剖宫产新生儿重度窒息37例临床分析

目的探讨降低新生儿重度窒息的有效措施。方法将37例剖宫产的新生儿重度窒息作为观察组，选择同期阴道助产的新生儿重度窒息16例为对照组，比较两组新生儿出生时的重度窒息情况并统计剖宫产新生儿重度窒息的原因。结果剖宫产组的新生儿重度窒息率显著高于阴道助产组（P〈0．05）。导致剖宫产新生儿重度窒息的主要原因有：高危妊娠、胎儿宫内窘迫、出生后未及时建立自主呼吸、取头时间过长等。结论应加强孕期检查及产前产时监护，及时发现高危因素，及早治疗；正确掌握剖宫产的手术时机，严格执行剖宫产手术分级管理制度，提高产科医生的专业技术水平；术中避免一切导致新生儿窒息的操作，特别应绝对避免无把握的反复娩出胎头，方可预防和减少剖宫产新生儿重度窒息的发生。     

Birth asphyxia associated oliguria: Relationship to outcome at 1 year

Abstract  The relationship between the degree of oliguria following severe birth asphyxia and outcome at 12 months was examined in 31 infants. All 31 infants developed encephalopathy following severe birth asphyxia and 25 had oliguria for 24 h or more following delivery. Eighteen had persistent oliguria (i.e. >48 h) and the remaining seven had transient oliguria (between 24 and 48 h). Poor outcome (death or neurological abnormality at 12 months) was significantly associated with the degree of oliguria. Encephalopathy, however, was found to be more closely correlated with poor outcome rather than duration of oliguria and a stepwise regression model confirmed that encephalopathy was the more powerful predictor of poor outcome. In those situations where an infant's degree of encephalopathy can not be assessed accurately (e.g. muscle relaxant use) the duration of oliguria may prove a useful prognostic indicator.     

Dyskinetic and dystonic cerebral palsy and birth

Two hundred and nineteen cases of the dyskinetic and dystonic forms of cerebral palsy which were seen in the course of three decades at a single clinic have been analysed. Fifty-seven patients had kernicterus. In the remaining 162, 71% of whom were born at term, birthweight was below the expected mean in two-thirds. There was no relationship between birth weight, or abnormal birth, or asphyxia, and the ultimate clinical severity of the children. We conclude that abnormal birth and asphyxia are not direct causes of the cerebral damage, but are expressions of a pre-existing condition resulting in susceptibility to the stress of birth, whether it is normal or abnormal.     

Early [18F]FDG positron emission tomography in infants with hypoxic-ischaemic encephalopathy shows hypermetabolism during the postasphyctic period

Six full-term infants suffering from perinatal asphyxia and with moderate or severe hypoxic-ischaemic encephalopathy were investigated by positron emission tomography (PET). Regional cerebral metabolic rates of glucose (rCMR_gi) were determined using [2-¹⁸F]2-fluoro-2-deoxy-D-glucose ([¹⁸F]FDG) PET scans at a median age of 2.5 days (range 2-5 days). Localized increases in rCMR_gi were visually observed in five infants. In a subgroup of three infants, absolute values of rCMR_gl in different brain regions were calculated. In all cases the results of the PET studies were in good agreement with those of the neuroradiological, neurophysiological and clinical investigations. Information indicating pathophysiological events could be extracted earlier with PET than with conventional morphological imaging techniques. We conclude that [¹⁸F]FDG-PET scans performed in critically ill, asphyxiated infants very soon after birth provide valuable information for the prediction about neurological outcome.     

SEVERE NEONATAL ASPHYXIA

ABSTRACT. In Sweden during the 1970's the incidence of severe asphyxia (an Apgar score of 3 or less at 5 min) has decreased significantly from 3.22 to 2.56 per 1000 infants. A follow-up study was undertaken concerning 116 infants (40 preterm, 76 full-term) admitted to St. Göran's Children's Hospital during a 7-year period (1973–79). The mortality rate was 48% in preterm and 21% in full-term infants. Significant sequelae were present in 27% of the surviving full-term and 14% of the preterm infants. The three severely-handicapped preterm infants had other serious diseases as well whereas this applied to only one full-term infant. The predictors of sequelae included perinatal complications, late onset of spontaneous ventilation (>20 min) and postnatal symptoms, such as seizures. Only two of 9 infants with regular breathing after 20 min and three of 16 infants with seizures were considered normal at follow-up.     

