正常新生兒及早產兒之毛細管血之酸鹼平衡及早產兒呼吸窘迫症之治療

Acid Base Balance in Capillary Blood of Chinese Normal and Premature Newborns and Management of Respiratory Distress Syndrome in Premature Newborns

盧文雄(Wen-Hsiung Lu) ； 李廷堅(Ting-Chien Lee)

《Acta Paediatrica Sinica》 8卷2期 (1967/06) Pp. 84-92

摘要

由於醫學的進步，環境衛生的改善，新生兒死亡率已大爲降低，但呼吸窘迫症在目前仍是新生兒，特別是早産兒最常見之死亡原因。在美國一歲以下嬰兒的死亡例中約有三分之一在生後24小時內死亡^1，其死因之約半爲吸系統障礙^2，早産兒死於呼吸衰竭者高達90%^3。當新生兒發生呼吸障礙時，常發生代謝性及呼吸性酸毒症，如果我們能及早改善其呼吸困難及治潦酸毒症，則新生兒呼吸窘迫症的預後會有很大的改善^4，而Usher^5認爲可以將其死亡率減至三分之一。但是嬰兒血液酸鹼度的過去的測定方法，所需靜脈血量較大，直到Astrup^6發表用微量血同時側定血液之pH , pCO2 ，Base Excess ( BE ) 及 Standard Bicarbonate(STB）方法後，才廣泛應用在臨床治療上，如Ushers^5,7,8, Hutchison^4,9等應用於新生兒酸毒症之治療指針有很好的成績。
本文粗告30例正常成熟新生兒及10例早産兒（體重在2公斤以下者）毛細管血之pH, pCO2, BE, STB值，並研討18例呼吸窘迫早産兒酸毒症之治療。

並列摘要

Thirty normal mature and 10 premature Chinese infants born at our Hospital were studied for acid-base equilibrium during the first 24 hours of age. Arterialized capillary blood was obtained by heel prick after a 10-minute warming period of the heel in tepid water, The blood was collected in a heparinized capillary tube and the tube was immediately sealed with paraffine. The pH value was determined by Astrup’s microapparatus and pCO2 calculated from pH measurements of blood equilibrated
at two known CO2 tensions. The mean values of pH, pCO2, base excess (BE) and standard bicarbonate (STB) of the 30 normal mature newborns were 7.39±0.05, 33.7±7.85mmHg, -4.0±2.43mEq/l, and 20.8±1.75mEq/l respectively, and those of the 10 premature newborns without complication were 7.37±0.08, 32.2±5.62mmHg, -5.59±2.5mEq/l, and 19.69±1.6 mEq/l respectively. No statistically significant differences were found between each of the 4 sets of mean values of these two groups.
Eighteen premature newborns with respiratory distress syndrome were also studied for acid-base equilibrium. Respiratory and metabolic acidosis were corrected according to Hutchison’s formula in 15 cases, of whcm 9 survived and 6 died, with a mortality rate of 40%. The 3 others died before the correction.
For comparison, 32 premature newborns with respiratory distress syndrome but without the correction of acidosis were selected, though not randomly during the same period of study, but having the mean birth weight and mean Apgar score and other treatments comparable to those of the 15 premature newborns with the correction of acidosis. Of the 32 for comparsion 21 died showing a mortality rate of 65.8%.
Literature about treatment of respirstory distress syndrome in premature newborns is also briefly reviewed.