目的 探讨自噬作用在早产儿视网膜病变大鼠病情进展中的调控作用及相关机制.方法 20只SD大鼠随机选取10只孕鼠正常分娩,不做任何特殊处理,待其顺利分娩后选取20只足胎龄幼鼠进行下一步实验;另取10只孕鼠采用脂多糖(LPS)制备早产模型,诱导孕鼠早产,取20只早产幼鼠.将所得幼鼠平均分为正常分娩+空气组、正常分娩+视网膜病变组、早产+空气组、早产+视网膜病变组,每组各10只.对比分析各组大鼠视网膜无血管区和新生血管区面积大小、视网膜血管内皮生长因子(VEGF)和胰岛素样生长因子1(IGF-1)表达水平以及白细胞介素-1β(IL-1β)和白细胞介素-6(IL-6)含量;同时检测幼鼠视网膜组织中自噬小体数量、自噬相关蛋白和Akt、p-Akt、mTOR、p-mTOR蛋白表达水平.结果 相较于正常分娩+空气组,正常分娩+视网膜病变组、早产+空气组、早产+视网膜病变组血管区和新生血管区面积、VEGF和IGF-1 mRNA表达水平、IL-1β和IL-6含量和P62、Akt、p-Akt、mTOR、p-mTOR蛋白表达水平均有所上调,自噬小体数量和自噬相关蛋白Beclin-1、LC3-Ⅱ和ATG5表达水平则有所下降,尤其是以早产+视网膜病变组最为显著(P<0.05).结论 早产儿视网膜病变大鼠病情进展与视网膜组织自噬活性降低有关,且作用机制可能通过Akt-mTOR信号通路调控自噬相关蛋白表达而实现.

Objective To explore the effects of different blue lights combined with phenobarbital in the treatment ot newborn pathological jaundice.Methods A total of 220 newborns with pathologic jaundice were selected and randomly divided into groups A,B and C.Group A was treated with continuous blue light exposure,group B with continuous blue light exposure combined with phenobarbital,and group C with multiple intermittent blue light exposures combined with phenobarbital.The effects,jaundice disappearance time,length of stay (LOS),levels of serum bilirubin and the incidence of adverse reactions among the three groups were compared.Results The overall response rate in groups B and C was higher than that in group A (P ＜ 0.05),and the jaundice disappearance time and LOS were shorter than those in group A (P ＜ 0.05);after the treatment,the levels of serum bilirubin in the three groups decreased(P ＜ 0.05),and the levels of serum bilirubin in groups B and C were lower than those in group A(P ＜ 0.05);the incidence of adverse reaction in group C was significantly lower than those in groups A and B(P＜ 0.05).Conclusion Multiple intermittent blue light exposures combined with phenobarbital has good effects in the treatment of newborn pathological jaundice;it has few side effects and is worthy of clinical popularization.

Objective To explore the pathogen characteristics and drug resistance in neonatal sepsis.Methods Retrospective analysis was conducted on the clinical data of 298 cases of neonatal sepsis treated in Shaanxi Province People' s Hospital during the period of January 2010 to December 2014.Drug analysis was done according to the results of blood culture and drug susceptibility.Results Among 298 cases of neonatal sepsis, 108 pathogenic bacteria strains were found in blood culture, among which 61.11% (66/108) were Gram-negative bacteria, 24.07% ( 26/108 ) were Gram-positive bacteria, and 14.82% ( 16/108 ) were Fungi.The first three were Klebsiella pneumoniae (29.63%, 32/108), escherichia coli (13.89%, 15/108) and pseudomons aeruginosa (6.48%, 7/108) in Gram-negative bacteria.Their drug resistance to piperacillin and piperacillin-tazobactam reached 90%, but that to cefoxitin and cefoperazone/sulbactam was low.No bacterium resistant to carbon penicillin antibiotics was found.Of Gram-positive bacteria, the detection rate of staphylococcus epidermidis (24.69%, 60/243), enterococcus faecium (3.70%, 4/108) and staphylococcus haemolyticus (2.78%, 3/108) were highest.Their resistance to erythromycin and oxacillin were rather high but to cefazolin was low.Staphylococci resistant to vancocin and teicoplanin were not found.Conclusion The main pathogens of neonatal sepsis are Gram-negative bacteria, and their drug resistance rates are higher.There is an increasing trend of incidence of fungal sepsis, which needs more attention.

