脐带血血气分析与乳酸值对围产期窒息的诊断价值探讨

目的探讨脐带血血气分析及乳酸值对围产期窒息的诊断价值。方法对63例足月窒息新生儿与89例足月正常新生儿的脐动脉血进行微量血气分析及乳酸测定，并在出生后第1、7、14、28d进行新生儿20项神经行为测定（NBNA）。结果窒息组与对照组的脐动脉血乳酸、pH值、BE差异有显著性，血乳酸与第1、7d的NBNA呈显著负相关，pH与第1d的NBNA呈正相关，BE与NBNA无明显相关性。结论窒息新生儿脐血乳酸水平高于对照组、pH值低于对照组，可作为围产期窒息诊断的指标，且乳酸值特异性优于pH值。     

窒息新生儿脐血乳酸值的临床意义(英文)

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22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14天进行新生儿20项行为神经测定(NBNA)。结果：轻、重度窒息组脐动脉血乳酸值［(6.42±0.14) mmol/L,(10.77±0.12) mmol/L］较对照组［(4.20±0.15) mmol/L］显著升高(P<0.01),pH值［(7.16±0.07),(7.04±0.09)］较对照组(7.18±0.11)明显降低(P<0.01);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<0.01)。脐血乳酸值与pH值及第14天NBNA评分呈显著负相关(r=-0.76,-0.85,P<0.01)。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。     

18例窒息新生儿高血糖与pH值及预后关系探讨

目的 探讨窒息新生儿高血糖与pH值及预后的关系。方法 用己糖激酶法测定45例窒息新生儿入院时血糖及动脉血气,若异常,则每12 h复查1次。结果 45例窒息新生儿有18例伴有高血糖,发生率40%;高血糖伴酸中毒15例,发生率83.3%;高血糖合并2个器官功能不全与多器官功能不全者,死亡率达22.2%。结论 窒息新生儿血糖越高、酸中毒越严重,高血糖、酸中毒合并有多器官功能不全者,预后不佳。     

18例窒自新生儿高血糖与pH值及预后关系探讨

目的 探讨窒息新生儿高血糖与ｐＨ值及预后的关系。方法 用已糖激酶法测定４５例窒息新生儿入院时血糖及动脉血气,若异常,则第１２ｈ复查１次。结果 ４５例窒息新生儿有１８例伴有高血糖,发生率４０％;高血糖伴酸中毒１５例,发生率８３．３％;高血糖合并２个器官功能不全与多器官功能不全者,死亡率达２２．２％。结论 窒息新生儿血糖越高、越中毒越严重,高血糖、酸中毒合并有多器官功能不全者,预后不佳。     

新生儿行为神经测定对高压氧治疗足月窒息儿的评价

本计经过高压氧治疗的４０例足月窒息儿，在治疗前后进行２０项ＮＢＮＡ，并对重度窒丐ＨＩＥ儿在４周，１８月用Ｇｅｓｅｌｌ智能发育一表纵向测试，与对照组比较，表明治疗后两组轻度窒息儿ＮＢＮＡ无显著差异，两组重度窒息并ＨＩＥ儿ＮＢＮＡ差异显著，且智能发育商比较有显著差异。ＮＢＮＡ主分与Ｇｅｓｅｌｌ发育商呈正相关，提示：重度窒息并ＨＩＥ儿加用高压氧治疗意义大，近期疗效好。     

窒息新生儿血乳酸、血糖检测的临床意义

目的：研究窒息新生儿血糖、血乳酸的变化。方法：对我院NICU47窒息新生儿进行血糖、血乳酸测定，并与对照组比较。结果：窒息组血糖、血乳酸水平显著高于对照组（P＜0．001），且血糖，血乳酸水平与窒息程度成正比，结论：窒息患儿血乳酸，血糖水平愈高，预后愈差，对息新生儿除进行新法复苏外，还应充分重视其应激状态下内环境的异常改变，重度窒息血糖，血乳酸检测应列为常规。     

