新生儿窒息肾损害及肾功能监测

新生和窒息可引起多器官损害,其中肾损害发生率最高。肾损害在超微结构上表现为细胞骨架、细胞极性的改变,从而引起肾小管堵塞,肾损害与能量代谢障碍、Ｃａ＾２＋与Ｃａ＾２＋依赖性蛋白酶、一氧化氮、氧自由基、细胞间粘附分子有关,并可通过一些方法监测。     

窒息新生儿肾功能测定分析

动态监测３２例窒息新生儿血，尿中α１－微球蛋白和β２－微球蛋白的浓度变化。结果表明，窒息新生儿普遍存在的肾功能损伤，损伤程度窒息程度加重而加重；在肾小球滤过功能恢复上，轻度窒息儿多在３天内，重度窒息儿需１周或更长时间；肾外管重吸收功能迟于肾小球滤过功能的恢复，在及时反映肾小球滤过功能变化上，α１－微球蛋白比β２－微球蛋白更为敏感。     

高原地区新生儿窒息与急性肾功能衰竭相关性探讨

为了探讨高原地区新生儿窒息对肾功能的影响，我科自1994．7～19957对窒息新生儿进行了血清肌酥、尿素氮、钾、钠、氯、钙及血气的检测，结果初步提示新生儿窒息为新生儿急性肾功能衰竭（ARF）的常见原因，现分析报告如下。资料与方法一、本文新生儿急性肾功能衰竭诊断标准符合中华）L科杂志1994；32（2）：103“］M＼急性肾功能衰竭的诊断标准（试行稿）”。血气参照西宁地区小儿血气正常值及酸碱失衡诊断标准。二、观察对象：1．正常新生儿组（对照组）：共25例，男20例，女5例。足月顺产，平均日龄18．2／J‘时，l分钟APgar评分9～10…     

新生儿窒息肾损害及肾功能监测

新生儿窒息可引起多器官损害,其中肾损害发生率最高。肾损害在超微结构上表现为细胞骨架、细胞极性的改变,从而引起肾小管堵塞,肾损害与能量代谢障碍、 Ｃａ２＋与Ｃａ２＋依赖性蛋白酶、一氧化氮、氧自由基、细胞间粘附分子有关,并可通过一些方法监测。     

西宁地区新生儿窒息引起急性肾功能衰竭的临床研究

本文对西宁地区６０例窒息新生儿与２５例正常足月儿进行了血清肌酐、尿素氮、钾钠、氯、钙及血气检测，表明窒息儿血清肌酐及尿素氮明显升高，结果两者相比有极为显著差异（Ｐ＜０．０１），提示窒息新生儿中普遍存在肾功能障碍。     

新生儿窒息与肾功能损害

近年已证实新生儿窒息后肾功能损害并不少见,且与病情的发展及预后关系密切。本文对窒息新生儿血肌酐(Cr)与尿素氮(BUN)的检测情况及相关因素进行分析。资料与结果1.一般资料　1996年1月至1997年6月对住院24小时以上出生时有窒息的新生儿进行血BUN及Cr检测共120例(美国产泰尔康2010型全自动生化分析仪),男76例,女44例,轻度窒息78例,重度窒息42例。2.窒息后肾功能损害的诊断:(1)氮质血症:BUN>7.14mmol/L;(2)急性肾功能衰竭(急肾衰):尿量<1ml/kg/h,Cr>88.4μmol/L,BUN>14.28mmol/L。3.窒息与肾功能损害关系:120例窒息儿有肾功能损害47…     

新生儿窒息对肾功能的影响

窒息对新生儿肾脏产生一系列影响，尿量的改变少尿甚至无尿，代表肾功能的血，尿生化 改变，肾血流量的减少，肾脏缺血再灌注损务与自由基的产生等，这些改变为窒息儿肾功能障碍提供了病理生理基础。     

窒息新生儿肾功能损害60例临床分析

窒息为新生儿最常见的症状,可引起肾脏、中枢神经、心血管、胃肠道等多脏器形态和功能的改变。本文就我院94年7月至97年6月收治的60例新生儿窒息与肾功能损害关系作初步分析。资料与结果一、临床资料本组60例窒息新生儿中男42例,女18例,均于出生24小时内入院。平均入院时间为7.5小时,足月儿47例、早产儿13例,其中24例伴有宫内窘迫史。60例均符合以下条件之一:(1)出生时Apgar评分小于7分,(2)动脉血气分析pH小于或等于7.25或paCO2大于或等于6.67KPa。重度窒息38例,轻度窒息22例。全部病例均于入院后24小时内采静脉血送尿素氮、肌酐、电解质…     

