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1.
目的:早产儿脑组织CT值普遍较低,难以判断是否为正常范围。该文探讨早产儿正常脑组织CT值与足月儿脑组织CT值的差异。方法:对76例早产儿(按胎龄分为28~33+6周早产儿36例及34~36+6周早产儿40例)及50例正常足月新生儿(胎龄为37~42足周)进行头颅CT检查并测定各部位脑组织CT值。结果:28~33+6周早产儿和34~36+6周早产儿小脑、脑干、基底节、丘脑、白质、灰质CT值均低于足月儿相应部位脑组织CT值,其差异有显著性(P<0.01)。28~33+6周早产儿不同部位脑组织CT值均低于34~36+6周早产儿相应部位脑组织CT值,其差异有显著性(P<0.01)。结论:早产儿脑组织CT值明显低于足月新生儿,故早产儿脑组织CT值有自己的正常值范围 相似文献
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目的 应用磁共振(MRI)、磁共振弥散张量成像(DTI)研究早产儿脑白质髓鞘发育的特点。方法 胎龄≤32周、出生体重<1 500 g的31例早产儿根据头部MRI检查分为早产脑损伤组(12例)和早产无脑损伤组(19例)。选取24例足月儿作为对照组。均于胎龄或纠正胎龄37~40周之间完成头部MRI及DTI检查。测定3组相同感兴趣区的部分各向异性参数(FA)和表观扩散系数(ADC)。结果 早产脑损伤组内囊后肢FA值小于早产无脑损伤组和足月对照组 (P < 0.05);早产脑损伤组和早产无脑损伤组的额叶白质和豆状核的FA值小于足月对照组 (P < 0.05);3组间枕叶白质的FA值差异无显著性 (P > 0.05)。早产脑损伤组和早产无脑损伤组内囊后肢、豆状核、枕叶白质、额叶白质的ADC值高于足月对照组 (P < 0.05)。结论 早产儿脑损伤容易出现内囊后肢深部脑白质髓鞘化障碍或延迟。早产儿至纠正胎龄足月时,无论有无脑损伤,脑周围白质及灰质成熟度均低于足月儿。 相似文献
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目的:该研究通过对于不同胎龄新生儿中性粒细胞活性氧代谢水平的检测研究,以了解新生儿中性粒细胞功能发育成熟的过程,并探讨早产儿对于细菌高易感性的部分原因。方法:选择早产儿35例,分为胎龄32周以下和33~36周两组,并选择足月新生儿23例作为对照组。在新生儿出生后取脐静脉血进行体外实验,分别以金黄色葡萄球菌和大肠杆菌刺激诱导呼吸爆发后用超氧阴离子特异性探针氢化溴乙非锭进行细胞内染色,通过流式细胞仪检测中性粒细胞超氧阴离子阳性细胞比率和产生水平;同时对两组不同胎龄早产儿细菌感染实际发生情况进行比较。结果:胎龄32周以下早产儿超氧阴离子阳性中性粒细胞比率与胎龄32周以上早产儿和足月新生儿相比差异有显著性,呈明显低下状态[金黄色葡萄球菌:(79.4±8.6)% vs (89±6.1)% vs (91.3±3.8)%,F=18.05,P<0.01;大肠杆菌: (78.2±7.8)% vs (89.3±5.3)% vs (92±4.1)%,F=28.3, P<0.01)];而且阳性率和早产儿胎龄大小密切相关(y=2.66 x ,P<0.01);但3组不同胎龄的新生儿活性氧代谢阳性细胞超氧阴离子产生水平之间的差异无显著性。临床观察发现小胎龄早产儿组全身性细菌感染实际发生率高于大胎龄组早产儿。结论:新生儿中性粒细胞细菌诱导活性氧代谢的总体能力直接和新生儿成熟度相关,在胎龄小于32周早产儿中处于明显低下状态,并随着胎龄的增加逐渐成熟。早产儿中性粒细胞活性氧代谢水平的总体低下是导致早产儿细菌感染高易感性的重要原因之一。[中国当代儿科杂志,2007,9(4):355-357] 相似文献
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目的采用近红外光谱技术比较早产儿和健康足月儿出生12~24 h脑组织氧合状况。方法对2011年4-6月南京大学医学院附属鼓楼医院妇产科收治的77例足月儿和2011年11月-2012年3月南京医科大学附属儿童医院新生儿医疗中心收治的61例早产儿进行出生12~24 h的脑组织氧饱和度(rSO2)监测,比较2组新生儿的临床情况及其与rSO2的关系。结果 2组新生儿分娩方式和性别比较,差异均无统计学意义(Pa>0.05)。2组新生儿胎龄、出生体质量及窒息(Apgar评分)比较,差异均有统计学意义(Pa<0.05)。2组新生儿的检测时间和外周血氧饱和度比较,差异均无统计学意义(Pa>0.05)。健康足月儿组的rSO2为(62.70±3.75)%,早产儿组rSO2为(64.66±3.93)%,二组比较差异有统计学意义(P=0.003)。健康足月儿组的动脉血二氧化碳分压[p(CO2)]为(5.26±0.36)kPa,早产儿组为(6.04±1.18)kPa,二组比较差异有统计学意义(P=0.000)。结论早期早产儿与健康足月儿相比,出生12~24 h的rSO2偏高,可能与该时期早产儿的脑血流丰富,动脉血p(CO2)分压偏高及脑组织的局部缺氧有关。 相似文献
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新生儿脑电背景抑制间期临床意义研究 总被引:1,自引:0,他引:1
目的 探讨不同胎龄新生儿早期脑电图最大背景抑制间期(IBImax)的变化,评价其在新生儿脑损伤中的临床意义.方法 选择深圳市人民医院120例不同胎龄的新生儿(其中无脑损伤者84例,脑损伤者36例),无脑损伤新生儿按胎龄分为:Ⅰ、Ⅱ、Ⅲ、Ⅳ组.脑损伤者分为足月儿缺氧缺血性脑病(HIE)组和早产儿脑损伤(PBL)组.根据胎龄分别选取无脑损伤的足月儿28例和早产儿20例作为脑损伤患儿的对照组.全部对象于生后3~5d以江苏伟思长程脑电图仪记录EEG,以IBImax为观察指标.结果 (1)Ⅰ、Ⅱ、Ⅲ、Ⅳ组IBlmax分别为(17.62±3.99)s、(10.70±2.58)s、(7.05±1.53)s、(4.00±1.79)s,四组比较,差异有统计学意义(P=0.000).IBImax与胎龄负相关(r=-0.843,P值为0.000).(2)HIE组与对照组IBImax分剐为(14.15±5.09)s、(4.04±1.81)s,差异有统计学意义(P=0.000).PBL组与对照组IBImax分别为(20.38 4±5.69)s、(13.00±5.82)s,差异有统计学意义(P=0.001).结论 脑电图IBImax与新生儿脑成熟度有关,是早期评价新生儿脑损伤的指标. 相似文献
