碱性成纤维细胞生长因子对新生大鼠缺氧缺血性脑损伤的保护作用

目的 探讨碱性成纤维细胞生长因子（ ｂＦＧＦ）对新生大鼠缺氧缺血性脑损伤( ＨＩＢＤ）的保护作用。方法 将 ３２只 ７日龄Ｗｉｓｔａｒ大鼠分为４组：假手术组、ＨＩＢＤ组、 ｂＦＧＦ治疗组（分大剂量组１７．５ μｇ／ｋｇ和小剂量组１０ μｇ／ｋｇ）,每组 ８只。后３组动物制成 ＨＩＢＤ模型,给予治疗组大鼠连续 ７ ｄ腹腔注射 ｂＦＧＦ, ＨＩＢＤ组腹腔注射等体积生理盐水作为对照。全部大鼠于术后１４ ｄ处死,对脑纹状体、皮质的光镜下结构、乙酰胆碱酯酶（ＡｃｈＥ）、酸性磷酸酶（ＡＣＰ）活性变化进行观察和比较。结果 新生大鼠 ＨＩＢＤ后皮质、纹状体有选择性神经元坏死及胶质细胞增生, ｂＦＧＦ治疗组上述病变明显减轻; ＨＩＢＤ后纹状体、皮质神经元 ＡｃｈＥ活性明显下降(－～＋）, ｂＦＧＦ组 ＡｃｈＥ活性（＋～＋＋）较ＨＩＢＤ组恢复快; ＨＩＢＤ后纹状体神经元 ＡＣＰ活性明显增高（＋＋＋）, ｂＦＧＦ组 ＡＣＰ活性（＋＋）变化程度小于ＨＩＢＤ组。但大、小剂量ｂＦＧＦ治疗组未见明显差异。结论 ｂＦＧＦ能通过影响受损神经元的酶物质代谢而加快ＨＩＢＤ新生大鼠神经元的修复。     

bFGF对缺氧缺血新生大鼠脑组织中SOD,MDA和NO的影响

目的 探讨碱性成纤维细胞生长因子（ｂＦＧＦ）治疗新生大鼠缺氧缺血性脑损伤（ＨＩＢＤ）的作用机制。方法 将７２只７日龄Ｗｉｓｔａｒ大鼠随机分为三组,即假手术对照组（８只）,ＨＩＢＤ组（３２只）,ｂＦＧＦ治疗组（３２只）,后两组常规制成ＨＩＢＤ模型,治疗组每日给ｂＦＧＦ腹腔注射,监测不同时间脑组织中ＳＯＤ、ＭＤＡ、及ＮＯ水平．结果 与假手术组相比,ＨＩＢＤ组脑组织中ＳＯＤ明显降低,而ＭＤＡ、ＮＯ明显升     

内皮素和一氧化氮在缺氧缺血新生鼠脑损伤中的作用及高压氧治疗机制

为探讨急性缺氧新生鼠血浆内皮素（ＥＴ）和一氧化氮（ＮＯ）含量变化及其高压氧（ＨＢＯ）干预治疗机理，应用缺氧新生鼠作为动物模型。结果：缺氧后脑组织含水量、血浆ＥＴ与ＮＯ水平均有所上升，ＨＢＯ治疗可降低脑组织含水量、血浆ＥＴ及ＮＯ水平。但ＥＴ水平仍高于正常，同时脑组织含水量与血浆ＥＴ及ＮＯ水平之间呈正相关，相关系数分别为０．８１３及０．４８２。提示：缺氧性脑水肿的发生与ＮＯ及ＥＴ过量生成有关，ＨＢＯ能减轻缺氧性脑水肿，其机理可能与抑制ＥＴ及ＮＯ生成相关。     

高压氧治疗新生大鼠缺氧缺血性脑病

４９只新生大鼠ＨＩＥ模型分成高压氧治疗组和对照组，分别于模型制作后４８小时及七天处死，观察脑大体改变和脑含水量。结果显示，采用２．３ＡＴＡ治疗三次有明显减轻脑水肿及脑软化作用。     

