宫内窒息后新生鼠的状态与脑损伤关系的研究

目的 探讨宫内窒息后的新生鼠脑病理变化。并与生后的状况相联系。方法 制备宫内不同程度缺血缺氧（15，30，45及60min)及再灌注（缺血缺氧15min后再灌注1，4，8，15及24h)模型。观察剖宫产后新生鼠的一般状况并进行光，电镜下的脑病理观察。结果 轻度的宫内缺血缺氧可引起神经元的变化，但生后的一般状态无明显改变；严重的宫内缺血缺氧当时即可引起胎死宫内，此时神经元表现为坏死，宫内轻度窒息的新生鼠，出生时一般状态尚可，但再灌注后状态越来越差，与神经元再灌注后呈现的进行性凋亡过程相平行。结论 急性宫内缺血缺氧可以引起胎死宫内，神经元表现为坏死，在坏死之前再灌注将引起凋亡。再灌注后进行性凋亡过程是某些宫内窒息新生儿在出生后状态越来越差的主要原因。新生儿缺氧缺血性脑病的病理变化可能在宫内已经开始发生。     

换血治疗新生儿重症黄疸的临床分析

目的探讨换血疗法治疗新生儿重症黄疸的疗效。方法重症黄疸患儿13例采用双通道同步换血疗法治疗。结果患儿换血后胆红素水平显著下降（P〈0.01）;换血前后及术中电解质、血气分析及生命体征平稳。结论换血疗法治疗新生儿重症黄疸快速、有效、安全。     

内源性激活素A水平与新生儿窒息及其预后的关系

目的研究内源性激活素A（ACT A）的水平变化及其与新生儿窒息后缺氧缺血性脑病（HIE）的发生、严重程度以及预后的相关性。方法用ELISA方法动态监测58例窒息足月新生儿（轻、重度窒息39、19例）和30例正常足月新生儿血清ACT A及成纤维细胞生长因子（FGF）、肿瘤坏死因子-α(TNF-α)的浓度（脐血、7d），同时观察意识状态、肌张力、原始反射、有无惊厥及瞳孔改变、呼吸、心率、囟门张力等临床指标，结合颅脑CT进行临床诊断与分度。结果窒息新生儿脐血血清ACT A,FGF和TNF-α水平明显升高（P均＜0.01）。ACT A水平与生后1min Apgar评分呈负相关（r＝-0.948, P＜0.01）。生后7?d窒息组患儿血清ACT A、FGF水平仍高于对照组(P均＜0.01)， TNF-α水平差异无统计学意义(P＞0.05)。各项临床指标按照新生儿HIE的临床分度标准量化赋分，与血清ACT A水平进行相关性分析，结果显示ACT A水平与HIE的严重程度呈正相关（r＝0.962，P＜0.01）。结论内源性ACT A参与窒息后新生儿HIE的发病过程,动态检测内源性ACT A水平对判断窒息所致新生儿HIE的严重程度及估计预后可能具有重要价值。     

Die Korrelation zwischen Hyperbilirubinämie und Körpergewicht bei reifen Neugeborenen

Zusammenfassung Es wurde eine statistisch gesicherte, negative Korrelation zwischen der Höhe des Gesamtbilirubins im Serum und dem Körpergewicht bei ausgetragenen Neugeborenen mit Hyperbilirubinämie nachgewiesen. Der bestehende Einfluß des Lebensalters wurde durch partielle Korrelationsrechnung ausgeschaltet. Die untersuchten Kinder zeigten keine immunologischen, infektiösen, erkennbar genetischen oder auf Mißbildungen beruhenden Ursachen für die Hyperbilirubinämie. Dabei wurden nur definitionsgemäß reife Neugeborene berücksichtigt.

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The correlation between hyperbilirubinemia and body weight of mature newborn infants

Summary A statistically significant negative correlation was established for the total serum bilirubin levels and body weight of mature newborn infants affected by hyperbilirubinemia. The effect of age on this condition was excluded by partial correlation computations. The report referring only to mature newborn infants stresses the absence of underlaying immunological, infectious, identified genetic or deformative conditions.

     

新生儿窒息后血清皮质醇及胰岛素水平与血糖的关系

目的：探讨新生儿窒息后血皮质醇、胰岛素水平动态变化与血糖的关系，以利临床正确处理低血糖，减少神经系统损害。方法：采用放射免疫法监测43例新生儿窒息后第1、3、7d血清皮质醇、胰岛素浓度，葡萄糖氧化酶法监测血糖浓度。结果：新生儿窒息后第1、3、7d血清皮质醇逐渐降低(P＜0．01)，血胰岛素水平第1d显著增高(P＜0．01)，第3d恢复正常(＜20mIU/L)；出生第1d，血皮质醇水平与血糖呈正相关(r＝0．432，P＜0．01)，血胰岛素与皮质醇比值，低血糖组高于正常血糖组(P＜0．01)，高胰岛素血症组低血糖发生率(76．9％)高于正常胰岛素组(41．2％，P＜0．05)。结论：新生儿窒息后低血糖的发生与暂时性高胰岛素血症及相对低的血皮质醇水平有关。     

