新生儿缺氧缺血性脑病治疗的现状与展望

围产期缺氧窒息后引起的缺氧缺血性脑病严重威胁着新生儿的生命健康,并且是我国伤残儿童重要病因之一。我国地域辽阔,各地经济发展和医疗水平差别很大,在某些边远地区和广大基层农村,新生儿缺氧缺血性脑病(HIE)至今还是常见病多发病。各地基层医院对HIE的治疗比较杂乱,治疗原则及目标不明确,采用的治疗方法更不一致,影响疗效的提高。根据HIE发病机制的研究成果,制定一个适     

新生儿缺氧缺血性脑病的临床及凝血因子的研究

研究新生儿缺氧缺血性脑病（HIE）的凝血因子活性减低与临床出血的关系上，我们运用AcL200型全自动凝血仪及配套试剂对25例患儿及25例无临床出血的正常新生儿进行凝血因子检测。结果表明患儿各种凝血因子活性减低与正常对照有显著性差异（P＜0．01）。凝血因子减少在4个以上占68％，多以Ⅱ、Ⅶ、Ⅸ、Ⅹ及Ⅺ、Ⅻ因子复合缺乏。结论：1．HIE患儿的凝血因子活性减低，个数减少与临床出血有明显的正相关。2．发病原因与缺氧缺血使脑组织损伤，维生素K缺乏，肝脏发展不全或感染有关。应加强对新生儿的防治。     

新生儿缺氧缺血性脑病所致中枢神经系统损害的前瞻性研究

新生儿缺氧缺血性脑病(HIE)是新生儿时期最常见的颅内病变,常导致新生儿死亡及其后的神经系统发育异常。为进一步研究HIE对中枢神经系统发育的影响,加强防治措施,我院儿科对住院的HIE存活儿进行3年的跟踪随访,现将结果分析如下。 资料及方法 一、临床资料 1996年1月～1996年8月我院儿科收治的头颅CT证实为HIE的患儿41例,其中早产儿8例;男31例,女10例;在本院产科出生19例,外院或农村分娩22     

新生儿缺氧缺血性脑病65例随访分析

目的：探讨新生儿缺氧缺血性脑病（HIE），几种脑损伤类型对预后的影响。方法：符合HIE诊断标准的65例患儿于生后5－10d做头部CT检查，并于生后6，12，18，24个月做智力测验及神经系统检查。结果：65例中53例发育正常（81．5％），12例有不同程度发育落后（18．5％），其中智能发育异常5例，可疑6例，脑性瘫痪（CP）6例，视听障碍1例，5例智能发育异常者中4例为生后头部CT呈广泛低密度改变导致的脑软化，脑发育不良（80％），结论：HIE患儿头部CT呈广泛低密度改善者预后差。     

新生儿缺氧缺血性脑病的早期干预研究

新生儿缺氧缺血性脑病是引起小儿智能伤残的重要原因之一。目前对该病的临床治疗已经取得很大的进步，并制定出诊疗常规。但对其智能伤残的早期干预研究还不多，因此我们对缺氧缺血性脑病患儿进行了早期干预，旨在了解通过早期干预是否能在一定程度上减轻其智能发育的落后，从而改善患儿的生存质量。     

川芎嗪治疗新生儿缺氧缺血性脑病临床效果观察

新生儿缺氧缺血性脑病(HIE)是新生儿死亡和致残的主要原因,细胞代谢异常在其发病中起重要作用,国内近年来通常应用胞二磷胆碱(CDPC)、脑活素等脑细胞激活剂。为进一步探索其治疗方法,我院采用能作用于多种细胞因子的活血化瘀中药川芎嗪(TMPZ)治疗新生儿HIE,并以CDPC作对照     

一氧化氮在新生儿缺氧缺血性脑病中的作用

新生儿缺氧缺血性脑病(HIE)是因围产期宫内缺氧缺血及产后窒息影响新生儿脑细胞能量代谢，导致缺氧性脑病变，出生后出现的一系列脑部症状。其发病率高，重症患儿将会发生脑瘫等严重后遗症，给家庭和社会带来沉重负担。但是其发病机制到日前为止     