窒息新生儿的肾功能损害

据Perlman报导新生儿窒息可引起肾脏、中枢神经、心血管、胃肠道等多脏器形态和功能的改变，其中以肾脏损害发生率为最高，占57％。为此观察了我院1995年4月到6月有进行血清尿素氮、肌酐检查的31例窒息新生儿，以了解缺氧窒息的程度对肾功能损害的有关情况。临床资料本组31例窒息新生儿中男性20例，女性11例，入院时间在生后24小时内，平均入院时间为7．5小时，足月儿24例，早产儿7例，其中12例伴有宜由窘迫史，31例均符合以下条件之一：（1）出生时Apgar评分小于7分，（2）动脉血气分析pH小于或等于7．25或PaCO3大于或等于6.67KPa．以A…     

窒息新生儿的肾功能损害

观察了３６例窒息新生儿血肌酐、尿素氮及血、尿α１－微球蛋白和β２－微球蛋白浓度的变化，结果表明；窒息新生儿中普遍存在肾功能障碍，主要表现为肾小球滤过率降低和肾小管重吸收功能障碍，在及时反映肾小球滤过率改变方面，血α１－微球蛋白比β２－微球蛋白更为敏感，且肾小球滤过率的恢复要早于肾小管功能的恢复。     

多普勒组织成像法评价窒息新生儿左心收缩功能

目的 探讨多普勒组织成像法（DTI）评价窒息新生儿左心收缩功能。方法 足月窒息新生儿根据出生时Apgar评分分成重度窒息组（Apgar评分≤3分）共31例，轻度窒息组（Apgar评分4-7分）共31例，在出生后24、48、72h内分别通过超声心动图检测左室射血分数（LVEF），然后转入DTI模式测定二尖瓣前叶收缩期运动速度（s），并与正常新生儿组30例相对照，同时检测心肌肌钙蛋白（cTnI）。结果 重度组LVEF在24h明显低于48h和72h（P〈0．001），亦明显低于轻度组和对照组（P〈0．01），除此之外，3组之间及3组各时段之间LVEF差异无统计学意义（P〉0．05）。DTI重度组、轻度组的s在3个时段均明显低于对照组（P〈0．001），且重度组s在24h亦明显低于48h和72h（P〈0．001），除此之外3组之间及3组各时段之间（s），差异无统计学意义（P〉0．05）。重度组cTnI在3个时段明显高于轻度组及对照组（P〈0．01），而轻度组与对照组比较，差异无统计学意义（P〉0．05）。结论 新生儿窒息时左心收缩功能降低，DTIs较LVEF更能反映窒息新生儿左心收缩功能的变化。     

多普勒组织成像法评价窒息新生儿左心收缩功能

目的探讨多普勒组织成像法(DTI)评价窒息新生儿左心收缩功能。方法足月窒息新生儿根据出生时Apgar评分分成重度窒息组(Apgar评分≤3分)共31例,轻度窒息组(Apgar评分4~7分)共31例,在出生后24、48、72h内分别通过超声心动图检测左室射血分数(LVEF),然后转入DTI模式测定二尖瓣前叶收缩期运动速度(s),并与正常新生儿组30例相对照,同时检测心肌肌钙蛋白(cTnⅠ)。结果重度组LVEF在24h明显低于48h和72h(P<0·001),亦明显低于轻度组和对照组(P<0·01),除此之外,3组之间及3组各时段之间LVEF差异无统计学意义(P>0·05)。DTI重度组、轻度组的s在3个时段均明显低于对照组(P<0·001),且重度组s在24h亦明显低于48h和72h(P<0·001),除此之外3组之间及3组各时段之间(s),差异无统计学意义(P>0·05)。重度组cTnⅠ在3个时段明显高于轻度组及对照组(P<0·01),而轻度组与对照组比较,差异无统计学意义(P>0·05)。结论新生儿窒息时左心收缩功能降低,DTI s较LVEF更能反映窒息新生儿左心收缩功能的变化。     

