羊水栓塞38例临床分析

目的 通过对３８例羊水栓塞患者的临床分析,找出其诱发高危因素,并提出防治措施,方法 对苏州市及所属６个县,市１９８４－１９９８年中发生的３８例羊水栓塞患者的临床资料进行回顾性分析,按每３年为１个阶段划分为５个阶段。结果 在１９８４～１９９８年的１５年中,共发生羊水栓塞３８例,其中初妇产３０例（含双胎１例）,经产妇８例,开始的前４个阶段。３１例全部死亡。第５阶段。７例中有３例死亡,４例存活。羊水栓塞     

羊水粪染：现代争议

羊水粪染发生率约９％－２０％。胎粪排入羊水可在产前或产时。胎粪吸入发生于前前、产时或第一次呼吸时，胎粪吸入综合征的新生儿预后与产前低氧血对肺的损害有关。本文综述胎粪排出和胎粪吸入综合征的病理生理学，预报胎粪吸入的治疗选择，以及胎儿监护的评估。     

胎粪吸入综合征的防治

胎粪吸入综合征(moconium aspiration syn-dronu;MAS)是指胎儿在缺氧时,将胎粪排入羊水,又将此含胎粪的羊水吸入呼吸道,造成气道阻塞而引起的一系列症状.也有称胎粪吸入性肺炎者.其临床表现较一般羊水吸人性肺炎严重,并发症较多.有胎粪吸入的新生儿在出生2～3日内可发展为进行性呼吸衰竭,严重缺氧,甚至死亡.是新生儿主要死亡原因之一。90%以上患者为过期儿及足月儿.病死率可高达19～34%据报道,在足月儿中,此症的病死率是其他死亡原因总和的20倍,山此可见其后果之严重。一、与发病有关的因素     

82例新生儿吸入性肺炎临床分析

目的：探讨82例新生儿吸入性肺炎的临床特点及发病原因,为高原地区防治新生儿吸入性肺炎提供借鉴。方法：对2010年1月至2013年6月,收住本院的82例吸入性肺炎患儿的临床资料进行回顾分析。结果：有围产高危因素的76例占92.68%,其中羊水污染和剖宫产在病因中占据较高比例,其临床表现不典型,常显示口吐白沫、吐奶、呛咳、口周发绀等非特异症状,X线胸片有助诊断。结论：新生儿吸入性肺炎的发病与产科因素密切相关,提高围产期的工作质量,加强新生儿护理及新生儿吸入性肺炎的早期诊断、早期治疗的能力,将大大降低新生儿吸入性肺炎的发病率和死亡率。     

羊水过少静脉输液加饮水治疗前后脐血流变化及妊娠结局

目的　探讨静脉输液加饮水在羊水过少治疗中对脐血流及妊娠结局的影响。方法　妊娠 35周前后B超诊断为羊水过少孕妇 4 5例 ,每天用能量合剂 ,生理盐水 ,林格氏液各 5 0 0ml静脉点滴 ,并适量饮水10 0 0ml,5d一个疗程 ,共 1～ 2个疗程。监测治疗前后羊水指数 (AFI)和脐血流收缩期最大血流速度 舒张期末血流速度的比值 (S D)、阻力指数 (RI)、波动指数 (PI)、快速血流比 (FVR)情况 ;观察出生后羊水污染 ,新生儿窒息 ,吸入性肺炎等指标 ;并与羊水正常组孕妇 5 0例进行比较。结果　羊水过少组治疗前后比较 ,并与羊水正常组比较 ,AFI、S D、FVR差异有统计学意义 (P <0 0 1) ,而羊水污染、新生儿窒息、吸入性肺炎等发生率无明显差异 (P >0 0 5 )。但羊水过少治疗有效组 (38例 )与治疗无效组 (7例 )比较 ,羊水污染和新生儿窒息差异明显 (P <0 0 1) ,治疗无效组胎儿宫内发育迟缓 (IUGR)占 85 7%。结论　静脉输液加适量饮水法治疗羊水过少可增加羊水量 ,降低脐血流阻力 ,改善妊娠结局 ,治疗同时应注意纠正IUGR。     

新法复苏对羊水胎粪污染新生儿的处理体会

羊水胎粪污染是导致新生儿窒息的重要原因之一，亦是导致胎粪吸入综合征（MAS）的直接原因。因此，对羊水胎粪污染新生儿的生后处理显得尤为重要。我院于2005—02～2007—01间按新法复苏对羊水胎粪污染的282例足月新生儿进行治疗，现将处理情况和转归分析如下。     