新生儿缺氧缺血性脑病的早期药物干预

新生儿缺氧缺血性脑病 (ＨＩＥ)是新生儿围产期的严重疾病 ,可遗留下神经系统后遗症。我科对收治的８４例ＨＩＥ患儿进行血清中丙二醛 (ＭＤＡ)、超氧化物歧化酶 (ＳＯＤ)水平的检测 ,同时进行早期药物治疗 ,观察其治疗后的变化 ,现将结果报告如下。资料与方法一、研究对象１９９８年１月至１９９９年１２月我科收治ＨＩＥ患儿８４例 ,随机分成治疗组和对照组 ,ＨＩＥ诊断标准根据１９９６年杭州会议制定的“新生儿缺氧缺血性脑病诊断依据和临床分度”［１］。两组在出生体重、胎龄、评分和生产方式等方面经统计学检验差异无显著性 (见表１)…     

新生儿缺氧缺血性脑病诊断与治疗的现状

新生儿缺氧缺血性脑病（ hypoxic-ischemic encephalopathy, HIE）是儿科常见难治危重症之一,可导致严重的神经系统后遗症。因此,HIE一直是新生儿疾病的研究重点。本文对目前新生儿HIE的诊断治疗现状作一简要述评。[第一段]     

Hypothermia for newborns with hypoxic ischemic encephalopathy

Hypoxic ischemic encephalopathy (HIE) remains a significant cause of mortality and long-term disability in late preterm and term infants. Mild therapeutic hypothermia to a rectal temperature of 34±0.5°C initiated as soon as possible within the first 6 h of life decreases mortality and severe long-term neurodevelopmental disabilities in infants with moderate HIE who are ≥36 weeks’ gestational age. There are minimal side effects, and the incidence of disability in survivors is not increased. Infants with severe encephalopathy are less likely to benefit from treatment. Cooling may be achieved by either total body or selective head cooling. As cooling is now considered a standard of care, infants ≥36 weeks’ gestational age who are depressed at birth should be assessed to determine whether they meet the criteria for cooling. There is currently no evidence that therapeutic hypothermia offers any benefit to infants <36 weeks’ gestational age.     

Prognostic value of sleep analysis in newborns with perinatal hypoxic brain injury

The correlation between the findings of polygraphic sleep analysis and the late prognosis was studied in 37 full-term newborns after perinatal hypoxic-ischaemic brain injury, and in 9 healthy neonates. The relationship with a poor prognosis was significant if there was (i) a sleep cycle disturbance (decreased level of active sleep; persistence of quiet sleep-trace alternate pattern in the total cycle); (ii) immaturity in bioelectric brain maturation greater than or equal to 4 weeks; (iii) depression of background activity. The correlation with favourable outcome was significant if (i) the EEG was normal; (ii) sleep spindles occurred. The following findings were unrelated to prognosis: asymmetry, paroxysmal abnormalities, and reactivity of EEG to light or sound stimulation.     

血浆内皮素及降钙素基因相关肽在新生儿缺氧缺血性脑病时的变化

目的探求内皮素（Endothelin，ET）及降钙素基因相关肽（calcitoniningene-relatedpeptide，CGRP）在新生儿缺氧缺血性脑病（HIE）时的变化。方法用放免法动态监测了18例HIE儿出生dl、d5血浆ET、CGRP的浓度，并与18例对照组比较。结果HIE组血浆ET、CGRP水平出生dl比对照组显著升高，经治疗5d后较前显著下降，治疗前后ET与CGRP呈正相关性。结论HIE时因缺氧缺血ET产生释放增多，CGRP因对ET有拮抗作用，在HIE时的升高可能是一种代偿机制。     

Perinatal hypoxic/ischemic spinal cord injury

We have reviewed our experience in 900 consecutive necropsies performed on infants who died in the first 4 weeks of life. The neuropathologic characteristics of acute hypoxic/ischemic spinal cord injury are described in 21 infants who expired in the perinatal period. Several distinct patterns of spinal cord injury were apparent in asphyxiated neonates. Cord infarction, rare in older age groups, was the commonest lesion and was associated with prematurity and with documented episodes of systemic hypotension. Lumbosacral cord segments were more severely affected, and at affected levels central cord parenchyma was completely necrotic with relative sparing of the periphery. Diffuse neuronal necrosis was more typical of infants delivered at or after term. In these neonates ventromedial neurons were most profoundly injured. Hematomyelia dissecting into spinal cord parenchyma was a consequence of germinal matrix hemorrhage in very premature infants. "Watershed zones" in the cord appear to be most severely affected in these infants. The patterns of spinal cord infarction and the association of this lesion with prematurity and systemic hypotension suggest that the absence or failure of spinal cord blood flow autoregulation may play a role in the etiopathogenesis of perinatal hypoxic/ischemic spinal cord injury.     

