固尔苏治疗早产儿肺透明膜病15例疗效观察

目的了解应用固尔苏治疗早产儿肺透明膜病的疗效,并探讨固尔苏的应用方法.方法将30例生后确诊新生儿肺透明膜病的早产儿随机分为两组,固尔苏(PS)治疗组15例,阴性对照组15例,患儿均为孕27～35w,体重1200～2600g,Apgar评分3～10分,生后5～10min入院的早产儿.结果患儿用药前均有不同程度的临床表现,如:紫绀、窒息、呼吸暂停,低氧血症、胃液泡沫振荡试验-～±,胸片:肺泡膨胀不良或并存肺炎等.用药后治疗组均改善缺氧症状,明显缩短双鼻道加压吸氧或持续低流量吸氧的时间以及住院时间,无1例死亡.对照组合并颅内出血1例,缺血缺氧性脑病 8例,死亡2例,因病情危重,放弃治疗2例.两组比较,有显著差异性(P<0.05).结论固尔苏治疗早产儿肺透明膜病疗效显著,明显提高了救治成功率.     

支气管肺发育不良20例病因分析

本文通过采用回顾性方法对１９９７年１月－１９９８年９月入住新生儿重症监护并采用呼吸机治疗的支气管肺炎不良（ＢＰＤ）的２０例患儿进行病因分析。结果发现在ＢＰＤ组中早产患儿的呼吸机参数吸气峰压、吸入氧浓度以及合并有肺出主感染、肺透明膜病、动脉导管未闭者与非ＢＰＤ组均有显著性差异（Ｐ〈０．０５）。我们认为ＢＰＤ的发生与早产儿、极低体重儿、新生儿肺透明膜病、肺出血及感染,以及高浓度氧及高ＰＩＰ等与有密切关     

肺泡的发育与新生儿肺透明膜病

新生儿肺透明膜病 (hyaline membranedisease,HMD)发生在新生儿出生后不久 ,多见于未成熟的早产儿。 HMD占新生儿死亡率的 3 0 % ,是一种早产儿和新生儿常见的严重疾病。 HMD的发病是由于胎儿肺发育不全、缺乏肺泡表面活性物质引起的。临床上表现婴儿低氧血症 ,进行性呼吸困难、青紫和呼吸衰竭等症 ,所以 HMD又称之为“新生儿呼吸窘迫综合症”。1　肺泡的发育与分化1 .1　肺的形态发生　人胚第 4周初 ,原始咽尾端底壁内胚层正中出现一纵行浅沟 ,此沟逐渐加深形成的喉气管憩室 (laryngo-tracheal diverticulum) ,即为喉、气管、支气管和…     

经鼻间歇正压通气治疗新生儿呼吸衰竭的随机对照研究

目的比较经鼻间歇正压通气（nIPPV）与经鼻持续气道正压通气（nCPAP）在新生儿呼吸衰竭中的疗效。方法采用RCT研究的方法,选择2008年1～12月在第三军医大学大坪医院NICU住院的呼吸衰竭新生儿作为研究对象,按随机数字表法将研究对象随机分为nIPPV组和nCPAP组,分别实施nIPPV或nCPAP干预,观察患儿动脉血气分析、应用nIPPV和nCPAP时间、并发症和预后等指标,比较nIPPV组和nCPAP组治疗后需气管插管行机械通气的比例及其预后结局。结果研究期间nIPPV组纳入48例,nCPAP组纳入53例。两组在性别构成比、胎龄、年龄、出生体重、出生后5 m inApgar评分、新生儿急性生理学评分和应用肺表面活性物质比例等方面差异无统计学意义（P均〉0.05）。两组呼吸衰竭原发病分布差异无统计学意义（P〉0.05）。两组治疗前血气分析指标差异均无统计学意义（P均〉0.05）,nIPPV组治疗后1 h血气分析pH和PaO2显著高于nCPAP组（P〈0.05）。nIPPV组治疗成功率为77.1%（37/48例）,nCPAP组为62.3%（33/53例）,nIPPV组显著高于nCPAP组（P〈0.05）。nIPPV组和nCPAP组治疗成功的患儿平均应用nIPPV和nCPAP的时间差异无统计学意义（P均〉0.05）。nIPPV组的预后结局中治愈和好转出院45/48例（93.8%）,nCPAP组为46/53例（86.8%）,两组差异无统计学意义（P〉0.05）。结论与nCPAP相比,nIPPV治疗可显著降低呼吸衰竭新生儿气管插管行机械通气的比例。     

