新生儿自发性全身运动对脑损害和脑性瘫痪预测的评估

目的探讨新生儿自发性全身运动（ＧＭｓ）对脑损害及其神经系统后遗症，特别是脑性瘫痪（简称脑瘫）的评估作用。方法对１８例新生儿ＧＭｓ进行了定性及半定量研究。结果（１）正常组ＧＭｓ评分为１２．３±１．１，异常组为８．４±１．０，两者差异有非常显著意义（Ｐ＜０．０１）。（２）ＧＭｓ评分与５分钟Ａｐｇａｒ评分具有正相关性。（３）ＧＭｓ评分对脑瘫的预测价值与颅脑超声检查相似，而优于常规神经系统检查。结论ＧＭｓ评分对脑损害和脑瘫的预测具有一定的实用意义     

新生儿窒息后血一氧化氮水平的动态变化及其临床意义

目的了解窒息后新生儿血一氧化氮（ＮＯ）的动态变化。方法采用镉柱比色法，分别对４０例窒息后新生儿及１８例正常新生儿于生后１、３、７天测定血清ＮＯ水平。结果足月儿、早产儿轻度和重度窒息后７天内血清ＮＯ水平的动态变化差异均有非常显著意义（Ｐ＜０．０１），窒息后血清ＮＯ的水平第３天最高，至第７天几乎接近出生后第１天的水平，血清ＮＯ水平与窒息程度呈正相关。３７例经颅脑Ｂ超证实伴缺氧缺血性脑病。结论血清ＮＯ水平与缺氧缺血性脑病密切相关     

一氧化碳和一氧化氮在新生儿缺氧缺血性脑病发病中的作用

目的：探讨一氧化碳（ＣＯ）和一氧化氮（ＮＯ）在新生儿缺氧缺血性脑病（ＨＩＥ）中的作用。方法：对２８例新生儿ＨＩＥ血浆ＣＯ和ＮＯ水平进行检测，并与３０例正常新生儿对照组比较。结果：与正常对照组比较，２８例新生儿ＨＩＥ患儿血浆ＣＯ、ＮＯ水平显著增高；与轻、中度新生儿ＨＩＥ患儿比较，重度者血浆ＣＯ、ＮＯ水平显著增高；ＣＯ和ＮＯ呈显著正相关。结论：ＣＯ和ＮＯ在新生儿ＨＩＥ的发病过程中具有重要意义。     

Neurosensory outcome and growth at three years in extremely low birthweight infants: follow-up results from the Swedish national prospective study

A prospective national investigation comprising 633 extremely low birthweight (ELBW) infants born alive in the 2-y period 1990-1992 with a birthweight of ≤1000 g and gestational age of ≥23 completed weeks was conducted regarding neurosensory outcome and growth. Three-hundred and sixty-two (98%) surviving ELBW infants were assessed at a median age of 36 months, using a specially designed protocol. At follow-up, mean height, weight and head circumference in both boys and girls were significantly lower than the reference values. The incidence of cerebral palsy was 7% among all children and 14%, 10% and 3% in children born at 23-24, 25-26 and ≥27 gestational weeks, respectively. At least one obvious handicap was present in 14%, 9% and 3% of these three groups of children, respectively. After adjustment for gestational age, a significantly increased risk of handicap was found in children with intraventricular haemorrhage grade ≥3 and/or periventricular leucomalacia and in children with retinopathy of prematurity stage ≥3. The results show that more than 90% of ELBW children born at ≥25 completed gestational weeks were without neurosensory handicap at 36 months of corrected age. In infants born at 23-24 weeks of gestation, both survival and long-term outcome were less favourable.     

孕妇下生殖道解脲脲原体感染与妊娠结局关系的探讨

应用聚合酶链反应技术，对２１６例妊娠１２－３７周孕妇的宫颈阴道分泌物和其中１０９例有孕妇分娩时的羊水进行解脲脲原体ＤＮＡ检测，同时临床观察２１６例孕妇的妊娠结局。结果：宫颈阴道分泌物ＵＵ ＤＮＡ阳性率为４３．０６％，宫颈阴道ＵＵ ＤＮＡ阳性组对应的羊水ＵＵ检出率明显高于阴性组，两组平均孕周，平均出生体重，平均Ａｐｇａｒ评分以及胎儿窘迫，早产，剖宫产，低出生体重儿，低Ａｐｇａｒ评分和瘭生儿畸形的发五     

