Apgar评分与早产儿窒息相关因素的研究

目的探讨Apgar评分与早产儿窒息相关因素的关系。方法采用同期住院的早产儿，分成三组：（1）无窒息组（Apgar评分8～10分）；轻度窒息组（Apgar评分4～7分）；重度窒息组（Apgar评分0～3分），然后分析各组与围产因素、动脉血pH值、血糖及早产儿脑损伤的关系。结果（1）重度窒息组的围产因素明显高于无窒息组和轻度窒息组（P〈0．01），而后二组则无显著差异（P〉0．05）。（2）首次动脉血气pH值≤7．2的病例，重度窒息组也显著多于无窒息组与轻度窒息组（P〈0．01），无窒息组与轻度窒息组则无显著差异（P〉0．05）。（3）重度窒息组发生严重低血糖（≤1．1mmol／L）的病例要明显高于无窒息组和轻度窒息组（P〈0．01），后二组则无显著差异（P〉0．05）。（4）出现脑损伤的情况：缺氧缺血性脑损伤（HIE）、脑室周周-脑室内出血（PIVH）及脑室周周白质软化（PVL），重度窒息组均显著高于无窒息组和轻度窒息组（P〈0．01），轻度窒息组与无窒息组则无显著差异性（P〉0．05）。结论Apgar评分评估早产儿轻度窒息时（4—7分），应考虑到各种影响因素，其准确性有一定的限度。但Apgar评分0～3时，则发生窒息的可能性大，需按窒息儿处理，以减少脑损伤的发生。

A study of Apgar score and relative factors of asphyxia in premature

Objective ： To investigate the relationship between Apgar score and relative factors of asphyxia in premature. Methods ： Hospitalized premature infants during the same period were divided into three groups： （1） no asphyxia group （Apgar score 8 -10） ; （2） mild asphyxia （ Apgar score 4 - 7 ） ; （ 3 ） severe asphyxia （ Apgar score 0 - 3 ）. The relationship between relative factors, blood pH value , blood sugar level and brain damage of premature was studied in each group. Results. （ 1 ） Premature infants in severe asphyxia group have more perinatal factors than infants in no asphyxia group and mild asphyxia group （ P 〈 0.01 ）. There was no significant difference between the later two groups. （2） In severe asphyxia group, there were obviously more cases with pH ≤ 7.2 in first artery blood gas analysis after birth than that in no asphyxia group and mild asphyxia group （ P 〈0.01 ）. There was no significant difference between no asphyxia group and mild asphyxia group . （3） There was more severe hypoglycemia （ blood sugar ≤1. lmmoL/L） cases in severe asphyxia group than in no asphyxia group and mild asphyxia group （ P 〈0. 01 ）. There was also no significant difference between the later two groups. （4） The morbidity of Hypoxia Ischemia Encepholophathy （HIE） , periventricular - intraventricular hemorrhage （PIVH） and periventricular white matter malacia （PVL） were obviously higher in severe asphyxia group than in no asphyxia group and mild asphyxia group （ P 〈 0. 01 ）. There was no significant difference between the later two groups. Conclusion ： Using Apgar score to evaluate mild asphyxia in premature , we should consider various influence factors and its accuracy is limit. But when Apgar score is 0 - 3, asphyxia will possibly occur, then management of asphyxia should be done to decrease brain damage.