脐动脉血气分析的临床应用价值
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摘要
脐动脉血气是评估胎儿氧合和酸碱代谢异常的重要指标,是诊断新生儿窒息的重要补充。建议高危孕产妇分娩后及产时可疑胎儿窘迫者常规行脐动脉血气分析,根据血气结果进行高危儿随访和治疗,可最大限度降低近期缺血缺氧性脑病和远期脑瘫等神经系统功能异常的发生率。
Umbilical arterial blood gas is an important indicator for assessing fetal oxygenation and acid-base metabolism abnormalities. Furthermore, it is an important supplement for diagnosing neonatal asphyxia.We recommend routine umbilical arterial blood gas analysis in high-risk pregnant women with post-partum and intra-partum suspicion of fetal distress. The follow-up and treatment of high-risk infants based on blood gas results can reduce the incidence of neurological dysfunctions such as ischemic hypoxic encephalopathy and long-term cerebral palsy in the near future.
Umbilical arterial blood gas is an important indicator for assessing fetal oxygenation and acid-base metabolism abnormalities. Furthermore, it is an important supplement for diagnosing neonatal asphyxia.We recommend routine umbilical arterial blood gas analysis in high-risk pregnant women with post-partum and intra-partum suspicion of fetal distress. The follow-up and treatment of high-risk infants based on blood gas results can reduce the incidence of neurological dysfunctions such as ischemic hypoxic encephalopathy and long-term cerebral palsy in the near future.
引文
[1]马存丽,罗佳,秦山红.脐动脉血气分析及乳酸值评价围生儿的意义[J].医学综述,2012,9(18):3044-3047.
[2]郭晓辉,李华英,夏俊霞,等.脐带血联合动脉血pH值对新生儿缺血缺氧性脑病的预测价值[J].中国医科大学学报,2011,40(8):738-740.
[3]Solevg AL,Cheung PY,Schmlzer GM.Chest compressions and ventilation in delivery room resuscitation[J].Neo Rev,2014,15:e396-400.
[4]Kapadia V,Wychoff MH.Chest compression for bradycardia or asystole in meonates[J].Clin Perinatol,2012,39(4):833-842.
[5]岳丽琴,虞人杰.产房复苏时的胸外按压和正压通气[J].中国新生儿科杂志,2015,30(3):316-317.
[6]Ehrenstein V.Association of Apgar scores with death and neurologic disability[J].Clin Epidemiol,2009,1:45-53.
[7]White CR,Doherty DA,Newnham JP.The impact of introducing universal umbilical cord blood gas analysis and lactate measurement at delivery[J].Aust N Z J Obstet Gynaecol,2014,54(1):71-78.doi:10.1111/ajo.12132.Epub 2013 Oct 1.
[8]董燕,程蔚.脐动脉血气分析对评价新生儿窒息及预后的临床研究[J].中国优生与遗传杂志,2015,23(1):79-81,99.
[9]Yeh P,Emary K,Impey L.The relationship between umbilical cord arterial pH and serious adverse neonatal outcome:analysis of 51,519 consecutive validated samples[J].BJOG,2012,119:824-831.
[10]中华医学会围产分会新生儿复苏学组.新生儿窒息诊断的专家共识[J].中华围产医学杂志,2016,19(1):3-6.
[11]Malin GL,Morris RK,Khan KS.Strength of association between umbilical cord pH and perinatal and long term outcomes:systematic review and meta-analysis[J].BMJ,2010,13(340):c1471.
[12]Ambalavanan N,carlo WA,Shankaran S,et al.Predicting outcomes of neonates diagnosed with hypoxemic-ischemic encephalopathy[J].Pediatrics,2006,118(5):2084-2093.
[13]王华利,陈俊,胡伟,等.脐血血气分析联合脑血流动力学检测对评价缺氧高危儿预后的意义[J].广东医学,2014,35(1):98-101.
[14]全国新生儿窒息多器官损害临床诊断多中心研究协作组.新生儿脐动脉血气分析在新生儿窒息多器官损害诊断中的作用[J].中国新生儿杂志,2016,31(2):91-96.
[15]Sheikh M,Zoham MH,Hantoushzadeh S,et al.Umbilical blood gas analysis in preeclamptic versus healthy pregnancies with preterm birth[J].J Matern Fetal Neonatal Med,2015,29(15):2548-2553.
[16]Aalipour S,Hantoushzadeh S,Shariat M.Umbilical cord blood acidosis in term pregnancies with gestational diabetes mellitus and its relations to maternal factors and neonatal outcomes[J].Iran Red Crescent Med J,2018,20:e59267.
[17]Nordstrom L,Achanna S,Naka K,et al.Fetal and maternal lactate increase during active second stage of labour[J].Br J Obstet Gynaecol,2001,108(3):263-268.
[18]杨菁,徐望明,薛小平.不同产程时间与胎儿酸碱值变化的关系[J].中国实用妇科与产科杂志,1997,13(5):283-284.
