目的 探讨血清单核细胞趋化蛋白-1(MCP-1)及细胞间黏附分子-1(ICAM-1)在早产儿视网膜病变(ROP)发生发展中的作用及早期预测价值.方法 前瞻性研究.选择2021年3月至2022年3月徐州医科大学附属医院新生儿重症监护室收治的出生胎龄＜32周或出生体重＜2 000 g的早产儿95例(190眼).收集早产儿出生时胎龄、体重、性别、1 min及5 min Apgar评分、分娩方式等一般资料.根据ROP筛查结果分为ROP组(46例)和非ROP组(49例).于出生后第1、7、14、21、28天分别采集早产儿外周血,ELISA检测早产儿血清MCP-1和ICAM-1水平,并比较各时间点的动态变化,采用受试者工作特征(ROC)曲线及曲线下面积(AUC)评价血清MCP-1及ICAM-1对ROP的早期预测价值.结果 两组早产儿胎龄、出生体重、性别、1 min及5 min Apgar评分、分娩方式、新生儿败血症发生率差异均无统计学意义(均为P＞0.05).ROP组与非ROP组早产儿血清MCP-1、ICAM-1水平差异均有统计学意义(均为P组间＜0.001);ROP组早产儿血清MCP-1水平在出生后第1天轻度上升,第7天下降,第14、21天再次上升,第28天轻度下降;ICAM-1水平在出生后第1、7、14天持续上升,第21、28天下降;且ROP组早产儿在出生后各时间点的血清MCP-1、ICAM-1水平均高于非ROP组,两组早产儿出生后第1、7、14、21、28天血清MCP-1及ICAM-1水平差异均有统计学意义(均为P时点＜0.001);两组时点与组间存在交互效应,提示两组早产儿血清MCP-1及ICAM-1水平随时间点变化趋势的差异均有统计学意义(均为P交互＜0.01).出生后第7天早产儿血清MCP-1、ICAM-1及联合预测对ROP的预测灵敏度分别为67.4％、78.3％、67.4％,特异度分别为89.8％、77.6％、93.9％,AUC分别为0.84、0.81、0.86.结论 血清MCP-1及ICAM-1可能参与了 ROP的发生发展过程.出生后第7天对其检测可能有助于ROP的早期预测.

目的 探讨早产儿生后1个月维生素D水平影响因素,为防治维生素D水平缺乏及不足提供依据.方法 选择2020年4月～2022年2月徐州医科大学附属医院新生儿重症监护室收治的胎龄≤34周早产儿为研究对象,根据生后1个月血清25-羟维生素D水平分为维生素D水平缺乏组、不足组及充足组;并收集相关信息.采用单因素分析及二元Logistic回归等统计方法,筛选出早产儿生后1个月维生素D水平的影响因素.结果 单因素分析显示,孕母补钙或维生素D水平时长、孕期有无抽筋、胎龄、出生季节、静脉营养时长及有无新生儿败血症、中重度支气管肺发育不良、坏死性小肠结肠炎、胆汁淤积症与早产儿生后1个月维生素D水平有关(P＜0.05).多因素二元Logistic回归显示,孕期抽筋、胎龄≤32周、冬春季出生、静脉营养时间长是早产儿生后1个月维生素D水平缺乏及不足的独立危险因素(P＜0.05,OR＞1);孕母补钙或维生素D≥3个月是早产儿生后1个月维生素D水平缺乏及不足的保护性因素(P＜0.05,OR＜1).结论 早产儿生后1个月维生素D水平缺乏及不足现象较普遍;孕母钙或维生素D的补充、孕期抽筋与否、胎龄、出生季节、静脉营养时长均可影响早产儿生后1个月维生素D水平营养状况.

