新生儿两种不同方式采血的临床分析

目的比较经桡动脉穿刺采血和股静脉穿刺采血在新生儿采血中所需时间长短、成功率及副作用。方法桡动脉穿刺、股静脉穿刺采血记录1次采血成功率，穿刺操作时间、观察损伤程度。结果观察组1次采血成功率为90％，对照组为84％，观察组平均操作时间为6min，对照组为10min；穿刺部位血肿发生率观察组为8％，对照组为20％。结论新生儿桡动脉穿刺采血比股静脉穿刺采血1次穿刺成功率高，操作时间短，损伤程度轻，值得临床推广应用。     

小儿静脉留置针留置失败原因分析及改进对策

目的分析小儿静脉留置针留置失败原因，探索改进对策。方法对采用不同穿刺和固定方法留置静脉套管针的患儿进行观察，比较两组的1次穿刺成功率、留置天数和并发症的发生率，并对留置失败原因进行分析。结果改进组较传统组能提高1次穿刺成功率，延长留置天数，降低脱管和导管堵塞的发生率。而对局部渗漏、静脉炎、针眼出血、周围皮肤炎症的发生率比较，差异无显著性（P〉0．05）。结论小儿活动过多、不易合作、血管过小、固定不佳、穿刺部位选择不当、刺激性药物的使用是导致并发症出现留置失败的主要因素，如何最大限度地避免这些因素的影响，有待于进一步探讨。     

小儿头皮静脉穿刺与固定方法的探讨

头皮静脉输液小儿治疗和抢救的主要途径，临床应用广泛，为提高穿刺成功率，减轻患儿痛苦，保证输液质量，我们根据基础护理学基础理论，结合临床实际，对头皮静脉穿刺手法、进针角度、固定方法进行研究，现总结报告如下。[第一段]     

经后囟穿刺部分换血治疗新生儿红细胞增多症

因新生儿周围血管细，血液淤滞粘稠、外周静脉穿刺成功率低，加之抽血量大，在抽血过程中易发生凝固等因素，而难以一次换血达到预定值，在临床实践中我们探索经后囟穿刺部分换血治疗新生儿红细胞增多症，取得满意疗效，现将方法报告如下：     

小儿颞部静脉穿刺的体会

头皮静脉穿刺技术是临床3岁以下小儿应用最广泛，最基本的护理技术操作之一，也是临床治疗抢救危重患儿的重要给药途径，同时也是对护士基本功的衡量和对护理工作质量的检验。笔者从事小儿头皮静脉穿刺8年，针对如何提高小儿颞部静脉穿刺的成功率，现总结经验如下。     

小儿静脉穿刺与护士情绪

静脉穿刺是临床护士常规基本操作，特别在儿科治疗给药多以静脉为主，所以静脉穿刺是儿科护士必备的一项最基本的技术操作，为了配合急、重患儿的抢救工作，应力求做到“一针见血”，如何提高小儿静脉穿刺的成功率，除受知识和技术熟练程度制约外，还受操作者自身情绪的影响。现将多年临床工作实践中的几点体会作一总结。     

极低出生体重早产儿经不同静脉途径留置中心静脉导管的应用评价

目的探讨极低出生体重早产儿经外周中心静脉置管(PICC)时选择不同静脉穿刺的临床效果。方法选择2004年4月至2011年3月本院新生儿重症监护病房进行PICC的极低出生体重早产儿,回顾性分析经不同外周静脉置入中心静脉导管的一次穿刺成功率及并发症发生率,分析并发症的原因及防治。结果共有238例极低出生体重早产儿进行PICC,一次穿刺成功227例,成功率95.4%,不同静脉一次穿刺成功率差异无统计学意义(P>0.05)。经贵要静脉置管的并发症最少,并发症发生率3.4%,应作为首选,其次为腋静脉和肘正中静脉。当肘部静脉被破坏时可选择腋静脉或下肢静脉途径。结论为极低出生体重早产儿行PICC时,应综合分析各种静脉途径利弊选择最合适的血管,首选贵要静脉。     

经后囟穿刺部分换血治疗新生儿红细胞增多症

因新生儿周围血管细,血液淤滞粘稠、外周静脉穿刺成功率低,加之抽血量大,在抽血过程中易发生凝固等因素,而难以一次换血达到预定值,在临床实践中我们探索经后囟穿刺部分换血治疗新生儿红细胞增多症,取得满意疗效,现将方法报告如下:     

