环甲膜切开术救治急性会厌炎突发窒息五例

急性会厌炎又称为急性声门上喉炎,是以主要累及声门上区会厌及其周围组织为主的急性特殊感染,起病急,进展迅速,临床上可迅速出现咽喉部剧烈疼痛、吞咽困难、呼吸困难,特别是小儿,是一种危及生命的严重感染[1-2]。多数患者经足量广谱的抗生素、糖皮质激素保守治疗或者及时预判行气管切开术能得到很好治疗。     

Increase of neuronal injury markers Tau and neurofilament light proteins in umbilical blood after intrapartum asphyxia

Aim: Compare the levels of the brain injury biomarkers Tau and neurofilament light protein (NFL) in cases of asphyxia with those in controls.

Materials and methods: We analyzed the neuronal proteins Tau and NFL in umbilical blood of 10 cases of severe-moderate intrapartum asphyxia and in 18 control cases.

Results: The levels of both Tau and neurofilament were significantly higher after asphyxia and it appeared to be a correlation between the levels of the biomarkers and the severity of the insult.

Discussion: Future studies are warranted to support or refute the value of Tau/NFLin clinical practice.

Conclusion: Fetal asphyxia remains a clinical problem resulting in life-long neurological disabilities. We urgently need more accurate early predictive markers to direct the clinician when to provide neuroprotective therapy.     

新生儿窒息的原因及治疗

胎儿宫内窘迫是分娩期的严重并发症,如果处理不及时常导致新生儿窒息;新生儿窒息是围生儿死亡的主要原因,也是人类基本素质降低的主要原因。新生儿窒息的原因大多是可以发现、预防和治疗的。治疗胎儿宫内窘迫,提高宫内复苏率,降低新生儿窒息的发生,完善新生儿窒息的抢救措施,对提高围生儿的存活率及其生存质量有重要的临床和现实意义。     

92例早产儿血糖紊乱高危因素分析

目的探讨早产儿血糖紊乱的高危因素及临床特点。方法采用微量法对92例早产儿进行连续血糖监测。结果血糖持续正常28例（30．5％）,异常64例（69．5％）;胎龄〈31周的早产儿（10．7％）无一例血糖持续正常;8例低体重早产儿（1200—1500g）空腹血糖全部异常;高低血糖交替发生18例（19．6％）;恢复正常血糖水平时问平均4．5d,最长达45d;重度窒息组全部异常,其中8例为高血糖,3例高血糖持续不能纠正死亡。结论低出生体重、胎龄、1分钟Apgar评分是早产儿发生血糖紊乱的高危因素,胎龄越小、体重越低、1分钟Apgar评分越低血糖紊乱发生率越高。持续高血糖不能纠正往往预示病情危重预后差。     

磷酸肌酸钠治疗新生儿窒息后心肌损害临床观察

目的:观察磷酸肌酸钠对新生儿窒息后心肌损害的治疗效果。方法:将60例新生儿窒息后心肌损害的患儿随机分为治疗组(32例)和对照组(28例),两组均给予常规治疗,治疗组在此基础上加用磷酸肌酸钠静脉滴注0.5g,1次/d,7d为1个疗程。观察两组患儿治疗后症状、体征、肌钙蛋白I(cTnI)及肌酸激酶同工酶(CK-MB)的改变。结果:治疗组总有效率96.9%,明显高于对照组的71.4%(P<0.01)。在改善CK-MB、cTnI方面,治疗组更优于对照组(P<0.01)。结论:磷酸肌酸钠可显著提高新生儿窒息后心肌损害的临床疗效。     

重症监护病房新生儿死亡病例分析

目的探讨新生儿重症监护病房（NICU）新生儿死亡的危险因素及变迁。方法回顾性分析我院NICU 2004年1月—2009年12月期间死亡的129例患儿的病历资料,筛选死亡危险因素。结果体重〈1.5 kg新生儿年均病死率9.2%;胎龄≤32周早产儿年均病死率为9.4%;死亡新生儿中出生48 h内病死率达34.9%.2004年—2009年新生儿直接死亡原因排序依次为感染性疾病、窒息及其并发症、先天性畸形、其他疾病。结论胎龄小、出生体重低及母亲高龄始终是新生儿死亡的高危因素,死亡高危时段在出生后48 h内。感染性疾病、窒息及其并发症是最主要的直接死因,先天性畸形致死率增高,疾病谱有扩大趋势。     