目的 比较容量保证(VG)与压力控制(PC)两种机械通气模式在呼吸窘迫综合征(RDS)早产儿中的应用效果.方法 前瞻性选择2017年03月至2021年04月NICU收治的胎龄<32周或出生体质量<1500 g,需要有创机械通气的RDS早产儿作为研究对象,按简单随机法分为VG组和PC组.比较两组拔管前的呼吸机参数及动脉血气,有创机械通气时间、总呼吸支持时间及平均住院时间,并发症发生率及病死率.结果 最终RDS早产儿79例完成研究,男46例、女33例,平均胎龄(30.1±1.2)周,平均出生体质量(1239.0±158.0)g,VG组36例、PC组43例.与PC组比较,VG组在拔管前的平均气道压较低,有创机械通气时间、总呼吸支持时间以及平均住院时间均缩短,差异有统计学意义(P<0.05).结论 在RDS早产儿的机械通气治疗中,VG通气可能是一种更加安全有效的通气方式,但仍需要大样本、多中心的临床试验证实.

目的 探讨血清血红素氧合酶-1(HO-1)、高迁移率族蛋白B1(HMGB1)在早产儿支气管肺发育不良(BPD)发病中的作用及近期神经系统发育评估中的价值.方法 选取2019年12月至2021年3月徐州医科大学附属医院新生儿重症监护室收治的96例早产儿作为研究对象.根据BPD诊断标准分为BPD组40例和非BPD组56例.根据矫正胎龄36周时需吸入氧浓度(FiO2)情况将BPD组分为轻度亚组(未用氧)、中度亚组(FiO2<30％)及重度亚组(FiO2≥30％或需机械通气).采用ELISA法检测两组早产儿出生后第1、7、14、28天血清HO-1、HMGB1水平,于出生后1周内及矫正胎龄40周时监测振幅整合脑电图(aEEG)评分.比较两组早产儿出生后第1、7、14、28天血清HO-1和HMGB1水平和出生后1周内及矫正胎龄40周时aEEG评分,同时分析BPD组早产儿血清HO-1、HMGB1水平与aEEG评分的相关性.结果 BPD组早产儿出生后第7、14、28天血清HO-1、HMGB1水平均高于非BPD组,差异均有统计学意义(均P<0.05);而两组早产儿出生后第1天血清HO-1、HMGB1水平比较差异均无统计学意义(均P>0.05).BPD轻度、中度及重度亚组早产儿出生后1周内、矫正胎龄40周时aEEG评分均低于非BPD组,差异均有统计学意义(均P<0.05);BPD中度及重度亚组早产儿出生后1周内、矫正胎龄40周时aEEG评分均低于轻度亚组,重度亚组早产儿出生后1周内、矫正胎龄40周时aEEG评分均低于中度亚组,差异均有统计学意义(均P<0.05).BPD组出生后第7天血清HO-1、HMGB1水平与出生后1周内aEEG评分均呈负相关(均P<0.01),出生后第7、14、28天血清HO-1、HMGB1水平与矫正胎龄40周时aEEG评分均呈负相关(均P<0.01).结论 HO-1、HMGB1可能与早产儿BPD的形成有关,并可能影响早产儿的近期神经系统发育.

目的 观察新生大鼠缺氧缺血性脑损伤后脑组织的病理损伤改变、脑组织内质网应激相关因子激活转录因子6(ATF6)、肌醇需求因子1(IRE1)、双链RNA依赖的蛋白激酶样内质网激酶(PERK)的分布及表达变化.方法 7 d龄新生大鼠分为假手术组(Sham组)和缺氧缺血性脑损伤组(HIBD组).采用改良Rice法建立HIBD模型.对造模72 h时间点的脑组织进行苏木精-伊红(HE)染色观察大脑病理变化,尼氏染色观察皮质及海马区神经元损伤情况,采用免疫组化法检测各组大鼠大脑皮质及海马区ATF6、IRE1、PERK的表达情况.造模后6、24、72 h分别处死大鼠,采用Western blot法检测各时间点ATF6、IRE1、PERK蛋白表达情况.结果 HIBD后72 h,HE染色显示Sham组未见神经细胞损伤,HIBD组可见脑组织神经细胞损伤,且主要损伤部位为脑皮层及海马区域.尼氏染色显示HIBD组皮质及海马区受损神经元比例均高于Sham组,差异有统计学意义(P<0.001).免疫组织化学染色显示,与Sham组比较,HIBD组脑组织大脑皮质及海马区中ATF6、IRE1、PERK阳性细胞数(棕黄色)增加(P<0.001).HIBD组神经细胞胞质及核内ATF6表达均增加,胞核内IRE1及胞质内PERK表达增加.HIBD组ATF6、IRE1、PERK各时间点的蛋白相对表达水平均高于Sham组,差异有统计学意义(P<0.05).结论 新生大鼠缺氧缺血性脑损伤后,脑损伤的部位主要在大脑皮质及海马区,且大脑皮质及海马区组织内质网应激因子表达升高,提示内质网应激相关因子参与其病理性损伤.

