神经节苷脂对早产脑白质损伤患儿神经行为发育的影响

目的 探讨神经节苷脂对早产儿脑白质损伤神经行为发育的影响.方法 2005年1月至2009年5月我院NICU收治的早产儿共636例,出生后1周内常规行床边头颅B超检查,确诊为早产儿脑白质损伤的患儿40例,随机分为治疗组与对照组,各20例.治疗组在出生后1周内给予单唾液酸四己糖神经节苷脂钠(GM1)20 mg/d加入葡萄糖液中静脉滴注,1疗程为14 d,根据病情使用1～3个疗程,其他治疗措施同对照组.2组脑白质损伤早产儿均于纠正胎龄40周时进行新生儿行为神经测定,在纠正年龄3、12个月时采用婴幼儿智能发育量表,评估神经系统发育情况.结果 治疗组在纠正胎龄40周时的行为神经测定得分为(38.10±0.91)分,明显高于对照组(36.10±1.59)分(t=4.88,P＜0.05).3个月和12个月时进行的智能发育评估显示智力发育指数(MDI)和心理运动发育指数(PDI),治疗组(3个月MDI:91.66±6.38,PDI:87.11±5.57;12个月MDI:104.10±6.45,PDI:100.46±3.87)均明显高于对照组(3个月MDI:81.07±0.72,PDI:81.90±6.70;12个月MDI:98.45±8.57,PDI:95.91±6.59)(P均＜0.05).结论 GM1对早产儿脑白质损伤神经行为发育有促进作用.

Abstract：

Objective To study the effect of monosialoteterahexosyl ganglioside (GM1) on neurobehavioral development in premature infants with white matter damage. Methods A total of 636premature infants who were hospitalized in NICU of two hospitals from Jan 2005 to May 2009 received routine bedside cranial sonography detection before 1 week-aged. Forty premature infants were diagnosed as being premature white matter damage and divided into the treatment group (20 cases ) and the control group (20 cases) randomly. The cases in the treatment group accepted GM1 20 mg additional to 5% glucose solutionthe iv drip, one time per day,for a cycle of 14 d. 1 -3 cycles were given in accordance with patient's condition. Other treatments were same to the control group. All cases were evaluated by neonatal behavioral and neurological assessment (NBNA) at the rectified age of 40 gestational weeks and by Children's Developmental Center of China (CDCC) test at 3 months-aged and 12 months-aged. Results The NBNA scores of the treatment group (38.10±0.91) were significantly higher than the control group (36.10±1.59) at the rectified age of 40 gestational weeks (P＜0.01). The indexes of mental development(MDI) and psychomotor performance development (PDI) by the CDCC tests in the treating group (3 months-aged MDI:91.66±6.38;PDI:87.11±5.57; 12 months-aged MDI:104.10±6.45; PDI:100.46±3.87) were significantly higher than those in the control group (3 months-aged MDI:81.07±0.72; PDI:81.90±6.70; 12 months-aged MDI:98.45±8.57; PDI:95.91±6.59) at 3 months-aged and 12 months-aged ( P ＜ 0. 05 ). Conclusion GM1 can accelerate the neurobehavioral development in premature infants with white matter damage.     

Measurement of tidal respiration in < 34 weeks premature infants with respiratory distress syndrome at 40 weeks corrected gestational age北大核心CSCD

