新生儿肺出血49例临床分析

目的探讨新生儿肺出血的临床特点。方法回顾性分析本院新生儿科2007年1月至2010年10月新生儿肺出血患儿的临床特点,总结新生儿肺出血患儿的胎龄、体重、原发病、血浆和呼吸机使用情况以及治疗和转归。结果共49例新生儿肺出血患儿,胎龄<30周19例(39%),30~36周17例(35%);体重<1000 g 12例(25%),1000~1499 g 22例(45%)。肺出血发生率较高的原发因素主要有新生儿肺透明膜病、窒息、肺部感染。共死亡11例,输血浆患儿31例,死亡5例;未输血浆患儿18例,死亡6例,差异有统计学意义(P<0.05)。常频机械通气35例,死亡7例;高频振荡通气14例,死亡4例,差异无统计学意义(P>0.05)。结论肺出血的发生与早产、低出生体重、肺透明膜病等缺氧性疾病及肺部感染性疾病有关,发生肺出血后应予综合治疗。     

肺表面活性物质治疗新生儿急性呼吸窘迫综合征的疗效

目的 观察肺表面活性物质(PS)治疗急性呼吸窘迫综合征(ARDS)新生儿的疗效.方法 将66例ARDS新生儿随机分为对照组和观察组.对照组予机械通气和常规治疗;观察组在此基础上,应用PS制剂猪肺磷脂注射液1剂.观察二组肺氧合功能改变.对二组患儿住院天数、机械通气天数、用氧天数和呼吸机参数[包括吸气峰压(PIP)、呼气末正压(PEEP)、平均呼吸道压(MAP)和吸入氧体积分数(FiO2)]进行比较.结果 观察组经PS治疗后,Pa(O2)和动脉血氧分压/肺泡氧分雎比值[a/A p(O2)]较对照组明显增高,而氧合指数(OI)较对照组明显降低,差异均有统计学意义(Pa<0.05).观察组呼吸机参数PIP、MAP和FiO2均明显低于对照组,二组比较具有显著件差异(Pa<0.005);观察组PEEP与对照组比较,差异无显著性意义(P>0.05).观察组用氧天数、机械通气天数和住院天数均明显短于对照组,二组比较具有显著性差异(Pa<0.05).结论 PS替代治疗能明显改善ARDS新生儿的氧合功能,降低呼吸机参数,缩短用氧时间、机械通气时间和住院天数,减少并发症的发生.     

呼吸机治疗新生儿肺透明膜病预后多因素分析

目的分析呼吸机治疗新生儿肺透明膜病(HMD)的疗效及影响预后的因素。方法对2000年1月~2002年12月在我科NICU呼吸机治疗的54例HMD患儿进行总结,分析其疗效,比较治愈组与病死组胎龄、出生体重、上机日龄、上机前血气及吸气峰压(PIP)、呼吸未正压(PEEP)、各种并发症的差异。结果呼吸机治疗新生儿HMD的治愈率为68.4％;病死组胎龄、出生体重均明显低于治愈组(P<0.05),病死组上机时的日龄及上机前的血pH值均明显小于治愈组(P<0.01),病死组呼吸机参数PIP、PEEP均明显高于治愈组(P<0.05),两组间各种并发症的比较差异无显著性。结论呼吸机是治疗新生儿HMD的主要手段;HMD患儿胎龄越小,体重越低,则病变发生越早,上机前酸中毒越明显,病死率就越高。     

早产儿支气管肺发育不良的高危因素及预防对策

目的分析早产儿支气管肺发育不良症(BPD)的发生率和高危因素,探讨BPD的诊治措施。方法回顾分析苏州大学儿童医院2002-01—2006-10在NICU诊治的孕周<32周的极低出生体重儿145例的临床资料。71例均有机械通气史,其中13例诊断为BPD(BPD组),而58例为非BPD组,对两组临床资料进行对照研究。结果孕周<32周的极低出生体重儿BPD的总发生率是10.34%,而有气管插管呼吸机辅助呼吸史的极低出生体重儿BPD的发生率高达18.31%。BPD组患儿胎龄和产重均较非BPD组低,胎膜早破史及合并PDA者BPD组均较对照组明显增高,有统计学意义(P<0.05);入院时间、肺表面活性物质(PS)的应用、有无窒息史均无明显差异,P>0.05;两组患儿在高浓度吸氧、PIP、PEEP及MAP几个呼吸机参数上差异无显著性(P>0.05),而上机时间和吸氧时间在两组间差异有显著性(P<0.05)。结论避免早产低体重、长时间吸氧机械通气、控制肺部反复感染是防止BPD的关键,积极早期综合治疗BPD疗效肯定,小剂量激素治疗有较好效果。     

