不同胎龄新生儿心电图中 RV_1、TV_1 振幅特点的研究

目的观察不同胎龄新生儿心电图中RV1、TV1振幅的特点,为新生儿心电图诊断提供科学依据。方法不同胎龄新生儿共142例,按胎龄分组,28～30周组、～33周组、～36周组、～40周组四组。测量RV1、TV1振幅。结果不同胎龄新生儿RV1振幅、TV1振幅各组间比较,差异均有统计学意义,且早产儿各组与足月儿组RV1振幅、TV1振幅比较差异均有统计学意义;RV1振幅、TV1振幅随胎龄增长而增高。结论不同胎龄新生儿RV1、TV1振幅不同,随胎龄增长而增高。     

心电图T波振幅与儿童扩张性心肌病左室射血分数的关系

目的 探讨心电图T波振幅与儿童扩张性心肌病左室射血分数（LVEF）的关系。方法 回顾性分析2009年5月至2018年6月诊断为扩张性心肌病的44例儿童的临床资料。根据LVEF分为LVEF ≥ 50%组（n=26）和LVEF<50%组（n=18）,且对治疗后25例进行3~42个月（平均14±9个月）的随访。采用广东中山SR-1000A心电综合自动分析仪描记仰卧位12导联体表心电图,程序自动分析结合人工干预测量12导联心电图T波振幅。结果 （1）T波振幅比较：LVEF<50%组较LVEF ≥ 50%组Ⅱ、V₄、V₅、V₆导联T波振幅明显降低（P < 0.05）。LVEF增高组（治疗后较治疗前LVEF增加>5%）治疗后aVR、V₅、V₆导联T波振幅明显增高（P < 0.05）;LVEF不变组（治疗后较治疗前LVEF增加≤ 5%）治疗后aVR导联T波振幅明显降低（P < 0.05）。（2）受试者工作特征曲线评价：Ⅱ、V₄、V₅、V₆导联T波振幅对扩张性心肌病患儿LVEF<50%具有预测价值（P < 0.05）。当同时出现Ⅱ导联T波振幅≤ 0.20 mV、V₄导联T波振幅≤ 0.40 mV、V₅导联T波振幅≤ 0.3 mV、V₆导联T波振幅≤ 0.30 mV时,预测扩张性心肌病患儿LVEF<50%的灵敏度为88.2%,特异度为76.0%。结论 心电图T波振幅可作为评估儿童扩张性心肌病左室收缩功能的指标。     

不同胎龄新生儿心电图心率及各时限特点的研究

目的 观察不同胎龄新生儿心率、P-R、QRS问期及经心率校正后的QT间期(QTLc)的特点,为新生儿心电图诊断提供科学依据.方法 不同胎龄新生儿共142例,按胎龄分为:28～30周组、31～33周组、34～36周组、37～40周组.测量心率、P-R、QRS时限及QTLc.结果 不同胎龄新生儿心率随胎龄增长而减慢,P-R间期相应延长,各组间比较差异有非常显著性(P＜0.01);不同胎龄新生儿QRS间期及QTLc无明显变化.结论 不同胎龄新生儿心率及P-R间期变化与胎龄相关,而QRS间期及QTLc与胎龄无明显相关.     

