新生儿窒息后S100B蛋白变化及其与脑损伤的关系

目的探讨外周血S100B蛋白在新生儿窒息中的变化及其与脑损伤的关系。方法采用酶联免疫吸附试验双抗体夹心法动态检测50例窒息新生儿及20例正常新生儿S100B蛋白,并分析其以窒息后脑损伤的关系。结果窒息新生儿急性期外周血S100B蛋白含量明显高于对照组（P〈0.01）,头颅CT显示有脑损伤组S100B蛋白明显高于CT正常组,差异有统计学意义（P〈0.05）;恢复期血S100B蛋白含量较急性期明显下降,与急性期相比具有显著性差异（P〈0.05）。结论窒息新生儿外周血S100B蛋白水平明显增高,血S100B蛋白检测有助于新生儿窒息后脑损伤的判断。     

脐绕颈与新生儿窒息的关系探讨

目的：探讨脐绕颈与新生儿窒息的关系。方法：回顾性分析2000年5月至2004年4月脐绕颈246例与同期分娩的无脐绕颈者800例进行对照性研究。结果：脐绕颈组与对照组在新生儿窒息、剖宫产率之间的差异有显著性,脐带长度与脐绕颈及新生儿窒息之间的差异有显著性。脐绕颈的周数与新生儿窒息之间的差异有显著性。结论：脐绕颈可导致新生儿窒息,故对脐绕颈者应加强产前诊断及产时监护。     

窒息新生儿血清胱蛋白酶抑制剂C检测及意义

目的探讨窒息新生儿血清胱蛋白酶抑制剂C（Cys C）水平在评价新生儿窒息后肾损害的意义。方法以68例窒息新生儿为研究对象,按Apgar评分分为轻度窒息组（47例）和重度窒息组（21例）;以40例健康足月新生儿作为对照组,在入院后抽取外周静脉血3mL,检测各组血清Cys C水平,并与血清尿素氮（BUN）、肌酐（Cr）等指标进行相关性分析。采用SPSS 10.0软件进行多因素方差分析和χ2检验比较其差异。结果在对照组、轻度窒息组和重度窒息组中,血清Cys C水平分别为（0.85±0.31）mg/L,（1.77±0.37）mg/L和（2.61±0.47）mg/L,血清BUN水平分别（4.61±1.16）mmol/L、（6.58±1.33）mmol/L和（8.73±2.67）mmol/L,血清Cr水平分别为（48.51±12.89）μmol/L,（49.93±14.62）μmol/L和（71.36±13.33）μmol/L,与对照组及轻度窒息组相比,重度窒息组血清BUN、Cr和Cys C水平显著升高,差异有显著性（P〈0.01）。三组之间对比Cys-C均有显著统计学意义,而BUN和Cr在对照组与轻度窒息组间差别无显著性。结论 Cys C是评价新生儿窒息后肾小球滤过功能损害的敏感指标。     

Brazilian guidelines for the diagnosis and treatment of hereditary angioedema

Hereditary angioedema is an autosomal dominant disease characterized by edema attacks with multiple organ involvement. It is caused by a quantitative or functional deficiency of the C1 inhibitor, which is a member of the serine protease inhibitor family. Hereditary angioedema is unknown to many health professionals and is therefore an underdiagnosed disease.The causes of death from hereditary angioedema include laryngeal edema with asphyxia. The estimated mortality rate in patients in whom the disease goes undetected and who are therefore incorrectly treated is 25-40%. In addition to edema of the glottis, hereditary angioedema often results in edema of the gastrointestinal tract, which can be incapacitating. Patients with hereditary angioedema may undergo unnecessary surgical interventions because the digestive tract can be the primary or only organ system involved, thus mimicking acute surgical abdomen. It is estimated that patients with hereditary angioedema experience some degree of disability 20-100 days per year.The Experts in Clinical Immunology and Allergy of the “Associação Brasileira de Alergia e Imunopatologia - ASBAI” developed these guidelines for the diagnosis, therapy, and management of hereditary angioedema.     

新生儿窒息与多器官功能损害的观察和护理

新生儿窒息是新生儿最常见的危重症,窒息时缺氧可致脑、心、肝、肾等多个系统器官损害,是新生儿期死亡和儿童期致残的主要原因之一。因此,加强临床观察与护理,提高护理质量是减少并发症和后遗症的综合治疗中的关键环节。我院新生儿科重症监护室（NICU）2008年7月-2009年6月共收治窒息新生儿265例,其中发生器官损害178例,通过积极治疗和精心护理,取得了较满意的效果,现将临床观察与护理体会介绍如下。     

脐带血血气分析与乳酸值对围产期窒息的诊断价值探讨

目的探讨脐带血血气分析及乳酸值对围产期窒息的诊断价值。方法对63例足月窒息新生儿与89例足月正常新生儿的脐动脉血进行微量血气分析及乳酸测定,并在出生后第1、7、14、28d进行新生儿20项神经行为测定(NBNA)。结果窒息组与对照组的脐动脉血乳酸、pH值、BE差异有显著性,血乳酸与第1、7d的NBNA呈显著负相关,pH与第1d的NBNA呈正相关,BE与NBNA无明显相关性。结论窒息新生儿脐血乳酸水平高于对照组、pH值低于对照组,可作为围产期窒息诊断的指标,且乳酸值特异性优于pH值。     

Does episodic hypoxia affect upper airway dilator muscle function? Implications for the pathophysiology of obstructive sleep apnoea