Objective To investigate pulmonary function in terms of tidal respiration and the influencing factors on it in <34 weeks premature infants with RDS at corrected gestational age of 40 weeks. Methods A total of 49 of <34 weeks premature infants with RDS (RDS group) and 36 of <34 weeks premature infants without RDS (non-RDS group) followed throughout entire twelve months were collected from December 2013 to October 2015. Of them, 35 RDS patients and 20 non-RDS patients had the pulmonary function examination. A total of 26 full term infants with hyperbilirubinemia (full term group) were recruited for comparison study. The differences in parameters of tidal respiration were compared among the three groups. The RDS patients were further divided into the mild RDS subgroup and severe RDS subgroup according to the severity of illness. Result (1) The TPEF [(0.17 ± 0.04) s vs. (0.23 ± 0.09) s], VPEF[(6.74 ±2.70) mL vs. (9.33 ±2.92) mL], TPEF/TE [(29.06 ±4.21)% vs. (38.27± 7.16)%], VPEF/VE [(32.54 ±4.43)% vs. (39.64 ±5.88)%] in RDS group were significantly lower than those in full term group (P < 0.05). The TPEF [(0.19 ± 0.06) s vs. (0.23 ± 0.09) s], TPEF/TE [(30.31 ±11.53)% vs. (38.27±7.16)%], VPEF/VE [(34.39 ±8.44)% vs. (39.64 ±5.88)%] in non-RDS group were significantly lower than those in full term group (P <0.05). The TPEF, TPEF/TE, VPEF/VE in RDS group were lower than those in non-RDS group, but the differences were not significant (P>0.05). (2) The TPEF, VPEF, TPEF/TE, VPEF/VE in mild RDS group were higher than those in severe RDS group, but the differences were not significant (P > 0.05). (3) Logistic regression analysis indicated that the gestational age was the protective factor of pulmonary function in premature infants with RDS. Conclusions Small airway resistance in <34 weeks premature infants with RDS is higher than that in full term infants. There was no significant difference in pulmonary function between RDS premature infants and non-RDS premature infants. The gestational age was the influencing factor of pulmonary function in premature infants with RDS.     

神经生长因子早期治疗中重度新生儿缺氧缺血性脑病的疗效

Objective To observe the curative efects of never growth factor (NGF)on neonates with moderate and severe hypoxic-ischemic encephalopathy (HIE). Methods Eighty-six neonates with HIE were randomly divided into NGF treatment group and control group. The control group (42 cases)were received routine treatment (including cerebrolysin and citicoline) ;the treatment group (44 cages)were given NGF on the basis of routine treatment as early as possible (within 6 hours after birth). Brain CT, neonatal behavioral neuro-logical assessment(NBNA) and children' s development center of China(CDCC) at 3 and 6 months after birth were proformed in both groups. Results Brain CT, NBNA and CDCC markers in treatment group were better than those in control group (P＜ 0. 05). There were great diferences between two groups (P＜ 0. 01). Conclusion Using NGF on the basis of the routine treatment as early as possible after resuscitation can reduce markely the severity of asphyxia induced brain damage in neonates. It is very effective using NGF in treating HIE in neonates.     

严多发伤并发症的早期控制

Objective To analyze the efficacy of early management of eomplications in patients with multi-ple traumas by applying the damage control theory. Method All total of 116 patients admitted to Wuhan Tongji Hospital between Jan 2006 and Jan 2008 were included in this retrospective study and were classified according to treatment method. Overall, 55 cases underwent damage control operations and 61 cases underwent conventional management. The groups of patients were compared in terms of parameters such as length of operation time, time to resuscitate from shock, lethal triad of death (LTD), complications and treatment outcomes after operation. Results The length of operation time was (67.43±19.52) min, resuscitation time from shock was (6.77±3.16) h and LTD was (11.54±4.10) h in the damage control group, and (163.95±55.41) min, (22.51±11.65) h and (34.55±5.63) h, respectively, in the conventional group, with significant differences between the two groups (P< 0.01). The per capita complication and mortality rates were 227.27 % and 3.64 %, respectively, in the dam-age control group and 363.93 % and 9.84%, respectively, in the conventional group (P <0.05). Couclusions Here, we demonstrated that early management of patients with multiple traumas undergoing operations by apply-ing the damage control theory significantly decreased the operation time, and decreased time to resuscitation from shock and LTD. Furthermore, this approach significantly reduced the incidence of comphcations and the mortality rate of patients with severe multiple traumas.     

严多发伤并发症的早期控制

Objective To analyze the efficacy of early management of eomplications in patients with multi-ple traumas by applying the damage control theory. Method All total of 116 patients admitted to Wuhan Tongji Hospital between Jan 2006 and Jan 2008 were included in this retrospective study and were classified according to treatment method. Overall, 55 cases underwent damage control operations and 61 cases underwent conventional management. The groups of patients were compared in terms of parameters such as length of operation time, time to resuscitate from shock, lethal triad of death (LTD), complications and treatment outcomes after operation. Results The length of operation time was (67.43±19.52) min, resuscitation time from shock was (6.77±3.16) h and LTD was (11.54±4.10) h in the damage control group, and (163.95±55.41) min, (22.51±11.65) h and (34.55±5.63) h, respectively, in the conventional group, with significant differences between the two groups (P< 0.01). The per capita complication and mortality rates were 227.27 % and 3.64 %, respectively, in the dam-age control group and 363.93 % and 9.84%, respectively, in the conventional group (P <0.05). Couclusions Here, we demonstrated that early management of patients with multiple traumas undergoing operations by apply-ing the damage control theory significantly decreased the operation time, and decreased time to resuscitation from shock and LTD. Furthermore, this approach significantly reduced the incidence of comphcations and the mortality rate of patients with severe multiple traumas.     