新生大鼠缺氧缺血后脑髓鞘化的观察及药物干预的效果

缺氧缺血性脑病（ＨＩＥ）存活儿会留有脑性瘫痪、癫痫、智力低下等不同程度的后遗症。本实验对新生大鼠缺氧缺血后脑髓鞘化的程度进行观察,并在急性期应用药物干预治疗,观察其对脑发育的作用。材料和方法：７日龄Ｗｉｓｔａｒ大鼠３０只,随机分为５组,每组６只,即：（１）假手术正常对照组（Ｃ组）;（２）缺氧缺血组（ＨＩ组）：结扎左侧颈总动脉,吸入含８％氧气的氮氧混合气体２小时,立即按体重腹腔内注射生理盐水;（３）１６二磷酸果糖（ＦＤＰ）组;（４）硫酸镁（ＭｇＳＯ４）组;（５）苯巴比妥（ＰＢ）组。至生后２８天断…     

丁咯地尔盐酸盐治疗新生鼠缺氧缺血性脑病的实验研究

目的 观察酏咯地尔盐酸盐（ＦＺ）治疗新生鼠缺氧因性脑病（ＨＩＥ）的疗效，寻求治疗ＨＩＥ的有效手段。方法 建立新生鼠ＨＩＥ模型，将１０４只新生鼠分为１３组，观察不同时间ＦＺ治疗后ＨＩＥ鼠脑灌流状态、脑花生四烯酸、自由基清除、细胞内游离钙代谢，以及脑组织病理变化。结果 治疗组用ＦＺ前后颈动脉血压无变化，缺血侧半球离膜血管扩张占１８．６％～２２．７％，较对侧正常半球软脑膜血管扩张程度大２倍，脑组织ＴＸＡ     

一氧化氮合酶mRNA在缺氧性肺动脉高压大鼠肺动脉的表达

目的探讨一氧化氮体系在缺氧性肺动脉高压形成机制中的作用。方法采用地高辛精标记的一氧化氮合酶（ＮＯＳ）ｃＲＮＡ探针对缺氧组大鼠（６只）及对照组大鼠（７只）进行原位杂交。结果缺氧２周后的大鼠肺动脉收缩压（３．８±０．７ｋＰａ）（２８±５ｍｍＨｇ，１ｋＰａ＝７．５ｍｍＨｇ）、肺动脉平均压（２．８±０．６ｋＰａ）及肺动脉舒张压（１．４±０．４ｋＰａ）与对照组（２．９±０．５ｋＰａ，１．９±０．５ｋＰａ及０．９±０．５ｋＰａ）相比均显著升高。缺氧组大鼠肺动脉内皮细胞中ＮＯＳｍＲＮＡ表达信号为弱阳性（３只）及阴性（３只），平滑肌细胞中表达信号均为阴性；对照组大鼠肺动脉内皮细胞中ＮＯＳｍＲＮＡ表达信号为阳性（７只），平滑肌细胞中表达信号均为阴性。ＮＯＳｍＲＮＡ的表达强度与大鼠肺动脉收缩压、肺动脉平均压及肺动脉舒张压分别呈负相关（ｒｓ＝－０．６７３、－０．５９６及－０．６２１，Ｐ均＜０．０５）。结论缺氧时肺动脉内皮细胞ＮＯＳｍＲＮＡ表达的改变可能参与慢性缺氧性肺动脉高压的形成。     

新生儿缺氧缺血性脑病血气血糖改变及其处理

８０例缺氧缺血性脑病（ＨＩＥ）住院患儿在治疗开始前检测了血气、血糖，其中３１例ｐＨ＜７．３０，３０例ＰａＣＯ２＜４．６６ｋＰａ，１８例ＰａＣＯ２＞６．６５ｋＰａ，１／２病例实际碱剩余（ＡＢＥ）在－６．０以下。酸碱紊乱以代酸＋呼碱最多共１８例，代酸＋呼酸１５例，呼碱１２例，重度组血气改变较轻、中度组有显著性差异。无论轻、中、重度病例，血糖均在正常的低值。     

新生儿缺氧缺血性脑病MRI和1HMRS检查的临床意义

目的 研究新生儿缺氧缺血性脑病（ＨＩＥ）时脑形态学及代谢改变,并探讨其与临床的关系。方法 对２１你ＨＩＥ新生儿进行头颅ＭＲＩ和＾１ＨＭＲＳ检查,并以７例无窒息史的新生儿作为对照。结果 ＭＲＩ显示ＨＩＥ患儿均存在不同程度的脑水肿,但脑水肿的范围轻度组与中、重度组无明显差异（Ｐ〉０．０６）,而脑实质及基底节区出血发生率中、重度组高于轻度组（Ｐ〈０．０５）。＾１ＨＭＲＳ显示缺氧早期决肌酸／乳酸（Ｌａｃ／     

高压氧对改善新生儿缺氧缺血性脑病预后的作用

高压氧对改善新生儿缺氧缺血性脑病预后的作用山东胜利石油管理局中心医院儿科（东营，２５７０３４）张玉琢周明琪蒲蕾李惠娟方伟王宏应用高压氧（ＨＢＯ）治疗新生儿缺氧缺血性脑病（ＨＩＥ）已在国内普遍开展，高压氧对ＨＩＥ患儿的远期预后效果如何，报道较少。本文总...     

