目的 探讨胎龄28～34周早产儿呼吸窘迫综合征(NRDS)INSURE策略失败的高危因素.方法 以收治的NRDS早产儿90例为研究对象,应用INSURE策略治疗,根据INSURE策略的成败,分为成功组和失败组.回顾性分析两组患儿的临床资料.结果 失败组27例(30％)、成功组63例(70％).失败组男性比例、剖宫产率明显高于成功组;而胎龄、出生体重则明显低于成功组,差异有统计学意义(P<0.05).失败组母患妊娠期糖尿病的比例明显高于成功组,差异有统计学意义(P<0.05).应用肺表面活性物质(PS)前,失败组动脉血氧分压(PaO2)、动脉血氧分压及吸入氧浓度比值(PaO2/FiO2)均低于成功组;而动脉血二氧化碳分压(PaCO2)则高于成功组,差异有统计学意义(P<0.05).失败组早产儿视网膜病变(ROP)、颅内出血(ICH)发生率高于成功组(P<0.05);而气胸(PNX)、新生儿坏死性小肠结肠炎(NEC)、支气管肺发育不良(BPD)发生率,两组比较差异无统计学意义(P>0.05).失败组吸氧时间、住院时间高于成功组,差异有统计学意义(P<0.05).多因素logistic回归分析,出生体重<1500 g、PS应用前血气分析PaCO2>55 mmHg、PaO2/FiO2<185是INSURE策略失败的独立危险因素.结论 应用INSURE策略治疗NRDS失败的独立高危因素包括低出生体重、高PaCO2及低PaO2/FIO2.临床工作中应综合分析NRDS患儿存在的各项高危因素,为NRDS患儿选择合适的早期呼吸支持模式.

目的 探讨B群溶血性链球菌(GBS)性脑膜炎临床特点和治疗方案.方法 对2008~2015年我院收治10例GBS败血症合并脑膜炎患儿临床资料行回顾性分析.结果 10例GBS败血症合并脑膜炎患儿中,4例为早发型,其中1例于出生后3d发病,以高热、抽搐入院,3例以气促为最初表现;6例为晚发型,均以中高热为最初表现.6例患儿WBC<4×109/L,3例患儿WBC为(10~20)×109/L,1例患儿WBC>20×109/L.行脑脊液检查,10例GBS均阳性,脑脊液呈典型化脓性脑膜炎改变.行血培养,均显示GBS阳性.入院经X线检查显示,10例均存在肺部感染;出院时7例经MRI检查,1例存在脑膜增厚;3例经头颅CT检查1例存在外部性脑积水.所有患儿均采用青霉素/万古霉素+美罗培南联合治疗,均治愈出院.随访1年,9例后期生长发育正常,1例发育略显缓慢.结论 新生儿GBS脑膜炎临床特点各异,病情严重,针对可疑新生儿,应尽早行血培养以明确致病菌,及时进行脑脊液检查以确诊,早期、足疗程使用敏感抗生素治疗为减少并发症及后遗症之关键.

ObjectiveTo compare the clinical value of humidified high flow nasal cannulae and nasal continuous positive airway pressure in application of mechanical ventilation weaning of newborn.Methods 102 newborns (gestational age ≥28 weeks,admitted to NICU during 2015) who needed endotracheal intubation and mechanical ventilation (≥24 hours) were randomly divided into HHFNC group and NCPAP group after extubation.The clinical effect, the rate of extubation failure and its causes were compared between the two groups.ResultsNo significant differences were found between the two groups in total time on invasive ventilation, non-invasive ventilation and using oxygen (P>0.05). Comparing with NCPAP group,the incidence of nasal impairment and feeding intolerance in HHFNC group was lower (P<0.05), but the rate of extubation failure in HHFNC group was higher (P<0.05). The incidence of extubation failure was 12 cases in HHFNC group, gestational age≤32weeks 10 cases (83.33%), its causes included hyoxemia 1 case (8.33%), hypercarbia 6 cases (50.00%) and apnoea 5 cases (41.67%). The incidence of extubation failure was 4 cases in NCPAP group, gestational age≤32weeks 2 cases (50.00%), its causes included hypercarbia 3 cases (75.00%) and apnoea 1 cases (25.00%).ConclusionComparing with NCPAP, HHFNC can decrease the incidence of nasal impairment and feeding intolerance after extubation, but the clinical effect in neonates whose gestational age ≤32 weeks is not as good as NCPAP.

