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目的探讨脐动脉血乳酸水平、阿氏评分、新生儿行为神经评分(NBNA)对新生儿缺氧缺血性脑病(HIE)预后判断的价值及临床意义。方法自2003年6月在我院产科出生的窒息新生儿,娩出后在第一声啼哭前立即抽取脐动脉血2ml送检乳酸,其中64例发生HIE的患儿按病情分为轻、中、重3组,第3天及第7天进行NBNA评分,随访至4岁行C-WYCSI智力测验,统计学方法分析上述临床资料。另选同期出生的80例正常新生儿为脐动脉血乳酸值正常对照组。结果各HIE组脐动脉血乳酸值较正常新生儿组均明显升高,脐动脉血乳酸值、阿氏评分、NBNA评分与C-WYCSI测验结果及四者之间均呈直线相关关系。结论脐动脉血乳酸水平能早期预测HIE的严重程度及预后,结合阿氏评分、HIE分度、NBNA评分动态观察结果,更有助于判定HIE患儿的预后。
Objective To investigate the value and clinical significance of umbilical artery lactate levels, Asperger’s score and neonatal behavioral neurological score (NBNA) in the prognosis of neonatal hypoxic-ischemic encephalopathy (HIE). Methods Asphyxial newborn was born in obstetrics and gynecology department in our hospital from June 2003, and immediately after the first crying, 2ml umbilical arterial blood was taken for lactic acid detection. 64 cases of HIE were divided into mild, moderate, Weighing NBNB score of 3 groups, 3 days and 7 days, followed up to 4 years old C-WYCSI intelligence test, statistical analysis of the above clinical data. Another 80 normal newborn born in the same period were umbilical artery blood lactate normal control group. Results The umbilical arterial blood lactate levels in all HIE groups were significantly higher than those in normal neonates. The values of umbilical arterial blood lactic acid value, Ashley’s score, NBNA score and C-WYCSI test results were linearly correlated with each other. Conclusion The umbilical arterial blood lactate level can predict the severity and prognosis of HIE at early stage. It is helpful to determine the prognosis of children with HIE by combining the dynamic observation results of Asperger’s score, HIE index and NBNA score.