新生儿窒息母儿血浆催乳素水平变化的研究(英文)

目的：目前发现催乳素(PRL)与缺氧缺血性脑病(HIE)的严重程度密切相关，PRL与新生儿窒息的关系较少报道，该文探讨窒息新生儿母儿血浆催乳素(PRL)水平变化与相关性及其意义。方法：采用放射免疫分析法对25例围产期窒息新生儿(窒息组，其中轻度窒息14例，重度窒息11例)及20例正 Ｐ律?对照组)母血、脐血及新生儿血浆PRL水平进行测定并进行动态观察。结果：窒息组母血、脐血及新生儿血浆PRL水平［(362.5±127.1)，(984.6±262.3)，(386.3±216.2)μg/L］均显著高于对照组［(96.4±26.2), (92.3±18.4), (68.7±7.27)μg/L］(P均0.05)。结论：围产期窒息时新生儿血浆、脐血及母血PRL水平显著增高，血浆PRL水平可作为判断新生儿窒息程度的一项参考指标。     

围产期窒息新生儿血浆内皮素的变化

应用放射免疫分析法观察３４例围产期窒息新生儿血浆内皮素（ＥＴ－１）的动态变化，其中轻度窒息１９例，重度窒息１５例，９例合并颅内出血，并与３３例正常新生儿进行对照。结果表明窒息组血浆ＥＴ－１测定值高于对照组，重度窒息组显著高于轻度窒息组，９例合并颅内出血患儿血浆ＥＴ－１升高更为显著，经过复苏及治疗后ＥＴ－１渐下降至正常水平。提示内皮素参与围产期窒息的病理生理过程，并与窒息的严重程度有关。     

围产期窒息新生儿抗利尿激素分泌变化的研究

围产期窒息除对脑、心、肾等重要脏器有影响外 ,还可导致内分泌系统的功能紊乱。抗利尿激素 (ＡＤＨ)分泌异常常见于颅脑和胸内疾病 ,而正常新生儿与窒息新生儿ＡＤＨ分泌规律如何 ?尚待研究。我们用放射免疫 (简称放免 )方法测定了围产期窒息及正常新生儿血ＡＤＨ ,以研究其变化规律及其与临床的关系 ,现报道如下。对象及方法窒息组 :为 1992年 11月～ 1993年 4月收住本病室的足月窒息新生儿共 5 2例 ,体重均在 2 5 0 0ｇ以上 ,其中男 39例 ,女 13例。根据出生时 1ｍｉｎＡｐｇａｒ评分分成两组 :重度窒息组 13例 ,轻度窒息组 39例。正常组…     

围产期窒息与β-内啡肽关系的研究

本文用放免法测定44例窒息新生儿血浆β－内啡肽（β－EP）的变化，同时测定31例正常新生儿为对照组。结果表明，窒息新生儿组血浆β－EP明显高于对照组，并发现血浆β－EP水平与Apgar评分密切相关，严重窒息组比中度窒息组血浆β－EP明显增高。在窒息组中有宫内窘迫者血浆β－EP水平高于无窘迫者，提示β－EP在围产期窒息的发病机制中起一定作用，对其治疗推荐用纳洛酮。     

围产期窒息新生儿脑血流变化及预后的探讨

围产期窒息是新生儿死亡及致残的主要原因之一,尤其脑损伤是导致脑瘫及智力障碍的重要原因。寻找安全可靠的检测方法,对预后作出初步的评估,及早治疗,使窒息新生儿后遗症减少到最低程度。我院对1995年5～12月间因围产期窒息住院的新生儿进行了脑血流速度的检测,对部分患儿进行智测随访,现报告如下。     

围产期窒息对新生儿糖代谢影响的研究

为研究围产期窒息对新生儿血糖及其调节激素的影响,对40例窒息患儿生后72小时进行连续血糖监测,同时测定血清皮质醇(CT)、胰岛素(INS)、胰高血糖素(GC)和生长激素(GH)的浓度.结果显示,轻度窒息对新生儿糖代谢无影响;重度窒息生后6小时血糖最高,36小时最低(P＜0.01).4种激素水平明显增高(P＜0.01),多元线性回归分析发现重度窒息后6～12小时血糖值与CT和GC水平呈显著性正相关(P＜0.01),证实了新生儿重度窒息后高胰岛素血症和高血糖并存现象.结论认为,应激反应在新生儿重度窒息后高血糖的发生中起重要作用,血糖监测对重度窒息患儿十分重要,治疗时不宜应用糖皮质激素和胰岛素.     

