid level in the non-organ damage group was lower than that in the organ damage group,the pH and BE were higher than those in the organ damage group

关 键 词：脐动脉血气 乳酸 新生儿窒息 

分 类 号：R722.12[医药卫生—儿科]