新生儿窒息多脏器血流动力学研究

目的研究新生儿窒息多脏器损伤的机理，提供早期诊断方法。方法应用美国Ｕｌｔｒａｍａｒｋ－９型彩色超声诊断仪及丹麦ＡＢＬ－５００型血气分析仪等，对新生儿窒息全身性多脏器血流动力学变化进行有对照组的前瞻性研究。结果（１）窒息新生儿脑、肾上腺、肾、肝、脾、胃及肠道等各脏器血液灌流量均减少，尤以舒张期为甚；但各脏器减少的程度不一致。（２）肺动脉压力与阻力增高，严重者可致持续胎儿循环，是病情严重的标志。（３）心脏功能障碍是缺氧缺血性心肌损伤的结果，窒息性心功能障碍表现为舒张功能首先受累，而收缩功能障碍则右室重于左室。（４）低氧血症是新生儿窒息各脏器损伤的病理生理基础，且低氧血症的程度与各脏器血流速度减慢的程度呈高度正相关（ｒ＝０．９３～０．９８，Ｐ均＜０．０１），与左室射血分数降低的程度呈高度正相关（ｒ＝０．９１，Ｐ＜０．０１），与肺动脉压力增高的程度呈高度负相关（ｒ＝－０．９７，Ｐ＜０．０１）。ＱＴ离散度是评价新生儿缺氧缺血性心肌损伤特异而敏感的指标。结论血流动力学紊乱是新生儿窒息各脏器损伤的主要原因，肺动脉压升高是新生儿窒息的重要病理生理变化。超声检测各脏器血流动力学变化，可用于新生儿窒息多脏器损伤的早期诊断     

新生儿窒息非生命器官血流动力学研究

运用脉冲多普勤超声对22例窒息新生儿肾动脉、肠系膜上动脉及腹腔干动脉等非生命器官的血流动力学指标如收缩期峰值流速（PSFV）、舒张末流速（EDFV）、时间平均流速（TMFV）、搏动指数（PI）及阻力指数（RI）等进行了监测，并以正常新生儿作对照。结果表明新生儿窒息后各脏器血流速度均有减慢，尤以ECFV显著；且非生命器官重于生命器官。并发现血流速度减慢的程度与低氧血症的程度呈高度正相关（P＜0.05）。运用脉冲多普勒超声观察其血流动力学变化，可用于各脏器损伤的早期诊断。     

新生儿窒息肾动脉血流动力学变化及临床意义

目的 研究新生儿窒息后肾动脉血流动力学变化的特点及临床意义,提供肾功能损害早期敏感的诊断方法。方法 应用脉冲多普勒超声仪对２２例窒息新生儿的肾动脉血流动力学参数进行前瞻性动态观察。     

足月窒息儿24小时内脑血流动力学变化

目的　研究足月新生儿窒息 2 4h内脑血流速度及阻力指数的改变 ,探讨新生儿窒息并发缺氧缺血性脑病 (HIE)的发病机制。方法　应用经颅彩色多普勒超声检测 3 7例有出生窒息史的新生儿脑血流速度及阻力指数变化 ,并与同期无出生窒息史 10例新生儿进行比较。结果　重度窒息尤其并发HIE新生儿于生后6± 2h、12± 3h右侧大脑中动脉血流速度明显增快 ,阻力指数明显降低 ;直至出生 2 4h ,中、重度HIE组脑血流速度仍明显增快 ,阻力指数明显降低。结论　窒息并发HIE新生儿多数在出生 12h内大脑中动脉存在血管麻痹和过度灌注 ,至出生 2 4h中、重度HIE患儿仍未能恢复     

新生儿窒息非生命器官血流动力学变化的观察

应用美国Ultramark－9型彩色多普勒超声诊断仪，于1995年8月～1996年7月，对新生儿窒息非生命器官（肾、肝、脾、胃、大肠、小肠）血流动力学变化进行了有对照组的前瞻性研究.结果证实新生儿窒息后备非生命器官血液灌流量均减少，且重于生命器官，舒张期减少更明显；并发现各脏器血流速度减慢的程度与低氧血症的程度至高度正相关（γ＝0．39～O．96。P＜0．0005）。证实血流量减少是新生儿窒息各脏器损伤和功能障碍的主要原因。     