窒息新生儿30例血浆内皮素变化

我们测定了30例窒息新生儿急性期与恢复期血浆内皮素（endothelin，ET）水平，并与16例正常新生儿进行对比，以探讨ET在新生儿窒息中的作用及临床意义。资料和方法一、对象窒息组为1994年8月～1996年1月我院收治的日龄＜3d的围生期窒息新生儿30例。其中男女各15例。轻度窒息8例     

围产期窒息次黄嘌呤代谢的初步观察

本文用改良酶学法测定20例宫内窘迫及出生时窒息的新生儿脐血浆次黄嘌呤（Hypoxanthine－Hx）水平，同时作Apgar评分，血气分析、电解质测定及临床观察。以18例正常新生儿为对照。结果显示：缺氧组新生地血浆Hx和Pco2明显高于对照组，而pH、PO2、氧含量（O2CT）、HCO3-明显低于对照组。Hx与Pco2呈正相关；与pH、PO2、HCO3-、O2CT是负相关；与Apgar评分呈负相关；与电解质变化的相关性符合缺氧后的改变。表明Hx参与缺氧损害过程，Hx能较客观、准确的反映组织细胞缺氧、酸中毒及能量代谢状况。     

新生儿窒息血浆前列腺素血栓素变化

本文测定28例新生儿窒息的前列腺素、血栓素代谢产物6－K－PGF1α、TXB2生后24小时及72小时血浆水平，且并与16例无缺氧性疾病的新生儿进行对照。结果表明三组的血浆6K－PGF1α生后24小时测值均比生后72小时高。且重度窒息组生后24小时测值明显高于另两组。血浆TXB2生后24小时和72小时测值均以重度窒息组增高明显。且重度窒息组中有脑损伤者72小时6－K－PGF1α、测定值高于无脑损伤组。提示血浆6－K－PGF1α、TXB2水平可作为新生儿缺氧及其严重程度判断的灵敏指标之一。     

Cholestasis in newborn infants with perinatal asphyxia

Abstract Objective : The aim of this study was to characterize the liver involvement in infants who have both neonatal asphyxia and neonatal cholestasis. Methods : We describe four asphyctic newborn infants (three born at term) who developed early (age 3.8 ± 2.1 days) intrahepatic neonatal cholestasis and in whom tests for causes of neonatal liver damage were negative. Results : The clinical picture and course were benign and similar to that of sporadic "idiopathic" neonatal hepatitis. Clinical signs and abnormal liver function tests tended to normalize within the first year of life in all. Conjugated bilirubin became normal at 6 months after the onset of cholestasis, while liver enzymes tended towards normal values thereafter, within 1 year of follow-up. Liver biopsy (taken in one patient) showed a typical picture of giant cell hepatitis; ultrastructure was nonspecific. Significance : Our results suggest that isolated asphyxia should be taken into account as a potential causal factor in term or pre-term asphyctic newborns who develop early "idiopathic" neonatal cholestasis.     

Plasma platelet-activating factor levels in newborn infants with and without perinatal asphyxia: Is it an additional marker of perinatal asphyxia?

Abstract Background: Hypoxic-ischemic encephalopathy (HIE) is still a very important cause of neonatal mortality and morbidity. Recently platelet-activating factor (PAF) has been accused of being responsible for the neuronal damage in hypoxic-ischemic brain.
Methods: Therefore, we conducted a study in newborns with perinatal asphyxia to try to show the relationship between the clinical severity and plasma PAF levels.
Results: Mean plasma levels of 19 asphyxiated infants (997.8 ± 363.5 pg/mL) were significantly higher than that of 20 healthy infants (410.2 ± 148.6 pg/mL, P< 0.0001). Patients with clinically severe HIE had significantly higher levels of PAF (1494.2 ± 386.6 pg/mL) when compared with patients with mild HIE (815 ± 114.5 pg/mL) and with moderate HIE (828.3 ± 61.1 pg/mL). There was a significant correlation between plasma PAF concentration and arterial pH and base deficit, but no correlation with platelet and leukocyte counts.
Conclusions: Plasma PAF levels correlating with the severity of HIE is interpreted to mean that high PAF levels may be an indicator of clinical severity and probably the poorer prognosis of patients with HIE.     

