目的 探讨加温湿化高流量鼻导管通气(HHHFNC)预防新生儿拔管失败的效果.方法 选取江西省儿童医院2016年6月～2019年6月新生儿重症监护病房接收的211例应用气管插管后需无创辅助通气患儿为研究对象,按照随机数字表法分为经鼻持续气道正压通气(NCPAP)组(102例)和HHHFNC组(109例).比较两组患儿拔管前平均气道压(MAP)、拔管前吸入氧气浓度(FiO2)、有创呼吸机应用时间和总用氧天数等呼吸参数情况、拔管失败情况、并发症发生情况.结果 两组患儿拔管前MAP和有创呼吸机应用时间、拔管前FiO2浓度等呼吸参数情况比较,差异无统计学意义(P>0.05).HHHFNC组总用氧天数短于NCPAP组,差异有统计学意义(P<0.05).两组拔管失败率比较,差异无统计学意义(P>0.05).HHHFNC组患儿不良事件(医院感染、慢性肺疾病)和并发症(腹胀、鼻部损伤)发生率均低于NCPAP组,差异有统计学意义(P<0.05).结论 相比NCPAP方法,HHHFNC的应用更能有效缩短患儿总用氧天数,减少发生并发症、不良反应,对预防新生儿拔管失败更有意义.

目的 探讨无创高频振荡通气(NHFOV)在预防新生儿拔管失败中的应用效果.方法 选取2017年6月-2020年6月江西省儿童医院收治的60例气管插管后需无创辅助通气的新生儿作为研究对象,按照随机数字表法分为实验组(30例)与对照组(30例).实验组采用NHFOV,对照组采用经鼻持续气道正压(NCPAP)通气.比较两组患儿的无创呼吸机使用天数、用氧天数、住院天数,观察两组患儿撤机后不同时间段的二氧化碳分压(Pa-CO2)、氧分压(PaO2)/吸入氧气浓度(FiO2)指标的变化,记录两组患儿的并发症发生率、不良事件发生率以及拔管失败率.结果 实验组患儿的无创呼吸机使用天数、用氧天数、住院天数短于对照组,差异有统计学意义(P＜0.05);两组患儿治疗前的PaCO2、PaO2/FIO2指标比较,差异无统计学意义(P＞0.05);两组患儿撤机后72 h的PaCO2、PaO2/FiO2指标比较,差异无统计学意义(P＞0.05);实验组撤机后24、48 h的PaCO2、PaO2/FiO2指标高于对照组,差异有统计学意义(P＜0.05);两组治疗72h后的PaCO2、PaO2/FiO2指标与治疗前比较,差异有统计学意义(P＜0.05);实验组患儿的并发症总发生率、不良事件发生率以及拔管失败率低于对照组,差异有统计学意义(P＜0.05).结论 应用NHFOV可预防新生儿拔管失败,改善患儿的供氧情况,降低并发症发生率、不良事件发生率的发生,值得推广.

目的 观察谷氨酰胺(Gln)对新生儿坏死性小肠结肠炎(NEC)的临床预防效果.方法 选取2016年8月至2018年10月住院的早产儿83例,随机分成治疗组35例和对照组48例.两组病人均给予保暖、心电监护、维持内环境稳定、营养支持等常规治疗.治疗组在常规治疗的基础上予以口服或鼻饲Gln.观察两组病人NEC的发生率、严重程度,达到全肠道喂养时间,体重增长情况,住院时间.结果 35例治疗组病人中,有2例出现NEC,发生率5.71％(2/35),无服药不良反应.48例对照组病人中,有11例出现NEC,发生率22.92％(11/48).两组比较,差异有统计学意义(P<0.05),治疗组在达到全胃肠道喂养时间、平均每日增长体重、平均住院时间上,明显优于对照组.结论 通过给早产儿补充Gln,可降低早产儿NEC的发生率,缩短达到全肠道喂养时间和住院时间,平均每日增长体重良好,值得临床推广.

患儿 女,13 d,因"咳嗽、气促、吐沫4 d"入住我院新生儿科.患儿系 G2P3,同卵双胎,双胎之小,胎龄40 周,头位阴道产,出生无抢救窒息史,出生体重2 950 g.父母均体健,母孕期无特殊不适. G1P1,男,1 岁5 个月,体健. G2P2,女,双胎之大,出生体重2 700 g,体健.

目的 探讨电子支气管镜检查在新生儿重症监护病房(NICU)的应用价值及安全性.方法 对我院NICU 2013年6月-2016年6月29例进行电子支气管镜检查的病例进行回顾性分析.结果 29例患儿中,喉软化6例,气管、支气管软化6例,杓状会厌赘生物2例,会厌囊肿2例,杓状会厌粘膜肿胀2例,会厌卷曲1例,气管狭窄1例,气管中段膜部窦道1例,食管性支气管1例,肺出血1例,单纯支气管内膜感染6例.合并支气管内膜感染14例.吸取痰培养标本18例,阳性8例.检查过程中,血氧饱和度下降6例,检查后24h内一过性发热1例.结论 电子支气管镜诊断新生儿呼吸道疾病方面,安全性和确诊性较高,对于喉鸣、三凹征明显及撤机困难病人,应尽快完善电子支气管镜检查,明确病因.

