低血糖高危新生儿发生低血糖的预测指标探讨OA
Exploration of predictive indicators for hypoglycemia in neonates at high risk of hypoglycemia
目的 探讨脐动脉血糖、脐静脉血糖、脐血葡萄糖摄取率对低血糖高危新生儿生后2h内发生低血糖的临床预测价值,为临床精准分层管理提供依据.方法 选取2023年6月至11月于深圳市南山区妇幼保健院出生的300例低血糖高危新生儿为研究对象,根据出生后2h内末梢血糖水平将其分为低血糖组(血糖<2.6mmol/L,52例)和非低血糖组(血糖≥2.6mmol/L,248例).出生后即刻检测脐动脉血糖、脐静脉血糖并计算脐血葡萄糖摄取率,比较两组新生儿的一般资料和脐动脉血糖、脐静脉血糖、脐血葡萄糖摄取率,绘制受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)评估低血糖的预测价值.结果 低血糖组新生儿的胎龄显著小于非低血糖组,剖宫产率显著高于非低血糖组(P<0.05);低血糖组新生儿的脐动脉血糖显著低于非低血糖组(P<0.001);两组新生儿的脐静脉血糖、脐血葡萄糖摄取率比较差异均无统计学意义(P>0.05).ROC曲线结果显示脐动脉血糖预测生后2h内低血糖的曲线下面积为0.757(95%CI:0.682～0.832),最佳临界值为3.95mmol/L,敏感度为75.0%、特异性为63.3%、阴性预测值为92.4%.结论 脐动脉血糖可有效预测低血糖高危新生儿生后2h内低血糖的发生,其检测操作简便、无创,可作为低血糖高危新生儿早期分层管理的实用临床指标.
Objective To explore the clinical predictive value of umbilical artery blood glucose,umbilical vein blood glucose and umbilical cord blood glucose uptake rate for hypoglycemia within 2 hours after birth in neonates at high risk of hypoglycemia,and to provide evidence for clinical precise hierarchical management.Methods A total of 300 neonates at high risk of hypoglycemia delivered in Shenzhen Nanshan Maternal and Child Health Hospital from June to November 2023 were selected as research subjects.According to the peripheral blood glucose level within 2 hours after birth,they were divided into hypoglycemia group(blood glucose<2.6mmol/L,52 cases)and non-hypoglycemia group(blood glucose≥2.6mmol/L,248 cases).Umbilical artery blood glucose,umbilical vein blood glucose were detected immediately after birth and umbilical cord blood glucose uptake rate was calculated.The general data and related indicators of two groups were compared,and receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of hypoglycemia.Results The gestational age of hypoglycemia group was significantly lower than that of non-hypoglycemia group,and cesarean section rate was significantly higher than that of non-hypoglycemia group(P<0.05).The umbilical artery blood glucose of hypoglycemia group was significantly lower than that of non-hypoglycemia group(P<0.001).There were no significant differences in umbilical vein blood glucose and umbilical cord blood glucose uptake rate between two groups(P>0.05).ROC curve results showed that area under the curve of umbilical artery blood glucose in predicting hypoglycemia within 2 hours after birth was 0.757(95%CI:0.682-0.832),the optimal cutoffvalue was 3.95mmol/L,the sensitivity was 75.0%,the specificity was 63.3%,and the negative predictive value was 92.4%.Conclusion Umbilical artery blood glucose can effectively predict the occurrence of hypoglycemia within 2 hours after birth in neonates at high risk of hypoglycemia.It is simple and non-invasive,and can be used as a practical clinical indicator for early hierarchical management of neonates at high risk of hypoglycemia.
计玲霞;杨卫国
汕头大学医学院研究生院,广东 汕头 515041||深圳市南山区妇幼保健院新生儿科,广东 深圳 518067深圳市儿童医院重症医学科,广东 深圳 518038
医药卫生
新生儿低血糖危险因素脐动脉血糖预测价值
NeonateHypoglycemiaRisk factorUmbilical artery blood glucosePredictive value
《中国现代医生》 2026 (19)
18-21,4
2022年深圳市南山区科技计划项目(医疗卫生类)(NS2022128)
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