窒息新生儿导纳式双侧脑血流图检测的意义

目的研究窒息新生儿脑血流动力学变化的意义。方法采用导纳式双侧脑血流自动检测仪于生后1~4 d对窒息新生儿及正常新生儿各20例进行监测,探讨其脑血流变化的规律性。结果生后1~4 d窒息组双侧流入容积速度(Hs/b-S)显著低于正常组(P<0.05),窒息组双侧脑导纳微分环(ADL)Ⅰ Ⅱ指数显著低于正常组(P<0.05);生后1 d窒息组双侧ADLⅣ指数显著高于正常组(P<0.05)。结论脑导纳图检测能较好地反映窒息患儿的脑血流动力学情况。     

窒息新生儿脑多普勒超声动态改变

目的 研究窒息新生儿脑血流变化规律。方法 应用脑彩色多普勒超声(TCD)对45例患儿脑血流参数及结构形态进行了连续监测。结果 无论是轻度窒息组或重度窒息组，脑血流均有变化，收缩期峰值速度(Vs)，舒张末期速度(Ved)及平均速度(mv)均减慢，阻力指数升高。病情愈重，以上变化愈明显。结论 检测脑血管阻力有助于脑损伤的判断和评价预后。     

新生儿脑血流动力学监测

各种因素导致的严重和(或)持久的脑血流动力学紊乱是新生儿脑损伤的根本原因,简便、准确、有效的监测技术在临床上的应用对维持患病新生儿脑血流动力学的稳定具有重要指导意义.该文对在新生儿临床上常用的脑血流动力学监测技术,如多普勒超声、近红外光谱及非侵入性磁共振成像等予以介绍,以指导临床应用.     

Myocardial ischaemia in neonates with perinatal asphyxia

In asphyxiated neonates, hypoxia is often responsible for myocardial ischaemia. To evaluate cardiac involvement in neonates with respiratory distress, ECG and echocardiographic recordings were performed, and cardiac enzymes determined. These data were related to clinical presentation and patient outcome. Three groups of neonates were studied: 22 healthy newborn infants (group I) with 5 min Apgar scores >9 and pH >7.3; 15 neonates with moderate respiratory distress (group II) which had Apgar scores ranging between 7 and 9, and pH between 7.2 and 7.3; and 13 neonates with severe asphyxia, Apgar scores <7, and pH <7.2 (group III). The ECGs were evaluated according to the 4-grade classification proposed by Jedeikin et al. [8]. On the echocardiograms, fractional shortening and aortic flow curve parameters were taken into account. Serum creatine kinase (CK), creatine kinase-MB isoenzyme (CK-MB) and lactate dehydrogenase were determined. All of groups I and II survived, but 5 out of 13 in group III died within the 1st week. Grade 3 or 4 ECG changes were observed only in group III patients, while all group II and 3 patients of group I showed grade 2 ECG changes. Fractional shortening, peak aortic velocity and mean acceleration were significantly reduced in group III, whereas the only abnormality found in group II was a reduced fractional shortening. CK, CK-MB, CK-MB/CK ratio and lactate dehydrogenase were all increased in group III, while in group II only CK-MB and the CK-MB/CK ratio were abnormal. Conclusion Severely asphyxiated newborn infants reflect relevant ischaemic electro- cardiographic changes, depressed left ventricular function and marked cardiac enzyme increase. These alterations are far less pronounced in neonates with mild respiratory distress. Received 5 May 1998 / Accepted in revised form: 11 January 1999     

窒息新生儿左室射血分数的临床观察

目的：左室射血分数是反映心脏收缩功能的指标,通过测定左室射血分数探讨窒息缺氧对新生儿心功能的影响。方法：采用彩色超声心动图对40例窒息新生儿生后2～3 d进行左室射血分数测定,经治疗7～10 d后复查,并以40例年龄、体重相近的正常新生儿作为对照组。结果：窒息新生儿左室射血分数56.6±5.7 明显低于正常新生儿 70.6±6.0,差异有显著性意义(P<0.05);窒息组经治疗后7～10 d,再与对照组相比,左室射血分数差异无显著性意义(P>0.05)。结论：窒息缺氧可引起心肌损伤,心脏功能下降,左室射血分数明显降低,经治疗可以逆转。 ［中国当代儿科杂志,2004, 6(4): 329-330］     