窒息与缺氧缺血性损害及血糖、乳酸变化

围产期窒息可导致器官缺氧缺血性损伤及代谢紊乱。在我国缺氧缺血性脑病尤受关注,有些学者认为缺氧缺血性脑病患儿存在乳酸性酸中毒时,将血糖维持在正常低限较为恰当。 葡萄糖是脑的能量主要来源。但在成年动物实验中观察到,于制作缺氧缺血脑损伤模型前,给葡萄糖产生高血糖会加重脑损害,并认为是与脑组织乳酸增高有关;而在新生鼠进行相同实验给予葡萄糖,这一组鼠的脑损害却较对照组轻,可能是因新生鼠     

窒息新生儿乳酸脱氢酶同功酶活性测定及临床应用

本文对179名围产期正常和窒息新生儿进行了末梢血乳酸脱氢酶同功酶（LDHi）活性测定，并对其与日龄、孕周、出生体重、Apgar评分、经皮胆红素测定值、窒息程度与预后的关系进行了分析，结果表明，LDHi的改变与新生儿的缺氧程度和预后有密切关系，窒息组LDH5及LDH5／LDH1比值明显升高,LDH1-3明显下降，其改变程度与新生儿窒息程度成正比。     

围产期窒息对新生儿糖代谢影响的研究

为研究围产期窒息对新生儿血糖及其调节激素的影响,对40例窒息患儿生后72小时进行连续血糖监测,同时测定血清皮质醇(CT)、胰岛素(INS)、胰高血糖素(GC)和生长激素(GH)的浓度.结果显示,轻度窒息对新生儿糖代谢无影响;重度窒息生后6小时血糖最高,36小时最低(P＜0.01).4种激素水平明显增高(P＜0.01),多元线性回归分析发现重度窒息后6～12小时血糖值与CT和GC水平呈显著性正相关(P＜0.01),证实了新生儿重度窒息后高胰岛素血症和高血糖并存现象.结论认为,应激反应在新生儿重度窒息后高血糖的发生中起重要作用,血糖监测对重度窒息患儿十分重要,治疗时不宜应用糖皮质激素和胰岛素.     

围产期窒息后颅内病变的MRI诊断

围产期窒息后颅内出血和脑缺氧缺血性损伤是新生儿期最常见的颅内病变,为新生儿死亡和存活者不良预后的重要原因。近年来,磁共振成像(MRI)开始应用于临床,MRI对围产或窒息后颅内病变有何诊断价值和临床意义?本文将就MRI原理和临床应用作一综述。     

围产期窒息对新生儿脑组织血流灌注的影响及意义

目的了解围产期窒息对新生儿脑血流(CBF)的影响及意义.方法对140例有围产期窒息的新生儿进行单光子发射型计算机断层(SPECT)脑显像.结果①围产期发生的胎儿窘迫或出生时窒息,有可能使CBF减少;②有胎儿窘迫和(或)出生时窒息时,新生儿CBF异常的发生率相似.结论围产期发生了胎儿窘迫或出生时窒息,虽经复苏抢救或去除了某些直接影响因素,这些新生儿仍然存在着发生缺氧缺血性脑损伤(HIBD)的高度危险.     

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目的探讨围生期窒息新生儿PaCO2及pH快速变化及其与神经系统损害之间的关系。方法2002年1月至2003年12月南华大学第一附属医院将55例足月窒息新生儿分为3组组Ⅰ,pH>7.00,无神经系统异常,无需呼吸支持;组Ⅱ,pH≤7.00,余同组Ⅰ;组Ⅲ,pH≤7.00,神经系统异常,需辅助呼吸支持。采集脐动脉血、产后1h和2h桡动脉血进行血气分析并观察Apgar评分和临床经过。结果脐动脉血pH值和PaCO2各组间差异有显著性;产后1h动脉血pH组Ⅰ、Ⅲ间和组Ⅱ、Ⅲ间差异有显著性;产后1h动脉血pH、PaCO2分别和脐动脉血pH、PaCO2比较,差异有显著性;三组间有不同的神经系统表现;Apgar评分组Ⅲ较低。结论在严重酸中毒时,胎儿出生后pH、PaCO2会发生显著改变,需持续辅助机械通气的患儿有不良的神经系统预后。     

