脑电图在新生儿缺氧缺血性脑病早期诊断和预后评估中的意义

目的分析脑电图在新生儿缺氧缺血性脑病(HIE)早期诊断和预后评估中的意义。方法回顾性选择我院收治的68例HIE患儿为观察组,另选择60例健康新生儿为对照组。2组新生儿均于出生后12~48h内行脑电图检查。根据检查结果,统计2组新生儿的脑电图异常率;同时,分析观察组患儿脑电图检查结果与HIE临床分度的关系及与HIE预后的关系。结果观察组患儿脑电图异常率为82.35%,对照组正常新生儿为0,差异有统计学意义(P0.05)。HIE轻度组患儿脑电图的异常率为67.86%,中度组为90%,重度组为100%,3组比较差异有统计学意义(P0.05);同时,HIE重度组患儿脑电图重度异常率HIE中度组HIE轻度组(P0.05)。HIE预后正常组患儿脑电图异常率为56.52%,轻中度不良组为94.59%,重度不良组为100%,预后轻中度及重度不良患儿脑电图的异常率均高于预后正常组(P0.05);且HIE预后重度不良组患儿脑电图重度异常率中度不良组轻度不良组(P0.05)。结论脑电图检查对HIE的早期诊断具有较好的特异性,且脑电图异常程度与HIE病情程度及预后情况基本一致,可作为HIE病情评估及预后判断的参考指标。     

纳洛酮在治疗新生儿缺氧缺血性脑病中的应用

目的 :观察纳洛酮在新生儿缺氧缺血性脑病 (HIE)治疗中的适应证、疗效、用药方法和副作用。方法 :本文对 13 2例HIE患儿随机分为两组 ,64例给予常规综合治疗 (简称对照组 ) ;68例在综合治疗的基础上每日加用纳洛酮 0 2～ 0 4mg溶入 5 %～ 10 %葡萄糖水 2 0ml中用输液泵泵入 ,连用 3～ 5d治疗 (简称纳洛酮组 )。结果 :(1)两组轻度HIE患儿在显效、总有效率上均无显著性差异(P >0 0 5 ) ;(2 )中、重度HIE患儿纳洛酮组在显效及其总有效率上均明显高于对照组 ,有显著性差异 (P <0 0 1)。结论 :轻度HIE患儿只需常规综合治疗 ;对中、重度HIE患儿在综合治疗基础上早期加用纳洛酮 ,能促进患儿意识恢复 ,改善呼吸 ,提高治愈率 ,改善预后。经临床观察 ,该药无明显副作用。     

脑电图检查在新生儿缺氧缺血性脑病中的价值

目的 探讨脑电图(EEG)检查在新生儿缺氧缺血性脑病中的价值.方法 对36例临床确诊的新生儿缺氧缺血性脑病(HIE)患儿进行EEG检查,并对所有患儿进行1～3次EEG复查,观察其变化情况.结果 (1)36例HIE患儿中EEG异常的35例,占97.2%;正常的1例,占3.8%.(2)临床预后均较好HIE轻度患儿EEG异常率95.2%,中、重度HIE患儿EEG异常率均为100%.(3)临床后遗症发生率:EEG轻度异常预后均较好,中度异常者为33.3%,重度异常为100%.结论 脑电图检查能客观、直接的反映脑的功能状态及损害程度,对HIE早期诊断、指导治疗及判断预后有重要价值.     

纳洛酮在治疗新生儿缺氧缺血性脑病中的应用

目的：观察纳洛酮在新生儿缺氧缺血性脑病（HIE）治疗中的适应证、疗效、用药方法和副作用。方法：本文对132例HIE患儿随机分为两组,64例给予常规综合治疗（简称对照组）;68例在综合治疗的基础上每日加用纳洛酮0．2－0．4mg溶入5％－10％葡萄糖水20ml中用输液泵泵入,连用3－5d治疗（简称纳洛酮组）。结果：（1）两组轻度HIE患儿在显效、总有效率上均无显著性差异（P＞0．05）;（2）中、重度HIE患儿纳洛酮组在显效及其总有效率上均明显高于对照组,有显著性差异（P＜0．01）。结论：轻度HIE患儿只需常规综合治疗;对中、重度HIE患儿在综合治疗基础上早期加用纳洛酮,能促进患儿意识恢复,改善呼吸,提高治愈率,改善预后。经临床观察,该药无明显副作用。     