目的:观察牛肺表面活性剂联合氨溴索治疗早产儿呼吸窘迫综合征(NRDS)的临床疗效.方法:选择2012年1月至2014年12月在陕西省人民医院确诊并接受治疗的NRDS早产儿62例,随机分为对照组32例和观察组30例.两组均给予相同的综合治疗,对照组在综合治疗基础上给予注射用牛肺表面活性剂70 ～ 100 mg/kg气管内滴入,观察组给予注射用牛肺表面活性剂(剂量同上)联合静脉滴注氨溴索7.5 mg/kg治疗,比较两组患儿治疗前后的机械通气参数与血气指标的变化,并比较两组患儿机械通气时间、吸入氧浓度(FiO2)及住院时间.结果:两组治疗前及治疗后血二氧化碳分压(PaCO2)、氧分压(PaO2)、血氧饱和度(SpO2)和pH组内比较差异均有统计学意义(P＜0.05);治疗1h、24h后两组患儿血PaCO2 、PaO2 、SpO2和pH比较差异无统计学意义(P＞0.05).治疗后24h观察组FiO2低于对照组(P＜0.05).两组患儿上机时间及住院时间比较差异无统计学意义(P＞0.05).观察组撤机后氧疗时间较对照组缩短(P＜0.05).结论:牛肺表面活性剂联合氨溴索治疗早产儿RDS可以尽早降低呼吸治疗中吸入氧浓度及撤机后氧疗时间,从而对早产儿的NRDS治疗起到积极作用.

Objective To study the clinical characteristics, pathogens and related factors of neonatal septice-mia, and provide evidence for prevention and early treatment. Methods The clinical data of 298 cases of newborns with neonatal septicemia, who admitted to Department of Neonatology of Shaanxi Provincial People's Hospital from Jan-uary 2011 to December 2014 was retrospectively analyzed. Results The onset time of neonatal septicemia was 2 d and 36 d after birth. All of the patients had poor reaction and feeding intolerance. Laboratory tests showed that all the pa-tients had abnormal white blood cell count, increased C-reactive protein (CRP) and procalcitonin (PCT), and decreased thrombocytopenia. The positive blood culture rate was 36.2%. The most common pathogens were Klebsiella pneumoniae (29.6%), Escherichia coli (13.9%), Staphylococcus epidermidis (13.0%), Pseudomonas aeruginosa (6.5%), Enterococcus fae-cium (4.6%). Premature infant, low birth weight infant, invasive medical operation, amniotic fluid pollution were high risk factors of neonatal septicemia. Conclusion Klebsiella pneumoniae is the main pathogen of neonatal septicemias in our hospital. Infection should be prevented and treated during pregnancy. Antibiotics for neonates are limited, so rational administration should be based on the clinical manifestations and antimicrobial susceptibility tests.

目的 探讨新生儿深部真菌感染的临床表现、病原菌、药物敏感性以及抗真菌治疗效果.方法 回顾性分析2011-01～ 2014-12陕西省人民医院新生儿科收治的新生儿深部真菌感染患儿的临床资料.结果 新生儿真菌败血症的发病率为0.23％,其易感人群为胎龄(31.29±3.61)周、出生体质量为(1478±593.1)g的早产儿.发病时均有反应差、喂养不耐受等表现;实验室检查可有外周血白细胞计数异常,血小板下降,超敏C反应蛋白和降钙素不同程度升高.常见病原菌为光滑假丝酵母菌.真菌败血症治愈率为75％;平均抗真菌治疗为25 d.结论 新生儿真菌败血症病原菌以光滑假丝酵母菌为主,对氟康唑敏感性较高;早期、足疗程抗真菌治疗预后效果较好,治愈率高.

