新生儿窒息| 血气分析| 诊断| 新生儿复苏," /> 新生儿窒息| 血气分析| 诊断| 新生儿复苏,"/> Neonatal asphyxia| Blood gas analysis| Diagnosis| Neonatal resuscitation,"/> <span style="line-height:2;font-size:14px;">窒息复苏后新生儿动脉血气分析对窒息的评估意义</span>
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发育医学电子杂志  2018, Vol. 6 Issue (3): 172-175    DOI: 10.3969/j.issn.2095-5340.2018.03.008
  发育基础   论著 |
窒息复苏后新生儿动脉血气分析对窒息的评估意义
郭果 祁娇 郭玉婷 张雪峰
中国人民解放军第三〇二医院 新生儿科,北京 100039)
The significance of arterial blood gas analysis for neonates with asphyxia after  resuscitation 
GUO Guo, QI Jiao, GUO Yu-ting, ZHANG Xue-feng
Department of Neonatology, 302 Military Hospital of China, Beijing 100039, China)
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摘要 

【摘要】目的 探讨窒息复苏后新生儿的动脉血气分析结果对窒息的评估意义。方法 2012 年 1 月 1 日至 2016 年 12 月 31 日,在中国人民解放军第三〇二医院新生儿诊疗中心收治的患儿中,纳入 116 例窒息后复

苏患儿,胎龄≥ 34 周,出生体重≥ 2 500 g,排除先天性出生缺陷及遗传代谢性疾病。所有研究对象均进行动脉血气分析,记录患儿的性别、胎龄、分娩方式、采血时间,1、5 及 10 分钟 Apgar 评分,以及窒息复苏用药情况。采用独立样本 t 检验和 χ2 检验进行统计分析,动脉血 pH 值和碱剩余(BE)对窒息诊断的敏感度和特异度采用受试者工作特征曲线(ROC)分析。结果 轻度窒息组与重度窒息组患儿的采血时间、性别、出生胎龄、出生体重、剖宫产率、产钳助产率比较,差异均无统计学意义(P ﹥ 0.05)。轻度窒息组患儿复苏过程中均未用药;重度窒息组患儿中,11 例未用药,其余采用肾上腺素、0.9% 氯化钠、碳酸氢钠、纳洛酮等药物治疗。轻度窒息组与重度窒息组的 pH 值(7.352±0.076 与 7.177±0.032)、BE 值 [(- 6.4±4.5)与(- 15.8±6.4)mmol/L]、HCO3 - [(18.7±3.6)与(11.3±4.1)mmol/L] 比较,差异均有统计学意义(P 值均 =0.000)。pH 值的 ROC 曲线下面积为 0.842(P=0.000,95%CI 为 0.733 ~ 0.950),BE 值的 ROC 曲线下面积为 0.896(P=0.000,95%CI 为 0.820 ~ 0.972)。当 pH ≤ 7.27 时,敏感度为86.0%,特异度为 75.0% ;当 BE ≤- 10.6 mmol/L 时,敏感度为 87.2%,特异度为 83.3%,约登指数最大,诊断价值最高。 结论 窒息复苏后新生儿的动脉血气分析对诊断及评估窒息程度有一定的价值,可以指导复苏后的进一步治疗。

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关键词:  font-size:14px  新生儿窒息| 血气分析| 诊断| 新生儿复苏')" href="#">">新生儿窒息| 血气分析| 诊断| 新生儿复苏    
Abstract: 【Abstract】Objective   To investigate the significance of arterial blood gas analysis for neonates with asphyxia after resuscitation.   Methods From January 1st, 2012 to December 31st, 2016, 116 cases of neonates with postasphyxial resuscitation, gestational age ≥ 34 weeks, birth weight ≥ 2 500 g, and excluding congenital birth defects and genetic metabolic diseases, were selected from the neonates admitted to the Newborn Clinic of the 302 Military Hospital of China. Arterial blood gas analysis was performed on all subjects. The neonates' gender, gestational age, mode of delivery, blood sampling time, Apgar score at 1, 5, and 10 minutes, and medication for resuscitation were recorded. Independent sample t-test and χ2 test were used for statistical analysis. The sensitivity and specificity of arterial blood pH and base excess (BE) for diagnosis of asphyxia were analyzed using receiver operating characteristic (ROC) curves. Results There were no significant difference in blood sampling time, sex,gestational age, birth weight, cesarean section rate, and forceps delivery rate between mild asphyxia
group and severe asphyxia group (P ﹥ 0.05). None of the neonates in the mild asphyxiation group received medication during the resuscitation. In the severe asphyxiation group, 11 neonates did not use medication, and the rest were treated with epinephrine, 0.9% sodium chloride, sodium bicarbonate naloxone, etc. There were significant difference in pH value (7.352±0.076 vs 7.177±0.032), BE value [(-6.4±4.5) vs (-15.8±6.4) mmol/L], HCO3 - [(18.7±3.6) vs (11.3±4.1) mmol/L] between mild asphyxia group and severe asphyxia group (all P=0.000). The area under the ROC curve of the pH value was 0.842 (P=0.000, 95%CI 0.733-0.950), and that of the BE value was 0.896 (P=0.000 95%CI 0.820-0.972). When pH ≤ 7.27, the sensitivity was 86.0% and the specificity was 75.0%and when BE ≤ -10.6 mmol/L, the sensitivity was 87.2%, the specificity was 83.3%. Meanwhile the Youden index was the largest, and the diagnostic value was the highest.  Conclusion  Arterial blood gasanalysis of neonates after asphyxial resuscitation is valuable in diagnosing and assessing the degree of
asphyxia and can guide further treatment after resuscitation.
Key words:  font-size:14px    Neonatal asphyxia| Blood gas analysis| Diagnosis| Neonatal resuscitation')" href="#">">Neonatal asphyxia| Blood gas analysis| Diagnosis| Neonatal resuscitation
收稿日期:  2017-12-20                出版日期:  2018-07-30      发布日期:  2018-08-21      期的出版日期:  2018-07-30
通讯作者:  张雪峰http://yyk.39.net/doctor/129552.html#practiceExperience    E-mail:  doctor1966@sina.com)
引用本文:    
郭果 祁娇 郭玉婷 张雪峰. 窒息复苏后新生儿动脉血气分析对窒息的评估意义[J]. 发育医学电子杂志, 2018, 6(3): 172-175.
GUO Guo, QI Jiao, GUO Yu-ting, ZHANG Xue-feng. The significance of arterial blood gas analysis for neonates with asphyxia after  resuscitation . Journal of Developmental Medicine(Electronic Version), 2018, 6(3): 172-175.
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http://www.fyyxzz.com/CN/10.3969/j.issn.2095-5340.2018.03.008  或          http://www.fyyxzz.com/CN/Y2018/V6/I3/172
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