目的 研究碳氧血红蛋白在新生儿ABO溶血病中的诊断价值。方法 将患者分为三组,选取144例足月新生儿ABO溶血病患儿为溶血组(A组),选取同期160例不合并溶血的足月黄疸新生儿为非溶血性黄疸组(B组),同时与88例足月健康新生儿(C组)对比。分析三组间碳氧血红蛋白、总胆红素、红细胞计数等有无差异。结果 溶血组患儿的碳氧血红蛋白水平较健康新生儿高,两组间差异有统计学意义(P＜0.001)。同时,溶血组患儿的碳氧血红蛋白水平较非溶血性黄疸组患儿高,两组间差异有统计学意义(P＜0.001)。碳氧血红蛋白在非溶血性黄疸组和健康新生儿组无统计学差异。碳氧血红蛋白ROC曲线值为1.27%时诊断新生儿ABO溶血病的敏感度和特异度最高(分别为90%和70%,P＜0.001)。溶血组患儿总胆红素水平与碳氧血红蛋白呈正相关关系(r=0.83523,P＜0.001),非溶血性黄疸患儿总胆红素水平与碳氧血红蛋白无相关性(r=0.12571,P＞0.05),溶血组患儿组总胆红素水平低于非溶血性黄疸患儿,而碳氧血红蛋白水平高于非溶血性黄疸患儿(P＜0.001)。结论 碳氧血红蛋白对新生儿ABO溶血病的诊断有临床意义,同时碳氧血红蛋白检测可作为体内胆红素产生量的指标,其有助于黄疸病因的鉴别、诊断及治疗。

Objective To explore clinical significance of determination of carboxyhemoglobin in ABO hemolytic disease of the newborn. Methods A total of 392 cases were randomly selected in the study. The experiment consisted of three groups: a total of 144 newborns consecutively hospitalized with ABO hemolysis were treated as experimental group(Group A); 160 newborns with hyperbilirubinemia and without hemolysis were collected(Group B); and 88 healthy newborns at term were the control group(Group C). Carboxyhemoglobin, serum total bilirubin and hemoglobin was collected and were compared with in the three subgroups. Results Compared with group C, carboxyhemoglobin were higher in ABO hemolytic disease(P<0.001). Compared with group B, carboxyhemoglobin were higher in ABO hemolytic disease(P<0.001), while carboxyhemoglobin showed no significant difference between group B and C (P>0.05). A carboxyhemoglobin cut-off value of 1.27% had 90% sensitivity and 70% specificity for predicting prescription. There was a positive correlation between total bilirubin level and carboxyhemoglobin level in newborns with ABO hemolysis(r=0.83523,P＜0.001). Conclusion Carboxyhemoglobin indicates the procedure of ABO hemolytic disease of the newborn, which is helpful to diagnose the cause of hyperbilirubinemia and taken as a guide in therapy.

目的 探究肺表面活性物质联合高频振荡通气治疗新生儿呼吸窘迫综合征的有效性及安全性。方法 选取我院新生儿科2016年2月—2018年7月收治的120例呼吸窘迫综合征新生患儿作为研究对象,随机将其分为常规组和试验组,每组各60例。常规组实施肺表面活性物质联合常频振荡通气治疗,试验组采取肺表面活性物质联合高频振荡通气治疗,比较两组治疗前后的肺氧合功能和并发症发生情况。结果 PaO₂、OI、a/A PO₂等指标在治疗前两组差异无统计学意义(P＞0.05),治疗后试验组均要优于常规组,差异有统计学意义(P＜0.05);常规组的并发症发生率为35.0%(21/60),试验组的并发症发生率为18.3%(11/60),试验组低于常规组,差异有统计学意义(P＜0.05)。结论 新生儿呼吸窘迫综合征采用肺表面活性物质联合高频振荡通气治疗效果显著,并发症少,安全性高。