目的：：探讨血清 S100B 蛋白在脑损伤早产儿中的变化及与早产儿临床特点的关系。方法：将符合入选标准的86例早产儿根据影像学检查结果分为无脑损伤组和脑损伤组，采用ELISA 方法检测出生后12h、24h、3d、7d 血清 S100B 蛋白含量变化。结果：86例早产儿中脑损伤发生率为48.8%，脑损伤早产儿出生后12h、24h 及3d S100B 蛋白含量显著高于无脑损伤早产儿(P<0.01)；出生后24h S100B 蛋白含量达峰值，而在出生后7d 脑损伤早产儿与无脑损伤早产儿S100B 蛋白含量无明显差异；以出生后24h S100B 蛋白含量10.0ng/ml 为临界值，脑损伤的发生在早产儿性别及胎龄方面差异无统计学意义，而在胎儿体重以及5minApgar 评分方面有显著差异(P<0.01或 P <0.05)。结论：血清 S100B 蛋白水平可以作为早期诊断早产儿脑损伤的特异指标，而且血清 S100B 蛋白水平与胎儿体重及5minApgar 评分关系密切。

Objective To investigate the clinical effect of milrinone combined with high frequency ventilation in the treatment of neonatal pulmonary hypertension .Methods 40 neonatal patients with pulmonary hypertension in the neonatal intensive care unit (NICU ) of our hospital were selected and randomly divided into two groups ,20 cases in each group .The control group was given the high frequency ventilation ,symptomatic therapy and supportive treat‐ment ,on this basis the treatment group was added with milrinone ,loading dose of 50 μg/kg and maintenance dose of 0 .50 - 0 .75 μg/ (kg ? min) by micropump continuous infusion .The clinical effective rate ,blood gas and blood pres‐sure after 3 d treatment were compared between before and after treatment .Results (1)The symptoms after treat‐ment in the two group were improved ,the effective rate in the treatment group was 85% ,which was significantly higher than 70% in the control group ,the difference was statistically significant (P< 0 .05) .(2)The blood gas levels after treatment in the two groups were improved ,and the improvement in the treatment group was more obvious than the control group ,the difference was statistically significant (P< 0 .05) .(3) the blood pressure after treatment in the two groups was improved ,but the improvement in the treatment group was more obvious ,the difference was statisti‐cally significant (P < 0 .05) .Conclusion Milrinone combined with high frequency ventilation can significantly im‐prove the clinical symptoms of neonatal pulmonary hypertension ,has the guidance significance in clinic and is worth clinical promotion .

早产儿出生时身体各器官未完全发育成熟，在母体外生活能力较弱，出生后还要完成追赶性生长的问题［1］。极低体质量早产儿的出院后的健康问题已经成为世界各国备受关注的问题。为改善早产儿远期预后，短期的住院护理已经远远不能满足需求［2］。居家护理是对住院患者出院后的延伸性护理服务，由于具有良好的成本效益，已经成为许多国家的基本卫生政策［3］。本次研究中主要探究居家护理对极低体质量早产儿出院后生长发育的影响，报道如下。

