摘要
目的 统计新生儿脐动脉血气的正常范围,重点研究临床上诊断新生儿窒息的脐动脉血气指标,为诊断本病增加循证医学依据.方法 组织5省6家医院从2008年3月至2009年9月前瞻性连续纳入单胎、足月、体重适于或大于胎龄新生儿共17 978例,统计其中17 645例Apgar 1 min评分≥8分者的脐动脉血气的正常范围;研究脐动脉血pH、BE与高危因素、Apgar评分、脏器损伤的相关性;拟诊窒息的标准：兼备①有导致窒息的高危因素,②1 min Apgar评分≤7分（须含呼吸抑制）,③至少1个脏器受损,④排除引起低Apgar评分的其他情况和疾病.重点研究低Apgar评分儿中窒息组和非窒息组脐动脉血pH值（按Eisenberg公式进行临床校正）、BE值的分布特点以及不同pH、BE阈值选点的敏感性和特异性,探索诊断新生儿窒息的脐动脉血气指标.结果 17 978例单胎、足月、体重适于或大于胎龄新生儿中,17 645例Apgar 1 min评分≥8分者的脐动脉血pH值和BE值的统计学正常范围分别为7.20±0.20（（-x）±1.96s）和-7.64±10.02（（-x）±1.96s）.pH与BE呈正相关（r=0.734,P〈0.01）.脐动脉血pH、BE与Apgar评分呈正相关,1 min0～3分、4～7分、8～10分3组的pH、BE均值±标准差比较,F分别=253.36、160.79,P均〈0.001;脐动脉血pH、BE与脏器损伤呈负相关（r均=1,P均=0.000）.333例低Apgar评分儿中,窒息组（163例）脐动脉血pH校正值和BE值分别为7.011±0.09（（-x）±s）和-14.98±2.99（（-x）±s）明显低于非窒息组（170例）的相应值7.18±0.07（（-x）±s）和-8.56±4.68（（-x）±s）,t分别为15.12、10.18,P均〈0.001;窒息患儿的脐动脉血pH校正值分布范围为〈7.00～〈7.20,BE分布范围为〈-10～〈-18;在窒息组pH和BE值的分布范围中,并无一个敏感性和特异性均强的固定点.结论 新生儿脐动脉血pH值和BE值的统计学正常范围参考值分别为7.20±0.20（（-x）±1.96s）和-7.64±10.02（（-x）±1.96s）.由于个体差异和血气检测值用于评估窒息时需经过临床校正,统计学的正常范围低限值并不完全等同于临床病理学的阈值.新生儿窒息的pH或BE病理学阈值不是一个固定点而是一个范围.新生儿窒息的脐动脉血pH临床校正值分布范围为〈7.00～〈7.20,BE分布范围为〈-10～〈-18,在具备其他4项指标的情况下,诊断新生儿窒息的血气指标似可在上述范围内灵活掌握.
Objective To obtain the normal range of statistics of umbilical artery blood gas parameters of the newborns for diagnosis of neonatal asphyxia.Methods From March 2008 through September 2009,17 978 singleton term appropriate for gestationa age（AGA）or larger than gestational age（LGA）newborns in six hospitals of five provinces/autonomous regions were consecutively enrolled in this prospective study.The normal ranges of umbilical artery blood gas parameters were obtained from 17 645newborns with 1 min Apgar score ≥ 8.The correlations between umbilical artery blood pH,BE and prenatal high-risk factors,Apgar scores,and organ damage were analyzed.The diagnostic criteria for asphyxia included the following：（1）Having high-risk factors that might cause asphyxia;（2）1 min Apgar score ≤7（the respiratory depression must be present）;（3）At least one organ showed evidence of hypoxic damage;（4）Other causes of low Apgar score were excluded.The study focused on the distributive characteristics of umbilical artery blood pH（clinically corrected by Eisenberg formula）and BE values of the asphyxiated and non-asphyxiated cases in low Apgar score group,as well as the sensitivity and specificity of different selected pH and BE threshold spots within their distributing ranges.Results Among the 17 978 singleton term AGA or LGA newborns,the statistically normal range of umbilical artery blood pH,BE for the 17 645 cases with 1 min Apgar scores ≥ 8 were 7.20 ±0.20（（-x）±1.96 s）and -7.64±10.02（（-x）± 1.96 s）,respectively.The pH well correlated positively with BE（r = 0.734,P 〈0.01）.The umbilical artery blood pH and BE values correlated positively with the Apgar scores.The umbilical artery blood pH and BE values correlated negatively with organ damage（r = 1 ,the P values =0.000 for both）.Among the 333 low Apgar score cases,the umbilical artery blood pH corrected values and BE values of the asphyxiated group（163cases）were7.011 ±0.09（（-x）±s）and -14.98 ±2.99（（-x）±s）,being lower than 7.18 ±0.07（（-x）±s）and -8.56 ±4.68（（-x）±s）of the non-asphyxiated group（170 cases）respectively（t = 14.3,8.79,P values 〈0.001）.The distributing ranges of the umbilical artery blood pH corrected values and BE values of the asphyxiated group were 〈7.00- 〈7.20 and 〈- 10- 〈- 18,respectively.Within the above ranges,none of selected spots with both high sensitivity and high specificity was found.Conclusions The statistically normal range of the umbilical artery blood pH and BE for the newborns was 7.20±0.20（（-x）± 1.96 s）and - 7.64±10.02（（-x）± 1.96 s）respectively.Owing to individual differences and the measured blood pH should be clinically corrected,the statistical threshold was not fully equal to the clinicopathological threshold.The pathological threshold of pH or BE for neonatal asphyxia is a range rather than a fixed point The distributing range of the umbilical artery blood pH clinically corrected values and BE values for neonatal asphyxia were 〈7.00-〈7.20 and 〈-8-〈-18,respectively.In the presence of the other four indexes for diagnosing neonatal asphyxia,the blood gas index should be used flexibly in the above ranges.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2010年第9期668-673,共6页
Chinese Journal of Pediatrics
基金
基金项目：广西自然科学基金重点项目（0833290）
北海市科技攻关项目（北科项字2008-1号）
《中华儿科杂志》第一届双鹤珂立苏基金项目
关键词
窒息
新生儿
诊断
血气指标
阈值
病理学
Asphyxia,neonatal
Diagnosis
Blood-gas index
Threshold,pathological