宫内生长受限新生儿多系统器官损害与临床管理

胎儿时期是各系统器官发育形成的关键时期,宫内生长环境的改变可导致胎儿-新生儿多系统器官损害,并与成人期疾病密切相关,包括神经系统损害(如脑发育障碍、功能异常及脑瘫等)、心血管系统损害(如冠心病、高血压等)、生长障碍与代谢性疾病(如胰岛素抵抗、2型糖尿病、肥胖症、生长发育障碍等)、泌尿系统损害(如肾间质性疾病、肾性高血压等)、呼吸系统损害(如呼吸窘迫综合征、支气管肺发育不良等)等,本文对此予以介绍,以助于临床医师对胎儿生长受限的认识及加强相关干预措施,提高其生存质量.     

胆汁酸代谢相关药物在胆道闭锁治疗中的应用与展望

胆道闭锁患儿胆汁酸代谢异常可损伤肝细胞及胆管上皮细胞。熊去氧胆酸作为目前胆道闭锁手术后常规用药,其疗效及使用方法仍存在争议;胆汁酸甾体类核受体激动剂(奥贝胆酸)及非甾体类核受体激动剂(LJN-452)、肠道胆汁酸重吸收相关蛋白调控药物(A4250)、肝脏内胆汁酸转运蛋白、肾脏转运蛋白相关药物的开发研究近年来发展迅速,不少药物已开始临床Ⅱ、Ⅲ期试验,将来可能对胆道闭锁肝门空肠吻合术后逐步恢复胆流的患儿有一定帮助,成为胆道闭锁肝门空肠吻合术后新辅助用药。     

Recent advances in the treatment of congestive heart failure

Treatment of heart failure should include correction of the underlying cause. These causes include large left to right shunts, obstructive lesions, arrhythmias, primary myocardial disease etc. The main pharmacological therapy includes inotropic agents, vasodilators and diuretics. Inotropic agents increase myocardial contractility and include digoxin, intravenous dopamine, dobutamine and isoproterenol. Vasodilators improve cardiac pump performance by decreasing the vascular resistance and/or increasing the venous capacitance. Commonly used vasodilator agents include angiotensin converting enzyme inhibitors (captopril, enalapril etc.), hydralazine, prazosin hydrochloride etc. Diuretics inhibit salt and water reabsorption promoting their excretion. Furosemide, thiazide diuretics, aldactone, are commonly used diuretics. Electrolyte and acid-base imbalance can occur on chronic diuretic therapy. Cardiac transplantation is considered for patients where all medical management has failed.     

Severe respiratory distress syndrome unresponsive to intensive care treatment--diagnostic and therapeutic considerations

Respiratory Distress Syndrome (RDS) is a common complication in preterm neonates. If RDS is not responding to conventional treatment modalities (surfactant therapy, ventilatory support, etc.), an underlying pathology (pulmonary lymphangiectasia, capillary alveolar dysplasia, alpha-1 antitrypsin deficiency, etc.) other then prematurity should be taken into consideration.Here, we report on a preterm neonate with the unusual simultaneous occurrence of pulmonary and systemic lymphangiectasia and homozygous alpha-1 antitrypsin deficiency who developed severe RDS that was refractory to conventional treatment. The diagnostic and therapeutic approach in this patient is presented.     

Can community health workers screen under 5yr children with computer program

EKALAVYA computer program aims at high risk screening of under 5 children in Primary Health Centers by Community Health Workers (CHWs) simulating existing programs like CSSM, ICDS etc. This integrates many common symptoms like fever, respiratory, diarrhea, convulsions etc. along with health promotional aspects like growth, immunization etc. at Community Health Workers skills level. EKALAVYA program was user friendly for CHWs who were trained in 2–3 weeks. CHWs with computer guidance were compared with clinical evaluation of Research Team in 96 pediatric OPD cases in a teaching institution. Overall concordance was 91.66%. Symptom wise and severity wise analysis also showed good concordance. The study also indicated training and programme errors which could be easily corrected. EKALAVYA Program is now ready for field trial in PHCs for the guidance of CHWs in decision making.     

