新生儿缺氧缺血性脑病血清电解质和渗透压改变

目的　探讨轻、中、重度缺氧缺血性脑病 (HIE)新生儿血电解质和渗透压等的变化及其相关性。方法　分析比较 12 0例不同程度的HIE新生儿和 32例正常新生儿的血清钠、钾、氯、游离钙及渗透压。结果　轻、中和重度HIE儿的血清钠分别为 (130 .2± 6 .0 )mmol/L ;(12 6 .3± 9.1)mmol/L ;(12 1.2± 12 .2 )mmol/L ;游离钙分别为 (1.0± 0 .2 )mmol/L ;(0 .9± 0 .2 )mmol/L ;(0 .8± 0 .2 )mmol/L和渗透压分别为 (2 5 6 .7± 11.2 )mOsm/L ;(2 48.7± 2 1.3)mOsm/L ;(2 41.1± 2 2 .2 )mOsm/L均低于正常儿 (136 .1± 1.1)mmol/L ;(1.2± 0 .1)mmol/L ;(2 6 2 .6± 8.8)mOsm/L ,而血清钾水平高于正常儿。轻度HIE患儿的血清氯水平与正常儿无差异 ,中和重度HIE儿的血清氯水平则低于正常儿 ;中度与重度HIE儿的血清钠、游离钙、氯和渗透压无显著差异 ,但均明显低于轻度HIE儿。轻、中和重度HIE儿的血清钾水平无明显差异 ;死亡的HIE儿血清钠和游离钙低且难以恢复 ,血清渗透压间隙 >10mOsm/L。结论　HIE儿可出现低钠、低钙、高钾和低渗透压血症 ;这些病理状态与预后有关。

Changges of Serum Electrolytes and Osmolality in Neonates with Hypoxic-Ischaemic Encephalophathy

Objective To inverstigate the changes of serum electrolytes and osmolality in the neonates with hypoxic ischaemic encephalophathy (HIE). Methods Serum levels of sodium Na +], potassium K +], chloride Cl -], ionized calcium Ca 2+ ], and osmolality were determined in 120 neonates with HIE and in 32 normal neonates. Results In all neonates with HIE (mild, moderate and severe), the serum levels of Na +] ( 130.2 ± 6.0 ) mmol/L, ( 126.3 ± 9.1 ) mmol/L, ( 121.2 ± 12.2 ) mmol/L respectively; Ca 2+ ] ( 1.0 ± 0.2 ) mmol/L, ( 0.9 ± 0.2 ) mmol/L, ( 0.8 ± 0.2 ) mmol/L respectively and osmolality ( 256.7 ± 11.2 ) mOsm/L, ( 248.7 ± 21.3 ) mOsm/L, ( 241.1 ± 22.2 ) mOsm/L respectively were lower than those in nomal neonates ( 136.1 ± 1.1 ) mmol/L, ( 1.2 ± 0.1 ) mmol/L, ( 262.6 ± 8.8 ) mOsm/L respectively, wheares serum K +] levels were higher. Serum Cl -] levels in the moderate and serere HIE neonates were lower compared with normal neonates. Serum levels of Na +] and Ca 2+ ] in the dead neonates were significantly decreased and obstinate; and osmolar gap was more than 10 mOsm/L. Conclusions Hyponatremia, hypocalcemia, and serum low osmolality occur in neonates with HIE and may be of prognostic significance.