中、重度缺氧缺血性脑病的早期干预及预后分析

目的探讨早期干预对中、重度缺氧缺血性脑病(HIE)患儿预后的影响。方法将60例中、重度HIE患儿分为干预组(30例)和对照组(30例),2组基本情况差异无统计学意义。对干预组进行系统的早期干预。结果治疗组平均智商及治疗有效率均高于对照组(P<0.05)。结论早期干预可改善中、重度HIE患儿的预后,能减少智能发育落后及伤残程度。     

肿瘤坏死因子-α和白介素-17在缺氧缺血性脑病患儿血清中的水平及临床意义

目的探讨血清肿瘤坏死因子-α(TNF-α)和白介素-17(IL-17)水平在缺氧缺血性脑病(HIE)患儿体内的变化及意义。方法采用ELISA法检测100例HIE患儿(轻度26例,中度44例,重度30例)和50例健康足月新生儿出生3d时血清中TNF-α和IL-17的水平。结果出生3d时轻、中、重度HIE患儿血清TNF-α和IL-17水平均高于健康足月新生儿(P0.05);HIE患儿血清TNF-α和IL-17水平与HIE的疾病严重程度关系密切(P0.05)。结论检测血清TNF-α和IL-17水平有助于HIE的确诊和判断预后。     

新生儿缺氧缺血性脑病脑动脉血流动力学变化及对预后的影响

目的探讨新生儿缺氧缺血性脑病脑动脉血流动力学变化及其预后评估价值。方法选取开封市妇产医院产科61例新生儿缺氧缺血性脑病(HIE)患儿作为研究组,其中轻度18例,中度26例,重度17例;并选取同期健康新生儿35例为对照组。检测、对比2组出生后24h、72h大脑前、中、后动脉血流动力学指标变化。结果出生后24h,与对照组相比,研究组大脑前、中、后动脉血流动力学指标平均流速、收缩期峰值流速、舒张期峰值流速均较低,阻力指数较高(P0.05);出生后24h、72h,重度患儿阻力指数较中度患儿高,而中度患儿较轻度患儿高(P0.05)。结论动态监测HIE患儿脑动脉血流动力学参数,可准确显示患儿脑部血流变化,指导临床早期诊治HIE,准确评估患儿病情及预后。     

尼莫地平治疗新生儿缺氧缺血性脑病疗效与随访

目的 :观察尼莫地平治疗中、重度新生儿缺氧缺血性脑病 (HIE)疗效及预后。方法 :75例HIE患儿给予支持及对症治疗 ,随机分为两组 ,4 0例加用尼莫地平 3～ 5mg/ (kg ,d) (治疗组 ) ,与 35例不用尼莫地平组对照 (对照组 )。观察两组患儿治疗前后新生儿神经行为评分 (NBNA) ,随访 12个月。结果 :治疗组NBNA≥ 35分 :第 7、14d分别 2 2 (5 5 % )、32 (80 % )例 ;对照组 11(31 4 % )、2 0 (5 7 1% )例 ,两组分别比较差异有显著性 (P均 <0 0 5 )。随访12个月 ,预后不良率治疗组 7 5 % ,显著低于对照组 2 5 7% (χ2 =4 6 0 8,P <0 0 5 ) ,治疗组发育商明显高于对照组(P均 <0 0 5 )。结论 :尼莫地平治疗中、重度新生儿缺氧缺血性脑病 ,能减少后遗症的发生 ,改善其预后     

白介素-1受体拮抗剂和C反应蛋白在缺氧缺血性脑病患儿血清中的水平及意义

目的探讨缺氧缺血性脑病(HIE)患儿血清白介素-1受体拮抗剂(IL-1Ra)和C反应蛋白(CRP)的水平及临床应用价值。方法采用ELISA法检测50例HIE患儿(轻度13例,中度22例,重度15例)和25例健康足月新生儿(对照组)血清IL-1Ra、CRP的水平。结果不同程度HIE患儿出生7d时的血清IL-1Ra、CRP水平均低于3d时(P0.05);不同程度HIE患儿出生3d和7d时的血清IL-1Ra、CRP水平均高于对照组(P0.05);HIE患儿血清IL-1Ra、CRP水平与HIE严重程度有关(P0.05)。结论患儿血清IL-1Ra、CRP水平检测可用于HIE的诊断和预后评估。     

