纳洛酮早期干预对重度窒息新生儿脑损伤程度的影响

为探讨纳洛酮早期干预对重度窒息新生儿脑损伤程度的影响 ,将90例重度窒息复苏后的新生儿随机分为2组 :常规治疗组(对照组)45例 ,即在对症支持处理的基础上使用脑活素和胞二磷胆碱治疗 ;纳洛酮治疗组45例 ,在常规治疗的基础上尽早(生后6h内)应用纳洛酮治疗。观察和比较两组惊厥或频繁惊厥的发生和病死率 ,缺氧缺血性脑病(HIE)的临床分度和行为神经评分测定。结果纳洛酮治疗组的惊厥或频繁惊厥的发生率明显低于对照组(44.44 %vs66.67 % ,χ2=4.500,P<0.05) ,生后7d～8d和12d～14d的行为神经评分<35分者所占百分比前者亦明显低于后者(50.00 %vs74.29 %,χ2=4.642,P<0.05;35.00 %vs57.14 %,χ2=4.601,P<0.05),两组病死率差异无显著性意义(11.11 %vs22.22 %,χ2=2.000,P>0.05)。提示 :对重度窒息的新生儿 ,在对症支持治疗基础上尽早使用纳洛酮 ,能显著减轻缺氧缺血性脑损伤程度     

纳洛酮对重度窒息新生儿脑细胞功能的保护作用

目的　探讨纳洛酮对重度窒息新生儿脑细胞功能的保护作用及意义。方法　将 12 0例重度窒息复苏后的新生儿随机分为两组 ,常规治疗组 6 0例 ;治疗组 6 0例在常规治疗的基础上使用纳洛酮治疗 ,观察和比较两组惊厥或频繁惊厥的发生率 ;缺氧缺血性脑病 (HIE)的临床分度 ;神经行为评分和血浆内皮素水平。结果　纳洛酮治疗组惊厥或频繁惊厥的发生率明显低于对照组 (75 0 %vs4 5 0 % ,χ2 值 11 2 5 ,P <0 0 1)。生后 7～ 8d和 12～ 14d的神经行为评分 <35分者所占百分比前者亦明显低于后者 (5 3 70 %vs 81 4 0 % ,χ2 =8 18,P <0 0 1;33 33%vs6 9 77% ,χ2 =12 71,P <0 0 1)。治疗组和对照组比较重度HIE发生率也有显著意义 (4 0 0 0 %vs 6 1 6 7% ,χ2 =5 6 3,P <0 0 5 ) ,血浆内皮素治疗一周后含量下降 ,亦有显著性差异 [(5 3 37%± 8 2 6 % )vs(81 2 7%± 10 19% ) ,t =14 4 6 ,P <0 0 1]。结论　对重度窒息新生儿在对症支持治疗基础上尽早使用纳洛酮 ,能增加脑血流灌注量 ,减轻脑水肿 ,显著减轻缺氧缺血脑损伤程度     

1,6-二磷酸果糖早期干预对重度窒息新生儿脑损伤程度的影响

目的　探讨 1,6 二磷酸果糖 (FDP)早期干预对重度窒息新生儿脑损伤程度的影响。方法　 84例重度窒息复苏后的新生儿随机分为常规治疗组及FDP治疗组。FDP治疗组在常规治疗的基础上尽早 (生后 6h内 )应用FDP治疗。观察与比较二组惊厥的发生率和病死率 ,缺氧缺血性脑病 (HIE)的临床、CT分度和行为神经评分测定。结果　FDP治疗组惊厥的发生率明显低于常规治疗组 ,前者重度HIE(包括头颅CT脑白质低密度呈中、重度改变者 )的发生率亦明显低于后者 (P <0 0 5 )。生后 7～ 8d和 12～ 14d的行为神经评分 <35分者所占百分比 ,FDP治疗组明显低于常规治疗组 ,FDP治疗组的病死率亦显著低于常规治疗组。结论　对重度窒息的新生儿 ,在对症支持治疗基础上尽早使用FDP能显著减轻缺氧缺血性脑损伤程度 ,并降低其病死率     

