窒息新生儿肾主动脉血流动力学改变与尿液中内皮素变化的关系研究

目的:探讨窒息新生儿肾主动脉血流动力学改变及与尿液中内皮素改变的关系;方法:采用高频彩色多普勒超声技术监测窒息新生儿生后24小时内肾主动脉的血流动力学参数(收缩期峰值流速、舒张末期流速、阻力指数)变化,同时采用放射免疫分析法(RIA)检测尿液中内皮素-1(ET-1)水平.结果:与对照组相比,窒息组肾主动脉阻力指数增大,而收缩期峰值流速和舒张末期流速降低(P<0.05),同时尿液中ET-1水平显著增加(P<0.05),且ET-1水平与阻力指数大小呈显著正相关关系,与舒张末期流速呈显著负相关关系(r分别为0.86和-0.72,P<0.05).结论:窒息新生儿存在肾主动脉血流动力学改变,表现为肾血流灌注不良,这可能与ET-1产生增多有关.     

双功超声多普勒对肝纤维化家兔门脉血流动力学的实验研究

实验用多普勒超声研究血吸虫病肝纤维化家兔门脉血流动力学的变化及药物对其的影响，并与正常兔对照。结果表明：与正常兔相比，血吸虫病肝纤维化家兔门脉内径明显增加（P＜0.01），血流速度明显降低（P＜O.05），而血流量稍增加（P＞0.05）。垂体后叶素能有效地减少门脉血流量，但它也降低心输出量；而硝普钠增加肝血流量的同时并不减低心输出量。提示多普勒可作为一种无创伤性的检测手段评价肝纤维化门脉血流动力学的变化及药物治疗门脉高压食道静脉曲张破裂出血的疗效。     

多巴酚丁胺对硬膜外阻滞后低血压时血流动力学影响

目的：观察多巴酚丁胺对硬膜外阻滞后低血压时的血流动力学影响。方法：大硬膜外阻滞后低血压时，静脉滴注5或10ug/kg多巴酚丁胺药液，观察用药后5和10min时对全身血流动力学和肝肾血流量的影响，心输出量，肝肾血流量均用电磁血流量仪直接测定。结果：两组药量静脉滴注后平均动脉压和外周血管阻力均未恢复到阻滞前水平，对肾血流量无明显影响，肝血管阻力较阻滞后增加，但仍低于阻滞前水平。结论：本文剂量的多巴酚丁胺对硬膜外阻滞后血流动力学影响较小。     

窒息新生儿尿系列微量蛋白与肾血流动力学改变的研究

目的探讨不同窒息程度新生儿尿系列微量蛋白与肾脏血流动力学指标变化的关系。方法对轻度窒息组新生儿30例、重度窒息组新生儿22例和26例正常新生儿(对照组)在出生后和24h内24～48h,进行尿白蛋白(Alb)、转铁蛋白(TRF)、β2-微球蛋白(β2-MG)、α1-微球蛋白(α1-MG)和血肌酐(Cr)的检测;所有新生儿在出生24h内用彩色超声测定肾动脉血流参数变化,包括收缩期峰值流速(PSFV)、舒张末血流速度(EDFV)、阻力指数(RI)、搏动指数(PI)。结果窒息组与对照组比较,尿系列微量蛋白水平显著升高(P<0.01),以重度窒息组升高为显著;血Cr水平3组间差异无统计学意义(P>0.05);窒息组与对照组比较,肾动脉血流速度降低(P<0.05),血管阻力增大(P<0.05);生后24h内肾血流动力参数与生后24～48h尿中系列微量蛋白呈明显的相关性,肾动脉血流速度与尿系列微量蛋白水平呈负相关(P<0.05),血管阻力与系列微量蛋白呈正相关(P<0.05)。结论通过尿微量蛋白的高低评估患儿肾血流,通过肾血流检测可估计尿微量蛋白的高低。尿系列微量蛋白和肾血流动力参数的测定对窒息新生儿肾功能损伤的早期诊断具有重要作用。     

窒息新生儿肾血流动力学与肾功能指标的相关性

目的探讨不同窒息程度新生儿肾血流动力学与肾功能指标变化的相关性。方法对71例窒息新生儿和20例健康新生儿在出生后1～3 d和5～7 d时,测定尿酶和血清尿素、肌酐的水平;在生后第1天、第3天和第7天采用彩色超声测定肾动脉血流参数变化。结果生后1～3 d时,窒息组与对照组比较,尿酶和血清尿素、肌酐水平显著升高（P〈0.05）,以重度窒息组升高为显著。生后第1天时,窒息组与对照组比较,肾动脉血流速度降低（P〈0.01）,血管阻力增大（P〈0.05）。生后第1天肾血流动力参数与生后1～3 d尿酶、血清尿素、肌酐呈明显的相关性,肾动脉血流速度与尿酶和血清尿素、肌酐水平呈负相关（P〈0.01）,血管阻力与尿酶和血清尿素、肌酐水平呈正相关（P〈0.05）。结论尿酶、血清尿素、肌酐和肾血流动力参数的测定对窒息新生儿肾功能损伤的早期诊断具有重要作用,缺血缺氧是导致新生儿肾血流动力学改变及肾功能异常的重要因素。     

