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目的了解围生期窒息缺氧缺血后对足月新生儿肾功能的影响。方法选取233例围生期窒息足月新生儿。男159例,女74例;孕周37～42+5周;平均出生体质量3 296 g。根据出生时Apgar评分及羊水情况分为重度窒息组37例、轻度窒息组100例及产前窒息组96例。采用肌氨酸氧化酶法测定其血清肌酐(Scr)水平,根据Swatch公式计算内生肌酐清除率(Ccr),与同期收集的100例健康对照组新生儿Scr水平进行比较。结果各窒息组Scr及Ccr水平与健康对照组比较,均有统计学差异;各窒息组之间两两比较,除重度窒息组Ccr与产前窒息组比较有统计学差异,余均无统计学差异。233例中144例Scr超过健康对照组50%以上,达急性肾损伤诊断标准,其中重度窒息组、轻度窒息组、产前窒息组分别为27例、64例、53例。好转129例,好转率89.58%(129/144例),重度窒息组、轻度窒息组、产前窒息组好转率分别为85.19%(23/27例)、89.06%(57/64例)、92.45%(49/53例);死亡1例,因病重放弃治疗14例,预后不良率为10.42%。结论围生期窒息时在缺氧缺血作用下,肾小球滤过率下降,部分患儿虽尚未达急性肾衰竭阶段,但已发生不同程度的急性肾功能异常。应尽早认识急性肾损伤,早期诊断、尽早改善缺氧状态,避免肾功能进一步恶化,降低病死率。
Objective To investigate the effect of perinatal asphyxia on neonatal renal function after hypoxic-ischemic insult. Methods 233 cases of perinatal asphyxia neonatal full-term. 159 males and 74 females; gestational weeks 37 to 42 +5 weeks; the average birth weight of 3 296 g. According to Apgar score and amniotic fluid at birth, they were divided into severe asphyxia group (37 cases), mild asphyxia group (100 cases) and prenatal asphyxia group (96 cases). Serum creatinine (Scr) levels were determined by sarcosine oxidase method. Endogenous creatinine clearance (Ccr) was calculated according to the Swatch formula and compared with Scr levels of 100 healthy controls collected in the same period. Results Compared with healthy control group, the levels of Scr and Ccr in asphyxia group were significantly different. Comparing pairs of asphyxia groups with Ccr in severe asphyxia group was statistically different from that in prenatal asphyxia group, with no statistical difference difference. Of the 233 cases, 144 cases of Scr exceeded 50% of the healthy control group, reaching the diagnostic criteria of acute renal injury, including severe asphyxia group, mild asphyxia group and prenatal asphyxia group were 27 cases, 64 cases and 53 cases. In the severe asphyxia group, mild asphyxia group and prenatal asphyxia group, the improvement rates were 89.58% (89/144), 85.19% (23/27), 89.06% (57/64) respectively, 92.45% (49/53 cases); 1 died, 14 cases were given up because of illness and the rate of poor prognosis was 10.42%. Conclusions Perinatal asphyxia reduces glomerular filtration rate under hypoxic-ischemic conditions. Although some children have not yet reached the stage of acute renal failure, acute renal dysfunction has occurred to some extent. Acute renal injury should be recognized as soon as possible, early diagnosis, as soon as possible to improve hypoxia, to avoid further deterioration of renal function and reduce mortality.