经鼻持续正压通气治疗新生儿肺透明膜病的评价

目的评价经鼻持续正压通气(NCPAP)与常规机械通气(CMV)对新生儿肺透明膜病(HMD)的治疗效果和NCPAP是否降低呼吸机相关肺炎(VAP),呼吸机所致肺损伤(VILI)等发生.方法对38例在我院新生儿科住院的HMD患儿进行临床观察,随机分为两组,NCPAP组18例,CMV组20例.所有38例患儿均在生后24小时内给予单剂猪肺表面活性物质(固尔苏120mg/kg).NCPAP组应用INFANTFLOWSYSTEM(英国EME公司产)呼吸机.CMV组应用VIPBIRD(美国产)呼吸机IPPV+PEEP.辅助呼吸.结果存活NCPAP组16/18例,CMV组成活17/20例,两组在存活率、用机时间、颅内出血上无显著差异,而在呼吸机相关性肺炎、呼吸机致肺损伤并发症上,NCPAP组明显低于CMV组,经x2检验两组差异有显著,P＜0.05.结论NCPAP可有效地治疗新生儿HMD,并可明显减少VAP和VILI的发生.     

三省六县农村地区巨大儿影响因素研究

目的:探讨中国三省六县农村地区巨大儿发生率的影响因素.方法:采用分层整群随机抽样相结合的方法,抽取三省六县25个医疗卫生机构2008年入院分娩的活产儿病案进行病历摘录.结果:共摘录17805份合格病案,其中巨大儿1765例,巨大儿发生率为9.91%(95%CI:9.47-10.35).单因素分析显示,新生儿性别、产妇分娩年龄、职业、孕次、产次、孕周、孕前体质指数(BMI)、孕期增重、首次产检孕周、产前检查次数可能是发生巨大儿的影响因素.非条件Logistic回归分析显示,发生巨大儿的风险,男婴是女婴的1.81倍,过期产是非过期产的1.91倍,孕前超重和肥胖的妇女分别是正常者的1.98倍和3.20倍,孕期增重超过18kg的妇女是正常者的1.80倍,孕13-20周和孕20周以后才进行首次产前检查的妇女分别是孕早期开始产检的2.72倍和3.60倍.结论:三省六县农村地区巨大儿发生率较高,新生儿性别、妇女分娩年龄、孕周、孕前BMI指数、孕期增重、首次产检孕周是巨大儿的影响因素.     

糖尿病母亲的新生儿出生体重和疾病发生率的比较

目的　了解糖尿病母亲的发病孕期对其新生儿出生体重和疾病发生率的影响。方法　应用回顾性对照分析的方法 ,对 9例孕早期发病的糖尿病母亲的新生儿 (NODM) (1组 ) ,32例孕中期发病的NODM (2组 ) ,32例孕晚期发病的NODM(3组 )进行比较。结果　三组出生体重和胎盘重量上无显著差异 ,且出生体重与胎盘重量之间存在正相关 (r >r0 .0 5　　P <0 .0 1 )。新生儿疾病发生率 1组高于 2组和 3组 ,1组与 3组间差异有显著性意义 (χ2 =3 .88　P <0 .0 5)。结论　在现有的干预措施下 ,不同孕期发病的NODM在出生体重上无差别 ,但孕母患病越早、其新生儿的围生期疾病发生率越高     

早产儿视网膜病的影响因素

目的 探讨早产儿视网膜病(ROP)的影响因素.方法 选择本院患ROP早产儿为观察组,32周以下的早产儿为对照组,对2组患儿胎龄、出生体质量、出生方式、性别、多胎、使用呼吸机时间、休克、呼吸暂停、新生儿寒冷损伤综合征、肺透明膜病(Ⅲ级以上)、严重感染、肺出血及并发症合计数等临床资料进行单因素分析,并对有意义的因素进行多因素Logistic分析.结果 本资料共有早产儿358例,胎龄均小于32周.ROP 34例,其中Ⅰ期13例,Ⅱ期18例,Ⅲ期3例.二组患儿窒息、呼吸暂停、新生儿寒冷损伤综合征、肺透明膜病、严重感染、肺出血等并发症的发生率比较差异均有统计学意义(Pa<0.05),并发症合计数(OR=2.152,P=0.048)、使用呼吸机时间(OR=1.514,P=0.009)是危险因素.结论 早产儿ROP的发生率和发生并发症的多少及使用呼吸机的时间长短有关.在临床工作中要更多关注并发症的情况.     

新生儿呼吸窘迫综合征呼吸机治疗的肺保护性研究

目的　通过肺力学参数的监测来指导呼吸机的应用 ,为最终降低新生儿呼吸机相关性肺损伤提供客观依据。方法　 1994年至 2 0 0 1年收住NICU的 110例新生儿呼吸窘迫综合征 (NRDS)需呼吸机支持治疗者。分非肺力学监测组 (NPM)和肺力学监测组 (PM) ,对两组在呼吸机设置、血气分析结果、呼吸机相关性肺损伤及其他临床资料进行比较分析。结果　PM组呼吸机参数吸气峰压(PIP)、平均气道压 (MAP)、吸气时间 (Ti)显著低于NPM组 (P均 <0 0 0 1)。PM组血气分析仅PaCO2[( 48± 6)mmHg]高于NPM组 (P <0 0 0 1) ,而呼吸机相关性肺损伤的发生率为 13 % ,显著低于NPM组的 3 2 % (P <0 0 5 ) ;动脉导管开放 (PDA)的发生率分别为 3 3 %和 3 6% ,脑室内出血 (IVH)的发生率分别为 40 %和 42 % (P均 >0 0 5 ) ;呼吸机应用的时间、用氧时间、住院天数、病死率差异均无显著性 (P均 >0 0 5 )。结论　肺力学监测能指导正确应用呼吸机 ,降低呼吸机相关性肺损伤发生率 ;适当降低PIP ,采用低潮气量和缩短Ti,使MAP下降 ,应用适当的呼气末正压 (PEEP)治疗NRDS患儿 ,并不影响氧合 ;PaCO2 的轻度增高 ,不增加IVH的发生率     

