足月儿与早产儿排尿方式的比较研究

目的 探讨足月儿与早产儿出生后排尿方式的不同.方法 选取2010年3月至5月人住郑州大学第一附属医院新生儿室的出生后3～7d足月儿12例与早产儿14例作为研究对象,足月儿孕(38.3±1.1)周,体重(3.1±0.4)kg,早产儿孕(32.5±1.6)周,体重(1.7±0.4)kg.观察新生儿在12 h内(上午9点至晚上9点)的自由排尿情况,记录每次排尿量、残余尿量、排尿时的意识状态(清醒/睡眠)、排尿次数及排尿时间等参数,同时记录饮奶量、液体输入量及摄入时间,液体摄人量按标准进行.每次排尿量等于排尿后尿垫重量减去排尿前尿垫重量,残余尿量由超声检测仪测得.共观察记录了220例次.结果 每次排尿量、残余尿量、排尿次数、排尿时意识清醒状态百分比在足月儿分别为(19.8±10.9)ml、(1.55±1.01)ml、(7.2±1.9)次、(43.5±26.8)%,而在早产儿则分别为(11.1±7.5)ml、(1.82±0.88)ml、(9.6±2.5)次、(24.7±19.1)%.二组数据相比,早产儿的每次排尿量及排尿时意识清醒状态百分比小于足月儿,残余尿量及排尿次数大于足月儿,均具有统计学差异(P＜0.05).结论 足月儿与早产儿排尿方式明显不同,提示足月儿膀胱功能的发育优于早产儿,早产儿膀胱功能及其受控制的神经系统发育较足月儿明显延迟.

Abstract：

Objective To study the voiding patterns of term and preterm newborns.Methods Between March 2010 and May 2010,26 hospitalized newborns aged 3 to 7 days at this center were recruited in this study.In these patients,12 were term newborns,with an average gestational age of (38.3 ± 1.1 ) weeks,weight of (3.1 ± 0.4) kg,14 were preterm newborns with an average gestational age of (32.5 ± 1.6) weeks,and weight of (1.7 ± 0.4) kg.The voiding volumes (VV),post-void residual volumes (PRV),state of consciousness at voiding,voiding time (VT),voiding frequency (VF)in 12 hours as well as the volume of milk and liquid fed in the same time frame were recorded and analyzed retrospectively.Results In the term newborns,the VV and consciousness voiding rate were significantly higher compared with the preterm newborns [VV and consciousness voiding rate,( 19.8 ±10.9) ml (43.5 ± 26.8%) vs (11.1 ± 7.5) ml (24.7 ± 19.1 %),P＜0.05].However,the PRV and VF were significant lower in term newborns [PRV and VF,(1.55 ± 1.01 ) ml (7.2 ± 1.9) times vs (1.82 ± 0.88) ml (9.6 ± 2.5) times,P＜0.05].Conclusions Incomplete voiding pattern exists in term and preterm newborns.The better urodynamic parameters of the term newborns indicate the term newborns have better mature bladder function than preterm newborns.     

手足口病病原体流行特征分析及临床意义

Objective To investigate the epidemic characteristics of etiological agents in children with hand, foot and mouth disease (HFMD) and analyze the differences between the severe and mild cases with HFMD seen from 2008 to 2009 in the Children's Hospital Methods A total of 154 patients with HFMD were enrolled from May 2008 to September 2008 and from May 2009 to September 2009, including 28 severe HFMD patients. Data from 80 cases with suspected herpangina were collected as control. Enterovirus universal type, enterovirus type 71 (EV71) and coxsackie virus group A 16 (CA16) were detected by realtime RT-PCR respoctively. Results The positive rate of enterovirus universal type in the 154 patients with HFMD was 81.82% (126/154). EV71 positive rate in these 126 patients with enterovirus universal type infection was 57.14% (72/126). The positive rate of enterovirus universal type in the 80 cases with suspected herpangina was 68.75% (55/80). There was no EV71 infection in these 80 cases with suspected herpangina. EV71 infection was mainly popular in 2008. Both EV71 and CA16 were prevalent in 2009. The epidemic characteristics of enterovirus infection with HFMD between 2008 and 2009 had significant differences (X2 = 23.50, P = 0.000) ( P ＜ O.01 ). The epidemic characteristics of enterovirus infection between severe and mild HFMD patients also had significant differences (X2 = 29.85, P ＜ O. 01). There were 28 cases with severe HFMD, in whom the EV71 positive rate was 92.86% (26/28). EV71 positive rate in the mild HFMD was 36.51% (46/126) (X2 =29.22, P ＜0.01). There was no significant difference in the gender ( X2 = 0.135, P = 0.714) and virus load (t = 0.141, P = 0.889) between the mild and severe HFMD cases. But the age of mild and severe HFMD showed a significant difference ( t = 2.926, P =O.009). Patients who were less than 2 years of age had a proportion of 88.89% (8/9) with severe HFMD.The mean age of mild HFMD patients was 3.19 years. Conclusion HFMD showed different epidemic characteristics at different times of enterovirus infection. There was no significant difference in the gender and virus load between the mild and severe cases with HFMD. Children under 3 years of age with EV71 infection were at high risk for severe HFMD.     