Obstructive sleep apnoea (OSA) is characterised by repetitive collapse of the upper airway during sleep owing to a sleep-related decrement in upper airway muscle activity with consequent failure of the pharyngeal dilator muscles to oppose the collapsing pressure that is generated by the diaphragm and accessory muscles during inspiration. The causes of upper airway obstruction during sleep are multi-factorial but there is evidence implicating intrinsic upper airway muscle function and impaired central regulation of the upper airway muscles in the pathophysiology of OSA. The condition is associated with episodic hypoxia due to recurrent apnoea. However, despite its obvious importance very little is known about the effects of episodic hypoxia on upper airway muscle function. In this review, we examine the evidence that chronic intermittent hypoxia can affect upper airway muscle structure and function and impair CNS control of the pharyngeal dilator muscles. We review the literature and discuss results from our laboratory showing that episodic hypoxia/asphyxia reduces upper airway muscle endurance and selectively impairs pharyngeal dilator EMG responses to physiological stimulation. Our observations lead us to speculate that episodic hypoxia--a consequence of periodic airway occlusion--is responsible for progression of OSA through impairment of the neural control systems that regulate upper airway patency and through altered respiratory muscle contractile function, leading to the establishment of a vicious cycle of further airway obstruction and hypoxic insult that chronically exacerbates and perpetuates the condition. We conclude that chronic intermittent hypoxia/asphyxia contributes to the pathophysiology of sleep-disordered breathing.     

胎心电子监护网络对产时胎儿的监护及出生评价

目的：探讨分娩时胎儿在宫内的安危及分娩后新生儿的结果,方法：选择1998年2至3月本院369名使用胎心监护网络分娩的产妇与应用单机监护分娩的产妇比较,观察两组宫内窘迫符合率、剖宫产、阴道助产发生率及新生儿窒息发生率．结果：网络监测组宫内窘迫符合率、剖宫产及阴道助产发生率明显高于对照组（P＜0.05）;而新生儿窒息发生率,尤其重度窒息发生率明显低于对照组（P均＜0．01）．通过对低危病人的监测,发现低危病人转为高危病人,两组分别为16．7％和19.2％,说明低危病人也应行常规监测．提示：使用网络监护能较早、更准确了解胎儿宫内安危,明显提高监测诊断水平．     

High blood carbon dioxide variability and adverse outcomes in neonatal hypoxic ischemic encephalopathy

Objective: Hypocarbia during the first 12?h of life is associated with mortality and disability in neonatal hypoxic ischemic encephalopathy (HIE). Notable variation in arterial carbon dioxide tension (PaCO₂) during the first 4?d of life is related to severe intraventricular hemorrhages in preterm infants. We examined the association between PaCO₂ during 72?h of whole-body therapeutic hypothermia for neonatal HIE and 2-year neurodevelopmental outcomes.

Methods: A retrospective review of 23 term neonates treated with whole-body hypothermia documented clinical, demographic and arterial blood gas data. Comparisons were made across good and severe neurodevelopmental outcome groups at 2 years of age.

Results: Severe neurodevelopmental outcomes were documented in 8 of 23 toddlers. There were no significant differences between outcome groups with regard to the number of patients with hypocarbic means or measurements. There were also no significant differences with mean PaCO₂, PaO₂, pH, time-weighted cumulative hypocarbia, and PaCO₂ range. The severe neurodevelopmental outcomes group had a significantly higher mean PaCO₂ standard deviation (p?=?0.04; 95% CI, ?5.46 to ?0.39).

Conclusion: Severe neurodevelopmental outcomes were significantly associated with high PaCO₂ variability over 72?h in whole-body-cooled HIE neonates. Mitigating these fluctuations may be a potential management strategy.     

Maternal and Perinatal Outcomes Among Adolescents and Mature Women: A Hospital-Based Study in the North of Mexico

Study ObjectiveTo compare maternal and newborn pregnancy outcomes from adolescents and mature women.Design, Setting, and ParticipantsA cross-sectional study was carried out in a public hospital, including women with singleton pregnancies, who were classified according to their age, as follows: group 1: younger than 16 years old (n = 37), group 2: 16-19 years old (n = 288), and group 3: 20-34 years old (n = 632).Interventions and Main Outcome MeasuresInformation on clinical characteristics, gynecological and obstetric history, pregnancy complications, and perinatal outcomes was obtained through interviews and from clinical records.ResultsThirty-four percent of deliveries were from adolescents. Mature women were more likely to have prepregnancy overweight or obesity than adolescents (odds ratio [OR] = 2.4, 95% confidence interval [CI], 1.7-3.4). The frequency of maternal complications during pregnancy or delivery was not different between groups. Birth asphyxia was more frequent in group 2 (P = .02). Women with inadequate prenatal care had an increased risk of preterm deliveries (OR = 1.64; 95% CI, 1.06-2.54) and of having newborns with low birth weight (OR = 2.02; 95% CI, 1.22-3.35). Weight of newborns from noncomplicated pregnancies was lower in group 1 (P = .02), after adjustment for prepregnancy body mass index, gestational weight gain, preterm delivery, and newborn sex.ConclusionThe frequency of maternal and perinatal complications was similar in adolescents and mature women. Birth weight was decreased in noncomplicated pregnancies of adolescents younger than 16 years of age. Adequate prenatal care might be helpful in prevention of some adverse perinatal outcomes.