窒息新生儿心率变异性的临床研究

目的 探讨窒息新生儿心率变异性(heart rate variability,HRV)与心肌损害的相关性.方法 对53例窒息新生儿与40例健康新生儿进行24h全程动态心电图记录,对24h窦性心律进行HRV时域分析,时域分析指标包括:正常窦性R-R间期的标准差(SDNN);全程记录中每5分钟R-R间期平均值的标准差(SDANN);全程记录中每5分钟R-R间期标准差的平均值(SDNNindex);相邻R-R间期差值的均方根值(rMSSD);正常R-R间期标准差＞50 ms的百分比(PNN50).结果 (1)窒息新生儿与正常对照新生儿24h最快心率、最慢心率、平均心率比较,差异均有统计学意义(P＜0.05);轻、重度窒息新生儿间以上指标比较差异也有统计学意义(P＜0.05);重度窒息3种心率指标明显降低.(2) HRV时域分析中,轻、重度窒息新生儿SDNN、SDANN与正常对照新生儿比较差异有统计学意义(P＜0.05),轻、重度窒息SDNN、SDANN、SDNNindex、rMSSD及PNN50 5项指标组间比较差异无统计学意义(P＞0.05).SDNNindex、rMSSD及PNN503组间未见明显差异.结论 新生儿窒息心肌损害会导致心脏自主神经功能受损并影响心率的变化,受损程度与窒息缺氧严重程度有关.     

新生儿心肌损害后心率变异的意义

目的 探讨新生儿心肌损害后心率变异(HRV)的变化及其临床意义.方法 应用Holter分析系统检测60例有心肌损害新生儿(心肌损害新生儿组)和50例无心肌损害新生儿(无心肌损害新生儿组)及160例有心肌损害的不同年龄组儿童的心电信号,对HRV参数进行分析.结果 心肌损害新生儿组窦性心率R-R间期标准差(SDNN)、每5分钟窦性心率R-R间期平均值的标准差(SDANN)、相邻窦性心博R-R间期之差>50 ms的心搏数占心搏总数的百分比(PNN50)、总功率(TP)、低频功能(LF)等与无心肌损害新生儿组比较,均无显著性差异(Pa>0.05),而相邻窦性心博R-R间期差的均方根(rMSSD)、高频功率(HF)显著低于无心肌损害新生儿组(Pa<0.05),LF/HF值显著高于无心肌损害新生儿组(P<0.01);心肌损害新生儿组与不同年龄心肌损害组中HRV比较,新生儿组SDNN、SDANN显著低于小婴儿组(Pa<0.05);而HR、LF/HF值显著高于小婴儿组(Pa<0.01);新生儿组SDNN、SDANN、rMSSD、PNN50、TP、LF、HF均显著低于婴幼儿及儿童组(Pa<0.01),HR、LF/HF值显著高于婴幼儿及儿童组(Pa<0.01).结论 新生儿心肌损害后心脏自主神经功能明显受损,HRV参数是判断新生儿心肌损害及预后判断较稳定的指标之一.     

催产素对葡萄糖-6-磷酸脱氢酶缺陷症新生儿黄疸的影响

目的　观察催产素对葡萄糖 6 磷酸脱氢酶 (G 6 PD)缺陷症新生儿黄疸的影响。方法　对 1998年1月～ 2 0 0 0年 1月出生的 2 5 2例足月新生儿进行回顾性分析。结果　观察组 (A组 )血清胆红素及高胆红素 (高胆 )发生率分别为 2 98.5 0± 94.0 8μmol/L及 83 .93 % ,而单纯催产素组 (B组 )、单纯G 6 PD缺陷组 (C组 )和正常对照组 (D组 )分别为 2 41.3 1± 47.87μmol/L及 64 .62 % ,2 2 2 .41± 79.0 6μmol/L及 48.3 3 %和13 4.49±5 2 .87μmol/L及 5 .63 % ,观察组与其他 3组相比 ,均有高度显著性差异 (P均 <0 .0 1)。且观察组血清胆红素 >3 42 .0 μmol/L(2 0mg/dl)达到可能发生胆红素脑病的比率为 3 0 .3 6% ,与其他 3组比较 (χ2 =41.83　P <0 .0 1) ,差异有高度显著性。结论　G 6 PD缺陷新生儿产前使用催产素更易发生高胆 ,且程度更重 ,有G 6 PD缺陷症或有家族史的孕妇 ,产前使用催产素应更慎重     