目的 探讨新生儿高促甲状腺素血症转归与先天性甲状腺功能减低的相关性。方法 选择2014年4月—2015年4月在本院新生儿疾病筛查中心筛查并诊断为高促甲状腺激素血症的患儿120例,期间密切监测甲状腺功能指标变化。结果 将非治疗组所有患儿按照入组该实验后首次抽取静脉血TSH检测水平分为3组:5.5~10.0 mU/L(20例)、10.1~15.0 mU/L(10例)、＞15.0 mU/L (8例)。非治疗组患儿第2次随访结果显示5.5~10.0 mU/L组所有患儿TSH水平<10.0 mU/L;10.1~15.0 mU/L组有1例患儿TSH水平＞10.0 mU/L,FT4水平在正常值上限;＞15.0 mU/L组有3例患儿 TSH水平＞10.0 mU/L,差异有统计学意义(P< 0.05),FT4水平在正常均值左右,差异没有统计学意义(P＞ 0.05),＞15.0 mU/L组3例患儿给予左旋甲状素钠治疗。治疗组有2例患儿分别在治疗15天和23天后出现医源性甲状腺功能亢进,停药和酌减药量后TSH、FT4水平均恢复正常。两组患者随访结束后TSH、TF4均恢复至正常水平。结论 大多数新生儿高促甲状腺素血症会随着年龄的增长恢复正常,而仅仅有少部分患儿会持续出现甲状腺功能异常,应积极随访;新生儿只有当TSH 基础值＞15.00 mU/L时才需要采用左旋甲状素钠替代治疗,并且严格随访甲状腺功能,避免过度治疗。

目的 研究低Apgar评分新生儿外周动脉(非脐动脉,以下同)血pH对新生儿窒息诊断的作用。方法 选取本院出生Apgar评分1min≤7分活产婴儿158例,复苏后1 h内,平均(33±3.9)min,抽取外周动脉血气,分析其pH与Apgar评分及多器官损害关系,以探讨它们之间作为窒息诊断的互补性。结果 复苏后的外周动脉血pH值比脐动脉血pH值高,动脉血pH与Apgar 评分呈正相关。1min Apgar评分4～7分组中pH＞7.25者占67%(109/158),且几乎在5min时Apgar评分转至8分以上,提示可能没酸中毒或窒息。动脉血pH在7.25以下或1min Apgar评分0～3分者发生多器官损害率较高,而4～7分者且pH＞7.25时多器官损害率较低。与目前窒息的诊断标准对比,本组符合率降低,可能与采用复苏后的外周动脉而非脐动脉血pH有关。结论 外周动脉血pH一定程度上可反映窒息情况,低Apgar评分不等同窒息,动脉血pH及多器官损害是判断低Apgar评分新生儿是否窒息的重要互补因素,采用复苏后才抽取的外周动脉血pH判断窒息时,如果仍以pH＜7.20为标准,可能会造成漏诊。

目的 通过超声造影成像技术( CEUS)观察颈动脉斑块内新生血管的情况,探讨颈动脉斑块的厚度与新生血管的关系。方法 选择颈动脉粥样硬化患者40例,经常规超声确诊存在斑块,共64个,应用CEUS成像技术检测斑块内新生血管情况。结果 不同厚度的颈动脉斑块的增强强度与斑块厚度成正相关(r=0.897 6,P=0.000 0)。结论 超声造影成像技术可以在常规超声的基础上通过检测斑块内的新生血管,进而判断斑块的性质,提供更多有用的信息进一步评估颈动脉斑块内新生血管增强强度与斑块厚度存在线性正相关性。

Objective To evaluate the neovascularization in carotid plaques by gray-scale harmonic contrast echocardiography (CEUS), and to investigate the relationship between the thickness of carotid artery plaque and the neovascularization.Methods 40 patients with carotid atherosclerosis were selected, and 64 plaques were diagnosed by regular ultrasound. The neovascularization in plaques was detected by CEUS imaging technique.Results The enhanced strength of carotid plaques with different thickness was positively correlated with plaque thickness (r=0.8976,P=0.0000).Conclusion Ultrasound contrast imaging can detect angiogenesis within the plaque based on conventional ultrasound, and then determine the nature of the plaque. More useful information is provided to further evaluate the linear positive correlation between the intensity of neovascularization and the thickness of plaque in carotid plaque.