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目的 通过分析新生儿视觉诱发电位(visual evoked potential,VEP)波形及潜伏期的发育规律,获得早产儿与足月新生儿的VEP潜伏期参考数据,评价其对早产儿远期预后的意义.方法 采用美国Nicolet公司生产的VikingⅣ诱发电位仪,对纠正胎龄近37周的91例早产儿及55例足月儿进行视觉诱发电位检测,同期对91例早产儿进行脑干听觉诱发电位(brainstem auditory evoked potential,BAEP)检测.并对早产儿进行远期追踪.结果 91例早产儿纠正胎龄至近足月时,82例VEP波形已发育成熟,9例未引出或单侧未引出.纠正胎龄近足月早产儿N75、P100、N145潜伏期仍较足月儿长,P均<0.05.随访至纠正胎龄6个月时.5例早产儿表现为不同程度的运动、语言发育落后及肌张力异常,其中3例为VEP未正常引出者;纠正胎龄1岁时均发育正常,无明显神经系统后遗症.VEP评价近期早产儿预后的敏感度为60.0%,特异度为93.0%,均高于ABR的40.0%及89.5%.结论 早产儿纠正胎龄至近足月时VEP波形已可正常引出,异常者应密切关注其预后.早产儿纠正胎龄接近足月时VEP检测对其预后评价优于ABR. 相似文献
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新生儿局部脑组织氧检测的多中心研究 总被引:4,自引:0,他引:4
目的 探讨近红外光谱测定技术(near-infrared spectroscopy,NIRS)检测新生儿局部脑组织氧饱和度(Regional oxygen saturation,rSO2)对评估脑氧合状态的价值,建立新生儿脑rSO2的测定值,为临床应用提供依据.方法 采用NIRS技术对无特殊疾病的223例足月儿和95例早产儿分别在生后第1天、第2天及第3天进行脑rSO2测定,选取102例患有影响脑氧合疾病的新生儿,对照两组间脑rSO2数值差异.同步分析脑rSO2与脉搏氧饱和度(pulse oxygen saturation,SpO2)及动脉血氧饱和度(arterial oxygen saturation,SaO2)间的关系.结果 (1)正常足月新生儿脑rSO2测定值为(62±2)%,以低于两个标准差作为脑rSO2测定值异常,可以认为低于58%提示为脑组织缺氧.疾病状态新生儿脑rSO2范围(55±7)%,与无特殊疾病新生儿组差异有统计学意义(P<0.05).(2)脑rSO2与经皮SpO2及SaO2呈正相关,直线相关系数r分别为0.74和0.71.(3)特殊的疾病状态下,脑rSO2与SpO2可出现不同步的变化趋势,表现为:①spO2尚正常,而脑rSO2已降低.体现在18例严重的颅脑疾病及血红蛋白较低的病例.②一些危重病儿病情恢复过程中,脑rSO2的恢复滞后于SpO2在6例多脏器功能衰竭患儿尤为突出.③在3例重度缺氧缺血性脑损伤(HIE)急性期,脑rSO2有异常增高现象.结论 正常足月新生儿脑rSO2测定值为(62±2)%,低于58%提示脑组织缺氧.NIRS技术客观反映了脑组织的氧合变化,可为临床应用提供依据. 相似文献
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早产儿脑反应性及其神经发育的近红外光谱评价研究 总被引:3,自引:0,他引:3
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。 相似文献
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三维超声对围产期脑损伤小儿脑额叶发育评价意义的探讨 总被引:5,自引:2,他引:3
目的探讨三维颅脑超声对围产期脑损伤小儿额叶体积发育评价的意义。方法通过三维超声观察226例不同胎龄新生儿及86例各类围产期脑损伤的足月儿在生后不同时间额叶体积增长规律,分析围产期脑损伤对小儿额叶发育的影响,额叶体积增长缓慢与神经系统发育异常的关系。结果新生儿生后7d内额叶体积随胎龄增加而增大(r=0.676,P<0.01);33例重度脑损伤小儿出生后1个月时脑额叶体积已低于对照组,3个月、6个月时差异显著(P<0.01),6个月时重度脑损伤组、轻度脑损伤组、对照组的额叶体积分别为:(107.82±28.76)cm3、(156.42±12.61)cm3、(174.0±13.27)cm3;远期神经系统发育异常与脑额叶体积增长缓慢具有一致的规律性,轻度与重度神经系统发育异常的小儿中,额叶体积增长缓慢率分别为22%和77%。结论额叶体积随胎龄增长而增加;围产期脑损伤影响额叶发育,与神经发育异常有关;三维超声有益于正常与异常脑发育的评价。 相似文献
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组织多普勒成像对早期新生儿心室功能的评价 总被引:3,自引:0,他引:3
目的 应用组织多普勒成像(TDI)检测新生儿房室环运动,探讨不同胎龄早期新生儿左右心室功能的特点。方法 采用TDI技术检测生后3—7d的36例胎龄32~36周早产儿(早产儿组)和33例足月新生儿(足月儿组)二、三尖瓣环运动,测量收缩期峰值速度(Sa)、舒张早期峰值速度(Ea)及舒张晚期峰值速度(Aa),以脉冲多普勒显像测量舒张期二、三尖瓣口血流E峰及A峰峰值速度。结果 早产儿组各部位Ea、Sa均显著低于足月儿组,早产儿组三尖瓣环Ea/Aa显著低于足月儿组,两组Aa及E/Ea无显著差异;各部位Ea、Sa与胎龄及出生体质量均呈正相关。结论 早产儿左、右室收缩及舒张功能均低于足月儿,早期新生儿心室功能与其出生前成熟程度有关,早产儿及足月新生儿生后早期左室舒张功能均明显增强。 相似文献