Cord blood endothelin-1 and perinatal asphyxia

Discordant data have been reported on endothelin-1 (ET-1), a potent endothelium-derived vasoconstriction peptide, during the neonatal period, and elevated levels have been found in various neonatal diseases. This study evaluated ET-1 in the cord blood of 74 neonates of different gestational age, birthweight, mode of delivery and 5'-Apgar score. CONCLUSION: Higher ET-1 levels were found in neonates born by emergency caesarean section, and in newborns with low 5'-Apgar score, suggesting that ET-1 could be a marker of perinatal asphyxia.     

Early cranial ultrasound changes as predictors of outcome during first year of life in term infants with perinatal asphyxia

OBJECTIVES: To identify the types of early cranial ultrasound changes that were significant predictors of adverse outcome during the first year of life in asphyxiated term infants. METHODOLOGY: This was a prospective cohort study. Shortly after birth, cranial ultrasonography was carried out via the anterior fontanelles of 70 normal control infants and 104 asphyxiated infants with a history of fetal distress and Apgar scores of less than 6 at 1 and 5 min of life, or requiring endotracheal intubation and manual intermittent positive pressure ventilation for at least 5 min after birth. Neurodevelopmental assessment was carried out on the survivors at 1 year of age. RESULTS: Abnormal cranial ultrasound changes were detected in a significantly higher proportion (79.8%, or n = 83) of asphyxiated infants than controls (39.5%, or n = 30) (P < 0.0001). However, logistic regression analysis showed that only three factors were significantly associated with adverse outcome at 1 year of life among the asphyxiated infants. These were: (i) decreasing birthweight (for every additional gram of increase in birthweight, adjusted odds ratio (OR) = 0.999, 95% confidence interval (CI) 0.998, 1.000; P = 0.047); (ii) a history of receiving ventilatory support during the neonatal period (adjusted OR = 8.3; 95%CI 2.4, 28.9; P = 0.0009); and (iii) hypoxic-ischaemic encephalopathy stage 2 or 3 (adjusted OR = 5.8; 95%CI 1.8, 18.6; P = 0.003). None of the early cranial ultrasound changes was a significant predictor. CONCLUSIONS: Early cranial ultrasound findings, although common in asphyxiated infants, were not significant predictors of adverse outcome during the first year of life in asphyxiated term infants.     

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目的探讨围生期窒息新生儿PaCO2及pH快速变化及其与神经系统损害之间的关系。方法2002年1月至2003年12月南华大学第一附属医院将55例足月窒息新生儿分为3组组Ⅰ,pH>7.00,无神经系统异常,无需呼吸支持;组Ⅱ,pH≤7.00,余同组Ⅰ;组Ⅲ,pH≤7.00,神经系统异常,需辅助呼吸支持。采集脐动脉血、产后1h和2h桡动脉血进行血气分析并观察Apgar评分和临床经过。结果脐动脉血pH值和PaCO2各组间差异有显著性;产后1h动脉血pH组Ⅰ、Ⅲ间和组Ⅱ、Ⅲ间差异有显著性;产后1h动脉血pH、PaCO2分别和脐动脉血pH、PaCO2比较,差异有显著性;三组间有不同的神经系统表现;Apgar评分组Ⅲ较低。结论在严重酸中毒时,胎儿出生后pH、PaCO2会发生显著改变,需持续辅助机械通气的患儿有不良的神经系统预后。     

围生期窒息新生儿血气分析与神经系统损害

目的探讨围生期窒息新生儿PaCO2及pH快速变化及其与神经系统损害之间的关系。方法将55例新生儿分为3组:组1 pH>7.00,无神经系统异常,无需呼吸支持;组2 pH≤7.00,余同组1;组3,pH≤7.00,神经系统异常,需辅助呼吸支持。采集脐动脉血、产后1 h和2 h桡动脉血进行血气分析并观察Apgar评分和临床经过。结果脐动脉血pH值和PaCO2各组间有显著差异;产后1h动脉血pH组1、3间和组2、3间有显著差异;产后1 h动脉血pH、PaCO2分别和脐动脉血pH、PaCO2比较,有显著差异;3组间有不同的神经系统表现;Apgar评分组3较低。结论在严重酸中毒时,胎儿出生后pH、PaCO2会发生显著改变,需持续辅助机械通气的患儿有不同的神经系统后遗症。     

