脐动脉血气指标联合Apgar评分评估新生儿窒息的应用价值

The application value of the umbilical artery blood gas index combined with the Apgar score in the assessment of neonatal asphyxia

摘要

目的 分析脐动脉血气指标联合Apgar评分应用于评估新生儿窒息的价值。方法 选取我院2021年1月至2023年3月收治的157例1min Apgar评分≤7分的新生儿作为研究组,另选同期160例1min Apgar评分≥8分的新生儿作为对照组,采集两组新生儿脐动脉血气指标[血液酸碱度(pH值)、动脉血氧分压(PaO₂)、动脉血二氧化碳分压(PaCO₂)、碳酸氢根(HCO₃^-)、碱剩余(BE)和二氧化碳结合力(CO₂CP)]及脏器损伤的数据,分析Apgar评分和脐动脉血气指标对新生儿脏器损伤的预测效能。结果 分析Apgar评分、pH值、PaO₂、PaCO₂、HCO₃^-、BE,研究组显著低于对照组(t值介于2.446~8.403之间),重度组显著低于轻度组(t值介于2.937~8.114之间),损伤组显著低于非损伤组(t值介于3.213~9.225之间);分析CO₂CP,研究组显著高于对照组(t=5.004),重度组显著高于轻度组(t=4.023),损伤组显著高于非损伤组(t=4.907),差异均有统计意义(P<0.05).比较三种方法预测新生儿脏器损伤的敏感度、特异度和符合度,Apgar评分明显低于脐动脉血气分析(χ²值分别为1.728、4.146、4.747),Apgar评分明显低于联合评估(χ²值分别为5.722、9.013、10.581),脐动脉血气分析明显低于联合评估(χ²值分别为4.551、3.693、4.384),差异均有统计学意义(P<0.05)。结论 脐动脉血气分析联合Apgar评分可有效提高评估窒息新生儿脏器损伤的敏感度、特异度和符合度,有利于降低新生儿窒息误诊率,对评估新生儿预后有重要临床价值.

Abstract

Objective To investigate the application value of umbilical artery blood gas index combined with Apgar score in the assessment of neonatal asphyxia. Methods A total of 157 neonates with 1min Apgar score≤7 admitted to our hospital from January 2021 to March 2023 were selected as the study group,and another 160 neonates with 1min Apgar score≥8 during the same period were selected as the control group.The data of umbilical artery blood gas indexes[pH value,partial pressure of oxygen in arterial blood(PaO₂),partial pressure of carbon dioxide in arterial blood(PaCO₂),bicarbonate(HCO₃ ^-),buffuer excess(BE)and carbon dioxide combining power(CO₂CP)]and organ injury were collected in two groups of neonates.The predictive efficacy of Apgar score and umbilical artery blood gas indexes for neonatal organ injury was analysed. Results For Apgar score,pH value,PaO₂,PaCO₂,HCO₃ ^-,BE,the study group was significantly lower than the control group(t=2.446-8.403,respectively),the severe group was significantly lower than the mild group(t=2.937-8.114,respectively),the injury group was significantly lower than the non-injury group(t=3.213-9.225,respectively);for CO₂CP,the study group was significantly higher than the control group(t=5.004),the severe group was significantly higher than the mild group(t=4.023),and the injury group was significantly higher than the non-injury group(t=4.907),all the differences were statistically significant(all P<0.05).Comparing the sensitivity,specificity and compliance of the three methods for predicting neonatal organ injury,the Apgar score was significantly lower than that of umbilical artery blood gas analysis(χ²=1.728,4.146 and 4.747,respectively),the Apgar score was significantly lower than that of combined assessment(χ²=5.722,9.013 and 10.581,respectively),and the umbilical artery blood gas analysis was significantly lower than that of combined assessment(χ²=4.551,3.693,and 4.384,respectively),all the differences were statistically significant(all P<0.05). Conclusion Umbilical artery blood gas analysis combined with Apgar score can effectively improve the sensitivity,specificity and conformity of assessing organ damage in asphyxiated neonates,which is conducive to reducing the misdiagnosis rate of neonatal asphyxia,and is of great clinical value in assessing the prognosis of neonates.

关键词

新生儿窒息 / 脐动脉血气分析 / Apgar评分 / 新生儿脏器损伤 / 评估

Key words

neonatal asphyxia / umbilical artery blood gas analysis / Apgar score / neonatal organ injury / evaluation

参考文献

[1] Kawakami M D, Sanudo A, Teixeira M L P, et al. Neonatal mortality associated with perinatal asphyxia:a population-based study in a middle-income country[J]. BMC Pregnancy Childbirth, 2021, 21(1): 169.

[2] 黄希希, 杨映. 血清BNP与NT-proBNP对窒息新生儿病情程度的评估效果研究[J]. 中国妇幼健康研究, 2019, 30(9): 1148-1151.

