窒息新生儿缺氧缺血性脑病相关因素分析

 目的 分析新生儿中重度缺氧缺血性脑病(hypoxic-ischemic encephalopathy, HIE)与非中重度HIE新生儿临床相关因素的差异。方法 对2013-01-01至2014-12-31我院新生儿科收治的80例窒息患儿进行回顾性分析,分为非中重度HIE组及中重度HIE组,对两组间各临床因素及实验室结果进行对比分析。结果 入组72例窒息患儿,中重度HIE组14例,非中重度HIE组58例。(1)两组患儿出生后1 min、5 min及10 min Apgar评分、生后1 h左右动脉血气分析pH值、碱不足及HCO^-₃浓度之间均有统计学差异(P<0.05),氧分压(Partial pressure of oxygen, PO₂)、二氧化碳分压(Partial pressure of carbon dioxide, PCO₂)之间差异无统计学意义(P>0.05);(2)中重度HIE组患儿生后3日内惊厥发生率、振幅整合脑电图(amplitude integrated electroencephalogram,aEEG)异常率及生后24 h内血糖异常、肾功能异常、心肌酶异常、消化道功能异常发生率以及需要机械通气的比例均高于非中重度HIE组(P<0.05);(3)生后12～24 h谷丙转氨酶(Alanine aminotransferase, ALT)、谷草转氨酶(Aspartate aminotransferase, AST)、前白蛋白、总胆红素、直接胆红素及总胆汁酸两组间差异均无统计学意义(P>0.05)。结论 出生后1 min Apgar评分低,5 min及10 min Apgar评分恢复差,生后1 h左右动脉血气提示严重酸中毒,合并多脏器功能损害等均提示窒息患儿可能发生中重度HIE。肝脏酶学指标及反映胆汁淤积的指标与中重度HIE发生的相关性不大。

Related factors of hypoxic ischemic encephalopathy in newborns with asphyxia

Objective To study the difference of clinical and laboratory findings between children with moderate and severe hypoxic-ischemic encephalopathy (HIE) and those with non-moderate-severe HIE in order to remind clinicians of early detection of moderate-severe HIE in infants and interventions.Methods The clinical data on eighty cases of asphyxia treated in our department between January 1, 2013 and December 31, 2014 was retrospectively analyzed.These patients were divided into non-moderate-severe HIE group and moderate-severe HIE group. Clinical factors and laboratory results were compared between the two groups. SPSS 17.0 software was used for statistical analysis, and P<0.05 was considered statistically significant.Results Seventy-two cases were enrolled, fourteen with moderate-severe HIE, and fifty-eight with non-moderate-severe HIE. (1) Apgar scores at 1 minute, 5 minutes and 10 minutes after birth, arterial blood gas analysis at 1 hour after birth, PH, BE and HCO-3 concentrations in both groups were significantly different between the two groups(P<0.05), but not in partial pressure of oxygen PO₂)or partial pressure of carbon dioxide (PCO₂) (P>0.05). (2) The incidence of seizures, the abnormal rate of amplitude integrated electroencephalogram (aEEG) within 3 days after birth and abnormal blood glucose, renal dysfunction, abnormal myocardial enzymes, incidence of abnormal digestive tracts, the proportion of patients in need of mechanical ventilation were higher in the moderate-severe HIE group than in the non-moderate-severe HIE group (P<0.05). (3) Alanine aminotransferase (ALT), aspartate aminotransferase (AST), prealbumin, total bilirubin, direct bilirubin, and total bile acids were not significantly different between the two groups 12-24 hours after birth (P> 0.05).Conclusions Low Apgar scores, severe acidosis suggested by arterial blood gas about 1h after birth, and complications with multiple organ dysfunction indicate that moderate to severe HIE may occur in children with asphyxia. Enzymatic liver indicators and indicators of reaction cholestasis are not closely correlated with moderate and severe HIE.