目的 探讨未足月胎膜早破(PPROM)早产儿生后肠道菌群的特征及其与早发败血症(EOS)的关系,为EOS的早期诊断和治疗提供依据.方法 选择2019年3月—2020年9月徐州医科大学附属医院新生儿科收治的38例PPROM早产儿,根据EOS诊断标准将其分为EOS组(20例)及非EOS组(18例),另外选择10例正常早产儿作为对照组.利用高通量测序技术检测并分析各组早产儿生后1d内粪便样本菌群的差异.结果 在多样性分析中,3组粪便菌群的Chao1指数差异无统计学意义,EOS组的Shannon指数显著低于非EOS组及对照组,差异有统计学意义(P<0.05).在门水平上,3组之间厚壁菌门、变形菌门和拟杆菌门的相对丰度差异无统计学意义(P>0.05);EOS组的放线菌门相对丰度低于对照组(P<0.05).在属水平上,EOS组的克雷伯菌属相对丰度高于非EOS组及对照组,EOS组的肠球菌属低于非EOS组及对照组,EOS组的梭菌属、乳杆菌属、双歧杆菌属低于对照组,非EOS组的脲原体属及链球菌属高于对照组,差异均有统计学意义(P<0.05).5例血培养阳性患儿所鉴定出的病原菌均为肠道菌群中相对丰度最高的菌属.结论 PPROM早产儿肠道菌群的多样性降低,克雷伯菌属、葡萄球菌属等条件致病菌的相对丰度升高,有益菌的相对丰度降低可能与EOS的发生有关.

目的 探讨导致新生儿机械通气撤机失败的影响因素及寻找预测指标减少撤机失败率.方法 回顾性分析我院2015年1月至2019年12月新生儿重症监护病室350例机械通气时间≥72 h并存活的新生儿.根据撤机48 h内是否再次插管,分为撤机成功组与撤机失败组.比较两组撤机前一般情况、临床变量、呼吸机设置及血气分析,撤机后无创通气模式及雾化情况.单因素及多因素分析确定高危因素,并预测指标价值.结果 47例(13.4％)发生撤机失败.单因素分析显示15个变量是撤机失败的影响因素(P<0.05).Logistic回归分析示机械通气时间长、吸痰耐受能力差、多脏器损害、高PCO2、撤机时自主呼吸及心率快是撤机失败的高危因素(P<0.05).PCO2预测撤机失败价值高,AUC为0.819(0.738,0.900),P<0.001.结论 多种因素与撤机失败相关,应针对高危因素进行干预,撤机前进行充分预测评估以减少撤机失败率.

目的 研究脐静脉置管对极低出生体质量儿早期肠道菌群的影响.方法 选择2019年6月至2020年6月新生儿监护室收治的41例极低出生体质量儿作为研究对象.根据是否进行脐静脉置管,分为脐静脉置管组24例和非脐静脉置管组17例.收集新生儿生后第1、3、7天的粪便样本,应用高通量测序技术对粪便样本中的细菌16 S基因全长进行测序,比较两组间各个时间段肠道菌群多样性及相对丰度.结果 入选41例新生儿中,男26例、女15例,胎龄30.0(29.3～30.6)周,出生体质量(1.25±0.10)kg.第1天肠道菌群检出率低.第3天,脐静脉置管组和非脐静脉置管组之间shannon指数差异无统计学意义(P>0.05),组间各个菌群相对丰度差异无统计学意义(P>0.05).第7天,与非脐静脉置管组相比,脐静脉置管组shannon指数较低,变形菌门相对丰度较大,厚壁菌门及放线菌门相对丰度较小,克雷伯菌属相对丰度较大,双歧杆菌属及肠球菌属相对丰度较小,差异均有统计学意义(P均<0.05).结论 脐静脉置管可改变极低出生体质量儿早期肠道菌群的构成,降低肠道菌群多样性.

