新生儿高胆红素血症胆红素脑病的危险性因素分析

目的：分析新生儿高胆红素血症胆红素脑病的危险性因素,为预防高胆红素血症胆红素脑病提供思路。方法回顾性分析我院收治的209例新生儿高胆红素血症患儿临床资料,将胆红素脑病致使神经功能系统障碍（ bilirubin－induced neurologic dysfunction,Bind）评分为7～9分的患儿定义为急性胆红素脑病（ABE）患儿,并将其作为观察组（40例）,其余为对照组（169例）,对可能影响高胆红素血症ABE发病的相关因素如性别、新生儿胎龄、出生体重、分娩方式、胎膜早破、喂养方式、妊娠期糖尿病、妊娠期高血压、窒息或宫内窘迫、总胆红素峰值、黄疸家族史、RH溶血病、ABO溶血病、出生后1 min 新生儿评分（ Apgar评分）、出生后5 min apgar评分、酸中毒、感染、发热、脱水、低蛋白血症分别进行单因素及多因素Logistic分析。结果经多因素Logistic分析后发现出生体重（OR＝3．739,95％CI：1．240～11．880）、总胆红素峰值（OR＝6．475,95％CI：1．724～17．419）、RH溶血病（OR＝11．473,95％CI：2．708～33．697）及ABO溶血病（OR＝9．143,95％CI：2．492～28．513）为新生儿高胆红素血症胆红素脑病的高危因素,P＜0．05。结论胆红素脑病与出生体重、总胆红素峰值、RH溶血病及ABO溶血病有关,临床医师应加强对极低出生体重、极高总胆红素峰值、伴有RH溶血病及ABO溶血病患儿的筛查及治疗。     

357例新生儿高胆红素血症发病相关因素探讨

目的：探讨新生儿高胆红素血症发病相关因素。方法：对３５７例新生儿高胆红素血症发病因素进行分析。结果：３５７例新生儿高胆占同期住院新生儿的５４．２％。轻度黄疸３６．４％，中度４３．７％，重度１９．９％。病因前３位依次为围产因素（４２．０％）、感染（２２．７％）、母乳性黄疸（１８．２％），其次为原因不明（９．２％）、其它因素（７．９％）。本组预后较佳，无胆红素脑病发生。结论：对高胆红素血症的早期干预提出４点意见。     

2650例新生儿听力筛查分析

目的：探讨新生儿听力筛查。方法：2008年1月～2010年1月在我院分娩的新生儿2650例（足月新生儿，早产儿，低体重儿，缺血缺氧性脑病，高胆红素血症）进行听力筛查。结果：足月新生儿通过率93．09％，早产儿通过率68．09％，低体重儿通过率70．71％，缺血缺氧性脑病通过率68．78％，高胆红素血症通过率63．96％。结论：有疾病的新生儿听力筛查通过率明显低于足月新生儿听力筛查通过率，听力筛查非常重要，特别对有疾病的新生儿尤为重要，能够及早发现听力损失，进行早期干预治疗，减少和防止言语发育、智力发育不受太大影响。     

妊娠期肝内胆汁淤积症183例临床分析

目的：探讨妊娠期肝内胆汁淤积症对母儿的不良影响。方法：对１８３例的临床资料进行回顾性分析。结果：妊娠期肝内胆汁淤积症１８３例中同期分娩数的３．９１％，其中早产３２例（１７．５％），死胎５例（２．７％），死产４例（２．２％），新生儿死亡１例（０．５％）。Ａｐｇａｒ评分≤７分２１例（１１．５％）。羊水Ⅱ°以上污染４５例（２４．６％）。产后出血２４例（１３．１％），新生儿体重３１０２．５±５２６．０ｇ。     

