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中国循证儿科杂志

中国循证儿科杂志 ›› 2022, Vol. 17 ›› Issue (6): 432-438.DOI: 10.3969/j.issn.1673-5501.2022.06.005

• 论著 • 上一篇    下一篇

云南高原地区健康足月新生儿脉搏血氧饱和度和脐动脉血气值的横断面调查

中国高原新生儿联盟泽碧1,7,高瑾2a,7,赖银珍3,7,毛辉4,秦明彩5,张铁松2b,杨永礼6,李杨方2a,周文浩1,刘晓梅2a,杜琨2a   

  1. 1 复旦大学附属儿科医院新生儿科 上海，201102；2 云南省昆明市儿童医院 昆明，650103，a 新生儿科，b 儿科；3 云南迪庆藏族自治州人民医院儿科 香格里拉，674499；4 云南大学附属医院产科 昆明，650031；5 云南迪庆藏族自治州香格里拉县妇幼保健院儿科 香格里拉，674499；6 云南省丽江市妇幼保健院儿科 丽江，674199；7 共同第一作者 
  • 收稿日期:2022-11-11 修回日期:2022-11-22 出版日期:2022-12-25 发布日期:2022-12-25
  • 通讯作者: 刘晓梅；杜琨

Oxygen saturation and umbilical blood gas values for healthy newborns in high lands of Yunnan Province in China: A cross-sectional study

Chinese High Altitude Neonatal Medicine Altitude Alliance(CHANMA), ZE Bi1,7, GAO Jin2a,7, LAI Yinzhen3,7, MAO Hui4, QIN Mingcai5, ZHANG Tiesong2b, YANG Yongli6, LI Yangfang2a, ZHOU Wenhao1, LIU Xiaomei2a, DU Kun2a   

  1. 1 Department of Neonatology, Children's Hospital of Fudan University, Shanghai 201102, China; 2 Kunming Children's Hospital, Kunming 650103, China; a. Department of Neonatology, b. Department of Pediatrics; 3 Department of Pediatrics, Diqing Tibetan Autonomous Prefecture People's Hospital, Shangri-La 674499, China; 4 Department of Obstetrics, Affiliated Hospital of Yunnan University, Kunming 650031, China; 5 Department of Pediatrics, Maternal and Child Health Hospital of Shangri-La, Shangri-La 674499, China; 6 Department of Pediatrics, Maternal and Child Health Hospital of Lijiang, Lijiang 674199, China; 7 Co-first author
  • Received:2022-11-11 Revised:2022-11-22 Online:2022-12-25 Published:2022-12-25
  • Contact: LIU Xiaomei；DU Kun

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摘要： 背景：对不同高海拔梯度新生儿生后早期氧饱和度（SpO2）和脐动脉血气值仍有进一步探索空间，特别是对构建高海拔情况下SpO2和脐动脉血气的正常值有重要意义。 目的：比较不同高海拔梯度新生儿生后2 h内SpO2和脐动脉血气值的差异。 设计：横断面调查。 方法：纳入2022年9月7日至2022年10月10日中国高原新生儿联盟（简称“联盟”）的4家医院连续分娩的胎龄≥37周且<42周的健康足月新生儿。经联盟指定的医护人员采集新生儿基线数据，在统一环境要求、相同标准下检测生后10、~30和~120 min时间段新生儿右手的SpO2值，在新生儿娩出、脐带夹闭后立即行脐动脉血气（pH、乳酸和碱剩余值）检测，并将数据录入联盟数据库。分为海拔2 000 m组、海拔2 400 m组和海拔3 500 m组。以零海拔点SpO2的95%为低氧高危界值参考。 主要结局指标：生后2 h内SpO2。 结果：进入联盟数据库229例健康新生儿，海拔2 000 m组73例，海拔2 400 m组42例，海拔3 500 m组114例，3组新生儿性别、胎龄、出生体重及母亲年龄差异均无统计学意义，藏族人群分布差异有统计学意义。总体新生儿人群随时间延长SpO2逐渐上升，海拔2 000 m组生后3个延续时段（10、~30和~120 min）SpO2中位数分别为96%、98%和100%，其第25百分位数与零海拔SpO2高危界值分别持平、高2%和高3%；海拔2 400 m组生后3个延续时段SpO2中位数分别为88%、90%和94%，其第75百分位数比零海拔SpO2高危界值分别低6%、4%和1%；海拔3 500 m组生后3个延续时段SpO2中位数分别为84%、89%和92%，其第75百分位数比零海拔SpO2高危界值分别低5%、5%和1%。脐动脉血气比较，3组不同高海拔组pH值差异均无统计学意义； 海拔2 400 m组和海拔3 500 m组乳酸高于、碱剩余值低于海拔2 000 m组，其中海拔2 400 m组和海拔3 500 m组的剖宫产新生儿乳酸高于、碱剩余值低于海拔2 000 m组，差异均有统计学意义。藏族与其他民族新生儿生后2 h内SpO2、脐动脉血气差异均无统计学意义，随着生后10、~30和~120 min检测时间延长，藏族与其他民族新生儿SpO2均呈上升趋势，SpO2检测点值离散度呈现明显缩窄，3个时段SpO2点值高于零海拔SpO2高危界值占22.8%（26/114）。 结论：足月健康新生儿在海拔2 000 m环境下生后2 h内SpO2高于零海拔SpO2高危界值，而海拔2 400 m和3 500 m则低于零海拔SpO2高危界值，在海拔3 500 m环境下藏族和其他民族SpO2差别不大。

