Brouillette R T, Waxman D H
The Department of Pediatrics, McGill University/Montreal Children's Hospital, Canada.
Clin Chem. 1997 Jan;43(1):215-21.
Blood gas measurements and complementary, noninvasive monitoring techniques provide the clinician with information essential to patient assessment, therapeutic decision making, and prognostication. Blood gas measurements are as important for ill newborns as for other critically ill patients, but rapidly changing physiology, difficult access to arterial and mixed venous sampling sites, and small blood volumes present unique challenges. This paper discusses considerations for interpretation of blood gases in the newborn period. Blood gas measurements and noninvasive estimations provide important information about oxygenation. The general goals of oxygen therapy in the neonate are to maintain adequate arterial PaO2 and SaO2, and to minimize cardiac work and the work of breathing. Pulse oximetry and transcutaneous oxygen monitoring are extraordinarily useful techniques of estimating and noninvasively monitoring the neonate's oxygenation, but each method has limitations. Arterial blood gas determinations of pCO2 provide the most accurate determinations of the adequacy of alveolar ventilation, but capillary, transcutaneous, and end-tidal techniques are also useful. An approach to and examples of acid-base disorders are presented. Three hemoglobin variants relevant to the newborn are considered: fetal hemoglobin, carboxyhemoglobin, and methemoglobin. Blood gases obtained in the immediate perinatal period can help assess perinatal asphyxia, but particular attention must be paid to the sampling site, the time of life, and the possible and proven diagnoses.
血气测量以及辅助的非侵入性监测技术为临床医生提供了对患者进行评估、做出治疗决策和预测所必需的信息。血气测量对于患病新生儿和其他重症患者同样重要，但新生儿生理状态快速变化、难以获取动脉和混合静脉血样采集部位以及血容量小等情况带来了独特的挑战。本文讨论了新生儿期血气解读的注意事项。血气测量和非侵入性评估提供了有关氧合的重要信息。新生儿氧疗的总体目标是维持足够的动脉血氧分压（PaO2）和血氧饱和度（SaO2），并尽量减少心脏做功和呼吸做功。脉搏血氧饱和度测定法和经皮氧监测是评估和非侵入性监测新生儿氧合的非常有用的技术，但每种方法都有局限性。动脉血二氧化碳分压（pCO2）的测定能最准确地判断肺泡通气是否充足，但毛细血管血、经皮和呼气末二氧化碳监测技术也很有用。本文介绍了酸碱紊乱的处理方法及实例。还讨论了与新生儿相关的三种血红蛋白变体：胎儿血红蛋白、碳氧血红蛋白和高铁血红蛋白。围生期即刻获取的血气有助于评估围生期窒息，但必须特别注意采样部位、出生时间以及可能的和已证实的诊断。