窒息新生儿肾损害及一氧化氮保护作用

为了解机械通气治疗的窒息新生儿肾损害的发生情况，比较不同窒息程度与肾损害的关系。并探讨一氧化氮（NO）吸入治疗对肾脏的影响。对机械通气治疗的41例窒息新生儿（轻度窒息19例，重度窒息22例），进行回顾性分析，其中13例同时予以NO吸入治疗。结果显示：41中17例（占41．5％），有不同程度的肾损害，重度窒息患儿肾损害发生率明显高于轻度窒息患儿（P＝0．014）。予以NO吸入治疗的窒息患儿肾损害的改善较未予以NO吸入治疗者明显，9例未用NO吸入治疗的肾损害患儿在机械通气治疗后2例肾损害好转，5例无好转，另2例未随访，8例用NO吸入治疗的肾损害患儿在NO吸入治疗后肾损害好转6例，另2例未随访，提示窒息新生儿肾损害的发生率相当高，而NO吸入治疗能较明显的改善窒息后的肾损害。     

围产期窒息对新生儿脑组织血流灌注的影响及意义

目的了解围产期窒息对新生儿脑血流(CBF)的影响及意义.方法对140例有围产期窒息的新生儿进行单光子发射型计算机断层(SPECT)脑显像.结果①围产期发生的胎儿窘迫或出生时窒息,有可能使CBF减少;②有胎儿窘迫和(或)出生时窒息时,新生儿CBF异常的发生率相似.结论围产期发生了胎儿窘迫或出生时窒息,虽经复苏抢救或去除了某些直接影响因素,这些新生儿仍然存在着发生缺氧缺血性脑损伤(HIBD)的高度危险.     

围生期窒息新生儿血气分析与神经系统损害

【摘要】目的探讨围生期窒息新生儿PaCO2及pH快速变化及其与神经系统损害之间的关系。方法将55例新生儿分为3组：组1pH〉7．00，无神经系统异常，无需呼吸支持；组2pH≤7．00，余同组1；组3，pH〈7．00，神经系统异常，需辅助呼吸支持。采集脐动脉血、产后1h和2h桡动脉血进行血气分析并观察Apgar评分和临床经过。结果脐动脉血pH值和PaC02各组间有显著差异；产后1h动脉血pH组1、3间和组2、3间有显著差异；产后1h动脉血pH、PaC02分别和脐动脉血pH、PaCO2比较，有显著差异；3组间有不同的神经系统表现；Apgar评分组3较低。结论在严重酸中毒时，胎儿出生后pH、PaC02会发生显著改变，需持续辅助机械通气的患儿有不同的神经系统后遗症。     

Effect of neonatal resuscitation courses on long‐term neurodevelopmental outcomes of newborn infants with perinatal asphyxia

Background: In previous studies, it has been demonstrated that Neonatal Resuscitation Program (NRP) courses improve the early outcomes of infants with perinatal asphyxia, but there has been no evidence to demonstrate the effect of NRP on long‐term outcomes of perinatal asphyxia. The goal of the present study was to determine the effect of NRP courses on the long‐term neurodevelopmental outcome of perinatal asphyxia. Methods: This prospective study included infants referred to the Neonatal Unit during the years 2003–2005. Those patients who were referred before NRP courses (pretraining period) were designated as group 1, those who were referred after the first NRP course (transition period) as group 2, and those who were referred after the second NRP course (post‐training period) as group 3. Neurodevelopmental outcomes were assessed and compared at 4–6 years of age. Results: The study involved 40 patients: 23 in group 1, nine in group 2 and eight in group 3. The number of patients who had been diagnosed with cerebral palsy was 13 in group 1, two in group 2, and one in group 3, which was a significant decrease. The number of patients with seizures and electroencephalography abnormality was 12 and 14 in group 1, three and two in group 2, and one and one in group 3, respectively, which was also a significant decrease. Conclusions: NRP courses have positive effects on short‐term as well as long‐term neurodevelopmental outcomes of infants with perinatal asphyxia. Further studies are required to determine the effects of NRP courses on minor deficits, such as cognitive and behavioral disturbances.