持续正压通气评分在早期诊断新生儿肺出血中的临床意义

目的探讨持续正压通气(CPPV)评分标准在新生儿肺出血早期诊断中的意义。方法用回顾性分析方法分析我院100例新生儿肺出血的病因．并使用CPPV的标准评分，判断CPPV分值与肺出血发生的关系。结果本组100例患儿均存在CPPV分值的改变。肺出血严重程度及预后与CPPV分值密切相关。肺出血CPPV评分值≤3分30例均治愈．4～6分53例，治愈率为18．86％，好转率为56．6％．病死率为24．5％．≥7分者17例均死亡。肺出血严重程度及预后与CPPV分值密切相关。临床资料分析提示缺氧和感染是新生儿肺出血的重要原因。结论使用新生儿肺出血CPPV评分标准有助早期诊断肺出血，以指导临床治疗，降低肺出血病死率。     

持续正压通气抢救新生儿肺出血的影响因素：附36例报告

本文对１９８９年１１月至１９９２年５月３６例５新生儿肺出血采用持续正压通过（ＣＰＰＶ）治疗，并重点研究影响ＣＰＰＶ抢救成功的因素：（１）影响ＣＰＰＶ疗效的因素有低体、低体温、酸中毒、机械通气升开始时间及呼衰类型。因素异常程度越重，病死痃越高。提高抢救成功率的关键在于能否在肺出血前使用ＣＰＰＶ。（２）本文按上述各类因素制定评分标准，建议对有肺出血高凶因素的患儿评分达４－６分时采用ＣＰＰＶ。（３）临床     

持续呼吸道正压通气在新生儿呼吸系统疾病中的应用

持续呼吸道正压通气(CPAP)能使肺泡在呼气末保持一定压力,增加功能残气量,防止肺泡萎陷,从而改善通气和换气功能。CPAP主要用于出现呼吸困难、两肺充气不良的新生儿,适应证主要有早期或轻中度新生儿呼吸窘迫综合征、早产儿呼吸暂停、新生儿湿肺、机械通气撤离后过度肺水肿等。CPAP为鼻塞法,避免气管插管、减少机械通气,是一种简便、适宜的新生儿呼吸支持技术。     

凝血酶,正压通气治疗新生儿肺出血

新生儿肺出血多发生在各种严重疾病的晚期，病死率极高，近年来使用正压通气治疗，成活率有所提高。本文应用凝血酶配合正压通气成功治愈三例新生儿肺出血，报告如下：例1，男，3天，孕36周，体重2．4kg，以发热、呼吸急促1天人院，查体：T41C，P180次／分，R80次／分，口周青紫，三凹症阳性，双肺少许湿罗音，心（－），腹平软，肝脾（－），双下肢硬肿，诊断新生儿肺炎，硬肿症予头晕吸氧等综合治疗4小时，症状无改善，双肺出现大量湿罗青，予气管插管，从导管中涌出大量血性液体，诊断肺出血行正压通气治疗，呼吸机参数：FIO。O．6，…     

持续气道正压通气治疗新生儿急性呼吸衰竭

目的探讨持续气道正压通气(CPAP)治疗新生儿急性呼吸衰竭56例疗效。方法在传统治疗基础上对56例急性呼吸衰竭新生儿采用CPAP辅助治疗,根据临床表现及血气变化,调节CPAP的压力、流量及氧浓度。结果所有患儿上机6 h后临床症状缓解,pa(O2)上升,平均使用时间28 h,与上机前比较有显著差异(P<0.05)。结论使用CPAP治疗新生儿急性呼吸衰竭效果显著。     

应用正压呼吸抢救新生儿肺出血

本文报道了应用IPPV加PEEP抢救新生儿肺出血11例,结果出血停止8例,其中5例存活。IPPV和PEEP有制止肺泡出血和改善通气的功能。还介绍了不具备血气分析条件下如何应用临床观察来调节呼吸参数。并提出提高抢救成功率的关键是早期诊断,及时应用呼吸器作正压呼吸。     

简易鼻塞持续呼吸道正压治疗新生儿呼吸衰竭

目的 观察简易鼻塞持续呼吸道正压通气(CPAP)治疗新生儿呼吸衰竭(呼衰)的疗效。方法 呼衰新生儿58例,其中Ⅰ型呼衰21例,Ⅱ型呼衰37例;观察患儿在用简易CPAP 6 h后临床表现及血气变化,比较pa(O2)及pa(CO2)变化。结果 用简易CPAP后53例呼吸困难及缺氧征好转,血气pa(O2)明显提高(P<0.01),pa(CO2)显著下降(P<0.01)。结论 简易CPAP可改善氧合,对轻中度呼衰有较好疗效。     

