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目的 :探讨新生儿缺氧缺血性脑病与酸中毒类型及预后情况。方法 :通过给 84例患儿生后 2 4小时内取挠动脉血检测血气分析、血电解质 ,血生化全套计算阴离子间隙 (AG)值 ,判断缺氧缺血性脑病程度与酸中毒AG变化及病死率的关系。结果 :本组 84例中 ,重度HIE46例均有不同程度的单纯性代谢性酸中毒 ,pH <7.3 ,最低pH为 7 0。HCO3<2 4,最低为 9。其中多数存在混合性酸中毒 ,其PCO2 >6.6kPa ,最高达 9 7kPa ,尤其是伴高AG酸中毒的发生率均明显高于轻度HIE组 ,其中 5例死亡新生儿酸中毒伴高AG者为 4人 ,占 80 % ,3例死亡新生儿AG >2 3 ,随着HIE程度的增加 ,其高AG酸中毒发生率及严重度亦相应升高 ,P <0 .0 0 1,有非常显著差异。结论 :在重度缺氧引起重度HIE时 ,强调AG升高对于代谢性酸中毒的诊断价值优于碳酸氢盐降低。AG升高对于代谢性酸中毒 ,尤其是潜在性代谢性酸中毒具有一定的诊断价值。
Objective: To investigate neonatal hypoxic-ischemic encephalopathy and acidosis type and prognosis. Methods: A total of 84 children with intranasal blood gas analysis, blood electrolytes and blood biochemistry were used to calculate the value of AG during 24 hours after birth. The relationship between mortality. Results: The 84 cases of severe HIE in 46 cases had different degrees of simple metabolic acidosis, pH <7.3, the lowest pH of 70. HCO3 <2 4, a minimum of 9. Most of them have mixed acidosis, the PCO2> 6.6kPa, up to 9 7kPa, especially with high acidosis incidence was significantly higher than mild HIE group, of which 5 cases of neonatal acidosis with high AG were 4, accounting for 80%, 3 newborns died of AG> 2 3, with the increase of HIE level, the incidence and severity of high AG acidosis also increased accordingly, P <0. Significant differences. CONCLUSIONS: In patients with severe HIE caused by severe hypoxia, the emphasis on AG elevation is superior to bicarbonate in the diagnosis of metabolic acidosis. Increased AG for metabolic acidosis, especially the potential metabolic acidosis has a certain diagnostic value.