新生儿溶血病与胆红素脑病的关系

新生儿溶血病是新生儿高胆红素血症的主要病因，也是发生胆红素脑病的高危人群，因此早期诊断、及时处理至关重要。本文回顾性地分析了我院十二年来确诊为新生儿溶血病的２１８例患儿的临床资料及３０例血清总胆红素（ｓｂ）≥３４０ｕｍｏｌ／Ｌ患儿的随访资料，并探讨新生儿溶血病中胆红素脑病的发生情况、危险因素及预防的关键。临床资料一般资料我院自１９８５年１月至１９９６年６月确诊为新生儿溶血病者２１８例，其中男１１９例、女９９例；早产２８例，足月１９０例；出生体重＜１５００ｇ２例、～２５００９１２例、＞２５００ｇ２…     

新生儿脑病的产时危险因素:澳大利亚西部的病例-对照研究

目的：确定足月婴儿新生儿脑病的产时预示因素。设计：人群为基础的非配对病例对照研究。单位与时间：澳大利亚西部城区，１９９３年６月至１９９５年９月。对象：全部患中度或重度新生儿脑病者１６４例；随机选择的对照４００例。主要结局测量指标：校正比数比。结果：中度或重度新生儿脑病的出生患病率为３．８／１０００足月活婴。新生儿死亡率为９．１％。新生儿脑病的危险因素有：母亲发热（比数比３．８２）；持续性枕后位（４．２９）；急性产时事件（４．４４）。病例组与对照组相比，引产较多（各为４１．５％与３０．５…     

新生儿胆红素脑病脑脊液胆红素及脑干听觉诱发电位检测的临床意义

目的探讨新生儿胆红素脑病脑脊液胆红素水平及脑干听觉诱发电位（BAEP）检查的临床意义。方法选取高胆红素血症新生儿为研究对象,分为胆红素脑病组（44例）和非胆红素脑病组（79例）,比较两组患儿脑脊液、血清胆红素水平以及BAEP变化。结果胆红素脑病组患儿脑脊液胆红素水平高于非胆红素脑病组[（11.0 ± 3 .9）mol／L VS（7. 4± 4.0）mol/L],差异有统计学意义（P〈0 .05）;胆红素脑病组BAEP异常发生率（61 4％）高于非胆红素脑病组（16 5％）,差异有统计学意义（P〈0 .01）。结论脑脊液胆红素水平检测可作为新生儿胆红素脑病早期诊断的可靠指标,胆红素脑病新生儿早期听觉损伤发生率高,需早期干预治疗。     

高胆红素血症对新生儿脑干听觉诱发电位的影响

目的：探讨高胆红素血症新生儿的脑功能状态，以早期评估新生儿高胆红素血症的预后，方法：对高胆红素血症新生儿（n=40)进行脑干听觉诱发电位（ABR）检查，对ABR异常者3个月后复查。结果：40例黄疸患儿中，ABR异常31例，异常率77．5％，血清胆红素水平越高，ABR异常率越高（P＜0．05），ABR异常越严重（P＜0．05），胆红素浓度恢复正常后3个月，仍有48．4％的患儿ABR异常，结论：高胆红素血症不仅导致患儿暂时性脑功能障碍，而且对临床未发生胆红素脑病的患儿（胆红素＞171umol/L），亦可导致永久性中枢神经损伤。     

新生儿缺氧缺血性脑病57例分析

新生儿缺氧缺血性脑病（ＨＩＥ）至今仍是威胁新生儿生命和健康的严重疾病,一直为临床医师所关注。现将我院从１９９６年６月～１９９８年６月收治的５７例报告如下：１　临床资料１．１　一般资料　我科新生儿病室自１９９６年６月～１９９８年６月,共收治３１４例新生儿,其中早产低出生体重儿３９例,其余２７５例为足月正常体重儿。３１４例病儿中患ＨＩＥ５７例,占同期住院新生儿的１８．２％,居第二位（高胆儿居第一位）。其中足月正常体重儿４４例,占同期住院足月儿的１６％;早产低出生体重儿１３例,占同期住院早产低出生体重…     

苯巴比妥预防新生儿缺氧缺血性脑病的探讨(附105例报告)

