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目的 探讨新生儿脐动脉血气分析与围产期高危因素、Apgar评分和窒息多器官损害的相关性.方法 选择2012年11月至2014年12月课题组协作医院新生儿科和新生儿重症监护病房收治的胎龄>34周、生后检测脐动脉血pH和BE的窒息新生儿,根据Apgar评分诊断新生儿窒息,根据脐血血气分析将轻度窒息组和重度窒息组分别分为严重代谢性酸中毒组(pH≤7和/或BE≤-16mmol/L)、非严重代谢性酸中毒组(77.2且BE>-8).根据围产期缺氧病史、临床表现、实验室检查和影像学检查等诊断新生儿窒息多器官损害.结果 共纳入新生儿窒息患儿111例,其中轻度窒息79例,重度窒息32例.(1)脐动脉血气pH和BE与1 min Apgar评分成正相关(pH:r=0.223,P=0.016;BE:r=0.293,P=0.002).(2)多因素分析显示胎心监护异常是影响血气pH和BE的重要因素(β=0.080,95℅CI 0.010~0.160,P=0.025).(3)重度窒息组多器官损害发生率显著高于轻度窒息组(75.0℅比29.1℅,Χ2=17.810,P34 weeks, birth weight >2500 g) with neonatal asphyxia, whose umbilical artery blood gas analysis ( including pH and BE) were tested were enrolled in our study. Neonatal asphyxia was diagnosed according to the Apgar score, umbilical artery blood gas analysis, mild asphyxia group and severe asphyxia group were assigned into three groups respectively: severe metabolic acidosis group: pH≤7 and/or BE≤-16 mmol/L; non-severe metabolic acidosis group:77. 2, BE> -8 mmol/L. The diagnosis of multiple organ damage of neonatal asphyxia was made according to the history of perinatal hypoxia,clinical manifestations,laboratory examination and imaging examination.Results Therewere 111 cases in our study ( mild asphyxia: n =79 , severe asphyxia: n =32 ) . ( 1 ) The pH and BE of umbilical artery blood gas were positively related to 1 minute Apgar score ( pH: r=0. 223, P=0. 016;BE: r=0. 293, P=0. 002). (2) Multi-factor analysis of umbilical artery blood pH and BE showed that abnormal fetal heart rate was an important factor (β =0. 080 , 95℅ CI 0. 010 -0. 160 , P =0. 025 ) . (3) The incidence of multiple organ damage in severe asphyxia group was significantly higher than that in mild asphyxia group (75. 0℅ vs. 29. 1℅, Χ2 =17. 810, P<0. 001). The incidence of multiple organ damage in patients suffering from mild asphyxia combined with severe acidosis, non-severe acidosis, and without acidosis was 52. 9℅, 26. 3℅, and 16. 7℅, respectively. The incidence of multiple organ damage in patients of mild asphyxia with acidosis was statistically higher than those patients without acidosis (Χ2 =6. 623, P=0. 036). The incidence of multiple organ damage of severe asphyxia were high in all the three groups ( severe metabolic acidosis group:80. 0℅, non-severe metabolic acidosis group:76. 9℅, no metabolic acidosis group:50. 0℅) , Differences among the three groups was not statistically significant (Χ2 =1. 559, P=0. 459). (4) Apgar score, umbilical artery blood pH and BE were selected to predict the risk of multiple organ damage of neonatal asphyxia. The sensitivity and specificity of 1 minute Apgar score of 0-3 points were 52. 2℅ and 87. 1℅. The sensitivity of umbilical artery blood pH ≤ 7 and BE ≤ -16 mmol/L were 42. 6℅ and 38. 3℅, and the specificity were 87. 6℅ and 92. 2℅. (5) Comprehensive index (1 minute Apgar score of 0-3 points, 5 minutes Apgar score≤5, umbilical artery blood pH ≤7 or/and BE ≤ -16 mmol/L) was used to predict multiple organ damage of neonatal asphyxia, the specificity ( 71. 9℅) and sensitivity ( 74. 5℅) were both high. Conclusions The umbilical artery blood pH and BE could evaluate reliably multiple organ damage of neonatal asphyxia. Combined Apgar scores with umbilical artery blood pH and BE would be help to improve the diagnostic accuracy of neonatal asphyxia and predict multiple organ damage.