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目的 Apgar评分和血气分析作为判断新生儿窒息程度和预后的指标有一定的局限性 ,为寻找更具敏感性和特异性的指标 ,该研究探讨脐血乳酸值在新生儿窒息中的临床意义。方法 对 31例足月窒息新生儿(分为轻度窒息组 2 2例和重度窒息组 9例 )和 30例正常新生儿 (对照组 )的脐动脉血进行乳酸测定及微量血液气体分析 ,并在第 1 4天进行新生儿 2 0项行为神经测定 (NBNA)。结果 轻、重度窒息组脐动脉血乳酸值 [(6 .4 2±0 .1 4 )mmol/L ,(1 0 .77± 0 .1 2 )mmol/L]较对照组 [(4 .2 0± 0 .1 5 )mmol/L]显著升高 (P <0 .0 1 ) ,pH值 [(7.1 6±0 .0 7) ,(7.0 4± 0 .0 9) ]较对照组 (7.1 8± 0 .1 1 )明显降低 (P <0 .0 1 ) ;其中重度窒息组的乳酸值高于轻度窒息组 ,pH值低于轻度窒息组 ,差异均有显著性 (P <0 .0 1 )。脐血乳酸值与pH值及第 1 4天NBNA评分呈显著负相关(r =- 0 .76 ,- 0 .85 ,P <0 .0 1 )。结论 脐血乳酸值可作为判断新生儿窒息程度和近期预后的指标。
Objective Apgar score and blood gas analysis as indicators of neonatal asphyxia and prognosis of the index has some limitations, in order to find more sensitive and specific indicators, the study of umbilical cord blood lactate in the clinical significance of neonatal asphyxia. Methods Lactate assay and micro blood gas analysis were performed on 31 umbilical arterial blood of 31 neonates with term asphyxia (divided into mild asphyxia group and 9 severe asphyxia group) and 30 normal newborns (control group) On day 14, 20 newborn neurobehavioral tests (NBNA) were performed. Results Compared with the control group, the umbilical arterial blood lactic acid value in the mild and severe asphyxia group was significantly lower than that in the control group [(6.2 ± 0.14 mmol / L, (10.77 ± 0.12 mmol / L] (P <0.01), pH value (7.16 ± 0.0.7) and (7.04 ± 0.90) in control group were significantly higher than that in control group (0 ± 0.1 5 mmol / L) 7.1 8 ± 0. 1 1) (P <0.01). The lactic acid value of severe asphyxia group was higher than that of mild asphyxia group, while the pH value was lower than that of mild asphyxia group (P < 0 .0 1). There was a significant negative correlation between umbilical blood lactic acid value and pH and NBNA score on the 14th day (r = - 0.76, -0.85, P <0.01). Conclusion The value of umbilical blood lactate can be used as an index to judge the degree of neonatal asphyxia and the recent prognosis.