300例孕妇与新生儿柯萨奇病毒感染分析

对３００例孕妇静脉血及新生儿脐静脉血进行测定，结果母血柯萨奇病毒感染阳性６０例，其中际期有感染症状者２００例，感染率为２０．００％；孕期正常者１００例，感染率为２０．００％。脐血中无一例出现感染。提示柯萨奇病毒不通过胎盘传播。     

综合内科护士柯萨奇病毒感染情况及预防措施

目的 :了解综合内科护士柯萨奇病毒感染的情况。方法 :检测综合内科护士 2 4例及献血员 2 4例抗柯萨奇病毒B组的IgG抗体。结果 :护士组感染率高于献血员对照组。结论 :根据柯萨奇病毒的生物特性采取有效措施 ,加强医护人员自我保护意识 ,采取相应的预防措施 ,可减少医护人员感染柯萨奇病毒的几率     

病毒性心肌炎患者的病原学检测及护理

目的探讨病毒性心肌炎惠者病原学检测及护理，为预防早期治疗及护理提供有效的依据和可行性方法。方法取59例病毒性心肌炎患者外周血栓测柯萨奇B组病毒、乙肝病毒、丙肝病毒、HIV病毒。结果59例中检测到柯萨奇B组病毒IgM阳性28例(47．5％)。乙肝病毒DNA9例(15．3％)、丙肝病毒RNA6例(10．2％)，HIV病毒4例(6.8％)，乙肝病毒DNA柯萨奇B组病毒IgM4例(6．8％)，未知8例(13．6%)。结论柯萨奇B组病毒是引起病毒性心肌炎的最常见病原体，其后依次是乙肝病毒、丙肝病毒、HIV病毒，在临床实践中应重视肝炎病毒引起病毒性心肌炎的可能。     

预防柯萨奇病毒在剖宫产手术中的污染及术后处理

预防柯萨奇病毒在剖宫产手术中的污染及术后处理中国医科大学第二临床医院（１１０００３）路德莲，孔秀华我们妇产科手术室自１９９３年１１月份以来，陆续接待了柯萨奇抗体阳性带菌产妇剖宫产手术２０余例，为了防止柯萨奇病毒的流行及感染，同时使我们同行对此有所了解...     

病毒性心肌炎血清柯萨奇B组病毒特异性IgM及RNA检测的临床意义

目的：探讨由柯萨奇Ｂ组病毒所致病毒性心肌炎的病原学诊断价值。方法：应用酶联免疫吸附试验及聚合酶链反应对４６例病毒性心肌炎患者血清柯萨奇Ｂ组病毒（ＣＢＶ）特异性ＩｇＭ和ＲＮＡ进行检测。结果：心肌炎组ＣＢＶ－ＩｇＭ检出率为６０．９０％，ＣＢＶ－ＲＮＡ为４３．５％，非心肌炎组分别为２０％和１２％，两组有非常显著的差异。表明ＣＢＶ是病毒性肌炎的主要病原。心肌炎组２周内检测ＣＢＶ－ＩｇＭ和ＣＢＶ－ＲＮＡ的阳性率分别为７８．６％和８５．７％，２～６周分别为４５．２％和２２．６％，其阳性检出率与病程呈负相关。结论：早期检测对于心肌炎的早期诊断及病因学研究具有指导意义     

茶色素治疗高纤维蛋白原血症100例疗效观察

茶色素治疗高纤维蛋白原血症１００例，口服１２５ｍｇ ｔｉｄ疗程一月。结 果纤维蛋白原下降＞ ２０ｍｇ／ｄｌ的 ８７例，总有效率为 ８７．００％，减至正常（＜ ４００ｍｇ／ｄｌ）的 ３５例，占 ４２．００％．减低幅度＜２０ｍｇ／ｄｌ的 ５例，服药后较服药前升 高的８例无效率占１３．００％。服药期间除少数出现失眠症状外，未见其它毒付作用。     