手足口病病原体流行特征分析及临床意义

Objective To investigate the epidemic characteristics of etiological agents in children with hand, foot and mouth disease (HFMD) and analyze the differences between the severe and mild cases with HFMD seen from 2008 to 2009 in the Children's Hospital Methods A total of 154 patients with HFMD were enrolled from May 2008 to September 2008 and from May 2009 to September 2009, including 28 severe HFMD patients. Data from 80 cases with suspected herpangina were collected as control. Enterovirus universal type, enterovirus type 71 (EV71) and coxsackie virus group A 16 (CA16) were detected by realtime RT-PCR respoctively. Results The positive rate of enterovirus universal type in the 154 patients with HFMD was 81.82% (126/154). EV71 positive rate in these 126 patients with enterovirus universal type infection was 57.14% (72/126). The positive rate of enterovirus universal type in the 80 cases with suspected herpangina was 68.75% (55/80). There was no EV71 infection in these 80 cases with suspected herpangina. EV71 infection was mainly popular in 2008. Both EV71 and CA16 were prevalent in 2009. The epidemic characteristics of enterovirus infection with HFMD between 2008 and 2009 had significant differences (X2 = 23.50, P = 0.000) ( P ＜ O.01 ). The epidemic characteristics of enterovirus infection between severe and mild HFMD patients also had significant differences (X2 = 29.85, P ＜ O. 01). There were 28 cases with severe HFMD, in whom the EV71 positive rate was 92.86% (26/28). EV71 positive rate in the mild HFMD was 36.51% (46/126) (X2 =29.22, P ＜0.01). There was no significant difference in the gender ( X2 = 0.135, P = 0.714) and virus load (t = 0.141, P = 0.889) between the mild and severe HFMD cases. But the age of mild and severe HFMD showed a significant difference ( t = 2.926, P =O.009). Patients who were less than 2 years of age had a proportion of 88.89% (8/9) with severe HFMD.The mean age of mild HFMD patients was 3.19 years. Conclusion HFMD showed different epidemic characteristics at different times of enterovirus infection. There was no significant difference in the gender and virus load between the mild and severe cases with HFMD. Children under 3 years of age with EV71 infection were at high risk for severe HFMD.     

2000-2006年杭州市三岁以上儿童肺炎支原体肺炎临床特征变化趋势

Objective To reveal changes in clinical manifestations of Mycoplasma pneumoniae (Mp) pneumonia in children older than 3 years of age during 2000 -2006. Method Totally 288 older children with Mp pneumonia hospitalized in the hospital between 2000 and 2006 were enrolled. Clinical manifestation, chest X-ray and clinical outcomes among three time periods (2000 - 2002, 2003-2004,2005 - 2006) were compared Result (1) Fever and its duration;281 cases (97.6% ) had fever of different duration (median = 7.2 d, 8.5 d, and 11.2 d, respectively) among the time periods, showing statistically significant difference(P ＜0.01 ). (2) Respiratory symptoms: different incidence of wheezing/dyspnea(6.1%, 9.9%, 16.3%), thrilling (6.9%, 11.3%, 19.8% ) and chest pain (12.2%,15.5%, 22. 1%) among different time periods had significant difference (X2 =5.87, 11.46, 5.21, P＜0.05). (3) The incidence of extrapulmonary damages ( 13.0%, 38. 0% , 48.8% ) among different time periods also had significant difference(X2 = 21.27, P ＜ 0.01 ). (4) Chest X-ray examination showed large area of lesions in most cases; 30.2% of cases seen during 2005 - 2006 were found having pulmonary complications such as pleural effusion or atelectasis. The incidences of pulmonary complications among different time periods had significant difference( P＜ 0.01 ). (5) Treatment and outcome: after comparing the efficacy of erythromycin or azithromycin, decline of clinical effectiveness was revealed among different time periods (P＜0.05 ). The duration of fever after macrolide administration (median = 3.2 d,4.5 d,6.2 d,respectively) and hospital stay ( median = 7.0 d, 8.7 d, and 11.4 d, respectively) among different time periods showed significant differences(P ＜ 0.05). Conclusion More refractory and severe Mp pneumonia cases appeared during 2000 -2006 in children older than 3 years of age in Hangzhou, with prolonged fever duration, aggravated respiratory symptoms and more complications and extrapulmonary damages.     

2000-2006年杭州市三岁以上儿童肺炎支原体肺炎临床特征变化趋势

Objective To reveal changes in clinical manifestations of Mycoplasma pneumoniae (Mp) pneumonia in children older than 3 years of age during 2000 -2006. Method Totally 288 older children with Mp pneumonia hospitalized in the hospital between 2000 and 2006 were enrolled. Clinical manifestation, chest X-ray and clinical outcomes among three time periods (2000 - 2002, 2003-2004,2005 - 2006) were compared Result (1) Fever and its duration;281 cases (97.6% ) had fever of different duration (median = 7.2 d, 8.5 d, and 11.2 d, respectively) among the time periods, showing statistically significant difference(P ＜0.01 ). (2) Respiratory symptoms: different incidence of wheezing/dyspnea(6.1%, 9.9%, 16.3%), thrilling (6.9%, 11.3%, 19.8% ) and chest pain (12.2%,15.5%, 22. 1%) among different time periods had significant difference (X2 =5.87, 11.46, 5.21, P＜0.05). (3) The incidence of extrapulmonary damages ( 13.0%, 38. 0% , 48.8% ) among different time periods also had significant difference(X2 = 21.27, P ＜ 0.01 ). (4) Chest X-ray examination showed large area of lesions in most cases; 30.2% of cases seen during 2005 - 2006 were found having pulmonary complications such as pleural effusion or atelectasis. The incidences of pulmonary complications among different time periods had significant difference( P＜ 0.01 ). (5) Treatment and outcome: after comparing the efficacy of erythromycin or azithromycin, decline of clinical effectiveness was revealed among different time periods (P＜0.05 ). The duration of fever after macrolide administration (median = 3.2 d,4.5 d,6.2 d,respectively) and hospital stay ( median = 7.0 d, 8.7 d, and 11.4 d, respectively) among different time periods showed significant differences(P ＜ 0.05). Conclusion More refractory and severe Mp pneumonia cases appeared during 2000 -2006 in children older than 3 years of age in Hangzhou, with prolonged fever duration, aggravated respiratory symptoms and more complications and extrapulmonary damages.     

