抗氧化剂治疗新生儿硬肿症疗效观察

应用抗氧化剂维生素E（ⅤE）、维生素C和别嘌呤醇治疗新生儿硬肿症31例，并与同期住院之常规治疗的30例患儿比较，发现其硬肿消退时间及住院日明显缩短（P＜0．05）、肺出血发生率和病死率明显减少（P＜0．01）。疗程结束时，治疗组与对照组比较，血清ⅤE浓度显著增加（P＜0．01），血清脂质过氧化物明显减少（P＜0．05），提示抗氧化剂有助于提高机体抗氧化能力，缩短病程，减少病死率。     

辅以甲状腺激素治疗重度新生儿硬肿症疗效观察

我们通过放射免疫分析法测定45例重度新生儿硬肿症体内甲状腺激素变化。同时在随机对照下观察了甲状腺激素对重度新生儿硬肿症的辅助治疗作用,结果显示治疗组其心率、体温恢复正常时间、硬肿消退时间、病死率均明显优于对照组。提示重度新生儿硬肿症体内甲状腺激素的不足,短期给予甲状腺激素替代治疗,是安全有效的,对于提高重度新生儿硬肿症的抢救成功率具有积极作用,现报告如下。     

中西医结合治疗新生儿硬肿症疗效观察

目的观察中药煎剂浸浴、局部按摩治疗新生儿硬肿症临床疗效。方法将67例有硬肿症的新生儿随机分为观察组和对照组,观察组在静脉应用酚妥拉明、间羟胺治疗的同时,应用中药煎剂浸浴,并按摩硬肿部位。对2组疗效及患儿的体温恢复正常时间、硬肿消退时间及平均住院天数进行对照分析。结果观察组的患儿体温恢复正常时间、硬肿消退时间及住院天数均较对照组缩短,经统计学处理,差异有统计学意义(P<0.01、P<0.05)。结论在静脉用药的同时,应用中药浸浴、局部按摩,可使体温恢复和硬肿消散增快,可明显缩短治疗时间,疗效显著,可推广应用。     

新生儿硬肿症80例临床治疗探讨

新生儿硬肿症８０例临床治疗探讨陈佛清我院自１９９２年２月～１９９３年１１月共收治新生儿硬肿症８０例，治愈７３例，治愈率为９１．３％。分析如下。临床资料：１．一般资料：男４７例，女３３例。发病日：自出生～３天６０例（占７５％），～６天１７例，＞７天３例...     

复方丹参治疗新生儿硬肿症90例疗效观察

复方丹参注射液为临床常用活血化瘀剂，近年来随着对其药理作用研究进展，临床作用日益广泛。本文就其在近几年我院儿科临床收治新生儿硬肿症的应用结合笔者临床实践的体会分析如下。     

新生儿硬肿症出凝血功能的变化及其临床意义

目的探讨不同病情新生儿硬肿症的出凝血功能改变,为合理治疗提供理论依据。方法比较观察组100例和对照组50例5项出凝血指标检测结果。结果观察组不同病情之间比较凝血酶原时间、3P试验、血小板计数和外周血红细胞形态无显著性差异(P均＞0.05);试管法凝血时间比较,有显著性差异(P＜0.05)。观察组与对照组5项指标比较有显著性差异(P＜0.01)。结论新生儿硬肿症存在出凝血功能改变,病情越重改变越明显,越易合并DIC、肺出血,病死率也越高。硬肿症早期血液多呈现高凝状态,晚期多呈现低凝状态。早期肝素治疗,不仅可改变血液的出凝血状态(高凝状态),而且是防治DIC、肺出血,提高治愈率的有效途径。     

新生儿硬肿症治疗进展（讲座）

新生儿硬肿症系指新生儿时期由于多种原因(受寒、早产或感染等)引起的皮肤和皮下脂肪变硬及水肿,常伴有低体温及多脏器功能低下。由受寒引起者称新生儿寒冷损伤综合征。本病是新生儿时 期常见病,迄今尚无特效疗法,现将近年来对其各种治疗进展介绍如下。 一、654-2疗法 王氏等在综合治疗的基础上用654-2,每次2～3mg/kg加入10％葡萄糖液80～100ml中静滴,每日1次,以后根据病情再给每次1mg/kg静注,每日至少1次,最多3次,至硬肿消退为止。用此法治疗27例重度硬肿症,16例治愈,     

Failure of systemic thrombolytic and heparin therapy in the treatment of neonatal aortic thrombosis

An unsuccessful attempt was made to lyse a large aortic thrombus in a newborn using systemic high-dose streptokinase and urokinase therapy and subsequently the use of heparin failed to prevent the propagation of thrombus. The patient was a seven-day old premature, sick neonate in whom an aortic thrombosis developed following umbilical artery catheterization. Surgical thrombectomy could not be performed in this patient, and local thrombolytic therapy was not technically feasible. Systemic thrombolytic therapy failed to induce any noteable clinical or laboratory response, and the use of heparin failed to prevent thrombus extension. Experience with the use of fibrinolytic agents in neonates is limited. Local therapy has been variably effective, and systemic therapy has not been adequately investigated. The thrombotic phenomenon in neonates and the role of umbilical vessel catheterization as a cause are discussed in reference to this patient and suggestions are made regarding the management of similar cases.     