新生儿持续肺动脉高压132例临床分析

目的探讨新生儿持续肺动脉高压(PPHN)的临床特点。方法对2010年10月至2014年10月收治的132例PPHN患儿的原发疾病、治疗及转归情况进行分析。结果 132例PPHN患儿原发疾病包括:围生期窒息、胎粪吸入综合征、新生儿呼吸窘迫综合征、新生儿肺炎、湿肺、先天性膈疝、新生儿败血症等。在治疗原发疾病的同时,给予NCPAP、机械通气等支持对症治疗,64例重度PPHN给予一氧化氮(NO)吸入治疗。临床治愈88例,好转28例,死亡16例(其中13例放弃治疗死亡)。结论 PPHN病因复杂,早期诊断和及时治疗是改善预后的关键。     

珂立苏治疗新生儿肺透明膜病临床应用初探

新生儿肺透明膜病（HMD）是早产儿的一种严重疾病，是由于肺泡表面缺乏活性物质所引起，国内用肺泡表面活性物质治疗肺透明膜病也有多年历史，但多为进口产品，我科用新型国产的肺表面活性物质珂立苏治疗肺透明膜病2例，总结报道如下。     

一氧化氮在新生儿的临床应用

新生儿低氧血症是由多种原因引起,肺动脉高压在低氧血症起重要作用.肺血管阻力增加,心脏排出量减少,受损的组织释放氧,其结果是多系统器官功能障碍.肺血管阻力增加,部分原因是受损的血管内皮减少了内源性一氧化氮(nitric oxide,NO)合成,最终导致局部血管收缩.NO吸入(inhaled nitric oxide,iNO)代替缺乏的内源性NO[1],目前已应用于成人呼吸窘迫综合征,新生儿持续肺动脉高压(PPHN),早产儿呼吸窘迫综合征(RDS)和儿童急性呼吸窘迫综合征(ARDS).     

早产儿颅内出血的高危因素分析

目的研究早产儿颅内出血的高危因素,探讨早产儿颅内出血的预防措施。方法选择湖南省儿童医院新生儿重症监护病房（NICU）2009年1月-2009年12月134例颅内出血早产儿作为研究组,同期130例无颅内出血的早产儿作为对照组,对23个临床因素进行单因素分析,筛选早产儿颅内出血的高危因素。结果单因素分析发现胎龄、出生体重、妊高征、前置胎盘、胎膜早破、产时窒息、脐带绕颈、宫内窘迫、呼吸暂停、代谢性酸中毒、低氧血症、高碳酸血症、机械通气、吸入高浓度氧等14项与早产儿颅内出血有关（P〈0.05）。再对这些相关因素进行Logistic回归分析确定胎龄、出生体重、产时窒息、宫内窘迫、代谢性酸中毒、低氧血症、高碳酸血症、机械通气、吸入高浓度氧等9项为早产儿颅内出血的高危因素（P〈0.05）。结论早产儿颅内出血的高危因素较多,在早产儿的诊治过程中应予足够重视,从而提高预见性并在早期采取相应干预措施。     

