出生时酸碱状态及阿氏评分对500 - 1000克婴儿存活率的影响。

Influence of acid-base status at birth and Apgar scores on survival in 500-1000-g infants.

作者信息

Gaudier F L, Goldenberg R L, Nelson K G, Peralta-Carcelen M, DuBard M B, Hauth J C

机构信息

Department of Obstetrics and Gynecology, University of Alabama at Birmingham, USA.

出版信息

Obstet Gynecol. 1996 Feb;87(2):175-80. doi: 10.1016/0029-7844(95)00407-6.

DOI:10.1016/0029-7844(95)00407-6

PMID:8559518

Abstract

OBJECTIVE

To evaluate the influence of acid-base status at birth and Apgar scores on survival in very low birth weight infants.

METHODS

We evaluated 1073 infants born alive and weighing 500-1000 g during 1979-1991; 658 had umbilical artery gas values examined. Apgar scores were assigned at 1 and 5 minutes after birth. Umbilical artery blood samples were collected at delivery for pH, carbon dioxide pressure (PCO2), and bicarbonate. Infants were grouped at 23-24, 25-26, 27-28, and 29 weeks or more. Using survival as the dependent variable, multiple logistic regression analyses were performed controlling for gestational age, birth weight, plurality, antenatal glucocorticoid use, mode of delivery, and year of birth, as well as for Apgar scores and cord blood gases.

RESULTS

In every gestational age grouping, compared with infants with a pH lower than 7.05, survival was higher in infants with an umbilical artery pH of 7.05 or higher, significantly so at 27-28 weeks. There was no consistent relationship between umbilical artery PCO2 or bicarbonate and survival. However, with the exception of the 1-minute Apgar score at 23-24 weeks, the relationship of Apgar scores to survival was significant in all gestational age periods. Using multiple logistic regression analyses, the only significant relationships between any of the cord blood gases, Apgar scores, and mortality involved low 1-minute (odds ratio [OR] 2.7 [95% confidence interval (CI) 2.0-3.6]) and low 5-minute Apgar scores (OR 2.8 [95% CI 2.0-3.8]) and a bicarbonate less than 21 mEq/L (OR 1.6 [95% CI 1.1-2.4]).

CONCLUSION

One- and 5-minute Apgar scores are better predictors of survival than umbilical artery blood gases in neonates weighing 500-1000 g at birth.

摘要

目的

评估出生时酸碱状态及阿氏评分对极低出生体重儿生存的影响。

方法

我们评估了1979年至1991年间出生且体重在500 - 1000克的1073例存活婴儿；其中658例检测了脐动脉血气值。出生后1分钟和5分钟时进行阿氏评分。分娩时采集脐动脉血样检测pH值、二氧化碳分压（PCO2）和碳酸氢盐。婴儿按孕周分为23 - 24周、25 - 26周、27 - 28周以及29周及以上组。以生存作为因变量，进行多因素逻辑回归分析，控制孕周、出生体重、多胎情况、产前糖皮质激素使用、分娩方式、出生年份，以及阿氏评分和脐血血气值。

结果

在每个孕周分组中，与脐动脉pH值低于7.05的婴儿相比，脐动脉pH值为7.05或更高的婴儿生存率更高，在27 - 28周时差异显著。脐动脉PCO2或碳酸氢盐与生存之间没有一致的关系。然而，除了23 - 24周时的1分钟阿氏评分外，阿氏评分与生存的关系在所有孕周期间均显著。通过多因素逻辑回归分析，脐血血气值、阿氏评分与死亡率之间唯一显著的关系包括低1分钟阿氏评分（比值比[OR] 2.7 [95%置信区间（CI）2.0 - 3.6]）、低5分钟阿氏评分（OR 2.8 [95% CI 2.0 - 3.8]）以及碳酸氢盐低于21 mEq/L（OR 1.6 [95% CI 1.1 - 2.4]）。