不明原因胸闷痛静息期儿童卧位与立位心电图T波及ST段振幅变化的临床意义

目的 探讨不明原因胸闷痛儿童静息期卧位与立位心电图T波及ST段振幅变化的临床意义。方法 选取以不明原因胸闷痛(静息期)为主诉的6~14岁儿童122例行直立倾斜试验(HUTT),分HUTT阳性组(n=61)和HUTT阴性组(n=61)。测量卧位与立位12导联心电图的心率及Ⅱ、Ⅲ、aVF、V5导联T波和ST段振幅。结果 (1)HUTT阴性组:立位较卧位心率增快(P<0.05),Ⅱ、Ⅲ、aVF、V5导联T波振幅降低(P<0.05);Ⅱ、aVF、V5导联ST段振幅增加(P<0.05)。(2)HUTT阳性组:立位较卧位心率增加(P<0.05),Ⅱ、Ⅲ、aVF、V5导联T波振幅降低(P<0.05);V5导联ST段振幅增加(P<0.05)。(3)T波振幅及ST段振幅变化:立位与卧位心电图Ⅱ、Ⅲ、aVF、V5导联T波及ST段振幅在HUTT阳性组、HUTT阴性组之间差异无统计学意义(P>0.05)。(4)卧位与立位心电图T波和ST段振幅差比较:HUTT阳性组卧位与立位心电图Ⅱ、Ⅲ、aVF、V5导联T波振幅差及心率差较HUTT阴性组增加(P<0.05)。结论 不明原因胸闷痛静息期儿童HUTT阳性组卧位与立位心电图T波振幅差及心率差较HUTT阴性组增加,表明卧位与立位心电图T波振幅变化对提示自主神经功能紊乱具有临床价值。     

直立性高血压儿童卧位、立位心电图T波和ST段振幅变化及其临床意义

目的 探讨直立性高血压（OHT）儿童卧位与立位心电图T波和ST段振幅变化及其临床意义。方法 选取确诊为OHT患儿49例为OHT组，同期按年龄与性别匹配43例健康儿童为对照组。测量两组卧位与立位12导联心电图心率、各导联T波和ST段振幅，比较同组卧位和立位T波振幅、ST段振幅，并比较两组卧位、立位T波振幅差和ST段振幅差。结果 对照组aVR、V₁、V₄~V₆导联T波振幅立位较卧位降低（P < 0.05），V₄、V₅导联ST段振幅立位较卧位增加（P < 0.05）。OHT组Ⅱ、aVR、aVF、V₄~V₆导联T波振幅立位较卧位降低（P < 0.05），Ⅱ导联ST段振幅立位较卧位增加（P < 0.05）。OHT组Ⅱ、V₆导联立位、卧位T波振幅差较对照组增大（均P < 0.05）。V₆导联卧位、立位T波振幅差对OHT有诊断价值（P < 0.05），V₆导联T波振幅差最佳截断值为0.105 mV，灵敏度为72.10%，特异度为57.10%。结论 V₆导联卧位、立位T波振幅差对OHT儿童具有一定的诊断价值。     

依那普利减轻肾小球硬化及与肾小球细胞凋亡的关系

目的进一步探讨血管紧张素转化酶抑制剂减轻肾小球硬化的机理.方法8～10周雄性SD大鼠72只,随机分为干预组、模型组和对照组,各24只.于实验第1天、第21天分别对干预组、模型组大鼠注射阿霉素2mg/kg,对照组注射等量生理盐水.第2次注药后干预组大鼠的饮用水加入依那普利50mg/L.第2次注药后4周、12周、20周、28周分别杀取各组4只大鼠,取肾组织行病理检测,并用末端标记法及电镜检测肾组织细胞凋亡情况.计算不同组别大鼠不同时期的肾小球硬化指数(GSI)、肾小球细胞凋亡指数(GAI),用中位数及范围表示.结果在20周后,干预组和模型组大鼠肾小球出现硬化,肾小球细胞凋亡频率也显著增加,但干预组大鼠20周和28周GSI[分别为0.10(0.07～0.10)和0.35(0.20～0.50)]较模型组大鼠GSI[分别为0.22(0.07～0.33)和0.62(0.37～0.77)]小,在20周时差异有显著性,(P＜0.05).干预组大鼠20周和28周GAI[分别为0.05(0～0.10)和0.10(0.05～0.10)]较模型组大鼠GAI[分别为0.20(0.10～0.25)和0.20(0.15～0.35)]小,差异均有显著性,P均＜0.05.两组大鼠GSI与GAI间有显著性相关(模型组rs=0.831,干预组rs=0.761,P＜0.01).结论大鼠阿霉素肾病肾小球硬化时,肾小球细胞凋亡增加;依那普利干预可减轻肾小球硬化,肾小球细胞凋亡也减少;其减轻肾小球硬化可能与肾小球细胞凋亡减少有关.     