新生儿缺氧缺血性脑病血清中VEGF MMP-2和MMP-9蛋白水平的变化及其临床意义

目的探讨新生儿缺氧缺血性脑病(HIE)患儿血清中血管内皮生长因子(VEGF)、基质金属蛋白酶-2(MMP-2)和MMP-9蛋白水平的变化及其临床意义。方法入组112例HIE患儿,其中轻度49例,中度34例,重度29例,采用酶联免疫吸附试验检测这些HIE患儿出生后72h内血清VEGF、MMP-2和MMP-9蛋白水平,同时比较不同程度HIE患儿血清VEGF、MMP-2和MMP-9蛋白水平的差异,并以50例足月正常新生儿作为对照。结果轻度、重度、重度HIE患儿血清中VEGF、MMP-2和MMP-9蛋白水平均高于足月正常新生儿,差异有统计学意义(P0.05)。不同程度HIE患儿血清中VEGF、MMP-2和MMP-9蛋白水平比较差异均有统计学意义(P0.05),且表达水平均随疾病严重程度的进展而升高。结论VEGF、MMP-2和MMP-9可能参与了HIE的疾病发生发展过程,且检测血清中三者的表达水平可用于诊断HIE或评估其预后。     

TERM INFANTS WITH HYPOXIC-ISCHEMIC ENCEPHALOPATHY: OUTCOME AT 3.5 YEARS

A total of 167 term neonates with a diagnosis of hypoxic-ischemic encephalopathy (HIE) had detailed neurodevelopmental follow-up at 3.5 years of age. All 66 children with mild HIE were free from handicap; all seven with severe HIE were severely handicapped; and of the 94 with moderate HIE at birth, 21.3 per cent were handicapped. Mean IQ was significantly related to the category of HIE. Within the moderate HIE category, the neurological examination at discharge from the Neonatal Intensive Care Unit was more useful than the presence of neonatal convulsions in identifying children with subsequent developmental delay. Abnormalities on this examination related significantly to an increased number of handicapped children, decreased motor and language skills, and lower IQs. Although neonatal convulsions were associated with an increased number of handicapped children, they did not significantly affect most other developmental outcome measures. In term infants with documented HIE at birth, major neurodevelopmental dysfunction at 3.5 years depended more on prospectively established category of HIE than on other perinatal or social factors.     

Neuron-specific enolase as a marker of the severity and outcome of hypoxic ischemic encephalopathy

The aim of this study was to evaluate serum concentrations of neuron-specific enolase (NSE) as a marker of the severity of hypoxic ischemic encephalopathy (HIE) and to elucidate the relation among the concentrations of NSE, grade of HIE and short-term outcome. Forty-three asphyxiated full-term newborn infants who developed symptoms and signs of HIE (Group 1) and 29 full-term newborn infants with meconium-stained amniotic fluid but with normal physical examination (Group 2) were studied with serial neurological examination, Denver developmental screening test (DDST), electroencephalogram and computerized cerebral tomography (CT) for neurological follow-up. Thirty healthy infants were selected as the control group. In the patient groups, two blood samples were taken to measure NSE levels, one between 4 and 48 h and the other 5-7 days after birth. Serum NSE levels were significantly higher in infants with HIE compared to those infants in Group 2 and control group. The mean serum concentrations of the second samples decreased in all groups studied but they were significantly higher in Group 1 compared to those in Group 2. Serum NSE concentrations of initial samples were significantly higher in patients with stage III HIE than in those with stages II and I. The sensitivity and specificity values of serum NSE as a predictor of HIE of moderate or severe degree (cut-off value 40.0 microg/l) were 79 and 70%, respectively, and as a predictor of poor outcome (cut-off value 45.4 microg/l) were calculated as 84 and 70%, respectively. The predictive capacity of serum NSE concentrations for poor outcome seems to be better than predicting HIE of moderate or severe degree. However, earlier and/or CSF samples may be required to establish serum NSE as an early marker for the application of neuroprotective strategies.     

