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目的评估血气分析对于缺氧相关的足月新生儿颅内出血(ICH)的预测价值。方法以中山大学附属第一医院新生儿科2006年1月至2009年1月住院的274例有围生期缺氧窘迫史的足月新生儿为研究对象,检测脐动脉血及生后1h桡动脉血血气,观察住院期间有无神经系统损害表现,并在生后7d内行头颅MRI或CT检查,判断有无ICH的发生。结果 ICH病例共61例,从ROC曲线分析得出,对足月儿缺氧后ICH有预测价值的血气指标有脐血pH值、BE值及脐血与生后1h动脉血PaCO2差值。按脐血和生后1h动脉pH值分组,各组间ICH发生率差异均有统计学意义(χ2值分别为17.364和5.314,P分别<0.001和=0.023)。按脐血联合生后1h血气pH值分组,ICH的发生率在各组间差异具有统计学意义(χ2=12.948,P<0.001)。剔除71例钳产儿后(剩余203例)进行分析,按脐血pH值分组,组间ICH差异具有统计学意义(χ2=11.844,P=0.003)。按生后1h动脉血pH值分组,组间ICH差异无统计学意义(χ2=0.904,P=0.43)。按脐血联合生后1h血气分组,组间ICH差异具有统计学意义(χ2=14.258,P=0.003)。结论脐血联合生后1h动脉血血气分析有助于预测足月儿缺氧后ICH的发生。
Objective To assess the predictive value of blood gas analysis for hypoxic-related full-term neonatal intracranial hemorrhage (ICH). Methods A total of 274 neonates with term neonates with perinatal hypoxia distress admitted to Department of Neonatology, First Affiliated Hospital of Sun Yat-sen University from January 2006 to January 2009 were enrolled in this study. Umbilical arterial blood and radial artery Blood gas, observed during hospitalization with or without nervous system damage performance, and within 7 days after birth, head MRI or CT examination to determine the presence of ICH. Results A total of 61 cases of ICH cases, from the ROC curve analysis, the predictive value of ICH for full-term children after hypoxia have blood gas indicators of umbilical cord blood pH, BE value and cord blood and PaCO2 1h after birth. According to the umbilical cord blood and arterial pH values 1h after birth, the incidence of ICH in each group was statistically significant (χ2 = 17.364 and 5.314, P <0.001 and = 0.023, respectively). The umbilical cord blood combined 1h blood gas pH value group, the incidence of ICH in each group was statistically significant (χ2 = 12.948, P <0.001). After removing 71 cases of forceps (the remaining 203 cases) were analyzed, according to the umbilical blood pH values, ICH difference between groups was statistically significant (χ2 = 11.844, P = 0.003). According to the pH value of arterial blood 1h after birth, there was no significant difference in ICH between groups (χ2 = 0.904, P = 0.43). According to 1h blood cord blood cord blood grouping, ICH difference between groups was statistically significant (χ2 = 14.258, P = 0.003). Conclusion Arterial blood gas analysis at 1 h after umbilical cord blood transplantation is helpful to predict the occurrence of ICH after term hypoxia.