出生24h内新生儿肺出血病因与死因分析

目的 探讨出生24h内新生儿肺出血的病因与死因,并推测其与胎儿肺出血的关系.方法 选择114例出生24h内即发生肺出血的新生儿,根据临床与病理资料进行分析.结果 114例患儿的肺部病理检查结果,点状肺出血6例,局灶性肺出血印例,弥漫性肺出血48例.28例于生后0～6h,71例于生后7～12h,15例于生后13～24h内发病.肺出血病因中缺氧因素110例,包括吸入性肺炎62例、呼吸窘迫综合征24例、青紫型复杂心脏畸形7例、肺膨胀不全7例、新生儿窒息7例、其他原因缺氧3例;感染因素4例,病因均为宫内感染所致败血症.肺出血患儿死亡因素中缺氧因素113例,包括肺出血74例、吸人性肺炎15例、呼吸窘迫综合征12例、青紫型复杂心脏畸形7例、肺膨胀不全2例、颅内出血2例、新生儿窒息1例;感染因素I例,为宫内感染所致败血症.82例有宫内窘迫史,在直接死于肺出血的74例中,3例有宫内窘迫史,且出生数分钟即死亡.结论 出生24 h内新生儿肺出血病因及死因均以缺氧因素为主,大多有宫内窘迫.其中3例弥漫性肺出血患儿于出生数分钟即死亡,从而推测出生24h内新生儿肺出血,有相当部分可能为胎儿肺出血的延续.     

新生儿肺出血的诊断和治疗

新生儿肺出血仍是新生儿期主要的危重疾病及死亡原因之一.新生儿肺出血可能主要与早产、低出生体质量、感染、寒冷损伤、围生期缺氧缺血性损伤及低体温等有关.目前在治疗方面研究的重点主要集中在机械通气和呼吸道应用止血药.虽然对新生儿肺出血的病因、危险因素、早期诊断及治疗进行了不少研究,但总体仍缺乏可靠的研究结果,尤其缺乏循证医学的证据,缺乏多中心的随机对照研究结果.     

新生儿肺出血病因探讨

1995年以前，由于诊疗技术尤其医疗设备落后，我国新生儿肺出血发生率及病死率均较高，此期间探讨其病因的文章亦较多，提及的病因以围生期窒息／缺氧、低体温／寒冷损伤、早产／低体重、严重感染为主，尚有报道文献不多、例数较少的急性心力衰竭、高黏滞血症／红细胞增多症、弥散性血管内凝血（DIC）、中枢神经损伤、核黄疸、机械通气不当、过量输液、氧中毒等。由于新生儿各系统发育均不成熟，患儿常有多种疾病并存，临床诊断多样化，又常与病理诊断不完全相符。所以过去的肺出血病因分析可能有偏差。近年来随着对肺出血发病机制研究的深入，某些病因可从分子生物学角度去解释，因而本文对其病因又重新进行探讨，以便更能明确新生儿肺出血的防治。     

新生儿肺出血65例临床分析

肺出血是新生儿重要死亡原因之一。本文对我院1984年1日～1989年12日经尸检证实“新生儿肺出血”65例予以分析。同期尸检172例,尸检发现率37.8％。根据资料分析考虑肺出血发病因素可能与早产和低出生体重儿、惑染、缺氧和酸中毒、寒冷损伤、性别,先心和心衰等多种因素有关。在患儿中可能是几个因素同时作用的结果。并根据病因和临床表现提出了肺出血的临床诊断,以便及早防治,减少肺出血的发生。     

新生大鼠肺出血动物模型的建立与临床应用的启示

新生儿肺出血病死率高 ,主要原因有窒息 /缺氧 ,寒冷损伤 /低体温 ,早产 /低出生体重及严重感染[1] ,但发病机制至今未明。在处理出生 1周内寒冷损伤 /低体温患儿中 ,采用快速复温并持续吸高浓度氧之方法 ,常导致肺出血[2 ,3 ] 。本试验拟利用低温缺氧后再复温供氧的方法 ,模拟临床肺出血病因 ,以建立与临床病因相符的新生大鼠肺出血动物模型。材料与方法一、主要材料　石蜡切片机 (德国ＭＩＣＲＯＭ ) ;光学显微镜 (日本ＯｌｙｍｐａｓＢＸ6 0 ) ;透视电镜 (日本Ｈｉｔａｃｈ) ;氧浓度计(美国Ｍａｘｔｅｃ公司 ) ;出生 4～ 7ｄ的二级Ｗｉｓ…     