新生儿口服高丽参的毒副作用

目的探讨新生儿口服高丽参后的毒副作用。方法选择口服高丽参的新生儿67例,分为无黄疸组和并母乳性黄疸组。观察其临床表现,检查血、尿常规、血生化、凝血系统及脑CT等。选取同期未服高丽参母乳性黄疸新生儿43例作为对照。结果新生儿口服高丽参主要表现为胃肠功能障碍腹胀、呕吐、呕血或(和)便血、精神疲乏或爱哭闹,并母乳性黄疸组血液直接胆红素、间接胆红素增高,但与对照组比较无显著差异(P>0.05)。血小板数升高50例(占74.6%)。死亡1例,表现为中毒性脑病、中枢性呼吸衰竭、药物性肝损害、代谢性酸中毒。结论新生儿口服高丽参后毒副作用较明显,严重中毒可死亡。新生儿应慎用高丽参,以免产生不良反应。     

早产儿心率变异性的临床研究

目的评价早产儿心脏自主神经功能发育情况.方法根据胎龄将90例早产儿分为A、B、C三组(胎龄分别为27～31周、～34周、～37周),以CompasXMHolter系统检测90例早产儿及21例足月儿的心率变异性时域指标.结果A、B、C三组24h窦性RR间期标准差的均值(SDNN)、每5min窦性RR间期标准差的均值(SDN-NIDX)、50ms间隔以上邻近周期的比例(PNN50)与对照组比较差异有显著性意义(P＜0.05).A组SDNNIDX与B、C组比较,差异有显著性意义(P＜0.05).SDNN与胎龄正相关(r=0.55,P＜0.01),PNN50与日龄正相关(r=0-23,P＜0.05).结论早产儿自主神经功能随胎龄增大逐渐成熟.胎龄大于34周早产儿交感神经功能接近足月儿.大于34周龄早产儿交感神经功能较稳定,副交感神经功能随日龄增加而增强.     

产前静滴缩宫素对新生儿脐血生化的影响

目的　探讨缩宫素对新生儿脐血生化指标的影响。方法　取孕妇分娩过程中曾应用缩宫素的健康新生儿 80例脐血 2ml,断脐后再取股静脉血 2ml,进行血钾、钠、氯、钙、镁、糖及尿素氮测定 ,并与产程中未用缩宫素的健康新生儿组比较。结果　缩宫素组脐血钠、氯、糖明显低于对照组 (P均 <0 .0 1或 <0 .0 0 1) ,而血钾、钙、镁、尿素氮变化不明显 (P均 >0 .0 5 )。股静脉血与脐血比较 ,血钾、钠、氯、钙、镁、糖及尿素氮均无显著性差异 (P均 >0 .0 5 )。结论　分娩过程中应用缩宫素易致新生儿低钠、低氯、低糖血症 ,故在临床应合理应用 ,并对新生儿血生化进行常规监测 ;脐血生化检测能替代股静脉血检查 ,有利于早期判断病情 ,指导临床用药     

维生素A对新生儿免疫功能的影响

小儿维生素Ａ（ＶｉｔＡ）缺乏主要发生于新生儿及婴幼儿期，特别是早产儿和人工喂养儿。近年研究发现，ＶｉｔＡ缺乏可损伤机体免疫功能，增加感染性疾病的易感性，并使其病程迁延，病死率亦明显增高。本文着重介绍新生儿ＶｉｔＡ的血清水平及其对免疫功能的影响。     

围生期窒息对新生儿糖代谢影响

目的　研究围生期窒息对新生儿血糖及其调节激素的影响。方法　对 4 0例窒息儿生后 72h进行连续血糖监测 ,同时测定血清皮质醇 (CT)、胰岛素 (INS)、胰高血糖素 (GC)和生长激素 (GH)水平。结果　轻度窒息对新生儿糖代谢无影响 ;重度窒息生后 6h血糖最高 ,36h最低 (P <0 .0 1)。 4种激素水平明显增高 (P <0 .0 1) ,多元线性回归分析发现重度窒息 6～ 12h血糖与CT和GC水平呈显著正相关 (P <0 .0 1)。结论　应激反应对新生儿重度窒息后高血糖发生起重要作用 ,监测血糖对重度窒息患儿非常重要 ,治疗时不宜应用糖皮质激素和胰岛素。     