Anticoagulant effects of heparin in neonatal plasma

Available data on the anticoagulant effects of heparin in neonatal plasma are scarce and conflicting: relative to adult plasma, neonatal plasma has been reported to show both resistance as well as sensitivity to heparin. We explored this apparent paradox by comparing how well heparin accelerated inhibition of exogenous thrombin and prevented thrombin generation in defibrinated neonatal and adult plasmas. Using amidolytic assays, we determined the effects of heparin on 1) the neutralization of exogenous human alpha-thrombin and on 2) the formation of endogenous thrombin activity after contact activation and recalcification. Neonatal plasma proved resistant to heparin (0.05 U/mL) during inhibition of added thrombin (15 NIH U/mL). Inhibition of thrombin in heparinized neonatal plasma became as efficient as in adult plasma only after raising the AT III activity to normal adult values. However, de novo generation of thrombin activity was very susceptible to inhibition by heparin, even in neonatal plasmas with physiologically low AT III levels. Peak thrombin activity generated in neonatal plasma in the absence of heparin was 50% or less of peak adult activity, and this already reduced ability of neonatal plasma to generate thrombin activity upon prothrombin activation was further decreased by heparin (0.05-0.2 U/mL). We conclude that due to the neonatal AT III deficiency, added thrombin is inactivated less effectively by heparin in neonatal than in normal adult plasma. Yet, the generation of thrombin activity is impaired in neonatal plasma and easily suppressed by heparin. We speculate that newborn infants may be resistant to heparin therapy during overt thrombotic disease, when neutralization of abnormal thrombin activity is the therapeutic goal.(ABSTRACT TRUNCATED AT 250 WORDS)     

静脉营养在新生儿疾病中的应用

目的 探讨静脉营养在危重新生儿及早产儿治疗中的应用价值。方法 通过外周静脉供给危重新生儿及早产儿完全或部分静脉营养,并监测硬肿的发生率、体重、血糖。结果硬肿的发生率由28.3%下降为9.4%,差异有显著性意义(P<0.01)。体重平均生后6 d开始增长,最多35 g/d,最少10 g/d。结论 静脉营养可减少危重新生儿的并发症,提高早产儿的生存质量。     

Follow-up results of neonatal renal vein thrombosis after heparin treatment (author's transl)]

The authors report on their experiences gained during follow-up studies in 3 children, who as neonates had had renal venous thrombosis, and had been treated with heparin. On the basis of the relevant literature and their own observations, the authors suggest heparinisation during the acute stage.     

The low molecular weight heparin dalteparin for prophylaxis and therapy of thrombosis in childhood: a report on 48 cases

We investigated the efficacy, safety and relation of dose to plasma anti-Xa activity of the low molecular weight heparin (LMWH) dalteparin in prophylaxis and therapy of arterial and venous thrombosis in pediatric patients. A total of 48 children were enrolled: 10 received dalteparin for prophylaxis (group I), 8 for reocclusion prophylaxis following successful thrombolysis (group II), 5 following failed thrombolysis (group III) and 23 for primary antithrombotic therapy (group IV). Two children were treated with dalteparin for pulmonary veno-occlusive disease (PVOD) and for primary pulmonary hypertension (PPH), respectively. Outcome: In group I no thrombo-embolic event occurred. In group II recanalization was maintained or improved, in group III vascular occlusion persisted under dalteparin. In group IV we saw complete recanalization in 7/23 (30%), partial recanalization in 7/23 (30%) and no recanalization in 9/23 (40%) cases. The child with PVOD had recanalization proven by lung biopsy; the clinical condition of the child with PPH also improved. Minor bleeding occurred in 2/48 (4%) children. For prophylaxis 95 - 52 (mean and SD) anti-Xa IU/kg BW, for therapy 129 - 43 (mean and SD) anti-Xa IU/kg BW proved effective. For both prophylaxis and therapy the required dose per kg BW was inversely related with age (r² = 0.64, P = 0.017; r² = 0.13, P = 0.013). Conclusion Dalteparin proved to be an effective and well tolerated drug for prophylaxis and therapy of thrombosis in pediatric patients. Dose requirement for effective treatment was higher in younger children and decreased with age.     

新生儿肺出血193例诊治探讨

为了探讨新生儿肺出血的诊治线索,回顾性分析 193例患儿临床资料.将患儿分 3组甲组 162例 (尸检证实,根据口鼻腔无或有流血又分Ⅰ组 68例,Ⅱ组 94例 ),乙组 16例应用呼吸机治疗,丙组为改进治疗措施后的 15例.诊断及结果判断标准根据发病的高危因素、临床特点、插管吸出血性液体及胸片表现.治疗予气管内滴入 1 10000肾上腺素或立止血.呼吸机参数平均为 I/E 1∶ 1.2, FiO2 0.8± 0.2, PIP 23.5± 5.2 cmH2O, PEEP4.1± 0.6 cmH2O,RR 55.2± 10.5次 /分,流量 8L/分.结果青紫、体温不升、惊厥、神志不清Ⅰ组高于Ⅱ组,而黄疸、心律失常、肺部罗音Ⅱ组高于Ⅰ组.乙丙 2组的治愈、病死率各为 43.8%、 100%及 56.2%、 0% (P均 <0.01);合并症各为 8、 3例.提示加强肺、心、肾、脑、循环功能的监测与防治,可提高治愈率.     

Systemic scleroderma in children. Apropos of 2 cases

Two cases of systemic scleroderma in girls are reported. One patient, aged 11 years, has systemic scleroderma with Raynaud's phenomenon, and pulmonary involvement. The other, aged 8 years, has systemic scleroderma with lung involvement. The specific features of pediatric systemic scleroderma are reviewed briefly.