目的：探究新生儿视网膜出血(RH)与脐动脉血气分析变化之间的相关性。

方法：回顾性研究。纳入2019-01/2021-12在我院产科出生的足月新生儿312例，根据RetCam Ⅲ眼底检查结果分为两组：对照组未发生RH的新生儿245例，RH组发生RH新生儿67例，比较两组患儿一般临床资料及脐动脉血气分析指标。根据RH程度分为Ⅰ度组20例，Ⅱ度组29例和Ⅲ度组18例。分析不同RH程度新生儿脐动脉血气分析指标水平，pH值与RH程度间的关系，影响新生儿发生RH因素。

结果：RH组与对照组产妇年龄、平均孕周、胎儿性别、胎次、妊娠糖尿病、胎儿出生体质量、羊水情况比较均无差异(均P>0.05)，分娩方式、妊娠高血压、产钳助产、新生儿窒息及脐带绕颈均有差异(均P<0.05)。RH组pH值、动脉血氧分压(PaO₂)及剩余碱(BE)值显著低于对照组(均P<0.01)，动脉二氧化碳分压(PaCO₂)显著高于对照组(P<0.01)。不同程度RH患儿脐动脉血气分析指标有差异(P<0.05)，且随着RH程度的增加，pH值、PaO₂及BE值逐渐下降(P<0.05)，PaCO₂逐渐增加(P<0.05)。RH程度与脐动脉血气分析pH值呈负相关(r_s=-0.593，P<0.05)。多因素Logistic回归分析结果显示，分娩方式、妊娠高血压、产钳助产、新生儿窒息、脐带绕颈、pH、PaO₂、PaCO₂及BE均是影响新生儿发生RH的因素。

结论：新生儿发生RH与脐动脉血气分析变化密切相关，脐动脉血气分析可用于新生儿RH的诊断。

METHODS: A total of 312 full-term neonates born in our obstetrics department from January 2019 to December 2021 were selected as the study subjects. According to the RetCam III fundus examination results, 245 neonates who did not experience RH were included in the control group, while 67 cases with RH were found to be included in the RH group. In addition, neonates were grouped into I degree group(n=20), II degree group(n=29), and III degree group(n=18)based on the degree of RH. General clinical data and umbilical artery blood gas analysis indicators between the RH group and the control group were compared; the levels of umbilical artery blood gas analysis indicators in neonates with different degrees of RH, the relationship between pH and RH degree, and the influencing factors of neonatal RH were analyzed.

RESULTS: There was no obvious difference in maternal age, average gestational week, fetal gender, parity, gestational diabetes, fetal birth weight, and amniotic fluid between the RH group and the control group(all P>0.05), while there were obvious differences in delivery methods, gestational hypertension, forceps assisted delivery, neonatal asphyxia, and umbilical cord around the neck(all P<0.05). The pH value, arterial blood sample partial pressure(PaO₂)and base excess(BE)values of the RH group were obviously lower than those of the control group(all P<0.01), while the arterial carbon dioxide partial pressure(PaCO₂)was obviously higher than that of the control group(P<0.01). There were obvious differences in umbilical artery blood gas analysis indicators among children with different degrees of RH(P<0.05), and with the increase of the degree of RH, pH value, PaO₂ and BE gradually decreased(P<0.05), and PaCO₂ gradually increased(P<0.05). There was a negative correlation between the degree of RH and the pH of umbilical artery blood gas analysis(r_s=-0.593, P<0.05). The results of multivariate Logistic regression analysis showed that delivery method, gestational hypertension, forceps assisted delivery, neonatal asphyxia, umbilical cord entanglement, pH, PaO₂, PaCO₂, and BE were all influencing factors for the occurrence of neonatal RH.

CONCLUSION: There is a close correlation between neonatal RH and changes in umbilical artery blood gas analysis, and umbilical artery blood gas analysis can be used for the diagnosis of neonatal RH, which can be used to guide clinical treatment.