血糖水平对缺氧缺血新生大鼠脑内葡萄糖转运蛋白1合成的影响

目的　探讨血糖水平对缺氧缺血 (HI)新生大鼠脑内葡萄糖转运蛋白 1(GLUT1)合成的影响。方法　在成功建立HI并高、低血糖新生大鼠模型的基础上 ,应用免疫组织化学方法定量检测新生大鼠脑内海马和皮质部位GLUT1的合成情况。结果　正常情况下GLUT1随日龄增加而合成增加 ,HI可引起GLUT1合成在短期内明显增加 ,以HI前重症高血糖对GLUT1合成的影响较明显 ,其合成量在HI后 2、2 4、48h显著高于其他各组。结论　在HI前预先补充足量葡萄糖 ,可改善脑内葡萄糖供应。此与HI时增加的无氧酵解代谢方式相适应。     

葡萄糖转运体与新生儿缺氧缺血性脑损伤

葡萄糖转运体(glucose transporter,GLUT)是葡萄糖通过细胞膜所需要的运载工具,在脑内有8种亚型的GLIYI表达,每种亚型表达部位及功能不同.新生儿缺氧缺血性脑损伤时未成熟脑组织对葡萄糖的利用程度及其GLUT的表达量与成熟脑组织相比有所不同.该文将对未成熟脑内8种GLUT的分布、功能及新生儿缺氧缺血性脑损伤后GLUT表达部位及时相的动态变化、与日龄的关系及意义作一综述.     

妊娠期母亲糖耐量减低对其新生儿血清脂联素水平的影响

目的探讨妊娠期孕妇糖耐量减低(GIGT)对其新生儿脐血血清脂联素(APN)水平的影响。方法采用放射免疫方法测定并比较18例GIGT孕妇的新生儿及50例糖耐量正常(NGT)孕妇的新生儿脐静脉血血清APN水平,二组新生儿于娩出后1h测末梢血糖。结果GIGT组新生儿脐血血清APN水平显著高于NGT组[(61.06±16.85)mg/Lvs(48.04±15.47)mg/L,t=2.38P<0.05],而其生后1h血糖显著低于NGT组[(2.31±0.71)mmol/Lvs(3.18±0.52)mmol/L,t=-4.46P<0.001]。GIGT组新生儿脐血血清APN水平与其生后1h血糖不存在相关性(r=-0.125P>0.05)。结论GIGT孕妇的新生儿脐血血清APN水平升高,GIGT孕母和新生儿的代谢状况应受到更多关注。     

新生儿发绀型先天性心脏病102例

目的了解新生儿发绀型先天性心脏病的类型分布及临床特点。方法对可疑病例予彩色多普勒超声心动图(CFM)检查,死亡病例尸解。结果本组完全性大血管转位最多见,占34.3%,多为复合畸形。临床表现以发绀最常见,占84.3%,部分病人无发绀、气促、心脏杂音。复合畸形患儿多并Ⅱ型呼吸衰竭、代谢性酸中毒。结论发绀型先天性心脏病类型众多,临床表现不典型,对可疑病例应尽早作CFM检查。     

Comparative Study of the Electrocardiograms of Healthy Fullterm and Premature Newborns

ABSTRACT. The electrocardiograms of 421 healthy fullterm and premature newborns, recorded on the fifth day of life, were evaluated for possible systematic differences related to gestational age. All newborns were appropriate for gestational age and were divided into four groups according to birthweight. As birthweight increased, we noted: ( a ) a progressive rightward shifting of the QRS axis in the frontal plane; ( b ) an increase in the amplitude mainly of the precordial R and S waves reflecting the right ventricle and both ventricles combined, whereas a less significant increase or even a decrease was noted in the R and S waves reflecting the left ventricle; ( c ) a more frequent occurrence of diphasic and positive T waves in the right precordial leads; and ( d ) a prolongation in the duration of the P wave and the QRS complex. These findings reflect both an increase in total myocardial mass as well as a progressive right ventricular predominance, as birthweight or gestational age increases. Practical implications for electrocardiographic identification of cardiac hypertrophy in newborns of different gestational age are discussed.     