复方丹参注射液治疗新生儿缺氧缺血性脑病100例

目的　探讨复方丹参注射液治疗新生儿缺氧缺血性脑病 (HIE)的临床意义。方法　对 10 0例HIE患儿随机抽样 5 2例为治疗组 ,余 4 8例为对照组 ,两组均采用综合治疗 ;治疗组加用复方丹参注射液 ,静滴 0 .5～1.0ml/kg ,1次 /d ,10d为 1个疗程。结果　治疗组脑水肿、肌张力、昏迷、惊厥等恢复时间均较对照组明显缩短。治疗组总有效率为 96 .2 % ,对照组为 83.3% ,两组比较有显著差异 (P <0 .0 1)。结论　复方丹参治疗HIE疗效显著     

脑苷肌肽治疗新生儿缺氧缺血性脑病的疗效

目的 探讨脑苷肌肽治疗新生儿缺氧缺血性脑病(HIE)的疗效.方法 将150例HIE新生儿随机分为脑苷肌肽治疗组(A组)、胞二磷胆碱治疗组(B组)、对照组(C组),每组各50例.3组均采用综合治疗.A组在综合治疗基础上加用脑苷肌肽注射液2 mL,1次·d-1,静脉滴注;B组加用胞二磷胆碱注射液125 mg,1次·d-1,静脉滴注.2组均用1个疗程.所有病例由专人每日检查临床表现;分别于出生后3 d内、5～7 d、10～14 d进行新生儿行为神经评分(NBNA);计算各组总有效率并观察各组不良反应.结果 1.A组、B组临床症状恢复时间较C组均明显缩短(Pa<0.05);A组与B组比较差异均无统计学意义(Pa>0.05).2.A组、B组NBNA均优于C组(Pa<0.05);A组与B组比较差异均无统计学意义(Pa>0.05).3.A组、B组总有效率均高于C组(P<0.05);A组与B组比较差异无统计学意义(P>0.05).结论 脑苷肌肽可作为治疗新生儿HIE的有效药物之一.     

纳洛酮治疗中重度新生儿缺氧缺血性脑病的疗效观察

目的　探讨纳洛酮治疗中重度新生儿缺氧缺血性脑病 (HIE)的疗效。方法　对 15例HIE患儿应用纳洛酮 0 .1～ 0 .2mg加入 10 %葡萄糖溶液 30～ 5 0ml静脉滴注每天 1次 ,共用 3d。结果　纳洛酮治疗组显效率80 % ,较对照组 33.33%有明显差异P <0 .0 5 ,治疗组有效率 93.33%较对照组 73.33%有显著差异P <0 .0 5。用纳洛酮治疗后 14例HIE患儿临床惊厥症状明显缓解。结论　纳洛酮治疗中重度新生儿HIE可降低脑水肿 ,减少惊厥的发生。     

复方丹参注射液、辅酶Q10预防新生儿缺氧缺血性脑病

窒息复苏后新生儿尽早采用复方丹参、辅酶Q10 治疗 ,以降低新生儿缺氧缺血性脑病 (HIE)的发病率 ,现报道如下。资料与方法一、一般资料　 135例均为 1999～ 2 0 0 2年我院儿科复苏后足月新生儿 ,男 86例 ,女 4 9例 ;随机分观察组 6 8例 ,对照组 6 7例 ,胎龄均≥ 37周 ,体重≥ 2 5 0 0 g。观察组轻度窒息 35例 ,重度窒息 33例 ;对照组轻度窒息 36例 ,重度窒息 31例。两组性别、胎龄、出生体重、窒息程度比较 ,差异均无显著意义 (P >0 .0 5 )。二、方法　对照组予常规吸氧、保暖等综合治疗、观察组在此基础上复苏后立即予复方丹参注射液 (上…     

新生儿缺氧缺血性脑病血浆血管活性肠肽的变化及纳洛酮对其的影响

目的　探讨新生儿缺氧缺血性脑病 (HIE)血浆血管活性肠肽 (VIP)的变化意义及纳洛酮对其的影响。方法　分别于入院时和入院 72h用放免法测定新生儿HIE 2 4例纳洛酮治疗 (A组 )、8例未用纳洛酮治疗的HIE对照组 (B组 )、1 3例正常对照组 (C组 )血浆VIP含量。结果　入院时A组和B组VIP含量均明显高于C组 (P <0 .0 1 ) ;入院 72hA组VIP明显下降 ,与C组比较无显著差异 (P >0 .0 5) ,而B组仍高于C组 (P <0 .0 5)。结论　HIE患儿血浆VIP升高 ,提示VIP可能参与了HIE的发病机制 ;纳洛酮治疗HIE的作用可能与降低血浆VIP有关     

