全肠道外营养在新生儿破伤风治疗中的应用

目的 :探讨全肠道外营养 (TPN)在新生儿破伤风治疗中的应用效果。方法 :37例新生儿破伤风患者 ,在综合治疗 (镇静止痉、破伤风抗毒素及抗生素应用等 )的基础上给予TPN支持 (TPN组 ) ;TPN主要成分有葡萄糖、电解质、氨基酸、维生素混合液及脂肪乳剂 ,从周围静脉输入。另有32例新生儿破伤风给予综合治疗和部分静脉营养 (对照组 )。结果 :在TPN组中 ,体重增加 33例 ,对照组中 ,体重增加 18例 ,差异具有显著性 (χ2 =5 6 80 7,P <0 0 2 5 )。TPN组治愈 35例 ,死亡 2例 ,对照组治愈 2 5例 ,死亡 7例 ,差异具有显著性意义 (χ2 =4 10 37,P <0 0 5 )。TPN组治疗过程中未发现明显不良反应和合并症。结论 :TPN应用于新生儿破伤风患儿 ,安全方便 ,能够提供足够和平衡的营养 ,辅助提高疗效。     

Cholinergic, monoaminergic and glutamatergic changes following perinatal asphyxia in the rat

Perinatal asphyxia (PA) is considered to lead to a variety of brain disorders including spasticity, epilepsy, mental retardation, and minimal brain disorder syndromes and may form the basis for psychiatric and neurodegenerative diseases later in life. We examined markers for neuronal transmission involved in the pathomechanisms of PA and candidates as mediators for long-term sequelae. We tested tyrosine hydroxylase (TH) and the vesicular monoamine transporter (VMAT) representing the monoaminergic system, the vesicular acetylcholine transporter (VAChT), and the excitatory amino acid carrier 1 (EAAC1), a neuronal subtype of the glutamate transporter, using immunohistochemistry on brain sections of rats subjected to graded PA. Three months following the asphyxiant insult immunoreactive (IR)-TH was decreased in striatum, hippocampus, thalamus, frontal cortex, and cerebellum; IR-VMAT was increased, and IR-VAChT was decreased in striatum. IR-EAAC1 glutamate transporter was increased in frontal cortex. The cholinergic, monoaminergic, and glutamatergic changes, still observed 3 months after the asphyxiant insult, may reflect their involvement in the pathomechanisms of PA and indicate mechanisms leading to long-term complications of PA. The variable consequences on the individual markers in several brain regions may be explained by specific susceptibility of cholinergic, monoaminergic, and glutamatergic neurons to the asphyxiant insult. Received 16 March 1999; received after revision 20 May 1999; accepted 8 July 1999     

新生儿缺氧缺血性脑病血液流变学观察

为探讨缺氧缺血性脑病发病机制与血液流变学的关系，对１９例新生儿缺氧缺血性脑病（ＮＨＩＥ）和１６例正常新生儿进行血液流变学综合指标对照观察。结果显示：患病组的血浆比粘度（ηｐ）、红细胞变形指数（ＴＫ）、红细胞聚集指数（ＲＡＩ）、微循环滞留时间（ＭＳＴ）、纤维蛋白原（Ｆｉｂ）、血栓形成系数（ＴＦＬ）均高于对照组，差异有非常显著性意义（Ｐ＜０．０１）。血液粘度（ηｂ）及还原粘度（ηｒ）也比正常组高（Ｐ＜０．０５）。红细胞压积（Ｈｃｔ）两组对照无显著性差异（Ｐ＞０．０５）。表明新生儿缺氧缺血性脑病存在着血液高粘滞，其主要原因为红细胞的聚集性增高和变形能力下降，以及血浆纤维蛋白原增加。     

足月新生儿微量血胆红素的测定及其临床应用

目的 :(1)制定清远地区足月新生儿不同日龄 (1～ 10d)的微量血胆红素动态变化值 ;(2 )探讨黄疸的临床分度与微量血胆红素测定值的相关性。方法 :5 0 0例正常足月新生儿为A组 ,于出生后第 1～ 10d ,每天同一时间测定微量血胆红素一次 ;2 0 0例黄疸组为B组 ,于出生后第 3～ 7d每天测一次微量血胆红素 ,由专人用双盲法对黄疸进行分度 ,分别计算出相应胆红素 (SB)均值及标准差。结果 :(1)正常足月新生儿生后第 2～ 3d开始出现黄疸 ,第 5～ 6d达高峰 ,平均峰值为(2 12 2 5± 5 7) μmol/L ,第 10d下降至 (171 4 5± 2 8 8) μmol/L ,男女性别无显著性差异 (P >0 0 5 )。(2 )临床判断无、轻度、中度、重度黄疸所对应的胆红素分别为 (12 8 2 5± 33 6 0 )、(2 0 2 35± 4 3 0 5 )、(2 6 3 70± 6 4 2 0 )、(2 95 5 0± 5 1 90 ) μmol/L。 结论 :正常足月新生儿黄疸出现的时间与国内外其他报道相似 ,但其生理性黄疸的诊断标准略高于传统标准。当胆红素大于相应的 x±s、 x± 2s或临床诊断为中度、重度黄疸 ,则应给予适当治疗。     

