早期血乳酸清除率检测在新生儿重度窒息预后评估中的价值
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摘要
目的探讨早期血乳酸清除率检测对重度窒息新生儿预后评估的价值,为新生儿重度窒息的预后评估提供参考。方法选取2014年2月-2017年2月在广东医学院附属惠东医院出生的重度窒息新生儿60例为观察组,另选取同期该院出生的正常新生儿60例为对照组。比较两组受试儿入组后即刻、6 h、12 h、24 h检测血乳酸水平、血乳酸清除率变化情况,并跟踪观察组患儿不同时间段出现不良预后情况(膈疝、死亡、多器官功能障碍)。将不同观察时间点的血乳酸清除率与不良预后率进行相关性分析。评价血乳酸清除率检测对新生儿重度窒息预后的预判价值。结果观察组新生儿入组即刻、入组后6 h、12 h、24 h血乳酸清除率显著低于对照组(P<0.05),血乳酸水平均显著高于对照组(P<0.05),观察组患儿入组即刻的血乳酸水平明显高于入组后不同时间(P<0.05),观察组患儿血乳酸清除率入组即刻及入组后6 h明显低于入组后12 h和24 h(P<0.05)。重度窒息新生儿入组后即伴有器官功能衰竭,随着入组时间的增加,预后不良事件均有发生,不同时间点的不良事件率差异无统计学意义(P>0.05)。观察组患儿不良预后率与入组即刻、入组后6 h、12 h、24 h的血乳酸清除率均呈负相关(均P<0.05),但以入组后6 h血乳酸清除率与不良预后率相关性最高(r=-0.893,P=0.004)。结论重视出生后重度窒息新生儿6 h的血乳酸清除率检测对患儿预后评估具有较高的临床价值,临床应充分利用早期血乳酸清除率及早对重度窒息新生儿采取急救方案,提高重度窒息新生儿的预后水平。
Objective To explore the value of early blood lactic acid clearance rate detection in prognosis evaluation of neonates with severe asphyxia,provide reference for prognosis evaluation. Methods Sixty neonates with severe asphyxia born in the hospital from February 2014 to February 2017 were selected as observation group,and sixty normal neonates born in the hospital during the same period were selected as control group. The changes of blood lactic acid levels and blood lactic acid clearance rates when grouping,at 6,12,and 24 hours after grouping in the two groups were compared. The incidence rates of adverse reactions( diaphragmatic hernia,death,multiple organ dysfunction syndrome) during different time periods in observation group were followed up. The correlations between blood lactic acid clearance rates at different time points and the rate of adverse prognosis were analyzed. The value of blood lactic acid clearance rate detection in prognosis assessment of neonates with severe asphyxia was evaluated. Results Blood lactic acid clearance rates when grouping,at 6,12,and24 hours after grouping in observation group were statistically significantly lower than those in control group( P<0. 05),the levels of blood lactic acid when grouping,at 6,12,and 24 hours after grouping in observation group were statistically significantly higher than those in control group( P<0. 05). In observation group,the level of blood lactic acid when grouping was statistically significantly higher than those at other time points( P<0. 05). Blood lactic acid clearance rate when grouping and at 6 hours after grouping in observation group were statistically significantly lower than those at 12 and 24 hours after grouping( P<0. 05). The neonates with severe asphyxia were complicated with organ failure after grouping,adverse events of prognosis occurred with time extension,there was no statistically significant difference in the rate of adverse prognosis among different time points( P>0. 05). The rate of adverse prognosis in observation group was negatively correlated with blood lactic acid clearance rates when grouping,at 6,12,and 24 hours after grouping( P<0. 05). The correlation between blood lactic acid clearance rate at 6 hours after grouping and the rate of adverse prognosis was the highest( r =-0. 893,P = 0. 004).Conclusion The clinical value of blood lactic acid clearance rate at 6 hours after birth in prognosis evaluation of neonates with severe asphyxia is high,the first-aid measures should be taken for the neonates with severe asphyxia based on full use of early blood lactic acid clearance rate to improve the level of prognosis of neonates with severe asphyxia.
