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1、新生儿血气分析与病情危重程度相关性分析摘要目的：总结 NICU 新生儿实验室检查结果，分析其与危重程度和预后的相关性，为临床衡量病情轻重和判断预后提供实验室依据。方法：收集重庆医科大学附属儿童医院 2015 年 7月至 12月 NICU 收治的资料完整的 250 例新生儿的病例资料，对其一般情况、实验室检查结果（包括血常规、血糖、电解质及血气分析）进行回顾性分析，比较不同危重组和不同预后组的各种实验室检查结果。结果：（1）本研究250例新生儿，男性患儿178例，女性患儿72例；早期新生儿占91.1%；早产儿占 61.3%，足月儿占 38.7%；平均出生体重为（2372.40743.29）g，其
2、中超低出生体重儿、极低出生体重儿、低出生体重儿、正常出生体重儿和巨大儿分别占 0.8%、9.3%、46.0%、42.3%和 1.6%。（2）所有患儿中主要诊断为新生儿肺炎和 NRDS 的患儿占 86.3%；治愈组、好转组和死亡或放弃组分别占 48.8%、45.6%和 5.6%；66.1%患儿住院天数在 14d 之内；根据 NCIS 评分，其中极危重者 4 例（占1.6%），危重者 169 例（占 67.6%），非危重者 77 例（占 30.8%）。（3）日龄3d，白细胞减少、正常和增多者分别占 1.0%、82.7%和 16.3%。日龄3d，白细胞减少、正常和增多者分别占 5.0%、85.0%和
3、 10.0%；足月儿中中性粒细胞减少占 26.0%（25/96 例），早产儿中性粒细胞减少占 17.1%（26/152 例）。（4）所有患儿平均 pH 值 7.190.12，pH 值降低者占 71.4%。血乳酸波动于 0.715mmol/L，2mmol/L 者占 7.2%（18/250 例），25mmol/L 者占 51.6%（129/250 例），5mmol/L 者占 41.2%（103/250例），其中乳酸酸中毒占所有患儿的 33.1%。HCO3-波动在 349.5mmol/L，HCO3-降低者占 79.1%。（5）除了在新生儿危重病例评分中已包括的实验室指标外，WBC、ANC、血乳酸和
4、HCO3-在不同危重等级组间比较有显著的统计学差异（P0.05），随着危重程度加重，WBC、ANC 和血乳酸升高，而 HCO3-降低。（6）在所有实验室指标中，pH 值和乳酸在不同预后组之间比较有显著的统计学差异（P0.05），死亡或放弃组的 pH 值最低，好转组的 pH 值最高，而死亡或放弃组的血乳酸水平最高，治愈组的血乳酸水平最低。结论：（1）NICU 患儿主要以早期新生儿、早产儿及低体重新生儿为主，病因大多为呼吸系统疾病。（2）绝大多数 NICU 患儿存在不同程度的血气紊乱，包括 pH 值及 HCO3-降低，血乳酸水平升高或乳酸酸中毒。（3）血乳酸水平和 NCIS 有显著的相关性，危重程
5、度越重，血乳酸水平越高。（4）血乳酸水平和预后也有显著的相关性，预后越差，血乳酸水平越高。故血乳酸水平测定对新生儿危重病例早期诊断是一项简易而灵敏的指标，并对预后判断有一定帮助，有望成为 NCIS 中的又一衡量病情轻重的量化指标。关键词：新生儿；重症监护病房；血气分析；病情危重评分；相关性AbstractObjective: To summarize the results of laboratory examination of neonatal NICU, analyze its correlation with the severity and prognosis of the clin
6、ical measure of the severity and prognosis judgment and provide laboratory evidence.Methods: collection of the childrens Hospital of Chongqing Medical University from July 2015 to 12 months in NICU data of 250 cases of neonatal clinical data, on the general situation, laboratory test results (includ
7、ing blood routine, blood glucose, electrolytes and blood gas analysis of) were retrospective analysis, comparison of different risk reorganization and different prognostic groups of laboratory tests.Results: (1) the study of 250 cases of neonatal, 178 cases of male patients, 72 cases of children wit
8、h women; early neonatal accounted for 91.1%; premature children accounted for 61.3%, full-term infants accounted for 38.7%; average birth weight was (743.29 2372.40 + G, the ultra low birth weight infants, very low birth weight infants, low birth weight infants and normal birth weight and macrosomia
9、 accounted for 0.8%, 9.3%, 46.0%, 42.3% and 1.6%. (2) all children in primary diagnosis for children with neonatal pneumonia and NRDS 86.3%; cure group, improved group and death or abandon the group accounted for 48.8%, 45.6% and 5.6%; 66.1% in hospitalization time in 14 days; according to NCIS scor
10、e, which critically severe in 4 cases (1.6%), critical, 169 cases (67.6%), non critical, 77 cases (30.8%). (3) days of age less than or equal to 3D, leukopenia, and normal increase accounted for 1%, 82.7% and 16.3%. Day old 3D, decreased white blood cells, normal and increased respectively, accounti
11、ng for 5.0%, 85.0% and 10.0%; reduction in neutrophils in full-term infants accounted for 26.0% (25/96 cases), preterm infants neutrophil decrease accounted for 17.1% (26/152 cases). (4) the average pH value of all the patients was 7.19 + 0.12, and the pH value decreased by 71.4%. Fluctuation of blo
12、od lactic acid to 0.7 15mmol / L, 5 mmol / L 46.2 41.2% (103/250 cases), the lactic acidosis accounted for 33.1% of all patients. HCO3- fluctuations in 3 HCO3-, 49.5mmol/L decreased 79.1%. (5) except in the neonatal critical illness score have been included in the laboratory indexes, WBC and ANC, bl
13、ood lactic acid and HCO3 - in different critical levels between groups had significant statistical difference (P 0.05), along with the aggravation of the severity, WBC and ANC and elevation of blood lactic acid and HCO3 - reduced. (6) in all laboratory indexes, pH and lactate between different progn
14、ostic groups compared with significant statistical difference (P 0.05), death, or give up group the pH minimum and improvement group the pH value was the highest, and death or give up group of blood lactic acid level the highest cure group of blood lactic acid level was the lowest.Conclusion: (1) NI
15、CU in children mainly in the early newborn, premature and low birth weight newborns, the cause of the disease is mostly respiratory diseases. (2) most NICU patients have different levels of blood gas disorder, including pH and HCO3-, the level of blood lactic acid or lactic acidosis. (3) there was a
16、 significant correlation between the level of blood lactic acid and NCIS, the more severe the critical degree, the higher the level of blood lactic acid. (4) there was a significant correlation between blood lactic acid level and prognosis, the worse the prognosis, the higher the level of blood lactic acid. It is a simple and sensitive index to measure the bl
