| Research background and objectiveNeonatal asphyxia refers to the failure of newborns to establish normal respiration of after birth due to antenatal,intrapartum or postpartum pathogenesis,which causes anoxia and systemic multiple organ damage and is one of the primary reasons of the death and disability of newborn in perinatal period.The basic reason of asphyxia is hypoxia,the longer the time of asphyxia is,the severer of the degree of anoxia and the system and organ damage of the body becomes.The newborn with asphyxia cannot have effective respiration after birth.The opening of alveoli is blocked,the absorption of lung fluid is influenced,the effective gas exchange can not be formed,so as to cause anoxia.SPO2 is reduced in asphyxia,with poor oxygenation,increasing anaerobic glycolysis and accumulation of lactic acid,which can cause prolonged contraction of pulmonary arteriole of child patients,continuous patent ductus arteriosus and blood shunt to aorta through arterial duct,which can aggravate anoxia.Apgar score is the most convenient and practical method of assessing neonatal asphyxia with international recognition in the traditional significance.But Apgar score can be influenced by premature delivery,certain congenital malformation,medication of puerpera before delivery and other reasons,therefore,Apgar score has certain limitation of estimating the degree of neonatal asphyxia and prognosis,therefore,in the recent years,many domestic and abroad experts and scholars proposed ABG(arterial blood gases)determination in newborns with anoxia after birth so that to provide reference base for clinical diagnosis and treatment.PH value of newborns with asphyxia in clinic in ABG index is low,lactic acid value is high,absolute value of base excess is increased,with the exacerbation of asphyxia and anoxia,the abnormality of all ABG indexes becomes more significant.In this research,through the retrospective analysis on all ABG indexes of newborns with asphyxia in our hospital,lactic acid,PH determination and Apgar score,the correlation of degree of neonatal asphyxia and the active significance on the diagnosis of neonatal asphyxia,clinical treatment and prognosis were studied.Research method(Ⅰ)Research object:60 single-birth term newborns with asphyxia delivered in Maternity and Child Health Care of Zaozhuang from March,2014 to November,2014 were selected andall were admitted to hospital one hour after birth.The diagnostic criterion is based on Practice of Neonatology(Edition 4,edited by Shao Xiaomei et al.).According to one minute score,they were divided into severe asphyxia group 11 cases(0-3 scores),mild asphyxia group 49 cases(4-7 scores).Besides,30 normal newborns were selected as the control group for contrastive analysis(Apgar score 8-10).Cases with history of fetal distress in uterus were excluded in the control group.Congenital malformation,infectious diseases,hereditary metabolic diseases and so on were excluded in all cases,among which,49 male newborns and 41 female newborns were included.The difference of the sex,birth weight,delivery way etc.of child patients in all groups had no statistical significance(P>0.05).(Ⅱ)Research method1.Specimen collection and detection means of peripheral arterial blood of newborns:injectors treated with heparin were used to extract radial artery blood of right hand 1ml of all newborns within one hour after birth;the specimens were sealed immediately after exhaust and detected within 5 minutes.The full automatic blood-gas analyzer was used to detect PH,Lac,Pa02 and PaC02 values of peripheral blood.2.Apgar score:refer to Practice of Neonatology(Edition 4)edited by Shao Xiaomei et al.1 minute and 5 minutes after the birth of newborns,conventional Apgar score was performed.When 5 minute score<7 scores,the score was performed every other 5 minutes,and to 20 minutes.3.Degrees of neonatal asphyxia:severe asphyxia:Apgar score one minute after birth<3,or Apgar score 5 minutes after birth ≤ 5,accord with any one of them;mild asphyxia:Apgar score 1 minute after birtd>3,but≤ 7,or though 1 minute score>7,5 minute Apgar score:≤ 3,≤ 7,or though 1 minute score>7,5 minute Apgar score<7,>3.4.Diagnostic criteria of HIE:refer to Practice of Neonatology(Edition 4)edited by Shao Xiaomei et al.(1)Medical history:with defined evidences of abnormal obstetric pathological conditions and cause fetal intrauterine hypoxia,and defined fetal intrauterine distress;or combined with grade 3 pollution of amniotic fluid,or defined history of asphyxia during birth process;(2)physical examination:newborns with abnormal manifestations of nervous quickly after birth,and with symptoms existing over 24 hours.(3)Support of imageological examination.(Ⅲ)Statistical methodSPSS 17.0 statistics software was used to analyze all statistical data.Measurement data was represented with mean ± standard deviation,the nonparametric rank sum test was used in comparison among groups;chi-square test was used in the test of enumeration data.When P<0.05,the difference has statistical significance.Research results1.In the newborns in this research,according to the results of rank sum test and comparison among severe asphyxia group,mild asphyxia group and control group,PH,PaC02,Lac had difference,and the difference had significant statistical significance(p<0.05);in the comparison among severe asphyxia group,mild asphyxia and control group,PH value was reduced,Lac was increased.The difference of PaC02 among severe asphyxia group,mild asphyxia and control group had statistical significance(p<0.05).2.Among 60 newborns with asphyxia in this research,5 newborns were combined with HIE,among which,2 had died after being abandoned,the dead newborns were all newborns with severe asphyxia.3.Mild asphyxia group PH<7.0 accounted for 6 cases(12.2%),PH>7.0 accounted for 43 cases(87.8%),severe asphyxia group PH<7 accounted for 6 cases(54.5%),>7 accounted for 5 cases(45.5%),the difference between two groups had statistical significance.(p<0.05). |
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