不同新生儿危重症评分对极低出生体重儿永久致残的预测价值

目的研究不同新生儿危重评分对极低出生体重儿永久致残的预测价值。方法用新生儿急性生理学评分Ⅱ(SNAP-Ⅱ)、新生儿急性生理学评分围产期补充Ⅱ(SNAPPE-Ⅱ)、新生儿临床危险指数评分(CRIB)、新生儿临床危险指数-Ⅱ(CRIB-Ⅱ)与新生儿危重病例评分(NCIS)评分系统对153例危重症的极低出生体重儿进行评价;随访以神经系统损伤造成的耳聋、视觉障碍、脑性瘫痪、智力障碍、癫痫为标准分为观察组与对照组,不同评分对永久致残的预测价值用受试者工作特征曲线评价(ROC曲线),应用logistic回归分析极低出生体重儿永久致残的危险因素。结果平均随访(32.8±2.3)个月,131例纳入统计,观察组43例,对照组88例,两组间SNAPPE-Ⅱ、CRIB、与NCIS评分差异有统计学意义(P<0.05),两组间SNAP-Ⅱ与CRIB-Ⅱ差异无统计学意义(P>0.05);ROC曲线下面积表明对极低出生体重儿永久致残的预测价值为NCIS相似文献   

新生儿危重病例评分与新生儿临床危险指数Ⅱ预测极低出生体重儿死亡风险的比较

目的：探讨新生儿危重病例评分（NCIS）和新生儿临床危险指数Ⅱ（CRIB-Ⅱ）评分对极低出生体重儿死亡风险的评估价值。方法：对112例胎龄≤32周的极低出生体重儿进行NCIS、CRIB-Ⅱ评分,比较两种评分系统对死亡风险预测的准确度。结果：死亡放弃组患儿NCIS评分68.21±8.92分,低于好转治愈组的83.12 ±7.00分,CRIB-Ⅱ评分19.64±3.03分,高于好转治愈组的13.03±3.35分,差异均有统计学意义（P<0.05）。死亡放弃率非危重组为0,危重组为8.24%,极危重组死亡放弃率为63.64%,差异具有统计学意义（P<0.05）。有单项指标组死亡放弃率18.46%,高于无单项指标组的4.26%,差异有统计学意义（P<0.05）。NCIS及CRIB-Ⅱ评分的ROC曲线下面积分别为0.90、0.93,差异无统计学意义（P=0.33）。NCIS与CRIB-Ⅱ评分呈负相关（r=-0.49,P<0.05）。结论：NCIS、CRIB-Ⅱ均可较好预测极低出生体重儿死亡风险,两者结合应用的效果更好。     

不同新生儿危重评分对超低体重儿死亡风险的预测价值比较

目的：比较不同危重评分对超低体重儿死亡风险的预测价值。方法：收集2019年1月1日至2020年1月1日南京医科大学附属儿童医院、南京医科大学附属妇产医院、南京医科大学第一附属医院新生儿科收治的所有超低体重儿,排除入院年龄1?h及以上、胎龄37周及以上、各项评分所需资料不全者。收集患儿的临床资料,计算患儿新生儿危重病例评分（NCIS）、新生儿急性生理学评分Ⅱ（SNAP-Ⅱ）、新生儿急性生理学评分围产期补充Ⅱ（SNAPPE-Ⅱ）、新生儿临床危险指数（CRIB）和新生儿临床危险指数Ⅱ（CRIB-Ⅱ）。比较死亡组与存活组的各项危重评分,采用受试者操作特征曲线评估各项危重评分对超低体重儿死亡风险的预测价值,并采用Pearson相关分析法分析各项危重评分与超低体重儿出生体重和胎龄的相关性。结果：共纳入192例超低体重儿,其中存活114例,死亡78例。死亡组与存活组出生体重、胎龄及阿普卡评分差异均有统计学意义（均P<0.01）。死亡组与存活组NCIS、SNAP-Ⅱ、SNAPPE-Ⅱ、CRIB和CRIB-Ⅱ评分差异均有统计学意义（均P<0.01）,但CRIB对患儿死亡风险的预测价值相对较高,其曲线下面积为0.787,敏感度为0.678,特异度为0.804,约登指数为0.482。各评分与超低体重儿出生体重和胎龄均存在一定的相关性（均P<0.05）,其中CRIB-Ⅱ和CRIB与超低体重儿出生体重和胎龄的相关系数较大,而NCIS与超低体重儿出生体重和胎龄的相关系数在五种评分中均最小（分别为0.191和0.244）。结论：五种危重评分中,CRIB对于超低体重儿的死亡风险预测价值更高,而我国主导推广的NCIS的敏感度及特异度相对较低,需要进一步修订以适应临床需要。     

