血乳酸及阴离子间隙在窒息新生儿中的应用价值

Value of blood lactate and anion gap in asphyxial neonates

摘要:

探讨窒息新生儿血乳酸、阴离子间隙变化与其窒息程度的关系，指导临床治疗及判断预后。方法选择2014 年1～12 月海口市人民医院新生儿科窒息新生儿201 例，纳入观察组；同期选择无窒息、病情稳定的新生儿205 例，纳入对照组。分别在入院后1h 检测血气指标及生化指标，按照窒息程度分组，比较各组间血气指标、血乳酸、AG值存在的差异。结果新生儿的性别、胎龄、体重等一般资料比较，差异无统计学意义（p >0.05），该条件下,观察组窒息患儿血乳酸水平、AG 值均高于对照组，差异均有统计学意义（p <0.05），重度窒息患儿1 min Apgar、血乳酸水平和AG 值高于轻度窒息患儿，差异有统计学意义（p <0.05）,但两组间患儿的pH值变化并不大（p >0.05）；治愈组和死亡组比较，两组患儿的胎龄、出生体重、pH值等指标，差异无统计学意义（p >0.05），但死亡组患儿的血乳酸、AG 值高于治愈组，且死亡组患者的1 min Apgar 评分明显低于治愈组，差异均有统计学意义（p <0.05）。结论血气乳酸水平和AG值在窒息患儿中表达高水平，有重要的诊断价值，并且在患儿的预后评估上也有一定的参考价值。

Abstract:

To investigate the relationship of changes of blood lactate and anion gap with the degree of asphyxia in neonates in order to guide clinical treatment and prediction of prognosis. Methods From January to December in 2014, 201 asphyxial neonates admitted to our hospital were included into study group, and 205 neonates in stable condition and without asphyxia during the same period were included in the control group. Blood gas indicators and biochemical indicators were detected 1 h after admission. The patients were grouped according to the degree of asphyxia. Blood gas indexes, blood lactate and AG value were compared among the groups. Results The general data of the neonates such as sex, gestational age and weight was not significantly different (p > 0.05).The blood lactate level and AG value of the observation group were significantly higher than those of the control group (p < 0.05). The 1-min Apgar scores, blood lactate level and AG value in the severe asphyxial neonates were significantly higher than those in the neonates with mild asphyxia (p < 0.05); but the pH value changes were not remarkably different between the two groups (p > 0.05). The blood lactate level and AG value in the death group were significantly higher than those in the cured group, but the 1 -min Apgar scores of the death group were significantly lower than those of the cured group (p < 0.05). Conclusions The blood lactate level and AG value are high in asphyxial neonates. These indexes have important diagnostic value, and also certain reference value in the prediction of prognosis.