β受体功能亢进症儿童立位与卧位同步12导联心电图T波及ST段变化的意义

目的 探讨β受体功能亢进症儿童立位与卧位同步12导联心电图(12 ECG)T波及ST段变化的意义.方法 β受体功能亢进症儿童(研究组)53例.男13例,女40例;年龄3.5～18.0(8.77±2.99)岁.广东中山SR-1000A心电综合自动分析仪描记卧位及立位12 ECG.匹配健康儿童40例为健康对照组.计算立位与卧位心率差及T波、ST段振幅及形态变化.采用SPSS 11.0软件进行统计学分析.结果 1.研究组发病年龄高峰为7～11岁.男女比例约为13.2.研究组立位较卧位心率增加幅度显著高于健康对照组[(17.96±10.16)次/min vs(9.67± 6.97)次/min P<0.01].3.T波形态:研究组立位与卧位比较,T波振幅降低主要在Ⅱ、V3、V4、V5、V6导联,T波倒置主要在Ⅲ、aVF导联,T波倒置且振幅增加主要在Ⅲ、V1、V2导联,卧位时T波倒置变为立位时T波直立出现在V1、V2导联.4.T波振幅:研究组立位较卧位T波振幅下降幅度在V1导联大于健康对照组(P<0.05),在V2导联显著大于健康对照组(P<0.01).5.ST段振幅:立位较卧位变化在研究组及健康对照组间无统计学差异(P>0.05).结论 儿童β受体功能亢进症发病年龄高峰在学龄期,尤以女性多见,心率明显增加,立位和卧位心电图T波形态和振幅变化明显.     

新生儿及新生儿疾病

510010 新生儿4713例出生胎龄与体重汪应富等重庆医药14(1,2):22～23,1985 观察新生儿出生胎龄与体重关系表明:新生儿出生体重均值,男婴较女婴、胎龄大较胎龄小者,总的看来均高,差异非常显著。出生体重的百分位数及出生体重均值递增(减)龄比值显示胎龄33～36～周的体重增长最为迅速,37～41～周时体重增长渐次减缓或不大,42～44～周时则体重不增或反而     

12导联同步体表心电图T波振幅对扩张型心肌病的评价

目的评价12导联同步体表心电图(12 ECGs)T波振幅在儿童扩张型心肌病(DCM)诊断和治疗中的价值。方法DCM患儿27例为研究组。男14例,女13例;年龄3个月~14岁,平均5.37岁。随机匹配健康儿童27例为对照组。受检对象描记12 ECGs,测量波形清晰12导联T波振幅。其中10例DCM患儿经氢氯噻嗪、依那普利、美托洛尔、螺内酯等综合治疗后随访5~39 d,平均19.67 d。结果研究组较对照组T波振幅在Ⅰ、Ⅱ、aVR、aVL、aVF、V4、V5、V6导联明显降低(P均<0.05),Ⅲ、V2、V3导联稍降低(P均>0.05),V1导联T波振幅增高(P<0.05)。DCM患儿治疗后较治疗前T波振幅在Ⅲ、aVF导联明显增高(P<0.05),Ⅱ、aVR、aVF、V5导联稍增高(P均>0.05),Ⅰa、VL、V1~V4、V6导联稍降低(P均>0.05)。结论动态观察12 ECGs的T波振幅,对儿童DCM诊断和评价疗效具有客观指导价值。     

儿童保健

911299 我国不同胎龄新生儿体格发育的现状/中国15城市新生儿体格发育科研协作组∥临床儿科杂志。-1991,9(2)。-72～77 1986～1987年对北方七个城市及南方八个城市的43个医疗保健单位分娩的单胎活产新生儿六项指标(体重,身长、顶臀长、头围、胸围、上臂围)进行调查研究。体重的测量于生后1小时内完成,其余五项指标于生后24～48小时内完成。结果表明,从孕32～41周六项指标均值随胎龄的增加而增加,各胎龄间的均值,其差异均有显著性(P<0.01),六项生长发育指标在宫内每周增长的速率大多数在30、31及34周时明显加快,从34周以后增长速率渐缓,至43～44周,还可出现负值,不同身长的新生儿出生体重值不能反映胎龄与生长的关系。文中将六项指标的百分位数修匀值予以公布,在衡量我国不同胎龄新生儿体格发育六项指标时,可主要参用本文数据。图3表8参8(沈宗熹)     

Serial electrocardiographic changes in healthy and stressed neonates.