促黄体激素释放激素类似物治疗难治的子宫内膜异位症…

１９９３年６月至１９９５年６月，用国产促黄体激素释放激素类似物（ＬＨＲＨ－Ａ）或配合炔诺酮治疗１０例难治的子宫内膜异位症。ＬＨＲＨ－Ａ５００μｇ／ｄ肌注，炔诺酮３．１２５ｍｇ／ｄ口服，持续３￣６月。所有患者痛经、性交痛、腹泻、阴道流血等症状词消失，卵巢七克力囊肿及阴道壁结节缩小。血清ＩｇＡ水平显著下降。低剂量炔诺酮合并应用对肝、肾功能及血脂成份未见不良影响。ＬＨＲＨ－Ａ治疗后ＩｇＡＩＩ ＧＵ ＧＨ     

应用羊水中板层小体计数预测胎肺成熟度

为探讨应用羊水中板层小体（ｌａｍｅｌａｒｂｏｄｙ,ＬＢ）计数预测胎肺成熟度的临床应用价值,我们通过羊水中ＬＢ计数,对新生儿呼吸窘迫综合征（ＲＤＳ）取得了较好的预测效果。现报道如下。一、资料与方法１临床资料：选取１９９７年１２月至１９９８年６月在我院...     

剖宫产儿窒息与胃食管返流误吸的临床研究

目的：分析剖宫产儿胃食管返流误吸（ＧＥＲ－Ａ）的原因、临床表现及处理方法，并探讨其预防措施。方法：对６例因ＧＥＲ－Ａ引起窒息的择期剖宫产儿的临床资料进行回顾性分析。结果：ＧＥＲＡ均发生在生后第５－１２分钟内，主要表现为呼吸道梗阻。经处理后４例恢复正常，１例发生吸入性肺炎，１例因严重支气管痉挛而死亡，结论：该并发症的民新生儿早期抗胃食管返流机制不健全及采用剖宫产这种非自然分娩方式有关，新生儿处理方法     

妊高征孕妇足月分娩新生儿死亡原因分析

目的：研究妊高征患者新生儿的发育状况、死亡原因及其相互关系。方法：分析４６例妊高征孕妇足月分娩新生儿死亡的尸体检查和临床资料，以体重、身长、肺重、肾重、肝重和脑重作为发育状况评估指标，按临床病理诊断重新评价死因。结果：轻度妊高征足月儿发育指标接近正常孕３７～３８周的各项参考值；中、重度妊高征孕妇的新生儿体重、肺重和肝重显著下降（Ｐ＜０．０５），而肾重、脑重下降相对不明显（Ｐ＞０．０５）。各项死因构成分别为：肺发育不全占２３．９％，原发性肺不张占１０．９％，肺透明膜病占２１．７％，弥漫性肺出血占１３．０％，大量羊水吸入占１９．６％，其它原因占１０．９％。死亡新生儿中不存在性别差异（Ｐ＞０．０５）。结论：妊高征阻碍胎儿发育进展随程度而加重，主要累及肺、肝等脏器。肺结构和功能性不成熟是妊高征患者分娩新生儿的主要致死原因。     

Respiratory distress syndrome of the preterm neonate — placenta and necropsy as witnesses

Aim.?To assess the agreement between clinical diagnosis of hyaline membrane disease (HMD) and lung necropsy pathological findings of deceased neonates.

Material and methods.?Review of clinical files and necropsy studies of 40 newborn infants?≤?37 weeks gestational age.

Results.?The concordance between clinics and necropsy for the diagnosis of HMD was 43% (n?=?17). At the necropsy study of the lungs, 11 cases (28%) of clinically diagnosed HMD were associated to meconium aspiration, pneumonia, or pulmonary hemorrhage; 12 (30%) cases were pneumonia and/or meconium aspiration and pulmonary hemorrhage without hyaline membranes. Of the 17 pneumonias, 15 (88%) were associated to histological chorioamnionitis, RR 3.76 (95%CI: 1.9–4.2) (p?<?0.001).

Conclusions.?The clinical diagnosis of HMD needs a cautious interpretation, as it may be mistaken, or HMD may occur in association with other pathological situations enhancing a more ominous prognosis.     

Meconium aspiration syndrome: intrapartum and neonatal attributes

To identify the fetus and newborn at risk for meconium aspiration syndrome the perinatal characteristics of 238 infants delivered through meconium-stained amniotic fluid were prospectively examined. All infants with meconium-stained amniotic fluid were routinely suctioned with a DeLee apparatus before tracheal intubation and suctioning. The type and presence of meconium in the trachea, neonatal breathing before intubation, and Apgar scores were recorded in the delivery room. Intrapartum fetal monitoring data were collected for 80% (190/238) of the mothers and umbilical artery pH for 74% (177/238) of the newborns. Despite suctioning with a DeLee apparatus and endotracheal suctioning, meconium was present in the trachea in 87/238 (37%) and meconium aspiration syndrome developed in 22 (9.2%). A total of 73% of newborns who had meconium aspiration syndrome were delivered through thick meconium. Thick meconium, the presence of fetal tachycardia, and absence of intrapartum fetal cardiac accelerations identified the fetus at high risk for meconium aspiration syndrome. The presence of these monitoring findings and thick meconium should alert obstetricians to the possibility of a fetus that requires intervention. Low umbilical artery pH, Apgar scores less than 5, and meconium in the trachea further characterized the newborn at high risk for meconium aspiration syndrome. The combination of these findings may best identify the infant delivered through meconium-stained amniotic fluid who requires close observation for meconium aspiration syndrome.     

