脐带血血气分析与乳酸值对围产期窒息的诊断价值探讨

目的探讨脐带血血气分析及乳酸值对围产期窒息的诊断价值。方法对63例足月窒息新生儿与89例足月正常新生儿的脐动脉血进行微量血气分析及乳酸测定,并在出生后第1、7、14、28d进行新生儿20项神经行为测定(NBNA)。结果窒息组与对照组的脐动脉血乳酸、pH值、BE差异有显著性,血乳酸与第1、7d的NBNA呈显著负相关,pH与第1d的NBNA呈正相关,BE与NBNA无明显相关性。结论窒息新生儿脐血乳酸水平高于对照组、pH值低于对照组,可作为围产期窒息诊断的指标,且乳酸值特异性优于pH值。     

脐带血血气分析与乳酸值对围产期窒息的诊断价值探讨

目的探讨脐带血血气分析及乳酸值对围产期窒息的诊断价值。方法对63例足月窒息新生儿与89例足月正常新生儿的脐动脉血进行微量血气分析及乳酸测定，并在出生后第1、7、14、28d进行新生儿20项神经行为测定（NBNA）。结果窒息组与对照组的脐动脉血乳酸、pH值、BE差异有显著性，血乳酸与第1、7d的NBNA呈显著负相关，pH与第1d的NBNA呈正相关，BE与NBNA无明显相关性。结论窒息新生儿脐血乳酸水平高于对照组、pH值低于对照组，可作为围产期窒息诊断的指标，且乳酸值特异性优于pH值。     

母婴体肤接触保暖对新生儿体温的影响

应用随机对照的方法，对新生儿娩出后“袋鼠式”母婴体肤接触方法进行了观察。观察组１２例，对照组１３例，两组平均体重无著差别。结果显示观察组新体温变动在１℃之内，与对照组无显著差别，同时，还观察了该方法对母乳喂养态度的影响。本文提出应用母婴体肤接触的方法对初生儿体温的恒定，保暖以及母乳喂养都是有利的。     

不同温度对新生儿油浴后体温的影响

为了有效防止新生儿油浴护理后体温不升 ,提高新生儿适应环境的能力 ,我科对 3 1 5例足月新生儿进行随机分组 ,在不同温度下对新生儿进行油浴护理 ,取得了满意的效果。现报告如下 :对象与方法一、资料来源1 998年 1 1月～ 1 999年 1月在我科分娩的足月新生儿 3 1 5例 ,两组新生儿出生时Ａｐｇａｒ评分平均为 1分钟 8分 ,5分钟 1 0分 ,体重3 1 50± 450ｇ。随机分为Ａ组 (观察组 ) 80例 ,Ｂ组 (对照组 ) 2 53例。均在出生 6小时对新生儿进行皮肤油浴护理 ,时间不超过 1 0分钟。二、设备及油浴护理用品ＦＸＱ3型辐射式抢救台 ,简称辐射台 ;热…     

不同温度对新生儿油浴后体温的影响

为了有效防止新生儿油浴护理后体温不升,提高新生儿适应环境的能力,我科对315例足月新生儿进行随机分组,在不同温度下对新生儿进行油浴护理,取得了满意的效果.现报告如下:对象与方法一、资料来源1998年11月～1999年1月在我科分娩的足月新生儿315例,两组新生儿出生时Apgar评分平均为1分钟8分,5分钟10分,体重3 150±450g.随机分为A组(观察组)80例,B组(对照组)253例.均在出生6小时对新生儿进行皮肤油浴护理,时间不超过10分钟.     

