高危新生儿血清心肌肌钙蛋白Ⅰ浓度变化的研究

目的探讨高危新生儿血清心肌肌钙蛋白Ⅰ(cTnI)浓度变化趋势。方法选择2009年4~12月本院产科出生、具有高危因素的新生儿,分为缺氧组、感染组及早产组,选择足月健康新生儿20例为对照组。分别测定脐血,生后1天及4天血清cTnI水平,并作对比分析。结果 (1)缺氧、感染及早产组脐血、生后1天cTnI值均高于对照组(P<0.05);缺氧组及感染组生后4天血cTnI值高于对照组(P<0.05),早产组与对照组差异无统计学意义(P>0.05)。(2)各组脐血、生后1天及4天血cTnI值均呈逐渐增高趋势;对照组、缺氧组和感染组各时间点血cTnI值差异有统计学意义(P<0.01),感染组和早产组生后1天血cTnI值与脐血差异无统计学意义(P>0.05),生后4天血cTnI值高于脐血,差异有统计学意义(P<0.05)。(3)感染组血cTnI恢复正常时间23天至5个月;缺氧组恢复正常时间4天至3.5个月;早产组恢复正常时间15天至1.5个月。结论缺氧、感染、早产等高危因素对新生儿血cTnI值的影响不同,动态监测所有高危儿血cTnI值十分必要。     

窒息新生儿心肌损害的早期诊断

目的探讨血清肌酸磷酸激酶同工酶(CK-MB)及心肌肌钙蛋白Ⅰ(cTnⅠ)对新生儿(MCI组)窒息心肌损害(MCI)的早期诊断价值。方法采用直接化学发光免疫夹心法和免疫抑制酶动力学法动态检测34例生后10 d内窒息并MCI新生儿(MCI组)血清cTnⅠ和CK-MB水平,并以38例窒息无心肌损害(NMCI组)及30例正常新生儿(NC组)作为对照组。结果NC组cTnⅠ水平在生后10 d内无变化,MCI组生后24 h内和1周时cTnⅠ水平均显著高于NMCI组和NC组(P均<0.01)。MCI组生后24 h内CK-MB水平显著高于NMCI组和NC组(P均<0.01);3组生后5~7 d检测值比较均无统计学差异(P均>0.05),且均明显低于生后24 h内水平。cTnⅠ诊断新生儿MCI的敏感度为91%,特异度为88%,准确度89%;CK-MB诊断新生儿MCI敏感度为85%,特异度为68%,准确度为74%。结论血清CK-MB及cTnⅠ均可用于新生儿窒息心肌损害的早期诊断,cTnⅠ优于CK-MB。     

新生儿病理性黄疸对机体的损害及其防治研究进展

由于新生儿胆红素代谢的特殊性,新生儿黄疸是一个临床较常见的重要表现.现概述近年来关于新生儿病理性黄疸常见病因的研究、新生儿黄疸对机体各脏器的损害、如何运用恰当的指标对新生儿病理性黄疸进行诊断和病情预测,并介绍近年来出现的新生儿黄疸治疗的新方法 和模式,同时对传统方法 进行回顾和评价.     

宫内窘迫对新生儿血清心肌酶水平的影响

目的 探讨宫内窘迫对足月新生儿血清心肌酶水平的影响.方法 2009年2月至2009年12月本院产科出生有宫内窘迫史而羊水和Apgar评分均正常的足月新生儿为观察组,同期出生的健康足月新生儿为对照组,分别测定两组生后1、4 d血清cTnI及CK-MB水平.结果 观察组30例,对照组16例.观察组生后1 d血清cTnI高于对照组(P＜0.001),CK-MB两组差异无统计学意义(P＞0.05),生后4 d血清cTnI及CK-MB均高于对照组(P＜0.05).观察组和对照组生后4 d时血清cTnI水平均较1 d时升高,差异有统计学意义(P＜0.001和P＜0.05);血清CK-MB浓度均低于1 d时(P＜0.05).观察组生后4 d cTnI浓度异常23例,经口服果糖二磷酸钠口服液痊愈14例,血清心肌酶水平恢复正常时间平均56 d(23～110 d).结论 单纯宫内窘迫可造成足月新生儿血清cTnI及CK-MB水平升高,常规检测血清cTnI及CK-MB能及时了解此类新生儿的心肌受损情况,从而尽早予以保护心肌治疗.     