Early application of nerve growth factor affects serum inflammatory cytokine levels in neonatal hypoxic ischemic encephalopathy

BACKGROUND: It has been demonstrated that there are changes of various cytokines, chemokines and adhesion factors in neonatal hypoxic ischemic encephalopathy (HIE). What are the changes of interleukin-6 and interleukin-18 in serum of HIE neonates. OBJECTIVE: To observe the dynamic changes of interleukin-6 and interleukin-18 in peripheral serum at different time after HIE in neonates, and analyze the possible therapeutic efficacy of early application of NGF. DESIGN: A non-randomized controlled observation synchronically. SETTING: Department of Neonatology, Sun Yat-sen Hospital affiliated to Sun Yat-sen University. PARTICIPANTS: Sixty neonates with HIE were selected from the Department of Neonatology, Sun Yat-sen Hospital affiliated to Sun Yat-sen University from January 2004 to October 2006, including 32 boys and 28 girls, who were all accorded with the diagnostic standards for moderate to severe HIE. The neonates were divided into two groups NGF-treated group (n =30), HIE group (n =30). The HIE neonates in the NGF-treated group were given routine treatment and intramuscular injection of NGF within 24 hours after birth. Those in the HIE group were given routine treatments. Meanwhile, 30 apneic normal neonates (17 boys and 13 girls) at the same period were selected as the control group. The gestational age was 37–42 weeks in all the three groups, the body mass at birth was 2 500–4 000 g. Informed contents were obtained from the relatives of all the enrolled neonates. METHODS: The HIE neonates in the NGF-treated group were given routine treatment and intramuscular injection of NGF (2 000 U) within 24 hours after birth, once a day, 10 days as a course. Those in the HIE group were given routine treatments. Blood samples (3 mL) were drawn from femoral vein in all the neonates 1, 3 and 7 days after birth. The levels of interleukin-6 and interleukin-18 in serum were detected with enzyme-linked immunoabsorbent assay (ELISA). MAIN OUTCOME MEASURES: Serum levels of interleukin-6 and interleukin-18 at 1, 3 and 7 days after birth. RESULTS: All the 60 HIE neonates and 30 normal neonates were involved in the final analysis of results. ① Serum level of interleukin-6: The serum levels of interleukin-6 at 1, 3 and 7 days after birth in the HIE group were all lower than those in the control group (P < 0.05), and gradually recovered to the normal level as time prolonged. The serum levels of interleukin-6 at 1, 3 and 7 days after birth in the NGF-treated group were higher than those in the HIE group (P < 0.05). ②Serum level of interleukin-18: The serum levels of interleukin-18 at 1, 3 and 7 days after birth in the HIE group were all higher than those in the control group (P < 0.05), especially that at 3 days. The serum levels of interleukin-18 at 1, 3 and 7 days after birth in the NGF-treated group were lower than those in the HIE group (P < 0.05). CONCLUSION: After hypoxic ischemia, the level of interleukin-6 was decreased and that of interleukin-18 was increased in peripheral serum in HIE neonates, while NGF could balance the levels of interleukin-6 and interleukin-18, adjust the immunological function, and protect the nerve cells.     

促血小板生成素对预测脑瘫高危儿的意义

目的探讨缺氧缺血性脑病(hypoxia-ischem ia encephalopathy,H IE)胎儿和H IE新生儿血清中促血小板生成素(Thrombopoietin,TPO)水平与脑损伤的关系,为脑瘫(cerebral palsy,CP)高危儿人群进行早期干预提供监测手段。方法收集23例H IE胎儿和34例H IE新生儿血清以及25例正常胎儿和30例正常新生儿血清,34例H IE新生儿包括11例轻度H IE,8例中度H IE和15例重度H IE。采用双抗体夹心ABC-ELISA法检测H IE胎儿组和轻、中、重H IE新生儿组血清中TPO的水平,并与正常胎儿组和正常新生儿组比较。结果H IE胎儿组和H IE新生儿组TPO分别高于正常胎儿组和正常新生儿组(分别P<0.01,P<0.01),重度H IE组TPO低于轻度H IE组(P<0.05)。结论血清TPO水平与H IE所致脑损伤严重程度有关。脐血TPO检测可为脑瘫高危儿人群进行早期干预提供监测手段。     