小剂量肝素微量泵持续定时静脉注射治疗小儿原发性肾病综合征的临床研究

Objective To explore the efficacy and safety of low-dose heparin in the treament of children with primary nephrotic syndrome (PNS). Methods It was an open and comparative trial. Eightyeight children with PNS in the hypercoagulable state,on the basis of administrating with glucocorticosteroid,were administrated with low-dose heparin that infused by micro pump oriented to time ( group A). Eighty patients only treated with glucocorticosteroid were chosen as control (group B). Results Serum-albumin and activated partial thromboplastin time (APTT) increased,but fibrinogen (Fib) decreased after therapy in the group A,and they all showed significant differences (P ＜ 0. 01 ). Serum-albumin increased after therapy in the group B and there was significant difference (P＜0. 01 ). However,APTT and Fib in the group B showed no significant difference( P ＞ 0. 05 ) between post-treatment and pretherapy. Post-treatment serum-albumin and APTT in the group A were significantly higher than those in group B, and Fib was significantly lower than that in group B ( P ＜ 0. 01 ). The rate of urine protein remission in group A (82/88) was significantly higher than that in group B (63/80). Urine protein remission time and edema disappearance time were significantly shorter in group A than group B ( P ＜ 0. 01 ). APTT of group A at the peak concentration of heparin after therapy was significantly higher than that of pretherapy ( P ＜ 0. 01 ), and the ratio was 2. 38. However, there was no significant difference in APTT at the valley concentration of heparin between post-treatment and pretherapy ( P ＞ 0.05 ). Conclusion Low dose-heparin infused by micro pump oriented to time in the treatment of children with PNS has an obvious anticoagulative effect. It can improve the rate of urine protein remission and shorten edema disappearance time. Meanwhile it is safety ,requires no laboratory monitor and has few drug side effects,thus it deserves further clinical application.     

多西环素对新生鼠高氧肺损伤影响的体视学研究

Objective To explore the influence and potential protective effects of non-specific panMetrix Metalloproteinases(MMPs) inhibitor Doxycycline on hyperoxic lung injury and lung development in neonatal rats.Methods Neonatal SD rats were divided into 4 groups randomly within 12 hours after birth:air with normal saline(AN),air with doxycycline(AD),hyperoxia with normal saline(ON),and hyperoxia with doxycycline group(OD).Hyperoxia groups(ON and OD) were exposed to ≥90% O2.Doxycycline 20 mg/kg or equal volume of 0.9% saline(Doxycycline concentration 2 mg/ml) was administered by gastric gavage,twice daily from day 1 to experimental day,but it didn't exceed 14 days.Stereological study was carried out at day 1,3,7,14 and 21 after birth.Results Enlarged mean alveolar area was noted both in hyperoxia and Doxycycline groups.OD group had larger star volume than ON group on day 14.Except ON group,all other groups had increased alveolar septum and the condition was worsened by hyperoxia with Doxycycline.The percentage of collagen in lung parenchymal tissue in ON group increased persistently.This increasing trend was stopped in OD group on day 14,and collagen percentage had no significantly difference between OD and AN groups on day 14 and 21.Conclusion Both hyperoxia and Doxycycline influence neonatal lung development,percentage of coUgen in lung parenchymai can be reduced by Doxycycline in hyperoxic lung injury.     

多西环素对新生鼠高氧肺损伤影响的体视学研究

Objective To explore the influence and potential protective effects of non-specific panMetrix Metalloproteinases(MMPs) inhibitor Doxycycline on hyperoxic lung injury and lung development in neonatal rats.Methods Neonatal SD rats were divided into 4 groups randomly within 12 hours after birth:air with normal saline(AN),air with doxycycline(AD),hyperoxia with normal saline(ON),and hyperoxia with doxycycline group(OD).Hyperoxia groups(ON and OD) were exposed to ≥90% O2.Doxycycline 20 mg/kg or equal volume of 0.9% saline(Doxycycline concentration 2 mg/ml) was administered by gastric gavage,twice daily from day 1 to experimental day,but it didn't exceed 14 days.Stereological study was carried out at day 1,3,7,14 and 21 after birth.Results Enlarged mean alveolar area was noted both in hyperoxia and Doxycycline groups.OD group had larger star volume than ON group on day 14.Except ON group,all other groups had increased alveolar septum and the condition was worsened by hyperoxia with Doxycycline.The percentage of collagen in lung parenchymal tissue in ON group increased persistently.This increasing trend was stopped in OD group on day 14,and collagen percentage had no significantly difference between OD and AN groups on day 14 and 21.Conclusion Both hyperoxia and Doxycycline influence neonatal lung development,percentage of coUgen in lung parenchymai can be reduced by Doxycycline in hyperoxic lung injury.     

多西环素对新生鼠高氧肺损伤影响的体视学研究

Objective To explore the influence and potential protective effects of non-specific panMetrix Metalloproteinases(MMPs) inhibitor Doxycycline on hyperoxic lung injury and lung development in neonatal rats.Methods Neonatal SD rats were divided into 4 groups randomly within 12 hours after birth:air with normal saline(AN),air with doxycycline(AD),hyperoxia with normal saline(ON),and hyperoxia with doxycycline group(OD).Hyperoxia groups(ON and OD) were exposed to ≥90% O2.Doxycycline 20 mg/kg or equal volume of 0.9% saline(Doxycycline concentration 2 mg/ml) was administered by gastric gavage,twice daily from day 1 to experimental day,but it didn't exceed 14 days.Stereological study was carried out at day 1,3,7,14 and 21 after birth.Results Enlarged mean alveolar area was noted both in hyperoxia and Doxycycline groups.OD group had larger star volume than ON group on day 14.Except ON group,all other groups had increased alveolar septum and the condition was worsened by hyperoxia with Doxycycline.The percentage of collagen in lung parenchymal tissue in ON group increased persistently.This increasing trend was stopped in OD group on day 14,and collagen percentage had no significantly difference between OD and AN groups on day 14 and 21.Conclusion Both hyperoxia and Doxycycline influence neonatal lung development,percentage of coUgen in lung parenchymai can be reduced by Doxycycline in hyperoxic lung injury.     

多西环素对新生鼠高氧肺损伤影响的体视学研究

Objective To explore the influence and potential protective effects of non-specific panMetrix Metalloproteinases(MMPs) inhibitor Doxycycline on hyperoxic lung injury and lung development in neonatal rats.Methods Neonatal SD rats were divided into 4 groups randomly within 12 hours after birth:air with normal saline(AN),air with doxycycline(AD),hyperoxia with normal saline(ON),and hyperoxia with doxycycline group(OD).Hyperoxia groups(ON and OD) were exposed to ≥90% O2.Doxycycline 20 mg/kg or equal volume of 0.9% saline(Doxycycline concentration 2 mg/ml) was administered by gastric gavage,twice daily from day 1 to experimental day,but it didn't exceed 14 days.Stereological study was carried out at day 1,3,7,14 and 21 after birth.Results Enlarged mean alveolar area was noted both in hyperoxia and Doxycycline groups.OD group had larger star volume than ON group on day 14.Except ON group,all other groups had increased alveolar septum and the condition was worsened by hyperoxia with Doxycycline.The percentage of collagen in lung parenchymal tissue in ON group increased persistently.This increasing trend was stopped in OD group on day 14,and collagen percentage had no significantly difference between OD and AN groups on day 14 and 21.Conclusion Both hyperoxia and Doxycycline influence neonatal lung development,percentage of coUgen in lung parenchymai can be reduced by Doxycycline in hyperoxic lung injury.     