浅析会阴侧切伤口的感染

会阴切开及缝合术是产科最常用的手术，切开的方式有斜切开及正中切开，我科自１９９２年１月至１９９６年１２月止共行会阴侧切１９６１例，切口感染６７例，感染率为３．４１５，单纯会阴侧切口１９９８例，感染４９例，感染率２．５６％，会阴例切口＋撕裂５３例，感染２０例，感染率３７．７３％，二者相比Ｐ〈０．０１。在各种分娩方式中，产钳助产１６例，切口感染６例，感染率３７．５％，胎头吸收９０２例，臀位产１２９例，     

136例医院内感染临床分析

对发生于我院的１３６例内感染患者进行临床分析结果显示：内感染率为２．１６％，感染部位主要发生于下呼吸道占４５．８３％，其次为伤口感染占２０．１４％，内科医院内杂率最高占全院的６０．２９％。     

对感染柯萨奇病毒的产妇在分娩过程中的消毒隔离及护理

感染柯萨奇病毒的产妇在分娩过程中常通过消化道和呼吸道传播病毒 ,我们通过控制传染源、阻断传播途径和保护易感人群这三个环节 ,对感染柯萨奇病毒的产妇进行特殊的消毒隔离。我院1993年 11～ 1999年 11月共阴式分娩院外感染柯萨奇病毒产妇 5 6例 ,无一例产妇及新生儿发生医源性交叉感染 ,有效地控制了柯萨奇病毒的传播     

浅析会阴侧切伤口的感染

会阴切开及缝合术是产科最常用的手术，切开的方式有侧斜切开及正中切开。我科自１９９２年１月至１９９６年１２月止共行会阴侧切１９６１例，切口感染６７例，感染率为３４１％。单纯会阴侧切１９０８例，感染４９例，感染率２５６％，会阴侧切＋撕裂５３例，感染２０例，感染率３７７３％，二者相比Ｐ＜０．０１。在各种分娩方式中，产钳助产１６例，切口感染６例，感染率３７５％；胎头吸引９０２例，臀位产１２９例，正常产９１７例，切口感染分别为４６例、４例、１３例，感染率分别为５０９％、３１０％、１４２％，产钳助产与后三者相比Ｐ＜０．０１。     

新生儿血常规指标在珠蛋白生成障碍性贫血筛查中的应用价值研究

目的探讨新生儿血红蛋白(Hb)、平均红细胞体积(MCV)、平均红细胞血红蛋白(MCH)及红细胞平均分布宽度变异系数(RDW-CV)等血常规指标在珠蛋白生成障碍性贫血(后简称地贫)筛查中的临床应用价值。方法选取2015年3~12月,在该院经基因确诊携带有地贫基因的150例新生儿(出生28d以内)作为地贫组,同期经确诊排除地贫基因携带的新生儿150例作为健康对照组。对2组新生儿的血常规相关指标Hb、MCV、MCH、RDW-CV进行比较,同时比较α-地贫及β-地贫血常规指标的差异。结果携带有地贫基因的新生儿Hb、MCV、MCH等检测指标的结果低于健康对照组,但RDW-CV高于健康对照组,差异有统计学意义(P0.05)。各类型地贫基因携带者中,β-地贫组的Hb、MCV、MCH均低于α-地贫组,差异有统计学意义(P0.05),但两者的RDW-CV差异无统计学意义(P0.05)。结论地贫各基因型Hb、MCV和MCH呈下降趋势,但RDW-CV增加。新生儿血常规指标(Hb、MCV、MCH、RDW-CV)在地贫的筛查中具有重要意义,可用于大规模人群地贫筛查。     

Reproducibility of the blood flow index as noninvasive,bedside estimation of cerebral blood flow