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������ 《中国实用儿科杂志》2017,32(11):833-837
??The brain structure and function of premature infant is underdevelopment, it is easy to be injured and develop abnormally. Correctly evaluating the state of brain in different stages can help early detection of brain injury, early intervention and reduction of disability rate. In this paper, the evaluation methods of brain development and brain injury of premature infants are summarized. 相似文献
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Normal values for changes in brain growth, chemical composition and morphologic features of the mongrel dog between birth and maturity were established in studies of 43 puppies between birth and 6 months of age and 3 adult dogs. Brain weight in puppies increased as the sodium, potassium and chloride contents of brain decreased between birth and 60 days; values similar to the adult were observed in puppies at 3 to 6 months of age. The concentrations of sodium and chloride decreased while the concentration of potassium increased in brain water between birth and 60 days, but the sum of sodium, potassium and chloride concentrations in brain water, an index of brain osmolality, did not change during postnatal development. Total protein (mg/g dry brain) did not change, but DNA (mg/g dry brain) decreased with age; ratios of total protein:DNA increased from birth and were maximal at 90 days. Morphologic changes in the canine brain were characterized by an extensive, densely cellular subependymal germinal zone at birth which, although diminished and focally discontinuous, was present at 30 days and had disappeared by 60 days of age. The gross appearance and histologic changes observed in the mongrel canine brain observed between 1 and 60 days of age are similar to changes described for the human brain between 28 and 40 weeks gestation. We conclude that the mongrel canine brain is a suitable model for studying mechanisms of injury to the neonatal human brain. 相似文献
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Objective To establish hypoxic-ischemic brain damaged (HIBD) rat model,investigate whether H2S and cystathionine-β-synthase (CBS), the key enzyme for its generation, may be a mediator of electro-acupuncture(EA) stimulation treatment for HIBD. Methods Thirty-two healthy Sprague-Dawley neonatal rats were divided into four groups randomly: sham control group ( n = 8 ); sham + EA group ( n =8); HIBD control group ( n = 8); and HIBD + EA group ( n = 8 ). HIBD rat models were established on their 7-day-old. From