长时程脑电监测对评估HIE预后的价值

目的:探讨脑电图(EEG)长时程监测对新生儿缺氧缺血性脑病(HIE)预后的临床价值。方法:对在我院高危儿室住院的52例HIE的患儿进行12～24 h的EEG监测,将其脑电信息储存,采用(日)福山幸夫"新生儿异常EEG"诊断标准进行回放分析。并随访35例患儿,对预后进行评估。结果:52例患儿中,35例表现为不同程度的背景脑电活动降低,异常率占67%,且临床为中、重型HIE患儿的EEG异常率(100%),明显高于轻型HIE患儿的异常率(39%)(P<0.01)。EEG表现为中、高度背景脑电活动降低者,留有后遗症的几率(8/24,33%)高于轻型EEG背景活动降低者的几率(2/28,7%)(P<0.05)。在出生>1周后的新生儿。EEG仍表现为中、高度背景脑电活动降低的患儿,留有癫癎、脑瘫的几率(11例均有后遗症)明显高于出生后1周内背景脑电活动降低患儿的几率(4/13,31%) (P<0.01)。结论:EEG表现为轻度背景脑电活动降低者,预后良好,中度背景脑电活动降低者预后不良,高度背景脑电活动降低者预后极差。因此长时程脑电监测对新生儿HIE诊断及预后的评估具有重要意义。     

Nucleus basalis lesions in neonate rats induce a selective cortical cholinergic hypofunction and cognitive deficits during adulthood

Summary Ibotenic acid was infused into the nucleus basalis magnocellularis (nBM) of 2-day old rats to eliminate immature cholinergic neurons before they develop functional synaptic connections in the neocortex. For bilaterally lesioned neonates, cognitive testing was initiated 2 months after lesioning and animals were sacrificed at 8 or 12 months of age. Lesioned animals exhibited a marked deficit in the retention of passive avoidance behavior, as well as in the acquisition of 2-way active avoidance behavior. Lesioned animals also made significantly more alternation errors than control animals in the Lashley III spatial maze and showed severe impairments in general learning, reference memory and working memory during 17-arm radial maze testing. For all 4 tasks, neonatally lesioned animals did not show any recovery to the performance level of control animals. Histological analysis of the subcortex from lesioned animals during adulthood revealed: (1) a substantial reduction in acetylcholinesterase-positive cells (presumably cholinergic) within the nucleus basalis, (2) decreased acetylcholinesterase staining in neocortex and (3) a gliosis essentially restricted to the globus pallidus. Surrounding brain regions were apparently not damaged as a direct result of excitotoxin infusion. Neurochemically, neonate nBM lesioning produced a long term cholinergic hypofunction as evidenced by significant reductions of 25% and 18% in frontal cortex chorine acetyltransferase (CAT) activity at 12 and 8 months of age, respectively. By contrast, prefrontal cortical concentrations of biogenic amines and their metabolites were unaffected, thus indicating a degree of neurochemical specificity for these neonatal nBM lesions. The persistant cortical cholinergic hypofunction in lesioned animals may be related to the long term deficits in learning/memory abilities that were also observed. It is suggested that neonatal nBM lesioning could provide a useful animal model for elucidating the plasticity of the developing brain after cortical anervation.     

Extensive surgical excision of large hemispheric “malignant” astrocytoma in a 6-week-old infant

A massive hemispheric high-grade astrocytoma, diagnosed in a 6-week-old infant, was totally excised by means of two craniotomies. The child is still alive and well with minimal neurological dysfunction 1.5 years after operation. This case report illustrates the benefit of aggressive surgical excision (without radiation or chemotherapy) of massive malignant neonatal astrocytomas. While surgical deficits may be minimized by the plasticity of the developing nervous system, extensive excision may yield occasional long-term palliation.     

不同严重程度高胆红素血症新生儿血清AST、CK MB、LDH、BUN、TBiL水平的表达及临床意义

目的探讨不同严重程度高胆红素血症新生儿血清总胆红素(TBiL)、谷草转氨酶(AST)、血尿素氮(BUN)、肌酸激酶同工酶(CKMB)及乳酸脱氢酶(LDH)水平的表达及临床意义,旨在为临床高胆红素血症新生儿的诊治以及预后评估提供参考。方法选择2020年4月-2021年4月在郑州市某医院就诊的65例高胆红素血症新生儿作为观察组,选择同期行实验室指标检测的63例健康新生儿作为对照组。观察组患儿根据血清TBiL水平分为重度(TBiL水平>342μmol/L)8例,中度(257~342μmol/L)21例,轻度(TBiL水平<257μmol/L)36例。所有研究对象均进行实验室检测,指标包括AST、CKMB、LDH、BUN、TBiL。对比2组研究对象血清相关实验室检测指标:观察组、对照组的AST、CKMB、LDH、BUN、TBiL水平。对比治疗前后24 h轻度、中度、重度患儿AST、CKMB、LDH、BUN、TBiL水平。对比不同病情患儿预后情况,即统计治疗过程中的并发症发生率。结果观察组研究对象AST、CKMB、LDH、TBiL水平均高于对照组,差异均有统计学意义(P<0.05)。2组研究对象BUN水平比较,差异无统计学意义(P>0.05)。治疗前,中、轻度患儿AST、CKMB、LDH、TBiL水平均低于重度组,轻度组患儿AST、CKMB、LDH、TBiL水平均低于中度组,差异均有统计学意义(P<0.05)。治疗后,3组患儿AST、CKMB、LDH、TBiL水平均低于治疗前,差异均有统计学意义(P<0.05)。中、轻度组患儿AST、CKMB、LDH、TBiL水平均低于重度组,轻度组患儿AST、CKMB、LDH、TBiL水平均低于中度组,差异均有统计学意义(P<0.05)。中、轻度组患儿并发症发生率低于重度组,差异有统计学意义(P<0.05)。轻、中度组患儿并发症发生率比较,差异无统计学意义(P>0.05)。结论AST、CK-MB、LDH、TBiL联合检测可用于评判高胆红素血症新生儿的病情严重程度,并可指导临床治疗,改善预后质量,值得临床推广。     