关键词: 高原, 新生儿, 氧饱和度, 脐动脉血气

Abstract: Background：The differences in oxygen saturation in the early postnatal period and umbilical artery blood gas values among different altitude gradients are still needed to be explored, especially for the establishment of normal values of pulse oximetry (SpO2)and umbilical artery blood gas at high altitudes. Objective：To compare the distribution of SpO2 within 2 hours after birth and umbilical artery blood gas analysis in well full-term neonates at different altitudes. Design：Cross-sectional study. Methods：Healthy full-term neonates who were delivered consecutively in 4 hospitals of the Chinese High Altitude Neonatal Medicine Alliance (CHANMA) from September 7, 2022 to October 10, 2022 were included. Designated medical staff collected the baseline data of the newborn, and tested the SpO2 value of the right hand of the newborn within 10, 11 to 30, and 31 to 120 minutes after birth under the same environments with the same standard. Immediately after birth, the umbilical cord was clamped and umbilical arterial blood gas (pH, lactic acid and BE) was detected. The data was recorded in the database of the CHANMA through the computer network. According to the altitude level, they are divided into 2,000 m above sea level group, 2,400 m above sea level group and 3,500 m above sea level group. The SpO2 value of 95% was taken as the hypoxic high-risk cut-off value for comparison. Main outcome measuresSpO2 within 2 hours after birth. Results：A total of 229 cases were included with 73 cases in the 2,000 m altitude group, 42 cases in the 2,400 m altitude group, and 114 cases in the 3,500 m altitude group. There was no significant difference in gender, gestational age, birth weight and mother's age among the three groups. Tibetan distribution was statistically significant. The SpO2 of the overall newborn population gradually increased over time. The median SpO2 at 2,000 m altitude group was 96%, 98% and 100% in three continuous periods after birth (10, 11 to 30 and 31 to 120 minutes), and the 25th quantile was equal to, 2% and 3% higher than the hypoxic high-risk cut-off value. The median SpO2 of the 2400m altitude group was 88%, 90% and 94% in the three continuous periods after birth, and the 75th quantile was 6%, 4%, and 1% lower than the hypoxic high-risk cut-off value respectively. The median SpO2 of the 3,500m altitude group in 3 consecutive periods was 84%, 89%, and 92%, respectively, and the 75th quantile was 5%, 5%, and 1% lower than the hypoxic high-risk cut-off value. There was no significant difference in the umbilical artery blood gas pH value among different altitude groups. The lactic acid was significantly higher and the BE was significantly lower in the 2,400 m altitude group and the 3,500 m altitude group than that in the 2,000 m altitude group, and the difference was significant in infants with cesarean birth as well. There was no statistically significant difference in SpO2 within 2 hours after birth and umbilical artery blood gas between newborns of Tibetan and other ethnic groups. The SpO2 of newborns of Tibetan and other ethnic groups showed an upward trend over time. The dispersion of point values was significantly narrowed, and 22.8% (26/114) of SpO2 value was higher than the hypoxic high-risk cut-off value. Conclusion：SpO2 in healthy full-term neonates within 2 hours of birth was significantly lower than the hypoxic cut-off values in altitudes above 2,000 meters, and higher at the altitude of 2,000 m and 3,500 m. There was not significant difference in SpO2 between Tibetans and other ethnic groups at 3,500 m altitude area.

Key words: High altitude, Neonate, Oxygen saturation, Umbilical artery blood gas