围生期窒息新生儿血气分析与神经系统损害

目的探讨围生期窒息新生儿PaCO2及pH快速变化及其与神经系统损害之间的关系。方法将55例新生儿分为3组:组1 pH>7.00,无神经系统异常,无需呼吸支持;组2 pH≤7.00,余同组1;组3,pH≤7.00,神经系统异常,需辅助呼吸支持。采集脐动脉血、产后1 h和2 h桡动脉血进行血气分析并观察Apgar评分和临床经过。结果脐动脉血pH值和PaCO2各组间有显著差异;产后1h动脉血pH组1、3间和组2、3间有显著差异;产后1 h动脉血pH、PaCO2分别和脐动脉血pH、PaCO2比较,有显著差异;3组间有不同的神经系统表现;Apgar评分组3较低。结论在严重酸中毒时,胎儿出生后pH、PaCO2会发生显著改变,需持续辅助机械通气的患儿有不同的神经系统后遗症。     

Use of brain lactate levels to predict outcome after perinatal asphyxia

Perinatal asphyxia is an important cause of neurological disability, but early prediction of outcome can be difficult. We performed proton magnetic resonance spectroscopy (MRS) and global cerebral blood flow measurements by xenon-133 clearance in 16 infants with evidence of perinatal asphyxia. Cerebral blood flow was determined daily in the first 3 days after birth in seven cases. Proton MRS was performed in 11 infants within the first week (mean 3.7 days), the rest within the first month (mean 22.2 days), and all had a scan around 3 months of age. Four infants died neonatally, three showed neurological deficits and the rest seemed to be progressing normally at neurodevelopmental follow-up at 1 year of age. A significant correlation was found between initial brain lactate levels and severe outcome ( p = 0.0003) just as between cerebral hyperperfusion (mean cerebral blood flow (CBF) 86ml(100g)^-1min^-1), ( p = 0.02) and outcome. The diagnostic and prognostic implications of early MRS and CBF are predictive of poor outcome in severely asphyxiated infants.     

新生儿血压节律及窒息或早产因素对血压节律影响的研究

目的了解正常新生儿生后早期(48h内)血压是否存在昼夜节律变化规律,以及窒息或早产因素对血压节律的影响.方法对106例正常足月自然分娩新生儿、30例足月重度窒息儿(1分钟Apgar评分<3分)及28例早产儿于生后48h内的测量血压,选择生后2、6、10、14、18、22时为测量时间点.结果正常足月自然分娩新生儿生后早期各时间点血压值(包括收缩压、舒张压和平均动脉压,下同)差异有显著性 ([ WTBX〗P均<0.05),表现为生后2时最低,6～10时升至最高,在14时有一低谷,在18 时又有一小高峰,至22时又下降.窒息组及早产组生后48h内各时间点血压值差异无显著性(窒息组 P分别为0.650、0.943和0.912,早产组P分别为0.283、0.575和0.327).结论正常足月自然分娩新生儿生后早期血压有昼夜节律变化,重度窒息儿及早产儿在生后早期未出现血压昼夜节律变化.     

Inflammatory chemokine expression in the peripheral blood of neonates with perinatal asphyxia and perinatal or nosocomial infections

AIM: The inflammatory response induced by perinatal infections and asphyxia is considered to participate in neonatal brain damage. Inflammatory responses are characterized by the expression of chemokines. Although chemokine levels have been investigated in healthy newborns, their role during neonatal pathological conditions has not been studied. The aim of our study was to examine chemokine serum levels in asphyxiated and infected neonates. METHODS: Peripheral blood samples were obtained from perinatally asphyxiated and infected neonates during the first days of life and from neonates who developed nosocomial infections. Serum levels of interleukin-8 (IL-8), interferon-gamma-inducible protein-10 (IP-10), monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1alpha (MIP-1alpha), and regulated upon activation, normal T cells expressed and secreted (RANTES) were determined. RESULTS: In perinatally asphyxiated neonates, IL-8 levels were significantly elevated on the 1st day of life. In perinatally infected neonates, IL-8 and IP-10 levels were significantly increased on the 1st day of life, while RANTES levels were significantly lower and remained so until the 4th day. In nosocomially infected neonates, IL-8, IP-10 and MIP-1alpha levels were significantly increased on diagnosis of infection. CONCLUSION: The neonatal immune system is able to produce chemokines for the induction of an inflammatory response during perinatal asphyxia and perinatal or nosocomial infections. Blockade of inflammatory chemokines could possibly contribute to the prevention of brain damage.     