双功超声多普勒对肝纤维化家兔门脉血流动力学的实验…

实验多普勒超声研究血吸虫病肝纤维化家兔门脉血流动力学的变化及药物对其的影响，并与正常兔对照。结果表明：与正常兔相比，血吸虫病肝纤维化家兔门脉内径明显增加（Ｐ＜０．０１），血流速度明显降低（Ｐ＜０．０５），而血流量稍增加（Ｐ＞０．０５）。垂体后叶素能有效地减少门脑海因流量，但它也降低心输出量；而血流量的同时并不减低输出量。提示多普勒可作为一流量，但它也降低心输出量；而硝普钠增加肝血流量的并不减低心输     

重度窒息的新生儿颅脑超声表现

目的:观察重度窒息新生儿颅脑超生的表现和脑血流动力学情况.方法:选取2015年1月至2016年10月该院52例重度窒息新生儿,采用颅脑超声对其大脑前动脉血流参数加以测定,同时和20例健康新生儿之间作出比对.结果:出生48 h内,在大脑前动脉收缩期或是舒张末期,窒息儿大脑的平均血流速度均有所降低.特别是舒张末期,其血流速度降低程度最为突出,相较于对照组有统计学差异(P＜0.01);脑血管阻力指数明显上升,相较于对照组同样有统计学差异(P＜0.01).结论:通过检测窒息儿脑血流动力学情况,能够对脑损伤作出科学地诊治,使新生儿恢复健康.     

新生儿窒息后肾血流改变

近年来,大量研究表明,窒息后脑血流动力学改变为脑损伤的主要致病因素,国内外有多篇文献报道彩色多普勒对窒息新生儿脑血流的研究,而对新生儿窒息后肾血流变化报道较少.1994年元月～1995年6月我科应用彩色多普勒动态检测1周内正常新生儿和窒息新生儿肾动脉(KA)血流变化,现将研究结果报道如下.     

参桂胶囊对犬心脏血流动力学的作用

目的：探讨参桂胶囊对犬心脏血流动力学的作用。方法：分别对杂种犬按1．0g/kg、2.0g/kg静脉注射参桂胶囊注射液。结果：参桂胶囊有扩张冠状动脉、增加冠脉血流量、减慢心率、降低血压、增加心输出量和降低外周阻力作用。结论：参桂胶囊对犬心脏血流动力学有明显的影响，可使缺血心肌氧的供——需平衡得到调整。     

复合辅酶、磷酸肌酸治疗新生儿窒息所致心肌损伤疗效观察

<正>围产期缺氧缺血可导致多脏器功能障碍、损伤,对心、脑、肾的影响尤为明显。有研究发现,窒息后心肌损伤或心功能障碍的发生率甚高。新生儿窒息后心脏功能被抑制,心输出量不同程度减少,进而加重全身各个重要脏器的缺氧[1-2]。新生儿窒息导致的酸碱失衡及低氧血症,仍是目前导致新生儿致死、致残的主要原因之一,而心肌损伤又是新生儿窒息的常见并发症,因此,对窒息后心肌损伤的早期诊断、及时治疗、疗效及预后的评估显得尤为重要。磷酸肌酸     

Recent Advances in Hypertension

The possible relationship between the renal mechanism of volume control and blood pressure regulation is discussed. Expansion of the extracellular fluid (ECF) and plasma volumes was demonstrated following renal artery constriction in the rat; after about one month ECF volume returned to normal although hypertension persisted. Measurements of cardiac output in the unanesthetized rat by an implanted electromagnetic flowmeter showed an initial rise in cardiac output after renal artery constriction, returning to normal in 10 to 15 days. A homeostatic hypothesis for the production of renal hypertension is put forward in which changes in ECF volume, capacity vessel tone and myocardial contractility participate in the development of hypertension by elevating cardiac output. Autoregulation of peripheral flow then occurs and the consequent restoration of blood pressure at a renal pressure receptor results in return to normal of cardiac output by negative feedback. Thus in chronic hypertension the high peripheral resistance is maintained by autoregulation.     