Objective To explore the value of early blood lactic acid clearance rate detection in prognosis evaluation of neonates with severe asphyxia,provide reference for prognosis evaluation. Methods Sixty neonates with severe asphyxia born in the hospital from February 2014 to February 2017 were selected as observation group,and sixty normal neonates born in the hospital during the same period were selected as control group. The changes of blood lactic acid levels and blood lactic acid clearance rates when grouping,at 6,12,and 24 hours after grouping in the two groups were compared. The incidence rates of adverse reactions( diaphragmatic hernia,death,multiple organ dysfunction syndrome) during different time periods in observation group were followed up. The correlations between blood lactic acid clearance rates at different time points and the rate of adverse prognosis were analyzed. The value of blood lactic acid clearance rate detection in prognosis assessment of neonates with severe asphyxia was evaluated. Results Blood lactic acid clearance rates when grouping,at 6,12,and24 hours after grouping in observation group were statistically significantly lower than those in control group( P<0. 05),the levels of blood lactic acid when grouping,at 6,12,and 24 hours after grouping in observation group were statistically significantly higher than those in control group( P<0. 05). In observation group,the level of blood lactic acid when grouping was statistically significantly higher than those at other time points( P<0. 05). Blood lactic acid clearance rate when grouping and at 6 hours after grouping in observation group were statistically significantly lower than those at 12 and 24 hours after grouping( P<0. 05). The neonates with severe asphyxia were complicated with organ failure after grouping,adverse events of prognosis occurred with time extension,there was no statistically significant difference in the rate of adverse prognosis among different time points( P>0. 05). The rate of adverse prognosis in observation group was negatively correlated with blood lactic acid clearance rates when grouping,at 6,12,and 24 hours after grouping( P<0. 05). The correlation between blood lactic acid clearance rate at 6 hours after grouping and the rate of adverse prognosis was the highest( r =-0. 893,P = 0. 004).Conclusion The clinical value of blood lactic acid clearance rate at 6 hours after birth in prognosis evaluation of neonates with severe asphyxia is high,the first-aid measures should be taken for the neonates with severe asphyxia based on full use of early blood lactic acid clearance rate to improve the level of prognosis of neonates with severe asphyxia.
引文
[1]王灵华,郑灵芝,郑婉丽,等.早期血乳酸清除率在判断新生儿重度窒息预后中的研究[J].中国现代医生,2016,54(5):17-20.
[2]Spies EE,Lababidi SL,Mc Bride MC.Early hyperglycemia is associated with poor gross motor outcome in asphyxiated term newborns[J].Pediatr Neurol,2014,50(6):586-590.
[3]van Steenis A,Kromhout HE,Steggerda SJ,et al.Perinatal asphyxia in monochorionic versus dichorionic twins:incidence,risk factors and outcome[J].Fetal Diagn Ther,2014,35(2):87-91.
[4]钱丽娟,杨莉,乔立兴,等.早期乳酸清除率评估重度窒息新生儿预后的临床价值[J].实用儿科临床杂志,2011,26(6):427-429.
[5]Varkilova L,Slancheva B,Emilova Z,et al.Blood lactate measurments as a diagnostic and prognostic tool after birth asphyxia in newborn infants with gestational age>or=34 gestational weeks[J].Akush Ginekol(Sofiia),2013,52(3):36-43.
[6]李志涛,李立新,包莉娜,等.早期乳酸清除率对重度窒息新生儿预后的临床价值研究[J].黑龙江医学,2016,40(7):599-601.
[7]王宝凤.血清乳酸水平和乳酸清除率在评估新生儿窒息预后中的意义研究[J].中国全科医学,2013,16(14):1620-1622.
[8]范倩倩.动态监测动脉血乳酸及生化因子在羊水污染新生儿窒息中的早期应用价值[D].南华大学,2014.