Serial changes in T-wave vector and polarity were assessed in 162 electrocardiograms, 117 from 44 healthy term neonates and 45 from 17 stressed neonates. Records were taken at 5 to 8 hours, 24 to 33 hours, and 71 to 96 hours after birth. Sequential changes in both T-wave amplitude and frontal and horizontal axes were found in both groups. A lag period was noted between healthy and stressed infants when comparing changes in T-wave amplitude, with greater flattening of T-waves for longer periods of time after birth in the stressed group. The normal changes in T-wave axis over time in the horizontal and frontal planes showed a similar lag in the stressed group. Alterations of T-wave amplitude and axis alone may be markers of myocardial ischaemia in neonates but are only reliable signs after the first 24 hours of life.     

Neonatal screening and long-term follow-up of phenylketonuria: the French database

Skin conductance shows the emotional state, as reflected in changes in the sympathetic nervous system. Skin conductance changes (number and amplitude of the waves, as well as mean skin conductance level) were measured in connection with heel prick from 29 weeks gestational age. The purposes of this study were to examine the development of emotional sweating in preterm infants, and to correlate the changes in emotional sweating with the changes in behavioural state.Fifty infants' behavioural state and skin conductance changes were measured for 2 min before, 2 min during, and 2 min after heel prick. Half of the infants were between 29 and 31 weeks gestational age. They were divided into three sub-groups; 0-10, 11-20 and 21-30 days postnatal age. The other half of the infants were between 32 and 34 weeks gestational age and they were divided into three similar sub-groups. They changed their behavioural state 114 times.Infants from 29 weeks gestational age and more than 10 days old showed emotional sweating as measured by the number and amplitude of the waves that were lowest in sleep and highest during crying (p<0.05). The mean skin conductance level mirrored the behavioural state from 34 weeks gestational age (p<0.05).To conclude, skin conductance changes increased with the level of behavioural state from 29 weeks gestational age and more than 10 days postnatal age.     

胎龄<32周早产儿中重度支气管肺发育不良危险因素的多中心回顾性分析

目的 分析胎龄<32周早产儿中重度支气管肺发育不良（bronchopulmonary dysplasia,BPD）的危险因素。 方法 回顾性收集2019年1月1日至2020年12月31日江苏省新生儿围产期协作网17家单位新生儿重症监护室收治的胎龄<32周且住院时间≥28 d诊断为BPD早产儿的临床资料,依据胎龄和BPD严重程度分组,采用多因素logistic回归分析不同胎龄段发生中重度BPD的危险因素。 结果 2年间17家协作单位新生儿重症监护室收治的胎龄<32周早产儿共2 603例,诊断BPD的961例,BPD发生率为36.92%（961/2 603）,中重度发生率为8.64%（225/2 603）,24⁺⁰~25⁺⁶周早产儿中重度BPD发生率为56.5%（26/46）,26⁺⁰~27⁺⁶周早产儿中重度BPD发生率为31.0%（66/213）,28⁺⁰~29⁺⁶周早产儿中重度BPD发生率为16.9%（75/445）,30⁺⁰~31⁺⁶周早产儿中重度BPD发生率为22.6%（58/257）。多因素logistic回归分析显示,各胎龄段早产儿中重度BPD危险因素不尽相同：24⁺⁰~25⁺⁶周为需治疗的动脉导管未闭;26⁺⁰~27⁺⁶周为胎膜早破≥18 h、复苏正压通气、临床败血症、机械通气时间≥14 d;28⁺⁰~29⁺⁶周为机械通气时间≥14 d、新生儿肺炎、需治疗的动脉导管未闭;30⁺⁰~31⁺⁶周为复苏正压通气、新生儿肺炎、早产儿贫血（均P<0.05）。 结论 胎龄<32周早产儿中重度BPD是多种因素共同作用的结果,并且每个胎龄段存在不尽相同的高危因素,对不同胎龄段提前采取有针对性举措,将有助于减轻BPD严重程度。     