依达拉奉对急性大面积脑梗死患者高敏C反应蛋白影响的临床研究

Objective To explore the effects of edaravone on high sensitivity C-reaction protein (hsCRP) in patients with acute massive cerebral infarction. Methods 86 cases with acute massive cerebral infarction were selected from December 2006 to December 2008. all the cases were divided into two groups, control group and cure group. routine treatment was used to the control group, on the basis of control group'therapy,edaravone was given to cure group. the level of hsCRP was detected before and after treatment, and the results of cure was compared. Results ①the total effective rate in two groups existed statistical difference (P<0.05);② the level of hsCRP in two groups before treatment and in the 7th and the 14th of treatment existed statistical difference(P<0.01), the level of hsCRP in the 7th and the 14th of treatment in cure group existed statistical difference(P<0.05). Conclusion Edaravone can decrease the level of hsCRP in patients with massive cerebral infarction, and has significant clinical efficacy,which should be the reference for the doctors.     

严多发伤并发症的早期控制

Objective To analyze the efficacy of early management of eomplications in patients with multi-ple traumas by applying the damage control theory. Method All total of 116 patients admitted to Wuhan Tongji Hospital between Jan 2006 and Jan 2008 were included in this retrospective study and were classified according to treatment method. Overall, 55 cases underwent damage control operations and 61 cases underwent conventional management. The groups of patients were compared in terms of parameters such as length of operation time, time to resuscitate from shock, lethal triad of death (LTD), complications and treatment outcomes after operation. Results The length of operation time was (67.43±19.52) min, resuscitation time from shock was (6.77±3.16) h and LTD was (11.54±4.10) h in the damage control group, and (163.95±55.41) min, (22.51±11.65) h and (34.55±5.63) h, respectively, in the conventional group, with significant differences between the two groups (P< 0.01). The per capita complication and mortality rates were 227.27 % and 3.64 %, respectively, in the dam-age control group and 363.93 % and 9.84%, respectively, in the conventional group (P <0.05). Couclusions Here, we demonstrated that early management of patients with multiple traumas undergoing operations by apply-ing the damage control theory significantly decreased the operation time, and decreased time to resuscitation from shock and LTD. Furthermore, this approach significantly reduced the incidence of comphcations and the mortality rate of patients with severe multiple traumas.     

严多发伤并发症的早期控制

Objective To analyze the efficacy of early management of eomplications in patients with multi-ple traumas by applying the damage control theory. Method All total of 116 patients admitted to Wuhan Tongji Hospital between Jan 2006 and Jan 2008 were included in this retrospective study and were classified according to treatment method. Overall, 55 cases underwent damage control operations and 61 cases underwent conventional management. The groups of patients were compared in terms of parameters such as length of operation time, time to resuscitate from shock, lethal triad of death (LTD), complications and treatment outcomes after operation. Results The length of operation time was (67.43±19.52) min, resuscitation time from shock was (6.77±3.16) h and LTD was (11.54±4.10) h in the damage control group, and (163.95±55.41) min, (22.51±11.65) h and (34.55±5.63) h, respectively, in the conventional group, with significant differences between the two groups (P< 0.01). The per capita complication and mortality rates were 227.27 % and 3.64 %, respectively, in the dam-age control group and 363.93 % and 9.84%, respectively, in the conventional group (P <0.05). Couclusions Here, we demonstrated that early management of patients with multiple traumas undergoing operations by apply-ing the damage control theory significantly decreased the operation time, and decreased time to resuscitation from shock and LTD. Furthermore, this approach significantly reduced the incidence of comphcations and the mortality rate of patients with severe multiple traumas.     