目的：探讨血浆髓鞘碱性蛋白（MBP）及S100B蛋白与新生儿脑损伤的关系。方法选取2013年1月至2014年6月该院产科出生后24 h内入院的足月获得性脑损伤新生儿50例为研究组，采用超声诊断仪对新生患儿的头颅进行检查，根据头颅B超检查结果，将患儿分为脑室周围‐脑室内出血（PV H‐IV H ）组和局部脑室周围低密度（PVL）组，另选取同期健康新生儿50例作为对照组，检测3组新生儿的血浆S100B蛋白和MBP表达水平。结果新生儿出生24 h内以及出生第3天，PV H‐IV H组新生儿的血浆S100B蛋白水平明显高于对照组，差异有统计学意义（P＜0．05），PVL 组新生儿的血浆 S100B蛋白水平明显高于 PVH‐IVH 组和对照组，差异有统计学意义（P＜0．05）。而新生儿出生后第7天和第14天，对照组新生儿和PVH‐IVH新生儿S100B水平比较，差异无统计学意义（P＞0．05），PVL组血浆S100B水平仍然明显高于对照组和 PVH‐IVH组，差异有统计学意义（P＜0．05）；新生儿出生24 h时，出生第4天、第7天及第14天，PVH‐IVH组新生儿的血浆MBP与对照组新生儿比较差异无统计学意义（P＞0．05），而PVL组新生儿在上述时间点时的MBP水平明显高于对照组及PVH‐IVH组新生儿，差异有统计学意义（P＜0．05）。结论存在脑损伤的新生儿在出生后24 h内血浆S100B和MBP蛋白水平明显升高，但是发生PVL的新生儿的血浆S100B和MBP水平较PVH‐IVH患儿高。

目的：探讨ELISA和荧光定量PCR方法检测EB病毒在小儿传染性单核细胞增多症诊断和治疗中的临床意义。方法：采用ELISA 和荧光定量PCR方法检测182例疑似小儿传染性单核细胞增多症患儿EBV-IgM 抗体与EBV-DNA。结果：182例疑似传染性单核细胞增多症患儿治疗前EBV-DNA检测阳性率显著高于 EBV-IgM 抗体检测阳性率（ P＜0．01）。对84例 EBV-IgM 抗体与EBV-DNA 阳性患儿应用更昔洛韦进行治疗，治疗后7 d及治疗后10 d 患儿 EBV-DNA检测阳性率显著高于EBV-IgM 检测阳性率（P＜0．05），而治疗后14 d患儿EBV-DNA检测阳性率与EBV-IgM 检测阳性率差异无统计学意义（P＞0．05）。结论：EBV-IgM 和EBV-DNA 检测对小儿传染性单核细胞增多症诊断和治疗具有重要价值，尤其是EBV-DNA检测更为敏感。

目的：探讨ELISA和荧光定量PCR方法在诊断小儿多种EB病毒感染相关性疾病中的临床意义。方法：采用ELISA和荧光定量PCR方法检测520例小儿多种EBV感染相关性疾病EBV-IgM 抗体与EBV-DNA。结果：EBV-IgM 检测阳性率和EBV-DNA 检测阳性率在上呼吸道感染、传染性单核细胞增多症、支气管炎及肺炎、特发性血小板减少性紫癜及病毒性心肌炎等EB V相关性疾病患儿有显著差异（ P＜0．01或 P＜0．05）；在上呼吸道感染及传染性单核细胞增多症患儿EBV-DNA检测阳性率显著高于EBV-IgM 检测阳性率（P＜0．01），而在支气管炎及肺炎、特发性血小板减少性紫癜及病毒性心肌炎患儿两种检测阳性率无明显差异（ P＞0．05）。结论：EB V-IgM和EBV-DNA检测对小儿多种EBV感染相关性疾病的诊断具有重要价值，尤其是EBV-DNA检测在某些EB V感染相关性疾病的诊断上更为敏感。

目的 探讨血清降钙素原(PCT)检测对新生儿败血症早期诊断及对治疗的指导意义.方法 选取陕西省渭南市第二医院儿科300例日龄2~26天的新生儿,其中100例正常新生儿为正常对照组,100例新生儿患有单纯败血症者为一般感染组,100例存在合并严重并发症的败血症为严重感染组,应用免疫色谱法进行PCT、C反应蛋白监测,对比分析1周后3组新生儿血浆PCT及C反应蛋白的浓度变化.结果 与正常新生儿组相比,一般感染组PCT和C反应蛋白明显升高(χ2=6.5117,P<0.05);与一般感染组相比,严重感染组PCT和C反应蛋白升高明显(χ2=3.4361,P<0.05);治疗1周后,一般感染组患儿恢复情况优于严重感染组,两组PCT和hsCRP指标比较差异均存在统计学意义(PCT:t=9.1083,P<0.05;hsCRP:t=7.4728,P<0.05).结论 对于新生儿败血症的早期诊断,应首选PCT监测方法,其诊断的敏感度、特异度均优于其他检测方式.

