Respiratory support in children

Respiratory failure is defined by the inability of the respiratory system to adequately deliver oxygen or remove carbon dioxide from the pulmonary circulation resulting in hypoxemia, hypercapnia or both. A wide variety of disease processes can lead to respiratory failure in children. Multiple interventions can support the paediatric patient with respiratory failure, from simple oxygen delivery devices to high frequency oscillatory ventilation and extracorporeal membrane oxygenation. This article will review available devices to improve oxygenation and ventilation, their advantages and disadvantages, and help guide physicians in the management of children with respiratory failure.     

彩色多普勒血流显像(CDFI)评价胎儿生长发育状况

目的阐明CDFI对评价胎儿宫内状况的可行性。方法200例经普通B超检查的胎儿,按测量各项常规指标的数值分为正常组100例和异常组100例,再分析经CDFI检查,所测定的指标包括胎儿大脑中动脉、肾动脉、胎盘床动脉、脐动脉血流搏动指数(PI)、阻力指数(RI)及脐动脉的收缩与舒张期峰值速率之比(S/D)。对其结果做详细记录,并进行统计学分析。结果正常组100例,经CDFI检查亦正常;胎儿出生时体重在2500g以上,新生儿发育正常。另100例异常组经CDFI检查各项指标中,54例正常,46例异常;胎儿出生时体重均小于2500g,其中54例新生儿虽体重较正常儿偏小,但发育正常;另46例胎儿宫内窘迫,导致导常分娩、新生儿生存率低。结论彩色多普勒血流显像对了解胎儿宫内情况有着重要的作用,是产科检查监护中不可缺少的部分。     

缺氧缺血性脑病新生鼠补钙前后脑细胞,红细胞内外钙的变化

为了观察一般剂量补钙对缺氧缺血性脑病（ＨＩＥ）脑细胞和红细胞内外钙变化的影响，以探讨ＨＩＥ时补钙是否增加脑细胞钙超载，用ＨＩＥ新生动物模型进行了实验研究，结果表明：（１）缺氧缺血时红细胞、脑细胞及脑组织出现钙积聚；（２）补钙后，血浆总钙浓度明显升高，而脑细胞、脑组织及红细胞钙积聚并未加重；（３）血浆总钙浓度与脑细胞或红细胞胞浆游离钙离子浓度无相关关系。提示：（１）ＨＩＥ时钙内流可能是全身性的；（２）对ＨＩＥ并低钙血症患儿吸氧后一般剂量补钙可能是安全的。     

左炔诺孕酮宫内节育器的制备及药物释放研究

采用改性乙烯-醋酸乙烯共聚物(mEVA)作为控释材料制备释放左炔诺孕酮(LNG)4μg/d,预期使用寿命为5年的钥匙形宫内节育器(IUD)。本IUD在体外和在人及动物子宫内均为零级释药。释药速度与释药管管壁厚度或管外内径比的对数成反比,提示本释药体系的释药模武符合膜控制释药的特性。动物血药浓度测定结果表明,家兔子宫内植入IUD 2d后,血中LNG浓度趋于稳定。     

缺氧对卵巢癌细胞Caov-3转移特性的影响

目的探讨缺氧条件对卵巢癌细胞Caov-3体外黏附和迁移能力的影响。方法在常氧和缺氧条件下培养卵巢癌细胞Caov-3,分别用四甲基偶氮唑蓝(MTT)比色法和细胞迁移试验测定常氧和缺氧条件下培养的Caov-3细胞体外黏附和迁移能力。结果缺氧条件下,Caov-3细胞在Matrigel和纤维连接蛋白Fn基质上黏附数量增加,黏附促进率分别为17.1%和15.2%,与常氧条件下比较有显著性差异(P<0.05)。缺氧条件下,Caov-3细胞在Matrigel基质上迁移距离增大,分别为258.8±19.5μm和331.3±24.4μm,迁移促进率为28.0%,与常氧条件下比较有显著性差异(P<0.05)。结论缺氧环境对卵巢癌细胞Caov-3体外黏附和迁移具有明显的促进作用。     

Six Cases of Prenatal and Neonatal Torsion of the Spermatic Cord

Torsions of the spermatic cord occurring from the intrauterine period to the end of the first year of life are termed perinatal. These are divided into prenatal and postnatal torsions, depending on their occurrence in the intrauterine or postuterine period. From January 1984 to January 1996, 6 cases were identified at our institution, involving 4 prenatal and 2 postnatal extravaginal torsions of the spermatic cord. These cases are reviewed with regard to optimal therapeutic approaches for the treatment of both the affected gonad as well as the contralateral one, and whether the event occurred prenatally or postnatally. The authors also propose several clinical indications useful for obstetricians, pediatricians, urologists and nurses.     