新鲜冰冻血浆预防早产极低出生体质量儿颅内出血的疗效观察

目的探讨输注新鲜冰冻血浆对早产极低出生体质量儿颅内出血的预防效果。方法选取中山大学附属东华医院出生的早产极低出生体质量儿为研究对象,随机分为实验组29例和对照组32例,对照组沿用常规方法预防颅内出血,实验组在其基础上加用新鲜冰冻血浆,治疗后比较两组患儿的凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)和颅内出血发生率。结果治疗后两组PT、APTT、FIB、D-D4个指标均有好转,实验组各指标数值改善更加明显。两组比较发现PT(t=-2.65,P<0.05)、APTT(t=-2.49,P<0.05)、FIB(t=3.89,P<0.01)3项差别有统计学意义,而D-D项比较差别无统计学意义(t=-1.79,P>0.05)。查CT后发现实验组颅内出血发生率为12%,而对照组为34%,二者比较差别有统计学意义(χ2=4.28,P<0.05)。结论早产极低出生体质量儿在常规治疗的基础上加用新鲜冰冻血浆可较显著地改善其凝血功能,对颅内出血起到一定的预防作用。     

新生儿疾病危重评分与缺氧缺血性脑病临床分度及预后的关系

目的探讨新生儿疾病危重评分与缺氧缺血性脑病临床分度及预后的关系。方法对60例足月新生儿缺氧缺血性脑病分别进行HIE临床分度、新生儿疾病危重评分、统计合并危重单项指标、NBNA的测定,同时比较两组危重评分与临床分度的关系,出现单项指标与无单项指标与临床分度关系,两组评分与NBNA的关系及预后情况。结果新生儿疾病危重评分越低,其HIE临床分度越差,两组比较有非常显著意义(χ2=25.31,P<0.01)。有单项指标出现中重度HIE明显高于无单项指标,两者比较有非常显著意义(χ2=25.58,P<0.01);新生儿危重评分越低,NBNA的评分越低,两组比较有非常显著性差异(t=5.574,P<0.01);两组评分患儿,评分越低,预后越差,比较有非常显著意义,(χ2=9.23,P<0.01)。结论新生儿疾病危重判定,不管是采取评分或采用单项指标,均能很好的反应出HIE的临床分度及预后。     

两种不同营养支持法在早产极低出生体质量儿中的临床对比研究

目的探讨两种不同营养支持法在早产极低出生体质量儿中的可行性。方法将123例早产极低出生体质量儿按照随机分为两组,治疗组(61例)行早期间歇持续微量喂养,对照组(62例)行常规胃管喂养,对比两组血生化指标、生长发育情况及并发症。结果治疗组患儿的生长发育情况优于对照组(P<0.05),且治疗组喂养相关并发症发生率低于对照组(P<0.05)。结论对早产极低出生体质量儿行早期间歇持续微量喂养,可有效地改善患儿的生长发育状况,减少喂养相关并发症。     

2709例低出生体质量患儿情况分析

目的了解重庆低出生体质量患儿情况并作5年动态比较。方法回顾性分析2005年1月至2009年9月重庆医科大学附属儿童医院新生儿诊疗中心收治的2 709例低出生体质量患儿的临床资料,应用SPSS 16.0软件进行统计学分析。结果①5年来,低出生体质量患儿在同期住院新生儿中的比例始终>11%。②住院新生儿中,不同出生体质量组的患儿其平均病死率比较,差异有统计学意义(χ2=50.070,P<0.05);出生体质量在1 500~2 000 g的患儿其病死率为正常出生体质量住院患儿的1.69倍,体质量<1 500 g的患儿病死率为正常出生体质量患儿的8.79倍。③男性患儿平均出生体质量较女性患儿重(t=2.247,P<0.05)。④重庆低出生体质量患儿以早产为主,平均占87.4%。⑤初产儿平均出生体质量较经产儿(产次≥2)高(F=15.146,P<0.05)。⑥低出生体质量患儿的母亲中,45.6%曾患各类感染性疾病。⑦近50.0%的孕母在生育旺盛期以外的年龄段进行生产,40.7%的母亲处于无业状态。结论尽可能防止早产,在可控范围内减少多胎妊娠并适度控制产次等方面是重庆市低出生体质量疾控工作的重要环节,加强对低出生体质量儿,尤其是极低出生体质量儿的监测护理,提高其存活率,是降低重庆市新生儿死亡率的关键。     