Clinical value of a single postnatal lactate measurement after intrapartum asphyxia

Our aim was to compare the respective values of base deficit and lactate in birth asphyxia. METHODS: Base deficit and lactate levels were measured from radial artery blood samples taken at 30 min of life in 115 term newborns suspected as having been asphyxiated during labour. Both base deficit and lactate levels were compared between patients who further developed moderate or severe encephalopathy and those who experienced no or only mild encephalopathy. Receiver operating characteristics curves and clinical values of both indicators were computed. RESULTS: The correlation between base deficit and lactate was significant (r2 = 0.51, p < 0.0001). Both indicators were significantly associated with neonatal outcome. Lactacidaemia lower than 5 mmol/l and/or base deficit level lower than 10 mEq/l were not followed by neurological complications. Plasma lactate concentration greater than 9 mmol/l was associated with moderate or severe encephalopathy with a sensitivity of 84% and a specificity of 67%. Base deficit and lactate had similar clinical values. CONCLUSIONS: Base deficit and lactate measurements in arterial blood at 30 min of life are equally valuable in assessing the severity of birth asphyxia.     

新生儿窒息血气和电解质变化的临床分析

目的分析新生儿窒息时血气及电解质变化。方法49例窒息新生儿根据Apgar评分分为轻度窒息组(n=20)和重度窒息组(n=29)。采用美国855血气分析仪测定动脉血血气和电解质变化。结果重度窒息组的血pH值、BE值、PaCO2均明显低于轻度窒息组,差异有非常显著性(P<0.01)。窒息新生儿血清K 、Na 均低于正常水平,但轻、重度窒息组间差异无显著性(P>0.05)。重度窒息患儿血清Cl-、Ca2 均明显低于轻度窒息者,差异有非常显著性(P<0.01)。结论新生儿窒息时血气变化以混合性酸碱失衡为主,重度窒息时血清Cl-、Ca2 明显降低,及时监测血气及电解质变化,有助于了解病情变化,指导治疗。     

新生儿生后早期外周动脉血气分析评估缺氧损伤的意义

目的探讨生后早期外周动脉血气分析对于新生儿窒息病情评判的临床价值。方法选取2012年3月至2013年4月本院新生儿科收治的足月窒息新生儿为观察组,其中1 min Apgar评分4-7者为轻度窒息组,≤3分者为重度窒息组,同期随机选取无窒息的足月新生儿为对照组,各组新生儿均在生后1 h内取右手桡动脉血进行血气分析并比较。将窒息组按外周动脉血气pH值分为〉7.25、7.0-7.25、〈7.0三组,比较各组发生脏器功能受损的比例。结果轻度窒息组98例,重度窒息组24例,对照组86例。各组新生儿性别、胎龄、出生体重、分娩方式、取血时间等差异均无统计学意义（P〉0.05）。对照组pH值和BE值均高于轻、重度窒息组[pH：（7.38±0.06）比（7.16±0.08）、（7.10±0.09）,BE：（-4.1±0.5）mmol/L比（-11.1±4.6）mmol/L、（-14.4±2.6）mmol/L,P〈0.05],轻、重度窒息组之间差异无统计学意义（P〉0.05）。窒息组患儿中,外周动脉血气pH值〉7.25组、7.0~7.25组和〈7.0组发生脏器功能受损的比例分别为53.3%、88.9%、100%,差异有统计学意义（P〈0.05）。结论 Apgar评分的轻重程度不能完全代表窒息的程度,生后1 h内外周动脉血气分析检测是弥补其不足的一项客观指标。