动脉血pH值联合乳酸测定在预测危重新生儿结局中的临床意义
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摘要
目的探讨联合新生儿动脉血pH值和乳酸水平在预测危重新生儿结局中的临床意义。方法收集NICU的危重足月新生儿101例,分为窒息组46例和非窒息组55例,入住后第一时间(入院0.5 h内)行血气分析,监测动脉血pH值及乳酸、肝肾功能、心肌酶、心电图、感染指标。入院3*～6 d进行神经行为(NBNA)测定、头颅B超或头颅核磁等影像学检查。比较2组间的临床资料。结果 2组患儿血气中窒息组pH平均值7.16±0.12,非窒息组pH平均值7.26±0.12,2组比较差异有统计学意义(t=-4.229,P<0.05);窒息组乳酸平均值11.26±4.09,非窒息组乳酸平均值7.92±2.73,2组比较差异有统计学意义(t=4.894,P<0.05);窒息组乳酸恢复时间平均值(24.15±23.97)h,非窒息组(15.12±14.19)h,2组比较差异有统计学意义(t=2.345,P<0.05);2组患儿6 h乳酸清除率差异有统计学意义(χ~2=30.45,P<0.05)。窒息组患儿入科时血糖平均值(7.80±2.22)mmoL/L,非窒息组(5.22±1.96)mmoL/L,2组比较差异有统计学意义(t=6.133,P<0.05);2组患儿动脉血乳酸值与主要血气参数pH (r=-0.582,P<0.05)、HCO~-_3(r=-0.699,P<0.05)、ABE(r=-0.788,P<0.05)均呈负相关;动脉血乳酸与器官功能损害相关指标(ALT、AST、BUN、Cr、CK、CK-MB、血糖、感染指标及NBNA)呈正相关(P<0.05)。结论动脉血pH联合乳酸测定对危重新生儿结局预测具有一定的临床应用价值。
Objective To explore the clinical significance of combined arterial blood pH and lactic acid level in predicting the outcome of critically ill neonates. Methods 101 critically ill full-term newborns admitted to NICU were collected and divided into asphyxia group(46 cases) and non-asphyxia group(55 cases). Blood gas analysis was performed at the first time after admission(within half an hour after admission) to monitor arterial blood pH and lactic acid,liver and kidney function,myocardial enzyme,electrocardiogram and infection index. Neurobehavior(NBNA) determination,cranial ultrasound or cranial nuclear magnetic resonance imaging were performed 3～6 days after admission. The clinical data between the two groups were compared.Results There was no significant difference between the two groups in terms of gestational age,birth weight,admission time and high risk factors during pregnancy(P>0.05). In arterial blood pH,the average pH value of asphyxiated group was 7.16±0.12,while that of non-asphyxiated group was 7.26±0.12,with statistical difference(t=-4.229,P<0.05). The average lactic acid in asphyxiated group was 11.26±4.09,while that in non-asphyxiated group was 7.92±2.73,with significant difference between the two groups(t=4.894,P<0.05).The average recovery time of lactic acid in the two groups was 24.15±23.97 hours in asphyxia group and 15.12±14.19(hours) in non-asphyxia group,with statistical significance(t=2.345,P<0.05). The 6-hour lactic acid clearance rate between the two groups was statistically significant(χ~2=30.45,P<0.05). The average blood sugar of the two groups was(7.80±2.22)mmoL/L in asphyxia group and(5.22±1.96)mmoL/L in non-asphyxia group when they entered the department. There was significant difference between the two groups(t=6.133,P<0.05). The Lactic acid value of arterial blood in the two groups was negatively correlated with the main blood gas parameters p H( r =-0. 582,P < 0. 05),HCO3( r =-0. 699,P < 0. 05),ABE( r =-0. 788,P < 0. 05). Arterial blood lactic acid is positively correlated with indexes of organ dysfunction( ALT,AST,BUN,CR,CK,CK-MB,Blood sugar,infection index and NBNA)( P< 0. 05). Conclusion The determination of arterial blood p H combined with lactic acid has certain clinical value in predicting the outcome of critically ill neonates.
