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。     

Therapeutic hypothermia for newborn infants with hypoxic–ischaemic encephalopathy

Peripartum asphyxia complicated by moderate or severe hypoxic–ischaemic encephalopathy is a devastating global health issue. A therapeutic ‘window of opportunity’ exists after resuscitation of the asphyxiated newborn and before the delayed phase of neuronal loss. Animal studies demonstrated that neuronal injury following hypoxia–ischaemia can be prevented or reduced by a mild reduction in brain temperature. Human infant pilot studies confirmed feasibility, without major adverse effects. Randomised trials and systematic reviews comprising term infants with moderate or severe encephalopathy and peripartum asphyxia have established the neuroprotective benefit of therapeutic hypothermia. Hypothermia reduces mortality or major disability to 18 months of age, as well as cerebral palsy, and neuromotor and cognitive delay. Importantly, mortality is reduced without any increase in major neurodevelopmental disability in survivors, and with only minor adverse effects. The evidence supports therapeutic hypothermia when used within strict protocols in tertiary centres to improve the outcome for term and near‐term newborns with moderate or severe hypoxic–ischaemic encephalopathy. Equally strict protocols in non‐tertiary nurseries will enable earlier initiation of hypothermia under guidance of the regional neonatal intensive care unit and transport team.     

Myocardial dysfunction in birth asphyxia

Evidence of myocardial dysfunction was present in all the 50 newborns who had suffered from moderate and severe birth asphyxia. Myocardial status were dependent on the degree of asphyxia. In 10 newborns who suffered from moderate asphyxia, myocardial status was as follows: respiratory distress in eight (80%) cardiac murmur in two (20%), cardiomegaly on X-ray was present in three (30%) and ischemic changes in form of ST, T changes in ECG in all. Shock and CHF were absent. Of 40 cases of severe birth asphyxia features observed were shock in four (100%) CHF in nine (22.5%) respiratory distress in 40 (100%) cardiac murmur in 30 (100%) ischemic changes inform of ST depression, abnormal Q and T waves in 40 (100%) cardiomegaly in 28 (70%). Early diagnosis and treatment of these cases reduced mortality in moderate asphyxia to zero and in severe asphyxia to 40% in the present study.     

窒息新生儿血清肌钙蛋白I和磷酸肌酸激酶同工酶变化的意义

目的探讨血清肌钙蛋白I(cTnI)和磷酸肌酸激酶同工酶(CK-MB)对窒息新生儿心肌损伤的早期诊断价值。方法选择轻度窒息新生儿29例(轻度组)、重度窒息新生儿18例(重度组)。采用ELISA法和酶动力法检测新生儿血清cTnI水平和CK-MB活性。结果出生d1窒息新生儿血清cTnI和CK-MB水平在轻度组[(2.25±0.54)μg/L、(223.4±23.5)U/L]和重度组[(4.25±0.83)μg/L、(256.3±21.8)U/L]均显著高于对照组(Pa<0.01);重度组血清cTnI和CK-MB水平均显著高于轻度组(Pa<0.01)。治疗后d7窒息新生儿血清cTnI和CK-MB水平均明显下降,轻度组[(0.69±0.18)μg/L、(151.4±18.4)U/L]与对照组均无显著差异(Pa>0.05),重度组[(1.54±0.72)μg/L、(188.9±21.5)U/L]显著高于轻度组和对照组(Pa<0.01)。结论窒息新生儿伴心肌损伤时血清cTnI和CK-MB水平升高;动态观察可用于窒息新生儿微小心肌损伤的早期诊断。     