新生儿缺血缺氧性脑病对早产儿排尿方式的影响

目的 探讨新生儿缺血缺氧性脑病(HIE)对早产儿排尿方式的影响.方法 选取出生后4～15d确诊为新生儿缺血缺氧性脑病早产儿48例,男34例,女14例,孕(32.1±0.7)周,出生时体重(2.5±0.3)kg.选取同期出生后4～15d无缺血缺氧性脑病的33例早产儿为对照组,男22例,女11例,孕(32.3±1.4)周,出生时体重(2.4±0.5)kg.记录4h(早上8点～10点)排尿情况,包括排尿量、残余尿量、排尿次数等参数,同时记录饮奶量、液体输入量及摄入时间,液体摄入量按标准进行.结果共记录了248次排尿,其中HIE组136次,对照组112次.HIE组排尿量和排空比例分别为(14.8±8.3)ml和11.6％,均显著小于对照组[(16.5±9.2)ml和24.3％];而HIE组的排尿次数、平均残余尿量分别为(2.8±1.1)次、(1.5±1.3)ml,对照组为(3.3±1.2)次、(1.7±0.9)ml,两者之间的差异无统计学意义.结论 缺血缺氧性脑病可使早产儿出现一定程度排空和储尿障碍,表现为每次排尿量及排空比例降低.     

出生1～7 d早产儿12 h自由排尿观察

目的 探讨出生7 d内早产儿的自由排尿特点.方法 选取2010年3-5月在本院NICU住院的113例出生7 d内无疾病的单胎早产儿.男60例,女53例;胎龄32～36周[(34.0±1.9)周];体质量1.16～2.07 kg[(1.48±0.34) kg].据日龄分为7组(第1天组～第7天组).第1天组6例,第2天组11例,第3天组11例,第4天组18例,第5天组18例,第6天组26例,第7天组23例.每组均进行12 h(900-2100)自由排尿观察,记录排尿时间、每次排尿量, B超测量排尿后残余尿量,排尿时觉醒状态.结果 113例早产儿12 h共观察排尿745次.第1天组6例早产儿观察时段位于出生0.5～12.5 h,12 h内排尿1～4次[(2.8±1.2)次],其中5例出生4 h内无排尿.第3天组开始发现早产儿排尿前有手臂或大腿微动或排尿后啼哭现象.第2、3、4天组平均2.5 h排尿1次.第5、6、7天组平均不到2 h排尿1次.第1天组、第4天组、第7天组排尿次数、排尿量比较差异均有统计学意义(Pa<0.05).各组残余尿量比较差异均无统计学意义(Pa>0.05),膀胱排空率均低于30%.总体27.39%(204/745次)的排尿发生在清醒状态.间断排尿(10 min内排尿次数≥2)见于第2天组以后的早产儿,达70%(522/745次).结论 出生7 d内的早产儿中枢神经系统参与排尿不明显.每次排尿量及排尿次数变异较大,但有随日龄增加的趋势.     

体位引流辅助气管吸引对胎粪吸入综合征的防治效果

目的 评价体位引流辅助气管吸引防治胎粪吸入综合征(MAS)的临床效果.方法 2007年1月至2008年12月我院收治的窒息合并MAS新生儿61例,分为对照组24例,生后气管插管应用胎粪吸引管气管内吸引;观察组37例,插管后体位引流再行气管吸引.主要观察两组气管内吸出胎粪量、MAS并发症及转归.结果 观察组气管内抽出胎粪量(2.16±1.82)ml,较对照组(1. 23±0.97)ml明显增多,差异有显著性(P＜0.05);观察组吸净胎粪所需插管次数为(1.19±0.46)次,较对照组[(1.79±0.83)次]显著减少,差异有显著性(P＜0.01).观察组并发症发生率为8.11%,明显低于对照组29.17%,差异有显著性(P＜0.05).观察组吸氧时间(包括机械通气)为(21.30±22.38)h,较对照组[(52.91±39.20)h]显著缩短,差异有显著性(P＜0.01);观察组住院天数(9.24±3.94)d,对照组为(14.39±6.49)d,差异有显著性(P＜0.01).观察组病死率为0,对照组病死率4.17%,差异无显著性(P＞0.05).观察组1 min Apgar评分与对照组相近,差异无显著性(P＞0.05);观察组5 minApgar评分8～10分者占70.16%,明显高于对照组(58.34%),差异有显著性(P＜0.05).结论 体位引流辅助气管吸引可有效清除气管内胎粪,减少MAS并发症的发生,缩短吸氧时间和住院天数.     

