小儿脑瘫的病因学及危险因素的研究

小儿脑瘫作为导致儿童神经系统严重残疾的主要疾病之一，越来越受到人们的关注。介绍了国内外在脑 因和危险因素方面的研究现状。研究表明：脑瘫的病因是多因性的，包括孕前、产前、产时及产后几个主要方面;早产和低出生体重是脑瘫的两个最主要危险因素。     

明确脑瘫病因 减少脑瘫患儿

明确脑瘫病因减少脑瘫患儿浙江省人民医院儿科副主任医师朱海峤最近有一对研究生夫妇，带着他们一岁多的小孩前来就诊。患儿已一岁零四个月，还不能步行，不会站立，甚至不能独坐，颈部也有点软绵绵的。医生根据家长主诉和患儿的体征，很快做出了脑瘫的诊断，并告之这孩子...     

儿童脑瘫的流行特征与危险因素

脑瘫是继脊髓灰质炎控制之后又一儿童严重的致残性疾病。由于低出生体重儿特别是极低体重儿存活增加，脑瘫患病率无明显下降。对脑瘫的病因揭示仍显不足，遗传和环境因素对胚胎及胎儿发育生物学作用研究可望加强。     

脑瘫诊断面面观

脑瘫是儿童期最常见的一种发育障碍性疾病, 是儿童残疾的重要原因之一。本文对脑瘫的定义及演变、病因、诊断年龄、分型、合并症、诊断策略等方面研究进行探讨, 以期对脑瘫诊断规范化和防治提供帮助。     

61例早产儿脑瘫的临床特征

脑瘫是儿科最常见的神经运动发育性残疾，患病率1‰～5‰。近年来，随着医学技术的发展，危重新生儿包括早产儿和低出生体重儿的存活率不断提高，但脑瘫发生率没有下降，反而有上升趋势。1997年我国江苏省等7省市的1～6岁3万余名儿童调查，脑瘫发生率为1．59‰，早产儿脑瘫发生率为29．13‰，为足月儿的25．16倍。我院儿童康复中心对61例早产儿脑瘫进行了初步临床研究，探讨其病因和临床表现。     

儿童脑瘫的流行特征与危险因素

脑瘫是继脊髓灰质炎控制之后又一儿童严重的致残性疾病。由于低出生体重儿特别是极低体重儿存活增加 ,脑瘫患病率无明显下降。对脑瘫的病因揭示仍显不足 ,遗传和环境因素对胚胎及胎儿发育生物学作用研究可望加强。     

脑性瘫痪的危险因素研究进展（综述）

脑性瘫痪目前发病率有上升趋势,病因相当复杂,其危险因素按脑损伤发生的时间常分为产前因素、产时因素和产后因素。以前普遍认为,产时和产后因素是脑瘫的主要原因,但近年来认为,产前因素是脑瘫的主要病因,产时和产后危险因素很可能是产前因素导致的结果变量,而不是脑瘫的直接病因。     

新生儿惊厥及预后

目的：探讨新生儿惊厥的远期预后与围生期疾病及惊厥情况的关系。方法：对5－12岁有新生儿惊厥史的儿童进行体格检查及IQ测定，部分行CT及EEG检查并回顾病史和出生情况。结果：后遗症（脑瘫、癫痫和智力低下）发生率为26．8％（15／56）。其中脑瘫4例、癫痫5例（2例合并脑瘫），智商低下12例（3例合并脑瘫，1例合并癫痫）。新生儿缺血缺氧脑病。惊厥次数≥3、持续48h以上、全身强直降挛型和多灶性阵挛型患儿后遗症发生高。结论：新生儿惊厥可致神经系统后遗症，预后与其病因、惊厥次数、惊厥持续时间和惊厥形式密切相关。     

家长的心态对脑瘫患儿康复治疗的影响

脑性瘫痪（脑瘫）是一种由各种因素引起的中枢性非进行性瘫痪。由于病因复杂，早期又无明显神经系统的阳性体征，往往因得不到足够重视而延误诊治。我科自2003年6月开展脑瘫康复治疗以来，对150例脑瘫患儿采用了穴位封闭配合功能训练等治疗，取得了满意的疗效。在治疗过程中通过对患儿家长心理调查发现家长的心态在治疗过程中起重要作用，直接影响着治疗效果。现报告如下：[第一段]     

