MULTIPLE ORGAN INVOLVEMENT IN PERINATAL ASPHYXIA
MULTIPLE ORGAN INVOLVEMENT IN PERINATAL ASPHYXIA
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DOI：
10.1016/s0022-3476(95)70174-5
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发表时间：
1995-11-01
影响因子：
5.1
通讯作者：
QUERO, J
中科院分区：
文献类型：
--
作者：
MARTINANCEL, A;GARCIAALIX, A;QUERO, J
目的：(1)评估围产期窒息后多系统功能障碍的发生率和严重程度；(2)分析围产期窒息的临床和生化指标与多器官损伤的关系。研究设计：对连续72例围产期窒息新生儿进行前瞻性研究。进行了系统的神经学、肾脏、肺、心脏和胃肠道评估。结果：82%的患儿累及一个或多个器官，以中枢神经系统受累最多见(72%)。重度中枢神经系统损伤(7例)常合并其他脏器受累，14例为中度中枢神经系统损伤。肾脏受累占42%，肺受累占26%，心脏受累占29%，胃肠道受累占29%；新生儿肾功能衰竭占15%，呼吸衰竭占19%。与受累器官数目和受累严重程度相关的围产期因素仅有1分钟和5分钟的阿普加评分；5分钟的阿普加评分具有较强的独立关联性。脐动脉血pH值、羊水粪染、脐带异常、头位、分娩方式与器官功能障碍无关。结论：在有其他窒息标准的新生儿中，5min的Apgar评分是最能识别器官功能障碍的围产儿标志物。
Objectives: (1) To evaluate the frequency and spectrum of severity of multisystem dysfunction after perinatal asphyxia and (2) to analyze the relationship between the clinical and biochemical markers of perinatal asphyxia and multiorgan involvement.Study design: Seventy-two consecutive term newborn infants with perinatal asphyxia were studied prospectively. Systematic neurologic, renal, pulmonary, cardiac, and gastrointestinal evaluations were performed. Involvement of each organ was classified as moderate or severe.Results: Involvement of one or more organs occurred in 82% of the infants; the central nervous system (CNS) was most frequently involved (72%). Severe CNS Injury (7 infants) always occurred with involvement of other organs, although moderate CNS involvement was isolated in 14 infants. Renal involvement occurred in 42%, pulmonary in 26%, cardiac in 29%, and gastrointestinal in 29% of the infants; 15% neonates had renal failure and 19% had respiratory failure. The Apgar scores at 1 and 5 minutes were the only perinatal factors related to the number of organs involved and the severity of involvement; the Apgar score at 5 minutes had the stronger independent association. No relationship of organ dysfunction was found with the umbilical cord arterial blood pH, meconium-stained amniotic fluid, umbilical cord abnormalities, presentation, or type of delivery.Conclusions: Our findings indicate that the Apgar score at 5 minutes, in infants who have other criteria for asphyxia, is the perinatal marker that may best identify infants at risk of organ dysfunction.