CAJ | 학술논문

目的探讨无窒息的宫内窘迫胎儿出生后是否合并有心肌损伤,以及检测心肌损伤的生化敏感指标.方法 2009年7月至12月,随机选择中山大学附属第一医院分娩的、有宫内窘迫史的53例新生儿为宫内窘迫组,新生儿出生后Apgar评分1 min及5 min均＞7分.同期分娩的无宫内窘迫史的新生儿36例作为对照组,新生儿出生后Apgar评分1 min及5 min均为10分.胎儿娩出后立即抽取脐动脉血进行血气分析和生化指标测定.结果 (1)宫内窘迫组新生儿脐动脉血pH值及剩余碱分别为7.23±0.07及(-4.8±3.0)mmol/L,明显低于对照组的7.31±0.03及(-2.1±1.5)mmol/L,两组比较,差异有统计学意义(P＜0.05).宫内窘迫组新生儿脐动脉血乳酸水平为(5.2±2.3)mmol/L,明显高于对照组的(2.3±1.1)mmol/L,两组比较,差异有统计学意义(P＜0.01).宫内窘迫组新生儿脐动脉血氧分压及二氧化碳分压水平分别为(16.2±7.9)及(54.0±11.2)mm Hg(1mm Hg=0.133 kPa),对照组分别为(17.5±6.7)及(48.5±5.4)mm Hg,两组分别比较,差异均无统计学意义(P＞0.05).(2)宫内窘迫组新生儿脐动脉血肌酸激酶同工酶MB(CK-MB)水平为(48±59)U/L,对照组为(36±27)U/L,两组比较,差异有统计学意义(P＜0.05);宫内窘迫组新生儿脐动脉血肌酸激酶(CK)及脑钠肽(BNP)水平分别为(194±73)U/L及(519±309)ng/L,对照组分别为(162±95)及(481±216)ng/L,两组比较,差异无统计学意义(P＞0.05).(3)新生儿脐动脉血CKMB水平与脐动脉血pH值、剩余碱呈负相关性(r=-0.296及-0.318,P均＜0.05);BNP与乳酸水平呈正相关(r=0.278,P＜0.05);其余各变量间均无相关性(P＞0.05).结论宫内窘迫的胎儿即使出生时无新生儿窒息的表现,也存在着不同程度的心肌损伤;脐血CK-MB水平变化可作为监测心肌损伤的敏感指标,心肌损伤的程度与胎儿酸中毒的程度有关.
목적 탐토무질식적궁내군박태인출생후시부합병유심기손상,이급검측심기손상적생화민감지표.방법 2009년7월지12월,수궤선택중산대학부속제일의원분면적、유궁내군박사적53례신생인위궁내군박조,신생인출생후Apgar평분1 min급5 min균＞7분.동기분면적무궁내군박사적신생인36례작위대조조,신생인출생후Apgar평분1 min급5 min균위10분.태인면출후립즉추취제동맥혈진행혈기분석화생화지표측정.결과 (1)궁내군박조신생인제동맥혈pH치급잉여감분별위7.23±0.07급(-4.8±3.0)mmol/L,명현저우대조조적7.31±0.03급(-2.1±1.5)mmol/L,량조비교,차이유통계학의의(P＜0.05).궁내군박조신생인제동맥혈유산수평위(5.2±2.3)mmol/L,명현고우대조조적(2.3±1.1)mmol/L,량조비교,차이유통계학의의(P＜0.01).궁내군박조신생인제동맥혈양분압급이양화탄분압수평분별위(16.2±7.9)급(54.0±11.2)mm Hg(1mm Hg=0.133 kPa),대조조분별위(17.5±6.7)급(48.5±5.4)mm Hg,량조분별비교,차이균무통계학의의(P＞0.05).(2)궁내군박조신생인제동맥혈기산격매동공매MB(CK-MB)수평위(48±59)U/L,대조조위(36±27)U/L,량조비교,차이유통계학의의(P＜0.05);궁내군박조신생인제동맥혈기산격매(CK)급뇌납태(BNP)수평분별위(194±73)U/L급(519±309)ng/L,대조조분별위(162±95)급(481±216)ng/L,량조비교,차이무통계학의의(P＞0.05).(3)신생인제동맥혈CKMB수평여제동맥혈pH치、잉여감정부상관성(r=-0.296급-0.318,P균＜0.05);BNP여유산수평정정상관(r=0.278,P＜0.05);기여각변량간균무상관성(P＞0.05).결론 궁내군박적태인즉사출생시무신생인질식적표현,야존재착불동정도적심기손상;제혈CK-MB수평변화가작위감측심기손상적민감지표,심기손상적정도여태인산중독적정도유관.
Objective To investigate whether no asphyxia neonates with intrauterine distress are complicated with myocardial injury and determine the sensitive biochemical diagnostic parameters. Methods A total of 89 neonates born in the First Affiliated Hospital of Sun Yat-sen University from July 2009 to December 2009 were enrolled. Fifty-three fetal distress cases with Apgar score ＞ 7 at 1 and 5 minites were enrolled in the study group; while the rest 36 healthy neonates, whose Apgar score = 10 at 1 and 5 minites, were the control group. Umbilical artery blood samples of all cases were collected for blood gas analysis and biochemical measurement. Results(1)pH(7.23±0.07) and BE [(-4.8±3.0)mmol/L] in the study group were significantly lower than pH (7.31 ±0.03) and BE [(-2.1±1.5)mmol/L] in the control group (P＜0.05).The lactic acid of study group [(5.2±2.3)mmol/L] was higher than that of the control group [(2.3±1.1)mmol/L], and the difference was significant (P＜0.01). However, there was no significant difference between the two groups in PaO2[(16.2±7.9)mm Hg(1 mm Hg=0.133 kPa) vs. (17.5±6.7)mm Hg] and PaCO2[(54.0±11.2)mm Hg vs. (48.5±5.4) mm Hg; P＞0. 05]. (2) The level of CK-MB in neonates with fetal distress[(48 ±59) U/L] was significantly higher than that of healthy neonates [(36±27)U/L]. However, no significant difference was found in CK [(194±73)U/L vs. (162±95) U/L]and BNP levels[(519±309)ng/L vs.(481±216)ng/L;P ＞ 0.05]. (3) Spearman rank correlation analysis showed that CK-MB level was negatively correlated with pH(r=-0.296, P＜0.05) and BE (r=-0.318,P＜0.05) of umbilical artery blood,while BNP level was positively correlated with umbilical lactic acid (r=0.278, P＜0.05). No correlation was found between other parameters (P＞0.05).Conclusions Intrauterine distress without neonatal asphyxia had effect on fetal myocardial injury. CK-MB can be used as a sensitive parameter for monitoring the development of myocardial injury. The severity of myocardial injury was related to fetal acidosis.