新生儿重度窒息产房复苏36例体会

世界卫生保健机构将新生儿娩出后发生进行性缺氧，二氧化碳积聚和酸中毒称为窒息，如果这一过程持续太久，可导致永久性脑损伤或死亡。新生儿窒息的死亡率受重度窒息发生率及复苏技术条件等多因素影响，及时有效地对重度窒息儿进行复苏，是产、儿科工作者面临的实际问题，现就我院产科近3年来对重度窒息儿的复苏结果进行分析。     

远郊区县级医院新生儿窒息预防与急救体会

目的：探讨新生儿窒息预防与急救的最佳管理方法。方法：分析148例新生儿窒息的临床资料，预防，急救，治疗及护理措施。结果：新生儿窒息的发生率下降了6．29％，窒息后吸入性肺炎的发生率下降了20．9％：坏死性小肠炎的发生率减少为0。通过对1～3周岁窒息患儿的定期随访，148例窒息复苏成功小儿DDST(丹佛智力筛查)与正常出生的小儿无明显区别。无1例因新生儿窒息而造成脑瘫和死亡。结论：及早地预防和及时、有效、迅速地复苏是降低新生儿窒息发生率，减少并发症的最佳管理办法。如果每一步骤都能很好地落实，窒息儿的死亡率大大降低，大多数缺血、缺氧性脑损伤可得到预防。     

新生儿窒息后脑损伤的CT诊断与临床分析

目的:为提高窒息后脑损伤的诊断率和探讨窒息程度与脑损伤的关系。方法:对43例窒息新生儿头颅行CT检查,并进行轻、重度窒息组的CT对比。结果:显示CT诊断脑损伤的阳性率为53.49％,窒息程度与脑损伤的关系为:轻度窒息组CT示脑损伤的发生率为48％,重度窒息组为61％,两者比较差异无显著性(P>0.05)。结论:提示CT是窒息后脑损伤的重要的辅助诊断手段,脑损伤的产生与窒息程度无明显正相关,不能仅靠出生时窒息的严重程度而判断脑损伤的发生和预后。     

新生儿窒息性脑损伤的CT临床分析

目的:研究新生儿窒息性脑损伤的CT特征及与窒息程度的关系。方法:回顾性分析经CT检查的窒息性脑损伤儿100例,进行脑损伤分度,并与窒息程度相对照。结果:100例窒息儿中脑损伤轻度者42例,中度36例,重度22例;重度窒息儿中有93.5％(43/46)为中、重度脑损伤,轻度窒息儿中有28％(15/54)为中、重度损伤。结论:围产期窒息是新生儿脑损伤的主要原因,CT检查对该病的诊断和治疗具有重要价值。     

新生儿窒息并多脏器损害相关危险因素探讨

目的探讨新生儿窒息后多脏器损害的危险因素。方法对218例新生儿窒息并发多脏器损害的发生率及其与各种因素的关系进行分析。结果窒息后脏器损害发生率达87.61%,多脏器损害发生率为60.09%。重度窒息组中多脏器损害的发生率明显高于轻度窒息组(P<0.01)。多脏器损害的发生率与窒息程度及是否及时合理复苏有密切关系。结论预防新生儿窒息并发多脏器损害,应重视围产期保健,加强产儿科合作,及时合理复苏和重视复苏后的监护。     

新生儿窒息后脑损伤的BAEP改变特征及相关因素分析

目的:探讨新生儿窒息后脑损伤的诱发电位(BAEP)改变特征及脑损伤发生的相关因素。方法:对282例新生儿进行脑干听觉BAEP检查,结合临床资料进行对比分析,并对部分患儿进行随访,复查BAEP及进行神经系统体查。结果:282例新生儿中共有BAEP异常81例,其中窒息组74例,占窒息新生儿37.9%,对照组BAEP异常7例,占无窒息儿的6.8%,两组比较有显著性差异(P<0.05);窒息组中早产儿、小于胎龄儿脑损伤发生率分别较足月儿、适于胎龄儿明显升高(P<0.05);对照组中早产儿、小于胎龄儿脑损伤发生率较足月儿、适于胎龄儿无显著性差异(P>0.05)。结论:新生儿室息是引起新生儿脑损伤的主要原因之一;BAEP对脑损伤具有高度敏感性,有助于窒息后脑损伤的研究并指导治疗及评估预后;新生儿窒息后脑损伤的发生与多种因素有关,不同情况下的窒息新生儿应有不同的干预标准。     

