新生儿先天性巨细胞病毒感染的临床研究

目的探讨新生儿先天性巨细胞病毒（CMV）感染的临床特征以及更昔洛韦治疗的临床疗效及其对预后的影响。方法先天性CMV感染新生儿73例分为试验组（n=32）、对照组（n=41）。二组患儿均给予茵栀黄退黄、蓝光照射、丙种球蛋白等对症支持治疗。试验组加用更昔洛韦[7.5mg/（kg.次）]治疗;对照组未使用更昔洛韦。观察更昔洛韦的临床疗效,并比较二组转归情况。结果1.临床特征：73例患儿均有症状性感染,以全身性感染为主（80.8%）;消化系统受累最常见（95.89%）,病理性黄疸是其主要首发症状和主要临床表现（95.89%）;病程中可并其他病原微生物感染,以机会菌败血症最常见（14.1%）;出生缺陷发生率为6.4%。2.临床疗效：试验组治疗后临床表现、辅助检查、病原学检查阴转率与对照组比较均有显著性差异（Pa〈0.001,0.005）。3.转归：试验组痊愈26例（81.3%）,显效6例（18.7%）;对照组进步14例（34.1%）,未愈27例（65.9%）,二组临床疗效比较有显著性差异（P〈0.005）。结论新生儿先天性CMV感染主要表现为有症状性全身性感染,及时予更昔洛韦正规治疗,能明显改善预后。     

轮状病毒感染婴幼儿预后的相关因素

目的探讨影响婴幼儿轮状病毒(RV)感染预后的相关因素。方法选择102例大便RV阳性的患儿作为研究对象,根据出院时痊愈和好转标准将患儿分为治愈组(58例)和好转组(44例)。治愈组男47例,女11例;年龄(15.19±5.03)个月。好转组男34例,女10例;年龄(10.02±4.92)个月。抽取2组患儿空腹静脉血2 mL,检测其血清ALT、CK-MB及LDH水平。采用单因素分析和Logistic回归法对患儿预后和临床资料进行分析。结果单因素分析结果显示2组间年龄、喂养方式、ALT、CK-MB及LDH水平和是否存在中枢神经系统(CNS)损害差异有统计学意义(Pa<0.05),而2组间性别、病程及是否存在呼吸道感染的差异无统计学意义(Pa>0.05)。Logistic回归分析结果显示年龄、喂养方式和CNS损害是对RV感染患儿的预后有显著性影响的独立危险因素(Pa<0.05)。心肌和肝脏损害在多数RV感染患儿中呈现一过性表现,对患儿的预后无显著影响。结论年龄、喂养方式和CNS损害是对RV感染患儿的预后有显著影响的独立危险因素。     

Herpes Simplex Virus Infection in the Newborn

Fourteen cases of neonatal herpes simplex virus infection in 10 boys and 4 girls are described. The disease was disseminated in 9 cases. In 5 cases skin symptoms predominated, and 1 had only central nervous system symptoms. Two had a vesicular eruption when born. Six of the children with disseminated disease died.EEG recordings were made on 7 patients: 5 had clinical symptoms compatible with encephalitis, and in these the EEG showed periodic complexes, consisting of triangular or sharp waves, a pattern described in adult cases of herpetic encephalitis.The diagnosis was made by virus isolation and antibody titration. Herpes virus type 2 was the causative agent in all 8 cases where the type was determined. In 5 patients herpes virus antigen was demonstrated using immunofluorescence either in vesicles or throat swabs, in the early phase of the disease.Two children with generalized disease were treated with intravenous iododeoxyuridine (IDU). The first died, but the other, treated early in his disease, recovered completely.The clinical picture, complemented by the immunofluorescent technique for virus detection and repeated EEG recordings, should lead to the early diagnosis of herpetic encephalitis in the newborn, and warrant the use of systemic IDU treatment.     

Serum IgM in Diagnosis of Infection in the Newborn

Serum IgM levels were determined at weekly intervals from birth in 100 normal low birthweight and 100 normal birthweight infants during the first 4 weeks of life. The dynamics of serum IgM was also studied in 36 newborn infants with different types of infection and in 19 infants with probable infection. The behaviour of serum IgM in the infants with systemic infection and also in those suffering from superficial infection with systemic symptoms was significantly different from the normal. Serum IgM rose within two days of appearance of symptoms and the rise persisted as long as the infection was `active''. With the eradication of infection the IgM level tended to fall. This characteristic dynamic pattern of serum IgM may be of considerable help in the diagnosis of neonatal infection, especially the clinically inapparent and atypical varieties that may have serious sequelae later in life.     

新生兔机械通气并氧吸入肺损伤的实验研究

目的研究新生兔机械通气并氧吸入肺损伤的病理改变及肺灌洗液白细胞的变化规律。方法将108只新生兔随机分为高氧、低氧组；每组又分为高吸气峰压（HPIP）、中吸气峰压（MPIP）和低吸气峰压（LPIP）共6组进行机械通气。于通气后1、3、6h3个时间点活杀取肺，行肺灌洗液细胞计数、沉渣涂片细胞分类，测定肺湿干比并结合病理切片分析。结果机械通气6h内，白细胞计数在高氧、低氧通气后均高于对照，且在HPIP通气中白细胞计数明显高于MPIP、LPIP（Pα〈0．05）；低氧通气、MPIP通气及对照组细胞反应以巨噬细胞为主；淋巴细胞反应与给氧方式无关，但与肺受到的机械牵拉力有关，以HPIP组最高（P〈0．05）；分叶核细胞数高氧组高于低氧组，MPIP组低于HPIP及LPIP组（Pα〈0．05）。肺损伤评分及病理分级肺损伤高氧组重于低氧组，HPIP组及LPIP组重于中压力组。病理片均有膨胀不均一的肺泡，低压力通气肺不张重，高压力通气肺出血、肺大泡明显。结论新生兔机械通气时，低压力通气易致肺不张损伤，高压力通气易致肺气压伤，适当的压力能减轻肺损伤。细胞数的改变随通气策略不同而不同。