目的 分析神经营养类药物单唾液酸四己糖神经节苷脂(monosialotetrahexosylganglioside,GM1)与胞磷胆碱(citicoline)联合使用在新生儿缺血缺氧性脑病(neonatal hypoxic-ischemic encephalopathy,NHIE)的临床疗效并探讨其可能的作用机制。方法 收集2014年1月—2017年6月在广州市第一人民医院新生儿病房住院的54例新生儿缺血缺氧性脑病患儿的临床资料,将收集到的患儿随机分为2组,对照组27例,治疗组27例。治疗组与对照组的治疗的不同在于前者予以单唾液酸四己糖神经节苷脂GM1联合胞磷胆碱治疗,而对照组仅用单唾液酸四己糖神经节苷脂GM1,无用胞磷胆碱。治疗三个疗程后,比较2组用药前后的临床表现、神经功能评分及MRI变化情况。结果 治疗组中临床总有效24例(88.9%);对照组中总有效17例(63.0%)(P<0.05);经过三个疗程后2组的神经功能评分均有上升,且治疗组的效果更明显(P<0.05);MRI检查示2组较用药前病灶范围减少,水肿减轻,治疗组改善更明显(P<0.05)。即经过三个疗程治疗后,两组患儿病情均有好转,且治疗组疗效更明显。结论 神经营养类药物GM1联合胞磷胆碱通过修复、重构神经元、改善其代谢等促进受损的神经功能的恢复,在新生儿缺血缺氧性脑病的应用中具有良好的疗效。

Objective To analysis the clinical therapeutic effect of monosialotetrahexosylganglioside and citicolineon neonatal hypoxic-ischemic encephalopathy, and explore its possible mechanism.Methods A total of 54 newborn with hypoxicischemic encephalopathy were enrolled from January 2015 to June 2017 in Guangzhou First People's Hospital, and they were divided into control group and treatment group according to the treatment methods, with 27 cases in the control group and 27 cases in the treatment group. Both groups were treated with conventional treatment, the control group added gangliosides, and the treatment group used ganglioside and citicoline. The clinical effects, neurological score and MRI were observed in the two groups.Results The total effective rate was 88.9% in the treatment group,which was higher than 73.0% in the control group (P<0.05). There was no significant difference on neurological score between the two groups before treatment (P>0.05). After treatment, the neurological scores of the two groups were significantly improved, and the score of the treatment group was higher than that of the control group (P<0.05). MRI examinations found that the lesions were significantly improved in the two groups after treatments, and the effect of the treatment group was higher than that of the control group (P<0.05).Conclusion Monosialotetrahexosylganglioside combined with citicolineinthe in treatment of newborn with hypoxicischemic encephalopathy has good effects through repairing and rebuilding the neurons, improving the metabolism to promote the recovery of neurological functions.

目的 探讨孕母甲状腺疾病的新生儿第一个月生长速率和甲状腺功能与2岁时神经发育结局之间的相关性。方法 2013年1月—2014年12月在我院出生的156例孕母甲状腺疾病的新生儿为实验组,观察其第1个月体质量、身长及头围生长的速率,生后当天、第7天、第28天的总甲状腺素(TT4)及促甲状腺素(TSH)的水平;妊娠期无高危因素的母亲分娩的正常新生儿中随机抽取150例为正常对照组,观察生后新生儿第1个月体质量、身长及头围生长的速率,2组均在2岁内分别每3个月均接受随访评估,2岁时行贝利婴幼儿发展量表进行Bailey智力发育指数(MDI)、精神运动发育指数(PDI)的评分。采用回归分析检验新生儿生后第一个月体质量、身长及头围生长的速率,新生儿生后当天、第7天、第28天的TT4及TSH水平与中位数的差值与2岁时MDI、PDI之间的关联性。结果 ①实验组生后第1个月体质量(29.5±4.2 g/d)、身长(1.18±0.67 cm/周)及头围(0.79±0.39 cm/周)生长的速率慢于正常对照组的体质量(35.4±6.3 g/d)、身长(1.69±0.85 cm/周)及头围(1.10±0.42 cm/周)生长的速率,2组差异有统计学意义(t值分别为9.672、5.882、6.768,P均<0.05);②实验组2岁时MDI(108±15)、PDI评分(109±16)低于正常对照组MDI(115±14)、PDI评分(118±11),2组差异有统计学意义(t值分别为16.129、21.279,P均<0.05);③实验组孕母甲状腺疾病的新生儿生后第1个月体质量、身长及头围生长的速率与2岁时MDI、PDI呈正相关(相关系数分别为:0.874,0.842,0.890,0.857,0.871,0.845,t值分别为22.584,59.296,65.441,61.214,62.662,59.507,P均<0.05);④实验组孕母甲状腺疾病的新生儿生后当天、第7天及第28天的TT4及TSH水平与中位数的差值与2岁时MDI、PDI呈负相关(相关系数分别为:-0.878,-0.894,-0.890,-0.690,-0.654,-0.702,t值分别为73.167,81.273,74.166,11.523,10.548,12.103,P均<0.05)。结论 母亲妊娠期患有甲状腺疾病会影响新生儿生后第1个月体质量、身长、头围生长的速率及2岁时的精神运动、智力发育,落后于母亲妊娠期无高危疾病的正常新生儿。另外孕母甲状腺疾病的新生儿第1个月体质量、身长及头围生长的速率和生后当天、生后第7天 及第28天的T4及TSH的水平与2岁时MDI、PDI密切相关。