Effect of oral glucose on the heart rate of healthy newborns

AIM: Increases in heart rate have been widely utilized as pain responses in different studies. In a previous study, we found an increase in heart rate in newborns when they received glucose as pain relief. Other research groups have shown a smaller increase in heart rate on administration of sweet solutions. We therefore investigated the question as to whether or not oral glucose itself can cause an increased heart rate in healthy infants. METHOD: This was a randomized, controlled, double-blind study comprising 70 healthy newborns. They were randomly allocated to receive 1 ml 30% glucose or 1 ml placebo solution (sterile water) orally without undergoing any painful procedure. The heart rate was recorded during and at different times after this administration. RESULTS: The heart rate was significantly higher in the glucose than in the placebo group (p = 0.020). The highest heart rate was noted during treatment, and the heart rate subsequently decreased in both groups (p = 0.002). CONCLUSION: Oral glucose causes an increase in heart rate in healthy newborns not undergoing any painful intervention.     

妊娠期糖耐量降低对新生儿的影响

目的：探讨妊娠期糖耐量降低(GIGT)对新生儿的影响。方法：对GIGT孕妇52例(GIGT组)、正常孕妇40例(对照组)的新生儿进行比较。结果：GIGT组巨大儿发生率明显高于对照组(21.2%vs 5.0%)，(P<0.05)，生后2 h血糖均值低于对照组［(1.52±0.66) mmol/Lvs(2.58±0.57) mmol/L］(P<0.01)，低血糖、高胆红素血症、红细胞增多症等并发症发病率高于对照组，但差异无显著性。结论：GIGT对新生儿的预后有一定影响，应引起重视。     

新生儿先天性心脏病患病率的调查和孕妇增补叶酸的预防效果

目的 探讨新生儿先天性心脏病(先心病)患病率和妊娠初期增补叶酸的预防效果。方法 对1992年1月1日至1998年12月31日嘉兴市妇幼保健院出生的全部活婴31 470例,进行先心病前瞻性调查;调查1996年8月1日至1998年7月31日7 445例活产婴儿的母亲孕前1月至孕后3月内增补叶酸情况与先心病的发病关系;调查1994年6月1日至1998年12月31日出生的217例先心病的母亲妊娠初期增补叶酸情况。结果 31 470例新生儿中检得先心病312例,不包括单纯性动脉导管未闭和缺损直径小于5 mm的房间隔缺损(ASD)。其中彩色多普勒超声心动图(CDFM)诊断298例,尸检确诊14例,患病率9.91‰。室间隔缺损(VSD)居首位(51.6%),患病率5.12‰。重症复杂先心病新生儿期死亡32例,病死率10.3%。7 445例新生儿的母亲孕期增补叶酸情况与先心病患病率关系,增补叶酸组先心病患病率7.43‰,未补组患病率15.17‰。两组患病率差异有显著性意义,(P<0.01),相对危险度(RR)0.4898,归因危险度(AR)0.00774,归因危险比数(ARP)51.02%。重症复杂先心病患病率未补组为增补组的4.6倍。217例先心病中母亲孕初增补叶酸组占30.9%,未补组占69.1%。重症复杂畸形增补组7例占11.4%,未补组34例占22.7%。结论 应用CDFM是先心病检出率增加的主要原因。妊娠初期增补叶     