OBJECTIVE: To investigate the feasibility and reproducibility of the blood flow index (BFI) method for measuring cerebral blood flow. DESIGN AND SETTING: Prospective functional study in pediatric intensive care. PATIENTS AND PARTICIPANTS: 14 consecutive patients with median age of 2 months (range 1 days-11 years) requiring artificial ventilation, invasive arterial blood pressure monitoring, and central venous access. INTERVENTIONS: The first passage of an intravenous indocyanine green (ICG) bolus through the cerebral vasculature was monitored by noninvasive near-infrared spectroscopy. BFI was calculated by dividing maximal ICG absorption change by rise time. Reproducibility was evaluated by six ICG injections at 5-min intervals. RESULTS: Of all ICG injections 6% were canceled, and 4% were eliminated due to injection failures. Median BFI of 17 reproducibility determinations was 71 (range 12-213) and median coefficient of variation (CV) of BFI was 10% (4.9-18.5). The quantity of ICG bolus did not affect the CV (0.1 vs. 0.3 mg ICG/kg). Eight reproducibility tests in patients after cardiac surgery had smaller CV than the others, and the eight in newborns had higher CV than in older children. Patient parameters such as arterial blood pressure, endtidal CO(2), and percutaneous oxygen saturation were stable and showed CV below 2% during reproducibility determination. CONCLUSIONS: The BFI method allows rapid and repeated measurements of CBF with good feasibility and reproducibility. As a relative but not absolute measure of CBF, BFI seems to be suited for clinical evaluation of intraindividual CBF changes during determination of cerebrovascular reactivities or during therapeutic interventions.     

Re‐evaluation of cord blood arterial and venous reference ranges for pH,pO2, pCO2, according to spontaneous or cesarean delivery

Umbilical cord blood gas analysis (pO₂ and pCO₂) is now recommended in all high‐risk baby deliveries and in some centers it is performed routinely following all deliveries. The aim of this study was to re‐evaluate cord blood arterial and venous reference ranges for pH, pO₂, pCO₂ in newborns, delivered by spontaneous vaginal delivery (SVD) and by cesarean section (CS) performed in Faculty Hospital Motol. Two groups of subjects were selected for the study. Group I consisted of 303 newborns with SVD. Group II consisted of 189 newborns delivered by cesarean section. Cord blood samples were analyzed for standard blood gas and pH, using the analytical device Rapid Lab 845 and Rapid Lab 865. We obtained reference values expressed as range (lower and upper reference value expressed as 2.5 and 97.5 percentiles) for cord blood in newborns with SVD: arterial cord blood: pH=7.01–7.39; pCO₂=4.12–11.45 kPa; pO₂=1.49–5.06 kPa; venous cord blood: pH=7.06–7.44; pCO₂=3.33–9.85 kPa; pO₂=1.80–6.29 kPa. We also obtained reference values for cord blood in newborns delivered by CS: arterial cord blood: pH=7.05–7.39; pCO₂=5.01–10.60 kPa; pO₂=1.17–5.94 kPa; venous cord blood: pH=7.10–7.42; pCO₂=3.88–9.36 kPa; pO₂=1.98–7.23 kPa. Re‐evaluated reference ranges play essential role in monitoring conditions of newborns with spontaneous and caesarean delivery. J. Clin. Lab. Anal. 24:300–304, 2010. © 2010 Wiley‐Liss, Inc.     

VEGF 在妊娠期糖尿病产妇分娩新生儿脐血中的表达研究

目的：探讨 VEGF 在妊娠期糖尿病产妇分娩新生儿的脐静脉血及动脉血中的表达及价值。方法对80例妊娠期糖尿病产妇分娩的新生儿及80例健康产妇分娩的新生儿的脐静脉和动脉血的 VEGF 水平进行放射免疫分析检测。结果观察组新生儿的脐动脉血 VEGF 水平为（24．06±8．79）pg/mL,脐静脉血 VEGF 水平为（20．69±7．78）pg/mL,均显著高于对照组;同时,观察组低血糖新生儿脐动脉血的 VEGF 水平显著高于对照组及观察组血糖正常的新生儿。结论妊娠期糖尿病产妇分娩新生儿的脐静脉和动脉血的 VEGF 水平明显高于健康产妇分娩的新生儿,新生儿脐动脉血的 VEGF 水平可以在一定程度上反映出妊娠期糖尿病对于胎儿的影响。     

