新生儿通气相关性肺炎

目的：探讨新生儿通气相关性肺炎病因、病原菌、耐药情况、相关防治措施。方法：分析１０３ 例新生儿通气相关性肺炎患儿痰培养结果、诊治情况。结果：醋酸不动杆菌、铜绿假单胞菌、肺炎克雷伯杆菌是三种主要致病菌,耐药率高,对泰能、环丙沙星最为敏感。结论：革兰阴性杆菌是新生儿通气相关性肺炎重要病原菌,耐药率高,治疗较为困难,应积极预防。     

Vanishing Psammoma Bodies in the Anterior Pituitary of the Human Newborn: An Immunohistochemical and Histometric Study

Adenohypophyses of human newborns contain characteristic psammoma bodies. Their numbers are maximal within 2 weeks of the neonatal period and diminish thereafter. They are very rare in infant pituitaries, seeming to disappear by shrinkage in that there is a significant direct correlation between their number and size. The bodies were found to contain a high concentration of endogenous peroxidase, thus suggesting that the enzyme may be responsible for their disappearance. A statistical majority of psammoma bodies were located within follicular lumens. By immunohistochemistry, the follicular epithelium surrounding psammoma bodies showed immunoreactivity for various pituitary hormones. Light microscopy demonstrated that adenohypophysial cells surrounding psammoma bodies contain randomly, scattered granules or globules exhibiting peroxidase activity. Extrusion of such granules into follicular lumens may play a role in the genesis of the concretions. The conspicuous lamellar nature of the calcified psammoma bodies suggests that waves of calcium deposition occur during their morphogenesis. Despite histologic similarities, the histochemical characteristics of this type of psammoma body differ from those in other organs as well as from the calcification encountered in prolactin (PRL)-producing pituitary adenomas.     

Increased whole blood chemiluminescence in patients with Shwachman syndrome: therapy trial with thiamine and α-tocopherol

Neutrophils purified from peripheral blood of patients with the Shwachman syndrome show enhanced chemiluminescence (CL) and depressed chemotaxis. Here we present data showing that the increased CL response can be demonstrated by using a whole blood CL assay. This assay is well-suited for studies in infants, because the blood sample volumes needed are small. Increase in CL was most distinct in the initial (1 min) activation induced by N-formyl-methionyl-leucyl-phenylalanine. The 1-min response is considered to derive from extracellular production of oxygen radicals. Such an extracellular oxygen radical production may render the patients susceptible to undue oxidant stress. We therefore treated the patients with two antioxidants, thiamine and -tocopherol, for 3 months. This supplementation, however, failed to exert any significant effect on either whole blood CL or migration of the patients' neutrophils under agarose.     

新生儿高胆红素血症的临床研究

目的　探讨新生儿高胆红素血症的临床表现、发病因素和防止并发症 ,降低致残率。方法　对 99例新生儿高胆红血症患儿临床及实验室资料进行回顾性分析。结果　 99例新生儿黄疸经光疗等综合治疗除 4例放弃治疗和死亡外 ,其余均痊愈出院。结论　新生儿高胆红素血症病因复杂 ,致残率高 ,应重视予防 ,加强围产保健 ,防止感染和核黄疸发生 ,措施可行。     

凝血酶治疗新生儿上消化道出血的研究

目的　探讨凝血酶治疗新生儿上消化道出血的临床效果。方法　对 2 0 0 0年至今收住院的新生儿上消化道出血患儿 17例 ,除常规综合疗法外 ,静脉滴注维生素K1 10mg/d ,连用 4～ 7d。结果　治疗组 17例 ,显效 16例 ,显效率 97% ,对照组 15例 ,显效 7例 ,显效率 40 % ,两组比较有明显差异性 (P <0 0 0 1)。治疗组止血时间 1 3 5± 0 6d ,对照组平均止血时间 3 2±0 5d ,两组比较有明显差异性 (P <0 0 0 1)。结论　凝血酶治疗新生儿上消化道出血为一种安全、方便 ,无副作用的首选止血药物     

