早期或晚期使用枸橼酸咖啡因防治极低出生体重儿呼吸暂停的临床分析

目的 比较早期或晚期使用枸橼酸咖啡因防治极低出生体重儿呼吸暂停的临床效果。方法 选取2015年6月至2017年5月于新生儿重症监护室住院治疗的极低出生体重儿共82例为研究对象,按开始使用枸橼酸咖啡因的日龄分为早期治疗组（日龄 < 3 d）（n=22）和晚期治疗组（3 d ≤ 日龄<10 d）（n=60）,回顾性收集并比较两组患儿围产期的基本情况、治疗过程情况及临床结局。结果 早期治疗组的出生体重明显低于晚期治疗组（P=0.004）;早期治疗组机械通气时间及吸氧时间明显短于晚期治疗组（P < 0.05）;早期治疗组支气管肺发育不良（BPD）的发生率明显低于晚期治疗组（P=0.032）。其余基本情况、治疗过程情况及临床结局在两组间比较差异均无统计学意义（P > 0.05）。结论 早期使用枸橼酸咖啡因可改善极低出生体重儿的预后。     

老年慢性阻塞性肺疾病患者淋巴细胞对肺炎链球菌荚膜多糖的反应能力

目的分析慢性阻塞性肺疾病(COPD)老年人体外培养的淋巴细胞在肺炎链球菌荚膜多糖干预环境下活化情况。方法研究对象分为老年COPD,健康老年,健康年轻3组,分离外周单个核细胞以PPV23干预培养,流式细胞技术检测CD3+细胞、CD19+细胞表面CD69表达。结果健康年轻组淋巴细胞对荚膜多糖抗原干预有显著反应,健康老年组T、B淋巴细胞及老年COPD组B淋巴细胞对多糖抗原干预无反应,老年COPD组T淋巴细胞对多糖抗原反应与健康年轻人组相反。结论 CD69为标志的各组人群T、B淋巴细胞对肺炎链球菌抗原刺激的反应能力不同,COPD老年人及健康老年人进行PPV23免疫后难以产生同健康年轻人相当的免疫效果。     

HADHB基因变异导致致死型线粒体三功能蛋白缺乏症1例

本文报告了1例HADHB基因复合杂合变异导致的致死型线粒体三功能蛋白缺乏症(mitochondrial trifunctional protein deficiency, MTPD)。患儿生后24 h内起病, 以"吃奶少伴心肌酶异常"为主诉在生后第4天转至南京医科大学附属儿童医院。入院时体格检查见精神稍萎靡, 反应尚可, 心肺腹无明显异常;实验室检查肌酸激酶同工酶及肌钙蛋白均偏高, 心电图提示窦性心动过速、肢导联低电压;血液代谢筛查提示十四烯酰基肉碱及多种3-羟基肉碱均偏高;全外显子组测序结果示胎儿HADHB基因复合杂合变异[c.739C>T(p.Arg247Cys)和c.607C>T(p.Arg203Ter, 272)]。随访至3月龄, 患儿受凉后出现吃奶差、精神差, 再入院后出现心力衰竭、呼吸衰竭等多脏器功能障碍表现, 经治疗无效后死亡。致死型MTPD较为罕见, 目前无有效治疗措施, 预后差。对于新生儿期出现不明原因心肌病、低血糖、酸中毒等代谢异常表现, 应警惕致死型MTPD可能, 新生儿期基因检测可早期明确诊断。     

Early risk factors for death in neonates with persistent pulmonary hypertension of the newborn treated with inhaled nitric oxide北大核心CSCD

Objective To evaluate the early risk factors for death in neonates with persistent pulmonary hypertension of the newborn (PPHN) treated with inhaled nitric oxide (iNO). Methods A retrospective analysis was performed on 105 infants with PPHN (gestational age ≥34 weeks and age <7 days on admission) who received iNO treatment in the Department of Neonatology, Children's Hospital of Nanjing Medical University, from July 2017 to March 2021. Related general information and clinical data were collected. According to the clinical outcome at discharge, the infants were divided into a survival group with 79 infants and a death group with 26 infants. Univariate and multivariate Cox regression analyses were used to evaluate the risk factors for death in infants with PPHN treated with iNO. The receiver operating characteristic (ROC) curve was used to calculate the cut-off values of the factors in predicting the death risk. Results A total of 105 infants with PPHN treated with iNO were included, among whom 26 died (26/105, 24.8%). The multivariate Cox regression analysis showed that no early response to iNO (HR=8.500, 95%CI: 3.024-23.887, P<0.001), 1-minute Apgar score ≤3 points (HR=10.094, 95%CI: 2.577-39.534, P=0.001), a low value of minimum PaO2/FiO2 within 12 hours after admission (HR=0.067, 95%CI: 0.009-0.481, P=0.007), and a low value of minimum pH within 12 hours after admission (HR=0.049, 95%CI: 0.004-0.545, P=0.014) were independent risk factors for death. The ROC curve analysis showed that the lowest PaO2/FiO2 value within 12 hours after admission had an area under the ROC curve of 0.783 in predicting death risk, with a sensitivity of 84.6% and a specificity of 73.4% at the cut-off value of 50, and the lowest pH value within 12 hours after admission had an area under the ROC curve of 0.746, with a sensitivity of 76.9% and a specificity of 65.8% at the cut-off value of 7.2. Conclusions Infants with PPHN requiring iNO treatment tend to have a high mortality rate. No early response to iNO, 1-minute Apgar score ≤3 points, the lowest PaO2/FiO2 value <50 within 12 hours after admission, and the lowest pH value <7.2 within 12 hours after admission are the early risk factors for death in such infants. Monitoring and evaluation of the above indicators will help to identify high-risk infants in the early stage. © 2022 Xiangya Hospital of CSU. All rights reserved.     

