肺表面活性物质治疗早产儿肺透明膜病的临床研究

目的:探讨肺表面活性物质(PS)治疗早产儿肺透明膜病(HMD)的疗效及临床价值。方法:对32例诊断肺透明膜病的早产儿采用气管内快速注入PS,观察使用PS前后的动脉血气变化及机械通气情况。结果:应用PS后患儿皮肤颜色迅速转红,使用PS前后PaO2、PaCO2、pH比较差异显著,23例HMD胸片Ⅰ级、Ⅱ级及2例Ⅲ级患儿只需采用持续气道正压通气、面罩等呼吸支持和氧疗技术,7例Ⅲ级患儿机械通气。治愈率96.88%。结论:PS能有效地改善HMD患儿肺顺应性和氧合功能,缩短机械通气时间,提高治愈率。     

胎龄小于34周早产儿骨强度影响因素分析

目的分析胎龄小于34周早产儿骨骼早期发育的影响因素,为早产儿代谢性骨病的早期预防提供依据。方法选取2017年5月-2018年12月在苏州市立医院出生胎龄<34周的早产儿224例,于矫正3月龄进行左侧胫骨中段超声骨强度测定。通过本院住院系统与儿童保健早产儿管理档案搜集与骨骼发育相关的资料。结果 224例早产儿矫正3月龄超声骨强度Z值为-1.4(-0.6,-2.0),其中,79例(35.27%)超声骨强度值正常,43例(19.20%)轻度骨强度不足,38例(16.96%)中度骨强度不足,64例(28.57%)重度骨强度不足。女婴(OR=4.184,95%CI:1.876～9.329,P<0.001)、出生胎龄≤31周(OR=2.854,95%CI:1.282～6.352,P=0.010)、新生儿静脉营养(全肠外)≥7 d(OR=3.180,95%CI:1.480～6.832,P=0.003)、新生儿咖啡因使用≥10 d(OR=5.673, 95%CI:1.820～17.686,P=0.003)、住院期间碱性磷酸酶(ALP)峰值≥400 U/L(OR=2.796,95%CI:1....     

喂养不耐受对早产儿近期结局的影响

目的 探讨喂养不耐受对早产儿近期结局的影响.方法 以2017年1月至12月住院且符合研究标准的早产儿为研究对象.根据是否发生喂养不耐受,分为喂养不耐受组和喂养耐受组.回顾分析早产儿住院及随访至校正月龄6个月的临床资料.结果 共纳入612例早产儿,其中喂养不耐受组182例和喂养耐受组430例.多因素分析结果显示,喂养不耐...     

Preterm premature rupture of membranes: is home care acceptable?

Background: Preterm prelabor rupture of membranes is a frequent obstetric condition associated with increased risks of maternal and neonatal morbidity and mortality. Conventional management is in hospital. Outpatient management is an alternative in selected cases; however, the safety of home management has not been established.

Objective: To study the obstetric and neonatal outcomes of women with preterm premature rupture of membranes between 24 and 34 weeks who were managed as outpatient (outpatient care group), compared with those managed in hospital (hospital care group).

Study design: A retrospective cohort study between 1 January 2009 and 31 December 2013 in three French tertiary care centers.

Results: Ninety women were included in the outpatient care group and 324 in the hospital care group. In the outpatient care group, the gestational age at membrane rupture was lower, compared to the hospital care group (28.8 (26.6–30.5) vs. 30.3 (27.6–32.1) weeks; p?p?Conclusion: We observed no major complication related to home care after a period of observation. A randomized study would be necessary to confirm its safety.     

