超声心动图评价新生儿窒息的左心功能

应用超声心动图（ＵＣＧ）对３５例窒息新生儿进行左心功能测定，显示：窒息儿心内结构测定结果明同于正常对新生儿；窒息儿左室功能测定结果明显低于正常新生儿，将小于正常新生儿测的下限数作为判定左室收缩功能降低的标准，则窒息新生儿左室收缩功能降低的检出率为ＬＶＳＶ７８．５７％，ＬＶＥＦ１００％ＳＶＩ７１．４３％△Ｄ％１００％，结果表明应用ＵＣＧ评价新生儿窒息的左心功能是敏感而实用的监测手段之一。     

重度窒息新生儿左心功能的动态研究

正常新生儿24例,重度窒息新生儿53例,应用二维脉冲多普勒超声心动图,在生后24,48、72小时内以及1周时连续测定心率(HR)、每搏心输出量(SV)、每分心输出量(CO)、升主动脉峰值血流速度(PFV_(AO))。发现1周内两组新生儿SV无明显差异,但出生3天内,重度窒息新生儿HR,CO,PFV_(AO)均高于正常新生儿,1周时相似。提示重度窒息新生儿左心泵血功能未见明显损害,经过治疗,1周左右其血液动力学指标与正常相似。     

妊娠期糖尿病的新生儿情况分析

妊娠期糖尿病 (ＧＤＭ)系指在妊娠期首次发现或发生的糖代谢异常 ,发生率 1%～ 5 % [1] 。将我院收治的ＧＤＭ母亲中 2 2例的新生儿情况进行分析 ,现报告如下。临床资料一、一般资料　我院近几年共收治ＧＤＭ孕妇 2 2例 ,年龄 2 3～ 2 5岁 ,平均 2 2± 2 .3岁 ,均经我院实验室检查确诊 ,并在我院分娩。初产妇 18例 ,经产妇 4例 ,阴道分娩 7例剖宫产 15例 ,孕前均无明显糖尿病史。二、诊断标准[1] 　诊断本病只需符合下列任何一项即可 :1.口服糖耐量试验结果 2次异常。 2 .2次空腹血糖≥ 5 .8ｍｍｏｌ/Ｌ( 10 5ｍｇ/ｄｌ) ;任何一次血糖≥ 11…     

超声心动图评价新生儿窒息的左心功能

应用超声心动图（ＵＣＧ）对３５例窒息新生儿进行左心功能测定。显示：窒息儿心内结构测定结果明显高于正常新生儿；窒息儿左室功能测定结果均明显低于正常新生儿。将小于正常新生儿测值的下限数作为判定左室收缩功能降低的标准，则窒息新生儿左室收缩功能降低的检出率为ＬＶＳＶ７８．５７％，ＬＶＥＦ１００％，ＳＶＩ７１．４３％，△Ｄ％１００％。结果表明应用ＵＣＧ评价新生儿窒息的左心功能是敏感而实用的监测手段之一。     

母亲妊娠期糖尿病对新生儿行为神经发育的影响

目的探讨母亲妊娠期糖尿病对围生期新生儿神经行为发育的影响。方法对57例妊娠糖尿病母亲所产新生儿及48例同期分娩的母亲孕期和出生时无异常的足月新生儿进行20项行为神经测定(NBNA),并行脑电图(EEG)和头颅B超检查。结果27.6%患儿生后7 d NBNA≤35分,观察组与对照组比较被动肌张力及主动肌张力有显著性差异(P<0.05),EEG检查也有显著差异(P<0.05)。结论NBNA测定和EEG检查能够早期发现母亲妊娠糖尿病对新生儿神经行为发育影响,可尽早对轻微脑损伤婴儿进行针对性干预。     