目的：监测血清中转化生长因子β1（ TGF－β1）的水平变化，探讨其与早产儿视网膜病（ ROP）发生发展的关系。方法以胎龄＜34周或出生体重＜2000 g的早产儿为研究对象，按有无ROP发生分为两组，ROP早产儿（ ROP组）和无ROP早产儿（早产对照组）各30例，另选取足月健康儿30例为足月对照组，分别在早产儿生后第1周及纠正胎龄32、34、36、40周时和健康足月儿于生后3 d内收集外周静脉血，检测血清TGF－β1的水平。结果早产对照组在生后第1周时TGF－β1水平低于足月对照组（P＜0.05）；在纠正胎龄32周后与足月对照组比较差异无统计学意义。 ROP组在生后第1周及纠正胎龄32周时TGF－β1水平明显低于足月对照组及早产对照组（P＜0.05）；在纠正胎龄34、36周时明显高于足月对照组及早产对照组（P＜0.05）。纠正胎龄40周时的ROP组及早产对照组水平与足月对照组比较差异无统计学意义（F＝1．919，P＝0.159）。结论纠正胎龄32～34周是早产儿发生ROP的关键时期，TGF－β1的高表达与ROP的发生发展密切相关。临床或可于关键时期通过TGF－β1抑制剂来预防和治疗早产儿ROP。

目的：探讨肺炎支原体（MP）感染对肠道病毒71型(EV71）感染重症手足口病患儿的病情及预后的影响。方法：回顾分析149例EV71感染重症手足口病患儿MP-IgM抗体的阳性率、临床表现、实验室检查结果、转归等临床资料，比较MP-IgM抗体阳性组和阴性组在临床表现及预后方面的差异。结果：EV71感染重症手足口病患儿MP-IgM阳性率（60.4%）较普通手足口病组高（40.1%），两者相比有统计学差异（X2=21.903，P<0.001）。2期EV71感染手足口病患儿中，MP-IgM阳性组中热程大于3天、呼吸增快、心率增快的比例明显高于MP-IgM阴性组（P均＜0.05）。3期患儿MP-IgM阳性组中热程大于3天、心率增快的比例亦高于MP-IgM阴性组（P均＜0.05）。结论：EV71感染重症手足口病血清MP-IgM抗体的阳性率较普通手足口病高，MP感染可能加重手足口病的病情。

In the present study, the aim was to reveal the relationship of serum IL-6, IL-10 and IL-13 levels in patient with Enterovirus 71 (EV71) infection. To elucidate the role of immune mechanisms in the pathogenesis of Hand, foot, and mouth disease (HFMD), we analyzed the cytokine of 112 EV71-infected patients. A significant elevation of serum (interleukin) IL-6, IL-10 and IL-13 levels in patients with EV71 infection compare with Un-EV71 infection HFMD patient and Healthy individuals. The production of inflammatory cytokines was increased with disease clinical stage. In addition, the immunological consequences of these cytokine in patient with EV71 infection showed a downward trend after cure. These data suggested that EV71 infection significantly increased the release of circulating IL-6, IL-10 and IL-13. The systemic inflammatory response may play an important role in the pathogenesis of HFMD. Moreover, this study may be designed to evaluate the potential therapeutic of medicine in the treatment of patients with EV71 infection.

Objective:To explore the alteration of plasma norepinephrine( NE)and epinephrine( E)in different clinical stages of children with severe hand-foot-mouth disease(HFMD)infected by entero virus 71( EV71)and its clinical sig-nificance. Methods:According to the clinical stages,patients with severe HFMD infected by EV71 who were treated in our hospital from June,2011 to May,2013 were divided into four groups:30 cases for phase 2(Study Group 1),30 cases for phase 3(Study Group 2),16 cases for phase 4(Study Group 3,not containing death cases),6 cases for death group(Study Group 4). The ordinary control group included 30 cases of mild hand-foot-mouth disease. Healthy control group included 30 healthy children during the same period in our hospital. Their plasma were collected respectively during acute phase and convalescence phase(Study Group 1,2 and 3),while the plasma of Study Group 4 were collected during acute phase. Then NE and E in plasma were measured respectively. Results:For NE and E levels in plasma of acute phase,there was no statistically significant difference between study group 1 and ordinary control group. Levels of the other study groups were higher than ordinary control group,and rising as the aggravation of the disease. NE and E levels of the four study groups were higher than healthy control group. For study group1,there were no statistically significant differences among levels of acute phase and convalescence. For study group 2 and 3,the levels of plasma NE and E during convalescence was lower than those during acute phase. Conclusion:Levels of NE and E in plasma of children with severe HFMD infec-ted by EV71 rose visibly,increased sympathetic tone is important pathogenesis of neurogenic pulmonary edema( NpE. Surveying the alteration of plasma NE and E in different clinical periods may act as a benchmark in estimating patient′s condition and curative effect,and calculating NpE.