【Objective】 To explore predictive capacity of serum S100B protein for hypoxic-ischemic encephalopathy(HIE) after birth asphyxia. 【Methods】 Serum S-100B protein were examined at cord blood,12 h and 24 h after birth in 36 asphyxiated infants and 16 control infants.The concentrations of S-100B protein in serum were measured by ELISA. 【Results】 At every time interval there was a significant difference in serum protein S-100B concentrations between the asphyxia group and the control group(P0.01).There was a significant difference in serum protein S-100B concentrations among control group,without and with HIE group at 12 h and 24 h after birth(P0.05).The combination of serum protein S-100B at 12h(cutoff value≥2.86 μg/L) and Apgar score at 1 min(cutoff value≤3) had the highest positive predictive value(85.7%)and specificity(97.6%). 【Conclusions】 HIE after birth asphyxia can be predicted reliably by elevated serum concentrations of S-100B protein.

新生儿缺氧缺血性脑病(Hypoxic Ischemic Encephalopathy, HIE)是导致儿童神经系统伤残的主要原因之一,严重者在发病早期死亡或后期造成不可逆的脑损伤.近年来国内外学者积极测定脑组织损伤后的特异生化指标S-100的改变,对于病情的判断、预后的评估、治疗方案的调整等方面有着重要临床意义.

目的:探讨影响儿童癔症的生物、心理、社会因素及临床特征,建立系统有效的预防方法。方法:对符合CCMD-3诊断标准的33例儿童癔症患者的临床资料进行回顾性分析。结果:33例中男、女比例为1.35∶1;有心理刺激因素而诱发者占81.8%,其中以家庭学校矛盾占首位(57.6%),内倾性格占57.5%;临床分型:分离型11例,转换型17例,混合型5例;脑电图检查轻度异常或可疑10例,占30.3%;近期疗效满意。结论:在儿童期营造一个良好的家庭、社会教育环境和塑造一个良好的性格可明显预防和减少本病发病率。

目的探讨双歧杆菌制剂金双歧辅助治疗新生儿高胆红素血症的临床疗效.方法 379例新生儿高胆红素血症患儿随机分为治疗组243例和对照组136例.对照组给予常规治疗,治疗组在常规治疗基础上,加用金双歧片1/2～1片,每天2～3次,温开水溶碎后喂服或经胃管注入,共7～10 d.检测治疗前后两组血清胆红素水平、计算日平均经皮测胆红素下降值、平均住院时间和黄疸消退时间.结果治疗后治疗组与对照组血清总胆红素水平分别为(58.21±4.36)μmol/L和(64.16±5.29)μmol/L(P<0.01);治疗组和对照组日平均经皮测胆红素下降值、平均住院时间和黄疸退尽平均时间分别为(10.35±2.46)、(7.68±1.35)μmol/L,(6.54±2.59)、(9.05±3.12)d,(6.38±1.38)、(8.75±2.68)d,均有显著性差异(P＜0.01).结论金双歧辅助治疗新生儿高胆红素血症,有助于胆红素消退且疗程明显缩短,也可作为干预发生胆红素脑病的有效辅助治疗药物,值得临床应用.

