新生儿坏死性小肠结肠炎的热点问题

陈超教授很高兴受<中国循证儿科杂志>编辑部的邀请,在"第三届上海国际新生儿医学论坛"会议期间,与荷兰阿姆斯特丹自由大学医学中心艾玛儿童医院Hans Van Goudoever教授和复旦大学附属儿科医院新生儿科张蓉博士共同就"新生儿坏死性小肠结肠炎(NEC)的热点问题"进行讨论.NEC是新生儿常见的消化道急症,在NICU中的发生率和病死率都较高,对早产儿近期和远期预后均有重要的影响.NEC的发病是多因素的,肠道的不成熟和感染在其中起重要的作用.     

子宫内膜异位症保守性手术后药物治疗进展

子宫内膜异位症（EMs）是育龄妇女的常见病,保守性手术后复发率高,有必要予以术后药物治疗。目前的术后用药多样,但几乎都表现为用药依赖,往往需要数年甚至更久的维持用药。口服避孕药、孕激素因其经济、方便,不良反应少,可作为术后治疗的一线选择;而促性腺激素释放激素类似物长期用药的益处相比于其昂贵的医疗费用及不良反应优势并不明显,因而与达那唑、孕三烯酮等作为二线用药。而左炔诺孕酮宫内缓释系统特别适用于合并子宫肌腺病的EMs患者。另外免疫调节、基因靶向治疗为其提供了新的治疗思路。     

早产儿母亲认知行为干预对母婴互动的效果研究

目的 探讨早产儿母亲认知行为干预对母婴互动效果的影响.方法 选择2007年8月至2008年5月我院新生儿重症监护病房住院的胎龄28～36周的适于胎龄儿,且危重指数评分＜40分、经过新生儿重症监护病房治疗、病情稳定转入早产儿病房且不需氧气支持的低危早产儿及其母亲,按照早产儿人院先后依次分为干预组和对照组各19对.对照组母亲常规探视,并阅读自行制定的"读懂早产宝宝行为"的宣教手册.干预组母亲在此基础上接受4次、每次2 h的认知行为干预.干预内容包括指导母亲"读懂早产儿行为"、指导喂养、指导个人卫生和急救复苏等.干预方式主要包括理论辅导和实践参与.干预效果通过母婴互动评价量表--婴儿哺喂评估量表(Nursing ChildAssessment Feeding Scale,NCAFS)进行评价.结果 母婴NCAFS总分在干预后即早产儿纠正胎龄40周时,干预组评分为(46.4±8.5)分,高于对照组的(42.7±5.9)分,但差异无统计学意义(t=1.55,P＞0.05);干预组母亲总分为(35.8±6.3)分,高于对照组母亲的(33.3±5.6)分,但差异无统计学意义(t=1.28,P＞0.05),其中母亲对早产儿暗示行为敏感得分为(12.2±1.7)分,显著高于对照组母亲的(10.7±2.4)分(t=2.10,P＜0.05);干预组婴儿总分为(10.6±3.2)分,高于对照组婴儿的(9.5±3.1)分,但差异无统计学意义(t=1.08,P＞0.05).结论 通过对早产儿母亲认知行为进行短期干预,可以提高母亲对早产儿暗示的敏感度,但对母婴互动总的影响需要进一步研究.

Abstract：

Objective To examine the impact of cognitive behavior intervention (CBI) on mother-infant interaction in the neonatal department. Methods Low-risk appropriate for gestational age premature infants with gestational age 28-36 weeks, who were admitted to the neonatal intensive care unit in our hospital between August 2007 and May 2008, and their mothers were assigned to intervention group and control group respectively. Intervention group mothers (n = 19)participated in CBI. Control group mothers (n= 19) were asked to read educational materials. Mothers in the intervention group, all received 4 times interventions and 2 h for each time. The CBI process include assessment, plan, implementation and evaluation. Mothers were educated for knowledge about appearance and behavioral characteristics of preterm infants and were guided about how to take care of their babies and participate in nursing care process. Mothers completed measures on mother-infant interaction (Nursing Child Assessment Feeding Scale, NCAFS) in the first follow-up after infant discharge. Results The results showed that the scores of NCAFS and total scores of the mothers in the intervention mother-infant dyads were 46.4 ± 8.5 and 35.8±6.3,higher than in the control group (42.7±5.9 and 33.3 ± 5.6), respectively, but there were no statistic difference between the two groups (t = 1.55 and 1.28, P＞ 0. 05). The scores of "mother's response to distress" were significantly higher in the intervention mother-infant group (12. 2± 1.7) than in the control group (10.7±2.4)(t=2.10,P＜0.05). Conclusions The levels of premature infant-mother interactions are low. CBI can improve mother's response to premature infant's distress. Further study is needed to investigate the effects of CBI in improving mother-infant interaction.     

择期剖宫产与新生儿呼吸窘迫综合征

近30年来世界各国剖宫产率有明显变化,欧美国家剖宫产率在1975年至1985年间增长较快,由不到10%上升至25%以上,1985年后剖宫产率逐渐平稳,在22%以上.大部分欧洲国家的剖宫产率保持在10%～15%[1-2].美国儿科学会2007年的总结显示,美国剖宫产率已连续11年升高,2007年达31.8%[3].世界卫生组织(World Health Organization,WHO)一项全球性调查显示,目前亚洲总体剖宫产率为27.3%,中国剖宫产率超过其他国家,达46.2%[4].1989年我国剖宫产学术研讨会报告指出,20世纪50年代剖宫产率仅1%～2%,到80年代后期上升到20%～30%[5],近20年仍呈逐年上升趋势,多在40%～60%,有些医院高达75.75%[6-9].     

