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目的通过大样本收集新生儿脐血血气,研究脐血血气统计学参考值范围与不同影响因素的相关关系。方法选择2012年5~11月广东省妇幼保健院和新会妇幼保健院产科出生的新生儿进行前瞻性研究,选取其中1 min Apgar评分>7分者的脐血血气结果进行统计分析,了解正常新生儿脐血血气的统计学参考值范围;重点分析影响新生儿脐血pH和BE的因素。结果 2000例新生儿中,1 min Apgar评分≤7分11例,>7分1989例,低Apgar评分组pH<7.2的比例为45.5%,正常Apgar评分组pH<7.2的比例为3.5%,差异有统计学意义(P<0.001);1800例足月单胎、体重适于或大于胎龄新生儿中,1794例1 min Apgar评分>7分者脐血pH和BE的统计学参考值范围分别是7.34±0.14(x±1.96 s)和-3.53±6.57(x±1.96 s)。单因素分析显示,宫内窘迫组、妊娠期并发症组pH值均低于对照组,剖宫产组pH和BE值均高于阴道分娩组,脐带绕颈组pH值降低,双胎组BE值高于单胎组;羊水性状对pH、BE值均无影响。多因素分析显示,宫内窘迫、分娩方式均对脐血血气有影响。结论足月单胎、体重适于或大于胎龄新生儿中,1 min Apgar评分>7分者脐血pH值和BE值的统计学参考值范围分别是7.34±0.14和-3.53±6.57;Apgar评分与脐血血气分析具有一致性,但单独使用Apgar评分诊断早产儿窒息可能会增加窒息的误诊率;宫内窘迫可能会增加新生儿酸中毒的发生率,不同分娩方式对脐血血气pH、BE值均有影响。
Objective To collect neonatal umbilical blood gas through a large sample to study the correlation between umbilical blood gas statistical reference values and different influencing factors. Methods A prospective study was conducted on neonates born in obstetrics and gynecology of MCH and Xinhui Maternal and Child Health Hospital of Guangdong Province from May to November in 2012. The results of blood gas of umbilical blood in 1 minute Apgar score> 7 were statistically analyzed to find out the normal Neonatal umbilical cord blood gas statistical reference value range; focus on analysis of neonatal umbilical cord blood pH and BE factors. Results In 2000 newborns, the Apgar score was less than or equal to 7 points and 11 cases at 1 minute, and more than 7 points and 1989 cases. The ratio of pH <7.2 in low Apgar score was 45.5% and that in normal Apgar score was <7.2, which was 3.5% (P <0.001). The statistical reference values of umbilical blood pH and BE in 1800 full-term singletons with 1794 Apgar scores> 7 at 1-month body weight or more than gestational age were statistically significant Was 7.34 ± 0.14 (x ± 1.96 s) and -3.53 ± 6.57 (x ± 1.96 s). Univariate analysis showed that the intrauterine distress group, gestational complications group pH values were lower than the control group, cesarean section group pH and BE values were higher than the vaginal delivery group, umbilical cord around the neck group pH value decreased, the twin group BE The value of amniotic fluid had no effect on pH and BE. Multivariate analysis showed that intrauterine distress, mode of delivery have an impact on cord blood. Conclusions The full-term singleton fetuses weighing more than or equal to gestational age, the statistical reference values of umbilical cord blood pH value and BE value of 1 min Apgar score> 7 points were 7.34 ± 0.14 and -3.53 ± 6.57 respectively; Apgar Score and cord blood gas analysis is consistent, but the Apgar score alone diagnosis of asphyxia in preterm infants may increase the misdiagnosis rate of asphyxia; intrauterine distress may increase the incidence of neonatal acidosis, different modes of delivery on cord blood gas pH, BE values have an impact.