目的 探讨新生大鼠缺氧缺血性脑损伤后脑皮质组织Caspase-12表达及意义.方法 7d龄新生SD大鼠30只随机分为三组,每组10只.缺氧缺血组和抑制剂组参照Rice法成功制备新生大鼠缺氧缺血性脑损伤模型,后者造模成功后予侧脑室注射Caspase-12特异性抑制剂Z-ATAD-FMK;对照组为假手术组.三组72 h后取脑组织标本,RT-PCR法和Western blot法分别检测大脑皮质组织Caspase-12 mRNA和活化的Caspase-12蛋白表达,原位末端标记染色法检测神经元细胞凋亡情况,HE染色光镜下观察脑组织病理变化.结果 与对照组比较,缺氧缺血组和抑制剂组Caspase-12 mRNA表达、活化的Caspase-12蛋白表达及细胞凋亡率均升高(P＜0.05),但抑制剂组低于缺氧缺血组(P＜0.05),且脑组织病理改变较轻.结论 新生大鼠缺氧缺血性脑损伤后脑皮质组织Caspase-12表达升高,表明内质网应激参与其病理损伤;选择性抑制Caspase-12表达,可减少细胞凋亡,发挥脑保护作用.

目的 探讨早产儿外周血胱抑素C(cystatin C,Cys C)水平变化及其临床意义.方法 选取2018年1月—2018年6月于徐州医科大学附属医院新生儿科住院治疗的早产儿89例,男47例,女42例,平均胎龄(32.78±2.26)周,平均体重(1.94±0.48)kg,采用颗粒增强透射免疫比浊法检测其生后第3天外周血Cys C水平,采用SPSS 18.0软件进行统计学处理,比较不同胎龄、性别、出生体重、生产方式、Apgar评分及母亲有无合并妊娠期高血压、胎膜早破时Cys C水平差异,分析Cys C和胎龄、出生体重、Apgar评分、肌酐(creatinine,Cr)、尿素氮(blood urea nitrogen,BUN)、血清总胆红素(total bilirubin,TBIL)水平的相关性.结果 早期早产儿Cys C水平明显高于中、晚期早产儿,差异有统计学意义(P<0.05),中、晚期早产儿比较差异无统计学意义(P>0.05);极低出生体重早产儿CysC水平高于低出生体重及正常出生体重早产儿,差异有统计学意义(P<0.05),而低出生体重早产儿与正常出生体重早产儿比较差异无统计学意义(P>0.05);3、5分钟Apgar评分<8分的早产儿Cys C水平明显高于>8分早产儿,差异有统计学意义(P<0.05);母亲合并胎膜早破的早产儿Cys C水平高于无胎膜早破早产儿,差异有统计学意义(P<0.05);不同性别、生产方式、TBIL水平及母亲有无合并妊娠期高血压早产儿Cys C差异无统计学意义(P>0.05).相关分析显示:Cys C水平与Cr、BUN呈明显正相关(P<0.05),与胎龄、出生体重、Apgar评分呈负相关(P<0.05),但相关关系不密切(r<0.5),与TBIL水平无相关性(P>0.05).结论胎龄、出生体重、5分钟Apgar评分、母亲合并胎膜早破均为早产儿Cys C水平的影响因素,胎龄越小、出生体重及5分钟Apgar评分越低早产儿Cys C水平越高,且呈负相关,此类早产儿应高度警惕肾脏损害存在,而性别、生产方式、TBIL水平及母亲合并妊娠高血压对Cys C水平无明显影响.