目的 探讨不同程度黄疸足月新生儿的听性脑干反应(ABR)特点.方法 对2010年7月至2011年4月入住我院新生儿科的黄疸(以间接胆红素增高为主)足月新生儿(除外合并缺氧缺血性脑病、颅内出血、颅内感染,机械辅助通气者)进行ABR检测,分别测定Ⅰ、Ⅲ、Ⅴ各波的潜伏期(PL)、波间期(IPL)与振幅(AMP).并根据性别分为男、女婴两组;根据胆红素水平分为3组:轻度组≤250 μmol/L,中度组251 ～ 299 μmol/L,重度组≥300 μmol/L.比较不同性别及不同程度黄疸新生儿的ABR特点.结果 共入选足月黄疸新生儿442例,其中男婴筛查异常率46.2％,女婴筛查异常率29.8％,差异有统计学意义(P＜0.01).男、女婴左耳平均阈值分别为39.6 dBnHL和32.2 dBnHL,右耳平均阈值分别为38.7 dBnHL和34.3dBnHL,男婴均高于女婴,差异有统计学意义(P＜0.01).重度组ABR筛查异常率(40.8％)明显高于轻度组(25.0％),差异有统计学意义(P ＜0.001),重度组与中度组(37.9％)之间、中度组与轻度组之间差异均无统计学意义(P＞0.05);重度组双耳Ⅰ波潜伏期、Ⅴ波潜伏期和Ⅰ～Ⅴ波间期均较轻度组和中度组延长,差异有统计学意义(P＜0.01),轻度组与中度组差异无统计学意义(P＞0.05).结论 黄疸足月儿中男婴听力损失发生率高于女婴.胆红素影响听力不仅表现在阈值升高,同时还存在波潜伏期及波间期延长、振幅降低.随着黄疸程度加重即胆红素水平的升高,ABR波形潜伏期也逐渐延长,达一定水平后影响中枢听觉神经.

Objective To establish and evaluate the effect of the neonatal necrotizing enterocolitis (NEC) model induced by lipopolysaccharide (endotoxin, LPS) combined with formula feeding. Method According to different modeling methods, 0-day-postnatal SD rats were divided into 9 groups randomly, each group including 8 rats. Group A was given formula feeding alone; group B1, B2, B3, B4, B5 and B6 were given formula feeding and LPS intragastric administration, the dosages of LPS were respectively 5, 10, 15, 20, 30, 40 mg/kg in order to screen out the best one; group C was given breast feeding and LPS intragastric administration; group D was set up as control group and given breast feeding only. All rats were weighed every day at regular time. After 3 days feeding and fasting for 24 hours and then all the rats had been sacrificed. Terminal ileum were harvested and observed the intestinal histopathological damage by HE staining, and evaluated the ileal damage by pathological score. The rats with pathological score higher than two were defined as NEC. According to the modeling method of group B5, repeated twice, 8 rats each time, and divided into group B5a and B5b. Result Neonatal rats in group A, B4, B5 and B6 showed various degrees of physical inactivity, tiredness, and then abdominal distention and changes of stool’s color and character. On day 3, the weight of neonatal rats in group A and B had no increase or even loss, and group C and D had weight gain. The terminal weights and weight changes of group A and B were significantly different from that of Group C and D (P<0.05). The pathological score of every group were respectively: group A:1.78±0.52, group B1: 1.76±0.32, group B2: 1.83±0.1, group B3: 1.87±0.33, group B4: 2.16±0.11, group B5: 3.34±0.37, group B6: 3.78±0.51, group C: 0.52±0.42, group D: 0.3±0.48. There were significant differences between model groups B5, B6 and control group D (P<0.05). Among the model groups, the pathological scores of group B5, B6 were significantly higher than group B1, B2, B3 and B4 (P<0.05). There were significant differences between model groups B5, B6 and group A (P<0.05). There were no significant differences between model groups B5a, B5b and group B5. The incidences of NEC in group B4, B5 and B6 respectively were 25%(2/8), 75%(6/8) and100%(8/8). While the incidences of NEC in group A, B1, B2, B3, C and D were all zero.Conclusion When the dosage of LPS was 30mg/kg and combined with formula feeding could induced serious intestinal damage, which had almost the same clinical features and pathological changes as human neonatal NEC. This modeling method has high incidence, good repeatability and high specificity, which could be used in the research of neonatal NEC.

<正>随着医疗技术的进步,高危新生儿的存活率得到很大提高,而其伴随的后遗症也成为临床关注的焦点。脑瘫、智力低下、癫疒间、听力障碍等一系列问题对患儿、家庭和社会都是沉重的负担。幸运的是,早期干预可以将部分后遗症的残障程度最小化,甚至恢复正常。因此早期发现、早期干预对于疾病的预后有着积极的作用。正常的听力是学习语言的前提,严重听力障碍的儿童由于缺乏语言环境刺激,不能建立正常的语言学习,最终轻者导致言语障碍、社会适应能力低下、注意力缺陷、学习困难及情感和智力等一系列心理行为问题,重者导致聋哑[1]。高危