早产儿出生后黄金小时体温集束化管理对入院体温及临床结局的影响

目的 探讨 < 34周早产儿出生后黄金小时体温集束化管理策略对入院体温及临床结局的影响。方法 纳入2015年12月至2016年6月及2017年1~5月在四川大学华西第二医院产房出生后1 h内转入该院新生儿科的早产儿为研究对象,其中2017年1~5月收治的早产儿为干预组（173例）,采用黄金小时体温集束化管理措施;2015年12月至2016年6月收治的早产儿为对照组（164例）,采用常规的体温管理方法。结果 干预组患儿入院平均体温高于对照组（36.4±0.4℃ vs 35.3±0.6℃,P < 0.001）。干预组入院低体温发生率低于对照组（56.6% vs 97.6%,P < 0.001）。干预组患儿入院1周内颅内出血发生率低于对照组（15.0% vs 31.7%,P < 0.05）。结论 对早产儿出生后1 h内实施黄金小时体温集束化管理,可降低其入院低体温的发生,改善临床结局。     

影响脐血IgE值因素的研究

目的　本研究对影响脐血IgE值的可疑因素进行分析 ,探讨影响儿童食物过敏的可疑因素。方法　选取孕期妇女 10 5名及其所生婴儿 ,采用标准问卷调查获取资料 ,对影响脐血IgE的因素进行分析。 结果　母亲的过敏性疾病史、父亲过敏性疾病史中的皮炎表现型、孕期妇女过敏性疾病发作史、有过敏史妇女孕后期摄入过量的牛奶和鸡蛋均与脐血IgE值的上升有关 ,且上述 5个因素对脐血IgE水平的影响依次降低。 结论　母亲的过敏性疾病史和父亲过敏性疾病史中的皮炎表现型是导致新生儿脐血IgE值升高的主要危险因素 ;同时 ,妊娠期加强对有过敏史妇女的保护 ,防止过敏性疾病的复发 ,在孕后期控制有过敏史妇女牛奶、鸡蛋等大分子食物致敏原的摄入 ,有助于降低脐血IgE值。     

两种不同深度鼻导管吸氧方式对血气影响的比较

鼻导管吸氧是临床上使用最广泛、最简单易行的给氧方法。国内过去一直采用鼻后孔吸氧法,近年来逐渐被鼻前庭吸氧所代替,而国外仍一直主张以鼻后孔吸氧,认为鼻前庭吸氧达不到鼻后孔吸氧的效果。为进     

鼻塞式CPAP对新生儿呼吸衰竭血气与血清CK-MB活性的影响

目的　探讨鼻塞式持续呼吸道正压 (CPAP)对新生儿呼吸衰竭的血气与血清肌酸激酶心型同工酶 (CK MB)活性的影响 ,以评价CPAP的临床应用价值。方法　对 4 5例呼吸衰竭新生儿采用鼻塞式CPAP给氧治疗 ,观察治疗后 1h血气改善及临床疗效情况和治疗 5d后血清CK MB活性变化。并与 4 0例头罩给氧的对照组比较。结果　治疗组CPAP后PaO2 和SaO2 较CPAP前明显升高 (P <0 0 1) ,pH和PaCO2 无明显变化 (P >0 0 5 )。氧疗前后PaO2 和SaO2 升高值治疗组较大 ,二组比较有显著差异 (P均 <0 0 5 ) ,pH升高值和PaCO2 下降值二组无显著性差异 (P均 >0 0 5 ) ,血清CK MB下降值治疗组较大 ,二组具有非常显著性差异 (P <0 0 1) ,且治疗组总有效率、存活率分别为 86 7%、88 9% ,明显高于对照组 5 5 %、6 7 5 % (P <0 0 1,0 0 5 )。结论　鼻塞式CPAP是治疗新生儿呼吸衰竭的有效方法 ,既能纠正严重低氧血症 ,又能减轻缺氧缺血性心脏损害 (HIM) ,对改善预后有益     

The influence of different environmental temperatures on pulmonary gas exchange and blood gas changes after birth.