振幅整合脑电图在足月新生儿缺氧缺血性脑病的应用

足月新生儿缺氧缺血性脑病因早期无特异性临床体征,早期诊断困难,如果该类患儿未能及时得到干预,将影响患儿远期预后及生存质量。振幅整合脑电图是一种简便有效的无创脑功能监测及评价方法,可为足月新生儿缺氧缺血性脑损伤早期诊断及预后评估提供确切依据。     

新生儿缺氧缺血性脑病与血浆纤维蛋白原Bβ基因多态性的相关性研究

新生儿缺氧缺血性脑病(H IE)是新生儿科较常见的疾病,是新生儿窒息后的严重并发症,病情重,病死率高,有的可产生永久性神经功能障碍,其对新生儿的健康及生命危害较大。近年来随着分子生物学和遗传学的发展,对新生儿H IE发病机制分子水平的研究日渐深入。我们通过对H IE患儿血浆纤维蛋白Bβ基因多态性的分析,探讨新生儿H IE的易感基因,从基因水平解释其发病机制,以便为更好地预防和治疗新生儿H IE提供依据。1对象与方法1.1对象选自2001年10月～2004年4月我院新生儿病房已确诊的H IE患儿106例,均为足月儿,其中男64例,女42例;日龄1～4d,…     

Alterations in antioxidant enzyme activities in cerebrospinal fluid related with severity of hypoxic ischemic encephalopathy in newborns

BACKGROUND: The antioxidant status of the tissue affected by ischemia-reperfusion is of great importance for the primary endogenous defense against the free-radical-induced injury. OBJECTIVE: In this study, we aimed to evaluate the relationship between the activities of antioxidant enzymes [superoxide dismutase (SOD), glutathione peroxidase (GPX), and catalase (CAT)] in cerebrospinal fluid (CSF) and severity of hypoxic-ischemic encephalopathy (HIE) in newborns. METHODS: Thirty full-term asphyxiated infants (gestational age >37 weeks) and 11 full-term infants (none of whom showed any signs of asphyxia) were included in this study. Activities of SOD, GPX, and CAT in CSF were measured within the first 72 h of life in infants with HIE and controls. RESULTS: Activity of SOD in CSF was significantly higher in infants with HIE compared with controls (p<0.05). GPX and CAT activities were higher in infants with HIE than they were in controls; however, the differences were not statistically significant (p > 0.05). The activities of GPX and CAT were significantly increased in severe HIE as compared with mild HIE and controls (p < 0.05). CONCLUSION: Both the duration of the hypoxic-ischemic insult and the severity of HIE modulate elevations of enzymatic activity as an adaptive response to excessive free radical production in CSF in newborn infants with HIE. The activities of antioxidant enzyme alterations in CSF correspond highly to the severity of HIE, and these patterns may be useful for diagnostic and prognostic purposes.     

高压氧对缺氧缺血性脑病新生儿免疫功能的影响及其机制的研究

目的　观察缺氧缺血性脑病 (HIE)新生儿高压氧 (HBO)治疗前后免疫功能及 β 内啡肽 (β EP)的动态变化 ,并探讨其中的免疫调节机制。方法　选择 2 0 0 2年 1～ 10月广东肇庆市第一人民医院收治的HIE新生儿 31例随机分成HBO治疗组 16例、无HBO治疗组 15例 ,同时设置正常组 2 0例。均在HBO治疗前和一疗程后分别检测 β EP、IL 2、TNF α、CD3、CD4、CD8、IgA、IgM、IgG及CH50 等各项指标。结果　与正常组和无HBO治疗组比较 ,HBO治疗组HBO治疗前后 ,除CH50 外 ,其余均有显著差异 (P <0 0 5 ) ,其中 β EP升高 (111 4 0± 5 2 35 )pg·mL-1,TNF α升高 (0 35± 0 2 2 )ng·mL-1,其它各项显著下降。除CD8外 ,HBO治疗组 β EP与各免疫指标均有显著的相关性 ,相关系数 (r)在 0 32 5～ 0 6 35之间。结论　HBO对HIE新生儿免疫功能有显著的抑制性影响 ,而 β EP水平的升高是其免疫下调的机制之一。     