Objective To investigate the correlation between the growth rate, thyroid function in the first month and neurodevelopmental outcome at the age of 2 in the infants of the maternal thyroid disease. Methods We chose 156 infants of maternal thyroid disease from January 2013 to December 2014 born in our hospital as the experimental group and 150 normal infants of their mothers without high risk factors during pregnancy as the control group. We observed the rate of weight, length and head circumference growth in the first month and TT4 、TSH level at the 1^st day, 7^th day, and 28^th day after birth. We followed up two groups every 3 months up to the age of 2. We assessed Bailey mental development index (MDI) and psychomotor development index (PDI) at the age of 2. Regression analysis was used to test the correlation between the growth rate, TT4,TSH level in the 1^st month and MDI, PDI at the age of 2. Results ① The rate of growth rate in the 1^st month of the experimental group was slower than the control group. It was statistically significant difference between the two groups (P<0.05); ②MDI, PDI at the age of 2 in the experimental group were lower than those of the control group. It was statistically significant difference between the two groups (P<0.05); ③The rate of growth rate in the first month of the experimental group was positively related to MDI and PDI at the age of 2.④The difference between the level of TT4,TSH at the 1^st day, 7thday, and 28^th day and the median after birth was negatively related to MDI and PDI at the age of 2. Conclusion The maternal thyroid disease will affect the first month growth rate and neurodevelopmental outcome at the age of 2 of their infants. Their infants will grow behind than the normal newborns on pregnancy without high-risk disease.The growth rate of the first month and the level of T4 and TSH on the 1^st day, 7^th day, and 28^th day in maternal thyroid disease are closely related MDI and PDI at the age of 2.

目的 通过波幅整合脑电图(aEEG)长程监测评估胆红素水平(TSB)、脑干听觉诱发电位(BAEP)及脑电图(EEG)异常程度对足月新生儿睡眠结构的影响。方法 对159例高胆红素血症足月新生儿行12小时床边监测长程脑电图,计算aEEG上睡眠-觉醒周期(SWC)安静睡眠(QS)时间长度比例、收集当日的TSB、BAEP及EEG结果。结果 在159例病人中,数据可视化结果显示随着胆红素水平的升高、EEG及BAEP异常程度的增加,QS期的比例逐渐减少。逐步广义线性模型结果证实胆红素水平及EEG异常是导致安静睡眠比例减少的主要因素,而BAEP异常程度则不显著。结论 随着胆红素水平的增高及脑电图异常率的增加,足月新生儿睡眠-觉醒周期安静睡眠比例逐渐减少,SWC结构发生改变。

Objective To investigate the impacts of total serum bilirubin level (TSB), EEG and BAEP abnormalities to full term neonates' sleep-wake cycles' (SWC) structure through the amplitude-integrated electroencephalography (aEEG). Methods Quiet sleep (QS) ratio of SWC within 12 hours of 159 neonates with hyperbilirubinermia were obtained from the aEEG traces, total serum bilirubin (TSB) level, EEG and BAEP results of the recording day were also recorded. Results QS ratio of SWC decreased along with the elevated TSB level, EEG and BAEP abnormality in 159 cases. Furthermore stepwise generalized linear regression model comfirmed the TSB level, EEG abnormalities were the key factors for the reduced QS ratio while the BAEP was no statistically significant. Conclusion Full term neonates' SWC showed a constructive change by means of QS ratio reduction according to the elevating TSB level and EEG abnormality.

