早产儿出血性与缺血性脑损伤

各种致病因素作用于不同发育阶段的早产儿,其损伤特征表现为成熟依赖性,即损伤的机率随发育的成熟而逐渐降低。早产儿脑损伤绝大多数发生于胎龄小于32周(或体质量<1500 g)的早产儿。生发基质-脑室内出血(germinal matrixhemorrhage-intraventricular hemorrhage,GMH-IVH)及脑室     

脑脊液中cAMP的变化对评价新生儿窒息后脑损伤的意义

如何早期评价新生儿窒息后脑 伤的预后备受临床医生关注，国内外学者就此进行了多方探讨，许多学者从脑组织能量代射角度进行研究，结果表明，能量代谢障碍是缺氧缺血性脑损伤的根本原因，且能通过脑脊液中环磷酸腺苷反映出来，本文就新生儿窒息后脑脊液中环磷酸腺苷的变化及其与脑损伤的关系，对预后的评估等作一综述，试图为临床上早期诊断及早期干预，减少后遗症的发生提供理论依据。     

全身亚低温治疗新生儿窒息的安全性评价

目的　探讨全身亚低温治疗对新生儿的不良影响 ,评价亚低温治疗新生儿窒息的安全性。方法　将中重度窒息足月新生儿 2 4例随机分为亚低温治疗组和常规治疗对照组各 12例 ,亚低温治疗组维持肛温在 3 3～ 3 4℃ 72h ,其他治疗措施与对照组相同。两组均连续进行监护和生化指标检测 ,记录临床症状及体征。结果　两组均无出血、严重感染及死亡。亚低温组治疗期间心率平均下降 3 0次 /min ,血压及呼吸未见明显改变 ,未发现与亚低温相关的心律失常及肺动脉高压。其凝血酶原时间及凝血酶时间与治疗前及对照组相比无明显差异。血钠、血钾、血钙在低温治疗后与治疗前及对照组相比无明显差异。窒息新生儿治疗前均有代谢性酸中毒 ,部分患儿有急性肾功能异常 ,治疗后均逐渐纠正 ,亚低温组与对照组相比无明显差异。结论　全身亚低温治疗无严重的不良反应 ,在严密监护下用于足月新生儿窒息的治疗是安全可行的。     

窒息早产儿T淋巴细胞亚群变化研究

目的 探讨窒息对早产儿免疫功能的影响及其临床意义.方法 采用流式细胞仪对25例轻度窒息早产儿及20例重度窒息早产儿生后第1天、第14天静脉血T淋巴细胞亚群进行测定,对照组为同期在本科住院的无窒息早产儿22例.结果 重度窒息组CD3、CD4、CD4/CD8明显低于对照组与轻度窒息组,P<0.05;轻度窒息组CD3、CD4、CD4/CD8亦明显低于对照组,P0.05),但重度窒息组各项指标与对照组比较,差异有统计学意义(P<0.05).结论 窒息缺氧可导致早产儿T淋巴细胞亚群紊乱,窒息程度越重,T淋巴细胞亚群改变越明显.     

早产儿262例临床分析

目的探讨引起早产的原因和影响预后的因素。方法回顾性分析262例早产主要原因，分析出生孕周及不同分娩方式对早产儿预后的影响。结果胎膜早破、妊娠高血压综合征、多胎妊娠是引起早产的主要因素；在本院进行定期产前检查组比无产前检查组新生儿病死率明显降低，二组差异有显著性（P〈0．05）；胎龄愈小，出生体质量愈低，其病死率愈高，特别是胎龄〈32周者；阴道分娩与剖宫产2种分娩方式早产儿结局比较无显著性差异（P〉0.05）。结论定期产前检查能及早发现异常，及时治疗预防发生早产；新生儿呼吸窘迫综合征及重度窒息是早产儿死亡的主要原因。     

窒息新生儿和早产儿血清生长激素的研究

目的研究窒息新生儿和早产儿血清生长激素水平的变化；了解窒息急性期与缓解期血清生长激素的变化及关系。方法采用时间分辨荧光分析法，测定66例窒息急性期新生儿和其中61例窒息缓解期新生儿以及27例早产儿血清生长激素，并测定50例足月健康新生儿血清生长激素作对照比较。结果窒息组（急性期与缓解期）与对照组比较，血清生长激素均明显下降（P〈0．01），且窒息缓解期血清生长激素继续下降，与窒息急性期相比较，差异有非常显著性（P〈0．01）；早产儿与对照组相比，血清生长激素也明显下降（P〈0．05）。结论新生儿窒息时垂体分泌生长激素受到抑制；早产儿垂体功能低下，使生长激素释放受影响。     

