应用近红外光谱技术评价早产儿认知功能的探讨

目的：通过建立对早产儿光刺激后的反应模式,评价早产儿早期的认知功能,研究早产儿在发育过程中的脑反应性与足月儿之间的差距。方法：对纠正胎龄3个月、6个月的早产儿进行光刺激,应用近红外光谱技术,观察光刺激后脑反应性的变化,并与同龄儿对照。结果：早产儿在纠正胎龄3个月时,光刺激后开始反应时间、反应高峰出现的时间分别为17.2±5.2s、38.4±9.6s,明显长于足月儿的13.1±2.7s、28.9±5.0s;脑组织还原血红蛋白、氧合血红蛋白、脑组织氧饱和度在刺激后的最大反应值分别为(1.2±0.5)%、(1.5±0.6)%、(1.3±0.4)%,明显低于足月儿的(2.3±0.3)%、(2.8±0.3)%、(2.4±0.5)%。到了纠正胎龄6个月时,光刺激后的脑反应性与足月儿相比,无统计学差异。结论：早产儿在发育过程中,认知功能存在一定的滞后,到纠正胎龄3个月时,外界刺激后的脑反应性仍落后于同龄儿,到了纠正胎龄6个月时,脑反应性接近同龄儿,应加强对早产儿的早期干预。     

皮肤接触护理对早产儿生理指标稳定性的影响

皮肤接触护理(Skin-to-skin care,SSC)又名袋鼠式护理(Kangaroo care,KC),是20世纪80年代初发展起来的主要针对早期新生儿的一种护理方式,其标准定义为住院或较早出院的极低出生体重儿(very low birthweight infant,VLBW)在出生早期即开始同母     

早产儿脑反应性及其神经发育的近红外光谱评价研究

目的研究早产儿脑对外界刺激的反应性与神经发育的关系,早期对早产儿进行脑功能的评价,为了解其神经发育水平、估价预后提供客观证据。方法对不同胎龄的早产儿进行声刺激,用近红外光谱技术,观察声刺激后脑反应性的变化,并进行神经发育随访,评价早产儿早期脑反应性与其后神经发育的关系。结果本组早产儿生后对声刺激均显示出不同程度的反应,30~32周的早产儿声刺激后开始反应时间、高峰出现时间、停止刺激后开始恢复时间分别为(278±94)s、(446±67)s、(199±52)s,明显长于足月儿的(107±30)s、(264±51)s、(131±46)s。氧合血红蛋白、还原血红蛋白、脑组织氧饱和度的最大反应值分别为(0.3±0.3)%、(0.7±0.5)%、(0.3±0.3)%,明显低于足月儿的(1.7±0.7)%、(1.7±0.8)%、(1.6±0.7)%。胎龄大于32周的早产儿反应的时间及最大反应值与足月儿相比,差异无统计学意义。围产期脑损伤可影响脑的反应性,早产儿脑反应性与纠正胎龄40周时的神经行为评分及神经发育相关。随访过程中颅脑超声表现为脑发育异常者,其新生儿期对声刺激无反应的比例明显高于脑发育正常者。结论近红外光谱技术能评价新生儿的脑反应性,早产儿具备对声刺激后的脑反应性,早期的脑反应性与神经发育水平有关。     

皮肤接触护理对早产儿生理指标稳定性的影响

皮肤接触护理(Skin-to-skin care,SSC)又名袋鼠式护理(Kangaroo care,KC),是20世纪80年代初发展起来的主要针对早期新生儿的一种护理方式,其标准定义为住院或较早出院的极低出生体重儿(very low birthweight infant,VLBW)在出生早期即开始同母亲进行一段时间的皮肤接触,并将此种方式坚持至校正胎龄为40周时(1).     

近红外光谱对早产儿脑组织氧饱和度监测的临床应用

与经皮血氧饱和度(percutaneous oxygen saturation,SpO 2)相比,脑组织氧饱和度(cerebral regional tissue oxygen saturation,CrSO 2)反映的是脑组织的混合氧饱和度,其变化与新生儿生后脑组织的新陈代谢密切相关。近红外光谱技...     

近红外光谱技术对新生儿脑组织氧检测的应用与展望

氧是维持人体组织细胞正常功能和生命活动的基础。一旦缺氧,可威胁到全身各系统的代谢与功能,尤其对中枢神经系统的危害更引人关注,因为在缺氧时脑细胞的生物氧化过程可发生障碍,可导致神经元急性坏死和凋亡,使小儿留下终生残疾。多年来,在临床工作中,机体的氧合状况始终是倍受关注的生命监测指标之一,但目前广泛应用的血气分析和经皮氧饱和度监测所得到的结果仅是血液中的氧分压和肢端搏动的小动脉血氧饱和度,而不是脑组     