Myocardial ischaemia in neonates with perinatal asphyxia

In asphyxiated neonates, hypoxia is often responsible for myocardial ischaemia. To evaluate cardiac involvement in neonates with respiratory distress, ECG and echocardiographic recordings were performed, and cardiac enzymes determined. These data were related to clinical presentation and patient outcome. Three groups of neonates were studied: 22 healthy newborn infants (group I) with 5 min Apgar scores >9 and pH >7.3; 15 neonates with moderate respiratory distress (group II) which had Apgar scores ranging between 7 and 9, and pH between 7.2 and 7.3; and 13 neonates with severe asphyxia, Apgar scores <7, and pH <7.2 (group III). The ECGs were evaluated according to the 4-grade classification proposed by Jedeikin et al. [8]. On the echocardiograms, fractional shortening and aortic flow curve parameters were taken into account. Serum creatine kinase (CK), creatine kinase-MB isoenzyme (CK-MB) and lactate dehydrogenase were determined. All of groups I and II survived, but 5 out of 13 in group III died within the 1st week. Grade 3 or 4 ECG changes were observed only in group III patients, while all group II and 3 patients of group I showed grade 2 ECG changes. Fractional shortening, peak aortic velocity and mean acceleration were significantly reduced in group III, whereas the only abnormality found in group II was a reduced fractional shortening. CK, CK-MB, CK-MB/CK ratio and lactate dehydrogenase were all increased in group III, while in group II only CK-MB and the CK-MB/CK ratio were abnormal. Conclusion Severely asphyxiated newborn infants reflect relevant ischaemic electro- cardiographic changes, depressed left ventricular function and marked cardiac enzyme increase. These alterations are far less pronounced in neonates with mild respiratory distress. Received 5 May 1998 / Accepted in revised form: 11 January 1999     

窒息新生儿血清肌钙蛋白I和磷酸肌酸激酶

目的探讨血清肌钙蛋白I（cTnI）和磷酸肌酸激酶同工酶（CK—MB）对窒息新生儿心肌损伤的早期诊断价值。方法选择轻度窒息新生儿29例（轻度组）、重度窒息新生儿18例（重度组）。采用ELISA法和酶动力法检测新生儿血清cTnI水平和CK—MB活性。结果出生d1窒息新生儿血清cTnI和CK-MB水平在轻度组[（2．25±0．54）μg／L、（223．4±23．5）U／L]和重度组[（4．25±0，83）μg／L、（256．3±21．8）U／L]均显著高于对照组（Pα〈0．01）；重度组血清cTnI和CK-MB水平均显著高于轻度组（Pα〈0．01）。治疗后d7窒息新生儿血清cTnI和CK—MB水平均明显下降，轻度组[（0．69±0．18）μg／L、（151．4±18．4）U／L]与对照组均无显著差异（Pα〉0．05），重度组[（1．54±0．72）μg／L、（188．9±21．5）U／L]显著高于轻度组和对照组（Pα〈0．01）。结论窒息新生儿伴心肌损伤时血清cTnI和CK—MB水平升高；动态观察可用于窒息新生儿微小心肌损伤的早期诊断。     

缺氧缺血性脑病新生儿脑型肌酸激酶同工酶、胱抑素C的变化及其临床意义

目的探讨HIE新生儿血清脑型肌酸激酶同工酶（CK—BB）、胱抑素C（CysC）的变化。方法对56例HIE患儿（轻、中、重度分别为18、19、19例）及42例正常新生儿用日本O（ympus AU 1000全自动生化分析仪测定其血清CK—BB、CysC。结果1．中度HIE患儿血清CK—BB与对照组比较明显增高（P〈0．05），重度与轻度组比较明显增高（P〈0．05），重度组与对照组比较显著增高（P〈0．01）；各组HIE患儿CySC与对照组比较明显增高（P均〈0．01），中重度HIE患儿与轻度组比较血清CysC均显著升高（P均〈0．01）。2．新生儿血清CK—BB与CysC呈高度正相关（r=0．85P〈0．01）。结论联合检测血清CK—BB、CysC水平，可尽早发现HIE患儿的脑、肾损害。     

新生儿窒息后血清在诱导人肾小管细胞损伤中的作用

目的研究窒息新生儿血清在诱导人近曲肾小管上皮细胞（HK-2）损伤中的作用。方法以HK-2为研究对象，实验分为15组：新生儿窒息后d1，d3，d7不同体积分数（2．5％，5.0％，10.0％、20．0％）血清处理HK-2细胞组，每个体数分数组均有相应的空白对照组。倒置相差显微镜下观察HK-2细胞的形态学变化，四唑盐（MTT）比色法检测HK-2细胞活力，生物化学法检测培养液中LDH漏出率。结果实验组细胞受损明显，形态改变，活细胞数量较空白对照组明显降低（P均〈0.05）；10.0％，20．0％血清组LDH漏出率较空白对照组明显升高（P均〈0.05），且以窒息后d1 20．0％组最为明显，差异具有显著性（P均〈0．05）。结论新生儿窒息后不同时间血清可诱导HK-2细胞损伤，以窒息后d1损伤最明显。此细胞模型的建立为进一步研究新生儿窒息后肾损伤的发病机制和防治提供实验基础。     