窒息新生儿胆红素动态观察

目的：了解窒息新生儿胆红素动态变化。方法：对窒息新生儿77例,正常新生儿70例,以经皮胆红素测定仪逐日测定胆红素动态变化。结果：窒息新生儿胆红素值在生后2 d内比正常新生儿略高,但无显著差异;窒息新生儿胆红素峰值在生后2～3 d,而正常新生儿在生后4～6 d;窒息新生儿生后3 d起,其胆红素值均低于正常新生儿,差异有显著性意义。结论：窒息新生儿初生时由于缺氧,酸中毒等使胆红素迅速升高,但其值下降较快,此与胆红素的抗自由基作用有关。     

窒息围产儿血液阴离子间隙状态的探讨

该文对 6 5例出生时窒息的围产儿复苏后同步作血气分析、血清电解质及阴离子间隙 (AG)测定。结果高AG 47例、正常AG 1 6例、低AG 2例。代谢性酸中毒 5 8例 ,发生率为 89% ,高AG代酸、三重性酸碱失衡分别占代谢性酸中毒的 81 %及 2 4%。分析表明 :窒息复苏后有严重的酸碱紊乱 ,以高AG状态为主 ,代谢性酸中毒发生率高 ;高AG代射性酸中毒与窒息的程度无关 (P >0 .0 5 ) ;高AG组血Cl-,HCO3 -比正常AG组、低AG组明显降低 (P <0 .0 5 )。因此强调除作血气分析外 ,须作AG分析 ,以便对酸碱紊乱作出更准确的诊断。除治疗原发病外 ,还应保证通气 ,改善微循环。     

室息新生儿器官功能损害的临床研究

目的　了解窒息新生儿器官功能损害的发生率及程度 ,探讨与之有关的高危因素 ,为降低窒息患儿病死率寻求新途径。方法　将 2 2 2例窒息患儿分为轻度窒息、重度窒息组进行研究。并将主要器官的功能损害分为轻度与重度加以分析。结果　窒息后器官损害发生率达 90 .1% ,多器官损害发生率为 71.6 %。重度窒息组器官受损率明显高于轻度窒息组 (P <0 .0 5 )。而各器官损害均以轻度为主。重度窒息 5minApgar评分≤ 6分、入院时即刻血气分析 pH≤ 7.2 0、入院晚及需用机械通气治疗患儿多器官损害发生率均明显高于对照组 (P均 <0 .0 5 )。结论　器官损害的发生与窒息程度、复苏效果及接受治疗的早晚有关 ;提示加强围生期母子保健、提高医护人员复苏水平、及时转运危重患儿及采取合理有效的综合治疗等措施均有利于降低窒息新生儿的器官损害发生率及病死率。     

窒息新生儿甲状旁腺素变化及临床意义

甲状旁腺素（PTH）是调节钙代谢的重要激素,其自身的合成与释放又要受血钙水平的影响。除已知的新生儿窒息后常见合并低钙血症,缺氧缺血时钙离子内流引起细胞损伤外,近年来,对于调节血钙的内分泌激素已受到人们的关注。但对于甲状旁腺激素在窒息新生儿中的变化了解甚少。本文对正常出生及同期出生重度窒息的新生儿,出生后24h、72h、7d的血清PTH、血钙水平进行对照分析。     

窒息新生儿血清同型半胱氨酸与叶酸的变化

目的：探讨血清中高同型半胱氨酸（Hcy）血症及低叶酸水平与新生儿窒息的发生是否具有相关性,并对性别、胎龄等因素对血清中同型半胱氨酸及叶酸水平是否有一定影响进行分析。方法：应用酶联免疫吸附实验方法检测血清中Hcy水平,应用放射免疫法测定血中叶酸浓度。结果：①与无窒息对照组相比, 新生儿窒息患儿血清Hcy水平显著升高,而叶酸水平显著降低;②窒息组男婴血清Hcy、叶酸水平分别为15.82 ±2.51 μmol/L; 2.49 ±0.19 ng/mL,女婴为10.50±2.19 μmol/L; 2.38±0.40 ng/mL,男、女婴之间比较差异无显著性;③窒息组足月儿血清Hcy、叶酸水平为12.34 ±2. 01 μmol/L,2.58 ±0.19 ng/mL;早产儿为21.25±5.01 μmol/L; 2.14±0.34 ng/mL。早产儿Hcy水平显著高于足月儿（P<0.05）。结论：①新生儿窒息与血清Hcy及叶酸水平具有显著相关性。②血清Hcy及叶酸水平在性别上无显著差异。③缺氧窒息合并早产者血清Hcy水平升高最为显著。     