轻度窒息新生儿动态心电图及心肌酶变化的临床研究

目的 探讨轻度窒息新生儿动态心电图（AECG）、心肌酶变化特点及其临床意义.方法 选取2011年6月至2013年8月我院新生儿科收治的轻度窒息新生儿为窒息组,同期选择本院分娩的30例健康新生儿为对照组,均于生后24h内行AECG检查,于出生18 ～24 h内抽取静脉血测定血清肌酸磷酸激酶（CK）、血清肌酸磷酸激酶同工酶（CK-MB）、血清乳酸脱氢酶（LDH）、血清谷草转氨酶（AST）、心肌肌钙蛋白（cTnI）.结果 窒息组（46例）与对照组（30例）新生儿AECG窦性心律指标（最慢心率、最快心率、平均心率）差异均无统计学意义（P＞0.05）;窒息组ST段改变及心律失常等其他几项综合指标（包括房早、房速、室早、Q-T间期延长、交界性逸搏）异常发生率高于对照组（65.2％比16.7％,89.1％比13.3％,P均＜0.01）.窒息组心肌酶指标及cTnI值均高于对照组[CK（604.7±275.4）比（162.0±95.1）,CK-MB（87.9±61.0）比（28.3±27.1）,LDH（686.0±383.5）比（310.7±133.5）,AST （95.0±63.1）比（35.2±13.9）,cTnI（0.12±0.11）比（0.02±0.01）,P均＜0.01].窒息组CK、CK-MB、LDH、AST异常发生率高于对照组（63.0％比16.7％,82.6％比6.7％,95.7％比20.0％,32.6％比6.7％,P均＜0.01）.结论 轻度窒息新生儿AECG监测可发现各种心律失常、ST段改变,其心肌酶亦明显高于正常新生儿,ST段改变及CK-MB的升高是诊断轻度窒息新生儿心肌损伤的可靠依据.     

新生儿窒息后心肌肌钙蛋白Ⅰ与心肌酶活性的时相变化及其意义

目的：探讨新生儿窒息后心肌肌钙蛋白Ⅰ(CTnⅠ)及心肌酶活性的时相变化。方法：化学发光法和全自动生化分析仪测定新生儿窒息组26例(轻度窒息16例，重度窒息10例)和对照组10例生后0 h，6 h，12 h，24 h，72 h，10 d血清CTnI水平、肌酸激酶(CK)、肌酸激酶心型同工酶(CK-MB)、乳酸脱氢酶(LDH)及天门冬酸氨基转移酶(AST)活性。结果：窒息组0 h血清CTnI水平，CK，CK-MB和LDH活性明显高于对照组，均P<0.01；其中CTnI峰值在12 h，48 h开始下降；CK活性峰值为6 h，而CK-MB活性于12～24 h达高峰，均于72 h后下降；LDH活性于12 h达高峰，AST活性则于6 h开始升高，24 h后降低。结论：窒息新生儿生后早期动态监测血清CTnI与心肌酶活性有助于及时诊断和治疗心肌损害。     

血清肌酸磷酸激酶同工酶及心肌肌钙蛋白早期诊断窒息新生儿心肌损害

目的　探讨血清肌酸磷酸激酶同工酶 (CK- MB)及心肌肌钙蛋白I(cTnI)测定对窒息新生儿心肌损害的早期诊断价值。方法　窒息组 40例 (轻度窒息、重度窒息各 2 0例 )、对照组 2 0例 ,生后 1、5、1 0d测定血清CK MB及cTnI水平。结果　窒息组生后 1d血清CK- MB及cTnI明显高于对照组 (P均 <0 .0 1 ) ,重度窒息组明显均高于轻度窒息组 (P均 <0 .0 1 ) ,治疗后呈逐渐下降趋势。血清CK- MB及cTnI对心肌损害诊断的敏感性无显著差异 (P >0 .0 5)。结论　血清CK MB及cTnI可用于窒息新生儿心肌损害的早期诊断。     