目的 探讨妊娠期宫内感染对胎龄＜37周早产儿免疫指标的影响及相关机制,为临床诊治提供参考依据.方法 收集2016年10月-2018年4月在徐州医科大学附属医院娩出的早产儿189例为研究对象,其中宫内感染组86例,未感染组103例.比较出生后24 h、7d的外周血T淋巴细胞亚群(CD3+、CD4+、CD8+)、免疫球蛋白(IgG、IgM、IgA)、白细胞介素(IL-6、IL-8、IL-1β)及肿瘤坏死因子(TNF-α)水平.收集脐带血,分离脐带血单个核细胞(UBMC),RT-PCR检测细胞中Tlr2、Tlr4、Socsl、Socs3 mRNA表达水平;使用细菌脂多糖LPS刺激未感染组UBMC,检测不同刺激时间(lh、3h、6h、12 h)的Tlr2、Tlr4、Socs1、Socs3 mRNA表达水平.结果 出生后24h、7d感染组早产儿血清CD3+、CD4+、CD8+水平明显高于未感染组,IgG、IgM、IgG水平明显低于未感染组,IL-6、IL-8、IL-1β、TNF-α水平明显高于未感染组(均P＜0.05).感染组早产儿UBMC中Tlr2、Tlr4、Socs1、Socs3 mRNA表达水平明显高于未感染组(均P＜0.05).LPS刺激各时间点Tlr2、Tlr4、Socs1、Socs3 mRNA表达水平均明显高于空白对照组(均P＜0.05);其中Tlr2 mRNA表达在LPS刺激3h时达到峰值,Tlr4 mR-NA表达在LPS刺激1h时达到峰值,Socs1和Socs3 mRNA表达在LPS刺激3h时达到峰值.结论 宫内感染可引发早产儿体内免疫指标异常改变,其机制可能通过Toll样受体和Socs信号通路调节体内免疫反应.

OBJECTIVE To investigate the percentages of peripheral blood γδ T cells and regulatory T cells (Treg) and the expression of associated cytokines, interleukin 17 (IL-17) and transforming growth factor-β1 (TGF-β1), in infants with human cytomegalovirus (HCMV) infection. METHODS Twenty-two infants with HCMV infection (HCMV group) and 22 healthy infants who underwent physical examination (control group) were enrolled in this study. The percentages of peripheral blood γδ T cells and Treg cells were determined by flow cytometry. The levels of IL-17 and TGF-β1 in plasma were measured using ELISA. RESULTS Compared with the control group, the HCMV group had significantly higher percentage of γδ T cells and IL-17 level (P<0.01) and significantly lower percentage of Treg cells and TGF-β1 level (P<0.01). In the HCMV group, the percentage of γδ T cells was negatively correlated with the percentage of Treg cells and TGF-β1 level (P<0.05), but positively correlated with IL-17 level (P<0.05); the percentage of Treg cells was positively correlated with TGF-β1 level (P<0.05), but negatively correlated with IL-17 level (P<0.05); there was no correlation between IL-17 level and TGF-β1 level (P>0.05). CONCLUSIONS There is an imbalance between γδ T cells and Treg cells in the peripheral blood of infants with HCMV infection, and γδ T cells may be involved in the secretion of IL-17.

OBJECTIVE:To compare the efficacy between synchronized intermittent mandatory ventilation (SIMV) and pressure support ventilation with volume guarantee (PSV+VG) in the weaning phase of preterm infants with respiratory distress syndrome (RDS). METHODS:Forty preterm infants with RDS who were admitted to the neonatal intensive care unit between March 2016 and May 2017 were enrolled as subjects. All infants were born at less than 32 weeks' gestation and received mechanical ventilation. These patients were randomly and equally divided into SIMV group and PSV+VG group in the weaning phase. Ventilator parameters, arterial blood gas, weaning duration (from onset of weaning to extubation), duration of nasal continuous positive airway pressure (NCPAP) after extubation, extubation failure rate, the incidence rates of pneumothorax, patent ductus arteriosus (PDA) and bronchopulmonary dysplasia (BPD), and the mortality rate were compared between the two groups. RESULTS:The PSV+VG group had significantly decreased mean airway pressure, weaning duration, duration of NCPAP after extubation, and extubation failure rate compared with the SIMV group (P<0.05). There were no significant differences in arterial blood gas, mortality, or incidence rates of pneumothorax, PDA and BPD between the two groups (P>0.05). CONCLUSIONS:For preterm infants with RDS, the PSV+VG mode may be a relatively safe and effective mode in the weaning phase. However, multi-center clinical trials with large sample sizes are needed to confirm the conclusion.