舒尼替尼及联合顺铂对小儿睾丸卵黄囊瘤荷瘤鼠模型的抗肿瘤作用

目的 探讨舒尼替尼(Sunitinib)、顺铂(CDDP)及两者联合用药对小儿睾丸卵黄囊瘤(TYST)异种移植荷瘤鼠模型的抗肿瘤作用及相关作用机制.方法 肿瘤标本来自本实验室的小儿睾丸卵黄囊瘤裸鼠第17代模型,并接种在雄性裸鼠单侧腹股沟皮下区,成瘤后随机分成4组(n=5):对照组、CDDP组、Sunitinib组和Sunitinib+CDDP组.绘制肿瘤体积和裸鼠体重变化曲线图,计算肿瘤消退率;HE染色观察肿瘤组织形态学变化;免疫组织化学法检测AFP、Ki-67、Glypican-3、CD105在各组肿瘤中的表达:CD105测定微血管密度(MVD),Ki-6表示细胞增殖率(PI);TUNEL法检测肿瘤细胞凋亡率(AI);实时荧光定量PCR(RT-qPCR)验证靶向因子的mRNA表达变化.结果 各治疗组均能显著抑制肿瘤生长,并能消退肿瘤体积.在治疗后肿瘤体积上,除顺铂组与舒尼替尼组间无统计学差异外(41.61±7.61比67.15±5.39,P＞0.05),其余各组间都有统计学差异:对照组与顺铂(651.72±121.16比41.61±7.61,P＜0.05),对照组与舒尼替尼组(651.72±121.16比67.15±5.39,P＜0.05),对照组联合舒尼替尼±顺铂组(651.72±121.16比23.03±2.37,P＜0.05),舒尼替尼组与联合舒尼替尼+顺铂组(67.15±5.39比23.03±2.37,P＜0.05),顺铂组与联合舒尼替尼+顺铂组(41.61±7.61比23.03±2.37,P＜0.05);在裸鼠体重上,相比对照组,除舒尼替尼组无统计学差异外(25.90±0.75比26.66±0.65,P＞0.05),其余各组间差异均有统计学意义:对照组与顺铂组(25.90±0.75比18.90±0.63,P＜0.05),对照组与联合舒尼替尼+顺铂组(25.90±0.75比18.26±1.20,P＜0.05);AFP、Glypican-3在各治疗组阳性表达面积(Pixels)均少于对照组(AFP:对照组与顺铂组,1.26×106土1.48×105比5.54×105±8.14×104,P＜0.05;对照组与舒尼替尼组,1.26×106±1.48×105比7.09×105±6.64×104,P＜0.05;对照组与联合舒尼替尼+顺铂组,1.26×106±1.48×105比3.62×105±4.83×104,P＜0.05.Glypican-3:对照组与顺铂组,9.68×105±7.63×104比4.04×105±5.04×104,P＜0.05;对照组与舒尼替尼组,9.68×105±7.63×104比4.59×105±2.32×104,P＜0.05;对照组与联合舒尼替尼+顺铂组,9.68×105±7.63×104比1.89×105±2.55×104,P＜0.05).两者在顺铂组与舒尼替尼组的比较中差异无统计学意义(P＞0.05);PI和AI在各治疗组中相比对照组,差异都具有统计学意义(PI和AI:对照组与顺铂组,58.97土1.38比42.36±1.28和1.69±0.20比54.62±2.49,P＜0.01;对照组与舒尼替尼组,58.97±1.38比43.48±1.00和1.69±0.20比47.32±2.00,P＜0.01;对照组与联合舒尼替尼+顺铂组,58.97±1.38比33.34±1.19和1.69±0.20比63.41土2.23,P＜0.01).顺铂组相比联合舒尼替尼+顺铂组,PI:P=0.001,AI:P=0.002;舒尼替尼组相比联合舒尼替尼+顺铂组,PI和AI:P＜0.001;顺铂组相比舒尼替尼组,PI.P=0.597,AI:P=0.059;RT-qPCR证实M-CSFR、PDGFR-β、RET、VEGFR-2的mRNA表达受到抑制.结论 Sunitinib能显著抑制小儿睾丸卵黄囊瘤的生长,并消退肿瘤体积:主要通过直接抑制肿瘤细胞的生长和肿瘤血管的新生,从而诱导肿瘤细胞凋亡,同时伴有直接细胞毒作用引起坏死;Sunitinib相比CDDP具有更轻的毒副作用,且联合CDDP具有增强抗肿瘤作用.

Abstract：

Objective To study the antitumor effects of Sunitinib or Sunitinib combind with cis - diamminedichloroplatinum (CDDP) on an athymic mouse human testicular yolk sac tumor xenograft model. Methods The athymic mouse human testicular yolk sac tumor xenograft model was established by subcutaneous injection of 17th passage pediatric testicular yolk sac tumor cells in the unilateral inguinal region of the male nude mice. The mice of control group didn't receive any treatment. The tumor bearing mice were treated with either CDDP, or Sunitinib group, or Sunitinib combined with CDDP. The tumor-bearing nude mice were divided into 4 groups (5 in each) according the treatment they underwent. The tumor volumes and mice weight were measured to calculate the regression rate of tumor. The tumor was collected for H&E staining and immunohistochemical staining of AFP, Ki-67,Glypican-3 and CD105. Microvessel density (MVD) was measured by analyzing the CD105 expression. The tumors' proliferation index (PI) was studied by analyzing Ki-67 expression. The apoptosis of the tumor was quantitated using TUNEL staining. The mRNA expressions of cytokines were determined by quantitative real-time PCR (RT-qPCR). Results The tumor volumes were significantly decreased after chemotherapy. No difference of tumor volume was found between CDDP group and Sunitinib group (41.61 ± 7. 61 vs. 67. 15 ± 5. 39, P＞0. 05). Significant differences of tumor volumes were found between CDDP group and CDDP+ Sunitinib group (41.61 ± 7. 61 vs. 23. 03 ± 2. 37, P＜0. 05), and between Sunitinib group and CDDP+ Sunitinib group (67. 15 ± 5. 39 vs. 23.03 ± 2. 37, P＜0. 05). Of the body weight of tumor-bearing mice, no difference was found between controls and Sunitinib group (25. 90 ± 0. 75 vs. 26. 66 ± 0. 65, P＞0. 05). And significant differences of the body weight were noted between controls and CDDP group (25.90 ± 0. 75 vs. 18. 90 ± 0. 63, P＜0. 05),controls and CDDP+ Sunitinib group (25. 90 ± 0. 75 vs. 18. 26 ± 1.20,P＜0. 05). The positive areas (pixels) of AFP in the mice with chemotherapy were less than those of control mice (Control vs. CDDP: 1.26 × 106±1.48 × 105 vs. 5. 54 × 105 ± 8. 14 × 104 , P＜0. 05. Control vs. Sunitinib: 1.26 × 106 ± 1.48 × 105 vs. 7. 09 × 105 ± 6. 64 × 104, P＜0. 05. Control vs. CDDP + Sunitinib: 1.26 × 106 ± 1.48 × 105 vs. 3. 62 × 105 ± 4. 83 × 104, P＜0. 05). The positive areas (pixels) of Glypican-3 in the mice with chemotherapy were less than those of control mice (Control vs. CDDP: 9. 68 × 105 ± 7. 63 × 104 vs. 4. 04 × 105 ± 5. 04 × 104 , P＜0. 05. Control vs. Sunitinib: 9. 68 × 105 ± 7. 63 × 104 vs. 4. 59 × 105 ± 2. 32 × 104 , P＜0. 05. Control vs. CDDP + Sunitinib: 9. 68 × 105 ± 7. 63 × 104 vs. 1.89 × 105 ± 2. 55 × 104, P＜0. 05). However, there were no statistical differences of the positive areas (pixels) of AFP and Glypican-3 between CDDP and Sunitinib groups (P＞0. 05). The PI was significantly decreased after chemotherapy (Control vs. CDDP: 58. 97 ± 1.38 vs. 42. 36 ± 1.28, P＜ 0. 01. Control vs.Sunitinib: 58. 97 ± 1.38 vs. 43. 48 ± 1.00, P＜0. 01. Control vs. CDDP+ Sunitinib: 58. 97 ± 1.38 vs.33. 34 ± 1.19, P＜0. 01 ). The apoptosis index (AI) was also significantly increased after chemotherapy (Control vs. CDDP: 1.69 ± 0. 20 vs. 54. 62 ± 2. 49, P＜0. 01. Control vs. Sunitinib: 1.69 ± 0. 20vs. 47. 32 ± 2. 00, P＜0. 01. Control vs. CDDP + Sunitinib: 1.69 ± 0. 20 vs. 63. 41 ± 2. 23, P＜0. 01). Significantly differences of PI and AI were found between CDDP and CDDP + Sunitinib groups (P＜0. 01 ), and Sunitinib and CDDP + Sunitinib (P＜0. 01 ). RT-qPCR study confirmed that the mRNA expressions of M-CSFR, PDGFR-β, RET and VEGFR-2 were decreased in the mice underwent chemotherapy. Conclusions Sunitinib is effective to suppress the pediatric testicular yolk sac tumor growth, and reduce the tumor volume. Sunitinib can inhibit the angiogenesis in tumor, induce apoptosis of tumor cells, and kill the tumor cells directly. Sunitinib is less toxic than CDDP, and synergistic with the antitumor effect of CDDP.     

