罗兆冰 张志哲 许成芳 廖彬 许誉耀 冉东 姚凯文 温百慧 何睿 刘开玲 莫珊

【摘要】 目的 探討三类胎心监测不同Apgar评分脐带血血气分析判断新生儿窒息的临床应用价值。方法 收集2018年1月至2020年1月在医院出生的新生儿271例，根据胎心监测类型分组，其中Ⅰ类胎监5分钟Apgar评分10分组为130例正常新生儿;Ⅱ类胎监组69例新生儿，其中5分钟Apgar 评分≤7分20例，5分钟Apgar 评分≥8分49例;Ⅲ类胎监组72例新生儿，其中5分钟Apgar 评分≤7分30例，5分钟Apgar评分≥8分42例。进行产前胎心监测，产后Apgar评分、脐带血血气酸碱度（pH）、二氧化碳分压（PCO2）、氧分压（PO2）值检测。结果 三类胎监组的pH、PCO2、PO2值分别进行方差分析，差异均有统计学意义（P<0.01），Ⅱ类、Ⅲ类胎监组的pH、PO2值低于Ⅰ类胎监组，PCO2值高于Ⅰ类胎监组（P<0.05）。对五组不同Apgar评分的pH、PCO2、PO2值分别进行方差分析，差异均有统计学意义（P<0.05或0.01），Apgar评分10分Ⅰ类胎监组的pH、PO2值最高，PCO2值最低。结论 脐带血血气分析能更直观反映新生儿窒息缺氧酸中毒状况，对新生儿窒息诊断优于胎心监护及Apgar评分，对新生儿窒息临床诊疗及预后有着重要意义。

【关键词】 胎心监测;脐带血;血气分析;新生儿窒息

【Abstract】 Objective To investigate the clinical application of three fetal heart types in monitoring neonatal asphyxia by Apgar score in umbilical cord blood.Methods 271 newborns born in hospital from January 2018 to January 2020 were collected，and they were divided into groups according to the type of fetal heart rate monitoring.130 normal newborns（type Ⅰ fetal heart rate monitoring group） were those who got 10 points in 5 minutes Apgar scoring.Of 69 newborns in type Ⅱ fetal heart rate monitoring group，20 cases were those with 5 minutes Apgar scoring≤7 points，and 49 cases were those with 5 minutes Apgar scoring≥8 points.Of 72 newborns in type Ⅲ fetal heart rate monitoring group，30 cases were those with 5 minutes Apgar scoring≤7 points，42 cases were those with 5 minutes Apgar scoring≥8 points.In addition，prenatal fetal heart monitoring，postpartum Apgar scoring，umbilical cord blood pH，PCO2 and PO2 were performed.Results Analysis of variance of pH，PCO2 and PO2 values in the three types of fetal heart rate monitoring showed that the differences were statistically significant（P<0.01）.The pH and PO2 values in the type Ⅱ fetal heart rate monitoring group and the type Ⅲ fetal heart rate monitoring group were lower than those in the type Ⅰ fetal heart rate monitoring group，but PCO2 values were higher than that in the type Ⅰ fetal heart rate monitoring group（P<0.05）.Analysis of variance of pH，PCO2 and PO2 values of different Apgar scores in 5 groups showed that the differences were all statistically significant（P<0.05 or 0.01）.The type Ⅰ fetal heart rate monitoring group with 10 points of Apgar scoring had the highest pH and PO2 values，and the lowest PCO2.Conclusion The analysis of umbilical cord blood gas can provide a more intuitive understanding of the status of neonatal asphyxia anoxic acidosis，which is better for the diagnosis of neonatal asphyxia than fetal heart care and Apgar score，and is of great significance for the clinical diagnosis，treatment and prognosis of neonatal asphyxia.

【Key words】 fetal heart monitoring;umbilical cord blood;blood gas analysis;neonatal asphyxia

新生儿窒息指的是胎儿娩出后不能建立规则有效的自主呼吸[1]。在产前、产程中、产后的缺氧所造成的血氧浓度降低和酸中毒均可引起新生儿窒息。产前、产程中常用胎心监护来监测胎儿宫内缺氧情况，产后常用传统简易的Apgar 评分来诊断窒息程度及预后，Apgar评分的主观性较大，单独使用其误诊率高达 50%～80%[2]，特异性低，受到许多因素的影响[3]评分会发生改变。为更直观了解到新生儿窒息缺氧酸中毒状况，更好地诊断新生儿窒息，现就2018年1月至2020年 1月在我院出生的271例新生儿，产前胎心监测与产后不同Apgar评分脐带血血气进行相关性分析，报告如下。

1 资料与方法1.1 临床资料 收集2018年1月至2020年1月，我院出生新生儿271例，进行产前胎心监测，产后5分钟Apgar评分及脐带血血气pH、PCO2、PO2值检测。根据胎……