目的:了解感染所引起的新生大鼠感染性脑组织中Sox17和(髓鞘碱性磷酸酶)MBP的表达.方法:将64只2日龄SD大鼠随机分为对照组、实验组.实验组生后第2～6d持续腹腔注射脂多糖(LPS)每日0.6 mg/kg(0.01 ml/g).对照组则按照相同的注射方式及注射剂量,给予生理盐水,建立新生大鼠脑白质损伤模型.注射后按观察时间点不同分为1d、3d、7d、15 d,4个亚组(n=8).处死大鼠取出脑白质,HE染色观察脑白质区病理变化,Western Blot法测定各组脑组织中Sox17和MBP蛋白的表达,RT-RCR法检测Sox17和MBPmRNA的表达变化.结果:实验组大鼠生长发育缓慢,HE染色显示脑白质区出现组织水肿,部分核固缩、核碎裂.PCR和Western Blotting结果发现Sox17在生后1d开始表达,7d达高峰,随后下降,各时间点实验组与对照组相比差异有统计学意义(P＜0.05).MBP在实验组的表达显著下降,各时间点实验组与对照组相比差异有统计学意义(P＜0.05).结论:生后感染可导致新生大鼠脑白质损伤,MBP表达减少,Sox17表达明显升高,提示Sox17剂量的升高对感染后新生大鼠脑组织可能具有保护性修复作用.

Objective To analyze the expression changes of placental growth factor(PLGF) in neonatal rats with hypoxic-ischemic brain damage,and to discuss the possible roles of PLGF in alleviating cerebral ischemia,promoting regeneration of blood vessels as well as the protective effects of Shenfu injection on the expression of PLGF.Method All the neonatal rats were randomly divided into three groups:sham operation group (S),Shenfu injection treatment group (SF),and saline control group (C).They were further divided into five subgroups(n=8 per subgroup) according to the time points:6 h,12 h,1 d,3 d,7 d.Models of postnatal 7-day Sprague Dawley rats with HIBD were established with Rice methods.Group SF was treated with Shenfu injection (10 mg/kg,ip) immediately after hypoxic-ischemic brain damage (HIBD).The injection lasted for three days once a day at the same time.Group C was treated with saline in the same way with the same dosage.There was no treatment with any drugs in Group S.RT-PCR and immunohistochemistry method were used to detect the changes of PLGF in the lesion side cerebral cortex in neonatal rats.Results Expression of PLGF in group S was the same at different time points(P＞0.05);In group C,the expression of PLGF started to increase at 6 h,and reached a peak at 1 d and then gradually declined.The expression level was higher than S group from 12 h to 7 d(P＜0.05);In SF group,the expression increased before 6 h,and the tendency of expression was similar to C group;However it had a more obvious decline at 3 d.The whole level was apparently higher than S and C groups.Conclusion The expression levels of PLGF increase highly after hypoxic-ischemic brain damage,and Shenfu injection can protect the brain from damage effectively through facilitating the expression of PLGF.