Brain-specific NSE and S-100 proteins in umbilical blood after normal delivery

BACKGROUND: To determine normal blood levels of brain-specific proteins S-100 and neuron specific enolase (NSE) in healthy newborns and their mothers following uncomplicated birth. METHODS: Umbilical artery and vein blood and maternal venous blood was collected at 112 consecutive uncomplicated deliveries. Venous blood samples were taken from 18 of the neonates 3 days after birth. S-100 and NSE were analyzed quantitatively by double antibody immunoluminometric assay (Sangtec Medical AB, Sweden). RESULTS: Compared with adults, healthy neonates had higher levels of both S-100 and NSE. For S-100, median levels (range) were 1.10 microg/l (0.38-5.50 microg/l and 0.98 microg/l (0.43-2.70 microg/l) in umbilical artery and vein, respectively. For NSE, median levels (range) in umbilical artery blood and vein were 27 microg/l (10-140 microg/l) and 10.75 microg/l (8.80->/=200 microg/l) respectively. The maternal venous blood levels of both S-100 and NSE were significantly lower than in their infants. At 3 days of life, neonatal venous levels of the proteins were still high: S-100, 0.48-9.70 microg/l; NSE, 17->/=200 microg/l. In contrast to adults, haemolysis affected the S-100 levels in umbilical blood significantly. CONCLUSION: Concentrations of both S-100 and NSE in blood are greater in newborns after normal birth than in healthy adults. The higher levels in umbilical artery blood than in umbilical vein blood are consistent with a fetal origin of these proteins. High levels in venous blood at 3 days of life suggest that the high levels at birth are not related to the birth process but reflect a high activity of these proteins during fetal development.     

新生儿游泳对足跟采血成功率的影响

目的探讨提高新生儿足跟采血成功率的方法。方法从临床选取300例足月健康新生儿，分成观察组和对照组，观察组新生儿在游泳后采集足跟血，对照组新生儿在沐浴后采集足跟血，比较两组采血难易程度。结果观察组采血成功率明显高于对照组（P〈0．01）。结论新生儿游泳后进行足跟采血可以明显提高采血成功率。     

不同类型标本及仪器对血糖检测结果的影响

目的探讨罗氏血糖仪与全自动生化分析仪检测不同类型标本血糖水平的差异。方法收集2017年2-5月于南京市栖霞区妇幼保健院就诊患者及体检者的末梢血及静脉血标本104例。比较罗氏血糖仪检测的末梢血(末梢血POCT组)、静脉全血(全血POCT组)、静脉血浆(血浆POCT组)、静脉血清(血清POCT组)和全自动生化分析仪检测的静脉血浆(血浆生化仪组)、静脉血清(血清生化仪组)的血糖水平;验证罗氏血糖仪的精密度及线性范围。结果3台罗氏血糖仪的批内CV和批间CV均小于7.5%,符合判定标准。罗氏血糖仪检测的静脉全血血糖水平在1.1~24.4 mmol/L呈线性,R 2>0.95;静脉血清血糖水平在0.6~25.3 mmol/L呈线性,R 2>0.95,均符合线性要求。血糖水平<6 mmol/L的检测结果中,全血POCT组血糖水平低于其余各组(P<0.05);血糖水平为6~10 mmol/L的检测结果中,全血POCT组血糖水平低于血浆POCT组、血清POCT组、血浆生化仪组及血清生化仪组(P<0.05)。各组检测的血糖水平两两之间均具有显著相关性(r>0.99,P<0.05)。结论罗氏血糖仪检测精密度高,具有良好的线性,末梢血、静脉血浆、静脉血清等标本在血糖仪上的检测结果与全自动生化分析仪检测结果具有较好的可比性;罗氏血糖仪检测静脉全血时需进行一定程度的校正以保证结果的准确性。     