Expression of T subsets and mIL-2R in peripheral blood of newborns with hypoxic ischemic encephalopathy

Background  Infantile and undifferentiated immune cells in the pathogenesis of neonates with HIE have been studied in recent years. This study was undertaken to observe the expression level of T subsets and membrane interleukin-2 receptor (mIL-2R) in the peripheral blood of newborns with hypoxic ischemic encephalopathy (HIE) and its clinical manifestations. Methods  The peripheral blood mononuclear cells (PBMCs) of newborns with HIE and normal controls were isolated by the routine Ficoll-Hypaque method, and the rates of CD₃ ⁺, CD₄ ⁺, CD₈ ⁺, CD₄ ⁺/CD₈ ⁺ and mIL-2R induced and not induced by phytohemagglutinin (PHA) were detected by biotin-streptavidin (BSA) at the first, third and seventh day after birth. Results  At the first day after birth, the positive rates of CD₃ ⁺, CD₄ ⁺, CD₈ ⁺, CD₄ ⁺/CD₈ ⁺ and mIL-2R induced and not induced by PHA were (37.4±6.7)%, (29.4±6.9)%, (16.7±3.3)%, 1.8±0.5, (3.6±1.1)% and (20.9±4.8)%, respectively. Significant differences were observed between the HIE group and the normal controls (P<0.01-P<0.05). At the third day after birth, the positive rates of CD₃ ⁺, CD₄ ⁺, CD₈ ⁺, CD₄ ⁺/CD₈ ⁺ and mIL-2R induced and not induced by PHA were (41.0±7.4)%, (35.8±6.9)%, (22.6±4.5)%, (1.7±0.5), (3.9±1.2)%, and (22.8±5.1)%, respectively. There were significant differences between the HIE group and the normal controls (P<0.05). At the seventh day after birth, the positive rates of CD₃ ⁺, CD₄ ⁺, CD₈ ⁺ were (41.8±6.1)%, (36.4±5.1)% and (25.6±4.3)%, respectively. There was significant difference between the HIE group and the normal controls (P<0.05). The ratio of CD₄ ⁺/CD₈ ⁺ and the expression level of mIL-2R induced and not induced by PHA were 1.5±0.3, (4.1±1.2)% and (23.8±5.2)%, respectively. There was no significant difference between the HIE group and the normal controls (P>0.05). Conclusions  Peripheral blood mononuclear cells of newborns are immature and undifferentiated with a very low expression level of surface markers. The changes of cell immunity involve in the pathogenesis of HIE. The disorder of cellular immune function exists in newborns with HIE. Cell immunity and immune regulative response in newborns are gradually improved or mature during the period of growing, facilitating the recovery from brain injury caused by HIE.     

动态观察新生儿缺氧缺血性脑病血胃动素和胃泌素水平的临床意义

目的探讨新生儿缺氧缺血性脑病(HIE)患儿血浆胃动素(MTL)和血清胃泌素(GAS)水平动态变化的临床意义。方法应用放射免疫分析法(RIA)测定41例HIE足月患儿病程2d内、3～5d、7～10d、12～15d血MTL和GAS含量,并与正常对照组比较。结果HIE患儿出生2d内血MTL和GAS水平最高,随病程延长而逐步降低;轻度HIE7～10d恢复正常;中度HIE12～15d恢复正常;重度HIE12～15d与正常对照组比较差异仍有统计学意义。血MTL和GAS水平与病情轻重程度呈正比。结论血MTL和GAS水平与HIE患儿病程、病情轻重程度及消化系统并发症之间存在密切联系。