From suspicion to action: the chemical conjunctivitis and silver nitrate connexion example in Brazilian hospitals

BACKGROUND: During the 20th century, silver nitrate (SN) eye drops instillation to newborns had been the best prophylaxis against ophthalmia neonatorum (ON) caused by Neisseria gonorrheae, the most frequent cause of ocular infections leading to blindness. At present, this treatment has been questioned because there is a growing prevalence of other pathogens such as Chlamydia trachomatis, and SN is associated with chemical conjunctivitis (ChC). In addition, SN could present some conservation problems in tropical climates. Among other alternative drugs, 2.5% povidone-iodine has a proven efficacy, not only against Neisseria, but also against Chlamydia, has no conservation problems, has not been associated with ChC and is cheap. METHODS: The recently created Setor de Farmacovigil?ncia (SF) of the S?o Paulo State in Brazil has created a pharmacovigilance network of 11 big public hospitals. During a periodical signal searching process, the SF found a cluster of 33 ChC reports from one of the network hospitals. RESULTS: The problem was discussed with the remaining participant hospitals and this signal was used as a way to strengthen the network. Thirteen months later, 622 ChC reports were received from six hospitals. DISCUSSION: Thus, this well-known side-effect in the literature was highlighted as a 'real' problem in Brazil, and some participant hospitals began a discussion period together with the delivery and newborn care professionals in order to switch SN by povidone-iodine. This is an example of both, how a simple pharmacovigilance exercise could improve the implication of health professionals with their own therapeutic problems and how a pharmacovigilance network could be strengthened.     

山莨菪碱外用按摩治疗新生儿硬肿症疗效分析

目的观察山莨菪碱外用按摩治疗新生儿硬肿症的治疗效果。方法119例新生儿硬肿症患儿随机分成两组，治疗组65例，对照组54例。两组均给予保暖复温、控制感染、补液及供给足够的热量、纠正器官功能紊乱等治疗，治疗组加用山莨菪碱外用按摩治疗。结果治疗组硬肿变软时间与硬肿消退时间均比对照组短，t值分别为3．667、5．568，P〈0．01，差异有统计学意义。治疗组疗效优于对照组，Χ^2=4．35，P〈0．05，两组比较差异有统计学意义。治疗组死亡率3．1％，对照组死亡率14．8％。治疗组未见明显不良反应。结论山莨菪碱外用按摩治疗新生儿硬肿症不仅可使硬肿较早变软，而且可缩短病程，提高治疗效果，降低死亡率。其操作方法简便、经济、安全、实用性强，值得在临床中推广。     

Clinical,pathogenetic and neuropathological correlates in dystonic cerebral palsy

Studies were made of three autopsied cases of dystonic (changing tone) cerebral palsy with the aim of correlating the clinical characteristics and pathogenetic factors with the neuropathological lesions.Clinically all three patients were small-for-dates and born at gestational ages of 31–34 weeks. They sustained either severe birth asphyxia or repeated hypoxic episodes with respiratory arrest, and all three had moderate hyperbilirubinemia during the perinatal period. All of them developed an identical non-progressive extrapyramidal cerebral palsy syndrome. Mental capacity was less affected than motor performance, which remained at a neonatal level.From the pathogenetic point of view, prenatal malnutrition, preterm birth, pre- and perinatal hypoxia, acidosis and icterus were considered to be cumulative brain-damaging factors in each of the three patients. The pattern of combined partial and total asphyxia could be discerned in all the cases.The outstanding neuropathological correlate was selective bilateral sclerosis of the globus pallidus.It is proposed that the time of operation of the above factors in relation to the developmental stage of the globus pallidus determined the site of the cerebral damage. This hypothesis finds support in recent experiments with graded asphyxia in Rhesus monkeys.Supported by¹ the Swedish Medical Research Council, and² the Norrbacka-Eugenia Foundation and the newspaper Expressen's Prenatal Research Foundation     

新生儿硬肿症护理

本文详细地介绍了新生儿硬肿症的护理方法,提出了一些护理要点,并指出快速复温效果较好,可供临床护理参考。     

胎儿宫内窘迫行剖宫产术221例临床分析

目的探讨如何预防和早期发现胎儿窘迫,减少新生儿窒息,正确诊断,及时行剖宫产术。方法将该院以胎儿窘迫为第一手术指征行剖宫产的221例患者进行回顾性分析,以宫口开大情况分为未临产组、潜伏期组、活跃期组,分析各组胎儿窘迫的相关因素、新生儿Apgar评分情况。结果新生儿窒息率5.43%。胎儿窘迫发生在未临产组115例(52.04%),潜伏期组54例(24.43%),活跃期组52例(23.53%)。3组诊断符合率分别为77.39%、98.14%、98.08%。221例病例中早产33例,未临产组30例(90.91%)。结论加强产前、产时胎儿的胎心监护,早期发现胎儿受损迹象,及时进行干预,可以减少新生儿窒息发生率。