Community perceptions on diarrheal diseases: a case study in swampy lowland area of south Sumatra, Indonesia. The Diarrheal Diseases Research and Training Study Group

Four investigators conducted participative observation at 4 hamlets, representing 4 typical topography in the area, wet or dry near the river and wet or dry far from the river, in District Rambutan, South Sumatera Province, Indonesia from July 1988 up until February 1989 to study the community perception and practices on diarrheal diseases (DD). The observation was supported by focus group discussions and informal interviews. It was found that the causes of DD can be grouped into: dirty water; wrong (cold, hot, sting) food; part of the growth process; physical condition (extreme heat, cold wind and inner abnormality, inner heat, muscle strain), and supernatural. The type of DD can be grouped into: mild without vomiting named ngadi, negenteng-ngentengi, nambah kepacakan, etc which was linked to the growth process; more severe diarrhea, might be with fever (mising-mising, murus, mencret, etc); more severe diarrhea with severe vomiting (muntager, kolera); bloody/mucoid stool (disentri, mising tai angin, mising umbal). The community had also the concept of prolonged diarrhea named as menerus (literally meaning prolonged) Muntaber was more associated with bad water while the prolonged one was more associated with inner abnormality. The danger of diarrhea perceived was susut = shrinkage, lisut = emaciation. Pale and red hair with lisut were recognized as the dangers of prolonged diarrhea. The community did not associate these conditions with fluid loss. The management started by self medication using tapel (pasta of herb applied) to the stomach), decoct (daun jambu, akar teratai etc), solid oral preparation (cassava with raw sugar, rast rice, etc).(ABSTRACT TRUNCATED AT 250 WORDS)     

儿童侵袭性真菌病的实验室检查方法与评价

儿童侵袭性真菌病（ invasive fungal disease,IFD）往往缺乏特征性的临床表现及影像学改变,是ICU中不易早期诊断的严重疾病。IFD的临床诊断多是针对高危人群借助实验室检测做出的。IFD的实验室检查通常包括直接检测（涂片镜检、真菌培养、组织病理学检查等）、血清学检测（1,3-β-D葡聚糖检测、半乳甘露聚糖检测等）,近年分子生物学检测也有一定发展。合理使用实验室检查及正确评价实验结果,是诊断IFD的关键之一。     

新生儿坏死性小肠结肠炎发病原因及预后研究进展

新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)是一种常见的胃肠道急症,属于新生儿期严重危及生命的疾病之一.其发病原因尚不完全明确,主要有早产、喂养不当、肠道感染和菌群失调、缺氧缺血及再灌注损伤等.疾病的临床分期、呼吸衰竭等严重并发症、治疗方法等多种因素均会影响NEC患儿的预后.该文就近期相关研究展开综述,为NEC的早期诊断、临床观察及治疗提供线索.     

急性肺损伤和急性呼吸窘迫综合征的预后评估指标

急性肺损伤、急性呼吸窘迫时机体发生一系列的病理生理变化,研究者通过对相关临床、生化指标进行研究发现其中一些指标与预后密切相关.临床指标包括年龄、病因、器官功能不全、免疫抑制等.生化指标包括心功能指标氨基末端脑钠肽前体、心肌酶;凝血纤溶相关指标蛋白C;肺表面活性物质;氧化应激产物:一氧化氮、血管假性血友病因子、炎症因子等.利用这些指标可以判断疾病进展,为指导后续治疗提供依据.     

Importance of using standardized birth weight increments to report neonatal mortality data

Neonatal mortality statistics are frequently reported in 100-g increments of birth weight. We tabulated our mortality statistics using two methods of incrementation: 500 to 599 g, 600 to 699 g, 700 to 799 g, etc. (method A) and 501 to 600 g, 601 to 700 g, 701 to 800 g, etc (method B). In each 100-g weight group, the mortality was less using method B. The average reduction in mortality using method B was 4.1%. Use of the two different methods creates difficulty in making meaningful comparisons of various published reports. We recommend that all future studies use method A, as that method is more consistent with previous recommendations of the World Health Organization.