the next day ,rats of sham + EA group and HIBD + EA group were electric stimulated 30 min daily for 14 d,BAIHUI and DAZHUI as the acupoints. Control ones were just fixed at the same time,without acupuncture. The rats were sacrificed on the 22 nd day, one day after the treatment course. Cortical H2S concentration was measured by sensitive sulphur electrode assay. The CBS protein expression was measured by western blot analysis and immunohistochemistry for localization. Results The concentration of cortical H2S in HIBD control group was (26. 83 ± 4. 31 ) nmol/mg protein, which was significantly higher than that of sham control group[(22. 78 ± 1.54) nmol/mg protein]( P < 0. 01 ). The H2 S levels in HIBD + EA group and sham + EA group were ( 18.08 ± 2.71 ) nmol/mg protein and ( 18.91 ± 2. 78 ) nmol/mg protein, respectively. Compared with corresponding control group, they were much lower( P < 0. 01 ). The expression of CBS protein in rats with EA stimulation decreased in cortex compared to corresponding control group( P <0. 05 ).Conclusion EA can down-resulate H2S/CBS pathway. This may be one of the mechanisms of how EA contributes to the recovery of brain damage. 相似文献
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The role of NO in the neonatal brain, particularly during hypoxia and ischaemia has been studied extensively in animal models of focal and global ischaemia. The n-NOS and i-NOS activation have been found to be harmful whereas e-NOS activation has a neuroprotective effect in focal ischaemia (Fig. 1). The findings following global ischaemia are somewhat more controversial. Although all these studies clearly demonstrate that NO has an important role in the neonatal brain, it may be difficult to apply the results to humans for it is not clear when and which isoform of NOS gets activated following ischaemia in newborn infants. Also it is hard to determine the timing of intervention to inhibit or stimulate the production of NO in humans since we still do not know all the details about protective mechanisms of the human body. Some interventions may have a deleterious effect on some of those mechanisms. In addition, the relatively selective NOS inhibitors which are now used in animal experiments are not appropriate for human studies. New studies regarding the production of NO following ischaemia will be needed in newborns, together with the development of selective NOS inhibitors which can be used in humans. If the NO production follows the same pattern in humans as in animals at least the effects of i-NOS may be prevented either by selective inhibitors or by neuroprotective agents. 相似文献
16.