新生儿窒息的脑血流动力学改变

目的：研究窒息新生儿的脑血流动力学改变。方法：应用彩色多普勒超声监测12例窒息新生儿脑血流参数变化。结果：生后＜72小时的大脑前、中、后动脉的收缩期峰值流速(Vs)与舒张末期流速(Ved)降低、搏动指数(PI)、阻力指数(RI)增高。与生后＞72小时监测值相比均有显著性差异(P＜0.01)。结论：窒息的新生儿在生后72小时内有脑血流减少与脑血管阻力增加的改变,从理论上阐明新生儿窒息与新生儿缺氧缺血性脑病时应用多巴胺类药物的必要性。     

Comparison of serum cardiac troponin-I and creatine kinase MB isoenzyme concentrations in asphyxiated neonates

Objective:To assess the correlation of signs of myocardial damage to serum cardiac tmponin I(cTnI)and creatine kinase MB isoenzyme(CK-MB)concentrations.Methods:Blood samples were collected from 25 term asphyxiated neonates and 25 controls at 12 h of age by immunoassay.The asphyxiated neonates were followed up until discharge or death.Results:Asphyxiated neonates had significanfly higher concentrations of cTnI and CK-MB than controls(P＜0.001).Serum cTnI concentrations were significantly higher in asphyxiated neonates who developed hypotension,heart failure or those had low ejection fraction(P＜0.01).Serum cTnI concentrations were significantly higher in asphyxiated who died than those who survived(P＜0.01).There was no significant difference in selMnl CK-MB mass concentrations between asphyxiated neonates with and without these complications.Conclusion:Unlike CK-MB,serum cTnI concentrations are significantly higher in asphyxiated neonates who died or developed cardiac dysfunction.     

Comparison of serum cardiac troponin-Ⅰ and creatine kinase MB isoenzyme concentrations in asphyxiated neonates

Objective： To assess the correlation of signs of myocardial damage to serum cardiac troponin I （cTnI） and creafine kinase MB isoenzyme （CK-MB） concentrations. Methods： Blood samples were collected from 25 term asphyxiated neonates and 25 controls at 12 h of age by immunoassay. The asphyxiated neonates were followed up until discharge or death. Results： Asphyxiated neonates had significantly higher concentrations of cTnI and CK-MB than controls （ P 〈 0.001 ）. Serum cTnI concentrations were significantly higher in asphyxiated neonates who developed hypotension, heart failure or those had low ejection fraction （P 〈 0.01 ）. Serum cTnI concentrations were significantly higher in asphyxiated who died than those who survived （P 〈 0. 01）. There was no significant difference in serum CK-MB mass concentrations between asphyxiated neonates with and without these complications. Conclusion： Unlike CK-MB, serum cTnI concentrations are significantly higher in asphyxiated neonates who died or developed cardiac dysfunction.     

新生儿窒息后血清皮质醇及胰岛素水平与血糖的关系

目的：探讨新生儿窒息后血皮质醇、胰岛素水平动态变化与血糖的关系，以利临床正确处理低血糖，减少神经系统损害。方法：采用放射免疫法监测43例新生儿窒息后第1、3、7d血清皮质醇、胰岛素浓度，葡萄糖氧化酶法监测血糖浓度。结果：新生儿窒息后第1、3、7d血清皮质醇逐渐降低(P＜0．01)，血胰岛素水平第1d显著增高(P＜0．01)，第3d恢复正常(＜20mIU/L)；出生第1d，血皮质醇水平与血糖呈正相关(r＝0．432，P＜0．01)，血胰岛素与皮质醇比值，低血糖组高于正常血糖组(P＜0．01)，高胰岛素血症组低血糖发生率(76．9％)高于正常胰岛素组(41．2％，P＜0．05)。结论：新生儿窒息后低血糖的发生与暂时性高胰岛素血症及相对低的血皮质醇水平有关。     

血清胱抑素C对新生儿窒息后肾损伤的诊断价值探讨

目的：探讨血清胱抑素C（Cystatin C,Cys C）水平在新生儿窒息后肾损伤中的诊断价值。方法：选取窒息新生儿120例,其中轻度窒息组74例、重度窒息组46例,同时选取30例健康足月新生儿作为健康对照组;窒息组新生儿在入院后第1 d、健康对照组新生儿在生后1-3 d各抽取外周静脉血3 ml,用乳胶颗粒增强比浊法检测各组血清Cys C水平,与其血清尿素氮（BUN）、肌酐（Cr）水平比较,并进行统计学处理。结果：轻度窒息组血清Cys C、BUN和Cr水平有显著升高,差异具有统计学意义（P〈0.01）;轻度窒息组血清Cys C、BUN和Cr的异常检出率分别为73%、35%和38%,重度窒息组血清Cys C、BUN和Cr的异常检出率分别为91%、65%、和70%,在轻度窒息组和重度窒息组血清Cys C的异常检出率显著高于血清BUN和Cr的异常检出率,差异有统计学意义（P〈0.05、P〈0.01）,血清Cys C与BUN和Cr水平之间呈显著正相关关系（r=0.81、r=0.84,P〈0.01）。结论：Cys C能较早反映肾脏受损时,肾小球滤过率的下降;血清Cys C可作为新生儿窒息后肾脏损伤的早期诊断指标之一。     

