脐血血气分析、C反应蛋白检测在新生儿窒息诊断中的临床意义

【目的】探讨脐血血气分析、C反应蛋白（CRP）及脑损伤在新生儿窒息的诊断及预后评估等方面的临床意义。【方法】选择2011年9月至2012年12月在本院住院的窒息新生儿60例，其中轻度窒息组36例，重度窒息组24例，选择同期在本院产科出生的健康足月新生儿30例作为对照组，所有受试新生儿抽取脐动脉血肝素抗凝行血气分析检测；另抽取股静脉血检测C反应蛋白含量；以缺血缺氧性脑病、死亡的发生率评估各组患儿的预后。【结果】轻度、重度窒息组患儿脐动脉血 pH、动脉氧分压（PaO2）显著降低，而脐动脉血二氧化碳分压（PaCO2）、剩余碱（BE）负值及股静脉血浆CRP含量明显高于对照组（ P＜0．05）；轻度、重度两组患儿比较，窒息程度越重，变化越显著（ P＜0．05）；缺血缺氧性脑病和死亡病例的发生率与窒息程度相关，与轻度窒息组相比，重度窒息组发生率显著升高（ P＜0．05）。【结论】新生儿窒息程度与脐动脉酸碱平衡紊乱、缺血缺氧性脑病病情密切相关，新生儿窒息的诊断和预后可结合Apgar评分、脐血血气分析、血浆CRP综合评价。

Clinical Significance of Umbilical Blood Gas Analysis and C-creative Protein in the Diagnosis of Neonatal Asphyxia

Objective]To explore clinical significance of umbilical blood gas analysis ,C-creative protein （CRP） and brain injury in the diagnosis and prognosis evaluation of neonatal asphyxia .Methods] A total of 60 neonates with asphyxia in our department from Sept .2011 to Dec .2012 were chosen and divided into mild asphyxia group（ n=36） and severe asphyxia group（ n=24） .In the same period ,30 healthy full-term neonates in our department were selected as control group .Umbilical arterial blood of all neonates was drawn and treated by anticoagulation by heparin for blood gas analysis .Other femoral venous blood was drawn to detect CRP level .The incidence of hypoxic ischemic encephalopathy and mortality was used to assess the prognosis of patients in two groups .Results] PH and PaO2 in umbilical arterial blood of mild and severe asphyxia groups were decreased significantly , while PaCO2 and BE in umbilical arterial blood and plasma CRP in femoral vein of mild and severe asphyxia groups were significantly higher than those of control group（ P 〈0 .05） .By comparison between mild group and severe group ,the severer the asphyxia ,the more significant the changes（ P 〈0 .05） .The incidence of hypoxic ischemic encephalopathy and mortality were related with the degree of asphyxia .Compared with mild asphyxia group ,the incidence and mortality in severe asphyxia group were increased significantly （ P〈0 .05） .Conclusion] The degree of neonatal asphyxia is closely related with acid-base balance disturbance and hypoxic ischemic encephalopathy . The synthetic evaluation by combining Apgar score ,umbilical blood gas analysis and plasma CRP can be used in the diagnosis and prognosis of neonatal asphyxia .