新生儿窒息复苏的新观点——空气复苏

新生儿窒息是引起新生儿缺氧缺血性脑损伤的重要原因之一，而及时、正确、有效的复苏是减少窒息引起的各种并发症的关键。传统的观点认为，应利用高浓度氧进行复苏，而随着对缺氧缺血性脑损伤的机制，尤其是氧应激反应副作用的认识，国外部分学者提出了利用空气进行复苏的新观点，认为在一定条件下空气复苏较纯氧复苏更有益。该文对近几年来有关空气复苏的研究进展作一综述。     

新生儿窒息复苏氧体积分数研究新进展

新生儿窒息是引起新生儿缺氧缺血性脑病(HIE)的重要原因之一,完善的窒息复苏方案可以最大限度地改善窒息新生儿预后。传统的窒息复苏方法是纯氧复苏,但随着对氧反常和再灌注损伤理论的深入研究,尤其是对新生儿窒息复苏氧体积分数研究的不断深入,人们提出了利用低氧进行复苏,甚至利用空气进行复苏的新观点,认为在一定条件下空气的复苏效果较纯氧好。本文对近几年来有关新生儿窒息复苏氧体积分数研究进展进行综述。     

新生儿窒息复苏首选纯氧还是空气的Meta分析

目的收集现有比较采用空气或者纯氧复苏窒息新生儿效果的临床文献,对其进行系统评价,试图寻找比较合理的新生儿复苏气源。方法检索在美国医学索引（MEDLINE）,荷兰医学文摘（EMBASE）,中国生物医学文摘（CBMA）及Cochrane图书馆（CL）上收录的自1966年1月至2005年6月,有关窒息新生儿复苏气源比较的文献,对符合纳入要求的文献进行系统评价,比较空气或者纯氧作为复苏气源在窒息新生儿病死率,缺氧缺血性脑病发生率,以及复苏失败率等方面内容。结果6篇文献符合纳入标准,共包括1940个窒息新生儿,其中采用空气复苏窒息新生儿988个,采用纯氧复苏窒息新生儿952个。对上述内容进行系统评价,得出采用空气复苏窒息新生儿病死率8．7％,与采用纯氧复苏窒息新生儿病死率13．4％比较,两者差异有显著统计学意义（P〈0．001）。OR为0．64,其95％可信区间（95％confidence interval,95％CI）为0．44-0．94。我们对其中5篇文献的窒息足月儿和窒息早产儿病死率进行分层系统评价,得出空气复苏窒息足月新生儿病死率5．9％,与纯氧复苏9．8％比较,两者差异有显著统计学意义（P〈0．001）,两者OR为0．59,其95％CI为0．40-0．87,在对窒息早产新生儿病死率的分析中也得到相似结果。空气或者纯氧复苏后窒息新生儿的其他情况如2-3度缺氧缺血性脑病（hypoxia ischemia encephalopathy,HIE）的发生率,复苏失败率等,两组比较差异无统计学意义（P〉0．05）。结论进行窒息新生儿复苏,空气和纯氧比,空气能降低窒息新生儿病死率,且不增加新生儿2-3度的HIE发生率和复苏失败率。但研究纳入文献的数量有限,对此结论的运用和推广仍应谨慎。     

胰岛素样生长因子1对新生儿缺氧缺血性脑损伤神经保护作用的研究进展

新生儿缺氧缺血性脑损伤(HIBD)是指围生期窒息缺氧致脑缺氧缺血而出现的一系列临床脑病表现,是新生儿窒息后的严重并发症,常可引起不可逆的脑组织损伤和一系列神经系统后遗症.如何预防、早期诊断及合理治疗窒息后脑损伤一直是围生期医学者研究的一个重要课题.     

胎鼠宫内窘迫复苏空气与高浓度氧复苏的效果比较

比较窒息时空气与纯氧复苏的效果,为窒息复苏方案的选择提供依据,应用方法将35只胎龄为20天的SD大鼠胎鼠随机分为3组,即假手术组(对照组,C组)11只,制成宫内窘迫模型而给予空气复苏者作为空气复苏组(A组)10只,给予92.8%浓度氧复苏者为高氧复苏组(Ox组)14只.监测各组胎鼠脑细胞内外钙、钠、钾含量的变化.结果显示,空气复苏组与高氧复苏组的脑细胞内游离钙离子浓度(分别为552.08±93.50和520.61±79.08 nmol/L)基本一样,均明显高于对照组(315.27±86.88nmol/L)(P＜0.001).各组脑组织总钙、钠、钾含量无显著差异(P＞O.05).因此,应用空气或92.8%浓度氧进行窒息复苏时,复苏效果相似,揭示临床上可考虑应用空气代替纯氧对窒息新生儿进行复苏.     

新生儿复苏用氧的研究进展

国外研究表明[1],使用100%氧气对新生儿进行复苏具有危害性,具体表现在以下4个方面:(1)新生儿病死率增加;(2)早产儿视网膜病(ROP)导致的失明;(3)新生儿慢性肺部疾病(CLD);(4)新生儿脑损伤.而用空气进行复苏具有与100%氧气复苏相同的效果,同时可在不增加病死率的情况下明显减少氧气的毒副作用[2].由于空气复苏尚存在诸多问题,因此用空气代替100%氧气对新生儿进行复苏仍是目前国内外尤其是发达国家研究者争论的焦点.现从氧气复苏的发展概况、纯氧复苏导致氧危害的发病机理、空气与100%氧气在复苏方面的动物实验和临床对比研究、存在的问题及未来展望作一综述.     