尿道下裂患儿包皮组织中FGFR2表达检测及意义

目的 检测成纤维细胞生长因子受体2(fibroblast growth factor receptor 2,FGFR2)蛋白和mRNA在包皮环切组和尿道下裂组包皮组织中的表达情况,初步探究FGFR2蛋白表达、基因功能和尿道下裂的关系.方法 采用Western blotting(免疫印迹)方法和RT-PCR方法;检测两组中FGFR2表达情况;结果包皮环切组和尿道下裂组FGFR2蛋白相对定量值分别为0.39±0.12和0.19±0.09(P＜0.05),尿道下裂组较包皮环切组降低.尿道下裂轻、中、重度三组间FGFR2蛋白相对定量值分别为0.27±0.08、0.16±0.04、0.09±0.03;中度和重度之间比较无统计学差异(P＞0.05).包皮环切组和尿道下裂组FGFR2 mRNA表达量分别为1.30±0.069和1.22±0.052,包皮环切组高于尿道下裂组(P＜0.05).尿道下裂轻、中、重度三组间FGFR2 mRNA定量值分别为1.23±0).054、1.24±0.034、1.16±0.020;轻度和中度之间之间无统计学差异(P＞0.05),重度尿道下裂FGFR2mRNA表达量低于其他两组.结论 尿道下裂患儿包皮组织中FGFR2蛋白和mRNA较包皮环切组表达下调.提示FGFR2和尿道下裂关系密切,进一步研究FGFR2蛋白和基因功能有助于明确FGFR2在尿道下裂发病机制中的重要地位,有可能揭示尿道下裂的发病机制.     

足月新生儿肺通气功能肺力学改变与心功能的关系

目的 探讨足月新生儿肺通气功能、肺力学及心功能的变化规律及其相关性.方法 200例足月儿,据日龄分为A、B、C、D四组,其日龄分别为0～24 h、～72 h、～1周、～28 d.采用德国耶格公司Master screen Paed型肺功能仪测定肺通气功能及单次阻断法测定气道阻力、肺顺应性.肺功能主要参数:潮气量(TV)、分钟通气量(MV)、呼吸系统顺应性(Crs)、呼吸系统阻力(Rrs).采用美国SonoSite 180 PLUS彩色多普勒超声诊断仪检测心功能.心功能主要参数:每搏输出量、心输出量(CO).结果 A、B、C、D四组的TV分别为20.2±3.8、21.1±3.7、22.3±4.5、23.9±4.9(ml),C、D组TV与A组比较,D组TV与B组比较,差异有显著性(P＜0.05).Rrs、Crs组间差异无显著性(P＞0.05).A、B、C、D四组CO分别为0.93±0.23、0.93±0.23、1.02±0.21、1.08±0.27(L/min),D组CO与A、B组比较差异有显著性(P＜0.05).CO与Rrs呈负相关(r=-0.16,P＜0.05),与MV、TV、Crs呈正相关(r分别为0.50、0.54、0.13,P均＜0.05).结论 足月儿生后72 h后肺通气功能趋于稳定.左心输出量于生后1周明显增加.肺通气功能和肺力学指标是影响心功能的因素.