CLB预防极低出生体质量儿中心静脉导管相关感染效果

目的探讨应用中心静脉导管集束(CLB)及检查表,预防极低出生体质量儿经外周静脉置入中心静脉导管(PICC)导管相关性感染(CRI)的有效性。方法选取青岛市某三级甲等医院2012年11月—2013年6月应用CLB及检查表的57例极低出生体质量儿作为观察组,2011年11月—2012年6月未应用CLB及检查表的53例极低出生体质量儿作为对照组,比较两组CRI发生率。结果观察组CRI发生率为2.199/1 000导管日,对照组为10.008/1 000导管日,两组差异有显著性(χ2=8.522,P<0.05)。其中,导管相关性血流感染率观察组为0,对照组为3.079/1 000导管日;定植菌感染率观察组为2.199/1 000导管日,对照组为6.928/1 000导管日,两组比较差异有显著性(χ2=4.082,P<0.05)。导管留置时间观察组长于对照组,差异有显著性意义(t′=3.326,P<0.05)。结论 CLB及检查表能有效预防极低出生体质量儿CRI的发生,同时可以延长导管留置时间。     

早产低出生体重儿早期血小板参数变化与新生儿出血的相关研究

目的 研究早产低出生体重儿早期血小板参数变化与新生儿出血的关系.方法 收集2006年9月～2007年1月收入我科的早产低出生体重儿合并并颅内出血或肺出血的29例早产儿作为出血组,同时取同期收入我科的早产低出生体重儿和/或早产低出生体重儿合并新生儿高胆红素血症,无合并肺炎、新生儿呼吸窘迫综合征、新生儿窒息等其它并发症的36例早产儿作为对照组,观察两组早产低出生体重儿血小板参数变化.结果 有出血组及无出血倾向组血小板计数(PLT)分别为(193.34±51.09),(245.44±50.21);血小板平均体积(MPV)为(8.09±0.84),(8.55±0.96);血小板比积(PCT)为(0.15±0.040),(0.21±0.039);血小板平均宽度为(17.50±1.51).(17.85±0.99).提示有出血倾向组的早产低出生体重儿的PLT、PCT、MPV显著降低(PLT:t=4.12,P＜0.01;PCT:t=5.362,P＜0.01;MPV:t=2.01,P＜0.05);而血小板分布宽度(PDW)差异不明显(PDW:t=1.081,P＞0.05).结论 血小板参数的异常变化可能参与了早产儿出血的发病机制,要重视对早产儿血小板参数的监测,尤其需严密监测血小板比积的变化,早期警惕早产儿出血的出现,并尽早预防及减少其发生.     

早产低出生体重儿早期血小板参数变化与新生儿出血的相关研究

目的:研究早产低出生体重儿早期血小板参数变化与新生儿出血的关系.方法:早产低出生体重儿合并颅内出血或肺出血的29例早产儿作为出血组,同时取同期选择早产低出生体重儿和(或)早产低出生体重儿合并新生儿高胆红素血症,无合并肺炎、新生儿呼吸窘迫综合征、新生儿窒息等其它并发症的36例早产儿作为对照组,观察两组早产低出生体重儿血小板参数变化.结果:有出血组及无出血倾向组血小板计数(PLT)分别为(193.34±51.09),(245.44±50.21);血小板平均体积(MPV)为(8.09±0.84),(8.55±0.96);血小板比积(PCT)为(0.15±0.040),(0.21±0.039);血小板平均宽度为(17.50±1.51),(17.85±0.99).提示有出血倾向组的早产低出生体重儿的PLT、PCT、MPV显著降低(PLT:t=4.12,P＜0.0l;PCT:t=5.362,P＜0.01;MPV:t=2.01,P＜0.05;),而血小板分布宽度(PDW)差异不明显(PDW:t'=1.081,P＞0.05).结论:血小板参数的异常变化可能参与了早产儿出血的发病机制,要重视对早产儿血小板参数的监测,尤其需严密监测血小板比积的变化,早期警惕早产儿出血的出现,并尽早预防及减少其发生.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.