脑瘫防治简谈

１９９９年６月２９日，《西安晚报》登载了一起医疗纠纷赔偿案，一对龙凤双胞胎出生后，由于医院婴儿观察室温箱发生故障，两婴儿未被及时护理而导致脑瘫，一审判决湖北省人民医院赔偿原告３８３万余元。这则消息成为人们关注的热点。被告为何会在原告面前低头？这得从脑瘫的诱发因素谈起。认识脑瘫脑性瘫痪，是一个综合名称，它包括多种原因引起的以非进行性中枢性运动功能缺陷为特点的疾病。病情严重者，除脑瘫外还可有智力低下、抽搐。视觉和听力或言语功能异常。本病并不少见，病因不一，如难产及产伤所致小儿颅内出血、各种原因导致的…     

Immunopotentiation of Staphylococcus aureus type 5 capsular polysaccharide co-entrapped in liposomes with alpha-toxin

Immunopotentiation of Staphylococcus aureus type 5 capsular polysaccharide (CP5) by use of liposomes as an alternative to protein-polysaccharide conjugates was investigated. Mice were immunized twice with cationic liposomes containing CP5 alone or CP5 co-entrapped with alpha-toxin or heat-detoxified alpha-toxin. Immunogenicity of these different antigens was compared with CP5-alpha-toxin conjugates. Antibodies against CP5 were elicited in mice immunized with conjugates or liposomes containing co-entrapped CP5 and alpha-toxin. Liposomes containing CP5 alone or co-entrapped CP5 and alpha-toxoid failed to induce antibodies against CP5. All the preparations entailed an antibody response against alpha-toxin and highest antibody and neutralizing activity titers were obtained with liposomes. These results show that liposomes can be used to immunopotentiate CP5, however, a co-incorporated protein able to insert lipids bilayers is probably required.     

环磷酰胺对小鼠体重和精子影响

目的探讨不同剂量的环磷酰胺（CP）对小鼠体重和精子畸形的影响。方法将雄性昆明种小鼠随机分成阴性对照组和不同剂量环磷酰胺试验组,经口连续灌胃5 d,正常饲养到35 d解剖动物,观察各试验组小鼠体重、精子畸形和精子数量的变化。结果连续灌胃5 d后,CP各组小鼠的体重与对照组比较均减轻（F=205.06,P〈0.01）;CP剂量越大,小鼠体重减轻越多。CP剂量越大,小鼠精子数量减少越多,CP 60 mg/（kg.BW）剂量组为最少,与空白对照组比较,差异有统计学意义（F=39.71,P〈0.01）。CP 30 mg/（kg.BW）以上剂量组均可引起精子畸形数量增加,随着剂量加大,畸形精子数越多。30与40 mg/（kg.BW）组的精子畸形率与对照组差异有统计学意义（F=51.24,P〈0.01）。结论 CP 40 mg/（kg.BW）以上剂量组,可使小鼠体重明显减轻、精子数量明显减少。     

The effect of varying crude protein level and the proportions of fibre in diets containing a mixture of meat-and-bone meal and wheat bran as the only protein source on nitrogen balance indices and energy digestibility in the rat

