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北京大学学报（医学版） ›› 2019, Vol. 51 ›› Issue (1): 159-164. doi: 10.19723/j.issn.1671-167X.2019.01.027

• 论著 • 上一篇    下一篇

脐动脉血气pH值对剖宫产新生儿住院期间并发症的预测价值

包菊1,刘佳2,曲元1,穆东亮1,△()   

  1. 1. 北京大学第一医院 麻醉科,北京　100034
    2. 北京大学第一医院 手术室, 北京　100034
  • 收稿日期:2018-05-21 出版日期:2019-02-18 发布日期:2019-02-26
  • 通讯作者: 穆东亮 E-mail:mudongliang@icloud.com

Predictive value of umbilical arterial cord pH on complications during hospitalization in neonates after cesarean section

Ju BAO1,Jia LIU2,Yuan QU1,Dong-liang MU1,△()   

  1. 1. Department of Anesthesiology,Peking University First Hospital,Beijing 100034, China
    2. Department of Operation Room,Peking University First Hospital,Beijing 100034, China
  • Received:2018-05-21 Online:2019-02-18 Published:2019-02-26
  • Contact: Dong-liang MU E-mail:mudongliang@icloud.com

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摘要：

目的:分析脐动脉血气pH值对剖宫产新生儿住院期间并发症的预测价值。方法:本研究为回顾性队列研究,选择2017年1月1日至6月30日在北京大学第一医院剖宫产娩出并完成脐动脉血气分析的新生儿为研究对象,主要观察终点是新生儿住院期间并发症发生率。按照新生儿是否发生住院期间并发症将研究对象分为两组,比较两组间脐动脉血气pH值。收集母婴围产期的资料和新生儿住院期间并发症的资料,采用ROC曲线分析脐动脉血气pH对新生儿住院期间并发症的预测价值。结果:共纳入872例新生儿(择期541例、急诊331例),新生儿住院期间并发症的总体发生率为14.1%,其中发生率最高的3项分别为感染、吸入性肺炎及心肌损伤。无并发症组pH值平均为7.31,有并发症组pH值平均为7.29,组间比较差异有统计学意义(P<0.001)。本研究中pH≤7.20的总体比例为3.1%(27/872),其中无并发症组pH值≤7.20的比例为1.6%(12/749),有并发症组pH值≤7.20的比例为12.2%(15/123),组间比较差异有统计学意义(P<0.001)。多因素Logistic回归分析显示,早产(OR=8.224, 95%CI: 4.910~13.777, P<0.001)、妊娠期高血压(OR=1.886, 95%CI: 1.004~3.546, P=0.049)、宫内生长受限(OR=4.429, 95%CI: 1.280~15.330, P=0.019)、急诊剖宫产(OR=2.711, 95%CI: 1.682~4.369, P<0.001)、脐动脉血气pH值≤7.20(OR=7.420, 95%CI: 2.951~18.655, P<0.001)及5分钟Apgar评分小于10分(OR=11.849, 95%CI: 3.977~35.128, P<0.001)是新生儿发生住院期间并发症的危险因素。脐动脉血气pH值预测全部新生儿、择期新生儿及急诊新生儿住院并发症的ROC曲线下面积分别为0.570(95%CI: 0.508~0.633, P=0.012)、0.559(95%CI: 0.465~0.652, P=0.189)及0.617(95%CI: 0.538~0.697, P=0.002)。结论:脐动脉血气pH值≤7.2与剖宫产新生儿住院并发症发生率增加有相关性,但是ROC分析显示其预测价值较低。

关键词: 脐动脉, 血气分析, 氢离子浓度, 婴儿, 新生, 疾病, 剖宫产术

Abstract:

Objective: To analyze the predictive value of umbilical arterial cord pH on complications of hospitalized neonates after cesarean section. Methods: This was a retrospective cohort study and carried out in Peking University First Hospital from January 1,2017 to June 30,2017. Neonates who were deli-vered by cesarean section were enrolled. The primary endpoint was the incidence of complications during in-hospital stay (including infection,aspiration pneumonia,myocardial damage,etc.). The subjects were divided into two groups:with or without complication. The umbilical arterial cord pH values were compared between the two groups. Perinatal baseline characteristics of maternal and neonatal data were recorded. The ROC curve was used to analyze the value of umbilical arterial cord pH in predicting neonatal complications during hospitalization. Multivariate Logistic regression was employed to analyze the potential risk factors of neonatal complications. Results: In the study,872 neonates were included in the final analysis (541 in elective surgery and 331 in emergency surgery). The overall incidence of neonatal complications during hospitalization was 14.1%. The first three higher incidences were infection,aspiration pneumonia and myocardial damage. The average pH value in neonates without complication was 7.31 while 7.29 in neonates with complication. There was statistical significance between the two groups (P<0.001). The overall incidence of pH≤7.20 was 3.1% (27/872). The patients in neonates without complication had higher incidence of pH≤7.20 than those in neonates with complication (1.6% vs. 12.2%, P<0.001). Multivariate Logistic regression showed 6 risk factors of neonatal hospitalized complications including preterm delivery (OR=8.224,95%CI:4.910-13.777, P<0.001),pregnancy-induced hypertension (OR=1.886,95%CI:1.004-3.546,P=0.049), intrauterine growth restriction (OR=4.429,95%CI:1.280-15.330,P=0.019), emergency cesarean section (OR=2.711,95%CI:1.682-4.369,P<0.001),umbilical arterial blood gas pH≤7.20 (OR=7.420,95%CI:2.951-18.655,P<0.001) and 5-minute Apgar score <10 scores (OR=11.849,95%CI:3.977-35.128,P<0.001). The areas under the ROC curve of umbilical arterial blood gas pH in all neonatal,elective and emergency cesarean section were 0.570 (95%CI:0.508-0.633,P=0.012),0.559 (95%CI:0.465-0.652,P=0.189) and 0.617 (95%CI:0.538-0.697,P=0.002),respectively. Conclusion: Umbilical arterial cord pH≤7.20 was related with increased incidence of neonatal complications after cesarean section,but ROC curve analysis showed a lower predictive value.