Die bronchopulmonale Dysplasie Frühgeborener

In very preterm neonates, bronchopulmonary dysplasia (BPD) complicates the course of respiratory distress syndrome, i.e., primary surfactant deficiency in a structural immature lung. In Germany, about 11 000 preterms having a gestational age below 32 weeks are born and treated in neonatal intensive care units per year. Within this high risk group, the rate of BPD is about 15%. Relevant prenatal risk factors include intrauterine inflammatory fetal reaction as a consequence of ascending maternal infections, intrauterine growth retardation apart from the main risk factor immaturity. Postnatal risk factors include genetic predisposition, mechanical ventilation, infections and hemodynamically relevant patent ductus arteriosus.Preventive measures include intratracheal surfactant administration; new studies indicate preventive effects of caffeine, vitamin A and hydrocortisone in a subgroup of neonates with prenatal fetal inflammatory response.Due to long-term detrimental effects of BPD on lung function and psychomotor development, further experimental and clinical studies are mandatory in order to continue to reduce the BPD rate.     

七氟醚和缺氧预适应诱导乳鼠心肌细胞HSP70表达的改变

目的 :探讨七氟醚预适应和缺氧预适应对乳鼠心肌细胞热休克蛋白 70表达的影响。方法 :第 2代培养心肌细胞随机分为正常对照组 (C组 )、缺氧 /复氧组 (A/R组 )、缺氧预适应组 (IP组 )和七氟醚预适应组 (S组 ) ,每组均缺氧 2h ,复氧 48h。分别取复氧 0 ,1,12 ,2 4,36和 48h的细胞 ,用免疫组化染色检测HSP70 表达并进行图象分析。结果 :在各个时间点 ,S组和IP组间的HSP70 表达均显著高于A/R组和C组 (P <0 .0 1) ,A/R组的HSP70 表达略高于C组 ,S组和IP组间的HSP70 表达差异无显著性 (P >0 .0 5 )。随着复氧时间的延长 ,S组和IP组间的HSP70 表达从 1h开始增加 ,2 4h表达最强 ,与 1h相比差异具有显著性 (P <0 .0 5 )。结论 :七氟醚预处理和缺氧预处理均可诱导乳鼠心肌细胞HSP70 在延迟相呈高表达 ,提示HSP70 参与了七氟醚预适应和缺氧预适应的延迟保护相。     

消炎痛及乙胺嗪对动物急性缺氧性肺、脑血管反应的影响

研究消炎痛及乙胺嗪对家兔肺、脑血管和大鼠脑微动脉缺氧反应的影响。发现吸入10％氧使家兔肺血管阻力(PVR)增加,脑血管阻力(CVR)降低,大鼠脑微动脉扩张。用消炎痛明显增强家兔缺氧性肺、脑血管反应。△PVR％由用药前26.6±16.7％增至44.2±7.7％;△CVR％则由一12.9±4.5％减至-30.7±4.7％;大鼠微动脉直径增大率(△D％)由用药前28.2±2.0％增至41.3±5.8％;用乙胺嗪则使缺氧时△PVR％由 84.6±18.1％降至 23.8±8.5％;△CVR％由-16.7±4.5％变为 6.9±2.8％;△D％由 29.7±5.8％减至 25.6±5.0％。结果表明前列腺素在缺氧性肺血管收缩反应及脑血管扩张反应中起调节作用,而白三烯则在缺氧性肺血管收缩反应中起介导作用。     

重度妊娠高血压综合征患者胎盘表皮生长因子受体的表达

目的：研究胎盘表皮生长因子受体(EGFR)蛋白及基因的表达在置度妊娠高血压综合征(妊高征)发病中的作用以及对妊高征胎儿生长发育的影响。方法：采用免疫组织化学法和逆转录-聚合酶链反应(RT-PCR)技术测定21例重度妊高征患者[分2组，重度妊高征合并胎儿宫内发育迟缓(IUGR)组9例和重度妊高征未合并IUGR组12例]胎盘EGFR的表达，并与15例正常妊娠者(对照组)比较。结果：与对照组相比，重度妊高征患者胎盘EGFR蛋白及其mRNA的表达显著降低(P＜0．01)，重度妊高征合并EGFR组与重度妊高征未合并IUGR组之间胎盘EGFR的表达差异无显著性(P＞0．05)。结论：胎盘滋养层细胞EGFR表达显著降低，可能是重度妊高征发病的重要因素；如果EGFR的低表达发生较早，容易发生IUGR。