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.     

可行走分娩镇痛临床研究

目的:探讨腰麻—硬膜外联合阻滞(CSEA)下罗哌卡因和布比卡因用于分娩镇痛的效果及对产程、母婴的影响。方法:R在蛛网膜下腔隙注入罗哌卡因3 mg和B布比卡因3 mg;然后PCEA用0.125%布比卡因+芬太尼0.125%罗哌卡因(R组)或0.125%布比卡因(B组)加芬太尼2μg/m l,持续给药(8~10 m l/h)。同期未接受PCEA分娩镇痛自然顺产的90例初产妇为对照组。用视觉模拟评分(VAS)和下肢运动神经阻滞评分(MBS)评估镇痛阻滞效果。结果:麻醉后15 m in观察组产妇VAS、MBS镇痛前后相比有显著差异P<0.01。观察组活跃期时间短于对照组P<0.01。观察组第2产程时间与对照组相比无显著性差异P>0.05。结论:CSEA罗哌卡因用于分娩镇痛较布比卡因对运动神经阻滞轻,不影响产程及新生儿。     

婴幼儿营养性贫血相关因素分析

目的探讨婴幼儿营养性缺铁性贫血发生的相关因素，从而有效降低贫血的患病率。方法对在郑州市妇幼保健院儿童保健门诊定期保健的418名6个月、1岁、1岁半儿童进行母乳喂养、辅食添加等情况进行调查、统计和分析。结果6个月、1岁、1岁半儿童贫血患病率分别为26．11％、19．17％、11．02％，差异有统计学意义（x^2=10．28，P〈0．05）；纯母乳喂养儿和非纯母乳喂养儿6月龄时贫血患病率分别为22．46％和38．10％，差异有统计学意义（x^2=4．08，P〈0．05）；母乳质量丰富与单一在6月龄时贫血患病率分别为16．50％、40．00％，差异有统计学意义（x^2=8．28，P〈0．05）。结论母乳是婴儿理想的食物；6月龄时要及时合理地添加辅食；儿童系统保健在儿童生长发育过程中起很重要的作用，要广泛开展并认真做好此项工作。     

补肾活血方对PCO大鼠瘦素、胰岛素和睾酮影响的实验研究

目的：探讨自拟补肾活血方对多囊卵巢（PCO）大鼠的作用机理。方法：将60只大鼠随机分为5组，正常对照组、模型对照组、补肾活血方高剂量组、补肾活血方低剂量组和西药对照组，每组各12只。除正常对照组外其余各组采用孕激素加HCG进行造模。采用放射免疫法对补肾活血方干预后的PCO大鼠进行血清瘦素（Leptin）、胰岛素（INS）和睾酮（T）的测定。结果：用药后，补肾活血方高剂量组、补肾活血方低剂量组及西药对照组大鼠体重均明显降低，与用药前比较，差异有显著性意义（P〈0．05）。补肾活血方高剂量组、补肾活血方低剂量组及西药对照组与模型组比较，差异有显著性意义（P〈0．05）。降低空腹血清INS水平，补肾活血方高剂量组、补肾活血方低剂量组与西药对照组比较，差异有显著性意义（P〈0．05）；在降低血清Leptin和T水平上，补肾活血方高剂量组与模型对照组、西药对照组比较，差异有显著性意义（P〈0．05）。补肾活血方能有效降低PCO大鼠空腹血清胰岛素、瘦素及睾酮水平，用药后大鼠体重明显降低。结论：补肾活血方可对PCO大鼠Leptin、INS及T等激素进行良性调节，此可能是其临床治疗PCOS高INS血症、高T血症和高Leptin血症的机制之一。     

Vojta法结合推拿按摩超早期诊治中枢协调障碍的临床观察

中枢协调障碍(Zentrale Koordination Storung,ZKS)是德国学者Vojta博士首先提出的用于早期诊断脑性瘫痪的代名词.Voita姿势反射是利用七种姿势反射来衡量小儿发育水平的.其临床表现主要是运动发育障碍和姿势异常,如不及时诊治,很容易发展为脑性瘫痪,不仅是儿科的难治之症,而且给家庭和社会带来沉重的负担.我院康复科从2003年3月至2005年3月采用Vojta法结合推拿按摩早期诊治ZKS126例,取得满意疗效,现报告如下.     

须水乡18所幼儿园儿童健康体检情况分析

目的 为了解该乡集体儿童健康状况，以便做好托幼园（所）的营养指导和卫生保健工作。方法 对1313名集体儿童进行体格检查并对体检结果进行评价。结果 龋齿患病率为21．17％；营养不良患病率为2．67％；轻度贫血患病率为2．13％；轻度肥胖患病率为1．75％；乙肝患病率为0．38％。结论 加强对幼儿园（所）卫生保健工作的监督、管理，对促进儿童身心健康有重要意义。     

瘢痕子宫再次分娩方式的选择

目的探讨降低再次剖宫产率的措施。方法对76例瘢痕子宫再次剖宫产病历进行回顾性分析。结果瘢痕子宫再孕分娩剖宫产率明显增高。结论严格掌握剖宫产指征、提高阴道分娩率是降低再次剖宫产率的有效措施。     

0～6岁儿童营养不良干预措施的研究

目的探索对营养不良儿童采取综合性干预措施的方法，降低营养不良儿童的患病率。方法通过营养知识教育、儿童体检、生化指标检测、膳食调查等，对营养不良儿童和正常儿童进行对比分析。结果营养不良儿童热能和三大营养索、维生索、矿物质摄人量明显低于正常儿童，且伴随其他疾病和微（宏）量元素缺乏、不良的饮食习惯和行为。通过对营养不良儿童分组，对比研究进行一年的综合干预措施或单一措施的干预效果。结论采取合理的综合干预措施可有效降低营养不良患病率，是改善儿童营养状况的有效手段。应加强对营养不良儿童及其家长营养知识和行为的干预。     

米非司酮配伍米索前列醇终止中期妊娠

我院自１９９６年１２月至１９９８年１１月采用米非司酮配伍米索前列醇片口服替代宫腔置管术,终止孕１２～１６周妊娠１０８例,取得较好效果,报道如下：１资料与方法１．１病例选择我院妇科病房住院自愿要求终止妊娠的健康妇女２０８例,孕周１２～１６周,随机分为服...     

徒手转位在持续性枕后位、枕横位中的应用

自１９９７年～１９９８年,我院足月妊娠分娩１３５０人发生的１０８例持续性枕横位或枕后位,采用适时徒手转位５４例,取得良好效果。现报告如下。１临床资料１１病例选择１０８例中除去巨大儿、疤痕子宫、骨盆狭窄和已有胎儿宫内窘迫者１２例,余９６例随机分为实验...