肺表面活性物质治疗新生儿胎粪吸入综合征的临床研究

目的探讨肺表面活性物质（ＰＳ）治疗新生儿胎粪吸入综合征（ＭＡＳ）的有效性及临床价值。方法采用气管内滴入ＰＳ治疗８例ＭＡＳ患儿，其中６例接受ＰＳ２剂，２例接受ＰＳ３剂。结果给予首剂ＰＳ后１０分钟患儿青紫迅速消失，皮肤转红润，经皮测定血氧饱和度（ＴｃＳａＯ２）升高。３０分钟后患儿低氧血症迅速改善，动脉血氧分压、动脉血氧分压与吸入氧浓度比值、动脉肺泡血氧分压比值、呼吸机有效指数较治疗前显著增高，分别由原来的５２８±０９８ｋＰａ、８６６±３５２ｋＰａ、０１２±００６ｋＰａ及０１４±００６ｍｌ·ｋＰａ－１·ｋｇ－１增加到８９１±１４３ｋＰａ、１６８１±４１８ｋＰａ、０２１±００５ｋＰａ及０２６±００７ｍｌ·ｋＰａ－１·ｋｇ－１；而吸入氧浓度及平均气道压逐渐降低，由原来的０６８±０１９ｋＰａ及２２０±０４２ｋＰａ降低到０５３±００８ｋＰａ及１９３±０４８ｋＰａ。重复应用ＰＳ后亦有相似效果。结论ＰＳ能有效地改善ＭＡＳ患儿肺顺应性及氧合功能。重复应用ＰＳ可巩固和加强疗效。     

新生儿颈外静脉的解剖观测及临床意义

本文解剖观察、测量了16具32例新生儿尸体的颈外静脉,结果其平均长度为4.37±0.94Cm,平均管径起点为0.16±0.05Cm,汇合点为0.24±0.07Cm,注入点为0.28±0.08Cm,被测量的颈外静脉中有98%的下段后壁上有一较大的属支.全长可分为三段,根据回流部位不同可分为三型,即锁骨下静脉型、静脉角型和颈内静脉型.     

Pathology of the lung in the fetus and neonate, with particular reference to problems of growth and maturation

The major forms of lung pathology in the perinatal period are reviewed with emphasis on disturbances of growth and maturation. Lung hypoplasia results from impairment in the physiological control of lung growth during the fetal period. It is more common than organogenetic defects which are discussed only briefly. Hyaline membrane disease is now seldom seen in a pure form due to improvements in perinatal care. However, its complications and sequelae such as interstitial emphysema, pneumothorax and bronchopulmonary dysplasia are encountered more frequently. In addition, a wide variety of pathological processes may localize to, or be expressed in, the lung of the newborn, notably asphyxial changes, persistent pulmonary hypertension, haemorrhage and infection.     

产程中应用杜冷丁对产程及新生儿的影响

目的　观察杜冷丁对产程及新生儿的影响。方法　将 16 0例初产妇随机分为观察组和对照组 ,各 80例 ,观察组在宫口开大 1.2cm时杜冷丁 10 0mg肌肉注射 ,对照组未用药。结果　第一产程用药组与对照组相比明显缩短 ,有显著差异 (P <0 .0 5 ) ,第二、三产程无差异 (P >0 .0 5 ) ,对新生儿影响、产后 2小时内出血量及新生儿体重两组无差异 (P >0 .0 5 )。结论　产程中应用杜冷丁可减轻产妇疼痛 ,缩短第一产程 ,不增加新生儿窒息 ,值得推广应用     

新生儿缺氧缺血性脑病血浆内皮素与肺功能的关系

目的 :探讨内皮素 (ET)、在新生儿缺氧缺血性脑病 (HIE)中的作用及与肺功能关系。方法 :将 4 2例 HIE患儿按病情分为轻、中、重三组 ,各组均在入院后第 2天采用婴儿体描箱进行潮气呼吸分析、有效气道阻力及功能残气量等肺功能测定同时用放射免疫法测定血浆 ET水平。结果 :中、重度 HIE组血浆 ET水平均高于轻度组及对照组 ;中、重度HIE组肺功能测定提示 TPTEF/ TE、VPEF/ VE、PEF的下降。重度 HIE组潮气量下降 ,有效气道阻力增高。结论 :血浆ET水平增高与 HIE病情的严重程度相一致 ,肺功能检测指标可以解释血浆 ET水平的增高在新生儿中、重度 HIE发生肺动脉高压及急性肺损伤中起的作用 ,对 HIE临床治疗有一定的指导作用     