血肌红蛋白、胱抑素C对窒息新生儿早期肾损害的临床研究

目的探讨足月窒息新生儿出生早期血肌红蛋白（Mb）及胱抑素C（Cys—C）浓度变化及对肾功能的影响。方法选择本院新生儿科出生3h内入院的足月窒息新生儿（60例）,分为轻度窒息组和重度窒息组,测定生后3h内Mb和CK水平,同时检测Cys—C、BUN、Scr,与无宫内窘迫、窒息及产伤的正常对照组（40例）进行比较分析。结果窒息新生儿出生早期血Mb与CK均高于正常对照组,重度窒息组高于轻度窒息组（P均〈0．05）;Mb与CK浓度呈正相关（重度窒息组r=0．764,轻度窒息组r=0．658,P均〈0．05）;窒息新生儿出生早期Cys—c与BUN、Scr较正常对照组明显升高,Cys—C与BUN、Scr值呈正相关（r=0．618、0．564,P均〈0．05）;Cys—c异常率高于BUN、Scr（轻度组X^2=6．14,重度组X^2=6．73;P均〈0．05）。结论新生儿窒息后缺氧可发生肌肉损伤及早期肾损害,血Mb和Cys—c可作为新生儿早期肾损害的监测指标。     

产前38周检查与新生儿窒息的关系分析

目的探讨妊娠38周产前检查结果与新生儿窒息的关系。方法回顾性分析我院在妊娠38周进行产前检查的3 846例孕产妇中138例发生新生儿窒息的临床资料,统计其危险分数及发生窒息的几率。结果危险分数越高,发生窒息几率越高,组间比较有显著性差异（P〈0.05）;新生儿窒息与孕妇、胎盘、脐带等多种因素有关。结论 38周产前检查结果及危险分数对评价新生儿窒息发生几率有重要的价值。     

Comparison of Cerebral Metabolism between Pig Ventricular Fibrillation and Asphyxial Cardiac Arrest Models

Background:

Morbidity and mortality after resuscitation largely depend on the recovery of brain function. Ventricular fibrillation cardiac arrest (VFCA) and asphyxial cardiac arrest (ACA) are the two most prevalent causes of sudden cardiac death. Up to now, most studies have focused on VFCA. However, results from the two models have been largely variable. So, it is necessary to characterize the features of postresuscitation cerebral metabolism of both models.

Methods:

Forty-four Wuzhishan miniature inbred pigs were randomly divided into three groups: 18 for VFCA group, ACA group, respectively, and other 8 for sham-operated group (SHAM). VFCA was induced by programmed electric stimulation, and ACA was induced by endotracheal tube clamping. After 8 min without treatment, standard cardiopulmonary resuscitation (CPR) was initiated. Following neurological deficit scores (NDS) were evaluated at 24 h after achievement of spontaneous circulation, cerebral metabolism showed as the maximum standardized uptake value (SUVmax) was measured by ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography. Levels of serum markers of brain injury, neuron specific enolase (NSE), and S100β were quantified with an enzyme-linked immunosorbent assay.

Results:

Compared with VFCA group, fewer ACA animals achieved restoration of spontaneous circulation (61.1% vs. 94.4%, P < 0.01) and survived 24-h after resuscitation (38.9% vs. 77.8%, P < 0.01) with worse neurological outcome (NDS: 244.3 ± 15.3 vs. 168.8 ± 9.71, P < 0.01). The CPR duration of ACA group was longer than that of VFCA group (8.1 ± 1.2 min vs. 4.5 ± 1.1 min, P < 0.01). Cerebral energy metabolism showed as SUVmax in ACA was lower than in VFCA (P < 0.05 or P < 0.01). Higher serum biomarkers of brain damage (NSE, S100β) were found in ACA than VFCA after resuscitation (P < 0.01).

Conclusions:

Compared with VFCA, ACA causes more severe cerebral metabolism injuries with less successful resuscitation and worse neurological outcome.     

新生儿窒息后心肌损害临床研究

目的研究新生儿窒息后心肌损害敏感指标,以求早期诊断。方法用上海长征医学科学有限公司血清心肌酶谱及美国惠普公司M1772A型多导心电记录仪和HP77020AC型超声诊断仪等。对初生新生儿窒息后心肌损害进行有对照的前瞻性研究。结果重度窒息组的血清心肌酶谱均升高,心电图异常率77.8％,超声心电图检查均发现异常;轻度窒息组的血清心肌酶谱α-HBD升高100％,CK升高82.6％,LDH升高73.9％,AST升高65.2％,心电图检查均无异常,超声心动图检查42.9％异常;对照组未见异常。结论缺氧和酸中毒是新生儿窒息后心肌损害的直接原因;心肌酶谱变化的敏感性高,可用于新生儿室息后心肌损害的早期诊断。