1. The experiment was designed to investigate the effect of protein level in diets on apparent protein digestibility (AD), true protein digestibility (TD), biological value (BV), net protein utilization (NPU) and energy digestibility (DE) in rats. The design involved fourteen dietary treatments in which a combination of wheat bran and meat-and-bone meal (1:1, w/w dry matter (DM) basis) was the only nitrogen source. Crude protein (N x 6.25; CP) level ranged from 60 to 329 g/kg DM in approximately even increments. All diets contained a constant level of minerals and vitamins. The balance of the diet consisted of a N-free mixture. 2. AD increased from 0.602 at 60 g CP/kg DM to 0.702 at 120 g CP/kg DM, with little change at the higher levels of dietary protein. The fitting of a curve indicated an asymptote of 0.721. 3. TD did not vary significantly between 60 and 225 g CP/kg DM (mean 0.781). At the higher protein levels there was a slight but significant reduction in the mean value (0.758). 4. BV increased from 0.475 at 60 g CP/kg DM to 0.498 at 80 g CP/kg DM where it plateaued, and then from 160 g CP/kg DM it decreased at an increasing rate to 0.216 at 329 g CP/kg DM. 5. The response in NPU closely reflected that obtained with BV, rising from 0.370 to 0.384, then declining to 0.162 at the highest CP concentration. 6. DE decreased linearly from 0.851 at 60 g CP/kg DM to 0.617 at 329 g CP/kg DM. 7. The results confirmed that AD values should only be compared at a defined protein level. TD was essentially independent of dietary CP level, except for a small reduction above 250 g CP/kg, whereas BV and NPU were stable only within the range 80-140 g CP/kg DM. DE was negatively related to dietary CP and fibre level.     

新疆维吾尔族儿童脑性瘫痪发生的危险因素分析

目的 分析新疆维吾尔族儿童脑瘫发生的危险因素,为脑瘫的预防和治疗提供临床依据。方法 收集2013年1月-2015年6月新疆自治区人民医院收治的0~6岁维吾尔族脑瘫患儿286例,与相同年龄段的维吾尔族健康儿童572名作比较,应用单因素和多因素Logistic回归分析脑瘫发生的危险因素。结果 单因素Logistic分析显示:影响脑瘫发生涉及遗传因素、产前、产时和产后的多种因素。多因素Logistic回归分析得出该种族儿童脑瘫的危险因素主要有近亲结婚、脑病家族史、母孕期感染、母不良孕产史、胎龄<32周、宫内窘迫、低出生体重、新生儿窒息、新生儿重度黄疸、新生儿缺氧缺血性脑病。结论 新疆维吾尔族儿童脑瘫的发生涉及多种危险因素,应积极加强对各危险因素的预防和干预工作,以降低儿童脑瘫的发生率。     

Relationship between exposure to chlorpyrifos and concentration of urinary alkylphosphates in termite control workers

Chlorpyrifos (O, O-diethyl-3,5,6-trichloro-2-pyridinyl phosphorothioate; CP) has been used for insecticide to prevent infestation of termites. A study was made on occupational exposure to CP of termite control workers engaged in spraying this organophosphorus insecticide. Workers were engaged in two types of spraying; that is spraying CP under floor and spraying CP around house. All the under-floor sprayers wore respirators during spraying. CP levels in air near the breathing zone, contact amounts of CP with skin, and urinary alkylphosphates levels were higher in the under-floor sprayers than in the around-house sprayers. The personal ambient CP levels of the under-floor sprayers were 0.012 to 0.145 (8 h-TWA, mg/m3) lower than the threshold limit value (0.2 mg/m3) proposed by ACGIH. A maximum diethylphosphate (DEP) excretion was observed in the first urine collected the next day, while the highest diethylthiophosphate (DETP) was excreted in the last urine in the working day. In the excretion amount, DEP was higher than DETP. Amounts of CP collected in respirators used by the under-floor spraymen averaged 0.76 mg/respiratory comparable to their estimated theoretical value of 0.69 mg/m3. The urinary total alkylphosphate (DEP + DETP) level was more closely correlated with the contact amount of CP with skin (r = 0.86) than with the personal ambient CP level (r = 0.05). These results indicate that 1) respiratory absorption of CP was prevented by the use of respirator; 2) the urinary alkylphosphates were mainly derived from the dermal absorption of CP; and 3) biological monitoring using urinary alkylphosphates levels is an useful index for CP exposure.     

