西宁地区的新生儿窒息高危因素的探讨

本文总结了西宁地工２８０７例新生活婴，其中窒息３５５例，窒息发生率１２．６５％，远高于平原地区。窒息死亡１７例，死亡率４７．９０‰。提出西宁地区的新生儿窒息密切相关的高危因素是：胎儿窘迫及羊水污染程度；脐带异常；早产及过期妊娠；手术产；母体并发症中的妊高闰。     

新生儿窒息60例

新生儿窒息是新生儿死亡和各种并发症后遗症的主要原因之一。现将我院近3年来收治的60例报道如下。     

西宁地区新生儿窒息高危因素的探讨

本文总结了西宁地区２８０７例新生活婴，其中窒息儿３５５例，窒息发生率１２．６５％，远高于平原地区。窒息死亡１７例，死亡率４７．９０％。提出西宁地区新生儿窒息密切相关的高危因素是：胎儿窘迫及羊水污染程度；脐带异常；早产及过期妊娠；手术产；母体并发症中的好高症。     

新生儿窒息复苏

新生儿窒息为胎儿娩出后 ,仅有心跳而无呼吸或未建立规律呼吸的缺氧状态。对任何出生时呼吸抑制的新生儿都必须立即开始复苏 ,以在引起永久性损害之前逆转窒息缺氧过程。相对其它任何年龄组来说 ,新生儿窒息发病率最高 ,需要复苏的机率最大 ,在窒息新生儿生命的最初几分钟内如何对其正确处理 ,将影响其终身健康和体质。因此 ,产科医生必须熟练而准确地掌握ＡＢＣＤ复苏方案 (见后 )和初步复苏处理。1　新生儿窒息的病理生理变化新生儿窒息后很快出现第一次短促的喘气相 ,系延髓呼吸中枢对血ｐＨ降低和高碳酸血症的反应 ,随着缺氧加重 ,呼吸…     

新生儿重度窒息96例

新生儿重度窒息即使抢救成功，也常因缺氧时间长、程度重而日致中枢神经损害，遗留智力障碍等后遗症。我院自1988年1月～1995年6月，发生新生儿重度串息96例，其巾死亡18例，病死率为本院同期新生儿总数的3．8％0。为探讨其发生原因和处理方法，对本组病例分析如卜。1临床资料1．1一般情况本组96例均为胎龄人于38周，出生时里重度窒息的新丁儿。诊断标准为出十lmin，Ap－gar评分为O～3分考”’。新生儿体检或尸检未发现先天性畸形。其中初产85例，经产11例。剖它产6例，其余均为阴道分娩。1．2窒息原因与妊娠病期件因素有关92例，占95．8％…     

新生儿窒息156例原因分析

为探讨新生儿窒息发生的原因，2002年1月～2004年12月，我们对某妇幼保健院住院分娩中发生的新生儿窒息156例进行了病因统计。现分析报告如下。     

新生儿窒息68例

新生儿窒息（Asphyxia of the newborn）是指新生儿因缺氧发生宫内窘迫及娩出过程中引起呼吸、循环障碍,在生后1min迟迟不出现自主呼吸,但心跳仍存在,是导致新生儿死亡和儿童神经系统发育异常的重要原因之一。其发生与妊娠期的保健、生产时及新生儿的处理手段有着密切的关系。国外报道该病的发生率为5％～6％,而国内为4．7％～8．9％。现对我院收治的68例新生儿窒息相关因素进行回顾性分析。     

新生儿窒息复苏58例体会

目的探讨新生儿窒息的诱因及复苏方法。方法回顾性分析2010年7月至2011年6月58例窒息新生儿临床资料。结果新生儿窒息治愈出院55例,家长放弃治疗1例,死亡2例。结论加强孕期保健,积极治疗并发症及合并症,适时终止妊娠,提高产科、儿科医务人员技术,是降低新生儿窒息发生率的有效措施,正确的复苏及加强复苏后的护理,是降低新生儿窒息死亡的重要措施。     

羊水胎粪污染与新生儿窒息的临床研究

羊水胎粪污染在产科较为常见 ,多年来临床常作为胎儿窘迫的诊断 ,有些甚至作为剖宫产指征。但部分学者认为是胎儿成熟的表现 ,不必过早干预。为了解羊水粪染及其程度对胎儿的影响究竟如何 ,本文对我院在产程中出现羊水胎粪污染的 136例病例进行临床研究 ,现报告如下。1　资料和方法1 1　研究对象1 1 1　研究组　 1999年 1月～ 2 0 0 0年 12月在我院分娩产妇中符合单胎、头位≥ 37孕周 ,无妊娠合并症 ,产程中出现羊水粪染的初产妇 136例。1 1 2　对照组　同期随机选择单胎、头位、≥ 37孕周 ,无妊娠合并症 ,产程中羊水清亮的初产妇 12 5例。1…     