Abstract：

Objective To investigate the dynamic change and correlation of the pulmonary ventilative function, mechanic and cardiac function in the term infants. Methods Twenty hundred term infants were divided into A 、B 、C and D groups by age which was 0 ～ 24 h, ～ 72 h, ～ 1 w and 28 d respectively. The lung ventilative and mechanical function were measured respectively by using techniques of tidal breathing flow-volume loop(TBFVL)and the single occlusion. The Master screen Paed-lung function devices of Germanic JAEGER Co. was be used in this study. The parameter of pulmonary function including minute volume(MV) ,tidal volume (TV), respiratory system compliance(Crs) and respiratory system resistance (Rrs). The cardiac function were measured by using SonoSite 180 PLUS color Doppler ultrasonic diagnostic apparatus. The main parameter of cardiac function including cardiac output(CO) and stroke volume(SV). Results The TV of A, B ,C and D group were 20. 2 ± 3.78,21. 1 ± 3.71,22. 3 ± 4. 48 and 23. 9 ±4.90 (ml)respectively, the TV of C and D group were higher than that of A group, and the TV of D group was higher than that of B group (P ＜ 0. 05).There were no significantly difference of Crs, Rrs among A, B, C and D group(P ＞ 0. 05). The CO of A,B,C and D group were 0.93 ±0. 23,0.93 ±0.23,1.02 ±0.21 and 1.08 ±0.27 (L/min) ,the CO of D group was higher than that of A and B groups (P ＜ 0. 05). The CO was negative correlation with Rrs (r = - 0. 16,P ＜ 0. 05) and positive correlation with MV、 TV、 Crs (r was 0. 50、 0. 54、0. 13 respectively, P ＜ 0. 05).Conclusion The lung ventilative function is mature gradually with increasing age. The cardiac output has been obviously improved for postnatal 1 week in the term infants. The pulmonary ventilative function and mechanic parameter are important effective factors of cardiac function.     

儿童呼吸机撤离失败相关因素分析

目的 分析机械通气患儿呼吸机撤离失败率及失败的相关因素.方法 回顾分析我院2005年1月至2008年12月内科重症监护室收治的机械通气患儿214例,统计撤机失败率,分析撤机失败的相关因素.结果 141例患儿按计划撤机,成功122例,失败19例,撤机失败率13.5%.年龄＜6个月患儿撤机失败率较年龄＞6个月患儿高,但差异无显著性(15.0% vs9.8%,P＞0.05).因肺炎进行机械通气的患儿撤机成功率(78/86,90.7%)最高.机械通气时间对撤机成功与否无影响.撤机后皮质激素应用时间成功组短于失败组,差异有显著性[(12.35±9.69)h vs(18.63±12.17)h,P＜0.05).多元线性逐步回归(R2=0.093)分析提示呼吸道梗阻是撤机失败的高危因素(F=14.256,P＜0.001).结论 目前PICU中机械通气患儿的撤机问题还依赖于临床医生的经验和客观指标相结合,探索合理可行的撤机方案,尽早发现和去除引起撤机失败的因素是提高撤机成功率的关键.     

升主动脉注射鱼精蛋白对体外循环后婴儿细胞因子与补体的影响

目的 通过升主动脉及上腔静脉注射鱼精蛋白,观察和评价不同注射途径对体外循环后婴儿血浆IL-6、TNF-α、G3a、G5a浓度的影响.方法 年龄≤12个月行体外循环心内直视手术的患儿60例,数字随机分为实验组(经升主动脉注射鱼精蛋白组,n=30)和对照组(经上腔静脉注射鱼精蛋白组,n=30).于注射鱼精蛋白前(T1)、注射鱼精蛋白后1 h(T7)取右心房肝素抗凝血1 ml,用ELISA法测定血浆IL-6、TNF-α、G3a、C5a浓度.分别于注射鱼精蛋白前、注射鱼精蛋白后1 min、2min、3 min、5 min、10min测左侧桡动脉动脉收缩压.结果 注射鱼精蛋白前两组患儿血浆IL-6、TNF-α、C3a、C5a浓度无统计学差异(P＞0.05);对照组患儿在注射鱼精蛋白后1 h血浆IL-6浓度(25.4±10.7)ng/L、TNF-α浓度(26.1±0.2)ng/L、C3a浓度(23.0±3.5)μg/L、G5a浓度(0.9±0.1)μg/L,均较注射鱼精蛋白前显著增多(P＜0.01);实验组患儿在注射鱼精蛋白后1h血浆TNF-α浓度(25.2±0.4)ng/L、C3a浓度(19.6±3.5)μg/L、C5a浓度(0.8±0.1)μg/L均较注射鱼精蛋白前无显著性差异(P＞0.05);IL-6浓度均较注射鱼精蛋白前有统计学差异(19.2±10.2)ng/L(P＜0.05);对照组患儿在注射鱼精蛋白后1 h血浆IL-6、TNF-α、C3a、C5a浓度较实验组显著增高(P＜0.01).注射鱼精蛋白前两组患儿左侧桡动脉收缩压分别为(90.9±4.9)mmHg、(89.8±6.0)mmHg无统计学差异(P＞0.05);注射鱼精蛋白后1 min、2 min、3 min两组患儿左侧桡动脉收缩压分别为(86.3±4.7)mm-Hg、(85.1±5.4)mmHg、(79.2±4.4)mmHg、(80.1±5.1)mmHg、(82.5±4.5)mmHg、(84.1±4.5)mmHg,较注射鱼精蛋白前均下降(P＜0.01);两组患儿同时点左侧桡动脉收缩压相互比较无统计学差异(P＞0.05).结论 升主动脉途径注射鱼精蛋白可显著减少体外循环后婴儿血浆IL-6、TNF-α、G3a、G5a浓度.

Abstract：

Objective To study the effects of protamine on complement activation and cytokine generation in infants with cardiopulmonary bypass. Methods Sixty infants under 1 year of age underwent cardiopulmonary bypass (CPB) from heart surgery were recruited in this study, and randomly grouped into 2 groups. Experimental group had 30 patients, who received protamine injection via ascending aorta. The control group also had 30 patients, but they received protamine injection via superior vena cava. Blood samples were collected from right atrium at the time prior to protamine injection (T1) and 1 hour after the injection (T2). IL-6, TNF-α, C3a and Csa plasma levels were measured by ELISA. Left radial artery systolic arterial pressures (SAPs) were measured at the time prior to protamine injection (Time 1), 1 min (Time 2), 2 min (Time 3), 3 min (Time 4), 5 min (Time 5), and 10min (Time 6) after the injection. Results At Time 1, IL-6, TNF-α, C3a and C5a plasma levels were not significantly different between the control group and the experimental group (P＞0. 05). In the patients of control group, IL-6 (25. 4 ± 10. 7 ng/L), TNF-α (22. 1 3. 5μg/l), C3a (23. 0 ± 3. 5 μg/L), and C5a (0. 9 ± 0. 1 μg/L) at Time 7 were significantly increased compared with these at Time 1 (P＜0. 01). In the patients of experimental group, levels of TNF-α (25. 2 ± 0. 4 ng/L), C3a (19. 6 ± 3. 5μg/L) and Csa (0. 8 ± 0. 1 μg/L) at Time 7 were not significantly different from those at Time 1 (P＞0. 05), but IL-6 (19. 2± 10. 2 ng/L) at Time 7 was significantly increased than that at Time 1 (P＜0. 05). Before injection, no difference of left radial artery SAPs was found between experimental group and control group (P＜0. 05). After injection, the left radial artery SAPs of the patients of the 2 groups were decreased compared with the SAPs before injection (P＜0. 05), but no difference between experimental and control group was found (P＞0. 05). Conclusions Protamine injection via ascending aorta decreased IL-6, TNF-α, C3a and C5a plasma levels in the infants with cardiopulmonary bypass.     