新生儿肺出血66例临床病理分析

目的探讨新生儿肺出血的高危因素、早期临床表现及诊断。方法回顾性分析66例新生儿肺出血死亡病例的临床表现、胸部X线检查及病理资料。结果早产、低出生体质量、严重缺氧、感染是新生儿肺出血的高危因素;肺出血早期临床表现为在原发疾病基础上突然出现呼吸困难加重,肺部出现湿音或湿音明显增加;双肺野透亮度广泛、均匀降低伴小斑点状影,肋间隙增宽为早期X线征象;尸体解剖病理表现为肺水肿伴少量出血。结论对有肺出血高危因素及早期临床表现的患儿,应及早诊断,早期干预。     

新生儿肺出血100例临床病理分析

本文综合100例经尸检证实的新生儿肺出血,分析了临床病理资料,着重探讨本病的发病因素与预防措施。认为早产、低体重、体温过低、窒息、颅内出血及感染在发病中起重要作用,指出新生儿肺出血是由于生理解剖缺陷,加上各种损伤血管壁诱因共同作用的结果。强调预防对本病具有格外重要意义,并提出预防本病的几点意见。     

新生儿肺出血

新生儿肺出血指肺泡出血、间质出血或两者同时存在 ,是多种新生儿疾病的临终表现 ,反映疾病的严重程度。其发病率国内外报道不一致 ,占活产儿1‰～ 5‰ ,尸检的 1%～ 4%。本症发病机制尚未完全明确 ,临床缺乏早期诊断方法 ,如不予治疗 ,病死率可高达 90 %左右 ,是新生儿死亡的主要原因。随着诊治技术的提高 ,近年治愈率明显提高。1　病因与发病机制　本病与多种因素有关 ,可能是几个因素共同作用的结果 ,与新生儿肺组织结构特殊性及肺局部血液凝固异常有关。常在以下疾病时出现 :早产、充血性心力衰竭、缺氧、感染、新生儿高黏滞血症、低体…     

新生儿肺出血与急性肺损伤

新生儿肺出血(PHN)是指肺大量出血,至少影响2个肺叶,是新生儿常见的危重病症。新生儿期许多疾病如窒息、休克、败血症、肺炎、肺透明膜病、低体温寒冷损伤综合征等,病情发展至危重阶段均可并发肺出血而死亡。本病病因不清,起病急,早期诊断困难,治疗很不满意,早在上世纪6 0年代,就被国外学者认为是新生儿临床的第一难题。急性肺损伤(acutelunginjury ,ALI)是指机体在遭受各种病理刺激(如创伤、休克、感染、败血症、缺氧等)后发生的急性炎症反应,以急性弥散性肺泡上皮细胞损伤及肺泡毛细血管内皮细胞损伤为主要病理变化,以进行性呼吸困难和…     

新生儿硬肿症危险因素分析

目的探讨新生儿硬肿症发病的危险因素,以便更有效地预防该病.方法以41例硬肿症新生儿为研究对象,并设疾病对照组.运用多元logistic回归,对8项可疑因素进行分析.结果早产、低体重、窒息和感染、酸中毒最终进入方程(P＜0.05),且OR值均大于1,是硬肿症发病的危险因素.硬肿症是原发病的一个并发症和严重征兆.寒冷不是本地区硬肿症的常见病因.结论流动人口的新生儿是硬肿症的高危人群;加强围产期母婴保健,普及新法复苏,感染的预防和早期有效干预,早产、低体重儿和重症新生儿热能供给和维持内环境平衡是预防硬肿症的有效措施.     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

�¶�֢��ϵ�ϰ���ע��ȱ�ݶද�ϰ������ڵ�ת��

孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

---

---

Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.