异丙酚镇静／麻醉在极不合作小儿腰椎穿刺中的应用

目的 探讨极不合作小儿腰椎穿刺的方法。方法 在小儿腰穿前建立静脉通道，由麻醉师监测血氧饱和度(SPO2)、血压(BP)及心率(HIR)，持续抵流量吸氧，异丙酚按0．5—1．0mg／Kg缓慢静脉注射，先给总量的一半，视镇静／麻醉程度再追加其余量直到完全麻醉时即停药。结果 9例于异丙酚静注后约1-3分入睡，之后按小儿腰椎穿刺操作规程进行腰穿，穿刺成功率100％。结论 异丙酚静脉镇静／麻醉下腰穿的方法对极不配合患儿腰穿来说不失为一种安全可行的方法，在临床上可有选择性地使用。     

早产儿经外周穿刺中心静脉导管置管91例次应用分析

目的　探讨早产儿应用外周穿刺中心静脉导管 (PICC)的价值。方法　对 84例早产儿采用 1 9Fr规格导管行置管术。结果　 84例患儿中 7例因导管堵塞等先后 2次施行PICC置入术 ,实际完成 91例次。穿刺贵要静脉 6 0例次、正中静脉 2 2例次、头静脉 7例次 ,导管顶端到达上腔静脉发生率分别为 6 1 6 7%、2 2 2 7%与14 2 9% ,差异有显著意义 (P <0 0 5 ) ;穿刺大隐静脉和前臂静脉各 1例。感染发生率为 4 2 9%。导管留置 3～6 8天 ,平均 (2 1 2 7± 15 14)天。完成治疗按计划拔管 75例次占 82 42 % ,因导管堵塞或脱出拔管各 5例次各占5 49% ,因导管裂拔管 3例次占 3 30 % ,因静脉炎拔管 2例次占 2 2 0 % ,因穿刺部位局部感染拔管 1例次占1 10 %。结论　早产儿应用PICC能有效解决建立通畅静脉通道的问题 ,穿刺血管首选贵要静脉 ;熟练掌握导管使用技术后可降低导管相关感染及因导管堵塞而致拔管的发生率。     

早产儿视网膜病的危险因素分析及随访调查

研究早产儿视网膜病(retinopathy of prematurity,ROP)的发生率、高危因素、治疗与随访情况。方法对2005年7月-2007年12月温州医学院附属第一医院NICU收治的符合ROP筛查标准的早产儿,于生后2周开始由资深眼科医师开始行间接眼底镜检查眼底,并进行随访。结果434例早产儿中ROP的发生率为5.5%(24/434例),24例ROP中Ⅰ期19例,Ⅱ期3例,Ⅲ期2例。Ⅲ期阈值病变者行激光光凝治疗,全部患儿均恢复正常。对434例早产儿行单因素分析得出,胎龄、出生体重、住院时间、吸氧、吸氧浓度、吸氧时间、呼吸暂停、新生儿肺透明膜病(RDS)、肺表面活性剂(PS)的应用、机械通气、输血、光疗时间、感染与ROP的发生有相关性(P<0.05)。Logistic回归分析显示胎龄、出生体重、胎数、吸氧时间、光疗时间、代谢性酸中毒、母亲妊高症、颅内出血是影响ROP发生的主要因素。结论早产是ROP的根本原因,防治各种并发症、合理的氧疗是预防ROP的关键。建立完善有效的ROP筛查制度,早期发现、早期治疗ROP,可改善ROP的预后。     

术中判断肠活力三种方法的比较

术中准确地评价肠活力是外科医师面临的一个普遍问题。应用兔肠缺血模型，比较静脉荧光素、表面血氧测定和激光多普勒三种技术判断肠活力的精确性。结果：诊断效率静脉荧光素法为７８％，表面血氧测定为６８％，激光多普勒为９５％。后者精确度显著优于前二者，且操作简便、迅速，具有临床应用前景。     

Spectrum of clinical presentations of vein of Galen aneurysm

Aneurysm of the vein of Galen is a rare intracranial vascular malformation. It is known to have diverse manifestations and varying severity. Four cases with different modes of presentation and outcome are reported. A mortality of 50 per cent was encountered. Among the survivors, one had neurologic sequelae whereas the other had attained age-appropriate developmental milestones. The former was a rare case of spontaneous thrombosis of the aneurysm while the latter was a boy who underwent therapeutic embolization.     