交换输血术对高胆红素血症新生儿血清免疫球蛋白的影响

目的 评估高胆红素血症新生儿的体液免疫状态及其进行交换输血治疗(换血术)前后的血清免疫球蛋白(Ig)水平变化情况,了解换血术对新生儿血清Ig的影响.方法 对62例高胆红素血症新生儿进行换血治疗,治疗前后分别测定其血清Ig(IgG、IgA、IgM)水平,并依据病因分成ABO溶血病组、Rh溶血病组、脓毒症组和其他组进行分析.结果 1.换血术前:ABO溶血病组、Rh溶血病组IgG水平均显著高于脓毒症组及其他组(Pa＜0.01),各组间IgA、IgM水平无明显差异(Pa>0.05).2.换血术后ABO溶血病组、Rh溶血病组IgG水平均较换血前显著下降(Pa＜0.05);其他组及脓毒症组IgG水平均较换血前升高,但差异无统计学意义(P=0.387,0.091).3.换血后4组IgA水平均较换血前升高,且其他组、ABO溶血病组和Rh溶血病组治疗前后比较差异有统计学意义(Pa=0.000),脓毒症组治疗前后无统计学意义(P=0.185).4.换血后4组IgM水平均较换血前升高,其他组、ABO溶血病组和Rh溶血病组治疗前后比较均有统计学意义(Pa＜0.05),但脓毒症组治疗前后无统计学意义(P=0.081);且其他组、ABO溶血病组和Rh溶血病组各组间治疗后比较有统计学意义(P＜0.01).结论 1.新生儿溶血病患儿术前血清IgG水平较高,换血术能迅速降低溶血病患儿血IgG水平,提升患儿血IgA、IgM水平;2.换血术对脓毒症患儿血清IgG、IgA、IgM的水平无明显影响;3.换血术能提高其他高胆红素血症患儿血清IgA、IgM水平,但对血清IgG水平无明显影响.     

Anxiety, Antisocial Behavior, and Heart Rate Regulation in Adolescent Males

We explored relationships between anxiety and antisocial behavior and autonomic heart rate regulation in a homogenous sample ( N = 175 (of 15-year-ofd males. Measures for anxiety and antisocial behavior were obtained at yearly intervals over a period of 4–6 years. Components of heart rate variability associated with postural (sympathetic) and respiratory (vagal) change and transfer of respiratory to heart rate variability were estimated an age 15 using Spectral analytic techniques. Anxiety and antisocial behavior were predictably related to enhanced and diminished levels of mean heart rate, respectively. Anxiety was also predictably related to enhanced sympathetic mediation of phasic postural effects on heart rate. Antisocial behavior was unexpectedly related to disruption of vagally mediated, phasic respiratory effects on heart rate. Anxiety and antisocial behavior showed distinct relationships to heart rate, and to the autonomically mediated component, of heart rate variability from postural and respiration sources. Spectral analytic techniques helped elucidate these unique regulator; patterns, suggesting utility for future research in this area.     

Evolution of Heart Rate Control After Transplantation: Conduction Versus Autonomic Innervation

In cardiac transplantation, the donor organ is not initially innervated and demonstrates decreased heart rate variability (HRV). However, HRV may improve after several months. The mechanism for HRV improvement has not been elucidated; autonomic reinnervation of the donor heart has been proposed. The role of atrioatrial conduction from recipient to donor organ has not been evaluated. We prospectively evaluated cardiac transplant patients with a limited electrophysiology study at the time of their surveillance biopsies. Recordings were made of recipient and donor signals, observing conduction properties between recipient and donor atria. Holter recordings were analyzed and HRV was determined using spectral analysis techniques, recording mean RR interval, low-frequency power (LF), high-frequency power (HF), and the LF/HF ratio. These were compared to published norms. From November 1999 to May 2000, 21 patients (6 female) who underwent cardiac transplantation participated at a median age of 101 months (range, 4.1–217 months). Time posttransplant ranged from 26 days to 71 months. Holter data were available for 20 patients and demonstrated dissociated P waves in 13 (65%). The mean heart rate on Holter was 111 beats per minute (bpm) (range, 85–161 bpm). We were able to record distinct recipient atrial signals in 16 of 21 (76%) patients. The average recipient tissue heart rate was 55% that of the donor heart rate. We documented atrioatrial association in only 1 patient. HRV did not reach normal values for most patients and did not increase with time posttransplantation. The LF values were in the normal range for most patients, whereas 3 patients had normal HF values and 2 patients had values just below normal. Recipients of heart transplantation have a predominantly sympathetic influence of HRV. These preliminary data suggest that atrioatrial conduction does not play a role in reestablishing normal heart rate control following pediatric cardiac transplantation.