Objective To investigate the common pathogeny and treatment of neonatal thrombocytopenia. Methods Retrospective analysis about clinical datas of 51 cases of neonatal thrombocytopenia admitted in our hospital Neonatology from January 2009 to December 2011. Results In the pathogeny, 22 cases neonatal infections(43.14%), 11 cases asphyxia at birth(21.57%), 11 cases pathological jaundice(21.57%), 3 cases respiratory distress syndrome(5.88%), 2 cases neonatal scleredema(3.92%), 2 cases multiple organ dysfunction syndrome(3.92%). The rate of cure and improvement was 86.27%, 2 cases death. Conclution Infections and asphyxia are major causes of neonatal thrombocytopenia, so primary disease treatment is critical, complemented by short-term hormone and intravenous gamma globulin, good efficacy, most good prognosis.

患儿,男,出生17min后气促、面色苍白于2013年4月8日收入我科.第3孕第2胎,胎龄38周,因其母瘢痕子宫、地中海贫血、输血后溶血性贫血在我院剖宫产出生,羊水清,Apgar评分8～9分,出生体重2.93kg.体格检查:体温36.2℃,呼吸63次/min,心率145次/min,血压76/48 mmHg,身长47cm,头围33cm.足月儿貌,神志清,反应—般,全身皮肤、黏膜稍苍白,唇周、甲床无紫绀.前囟平,斜径1.0cm×1.0cm,张力不高,双侧瞳孔正圆等大,直径3mm,对光反射灵敏.颈软,胸廓无隆起,三凹征(-),双肺呼吸音粗,对称,可闻及少量湿啰音.心律齐,心音有力,胸骨左缘闻及2/6级吹风样杂音.

Objective To study the common aetiology and the principle of treatment of neonatal hyponatremia.Methods The clinical data of 48 neonatal hyponatremia cases,admitted to our hospital from June 2006 to January 2010,were analyzed retrospectively. Results The main manifestations of neonatal hyponatremia were poor response ( 37.5％ ) and anorexia ( 31.3％ ).The common causes included anoxic diseases during perinatal period,improper feeding,effects of specific diseases,premature birth et al.After active treatment,the serum sodium returned to normal in 47 neonate within three days,except for 1 premature infants died of serious respiratory distress syndrome.Conclusion Neonatal hyponatremia shows no special clinical manifestation.The aetiologies are complicated,which should be treated in different methods correspondingly.The inquiry of feeding history,the treatment of primary illness,the early detection of serum sodium levels and timely correction of the serum sodium levels are very important to improve the successful rate and reduce sequela.

Objective To investigate common complications to small for gestaional age(SGA),and guide clinic therapy.Methods 74 cases of SGA were clinical analyzed in hosiptal from June 2007 to January 2009.Results Among 74 cases of SGA,there were 52 cases complicated hyperbilirubinemia(70.27%),22 cases hypoglycemia(29.73%),18 cases aspiration pneumonia(24.32%),16 cases asphyxia(21.62%),12 cases hypocalcemia(16.22%),6 cases thrombocytopenia(8.11%),1 cases neonatal acute respiratory distress syndrome(1.35%),2 cases subarachnoid hemorrhage(2.70%) and 1 cases neonatal hypoxia ischemic encephalopathy.Some cases had 2 to 3 kinds of complications.Conclution There were more complications after birth of SGA.Medical personnel should strengthen monitor,discover and intervene early,to reduce the risk of sequel and improve the living quality of SGA.

目的探讨前置胎盘产前出血对新生儿临床病理的影响。方法根据产前出血量的多少,将我院新生儿科近4年收治的前置胎盘产前出血新生儿分为2组,小出血A组22例和大出血B组18例,回顾性分析2组患儿的各项临床资料。结果 B组新生儿的胎龄、出生体重明显低于A组;完全性前置胎盘、贫血、酸中毒、CK-MB增高、颅内病变的发生率明显高于A组,平均住院天数明显多于A组;2组性别、Apgar评分、HCT水平及治愈率无统计学差异。结论早产、低出生体重,贫血和休克,缺氧缺血性损害是前置胎盘产前出血新生儿的主要临床病理特征。与产前小出血患儿相比,大出血患儿的胎龄、出生体重更低,贫血发生率更高,各项缺氧缺血性损害更明显。