老年人自然免疫状态下抗肺炎链球菌抗体的检测

目的 探讨自然免疫状态下血清抗肺炎链球菌荚膜多糖特异性抗体值,为老年人是否需常规使用PPV23免疫提供参考.方法 健康人85例(健康组),分为青年、中年、老年组;老年COPD患者18例(C()PD组),ELISA检测血清特异性抗体.结果健康组:IgA老年组同中、青年组差异无统计学意义;IgM青年组高于其他两组(P＜0.05);总IgG差异无统计学意义,IgG4老年及中年组高于青年组(P＜0.05).IgM浓度与年龄负相关(r=-0.274,P＜0.05),IgG4与年龄正相关(r=0.342,P＜0.05).COPD组和健康老年人组差异无统计学意义.结论 未发现健康及COPD老年人血清抗肺炎链球菌保护性抗体整体水平低下,不支持该人群常规使用PPV23.     

极早和超早产儿支气管肺发育不良的回顾性研究

目的：分析并总结本新生儿重症监护室（neonatal intensive care unit,NICU）极早和超早产儿的救治现状及支气管肺发育不良（bronchopulmonary dysplasia,BPD）发病情况。方法：回顾性分析2018年1月—2020年12月南京医科大学附属儿童医院新生儿医疗中心收治的胎龄<32周且出院日龄≥28 d共547例早产儿的临床资料,按临床诊断分为BPD组（n=126）和非BPD组（n=421）,综合比较两组早产儿的情况,并纵向分析、总结3年的临床资料及BPD情况。结果：BPD组胎龄为（28.57±1.49）周,胎龄<28周的超早产儿占31.7%,而非BPD组胎龄为（30.05±1.39）周,超早产儿仅占8.1%(P <0.05)。BPD组出生体重（1 132.18±251.25）g,<1 000 g的超低出生体重儿占28.6%,而非BPD组出生体重（1 384.47±267.44）g,超低出生体重儿仅占6.4%(P <0.05)。BPD组5 min Apgar评分≤7分、产房复苏率均升高（P <0.05）。非BP...     

珠海地区384例继发型肺结核临床及影像学表现

目的探讨继发型肺结核各类病变与年龄、发病时间、初治或复治之间的相互关系。方法收集继发型肺结核384例,统计分析渗出性病变、干酪性肺炎、结核球、空洞性病变与增殖性病变的发生率与发病年龄、发病时间和细菌学检查的关系。结果在不同年龄组中,各类病变的分布无统计学差异(χ2=14.916,P=0.061)。初治与复治组中,各类病变发生率的差异具有统计学意义(χ2=122.293,P=0.0001)。按从出现症状到CT检查的时间间隔,将327例新发病例分为急性组、亚急性组和慢性组。随着发病时间延长,渗出性病变、干酪性肺炎发生率下降、空洞性病变发生率上升,差异具有统计学意义(χ2=97.280,P=0.001)。各类病变的痰检阳性率具有显著差异(χ2=12.813,P=0.012)。结论随着发病时间延长,空洞性病变明显增多,渗出性病变和干酪性肺炎比例有所下降。     

无创经皮监测氧气和二氧化碳在新生儿的应用

无创经皮监测(transcutaneous monitoring,TCM)氧气和二氧化碳是新生儿重症监护室(neo-natal intensive care unit,NICU)的常用技术,具有连续性、无创性的特点,能直观反映危重新生儿呼吸和循环功能的变化,对新生儿监护意义重大.该文阐述TCM的使用方法,比较TCM与其他监测手段的优缺点,并介绍其在新生儿转运及NICU的应用.