Development of epilepsy in newborns with moderate hypoxic-ischemic encephalopathy and neonatal seizures

Background: Hypoxic-ischemic encephalopathy (HIE) is one of the most frequent causes of neonatal death or neurological handicaps such as cerebral palsy, mental delay, and epilepsy. Moreover, an acute consequence of HIE are neonatal seizures which can cause an additional brain damage. The neurodevelopmental outcome is known in the mild or severe cases of HIE, but in the moderate conditions the predictivity results, to date, unsatisfying. Objective: The purpose of this prospective study was to appraise the development of post-neonatal epilepsy in a cohort of term infants with moderate HIE and neonatal seizures. Methods: This study considered all newborns admitted to Neonatal Intensive Care Unit of the University of Parma between January 2000 and December 2002 for perinatal asphyxia, then followed by Neonatal Neurology Service. In all patients, neonatal variables such as type of delivery, birth weight, gestational age, Apgar scores, the need for resuscitation and assisted ventilation soon after birth, and arterial-blood pH were analyzed. Results: Ninety-two newborns were enrolled in the study because of perinatal asphyxia. Of these, 27 subjects developed mild HIE, 25 moderate, and five severe HIE. Neonatal seizures were present in 13 subjects with moderate HIE and in all newborns with severe HIE. At the last follow-up, only three infants belonging to patients with severe HIE developed epilepsy. Conclusion: Moderate HIE seems not to be related to post-neonatal epilepsy either if associated or not with neonatal seizures.     

Vascular endothelial growth factor in neonates with perinatal asphyxia

Background: Vascular endothelial growth factor (VEGF) is a polypeptide growth factor that is activated by tissue hypoxia. The role of VEGF in perinatal asphyxia in human neonates is yet to be clarified. In infants who develop moderate to severe acute hypoxic ischemic encephalopathy (HIE) it is crucial to clearly understand physiologic and biochemical changes that accompany HIE before a novel treatment can be developed. Objectives: To assess VEGF in cord blood of infants suffering from perinatal asphyxia, and to determine whether an association exists between increased concentrations of VEGF and the risk for development of encephalopathy. Study design: We prospectively studied 40 full term infants; of them 20 infants suffered from perinatal asphyxia, and 20 control infants of comparable age and sex. We obtained cord blood samples from all subjects immediately after delivery. Neurological examination and grading of HIE were performed during the first day of life. Results: Birth weight, gestational age and gender did not differ between the control (n = 20) and asphyxia (n = 20) groups. Within the asphyxia group four infants developed HIE; one with severe encephalopathy who died shortly after birth, while the other three infants had moderate HIE. Concentrations of VEGF were increased in infants with asphyxia when compared to controls (P  0.001). Within the asphyxia group, infants with HIE had significantly increased concentrations of VEGF when compared to non-HIE asphyxiated infants (P = 0.008). In the logistic regression model, VEGF inversely correlated with pH and PO₂ in cord blood, and Apgar scores at 1 min, while it did not associate with gestational age and birth weight. Conclusions: This study indicates that VEGF is increased in cord blood of neonates following birth asphyxia, and that VEGF is specifically most increased in infants who later developed encephalopathy. Further studies are required to determine the role of VEGF in brain insult. Such studies will help determine whether a therapeutic role for VEGF or VEGF inhibitors can exist for HIE infants.     