新生儿缺氧缺血性脑病的CT诊断分析

新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy, HIE)是由于各种因素引起的围产期脑缺氧缺血导致胎儿或新生儿的脑损伤,主要由宫内窘迫、新生儿窒息缺氧引起,少数可发生于其他原因引起的脑损害,多发生在窒息的足月儿,但也可发生在早产儿.     

新生儿窒息后心率减慢对脑组织的再损伤

为进一步探讨新生儿脑损伤的原因 ,对 71例因窒息引起的新生儿缺氧缺血性脑病并心率减慢的患儿进行观察 ,结果心率缓慢的患儿脑损伤更重 ,恢复较慢新生儿窒息后心率减慢对脑组织的再损伤     

早产儿复苏中氧气的使用

近年来,新生儿复苏用氧的观点发生了巨大变化.2005年,新生儿复苏指南提出,在某些情况下,应用低于100%浓度氧气进行复苏是合理的.多个研究也陈述100%氧复苏并不比空气复苏有益.Vento等证实高氧暴露可使血清氧化标记物浓度升高,并持续至生后28d,故复苏过程中短时间的高氧暴露也会对患儿产生持续的影响.由于早产儿与足月儿在分娩过程中肺生理及抗氧化能力不同,空气复苏正面临着挑战.     

氧透射载体疗法治疗新生儿缺氧缺血性脑病的疗效观察

新生儿缺氧缺血性脑病(HIE)是因宫内窘迫、新生儿窒息所致脑部缺氧缺血性病变,是围产期足月儿脑损伤的最常见原因,严重时可致新生儿早期死亡或造成永久性神经功能缺损。因此,日益引起新生儿科医师的重视,但其治疗尚无特效方法。本文应用氧透射载体疗法治疗HIE进行了系统的临床观察。目前国内有应用该疗法治疗新生儿肺炎的     

Malaria: new challenges,new treatments

Malaria remains a challenge of global significance. This article has attempted to illustrate why the problems of malaria are intensifying, how control policy has changed, and the direction in which it is likely to evolve. The disease has, at last, been recognized as an urgent health priority by WHO and by international governments, which makes one hope that the current horrifying situation in Africa, where a child dies from malaria every 30 seconds, may soon become history.     

Educare: new product, new future.

On September 2, 1990, something very informative about the evolution of early childhood programs in the minds of people appeared in The New York Times. Perhaps only another historian of trivia would have noticed it, but it was significant. The Sunday crossword puzzle had the following cue for 4 down: "Places for day-care" (spelled, with the purist's uncertainty, with a hyphen). Even such a cautious horizontal-vertical weaver as I am did not have to wait very long before filling in the correct 10 letters: "preschools." Preschools = day-cares; day-cares = preschools. I am told that actors and authors and scientists know that they have it made when their names are required as solutions in a Times crossword puzzle. If so, perhaps we now have tangible proof that those of us have at last been heard who have urged acceptance of the concept that early childhood education (or preschool education) and child care (or day care) are really one and the same essential service operated for different lengths of time. Day care, the illegitimate child of the scientific field that gave birth to the early childhood movement, has turned out to be the only offspring sufficiently well endowed and robust to make it in the modern world. It is the only one possessing the characteristics that will enable it to take the family enterprise into the future. At this juncture, near the close of the century during which programs for young children multiplied to the point where they cannot be ignored as significant factors in family and public life, we are on the threshold of a new era.(ABSTRACT TRUNCATED AT 250 WORDS)     

Posthaemorrhagic ventricular dilatation: new mechanisms and new treatment

Post haemorrhagic ventricular dilatation is associated with a high rate of disability, multiple impairments and adverse effects of shunt surgery for hydrocephalus. Post haemorrhagic ventricular dilatation results initially from multiple small blood clots throughout the cerebrospinal fluid channels impeding circulation and re-absorption. Transforming growth factor β is released into the cerebrospinal fluid and there is evidence that this cytokine stimulates the laying down of extracellular matrix proteins which produce permanent obstruction to the cerebrospinal fluid pathways. Prolonged raised pressure, pro-inflammatory cytokines and free radical damage from iron may contribute to periventricular white matter damage and subsequent disability. Interventions such as early lumbar punctures, diuretic drugs to reduce cerebrospinal fluid production and intraventricular fibrinolytic therapy have been tested and, not only fail to prevent shunt dependence, death or disability, but have significant adverse effects. Surgical interventions such as subcutaneous reservoir, external drain, choroid plexus coagulation and third ventriculostomy have not been subject to controlled trial. Ventriculoperitoneal shunt is not feasible in the early phase after intraventricular haemorrhage but, despite the problems with blockages and infections, remains the only option for infants with excessive head expansion over periods of weeks. We have piloted drainage, irrigation and fibrinolytic therapy as a way of removing blood early enough to stop the progressive deposition of matrix proteins, permanent hydrocephalus and shunt dependence.