HIGH DENSITY LIPOPROTEIN CONCENTRATIONS IN NEWBORN INFANTS

Abstract The lipoprotein pattern was analyzed by agarose gel electrophoresis in 19 newborn infants of varying gestational age. The HDL concentration was determined by rocket Immunoelectrophoresis in another 41 newborn infants. Infants with a gestational age of <33 weeks had very low HDL concentrations compared to preterm infants with a gestational age of 33 weeks and term infants. In the first 5–10 days after birth the HDL concentration increased markedly in preterm infants (gestational age <37 weeks) whereas it remained unchanged in term infants.     

Cardiac effects of a single course of antenatal betamethasone in preterm infants

AIM: To show the effects of a single course of antenatal betamethasone on cardiac measurements and systolic functions in premature newborn infants. METHODS: Seventy six newborn infants with a gestational age of 25-33 weeks were included in the study. They were first classified according to their gestational age: 25-29 weeks (n = 28) and 30-33 weeks (n = 48). They were then reclassified as betamethasone positive (mother received one course of betamethasone) or betamethasone negative (mother did not receive any antenatal glucocorticoid treatment). Cross sectional M mode echocardiographic scans were performed during the first three postnatal days and at the end of the first and third weeks. Left interventricular septum (IVS), left ventricular posterior wall (LVPW), left ventricular end diastolic (LVED), and left ventricular end systolic (LVES) dimensions, aortic root (AO), and left atrial diameters (LAs) were measured. The IVS to LVPW ratio was calculated to identify asymmetrical septal hypertrophy. RESULTS: In neither group was any statistically significant difference noted in IVS, LVED, LVES, LVPW, LA, and AO measurements during the three cardiac ultrasonography scans. Systolic function, as assessed by fractional shortening, was not significantly different in infants who received betamethasone antenatally, in either age group. There was no difference in the IVS/LVPW ratios between those who received antenatal steroid and those who did not for the 25-29 week and 30-33 week groups during these three consecutive scans. CONCLUSION: One course of antenatal betamethasone did not affect the cardiac wall thicknesses and systolic function in premature infants.     

新生儿成熟度和产后日龄对血清钾水平的影响

目的　探讨新生儿成熟度和产后日龄对血清钾浓度的影响。方法　回顾性分析了胎龄为 2 4～ 2 8周 (A组 ) ,2 9～ 3 2周 (B组 ) ,3 3～ 3 6周 (C组 )和 3 7～ 4 2周 (D组 )新生儿生后 1～ 72h内的血清钾水平及其变化。结果　①新生儿的胎龄、体重和尿量与血清钾水平存在着线性关系。②生后 1～ 2 4h ,A组新生儿的血清钾水平最高 ,B组次之 ,C和D组相当 ,为最低。生后 4 8h内 ,A和B组的血清钾水平开始下降 ,并于 72h内下降至C和D组新生儿水平。C和D组新生儿生后 72h内的血清钾水平无明显变化。③A ,B和C组早产儿生后 2 4h内高钾血症 (≥7.0mmol/L)发生率分别为 2 0 .0 % ,12 .5%和 4 .0 % ;2 4例高钾血症患儿经常规治疗后 ,14例 (58.3 % )于 72h内血钾降至 7.0mmol/L以下并存活 ;10例 (4 1.7% )高钾血症状态持续存在 ,其中 7例死亡。D组足月儿于生后 72h内未出现高钾血症。结论　新生儿的成熟度和产后胎龄影响血清钾水平 ;极不成熟新生儿 (2 4～ 3 2周 )在生后 2 4h内具有较高的血清钾水平 ,继之随生后日龄的增加而降低 ;早产儿可有致命性高钾血症存在 ,常规治疗仅部分有效。     

High density lipoprotein concentrations in newborn infants.