先天性甲状腺功能低下症对新生儿左心功能的影响

目的　评价先天性甲状腺功能低下症 (CH)新生儿的左心收缩和舒张功能变化 ,并探讨其与血甲状腺激素水平的相关性。方法　对 35例确诊为CH的新生儿和 30例正常新生儿进行超声心动图检查 ,分别用M型超声心动图测量左室射血分数 (LVEF)、左室短轴缩短率 (LVFS) ;脉冲多普勒 (PWD)测量二尖瓣口血流舒张早期峰值速度 (Em)、二尖瓣口血流舒张晚期峰值速度 (A m) ;定量组织速度成像 (QTVI)测量二尖瓣环收缩期运动峰值速度 (sm)、二尖瓣环舒张早期运动峰值速度 (em)、二尖瓣环舒张晚期运动峰值速度 (am) ;组织追踪显像 (TTI)测量收缩期二尖瓣环下移距离 (MAD) ,并对血甲状腺激素水平和心功能指标行相关性分析。结果　两组间收缩功能指标LVEF、LVFS、sm、MAD及舒张功能指标Am、Em/Am、、em/am、、Em、em 差异均有显著性意义 (P <0 0 5 ) ,其中两组间MAD、sm、Em、em 差异有极显著性意义 (P <0 0 0 1)。心脏收缩功能指标LVEF、sm、MAD及舒张功能指标Em、Am、em、em/am 与TT3 、TT4呈正相关 (P <0 0 5 ) ,与TSH呈负相关 (P <0 0 5 ) ,MAD、sm、Em、em 与血TT4、TSH水平的相关性最好 (P <0 0 0 1)。结论　先天性甲状腺功能低下症新生儿常伴有左心收缩和舒张功能下降 ,血甲状腺激素水平可直接影响左心功能 ,QTVI     

母亲糖尿病对新生儿神经系统的影响

糖尿病在人群中的发病率日趋增多，妊娠期糖尿病近年来更是为人们所关注。妊娠期糖尿病不但会造成孕妇一系列代谢紊乱，也会造成胎儿、新生儿，甚至在儿童期、青春期各类疾病的发生。人们在注意母亲孕期内分泌代谢异常和新生儿早期疾病的同时，十分关注糖尿病母亲后代遗留的长远问题，除与糖代谢紊乱相关的疾病外，也很注意神经系统的异常，并积极寻找在胎儿期和围生期的发病根源。     

妊娠期糖尿病母亲所生新生儿肾功能的变化

目的 探讨妊娠期糖尿病(GDM)母亲所生新生儿肾功能的变化,加强对GDM母亲所生新生儿并发症的认识,从而提高GDM母亲所生新生儿的生活质量.方法 选取2009年3月-2010年9月山东大学附属省立医院新生儿科收治的GDM母亲所生新生儿45例作为观察组.男23例,女22例;早产儿25例,足月儿20例;巨大儿20例,非巨大儿25例.选取同期出生的非GDM母亲所生新生儿45例作为对照组.男21例,女24例;早产儿18例,足月儿27例;巨大儿22例,非巨大儿23例.研究对象均于出生72 h内采集空腹外周静脉血,应用广州OLYMPUS-AU5400全自动生化分析仪检测血清胱抑素C(Cys-C)、β2微球蛋白(β2-MG)、BUN、肌酐(CREA)水平,观察各检测指标变化.结果 观察组BUN、CREA水平与对照组比较均无统计学差异(Pa＞0.05),血清Cys-C、β2-MG均较对照组升高(Pa＜0.05);观察组早产儿、足月儿Cys-C、β2-MG水平均较对照组显著升高(Pa＜0.05),而观察组早产儿和足月儿间Cys-C、β2-MG水平比较均无统计学差异(Pa＞0.05);观察组巨大儿和非巨大儿Cys-C、β2-MG水平均较对照组升高(Pa＜0.05),观察组巨大儿与非巨大儿间Cys-C、β2-MG水平均无统计学差异(Pa＞0.05).结论 GDM母亲所生新生儿较非GDM母亲所生新生儿血清Cys-C与β2-MG水平升高,GDM母亲所生新生儿可能存在早期肾功能损害,且不受胎龄、体质量影响.     

