血清Toll样受体4联合超声血流指标与子痫前期围生儿结局的相关性

目的探讨血清Toll样受体4 (TLR4)联合超声血流指标与子痫前期围生儿结局的相关性。方法选择2017年2月-2019年6月在南充市中心医院住院分娩的子痫前期孕妇125例作为病例组,同期选择孕期健康和血压正常的孕妇125例作为对照组,所有入选者都给予超声血流检查,检测血清TLR4表达情况,调查病例组围生儿的结局并进行相关性分析。结果病例组孕妇大脑中动脉超声RI与PI值都显著高于对照组孕妇,血清TLR4值显著高于对照组孕妇,差异均有统计学意义(P<0.05)。所有围生儿都顺利分娩,病例组围生儿的1 min Apgar评分与5 min Apgar评分都显著低于对照组,差异有统计学意义(P<0.05)。在病例组中Pearson相关分析显示围生儿的5 min Apgar评分水平都与血清TLR4值及RI、PI呈现负相关性(P<0.05)。结论子痫前期患者表现为血清TLR4表达量上升与超声血流指标升高,且与患者的围生儿结局密切相关。     

2014-2018济南市522437例围产儿出生缺陷发生情况分析

目的 了解近5年济南市出生缺陷发生情况,为政府部门制定针对性的防控措施提供依据。方法 利用济南市妇幼信息平台收集出生缺陷相关信息,分析出生缺陷发生率、发生顺位变化趋势。结果 2014-2018年济南市出生缺陷平均发生率为136.02/万,发生率最高的年份为2017年（183.87/万）,发生率最低的年份为2014年（99.63/万）总体呈上升趋势（Z=185.153,P<0.05）。男性围产儿缺陷发生率为152.79/万,女性围产儿缺陷发生率为117.34/万。出生缺陷围产儿的母亲发生年龄分布呈“U”型,20岁以下低年龄段和35岁以上高年龄段发生率较高,其中2014年、2015年20岁以下年龄段发生率最高,2016、2017、2018年35岁以上年龄段发生率最高;主要出生缺陷病种为先天性心脏病、多指/趾、总唇裂、并指/趾、尿道下裂,其中先天性心脏病发病率逐年上升（Z=223.604,P<0.05）。结论 济南市出生缺陷发生率呈逐年上升趋势,应特别关注低年龄段人群,重点关注先天性心脏病的防控工作。     

Urinary endothelin excretion in the neonate: influence of maturity and perinatal pathology

The present study was undertaken to establish the developmental pattern of urinary endothelin-1 (ET-1) excretion and to define its possible role in mediating pathophysiological changes related to perinatal asphyxia/infection and dopamine treatment. Urinary ET-1 levels were measured by radioimmunoassay in 7 full-term neonates (mean gestational age 39.3 weeks) on days 1, 3 and 5, and in 9 pre-term neonates (mean gestational age 30.8 weeks) on days 1, 3, 5, 7 and weekly thereafter for 5 consecutive, weeks. The results were compared with those of three age-groups of 30 normal children (4–8 years, 9–12 years and 13–18 years); each group, consisted of 10 children. The influence of severe cardiopulmonary distress (n=16, mean gestational age 33.9 weeks, post-natal age 3.3 days) and dopamine administration in a dose of 2 g/min per kg (n=10, mean gestational and post-natal ages 32.1 weeks and 5.6 days, respectively) were also studied. In full-term infants, ET-1 concentration fell from 34.3±1.8 pmol/l on day 1 to 21.5±1.5 pmol/l on day 5 (P<0.01). In premature infants its absolute value and its post-natal fall were similar in the 1st week and no further change occurred in weeks 2–5; it stabilized at levels between 17.1±2.2 and 16.7±1.7 pmol/l. These concentrations tended to be lower than those of 25.5±1.3, 23.0±1.0 and 26.2±0.7 pmol/l measured in three groups of older children. During the 1st week, daily ET-1 excretion remained unchanged in term infants (3.1±1.0 vs. 3.7±1.5 pmol/m² per day), but there was a significant increase from 6.5±1.0 to 12.4±0.7 pmol/m² per day (P<0.01) in premature infants. During weeks 2–5, preterm infants excreted more ET-1 than older children (P<0.01). In response to perinatal ashphyxia/infection and dopamine therapy, urinary ET-1 excretion markedly rose and there was a significant positive correlation between urine flow rate and ET-1 excretion (P<0.001). We conclude that ET-1 concentration rather than excretion rate may have a role in mediating the changes in renal functions that occur soon after birth. The pathophysiological significance of the flow-dependent increase in urinary ET-1 excretion needs to be further studied.     