Objective To explore the clinical significance of combined arterial blood pH and lactic acid level in predicting the outcome of critically ill neonates. Methods 101 critically ill full-term newborns admitted to NICU were collected and divided into asphyxia group(46 cases) and non-asphyxia group(55 cases). Blood gas analysis was performed at the first time after admission(within half an hour after admission) to monitor arterial blood pH and lactic acid,liver and kidney function,myocardial enzyme,electrocardiogram and infection index. Neurobehavior(NBNA) determination,cranial ultrasound or cranial nuclear magnetic resonance imaging were performed 3～6 days after admission. The clinical data between the two groups were compared.Results There was no significant difference between the two groups in terms of gestational age,birth weight,admission time and high risk factors during pregnancy(P>0.05). In arterial blood pH,the average pH value of asphyxiated group was 7.16±0.12,while that of non-asphyxiated group was 7.26±0.12,with statistical difference(t=-4.229,P<0.05). The average lactic acid in asphyxiated group was 11.26±4.09,while that in non-asphyxiated group was 7.92±2.73,with significant difference between the two groups(t=4.894,P<0.05).The average recovery time of lactic acid in the two groups was 24.15±23.97 hours in asphyxia group and 15.12±14.19(hours) in non-asphyxia group,with statistical significance(t=2.345,P<0.05). The 6-hour lactic acid clearance rate between the two groups was statistically significant(χ~2=30.45,P<0.05). The average blood sugar of the two groups was(7.80±2.22)mmoL/L in asphyxia group and(5.22±1.96)mmoL/L in non-asphyxia group when they entered the department. There was significant difference between the two groups(t=6.133,P<0.05). The Lactic acid value of arterial blood in the two groups was negatively correlated with the main blood gas parameters p H( r =-0. 582,P < 0. 05),HCO3( r =-0. 699,P < 0. 05),ABE( r =-0. 788,P < 0. 05). Arterial blood lactic acid is positively correlated with indexes of organ dysfunction( ALT,AST,BUN,CR,CK,CK-MB,Blood sugar,infection index and NBNA)( P< 0. 05). Conclusion The determination of arterial blood p H combined with lactic acid has certain clinical value in predicting the outcome of critically ill neonates.
引文
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[8] 马晓花,张环,陈彤,等.动脉血乳酸在新生儿病情严重程度评估中的应用价值[J/CD].中华临床医师杂志:电子版,2012,6(16):4692-4695.
[9] 赵琳,朱慧花,宋祥晖,等.动脉血乳酸水平及乳酸清除率变化对危重新生儿预后的评估意义[J].云南医药,2013,34 (4):296-297.
[10] 孔艳婷,严恺,胡黎园.生后72 h内动脉血气评估窒息新生儿脑损伤的临床价值[J].中华新生儿科杂志,2018,33(1):18-21.
[2] 中华医学会急诊学分会儿科学组,中华医学会儿科分会急诊学组、新生儿学组.新生儿危重病例评分法(草案)[J].中华儿科杂志,2001,39:42-43.
[3] 全国新生儿行为神经科研协作组,全国新生儿生长发育科研协作组,中国12城市正常新生儿20项行为神经评价[J].中华儿科杂志,1990,28(3):160-162.
[4] 吴立志,刘云,阚清,等.无创经皮监测在氧疗新生儿中的应用[J].南京医科大学学报:自然科学版,2016(4):456-460.
[5] Le SE,Saeed N,Cowan FM,et al.Mr imaging quantification of cerebeLLar growth foLLowing hypoxic-ischemic injury to the neonataL brain[J].American Journal of Neuroradiology,2004,25(3):463-468.
[6] Rutherford M,Ramenghi LA,Edw AA,et al.Assessment of brain tissue injury after moderate hypothermia inneonates withhypoxic-ischaemc encephaLopathy:a nested substudy of a randomised controLLed triaL[J].Lancet Neurolog,2010,9(9):70295-70299.
[7] 王静,贾秀红.新生儿血气分析与病情危重程度相关性分析[J].医药卫生,2016,6:3.
[8] 马晓花,张环,陈彤,等.动脉血乳酸在新生儿病情严重程度评估中的应用价值[J/CD].中华临床医师杂志:电子版,2012,6(16):4692-4695.
[9] 赵琳,朱慧花,宋祥晖,等.动脉血乳酸水平及乳酸清除率变化对危重新生儿预后的评估意义[J].云南医药,2013,34 (4):296-297.
[10] 孔艳婷,严恺,胡黎园.生后72 h内动脉血气评估窒息新生儿脑损伤的临床价值[J].中华新生儿科杂志,2018,33(1):18-21.