新生儿高胆红素血症与NBNA及CK-MB相关性探讨

目的　为研究新生儿高胆红素血症 (简称高胆 )与行为神经 (NBNA)及血清肌酸磷酸激酶同工酶 (CK -MB)的相关性。方法　采用新生儿 2 0项行为神经评分法及全自动生化分析仪对 5 8例高胆新生儿及 5 0例正常新生儿进行NBNA及CK -MB测定。结果　高胆组NBMA及CK -MB明显异常 ,与对照组比较差异有显著性 (P均 <0 .0 1)。结论　高胆对新生儿神经系统及心肌均有损伤 ,但早期治疗预后良好 ,建议高胆应尽早治疗。     

高胆红素血症对新生儿神经行为及其预后的影响

①目的 探讨高胆红素血症(简称高胆)对新生儿神经行为评分及婴幼儿期智能发育的影响.②方法 对46例不同程度黄疸的足月新生儿,在生后2～5天、12～14天、26～28天进行神经行为评分(NBNA),12～18个月时用<贝莱智力发育量表>测定智力发育指数(MDI)和运动发育指数(PDI).采用同期出生的38例健康新生儿作为对照组.③结果 高胆组NBNA明显低于健康对照组(P<0.01),主要表现为行为能力及肌张力异常;当血清胆红素≥204mmol/L时,胆红素水平与NBNA评分呈显著负相关(P<0.01).高胆组MDI、PDI与对照组比较差异显著(P<0.01).④结论 不同程度高胆红素对新生儿神经行为能力及婴幼儿期智能发育有一定影响.     

新生儿高胆红素血症118例临床与预后分析

新生儿高胆红素血症 (高胆 )是新生儿期最常见的病症之一 ,近年来其发病率有上升的趋势 [1 ] (我院新生儿高胆患儿占新生儿患病住院人数的 4 1.1% ) ,严重者可并发胆红素脑病而遗留神经系统永久性损害。及早合理控制新生儿高胆的发生发展 ,减少其后遗症及致残率一直是临床儿科医师共同努力的方向。我们对在本院儿科住院资料较完整的高胆患儿 118例进行病因分析及预后远期随访观察 ,现报告如下。1　资料和方法1.1　临床资料　 1994年 2月至 1997年 2月在我院儿科住院的高胆新生儿 118例 ,血清胆红素峰值均在 2 0 5 .2 μmol/ L(1.2 mg/ L )…     

新生儿母乳喂养满月时体格发育的调查分析

目的:探讨母乳喂养对新生儿满月体格发育的影响。方法:母乳喂养新生儿250例,人工喂养200例,对450例健康的足月新生儿体格发育的情况进行调查,并进行新生儿高胆红素血症(简称高胆)和低血糖发病率的调查。结果:满月时,母乳喂养的新生儿,其体重和身长的增值明显优于人工喂养的新生儿(P<0.05),其新生儿高胆和低血糖的发病率也明显低于人工喂养喂养(P<0.05)。结论:新生儿母乳喂养能促进新生儿的体格发育,降低新生儿的高胆和低血糖的发病率。     

新生儿高间接胆红素血症77例病因探讨

目的: 探讨新生儿高间接胆红素血症(简称高胆)的病因及预防措施。方法: 对77例高胆的病因进行分析,对不同病因引起的高胆采取相应的治疗。结果: 病因依次为感染因素53例次,围生因素24例次,母乳性黄疸11例次,新生儿溶血病3例次。同一高胆患儿可存在2~3种致病因素,多因素发生率为16.88%。预后较好,77例中痊愈64例,好转12例,放弃治疗1例。结论: 做好围生期保健对预防新生儿高胆,降低其发病率有重要意义。     

新生儿高胆红素血症研究新进展

新生儿高胆红素血症(高胆)是新生儿期常见疾病,发病率高,占新生儿住院的首位;严重者若未及时发现和治疗,易导致胆红素脑病,引起死亡,存活者三分之二留有永久性神经系统后遗症.对新生儿高胆的防治措施的研究,提出除重度高胆红素血症外,轻中度高胆红素血症也可对新生儿神经损害,致神经精神发育异常.陈骏田等研究结果显示高胆可导致新生儿听神经损伤.此外,有的学者研究得出高胆红素血症能够对新生儿心、肝、肾引起脂质过氧化损伤;光疗对新生儿高胆红素血症的预防效果好,副作用小,其中日光散光用于预防高胆有效,机理是胆红素分子能吸收可见光波长在 380-700 nm之间,而太阳光的波长为510 nm.对新生儿高胆红素血症,要早发现,早预防治疗,避免高胆红素血症对新生儿的危害.     