严多发伤并发症的早期控制

Objective To analyze the efficacy of early management of eomplications in patients with multi-ple traumas by applying the damage control theory. Method All total of 116 patients admitted to Wuhan Tongji Hospital between Jan 2006 and Jan 2008 were included in this retrospective study and were classified according to treatment method. Overall, 55 cases underwent damage control operations and 61 cases underwent conventional management. The groups of patients were compared in terms of parameters such as length of operation time, time to resuscitate from shock, lethal triad of death (LTD), complications and treatment outcomes after operation. Results The length of operation time was (67.43±19.52) min, resuscitation time from shock was (6.77±3.16) h and LTD was (11.54±4.10) h in the damage control group, and (163.95±55.41) min, (22.51±11.65) h and (34.55±5.63) h, respectively, in the conventional group, with significant differences between the two groups (P< 0.01). The per capita complication and mortality rates were 227.27 % and 3.64 %, respectively, in the dam-age control group and 363.93 % and 9.84%, respectively, in the conventional group (P <0.05). Couclusions Here, we demonstrated that early management of patients with multiple traumas undergoing operations by apply-ing the damage control theory significantly decreased the operation time, and decreased time to resuscitation from shock and LTD. Furthermore, this approach significantly reduced the incidence of comphcations and the mortality rate of patients with severe multiple traumas.     

严多发伤并发症的早期控制

Objective To analyze the efficacy of early management of eomplications in patients with multi-ple traumas by applying the damage control theory. Method All total of 116 patients admitted to Wuhan Tongji Hospital between Jan 2006 and Jan 2008 were included in this retrospective study and were classified according to treatment method. Overall, 55 cases underwent damage control operations and 61 cases underwent conventional management. The groups of patients were compared in terms of parameters such as length of operation time, time to resuscitate from shock, lethal triad of death (LTD), complications and treatment outcomes after operation. Results The length of operation time was (67.43±19.52) min, resuscitation time from shock was (6.77±3.16) h and LTD was (11.54±4.10) h in the damage control group, and (163.95±55.41) min, (22.51±11.65) h and (34.55±5.63) h, respectively, in the conventional group, with significant differences between the two groups (P< 0.01). The per capita complication and mortality rates were 227.27 % and 3.64 %, respectively, in the dam-age control group and 363.93 % and 9.84%, respectively, in the conventional group (P <0.05). Couclusions Here, we demonstrated that early management of patients with multiple traumas undergoing operations by apply-ing the damage control theory significantly decreased the operation time, and decreased time to resuscitation from shock and LTD. Furthermore, this approach significantly reduced the incidence of comphcations and the mortality rate of patients with severe multiple traumas.     

早期干预对早产儿预后的影响

目的 探讨早期干预对早产儿体格、智能及运动发育的影响。方法 将存活出院的120例早产儿随机分为观察组和对照组，观察组按0一2岁早期干预大纲进行干预训练，由专人定期进行体格发育与神经系统检查及智力测定，对照组未进行系统干预，每3—6月随访1次。两组均随访至2岁。结果 观察组和对照组患儿身长、体重、头围无显著性差异(P＞0．05)；观察组在智力发育指数(P＜0．05)、精神运动发育指数(P＜0．01)方面均高于对照组；在早产儿智力低下、运动低下与脑瘫发生率方面观察组明显低于对照组(P＜0．01)。结论 早产儿经早期系统干预，2岁时可达到正常同龄儿水平。     

早产儿早期干预效果观察

目的观察早期干预对早产儿发育的影响。方法对56例早产儿（干预组）临床上对症处理,保持体温,正确哺乳,干预措施为抚触、婴儿操、听觉刺激、视觉刺激等。96例早产儿为对照组。采用CDCC婴幼儿智能发育检查量表的智力发育指数（MDI）和心理运动发育指数（PDI）于月龄6个月、12个月和18个月时进行评定。结果第6个月时,干预组的MDI落后于对照组（P〈0.05）,但PDI的差异无显著性意义;第12个月时,两组婴幼儿的MDI和PDI差异无显著性意义;第18个月时,干预组的MDI和PDI高于对照组（P〈0.05）。结论早期干预可以促进早产儿正常发育。     