离子交换HPLC法和亲和层析HPLC法检测糖化血红蛋白结果的比较和分析

目的比较两种不同原理高效液相（HPLC）法测定HbA1c结果的一致性。方法采用Primus的PDQ亲和层析高效液相仪和Bio-Rad的VARIANT离子交换高效液相仪对87例2型糖尿病患者、10例透析的尿毒症患者和5例新生儿脐带血测定的糖化血红蛋白进行比较和分析。结果两种方法的线性试验中离子交换HPLC法的平均回复率为98．9％,亲和层析HPLC法平均回复率为100．9％;精密度试验离子交换HPLC法的批内CV〈1％,批间CV〈2％,亲和层析HPLC法批内和批间CV均〈2％;87例糖尿病患者检测结果比较没有显著性差异,r=0．901,P〈0．001;尿毒症患者HbA1c结果离子交换法均高于亲和层析法;亲和层析HPLC法能准确检测新生儿脐带血的HbA1c,而离子交换法不能测出。结论两种方法检测HbA1c准确度很高,都能真实的反映患者的糖化血红蛋白和血糖水平,但检测尿毒症患者和新生儿脐带血的糖化血红蛋白结果有很大差异。     

新生儿静脉输液外渗风险因素分析及预防

目的 探讨新生儿静脉输液外渗风险因素及预防。方法 回顾性分析2017年3月-2018年3月我院1 300例静脉输液新生儿的临床资料,分析新生儿静脉输液外渗情况。结果#br# 1 300例新生儿中,发生静脉输液外渗200例(15.38%);Logistic多因素分析显示,是否早产、输注药物、患儿血管弹性、置管材质、穿刺部位,穿刺护士工作年限是新生儿静脉输液外渗的独立影响因素(P<0.05)。结论 新生儿静脉输液存在严重的外渗风险,应针对风险因素进行监测和干预,以预防新生儿静脉输液外渗的发生。     

The utility of quantitative calf muscle near-infrared spectroscopy in the follow-up of acute deep vein thrombosis

BACKGROUND: To investigate patterns of venous insufficiency and changes in calf muscle deoxygenated hemoglobin (HHb) levels after an acute deep vein thrombosis (DVT). METHODS: A total of 78 limbs with an acute DVT involving 156 anatomic segments were evaluated with duplex scanning and near-infrared spectroscopy (NIRS) at 1, 3, 6 and 12 months. Venous segments were examined whether they were occluded, partially recanalized, and totally recanalized, and the development of venous reflux was noted. The NIRS was used to measure calf muscle HHb levels. Calf venous blood filling index (HHbFI) was calculated on standing, then the calf venous ejection index (HHbEI), and the venous retention index (HHbRI) were obtained after exercise. RESULTS: The segments investigated were the common femoral vein (CFV; 38 segments), femoral vein (FV; 37), popliteal vein (POPV; 44), and calf veins (CV; 37). At 1 year, thrombi had fully resolved in 67% of the segments, 27% remained partially recanalized, 6% were occluded. The venous occlusion was predominant in the FV (24%) at 1 year. On the contrary, rapid recanalization was obtained in CV than proximal veins at each examination (P < 0.01). Venous reflux was predominant in POPV (55%), followed by FV (19%), and no reflux was found in CV. At 1 year, the HHbFI in POPV reflux patients was significantly higher than those with resolution (0.19 +/- 0.14, 0.11 +/- 0.05 microm s, P = 0.009, respectively). Similarly, there was a significant difference in the HHbRI between the two groups (3.08 +/- 1.91, 1.42 +/- 1.56, P = 0.002, respectively). In patients with FV occlusion, the value of HHbRI was significantly higher than those with complete resolution (2.59 +/- 1.50, 1.42 +/- 1.56, P = 0.011, respectively). CONCLUSIONS: The lower extremity venous segments show different proportions of occlusion, partial recanalization, and total recanalization. The CV shows more rapid recanalization than proximal veins. The NIRS-derived HHbFI and HHbRI could be promising parameters as the overall venous function in the follow-up of acute DVT. These findings might be very helpful for physician in detecting patients who require much longer follow-up studies.