探讨脐动脉血乳酸(lactic acid，LA)水平与新生儿20项行为神经测定(NBNA)的关系。

将经阴道分娩的269例新生儿分为：窘迫组95例(产时发生胎儿宫内窘迫)，对照组174例(正常分娩新生儿)。窘迫组中新生儿出生无窒息为窘迫Ⅰ组，有窒息为窘迫Ⅱ组。分别测定各组脐动脉血LA水平及微量血液气体分析，并在第4〜第6天和第26〜第28天进行NBNA评分。

窘迫Ⅰ组及窘迫Ⅱ组脐动脉血LA值分别为(3.57±1.17)mmol/L和(3.84±0.72)mmol/L，较对照组(2.82±0.68)mmol/L显著升高(P <0.01);pH值分别为(7.21±0.06)mmol/L,(7.19±0.11)mmol/L)，较对照组(7.26 ± 0.07)mmol/L明显降低(P<0.01)；窘迫Ⅱ组第4〜第6天及第26〜第28天NBNA评分为(33.82±2.46)和(36.50±1.00)，较对照组(36.71 ± 1.18)和(38.11±1.17)及窘迫Ⅰ组(36.42±1.16)和(38.10±1.16)显著降低(P<0.01)。窘迫Ⅱ组脐血LA值与pH值及第4〜第6天NBNA评分呈显著负相关(r=-0.67,r=-0.78，P<0.01)。

胎儿宫内窘迫时，脐动脉血LA及NBNA评分存在一定相关性，联合应用有助于判断胎儿宫内窘迫的发生及改善预后。

To study the changes of 20-item neonatal behavioral neurological assessment(NBNA)with cord blood lactate.

During Feb.2005 to Mar.2006, 269 cases of newborn were born via vagina in our hospital.95 newborns with fetal distress(distress group)and 174 healthy newborns(control group)were studied.Distress group were divided into distress group I and distress group Ⅱrespectively, based on without neonatal asphyxia.The lactate level and the PH value of cord arterial blood were determined respectively.At the 4th〜6th days and the 26th〜28th days, NBNA was taken for each subject.

The levels of cord blood lactate in the distress group I and distress group Ⅱ[(3.57 ± 1.17)mmol/L, (3.84 ± 0.72)mmol/L]were significantly higher than that in the control group[(2.82 ± 0.68)mmol/L](P<0.01).The pH values in the distress group I and distress group Ⅱ were markedly lower than that of the control group[(7.21 ± 0.06)vs.(7.26 ± 0.07)], [(7.19 ± 0.11)vs.(7.26 ± 0.07)](P<0.01).The 4th〜6th days and the 26th〜28th days NBNA in the distress group Ⅱ[(33.82 ± 2.46), (36.50±1.00)]were significantly lower than that in the control group[(36.71 ± 1.18), (38.11 ± 1.17)]and distress group I[(36.42 ± 1.16), (38.10±1.16)](P<0.01).The lactate level was negatively correlated with the PH value and the score of NBNA(r=-0.67,r=-0.78,respectively,both P<0.01).

NBNA association with cord blood lactate can provide the proof for diagnosis and prognosis of fetal distress.