[9]Hamed HO.Intrapartum fetal asphyxia:study of umbilical cord blood lactate in relation to fetal heart rate patterns[J].Arch Gynecol Obstet,2013,287(6):1067-1073.
[10]朱荣平,李晓英,顾春燕,等.动脉血乳酸变化对重度窒息新生儿预后的评估[J].中国小儿急救医学,2015,22(11):780-782,786.
[11]Takahashi K,Hasegawa S,Maeba S,et al.Serum tau protein level serves as a predictive factor for neurological prognosis in neonatalasphyxia[J].Brain Dev,2014,36(8):670-675.
[12]吕玉涵.乳酸清除率在评估新生儿窒息预后中的意义[J].中国实用医药,2013,8(28):99-100.
[13]李春亮,劳晓玲,莫洁洁,等.围产期窒息新生儿严重高乳酸血症快速清除治疗研究[J].临床医学,2016,36(12):44-46.
[14]范倩倩,王少华.乳酸检测在围产儿窒息诊断中的研究进展[J].中国新生儿科杂志,2014,29(1):63-66.
[15]邢子君,周宁,梁燕清,等.脐血血气分析和乳酸测定对早产儿窒息的诊断意义[J].中国民族民间医药,2015,24(4):101-103.
[2]Spies EE,Lababidi SL,Mc Bride MC.Early hyperglycemia is associated with poor gross motor outcome in asphyxiated term newborns[J].Pediatr Neurol,2014,50(6):586-590.
[3]van Steenis A,Kromhout HE,Steggerda SJ,et al.Perinatal asphyxia in monochorionic versus dichorionic twins:incidence,risk factors and outcome[J].Fetal Diagn Ther,2014,35(2):87-91.
[4]钱丽娟,杨莉,乔立兴,等.早期乳酸清除率评估重度窒息新生儿预后的临床价值[J].实用儿科临床杂志,2011,26(6):427-429.
[5]Varkilova L,Slancheva B,Emilova Z,et al.Blood lactate measurments as a diagnostic and prognostic tool after birth asphyxia in newborn infants with gestational age>or=34 gestational weeks[J].Akush Ginekol(Sofiia),2013,52(3):36-43.
[6]李志涛,李立新,包莉娜,等.早期乳酸清除率对重度窒息新生儿预后的临床价值研究[J].黑龙江医学,2016,40(7):599-601.
[7]王宝凤.血清乳酸水平和乳酸清除率在评估新生儿窒息预后中的意义研究[J].中国全科医学,2013,16(14):1620-1622.
[8]范倩倩.动态监测动脉血乳酸及生化因子在羊水污染新生儿窒息中的早期应用价值[D].南华大学,2014.
[9]Hamed HO.Intrapartum fetal asphyxia:study of umbilical cord blood lactate in relation to fetal heart rate patterns[J].Arch Gynecol Obstet,2013,287(6):1067-1073.
[10]朱荣平,李晓英,顾春燕,等.动脉血乳酸变化对重度窒息新生儿预后的评估[J].中国小儿急救医学,2015,22(11):780-782,786.
[11]Takahashi K,Hasegawa S,Maeba S,et al.Serum tau protein level serves as a predictive factor for neurological prognosis in neonatalasphyxia[J].Brain Dev,2014,36(8):670-675.
[12]吕玉涵.乳酸清除率在评估新生儿窒息预后中的意义[J].中国实用医药,2013,8(28):99-100.
[13]李春亮,劳晓玲,莫洁洁,等.围产期窒息新生儿严重高乳酸血症快速清除治疗研究[J].临床医学,2016,36(12):44-46.
[14]范倩倩,王少华.乳酸检测在围产儿窒息诊断中的研究进展[J].中国新生儿科杂志,2014,29(1):63-66.
[15]邢子君,周宁,梁燕清,等.脐血血气分析和乳酸测定对早产儿窒息的诊断意义[J].中国民族民间医药,2015,24(4):101-103.