新生儿局部脑组织氧检测的多中心研究

Objectives To understand the value of measuring neonatal cerebral regional oxygen ‘saturation(rSO2)using near infrared spectroscopy (NIRS) in assessing cerebral oxygenation,to establish the normal range of neonatal cerebral rSO2,and to collect data of the changes of cerebral rSO2 under certain disease status.Methods Nine large hospitais participated in the multicenter randomized clinical trial from Jan 2007 to Apr 2008.Using the NIRS human tissue oximeter(TSAH-100)independently developed in China.tIle cerebral rSO2 of 223 normal full-term and 95 otherwise healthy preterm neonates without any stmcial disease,Was detected at 1.2 and 3 days after birth,respectively.The cerebral rSO2 of 102 neonates with diseases which may affect the cerebral oxygenation.Was also detected during the severe phases.The pulse oxygen saturation(SpO2)measured at the finger tip,and also the arterial oxygen saturation(SaO2) measured by blood gas analysis,which could indicate the oxygen supply of the whole body,were obtained simultaneously.The correlations among cerebral rSO2,putse SpO2 and arterial SaO2 were analyzed.Results (1)The cerebral rSO2 of the normal full-term neonates wag(62±2)%.Cerebral hypoxia Was deftned as rSO2 lower than 58%. The cerebral rSO2 of the normal full-terms was steady at 1, 2 and 3 days after birth respectively, without any significant differences among them (F = 0. 610, P >0. 05 ). The cerebral rSO2 of the neonates with diseases was ( 55 + 7 ) %, which was significantly lower that that of the normal full-term neonates (t = 15.492,P <0. 05). (2) The cerebral rSO2 was positively correlated with the SpO2(r =0. 74,P < 0. 01 ) and the SaO2 ( r = 0. 71, P < 0. 01 ). ( 3 ) Under some special diseases, the changes of cerebral relatively low hemoglobin concentration, the cerebral rSO2 was significantly low (50%～58% ), but the cerebral rSO2 was lagged as compared with that of pulse SpO2. Especially, during the severe phases of 6 cases with multi-organ failure, the SpO2 and the cerebral rSO2 were both significantly low (55%～80% for SpO2, and 44%～50% for cerebral rSO2 ) ; when the diseases were alleviated, although the SpO2 recovered phases of serious hypoxic-ischemic encephalopathy (HIE), the cerebral rSO2 significantly increased to 70%～72%, which was significantly higher than the normal value (62%). Condusions The range of cerebral rSO2 of the normal full-term neonates was (62 + 2) %. Cerebral oxygenation can be externally indicated by the rSO2 noninvasively and continuously measured by NIP, S, which was positively correlated with traditional pulse SpO2 and arterial SaO2. In some special diseases, the rSO2 measured by NIRS can be helpful for clinical diagnoses and treatments.     

新生儿局部脑组织氧检测的多中心研究

目的 探讨近红外光谱测定技术(near-infrared spectroscopy,NIRS)检测新生儿局部脑组织氧饱和度(Regional oxygen saturation,rSO2)对评估脑氧合状态的价值,建立新生儿脑rSO2的测定值,为临床应用提供依据.方法 采用NIRS技术对无特殊疾病的223例足月儿和95例早产儿分别在生后第1天、第2天及第3天进行脑rSO2测定,选取102例患有影响脑氧合疾病的新生儿,对照两组间脑rSO2数值差异.同步分析脑rSO2与脉搏氧饱和度(pulse oxygen saturation,SpO2)及动脉血氧饱和度(arterial oxygen saturation,SaO2)间的关系.结果 (1)正常足月新生儿脑rSO2测定值为(62±2)%,以低于两个标准差作为脑rSO2测定值异常,可以认为低于58%提示为脑组织缺氧.疾病状态新生儿脑rSO2范围(55±7)%,与无特殊疾病新生儿组差异有统计学意义(P<0.05).(2)脑rSO2与经皮SpO2及SaO2呈正相关,直线相关系数r分别为0.74和0.71.(3)特殊的疾病状态下,脑rSO2与SpO2可出现不同步的变化趋势,表现为:①spO2尚正常,而脑rSO2已降低.体现在18例严重的颅脑疾病及血红蛋白较低的病例.②一些危重病儿病情恢复过程中,脑rSO2的恢复滞后于SpO2在6例多脏器功能衰竭患儿尤为突出.③在3例重度缺氧缺血性脑损伤(HIE)急性期,脑rSO2有异常增高现象.结论 正常足月新生儿脑rSO2测定值为(62±2)%,低于58%提示脑组织缺氧.NIRS技术客观反映了脑组织的氧合变化,可为临床应用提供依据.     

“远程医疗”背景下的紧密型医联体建设探讨△

分析紧密型医联体和“远程医疗”在促进分级诊疗实施中的优势，发现“远程医疗”能够促进紧密型医联体建设，有益于分级诊疗实施。但由于缺乏政府的宏观调控和指导，基于“远程医疗”的紧密型医联体建设过程面临缺乏顶层设计、标准体系、基础设施不均衡等问题。本文从政府主导的角度，提出建立紧密型医联体“远程医疗”体系、“远程医疗”公共平台、利益分配体系的“远程医疗”背景下的紧密型医联体建设的对策建议。     