纳络酮治疗新生儿缺氧缺血性脑病40例临床观察

目的探讨新的、有科学理论依据安全高效的治疗新生儿缺氧缺血性脑病(HIE)的方法,使HIE预后得以改善.方法将80例HIE新生儿随机分为纳络酮(NX)治疗组和对照组、各40例.两组患儿一般情况、孕产情况和临床表现方面相似(P＞0.05).结果治疗组有效率优于对照组(P＜0.01).病死率治疗组低于对照组(P＜0.05).结论 NX能促进HIE的恢复,对减少HIE后遗症起重要作用.     

围产期缺氧对新生儿脐血氧自由基的影响及意义

目的:探讨围产期缺氧而Apgar评分≥8分的新生儿脐血中氧自由基的变化情况。方法:以同期正常新生儿作对照,搜集围产期缺氧而生后Apgar评分≥8分的新生儿脐血,测定脐血中的超氧化物歧化酶(SOD)、过氧化物酶(GPX)及丙二醛(MDA)的含量。结果:围产期缺氧能引起新生儿脐血中SOD及MDA显著意义的改变;GPX有一定程度的降低,与对照组比较无差异。结论:围产期缺氧能够造成氧自由基的生成增多和抗氧化酶的消耗,即使生后Apgar评分≥8分的新生儿,亦应加强监护,及时补充外源性抗氧化剂以预防缺氧后的多器官系统损伤。     

新生儿乳酸脱氢酶同功酶测定及其临床意义

目的：测定新生儿末梢血乳酸脱氢酶同功酶活性。并探讨其临床意义。方法：采足跟血0.1ml,应用琼脂糖凝胶电泳法测定LDH1-5,并对其与新生儿日龄、孕出生体重、Apgar评分、窒息和预后关系进行分析。结果：随着日龄的增加,LDH1增高,LDH5下降,过期产、早评分、窒息和预后关系进行分析。结果：随着日龄的增加,LDH1增高,LDH5下降,过期产、早产、巨大儿、低体重儿与正常儿相比均出现了LDH5增高,LDH1降低,LDH5/LDH1比值增大的缺氧表现,LDH1、LDH5和LDH5/LDH1比值的改变与新生儿的缺氧状态、程度、预后有密切关系。结论：LDH1改变能较灵敏的反映新生儿的缺氧情况,能帮助判断预后和指导治疗,可成为新生儿监护的重要指标。     

新生儿窒息后血清心肌肌钙蛋白I的检测及其意义

目的　探讨血清心肌肌钙蛋白I(cTnI)评估新生儿窒息后的心肌损害的临床价值。方法　采用ELISA法对 2 0例窒息新生儿和 2 5例正常新生儿进行cTnI检测 ,同时检测肌酸磷酸激酶同功酶 (CK -MB)。结果　窒息组急性期血清cTnI、CK -MB水平明显高于对照组 (P <0 .0 5 ) ,且窒息时间越长 ,血清cTnI、CK -MB水平升高越明显 ,cTnI诊断新生儿窒息后心肌损伤的特异性均优于CK -MB。结论　血清cTnI和CK -MB的测定有助于早期预测心肌细胞损害 ,cTnI优于CK -MB     

新生儿缺氧缺血性脑病血清心肌酶活性的变化

目的：探讨新生儿缺氧缺血性脑病（ＨＩＥ）患儿血清心肌酶活性的变化及其临床意义。方法：对４２例ＨＩＥ患儿分设轻度组、中度组、重度组、分别于入院２４ｈ内及ｄ７检测其血清ＧＯＴ、ＣＫ、ＬＤＨ、α－ＨＢＤＨ的活性,并作对比分析。结果：ＨＩＥ患者血清ＧＯＴ、ＣＫ、ＬＤＨ、α－ＨＢＤＨ浓度均升高,且重度组高于中度组,中度组高于轻度组（Ｐ〈０．０５,Ｐ〈０．０１）,治疗后７ｄ且的心肌酶浓度均下降,轻至中度组已基     

母婴同室新生儿感染因素分析

目的：把母婴同室的新生儿感染率控制到最低限度。方法：采用回顾性分析方法,对近两年我院母婴同室新生儿感染情况与过去母婴分室新生儿感染的情况进行对比,分析新生儿感染因素。结果：母婴同室新生儿感染发生率４．４％,比母婴分室新生感染率１０．２８％明显降低。晶龄大于３ｄ的新生儿母婴同室的感染率明显低于母婴分室的感染率,晶龄３ｄ内的新生儿母婴同室与母婴分室无明显差异。结论：母婴同室实行的各项措施比较有效地控制