肺透明膜病早产儿尸检肺组织肺表面活性蛋白-C及Ki67的表达

Objective To determine the expression of surfactant protein-c (SP-C) and Ki67 in autopsy lung tissues of premature infants died of hyaline membrane disease (HMD) who were exposed to mechanical ventilation and high oxygen concentrations/pulmonary surfactant (PS). The possible influence of surfactant on the expression of SP-C and Ki67 was also investigated. Methods Thirty preterm infants diagnosed as HMD by clinical data and pathology were selected. Mechanical ventilation and supplemental oxygen (FiO2 0.6-1.0) were given to these infants within 6 hours after birth. According to the duration of ventilation at high oxygen concentrations, all subjects were diveded into four groups: ventilation for 1-3 days, 4-8 days, 9-16 days and >16 days. Five premature infants died within 1 day after delivery for none pulmonary reasons served as controls. The expression of SP-C and Ki67 in lungs were detected by immunobistochemistry. Results The pulmonary pathology in these HMD infants at different phases was consisitent with the main features of different stages during the progress from HMD towards bronchopulmonary dysplasia. The positive staining of SP-C was restricted to type Ⅱ alveolar epithelial cells, and Ki67 positive were preferentially localized in nuclei of alveolar and bronchiolar epithelial cells and fihroblasts. Compared with the control group, the expression of SP-C and Ki67 in HMD infants decreased significantly after 1-3 days of ventialation, but increased after 4 days and reached the peak value after 9-16 days. The expression of SP-C and Ki67 in control group, 1-3 days and 9-16 days of ventialation were 0. 1891±0. 0253, 0. 1576±0. 0327 and 0. 2271±0. 0238 for SP-C and 0. 2297±0. 0380, 0.1929±0. 0403 and 0. 2849±0. 0368 for Ki67, respectively. No significant difference in the expression of SP-C and Ki67 was found between infants treated with PS and those without (P>0.05). Conclusions SP-C and Ki67 may have participated in the pulmonary pathological process in ventilated/oxygen treated preterm infants with HMD, and exogenous surfactant had no effect on the expression of SP-C and Ki67.     

间苯三酚与硫酸镁治疗先兆早产的临床效果比较

目的比较间苯三酚及硫酸镁治疗先兆早产的临床效果。方法对60例诊断为先兆早产的孕妇作为研究组,给予间苯三酚治疗,并选择43例符合相同条件的病例作为对照组,给予硫酸镁治疗。结果应用间苯三酚及硫酸镁治疗治疗能使有效率分别达90.0%和88.4%,延长孕周至37周数达83.3%和83.7%,两者疗效比较无显著性差异（P〉0.05）,但间苯三酚副作用较硫酸镁少。结论间苯三酚能有效抑制宫缩,是治疗先兆早产有效而且安全和方便的方法。     

经鼻持续气道正压通气对肺表面活性物质治疗新生儿呼吸窘迫综合征效果的影响

目的 探讨不同时间点应用经鼻持续气道正压通气(nCPAP)对肺表面活性物质(PS)治疗新生儿呼吸窘迫综合征(RDS)效果的影响.方法 对湖北科技学院附属第一医院于2013年1月-2016年6月收治的RDS 100例的临床资料进行回顾性分析.根据应用nCPAP时间分为≤2h组38例、2～4h组41例、≥4 h组21例.观察3组治疗前后动脉血气变化、治疗3、7d的机械通气率及并发症发生情况.结果 3组给药24 h后吸入氧浓度(FiO2)和二氧化碳分压(PaCO2)低于给药前,pH和氧分压(PaO2)高于给药前,且2～4h组改善情况优于≤2h组和≥4h组;给药2h后,2～4h组FiO2低于≤2h组和≥4 h组,≥4h组PaO2均高于≤2h组和2～4h组(P＜0.05);治疗3d2～4h组需机械通气率低于≤2h组和≥4 h组(P＜0.05);支气管肺发育不良发病率≤2h组高于2～4h组和≥4h组(P＜0.05).结论 早期给予nCPAP对PS治疗RDS效果明显,可改善预后,在发病2～4h应用效果最佳.     

1例陈旧性心梗PCI术后频发室性早搏的处理

1例77岁男性陈旧性下壁心肌梗死患者入院行经皮冠状动脉介入（PCI）治疗,术后第2天突发胸闷,心电图示频发室性早搏,给予改善心肌血供、维持电解质平衡及抗心律失常治疗后病情逐渐稳定。考虑频发室性早搏与PCI术、血钾偏低、不规范使用胺碘酮及患者睡眠差、情绪紧张相关。     

龙江韩氏妇科治疗早发性卵巢功能不全经验

龙江韩氏妇科认为,肾虚是早发性卵巢功能不全发病之根本,肝郁气滞、瘀血内结为发病之关键.治疗本病以补肾疏肝、活血调经为大法,以百灵育阴汤为主,配合雌激素、孕激素、中成药及膏方分阶段治疗,并在药物治疗的同时配合药膳疗法及心理疗法.     

Beclin1介导的自噬在辐射诱导细胞早衰中的作用

自噬是机体及细胞必不可少的调节过程,在维持细胞的正常生理状态过程中发挥重要的作用.Beclin1是自噬的核心功能基因之一,其影响自噬体形成,并通过自噬影响肿瘤的发生和发展.研究发现Beclin1在p62蛋白介导的早衰调控中发挥一定作用,电离辐射可引起细胞发生自噬及早衰等细胞反应,导致细胞死亡.研究Beclin1介导的自...