新生儿Rh溶血病的换血治疗

目的　用Rh阳性血换血治疗 12例新生儿Rh溶血病获得成功。方法　血液选用ABO与婴儿同型的肝素抗凝血 ,换血前严格做血交叉和抗人球蛋白实验 ,不测献血员Rh血型 ,换血量为 180ml/kg。 结果　换血后大多数婴儿黄疸无明显加重 ,仅一例因血清胆红素 >3 4 0 μmol/L而需第二次换血 ,所有病例均痊愈出院 ,平均住院天数为 (12± 4)d。结论　在病情紧急时 ,用Rh阳性血换血治疗 ,是一项安全有效的替代措施。     

机械通气治疗新生儿呼吸衰竭疗效观察

目的 观察机械通气治疗新生儿呼吸衰竭的疗效。方法 对96例呼吸衰竭的新生儿上呼吸机行机械通气治疗。结果 平均上机时间68．8h，存活75例，死亡9例，自动出院12例。结论 对呼吸衰竭的新生儿应及时行机械通气治疗，并掌握好呼吸机参数的调节，及时安全撤机，防治呼吸和相关肺炎的发生。     

新生儿呼吸窘迫综合征肺表面活性物质治疗后肺氧合功能和尿量变化的观察

目的　探讨新生儿呼吸窘迫综合征 (RDS)予肺表面活性物质 (PS)治疗后的尿量变化及尿量与肺氧合功能的关系。方法　对新生儿重症监护病房 (NICU)行呼吸机治疗的 2 0例RDS患儿予血气监测及每小时尿量和入量监测。结果　观察组 (PS组 )最大尿量峰值出现于生后 6 0h ,与对照组比较有显著性差异 (P <0 0 5 )。尿量 /入量比值PS组于生后 48h即大于 0 8,而对照组的上述比值大于 0 8出现于生后 6 0h。尿量与动脉 /肺泡氧分压比值 (PaO2 /PAO2 )有显著相关性 (r =0 7414,P <0 0 5 )。结论　RDS病程中随着尿量增加肺氧合功能改善 ,予PS治疗后利尿期最大尿量峰值增大 ,出现时间早 ,提示在PS治疗后更应该密切观察尿量变化 ,判断病情的恢复。     

新生儿疾病危重评分与美国新生儿紧急生理学评分的比较

目的　 比较新生儿疾病危重评分法和美国新生儿紧急生理学评分 (SNAP)的优越性 ,探讨更适合我国NICU应用的评分方法。 方法 　对我院NICU39例病危新生儿分别用两套评分系统进行评分 ,将结果进行对比分析。 结果 　新生儿危重病例评分结果显示 ,非危重组无一例病情转重或死亡 ,危重组病死率为 30 4 7%,极危重组病死率为 10 0 %。随分值下降 ,具备单项指标的病例增多 ,各组间差异经卡方检验有显著性意义。SNAP结果显示 ,≤ 10分组无一例病情加重或死亡 ,10～ 2 0分组病死率为 2 7 78%,≥ 2 0分组病死率为 85 71%,随分值增加 ,具备单项指标的病例增多 ,各组间差异均有显著性意义。两套评分方法高度相关 ,r=-0 86 16 ,P <0 0 1。 结论 　新生儿危重病例评分及SNAP对危重病例的检出率均可达 10 0 %,但前者仅有 10个项目 ,更为简便经济 ,更符合我国国情。单项指标与两套评分方法均平行 ,可作为一个可靠的分辨危重病病例的方法在基层医院推广。     

新生儿黄疸中碳氧血红蛋白检测的临床应用研究

为探讨常见新生儿黄疸中碳氧血红蛋白(COHb)检测的临床价值,以德国800系列生化血气分析仪附加的270-血氧仪检测动脉化毛细血管血COHb,同步取静脉血检测血清总胆红素(STB)。病例选自本院新生儿病房2001年7月～2002年6月收治的伴有常见黄疸原因的足月新生儿157例[新生儿溶血病75例、感染51例、晚发性母乳性黄疸31例]。对照组101例为日龄匹配无病理性黄疸者,其中≤7天者52例,检测不同日龄的COHb,共测120例次。结果对照组中COHb生后5天内较高,峰值在1～2天,一周后接近成人正常水平。COHb与STB无相关性;溶血组COHb及STB均显著高于对照组(P<0.001),感染、母乳性黄疸组COHb与对照组比较差异无显著性(P>0.05)。结果提示COHb可用于证实新生儿黄疸中有无胆红素产量的增多,有助于黄疸病因的诊断。