延迟钳夹脐带对早产儿早期血容量影响的临床研究

目的 探讨延迟钳夹脐带对早产儿早期血容量的影响.方法 将2007年10月至2010年6月在东莞市石龙博爱医院产科经阴道分娩的194例早产儿随机分为两组,即常规钳夹脐带组100例和延迟钳夹脐带组94例.比较分析两组经阴道分娩早产儿的钳夹脐带时间,生后24h、48h、72 h的Hb、RBC、红细胞压积、血压、血氧饱和度和贫血的发生率,以及生后第1天、第2天、第3天和第7天的静脉血胆红素值.结果 延迟钳夹脐带组脐带钳夹时间为(100.14±10.57)s,常规钳夹脐带组脐带钳夹时间为(22.40±5.02)s,两组脐带钳夹时间比较差异有统计学意义(P＜0.005).延迟钳夹脐带组早产儿生后前3 d的Hb及血压均比常规钳夹脐带组高,两组比较差异有统计学意义(P＜0.05).延迟钳夹脐带组94例早产儿中,3 d内发生贫血3例,发生率为3.19%,常规钳夹脐带组100例早产儿中,3 d内发生贫血11例,发生率为11.00%,延迟钳夹脐带组贫血发生率低于常规钳夹脐带组(P＜0.05).两组早产儿出生后7 d内的静脉血胆红素值比较无明显差异(P＞0.05).结论 延迟钳夹脐带对早产儿Hb及血压有明显影响,可提高阴道分娩早产儿早期血容量,减少早产儿早期贫血的发生.     

腹腔镜下高位肛门闭锁肛门成形术及中期临床评估

目的 评估腹腔镜下高位肛门闭锁成形术后临床疗效和直肠肛门功能.方法 2004年6月至2007年9月收治高位肛门闭锁患儿61例,33例行腹腔镜下肛门成形术(LAARP),平均年龄5.3个月;28例行后矢状入路肛门成形术(PSARP),平均年龄4.9个月.随访包括手术时间、住院时间和并发症.手术后3～4年对患儿进行排便功能的Kelly评分(KCS)、磁共振成像(MRI)和直肠肛管向量测压(AVVM)评估.结果 LAARP和PSARP组手术时间分别为(112.5±12.4)min和(120.4±18.5)min(P＞0.05),LAARP组住院时间(11.3±2.1)d短于PSARP组(14.6±2.3)d(P＜0.01).两组患儿KCS无显著差异(3.52±1.42比3.49±0.82,P＞0.05).MRI显示:LAARP组33例患儿中在I线上和M线上各有1例存在直肠位置偏移;PSARP组28例患儿中I线上有4例存在直肠位置偏移,M线上有3例存在直肠位置偏移.直肠肛管向量测压结果显示:与PSARP组相比,LAARP组非对称指数小,向量容积大,静息时和收缩时肛管压力高(P＜0.05).但高压带长度(15.2±5.8比15.1±6.2 mm)和直肠肛管抑制反射阳性率(84.8%比85.7%)无显著差异.结论 高位肛门闭锁患儿LAARP术后排便控制满意,与PSARP相比,LAARP术后住院时间短、直肠位置更准确.长期随访对评估LAARP术后功能非常必要.

Abstract：

Objective To evaluate the clinical outcomes and postoperative anal function in infants with congenital high imperforate anus who underwent laparoscopically assisted anorectal pullthrough (LAARP). Methods From January 2004 to July 2007,33 consecutive patients (28 males and 5 females,age ranging from 3 to 10 months) with high imperforate anus underwent LAARP. Clinical data of the LAARP group were retrospectively compared with those treated by posterior sagittal anorectoplasty ( PSARP,n = 28) at the same time period. Anorectal function of these patients was evaluated using the Kelly's score,anorectal vector volume manometry(AWM) and magnetic resonance imaging (MRI) at the age of 3. 1 to 4. 4 years. Results The operative time in LAARP and PSARP groups was 112. 5 ± 12.4 and 120.4 ± 18.5 min (P ＞ 0. 05), respectively. The length of hospital stay in LAARP group was shorter than that of PSARP group (11. 3 ± 2. 1 vs. 14. 6 ± 2. 3 days,P＜0. 01). No significant difference was observed between LAARP and PSARP groups regarding Kelly's score (3. 52 ± 1. 42 vs. 3. 49 ± 0. 82). Although MRI revealed the lower rate of poorly aligned rectum in LAARP group than PSARP group at both I-line (3. 0% vs. 14. 3%) and M-line (3. 0% vs. 10. 7%) levels,no statistically significant difference was noted (P＞0. 05). Compared with the PSARP group, lower asymmetric index, larger vector volume, and higher anal canal pressure at rest and during voluntary squeeze were observed in LAARP group (P＜0. 05), without significant differences in the length of high-pressure zone (15. 2 ± 5. 8 vs. 15. 1 ± 6. 2 mm) and the presence of rectoanal relaxation reflex (84. 8% vs. 85.7%). Conclusions Satisfactory fecal continence can be achieved in patients with high/intermediate type imperforate anus after LAARP. LAARP has some advantages over PSARP, including shorter hospital stay and better position of rectum. However, long-term follow-up is necessary to compare the benefits of LAARP against PSARP.