联合检测脐血与外周动脉血pH值评估新生儿缺氧缺血性脑损伤

目的 测定新生儿缺氧缺血性脑病(HIE)患儿脐血及外周动脉血pH值,探讨二者联合检测对新生儿缺氧缺血性脑损伤的临床诊断价值.方法 选择2011年6月至2013年6月河北医科大学附属邢台市人民医院产科自然分娩的足月新生儿917例,于生后第1声啼哭前采集脐血,检测pH值;对其中生后1 min Apgar评分≤7分的138例新生儿于生后1 h抽取外周动脉血进行血气分析.比较单独检测脐血、外周动脉血及二者联合检测对HIE的检验效能.结果 pH<7.10作为预测新生儿HIE的指标时其阳性预测值为55.38%,灵敏度60.00%,特异度96.61%,脐带血联合生后1 h外周动脉血pH值预测HIE的阳性预测值95.74%、灵敏度88.26%,特异度97.10%.结论 对于脐血pH<7.10的新生儿应当于生后1 h复查外周动脉血pH值,二者联合检测对新生儿HIE的预测具有较高的临床价值.

Predictive value of umbilical cord blood in combination with peripheral artery blood pH for neonatal hypoxic ischemia encephalopathy

Objective To explore the predictive value of pH in umbilical blood and peripheral arterial blood for the occurring of neonatal hypoxic-ischemic encephalopathy(HIE). Methods pH value of umbilical arterial blood was measured in 917 cases of full-term neonates, sampled during June 2011 to June 2013, before the first cry. Blood gas was analyzed with peripheral arterial blood, sampled at 1 hour after born, from 138 cases whose Apgar scores were less or equal to 7. The effectiveness of HIE detection was compared among umbilical blood, peripheral arterial blood and their combination. Results When umbilical arterial blood pH<7.10 was used as an indicator for HIE diagnosis, the positive prediction value was 55.38%, sensitivity was 60.00% and specificity was 96.61%. When pH value of umbilical arterial blood and arterial blood was used together as the indicator for HIE, the positive prediction value was 95.74%, sensitivity was 88.26% and specificity was 97.10%. Conclusion pH value of peripheral arterial blood is suggested to be determined for new borns whose umbilical arterial blood pH was less than 7.10. The combination of the two indexes can be used to objectively evaluate HIE.