心肌酶谱测定对新生儿窒息合并心肌损害的临床意义

目的探讨心肌酶谱测定对新生儿窒息患者心肌损害的临床意义。方法将86例新生儿窒息患儿分轻、重度窒息组,其中轻度窒息组48例,重度窒息组38例,选择52例正常新生儿作为对照组,测定对比三组患儿天门冬氨酸氨基转移酶（AST）、磷酸肌酸激酶（CK）、磷酸肌酸激酶同工酶（CK-MB）、乳酸脱氢酶（LDH）衙性。结果正常对照组与轻、重度窒息组间心肌酶谱比较差异有统计学意义（P〈0．01）,且重度窒息患儿治疗前后心肌酶谱变化差异有统计学意义垆〈0．05）。结论心肌酶谱的测定能较好地协助临床早期诊断窒息时有无并发心肌损伤及损伤程度,对判断病情轻重、治疗效果、估计预后都有着重要的临床意义。     

窒息新生兔中枢及外周血脑啡肽含量的变化

目的　探讨脑啡肽与新生兔窒息的关系。方法　采用放射免疫测定法测定 2 4只正常新生兔 (对照组 )及 2 6只窒息新生兔 (窒息A组 )中枢及外周血中脑啡肽的含量。将 2 0只孕 3 0d母兔窒息后立即剖宫取出仔兔 ,随机分为 4组 :新生兔窒息未治疗组 (窒息B组 ) ,新生兔窒息ICI17486 4 治疗组 (ICI组 ) ,新生兔窒息脑啡肽抗血清治疗组 (抗血清组 ) ,新生兔窒息兔血清治疗组 (血清组 )。后2组仔兔在分娩后分别脑内注入脑啡肽抗血清 (滴度 1∶60 0 0 )或等量不含抗体的兔血清 ,ICI组按体重静脉注入ICI17486 4 80ng kg。仔兔均于剖宫产后 1、5、10、15及 3 0min进行Apgar评分。结果　①窒息A组新生兔下丘脑、垂体及外周血脑啡肽的含量分别为 (63 5.2± 57.6)、(452 .7± 3 7.5)及 (2 97.6± 2 8.4)ng L ,对照组分别为 (185.7± 2 9.6)、(150 .9± 2 1.4)及 (12 1.5± 19.9)ng L。与对照组相比 ,窒息A组中枢及外周脑啡肽含量均明显升高 (P <0 .0 1及 <0 .0 5)。②抗血清组及ICI组兔Apgar评分明显高于窒息B组及血清组 (P <0 .0 1及 <0 .0 5) ,后两组间差异无显著性 (P >0 .0 5)。结论　脑啡肽与新生兔窒息的发生发展密切相关 ,其不利作用为通过δ受体介导     

西宁地区新生儿窒息高危因素的探讨

本文总结了西宁地区２８０７例新生活婴，其中窒息儿３５５例，窒息发生率１２．６５％，远高于平原地区。窒息死亡１７例，死亡率４７．９０％。提出西宁地区新生儿窒息密切相关的高危因素是：胎儿窘迫及羊水污染程度；脐带异常；早产及过期妊娠；手术产；母体并发症中的好高症。     

Histopathology of renal asphyxia in newborn piglets: Individual susceptibility to tubular changes

AIM: To analyze the effects on the kidney of hypoxiareoxygenation in an experimental model of normocapnic asphyxia.METHODS: To this end, 40 newborn Landrace/LargeWhite piglets aged 1-4 d were studied in this work. Hypoxia was induced by decreasing the inspired fiO_2 to 0.06-0.08. Animals were resuscitated with different fiO_2 and subdivided into 4 groups: group 1, 2, 3 and 4 received 18%, 21%, 40% and 100% O_2 respectively. Macroscopic examination was carried out to evidence possible pathological features. Tissue sample were obtained from both kidneys. Four or five micron paraffin sections were stained with H-E and PAS stain and examined under an optical microscope.RESULTS: Pathological changes, mainly affecting tubular cells, were observed in the vast majority of kidneys of asphyxiated piglets. The most frequent tubular changes were: tubular casts(95%), tubular dilatation(87.5%), tubular vacuolization(70%), tubular eosinophilia(52.5%), sloughing(50%), fragmentation of the brush border(50%), oedema(32.5%), apoptosis(15%) and glomerular changes(meningeal cell proliferation, capsular adhesion between the flocculus and Bowman's capsule, glomerulosclerosis and fibrous or cellular crescents associated with collapse of the glomerular tuft). Statistical analysis was carried out on changes observed when the animals were allocated in the 4 groups(χ~2-test 0.05). The statistical analysis showed no evidence of differences regarding kidney lesions among the animals groups.CONCLUSION: Our data show that renal pathology in newborn piglets is characterized by interindividual variability to hypoxia and is not associated with oxygen concentration.     