点穴结合运动疗法对早期脑瘫患儿神经发育及预后的影响

目的探讨点穴结合运动疗法对早期脑性瘫痪的治疗效果。方法选取我院小儿神经康复部初诊的脑瘫患儿78例,其中40例采用点穴按摩结合运动训练的综合康复方案,设为干预组;38例给予家庭康复干预,设为对照组。两组均于治疗前后用CDCC婴幼儿智能发展量表进行发育商（DQ ）评定。同时进行运动模式、肌张力等综合评定。比较两组运动发育指数（MDI）、智力发育指数（PDI）及治疗总有效率的差异。结果干预组MDI、PDI得分明显高于对照组（P＜0．01）;治疗总有效率明显高于对照组（P＜0．01）。结论早期综合康复干预能促进脑瘫患儿的神经发育及修复,提高其运动、智力水平及康复治疗效果。     

脑瘫高危儿不同时期干预的预后临床对比

目的探讨不同时间开始干预脑性瘫痪高危儿对预后的影响。方法根据干预时间的不同,将95例临床诊断为脑瘫高危儿分为早期干预组（48例）及晚期干预组（47例）;早期干预组在新生儿期即接受系统干预,晚期干预组在6个月以后进行干预,并在6、9、12、18月龄时进行运动发育和智力测定。结果早期干预组平均智力发育指数（MDI）高于晚期干预组（P〈0.05）,早期干预组平均运动发育指数（PDI）高于晚期干预组,差异具有显著性（P〈0.01）。早期干预组脑瘫、智能低下发生例数明显低于晚期干预组。结论对脑瘫高危儿尽早干预可改善其智力及运动发育,帮助他们早日康复,减少伤残。     

药物配合早期护理干预在早产儿潜能开发中的应用

目的探讨施捷因配合早期综合护理干预对早产儿潜能开发的影响。方法将320例早产儿按随机数字表法分为观察组和对照组各160例,对照组仅接受常规治疗及育儿指导、评估,观察组除常规治疗外,施行施捷因配合早期丰富的环境干预和综合康复功能训练,出院后依据0—3岁小儿智能发育规律及教育大纲,随访干预治疗至5岁。比较两组早产儿潜能开发情况。结果观察组早产儿新生儿行为神经系统评分（NPNA）中行为能力及一般状态得分分别为（9．32±0．33）,（5．94±0．83）分,均高于对照组的（6．35±1．35）,（4．39±0．42）分,差异均有统计学意义（t分别为9．573,3．590;P〈0．01）;观察组早产儿神经、心理发育完成月份中俯卧位抬头、头竖立、翻身、有意识发音笑出声、用手指抓小玩具、坐稳（双手自由活动）及手腹向前匐行完成月份均明显少于对照组,差异均有统计学意义（t分别为3．29,4．27,3．62,2．98,4．62,4．52,4．51;P〈0．01）;观察组早产儿智能发育商（CDCC）监测中智能发育指数（MDI）和运动发育商数（PDI）分别为（95．46±12．35）,（98．87±12．20）分,分别高于对照组的（79．12±14．71）,（84．03±13．37）分,差异均有统计学意义（t分别为5．761,6．832;P〈0．01）;观察组早产儿智能发育商及各能区发育商评分比较均高于对照组,且发育落后及后遗症发生率均低于对照组,差异均有统计学意义（P〈0．05）。结论早产儿应用施捷因配合早期丰富的环境干预、系统的综合康复功能训练、足够的治疗疗程及随访,可降低早产儿脑瘫及智能低下的发生率,在降低了早产儿后遗症的同时也促进了早产儿潜能的全面发展,提高早产儿的存活质量及人口素质。     

