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目的探讨血浆游离钙([Ca2+]i)在血钙中的构成与新生儿重度窒息预后的关系。方法 73例新生儿重度窒息复苏后于生后2 h内、24～48 h、7 d各进行一次血浆[Ca2+]i与血钙的检测,将生后2 h内血浆[Ca2+]i在血钙中的构成比>0.48的30例作为A组,将该构成比≤0.48的43例作为B组。观察患儿生后24～48 h、7 d的血浆游离钙和血钙的变化和缺氧缺血性脑病(HIE)的发生率及严重程度。计量资料采用t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果生后2 h内所有病例血浆[Ca2+]i与血钙的测定值都在正常范围,血浆[Ca2+]i在血钙中的构成比A组>0.48,B组≤0.48。24～48 h血浆[Ca2+]i与血钙的测定值两组都较生后2 h内有明显的下降(P<0.01),且B组较A组下降幅度大(B组与A组相应值比较,P<0.01)。B组[Ca2+]i的下降更为明显(B组[Ca2+]i在血钙中的构成比下降了1.6%,而A组仅下降了0.2%),其中血浆[Ca2+]i<0.9 mmol/L的A组8例,占26.7%,B组35例,占81.4%,B组与A组低钙血症发生率差异有统计学意义(χ2=21.87,P<0.001)。经过系统治疗,A组16例HIE(轻度14例,中度2例),占53.3%,B组33例HIE(轻度21例,中度11例,重度1例),占76.7%,两组HIE发生率比较,B组高于A组(χ2=4.39,P<0.05)。两组中重度HIE的发生率比较,B组亦高于A组(连续性校正后χ2=3.86,P<0.05)。结论生后2 h内血浆[Ca2+]i在血钙中的构成比以0.48为界可以作为早期评估新生儿重度窒息预后的依据之一,该比值等于或低于0.48提示发生HIE的可能性大。
Objective To investigate the relationship between plasma calcium ([Ca2 +] i) in serum calcium and prognosis of neonatal severe asphyxia. Methods Serum [Ca2 +] i and serum calcium were detected in 73 neonates with severe asphyxia resuscitation within 2 hours, 24-48 hours and 7 days after birth. Plasma [Ca2 +] i was measured in blood Thirty cases with a compositional ratio of calcium> 0.48 were classified as group A, and 43 cases whose composition ratio was ≤0.48 were classified as group B. The change of plasma free calcium and serum calcium and the incidence and severity of hypoxic-ischemic encephalopathy (HIE) in 24-48 h, 7 d after birth were observed. Measurement data using t test, count data using χ2 test, P <0.05 for the difference was statistically significant. Results The measured values of plasma [Ca2 +] i and calcium in all cases within 2 hours after birth were within the normal range. The content of [Ca2 +] i in blood calcium was> 0.48 in group A, and 0.48.24 to 48 h in group B The plasma [Ca2 +] i and the measured value of serum calcium decreased significantly within 2 h after birth (P <0.01), and decreased more in group B than in group A (P and B respectively, P <0.01). The decrease of [Ca2 +] i in group B was more obvious (the proportion of [Ca2 +] i in blood group B decreased by 1.6% in group B compared with only 0.2% in group A) There were 8 cases in group A, 26.7% in group L, 35 cases in group B, accounting for 81.4%. There was significant difference in the incidence of hypocalcemia between group B and group A (χ2 = 21.87, P <0.001). After systematic treatment, 16 cases of HIE in group A (mild 14 cases, moderate 2 cases) accounted for 53.3%, group B 33 cases of HIE (mild 21 cases, moderate 11 cases, severe 1 case), accounting for 76.7% The incidence of HIE in both groups was higher in group B than in group A (χ2 = 4.39, P <0.05). The incidence of moderate and severe HIE in both groups was also higher in group B than in group A (χ2 = 3.86 after continuity correction, P <0.05). Conclusions The ratio of plasma [Ca2 +] i to calcium in plasma within 2 h after birth may be used as an early basis for assessing the prognosis of neonates with severe asphyxia, with a ratio equal to or lower than 0.48 indicating a high likelihood of developing HIE .