Scientific Journal of Kurdistan University of Medical Sciences
مجله علمي دانشگاه علوم پزشكي كردستان
SJKU
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http://sjku.muk.ac.ir
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1560-652X
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10.61186/sjku
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2021
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ارزش تشخیصی اندکس های گاز خون شریانی در پیش بینی عوارض زودرس نوزادی
Diagnostic value of arterial blood gas indices in predicting early neonatal complications
عمومى
General
پژوهشي اصیل
Original Research
<div style="text-align: justify;"><strong><span style="font-family:B Zar;"><span style="font-size:12.0pt;">زمینه و هدف:</span></span></strong> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">این مطالعه با هدف تعیین</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">ارتباط</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">اندکس</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">های گازهای</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">خون</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">شریانی(</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">ABG</span></span></span></span><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">)</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;"> بند</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">ناف</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">با</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">عوارض</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">زودرس</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">نوزادی</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">در</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">نوزادان</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">متولدشده</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">با</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">دیسترس</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">جنینی</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">و</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">در</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">صورت</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">امکان</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">تعیین</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">سطح</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">آستانه</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">ی</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">مقادیر</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">اندازه</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">گیری</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">شده</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">برای</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">ایجاد</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">ریسک عوارض.انجام می گردد</span></span></span><br>
<strong><span style="font-family:B Zar;"><span style="font-size:12.0pt;">مواد و روش­ ها:</span></span></strong><span style="font-family:B Zar;"><span style="font-size:12.0pt;"> <span style="color:black;">در</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">این</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">بررسی</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">مقطعی</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">در</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">طی</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">12</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">ماه از سال 94 تا 95 در دانشگاه علوم پزشکی مشهد</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">تعداد</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">221</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">نفر</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">از</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">مادران</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">با نوزادان دارای</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">دیسترس جنینی</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">که</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">با</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">معیارهای</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">ورود</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">و</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">خروج</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">در</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">مطالعه</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">مطابقت</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">داشتند</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">مورد</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">بررسی</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">قرار</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">گرفتند</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">. </span></span></span></span><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">پس</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">از</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">تولد نمونه خون</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">از</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">شریان</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">نافی</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">گرفته</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">شد. عوارض زودرس</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">پری</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">ناتال و ارتباط آنها با </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">PH</span></span></span></span> <span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">و</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">BE</span></span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">(فزونی باز) </span></span></span><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">بدو تولد و 8 ساعت بعد و دقت تشخیصی موارد مذکور مورد بررسی</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">قرار گرفت.</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;"></span></span></span></span><br>
