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目的研究脐动脉血气分析及Apgar评分对新生儿窒息多器官损害的诊断意义。方法选取2014年11月—2016年3月期间收治的136例窒息新生儿作为研究对象,所有患儿均经过Apgar评分、脐动脉血气分析检查,比较不同窒息程度评分患儿代谢性酸中毒及多器官损害的发生率。绘制Apgar评分、脐动脉血p H及BE诊断多器官损害的ROC曲线,选取上述指标的临界值,并比较不同指标的敏感度、特异度及曲线下面积。结果136例患儿中32例(23.52%)发生多器官损害,轻度窒息与重度窒息患儿多器官损害发生率的差异具有统计学意义(P<0.05),代谢性酸中毒的差异无统计学意义(P>0.05)。重度酸中毒患儿多器官损伤发生率为87.87%(29/33),非重度酸中毒患儿多器官损伤发生率为6.90%(2/29),非酸中毒患儿多器官损害发生率为1.35%(1/74)。多器官及非多器官损害患儿1 min Apgar评分、p H及BE差异具有统计学意义(P<0.05),5 min Apgar评分的差异无统计学意义(P>0.05)。1 min Apgar评分诊断新生儿窒息多器官损害的AUC为0.535,临界值为3,敏感度为78.13%,特异度为65.38%;p H的AUC为0.712,临界值为7.05,敏感度为90.63%,特异度为96.15%;BE的AUC为0.627,临界值为-15.23 mmol/L,敏感度为78.13%,特异度为88.46%。结论与单纯应用Apgar评分相比,应用脐动脉血p H及BE可以更加准确地评价新生儿窒息多器官损害,提高诊断准确率。
Objective To study the significance of umbilical arterial blood gas analysis and Apgar score in diagnosis of neonatal asphyxia and multiple organ damage. Methods 136 newborns with asphyxia admitted from November 2014 to March 2016 were selected as subjects. All children were examined by Apgar score and umbilical arterial blood gas analysis. Metabolic acidosis was compared between children with different degree of suffocation The incidence of organ damage. Draw Apgar score, umbilical arterial blood p H and BE diagnosis of multiple organ damage ROC curve, select the critical value of these indicators, and compare the sensitivity of different indicators, specificity and area under the curve. Results 32 cases (23.52%) of 136 children had multiple organ damage. The incidence of multiple organ damage in children with mild asphyxia and severe asphyxia had statistical significance (P <0.05), but there was no statistical difference in metabolic acidosis Significance (P> 0.05). The incidence of multiple organ injury in children with severe acidosis was 87.87% (29/33). The incidence of multiple organ injury in non-severe acidosis children was 6.90% (2/29). The incidence of multiple organ damage in children with nonacidosis was 1.35% (1/74). Apgar scores, p H and BE differences in children with multiple organ and non-multiple organ damage at 1 min were statistically significant (P <0.05). There was no significant difference in Apgar scores at 5 min (P> 0.05). The AUC of 1 minute Apgar score in diagnosis of neonatal asphyxia and multiple organ damage was 0.535, the critical value was 3, the sensitivity was 78.13% and the specificity was 65.38%. The AUC of p H was 0.712, the critical value was 7.05 and the sensitivity was 90.63% , The specificity was 96.15%. The AUC of BE was 0.627, the critical value was -15.23 mmol / L, the sensitivity was 78.13% and the specificity was 88.46%. Conclusion Compared with the Apgar score alone, umbilical arterial blood p H and BE can be used to evaluate the multiple organ damage in neonatal asphyxia more accurately and improve the diagnostic accuracy.