蓝丽霞　平永美　雷君

[摘要] 目的 探討脐动脉血气分析对新生儿窒息诊治敏感性及特异性。 方法 选取2014年6月～2016年6 月期间，于本院分娩的Apgar 评分<8分的单胎足月新生儿144例作为研究组，同时期于本院分娩的Apgar 评分≥8分的单胎足月新生儿144例为对照组。新生儿分娩后的第一声啼哭前，采集其脐动脉血进行分析，检测其pH、PaO2、PaCO2、HCO3-及 BE 值并对比。 结果 对照组的 PaO2值、pH 值和HCO3-显著高于研究组，而对照组中脐动脉血的 PaCO2值和BE绝对值显著低于研究组，差异有统计学意义（P<0.05）；对照组pH值<7.20的新生儿显著少于研究组，但pH值7.21～7.25、>7.25两种情况下新生儿均显著高于研究组，差异有统计学意义（P<0.05）；脐动脉血pH值<7.20的新生儿HIE发病率显著高于pH值为7.21～7.25及>7.25的新生儿，pH值为7.21～7.25的新生儿HIE发病率则显著高于pH值>7.25的新生儿，差异有统计学意义（P<0.05）。 结论 脐动脉血气分析对新生儿窒息诊治效果较好，值得临床关注。

[关键词] 脐动脉血气分析；新生儿；窒息诊治；Apgar 评分

[中图分类号] R722.1 [文献标识码] A [文章编号] 1673-9701（2018）20-0033-03

Analysis on the value of umbilical artery blood gas analysis in the diagnosis and treatment of neonatal asphyxia

LAN Lixia1 PING Yongmei1 LEI Jun2

1.Department of Anesthesiology， Lishui Women and Children's Hospital in Zhejiang Province， Lishui 323000， China； 2.Department of Anesthesiology， Jingning County People's Hospital in Zhejiang Province， Jingning 323500， China

[Abstract] Objective To investigate the sensitivity and specificity of umbilical arterial blood gas analysis in the diagnosis and treatment of neonatal asphyxia. Methods A total of 144 singleton full-term newborns with Apgar score <8 who were born in our hospital were selected as the study group from June 2014 to June 2016. Another 144 cases of singleton full-term newborns with Apgar score ≥8 who were born in our hospital during the same period were selected as the control group. Before the first cry of the newborns after delivery， umbilical artery blood was collected for analysis. The pH， PaO2， PaCO2， HCO3- and BE values were measured and compared. Results PaO2， pH and HCO3- in the control group were significantly higher than those in the study group. In the control group， the PaCO2 value and the absolute value of BE in umbilical artery blood were significantly lower than those in the study group. The difference was statistically significant（P<0.05）； the control group had a significantly lower number of newborns with pH <7.20 than the study group. However， the newborns in pH 7.21-7.25 and>7.25 were significantly more than the study group. The differences were statistically significant（P<0.05）； the incidence rate of HIE in neonates with umbilical arterial blood pH <7.20 was significantly higher than that in neonates with pH values of 7.21-7.25 and>7.25. The incidence rate of neonatal HIE in the newborns with pH 7.21-7.25 was significantly higher than that of neonates with pH>7.25. The differences were statistically significant（P<0.05）. Conclusion Umbilical arterial blood gas analysis of neonatal asphyxia has a better effect of diagnosis and treatment，which is worthy of clinical attention.

[Key words] Umbilical arterial blood gas analysis； Newborns； Diagnosis and treatment of asphyxia； Apgar score

新生儿窒息是指新生儿在分娩过程中因为缺氧或者缺血而导致的体内酸碱不平衡、血液或气体紊乱的综合征[1-2]。新生儿窒息过程中可能因为缺氧和缺血造成新生儿器官功能性损伤，严重的甚至会威胁到新生儿的生命，严重影响到患儿的生活质量和生命安全[3]。国内新生儿窒息诊断传统方法是对新生儿进行Apgar评分，但是Apgar评分受主观因素影响较大，需要评价者有充足的临床诊断经验，否则很容易出现误诊和漏诊等现象，不利于新生儿及时接受治疗。近年来，脐动脉血气分析因为其取材方便、无创性、准确性高、灵敏度高等而被广泛应用于新生儿窒息的临床诊断[4]。脐动脉血气分析可准确地判断新生儿是否酸中毒，且能够判断酸中毒的程度，便于医生及时采取必要措施。

1 资料与方法

1.1 一般资料

选取2014年6月～2016年6月期间，于本院分娩Apgar评分<8分的单胎足月新生儿144例作为研究组，同时期于本院分娩的Apgar评分≥8分的单胎足月新生儿144例为对照组。两组新生儿临床一般资料，分娩方式、性别组成、出生体重、平均胎龄等方面比较，差异无统计学意义（P>0.05），具有可比性。见……