HBsAg母婴传播的研究

对HBsAg(+)母亲所生婴幼儿,连续两年的动态观察,发现这些婴幼儿的感染绝大多数皆在出生3个月后,其感染频率与母亲HBsAg的滴度成正相关,表明母婴传播阻断应以HBsAg(+)母亲所生之子女为重点对象。     

妊娠合并肝内胆汁郁积症的围生儿结局57例分析

目的 探讨妊娠合并肝内胆汁郁积症（ICP）患者致围生儿不良结局的相关指标。方法 总结本院57例ICP患者的相关临床资料，将其与围生儿结局进行分组对照分析。结果 血清胆汁酸升高与围生儿不良结局关系不明显（P＞0.05)；血清转氨酶水平在产生围生儿不良结局组与未产生围生儿不良结局组之间有显著性差异（P＞0.01)；皮肤瘙痒持续时间大于3周组围生儿不良结局发生率与持续时间小于3周组有显著性差异（P＜0.05)；有、无NST基线变异消失组的围生儿不良结局发生率有极显著性差异（P＜0.01)。结论 血清转氨酶水平、皮肤瘙痒持续时间及NST基线变异是否消失是预示围生儿不良结局的相关指标。     

窒息鼠脑组织型纤溶酶原激活物活性变化与脑水肿的关系

目的：探讨窒息对鼠脑分泌组织型纤溶酶原激活物（TPA）的影响与脑水肿的关系。方法：通过“延迟剖宫产术”致胎鼠宫内窘迫，实验分空白对照组，窒息15min组，窒息30min组，窒息15min复氧30min组，窒息30min复氧30min五个实验组，每组各取8例测试脑组织TAP的活性及含水量，结果：窒息后鼠脑TPA活性与含水量均升高（P＜0．01），结论：窒息可致TAP活性增高，同时发生脑水肿，高活性的TPA可能是脑缺氧缺血致不可逆神经元损伤的一个重要媒介。     

围产儿死亡545例原因分析

目的 探讨围产儿死亡原因，以提高围产期保健工作质量及降低围产儿死亡率。方法 对我院12年来围产儿死亡病历进行回顾性分析。结果 12年间围产儿死亡95例，占16．88‰，死胎64．84％，死产26．37％，新生儿死亡8．79％。围产儿死亡原因依次为早产、胎儿畸形、缺氧综合征、脐带因素、胎位异常、胎盘因素及妊娠并发症。新生儿死亡主要因早产、呼吸窘迫综合症(RDS)所致。结论 加强围产期监护，预防为主，提高产科质量，达到降低围产儿死亡率。     

128例双胎妊娠临床结局分析

目的 :探讨影响双胎妊娠临床结局的相关因素。方法 :回顾性分析 12 8例双胎妊娠临床结局与胎方位、分娩方式、孕周、新生儿体重、新生儿窒息之间的关系。 结果 :胎方位、孕周、胎儿体重及分娩方式均影响围产儿预后。 结论 :加强孕产期保健 ,提高产科质量能改善双胎妊娠围产儿的预后。     

Arachidonic acid metabolites in CSF in hypoxic-ischaemic encephalopathy of newborn infants

The aim of this study was to evaluate the cerebral synthesis of eicosanoids in the asphyctic newborn and to investigate the relation between the prostanoid profiles in cerebrospinal fluid (CSF) and the appearance and severity of hypoxic-ischaemic encephalopathy (HIE). Levels of 6-keto-PGF _1-α, TXB₂, PGE₂ and PGF_2-α in CSF were measured in 40 full term newborns during the first day of life. Thirty of these newborns had birth asphyxia and were divided into three groups: 10 without HIE, 12 with mild HIE and 8 with moderate-severe HIE. They were compared to a control group of 10 non-hypoxic newborns. Determinations of the metabolites in CSF were performed by RIA and expressed as pg/ml (mean ± SD). The CSF TXB₂ (thromboxane A₂ metabolite) in asphyxiated newborns was always higher than in the control group (28.12 ± 10.6), and related to the severity of HIE ( p = 0:005): without HIE (50.84 ± 16.4; p = 0:02), mild HIE (80.65 ± 12.64; p ± 0:01) and moderate-severe HIE (178.14 ± 20.5; p < 0:01). The CSF 6-keto-PGF _1-α (prostacyclin metabolite) in asphyxiated newborns was always higher than in the control group (80.55 ± 12.56), but indirectly related to the severity of HIE: without HIE (240.95 ± 28.12; p < 0:01), mild HIE (183.65 ± 30.1; p < 0:01) and moderate-severe HIE (140.55 ± 25.12; p < 0:01). In the moderate-severe HIE group, the increase in TXB₂ was higher than the rise in 6-keto-PGF _1-α.     

Prevalence of the Neonatal Autopsy: A Report of the Study Group for Complications of Perinatal Care

Neonatal autopsy findings are valuable additions to the information base for current cases and future perinatal care, so the reported decline in the autopsy rate is disturbing. In order to estimate the prevalence of the neonatal autopsy among a large population of deaths, we surveyed participating institutions of the Study Group for Complications of Perinatal Care. Investigators from 37 neonatal intensive care units, located in 9 children's hospitals, 4 hospitals for women and infants, and 24 full-service pediatric and adult care hospitals, reported their neonatal death and autopsy rates for 1989. The overall neonatal autopsy rate was 51% among 1645 neonatal deaths. The rate was variable, ranging from 22 to 100%. We found the neonatal autopsy rate to be lower than previously reported and not apparently influenced by the type of center or by the type of medical staff at the centers. In order to assess and potentially reverse the current low rate, the influence of neonatal demographic and clinical factors, as well as physician-related factors, must be studied.     

Apoptosis in perinatal hypoxic-ischaemic cerebral damage

Perinatal hypoxia-ischaemia induces a biphasic cerebral injury: the depletion in high energy phosphates during the insult returns to normal soon after resuscitation. However, some 8–15 h later a second phase of impaired energy metabolism begins, which is related to the severity of later neurodevelopmental impairment. Delayed injury differs from acute hypoxia-ischaemia because intracellular acidosis does not occur. Apoptosis may be a mechanism of delayed cellular injury. Apoptotic cells and typical DNA fragmentation have been found after perinatal hypoxia-ischaemia. In newborn piglets, fraction of apoptotic cells was directly related to the degree of high energy phosphate depletion during hypoxia-ischaemia. Apoptosis may be interrupted: in piglets, brain cooling for 12 h following resuscitation reduced the fraction of apoptotic but not necrotic cells. These results have implications for both the understanding of cerebral injury and the use of hypothermia as a neural rescue strategy in the developing brain.     

胎儿脐带缠绕253例分析

目的　探讨胎儿脐带缠绕的临床意义及处理。方法　分析 2 5 3例有脐带缠绕的孕妇的脐带长度、剖宫产率、脐动脉血流S/D的值及对围产儿的影响 ,并与 2 6 9例无脐带缠绕者作比较。结果　 2 5 3例脐带缠绕组中脐带过长者明显高于无脐带缠绕组 (P <0 .0 1)。因脐带缠绕组中脐动脉血流S/D值≥ 3.0的百分率、胎儿宫内窘迫的发生率及新生儿窒息率明显高于对照组 (P <0 .0 1) ,故临床剖宫产率也高于对照组。结论　脐带缠绕可对围产儿造成不良影响 ,临床应提高孕期监测、产程监护 ,从而减少对围产儿的影响 ,降低不必要的剖宫产