神经行为发育监测及早期干预对新生儿智能发育的影响

目的探讨神经行为发育监测及早期干预对缺血缺氧性脑病新生儿智能发育的影响。方法将150例缺血缺氧性脑病新生儿分为早期干预组和对照组。早期干预组在综合治疗的基础上给予针对性的个性化早期干预。比较两组患儿早期神经行为评分法(NBNA)、治疗3个月后智能发育指数(MDI)和运动发育指数(PDI)评分。结果治疗后两组患儿NBNA评分均显著提高,差异有统计学意义(P0.05),但早期干预组患儿治疗后7d和14d NBNA评分均显著高于对照组患儿,差异有统计学意义(P0.05);治疗3个月后不同时期,早期干预组患儿MDI和PDI评分均显著高于对照组患儿,差异有统计学意义(P0.05);随访18个月后,早期干预组预后良好率(86.7%)显著高于对照组(72.0%),差异有统计学意义(P0.05)。结论神经行为发育监测及早期干预对缺血缺氧性脑病新生儿具有重要的积极意义,可改善患儿预后,促进患儿智能发育。     

个体化发育支持对早产儿体格及神经发育的影响

[目的]探讨个体化发育支持对早产儿体格及神经发育的影响。[方法]选取120例早产儿为研究对象,根据随机数字表法将患儿分为观察组及对照组各60例,对照组实施常规性护理,观察组实施个体化发育支持,对两组患儿随访至产后42d,分别于患儿出生时、出院时及产后42d应用新生儿智力发育指数(MDI)量表、新生儿神经行为量表(NBNA)、心理运动发育指数(PDI)对两组患儿智力发育、神经行为及心理运动发育进行评定,并记录两组患儿产后42d体重增长情况。[结果]观察组患儿干预后头围、身长、体重增长较对照组明显(P0.05)。观察组出院时、产后42d时MDI评分、NBNA评分、PDI评分均高于对照组(P0.05)。[结论]个体化发育支持可促进早产儿体格发育,有利于早产儿神经功能及智力发展。     

黄疸新生儿血清降钙素原（PCT）与行为神经功能的相关性

目的探究黄疸新生儿血清PCT与新生儿行为神经测定的相关性。方法选择2017年5月～2018年5月在我院出生的足月新生儿138例,根据是否发生病理性黄疸分为观察组42例和对照组96例。测定观察组黄疸高峰期、干预后胆红素、血清PCT水平及对照组的胆红素、血清PCT水平,使用新生儿行为神经测定评分(NBNA)评估观察组干预前后神经功能,使用Pearson分析血清PCT水平与NABA评分的相关性。结果观察组高峰期时胆红素、PCT显著高于对照组,NBNA评分显著低于对照组,差异有统计学意义(P0.05);经治疗干预后胆红素、PCT水平较治疗前显著降低,NBNA评分较治疗前显著提高,差异有统计学意义(P0.05);Pearson相关性分析结果显示,黄疸高峰期及干预后PCT与NABA评分均呈显著负相关(P0.05)。结论黄疸新生儿血清PCT与行为神经功能存在显著相关性,可有效判断神经功能损伤程度。     

抚触干预对早产儿神经行为影响的临床观察

目的 探讨抚触对早产儿神经行为的影响.方法 选择我院出生的早产儿60例,系孕周31～36周自然分娩或选择性剖宫产儿,随机分为抚触组和对照组各30例.在综合护理措施及育儿指导相同的情况下,抚触组增加抚触护理并随访半年.对两组早产儿在出生后1个月进行神经行为评分(NBNA):3个月、6个月进行智能发育指数(MDI)和心理运动发育指数(PDI)测查及对比分析.结果 抚触组在出生后1个月NBNA与对照组比较差异有统计学意义(P<0.01);3个月、6个月两组MDI和PDI测查差异亦有统计学意义(P<0.05).结论 抚触对早产儿神经系统有良好作用.     

早期护理干预对缺氧缺血性脑病新生儿智能及运动发育的影响

目的探讨早期护理干预对缺氧缺血性脑病新生儿(HIE)智能及运动发育的影响。方法 86例HIE新生儿随机分为观察组和对照组,每组43例。2组均接受常规治疗,对照组实施对症护理,观察组在对症护理基础上实施早期护理干预,比较2组干预前及干预后6个月体质量、身高、智力发育指数(MDI)及运动发育指数(PDI),并采用Gesell发育量表对智能发育商进行评定。结果干预后6个月,2组体质量、身高、MDI及PDI均较干预前显著增加(P0.01),且观察组各指标增加幅度显著大于对照组(P0.01);2组应物能、应人能、动作能及言语能评分亦显著高于对照组(P0.01)。结论对HIE新生儿进行早期护理干预能有效改善其智能及运动发育,提高生活质量。     

发展性照顾护理模式对早产儿智力发育及神经行为的影响

目的:探讨发展性照顾护理模式对早产儿智力发育及神经行为的影响。方法:回顾性分析2011年1月~2012年1月在本院出生的62例早产儿的临床资料,根据早产儿出生后护理方式将其分为对照组(常规性护理)30例以及观察组(发展性照顾护理)32例,分别于干预后第3,15,30天时应用心理运动发育指数(PDI)对两组早产儿智力发育、神经行为及心理运动发育进行评定并观察两组早产儿干预42 d后体格发育情况。结果:观察组早产儿干预后头围、身长、体重与对照组比较差异有统计学意义(P0.05),观察组早产儿在干预后第15,30天时MDI评分、PDI评分显著高于对照组,差异有统计学意义(P0.05)。结论:发展性照顾护理模式可促进早产儿智力、神经行为及体格发育,值得临床推广应用。     