新生儿呕吐性疾病的消化道造影研究

目的:研究新生儿呕吐性疾病的造影技术,探讨其影像特征。方法:对比剂引入方式采用吸吮法和插胃管抽液后再注入对比剂两种方法;选用对比剂有6 0 %～80 % (W/V)的硫酸钡混悬液30～4 0ml或30 %泛影葡胺30ml;采用不同体位多轴位观察摄片,并对5 4例造影表现进行分析。结果:5 4例新生儿消化道造影均满足诊断要求,其中先天性幽门狭窄11例(19 6 % ) ,胃食管反流34例(6 3 0 % ) ,环形胰腺9例(16 .7% )。经手术治疗2 0例均与术前X线诊断相一致。结论:传统的上消化道造影是诊断新生儿呕吐病因的有效方法,熟练掌握造影技术和特有的造影征像能够及时地明确诊断。     

窒息新生兔中枢及外周血脑啡肽含量的变化

目的　探讨脑啡肽与新生兔窒息的关系。方法　采用放射免疫测定法测定 2 4只正常新生兔 (对照组 )及 2 6只窒息新生兔 (窒息A组 )中枢及外周血中脑啡肽的含量。将 2 0只孕 3 0d母兔窒息后立即剖宫取出仔兔 ,随机分为 4组 :新生兔窒息未治疗组 (窒息B组 ) ,新生兔窒息ICI17486 4 治疗组 (ICI组 ) ,新生兔窒息脑啡肽抗血清治疗组 (抗血清组 ) ,新生兔窒息兔血清治疗组 (血清组 )。后2组仔兔在分娩后分别脑内注入脑啡肽抗血清 (滴度 1∶60 0 0 )或等量不含抗体的兔血清 ,ICI组按体重静脉注入ICI17486 4 80ng kg。仔兔均于剖宫产后 1、5、10、15及 3 0min进行Apgar评分。结果　①窒息A组新生兔下丘脑、垂体及外周血脑啡肽的含量分别为 (63 5.2± 57.6)、(452 .7± 3 7.5)及 (2 97.6± 2 8.4)ng L ,对照组分别为 (185.7± 2 9.6)、(150 .9± 2 1.4)及 (12 1.5± 19.9)ng L。与对照组相比 ,窒息A组中枢及外周脑啡肽含量均明显升高 (P <0 .0 1及 <0 .0 5)。②抗血清组及ICI组兔Apgar评分明显高于窒息B组及血清组 (P <0 .0 1及 <0 .0 5) ,后两组间差异无显著性 (P >0 .0 5)。结论　脑啡肽与新生兔窒息的发生发展密切相关 ,其不利作用为通过δ受体介导     

MR and CT evaluation of profound neonatal and infantile asphyxia.

PURPOSE: To determine the CT and MR characteristics of the brains of infants who have suffered profound asphyxia and correlate those characteristics with pathophysiologic processes. METHODS: MR and CT scans of 16 patients who suffered profound hypoxic-ischemic injury in the perinatal (12 patients) and postnatal (4 patients) periods were retrospectively reviewed in a search for characteristic imaging features. RESULTS: Injury in the perinatal period: subacute MR showed short T1 and T2 in the ventral lateral thalami, posterolateral lentiform nuclei, posterior mesencephali, and hippocampi; MR 1 to 16 years after injury showed atrophy or T2 prolongation in the aforementioned regions, the lateral geniculate nuclei and perirolandic cerebral cortex. Asphyxia later in infancy: subacute MR showed T2 prolongation in the corpus striatum and most of the cerebral cortex (perirolandic sparing); MR weeks to months later showed atrophy of the aforementioned areas, the lateral geniculate nuclei and hippocampi. Acute CT in both groups showed basal ganglia hypodensity. CONCLUSIONS: The injury patterns observed in neonates and infants with profound hypoxic-ischemic injury vary with the age of the patient at the time of the injury. The change in pattern of damage is suggested to be the result of structural and physiologic changes in the maturing brain. The patterns appear to be consistent and are well demonstrated by MR.     

窒息新生儿肾血流动力学改变与血清胱抑素C的相关性研究

目的探讨窒息新生儿肾血流动力学与血清胱抑素C变化的相关性。方法将新生儿分成轻度窒息组、重度窒息组及对照组。检测肾主动脉的血流动力学参数收缩期峰值流速（Vmax）、舒张末期流速（Vmin）及阻力指数（RI）,检测血清尿素氮（BUN）、肌酐（Cr）及胱抑素C（Cys-C）水平。分析各组间指标的变化及相关性。结果肾主动脉血流动力学参数及Cys-C的异常率高于BUN、Cr的异常率。窒息组Vmax、Vmin与BUN、Cr、Cys-C之间呈负相关关系,RI与BUN、Cr、Cys-C之间呈正相关关系。结论肾主动脉血流动力学参数及Cys-C可用于判定窒息新生儿早期肾损害。     