132例新生儿窒息的产科原因分析

目的探讨新生儿窒息的产科原因,提出有效的预防措施.方法对132例新生儿窒息进行回顾性分析.结果新生儿窒息的产科原因中脐带因素、胎位及产程异常为主要原因,分别占35.16%和32.58%;分娩方式中以阴道助产发生率最高,达59.85%,78例为胎儿宫内窘迫的延续.结论做好产前保健,定期产前检查,发现高危妊娠及时处理;避免早产,及早发现胎儿宫内窘迫并进行恰当处理;合理掌握手术适应证,提高产科质量,降低新生儿窒息的发生率.     

窒息对新生大鼠肾组织一氧化氮和一氧化氮合酶含量的影响

目的探讨一氧化氮合酶(NOS)和一氧化氮(NO)在窒息后肾损伤中的作用。方法Wistar新生大鼠48只,随机分为对照组、窒息后复氧2h组、24h组和48h组,制备常压窒息模型。窒息30min后在上述时间点处死动物,测定肾脏NOS和NO含量,并在光镜下对肾小管损伤程度进行评分。结果窒息复氧2h肾脏NOS和NO即显著升高,持续时间达24h,肾小管评分在窒息后24h和48h明显增高。结论NOS和NO在新生大鼠窒息后的肾损伤中起重要作用。     

全身亚低温治疗新生儿窒息的安全性评价

目的　探讨全身亚低温治疗对新生儿的不良影响 ,评价亚低温治疗新生儿窒息的安全性。方法　将中重度窒息足月新生儿 2 4例随机分为亚低温治疗组和常规治疗对照组各 12例 ,亚低温治疗组维持肛温在 3 3～ 3 4℃ 72h ,其他治疗措施与对照组相同。两组均连续进行监护和生化指标检测 ,记录临床症状及体征。结果　两组均无出血、严重感染及死亡。亚低温组治疗期间心率平均下降 3 0次 /min ,血压及呼吸未见明显改变 ,未发现与亚低温相关的心律失常及肺动脉高压。其凝血酶原时间及凝血酶时间与治疗前及对照组相比无明显差异。血钠、血钾、血钙在低温治疗后与治疗前及对照组相比无明显差异。窒息新生儿治疗前均有代谢性酸中毒 ,部分患儿有急性肾功能异常 ,治疗后均逐渐纠正 ,亚低温组与对照组相比无明显差异。结论　全身亚低温治疗无严重的不良反应 ,在严密监护下用于足月新生儿窒息的治疗是安全可行的。     

新生儿神经行为测定在高压氧治疗新生儿重度窒息中的效果评价

目的: 为了探讨新生儿神经行为测定(NBNA) 在评价高压氧治疗新生儿重度窒息中的意义。方法: 将新生儿重度窒息的患儿采用随机分组的方法分为高压氧治疗组和对照组, 两组各项指标具有可比性, 同时每例在出生后1 ~7d、12 ~14d、26~28d分别进行新生儿神经行为测定, 将结果进行统计学分析。结果: 出生后1~7d治疗组和对照组NBNA值分别为33 .3±8 .83、32. 7±7. 34, 两组结果经统计学处理无显著性差异。出生后26 ~28d治疗组和对照组NBNA值分别为39. 03±2 .92、37. 72±2. 91, 两组结果经统计学处理有显著性差异。1周内两组NBNA值<35分与>35分的发生率经统计学处理无显著性差异, 26~28d两组NBNA值<35分与>35分的发生率经统计学处理有显著性差异。结论: 高压氧治疗能减轻新生儿重度窒息的后遗症, 改善预后, NBNA对高压氧治疗新生儿重度窒息的疗效具有较好的评价效果。     

新生儿窒息脑脊液血栓素A2及前列环素的变化及其临床意义

目的 探讨窒息新生儿脑脊液(CSF)中血栓素A2(TXA2)、前列环素(PGI2)的浓度变化及与脑损伤的关系。方法36例足月新生儿中中、重度缺氧缺血性脑病(HIE)12例,轻度HIE13例,对照组11例。生后36～72h取CSF和血液测定TXB2(TXA2之代谢产物)及6-K-PGF1α(PGI2之代谢产物)浓度(放免法)。结果中、重度HIE组CSF中TXB2及6-K-PGF1α浓度最高(206.06±29.74ng/L,168.47±23.02ng/L),轻度组次之(83.37±28.57ng/L,131.42±16.75ng/L),对照组最低(41.77±21.58ng/L,86.23±13.05ng/L),经方差分析有非常显著意义(P<0.01);血浆TXB2及6-K-PGF1α浓度变化有同样趋势,但轻度HIE组与对照组差异无统计学意义(P>0.05)。结论 窒息后CSF中TXA2和PGI2是预示脑损伤的敏感指标。