[3] Rozycki H J, Yitayew M. The Apgar score in clinical research:for what,how and by whom it is used[J]. J Perinat Med, 2022, 51(4): 580-585.

[4] Landman A J E M C, Immink-Duijker S T, Mulder E J H, et al. Significant reduction in umbilical artery metabolic acidosis after implementation of intrapartum ST waveform analysis of the fetal electrocardiogram[J]. Am J Obstet Gynecol, 2019, 221(1): 63.e1-63.e13.

[5] Torres Yordán N C, Lewis A G, McElrath T F, et al. Point-of-care assessment of combined umbilical arterial and venous lactate:a potential screening test for neonatal acidosis[J]. Int J Gynaecol Obstet, 2022, 158(1): 86-92.

[6] American Academy of Pediatrics Committee on Fetus and Newborn, American College of Obstetricians and Gynecologists Committee on Obstetric Practice. The Apgar score[J]. Pediatrics, 2015, 136(4): 819-822.

[7] Sweetman D U, Strickland T, Isweisi E, et al. Multi-organ dysfunction scoring in neonatal encephalopathy(MODE score)and neurodevelopmental outcomes[J]. Acta Paediatr, 2022, 111(1): 93-98.

[8] 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M].4版. 北京: 人民卫生出版社, 2011: 390-393.

[9] Zhou K Q, McDouall A, Drury P P, et al. Treating seizures after hypoxic-ischemic encephalopathy-current controversies and future directions[J]. Int J Mol Sci, 2021, 22(13): 7121.

[10] Min Y J, Ling E A, Li F. Immunomodulatory mechanism and potential therapies for perinatal hypoxic-ischemic brain damage[J]. Front Pharmacol, 2020, 11: 580428.

[11] La Rosa D A, Ellery S J, Walker D W, et al. Understanding the full spectrum of organ injury following intrapartum asphyxia[J]. Front Pediatr, 2017, 5: 16.

[12] Abubakar H D, Galadanci H S, Farouk Z L. Predictive accuracy of admission cardiotocography as a screening tool for perinatal asphyxia in high-risk parturients in Northern Nigeria[J]. Int J Gynaecol Obstet, 2022, 159(3): 796-802.

[13] Xiang B, Yang J, Lei X, et al. Adjuvant sufentanil decreased the EC50 of epidural ropivacaine for labor analgesia in healthy term pregnancy[J]. Drug Des Devel Ther, 2021, 15: 2143-2149.

[14] Pérez M L M, Hernández Garre J M, Pérez P E. Analysis of factors associated with variability and acidosis of the umbilical artery pH at birth[J]. Front Pediatr, 2021, 9: 650555.

[15] Irmak K, Tüten N, Karaoglu G, et al. Evaluation of cord blood creatine kinase(CK),cardiac troponin T(cTnT),N-terminal-pro-B-type natriuretic peptide(NT-proBNP),and s100B levels in nonreassuring foetal heart rate[J]. J Matern Fetal Neonatal Med, 2021, 34(8): 1249-1254.

[16] Wood S, Crawford S, Hicks M, et al. Hospital-related,maternal,and fetal risk factors for neonatal asphyxia and moderate or severe hypoxic-ischemic encephalopathy:a retrospective cohort study[J]. J Matern Fetal Neonatal Med, 2021, 34(9): 1448-1453.

[17] Admasu F T, Melese B D, Amare T J, et al. The magnitude of neonatal asphyxia and its associated factors among newborns in public hospitals of North Gondar Zone,Northwest Ethiopia:a cross-sectional study[J]. PloS One, 2022, 17(3): e0264816.

[18] Mohta M, Bambode N, Chilkoti G T, et al. Neonatal outcomes following phenylephrine or norepinephrine for treatment of spinal anaesthesia-induced hypotension at emergency caesarean section in women with fetal compromise:a randomised controlled study[J]. Int J Obstet Anesth, 2022, 49: 103247.

[19] Torres Yordán N C, Lewis A G, McElrath T F, et al. Point-of-care assessment of combined umbilical arterial and venous lactate:a potential screening test for neonatal acidosis[J]. Int J Gynaecol Obstet, 2022, 158(1): 86-92.

[20] Raghuraman N, Temming L A, Doering M M, et al. Maternal oxygen supplementation compared with room air for intrauterine resuscitation:a systematic review and meta-analysis[J]. JAMA Pediatr, 2021, 175(4): 368-376.

[21] Mlodawska M, Mlodawski J, Gladys-Jakubczyk A, et al. Relationship between Apgar score and umbilical cord blood acid-base balance in full-term and late preterm newborns born in medium and severe conditions[J]. Ginekol Pol, 2022, 93(1): 57-62.

[22] 中华医学会围产医学分会新生儿复苏学组. 新生儿窒息诊断的专家共识[J]. 中华围产医学杂志, 2016(1): 3-6.