纳洛酮治疗新生儿缺氧缺血性脑病的临床观察

目的：观察纳洛酮对新生儿缺氧缺血性脑病（ＨＩＥ）的临床疗效。方法：将３２例ＨＩＥ患儿随机分为纳洛酮治疗组（１７例）和对照组（１５例）,并行ＣＴ,ＥＥＧ和临床分度,分别给予纳洛酮０．１ｍｇ．ｋｇ＾－１,ｄ＾－１治疗１周和一般常规治疗。结果：两组平均临床症状消失时间有非常显著差异（Ｐ〈０．０１）,ＥＥＧ好转率也有显著差异（Ｐ〈０．０５）。结论：纳洛酮对ＨＩＥ的疗铲明显高于一般常规治疗,中、重度ＨＩＥ的     

A model for detecting early metabolic changes in neonatal asphyxia by 1H-MRS

In newborn rabbits, the early cerebral metabolic changes caused by hypoxic-ischemic (H-I) insult was examined by using volume localized 1H-MRS (STEAM). Partial ischemia was caused by unilateral carotid artery ligation, and hypoxia was induced by 10% oxygen inspiration for 150 minutes. Lactate immediately increased after hypoxia induction and almost disappeared 120 to 150 minutes after removal of hypoxia in both H-I and hypoxia-only experiments. Lactate production correlated well with decrease of the blood oxygen saturation. More lactate was produced on ischemic side 50 minutes post-hypoxia induction in H-I study. Ischemia alone did not cause any significant lactate production. Lactate caused by hypoxia can be dynamically monitored by localized 1H-MRS. Existence of regional ischemia can induce greater anaerobic glycolysis and may affect the pattern of brain injury under hypoxia. 1H-MRS is a sensitive tool to detect the acute metabolic changes caused by H-I insult.     

Birth asphyxia

The term Birth asphyxia covers a number of clinical and physiological definitions. Birth asphyxia is a relatively common clinical event. In the majority of cases the outcome in terms of brain damage and future development of the child is excellent. However, a small number of children go on to develop patterns of brain damage which are then associated with disability. The article seeks to provide a basic understanding of the various mechanisms involved in producing injury.     

Markers of mechanical asphyxia: immunohistochemical study on autoptic lung tissues

Forensic pathologists are often asked to provide evidence of asphyxia death in the trial and a histological marker of asphyxiation would be of great help. Data from the literature indicate that the reaction of lung tissue cells to asphyxia may be of more interest for forensic purposes than migrating cells. The lungs of 62 medico-legal autopsy cases, 34 acute mechanical asphyxia (AMA), and 28 control cases (CC), were immunostained with anti-P-selectin, anti-E-selectin, anti-SP-A, and anti-HIF1-α antibodies, in order to verify if some of them may be used as markers of asphyxia death. Results show that P- and E-selectins expression in lung vessels, being activated by several types of trigger stimuli not specific to hypoxia, cannot be used as indicator of asphyxia. Intra-alveolar granular deposits of SP-A seem to be related to an intense hypoxic stimulus, and when massively present, they can suggest, together with other elements, a severe hypoxia as the mechanism of death. HIF1-α was expressed in small-, medium-, and large-caliber lung vessels of the vast majority of mechanical asphyxia deaths and CO intoxications, with the number and intensity of positive-stained vessels increasing with the duration of the hypoxia. Although further confirmation studies are required, these preliminary data indicate an interesting potential utility of HIF1-α as a screening test for asphyxia deaths.     

新生儿败血症临床特点及其预后的影响因素

 目的 探讨新生儿败血症临床特点及其预后的相关影响因素。方法 选择深圳市龙华区人民医院2016-01至 2018-06的新生儿败血症147例,采集所有患儿血液标本,分离鉴定病原菌。分析新生儿败血症患儿临床表现和病原菌特点, 采用多因素分析影响新生儿败血症患儿预后危险因素。结果 新生儿败血症患儿147例,临床表现以反应差、面色灰白和呼吸困难为主。147例中培养病原菌106株,以革兰阴性菌为主,分离出59株;其次为革兰阳性菌,分离出43株。所有患儿根据相关感染指标检测及血培养后给予抗菌药物经验治疗,存活组109例,死亡组38例。经单因素分析表明,两组性别、年龄、精神状况、血压、尿量和WBC比较无统计学意义;两组低出生体重儿、早产儿、MODS、PLT和休克评分比较具有统计学意义(P＜0.05)。多因素Logistic回归分析显示,MODS (OR:1.532, 95%CI: 1.089~2.109) PLT( OR:2. 115,95% CI: 1.481~2.897)和休克评分(OR:1.809,95% CI: 1.276~2.468)为影响新生儿败血症患儿预后的独立危险因素。结论 新生儿败血症临床表现以反应差、面色灰白和呼吸困难为主,培养病原菌以革兰阴性菌为主,MODS、PLT和休克评分均是影响新生儿预后的相关危险因素,为改善患儿应采取针对性预防措施,值得临床借鉴。