脐动脉血气及乳酸值测定512例分析

目的探讨脐动脉血气分析及乳酸值的临床价值。方法选取2011年1月至2012年7月经玉溪市医院采集检验新生儿脐动脉血血气分析的产妇512例，按照临床有无胎儿窘迫征象分为研究组294例和对照组218例，在胎儿娩出后立即行脐动脉血气分析及乳酸值测定，追踪新生儿结局并进行分析。结果①两组的1min Apgar评分比较，差异无统计学意义（P〉0．05）；而脐动脉血乳酸-9pH呈显著负相关（r=-0．818，P〈0．05）。两组脐血pH均值在正常范围内，而研究组乳酸均值较对照组高；②追踪两组产后2-19个月，新生儿发生脑损伤35例，其中死亡3例，比较有无脑损伤组的1min Aic，gar评分、脐动脉血乳酸与血pH，脑损伤新生儿脐动脉血乳酸升高显著。结论产时胎儿窘迫者大多数新生儿出生时脐血气正常；血气分析、乳酸值测定是Apgar评分的补充，联合评估新生儿是诊断新生儿窒息更为客观、准确的方法，能增加对脑损伤的预测，评价新生儿预后。

Test of Umbilical Cord Arterial Blood Gas and Lactic Acid Analysis via 512 Samples

Objective To analyze the clinical value of testing umbilical cord arterial blood gas and lactic acid. Methods Five hundred and twelve samples of fetal delivery at Yuxi Hospital during January 2011 and July 2012 were selected. Based on whether the fetal distress existed in dclivery,the 512 samples were divided into two groups ： research group and control group. The umbilical cord arterial hlood were taken right after fetal delivery for umbilical cord arterial blood gas and lactic acid test, and all the samplc neonates were tracked to analyze the causal relation between them. Results ①The 1 rain Apgar score of the two groups had no statistical value（ r = - 0.818, P 〉 0.05 ） ;however,the lactic acid had a negative correlation with blood pH. The pH of the two groups Were in normal range,but the lactic acid in the research group was higher than the control group;②the neonates of the two groups were followed up for 2 to 19 months in this study;35 had been diagnosed as brain damage,including 3 deaths. The 1min Apgar score, umbilical cord arterial blood lactic acid and pH of neonates who suffered the brain damage had significantly higher lactic acid. Conclusion. Most fetuses who were born with fetal distress, showed a normal umbilical cord arterial blood gas, so the blood gas and lactic acid should be adopted as a complementary for Apgar score. With the three indexes, the neonatal asphyxia can be diagnosed more objectively and accurately, which then can increase the prediction of the neonatal brain damage and evaluate the prognosis.