一氧化氮在新生儿的临床应用

新生儿低氧血症是由多种原因引起 ,肺动脉高压在低氧血症起重要作用。肺血管阻力增加 ,心脏排出量减少 ,受损的组织释放氧 ,其结果是多系统器官功能障碍。肺血管阻力增加 ,部分原因是受损的血管内皮减少了内源性一氧化氧 (ＮｉｔｒｉｃＯｘｉｄｅ ,ＮＯ)合成 ,最终导致局部血管收缩。ＮＯ吸入 (ｉｎｈａｌｅｄＮｉｔｒｉｃＯｘｉｄｅ ,ｉＮＯ)代替缺乏的内源性ＮＯ[1] ,目前已应用于成人呼吸窘迫综合征 ,新生儿持续肺动脉高压(ＰＰＨＮ) ,早产儿呼吸窘迫综合征 (ＲＤＳ)和儿童急性呼吸窘迫综合征 (ＡＲＤＳ)。1 ｉＮＯ选择性扩张肺血管的作…     

鼻塞式CPAP治疗新生儿肺透明膜病疗效观察

目的：观察鼻塞式CPAP(NCPAP)治疗新生儿肺透明膜病的疗效。方法对20例早期新生儿肺透明膜病进行X线检查，根据血气分析结果调整呼吸机参数。结果20例患儿放弃治疗1例，转上级医院治疗1例，余18例顺利撤除鼻塞式CPAP。结论鼻塞式CPAP治疗早期新生儿肺透出明膜病能明显的提高治疗效果，对早产儿非常适用。     

Zuverlässigkeit des Heimmonitorings am Beispiel des Gerätes Nellcor Puritan Bennett Assurance A4000 kombiniert mit dem Pulsoximeter NPB 290

Question of the study

The realiable recognition of hypoxemia as well as apnea, bradycardia, tachycardia is necessary for the sufficient quality of home monitoring. There are some commercially available cardiorespiratory home monitors that have not been evaluated with complete polysomnographic studies. The purpose of this study was to determine the reliability of the home monitoring system Nellcor Puritan Bennett Assurance A4000 combined with pulse oximeter NPB 290 by comparing it with the manual evaluation of polysomnography (polysomnographic system Alice 3).

Patients and methods

21 infants (12 males; 9 females) whithin 3 and 51 weeks of life with suspected cardiorespiratory regulation disorders were examined simultaneously with polysomnography Alice 3 and home monitoring system Nellcor Puritan Bennett Assurance A4000 inclusive pulse oximeter NPB 290.

Results

There were no recordings in 7 of 21 children with both systems, which corresponds to a specificity of 100%. 16 cases of apnea associated with hypoxemia in 4 infants were not detected by the home monitor system. Out of 26 cases of apnea with bradycardia and of 42 cases of isolated bradycardia only 10 and 26 were recognised by the home monitoring system, respectively. 116 isolated hypoxemia events were not identified at all. Sensitivity with regard to recognition of central apnea was 64,3%. The recognition of apnea, bradycardia and hypoxemia by this home monitoring system was insufficient.

Conclusion

Generally a polysomnographic realiability test is required for all kinds of home monitors prior to commercial introduction.     

Postoperative outcome in formerly premature infants undergoing herniorrhaphy: comparison of spinal and general anesthesia

To compare the postoperative outcome according to the type of anesthesia, formerly prematured and high-risk infants who had received and weaned ventilator care preoperatively and had undergone inguinal herniorrhaphy were enrolled in this study. Immediate pre- and post-operative respiratory data which contained the lowest respiratory rates, SpO2, heart rates and the incidence of hypoxemia and bradycardia were collected with the incidence of ventilator care, application of continuous positive airway pressure (CPAP), application of oxygen, hospital stay, and respiratory mortality by chart review, retrospectively. Among the twenty-nine infants, fourteen received the general anesthesia (GA group), and fifteen received the spinal anesthesia (SA group). Postoperatively, the infants in the GA group had lower SpO2 (77.1 +/- 20.9% vs. 93.0 +/- 5.5%), higher incidence of hypoxemia (6 vs. 0), ventilator care (5 vs. 0) and application of CPAP (4 vs. 0) than the infants in the SA group. One infant in the GA group died because of acute respiratory failure caused by respiratory syncythial virus pneumonia. We concluded that spinal anesthesia reduces postoperative oxygen desaturation and respiratory morbidity in formerly prematured and high-risk infants who underwent inguinal herniorrhaphy.     

