摘要
目的：初步探讨分娩过程中诊断为胎儿宫内窘迫的新生儿出生时脐动脉血气分析、Apgar评分与新生儿预后的关系及其临床意义。方法：选取2009年10月2011年1月在我院分娩过程中诊断为胎儿宫内窘迫的产妇220例,在胎儿娩出后立即行脐动脉血气分析,并追踪新生儿结局,同时取同期正常分娩的新生儿脐动脉血气分析对照。结果：胎儿窘迫组中脐血血气分析pH值〈7.2者76例,占34.5%,其中单纯胎心监护异常组占23.6%,单纯羊水污染组占43.2%,胎心监护异常合并羊水污染组占32.9%,而正常对照组脐血血气分析pH值〈7.2者8例,占8%。两者间差异有统计学意义（P〈0.05）;在胎儿窘迫组中新生儿出生后Apgar评分〉7分病例中脐动脉血气pH〈7.2者占23.6%,而Apgar评分〈7分病例中,有86.8%新生儿脐动脉血气pH〈7.2,两者差异有统计学意义（P〈0.05）。对预测新生儿围生期患病率,单纯Apgar评分预测新生儿患病率的阳性预测值为42.1%,单纯脐血血气分析预测新生儿患病率阳性预测值为26.3%,两个指标联合预测新生儿患病率的阳性预测值为51．5％。结论：临床诊断分娩过程中胎儿窘迫者新生儿出生后脐血血气分析及Apgar评分多数正常，可能存在过度诊断现象；脐血血气分析和Apgar评分相互补充，应结合Apgar评分和脐动脉血气分析来共同评价新生儿预后，降低围生期新生儿患病率。
Objective： To evaluate the clinical significance of blood gas analysis of umbilical cord blood,Apgar scale in the diagnosis of fetal distress.Methods： A retrospective study of 220 pregnant women who suffered from fetal distress in the process of delivery in our hospital between October,2009 and January,2011 was performed.Blood gas analysis of umbilical cord blood was carried out immediately after delivery and the outcome of neonates were followed up.Meanwhile,umbilical arterial blood from normal births during the same period were taken and analyzed to make a contrast. Results. The PH valueof umbilical cord blood from 76 cases was less than 7.2 in the fetal distress group, which accounted for 34.5 %. Of them, 23.6 % had pure abnormal monitoring fetal heart, 43.2%had pure amniotic fluid pollution, and 32.9% had both abnormalities. Analysis showed that the PH value of eight cases was less than 7.2, which accounted for 8% The difference was statistical significance （P〈0.05）. Cases with pH of umbilical arterial blood less than 7.2 and with higher Apgar score than 7 accounted for 23.6%, while cases with pH lower than 7.2 and Apgar score lower than 7 accounted for 86.8%. There was a significant differ- ence （P%0.05） between the two groups. To predict the neonatal morbidity in perinatal period, the posi- tive predictive value of Apgar score was 42. 1% ,while gas analysis was 26. 3%, The positive predictive value of combined indicators was 51.5 %. Conclusions： Excessive diagnosis phenomenon with normal blood gas analysis and Apgar score may exist in the clinical diagnosis of fetal distress in the process of delivery. Blood gas analysis of umbilical cord blood and Apgar scale should be combined to evaluate neonatal outcomes, so that the neonatal morbidity rates in the perinatal period can be reduced.
出处
《海南医学院学报》
CAS
2011年第2期253-256,共4页
Journal of Hainan Medical University
基金
海南医学院科研基金资助学报项目(0020110052)~~
关键词
胎儿宫内窘迫
脐动脉血气分析
新生儿窒息
围生期
Fetal distress； Blood gas analysis of umbilical cord artery blood； Neonatal distress； Perinatal period；
