超声心动图在监测重度窒息及并发脑损伤新生儿心功能中的临床意义研究

目的探讨新生儿重度窒息及脑损伤后超声心动图的变化和临床意义。方法将2006-01—2006-12江西省宜春市人民医院40例重度窒息新生儿分为2组:单纯窒息组和窒息+脑损伤组(后者简称为脑损伤组)。另设20例正常新生儿为对照组。各组均在入院72h内完成心脏彩超检查。对脑损伤组治疗12~15d复查超声心动图。结果单纯窒息组、脑损伤组均表现为左室短轴缩短百分率(FS)下降,右室射血分数(RVEF)减低及右室射血前期与射血期比值(RVPEP/RVET)升高,尤以脑损伤组改变最为明显,其与对照组比较,差异有显著意义。脑损伤组经治疗后,心功能指标可基本恢复正常。结论超声心动图能早期观测重度窒息新生儿心功能的改变,合并了脑损伤的窒息新生儿心肌损伤更为严重。     

中心电子监护系统的临床应用

目的 探讨使用中心电子监护系统对提高产科质量的作用。方法 对１９７９年１１月 １９９８年３月在我院分娩的孕周≥３７周的１２１６例孕妇进行ＣＥＭＳ监护,并与１９９６年１１月至１９９７年３月在我院分娩的孕周≥３７周、未行ＣＥＭＳ监护的１１３７例孕妇（对照组）进行比较,分析两组胎儿窘迫发生率,新生儿窒息发生率,剖宫痃和阴道手术率。结果 姐与则组胎儿窘迫发生率分别为９．８％、１２．８％;新生窒息发生率分别     

纳洛酮预防窒息早产儿呼吸暂停的研究

目的:探讨纳洛酮对窒息早产儿发生呼吸暂停的预防作用。方法:将55例体重1500~2500g、围产期有窒息的早产儿随机分为治疗组34例和对照组21例,治疗组在对照组综合治疗的基础上加用纳洛酮。结果:治疗组发生呼吸暂停的比例明显低于对照组,有极显著差异(P<0.01)。结论:纳洛酮对窒息早产儿有预防呼吸暂停作用。     

新生儿窒息后血中胃肠激素水平的测定和临床意义

目的 :探讨新生儿窒息后血中胃泌素、胃动素的变化及临床意义。方法 :采用放射免疫法测定 38例窒息新生儿 (其中轻度窒息 2 0例、重度窒息 18例 )和 30例无消化系统疾病的新生儿上述2种胃肠激素水平 ,并进行相关分析。结果 :①轻度窒息组血中胃泌素、胃动素与对照组比较无显著性意义 (P >0 .0 5 ) ,②重度窒息组血中胃泌素、胃动素水平则明显低于对照组 ,有显著性意义 (P <0 .0 1)。结论 :①轻度窒息新生儿血中胃泌素、胃动素的水平基本同正常新生儿 ,提示可酌情早期喂养。②重度窒息新生儿血中胃泌素、胃动素的水平明显降低 ,提示早期喂养将会导致喂养不耐受。     

Induced cerebral hypothermia reduces post-hypoxic loss of phenotypic striatal neurons in preterm fetal sheep

Perinatal hypoxic-ischemic injury of the basal ganglia is a significant cause of disability in premature infants. Prolonged, moderate cerebral hypothermia has been shown to be neuroprotective after experimental hypoxia-ischemia; however, it has not been tested in the preterm brain. We therefore examined the effects of severe hypoxia and the potential neuroprotective effects of delayed hypothermia on phenotypic striatal neurons. Preterm (0.7 gestation) fetal sheep received complete umbilical cord occlusion for 25 min followed by cerebral hypothermia (fetal extradural temperature reduced from 39.4+/-0.3 degrees C to 29.5+/-2.6 degrees C) from 90 min to 70 h after the end of occlusion. Hypothermia was associated with a significant overall reduction in striatal neuronal loss compared with normothermia-occlusion fetuses (mean+/-SEM, 5.5+/-1.2% vs. 38.1+/-6.5%, P<0.01). Immunohistochemical studies showed that occlusion resulted in a significant loss of calbindin-28 kd, glutamic acid decarboxylase isoform 67 and neuronal nitric oxide synthase-immunopositive neurons (n=7, P<0.05), but not choline acetyltransferase-positive neurons, compared with sham controls (n=7). Hypothermia (n=7) significantly reduced the loss of calbindin-28 kd and neuronal nitric oxide synthase, but not glutamic acid decarboxylase-immunopositive neurons. In conclusion, delayed, prolonged moderate head cooling was associated with selective protection of particular phenotypic striatal projection neurons after severe hypoxia in the preterm fetus. These findings suggest that head cooling may help reduce basal ganglia injury in some premature babies.     