母乳喂养对妊娠期糖尿病母亲子代儿童期超重的影响

目的：通过对妊娠期糖尿病（GDM）母亲子代的随访,探讨母乳喂养是否可以降低GDM子代发生超重的风险性。方法：对2003年1月至2009年12月GDM母亲子代1189例进行随访,采用logistic回归分析出生后0～3月母乳喂养方式及母乳喂养持续时间对GDM子代超重发生风险的影响。结果：在对孕前BMI、孕期增重、孕期血糖水平、性别、出生体重、年龄及父亲体重等混杂因素进行校正后,0～3月纯母乳喂养组GDM子代儿童期超重发生风险低于人工喂养组（OR：0.479,95%CI：0.256～0.897）;接受0～3月母乳喂养、4～6月母乳喂养及大于6月母乳喂养GDM子代儿童期超重发生风险均低于人工喂养组（分别OR：0.456,95%CI：0.233～0.827;OR：0.29,95%CI：0.103～0.817;OR：0.534,95%CI：0.280～0.970）;接受4～6月母乳喂养GDM子代儿童期超重发生风险低于0～3月母乳喂养组（OR：0.372,95%CI：0.129～0.874）;而接受母乳喂养时间<6月与接受母乳喂养时间≥6月与GDM子代儿童期超重发生风险无相关性（OR：0.769,95%CI：0.4701～1.258）。结论：出生后0～3月母乳喂养,尤其是纯母乳喂养可以降低GDM子代发生超重的风险,且在出生后6月内,随着母乳喂养时间的增加,GDM子代超重发生风险降低,而出生6月以后,延长母乳喂养时间可能并不能降低超重的发生风险。     

Altered diastolic function in infants of mothers with gestational diabetes: No relation to macrosomia

In a previous study, asymptomatic infants of mothers with gestational diabetes (IGDMs) were observed to have altered left ventricular (LV) filling. In the present study, we reanalyzed the data to examine whether the observed abnormalities were related to maternal diabetes or due to the greater preponderance of macrosomic infants (32%) in the gestational diabetes group. No echocardiographic (systolic or diastolic) differences were observed when the data were compared in 16 large-for-gestational-age (LGA) and 24 appropriate-for-gestational-age (AGA) infants among IGDM. Comparison of 16 LGA IGDM and 17 LGA infants of control mothers revealed lower LV size during diastole and systole in the IGDM. The present analysis suggests that the cardiac alterations in the IGDMs are not due to the preponderance of macrosomia but, rather, the consequence of altered in utero metabolic environment.     

Reduced left ventricular afterload and increased contractility in children with insulin-dependent diabetes mellitus: An M-mode and Doppler-echocardiographic evaluation of left ventricular diastolic and systolic function

Summary Twenty-three children with diabetes mellitus, their ages ranging from 0.2–9.8 years, but with no sign of diabetic microvascular disease were investigated by M-mode and Doppler echocardiography, along with a comparable group of control subjects. In the diabetics, the fractional shortening and the mean velocity of fractional shortening were 14 and 18% higher, respectively, whereas the left ventricular end-systolic wall stress, an indicator of left ventricular afterload, was markedly reduced (22%). Assuming an unchanged preload in the two groups, this indicates a reduced afterload in these children. Systolic and diastolic time intervals, heart rate, and blood pressure were similar in diabetics and controls. Doppler-derived transmitral left ventricular filling indices were also similar. Thus, in these diabetic children no signs of left ventricle is considered to be due to a reduced afterload in early insulin-dependent diabetes.     

不同胎龄早产儿潮气呼吸肺功能的测定及分析

目的　探讨不同胎龄早产儿潮气呼吸肺功能的特点。方法　根据胎龄将75例早产儿分为3组：+6周组、34~36+6周组; 55例39~40周的足月儿作为对照组。生后3~5 d测定各组潮气呼吸肺功能, 并在纠正胎龄40周时对各组再次进行潮气呼吸肺功能的测定。结果　生后3~5 d时, 3个早产儿组的吸气时间(tI))、达峰时间(TPEF)、达峰时间比(TPEF/tE)均低于对照组(PP结论 新生儿潮气呼吸肺功能受胎龄的影响, 早产儿有明显的潮气呼吸肺功能受损, 胎龄越小, 潮气呼吸肺功能受限越明显。     

Immature sucking patterns in infants of mothers with diabetes

OBJECTIVE: To evaluate immaturity of sucking patterns of infants of mothers with diabetes. STUDY DESIGN: Term infants born to mothers with gestational diabetes mellitus (16 mothers managed with insulin and 31 with diet alone) were compared with 55 matched healthy infants (control group). Sucking patterns were recorded and analyzed for number of sucks and bursts and averages maximum suck pressure, number of sucks per burst, suck width, and time between bursts. The measurements were made for feedings of 5 minutes duration with Kron's Nutritive Sucking Apparatus on the third day of life. RESULTS: Relative to the control group, newborns of the insulin-treated mothers averaged 5.2 fewer bursts and 42 fewer sucks (P = .013 and P = .04, respectively). No differences were noted for other variables tested. There were no differences in sucking patterns between newborns of diet-managed mothers and control newborns. CONCLUSION: Poorer sucking patterns were found among infants of insulin-managed mothers with diabetes. The present findings indicate some degree of neurologic immaturity during the early neonatal period.     

