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目的探讨新生儿缺氧缺血性脑病(HIE)高危患儿的脐血血气指标、大脑中动脉血流动力学及出生后Apgar评分对其预后的影响情况。方法选取2012年6月-2015年6月在该院诊断为胎儿宫内窘迫的HIE高危患儿57例为观察组,按照脐带血pH值将其分为pH≥7.2组(36例)与pH<7.2组(21例)。另选取同期20例正常足月儿为对照组。对比3组生后1 min、5 min Apgar评分、脐带血气分析指标、大脑中动脉脑动力学指标及预后行为神经(NBNA)评分、智力发育指数(MDI)、运动发育指数(PDI),分析3个预后指标的相关影响因素。结果 (1)pH<7.2的观察组患儿生后1 min与生后5 min Apgar评分均显著低于其他两组患儿(P<0.05);(2)pH<7.2的观察组剩余碱(BE)、实际碳酸氢根(AB/HCO3-)、氧分压(PaO_2)显著低于其他两组(P<0.01),二氧化碳分压(PaCO_2)及其动静脉差值均显著高于其他两组(P<0.05);(3)pH<7.2组的12 h大脑中动脉血流速度(Vs)明显低于其他两组,其12 h舒张期血流速度(Vd)显著低于对照组(P<0.05);(4)pH<7.2组的7 d、28 d NBNA评分及6月龄、12月龄MDI、PDI均显著低于其他两组(P<0.05);(5)生后1 min Apgar评分与脐带血PaO_2是生后28 d NBNA评分的负相关因素;生后1 min Apgar评分、脐带血PaO_2与大脑中动脉12 h Vs是12月龄MDI指数的负相关因素;生后1 min Apgar评分、脐带血PaO_2、PaCO_2是12月龄PDI指数的负相关因素。结论生后1 min Apgar评分、脐带血PaO_2、大脑中动脉12 h Vs值越低,脐带血PaCO_2越高,HIE高危患儿的预后越差。对于HIE高危患儿,应采取对症措施,将脐带血PaO_2、PaCO_2及脑动脉Vs值维持在正常水平,以改善行为神经、智力及心理发育情况。
Objective To investigate the effects of cord blood gas index, middle cerebral artery hemodynamics and postnatal Apgar score on the prognosis of neonates with high-risk hypoxic-ischemic encephalopathy (HIE). Methods Fifty-seven children with HIE who were diagnosed as fetal distress in our hospital from June 2012 to June 2015 were selected as the observation group. According to the umbilical cord blood pH, they were divided into pH≥7.2 group (36 cases) and pH <7.2 group (21 cases). Another 20 cases of normal full-term selection of the same period for the control group. Apgar score, umbilical blood gas analysis index, middle cerebral artery hemodynamics and NBNA score, mental retardation index (MDI), motor development index (PDI) at 1 min after birth, Correlation factors of prognostic indicators. Results (1) The Apgar scores at 1 minute after birth and 5 minutes after birth in the observation group with pH <7.2 were significantly lower than those in the other two groups (P <0.05); (2) BE), actual bicarbonate (AB / HCO3-) and partial pressure of oxygen (PaO_2) were significantly lower than those of the other two groups (P <0.01) (P <0.05). (3) The blood flow velocity (Vs) of middle cerebral artery of 12 h group at pH <7.2 was significantly lower than that of the other two groups, and the diastolic blood flow velocity (Vd) at 12 h was significantly lower than that of the control group P <0.05). (4) On the 7th, 28th day, the NBNA score at pH <7.2 and the MDI and PDI at 6 months and 12 months were significantly lower than those in the other two groups (P <0.05) min Apgar score and cord blood PaO_2 was the negative correlation factor of NBNA score at 28 d after birth. Apgar score, PaO 2 cord blood and middle cerebral artery 12 h Vs at 1 min after birth were the negative correlation factors of MDI index at 12 months. min Apgar score, cord blood PaO_2 and PaCO_2 were negative correlation factors of PDI index at 12 months. Conclusion The Apgar score, cord blood PaO_2, middle cerebral artery 12 h Vs value at 1 min after birth are lower, and the higher the PaCO_2 in umbilical cord blood, the worse the prognosis of children with HIE. For children with HIE at high risk, symptomatic measures should be taken to maintain normal levels of cord blood PaO_2, PaCO_2 and cerebral artery Vs in order to improve behavioral neurological, mental and psychological development.