纳洛酮与硫酸镁治疗新生儿缺氧缺血性脑病疗效对比

目的　比较纳洛酮与 2 5 %硫酸镁治疗新生儿缺氧缺血脑病 (HIE)疗效。方法　将 79例HIE患儿随机分为A组 (39例 )和B组 (4 0例 ) ,A组肌注 2 5 %硫酸镁 ,B组静滴纳洛酮。治疗后检测其红细胞游离钙、血浆钙、镁及 β 内啡肽浓度变化。 结果　A组患儿红细胞游离钙浓度和血浆钙、镁浓度改善较B组快 ,而B组患儿β 内啡肽降低幅度大于A组。 结论　 2 5 %硫酸镁对HIE急性期治疗效果较好 ,而纳洛酮有利于受损神经细胞功能恢复。     

窒息新生儿血清总胆汁酸及前白蛋白变化的临床意义

目的 分析新生儿窒息时血清总胆汁酸(TBA)、前白蛋白(PAB)变化趋势及其临床意义.方法 50例轻度窒息、50例重度窒息和50例正常新生儿的第1、3、5、7天进奶后2 h检测血清TBA、PAB、丙氨酸转氨酶(ALT)和白蛋白(ALB),并把病例中发生缺氧缺血性脑病(HIE)的40例列为HIE组.结果 100例窒息新生儿生后第1天血清TBA异常率为65%,4组间TBA和PAB随着时间变化趋势有统计学意义(P<0.05),各病例组经治疗后血清TBA逐渐下降,轻度、重度窒息组分别在第3、7天恢复正常,HIE组第7天仍高于对照组(P<0.05);各病例组经治疗后血清PAB值逐渐上升,轻度、重度窒息组分别在第5、7天恢复正常,HIE组第7天仍低于对照组(P<0.05);窒息时新生儿Apgar评分与TBA值呈负相关(P<0.05),与PAB值呈正相关(P<0.05).结论 血清TBA和PAB是反映窒息患儿肝功能损害灵敏的生化指标,动态测定血清TBA和PAB值变化趋势能反映窒息患儿肝脏损害情况及其病情转归.     

头颅CT影像在判断新生儿缺氧性脑损伤时的作用

目的：围生期缺氧可致新生儿脑损伤。该文探讨头颅CT对新生儿缺氧后脑损伤程度判断的作用。方法：收集有缺氧过程的足月新生儿114例,分为HIE组、窒息组、窘迫组;取同期正常新生儿20例为对照组,于生后2~7d做头部CT检测及NBNA评分。结果：HIE组、窒息组、窘迫组、对照组NBNA评分异常率及组间NBNA评分分值比较差异有显著性(均P<0.05)。4组间CT异常率比较及HIE组与其他3组CT异常率比较差异有显著性(均P<0.01),对照组、窘迫组、窒息组之间两两比较CT异常率没有差异(均P>0.05)。HIE组25例患儿中,临床分度为轻度HIE15例,中度HIE6例,重度HIE4例。CT分度为正常3例,轻度10例,中度7例、重度5例。HIE的CT分度与临床分度不完全吻合。CT对于轻、中、重度HIE诊断的灵敏度分别为47%,33%,50%,特异度为70%,74%,86%,准确度为48%,64%,80%。结论：头颅CT对HIE临床分度的判断存在不确定性,对宫内窘迫、窒息所致轻微脑损伤的判断更无把握。     