Evaluation of amniotic fluid in preterm labor with intact membranes

Amniotic fluid was obtained from 35 pregnant women in preterm labor with intact membranes. Their gestational ages ranged from 24 to 34 weeks. Bacteria were detected in only 1 (3%) of the 35 amniotic fluid samples. The anaerobic culture grew Bacteroides corrodens and Fusobacterium nucleatum. The L/S ratio was greater than 4.0 in six patients (17%), 2.5-4.0 in two (6%) and less than 2.5 in 23 (66%); the quantity of fluid was inadequate for L/S analysis in four (11%). None of the 35 newborns developed evidence of infection in the neonatal period. Only two women (6%) were febrile postpartum, and none experienced a prolonged hospital stay. Seven (20%) of the infants developed respiratory distress syndrome. Five (14%) developed hyaline membrane disease, and two (6%) had transient tachypnea of the newborn. Intrauterine infection may play a lesser role in preterm labor with intact membranes than previously postulated. Amniocentesis may provide useful information for directing management by permitting one to assess fetal pulmonary maturity and the presence of meconium.     

Outcome of very low-birth weight infants born at a perinatal center

One hundred six infants with birth weights less than or equal to 1,000 gm were born at a Perinatal Center in 1979 and 1980. Eighty-three (78%) were born to women transferred to the Center because of antenatal problems. The most common obstetric problem was premature labor with or without premature rupture of the membranes. Seventy-two infants (68%) survived. The following perinatal factors were associated with increased survival: increased birth weight and gestational age, intrauterine growth retardation, antenatal steroids, absence of hyaline membrane disease, and absence of seizures or clinical signs of intraventricular hemorrhage. Of the 72 survivors, two were lost to follow-up and one died (sudden infant death syndrome). The most common general health problem was recurrent middle ear infection. Growth was satisfactory. Significant neurological or developmental handicap was found in nine infants (13% of the 69 evaluated).     

Clinical amniotic fluid infection and its effect on the neonate

This study was undertaken to determine the effects of clinical amniotic fluid infection on the neonate in terms of bacterial infection, hyaline membrane disease, asphyxia, and mortality. A retrospective chart review was made of 107 mothers with clinical amniotic fluid infection and their infants at this institution over a 3-year period. The next live-born infant with a birth weight within 100 gm and gestational age within 2 weeks was chosen as a control for each study patient. The rate of prematurity in the study group was 71%. When prematurity was controlled for, there was no significant difference in regard to asphyxia, hyaline membrane disease, bacterial sepsis, and death between the study and control groups. These findings suggest that the adverse outcome for infants delivered to mothers with clinical amniotic fluid infection at this institution was related primarily to their prematurity.     

11年住院早产儿发生原因、并发症和死亡原因探讨

目的：探讨早产儿的发生原因、并发症和死亡原因。方法：对我科1991年1月～2001年12月11年期间住院的834例早产儿的围产期临床资料进行回顾性分析。结果：住院早产儿有逐年增多趋势，多数有明确早产的诱因。冬季早产儿住院比例高于其它季节。87．6％有各种疾病，后6年硬肿症、肺炎、呼吸暂停和颅内出血发生率下降。本组早产儿死亡64例，病死率7．7％，胎龄愈小、出生体重愈小，病死率愈高；早产儿死亡的危险性相关因素依次为：出生体重、胎龄、生后1min Apgar评分、肺出血、肺透明膜病。结论：应加强围产保健措施，加强产科儿科合作，减少早产儿合并症；进一步提高各级围产保健人员对危重早产儿的抢救水平，建立区域性围产转运系统；在NICU中提高早产儿的管理水平，进一步降低早产儿病死率，改善其预后。     