PAIN CRY IN FULL-TERM ASPHYXIATED NEWBORN INFANTS CORRELATED WITH LATE FINDINGS

Abstract. 115 pain-induced cries from 45 full-term newborn infants with pre- and perinatal asphyxia were analyzed by sound spectrographic methods. All the infants had signs of intrauterine asphyxia and Apgar score of 6 or less at 5 min. The mean birth weight was 3170 g. The pain cries were recorded before the age of 8 days, 83 % of the cries before 3 days of age. The cry analysis was compared with the pain cries of 75 full-term, healthy newborn infants of corresponding birth weight and gestational age. The results showed significant differences between the cries of the asphyxiated newborn and the healthy infants. The duration of the phonation was shorter, the maximum and minimum pitch of the fundamental frequency was significantly higher. Bi-phonation and vibrato occurred more often, double harmonic break and glottal roll less often. An increase in rising, falling-rising and flat types of melody was observed. Retrospectively, the cries were more abnormal if the infant was found to be neurologically damaged at the check-up at 2–8 years.     

γ-Aminobutyric acid concentrations in the cerebrospinal fluid of newborn infants

γ-Aminobutyric acid (GABA) concentrations in cerebrospinal fluid (CSF) were measured in 20 neonates with various gestational and postnatal ages. These concentrations varied between 8 and 45 nmol/ml which is approximately 20–100 times the concentrations found in adults. CSF GABA concentrations tended to decrease with advancing gestational age. No apparent alterations were noted with increasing postnatal age (until 6 weeks of age). Asphyxia but not neonatal sepsis was accompanied by an increase in CSF GABA concentrations compared to respective controls.     

Is serum troponin T a useful marker of myocardial damage in newborn infants with perinatal asphyxia?

AIM: To assess the correlation of echocardiographic signs of myocardial damage to serum cardiac troponin T (cTnT) concentrations in newborn infants with perinatal asphyxia. METHODS: Electocardiograms (ECG) and echocardiograms (Echo) were obtained during the first 24 h of life from 29 asphyxiated and 30 control infants and correlated with cTnT concentrations. The echocardiographic parameters included systolic ventricular performance, preload, afterload, diastolic function, stroke volume (SV), left ventricular output (LVO), hyperechogenity of the papillary muscles and insufficiency of the atrioventricular valves. RESULTS: LVO and SV were lower but CTnT were significantly higher in asphyxiated than in control infants: 0.15 (010-0.23) vs. 0.05 (0.02-0.13), p < 0.001). Asphyxiated infants with signs of myocardial damage were associated with significantly higher cTnT than those without, 0.20 (0.11-0.28) and 0.11 (0.05-0.14 ug/L), p = 0.04. CONCLUSION: Cardiac troponin may prove to be valuable in evaluating myocardial damage in birth asphyxia. However, the degree of prematurity may complicate the assessment.     

The dangers of premature extubation after severe birth asphyxia

Abstract The records of all 91 neonates with asphyxia who were referred to the Royal Children's Hospital in 1982 and 1983 were reviewed and information was obtained on their subsequent neurological outcome. Thirty children had been extubated after their initial resuscitation, before transfer to the Royal Children's Hospital; 21 of these children had been extubated despite the fact that they had taken more than 5 min to take their first breath, and 11 (52%) of them died (while none of the nine infants who breathed within 5 min died). A paediatrician was involved with two-thirds of the 21 children who were extubated despite having more than 5 min to breathe. Twelve children required cardiac massage; seven of them were extubated and then reintubated before transfer, and six of the seven infants died. These findings suggest that many paediatricians are not aware of the importance of continuing ventilatory support in neonates who have suffered a severe asphyxial insult. Asphyxiated babies who require cardiac massage, and babies who do not start breathing within 5 min of birth, should not be extubated as soon as they have established regular respiration; they should remain intubated and be transferred to an intensive care unit.     