芪参益心方治疗风湿性心脏病慢性心力衰竭临床观察

目的：探索芪参益心方治疗风湿性心脏病慢性心力衰竭的临床治疗效果。方法76例风湿性心脏病慢性心力衰竭患者随机分为治疗组和对照组,每组38例。对照组给予西药常规治疗,治疗组在西药常规治疗的基础上加服芪参益心方,4周疗程结束后对比两组患者的治疗效果。结果治疗组总有效率达81.58%,对照组总有效率为65.79%,两组比较治疗组疗效明显优于对照组(P<0.05);且治疗后治疗组超声心动图射血分值改善情况优于对照组(P<0.05)。结论风湿性心脏病慢性心力衰竭患者在西药常规治疗的基础上合用芪参益心方能够显著提高治疗效果,值得临床借鉴和进一步探索。     

小儿先天性甲状腺功能减退症99mTc甲状腺显像的临床意义

43例先天性甲状腺功能减退症(CH)患儿以左旋甲状腺素钠治疗至2-3周岁,暂停药4周行99mTcO-4甲状腺显像.结果 示甲状腺发育不良37例(86.05%),99mTcO-4甲状腺显像正常6例(13.95%).99mTcO-4甲状腺显像对CH的病因诊断、治疗方案选择有指导作用.     

新生儿经外周置入中心静脉导管相关感染研究

目的本研究旨在探讨PICC相关感染的类型、主要病原菌和危险因素。方法回顾性分析300例应用PICC治疗的新生儿导管相关感染的发生率,导管相关性血流感染(CRBSI)的病原菌构成。对CRBSI的危险因素进行Logistic回归分析。结果导管定植的发生率为3.0%,1.2/1000导管日。局部感染(出口部位感染+隧道感染)率为7.4%,2.8/1000导管日。CRBSI发生率为9.0%,3.6/1000导管日。CRBSI病原菌G+菌占57%,主要为凝固酶阴性的表皮葡萄球菌。G-菌占18%,以肺炎克雷伯杆菌为主,真菌占25%,主要为念珠菌。Logistic回归分析显示仅置管时间为CRBSI的独立危险因素[OR=1.58(1.12~1.73)]。结论 PICC相关感染以CRBSI最常见,CRBSI的病原菌以凝固酶阴性葡萄球菌为主,真菌也较常见。置管时间是CRBSI的独立危险因素。     

中药治疗急性踝关节扭伤38例疗效观察

目的 观察壮骨关节丸联合云南红药胶囊治疗急性踝关节扭伤的临床疗效.方法 随机将急性踝关节扭伤的67例患者分为两组,治疗组38例口服壮骨关节丸,6 g/次,2次/d;云南红药胶囊,0.5g/次,3次/d.对照组29例口服中华跌打丸,6 g/次,2次/d.观察两组患者的临床疗效、疼痛评分、治愈时间等情况.结果 治疗组总有效率为97.4%,对照组为75.86%.两组总有效半比较差异有统计学意义(χ~2=5.33.P＜0.05).治疗组治疗前后疼痛评分分别为3.92±0.49、1.00±0.92;对照组分别为3.69±1.07、2.17±1.66,两组组内治疗前后疼痛评分比较,差异有统计学意义(t值分别为16.2、4.1,P均＜0.01),治疗后组间疼痛评分比较,差异有统计学意义(t=3.65,P＜0.01).治疗组治愈时间为(4.62±1.92)d,对照组为(17.2±0.53)d,两组治愈时间比较,差异有统计学意义(t=20.97,P＜0.01).结论 壮骨关节丸联合云南红药胶囊治疗急性踝关节扭伤有效,且缩短治愈时间.     

新生儿窒息患者血浆中凝血分子标志物的测定

目的　探讨新生儿窒息患者血浆中凝血分子标志物蛋白C(PC)、抗凝血酶(AT)、血管性血友病因子(VWF)、D 二聚体(D -D)的变化,为临床判断病情发展、及时治疗提供依据。方法　用法国Biomerix公司的Mini Vidas免疫荧光仪测定4 3例窒息新生儿和32例足月新生儿PC的活性、VWF及D- D的含量,同时采用美国IL公司的ACLFuturaPlus型全自动血凝仪检测AT的活性。结果　与对照组相比,窒息组AT、PC的活性降低,VWF及D -D的含量明显增高,两者相比均有显著性差异(P <0 .0 1)。结论　窒息新生儿存在抗凝因子活性降低,血管内皮细胞损伤和以高凝状态为主的早期DIC ,测定窒息新生儿血浆中AT、PC、VWF、D D有助于早期诊断和判断病情。     

增强校报可读性的探讨

可读性强是报刊赢得读者青睐的法宝。在新闻事业飞速发展的今天,各种新闻媒介增多,知识、信息大爆炸,读者对刊物的选择性强,质量要求高,可读性问题更应该引起高校校报界的高度重视。尤其是目前的全国高校校报普遍存在着反映范围小,知识面窄;出版周期长,时效性差;内容陈旧,缺少新意等不足[1],如果不积极探索、改革,增强可读性,校报必然难以走出困境,失去读者,不能充分地发挥其应有的作用。因此,改革校报的内容和形式,增强可读性,已经成为校报发展的永恒主题。1　改革会议报道“长、滥、旧、呆板”等弊病,追求“短、深、新、活”[2]作为新闻报…     

难治性血小板减少性紫癜的治疗进展

难治性血小板减少性紫癜的治疗进展焦富勇刘春风李志光宋银子特发性血小板减少性紫癜（ＩＴＰ）是小儿较常见的一种出血性疾病，近年来有关难治性或慢性ＩＴＰ的治疗进展颇快。１大剂量甲基泼尼龙冲击治疗难治性ＩＴＰ对静脉输注大剂量丙种球蛋白和口服激素无效的病例采用...