早产儿支气管肺发育不良危险因素分析及防治措施

目的 分析早产儿支气管肺发育不良(BPD)的发生率和危险因素，探讨防治BPD的措施。方法 回顾性分析中山大学第一附属医院新生儿科1999年6月至2004年6月期间胎龄≤32周且出生体重≤2000g，存活时间>28d的早产儿72例，比较机械通气治疗中15例BPD(BPD组)和31例非BPD(对照组)患儿性别、胎龄、出生体重、生前使用糖皮质激素、生后使用肺表面活性物质、肺透明膜病、机械通气时间、呼吸支持条件、胃食管反流、动脉导管未闭、生后早期液体摄取量、反复肺部感染情况。结果早产儿BPD的总发生率为20.83%(15/72)，其中<1500g早产儿BPD的发生率为38.71%(12/31)；BPD组FiO2、PIP、PEEP和MAP与对照组差异无显著性意义(P>0.05)；多因素Logistic回归显示，胎龄<30周、体重<1250g、机械通气≥10d和反复肺部感染是发生BPD的独立危险因素(P<0.05)，而性别、生前使用糖皮质激素、生后使用肺表面活性物质、肺透明膜病、胃食管反流、动脉导管未闭、生后早期液体摄取量没有统计学意义(P>0.05)。结论 避免低体重早产、长时间机械通气和有效控制肺部感染是防治BPD的关键。 Abstract Objective To study the incidence,risk factors,prophylaxis and treatment for bronchopulmonary dysplasia (BPD) in premature.Methods From June 1999 to June 2004 seventy two prematures with gestational age less than 32 weeks,birth weight less than 2000 grams and surviving more than 28 days were enrolled in the study.Fifteen prematures with BPD were compared to thirty one prematures without BPD in terms of sex,gestational age,birth weight，usage of prenatal steroids,usage of postnatal surfactant,hyaline membrane disease,duration of mechanical ventilation,supportive conditions for ventilation,gastroesophageal reflux,patent ductus arteriosus,fluid intake in the first few days and recurrent pneumonia.Results The overall incidence of BPD in preterm newborns was 20.83%,and 38.71% in those infants weighting <1500g at birth；Fio2,PIP,PEEP and MAP were all not statistically significant between BPD group and control (P>0.05)；Multivariate logistic analysis revealed that gestational age less than 30 weeks,birth weight less than 1250 grams,prolonged mechanical ventilation (≥10days) and recurrent pneumonia were independent risk factors for BPD (P<0.05).Other factors including sex,usage of prenatal steroids,usage of postnatal surfactant,hyaline membrane disease,gastroesophageal reflux and excessive fluid intake in the first few days of life were not statistically significant (P>0.05).Conclusion Preventing small gestational age and low birth weight prematurity,shortening the duration of mechanical ventilation and controlling pneumonia were effective in preventing BPD. Key words Premature;Bronchopulmonary dysplasia;Risk factors     

产前B族链球菌感染对母儿的影响

目的　了解孕妇的Ｂ族链球菌（ＧＢＳ）带菌情况及对新生儿的影响。　方法　对１２０ 例产妇产前取阴道后穹窿分泌物,分娩后取胎盘子面分泌物及新生儿胃液分别检测ＧＢＳ,留脐血检测Ｃ反应蛋白、ＩｇＭ、ＩｇＧ 抗体,产后观察母婴情况并随访６ 周。　结果　产前母体ＧＢＳ带菌率１５－８％ ,胎盘带菌率１０ ％ ,新生儿带菌率３－３ ％ ,患病率０－８３ ％ 。ＧＢＳ阳性孕妇既往流产史多,胎膜早破、早产发生率较阴性者高（Ｐ＜ ０．０５） 。产时胎儿窘迫、羊水混浊及新生儿低体重、新生儿肺炎发生率虽比阴性者高,但无统计学意义。脐血Ｃ反应蛋白、ＩｇＭ、ＩｇＧ 无明显升高。　结论　为降低ＧＢＳ感染对围产期母儿的患病率,应对孕妇常规行ＧＢＳ筛检,阳性孕妇应给予预防性治疗并于产前复查,产时应对ＧＢＳ阳性孕妇及新生儿给予适当治疗以避免发生并发症。     

高频振荡通气治疗新生儿呼吸窘迫综合征的临床对照研究

目的　观察高频振荡通气 (HFV)对新生儿呼吸窘迫综合征 (NRDS)的治疗效果。　方法　采用高频振荡通气治疗 NRDS患儿 2 5例 ,并与同期一般常规通气治疗的 2 5例 NRDS患儿进行前瞻性临床对照研究。　结果　察组存活 2 0例 ,并发肺炎 12例 ,脑室内出血 (IVH ) 3例 ,肺出血4例 ,动脉导管未闭 (PDA) 4例 ,支气管 -肺发育不良 (BPD) 2例 ,无气漏发生 ;死亡 5例。存活儿使用呼吸机平均时间 88.6 h。对照组存活 14例 ,并发肺炎 12例 ,IVH 3例 ,肺出血 11例 ,PDA 8例 ,BPD6例 ,气漏 3例 ,死亡 11例。存活儿平均呼吸机使用时间为 15 4.7h。　结论　高频振荡通气可有效地减少了气压伤 ,缩短了使用呼吸机的时间 ,较常频呼吸机使用更为安全。