摘要 目的：由于Apgar评分的局限性,有可能造成新生儿窒息的误诊和漏诊，为弥补其不足，探讨脐动脉血pH值在新生儿窒息诊治中的意义和价值。方法：对经胎心电子监护异常的单胎足月新生儿140例，出生后立即采集脐动脉血进行pH值测定，同时给予生后1 min及5 min Apgar评分，对于62例1 min Apgar≤7分者,窒息复苏后立即转入儿科病房观察治疗，进行血清肌钙蛋白Ⅰ（CTnI）和脏器损伤指标的检测，并进行统计学分析。结果：脐动脉血pH值与出生后1 min和5 min Apgar评分呈正相关(r=0.513和0.478，均P＜0.01)，Apgar评分愈低，脐动脉血pH值愈低，各分值组之间差异有显著性（P＜0.01）。出生后1 min及5 min Apgar评分与血清CTnI呈负相关（r=-0.614和-0.569，均P＜0.01）。脐动脉血pH值＞7.20，7.00~7.20，＜7.00相对应的血清CTnI值分别为（31.82±8.63）ng/L，（53.24±11.18）ng/L和（79.36±18.51）ng/L，随脐动脉血pH值的降低, 血清CTnI值明显升高(P＜0.01)。脏器损伤的发生率随Apgar评分的降低而升高（P＜0.05）,两者呈负相关(r=-0.548和-0.496，均P＜0.01)。脐动脉血pH值＞7.2，7.00~7.20，＜7.00相应的脏器损伤发生率分别为36.4％，60.0％及83.3％，脏器损伤的发生率随脐动脉血pH值的降低而升高（P＜0.05）, 两者呈负相关(r=-0.578,P＜0.05)。结论：①脐动脉血pH值和Apgar评分具有相关性，可作为诊断新生儿窒息的敏感指标之一，与Apgar评分相互补充。②脐动脉血pH值对于诊断新生儿窒息，判断病情轻重及预后评估具有重要临床意义。［中国当代儿科杂志，2009，11（7）：521-524］
Abstract：OBJECTIVE: To study the role of pH value of umbilical artery blood in the diagnosis and the assessment of prognosis of neonatal asphyxia. METHODS: A total of 140 single term newborn infants who were found abnormal by the fetal electrocardiogram monitoring were enrolled. The pH value of umbilical artery blood was measured immediately after birth. The Apgar score was performed 1 minute and 5 minutes after birth. The infants with the Apgar score ≤ 7 (n=62) were transferred to the pediatric ward for further management after resuscitation. Serum CTnI content was determined 24 hrs after birth. RESULTS: pH value of umbilical artery blood was positively correlated to 1 min and 5 min Apgar scores (r=0.513 and 0.478 respectively; P<0.01). There were significant differences for the umbilical pH value in infants with different Apgar scores (P<0.01). Serum CTnI content was negatively correlated to 1 min and 5 min Apgar scores (r=-0.614 and -0.569 respectively; P<0.01). The infants with umbilical artery pH value of more than 7.2, 7.0-7.2 and less than 7.0 had serum CTnI contents of 31.82±8.63, 53.24±11.18 and 79.36±18.51 ng/L, respectively (P<0.01). There was a negative correlation between umbilical artery pH value and serum CTnI content (r=-0.578, P<0.01). The incidence of organ injuries increased significantly with decreasing Apgar scores (P<0.05) and showed a negative correlation with 1 min and 5 min Apgar scores (r=-0.548 and -0.496 respectively; P<0.01). The infants with umbilical artery pH value of more than 7.2, 7.0-7.2 and less than 7.0 had the incidence of organ injuries of 36.4%, 60.0% and 83.3%, respectively (P<0.05). There was a negative correlation between umbilical artery pH value and the incidence of organ injuries (r=-0.578, P<0.05). CONCLUSIONS: Umbilical pH value correlates with Apgar score and may serve as sensitive indexes together with Apgar score for the diagnosis of neonatal asphyxia. Umbilical pH value is useful in the assessment of severity and prognosis of neonatal asphyxia.［Chin J Contemp Pediatr, 2009, 11 (7):521-524］
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