早期新生儿病理性气胸的围生因素分析

目的分析早期新生儿病理性气胸的围生因素。方法收集2005年1月-2011年2月本院病理性气胸患儿38例(病例组),按13的比例,选择病例组住院号连续3份相同孕周产科分娩新生儿为对照组,对其临床资料进行回顾分析,分析发生病理性气胸的围生因素。结果早期新生儿病理性气胸占同期活产儿比例即发病率为0.25‰(38/150 575例)。肺部基础疾病包括肺炎(7.9%)和湿肺(92.1%)2种。经保守治疗和胸腔穿刺或引流后痊愈。病例组63.2%的患儿孕周<39周。病例组剖宫产娩出率(73.7%)、男童比例(81.6%)、羊水混浊率(34.2%)均显著高于对照组(Pa<0.05)。Logistic回归分析显示:男童、羊水混浊、剖宫产是增加7 d内新生儿发生气胸的危险因素,OR值(95%CI)分别为5.585(2.169～14.382)、3.431(1.336～8.811)、3.294(1.356～8.001)。结论湿肺是引起新生儿病理性气胸的原因之一,剖宫产是早期新生儿发生病理性气胸的重要危险因素。产科医师应严格控制选择性剖宫产率,尽可能在39周后进行选择性剖宫产,儿科医师对合并肺部并发症的新生儿出生48 h内严密观察病情,及时随访胸片,及早诊治病理性气胸。     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.     

Psychopathologie du syndrome d’Asperger et « aspérigisation » de la société contemporaine

The author has attempted here to point out, just for a start, the characteristics of Asperger syndrome from the point of view of psychopathology through a rereading of Hans Asperger's original paper (1944). This thesis merits reevaluation, if for no other reason than to fill the gaps in operational diagnostics based on the DSM. It is found by rereading that Asperger's view of the principal disturbances of autistic psychopathy include a “disturbance of natural evidence” or a “crisis of common sense”. This question of natural evidence that he evokes with regard to autistic psychopathy corresponds to W. Blankenburg's natural evidence, which constitutes a key concept for comprehending schizophrenia in the form poor-symptom (“symptomarme Schizophrenie”) that he observes in the speech of his patient Anne Rau. One can deduce from this that in terms of fundamental disturbances, Asperger syndrome and this “symptom-poor” schizophrenia overlap at the level of loss of natural evidence. It is moreover possible to classify Asperger syndrome among the disturbances of spacing in the sense meant by the evolutionary psychiatry of A. Stevens and J. Price. The author then develops our comprehension of Asperger syndrome from the point of view of the perspective proposed by the notion of resilience in people with Asperger syndrome and of the possibility for them, through these mechanisms of adaptation, to find in the organization of the personality of the “as if” type a position of relative equilibrium. They concur or overlap in the creation of crutches, of borrowed personalities secondarily legitimated by the reaction of the socius. This will end up in the production of inventions and œuvres (works). Clearly, one rarely encounters several cases that one could consider pertinently to be “successful” Asperger syndrome. Finally, the author notes that one can find a sort of isomorphism between Asperger syndrome and contemporary society when he proposes the term “asperigisation” to characterize our society, given that the equilibrium between emotion and logic is strongly disturbed in these patients, in whom logic undergoes hypertrophy while emotion is impoverished. From this perspective, the author hopes to suggest reasons for the increase in the number of cases of Asperger syndrome in the clinical setting and in society in general in our contemporary era.     

Bibliometric data: a disaster for many non-American biomedical journals

Bibliometric data published by the Institute of Scientific Information in Philadelphia (ISI), and which was previously discussed in Acta Paediatrica , has increasingly been used despite all the relevant and severe criticism that has been raised against this method of evaluating individual research results and grading scientific journals. It is obvious that the present trend regarding the use of bibliometric data as a basis for priorities and funding of research and for the promotion of individual scientists favours American-oriented research projects at the expense of those that are based on concepts of predominantly European relevance.

Conclusion: For the future of non-American research, it is important that no single super-power, i.e. the USA, should dominate scientific priorities. The condition for efficient European competition is that European Centres with high levels of competence for creative research and training of scientists from all over the world are established. In addition, it is important that the results of European research are published in prestigious European journals, as was the situation before World War II.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.