摘要
目的研究多种生物学因素对新生儿脐动脉血气的影响，建立正常新生儿脐动脉血气的正常参考值范围。方法2008年3月至2009年9月，连续纳入国内6家协作医院分娩的1minApgar评分≥8分且无畸形的新生儿为研究对象，采用规范化的采集脐带和脐动脉血的方法及统一的血气分析仪检测脐动脉血pH、PO2、PCO。和碱剩余（baseexcess，BE）。采用方差分析（LSD两两检验）和两独立样本t检验比较不同产次、胎别、性别、胎龄、出生体重、出生体重与胎龄的关系、分娩方式等生物学因素对新生儿脐动脉血气的影响。在此基础上，建立排除生物学影响因素后的正常新生儿的脐动脉血气值。结果研究期间6家协作医院共分娩活产婴儿20605例，符合纳入标准者20191例。除性别外，其余生物学因素对脐动脉血气均有影响。第1产新生儿脐动脉血pH（7．19±0．10）和BE值[（-7．75±3．03）mmol／L]较其他产次组低，第2产新生儿BE值[（-7．60±3．02）rnmol／L]又分别较第3、4及以上产次组低。单胎儿组的PO2[（3．16±1．24）kPa]高于，而PCO2[（7．01±1．65）kPa]和BE[（-7．65±3．11）mmol／L]低于双胎儿组[分别为（2．91±1．21）kPa、（7．18±1．43）kPa和（6．84±3．26）mmol／I，]（t=3．612、2．092和2．930，P均d0．05）。不同胎龄组中pH、BE和PO2随着胎龄的增加而降低，而PCO2随着胎龄的增加而升高。低出生体重儿pH、BE较正常体重儿和巨大儿高。小于胎龄儿的pH、BE、PO2低于而PCO2高于适于胎龄儿和大于胎龄儿。剖宫产组与自然分娩组、臀位和产钳助产组相比，其pH、PO2和BE稍高，而PCO2稍低；产钳助产组与自然分娩组相比，其PO2和BE较低而PCO2较高，差异均有统计学意义（P均〈0．05）。排除有影响的生物学因素后，10645例单胎、足月、自然分娩、正常出生体重、适于胎龄、lminApgar评分≥8分且无畸形的正常新生儿的脐动脉血气参考值范围（z±1．96s）如下：pH为7．20土0．20，PO2为（3．15±1．23）kPa，PC02为（7．02±1．62）kPa，BE为（-7．64±6．36）mmol／L。结论多种生物学因素对新生儿脐动脉血气有影响，建立正常新生儿脐动脉血气参考值范围应排除这些影响因素；临床上应用脐动脉血pH和BE阈值作为评估窒息的综合指标之一时，适当考虑生物学因素的影响，可能有助于改进评估的准确性。
Objective To study the influences of biological factors on umbilical artery blood gas （UABG） of the newborns and to establish the normal UABG range. Methods From March 2008 to September 2009, all newborns without anomalies whose 1 min Apgar score 8 born in six hospitals in China were consecutively enrolled into this study. Umbilical cord and blood samples were collected with standardized method, pH value, PO2 , PCO2 and base excess （BE） of umbilical artery weredetected by uniformed blood gas analyzer. The influences of biological factors, such as parity, fetal number,gender, gestational age, birth weight, relationship of birth weight to gestational age, and delivery mode on UABG were analyzed by analysis of variance （LSD test） and two-independent sample t test. Based on the investigation results, normal range of UABG of the newborns was established after ruling out biological influence factors. UABG reference values were expressed as1.96s. Results Totally 20 605 newborns were born in the six hospitals during the study period, among which 20 191 newborns were enrolled in this study. Gender had no significant influence on UABG parameters （P〉0.05）. pH （7.19±0.10） and BE E（-7. 75±3. 03） mmol/L] of newborns of primiparous were lower than those born from multiparous （P〈0.05）. BE of second babies{-（--7. 601±3.02） mmol/L] was lower than that of babies born from mothers of more than three parities （P〈0.05）. Compared to twins EPO2 （2. 91±1.21） kPa, PCOe （7.18±1.43） kPa and BE （-6.84±3.26） mmol/L, the PO2 of singletons was higher F（3. 16±1.24） kPa, t=3. 612, P〈0. 051, and PCO2[-（7.01±1.65） kPa, t=2.092, P〈0.05] and BE I-（-7. 65 ± 3.11） mmol/L, t=2.930, P〈0.05 were lower. As gestational age increased, the value of pH, BE and PO2 decreased, and PCO2 increased （P〈0.05, respectively）, pH and BE of low birth weight infants were higher than those of normal birth weight infants and macrosomia （P〈0.05 respectively）, pH, BE and PO2 of small for gestational age infants were lower than those of appropriate and large for gestational age infants, while PCO2 was higher （P〈0.05 respectively）, pH, POe and BE of cesarean section group were higher than those of other delivery mode groups, while PCO2was lower （P〈0.05 respectively）. PO2 and BE of forceps group were lower than those of normal delivery group, while its PCO2 was higher （P〈0.05 respectively）. After ruling out the influence factors, the normal ranges of UABG and BE of the 10 645 singleton, term, normal delivered, normal birth weight, appropriate for gestational age, 1 min Apgar score, non-anomalous newborns were （7.20±0.20） for pH, （-7.64±6.36） mmol/L for BE, （3.15±1.23） kPa for POz and （7.02±1.62） kPa for PCO2. Conclusions Many biological factors might affect UABG parameters. When using pH or BE threshold as one of the criteria for evaluation of birth asphyxia, the influences of biological factors should be considered.
出处
《中华围产医学杂志》
CAS
北大核心
2012年第11期664-669,共6页
Chinese Journal of Perinatal Medicine
基金
广西自然科学基金项目（0832290）
北海市科技攻关项目（北科项字20081）
关键词
脐动脉
血气分析
参考值
氢离子浓度
婴儿
新生
多中心研究
Umbilical arteries
Blood gas analysis
Reference values
Hydrogen-ioncincentration
Infant, newborn
Multicenter study