黄芪注射液对新生儿窒息后血清诱导人近曲肾小管上皮细胞损伤的保护作用

目的探讨黄芪注射液对新生儿窒息后血清攻击人近曲肾小管上皮细胞（HK-2）损伤模型的保护作用。方法以人HK-2为研究对象。实验共分为对照组、模型组和黄芪干预组。黄芪干预组设立5个质量浓度亚组，预处理24h。以200mL／L窒息血清作为攻击因素，观察不同质量浓度黄芪干预组间细胞形态学变化，LDH漏出率和细胞活力情况[四甲基偶氮唑盐比色法（MTT法）]。结果与对照组比较，模型组细胞形态发生改变，LDH漏出率增加、细胞活力降低，均具有显著性差异（Pa〈0．05）；与模型组比较，黄芪干预组细胞形态得到明显改善，LDH漏出率降低、细胞活力增加，均具有显著性差异（Pa〈0．05），5～40mg／L保护效应逐渐增加，40mg／L时保护效果最强，〉40mg／L时保护效应反而下降。结论黄芪注射液具有减轻窒息血清所致HK-2细胞损伤的作用。     

缺氧缺血性脑病新生儿血浆肾上腺髓质素、血清肿瘤坏死因子-α水平的变化及其与窒息后脑损伤的关系

目的探讨HIE新生儿血浆肾上腺髓质素(ADM)和血清肿瘤坏死因子-α(TNF-α)水平的变化及其与窒息后脑损伤的关系。方法按病情程度将50例HIE分为轻度HIE组(20例)、中度HIE组(16例)和重度HIE组(14例);同期选择10例健康足月新生儿作对照(健康对照组)。采用放射免疫分析法测定不同程度HIE患儿和健康对照组新生儿血浆ADM和血清TNF-α、神经特异性烯醇化酶(NSE)水平。结果1.与健康对照组相比,HIE组患儿血浆ADM和血清TNF-α、NSE水平明显升高,差异有显著统计学意义(Pa<0.01);轻度HIE组、中度HIE组和重度HIE组患儿血浆ADM和血清TNF-α、NSE水平依次升高,两两比较差异有显著统计学意义(Pa<0.01)。2.HIE组患儿血浆ADM、血清TNF-α和NSE水平均呈显著正相关(r=0.85,0.89,0.83 Pa<0.01)。3.HIE预后差患儿血浆ADM、血清TNF-α和NSE水平高于预后好者(Pa<0.01)。结论ADM和TNF-α均参与新生儿HIE的病理生理过程,其可作为判断HIE病情严重程度和预后的早期标志物。     

Methods of resuscitation in low-Apgar-score newborn infants— a national survey

The incidence, treatment and immediate course in infants with postnatal apnoea were studied. Information on all infants born in Sweden in 1985 with a low Apgar score (3 or less at 1 min or 6 or less at 5 min) was collected from the midwife and from the baby's chart. Of the 97,648 live births, 1633 (1.7%) had a low Apgar score. The risk increased with decreasing birthweight and with severe malformations. Before delivery, 19% of the low-Apgar-score infants were not expected to require resuscitation. Eighty percent of the ventilated infants were satisfactorily ventilated by bag and mask; the remainder were intubated. Of the ventilated infants, 78% developed spontaneous breathing within 10 min after birth and 89% within 20 min. Routine intubation or administration of buffer in cases of postnatal asphyxia had no influence on the time to onset of regular spontaneous breathing.     

Myocardial Dysfunction and Cerebral Blood Flow Velocity Following Birth Asphyxia

ABSTRACT. Birth asphyxia often leads to left ventricular myocardial dysfunction. To assess the effect of myocardial dysfunction on cerebral perfusion, we evaluated cardiac output and cerebral blood flow velocity in the anterior cerebral and internal carotid arteries in 20 asphyxiated term newborn infants during the first 4 days of life using 2-dimensional/pulsed Doppler ultrasound. In 8 infants with myocardial dysfunction cardiac output was reduced on days 1 and 2 and within normal limits thereafter. In these infants changes in mean cerebral blood flow velocity and pulsatility index were passively related to changes in mean arterial pressure and cardiac output. In 12 infants without myocardial dysfunction a stable cerebral blood flow velocity pattern was found, which was unaffected by changes in mean arterial pressure. We conclude that infants presenting with a reduced cardiac output after deliveries associated with severe asphyxia may be at risk for additional ischemic or hemorrhagic cerebral damage because of lack of autoregulation.     