Assisted reproductive technologies and the risk of birth defects--a systematic review

BACKGROUND: The risk of birth defects in infants born following assisted reproductive technology (ART) treatment is a controversial question. Most publications examining the prevalence of birth defects in ICSI and IVF infants compared to spontaneously conceived infants have serious methodological limitations; despite this, most researchers have concluded that there is no increased risk. METHODS: We carried out a systematic review to identify all papers published by March 2003 with data relating to the prevalence of birth defects in infants conceived following IVF and/or ICSI compared with spontaneously conceived infants. Independent expert reviewers used criteria defined a priori to determine whether studies were suitable for inclusion in a meta-analysis. Fixed effects meta-analysis was performed for all studies and reviewer-selected studies. RESULTS: Twenty-five studies were identified for review. Two-thirds of these showed a 25% or greater increased risk of birth defects in ART infants. The results of meta-analyses of the seven reviewer-selected studies and of all 25 studies suggest a statistically significant 30-40% increased risk of birth defects associated with ART. CONCLUSIONS: Pooled results from all suitable published studies suggest that children born following ART are at increased risk of birth defects compared with spontaneous conceptions. This information should be made available to couples seeking ART treatment.     

肾移植后重症卡氏肺囊虫肺炎1例

背景：卡氏肺囊虫肺炎是肾移植后较为少见的严重并发症,起病隐匿,临床症状不典型,病情进展迅速,死亡率高。 目的：探讨肾移植后并发卡氏肺囊虫肺炎的临床特点、治疗及预防方法。 方法：回顾性分析2011年在西安交通大学医学院第一附属医院诊断治疗的1例肾移植后并发重症卡氏肺囊虫肺炎患者的临床资料。 结果与结论：1例62岁女性同种异体肾移植患者术后100 d出现发热及进行性低氧血症,经支气管镜检及肺泡活检检出卡氏肺囊虫,病情进展迅速,经口服复方磺胺甲噁唑片、呼吸机辅助通气及对症支持治疗后治愈。结果提示具有危险因素的患者在出现发热及进行性低氧血症时应提高警惕,预防应用复方磺胺甲噁唑片等药物尤为重要;另外免疫抑制剂的调整在卡氏肺囊虫肺炎的治疗过程中很关键,CD4+/CD8+可作为一项有益的指导指标。     

Sudden infant death syndrome: a preconditioning approach to acute arterial hypoxemia

The blood hemoglobin F (HbF) concentration increases in response to chronic arterial hypoxemia and is abnormally elevated in sudden infant death syndrome (SIDS) post-mortem indicating a need for greater oxygen affinity of hemoglobin (Hb) or diminished oxygen usage by tissues or both.Modifying Hb oxygen affinity in rats revealed that increased, rather than decreased, hemoglobin-oxygen affinity permitted survival at greatly reduced environmental oxygen pressures equivalent to high altitude. Decreased Hb-oxygen affinity resulted in bradycardia 5-10 minutes before death. Cardiorespiratory recordings from infants dying suddenly and unexpectedly at home demonstrated cardiovascular failure with hypotension and bradycardia, rather than a cessation of breathing.A fall in blood pressure and acidosis due to hypoxemia in combination with reduced arterial oxygen saturation leads to circulatory failure, heart failure and death.It is speculated that the final mechanism of SIDS mimics failure to survive at high altitudes and very low environmental oxygen pressures when low arterial oxygen pressures combine with decreased Hb-oxygen affinity lead to severe hypoxemia and death.     