早期干预对缺氧缺血性脑病患儿智能和心理运动发育的影响

背景围产期缺血缺氧性脑病易导致脑损伤,对患儿智能发育产生影响.目的观察早期干预对缺氧缺血性脑病患儿智能和心理运动发育的影响,研究早期干预的时间和效果的关系,从而找到最佳干预时机.设计非随机化同期对照,不同时相点随访.单位中南大学湘雅医院及湘雅医学院.对象选择1999-01/2001-05中南大学湘雅医院新生儿科诊治的进行早期干预缺氧缺血性脑病患儿(干预组n=32,中度10例,重度22例),与未行早期干预而在门诊确诊的缺氧缺血性脑病患儿(对照组n=36,中度10例,重度26例)作比较.方法采用新生儿行为神经测定,中国科学院心理研究所和中国儿童发展中心共同编制的婴幼儿智能发育量表分别对两组的患儿进行测定评估.主要观察指标两组患儿智能发育指数、心理运动发育指数比较.结果①智能发育指数/心理运动发育指数3,6,18个月时干预组(90.50±11.12/90.34±12.49,94.06±14.96/92.03±13.07,90.78±7.46/91.38±13.87)比对照组明显增高(62.28±7.44/62.67±6.06,59.11±4.74/58.19±4.92,58.83±6.44/58.17±5.33,P＜0.01).②随访结果显示,干预组智能发育指数在临界水平者1例,心理运动发育指数在临界水平者2例,其余患儿智能发育指数和心理运动发育指数检测结果均在中等范围以上;对照组36例患儿均为智能缺陷患儿.结论干预在3个月时就出现量化效果,说明早期干预对促进缺氧缺血性脑病的患儿智能发育具有重要意义.     

早期针康法干预对脑瘫高危儿预后的临床观察

目的探讨针康法作为早期干预手段对高危儿预后的影响。方法将2006年1月～2008年12月62例具有高危因素患儿分为干预组(n=32)和对照组(n=30),治疗前及3个月后对两组进行智能发育指数(MDI)、运动发育指数(PDI)评分并定期随访。结果治疗3个月后,两组患儿临床疗效、MDI和PDI评分均较治疗前有非常显著性差异(P<0.01),且干预组明显优于对照组(P<0.01)。在降低其他功能障碍上,干预组也明显优于对照组(P<0.01)。随访结果:干预组在降低脑瘫发生率上存在一定优势。结论针康法作为早期干预手段能提高脑瘫高危儿的运动功能和促进智能发育。     

运动终板药物注射治疗痉挛型脑性瘫痪的效果

目的观察运动终板药物注射治疗痉挛型脑瘫患儿的效果。方法230 例痉挛型脑瘫患儿分为对照组和观察组,每组115 例。对照组给予综合康复,包括功能训练、物理因子治疗及药物应用;观察组在此基础上加痉挛肌肉运动终板注射维生素B1和维生素B12。治疗前后采用粗大运动功能测试(GMFM)评价患儿功能区的运动功能,采用改良Ashworth 量表(MAS)评价痉挛程度,采用CDCC婴幼儿智能发育量表测定智力发育指数(MDI)和心理运动发育指数(PDI)。结果治疗后,两组患儿的粗大运动功能明显改善,MAS分级明显降低,MDI和PDI评分明显增加(P<0.01);且观察组均优于对照组(P<0.05)。结论肌肉运动终板药物注射能提高脑瘫患儿粗大运动功能,减轻痉挛,改善智力发育。     

循证护理在胎膜早破合并感染低体重早产儿中的应用

目的探讨循证护理在胎膜早破合并感染低体重早产儿中的应用效果。方法选择2015年6月至2017年1月我院新生儿科室及门诊就医的100例胎膜早破合并感染低体重早产儿,按照就医时家长的自愿原则进行建档,等分为观察组和对照组。选择同期的50例足月儿作为健康对照组。对照组采用常规护理模式,观察组患儿给予循证护理模式。采用患儿神经行为发育评估法对两组早产儿在矫正月龄3,6,9,12个月行神经行为发育评估,健康对照组同时进行发育评估。三组患儿在12个月时进行发育商测评。统计分析患儿不同模式下神经行为发育的情况及12个月后两组患儿成活率比较。结果(1)观察组与对照组在3,6个月时植物神经调节系统、行为调节系统、运动发育评分显著改善但仍低于健康对照组(P<0.05)。(2)三组智力发育指数(MDI)、运动发育指数(PDI)变化在12个月时指标变化比较均有显著性差异,对照组PDI,MDI明显低于观察组和健康对照组(P<0.05);观察组与对照组比较MDI,PDI明显升高。(3)观察组患儿12个月后成活率高于对照组,差异有统计学意义(P<0.05)。结论对胎膜早破合并感染低体重早产儿采用循证护理模式,可以明显提高低体重早产儿的成活率,同时改善了患儿神经行为发育,更好地保证了产妇及患儿的后期健康。