论文部分内容阅读
目的探讨胎心率、Apgar评分及脐动脉血气分析在围生儿窒息评估中的意义。方法收集本院胎心率<90次.min-1、持续时间>1 min、重复出现5次以上、儿科医师提前到场接生、电子胎心监护(EFM)异常的73例足月儿为EFM异常组。对照组为同期分娩胎心监护正常,按EFM异常组胎龄、体质量、分娩方式、Apgar分值及高危因素等配对的73例新生儿。观察2组不同Apgar评分新生儿脐动脉血气变化。结果 EFM异常组血气pH、碳酸氢根(HCO3-)、碱剩余(BE)较对照组显著降低(Pa<0.05,0.01)。EFM异常组1 min Apgar8～10分患儿血HCO3-、BE均较对照组降低(Pa<0.05)。EFM异常组Apgar 1～7分患儿血pH、HCO3-、BE较对照组降低(Pa<0.05,0.01)。EFM异常组Apgar 1～3分、4～7分、9～10分三者间血气pH、pa(CO2)、HCO3-、BE比较,差异有统计学意义(Pa<0.05,0.01);Apgar4～7分患儿血气pH、pa(CO2)、HCO3-、BE与Apgar 8分患儿一致,差异均无统计学意义(Pa>0.05);Apgar评分8分患儿血pH、HCO3-、BE均较Apgar9～10分患儿降低(Pa<0.05)。对照组不同Apgar评分组间血气比较,差异均无统计学意义(Pa>0.05)。结论胎心率持续减速对胎儿窘迫有预警作用;胎心率、Apgar评分及脐动脉血气3种方法组合应用,对准确评估围生儿窒息具有重要意义。
Objective To investigate the significance of fetal heart rate, Apgar score and umbilical artery blood gas analysis in the assessment of perinatal asphyxia. Methods Fetal heart rate <90 times .min-1, duration> 1 min, repeated more than 5 times, pediatric physicians arrived at the scene ahead of schedule, electronic fetal heart monitoring (EFM) abnormalities in 73 cases of full-term children with EFM abnormalities group. The control group was normal fetus guardianship during the same period of delivery. According to the gestational age, weight, mode of delivery, Apgar score and risk factors, 73 newborns matched with abnormal EFM group. The changes of umbilical arterial blood gas in 2 neonates with different Apgar scores were observed. Results The blood gas pH, bicarbonate (HCO3-) and alkali excess (BE) in the EFM abnormal group were significantly lower than those in the control group (P <0.05, 0.01). The levels of HCO3- and BE in children with EFM abnormalities at 1 minute and 7 minutes after Apgar were lower than those in controls (Pa, <0.05). The blood pH, HCO3- and BE in children with EFM abnormalities were decreased from 1 to 7 points (P <0.05, 0.01). There were significant differences in the blood pH, pa (CO2), HCO3- and BE between 1 ~ 3, 4 ~ 7 and 9 ~ 10 in the abnormal EFM group (Pa <0.05,0.01) The blood pH, pa (CO2), HCO3- and BE in 7 points were the same as those in Apgar 8, but there was no significant difference (P> 0.05). The blood pH, HCO3- and BE in children with Apgar score of 8 Compared with Apgar 9 ~ 10 points in children decreased (Pa <0.05). There was no significant difference in blood gas between different Apgar scores in the control group (Pa> 0.05). Conclusion Fetal heart rate deceleration may have an early warning effect on fetal distress. Fetal heart rate, Apgar score and umbilical arterial blood gas can be used in combination to evaluate fetal perinatal asphyxia accurately.