窒息新生儿阴离子间隙值与缺氧缺血性脑病关系的探讨

目的：新生儿缺氧缺血性脑病(HIE)患儿的酸碱紊乱及阴离子间隙(AG)状态研究报道较多,但窒息新生儿AG值与HIE发生的关系尚未见报道。该文探讨窒息新生儿AG值与HIE发生率之间的关系,以帮助早期诊治。方法：采用瑞士产AVL-945型血气分析仪作血气分析,同时测定电解质,计算出AG值。结果：105例窒息新生儿均存在程度不等的酸中毒,正常AG组与高AG组之间pH值和BE值差别无显著意义( P > 0.05 ),两组之间HIE发生率差异有显著性意义( P < 0.05 )。结论：窒息新生儿AG值可作为预测HIE发生的重要指标,并对临床治疗有一定的指导意义。     

磁共振成像和计算机X线断层照像术对婴儿痉挛病因和预后判断的意义

目的　探讨头颅磁共振成像 (MRI)和计算机X线断层照像术 (CT)对婴儿痉挛 (IS)的病因和预后判断的意义。方法　采用螺旋CT平扫和MRI扫描T1和T2加权相、反转恢复序列和磁共振血管成像等技术对4 2例IS颅脑病变进行检测和分析。结果　CT检查 14例发现异常 ,对脑萎缩、出血、粗大畸形和钙化显示较好 ;2 4例MRI扫描阳性 ,对脑白质软化或髓鞘化延迟、海马和脑干萎缩、缺氧缺血性脑病 (HIE)和核黄疸、结节性硬化、灰质异位及胼胝体和脑血管畸形等病变都具有良好诊断价值 ;MRI对IS预后判断应结合临床和年龄。结论　MRI和CT对探寻IS等癫潜在病因、评估预后和指导治疗具有重要意义 ,前者对脑白质软化与髓鞘化、HIE、海马萎缩、局限性脑发育不全和灰质异位等病变检测尤敏感。     

计算机X线断层照像术在支气管异物诊断中的意义

目的探讨计算机X线断层照像术(CT)在儿童支气管异物诊断中的临床意义。方法对21例可疑支气管异物的患儿进行螺旋CT横断面扫描和冠状面重建,采用支气管镜术证实诊断。结果患儿均显示异物的直接征象,CT显示异物位于右肺主支气管12例,右中间支气管1例,右下叶支气管2例,左肺主支气管6例。支气管异物均经支气管镜术取出。结论CT扫描可显示儿童支气管异物,并能精确定位,对病史、体征和常规X线表现不典型的患儿有重要诊断价值。     

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     

Pediatric brain computed tomography

Computed tomography today provides good anatomic depiction of the brain and its gross disease processes that have as a manifestation alteration of brain density, disturbance in blood-brain barrier, or mass effect. As such, computed tomography often provides valuable diagnostic information in the appropriate clinical setting. This article reviews many of the more common pediatric central nervous system disease states that have been demonstrated more easily as a result of computed tomography.     

Early markers of brain damage in premature low-birth-weight neonates who suffered from perinatal asphyxia and/or infection

We studied 57 low-birth-weight premature neonates, of whom 29 suffered from perinatal asphyxia and/or infection, while the remaining 28 did not and served as controls. We measured peripheral nucleated red blood cell (NRBC) absolute numbers as well as interleukin (IL)-1beta, IL-6 and tumour necrosis factor (TNF)-alpha cytokine serum levels at 24 h postnatally and on days 3 and 7 following birth. Fourteen of the asphyxiated/infected neonates and 12 controls had neurologic assessments at the corrected postnatal age of 18 months. We found NRBC absolute numbers and serum IL-1beta and IL-6 cytokine levels at 24 h postnatally to be significantly higher in neonates with perinatal asphyxia/infection than in the controls (p = 0.022, p = 0.036 and p = 0.037, respectively). TNF-alpha levels did not differ. Neurologic examination at the corrected postnatal age of 18 months showed 8 out of the 14 children who had been asphyxiated/infected as neonates to have abnormal findings, while 12 children who were used as controls during their neonatal period were normal. Abnormal neurologic findings correlated with high NRBC counts and IL-1beta and IL-6 levels at 24 h postnatally. In conclusion, increased NRBC counts and proinflammatory cytokine levels in asphyxiated/infected neonates represent early markers for subsequent neurologic impairment.     

Computed tomography of brain in symptomatic birth asphyxia.