Objective To study the changes of somatostatin(SOM) in plasma and cerebrospinal fluid (CSF) of children with convulsive diseases.Methods Sixty-seven children with convulsive diseases were studied as following:obtaining the samples of plasma in the 1st and 7th day after being in hospital,and the samples of CSF in the 1st after being in hospital.We investigated the changes of SOM in plasma and CSF with radioimmunoassay(RIA).Results 1.Convulsive group:the concentration of SOM in plasma in the 7th day(29.47±9.40 ng/L) was significant lower than that in the 1st day(39.23±11.00 ng/L)(t=21.530 P0.001).Each group in convulsive subjects were significant different(t=16.551,10.968,13.715 P0.01).Encephalitis group without convulsion:The concentration of SOM in plasma in the 7th day(20.57±4.82 ng/L) was lower than that in the 1st day(21.66±5.01 ng/L),but there was no significant difference(t=1.321 P0.05).The concentration of SOM in plasma in the 1st day in control group was(19.58±6.04) ng/L.There were significant differences in convulsive group and encephalitis group without convulsion, control group(t= 6.847,7.921 P0.01).There was also positive difference in each group in convulsive subject(F=56.114 P0.01),2.The concentrations of SOM in CSF in the 1st day was(44.14±12.50) ng/L(convulsive group),(22.88±5.60) ng/L(encephalitis group without convulsion),(18.88±5.27) ng/L(control group),respectively.There were positive differences in convulsive group and encephalitis group without convulsion,control group(t=7.406,7.786 P0.001).Each group in convulsive subjects showed positive difference(F=51.150 P0.01)3.The levels of SOM in plasma and CSF had correlated to the degree of convulsion.The concentrations of SOM in plasma in the 1st and 7th day had significantly positive correlation to those in CSF in the 1st day (r=0.956 P 0.001).Conclusions There are levels of SOM in plasma and CSF in cases with convulsions,changing in the different course of convulsion.The levels of SOM in plasma can indirectly reflect the levels of SOM in CSF,positively correlating with seizure severity.These findings suggest that monitoring SOM in children with convulsive diseases can help to guild diagnosis and treatment of convulsive diseases.$$$$

目的 探讨双歧杆菌制剂金双歧辅助治疗新生儿高胆红素血症的临床疗效.方法 379例新生儿高胆红素血症患儿随机分为治疗组243例和对照组136例.对照组给予常规治疗,治疗组在常规治疗基础上,加用金双歧片1/2～1片,每天2～3次,温开水溶碎后喂服或经胃管注入,共7～10 d.检测治疗前后两组血清胆红素水平、计算日平均经皮测胆红素下降值、平均住院时间和黄疸消退时间.结果治疗后治疗组与对照组血清总胆红素水平分别为(58.21±4.36)μmol/L和(64.16±5.29)μmol/L(P<0.01);治疗组和对照组日平均经皮测胆红素下降值、平均住院时间和黄疸退尽平均时间分别为(10.35±2.46)、(7.68±1.35)μmol/L,(6.54±2.59)、(9.05±3.12)d,(6.38±1.38)、(8.75±2.68)d,均有显著性差异(P＜0.01).结论金双歧辅助治疗新生儿高胆红素血症,有助于胆红素消退且疗程明显缩短,也可作为干预发生胆红素脑病的有效辅助治疗药物,值得临床应用。

[目的]观察东莨菪碱治疗儿童哮喘急性发作的临床疗效.[方法]按随机化原则将62例患儿随机分为观察组和对照组,对照组给予吸入普米克、喘乐宁气雾剂,观察组除吸入普米克、喘乐宁气雾剂外,给予静脉滴注东莨菪碱.观察用药前后患儿症状、体征(咳嗽、气喘、哮鸣音)改善情况及消失天数.[结果]观察组治疗后1 d症状、体征(咳嗽、气喘、哮鸣音)改善分数明显好于对照组(P＜0.01).观察组咳嗽、气喘、哮鸣音消失天数分别较对照组显著缩短(P＜0.01).[结论]对哮喘急性发作患儿,在吸入β2受体激动剂及皮质激素气雾剂的同时加用静脉滴注东莨菪碱,对改善症状和缩短病程疗效显著.