新生儿窒息血清酶变化与脑损伤相关性及预后评估

目的 观察血清酶活性在新生儿窒息的变化,探讨其与脑损伤程度的相关性及预后.方法 103例窒息新生儿(轻度69例,重度34例)和40例正常新生儿作对照,均在生后24～48h测定磷酸肌酸激酶(CK)、磷酸肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、α-羟丁酸酶(α-HBDH)、谷草转氨酶(AST);并于生后第2d做神经行为测定(NBNA),分析其与各个血清酶之间的相关性;100例窒息组患儿(3例因合并多脏器功能衰竭死亡)均于生后4～7d做头颅CT检查;并于生后第3个月及第6个月随访神经发育情况.结果 轻度窒息组及重度窒息组患儿血清酶活性均高于对照组(P<0.01),与临床分度呈正相关(窒息程度越重,血清酶活性越高,NBNA评分越低);α-HBDH、LDH、CK、CK-MB、AST与NBNA评分有一定的相关性(相关系数r分别为-0.797、-0.853、-0.826、-0511、-0.585);临床分度与头颅CT密切相关;血清酶α-HBDH、LDH、CK对预后判断具有一定的敏感性和特异性.结论 r羟丁酸酶、乳酸脱氢酶、磷酸肌酸激酶对早期评价脑损伤程度及判断预后具有重要价值,而磷酸肌酸激酶同工酶(心肌型)、谷草转氨酶活性升高仅提示可能存在脑损伤,不能判断其损伤程度及预后.     

The relationship between the cardiac contractile function,adenine nucleotides and amino acids of cardiac tissue and mitochondria at acute respiratory hypoxia

The effect of asphyxia and subsequent resumption of respiration on the content of adenine nucleotides and some amino acids in heart tissue and mitochondria, as well as respiration of heart mitochondria was studied in rats. The depression of cardiac contractile function during asphyxia showed a better correlation with losses in mitochondrial adenine nucleotides (ATP+ADP+AMP) than those in cardiac tissue. The decrease in the heart work index was accompanied by a decrease in state 3 respiration with glutamate and malate as well as uncoupled respiration with these substrates. This did not occur with succinate. Nonphosphorylating (state 4) respiratory rates and ADP/O ratios were slightly affected by asphyxia, when respiratory substrates of both types were used. The decreased level of glutamic acid in the tissue and mitochondria of asphyxic hearts was simultaneously observed with a significant increase of alanine in cardiac tissue and of aspartic acid in the mitochondria. The losses of intramitochondrial ATP and respiratory activity with NAD-dependent substrates during asphyxia were associated with a reduction of glutamic acid level in mitochondria. The recovery of cardiac function during resumption of respiration was related to the restoration of mitochondrial respiration supported by glutamate and malate, as well as to the restoration of mitochondrial adenine nucleotides and glutamic acid. The results suggest that the depression of cardiac function caused by acute respiratory hypoxia may be attributed to impairment of electron transport, particularly in complex I of the respiratory chain and changes in metabolism of glutamic acid.     

纯氧与空气复苏对窒息新生大鼠肺泡超微结构的对比观察

目的研究纯氧和空气复苏窒息新生大鼠后,肺泡超微结构的变化。方法选用清洁级7d龄SD大鼠（n=30）,随机分为正常对照组、实验组（空气组和纯氧组）,将实验组建立缺氧模型后,分别给与空气和纯氧复苏,每组又分为24h、72h两个亚组（n=5）。制作常规电镜标本,在透射电镜下观察。结果1.与正常组比较,实验组出现AECⅠ局部肿胀、胞质脱落,AECⅡ线粒体肿胀、板层小体失去正常结构及数目减少、游离面微绒毛稀少,间质细胞水肿及染色体淡染等超微病理学改变,但空气组的病理改变较纯氧组轻微;2.无论空气组还是纯氧组,其各自的72h组与24h组两个亚组比较,超微病理学改变并无明显差异。结论与空气复苏比较,采用纯氧复苏窒息新生大鼠对于肺组织超微结构损伤严重。     

Hypoxia and hypercapnia in asphyctic differentiation of regional sympathetic activity in the anesthetized rabbit

Summary The contributions of hypoxia and of hypercapnia to the differentiated changes of regional sympathetic activity during asphyxia were investigated in anesthetized, paralyzed rabbits. Under artificial ventilation with gas mixtures of various O₂ and CO₂ contents, the discharges of a postganglionic nerve twig accompanying the retroauricular artery (cutaneous sympathetic) and of a splanchnic nerve branch (visceral sympathetic) were recorded. PaO₂, PaCO₂, pH, arterial pressure, and heart rate were measured.Moderate hypoxia (PaO₂ 27.2 Torr) induced a differentiated response of regional sympathetic activity similar to that observed during moderate asphyxia, i.e. increase of visceral and decrease of cutaneous sympathetic activity. During severe hypoxia (PaO₂ 16.4 Torr) both visceral and cutaneous sympathetic activity increased, the latter after a temporary decrease.—During hypercapnia (PaCO₂ 59.3 Torr) only a slight increase of visceral sympathetic activity was observed, while cutaneous sympathetic activity did not change.—It is concluded that the differentiated responses of the sympathetic nervous system during asphyxia are caused mainly by hypoxia.