窒息新生儿脑损伤的早期防治

目的 窒息新生儿心肺复苏后，由于缺血缺氧带来了一系列的全身性病理生理变化，其中脑病及脑出血是常见的较严重的并发症。为了提高治疗效果，我院产科对112例窒息儿采取脑损伤早期药物预防和治疗临床观察。方法 窒息新生儿在出生后2－6h给予鲁米那、水合氯醛交替应用，地塞米松与速尿交替应用，同时加用止血药治疗。结果 112例窒息新生儿治愈104例，抢救成功率92．86％，足月新生儿死亡率0．01％。结论 窒息新生儿早期应用鲁米那干预不但可以预防脑损伤，对已有脑病及脑出血的患儿也可以达到治疗效果。     

新生儿新法复苏与降低窒息后脑损伤并发症探讨

新生儿窒息后脑损伤包括新生儿缺氧缺血性脑病(ＨＩＥ)和颅内出血(ＩＣＨ),是新生儿窒息后的严重并发症。我院自1997年1月以来,坚持实施新生儿新法复苏,观察1997年1月至1999年10月窒息新生儿缺氧缺血性脑损伤发生率较前明显下降。1　临床资料我院1995年1月至1996年12月,活产分娩1912例,发生窒息新生儿数184例,其中Ａｐｇａｒ评分0～3分,窒息儿为41例,并发ＨＩＥ57例,发生率3098%,ＩＣＨ55例,发生率2989%,其中ＨＩＥ并ＩＣＨ29例。新法复苏实施后,我院1997年1月至1999年10月,活产分娩2450例,发生窒息新生儿数123例,其中Ａｐｇａｒ评分0～3分,…     

苯巴比妥早期干预对重度窒息新生儿脑损伤程度的影响

目的 探讨苯巴比妥早期干预对重度窒息新生儿脑损伤程度的影响。方法 将如例重度窒息复苏后的新生儿随机分为两组：常规治疗组(对照组)25例，即在对症支持处理的基础上使用脑活素和胞二磷胆碱治疗；苯巴比妥预防组25例，在常规治疗的基础上，尽早(生后6小时内)应用苯巴比妥治疗。结果 观察和比较两组惊厥或频繁惊厥的发生率，苯巴比妥干预组有3例(12％)发生惊厥，对照组有12例(48％)发生惊厥，两组差别具有统计学意义。(X^2＝16．48，P＜0．01)，检测两组出生后第四天头颅CT及视觉诱发电位VEP，头颅CT显示干预组异常发生率为32％(8／25)与对照组60％(15/25)相比，差异有统计学意义(X^2＝8．15，P＜0．01)VEP资料表明干预组异常发生率68％(17／25)与对照组92％(23／25)相比，两组差异具有统计学意义(X^2＝7．7，P＜0．01)。结论对重度窒息复苏后的新生儿，在对症支持治疗的基础上尽早使用苯巴比妥，能显著减轻缺氧缺血性脑损伤的程度。     

新生儿窒息致多脏器功能不全综合征临床分析

目的 了解新生儿窒息后多脏器功能不全综合征(MODS)的发生率、临床特点及相关危险因素。方法 分析286例窒息新生儿MODS的发生率及相关危险因素。结果 (1)窒息后器官功能不全发生率依次为脑(71．7％)、肾(35．3％)、肺(32．5％)、心(26．2％)、胃肠(7．O％)。(2)重度窒息致MODS发生率高于轻度窒息。(3)MODS发生率及严重程度与围产因素密切相关。结论 加强围产期保健，防止早产，预防窒息，推广新法复苏及监护，是降低MODS的关键。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.