高危新生儿血清心肌肌钙蛋白I浓度变化的研究

目的探讨高危新生儿血清心肌肌钙蛋白I（cWnI）浓度变化趋势。方法选择2009年4～12月本院产科出生、具有高危因素的新生儿,分为缺氧组、感染组及早产组,选择足月健康新生儿20例为对照组。分别测定脐血,生后1天及4天血清cTnI水平,并作对比分析。结果（1）缺氧、感染及早产组脐血、生后1天cTnI值均高于对照组（P〈0．05）;缺氧组及感染组生后4天血eTnI值高于对照组（P〈0．05）,早产组与对照组差异无统计学意义（P〉0．05）。（2）各组脐血、生后1天及4天血cTnI值均呈逐渐增高趋势;对照组、缺氧组和感染组各时间点血cTnI值差异有统计学意义（P〈0．01）,感染组和早产组生后1天血cTnI值与脐血差异无统计学意义（P〉0．05）,生后4天血cTnI值高于脐血,差异有统计学意义（P〈0．05）。（3）感染组血cTnI恢复正常时间23天至5个月;缺氧组恢复正常时间4天至3．5个月;早产组恢复正常时间15天至1．5个月。结论缺氧、感染、早产等高危因素对新生儿血eTnI值的影响不同,动态监测所有高危儿血cTnI值十分必要。     

新生儿心肌损害后心率变异的意义

目的 探讨新生儿心肌损害后心率变异(HRV)的变化及其临床意义.方法 应用Holter分析系统检测60例有心肌损害新生儿(心肌损害新生儿组)和50例无心肌损害新生儿(无心肌损害新生儿组)及160例有心肌损害的不同年龄组儿童的心电信号,对HRV参数进行分析.结果 心肌损害新生儿组窦性心率R-R间期标准差(SDNN)、每5分钟窦性心率R-R间期平均值的标准差(SDANN)、相邻窦性心博R-R间期之差>50 ms的心搏数占心搏总数的百分比(PNN50)、总功率(TP)、低频功能(LF)等与无心肌损害新生儿组比较,均无显著性差异(Pa>0.05),而相邻窦性心博R-R间期差的均方根(rMSSD)、高频功率(HF)显著低于无心肌损害新生儿组(Pa<0.05),LF/HF值显著高于无心肌损害新生儿组(P<0.01);心肌损害新生儿组与不同年龄心肌损害组中HRV比较,新生儿组SDNN、SDANN显著低于小婴儿组(Pa<0.05);而HR、LF/HF值显著高于小婴儿组(Pa<0.01);新生儿组SDNN、SDANN、rMSSD、PNN50、TP、LF、HF均显著低于婴幼儿及儿童组(Pa<0.01),HR、LF/HF值显著高于婴幼儿及儿童组(Pa<0.01).结论 新生儿心肌损害后心脏自主神经功能明显受损,HRV参数是判断新生儿心肌损害及预后判断较稳定的指标之一.     

左卡尼汀对新生儿窒息致心肌损害的疗效

目的 探讨左卡尼汀治疗新生儿窒息致心肌损害的疗效.方法 窒息致心肌损害新生儿91例随机分为左卡尼汀治疗组(治疗组,48例)和常规治疗组(对照组,43例),二组患儿均予常规治疗,治疗组在常规治疗的基础上加用左卡尼汀针0.1 g/(kg·d)静脉滴注,1次/d,10 d为1个疗程.观察治疗前以及治疗过程中患儿症状体征的变化.在治疗前和治疗1个疗程,抽取患儿静脉血3 mL,分离血清,采用免疫抑制法和酶速率法分别检测其血清CK-MB和AST水平的变化,采用免疫比浊法和溴甲酚绿比色法分别检测血清前清蛋白和清蛋白水平的变化.采用Stata 7.0软件进行t、鳘2检验.结果 治疗组临床有效率(91.67%)明显高于对照组(74.42%)(P<0.05).治疗组心率恢复正常时间[(3.18 ±1.10) d]短于对照组[(4.32±1.43) d](P<0.05);治疗组CK-MB及AST分别为(22.48±4.72) U/L、(42.18±9.27) U/L,均较对照组[(29.06±6.10) U/L、(51.31±11.81) U/L]更接近正常值(Pa<0.05);治疗组前清蛋白[(125.25±30.64) mg/L]较对照组[(110.73±25.46) mg/L]提高更为明显(P<0.05);治疗组清蛋白[(38.58±6.56) g/L]较对照组[(35.79±6.44) g/L]也提高更为明显(P<0.05).结论 左卡尼汀治疗新生儿窒息致心肌损害具有良好疗效.     

