脐血乳酸、碱剩余值检测对新生儿窒息后多器官功能损害的诊断价值  

Diagnostic value of umbilical cord blood lactic acid and base excess for multi-organ dysfunction following neonatal asphyxia

作　　者：方潇倩 包婉婉 王秀云 金英兰 楼华妃 陈婷甜 Fang Xiaoqian;Bao Wanwan;Wang Xiuyun;Jin Yinglan;Lou Huafei;Chen Tingtian(Department of Neonatology,Dongyang People's Hospital,Dongyang 322100,Zhejiang Province,China)

机构地区：[1]东阳市人民医院新生儿科,东阳322100

出　　处：《中国基层医药》2025年第3期387-391,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省金华市公益性技术应用研究(2022-4-273)。

摘　　要：目的观察脐动脉血乳酸(Lac)、碱剩余值(BE)检测对评估新生儿窒息后多器官功能损害的临床价值。方法回顾性分析东阳市人民医院2021年1月至2023年12月符合纳入标准的244例围产期窒息高危患儿的临床资料,根据患儿存在器官功能损害情况分为单器官功能损害组(A组)55例、多器官功能损害组(B组)16例和无器官功能损害组(C组)173例,比较三组患儿乳酸水平、BE值的差异;采用受试者工作特征曲线(ROC)验证乳酸、BE对器官功能损害的预测价值。结果A、B、C三组患儿的一般资料比较,差异无统计学意义(P>0.05);B组乳酸为15.10(13.85,16.83)mmol/L,BE值为9.80(6.65,15.18)mmol/L;A组乳酸为7.70(6.25,11.70)mmol/L,BE值为5.70(3.85,9.60)mmol/L;C组乳酸为6.80(4.30,9.00)mmol/L,BE值为4.00(3.00,6.50)mmol/L;B组高于A组和C组,且A组高于C组(t=2.60、20.19、2.95、1.92,均P<0.05)。通过ROC曲线分析,在预测是否存在器官损害及多器官功能障碍综合征(MODS)中,BE和乳酸联合检测优于BE、乳酸的单独检测,且BE优于乳酸检测,联合检测曲线下面积(AUC)分别为0.694、0.856,BE检测AUC值分别为0.678、0.846,乳酸检测AUC值分别为0.633、0.797。结论脐血乳酸水平、BE值与新生儿窒息后器官功能损害存在相关性,两者对评估器官功能损害有临床应用价值。Objective To investigate the diagnostic value of umbilical cord blood lactic acid and base excess for multi-organ dysfunction following neonatal asphyxia.Methods A retrospective analysis was conducted on the clinical data of 244 patients at high risk for perinatal asphyxia who received treatment at Dongyang People's Hospital from January 2021 to December 2023.Based on the presence of organ dysfunction,the infants were divided into three groups:a single organ dysfunction group(Group A,n=55),a multi-organ dysfunction group(Group B,n=16),and a no organ dysfunction group(Group C,n=173).Lactic acid levels and base excess values were compared among the three groups.Receiver operating characteristic curves were used to validate the predictive value of lactic acid and base excess values for organ dysfunction.Results There were no statistically significant differences in general data among the three groups(P>0.05).In Group B,the lactic acid level was 15.10(13.85,16.83)mmol/L,and the base excess value was 9.80(6.65,15.18)mmol/L.In Group A,the lactic acid level was 7.70(6.25,11.70)mmol/L,and the base excess value was 5.70(3.85,9.60)mmol/L.In Group C,the lactic acid level was 6.80(4.30,9.00)mmol/L,and the base excess value was 4.00(3.00,6.50)mmol/L.The lactic acid level and base excess value in Group B were significantly higher than those in both Group A and Group C.Additionally,the lactic acid level and base excess value in Group A were significantly greater than those in Group C(t=2.60,20.19,2.95,1.92,all P<0.05).Receiver operating characteristic curve analysis revealed that the combined assessment of base excess value and lactic acid level was more effective than evaluating each parameter individually in predicting the presence of organ damage and multiple organ dysfunction syndrome.Additionally,the detection of base excess value was found to be superior to the measurement of lactic acid level.The areas under the curve values for the combined assessment of base excess value and lactic acid level for the presence of organ

关 键 词：新生儿窒息 血气分析 多器官功能衰竭 乳酸 酸碱平衡 

分 类 号：R72[医药卫生—儿科]