亚低温治疗新生儿缺氧缺血性脑损伤的近期疗效分析

目的 评价亚低温治疗对于围产期窒息后新生儿缺氧缺血性脑损伤的短期疗效.方法 将23例中重度缺氧缺血性脑病(HIE)新生儿分为治疗组(14例)和对照组(9例).治疗组采用选择性头部降温方法,使新生儿直肠温度、鼻咽温度保持34.0～35.0℃、(34.0±0.5)℃,持续72 h;对照组进行常规治疗.动态监测两组患儿血压、心率及神经系统症状.生后28 d采用新生儿神经行为评分(NBNA)进行神经行为发育评价.结果 治疗组随鼻咽温降低,患儿心率减慢,与对照组比较差异有显著性(P＜0.05).在治疗过程中,患儿未发生呼吸暂停、心律失常.治疗组惊厥、拥抱反射、吸吮反射、握持反射及上下肢肌张力等恢复优于对照组.在两组患儿于28 d进行的NBNA测定的结果上,治疗组的测定值为35.00±1.41,明显高于对照组30.67±1.58,差异有显著性(P＜0.05).结论 对于中重度HIE新生儿实行选择性头部降温,维持鼻咽温度于(34.0±0.5)℃,直肠温度维持于34～35℃是安全的,可短期改善神经系统症状,提高近期神经行为评分,但长期疗效仍有待进一步研究.     

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??Abstract?? Objective??To investigate the effects of early therapeutic intervention with nerve growth factor??NGF?? on brain damage following severe asphyxia in neonates. Methods??From Jan.2007 to Oct.2009??fifty-two cases of perinatal severe asphyxia in Guangzhou Children’s Hospital were randomly assigned to two groups?? the control group ??26 cases?? received routine treatment??including cerebrolysin and citicoline???? the study group ??26 cases?? was given NGF on the basis of routine treatment as early as possible ??within twenty-four hours after birth??. The incidence of the mortality were observed?? the degree of hypoxic-ischemic encephalopathy ??HIE?? was evaluated?? and the Neonatal Behavioral Neurological Assessment ??NBNA?? was done in both groups. Myelin basic protein??MBP?? and S-100 protein were measured dynamically by ELISA in serum from all patients. Results??There was no significant difference of the incidence of severe HIE and the mortality between the study group and the control group??23.08% vs 38.46%??χ2 = 1.4444??P > 0.05?? 3.85% vs 7.69%??χ2 = 0.0000??P > 0.05??. The level of blood serum MBP or S-100 protein in the asphyxiated newborns was higher than that of the normal term newborns. At 3d and 7??8d after birth??the level of blood serum MBP or S-100 protein in the study group was much lower than that in the control group. The percentage of the cases whose NBNA marks were less than 35 at 7??8 d and 14??16 d after birth in the study group was much lower than that in the control group??40.00% vs 70.83%??χ2 = 4.7055??P < 0.05??20.00% vs 50.00%??χ2 = 4.8640??P < 0.05??. Conclusion??Using NGF on the basis of the routine treatment as early as possible after resuscitation can reduce markedly the severity of asphyxia-induced brain damage in neonates.     

Subcutaneous Fat Necrosis as a Complication of Therapeutic Hypothermia in a Term Neonate

Subcutaneous fat necrosis of the newborn (SCFN) is a benign self-limited disorder commonly associated with hypothermia and perinatal asphyxia. SCFN secondary to therapeutic whole body hypothermia has rarely been reported. With increasing use of cooling for moderate to severe hypoxic ischemic encephalopathy (HIE), clinicians should recognize this potential complication.     

Lactate dehydrogenase predicts hypoxic ischaemic encephalopathy in newborn infants: a preliminary study

Background: Enzyme leakage as a result of hypoxia‐ischaemia induced cell damage in affected organs is seen together with hypoxic ischaemic encephalopathy (HIE) after perinatal asphyxia. Aim: To investigate whether plasma lactate dehydrogenase [LDH], alanine aminotransferase [ALT] and aspartate aminotransferase [AST] during the first 12 h after birth predict HIE and adverse neurodevelopment outcome in newborn term infants with intra‐partum signs of foetal distress. Methods: Enzymes were measured within 12 h post partum in newborn infants with differing degree of HIE (n = 41) and in infants with signs of foetal distress during birth (n = 205) without HIE (non‐HIE group). All infants were randomized into two groups. One group (n = 123) was used for calculation of cut off limits for the enzymes studied and the other group (n = 123) was used for calculation of the predictive value of the enzymes for detection of HIE. Results: Using ROC curves, a cut off level of 1049 U/L for [LDH] was the best predictor of HIE (sensitivity 100% and specificity 97%) but also for long term outcome after HIE. Conclusion: [LDH] is a good predictor of HIE during the first 12 h after birth. This result is of clinical interest offering a potential inexpensive and safe prognostic marker in newborn infants with perinatal asphyxia.     