Neonatal Jaundice

In 1956 Rolf Zetterström & Lars Ernster published their seminal observations demonstrating that bilirubin uncoupled oxidative phosphorylation in isolated mitochondria (1). On the other side of the Atlantic, Richard Day had found that bilirubin inhibited the uptake of oxygen by slices or homogenates of rat brain (2). These novel discoveries appeared to lead the way to understanding the unique toxicity of bilirubin in the newborn. The decades which followed the publication of these papers have seen thousands of additional publications concerning bilirubin and neonatal jaundice, but we do not seem that much closer to a convincing demonstration of the basis for kernicterus nor lesser forms of bilirubin toxicity (3). The neurotoxicity of bilirubin was recently reviewed here by Hansen & Bratlid (4); their article provides an excellent, balanced summary of the field. In contrast, this article offers a particular perspective of evolving work on the toxicity of bilirubin.     

Effect of Albumin Administration on Phototherapy for Neonatal Jaundice

Two clinical trials were designed to test the effect of albumin administration before phototherapy for non-haemolytic neonatal jaundice. The first with 18 hours of phototherapy showed that the albumin-treated group (23 infants) had higher and more prolonged jaundice than the group (27 infants) given phototherapy alone.In the second study on 29 infants there were two groups as before, but the duration of phototherapy was increased to at least 48 hours and a third untreated group was included. These results showed significant differences between all three groups, the cases receiving phototherapy alone having the shortest and those receiving no specific therapy, the longest duration of jaundice.Those patients given albumin intravenously had significantly greater albumin-binding capacity at the end of treatment.     

Management of Neonatal Obstructive Jaundice

A plan of management of neonatal obstructive jaundice is proposed for use in units specializing in the treatment of this difficult condition. Reliance is placed in needle liver biopsy used early (and repeatedly if necessary) to judge the rate of development of fibrosis in the liver and to reach a diagnosis. Blind porto-enterostomy is used in biliary atresia when no patent proximal duct is found. Emotional support of parents through this long illness is important. The procedures described should not be attempted by surgeons less experienced with this disease.     

新生儿黄疸治疗中的矛盾和对策

新生儿黄疸的治疗常遇到一些矛盾,如胆红素升高的利与弊,过度治疗与延误治疗,用药的适应证及药物的选择,光疗的适应证与禁忌证、光疗的利与弊、光疗标准的掌握,换血疗法的作用与风险、换血标准的掌握、换血方法的选择等。现结合当前国内外新生儿黄疸干预指南(方案)和有关文献对上述矛盾展开讨论,并提出对策,指出既要遵循指南(方案),但对待少数特殊情况也要具体情况具体分析,灵活处理。     

Prolonged Neonatal Jaundice in Cystic Fibrosis

Four patients with cystic fibrosis developed prolonged obstructive jaundice starting in the newborn period. Obstructive biliary cirrhosis was shown post mortem in one of them who died at 5 months from pneumonia, while another dying at 8 years had an histologically normal liver at necropsy. The two survivors were jaundiced for 6 months and 5 weeks respectively, before making a clinical recovery, and in both liver biopsy at the height of the jaundice showed bile stasis.Meconium ileus was present in half of all recorded cases of cystic fibrosis with prolonged neonatal jaundice. Jaundice is probably due to extrahepatic biliary obstruction from bile of increased density, with secondary intrahepatic bile stasis.     

Somatosensory Evoked Potentials in Neonatal Jaundice

ABSTRACT. Somatosensory evoked potentials (SEPs) were studied in jaundiced and normal neonates on the day the highest bilirubin values were reached, 2-3 days later, and at five weeks. During the first week three groups were formed according to peak bilirubin values: A: 250 μmol/I (n=20), B: 125-250 μmol/I (n=6), C: <125 μmol/I or no jaundice (n=19). At five weeks 10 infants of group A were reinvestigated, together with 17 controls. Cervical (N13) and scalp SEPs (N19) were recorded with a variable number of stimuli. The SEPs of group B and C did not differ from each other. In group A the N13 peak latencies were within the range of group C at the first investigation, but prolonged at the second and third. The cortical components were prolonged at the first investigation, improved but still prolonged at the second, while the N19 peak latency was still prolonged at the third investigation. The central conduction time (CCT) correlated positively with the bilirubin level. Since a rapid decrease in the N19 amplitude was found for all groups from 25 to 100 stimuli, recordings should be done with a low number of stimuli (less than 100). Our findings indicate that both the periferal and the central components of the SEPs in the neonatal period are delayed by jaundice and that full recovery is not obtained at five weeks. The non-invasive SEP technique can be used as a daily monitor of the effect of bilirubin on the CNS.