剖宫产取胎时限对脐动脉血气和Apgar 评分的影响(1)
[摘要] 目的 探讨取胎时限对脐动血气和Apgar评分的影响。 方法 选择318例妊娠足月单胎择期剖宫产手术的产妇，根据Apgar评分标准分为三组，0～3分为重度窒息组，4～7分为轻度窒息组，8～10分为对照组，比较其取胎时限、1 min Apgar评分及脐动脉血气分析和乳酸值，分析取胎时限与血气结果及Apgar评分的相关性。 结果 318例新生儿重度窒息组3例，取胎时限为(186.20±12.00)s ；轻度窒息组12例，取胎时限为(107.0±16.72)s；正常组303例，取胎时限为(45.50±8.06)s，三组取胎时限差异有统计学意义(P<005)。三组脐动脉血气分析进行比较，pH值、PaCO2、PaO2、Lac及BE值间差异有统计学意义(P<0.05)。取胎时限与新生儿脐动脉pH值成负相关(r=-0.491，P=0.0017)。取胎时限与新生儿脐动脉Lac值呈正相关(r=0.652，P<0.001)。 结论 在行剖宫产手术时，取胎时限应尽量控制在120 s 以内，能明显减少新生儿窒息的发生。
[关键词] 取胎时间；脐动脉血；血气分析；乳酸；Apgar评分
[中图分类号] R719.8 [文献标识码] B [文章编号] 1673-9701(2018)08-0090-04
Effect of cesarean section time on umbilical artery blood gas and Apgar score
PING Yongmei DU Xiaodong ZHENG Jiangmei
Department of Anesthesiology，Lishui Women and Children’s Hospital in Zhejiang Province，Lishui 323000，China
[Abstract] Objective To investigate the effect of cesarean section delivery time on umbilical arterial blood gas and Apgar score. Methods A total of 318 puerpera undergoing selective cesarean section were enrolled in this study. Participants were divided into three groups according to Apgar grading standards： 0 to 3 as severe asphyxia group， 4 to 7 as mild asphyxia group and 8 to 10 as the control group. The delivery time， 1 min Apgar score， umbilical arterial blood gas analysis and lactic acid value were compared among the three groups. The correlation of delivery time with blood gas and Apgar score were also analyzed. Results Among 318 neonates， there were 3 cases of severe asphyxia with a delivery time of(186.20±12.00)s， 12 cases of mild asphyxia with a delivery time of(107.0±16.72)s， and 303 normal cases with a delivery time of(45.50±8.06)s， the difference was statistically significant(P<0.05). The blood gas analysis of umbilical arteries showed that the differences of pH， PaCO2， PaO2， Lac and BE value were statistically significant among three groups(P<0.05). There was a negative correlation between delivery time and pH of neonatal umbilical artery(r=-0.491， P=0.0017). There was a positive correlation between delivery time and neonatal umbilical artery Lac value(r=0.652， P<0.001). Conclusion During cesarean section， the delivery time should be limited within 120 s as much as possible， which can significantly reduce the incidence of neonatal asphyxia.
[Key words] Delivery time；Umbilical artery；Blood gas analysis；Lactic acid；Apgar score
新生儿窒息是导致新生儿死亡、脑损伤的主要原因之一。新生儿窒息发病机理是低氧血症和酸中毒引发的多脏器功能损害，大多数伴随着神经系统后遗症[1]。早期及時预防对于减少新生儿致残甚至死亡尤为重要[2]。在剖宫产手术中影响新生儿窒息因素较多，取胎时限是其中一个重要因素[3]，如发生取胎困难，将会明显增加新生儿窒息发生率及产妇损伤[4]。目前国内外关于剖宫产取胎时限的研究较少，且缺乏可应用于临床的相关指标。该研究收集2014年4月～2015年12月在我院妇产科出生的318例新生儿的信息，分析取胎时限对脐动脉血气Apgar 评分的影响，并以此试探讨取胎时限的范围。, http://www.100md.com(平永美 杜晓东 郑江美)
[关键词] 取胎时间；脐动脉血；血气分析；乳酸；Apgar评分
[中图分类号] R719.8 [文献标识码] B [文章编号] 1673-9701(2018)08-0090-04
Effect of cesarean section time on umbilical artery blood gas and Apgar score
PING Yongmei DU Xiaodong ZHENG Jiangmei
Department of Anesthesiology，Lishui Women and Children’s Hospital in Zhejiang Province，Lishui 323000，China
[Abstract] Objective To investigate the effect of cesarean section delivery time on umbilical arterial blood gas and Apgar score. Methods A total of 318 puerpera undergoing selective cesarean section were enrolled in this study. Participants were divided into three groups according to Apgar grading standards： 0 to 3 as severe asphyxia group， 4 to 7 as mild asphyxia group and 8 to 10 as the control group. The delivery time， 1 min Apgar score， umbilical arterial blood gas analysis and lactic acid value were compared among the three groups. The correlation of delivery time with blood gas and Apgar score were also analyzed. Results Among 318 neonates， there were 3 cases of severe asphyxia with a delivery time of(186.20±12.00)s， 12 cases of mild asphyxia with a delivery time of(107.0±16.72)s， and 303 normal cases with a delivery time of(45.50±8.06)s， the difference was statistically significant(P<0.05). The blood gas analysis of umbilical arteries showed that the differences of pH， PaCO2， PaO2， Lac and BE value were statistically significant among three groups(P<0.05). There was a negative correlation between delivery time and pH of neonatal umbilical artery(r=-0.491， P=0.0017). There was a positive correlation between delivery time and neonatal umbilical artery Lac value(r=0.652， P<0.001). Conclusion During cesarean section， the delivery time should be limited within 120 s as much as possible， which can significantly reduce the incidence of neonatal asphyxia.
[Key words] Delivery time；Umbilical artery；Blood gas analysis；Lactic acid；Apgar score
新生儿窒息是导致新生儿死亡、脑损伤的主要原因之一。新生儿窒息发病机理是低氧血症和酸中毒引发的多脏器功能损害，大多数伴随着神经系统后遗症[1]。早期及時预防对于减少新生儿致残甚至死亡尤为重要[2]。在剖宫产手术中影响新生儿窒息因素较多，取胎时限是其中一个重要因素[3]，如发生取胎困难，将会明显增加新生儿窒息发生率及产妇损伤[4]。目前国内外关于剖宫产取胎时限的研究较少，且缺乏可应用于临床的相关指标。该研究收集2014年4月～2015年12月在我院妇产科出生的318例新生儿的信息，分析取胎时限对脐动脉血气Apgar 评分的影响，并以此试探讨取胎时限的范围。, http://www.100md.com(平永美 杜晓东 郑江美)