目的 探讨科学的出院后营养管理对肠道术后新生儿体格追赶的效果,分析影响体格追赶的相关因素。方法 通过营养门诊对出院术后婴儿及社区婴儿进行个体化营养喂养指导和营养咨询,比较两组每月体质量、身长及头围,并随访至生后9月龄。两组生后半年生长趋势行重复测量检验。结果 第1月龄时,手术组患儿体质量、身长、头围均落后于对照组婴儿(P<0.001, P=0.004, P=0.008),第2月龄时,手术组患儿体质量、头围仍落后于对照组(P=0.003,P=0.031),第4月龄时,手术组体质量低于对照组(P=0.012),第5～9月龄,两组体格指标均无明显差异。生后半年内两组的生长趋势差异无统计学意义。前半年身长的增长与出生身长、父母文化以及父亲的不良习惯存在负相关关系,头围的增长与住院天数呈明显负相关关系、与出生以及首诊时的体格状况呈正相关关系。结论 合理喂养对新生儿肠道术后体格追赶有利,帮助其接近正常生长曲线。再次手术可能是导致体质量增长下降的主要因素,但未明显影响身长、头围的正常增长。出生时和就诊时的体格状况、父母教育程度和不良习惯以及住院天数均是影响体格追赶的相关因素。

Objective To investigate the effect of scientific nutrition management after discharge on neonatal physical catch-up after intestinal operation, and to analyze the related factors affecting physical catch-up. Methods Individualized nutritional feeding instruction and nutrition consultation were performed on infants and community infants after discharge from hospital through nutrition clinic. The monthly body weight, body length and head circumference were compared between the two groups, and followed up to 9 months old. The growth trend of the two groups in half a year after birth was tested by repeated measurement. Results At the first month of age, the body weight, body length and head circumference of the patients in the operation group were lower than those in the control group (P<0.001, P=0.004, P=0.008). At the second month, the body weight and head circumference of the operation group were still behind those of the control group (P=0.003, P=0.031), and at the fourth month of age, the weight and head circumference of the patients in the operation group were still lower than those in the control group. The body weight of the operation group was lower than that of the control group (P=0.012), and there was no diffence in the physical indexes between the two groups at the age of 5~9 months. There was no statistical significance in growth trend between the two groups within half a year after birth. The growth of body length in the first half of the year had a negative correlation with the length of birth, parents' culture and father's bad habits. The growth of head circumference had a negative correlation with the length of stay in hospital, and had a positive correlation with the physical condition at birth and at first visit. Conclusion Reasonable feeding is beneficial to the physical catch-up of the newborn after intestinal operation and helps them approach the normal growth curve. Reoperation may be the main cause of weight loss, but it does not affect the normal growth of body length and head circumference. The physical condition at birth and medical visit, parents' education level, bad habit and hospitalization days were all related factors of physical catch-up.

目的 探讨妊娠期高血糖患者母体胰岛β细胞自身抗体对新生儿的影响。方法 选取2014年3月—2016年3月于我院就诊的口服75 g葡萄糖耐量试验(OGTT)异常的孕妇共276例,以60例健康孕妇作为对照组,分别在产前和OGTT试验后空腹抽取静脉血进行检测,检测指标包括谷氨酸脱羧酶抗体(GADA)、胰岛细胞抗体(ICA) )和胰岛素自身抗体(IAA),记录每个出生患儿的体重、Apgar评分、血糖指标进行分析。结果 276例GDM患者中34.41%至少存在一种相关抗体阳性,GDM组GADA阳性、IAA阳性和阴性的搏动指数异常比例均高于健康组(P<0.05),IAA阳性的胎儿生长受限比例比例较GDM组抗体阴性的比例高(P<0.05),妊娠晚期胰岛细胞抗体阳性(OR:6.41,95%CI:1.41~34.13)均为新生儿产后进入ICU进行监护的风险因素,妊娠中、晚期GADA阳性(OR:10.26,95%CI:1.42~75.14) 和妊娠晚期GADA阳性(OR:8.15,95%CI:1.43~46.83)均为新生儿窒息的风险因素 。结论 妊娠晚期胰岛细胞抗体阳性为新生儿产后进入ICU进行监护的风险因素,妊娠中、晚期GADA阳性是新生儿窒息的风险因素。