Josten B E, Johnson T R, Nelson J P
Department of Family Practice, Malcolm Grow United States Air Force Medical Center, Andrews Air Force Base, Maryland.
Am J Obstet Gynecol. 1987 Oct;157(4 Pt 1):843-8. doi: 10.1016/s0002-9378(87)80069-8.
In an effort to determine the clinical usefulness of Apgar scoring and cord pH in neonatal management, specimens of umbilical cord blood were obtained after 257 of 329 consecutive deliveries at a community-based hospital. A notable number of babies who were born in a vigorous state were in fact acidotic (umbilical arterial pH greater than 1 SD below mean). Seventy-two percent of acidotic babies had an Apgar score greater than 7 at 1 minute, and 92% had an Apgar score greater than 7 at 5 minutes. Correlation coefficients of Apgar scores at 1 and 5 minutes and arterial pH with the health status of newborn infants were poor. A chi 2 analysis of arterial pH and Apgar scores at 1 and 5 minutes indicated that a larger number of sick babies had an Apgar score less than 7 and acidosis than expected by pure chance. However, the sensitivity values of the Apgar score at 1 minute (0.48) and 5 minutes (0.24) and the arterial pH (0.40) for predicting sick children limit the clinical usefulness of these tests. While technically feasible in a community hospital, routine cord pH measurements add little to neonatal evaluation and management.
为了确定阿氏评分和脐带血pH值在新生儿管理中的临床实用性，在一家社区医院连续329例分娩中的257例分娩后采集了脐带血样本。相当数量出生时状态良好的婴儿实际上存在酸中毒（脐动脉pH值低于平均值1个标准差）。72%的酸中毒婴儿1分钟时阿氏评分大于7分，92%的婴儿5分钟时阿氏评分大于7分。1分钟和5分钟时的阿氏评分以及动脉pH值与新生儿健康状况的相关系数较低。对1分钟和5分钟时的动脉pH值和阿氏评分进行的卡方分析表明，与纯粹随机情况相比，更多患病婴儿的阿氏评分低于7分且存在酸中毒。然而，1分钟（0.48）和5分钟（0.24）时阿氏评分以及动脉pH值（0.40）预测患病儿童的敏感度值限制了这些检查的临床实用性。虽然在社区医院技术上可行，但常规脐带血pH值测量对新生儿评估和管理的帮助不大。