早产儿及低体重儿四种支原体感染状况研究

为了解早产儿、低体重儿人型支原体 (Mh)、解脲脲原体 (Uu)、生殖支原体 (Mg) ,发酵支原体 (Mf)等 4种支原体的感染状况 ,我们于 1997年～ 1998年分别收集了 2 7例早产儿和 2 1例低体重儿的咽拭子标本应用套式PCR (nPCR)法进行上述 4种支原体特异性核酸检测。结果早产儿和低体重儿的Mh阳性率分别为 92 6 %、95 2 % ;Uu阳性率分别为 5 5 5 %、38 1%。Mh Uu合并感染状况严重 ,分别为 5 5 5 %、33 3%。Mg只有 1例阳性 ,Mf无阳性病例发现。无论是早产儿 ,还是低体重儿 ,剖宫产与阴道产的各种支原体检出率无差别 (P均 <0 0 5 )。剖宫产娩出儿咽部查出支原体可确认为宫内感染 ,由此可见 ,支原体宫内感染状况严重。本文并就支原体感染与早产和新生儿出生低体重的发生原因进行了讨论。     

早产儿智能发育相关因素初探

目的：研究环境因素对早产儿智能发育的影响。方法：应用麦卡易幼儿智能量表,对２８３名４－９岁早产低体重儿进行追踪研究。结果：环境因素对早产低体重儿智能发育起着重要的作用。经多元逐步回归分析显示：早期教育、父母受教育程度、不同类别的师资对早产儿智能发育有着显著的影响。结论：应高度重视环境因素对早产儿智能发育的影响。为早产儿提供良好的生活环境能帮助早产儿克服潜在的严重问题。     

Detection of previously unrecognized daytime desaturation in children with chronic lung disease

PRIMARY OBJECTIVE: The prime rationale of this research is to investigate the possible occurrence of previously unrecognized episodes of desaturation apparent in preterm infants with chronic lung disease as they freely move around a non-artificial environment. RESEARCH DESIGN: The study comprises 58 hours of telemetric recordings of SpO2, heart rate, body movement and temperature, along with full ECG and photoplethysmographic waveforms for eight preterm subjects in their home environment. MAIN OUTCOME/RESULTS: The data is analysed for remarkable events, more particularly periods of spontaneous desaturation. Statistical results for all case studies are collated into a table along with examples of graphical analysis. CONCLUSIONS: This study has shown that some patients are prone to episodes of hypoxemia during the course of normal daily activity or daytime sleep that would usually go unrecognized and that more effective management of supplemental oxygen treatment may be possible with continual unobtrusive monitoring.     

Deficiency of IgG subclasses in mothers of infants with group B streptococcal septicemia

Serum IgG subclasses were studied in 19 mothers of infants with serious infections caused by group B streptococci (GBS) and compared with a control group of 20 mothers of healthy infants. 13 of 19 mothers showed decreased subclass levels: 10 of 19 low IgG2, 9 of 19 low IgG1 and 4 of 19 low IgG3. The levels of IgG1, IgG2 and IgG3 were significantly lower among mothers of GBS-infected infants than among the controls. Thus, there is indirect evidence that the infants were immunodeficient at birth.     

Effect of tolazoline on persistent hypoxemia in severe hyaline membrane disease

Ten critically-ill preterm infants with severe hyaline membrane disease received tolazoline because of persistent hypoxemia refractory to the administration of 100% oxygen and mechanical ventilation. Seven infants (70%) responded immediately with an increase in PaO2 greater than or equal to 20 mmHg in the umbilical arterial gas within 60 minutes after bolus infusion (1 to 2 mg/kg) of tolazoline. Twenty-four hours later after the tolazoline infusion, the FiO2 had been decreased from 1.0 to a mean of 0.82 +/- 0.16, and the MAP from 16.5 +/- 1.8 to 15.6 +/- 4.5 cm H2O. Four of 7 infants (57%) who had an immediate response survived, whereas none survived out of 3 infants who failed to respond initially. Three infants experienced relatively severe complications possibly related to tolazoline. There appears to be a place for the use of tolazoline in a severely hypoxemic infant with hyaline membrane disease who is being ventilated, and in whom arterial oxygenation cannot be improved by a further increase in the inspired oxygen concentration or by an alteration of ventilator settings.