窒息新生儿脐血乳酸值的临床意义(英文)

目的：Apgar评分和血气分析作为判断新生儿窒息程度和预后的指标有一定的局限性,为寻找更具敏感性和特异性的指标,该研究探讨脐血乳酸值在新生儿窒息中的临床意义。方法：对31例足月窒息新生儿(分为轻度窒息组22例和重度窒息组9例)和30例正常新生儿(对照组)的脐动脉血进行乳酸测定及微量血液气体分析,并在第14天进行新生儿20项行为神经测定(NBNA)。结果：轻、重度窒息组脐动脉血乳酸值［(6.42±0.14) mmol/L,(10.77±0.12) mmol/L］较对照组［(4.20±0.15) mmol/L］显著升高(P<0.01),pH值［(7.16±0.07),(7.04±0.09)］较对照组(7.18±0.11)明显降低(P<0.01);其中重度窒息组的乳酸值高于轻度窒息组,pH值低于轻度窒息组,差异均有显著性(P<0.01)。脐血乳酸值与pH值及第14天NBNA评分呈显著负相关(r=-0.76,-0.85,P<0.01)。结论：脐血乳酸值可作为判断新生儿窒息程度和近期预后的指标。     

新生儿缺氧缺血性脑病诊断标准中存在的问题

新生儿缺氧缺血性脑病(HIE) 是围生期窒息的严重并发症。国内HIE 的诊断标准和国外标准差 别很大,国内标准未将脐动脉血气和多脏器功能障碍(MOD) 指标纳入其中,容易误诊;国外标准较科学、全面,但过 于严格,可导致漏诊。目前,HIE 缺乏高度特异性和敏感性的诊断指标,诊断应结合病史、Apgar 评分、脐动脉血气、 MOD、头颅影像学及临床经过等多项指标对其进行综合评价。     

S100 protein in serum as a prognostic marker for cerebral injury in term newborn infants with hypoxic ischemic encephalopathy

The astroglial protein S100 is an established biochemical marker for CNS injury in the adult. The aim was to investigate whether S100 in serum is a prognostic marker of cerebral injury in term newborn infants with hypoxic ischemic encephalopathy (HIE) after perinatal asphyxia. Serum S100 was measured on postnatal days 1-4 in 62 term infants with birth asphyxia. The infants were classified for HIE and had follow-up for at least 18 mo.Infants with moderate and severe HIE had significantly higher S100 levels on postnatal day 1 (p = 0.031) and day 2 (p = 0.008) than infants with mild or no HIE. The levels of S100 decreased on days 2 and 3 in all infants with HIE. The median S100 level on postnatal day 1 was higher in nine infants who died neonatally and in 10 infants who developed cerebral palsy (CP), compared with 43 infants with no signs of impairment at follow up, 14.0 (0.5-60.0) microg/L, 20.7 (0.2-64.0) microg/L and 5.5 (0.7-120.0) microg/L, respectively. A level of S100 above 12 microg/L the first day of life was significantly more frequent in infants who died or developed CP than in infants with no impairment at follow up (p = 0.02). Increased S100 levels were significantly inversely correlated with perinatal pH in the infants and associated with abnormal CTG at admission to the labor ward. Early determination of serum S100 may reflect the extent of brain damage in infants with HIE after asphyxia.     

新生儿缺氧缺血性脑病诊断标准

新生儿缺氧缺血性脑病(HIE)是指围产期窒息导致脑的缺氧缺血性损害,临床出现一系列中枢神经异常的表现。其诊断根据临床表现,同时具备以下4条者可确诊,第4条暂时不能确定者可作为拟诊病例:①有明确的可导致胎儿宫内窘迫的异常产科病史,以及严重的胎儿宫内窘迫表现(胎心<100次,持续5min以上;和/或羊水III度污染),或者在分娩过程中有明显窒息史;②出生时有重度窒息,指Apgar评分1min≤3分,并延续至5min时仍≤5分;或者出生时脐动脉血气pH≤7. 00;③出生后不久出现神经系统症状、并持续至24h以上;④排除电解质紊乱、颅内出血和产伤等原因引起的抽搐,以及宫内感染、遗传代谢性疾病和其他先天性疾病所引起的脑损伤。本诊断标准仅适用于足月新生儿HIE的诊断。