电针加颈动脉注药治疗脑梗塞临床疗效观察

选脑梗塞患者１６０例，随机分为两组。观察组采用电针加颈动脉注药治疗，对照组单用颈动脉注药治疗。结果表明，两组治疗脑梗塞均有肯定疗效，而电针加颈动脉注药疗效明显优于单纯颈动脉注药。     

脑缺血实验模型的制作及头针治疗

以恒河猴为实验动物，采用介入方法行大脑中动脉栓塞术，建立局部脑缺血病理变化，并模拟国际标准化头穴方案取穴治疗，发现头针治疗有利于实验性脑缺血病的恢复。     

Randomized trial examining cerebral haemodynamics following artificial or animal surfactant

To determine the effects of animal and artificial surfactants on cerebral haemodynamics, 20 premature babies receiving mechanical ventilation were randomized to receive Curosurf or Exosurf surfactant. Anterior cerebral artery blood flow velocity (CABFV) was measured using Doppler ultrasound before and up to 2 h after treatment. Following animal surfactant there was a rapid reduction in CABFV (median -36%, range -43% to +8%, p < 0:01), whereas artificial surfactant resulted in a slower rise which was less marked (median +20%, range -7% to +62%, p < 0:05). There were no significant changes in blood pressure. Two hours after administration, the oxygenation index (OI) improved significantly only in babies receiving animal surfactant. In this group there was a significant association between the change in CABFV at 1 min and the change in OI at 2 h ( r = 0:66, p < 0:05). Animal surfactant produces rapid improvements in ventilation which are associated with marked alterations in cerebral haemodynamics.     

新生儿缺氧缺血性脑病远期预后分析

目的了解新生儿颅内出血及缺氧缺血性脑病患儿远期预后。方法对４１例存活者进行随访，采用韦氏法及绘人法测定智商（ＩＱ），同时进行体格发育和神经系统、视力、听力检查。结果１２例遗留各种类型神经系统后遗症，其中５例重度残废。结论远期预后与急性期临床分型及危重指标数量密切相关。早期诊断、早期干预补救对部分智力落后患儿有效，而对严重脑损伤患儿则不能改善预后     

Experimental Evidence of Cerebral Injury from Profound Hypothermia During Cardiopulmonary Bypass

Choreoathetosis, seizures, and impaired mental development continue to occur in children undergoing cardiopulmonary bypass (CPB) and profound hypothermia with or without circulatory arrest. Although there is some evidence that the hypothermia itself may be causing these neurologic problems, skepticism remains because of lack of evidence from experimental studies simulating the clinical setting. In this experimental study, we examined the effect of profound and moderate hypothermia on the brain while maintaining normal flow rates during CPB. Ten adult mongrel dogs equally divided into two groups were anesthetized and subjected to CPB and varying levels of hypothermia (group 1, ≤15°C; group 2, ≤32°C). Both groups were kept at the desired temperature for 1 hour prior to rewarming and discontinuation of CPB. The dogs were euthanized 4–6 weeks later and neuropathologic studies were performed. The mean CPB flow rates during cooling and at the desired rectal temperature were comparable in both groups: group 1, 108 ± 10 ml/kg/min versus 106 ± 7 ml/kg/min in group 2 (p= NS) and 95 ± 12 ml/kg/min in group 1 versus 101 ± 5 ml/kg/min in group 2 (p= NS). Because of the difference in temperature between the two groups, the mean cooling time (onset of CPB to desired rectal temperature) was longer in group 1 (70 ± 14 minutes) than in group 2 (28 ± 11 minutes, p= 0.007). Hence, the total mean CPB time was also longer in group 1 (198 ± 25 minutes) than in group 2 (143 ± 13 minutes, p= 0.002). The lowest mean blood and rectal temperature achieved in group 1 were 11 ± .9°C and 12 ± 1°C versus 29 ± .4°C (p < 0.001) and 30 ± .6°C (p= 0.001), respectively, in group 2 (p= 0.001). Neuronal loss and degeneration was noted in all dogs in group 1 ranging from 2 to 8 cells per 1000 cells counted compared to none in group 2 (p= 0.05). These lesions occurred in both the basal ganglia and the cortex, although they were more marked in the caudate when compared to the cortex and cerebellum. Both in the cortex and in the caudate, neuronal loss was more marked around the capillaries. We conclude that the use of profound hypothermia of ≤15°C and maintenance of normal flow rates during cooling at this temperature for 1 hour produces neuronal loss and degeneration in the brain. These lesions being more marked around capillaries points to the vulnerability of the neurons, probably because of their high lipid content to injury from the cold perfusate.