The effects of losartan on renal function in the newborn rabbit

The low GFR of newborns is maintained by various factors including the renin-angiotensin system. We previously established the importance of angiotensin II in the newborn kidney, using the angiotensin-converting enzyme inhibitor perindoprilat. The present study was designed to complement these observations by evaluating the role of angiotensin-type 1 (AT(1)) receptors, using losartan, a specific AT(1)-receptor blocker. Increasing doses of losartan were infused into anesthetized, ventilated, newborn rabbits. Renal function and hemodynamic variables were assessed using inulin and para-aminohippuric acid clearances as markers of GFR and renal plasma flow, respectively. Losartan 0.1 mg/kg slightly decreased mean blood pressure (-11%) and increased diuresis (+22%). These changes can be explained by inhibition of the AT(1)-mediated vasoconstrictive and antidiuretic effects of angiotensin, and activation of vasodilating and diuretic AT(2) receptors widely expressed in the neonatal period. GFR and renal blood flow were not modified. Losartan 0.3 mg/kg decreased mean blood pressure significantly (-15%), probably by inhibiting systemic AT(1) receptors. GFR significantly decreased (-25%), whereas renal blood flow remained stable. The decrease in filtration fraction (-21%) indicates predominant efferent vasodilation. At 3 mg/kg, the systemic hypotensive effect of losartan was marked (mean blood pressure, -28%), with decreased GFR and renal blood flow (-57% and -51%, respectively), a stable filtration fraction, and an increase in renal vascular resistance by 124%. The renal response to this dose can be considered as reflex vasoconstriction of afferent and efferent arterioles, rather than specific receptor antagonism. We conclude that under physiologic conditions, the renin-angiotensin is critically involved in the maintenance of GFR in the immature kidney.     

The effects of theophylline on renal function in the premature newborn.

The effects of aminophylline on renal function in 10 premature infants with idiopathic apnea are evaluated. The percent increases in creatinine clearance (128 +/- 339%, mean +/- SD) and sodium clearance (196 +/- 304%, mean +/- SD) are variable while the percent increase in fractional sodium excretion (69 +/- 109%, mean +/- SD) is significant. This effect is postulated to be at the proximal tubule and may be modified by the effects of postnatal age and infusion of albumin. Gestational age, birth weight, heart disease, water and sodium intake and ventilatory support did not appear to influence the results. Hyponatremia is a potential consequence of theophylline therapy for apnea.     

The effects of dimethyl sulfoxide on renal function of the newborn rabbit

The purpose of this study was to establish the effects of intravenous dimethyl sulfoxide (DMSO), a solvent used in a wide variety of products (medicines), on kidney function in the newborn rabbit. Three groups of anesthetized, ventilated, normoxemic 4- to 8-day-old New Zealand White rabbits received a 90-min intravenous infusion of DMSO at a dose of 1.11 (group 1), 16.5 (group 2) or 111 microgram/ kg/h (group 3). The only change observed in the animals of group 1 was a significant increase in filtration fraction (FF; p < 0. 001), whereas no change at all was observed in the renal functional parameters of the animals of group 2. The highest dose of DMSO (group 3), however, caused a very significant (p < 0.001) decrease in renal blood flow (RBF) and a rise in renal vascular resistance (RVR), FF and urine volume (UV). Glomerular filtration rate (GFR) and systemic parameters such as pH, mean arterial blood pressure and heart rate did not change. The rise in GFR, RVR, UV (group 3 vs. 2) and FF (groups 3 vs. 2 and 2 vs. 1) was dose-dependent. No significant dose-dependent decrease in RBF was found. To the best of our knowledge, there are no previous reports on the effect of DMSO on renal function in the solvent doses used in this study. We ascribe the reported effects to the 'immaturity' of the newborn rabbit kidney. Consequently, this agent should be used with great caution in developmental studies.     

Effects of asphyxia on renal function in the newborn piglet

This investigation was undertaken to determine the nature of acute alterations in renal function following the production of hypoxemia, hypercarbia, and acidosis in newborn piglets 6-96 hr of age. After completion of the surgical procedure piglets were allowed to recover from the effects of anesthesia. When respiratory dead space was increased arterial oxygen tension decreased whereas arterial carbon dioxide tension and hydrogen ion concentration increased. There was little change in glomerular filtration rate. Total renal blood flow decreased and renal vascular resistance increased significantly (504 +/- 78 mm Hg/liter/mm/m2 to 1422 +/- 504). There was no change in distribution of intrarenal blood flow. Sodium excretion and urinary flow rate demonstrated significant parallel increases following the increase in dead space. Plasma renin concentration increased from 67 to 110 ng/ml.     

新生儿高胆红素血症对肾小管功能损害与尿β2微球蛋白的关系

新生儿高胆红素血症（高胆）是新生儿常见疾病之一,临床儿科医师治疗高胆的重点多在防治贫血和高胆红素脑病上,对高胆引起的肾脏损害认识尚浅。本文通过测定高胆红素血症患儿的尿β,微球蛋白（β2-MG）,以探讨高胆红素血症对新生儿恃小管功能的影响。