The oxygen uptake (VO2) and respiratory exchange ratio (R) was determined during the first 20 min and at one and at 2 hours after birth in 16 healthy full-term newborn infants studied in different environmental temperatures. Arterial blood gases and acid-base balance were determined on repeated blood samples from the abdominal aorta. The infants were grouped in a "warm" group (n equal to 10) where efforts were made to avoid cooling after birth, and a "cold" group (n equal to 6) where a decrease in rectal temperature to a mean value of 35.4 degrees C at 2 hours occurred. Irrespective of environmental temperature, VO2 was approximately 10 ml/kg min during the first 8 min after birth, thereafter decreasing to about 6-7 ml/kg min. During the first 8 min the main increase in PaO2 occurred and about 2 ml/kg min of the VO2 was accounted for by changes in oxygen stores after birth. At 16-20 min and at 60 min after birth a negative relationship was found between VO2 and PaO2. During the period 8-120 min after birth a close relationship was found between VO2 and the degree of muscular activity. Within 4-16 min after birth, R values above 1.0 were regularly found simultaneously with the main decrease in PaO2. In infants kept "cold" a tendency to hyperventilate was found, probably elicited by cold stimuli. The rapid drop in deep body temperature regularly seen after birth could thus not be explained by a limited ability to increase pulmonary gas exchange. A high degree of evaporative heat loss, a relatively low "basal" metabolic rate and a limited response in "non-shivering thermogenesis" seem to be the main reasons for the heat loss after birth.     

The influence of body composition on youth throwing kinetics

The primary objective of this study was to investigate the influence of segmental mass and body composition on the upper extremity biomechanics of overweight youth participating in baseball activities. The study used a regression framework to investigate the relationship between whole body, throwing arm segmental mass and body composition measures to kinetic variables about the shoulder and elbow. The multivariate regression results indicated a strong positive significant relationship between each of the mass variables to that of the moment variables about the shoulder and elbow. Participants who had a greater percentage of fat mass produced greater injury correlated moments about the shoulder and elbow.     

��Ѫ��������Ũ�������������߹��ܵ������

目的探讨脐血瘦素(leptin)质量浓度与新生儿免疫功能的关系及其可能的免疫调控机制。方法2003年3~10月河北医科大学第四医院儿科对正常分娩的早产儿30例、足月儿60例,分别采用放射免疫分析(RIA)、免疫透射比浊法及流式细胞术(FCM)检测脐血leptin、粒细胞-巨噬细胞集落刺激因子(GM-CSF)、IgG、IgA、IgM、补体(C3、C4)、白细胞介素-4(IL-4)、γ-干扰素(IFN-γ)质量浓度及bcl-2蛋白表达量、T淋巴细胞亚群、淋巴细胞凋亡率。结果脐血leptin质量浓度与IgG(r=0·630,P<0·01)、C3(r=0·340,P<0·01)、C4(r=0·253,P<0·05)、CD4+T淋巴细胞百分率(r=0·295,P<0·05)、CD8+T淋巴细胞百分率(r=0·377,P<0·01)及IFN-γ质量浓度(r=0·323,P<0·05)、GM-CSF质量浓度(r=0·236,P<0·05)、bcl-2蛋白表达量(r=0·318,P<0·05)均呈正相关,与IL-4质量浓度(r=-0·277,P<0·05)、淋巴细胞凋亡率(r=-0·532,P<0·01)呈负相关,而与IgA、IgM无显著相关(均P>0·05)。结论脐血leptin质量浓度与新生儿免疫功能密切相关,leptin具有增强新生儿细胞免疫功能的作用,而对体液免疫功能影响较小。leptin可上调bcl-2蛋白表达和GM-CSF质量浓度,抑制淋巴细胞的凋亡,此作用可能是leptin免疫调节作用的重要机制。     

The effects of bedside blood gas monitoring on blood loss and ventilator management

