作　　者： ; ; ;

机构地区： 中山市中医院

出　　处： 《黑龙江医学》 2019年第12期1448-1451,共4页

摘　　要： 目的探讨产后不夹闭脐带实施延迟断脐的过程中,采集脐动脉血气标本的可行性和临床意义。方法正常足月健康新生儿50例,在生后15 s内夹闭脐带采血(1组),放开夹闭后再次采血(2组),1 min时(3组),脐带搏动停止时(约3 min时)(4组)共采4次。同时在足背进行经皮血氧饱和度的测量,观察记录并进行分析。结果新生儿脐动脉血气分析pH值平均(7.25±0.08)mmol/L,经皮测足背血氧饱和度平均值(89.24±5.90)mmHg。单因素方差分析ANOVA结果显示,不同分组间的脐动脉血pH值差异无统计学意义(F=0.921,P=0.432),随生后时间推移,血气pH值相对稳定在7.23~7.26之间;经皮测血氧饱和度组间比较差异有统计学意义(F=131.291,P=0.000),组间分析显示,1组与2组间差异无统计学意义,其他各组间差异均有统计学意义,血氧饱和度呈现上升趋势直至100%。按pH值为7.00,7.10,7.15和7.20为新生儿窒息诊断的下限,分别有0、18%、46%和67%的新生儿会达到下限。结论不夹闭脐带直接在搏动的血管上进行采血是可行的方法,新生儿脐动脉血pH值在生后15 s,1 min和3 min没有明显的变化,处于一个稳定的水平;经皮血氧饱和度自76%逐渐上升达到100%。正常足月新生儿Apgar评分大于8分者的脐动脉血pH值可达7.02,没有窒息表现,建议将pH值<7.02结合临床表现作为新生儿窒息的客观标准,并在采集脐动脉血气标本时保持脐带不夹闭,以保证新生儿得到延迟断脐的益处。 objective to investigate the feasibility and clinical significance of collecting umbilical artery blood gas samples during delayed umbilical cord amputation without clamping.Methods the umbilical cord was clamped and blood samples were collected from 50 cases normal healthy full-term neonates within 15 seconds after birth(group1),and again after the clamping was released(group2),at 1 minute(group3)and 3 minutes(group4).Meanwhile,percutaneous oxygen saturation was measured at the dorsum of the foot,observed,recorded and analyzed.Results:the mean pH value of neonatal umbilical artery blood gas analysis was 7.250.08(mmol/L),(7.02-7.50),Mean blood gas partial pressure measured by skin was 89.245.90(mmHG),(76-100).ANOVA analysis showed that there was no statistical difference in the PH value of the umbilical artery between different groups(F=0.921 P=0.432),and the blood gas PH value was relatively stable between 7.23-7.26 with the passage of time after birth.There was a difference in percutaneous blood oxygen saturation between the groups(F=131.291 P=0.000),and further 22 analysis showed that there was no statistical difference between the groups 1 and 2,while there was a statistical difference between the other groups,and the blood oxygen saturation showed an upward trend until 100%.According to pH 7.00,7.10,7.15 and 7.20 as the lower limit of neonatal asphyxia diagnosis,0%,18%,46%and 67%of newborns will reach ed the lower limit,respectively.Conclusion it is feasible to collect blood directly on pulsatile vessels without clamping umbilical cord.Percutaneous oxygen saturation gradually increased to 100%.The PH of umbilical arterial blood of normal full-term neonates can reach 7.02.It is suggested pH less than 7.02 combined with clinical manifestations can be regarded as the objective standard of neonatal asphyxia,and keep umbilical cord unclipped during the collection of umbilical artery blood gas samples to ensure the benefit of delayed umbilical amputation for neonates.

关 键 词： 延迟断脐 脐动脉血气分析 经皮血氧饱和度 新生儿窒息

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