Key words: Umbilical arteries, Blood gas analysis, Hydrogen-ion concentration, Infant, newborn, diseases, Cesarean section

中图分类号: 

  • R722.1

表1

基本资料"

Variables Total
(n=872)		 Without complication
(n=749)		 With complication
(n=123)		 P value
Age (≥35 years), n (%) 339 (38.9) 296 (39.5) 43 (35.0) 0.370
BMI/(kg/m2), x?±s 28.05±3.65 27.98±3.59 28.54±3.94 0.138
Preterm (<37 weeks), n (%) 114 (13.1) 56 (7.5) 58 (47.2) <0.001
Gestation (frequency), median (minimum, maximum) 2 (1, 7) 2 (1, 7) 2 (1, 7) 0.128
Production (frequency), median (minimum, maximum) 1 (0, 3) 1 (0, 3) 1 (0, 3) 0.405
ASA classification, n (%) <0.001
Ⅰ 108 (12.4) 98 (13.1) 10 (8.1)
Ⅱ 709 (81.3) 621 (82.9) 88 (71.5)
Ⅲ 55 (6.3) 30 (4.0) 25 (20.3)
Maternal comorbidity, n (%)
Hypertension 30 (3.7) 26 (3.5) 4 (3.3) >0.999
Diabetes 21 (2.4) 20 (2.7) 1 (0.8) 0.341
Renal diseases 16 (1.8) 12 (1.6) 4 (3.3) 0.264
Previous cesarean delivery 278 (51.3) 253 (51.1) 25 (54.3) 0.758
PIH 87 (10.0) 55 (7.3) 32 (26.0) <0.001
GDM 248 (28.4) 211 (28.2) 37 (30.1) 0.667
Fetal conditions, n (%)
Twins 162 (18.6) 130 (17.4) 32 (26.0) 0.033
Cord around the neck 344 (39.4) 300 (40.1) 44 (35.8) 0.426
IUGR 18 (2.1) 9 (1.2) 9 (7.3) <0.001

表2

围术期资料"

Variables Total (n=872) Without complication (n=749) With complication (n=123) P value
Emergency surgery, n (%) 331 (38.0) 254 (33.9) 77 (62.6) <0.001
Anesthetic technique, n (%) 0.019
Neuraxial anesthesia 843 (96.7) 729 (97.3) 114 (92.7)
General anesthesia 22 (2.5) 14 (1.9) 8 (6.5)
Combined anesthesia 7 (0.8) 6 (0.8) 1 (0.8)
Anesthesia time/min, x?±s 89.7±19.7 89.5±18.8 90.2±24.3 0.457
Operation time/min, x?±s 50.6±16.6 50.1±15.9 53.6±20.3 0.071
Hypotension, n (%)a 206 (23.6) 183 (24.4) 23 (18.7) 0.172
Volume transfusion/mL, x?±s 965.4±446.2 967.2±429.8 954.9±537.3 0.810
Neonatal conditions
Male, n (%) 462 (53.0) 392 (52.3) 70 (56.9) 0.381
Neonatal weight/g, x?±s 3 191.1±595.9 3 258.7±519.6 2 778.1±824.7 <0.001
1-min Apgar scores, x?±s 9.8±0.6 9.9±0.4 9.0±1.6 <0.001
5-min Apgar scores, x?±s 9.9±0.2 10.0±0.1 9.8±0.7 <0.001
UABGA pH, x?±s 7.30±0.05 7.31±0.04 7.29±0.08 0.003
UABGA pH classification, n (%) <0.001
≤7.20 27 (3.1) 12 (1.6) 15 (12.2)
Elective 5 (0.6) 4 (0.5) 1 (0.8)
Emergency 22 (2.5) 8 (1.1) 14 (11.4)
≥7.21 845 (96.9) 737 (98.4) 108 (87.8)
Elective 536 (61.5) 491 (65.6) 45 (36.6)
Emergency 309 (35.4) 246 (32.8) 63 (51.2)

表3

新生儿住院期间并发症的危险因素"

Variables Univariate analysis Multivariate Logistic regression analysis
OR (95%CI) P OR (95%CI) P
Preterm delivery 11.042 (7.065-17.259) <0.001 8.224 (4.910-13.777) <0.001
Age>35 years 0.823 (0.552-1.225) 0.337
Twins 1.674 (1.073-2.613) 0.023
GDM 1.097 (0.723-1.664) 0.663
PIH 4.437 (2.725-7.225) <0.001 1.886 (1.004-3.546) 0.049
IUGR 6.491 (2.524-16.696) <0.001 4.429 (1.280-15.330) 0.019
ECS 3.262 (2.197-4.844) <0.001 2.711 (1.682-4.369) <0.001
Hypotension 0.711 (0.439-1.153) 0.167
UABGA pH≤7.20 8.530 (3.889-18.711) <0.001 7.420 (2.951-18.655) <0.001
5-min Apgar scores < 10 26.974 (10.682-68.113) <0.001 11.849 (3.977-35.128) <0.001

图1

pH值对剖宫产新生儿住院期间并发症的ROC曲线"

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