新生儿经鼻持续呼吸道正压通气改良固定装置的临床应用

目的探讨新生儿经鼻持续呼吸道正压通气(NCPAP)改良固定装置的临床应用。方法随机将370例使用NCPAP治疗的新生儿分为试验组184例与对照组186例。对照组使用原有NCPAP机配套的固定装置,试验组使用改良的固定装置。比较试验组和对照组新生儿使用后鼻部、皮肤的损伤情况,肺部并发症的发生率,颅内出血发生率,转换成呼吸机的发生率,通气时间,住院费用情况。结果试验组NCPAP总有效率(87.50%)显著高于对照组(68.28%)(P<0.01),试验组并发症发生率(8.70%)明显低于对照组(71.51%)。试验组鼻中隔损伤发生率为5.44%,头部皮肤损伤发生率为0.54%,气胸发生率为0,转换成呼吸机的比率为10.87%,机械通气时间为(120±43)h,住院费用为(13 370±4 346)元;对照组鼻中隔损伤发生率达26.34%,头部皮肤损伤发生率为5.38%,气胸发生率达15.10%,转换成呼吸机的比率为30.12%,机械通气时间为(166±39)h,住院费用为(17 408±3 376)元,2组比较差异均有统计学意义(Pa<0.05)。结论新生儿NCPAP改良固定装置能显著减少NCPAP并发症的发生率,减少机械通气时间及住院费用,方法简便且经济。     

新生儿肺出血的诊断和治疗

新生儿肺出血仍是新生儿期主要的危重疾病及死亡原因之一.新生儿肺出血可能主要与早产、低出生体质量、感染、寒冷损伤、围生期缺氧缺血性损伤及低体温等有关.目前在治疗方面研究的重点主要集中在机械通气和呼吸道应用止血药.虽然对新生儿肺出血的病因、危险因素、早期诊断及治疗进行了不少研究,但总体仍缺乏可靠的研究结果,尤其缺乏循证医学的证据,缺乏多中心的随机对照研究结果.     

双管鼻塞式持续呼吸道正压通气联合多巴胺、酚妥拉明治疗重症新生儿肺炎的效果

目的探讨双管鼻塞式持续呼吸道正压通气(CPAP)联合多巴胺、酚妥拉明治疗重症新生儿肺炎的效果。方法重症肺炎新生儿172例,随机分为治疗组87例,对照组85例。二组在相同综合治疗的基础上,对照组予头罩吸氧;治疗组予双管鼻塞式CPAP,其参数设定为流量6～8L/min,吸入氧体积分数(FiO2)0.4～0.6,压力0.67～1.067kPa,应用多巴胺、酚妥拉明,均为3～5mg/(kg.min)持续静脉滴注。观察二组治疗12及48h临床表现及血气变化,比较pa(O2)及pa(CO2)、pa(O2)/FiO2变化。结果治疗组72例经治疗后,呼吸困难明显减轻,血pa(O2)升高,pa(CO2)下降,氧合参数明显增加,治疗组总有效率82.7%;对照组总有效率38.8%,二组疗效及血气、氧合指数比较均有显著差异(Pa<0.05)。结论双管鼻塞式CPAP联合多巴胺、酚妥拉明能改善通气及氧合。早期应用可避免气管插管,减少机械通气率。     

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目的探讨美罗培南在治疗机械通气新生儿下呼吸道细菌感染中的疗效。方法对应用机械通气的新生儿下呼吸道细菌感染患儿37例采用美罗培南静脉注射治疗,美洛培南治疗方法和剂量为20~30mg/kg,每日2次,静脉滴注。临床疗效评价分为痊愈、显效、进步和无效。痊愈和显效作为有效统计。结果除1例嗜麦芽窄食单胞菌对美罗培南耐药外,其余22例革兰阴性细菌均为敏感,达95·7%。在治疗结束时,痊愈19例,显效7例,进步2例,无效9例。总有效率为70·3%。无不良反应发生。结论美罗培南适用于机械通气的新生儿下呼吸道细菌感染,值得临床进一步研究。     

Intrathoracic pressure fluctuations and periventricular haemorrhage in the newborn

The incidence of periventricular intraventricular haemorrhage (PVH-IVH) in premature infants with respiratory distress syndrome (RDS) remains at about 40%. Although there are certain inherent anatomical and physiological features of a neonate which predisposes them to PVH-IVH, there is conflicting evidence about the precipitating cause. The most significant antecedents of PVH-IVH are mechanical ventilation and barotrauma. This report examines the hypothesis that the final common pathway in PVH-IVH is fluctuation in intrathoracic pressure, and then attempts to explain previous anomalies and conflicting results which have implicated other causes. Suggestions are offered as to how changes in current management could contribute to a decreased incidence of this serious and widespread complication in premature infants with RDS.     