新生儿胃穿孔18例诊治报告

目的 :探讨新生儿胃穿孔的诊断、治疗效果及预后因素。方法 :对 1 8例新生儿胃穿孔病例诊断、治疗及预后因素进行分析。结果 :1 8例患儿均有拒奶、腹胀、呕吐、呼吸困难等症状。腹部立位 X线片示膈下有大量游离气体。其中单纯穿孔 6例 ,多发穿孔 4例 ,胃壁缺损 7例 ,全胃壁缺如 1例。单纯及多发胃穿孔行胃修补术 ,3例同时行胃造痿术。胃壁肌层缺损行病变组织切除、胃壁修补及胃造痿术。 1例全胃壁肌层缺如仅行腹腔引流术。本组存活 8例 ;死亡 1 0例 ,病死率 5 5 .5 6%。死亡原因为多脏器功能衰竭、DIC。结论 :新生儿胃穿孔预后差 ,且受发病时间、就诊时间、病变严重程度等综合因素影响     

Effect of mite-impermeable mattress encasings and an educational package on the development of allergies in a multinational randomized, controlled birth-cohort study – 24 months results of the Study of Prevention of Allergy in Children in Europe

BACKGROUND: Sensitization to house dust mite (HDM) is an important risk factor for the development of asthma and allergic disease in childhood. Higher levels of HDM allergen are linked to increased sensitization to HDM. OBJECTIVE: To study the effect of mite-impermeable mattress encasings and an educational package on the development of allergies in a newborn cohort. METHODS: Six hundred and ninety-six newborns at high risk of developing allergies were enrolled in three European countries (Germany, Austria, UK) in a prospective, randomized, controlled birth-cohort study. Children were randomly assigned to an intervention and control group. Intervention measures included the use of mite-impermeable mattress encasings for the child's bed and a simple educational package on allergen avoidance. The control group received basic information about allergies. Children were followed up at age 6, 12, 18 and 24 months. RESULTS: 80.9% of the children were followed up to the age of 24 months. No difference in the prevalence of sensitization to HDM (control vs. intervention group: 8.4% vs. 6.1%, P=0.33) or the development of symptoms (recurrent wheezing 10.3% vs. 10.7%, nocturnal cough 12.5% vs. 12.5%) or allergic diseases (asthma 3.5% vs. 5.1%, eczema 20.0% vs. 19.6%, rhinitis 28.9% vs. 25.8%) could be found between the control and intervention group. CONCLUSION: In this study, HDM avoidance did not show a protective effect on the development of sensitization to HDM or symptomatic allergy in children at age 24 months.     

第1产程潜伏期指导对分娩的影响

目的 :观察规范指导对处于分娩第 1产程潜伏期孕妇的影响。方法 :为处于分娩第 1产程潜伏期的 15 0例产妇讲解分娩知识 ,训练助产动作 ,树立自然分娩信心 ,并动态观察产妇的分娩情况。以条件相同 ,未在潜伏期做指导的产妇 15 0例为对照组。结果 :观察组总产程、第 1产程活跃期及第 2产程明显短于对照组 (P <0 0 1) ,新生儿窒息率、剖宫产率明显低于对照组(P <0 0 1)。第 1产程潜伏期、阴道助产率及产后出血发生率两组差异无显著性。结论 :在第 1产程潜伏期对产妇进行规范指导可以缩短产程 ,促进自然分娩 ,降低新生儿窒息发生率。     

新生儿血糖监测（附32例临床分析）

应用英国产“ＨＹＰＯＣＯＵＮＴＧＡ”微量血糖测定仪（氧化酶光电比色法）对同期住院新生儿不分病种连续３天进行空腹血糖监测。结果在原发疾病情况下表现出低血糖发生频率高，而低血糖症状又被原发疾病所掩盖。在３２例中足月儿２３例，足月小样儿４例，早产儿５例，在３２例９６次监测中发现低血糖１４例，其中足月儿９例，早产儿５例．发病率为４３．７％；高血糖３例。无一例死亡。提示：新生儿患病情况下，易发生低血糖，其发生与疾病、孕周有关而与体重无关。因此，在新生儿期必须注意及时喂养与补充葡萄糖，防止低血糖时间过长对脑部造成损伤。     

足月新生儿颅内出血的CT诊断

经CT扫描诊断的足月新生儿颅内出血8例,就其病因、CT表现特点及CT与超声检查的比较进行讨论。提出新生儿颅内出血与孕期、胎次、分娩方式均有一定的关系,同时还应注意新生儿因脑发育不成熟在CT扫描图像上有其特殊表现。