近红外光谱测定技术对缺氧新生儿脑反应性功能检测的意义

为评价近红外光谱测定技术（ＮＩＲＳ）对正常及围产期缺氧新生儿脑反应性功能的检测意义，本文检测了５４例不同程度缺氧新生儿及３３例正常新生儿安静状态下脑活动时氧合状态和听觉刺激后脑活动增强时氧合状态反应性变化。结果显示出正常新生儿稳态的脑功能活动及对刺激良好的反应状态；重度缺氧后７２小时内脑反应性功能状态时明显减弱，尤以生一２４小时最差，与临床明显中枢神经系统症状及心血管系统相平称。提示ＮＩＲＳ可用于     

近红外光谱技术对有血流动力学意义的动脉导管未闭早产儿肠道组织氧饱和度监测价值的前瞻性研究

目的 使用近红外光谱技术研究有血流动力学意义的动脉导管未闭（hemodynamically significant patent ductus arteriosus,hsPDA）早产儿肠道组织氧饱和度（regional oxygen saturation,rSO₂）的变化及规律,初步探索hsPDA早产儿肠道组织血氧水平变化的临床意义。 方法 前瞻性选取2017年10月至2020年10月深圳市龙岗中心医院新生儿科收治的胎龄<32周和/或出生体重<1 500 g的动脉导管未闭（patent ductus arteriosus,PDA）早产儿。按照hsPDA的诊断标准分为hsPDA组和无血流动力学意义的动脉导管未闭（non-hemodynamically significant patent ductus arteriosus,nhsPDA）组,将hsPDA组早产儿根据口服布洛芬后动脉导管关闭情况分为hsPDA关闭亚组和hsPDA未闭亚组。分别在诊断PDA时及治疗后测定血流动力学指标,持续监测患儿肠道组织rSO₂水平,分析其变化规律。 结果 共有241例PDA早产儿纳入研究,其中hsPDA组55例（22.8%）,nhsPDA组186例（77.2%）;hsPDA关闭亚组36例（65%）,hsPDA未闭亚组19例（35%）。hsPDA组左心房内径/主动脉根部内径值大于nhsPDA组,左室射血分数和短轴缩短率均低于nhsPDA组（P<0.05）。hsPDA组患儿肠道组织rSO₂在诊断后6 h内各时间点（1、2、4、6 h）均低于nhsPDA组（P<0.05）;hsPDA组早产儿肠道组织rSO₂随时间呈下降趋势（P<0.05）,至6 h时达最低值（0.448±0.014）。hsPDA关闭亚组左心房内径/主动脉根部内径值低于hsPDA未闭亚组,左室射血分数和短轴缩短率高于hsPDA未闭亚组（P<0.05）。hsPDA关闭亚组患儿肠道组织rSO₂在治疗后48~96 h内各时间点（48、72、96 h）均高于hsPDA未闭亚组（P<0.05）;hsPDA关闭亚组早产儿肠道组织rSO₂从治疗24 h后随时间呈上升趋势（P<0.05）,至96 h达最高值（0.578±0.031）。 结论 hsPDA对早产儿肠道组织氧合有影响,可通过近红外光谱技术持续监测hsPDA早产儿肠道组织rSO₂变化趋势指导临床管理。     

几种药物减少红霉素静滴中胃肠道反应的临床观察

为克服红霉素静滴引起的胃肠道平滑肌及血管平滑肌痉挛,我们对几种药物伍用减少红霉素静滴副作用的情况进行比较,现报道如下。1临床资料选择我院2003年11月至2004年11月因患肺炎支原体感染住院患儿120例,其中男52例,女68例,年龄1～13岁。原发病有支气管炎46例、肺炎60例、支气管哮喘合并感染14例。所有患儿再发病7～10d时采血测肺炎支原体抗体(MP-IgM),其中MP-IgM阳性者112例(阴性8例,因胸片呈典型淡片状密度增高影,加之年长儿稽留热,刺激性干咳,临床诊断肺炎支原体肺炎,经红霉素治疗后均明显好转。按入院先后将所选120例随机分成4组,每…     

脑脊液中C反应蛋白的检测及其临床意义

本文介绍了CRP的生物功能,脑脊液中CRP的检测方法、正常值和临床意义。CRP能与多种物质结合激活补体系统。正常脑脊液中含微量CRP,化脓性脑膜炎时,CRP迅速升高,测定脑脊液中CRP是化脓性脑膜炎早期诊断及其鉴别诊断的简便、敏感和可靠的方法。CRP在其它中枢神经系统疾病中的意义及升高机理值得深入研究。     

A new method of blood sampling reduces pain for newborn infants: a prospective, randomized controlled clinical trial

