正常新生儿及胎儿宫窘迫新生儿的乳酸测定.docVIP

正常新生儿及胎儿宫内窘迫新生儿的乳酸测定 刘晓巍 吴连方 首都医科大学附属北京妇产医院 100006 【摘要】 目的：乳酸作为无氧代谢的终产物，可直接反应缺氧和代谢性酸中毒的程度，应用微量乳酸检测仪，简单易行、需血量少（5ul）。本研究的目的是摸索正常新生儿乳酸的范围及研究脐动脉血乳酸水平与脐血血气的相关关系。方法：对108例正常新生儿及55例诊断胎儿宫内窘迫的新生儿，在建立自主呼吸以前，分别采集脐动脉血、脐静脉血及末梢血，应用微量乳酸测定仪，测定相应的乳酸值，并对临床诊断胎儿宫内窘迫的新生儿同时监测脐动脉血的血气分析。结果：1、108例正常新生儿的乳酸平均范围分别为脐动脉血2.6±1.4mmol/L、脐静脉血2.3±1.2mmol/L、末梢血2.8±1.3mmol/L。2、55例胎儿宫内窘迫新生儿乳酸平均范围分别为脐动脉血4.3±2.4mmol/L、脐静脉血3.9±2.1mmol/L、末梢血4.1±2.0mmol/L。3、对55例可疑胎儿宫内窘迫的监测提示，只有13例pH值≤7.20（提示缺氧和酸中毒），其相应乳酸范围分别为脐动脉血6.3±2.3mmol/L。4、脐动脉血、脐静脉血及末梢血乳酸值之间的直线相关关系明显，p值＜0.01。5、新生儿的乳酸水平与相应的血气分析比较，乳酸分别与pH值、HCO3ˉ、Pco2相关关系非常明显。结论：1、新生儿脐动脉、脐静脉、末梢血的乳酸值具有明显的相关关系，测量其一即可代表新生儿的乳酸水平。2、乳酸与pH值、HCO3ˉ呈明显负相关，尤其与pH值呈明显的直线相关，可作为代谢性酸中毒的监测指标。3、正常新生儿及第一产程的乳酸界值可为3.0mmol/L，第二产程及缺氧、酸中毒的乳酸界值可为4.7mmol/L，两者之间则为可疑。 【关键词】 新生儿 乳酸 胎儿宫内窘迫 血气分析 酸中毒 Lactate Levels From Neonates of Normal or Intrauterine Fetal Distress 【ABSTRACT】 OBJECTIVE： Lactate acid is the end product of anaerobic metabolism, it can reflect the degree of hypoxia and metabolic. Micro-lactate monitor is simple to use, and only 5ul blood is needed. The objective is to find out the normal neonatal lactate value and the lactate value’s relationship with the umbilical artery blood gas . METHODS: The lactate acid values from umbilical artery blood, umbilical vein blood and ending blood of 108 cases of normal neonates and 55 cases of neonates diagnosed with intrauterine fetal distress were detected before their self breath setting up with micro-lactate monitor, and we measured umbilical artery blood gas to the other 55 cases simultaneously. RESULTS: 1、The average lactate acid values of 108 cases of normal neonates are 2.6±1.4mmol/L from umbilical artery blood and 2.3±1.2mmol/L from umbilical vein blood respectively and 2.8±1.3mmol/L from ending blood. 2、The average lactate acid values of 55 neonates with intrauterine distress are 4.3±2.4mmol/L from umbilical artery blood, 3.9±2.1mmol/L from umbilical vein blood, and 4.1±2.0mmol/L from ending blood respectively. 、Through we have tes