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目的探讨缺氧缺血性脑病(HIE)新生儿脑氧利用率(O2UCc)的变化及临床意义。方法 HIE患儿75例。男51例,女24例;胎龄(39.4±1.6)周;出生体质量(3 136±78)g。其中轻、中、重度分别为23例、39例和13例。健康对照组为同期出生的健康足月儿40例。健康对照组在出生24 h内采集桡动脉和颈内静脉血各2 mL。HIE组分别于入院时,出生24 h、48 h、72 h、7 d采集桡动脉和颈内静脉血各2 mL。采血后立即送检验科行血气分析,测定血氧饱和度。HIE患儿经常规治疗后分为痊愈组67例,后遗症组8例。第28天复查血气。根据动脉血氧饱和度和动脉-静脉血氧饱和度差计算O2UCc。结果 HIE组患儿入院时O2UCc为(42.86±2.31)%,健康对照组O2UCc为(32.67±4.49)%,二者比较差异有统计学意义(t=8.32,P<0.05)。不同程度HIE组入院时及出生24 h组间两两比较,差异均有统计学意义(Pa<0.05),中重度HIE组明显高于轻度组。各组HIE患儿O2UCc在入院后逐渐降低,至出生72 h达最低,以后逐渐升高至正常。轻度组O2UCc在出生48 h与健康对照组比较,中度组在出生72 h与健康对照组比较,重度组出生7 d与健康对照组比较差异均无统计学意义(t=0.32、1.14、1.23,Pa>0.05)。痊愈组O2UCc与健康对照组比较差异无统计学意义(t=0.56,P>0.05);后遗症组O2UCc低于痊愈组和健康对照组,差异均有统计学意义(t=7.65、7.87,Pa<0.05)。结论 O2UCc可作为判断HIE患儿病情严重程度和预后的指标之一。
Objective To investigate the changes of cerebral oxygen utilization (O2UCc) in neonates with hypoxic-ischemic encephalopathy (HIE) and its clinical significance. Methods 75 children with HIE. 51 males and 24 females; gestational age (39.4 ± 1.6) weeks; birth weight (3 136 ± 78) g. Among them, mild, moderate and severe were 23 cases, 39 cases and 13 cases. Healthy control group was born in the same period 40 healthy full-term children. Healthy control group were collected within 24 h of radial artery and internal jugular vein blood 2 mL. HIE group were admitted to hospital, were born 24 h, 48 h, 72 h, 7 d were collected radial artery and internal jugular vein blood 2 mL. Blood samples were taken immediately after blood test analysis, determination of oxygen saturation. HIE children after routine treatment were divided into recovery group of 67 cases, 8 cases of sequelae. Day 28 review of blood gas. O2UCc was calculated based on arterial oxygen saturation and arterial-venous oxygen saturation difference. Results The O2UCc in admission group was (42.86 ± 2.31)% in the HIE group and (32.67 ± 4.49)% in the healthy control group. The difference was statistically significant (t = 8.32, P <0.05). There were significant differences (P <0.05) between different groups of HIE on admission and at 24 h after birth, and those in moderate and severe HIE group were significantly higher than those in mild HIE group. The O2UCc of HIE children in each group decreased gradually after admission, reached the lowest level at 72 hours after birth, then gradually increased to normal. Compared with healthy control group, the positive rate of O2UCc in mild group was significantly higher than that in healthy control group at 48 h after birth (P <0.05), and there was no significant difference between healthy control group and healthy group at 72 d after birth (t = 0.32, 1.14, 1.23, Pa> 0.05). There was no significant difference between O2UCc and healthy control group (t = 0.56, P> 0.05); the O2UCc in the sequelae group was lower than that of the cured group and healthy control group (t = 7.65, 7.87, Pa < 0.05). Conclusions O2UCc can be used as one of the indicators to judge the severity and prognosis of children with HIE.