新生儿酸碱失衡时脐血及动脉血气分析的临床特征

目的通过新生儿脐血及动脉血气分析的变化,探讨新生儿酸碱失衡的临床特征及其危害性。方法采用美国进口全自动血气分析仪对192例新生儿脐血及113例病理新生儿外周动脉血进行血气分析,同时用全自动生化仪进行K 、Na 、Cl-等血生化检测。结果脐血血气分析显示,192例新生儿中正常分娩者179例,窒息13例。全组156例发生酸中毒,发生率81.3%。其中呼吸性酸中毒(呼酸)84例(43.8%),代谢性酸中毒(代酸)47例(24.5%),混合性酸中毒25例(13.0%)。窒息13例均发生酸中毒,其中重度窒息2例均为严重混合性酸中毒。113例病理新生儿外周动脉血气分析显示,99例发生不同类型酸碱失衡(87.6%),其中单纯型代酸50例(44.2%)占首位,其次是单纯型呼酸20例(17.7%),居第3位为代酸 呼碱16例(14.2%),混合性酸中毒11例(9.7%),呼碱 代碱2例(1.8%)。结论即使正常分娩新生儿亦易发生酸中毒,病理新生儿酸碱失衡更为突出,危重新生儿往往发生多重酸碱失衡。严重的酸碱失衡可使机体发生致命性的病理改变。酸中毒和碱中毒的危害均不容忽视。血气分析与阴离子间隙(AG)相结合,能更加准确地判断新生儿酸碱失衡状况。

Clinical Features of Cord and Artery Blood Gas Analysis in Neonate with Acid- Base Imbalance

Objective To discuss clinical features and harmfulness of acid-base imbalance in newborn by investigating the changes in blood gas of cord and artery blood,and to establish more appropriate prevention measures. Methods One hundred and ninety-two cord blood and 113 peripheral artery blood of neonates were measured for blood gas analysis by automatic blood gas analysis instrument from America;meanwhile,the concentrations of K~ ,Na~ and Cl~- were detected by biochemical analyzer.Results Among 192 neonates,179 were normal labor and 13 neonates underwent acidosis of different degrees.The incidence was 79.9%.Among the 13 ca-(ses),2 cases had severe asphyxia and both of them got serious mixed acidosis.For all the neonates, 156 cases got acidosis, 84 neonates underwent respiratory acidosis (43.8%), 47 cases with metabolic acidosis (24.5%) and 25 cases with mixed acidosis (13.0%).The left 113 neonates were abnormal labor.Among them,99 cases had acid-base disturbance of different degrees (87.6%). Among the 99 acid-base disturbance cases, 50 cases were single metabolic acidosis (44.2%) and presented the most common changes; the second was single respiratory acidosis, totally 20 cases (17.7%).The third was metabolic acidosis combined with respiratory alkalosis, totally 16 neonates (14.2%).Eleven cases had mixed acidosis (9.7%) and 2 cases were respiratory alkalosis combined with metabolic alkalosis (1.8%).Conclusions While the normal labor neonates still got acidosis of different degrees,the acid-base imbalance of abnormal labor is much more prominent,and the critical neonates often got mixed acid-base imbalance.Serious acid-base imbalance can cause fatal pathological changes in body.The dangers of acidosis and alkalosis can not ignore either. The condition of acid-base imbalance can be judged more accurately by the combination of blood gas analysis and anion gap.The perinatal health cares are important measures to prevent acid-base imbalance.