缺氧缺血可导致严重的神经系统疾病,如脑卒中、新生儿缺氧缺血性脑病。诱导型一氧化氮合酶在缺氧、缺血过程中被诱导表达,产生过量一氧化氮,导致神经系统的炎症反应及神经元死亡,加重神经损伤。抑制诱导型一氧化氮合酶表达在体内体外实验及临床应用中显示了一定的神经保护作用。该文综述了诱导型一氧化氮合酶在中枢神经系统中的表达及与缺氧缺血脑损伤的相关性,展望了诱导型一氧化氮合酶抑制剂作为缺氧缺血脑损伤治疗策略的前景。 相似文献
17.
《Paediatrics & Child Health》2022,32(10):394-401
Acute paediatric brain injury is a major cause of mortality and morbidity worldwide. Historically raised intracranial pressure (ICP) has been the hallmark for escalating management in acute brain injuries, however there is limited evidence behind this, and no UK approved guidance advocating its use. This article summarises the current role of ICP monitoring within traumatic and non-traumatic paediatric brain injury and discusses the evidence base for different modalities and their uses. 相似文献
18.
目的 探讨并总结小儿外伤性脑梗塞的临床特点及治疗.方法 回顾性总结我院2000年至2006年收治的57例小儿外伤性脑梗塞临床及影像学特点及治疗方法.本组患儿均经CT扫描发现梗死灶,行适量脱水、Ca2+拮抗剂、扩血管、营养神经以及高压氧、针灸按摩等综合治疗措施保守治疗.结果 49例患儿于5~30 d内逐渐恢复良好,5例患儿出院时仍有肢体轻瘫,肌力4~5级,2例轻度面瘫,出院后均在半年内恢复,死亡1例,为大面积脑梗塞.结论 小儿外伤性脑梗塞,由于原发性脑损伤较轻,往往容易误诊及漏诊,临床治疗后症状加重尤其出现偏瘫者需及时复查CT或MRI,早期诊断,及时治疗,预后多较好. 相似文献
19.
Christopher J. Williams 《Pediatric blood & cancer》1978,4(4):305-310
In small-cell carcinoma of the bronchus, extension to the brain is common. The role of prophylactic whole-brain irradiation and combination chemotherapy using CCNU in the prevention of brain extension is examined in the light of recent studies. 相似文献
20.
Magnetic resonance imaging (MRI) has become an essential tool for assessing the neonatal brain. Conventional imaging can detect patterns of injury that relate to the aetiology and timing of an insult and provide valuable information about prognosis. Sequences must always be adapted for the immature brain. Diffusion techniques improve the detection of ischaemic tissue and allow more accurate timing of an insult. Diffusion tensor imaging allows the assessment of tissue microstructure changes with normal development as well as in response to tissue injury. Diffusion tractography will further our understanding of the long-term effects of perinatal injuries on brain development, and when used in combination with clinical and functional imaging studies will allow the plasticity of the immature brain to be studied. MR angiography and venography are important adjuncts to the clinical examination, and when combined with perfusion studies can provide valuable information about vessel development following injury. Detailed vascular studies may detect inherent susceptibilities, which give rise to lesions in some babies but not others. The future for neonatal imaging is exciting; however, detailed and serial imaging of carefully chosen cohorts of infants coupled with long-term clinical follow-up are essential to ensure the clinical significance of any new findings. 相似文献