INTRODUCTION: We examined whether the bedside SensiCath Blood Gas Monitoring System could reduce both blood loss and the time needed to make ventilator-setting changes in a population of very low birth weight (VLBW; <1,500 g) infants. MATERIAL AND METHODS: A prospective, group sample trial was conducted on ventilator-dependent newly born VLBW infants. The trial was unblinded due to the nature of the device and parental consent was obtained before study enrollment. A total of 44 patients were studied. RESULTS: There was no difference (mean +/- SD) between the SensiCath group and controls with respect to birth weight, gestational age, pH, PCO(2), PO(2) or Apgar at 5 min (median 6, both groups). The amount of blood loss for arterial blood gas (ABG) measurement alone was less in the SensiCath group compared to the control group (1.2 +/- 0 ml vs. 6.7 +/- 2.4 ml, p < 0.001) and the total blood loss was also less in the SensiCath group (8.1 +/- 5 ml vs. 10.5 +/- 6.3 ml, p < 0.001), but there was no significant difference between each group in the amount of blood transfused. The time to obtain ABG results and to make a ventilator change was shorter in the SensiCath group compared to control (2 +/- 0 vs. 26 +/- 21 min, p < 0.001). DISCUSSION: Use of the modified SensiCath monitoring system permits near zero blood loss for ABG assessment and greatly reduces the time needed to make ventilator management decisions.     

The influence of some perinatal variables on neonatal blood pressure

Adult hypertension has been linked to fetal growth. This study investigates whether this link is evident in the newborn. We measured blood pressure by oscillometry in 248 healthy neonates on day 3/4 of life. Antenatal data and neonatal measurements were obtained from hospital records. Elevated neonatal blood pressure correlated with higher birthweight. There was no correlation between placental weight and blood pressure. Babies born by caesarean section had lower systolic blood pressure. Babies of maternal smokers had higher diastolic blood pressure, but their mothers (45% of this study) had lower blood pressure than non-smokers. Thus, smoking was associated with a significant change in both maternal and neonatal blood pressure, and may be an important influence on the developing cardiovascular system.     

The influence of blood transfusion on brain blood flow autoregulation among stable preterm infants

Prior to and 24 h following blood transfusion serial determinations of both cerebral artery flow velocity waveforms and mean arterial blood pressure have been used to reconstruct the autoregulatory curve and its upper blood pressure limit among five stable preterm infants. Prior to transfusion the autoregulatory range of cerebral blood flow (CBF) was narrow due to a relatively low-set upper blood pressure limit. At 24 h after transfusion each individual has been re-examined. Following correction of anemia both a significant reduction of CBF velocities as well as a concomitant rise of the Pulsatility Index (PI) occurred over the entire range of blood pressures indicating a reduction of CBF after transfusion. In addition a right-sided shift of the upper limit towards higher mean blood pressures occurred after transfusion and resulted in an extension of the autoregulatory plateau of CBF. These favourable effects of blood transfusion ameliorating autoregulation of brain blood flow particularly at higher blood pressures might well bear important therapeutic perspectives in our effort to prevent intracranial haemorrhage among sick preterm infants.     

Comparative study of body temperature measured with a non-contact infrared thermometer versus conventional devices. The first Italian study on 90 pediatric patients

AIM: The aim of this study was to evaluate the reliability of measuring body temperature with an infrared non contact thermometer versus conventional devices in infants and children. METHODS: A total of 90 pediatric patients, comprising inpatients and ambulatory patients, examined at the Second Children's Clinic of the University of Milan were recruited and divided by age into 3 groups (<1 year, 1-5 years, >5 years of age). The body temperature of each patient was measured using the study device at three sites (forehead, navel, axilla) and three other commercially available thermometers. Correlation between the measurements was tested with linear regression analysis. RESULTS: The correlation between the measurements was statistically significant; the temperature measured at the three body sites (forehead, navel, axilla) were comparable with those taken with the other thermometers in a statistically significant way. CONCLUSION: The noncontact Thermofocus infrared thermometer can measure body temperature accurately and reproducibly at various body sites. Thanks to its technology, the device can measure body temperature quickly and noninvasively, an essential feature in pediatric practice.