[19]Perlman JM.Interruption of placental blood flow during labor:potential systemic and cerebral organ consequences[J].J Pediatr,2011,158:e1-4.
[20]Report of American College of Obstetricians and Gynecolo.gists'Task Force on Neonatal Encephalopathy.Neonatal Encephalopathy and Neurologic Outcome[J].Pediatrics,2014,133(5):e1482-e1488.
[21]Ferreira CS,Melo A,Fachada AH,et al.Umbilical cord blood gas analysis,obstetric performance and perinatal outcome[J].Rev Bras Ginecol Obstet,2018,40(12):740-748.
[22]Rennie JM.Roberton'S Textbook of Neonatology.刘锦纷(译).罗伯顿新生儿学[M].4版.北京:北京大学医学出版社,2009:256.
[2]郭晓辉,李华英,夏俊霞,等.脐带血联合动脉血pH值对新生儿缺血缺氧性脑病的预测价值[J].中国医科大学学报,2011,40(8):738-740.
[3]Solevg AL,Cheung PY,Schmlzer GM.Chest compressions and ventilation in delivery room resuscitation[J].Neo Rev,2014,15:e396-400.
[4]Kapadia V,Wychoff MH.Chest compression for bradycardia or asystole in meonates[J].Clin Perinatol,2012,39(4):833-842.
[5]岳丽琴,虞人杰.产房复苏时的胸外按压和正压通气[J].中国新生儿科杂志,2015,30(3):316-317.
[6]Ehrenstein V.Association of Apgar scores with death and neurologic disability[J].Clin Epidemiol,2009,1:45-53.
[7]White CR,Doherty DA,Newnham JP.The impact of introducing universal umbilical cord blood gas analysis and lactate measurement at delivery[J].Aust N Z J Obstet Gynaecol,2014,54(1):71-78.doi:10.1111/ajo.12132.Epub 2013 Oct 1.
[8]董燕,程蔚.脐动脉血气分析对评价新生儿窒息及预后的临床研究[J].中国优生与遗传杂志,2015,23(1):79-81,99.
[9]Yeh P,Emary K,Impey L.The relationship between umbilical cord arterial pH and serious adverse neonatal outcome:analysis of 51,519 consecutive validated samples[J].BJOG,2012,119:824-831.
[10]中华医学会围产分会新生儿复苏学组.新生儿窒息诊断的专家共识[J].中华围产医学杂志,2016,19(1):3-6.
[11]Malin GL,Morris RK,Khan KS.Strength of association between umbilical cord pH and perinatal and long term outcomes:systematic review and meta-analysis[J].BMJ,2010,13(340):c1471.
[12]Ambalavanan N,carlo WA,Shankaran S,et al.Predicting outcomes of neonates diagnosed with hypoxemic-ischemic encephalopathy[J].Pediatrics,2006,118(5):2084-2093.
[13]王华利,陈俊,胡伟,等.脐血血气分析联合脑血流动力学检测对评价缺氧高危儿预后的意义[J].广东医学,2014,35(1):98-101.
[14]全国新生儿窒息多器官损害临床诊断多中心研究协作组.新生儿脐动脉血气分析在新生儿窒息多器官损害诊断中的作用[J].中国新生儿杂志,2016,31(2):91-96.
[15]Sheikh M,Zoham MH,Hantoushzadeh S,et al.Umbilical blood gas analysis in preeclamptic versus healthy pregnancies with preterm birth[J].J Matern Fetal Neonatal Med,2015,29(15):2548-2553.
[16]Aalipour S,Hantoushzadeh S,Shariat M.Umbilical cord blood acidosis in term pregnancies with gestational diabetes mellitus and its relations to maternal factors and neonatal outcomes[J].Iran Red Crescent Med J,2018,20:e59267.
[17]Nordstrom L,Achanna S,Naka K,et al.Fetal and maternal lactate increase during active second stage of labour[J].Br J Obstet Gynaecol,2001,108(3):263-268.
[18]杨菁,徐望明,薛小平.不同产程时间与胎儿酸碱值变化的关系[J].中国实用妇科与产科杂志,1997,13(5):283-284.
[19]Perlman JM.Interruption of placental blood flow during labor:potential systemic and cerebral organ consequences[J].J Pediatr,2011,158:e1-4.
[20]Report of American College of Obstetricians and Gynecolo.gists'Task Force on Neonatal Encephalopathy.Neonatal Encephalopathy and Neurologic Outcome[J].Pediatrics,2014,133(5):e1482-e1488.
[21]Ferreira CS,Melo A,Fachada AH,et al.Umbilical cord blood gas analysis,obstetric performance and perinatal outcome[J].Rev Bras Ginecol Obstet,2018,40(12):740-748.
[22]Rennie JM.Roberton'S Textbook of Neonatology.刘锦纷(译).罗伯顿新生儿学[M].4版.北京:北京大学医学出版社,2009:256.