目的:探讨生长激素释放肽(Ghrelin)与小于胎龄儿(SGA)生长追赶的关系。方法:选择SGA和适于胎龄儿(AGA)各30例,分别于出生后3 d、1个月及1岁时测量生长发育指标及检测血浆Ghrelin值。结果:SGA组在出生后3 d及1个月时的体质量、身长、头围、BMI水平均明显低于AGA组(P均<0.05);1岁时SGA组的体质量、头围、BMI水平与AGA组比较差异无统计学意义(P>0.05),但身长仍低于AGA组(P<0.05)。SGA组在出生后3 d及1个月时的血浆Ghrelin水平高于AGA组,1岁时两组Ghrelin水平比较差异无统计学意义(P>0.05)。SGA组在出生后3 d及1岁时血浆Ghrelin水平与体质量呈负相关,AGA组在3个时间点上Ghrelin水平均与体质量呈负相关。结论:SGA在出生后头1年存在明显的生长追赶。SGA出生时的高Ghrelin水平,反映了胎儿在宫内的不良营养状态。其追赶生长与体内的高水平Ghre-lin密切相关。

目的 了解早产儿视网膜出血相关的临床高危因素.方法 对在我院住院的208例早产儿生后2周内由眼科进行眼底检查,并记录其性别、胎龄、孕周、吸氧、分娩方式、原发病等临床资料,对结果进行统计学分析.结果 208例早产儿中视网膜出血20例,发生率9.6%,视网膜出血分度以Ⅱ度居多(52.5%).多因素Logistic回归分析示出生体重≥2kg、顺产分娩、卵圆孔未闭是视网膜出血的危险因素.结论 早产儿视网膜出血在临床上并不少见,本研究发现其发病率低于足月新生儿.出生体重、分娩方式、卵圆孔关闭情况可能与该病发生有关,值得临床重视.

Objective:To investigate the high-risk factors,clinical characteristics and preventing methods of newborn pneumothorax.Methods:The data were analyzed that 26 cases of newborn pneumothorax admitted in our hospital from Jan.2003 to Apr.2011.Results:26 cases were secondary pneumothorax,in which 13 cases were inhalant pneumonia(50.0%),11 cases were respiratory distress syndrome(42.3%),11 cases were respiratory distress syndrome and pneumonia(7.7%).14 cases were asphyxia when born(53.8%),6 examples cases used breathing lug in cardiopneumonopexy(23.1%).17 cases once with machanical ventilation(65.4%),7 cases used the lung surface-active substance(26.9%).Two-sided pneumothorax 3 cases(11.5%),single side pneumothorax 23 cases(88.5%).The compression area,30% 15 cases(57.7%),≤30% 11 cases(42.3%).23 cases were cure(88.5%),1 case death because of giving up treatment,2 cases discharged from hospital automatically.Conclusion:The newborn pneumothorax often occurs in the infants with original lung disease,the iatrogenic pneumothorax is not rare because of machanical ventilation.So enhancing the understanding of newborn pneumothorax,using the respiratory machine and breathing lug correctly,may reduce the occurrence of pneumothorax.

Objective To investigate the function and relationship among Ghrelin,insulin growth factor-1 (IGF-1) and Leptin in the small for gestational age (SGA). Methods Thirty SGA newborn infants as study group and 30 appropriate for gestational age (AGA) newborn infants as control group born in obstetrics of our hospital were enrolled. Their body weight,length,head circumference and body mass index(BMI) at birth were measured and calculated,then the blood levels of Ghrelin,IGF-1 and Leptin at the third day were examinated. Results The body weight,length,head circumference and BMI of infants in SGA group were all lower than those in the group of AGA [(2280±190) g vs (3220±320) g,(46.3±1.8)cm vs(50.5±2.0) cm,(31.8±1.1)cm vs(33.6±1.1)cm,(10.6±0.8)cm vs(12.6±0.9)cm,all P<0.05]. The blood levels of IGF-1 and Leptin in SGA group were lower than that in AGA group [(49.6±10.3)μg/L vs(55.3±9.9)μg/L,(2.4±0.8)μg/L vs(3.0±1.0)μg/L],but Ghrelin higher [(25.2±11.0)μg/L vs(17.3±7.4)μg/L],P<0.05. In two groups,IGF-1 was positively correlated with weight,Leptin had a positive correlation with weight and length,but Ghrelin was negatively correlated with weight and BMI,all P<0.05. In both groups,Ghrelin was negatively correlated with IGF-1,while IGF-1 was positively correlated with Leptin; in SGA group,Ghrelin was also negatively correlated with Leptin,all P<0.05. Conclusions The infants in SGA group have high level of Ghrelin,but low levels of IGF-1 and Leptin. Ghrelin,IGF-1 and Leptin might all involve in the adjustment of intrauterine growth retardation,playing the roles of coordination and antagonism mutually.