为了解苯巴比妥预防新生儿缺氧缺血性脑病（ＨＩＥ）的效果，以１０５例新生儿窒息患儿为预防组，在出生后６ｈ内给予苯巴比妥负荷量，维持量用３～５天，对照组为同一病区未使用苯巴比妥预防前２年的１２４例新生儿窒息患儿。结果显示预防组ＨＩＥ的发生率（３９．０５％）较对照组（５２．４２％）显著降低（χ２＝４．０８，Ｐ＜０．０５），在中重度ＨＩＥ发生率之间的差异也有显著性（χ２＝３．９３，Ｐ＜０．０５）。提示苯巴比妥对ＨＩＥ的预防有一定效果，可降低ＨＩＥ的严重程度且未见不良反应。建议对新生儿窒息患儿在出生后６ｈ内常规给予苯巴比妥预防量，以期进一步降低ＨＩＥ的发生率及其严重程度。     

The relationship of placental weight with birth weight

To assess the relationship between placental weight and birth weight, two hundred forty six pregnant mothers, who were otherwise healthy, were prospectively followed in a city hospital during antenatal period until delivery and immediate post-partum period. Height of mothers was measured initially and weight measured at each visit during the antenatal check-up. Placental weight and birth weight of babies were measured by one of the authors immediately after delivery by a weighing scale. Eighty one percent of the mothers were between the age group of 20-29 years. The BMI of 92% mothers was 18.5 and above. Most of the mothers came both with primigravida (42%) or second gravida (33%) and in 25% cases 3rd or onwards. In 49% cases the placental weight was between 401-500 gm, in 30% cases >500 gm and in 21% cases 400 gm or less. There was delivery of appropriate-birth-weight babies in 85% cases and low-birth-weight babies in 15% cases. It was observed that a very strong correlation existed between placental weight and birth weight (r = 0.391, p<0.001). Even this correlation was stronger in small for gestational age babies. However, there was no correlation between placental weight and APGAR score at one minute. It is concluded that increment of birth weight occurs with increase of placental weight. If placental weight can be measured by ultrasonography in second or early third trimester of pregnancy birth weight is possible to be assessed and appropriate measure can be taken to increase the birth weight.     

北京市西城区35～70岁居民高血压流行现况及相关危险因素调查

采用整群抽样的方法对北京市西城区10个居委会中35～70岁常住居民进行横断面调查,对该地区高血压流行现状及相关危险因素进行研究。结果抽样调查2230人,签署知情同意书后进行问卷调查及体检。完成调查1958人,数据完整的1889人。其中高血压902例,患病率为47．8％（年龄别标化率为40．1％）,男性居民中高血压368人（现患率53．0％）,女性居民中高血压患者534人（44．7％）,两者之问差异有统计学意义（P〈0．01）。患者的知晓率、治疗率和控制率分别为47．5％、38．5％、24．1％。高血压患病率随着年龄增加有线性增长趋势（P〈0．01）。在各年龄组中,从35～44岁年龄组到45～54岁年龄组升高幅度最大（21．6％）。经多元logistic回归分析发现男性发生高血压的风险是女性的1．33倍（95％CI：1．08～1．64）。收缩压随着BMI的升高而增高,两者具有线性关系（P〈0．01）。肥胖者是体重正常者发病风险的2．81倍（95％CI：2．00～3．97）。提示高血压已成为影响该地区35～70岁居民身体健康的严重问题。中年人特别是男性以及肥胖者更应当关注血压变化。需进一步加强健康教育和高血压防治工作,重视危险因素干预,以遏制高血压流行的快速增长趋势。     

Mortality patterns in low birth weight babies in ICDS urban slum area

There were 920 live-births over the period of one year in urban slums (covering 40 anganwadi centres) of Gorakhpur city. Incidence of low birth weight (LBW) babies weighing 2.5 kg or less and those weighing 2 kg or less were 40.7% (19.8% preterm LBW and 80.2% term LBW) and 24% (25.3% preterm LBW and 74.7% term LBW) respectively. Incidence of preterm babies was 8.5%. Infections and respiratory distress were found to be the major killers of LBW babies. The neonatal mortality rate was observed to be significantly high in LBW and preterm babies. Again, babies weighing 2 kg or less and preterm were at greater risk and should be referred to specialised neonatal centres while those weighing 2.001-2.5 kg could be looked after at home by trained personnel in domiciliary newborn care.     