盐酸多奈哌齐联合认知训练治疗缺血性脑卒中后轻度认知功 能障碍的临床研究

目的:比较盐酸多奈哌齐和石杉碱甲联合认知功能训练治疗缺血性脑卒中后轻度认知功能障碍的临床效果。方法:将2017年3月至2019年3月在珠海市人民医院神经内科门诊符合本研究要求的120例缺血性脑卒中患者随机均分为对照组和研究组各60例,分别应用石杉碱甲和盐酸多奈哌齐治疗,并联合认知功能训练,比较两组的临床疗效、不良反应及认知功能和日常生活自理能力。结果:与对照组比较,治疗后研究组显效率和总有效率均明显增高(均P0.05),不良反应发生率虽略低,但无统计学意义(P0.05);研究组MoCA量表和Barthel指数均明显增高(均P0.05)。结论:盐酸多奈哌齐联合认知功能训练治疗缺血性卒中后轻度认知功能障碍的疗效较石杉碱甲联合认知功能训练治疗好,且不良反应少,可以改善患者认知功能和提升患者生活质量,建议临床推广应用。     

新生儿坏死性小肠结肠炎的热点问题

陈超教授 很高兴受《中国循证儿科杂志》编辑部的邀请,在＂第三届上海国际新生儿医学论坛＂会议期间,与荷兰阿姆斯特丹自由大学医学中心艾玛儿童医院Hans Van Goudoever教授和复旦大学附属儿科医院新生儿科张蓉博士共同就＂新生儿坏死性小肠结肠炎（NEC）的热点问题＂进行讨论。     

北京军区红山军马场草畜平衡状况研究

本文通过对北京军区红山军马场的家畜数量与分布、草地生产力状况的调查,对该地区草畜平衡进行了分析,发现军马场总体超载过牧,放牧区划欠佳,局部地区过牧较为严重。为合理利用草地资源,加快生态恢复,发展军马场的区域优势,本文对放牧管理方式和生态保护措施提出了相关建议,为实现草地畜牧业和军马旅游业可持续发展提供参考和依据。     

经峡部径路行双侧甲状腺次全或近全切除术术式改进的临床研究

目的：探讨经峡部径路行双侧甲状腺次全或近全切除手术的临床价值。方法：回顾性分析我院自5年间1 051例行双侧甲状腺手术患者的临床资料。按手术方式分为两组：经经峡部径路行双侧甲状腺次全或近全术的588例为改良组,同期施行传统切除术式的463例为常规组。比较两种手术方式对手术时间、术中出血、术后引流及并发症的影响。结果：改良组手术时间较常规组明显缩短（P〈0.01）,术中出血量、喉返神经神经损伤率、术后气管局部不适及低钙血症的发生率明显减少（P〈0.01）,术后引流量减少（P〈0.05）,患者对手术耐受性好,术后出血发生率无统计学差异。结论：经峡部径路行双侧甲状腺次全或近全切除术可明显缩短手术时间;减少术中出血量,以及降低喉返神经损伤、术后出血、低钙血症等并发症的发生,利于临床开展。     

内皮祖细胞与骨再生修复相关研究进展

血管生物学和发育生物学的研究进展开辟了血管再生治疗的新方向:细胞移植介导的血管新生。该领域在Asahara发现内皮祖细胞(endothelial progenitor cells,EPCs)的血管新生能力后快速发展。目前EPCs多用于探讨其与疾病状态(冠心病、高血压、糖尿病、代谢综合征、风湿性疾病等)的     

改良第二掌背动脉皮瓣修复示中指中末节套脱伤

Objective To investigate the operative procedure and the clinical results of the modified reversed island flap based on the second dorsal metacarpal artery (SDMA) for repairing index or long finger degloving defects.Methods From May 2004 to January 2010, circumferential soft tissue defect in the middle and distal phalanx of the index or long fingers in 17 patients were repaired by the modified reversed island flaps based on SDMA.The dorsal digital nerve in the flap was coapted to the severed proper digital nerve.The area of the flaps ranged from 2.5 cm × 5.6 cm to 5.0 cm × 6.5 cm.The donor sites were closed by skin graft.Results Postoperatively blister and necrosis of the distal flap occurred in 2 cases which was cured by dressing change.All the other flaps survived uneventfully.Primary healing of the flaps and donor sites was achieved.All 17 patients were follow-up for 4 to 27 months with an average of 15.3 months.The flaps were pliable, full but not bulky.Two-point discrimination was 7 to 11 mm (mean 8.6 mm).Hand function as judged by the total active range of motion of the fingers was excellent in 8 fingers, good in 7 fingers and fair in 2 fingers.The satisfactory rate was 88.2%.Conclusion Modified SDMA reversed island flap transfer with dorsal digital nerve coaptation is an ideal procedure to repair index or long finger degloving injuries.The area of the harvested flap is large enough to cover the circumferential soft tissue defect in the middle and distal phalanx.The surgery is safe due to the reliable flap circulation.