目的 通过观察宫内发育迟缓的婴儿血中胰岛素样生长因子-1(IGF-1)及瘦素(Leptin)水平的变化情况,探讨其在宫内发育迟缓婴儿生长发育过程中的意义.方法 将足月新生儿分为小于胎龄儿(SGA)组和适于胎龄儿(AGA)组,各30例.分别在出生后3 d、1个月及1岁时测定血IGF-1和Leptin浓度,同时测量其体重、身长,并计算BMI,分析其相关性.结果 SGA组在出生3 d和1个月时IGF-1、Leptin水平均低于AGA组(P<0.05),而1岁时两组比较差异无统计学意义(P>0.05).SGA组和AGA组各时期的血清IGF-1与Leptin水平呈正相关,两者与3个时期的体重均呈正相关,而部分时期与身长、BMI均无明显相关关系.结论 SGA生后第1年追赶生长最活跃,IGF-1和Leptin作为促生长激素在其中起着不可替代的作用.测定IGF-1和Leptin水平可为预测宫内发育迟缓婴儿追赶生长能力提供一定的参考.

目的探讨胃饥饿素（Ghrelin）、胰岛素样生长因子-1（IGF-1）及瘦素（Leptin）在足月小于胎龄儿（SGA）中的作用及其关系。方法本院产科出生的足月SGA和适于胎龄儿（AGA）各30例,生后测量体重、身长、头围,并计算体重指数（BMI）,生后第3天测定血Ghrelin、IGF-1及Lep-tin水平。结果 SGA组体重、身长、头围、BMI均明显低于AGA组[（2280±190）g比（3220±320）g,（46.3±1.8）cm比（50.5±2.0）cm,（31.8±1.1）cm比（33.6±1.1）cm,（10.6±0.8）cm比（12.6±0.9）cm,P均〈0.05]。SGA组血清IGF-1及Leptin水平均低于AGA组[（49.6±10.3）μg/L比（55.3±9.9）μg/L,（2.4±0.8）μg/L比（3.0±1.0）μg/L],血浆Ghrelin水平高于AGA组[（25.2±11.0）μg/L比（17.3±7.4）μg/L],P均〈0.05。两组IGF-1与体重呈正相关,Leptin与体重、身长呈正相关,Ghrelin与体重、BMI呈负相关,P均〈0.05。两组Ghrelin水平与IGF-1呈负相关,IGF-1与Leptin呈正相关;SGA组Ghrelin水平与Leptin呈负相关,P均〈0.05。结论生后早期SGA新生儿存在高Ghrelin、低IGF-1、低Leptin水平状态。Ghrelin、IGF-1及Leptin共同参与胎儿宫内营养的调节,相互起协同及拮抗作用。

目的:探讨不同剂量猪肺磷脂注射液治疗足月新生儿呼吸窘迫综合征(NRDS)的临床疗效及安全性。方法:20例足月NRDS患儿随机分为A、B组各10例,均予相同的常规药物治疗和机械通气治疗,在此基础上A组予气管内注入猪肺磷脂注射液100 mg/kg,B组予气管内注入猪肺磷脂注射液50 mg/kg。观察两组患儿使用猪肺磷脂注射液治疗前及治疗后6、12、24h PaO2及PaCO2水平,比较两组的机械通气时间和住院时间,记录治疗过程中的并发症。结果:与治疗前比较,A、B组患儿治疗后各时点PaO2均明显升高(P均<0.05),PaCO2无明显改变(P均>0.05),两组间比较差异均无统计学意义(P均>0.05)。A组机械通气时间为(108±13)h,住院时间为(19.1±4.6)d;B组机械通气时间为(102±21)h,住院时间为(17.0±4.1)d,两组比较差异均无统计学意义(P>0.05)。治疗过程中A组4例发生气胸,B组无1例发生气胸。结论:猪肺磷脂注射液治疗NRDS疗效确切,100 mg/kg剂量与50 mg/kg疗效接近,而后者安全性较高。

Objective To investigate the clinical features of neonatal scleredema and etiology.Methods From January 1999 to December 2008 the Court treated the 118 cases of neonatal scleredema on gestational age,weight,at birth,the clinical features and prognosis were retrospectively analyzed,and the etiology of conduct before and after the five Comparative analysis of the year.Results Infection,perinatal asphyxia,premature birth is more common neonatal scleredema pathogenic factors.Conclusion Strengthen the pathology of neonatal treatment and perinatal care,early prevention of infection,improve the microcirculation oxygen supply can reduce the incidence of neonatal scleredema and improve their prognosis.