大剂量静注免疫球蛋白治疗新生儿溶血病的临床疗效及远期随访观察

目的　探讨大剂量静注免疫球蛋白 (IVIG)治疗新生儿溶血病的临床疗效及其对远期预后的影响。方法　将 5 4例新生儿溶血病 (HDN)患儿随机分为两组 ,治疗组 2 8例 (ABOHDN 2 5例 ,RhHDN 3例 ) ,对照组2 6例 (ABOHDN 2 4例 ,RhHDN 2例 ) ,治疗组在常规治疗基础上给IVIG首次 1g kg ,以后 4 0 0mg kg ,每日 1次 ,连用2～ 4次。 5岁以后进行体格发育、智力测定、脑干听觉诱发电位 (BAEP)及神经系统随访检查。结果　治疗组无 1例换血 ,全部治愈 ,对照组需 5例换血。两组在黄疸消失时间、住院天数及需换血例数方面差异有显著性 (P <0 .0 1,P <0 .0 5 ) ,5 4例患儿随访到 5 1例 ,治疗组 2 7例 ,对照组 2 4例 ,两组智力缺陷率及BAEP异常率差异有显著性(P <0 .0 5 ) ,体格发育及神经系统检查治疗组优于对照组 ,但差异无显著性 (P >0 .0 5 )。结论　IVIG治疗HDN能明显降低血清胆红素浓度 ,减少换血次数 ,并能改善预后、减少神经系统后遗症的发生     

高胆红素血症对新生儿神经行为的影响

<正> 新生儿神经行为测定(NBNA)能有效地检测出新生儿中枢神经系统的功能异常,在新生儿窒息预后评价方面已被背定,为了解无核黄疸的高胆患儿脑功能是否受影响,其功能障碍是否随高胆的治愈而恢复等,我们用鲍氏创建的NBNA20项对31例高胆红素血症患儿进行神经行为评估。现报道如下。 1 资料与方法 1.1 研究对象:31例均为本科住院患儿,男20例,女     

新生儿胆红素脑病(警告期)换血治疗远期疗效观察

目的:评价新生儿胆红素脑病(警告期)换血治疗后的远期预后情况.方法:34例应用外周动静脉同步换血治疗的新生儿胆红素脑病(警告期)作为观察组, 选取同期未应用换血治疗的新生儿胆红素脑病(警告期)44例作为对照组,测定治疗前及治疗6 h后总胆红素水平、血氧分压、pH值,并观察治疗后12个月时的听力、行为发育及神经运动功能的状况.结果:观察组在治疗后,总胆红素水平降低、血氧分压及pH值得到明显改善,听力障碍发生率、行为发育异常率及神经运动检查得分分别为20.6%,23.2%,83.86±16.0;对照组则为45.2%,59.5%,77.53±12.63,两组间比较差异有统计学意义(P<0.05).结论:换血术是治疗新生儿胆红素脑病(警告期)的有效方法,可防止胆红素脑病的进一步发展,有效地降低听力障碍及行为发育异常的发生率,并促进受损神经的恢复.     

新生儿行为神经测定预测高胆红素脑损伤的意义

目的探讨新生儿行为神经测定(NBNA评分)在及早发现高胆红素脑损伤中的作用.方法对80例总胆红素220.6~307.8μmol/L的新生儿高胆红素血症患儿(高胆组),于黄疸高峰期及消退期进行NBNA评分,并在生后3、6、18个月以发育评估方法评估预后,并与正常新生儿80例(对照组)进行对比.结果高胆组黄疸高峰期NBNA评分(37.53±1.60)分,低于对照组的(38.91±0.78)分,差异有统计学意义(P<0.01);黄疸消退后NBNA评分提高至(39.15±1.09)分,与黄疸高峰期比较差异有统计学意义(P<0.05).高胆组视听反应黄疸高峰期检测视听反应为(3.55±0.61)分,低于对照组的(3.90±0.30)分,差异有统计学意义(P<0.01);高胆组满月时检测为(3.89±0.39)分,比黄疸高峰期明显升高(P<0.01).经预防干预后发育商正常者占90.%(18/20).结论NBNA评分能发现传统神经反射检查难以发现的中枢异常,及早发现轻微脑损伤,对评估预后、指导早期干预有价值.     

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.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

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.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.