The diagnosis of measles in the newborn and infant age groups

An outbreak of measles in an infants' and small-children's ward is reported in which the disease ran a completely atypical course. Despite exact observation Koplik spots were not demonstrable in any of the affected children and even the rash did not have the usual appearance. Thus the final diagnosis could only be made serologically. It is possible that the infection in the infants and small children was so modified by transplacental maternal antibodies that the disease ran a completely atypical course.This was read in parts at the 10th meeting of the Austrian Society of Pediatrics in Vienna, October 20th, 1972.     

Usefulness of continuous positive airway pressure in differential diagnosis of cardiac from pulmonary cyanosis in newborn infants.

Differential diagnosis of cyanosis in the neonate is difficult and cardiac catheterisation may be required for a correct diagnosis. It has been suggested that the response of PaO2 to continuous positive airway pressure (CPAP) with 100% oxygen may be useful. The purpose of this study was to test further this hypothesis by studying all neonates investigated for cyanosis with a PaO2 less than or equal to 50 torr in 0-8 to 1-0 F1O2. Arterial blood samples were obtained in an F1O2 of 0-21-0-4 and 0-8-1-0, and in an F1O2 of 0-8-1-0 with 8-10 cm CPAP, and were analysed for PaO2, PaCO2, and pH, bicarbonate being calculated. The final diagnoses were congenital heart disease (CHD) 21 cases, pulmonary parenchymal disease (PD) 10 cases, and persistent fetal circulation (PFC) 3 cases. No significant difference in pH, bicarbonate, or PaCO2 was observed among the three groups or with CPAP. In the CHD and PFC infants CPAP produced no significant change in PaO2. In the PD babies PaO2 increased by an average of 33 torr (P less than 0-05). Despite thus attaining statistical significance 2 PD infants had no increase in PaO2 with CPAP. An increase of PaO2 greater than 10 torr with CPAP suggests PD, and a nonsignificant increase in PaO2 does not rule out PD. Irrespective of initial PaO2, final PaO2 in 0-8-1-0 F1O2 with CPAP greater than 50 torr suggests PD, and less than 50 torr suggests CHD. The results indicate that CPAP may be used as an adjunct in differentiating cardiac from pulmonary disease.     

Assessment of pain in newborn infants

Hospitalized newborn infants experience pain that can have negative short- and long-term consequences and thus should be prevented and treated. National and international guidelines state that adequate pain management requires valid pain assessment. Nociceptive signals cause a cascade of physical and behavioral reactions that alone or in combination can be observed and used to assess the presence and intensity of pain.Units that are caring for newborn infants must adopt sufficient pain assessment tools to cover the gestational ages and pain types that occurs in their setting. Pain assessment should be performed on a regular basis and any detection of pain should be acted on. Future research should focus on developing and validating pain assessment tools for specific situations.     

新生儿及婴儿发育性髋关节异常早期筛查及早期治疗的探讨

目的通过对新生儿及婴儿发育性髋关节异常的早期筛查,结合临床检查与超声检查诊断的评价,推动新生儿及婴儿发育性髋关节异常的早期诊治。方法对本院出生的1213例新生儿及866例年龄6个月以下婴儿进行临床及超声早期筛查（Graf方法）,以明确诊断,及时治疗。结果新生儿早期疑诊45例,最终确诊5例,婴儿确诊3例,经用Pavlik吊带治疗6例痊愈,1例6个月后行闭合复位石膏固定治疗。结论新生儿期超声检查髋关节不稳定率偏高（Graflla型髋）,发育性髋关节异常的早期筛查,特别是低于6个月的超声检查检出率高,各科医师合作有利于DDH的早期诊治。     

新生儿硬肿症出凝血功能的变化及其临床意义

目的探讨不同病情新生儿硬肿症的出凝血功能改变,为合理治疗提供理论依据。方法比较观察组100例和对照组50例5项出凝血指标检测结果。结果观察组不同病情之间比较凝血酶原时间、3P试验、血小板计数和外周血红细胞形态无显著性差异(P均＞0.05);试管法凝血时间比较,有显著性差异(P＜0.05)。观察组与对照组5项指标比较有显著性差异(P＜0.01)。结论新生儿硬肿症存在出凝血功能改变,病情越重改变越明显,越易合并DIC、肺出血,病死率也越高。硬肿症早期血液多呈现高凝状态,晚期多呈现低凝状态。早期肝素治疗,不仅可改变血液的出凝血状态(高凝状态),而且是防治DIC、肺出血,提高治愈率的有效途径。     

体重5kg以下完全性肺静脉异位引流患儿的外科治疗

目的 探讨体重5 kg以下完全性肺静脉异位引流患儿的外科治疗效果.方法 2002年1月至2009年12月,首都医科大学附属北京儿童医院外科手术矫治体重5 kg以下各型完全性肺静脉异位引流患儿52例,均在全麻、低温体外循环下手术.对心上型采取经左、右心房联合切口或心上入路完成肺静脉共腔与左房的侧侧吻合;心内型剪除冠状静脉...