Twenty five asphyxiated newborns (seventeen term and eight preterm) with mean gestational age of 37 weeks (range 28-48 weeks) and mean birth weight of 2.4 kg (range 0.75 kg to 3.5 kg), respectively, constituted the cases in present study. Normal CT scan was found in five term (29.4%) and two preterm babies (25%). CT abnormalities noted in term babies included hemorrhage (subarachnoid 5.8%, intracerebral 11.6%), hypodensity (mild 23.2%, moderate 11.6% severe 5.8%); hypodensity with hemorrhage 5.8% and cerebral atrophy 5.8%. In the preterm babies abnormalities included intraventricular hemorrhage in 25%, isolated hypodensity in 37.5% and hypodensity with hemorrhage in 12.5% cases. Where as mild hypodensity on CT scan in the absence of hemorrhage or other gross abnormality was indicative of a favourable outcome, moderate to severe hypodensity was indicative of ischemic brain injury and an unfavourable outcome. The presence of intraventricular hemorrhage irrespective of the size of bleed was associated with mortality in all in the present study.     

Clinical and computed tomographic observations on newborn infants with generalized brain edema due to perinatal asphyxia

We observed a sudden respiratory arrest in four term newborn infants after a clinically symptom-free period. There were no cardiac, pulmonary or metabolic changes responsible for these events. Signs of cerebral dysfunction existed (muscular hypotonia, jitterness, seizures). Cranial computerized tomographic scans were performed during the period of respirator treatment within the first week of life. The density of the brain structures was significantly decreased in all cases, three of the patients showed a complete compression of the lateral ventricles. These findings indicated severe brain swelling as a consequence of cerebral hypoxia. There was a history of umbilical cord occlusion in two cases. In the remaining patients we must assume an undetected hypoxic-ischemic episode prior to the onset of labor. We used hyperventilation, corticosteroids, phenobarbital, diuretics and fluid restriction for therapy. Later on the babies received special physiotherapy. Control CT-scans were performed during the fourth or fifth week of life. The findings were normal in one patient. Signs of mild focal brain atrophy developed in two babies. A more severe cortical atrophic lesion of both temporal lobes was found in one patient. He suffered from a slight cerebral palsy. No neurodevelopmental handicaps could be found in all the other patients on long term follow-up. The EEG examination was performed between the fifth and seventh month of life. No pathologic changes were observed. We conclude that severe generalized brain edema in the newborn is not necessarily followed by extensive brain damage. We think it important to develop more sensitive methods for detecting a hypoxic ischemic crisis preceding the birth.     

炎症反应与早产儿脑损伤

早产是影响新生儿发病率与死亡率最重要的因素,其发生率在美国报道为10％-12％,国内为12．7％-20．8％。早产儿是神经发育受损的高危群体,其脑损伤及随后脑瘫（cerebral palsy,CP）的发生率较足月儿显著增高。早产儿脑损伤主要包括脑室周及脑室内出血（periventrlcular／intraventricular hemorrhage,PVH／IVH）、脑白质损伤（whiter matter damage,WMD）尤其是脑室周围白质软化（periventricular leukomalacia,PVL）。1950年,Eastman首次提出胎盘感染及炎症反应与儿童早期神经系统发育异常密切相关,近10年来大量资料证明宫内感染、围生期窒息等损伤因素可诱发胎儿炎症反应,     

CT and MR patterns of hypoxic ischemic brain damage following perinatal asphyxia

The objectives were to study the clinical and neurological abnormalities in children with cerebral palsy and to attempt to correlate the signs with radiological abnormalities detected by CT scan and/or MRI of the brain. In a prospective, hospital-based study, 65 children with cerebral palsy were examined neurologically and their perinatal history was reviewed. Their cranial CT scan, and/or magnetic resonance images were studied. The association between the gestational ages, perinatal history, neurological deficits, and the radiological appearances were studied. Of the 24 preterm-born and 41 term-born children, 23 had spastic diplegia; 57 per cent of these children has significant periventricular leucomalacia, which was more common among preterm-born children. Of the 13 children with hemiplegia, 12 had unilateral lesions on neuroimaging. Spastic tetraplegia was associated with extensive, bilateral, diffuse brain damage. Extrapyramidal cerebral palsy was far more common among term-born infants and 80 per cent of these showed significant abnormalities in the basal ganglia region. Ataxic cerebral palsy was an uncommon variety and there was no significant correlation between neurological signs and abnormalities on brain imaging. In conclusion, the radiological findings were closely related to the type of cerebral palsy and the neurological deficit except in the ataxic type. We believe that CT and MRI imaging are helpful in understanding the pathology and the timing of the lesion in cerebral palsy.