Shah Sachin, Tracy Mark, Smyth John
Neonatal Intensive Care Unit, Nepean Hospital, Sydney, NSW 2750, Australia.
J Perinatol. 2004 Jan;24(1):16-20. doi: 10.1038/sj.jp.7211023.
To compare the predictive value of pH, base deficit and lactate for the occurrence of moderate-to-severe hypoxic ischaemic encephalopathy (HIE) and systemic complications of asphyxia in term infants with intrapartum asphyxia.
We retrospectively reviewed the records of 61 full-term neonates (> or =37 weeks gestation) suspected of having suffered from a significant degree of intrapartum asphyxia from a period of January 1997 to December 2001. The clinical signs of HIE, if any, were categorized using Sarnat and Sarnat classification as mild (stage 1), moderate (stage 2) or severe (stage 3). Base deficit, pH and plasma lactate levels were measured from indwelling arterial catheters within 1 hour after birth and thereafter alongwith every blood gas measurement. The results were correlated with the subsequent presence or absence of moderate-to-severe HIE by computing receiver operating characteristic curves.
The initial lactate levels were significantly higher (p=0.001) in neonates with moderate-to-severe HIE (mean+/-SD=11.09+/-4.6) as compared to those with mild or no HIE (mean+/-SD=7.1+/-4.7). Also, the lactate levels took longer to normalize in these babies. A plasma lactate concentration >7.5+/-mmol/l was associated with moderate-or-severe HIE with a sensitivity of 94% and specificity of 67%. The sensitivity and negative predictive value of lactate was greater than that of the pH or base deficit.
The highest recorded lactate level in the first hour of life and serial measurements of lactate are important predictors of moderate-to-severe HIE.
比较pH值、碱缺失和乳酸对足月儿产时窒息后中重度缺氧缺血性脑病（HIE）及窒息相关全身并发症发生的预测价值。
我们回顾性分析了1997年1月至2001年12月期间61例怀疑有严重产时窒息的足月新生儿（孕周≥37周）的记录。如有HIE临床症状，根据萨纳特和萨纳特分类法分为轻度（1期）、中度（2期）或重度（3期）。出生后1小时内通过留置动脉导管测量碱缺失、pH值和血浆乳酸水平，此后每次进行血气分析时均进行测量。通过计算受试者工作特征曲线，将结果与随后是否发生中重度HIE进行相关性分析。
与轻度或无HIE的新生儿（均值±标准差=7.1±4.7）相比，中重度HIE新生儿的初始乳酸水平显著更高（p=0.001）（均值±标准差=11.09±4.6）。此外，这些婴儿的乳酸水平恢复正常所需时间更长。血浆乳酸浓度>7.5±mmol/L与中重度HIE相关，敏感性为94%，特异性为67%。乳酸的敏感性和阴性预测价值高于pH值或碱缺失。
出生后第一小时记录的最高乳酸水平及乳酸的系列测量是中重度HIE的重要预测指标。