Auditory brainstem response in neonates with asphyxia and intracranial haemorrhage

Auditory brainstem response (ABR) was used to assess possible brainstem damage in 76 neonates with asphyxia and intracranial haemorrhage (ICH). Fifty-eight neonates had ICH, 52 had neonatal asphyxia and 34 of these patients had both. Eighty-nine percent of the patients with neonatal asphyxia showed some abnormal patterns in response, the major one being an increase in the threshold of wave V. In the ICH group, abnormal patterns were observed in 62.5%, among whom the prolongation of the I–V interpeak latency (IPL) and of wave V latency was seen more frequently than the increase of threshold of wave V. In the case of neonatal asphyxia associated with ICH, both the prolongation of the latency and the increase of threshold were observed equally. These abnormalities of ABR were associated with worsening clinical condition and conversely normalized gradually following the improvement of the underlying disease. Especially the I–V IPL, wave V latency and the threshold of wave V could serve as indicators of the treatment.Abbreviations ABR auditory brainstem response - ICH intracranial haemorrhage - IPI interpeak latency - NICU neonatal intensive care unit - AFD appropriate-for-date - SFD small-for-date - SDH subdural haemorrhage     

Cerebral function monitoring: a method of predicting outcome in term neonates after severe perinatal asphyxia

Thornberg E, Ekström-Jodal B. Cerebral function monitoring: a method of predicting outcome in term neonates after severe perinatal asphyxia. Acta Pædiatr 1994;83:596–601. Stockholm. ISSN 0803–5253
The cerebral function monitor (CFM), a simplified one-channel EEG monitor, was evaluated in predicting outcome after severe perinatal asphyxia in 38 term infants. Survivors were followed until 1.5–2.5 years of age. All those 17 infants who survived without major neurological handicap showed continuous activity on the CFM trace during the first and/or second day of life. Twenty of the 21 infants who either died or developed severe neurological damage had burst suppression or paroxysmal activity on the first or second day of life. Thus cerebral function monitoring can be a valuable tool in predicting prognosis for infants with severe perinatal asphyxia.     

选择性头部降温治疗对窒息新生儿心脏功能影响的研究

目的　研究亚低温治疗对窒息新生儿心脏功能的影响。方法　将 50例重度窒息足月新生儿分为治疗组 (2 3例 )和对照组 (2 7例 )。治疗组采用选择性头部降温方法 ,维持鼻咽温度在34 0℃± 0 .5℃ ,持续 72h ;对照组不进行亚低温治疗。超声心动图评估心脏收缩及舒张功能 ,并测定肌钙蛋白T(cardiactroponinT ,cTnT)的含量 ,以判断心肌细胞的损伤程度。 结果　 (1 )亚低温治疗组患儿心率与对照组比较 [分别为 (1 0 3± 1 5)次 /min、(1 2 6± 1 4 )次 /min ,P <0 .0 5]明显降低 ,但无心律失常和低血压。 (2 )亚低温治疗组左室射血分数 (EF)、每搏量 (SV)、每分输出量 (CO)与对照组相比 ,差异无显著意义 (P均 >0 .0 5) ;两组左、右室舒张功能不全例数和肺动脉高压例数 ,差异也无显著意义 (P均 >0 .0 5)。 (3)亚低温治疗组和对照组cTnT水平分别为 (0 .47± 0 .1 5)ng/ml和 (0 .35±0 2 1 )ng/ml,差异无显著意义 (P >0 .0 5)。结论　选择性头部降温 (鼻咽温度 34℃ ,持续 72h)治疗新生儿窒息 ,未加重患儿心脏功能的损伤