摘要
目的了解分娩时脐动脉血气的临床意义。方法选取2005年3月至2006年12月在北京大学第一医院分娩的产妇810例,临床诊断胎儿窘迫401例,无胎儿窘迫409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,进行分析。结果①胎儿窘迫组中脐血pH值<7.2者49例,占12.2%,而无胎儿窘迫组pH值<7.2者26例,占6.4%。二者间差异有统计学意义(P=0.004);胎儿窘迫组脐血pH均值(7.25±0.24),无胎儿窘迫组脐血pH均值(7.28±0.05),两组差异有统计学意义(P=0.023);②新生儿出生后1minApgar评分>7分者中脐血pH值<7.2占8.3%,而Apgar评分≤7分者中高达34.5%,二者差异有统计学意义(P=0.000);③本研究中新生儿缺氧缺血性脑病(HIE)共18例,Apgar评分≤7分对HIE诊断的敏感性为38.9%,特异性为97.2%,阳性预测值24.1%,阴性预测值98.6%;脐血pH值<7.2对HIE诊断的敏感性55.6%,特异性91.8%,阳性预测值13.3%,阴性预测值98.9%;Apgar评分≤7分和pH值<7.2联合预测HIE的发生,特异性能增加至99.4%,阳性预测值增加至50%,阴性预测值98.4%。结论临床诊断胎儿窘迫者大多数出生时脐血气正常,可能存在过度诊断和治疗现象;血气分析是Apgar评分的补充,二者结合能增加对HIE诊断的特异性和阳性预测值,应结合Apgar评分和脐动脉血气分析来共同评价新生儿预后。
Objective To evaluate the clinical significance of umbilical cord artery blood gas analysis in labor. Methods Retrospective study of 810 pregnancy women delivered at Department of Obstetrics and Gynecology, Peking University First Hospital, between March, 2005 and December, 2006 was performed. There were 401 women who had fetal distress （distress group ） and 409 women who had no fetal distress （non- distress group）. Umbilical cord artery blood gas analysis was performed immediately after delivery and the outcome of neonates were follow- up. Results ① There were 49 cases （12.2%） whose pH value were less than 7.2 in distress group and 26 cases （6.4%） in non - distress group, the difference was significantly （P=0. 004）. The average value of pH in dis- tress group （7. 25±0. 24） was significantly lower than that in non-distress group （7. 28±0. 05, P=0. 023）. ② Among the neonates whose Apgar score〉7, the rate of umbilical artery pH value %7.2 was 8.3%, and among that whose Apgar score ≤7, the rate was 34.5%. There was a significant difference （P = 0. 000） between the two groups. ③ There were 18 neonates with hypoxic ischemic encephalopathy （HIE）. The sensitivity for Apgar seore≤ 7 was 38. 9%, specificity was 97. 2%, the positive predictive value was 24. 1%, negative predictive value was 98.6%. The sensitivity, specificity, positive predictive value and negative predictive value of pH〈7. 2 for detect HIE were 55. 6%, 91.8%, 13.3% and 98. 9% , respectively. The specificity, positive predictive value and negative predictive value could be increased to 99.4%, 50% and 98.4% after combining Apgar score and pH value. Conclusions There were over- diagnosis and over- treatment of fetal distress in clinical practice because only a few neonates had decreased pH value among fetal distress cases. The umbilical cord artery blood gas analysis is the supplement of Apgar score for fetal distress diagnosis. If we combine Apgar score and pH value of umbilical cord gas analysis,the specificity and positive predictive value for diagnosing HIE could be increased.
出处
《中国妇产科临床杂志》
2009年第4期262-264,共3页
Chinese Journal of Clinical Obstetrics and Gynecology
关键词
脐动脉血气分析
胎儿窘迫
新生儿窒息
新生儿预后
umbilical cord artery blood gas analysis
fetal distress
neonatal distress
neonatal prognosis
作者简介
通信作者：时春艳Email：shichunyan1996@vip．sohu．com