Objective To analyze high risk factors for poor prognosis in the refractory neonatal respiratory distress syndrome(NRDS).Methods A retrospective analysis was conducted at NICU in the Affiliated Hospital of Xuzhou Medical university.The newborns with NRDS,chest radiograph for grades 3 and 4,who required mechanical ventilation and pulmonary surfactant(PS)therapy were recruited from January 2014 to December 2015.According to treatment rusults,they were divided into death group(21 cases)and survival group(25 cases).Data regarding antenatal corticosteroid administration,maternal high risk factors,the basic situation of neonatal in the perinatal period,surfactant applications,the blood routine,albumin,lactate dehydrogenase(LDH),creatine kinase(CK),creatine kinase isoenzyme(CK-MB),blood coagulation function with the first 24 hours after birth were collected and analyzed.Results The frequency of using PS in the death group and the survival group was(2±0.9)times and(1.5±0.6)times,the difference between the two groups was statistically significant(t=2.131,P=0.039).Dangerous placenta previa in death group was 19％(4/21),in the survival group was 0％(0/25),the two groups had statistical differences(x2=5.215,P=0.022).CK in death group was(541.5±399.1)U/L,in the survival group was(345.4±173.3)U/L,the difference between of the two groups was statistically significant(t=2.224,P=0.031).Prothrombin time(PT)in the death group was(23.2±6.3)s,in the survival group was(18.5±3.6)s,there was a significant difference between the two groups(t=3.008,P=0.039).Maternal risk factors of premature rupture of the survival group(38.9％)was higher than that of death group(5.0％),the two groups was statistically significant(x2=4.29,P=0.038).The application of prenatal hormone NRDS newborns were more likely to survive,there was statistical difference between two groups(x2=5.197,P=0.023).Multivariate Logistic analysis showed that PT was an independent risk factor for poor prognosis of NRDS.Conclusion PT is an independent risk factor for poor prognosis of neonatal respiratory distress syndrome.

目的 总结本院NICU住院超过30d早产儿的临床特点,分析导致住院时间长的原因.方法 选择2011年1月-2014年12月本院NICU住院超过30 d的104例早产儿为研究对象,采用回顾性分析方法,对性别、胎龄、出生体质量、孕母导致早产的高危因素、Apgar评分、住院期间合并症、转归、住院费用等进行总结和分析.结果 在这104例早产儿中,男62例,女42例,平均胎龄(31.0±2.1)周,平均出生体质量(1 506±341)g,其母妊高症、重度子痫前期、胎膜早破是导致早产主要原因(64例,67.8％),5min Apgar评分＜7分的占71.7％,合并症中常见的以新生儿呼吸窘迫综合征(NRDS)最多见,共89例(85.6％),84例(80.8％)患儿有呼吸机使用史,其中有创机械通气60例(57.7％),平均呼吸机使用时间(14.3±9.9)d,使用肺表面活性剂的87例(83.7％),其次是新生儿肺炎和呼吸机相关性肺炎(61.5％)、呼吸暂停(48.1％)、新生儿败血症(40.4％)、慢性肺病(32.7％).好转出院90例(86.5％),放弃11例,死亡3例,出院时宫外发育迟缓80例(76.9％),有33例出院前行头颅MRI或CT、脑干诱发电位检查,均有不同程度异常.平均住院时间(40.7±10.8)d,人均住院费用(50 299±18 314.2)元.结论 胎龄、出生体质量、合并症多且重是导致早产儿住院时间长的主要原因,而合并症中仍以呼吸系统疾病和感染为主,积极预防早产和治疗各种早产儿并发症是缩短早产儿住院时间的重要举措.

Objective To study the protective effect of ceftriaxone against hypoxic-ischemic brain injury in neonatal rats, and investigate its mechanism. Methods Neonatal SD rats were randomly divided into Sham group, model group, and ceftriaxone group, and each group was divided into 6 h, 12 h, 24 h, 3 d, 5 d, and 7 d subgroup with 8 rats according to observation time. Rats in the Sham group were performed only by incision of neck and right common carotid artery dissection without ligation. Rats in the ceftriaxone group and model group were successfully established hypoxic ischemic brain damage (HIBD) models. Rats in the Sham group and model group were ip administered with normal saline after the operation, 10 mL/kg, once daily, treated for 3 d. Rats in the ceftriaxone group were ip administered with Ceftriaxone Sodium for injection after the operation, 200 mg/kg, once daily, treated for 3 d. Hot plate test method was used to record hot plate test time in neonatal rats. HE staining was used to observe the pathological changes of cortex. FADD expression was detected by Western blotting method. The number of FADD positive cells was detected by immunohistochemical staining. Results Compared with the model group, hot plate test time in the ceftriaxone group were significantly shorter on days 3 and 5, and there were differences between two groups (P < 0.05). By optical microscope observation, brain tissue cell arrangement in ceftriaxone group was still rule, the volume slightly larger, and a slight edema changes. Compared with the model group, FADD expression and positive cells numbers in the ceftriaxone group were obviously decreased at various time points, (P < 0.05). Conclusion Ceftriaxone can down-regulate FADD expression in cerebral cortex of neonatal rats with HIBD, reduce neuron cell apoptosis, improve behaviors, and play neuroprotective effect.