BACKGROUND: Using a new simple blood glucose measurement device (Free Style), blood can thus be sampled from the forearm, which is less sensitive to pain than from the heel. Measuring the blood glucose levels in newborn infants using Free Style is therefore a potentially less painful testing modality than traditional blood sampling methods. OBJECTIVE: To compare the pain intensity at the time of blood sampling from the forearm using the Free Style with the conventional method from the heel. DESIGN: A prospective, randomized controlled clinical trial. PATIENTS AND METHODS: Sixty healthy neonates were randomized by the sealed envelope method into two groups-Group F, in which blood was sampled from the forearm using the Free Style, and Group H, in which blood was conventionally sampled from the heel using a lancet. The pain intensity was assessed based on their crying, the Neonatal Facial Coding System (NFCS) and the Neonatal Infant Pain Scale (NIPS). RESULTS: After skin puncture, 12 (40%) of the infants cried in Group F and 27 (90%) in Group H. The duration of crying was also significantly shorter in Group F than in Group H. Both of pain scores between the two groups differed significantly, these findings indicated less pain for Group F. CONCLUSION: The new blood sampling method from the forearm was found to be less painful than the conventional method, thus making it possible to clinically use this product as an innovative method for blood sampling in neonatal medicine.     

Skin-to-skin contact as a method of body warmth for infants of low birth weight

Skin-to-skin mother/infant contact as a means of warmth for newborns of low birth weight (less than or equal to 2500 g) was studied in 132 infants admitted consecutively during the cold season July/September at the Central Hospital in Maputo. The mean (+/- SD) birth weight was 1788 g (+/- 304 g) and the gestational age 34 weeks (+/- 2.7). Fifty-seven (43 per cent) infants were born outside the hospital and were referred. The ambient temperature ranged from less than 22 degrees C to 32 degrees C. Skin-to-skin contact as the principal means of warmth commenced in more than a third by age 3 days and in more than a half by age 5 days after periods of observation to exclude clinical problems. The infants were kept warm using conventional methods during observation. Re-admission to the intensive care unit was required in nine cases: four for diarrhoea; two for respiratory infection; two with jaundice; and one for poor suckling. Infants were discharged home at a mean (+/- SD) weight of 1864 g (+/- 227), and age 15.6 d (+/- 7.9). Skin-to-skin contact, either by itself or in combination with other methods of warmth, was reportedly followed at home by 67 per cent of the mothers who received home visits. No infant needed readmission for hypothermia either from the neonatal wards or after being discharged home. At follow-up, when body weight had reached greater than or equal to 2500 g, the outcome was graded as 'good' in 64; 'satisfactory' in 6; and 'poor' in 4.(ABSTRACT TRUNCATED AT 250 WORDS)     

早产儿脑损伤早期干预模式与临床路径研究

目的 探讨早产儿脑损伤早期干预模式与临床路径的临床应用效果,以降低早产儿脑损伤神经伤残的发生率。方法 2008年3月至2010年2月出生的早产儿117例纳入该研究,根据随机原则分为临床路径组（n=63）和对照组（n=54）。临床路径组定期发育监测、脑损伤筛查、营养神经治疗、神经发育和康复训练。对照组按照常规早期干预方案进行。结果 6个月至1岁临床路径组姿势、反射、睡眠、肌张力和脑电图检查异常发生率明显低于对照组（P<0.05）;临床路径组在纠正月龄6~24个月时智力发育指数（MDI）和运动发育指数（PDI）明显高于对照组,差异均有统计学意义（P<0.05）。3岁时临床路径组脑性瘫痪、语言障碍、肌张力异常、听力异常发生率明显低于对照组,差异均有统计学意义（P<0.05）。结论 多学科紧密结合的早期干预模式与临床路径较对照组明显改善早产儿脑损伤的智能和运动发育水平,可进一步降低小儿脑性瘫痪等神经伤残发生率。     

The relationship between behavioral states and pain responses to various NICU procedures in premature infants

An explanatory observational study was conducted to assess the behavioral state before and during various procedures in the neonatal intensive care unit (NICU) and to investigate the relationship between the behavioral state measured by Anderson Behavioral State Scoring System (ABSS) and the degree of pain responses as measured using CRIES (Crying, Requires O(2) for oxygen saturation above 95, Increased vital signs, Expression, and Sleeplessness.) and PIPP (Premature Infants' Pain Profile). Ninety-one observations in 6 NICU procedures were made from 54 infants with a mean gestational age (GA) of 30(+4) weeks and a mean body weight (BW) of 1484.87 g. A positive relationship was identified between ABSS and CRIES, both before (r=0.244, p=0.020) and during (r=0.745, p=0.000) the procedures, and between CRIES and PIPP (r=0.447, p=0.000) during the procedures. However, no correlation was identified between PIPP and ABSS before (r=-0.055, p=0.651) and during (r=0.214, p=0.074) the procedures. This study concluded that relatively healthy, premature infants are in a state of quiet or active sleep and can adequately express pain-related responses to the NICU procedures that are appropriate with the nature of stimulation. However, it was observed that clinicians tend to pay little attention to the state of premature infants before performing the procedures, regardless of their invasive and stimulatory nature. Further research needs to be conducted on the pain responses in physiologic and behavioral expression of critically ill infants who possibly have alteration and developmental limitations in response.