血清tau蛋白、NGF、BNP在缺血缺氧性脑病患儿中的表达及与神经系统发育的相关性

目的研究血清tau蛋白、神经生长因子(NGF)、脑钠肽(BNP)在缺血缺氧性脑病(HIE)患儿中的表达及与神经系统发育的相关性。方法回顾性分析2017年2月至2018年10月暨南大学附属深圳市宝安区妇幼保健院妇产科收治的46例HIE新生儿(HIE组),按疾病严重程度分为轻度12例,中度18例,重度16例。选择同期分娩的健康新生儿40例作为对照组。分别于出生第7天时采用酶联免疫吸附试验测定血清tau蛋白、NGF、BNP水平,出生第7、14、28天进行新生儿神经行为(NBNA)评分,于出生第3、6个月时采用婴幼儿发育量表检测智力发育指数(MDI)、运动发育指数(PDI)。采用Pearason分析HIE患儿血清tau蛋白、NGF、BNP与NBNA评分、MDI、PDI的相关性。结果HIE组血清tau蛋白、BNP水平明显高于对照组,NGF水平明显低于对照组,差异有统计学意义(P<0.05);不同程度HIE患儿血清tau蛋白、BNP水平随疾病严重程度变化而升高,NGF水平随疾病严重程度变化而降低(P<0.05)。HIE组出生第7、14、30天NBNA评分明显低于对照组,HIE轻度、中度及重度患儿NBNA评分随着疾病严重程度变化而降低,出生第7、14、30天NBNA评分均明显低于对照组(P<0.05)。HIE组出生第3个月、6个月MDI、PDI指数明显低于对照组,轻度、中度及重度患儿MDI和PDI指数随着疾病严重程度变化而降低,出生第3个月、6个月MDI、PDI指数均明显低于对照组(P<0.05)。血清tau蛋白、BNP与NBNA评分呈负相关性(P<0.05),NGF与NBNA评分呈正相关性(P<0.05);血清tau蛋白、NGF、BNP与MDI、PDI呈负相关性(P<0.05)。结论血清tau蛋白、BNP水平变化随着HIE疾病严重程度升高,NGF水平变化随着HIE疾病严重程度降低,且与HIE患儿神经系统发育密切相关。     

高胆红素血症新生儿血清神经元特异性烯醇化酶的变化及临床意义

目的：分析高胆红素血症新生儿血清神经元特异性烯醇化酶（NSE）含量和新生儿行为神经能力测评（NeonatalBehavioral Neurological Assessment,NBNA）的变化,探讨高胆红素血症新生儿血清NSE含量变化的临床意义。方法：应用放射免疫分析法分别测定60例高胆红素血症新生儿和20例对照组新生儿血清NSE含量,同步测定血清总胆红素（TSB）,进行NBNA评分;高胆红素血症组早期干预后再次测定血清NSE含量。结果：与对照组比较,高胆红素血症新生儿血清TSB、NSE含量显著升高,而NBNA评分明显降低,差异有显著性意义（P〈0.01）;对照组与高胆红素血症新生儿轻度增高、中度增高、重度增高四组两两比较（均P〈0.05）,存在显著性差异;血清NSE含量与NBNA评分呈明显负相关（r=-0.628,P〈0.01）;高胆红素血症新生儿经早期干预治疗后,血清NSE含量均下降（P〈0.05）,差异有显著性。结论：高胆红素血症可导致新生儿脑损伤,血清NSE含量可以作为脑损伤的监测指标。     

高胆红素血症对婴儿神经行为发育的影响及其早期干预研究

目的探讨高胆红素血症（hyperbilimbinemia,HB）对婴儿神经行为发育的影响及其早期干预的效果。方法根据血清未结合胆红素（unconjugated bilirubin,UCB）水平,将系统管理中出生后3d的126例足月新生儿分为：对照组[（125．12±20．36）μmol／L]30例、HBI组[（215．71±35．12）μmol／L]33例、HBH组[（274．16±42．55）μmol／L]31例和HBⅢ组[（382．02±56．03）μmol／L]32例。在此基础上,给予HB组干预性治疗;出生后第3、7、14和28天,进行血清UCB测定和新生儿20项神经行为评定;出生后第1、3、6和12个月,运用Gesell发育诊断量表进行神经行为发育商数评估。结果HBⅢ组神经行为评分和神经行为发育商数最低,HBⅡ组和HBⅠ组次之,对照组最高。干预后,HB组血清UCB水平均降低,神经行为评分和神经行为发育商数均提高;出生后第12个月时,HBI组和HBⅡ组神经行为发育商数与对照组相近（P〉0．05）,HBⅢ组与对照组比较差异仍存在极显著统计学意义（t=13．472,P〈0．01）。结论新生儿HB可影响婴儿神经行为发育,早期干预能改善其影响。     

游泳对新生儿神经发育及适应行为影响的研究

目的探讨游泳对新生儿神经行为发育、社会适应行为及神经心理发育的影响。方法选择足月顺产第一胎新生儿400名,按是否游泳分为实验组和对照组各200名。通过新生儿神经行为发育、社会适应行为及神经心理发育的测定,比较2组间的差异。结果新生儿在生后第4、28天的比较中,新生儿神经行为评分(NBNA)实验组均高于对照组(P均<0.01),差异有非常显著性;新生儿在生后3个月的比较中,2组(高常+正常)与(边缘+轻度+中度)构成比间差异有显著性(P<0.05);无论是精神发育指数(MDI)还是心理运动发育指数(PDI)比较,实验组均高于对照组(P均<0.01)。结论游泳在新生儿神经行为发育、社会适应行为及神经心理发育等方面有积极的促进作用。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.