<strong><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">یافته ها:</span></span></span></strong><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;"> 221 مادر باردار با حاملگی 37- 41 هفته (میانه سن حاملگی 38 هفته و 4 روز) که در طی بستری دچار دیسترس جنینی شده بودند وارد مطالعه شدند</span></span></span><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">.</span></span></span><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;"> تشنج ( 0/01>P </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">( </span></span></span></span><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">، ایکتر ( 0/015>P </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">( </span></span></span></span><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">، عارضه گوارشی ( 0/01>P </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">( </span></span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">و بستری</span></span><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">≥</span></span></span><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">1 هفته در </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">NICU</span></span></span></span><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">( 0/001>P </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">( </span></span></span></span><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;"> به طور معنی داری در نوزادان با</span></span></span> <span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">PH</span></span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;"><7/2 </span></span></span></span><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;"> بیشتر و تشنج ( 0/01>P </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">( </span></span></span></span><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">، عارضه گوارشی ( 0/049=P </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">( </span></span></span></span><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;"> و بستری</span></span><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">≥</span></span></span><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">1 هفته در </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">NICU</span></span></span></span><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;"> (</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">p<0/001</span></span></span></span><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">) به طور معنی داری در نوزادان با </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">BE</span></span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;"><-14</span></span></span></span><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;"> بیشتر مشاهده شد. بیشترین سطح زیر منحنی راک (دقت تشخیصی) برای عوارض تنفسی(85%)مربوط به </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">BE</span></span></span></span><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">8</span></span></span><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;"> ساعت بعد از تولد و برای عوارض مغزی(88%)و گوارشی(77%)مربوط به </span></span></span> <span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">PH </span></span></span></span><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">8 ساعت بعد از تولد و برای عوارض کلیوی (82%)و ایکتر (60%)مربوط به</span></span></span> <span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">PH</span></span></span></span><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">بدو</span></span></span><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;"> تولد بود.</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;"></span></span></span></span><br>
<strong><span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">نتیجه گیری</span></span></span></strong>: <span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">PH</span></span></span></span><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">و</span></span></span> <span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">BE</span></span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;"> می توانند به عنوان پیشگویی کننده های قابل اعتمادی برای</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">عوارض زودرس نوزادی</span></span></span> <span style="color:black;"><span style="font-family:B Zar;"><span style="font-size:12.0pt;">به کار روند.</span></span></span></div>
<pre style="text-align: justify;">
<span style="font-size:16px;"><span style="font-family:Times New Roman;"><strong>Background and Aim</strong>: The aim of this study was to determine the relationship between cord arterial blood gas (ABG) indices and early neonatal complications in neonates born with fetal distress and also the threshold level of measured values for the risk assessment of complications.</span></span></pre>
<pre style="text-align: justify;">
<span style="font-size:16px;"><span style="font-family:Times New Roman;"><strong>Materials and Methods: </strong>221 mothers with fetal distress who met our inclusion criteria participated in this 12 month cross-sectional study in Mashhad University of Medical Sciences from 2015 to 2016 . Blood samples were taken from umbilical artery of the neonates after birth. Early perinatal complications and their association with PH and BE at birth and 8 hours later and also the diagnostic values of the afore mentioned values were evaluated.</span></span></pre>
<pre style="text-align: justify;">
<span style="font-size:16px;"><span style="font-family:Times New Roman;"><strong>Results</strong>: 221 pregnant mothers at 37-41 weeks of gestation (mean gestational age of 38 weeks and 4 days) who had developed fetal distress during hospitalization were entered into the study. Seizure (p<0/01), jaundice (p<0/015), gasterointestrinal complication (p<0/01) ,NICU haspitalization ≥ 1 week (p< 0/001) were significantly higher in the neonates with PH<7/2. Seizure (p<0/01), gastero intestinal complication ( p=0/049). NICU hospitalization ≥ 1 weak (p<0/001) were significantly higher in the neonates with BE < -14. The highest diagnostic accuracy rates for respiratory complications (85%) was related to BE measured 8 hours after birth. The highest diagnostic accuracy rates for seizure (88%) and gastrointestinal (77%) complications were related to PH measured 8 hours after birth. But for renal complications (82%) and jaundice (60%) it was associated with PH at birth.</span></span></pre>
<pre style="text-align: justify;">
<span style="font-size:16px;"><span style="font-family:Times New Roman;"><strong>Conclusion</strong>: PH and BE can be used as reliable predictors for some early neonatal complications.</span></span></pre>
خون بند ناف, بررسی گازهای خونی, دیسترس جنینی
Umbilical cord blood, Blood gas analysis, Fetal distress
105
116
http://sjku.muk.ac.ir/browse.php?a_code=A-10-2883-2&slc_lang=fa&sid=1
Nayere
Ghomian
نیره
قمیان
GhomianN@mums.ac.ir
5400319475328460041723
5400319475328460041723
Yes
department of Obstetrics and Gynecology,Neonatal and Maternal Research Center,Mashhad University of Medical Sciences,Mashhad,Iran
گروه زنان و مامایی،دانشکده پزشکی ،دانشگاه علوم پزشکی مشهد،مشهد،ایران
Asieh
Maleki Abardeh
آسیه
ملکی ابرده
MalekiAA@mums.ac.ir
5400319475328460041724
5400319475328460041724
No
department of Obstetrics and Gynecology,Neonatal and Maternal Research Center,Mashhad University of Medical Sciences,Mashhad,Iran
گروه زنان و مامایی،دانشکده پزشکی ،دانشگاه علوم پزشکی مشهد،مشهد،ایران
Somayeh
Moein Darbari
سمیه
معین درباری
MoeinS@mums.ac.ir
5400319475328460041725
5400319475328460041725
No
department of Obstetrics and Gynecology,Neonatal and Maternal Research Center,Mashhad University of Medical Sciences,Mashhad,Iran
گروه زنان و مامایی،دانشکده پزشکی ،دانشگاه علوم پزشکی مشهد،مشهد،ایران
Hoda
Bagheri
هدی
باقری
BagheriH921@mums.ac.ir
5400319475328460041726
5400319475328460041726
No
department of Obstetrics and Gynecology,Neonatal and Maternal Research Center,Mashhad University of Medical Sciences,Mashhad,Iran
گروه زنان و مامایی،دانشکده پزشکی ،دانشگاه علوم پزشکی مشهد،مشهد،ایران