Pinheiro J M B
Department of Pediatrics/Neonatology, Albany Medical College, Albany, New York, USA.
Arch Dis Child Fetal Neonatal Ed. 2009 Jan;94(1):F70-2. doi: 10.1136/adc.2008.145037. Epub 2008 Aug 14.
Apgar scores are universally recorded, but they should no longer be used to guide resuscitation; thus, some authorities have suggested that the scores should be abandoned. However, the physiological relationships underlying the elements of the Apgar scoring system can be conceptualised as a cycle, wherein the five functions are linked by cardiorespiratory reflexes and metabolically supported by the oxygen pathway. Respiratory effort represents both the main input into the system and its functional output (sustained respirations). The progressive deterioration of functions during asphyxia, and their recovery during resuscitation, are readily understood within the sequence. This depiction helps in learning concepts such as primary and secondary apnoea and bradycardia. The visual model harmonises the pedagogical and practical values of the Apgar scoring system, by placing the rapid assessment of respirations, heart rate and colour during neonatal resuscitation (as taught in the Neonatal Resuscitation Program) in its broader physiological context. The understanding imparted by the Apgar cycle may directly enhance patient care during resuscitation, apart from the attribution of numerical scores.
阿氏评分被广泛记录，但不应再用于指导复苏；因此，一些权威人士建议应摒弃该评分。然而，阿氏评分系统各项要素背后的生理关系可被概念化为一个循环，其中这五项功能通过心肺反射相互关联，并由氧代谢途径提供代谢支持。呼吸努力既是该系统的主要输入，也是其功能输出（持续呼吸）。窒息期间功能的逐渐恶化以及复苏期间功能的恢复，在这个序列中很容易理解。这种描述有助于理解诸如原发性和继发性呼吸暂停及心动过缓等概念。通过将新生儿复苏过程中对呼吸、心率和肤色的快速评估（如新生儿复苏项目中所教授的）置于更广泛的生理背景下，这个可视化模型协调了阿氏评分系统的教学价值和实用价值。除了给出数字评分外，阿氏循环所传达的理解可能会直接提高复苏期间的患者护理水平。
