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目的探讨围产期窒息因素与血清心肌酶、Apgar、NBNA三者关系。方法筛选有明确围产期窒息因素新生儿86例与同期正常新生儿24例行血清心肌酶(AST、LDH、CK、CK-MB、HBDH)检测、Apgar评分、新生儿行为神经测定(NBNA)评分。结果①有明确围产期窒息因素的新生儿血清心肌酶明显高于同期正常新生儿心肌酶(P<0.01)。②有明确围产期窒息因素新生儿86例,其血清心肌酶异常者62例(占72%)、其Apgar评分≤7分者14例(占16%),两者比较差异显著(P<0.01)。3血清心肌酶异常者62例行NBNA评分≤35分18例,Apgar评分异常的14例新生儿NBNA评分≤35分11例。结论新生儿窒息后心肌酶明显高于正常新生儿心肌酶,心肌酶异常可作为判断新生儿窒息的可靠指标且优于Apgar评分;单纯以Apgar评分判断新生儿是否窒息、忽视围产期窒息因素等情况可能造成漏诊、漏治,是儿科医疗纠纷的隐患。
Objective To investigate the relationship between perinatal asphyxia and serum myocardial enzymes, Apgar and NBNA. Methods Eighty-six neonates with perinatal asphyxia and 24 normal neonates were enrolled in this study. Serum myocardial enzymes (AST, LDH, CK, MB, HBDH), Apgar score, neonatal behavioral nerve assay (NBNA) score. Results ① Serum myocardial enzymes of neonates with definite asphyxia factors were significantly higher than those of normal neonates during the same period (P <0.01). ②There were 86 neonates with perinatal asphyxia, 62 with abnormal myocardial enzymes (72%), 14 with Apgar scores ≤7 (16%), the difference was significant (P < 0.01). 3 abnormal serum myocardial enzymes in 62 cases NBNA score ≤ 35 points in 18 cases, Apgar score of 14 cases of neonatal NBNA score ≤ 35 points in 11 cases. Conclusions Myocardial enzymes in neonates with asphyxia are obviously higher than those in normal neonates. The abnormal myocardial enzymes can be used as a reliable indicator of neonatal asphyxia and better than the Apgar score. Apgar score can be used to determine whether neonates are asphyxiated or ignoring perinatal asphyxia factors Such circumstances may cause misdiagnosis, missed treatment, is a hidden danger of pediatric medical disputes.