目的 探讨参附注射液对缺氧缺血性脑损伤(HIBD)新生大鼠皮质区钙离子相关蛋白钙网蛋白(CRT)的表达、细胞内游离Ca2+浓度以及神经元凋亡的影响,探讨其可能的脑保护机制.方法 将7日龄新生SD大鼠随机分为对照组、缺氧缺血组和参附干预组,各组进一步分为缺氧缺血后3、6、12、24、72h5个亚组,每组均10只.参照Rice等法制备HIBD模型.参附干预组于造模成功后立即腹腔注射参附注射液10 mL/(kg·d),连用3d.缺氧缺血组和对照组注射等量生理盐水.HE染色观察大鼠病变侧脑组织病理变化;RT PCR及Western-blot法检测各组CRT的表达变化;荧光显微镜法检测脑细胞中游离Ca2+浓度;流式细胞术检测神经元凋亡率.结果 缺氧缺血组和参附干预组各时间点CRT mRNA及蛋白表达量均较对照组升高(P＜0.05),且参附干预组较缺氧缺血组升高(P＜0.05);缺氧缺血组各时间点细胞内游离Ca2+浓度均较对照组明显升高(P＜0.05),参附干预组细胞内游离Ca2+浓度较缺氧缺血组降低(P＜0.05),但仍高于对照组(P＜0.05);参附干预组各时间点的神经元凋亡率均明显低于缺氧缺血组(P＜0.05),但较对照组仍升高(P＜0.05).结论 参附注射液可能通过上调CRT的表达,降低细胞内钙超载来减轻新生大鼠缺氧缺血性脑损伤.

目的:研究TRPM2在缺氧缺血性脑损伤新生大鼠脑皮层内的表达变化,以探讨其在缺氧缺血性脑损伤中的作用,并初步探讨参附注射液(SFI)干预治疗后对其影响及可能机制.方法:制备新生大鼠HIBD模型,将新生7日龄SD大鼠随机分为假手术组(S组)、模型组(HI组)、参附治疗组(SF组),HI组、SF组按术后观察时间点不同进一步分为6h、12h、1天、3天、5天、7天6个亚组,每组8只.处死时观察每只新生大鼠脑组织的大体形态;并用免疫组化和Western Blotting法检测各组病变侧脑组织TRPM2蛋白的表达变化.结果:①脑大体形态观察:模型组大鼠结扎侧半球脑组织受损严重,1天时苍白、水肿明显,体积明显大于对侧.S组大鼠大脑半球左右对称,未见任何病理变化.②Western blotting结果:HI组TRPM2蛋白的表达水平在各时间点均较S组明显升高(P＜0.05).TRPM2在HIBD后3天达到高峰,随后开始下降.SF组在l天、3天、5天、7天时TRPM2的水平均低于HI组(P＜0.05),但高于S组(P＜0.05).③免疫组化染色结果:C组病变侧大脑皮层TR-PM2阳性细胞数在HIBD后3天达到高峰,随后降低,SF组在HI后3天、5天、7天的相应时间点TRPM2阳性细胞数均低于HI组(P＜0.05),但高于S组(P＜0.05).结论:①新生大鼠HIBD后病变侧大脑皮层TRPM2的表达水平明显升高,并具有时间差异性,表明其参与了HIBD的病理过程,可能在HIBD诱导的细胞凋亡中发挥重要作用.②参附注射液能够下调TRPM2的表达,从而起到对HIBD新生大鼠的保护作用.