促红细胞生成素治疗缺氧缺血性脑病新生儿的药代动力学变化

目的通过测定缺氧缺血性脑病（HIE）新生儿用药前后血清、脑脊液（CSF）促红细胞生成素（EPO）水平,探讨EPO的药代动力学变化及透过患儿血脑脊液屏障的情况。方法对35例48 h内收入院的中、重度HIE患儿随机分为用药前组10例,观察组25例。入院后观察组立即予重组人促红细胞生成素（rhEPO）500 U/kg皮下注射。其中用药后3 h组10例,8 h组8例,24 h组7例。用药前组在常规治疗前,观察组在给予EPO后的各时间点分别抽取静脉血、CSF,采用放射免疫法测定血清、CSF中EPO水平。结果观察组血清EPO水平3 h达峰值,是用药前的2.6倍（P〈0.01）,用药后24 h仍高于用药前水平,但无显著性差异。CSF中EPO水平也在用药后3 h达高峰（P〈0.05）,但在用药后8 h回落至用药前水平。观察组用药后3 h血清与CSF中EPO水平呈直线相关（r=0.69 P〈0.05）,而其他组间未发现相关性。结论EPO能通过HIE患儿的血脑脊液屏障,CSF中EPO水平与血液EPO水平有关。     

窒息新生儿导纳式双侧脑血流图检测的意义

目的研究窒息新生儿脑血流动力学变化的意义。方法采用导纳式双侧脑血流自动检测仪于生后1~4 d对窒息新生儿及正常新生儿各20例进行监测,探讨其脑血流变化的规律性。结果生后1~4 d窒息组双侧流入容积速度(Hs/b-S)显著低于正常组(P<0.05),窒息组双侧脑导纳微分环(ADL)Ⅰ Ⅱ指数显著低于正常组(P<0.05);生后1 d窒息组双侧ADLⅣ指数显著高于正常组(P<0.05)。结论脑导纳图检测能较好地反映窒息患儿的脑血流动力学情况。     

胎儿宫内窘迫孕妇静脉血及脐血孤啡肽的变化

目的探讨宫内窘迫脐血孤啡肽(OFQ)的变化及其临床意义。方法采用放射免疫法测定30例正常妊娠妇女(对照组)及23例胎儿宫内窘迫孕妇(缺氧缺血组)静脉血及脐血OFQ的含量,同时行脐动脉血血气分析。结果1.缺氧缺血组脐血OFQ(23.46±6.72)ng/L,对照组为(13.29±4.14)ng/L,两组相比有显著差异(P<0.05)。2.脐动脉血血气分析,pH 为(7.00±0.15),p(O2)为(1.70±0.42)kPa,p(CO2)为(8.80±0.69)kPa;OFQ与脐血pH、p(O2)呈显著负相关(r= -0.418,-0.437 P均<0.05),与p(CO2)呈显著正相关(r=0.442 P<0.05)。3.缺氧缺血组及对照组母血浆OFQ含量分别为(9.23±3.01)ng/L及(8.57±2.83)ng/L,两组相比无显著差异(P>0.05).4.脐血OFQ含量与母血OFQ含量无显著相关(r=0.287 P>0.05)。结论OFQ与缺氧缺血导致的胎儿窘迫及新生儿窒息的发生发展密切相关。     

新生儿缺氧缺血性系列疾病的探讨

目的　 分析窒息致新生儿缺氧缺血性系列疾病 (HID)临床资料和预后 ,探讨改善预后的措施。 方法 　对 72例HID进行资料分析。 结果 　在 72例HID中 ,新生儿缺氧缺血性脑病 (HIE) 64例 ,新生儿缺氧缺血性肾脏损害 (HIR) 40例 ,新生儿缺氧缺血性心脏损害 (HIM ) 2 4例 ,经治疗 ,存活 60例 ,死亡 7例 ,放弃治疗 5例 ;胎儿期缺氧缺血较出生后缺氧致脏器损害多而重 ( χ2 =8 974,P <0 0 1) ,且预后差 ( χ2 =4 816,P <0 0 5 ) ;保持患儿血糖在正常的高值 ,预后明显优于低值正常血糖的患儿( χ2 =6 0 3 8,P <0 0 5 1,而中值正常水平血糖患儿预后与低值正常水平血糖患儿无显著差异 χ2 =1 3 0 2 ,P <0 0 5 )。 结论 　胎儿期缺氧缺血性HID和血糖在正常的低值的HID预后均差 ,保持血糖在正常的高值预后佳