链脲霉素致大鼠妊娠糖尿病影响子鼠发育的实验模型研究

目的 建立SD大鼠腹腔注射链脲霉素(STZ)致妊娠糖尿病的实验动物模型,为研究妊娠糖尿病对胎儿发育影响提供实验基础.方法 将54只SD孕鼠随机分为STZ注射组(30只)和柠檬酸缓冲液注射对照组(24只),两组又按取材时孕龄不同随机分为第13、16天和19天3个亚组.对STZ注射组孕鼠,给予新配2%STZ溶液,按STZ 40 mg/kg,一次性腹腔注射,3 d后空腹尾静脉采血监测血糖、尿糖和体重.对照组用同样方法注射等量的柠檬酸钠缓冲液.孕鼠于孕龄13、16、19 d随机分批剖宫,观察完全流产、吸收胎、死胎及存活胎数等情况,检查子鼠的外部形态,测量子鼠体重.子鼠心脏切片经常规HE染色后,进行病理分析.结果 STZ注射组孕鼠用药后出现"三多一少"现象,3 d后血糖水平明显高于对照组(14.65±1.12)mmol/L比(3.06±0.39)mmol/L,t:48.29,P＜0.01,尿糖均阳性,体重明显低于对照组(260.7±14.0)g比(273.7±16.7)g,t=3.11,P＜0.01;13、16 d和19 d流产率均高于对照组,χ2分别为4.37、7.51和11.05,P＜0.05;子鼠液化吸收胎、死胎、畸心胎例数较相应对照组高,χ2=77.21,P＜0.01.STZ注射组子鼠心脏发育异常数较对照组多,F=196,P＜0.01.结论 该动物实验模型与人类妊娠糖尿病(GDM)拟合较好,且操作简便,重复性高,是研究妊娠糖尿病致胎儿发育异常较理想的实验模型.     

Impaired left ventricular diastolic function in newborn infants of mothers with pregestational or gestational diabetes with good glycemic control

THE AIM OF THE STUDY: We assessed by echocardiography the left ventricular systolic and diastolic function in newborn infants of mothers with well-controlled pregestational type 1 or gestational diabetes (IDM) in comparison to normal term neonates. SUBJECTS AND METHODS: Two-dimensional/M-mode and Doppler transmitral flow velocity measurements were performed in 18 IDM and 26 control infants of non-diabetic mothers (gestational ages 36-40 and 36-41 weeks, respectively) between days 2 and 5 after birth. In the IDM, there were nine mothers with pregestational (White class C or D) and nine mothers with gestational diabetes (White class A or A/B). Peak early and atrial filling velocity, early deceleration time, early acceleration time, early, atrial and total time velocity integrals were used to examine the left ventricular diastolic performance. We also calculated the early/atrial velocity ratio, early/atrial integral ratio and early/total integral ratio. The fractional shortening, fractional shortening area, midwall fractional shortening (mFS), left ventricular mass and indexed left ventricular mass for body surface area (BSA) and birth weight were used in assessment of left ventricular systolic performance. RESULTS: The early deceleration time was longer, resulting in higher early integral and early filling fraction (EFF) in the IDM than in the control infants (p<0.01). In the IDM, the fractional shortening was somewhat greater and the left ventricular mass/body surface area ratio was higher than in the control group (p<0.05), although the measures of systolic performance were within the normal range. There were no significant differences in the systolic or diastolic function parameters between the gestational and pregestational groups. CONCLUSION: In the infants of mothers with well-controlled pregestational or gestational diabetes, we found prolonged deceleration time of early left ventricular diastolic filling, probably reflecting an impaired left ventricular relaxation rather than compliance. The mechanism for the findings may be maternal hyperglycemia during the third trimester and subsequent fetal hyperinsulinaemia leading to neonatal cardiac hypertrophy.     

辅助生殖技术与妊娠期糖尿病孕产妇肠道菌群的特异表达

目的 通过检测和比较不同受孕方式及是否并发妊娠期糖尿病(gestational diabetes mellitus,GDM)孕产妇的肠道菌群,明确辅助生殖技术(assisted reproductive technology,ART)及GDM孕产妇肠道菌群的特异性表达,分析其机制,为今后预防干预、促进ART妊娠母婴健康...