不同低氧环境对大鼠肺动脉平滑肌细胞增殖的影响

目的 探讨不同低氧环境对大鼠肺动脉平滑肌细胞(pulmonary arterial smooth muscle cells,PASMCs)增殖活性的影响.方法 将原代培养的大鼠PASMCs分为常氧组(21% O2,5% CO2)、低氧组(10% O2,85% N2,5% CO2)、缺氧组(1% O2,94% N2,5%...     

阻塞性睡眠呼吸暂停患者瘦素、性激素水平与呼吸调节的关系研究

目的 探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者血中雌二醇、睾酮、瘦素水平的变化及其与呼吸调节的关系.方法 选取OSAS患者45例(分为5≤AHI＜40组和AHI≥40组)和健康对照15例,测定并比较各组间吸气开始后0.1 s时的口腔阻断压(P0.1)、低氧通气反应(HVR)及雌二醇、睾酮、瘦素水平.结果 OSAS患者瘦素水平增高,雌二醇、睾酮水平只在重度OSAS患者有变化.相关分析示5≤AHI＜40组P0.1与瘦素、雌二醇、睾酮相关(r值分别为0.62、0.57和-0.43,P＜0.05),HVR与瘦素负相关(r=-0.89,P＜0.01);AHI≥40组只有瘦素、雌二醇与P0.1呈正相关(r分别为0.53和0.43,P＜0.05).结论 OSAS患者体内瘦素、雌激素、睾酮水平发生了改变,且随病情程度而变化,这些变化在疾病早期可能通过呼吸调节起保护作用.     

复方丹参、脑蛋白水解物治疗HIE疗效观察

目的探讨复方丹参与脑蛋白水解物联合应用治疗新生儿缺氧缺血性脑病（HIE）的临床疗效。方法将新乡市中心医院自2007年2-11月人院治疗的新生儿缺氧缺血性脑病85例随机分为2组,对照组43例采用常规3项支持疗法和对症治疗,治疗组42例在对照组治疗基础上加用复方丹参注射液与脑蛋白水解物注射液联合应用,观察其疗效。结果治疗组总有效率为95.23％,对照组为76.74％,2组比较,差异有统计学意义（P〈0.05）。结论复方丹参注射液与脑蛋白水解物注射液联合应用治疗HIE疗效确切,值得推广。     

The impact of Neonatal Resuscitation Program courses on mortality and morbidity of newborn infants with perinatal asphyxia

OBJECTIVE: Neonatal care provided within the first few minutes of life plays a major role in the reduction of neonatal morbidity and mortality. Neonatal Resuscitation Program (NRP) courses had been held since 1996. The aim of this study was to evaluate the impact of the NRP on morbidity and mortality of newborn infants with perinatal asphyxia. METHODS: This retrospective study comprised newborn infants who were born in hospitals at Trakya region of Turkey during the last 3 years and were diagnosed as perinatal asphyxia and were referred to our Neonatal Unit. Those patients who were referred before NRP course (pretraining period) were designated as Group 1, those who were referred after the first NRP course (transition period) as Group 2, and those who were referred after the second NRP course (post-training period) as Group 3. Chart review was performed with regard to gestational age, birth weight, Apgar scores, resuscitation type, stage of hypoxic ischemic encephalopathy (HIE), existence of meconium aspiration syndrome (MAS), progress of the disease, duration of hospitalization. RESULTS: The study comprised 66 patients; 35 in Group 1, 18 in Group 2 and 13 in Group 3. The number of cases who had not been resuscitated was 10 in the pretraining period, 3 in the transition period and 1 in the post-training period which decreased significantly. The first minute Apgar scores in three groups were as follows; 2.08+/-1.2, 2.2+/-1.1 and 3.7+/-1.4, and this increase was statistically significant. The fifth minute Apgar scores also increased from 5.43+/-1.5 in the pretraining period to 6.5+/-1.9 in the post-training period, but this increase was not statistically significant. The number of patients with Stage 1 and 2 HIE decreased more in Group 3 (n=11 in Stage 1 HIE, n=17 in Stage 2 HIE) compared to those in Group 1 (n=7 in Stage 1 HIE, n=5 in Stage 2 HIE) but the difference was not statistically significant. The duration of hospitalization decreased in post-training period (15.1+/-10.3 days in pretraining period, 12.0+/-8.9 days in transition period, 6.1+/-1.2 days in post-training period). CONCLUSIONS: After NRP courses, the number of patients with perinatal asphyxia and with no resuscitation and also the duration of hospitalization decreased significantly, whereas the first minute Apgar scores increased significantly.     

新生猪缺氧缺血性脑损伤时地塞米松对甲状腺功能的影响

目的 探讨新生猪缺氧缺血性脑损伤（hypoxic-ischemic brain damahe,ＨＩＢＤ）时地塞米松对甲状腺功能的影响。方法 在建立新生猪ＨＩＢＫ模型的基础上，对治疗组新生猪使用不同剂量地塞米松（５mg．kg＾－１和１mg．kg＾－１．d＾－１）共３天，分别于第２４小时，第４８小时及第７２小时采股静脉血收集血清，以放射免疫法（radioimmunoassay,ＲＩＡ）测定其游离Ｔ３（ＦＴ３）和游离Ｔ４（ＦＴ４）浓度。结果 ＨＩＢＤ新生猪     

Neurogenic diabetes insipidus in children with hypoxic encephalopathy: Six new cases and a review of the literature

Hypoxic encephalopathy is rarely mentioned as a cause of neurogenic diabetes insipidus (DI) in children. We here report six cases of DI which occurred after severe hypoxic/ischaemic brain damage and include a review of the literature on 28 paediatric cases of neurogenic DI due solely to severe hypoxia/ischaemia. Airway obstruction, haemorrhagic shock and sudden infant death syndrome are the three major causes of hypoxia/ischaemia. The ages (25/28) ranged from 0.03 to 18 years (mean 7.27 years, median 5 years). The intervals between the hypoxic insult and the onset of DI (23/28) ranged from 0.08 days (2 h) to 13 days (mean 4.07 days, median 3.5 days). Linear regression analysis revealed no significant correlation between the age and the interval. Nineteen cases (82.6%) developed DI within 6 days after the hypoxic/ischaemic insult. Only two neonates survived with developmental delay. The remaining 26 cases died.Conclusion Neurogenic DI can be caused by hypoxia/ischaemia and is an ominous sign of severe brain damage in children with hypoxic encephalopathy. It is important to recognize this potential sequel by regularly monitoring intake and output, plasma sodium level, and urine specific gravity.     