彩色多普勒超声对糖尿病肾病肾血流的观察分析

目的:探讨彩色多普勒超声肾血流参数诊断糖尿病肾病的临床价值。方法:应用彩色多普勒超声对26例健康成人、46例2型糖尿病肾病患者肾段动脉、叶间动脉血流参数进行测定。结果:疾病组肾段动脉、叶间动脉收缩期最大血流速度(Vs)、舒张期末最低血流速度(Vd)较正常组降低(P<0.01),阻力指数(RI)较正常组明显升高(P<0.01)。结论:彩色多普勒超声肾血流参数在预测糖尿病肾病肾脏损害方面有一定临床参考价值,为糖尿病肾病的诊断提供了一种简便的方法。     

Measurement and Clinical Significance of Endothelin inNeonatal Urine

Endothelin(ET),a21--aminoacidpeptide,isthemostpotentendogenousvasoconstrictoridentifiedtodate.Itisoriginallyisolatedfromtheculturemediumofporcineaorticendothelialcells[lj.Researchesonithavemadefastprogressinrecentyears,butrarelyinvolvedinurinaryET.ThepresentstudywasdesignedtoexamineurinaryETlevelsinhealthyandasphyxiatedneonates,toelucidatethesourceofurinaryETanditsclinicalsignificance.1PATIENTSANDMETHODS1'1SubjectsForreasonsofconvenientandaccurateurinecollections,onlymaleinfantswere…     

Coronary bypass revascularization with radial artery and internal mammary artery grafts

Objective To evaluate radial artery (RA) and internal mammary artery (IMA) grafts in coron ary artery bypass and the use of color Doppler ultrasound in the peri- operative evaluation of IMA and radial- ulnar collateral circulation. Methods From June 1998 to June 2000, sixty cases of coronary bypass revascularization wi th RA and IMA were performed. Preoperatively, the radial- ulnar collateral circ ulation was evaluated with the modified Allen’s test, color Doppler ultrasound a nd noninvasive oxygen saturation measurement. The IMA lumen and blood flow were measured at the first intercostal space with color Doppler ultrasound preoperat ively and postoperatively. Results One patient (1. 7%) died of serious cardiac arrhythmia on the fourth postoperati ve day. There were no arterial graft harvest related complications. Before har vesting, the ulnar artery blood flow was 30. 78±9. 71 ml/min, and it increased to 43. 36±13. 98 ml/min (40. 87% increase, P&lt;0. 01) after the operation. Compared with the baseline, there was no obvious change of IMA blood flow posto peratively (P&gt;0. 05), but the systolic/diastolic flow ratio markedly dec reased from 8. 57±3. 98 ml/min to 3. 41±4. 87 ml/min (P&lt;0. 01). Conclusions Arterial grafts can be safely used for coronary bypass revascularization with go od results. The ulnar artery blood flow can increase compensatively after RA ha rvesting. The diastolic blood flow of grafted IMA markedly increased postoperat ively. Color Doppler ultrasound was very helpful both in evaluating the radial - ulnar collateral circulation before RA harvesting and in assessing the patency of the grafted IMA after coronary artery bypass grafting (CABG).     

超声引导下穿刺肾囊肿乙醇硬化治疗的评价

目的探讨超声引导下穿刺注射99·9%乙醇治疗肾囊肿的作用。方法采用超声对26例肾囊肿行定位穿刺抽液和注入99·9%乙醇,治疗前、后测量并比较患肾主动脉及囊肿毗邻处动静脉血流,设对照组20例。随访6个月~1年。结果超声引导下共治疗26例囊肿,5例未完全消失,进行2次治疗,共穿刺31次,无严重并发症;治疗前、后患肾段动脉流速及阻力指数(RI)间差异有显著性意义(P<0·05)。结论超声引导下穿刺注射99·9%乙醇治疗肾囊肿是一种安全、微创、高效、经济的治疗方法;多普勒频谱检测肾血流有助于了解肾囊肿对肾脏的影响。