Are general practitioners doing enough to promote healthy lifestyle? Findings of the Medical Research Council's general practice research framework study on lifestyle and health

The health survey questionnaire was used to collect information about cigarette smoking, alcohol consumption, physical exercise, and dieting and weight. Completed questionnaires were received from 25,496 men and 36,657 women registered with 47 group practices in England and Scotland. The proportions of respondents who stated that they had a problem ranged from 1% (women and drinking, n = 406) to 34% (women and weight, n = 12,526). Between 49% (women and drinking, n = 18,048) and 67% (men (n = 17,095) and women (n = 24,550) and weight) thought that their general practitioners should be interested in their lifestyle. The proportions who could recall having received relevant advice ranged from 2% (women and drinking, n = 591) to 24% (women and weight, n = 8946). Advice about smoking had been given to 4055 (40%) of the women and 2941 (39%) of the men who smoked. Only 96 (10%) of the 989 women and 331 (17%) of the 1948 men who drank excessively could recall having received advice about alcohol consumption. These results suggest that patients are concerned about their lifestyle, that most would welcome relevant counselling, and that doctors should become more concerned with prevention of this kind.     

Treatment of candidal infections with fluconazole in neonates and infants

To study the therapy, efficacy and safety of fluconazole in candidal mycoses during neonatal phase and infancy a case review in 53 newborns and infants was performed. The majority of these patients were premature with a median birth weight of 1120 g and born within gestational week 23-38. The median age at the onset of fluconazole treatment was 5 weeks. All patients had underlying diseases and several risk factors, which favored the occurence of a systemic candidal mycosis. Systemic candidiasis was the most frequent diagnosis (75.5%). Fluconazole was administered at a daily dosage of 5-6 mg/kg for a median duration of 21 days. The hepatic, renal and hematologic functions were assessed before, one, two, and three weeks after start of treatment. Yeasts were identified in 37 patients. The most common fungus isolated at baseline was Candida albicans (68%). Clinical cure or improvement was reported in 31 out of 38 patients (81.6%). Mycological cure was achieved in 25 out of 32 newborns and infants. Despite the limited number of patients with outcome data, these preliminary results of a small cohort clearly indicate the effective antifungal therapy with fluconazole in neonates and infants. No serious side effects were observed in fluconazole-treated patients. Two patients with megaureter-megacystis-hydronephrosis syndrome and severe meningoencephalitis showed a mild increase in liver enzymes. - Conclusion: Fluconazole seems to be an effective therapy for systemic and other forms of candidiasis in infants including very low birth weight infants (VLBWI; <1500 g). These favorable safety and efficacy data are similar to results obtained with fluconazole in older children and adults. These findings, however, must be supported by larger trials. The recommended daily dose is 5 mg/kg body weight. Only in VLBWI the dosage interval within the first two weeks of life should be prolonged up to 3 days and fluconazole serum levels should be monitored.     

Early gastric cancer: the case for long term surveillance

Thirty five patients with early gastric cancer have been treated at the Bristol Royal Infirmary since 1965. The number of cases diagnosed has doubled in the last 10 years. Epigastric pain (74%), loss of weight (63%), and gastrointestinal bleeding (43%) were the most common presenting symptoms, with a median length of history of 12 months (range five days to 72 months). Life table survival curves showed a crude five year survival of 71% (age adjusted 92%) and a crude 10 year survival of 63% (age adjusted 85%). Sixteen patients have been followed up clinically, endoscopically, and by scintigraphy with technetium-99m p-butyl iminodiacetic acid to assess the risk of recurrent disease. Of seven patients with pronounced bile reflux, two had moderate dysplasia of the gastric remnant, and one patient was found to have developed a metachronous tumour nine years after surgery. Partial resection seems to be the best choice of treatment for early gastric cancer, giving good functional results. Consideration should, however, be given to Roux en Y diversion, and long term surveillance of the gastric remnant is recommended.     

Overweight--a common problem among women treated for hyperthyroidism.