缺氧缺血性脑病对新生儿的心电图和心肌酶学的影响及其临床意义

目的探讨缺氧缺血性脑病（HIE）对新生儿的心电图（ECG）和心肌酶学的影响及其临床意义。方法选自2010年1月~2012年12月间在本院新生儿科被确诊为HIE的84例新生儿,其中轻度组46例,重度组38例,对照组54例。,采用不同生物化学方法检测各组新生儿血清中的肌酸激酶（CK）、肌酸激酶同工酶（CK—MB）和心肌肌钙蛋白T（CTnT）的活性,利用非侵人性床边常规ECG记录各组ECG变化特征,并作组间比较分析。结果与对照组比较,轻度组有58．70％患儿的ECG出现异常变化（PG0．01）,ECG的类型主要为I级（34．78％）和Ⅱ级（19．57％）,I级又显著多于Ⅱ级;患儿血清中CK和CK-MB水平略有增高（P均〉0．05）,但cTnT值显著高于对照组（PG0．01）。在重度组有100％新生儿的ECG出现ST段改变,甚至出现病理性Q波、束支传导阻滞,其ECG异常发生率不仅高于对照组,还显著高于轻度组（P均〈0．01）,ECG的特征主要为Ⅲ级（50．00％）和Ⅳ级（39．47％）;血清中的CK、CK-MB和cTnT值不仅显著高于对照组,也明显高于轻度组（P均〈0．01）,特别是CK-MB值,超过对照组的6倍,cTnT值超过对照组的20倍。从临床病情看轻度组中没有死亡病例出现,而重度组出现11例患儿死亡（28．95％）。结论HIE的发生引起新生儿出现异常ECG和心肌酶学水平改变,提示患儿心肌组织可能受到损伤,HIE病情越深,患儿心肌受损越严重。监测HIE患儿ECG具有实用性和直观性,测定患儿血清中cTnT具有显著的敏感性和特异性,二者在诊断、治疗有关HIE发生可能诱使心肌受到损伤等方面具有非常重要的临床意义。     

IL-1beta, IL-6 and TNF-alpha and outcomes of neonatal hypoxic ischemic encephalopathy

The role of cytokines in the pathogenesis of brain injury and their relation to neurological outcomes of asphyxiated neonates is not fully defined. We hypothesize that interleukin-1 beta (IL-1beta), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) in cerebrospinal fluid (CSF) correlate with the severity of brain injury and can predict neurological deficits in infants who suffered from hypoxic ischemic encephalopathy (HIE). A prospective study was conducted on 24 term infants diagnosed with HIE and 13 controls. HIE was clinically classified into mild, moderate and severe according to Sarnat and Sarnat grading. Blood and CSF samples were obtained from all infants in the first 24h of life as part of routine investigations for suspected meningitis and/or sepsis. Neurological examination and Denver Developmental Screening Test II (DDST II) were performed at 6 and 12 months of life. IL-1beta, IL-6 and TNF-alpha were all significantly increased in HIE infants when compared to control. IL-1beta in the CSF correlated with the severity of HIE (r=0.61, P=0.001) more than IL-6 (r=0.45, P=0.004) or TNF-alpha (r=0.47, P=0.003). IL-1beta exhibited the highest CSF/serum ratio among the three studied cytokines suggesting its local release in the brain after the initial hypoxic injury. Abnormal neurological findings and/or abnormal DDST II at 6 and 12 months were best predicted by IL-1beta in the CSF (sensitivity=88% and specificity=80%). This study confirms the role of IL-1beta in the ongoing neuronal injury that occurs in the latent phase following the original HIE insult.     

神经节苷脂GM1治疗新生儿缺氧缺血性脑病30例疗效观察

目的 探讨神经节苷脂GM1治疗新生儿HIE的疗效.方法 将60例HIE新生儿按照有无接受神经节苷脂GM1治疗分为治疗组和对照组各30例,比较2组治疗前后的神经行为评分(NBNA).结果 治疗组生后20 d时NBNA评分较对照组明显升高(25.700±2.706 vs 21.833±2.214),差异具有统计学意义.结论...     

258例高血压脑出血手术治疗临床分析

目的：分析258例高血压脑出血手术疗效并探讨提高手术疗效与生存质量的相关因素。方法：总结1992年5月～2002年5月高血压脑出血手术治疗的临床资料，选定手术时机、手术适应症、手术方法与技巧及术后治疗和康复与疗效比较。结果：手术死亡率13．2％(34例)。190例手术2～72个月随访，恢复良好41％(78例)，轻残28．9％(55例)，重残(含植物生存)22％(43例)。结论：认为超早期手术尽早解除脑受压是手术成功的关键，采用微创与及时术后康复治疗是提高生存质量的重要手段。分析疗效提出了本病的适应症。