参附注射液对家兔缺氧型心跳骤停模型复苏后平均动脉压的影响

目的观察参附注射液对家兔缺氧型心跳骤停模型的复苏后平均动脉压(MAP)的影响。方法采用夹闭气管法致家兔心跳骤停模型,12只家兔随机分为参附组及对照组,造模后立即进行心肺复苏(CPR),并分别静推参附注射液及0.9%氯化钠注射液,观察自主循环恢复时间及复苏后6 h内平均动脉压(MAP)变化。结果参附组自主循环恢复时间为(91.38±31.47)s,对照组为(179.85±27.82)s;参附组自主循环恢复后6 h内MAP高于对照组。结论参附注射液可缩短缺氧型心跳聚停家兔模型自主循环恢复时间,同时对MAP具有积极的提升和稳定作用,能提高CPR的成功率。     

What to do if A + B doesn't work

The majority of newborn resuscitations require very little beyond simple airway management and assisted ventilation. If cardiovascular collapse is serious enough to warrant additional support, resuscitation algorithms recommend moving to chest compressions and then on to medications and possibly volume replacement if vital signs remain marginal or absent. The evidence base upon which this part of the neonatal resuscitation algorithm is structured is sparse. Chest compressions and medications are rare interventions that do not lend themselves easily to clinical trials. Slowly but surely, however, the genesis of an empirical evidence base for this part of the algorithm is beginning to appear.     

Quality of general movements in term infants with asphyxia

Background

Perinatal asphyxia may result in a developmental disorder. A recently developed non-invasive tool to investigate brain function at an early age is the assessment of general movements (GMs).

Aim

To evaluate relationships between perinatal risk factors and the quality of GMs in the neonatal period and at 3 months in term newborns with asphyxia in a secondary paediatric setting.

Methods

64 term (> 36 weeks postmenstrual age (PMA)) infants with perinatal asphyxia were studied. GMs were assessed at ‘writhing’ GM age (38-47 weeks PMA) and at ‘fidgety’ GM age (48-56 weeks PMA). Pre- and perinatal factors were collected in a standardized way.

Results

Multivariate analysis revealed that DA GMs at ‘writhing’ age mainly correlated with asphyxia related illness. DA GMs at ‘fidgety’ age correlated in particular with abnormalities on the neonatal ultrasound scan of the brain.

Conclusion

In secondary paediatric settings GM-assessment especially around 3 months is a valuable tool for the assessment of the integrity of the nervous system in term infants with asphyxia.     

生后6小时床旁视频脑电图诊断围产期缺氧缺血性脑病及其与近期神经行为发育相关性的研究

目的 探讨新生儿生后6 h床旁视频脑电图(video electroencephalogram,VEEG)对缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)的诊断价值以及与早期神经行为发育结局的相关性.方法 采用前瞻性研究方法,连续纳入2009年3月至9月间我院收治的重度窒息新生儿,记录生后6 h床旁VEEG并分度;以HIE标准诊断方案作为临床诊断HIE和分度的金标准.分析生后6 h不同程度VEEG预测相应程度HIE的敏感性和特异性;在观察者盲法的基础上,比较生后6 h、3和7 d异常VEEG预测HIE的敏感性和特异性.生后7～14 d行新生儿行为神经评分(neonatal behavior neurological assessment,NBNA),出院后3月龄门诊随访行脑电图(electroencephalogram,EEG)、全身运动(general movements,GMs)质量评估和0～6岁发育筛查测验(developmental screening test for child under six,DST)评估;6月龄行EEG、贝利婴幼儿发展量表(Bayley scales of infant development,BSID)评估,分析6 h VEEG与近期神经发育结局的相关性.结果 重度窒息新生儿48例纳入分析.诊断为单纯重度窒息12例;HIE 36例,其中轻、中和重度分别为14、12和10例.生后6 h VEEG正常9例;异常39例(81.3%),其中轻、中、重和极重度异常分别为16、11、5和7例.36例HIE新生儿生后6 h VEEG异常32例.异常率88.9%.生后6 h VEEG异常程度与脑损伤程度的等级相关系数为0.849,P<0.01,生后6 h VEEG重度与极重度异常预测重度HIE敏感性为100%,特异性94.7%;生后6 h、3和7 d VEEG预测HIE的敏感性分别为88.9%、83.9%和28.6%,特异性分别为41.7%、91.7%和100.0%.生后6 h VEEG异常并持续异常于院内死亡9例,生后6 h VEEG中、重度异常者NBNA评分显著低于VEEG正常患儿(P均<0.01);VEEG重度异常者NBNA评分显著低于中度异常患儿(P<0.05).3月龄时35例患儿来院随访,32例DST>85分,3例DST 70～84分且伴有EEG异常,其中1例GMs质量评估示不安运动缺乏,提示脑性瘫痪可能性大.6月龄时14例患儿来院随访,7例EEG异常,4例BSID异常且均伴有EEG异常.结论 生后6 h VEEG预测HIE及其严重程度的敏感性和特异性较高,与早期神经发育结局有较好的相关性.     

Hypothermia in the resuscitation of the neonate: a glance in my rear-view mirror

Recent research indicates that the outcome of perinatal hypoxia-ischaemia can be improved by hypothermia. This was actually first observed about 40 years ago, as discussed in this article. Clinical application of whole-body hypothermia in the asphyxiated neonate showed a positive effect. Reference is made to previous review articles on the subject. A large experimental study indicated that the degree of protection against hypoxic-ischaemic damage, as judged by the conditioned avoidance response, was dependent on the fall in body temperature. The earlier reported resistance against hypothermia in the asphyxiated neonate is discussed and analysed.

Conclusion: Experimental and clinical evidence suggest that hypothermia may be of value in resuscitation of the neonate.