目的 分析生后早期动脉血气分析与早产儿脑损伤的相关性,为早产儿脑损伤的早期发现和干预提供参考依据。方法 收集2010年1月-2012年12月本院有生后1 h内动脉血气分析结果的早产儿,抽取脑损伤早产儿51例,按1∶3比例抽取3份相同或相近孕周产科分娩的无脑损伤早产儿为对照组,对两组早产儿血气分析中PH值、PaO2、PaCO2、BE值与脑损伤关系进行比较,并进行相关性分析,探讨早期动脉血气分析与早产儿脑损伤的相关性,评估早期动脉血气分析在预测早产儿脑损伤中的价值。结果 早产儿脑损伤检出率为16.4%,其中脑室内出血检出率为13.4%,脑室周围白质软化检出率为3.0%。脑损伤组PH(7.23±0.13)、PaO2(68.53±30.85)、BE(-6.50±3.93)值较对照组PH(7.32±0.08)、PaO2(81.05±29.19)、BE (-4.04±3.66)明显降低(P均<0.01)。PaCO2(50.16±14.13)较对照组(44.30±10.27)明显升高(P<0.01)。进一步研究发现:当PH<7.15、PaO2<35 mmHg、PaCO2>65 mmHg、BE<-10 mmol/L时,早产儿脑损伤发生率明显增加。Logistic回归分析显示:PH<7.15、PaO2<35 mmHg、PaCO2>65 mmHg与早产儿脑损伤密切相关,OR值(95%CI)分别为0.14(0.03～0.68)、0.04(0.01～0.68)、0.06(0.01～0.55)。结论 早期动脉血气分析异常与早产儿脑损伤密切相关,早产儿脑损伤发生率明显增加,提示早期监测动脉血气分析,及时纠正低氧血症、高碳酸血症、代谢性酸中毒,可减轻早产儿脑损伤发生发展。
Abstract
Objective To investigate the correlation between early arterial blood gas analysis and brain injury in preterm infants,and further to provide reference for early diagnosis and intervention of it. Methods The preterm infants with arterial blood gas analysis results in 1 hour after birth in our hospital from Jan.2010 to Dec.2011 were collected.51 infants diagnosed as brain injury were selected as case group,and each case were matched with 3 normal infants with same gestational age as control group.PH,PaO2,PaCO2,BE between the two groups were compared,and the correlation analysis on their relationship with brain injury were carried out. Results The incidence of brain injury in preterm infants was 16.4%,IVH and PVL were 13.4% and 3.0% respectively.PH(7.23±0.13),PaO2(68.53±30.85),BE(-6.50±3.93)from the brain injury group were significantly lower than those from the control group (7.32±0.08,81.05±29.19,-4.04±3.66)(all P＜0.01),while PaCO2(50.16±14.13) was significantly higher than that of the control group(44.30±10.27)(P＜0.01).Further research,when PH<7.15,PaO2<35 mmHg,PaCO2>65 mmHg,BE<-10 mmol/L,the incidence of brain injury in preterm infants increased.And logistic analysis showed that PH<7.15,PaO2<35 mmHg,PaCO2>65 mmHg were closely related to brain injury in preterm infants,values of OR (95%CI) were 0.14(0.03～0.68),0.04(0.01～0.68),0.06(0.01～0.55) respectively. Conclusions Early arterial blood gas analysis are closely related to brain injury in preterm infants.
关键词
早产儿 /
脑损伤 /
动脉血气分析
Key words
preterm infants /
brain injury /
early arterial blood gas
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参考文献
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基金
江苏省科技创新与成果转化(生命健康科技)专项资金(BL2012058)
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