CT在诊断新生儿缺氧缺血性脑病中的价值

目的：通过对120例足月新生儿缺氧缺血性脑病（HIE）进行CT检查、诊断及随访复查，探讨CT在诊断新生儿缺氧缺血性脑病中的价值。方法：对120例HIE患儿进行CT检查，初次CT扫描时间为生后4－10d，生后14d所有病例均进行了新生儿行为神经评分，追踪复查时间分别为生后1，3，6，12，18，24及24个月以上。结果：①本组120例HIE中，轻度39例，新生儿行为神经评分≥35；中度67例，其中34例新生儿行为神经评分＜35,33例新生儿行为神经评分≥35；重度14例，梗死新生儿行为神经评分＜35。②随访复查：最后一次CT复查所见，正常46例，外部性脑积水28例，单纯脑沟加深26例，脑软化13例，脑萎缩7例，脑梗死7例，脑穿通畸形3例，脑钙化灶5例，死亡2例。结论：CT在诊断新生儿缺氧缺血性脑病中仍具有重要的价值。     

NO吸入降低高原肺水肿患者肺动脉高压的动态观察

目的 了解NO吸入对高原肺水肿的治疗作用及突然停止吸入NO引起的肺动脉压反跳作用。方法 采用右心漂浮导管检测法，观察了7例高原肺水肿患者吸入NO及突然停止吸入NO后血流动力学及动脉血气等指标的变化，同时采用Lake评分法对患者的病情进行定量评估。结果 吸入NO 5min后，高原肺水肿患者的肺循环阻力、肺动脉平均压明显下降，血氧分压明显升高，而对心事、体动脉压平均值、心输出量等指标无明显影响；高原肺水肿患者在突然停止吸入NO而改吸室内空气后，下降的肺动脉压迅速反弹，5min后肺动脉压已明显高于吸入NO前水平，10min后肺动脉压反跳达最高值，与此同时，患者的血氧分压明显下降，病情定量分数已显著高于吸入NO前水平。结论 吸入NO对高原肺水肿患者肺动脉高压有选择性降低作用，对体循环压无明显影响，吸入NO的高原肺水肿患者，在短时间吸NO突然撤离后，存在着肺动脉压反跳性的异常升高及血流动力学不稳等现象。     

左旋克罗卡林对低氧性肺动脉高压患者的治疗作用

目的　探讨 ATP敏感性钾通道 (KATP)开放剂左旋克罗卡林 (levcrom akalim)对低氧性肺动脉高压 (HPH)患者治疗的急性效应。方法　给予 10例 HPH患者舌下含服左旋克罗卡林 2 5 μg/ kg,采用右心飘浮导管测定其用药前后平均肺动脉压 (m PAP)、平均体动脉压 (m SAP)、血氧饱和度 (Sa O2 )、中心静脉压 (CVP)和心输出量 (CO) ,并计算出肺血管阻力 (PVR)。结果　本组 10例 HPH患者在使用左旋克罗卡林后 ,其 m PAP和 m SAP均明显下降 ,其中 m PAP在用药后 180分钟 ,从用药前的 4 .6 4± 0 .4 3k Pa最低降至 3.12± 0 .71k Pa;m SAP在用药后 6 0分钟 ,从用药前的 11.2 5± 0 .6 2 k Pa最低降至 9.31± 1.2 0 k Pa;PVR与 m PAP一样 ,也出现相同的变化 ;且前二者在用药 8小时内均维持在较低水平 ,与用药前相比 ,差异非常显著 (P=0 .0 1～ 0 .0 0 1)。 Sa O2 在用药后 12 0分钟 ,从用药前的 87.3%± 7.2 %增加至 92 .0 %± 5 .1% ,用药前后比较 ,差异显著 (P<0 .0 5 ) ;而用药前后 CVP和CO无明显变化 (P>0 .0 5 )。结论　左旋克罗卡林在用药剂量为 2 5 μg/ kg时 ,对 HPH患者具有明显而持久的降低肺动脉压的作用 ,且安全有效     

缺氧缺血性脑病患儿丙二醛含量和颅脑CT改变的临床意义

目的观察缺氧缺血性脑病(HIE)患儿血浆和脑脊液中的丙二醛含量以及颅脑CT的改变情况。方法利用TBA比色法同步测定各组患儿血浆和脑脊液中丙二醛(MDA)含量，同时适时对各组患儿进行颅脑CT的平扫。结果HIE患儿急性期和恢复期MDA含量均显著高于正常儿，且病情越重MDA含量越高；HIE临床症状越重，CT所表现的脑实质损害也越重，重者多合并颅内出血。各组患儿MDA含量和颅脑CT改变具有高度一致性。结论MDA是反映脑实质损伤的重要指标，而且参与了脑损害过程；颅脑CT改变能更客观地反映HIE惠儿的病情轻重，测定MDA的同时做颅脑CT对HIE的早期诊治和判断预后具有重要的意义。