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。     

10年早产儿及新生儿结果分析

目的 探讨早产儿的发生因素和对母儿的影响及防治。方法 收集１９８９年１月至１９９８年１２月,１０年中我院住院分娩的全部早产病例８１６例,按产５年和后５年分为两组进行回顾性分析。结果 前组早产数为５３４例,早产发生率为３．２０％;后组早产数为２８２例,发生率为３．０５％,两组发生率对比无统计学差异（Ｐ〉０．０５）。其流行病学调查显示在职业、流动人口数和产前检查方面两组对比有极其显著性差异（Ｐ〈０．０     

过期妊娠104例临床分析

本文对104例过期妊娠与同期2571例足月妊娠的并发症及分娩方式进行了比较分析,结果表明:过期妊娠中头盆不称、胎位异常、胎儿宫内窘迫、巨大儿等发生率明显高于足月妊娠,且剖宫产率也较高,故认为适时终止妊娠对减少过期妊娠的发生至关重要。     

磁共振早期诊断围产期窒息性脑瘫痪

目的：研究围产期窒息性脑性瘫痪患儿颅脑形态学病理变化。方法：围产期窒息患儿20例,男15例,女5例。生后第7—10天和第5—6月,进行两次头颅磁共振成像（MRI）检查。结果：5例患儿存在颅脑形态学异常,临床均表现为脑性瘫痪。新生儿期发现缺血缺氧性脑病1例,颅内出血4例。后者均存在脑实质出血,其中合并脑室内出血1例,合并蛛网膜下腔出血3例。婴儿期追踪复查MRI发现脑室周围白质软化症1例,脑萎缩2例,慢性血肿──脑内囊腔形成2例。结论：MRI可早期诊断国产期窒息性脑性瘫痪。     

广州地区一九九七年孕产妇死亡原因分析

目的：分析广州地区１９９７年２７例孕产妇死亡原因。方法：对广州地区１９９７年孕产妇死亡资料进行回顾性分析并与１９８１～１９８７年资料进行对比。结果：产后出血是直接产科致死原因的首位原因。结论：加强围产保健是降低孕产妇死亡的重要手段。     

Perinatal mortality trends in a referral hospital

A comparative study of perinatal mortality patterns over a period was conducted at a teaching hospital of South India. Among the 6,048 babies born from January 1984 to December 1985 (Group A), there were 265 (43.8/1000) still births and 127 (22.0/1000) early neonatal deaths. Three hundred and thirty seven (41/1000) babies were still born and 235 (29.8/1000) early neonatal deaths out of 8,215 deliveries during 1992–93 (Group B). The perinatal mortality rate (PMR) in Group A and B were 57.9/1000 and 57.7/1000 respectively. Unbooked cases accounted for the majority (> 75%) of perinatal deaths during both the periods. The overall mortality rates in unbooked cases were three to four times higher than booked cases. Among the various causes of still births, antepartum haemorrhage and uterine rupture had increased. Septicaemia was the major cause of early neonatal deaths in Group A, but in Group B birth asphyxia and prematurity were the leading causes. Effective interventions like creating awareness among the target population to utilise maternal and child health services and early referral of high risk cases with improved intranatal and perinatal care can decrease the perinatal mortality.     

Early neonatal mortality in an intramural birth cohort at a tertiary care hospital

Early neonatal mortality (ENM) occurring among 12,283 consecutive live birthsover a period of 3 years were analysed. The early neonatal mortality rate (ENMR) was 26.6/1000 live births. Birth weight less than 2,000 gm, lack of antenatal care, male sex, operative vaginal delivery, prematurity and multiple pregnancy were significantly associated with early neonatal deaths. Birth asphyxia was found to be the most important cause of death, followed by hyaline membrane disease and congenital malformations. Majority of the asphyxia related deaths were due to late intrapartum referral of the mothers. Forty-two per cent of early neonatal deaths occurred in babies weighing less than 1,500 gm. Early identification and referral of high risk mothers and health education would significantly reduce the early neonatal deaths.