基于文献计量方法的我国临床路径政策问题论证

目的:分析我国临床路径不同发展阶段及特点,论证现阶段我国临床路径面临的主要问题并提出对策建议。方法:采用文献计量方法分析国内临床路径文献总体趋势,采用内容分析法分析我国临床路径政策及阶段特点,采用关键词共现法分析现阶段我国临床路径面临的主要问题。结果:我国临床路径发展可划分为理论探索、试点探索和综合发展3个阶段。临床路径已进入常态化管理,但尚面临管理水平、标准化、信息化和医保支付等多方面问题。结论:在政策推动下,临床路径已成为医院科学化管理的重要工具,但仍需通过提升临床路径管理水平、规范临床路径实施流程、完善医保支付方式、加强信息化建设等方式,促进我国临床路径的发展。     

A preliminary study into the economic burden of cerebral palsy in China

OBJECTIVES: To measure the economic burden of cerebral palsy (CP) in China is to provide information on CP's societal impacts to policy-makers. METHODS: The economic burden of CP includes direct healthcare costs, direct non-healthcare costs, developmental costs and indirect costs such as productivity loss. The incidence approach is employed to estimate the lifetime economic burden of a new CP birth and that of all new cases in China in 2003. Caregivers of 319 CP patients were interviewed in specialty hospitals in five cities in 2004. Average expenditure and utilization rates for different services by age groups from this sample were obtained to estimate the economic burden of CP. Chinese CP patients' life expectancy and survival rate were simulated with reference to Australian data with Human Development Index adjustment. RESULTS: From the societal perspective, the average lifetime economic burden of a new CP case in China was US$ 67,044 in 2003, and the life-span total economic loss due to all new CP cases in 2003 amounted to US$ 2-4 billion. Indirect (productivity) costs are responsible for 93% of total economic loss, and direct healthcare and developmental costs make up 3% each. There are several factors which contribute to the extraordinarily high economic burden of CP, including productivity loss, reduced life expectancy, dependency, progressive deterioration of motor physical function, and recurrent use of rehabilitation services. CONCLUSION: The economic burden of CP in China is substantial for the family of a CP patient, as well as to society. Public provision and financing of necessary preventive and rehabilitative services is urgently needed to mitigate this heavy burden for patients and their families.     

Has Campylobacter pylori infection any clinical relevance? Methodologic, epidemiologic and clinical studies

The occurrence of Campylobacter pylori (CP) was studied in 180 patients referred for endoscopy. The bacterium was detected by culture, histology (Warthin-Starry staining) and urease test of antral biopsy samples. Patient groups were formed according to endoscopic diagnoses, clinical symptoms and antral mucosal histology. 50 CP positive patients with chronic antral gastritis were treated by bismuth subsalicylate (2,4 g/day) for 3 weeks. Positivity by culture and/or silver-stained histology proved to be the most reliable way for detecting CP. CP was proved in about 30% in patients with normal gastroduodenum (13/42) or with stump gastritis (4/15), in 75% with endoscopic antral gastritis (51/68) and in 89% with duodenal ulcer (49/55). A close relationship between CP and histological chronic antral gastritis could be demonstrated. No causal link between CP positive chronic active antral gastritis and non-ulcer dyspepsia could be verified. The decrease in histological activity of chronic gastritis and in dyspeptic complaints after bismuth salt therapy was found to be independent of CP elimination. The results of control investigations following a therapy-free interval of 7-10 days speak in favour of CP recolonialisation within a relativelly short period. It can be concluded that, despite the undeniable relationship between CP and chronic antral gastritis and duodenal ulcer, further studies are necessary to clarify the clinical relevance of the CP infection.     

不同神经学评估工具及其对脑瘫预测效度的研究进展

脑瘫严重危害着儿童的身心健康,因此脑瘫患儿的早期筛查、诊断及干预对改善脑瘫患儿的预后、提高脑瘫患儿的生活质量有重要作用,目前用于早期预测脑瘫患儿神经学检 查工具包括:全身运动质量评估、新生儿20项行为神经测定方法、贝利婴幼儿发育量表III、0~1岁神经运动20项检查、Vojta姿势反射等,这些神经学检查工具对脑瘫患儿有一定的评估作用,并且一定程度上能够预测脑瘫的发生,本文就几种神经学评估工具及其对脑瘫患儿的预测效度进行综述。