Evidence for no relationship of the pineal activity with the neonatal shrinkage of Leydig cells in the rat

Summary The collective volume of Leydig cells in prenatally pinealectomized newborn rats declined as sharply as in intact newborn rats. Also, the collective volume in pups born in the dark declined in a fashion similar to that in pups born in the light. The results indicate that neither the pineal gland nor the light is responsible for the neonatal shrinkage of Leydig cells.This study was supported in part by a Grant-in Aid for Scientific Research (No. 548067) from the Ministry of Education, Science and Culture of Japan.     

早期干预对新生儿缺氧缺血性脑病预后影响的综合评估

目的：探讨早期干预对减少中重度缺氧缺血性脑病（HIE）患儿脑瘫、精神发育迟滞等后遗症的作用。方法：将118例中、重度HIE患儿按入院顺序分单号为干预组（A组）66例，双号为对照组（B组）52例。对A组从1个月起进行早期干预至24个月。结果：24个月时A组患儿智能发育指数（MDI），运动发育指数（PDI），社会适应能力明显高于B组（P〈0．05），而脑瘫的发生率明显低于B组。结论：对HIE患儿进行早期干预能显著减少脑瘫、精神发育迟滞等后遗症的发生，改善其预后。     

新生儿重度窒息的临床观察及护理

新生儿出生后1 min的Apgar评分≤4者为重度新生儿窒息.新生儿窒息时间过久、程度过深可导致严重的神经系统的后遗症.因此,及时有效的抢救重度窒息儿,缩短新生儿窒息的时间,对改善新生儿预后,提高我国人口素质是非常必要的.     

抚触对窒息新生儿行为神经评分与摄乳量的影响

目的 :探讨抚触对窒息复苏术后新生儿行为神经评分和摄乳量的影响。方法 :对 2 6例窒息新生儿实施新生儿抚触 (17例有窒息史但未施行抚触的新生儿为对照组 ) ,于生后第 7、15和2 8d观察抚触对新生儿行为神经评分与 2 4h摄乳量的影响。结果 :抚触组的摄乳量在生后 7、15和 2 8d分别为 (36 8 0± 17 4 )、(46 5 2± 2 1 0 )和 (5 6 8 9 18 6 )mL ,与对照组比较 ,其摄乳量明显提高 ,从第 7d开始差异就具有显著性 (P <0 0 5 )。抚触组在生后 7、15和 2 8d的行为神经评分为(2 9 2± 1 6 )、(34 7 2 9)及 (38 2± 1 4 )分 ,与对照组相比 ,在第 15和 2 8d ,差异有显著性 (P <0 0 5 ,P <0 0 0 1)。结论 :婴儿抚触有利于窒息新生儿行为神经功能恢复和食欲增加     

围产窒息儿血清类胰岛素样生长因子－1水平变化及意义

目的 :了解围产窒息存活儿血清类胰岛素样生长因子 - 1(IGF - 1)水平变化规律 ,探讨其与缺氧缺血性脑病的关系。方法 :以围产窒息的足月存活儿为对象 ,根据缺氧缺血性脑病程度分为轻度组和中重度组 ,并以正常足月儿为对照 ,于生后 3d内 (急性期 )和 (14± 3)d(恢复期 )采外周静脉血 ,采取双抗体不平衡的放射免疫分析法进行测定。结果 :围产窒息 (轻、中重度 )存活儿生后 3d内 (急性期 )IGF - 1的含量水平与正常对照组差异无显著性 ,而生后 (14± 3)d(恢复期 )IGF -1明显升高 ,显著高于正常对照组 ,且中重度缺氧缺血性脑病组较轻度组升高更加显著。结论 :IGF- 1在围产期窒息脑损伤修复过程中起重要作用。     

Effects of chronic caffeine feeding on the activities of oxygen free radical defense enzymes in the growing rat heart and liver

The purpose of the present study was to determine the relationship between concentration of Zn, Cu and Fe, and the catalase, glutathione peroxidase and superoxide dismutase activities in the heart and liver of newborn rats whose dams were fed a diet supplemented with caffeine. Heart Zn levels of the 22- and 30-day-old rats of the caffeine group showed a decrease, whereas liver Zn levels showed an increase compared to the control. Cu levels in the liver at day 22 in the caffeine group were less than in the control. Cu- and Zn-containing superoxide dismutase activities showed an increase in the hearts of the caffeine group compared to the control. The activity of catalase and glutathion peroxidase showed no difference in the heart and liver between the groups. The present study suggests the possible involvement of superoxide dismutase enzyme in the impairment of heart formation as a result of chronic caffeine intake in the early growing period.