We sent out a questionnaire to 112 women treated for diffuse toxic goitre 2-5 years earlier to evaluate the prevalence of problems with overweight after the disease. Of 87 responders, about 50% (irrespective of surgical or radioiodine treatment) reported weight problems, and we randomly selected 40 of these women (20 with and 20 without reported weight problems) for a clinical follow-up (32 appearing). At the follow-up examination (mean 4 years after treatment for hyperthyroidism), 27 women had a higher weight than their estimated premorbid weight. The weight gain correlated with the estimated premorbid body mass index (BMI; P < 0.005), indicating that excess weight gainers may have had a premorbid problem now exaggerated in the post-hyperthyroid period. However, many women with a BMI within the limits stated to be ideal (21-25 kg/m2) also showed dramatic increases in weight. In contrast, the average middle-aged woman in our region did not appear to have gained in weight during a corresponding time period as judged from a longitudinal population study. Women with reported weight problems (mean weight increase 15.6%, n = 16) did not differ from women without (mean weight increase 6.7%, n = 16) as regards pretreatment hormone levels, method of treatment, (change of) smoking habits or post-treatment levothyroxine administration, or in serum concentrations of thyroid hormones, thyrotrophin, cortisol, procollagen-III-peptide, cholesterol, HDL cholesterol or triglycerides. Women with hyperthyroidism should be informed about the risk of gaining weight after therapy and given early support as to dietary and lifestyle change.     

Resolution of diabetic autonomic neuropathy

Many consider diabetic autonomic neuropathy to be an irreversible complication of diabetes of long duration. Three patients developed symptoms of autonomic neuropathy which subsequently resolved. Their autonomic neuropathy was not associated with long duration of diabetes, but with weight loss. Each had marked weight loss and resolution occurred on regaining remembered premorbid weight. A woman aged 20 was admitted with anorexia nervosa (weight loss 6 kg). She complained of feeling bloated. Gastroenterological investigations showed delayed gastric emptying. RR ratio (respiration and standing) was abnormal. Resolution occurred after two years. A male aged 18 developed diabetic symptoms, which were overlooked. Twelve months later he presented underweight and ketonuric; insulin treatment was started but within one month he became impotent. Resolution occurred after 18 months. An 80 year old man presented after six months trial of diet and sulphonylurea therapy. He was underweight, had ketonuria, and such muscle loss that he was unable to sit unaided. Insulin treatment was started. He developed severe symptomatic postural hypotension. This resolved six months later by which time he had regained his normal weight. These cases illustrated symptomatic autonomic neuropathy occurring in relation to weight loss with resolution on recovery of normal weight, a temporal pattern mimicking that of acute cachectic painful neuropathy. Treatment of autonomic neuropathy should be like that of cachectic neuropathy, that is with an expectation of recovery and should include strategies to regain premorbid weight and achieve glycaemic control.     

慢性住院精神分裂症患者腹部B超检查结果的临床现象学调查

目的:探讨长期服用抗精神病药物的住院精神分裂症患者腹部B超的异常情况及其相关因素,总结临床经验。方法:采用自编的调查量表对2010年8月至2011年7月期间在我院住院的335例慢性精神分裂症患者进行一般情况调查,同时进行腹部B超检查,分析腹部B超结果的阳性率及其相关因素。结果:腹部B超异常结果病例105例(31.3%),其中脂肪肝78例(23.3%),占阳性率的74.3%,胆囊结石20例(6.0%),肝内回声改变13例(3.9%),胆管结石4例(1.2%),肝肿瘤1例(0.3%),肝硬化1例(0.3%),肾结石7例(2.1%),肾囊肿2例(0.6%),附件囊肿2例(0.6%);腹部B超阳性结果与年龄、体重、服药时间及住院时间呈正相关(P<0.001);与性别、职业、病程、疾病类型不相关(P>0.05)。结论:长期服用抗精神病药物易出现药源性脏器损伤,尤以肝脏最为严重,并可能随年龄、体重、服药时间、住院时间等增长不断加重。应定期检查,及时防治。