新生儿缺氧缺血性脑病酸碱紊乱及阴离子间隙状态

目的探讨新生儿缺氧缺血性脑病(HIE)的酸碱紊乱发生情况和血液阴离子间隙 (AG)状态.方法对65例HIE患儿进行血气、血清电解质及AG测定,应用预计代偿公式判 断酸碱紊乱类型.结果高AG 73.8%(48/65),正常AG 23.1%(15/65),低AG 3.1% (2/65).单纯酸碱紊乱32.3%(21/65),双重酸碱紊乱56.9%(37/65),三重酸碱紊乱 (TABD)6.2%(4/65),正常4.6%(3/65).HIE患儿血液酸碱紊乱呈高AG状态;AG值的高 低、高AG发生率及酸碱紊乱类型的分布与HIE临床分度无关(P＞0.05).结论HIE酸碱紊 乱呈高AG状态,代谢性酸中毒和呼吸性碱中毒是2种最基本的酸碱紊乱.

Acid-base disorders and blood anion gap in neonates with hypoxic ischemic encephalophathy

Objective To characterize blood anion gap (AG) status and acid-base disorders in patients with hypoxic ischemic encephalophathy (HIE). Methods Blood gas, serum electrolytes and AG values were measured, and acid-base disorder types were determined by estimated compensation formula in 65 neonates with HIE. Results Elevated AG values were observed in 48 cases, decreased values in 2 cases, and no change in 15 cases. 21 cases with simple acid-base disorders, 37 cases with double acid-base disorders, and 4 cases with triple acid-base disorders were noticed, while 3 cases were normal in acid-base status. Conclusion High AG values were associated with acid-base disorders in neonates with HIE. No relations of AG values, frequency of high AG values, and types of acid-base disorders to the clinical degrees of HIE were observed. Asphyxia hypoxia, lactic acid accumulation, and functional lesions in major organs were the main causes of acid-base disorders and high AG conditions in neonates with HIE. Correcting acid-base disorders should be based on measures, such as increasing ventilation and oxygen supply, improving microcirculation, and improving kidney functions.