Outcome of the Treatment of Inborn Errors of Metabolism

The use of specific dietary restrictions, cofactor administration, mobilisation of insoluble substances, environmental modifications, product replacement and selective enzyme inhibition are now established for the treatment of some inborn errors of metabolism. There is no generally accepted application for enzyme administration, cytopharmacology (manipulation of the cytoskeleton) or for cell transplantation except for bone marrow transplantation in disorders where the bone marrow is primarily at fault. The other uses of bone marrow transplantation which have been proposed require further evaluation. Results of recent research suggest that the scope of this approach is gradually being widened. There is also scope for development in the field of organ transplantation taking advantage of recent technical¹ and immunological progress. The treatment of inborn errors of metabolism by genetic modification is not yet on a practical clinical level; more laboratory and animal studies are needed before this can be attempted in man. Adenosine deaminase deficiency appears to be the disease in which this will be first attempted using a retroviral vector to insert the gene into the genome of pluripotential bone marrow cells.     

婴幼儿法乐四联症手术治疗近期疗效的影响因素

目的 探讨影响婴幼儿法乐四联症手术治疗近期疗效的各相关因素.方法 将2003年8月至2011年2月经作者一期手术纠治的117例年龄≤3岁的法乐四联症患儿分为疗效良好、疗效较差两组.分析手术时患儿年龄、体重、术前HCT值、McGoon指数、EDVI、主动脉阻断时间、转流时间、室间隔缺损大小、升主动脉与肺动脉干直径比、...     

主动脉缩窄的治疗研究进展

主动脉缩窄(coarctation of aorta,CoA)是主动脉的局限性狭窄,狭窄最常见于峡部,是一种常见的先天性心血管畸形,占所有先天性心脏病的5％ ～8％.缩窄导致上肢血压升高,下肢血压降低,并可引起心功能下降,未经治疗的CoA预后不佳.治疗方式包括外科治疗及经皮介入治疗,不同治疗方式的并发症发生率不同,术后长期监测其并发症、心功能是评估预后的重要指标.该文对主动脉缩窄的治疗方式及术后并发症、心功能情况的研究进展作一综述.     

早产儿脑病研究进展

早产儿脑病是复杂的原发性脑损伤和继发性脑发育异常疾病.过去几年对该病有了较为深刻的认识,该文就最新的有关早产儿脑病概念演变,脑损伤后的细胞分子机制和损伤后发育障碍,尤其是活化小胶质细胞介导的少突胶质细胞损伤机制、神经/髓鞘受损和丘脑、板层下神经元及大脑皮层的受损机制或发育成熟障碍进行综述,以便对该病有更深刻的认识.     

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??Inhaled corticosteroids??ICS?? are the most effective medicine for chronic airway inflammation nowdays. Atomization inhalation has been widely applied in clinics because of its efficacy??fewer side-effects and convenience. Here??we focused on some points which should be paid attention to??including how to choose appropriate patients??how to ensure the effectiveness of inhaled steroids and how to reduce possible side-effects.     

Treatment of retinopathy of prematurity

Retinopathy of prematurity is a potentially blinding disorder of premature infants. Retinal ablation of the avascular retina originally described using cryotherapy but now most commonly undertaken with laser photocoagulation, reduces the unfavourable structural outcomes and improves the functional visual acuity outcome. The CRYO-ROP study showed the long-term benefit of treatment of threshold disease compared with no treatment, however even with cryoablation 44.4% of treated eyes had a visual acuity of 6/60 or worse at 10 year follow-up. The ETROP study of earlier treatment for high-risk pre-threshold disease, rather than treatment at threshold, has shown that pre-threshold treatment of type 1 disease produces a significantly improved outcome. Despite treatment some infants develop retinal detachment for which various surgical treatments have been described, although not always with a good functional outcome. Future treatment modalities may include the use of anti-VEGF therapies.     

Epidemiology of respiratory distress of newborns

The present prospective study was conducted to find out the incidence, etiology and outcome of respiratory distress (RD) in newborns. All newborns (n=4505), delivered at this hospital over a period of 13 months, were observed for respiratory problems. Relevant antenatal, intranatal and neonatal information was noted. Cases were investigated for the cause of respiratory distress and followed up for the outcome. The overall incidence of RD was 6.7% Preterm babies had the highest incidence (30.0%) followed by post-term (20.9%) and term babies (4.2%). Transient tachypnea of newborn (TTN) was found to be the commonest (42.7%) cause of RD followed by infection (17.0%), meconium aspiration syndrome (10.7%), hyaline membrane disease (9.3%) and birth asphyxia (3.3%). TTN was found to be common among both term and preterm babies. While Hyaline membrane disease (HMD) was seen mostly among preterms, and Meconium aspiration syndrome (MAS) among term and post-term babies. Overall case fatality ration for RD was found to be 19%, being highest for HMD (57.1%), followed by MAS (21.8%) and infection (15.6%). Our results indicate that RD is a common neonatal problem. TTN accounts for a large proportion of thhese cases. MAS and infection also contribute significantly and are largely preventable. Without adequate ventilatory support HMD and MAS carry high mortality.