The lipoprotein pattern was analyzed by agarose gel electrophoresis in 19 new born infants of varying gestational age. The HDL concentration was determined by rocket immunoelectrophoresis in another 41 newborn infants. Infants with a gestational age of less than 33 weeks had very low HDL concentrations compared to preterm infants with a gestational age of less than or equal to 33 weeks and term ihfants. In the first 5-10 days after birth the HDL concentration increased markedly in preterm infants (gestational age less than 37 weeks) whereas it remained unchanged in term infants.     

TRANSEPIDERMAL WATER LOSS IN NEWBORN INFANTS

Abstract. Using a method described earlier, the evaporation rate (ER) was studied at different humidities in 12 newborn infants born after 25 to 30 weeks of gestation and 10 infants born after 32 to 35 weeks. Transepidermal water loss (TEWL) was estimated in 32 infants born after 25 to 39 weeks of gestation. The ER values were highest in the infants with the lowest gestational age and the susceptibility to changes in ambient humidity was also greater at lower gestational ages. An exponential relationship was found between TEWL and gestational age, TEWL being 15 times higher in infants born after 25 weeks of gestation than in full-term infants.     

Fetal and neonatal cortical adrenal function in birth asphyxia

Eighteen newborn infants, gestational age between 36 and 42 weeks with birth asphyxia were compared with 23 normal newborn infants to determine serum cortisol and dehydroepiandrosterone sulfate levels in cord blood and in venous blood samples collected 12-18 hours after birth. Both groups were similar in gestational age, birthweight, proportion of small for gestational age and large for gestational age infants, proportion of infants delivered by cesarean section with and without labor, and proportion of mothers with pre-eclampsia. There was no antenatal exposure to corticosteroid. The asphyxiated newborn infants had a significantly higher mean cord serum level of cortisol, and a significantly lower mean cord serum level of dehydroepiandrosterone sulfate than the control group. Mean serum cortisol and dehydroepiandrosterone sulfate levels collected 12-18 hours after birth were similar between both groups. It is suggested that elevated cord serum level of cortisol is related to birth asphyxia stress stimulating the adrenal definitive zone, and the low cord serum level of dehydroepiandrosterone sulfate is secondary to a transient hypoxemic-ischemic insult to the adrenal fetal zone.     

Longitudinal measurements of bone status in preterm infants

BACKGROUND: Quantitative ultrasound measurement of the speed of sound (SOS) through bone has been investigated as a means of assessing bone status in preterm infants. Few studies report longitudinal measurements. OBJECTIVE: To assess longitudinal changes in bone SOS in preterm infants. METHODS: Sixty preterm infants with gestational ages of < 33 weeks and with birth weight appropriate for gestational age (AGA), and 48 healthy, term AGA infants were enrolled. SOS measurements of the tibia were made within the first week of life in the preterm infants, and within the first 72 hours of life in the term infants. During their hospital stay, weekly measurements of tibial SOS were made in 29 of the preterm infants, who were divided into three gestational age groups: Group 1: 24-26 weeks (n = 8), Group 2: 27-29 weeks (n = 9), and Group 3: 30-32 weeks (n = 12). RESULTS: The median SOS value for the 60 newborn preterm infants was significantly lower than that for the 48 newborn term infants (2,924 versus 3,036 m/sec, p < 0.001). At each time point, SOS values for each of the preterm infant gestational age groups were significantly lower than the term newborn infant SOS values. SOS values decreased significantly over time for the entire cohort of 29 preterm infants (p < 0.001), and for Groups 1 (p = 0.015) and 2 (p = 0.003). At several time points, there was a significant negative correlation between serum alkaline phosphatase levels and SOS values, and a significant positive correlation between serum phosphorus levels and SOS values. CONCLUSION: SOS measurements of the tibia decline during hospitalization in preterm infants, suggesting a progressive loss of bone strength. Longitudinal measurements of bone SOS in combination with serum alkaline phosphatase and serum phosphorus levels may identify infants at risk of developing osteopenia of prematurity.