早产儿呼吸窘迫综合征经鼻间歇正压通气治疗的Meta分析

Objective To agsess the efficacy of nasal intermittent positive pressure ventilation (NIPPV)in treatment of respiratory distress syndrome(RDS) in premature infants.Methods According to the requirements of Cochrane systematic review,a thorough literature search was performed among PubMed(1977-2008),Embase(1989-2008),OVID,Cochrane(2008),Chinese Digtal Hospital Library (www.chkd.cnki.net) and Chinese Biomedical Literature Disk Database(CBMdisc).Quality assessments of clinical trials were carried out Randomized controHed trials(RCTs)with NIPPV and RDS were enrolledand ReVnlan 4.2 software was used for meta-analysis.The trials were analyzed using relatire risk(RR) for dichotomous data,weighted mean difference(WMD) were used for continuous data,both kind of data were expressed by 95% confidence intervals(95%CI).For homogenous data(P≥0.10),fixed effects model was calculated,for heterogeneity data(P<0.10),random effects model was calculated.Results Five RCTs involving 284 premature infants diagnosed as respiratory distress syndrome(RDS) were included.Three studies comparing NIPPV with nasal continuous positive airway pressure(NCPAP) in the postextubation period,tHe extabation failure rate was 8.34%vs 40.79% in NIPPV group and NCPAP group,the NIPPV group had significantly lower extubation failure rates[RR 0.21(95%CI:0.10-0.45;P<0.001)].Two of the above.mentioned three studies analyzed bronchopulmonary dysplasia(BPD)rates,the incidence of BPD was 39.34%vs 54.39%in NIPPV group and NCPAP group,the NIPPV group had a trend towards lower BPD rates,but this did not reach statistical significance[RR 0.73(95%CI:0.49-1.07;P=0.11)].NIPPV was used as primary mode in two studies,one compared with conventional ventilation(CV),which detected that the NIPPV group had significantly lower BPD rates(10% vs.33.33%,P:0.04);the other compared with NCPAP,which also showed that NIPPV group had significantly lower BPD rates(2.33% vs.17.07%,P=0.03).Conclusion The primary mode NIPPV was found to be feasible as a method of ventilation in preterm infants with RDS,and Was associated with a decreased incidenee of BPD.In the postextubation period,NIPPV is more effective in preventing failure of extubation than NCPAP.     

新生儿心力衰竭的常见病因、诊断及治疗

新生儿心力衰竭(心衰)是新生儿常见的危重急症之一,病情发展迅速,临床表现不典型,与年长儿表现也有很大不同,易与其他疾病相混淆,较难及时诊断,而贻误病情,因此必须提高对心衰的认识和警惕,早期诊断和积极治疗。一、新生儿心衰定义新生儿心衰是指在某些病因作用下,心脏排出血量不能满足血液循环及组织代谢需要而出现的一系列病理症状。二、新生儿心衰病因(一)新生儿易发生心衰的因素1.新生儿心肌结构未发育成熟。心肌肌节数量少,肌细胞较细,收缩力弱,心肌结构未成熟,心室顺应性差,代偿能力差。2.新生儿心肌中交感神经未发育成熟。心肌中交感…     

早产儿呼吸窘迫综合征经鼻间歇正压通气治疗的Meta分析

Objective To agsess the efficacy of nasal intermittent positive pressure ventilation (NIPPV)in treatment of respiratory distress syndrome(RDS) in premature infants.Methods According to the requirements of Cochrane systematic review,a thorough literature search was performed among PubMed(1977-2008),Embase(1989-2008),OVID,Cochrane(2008),Chinese Digtal Hospital Library (www.chkd.cnki.net) and Chinese Biomedical Literature Disk Database(CBMdisc).Quality assessments of clinical trials were carried out Randomized controHed trials(RCTs)with NIPPV and RDS were enrolledand ReVnlan 4.2 software was used for meta-analysis.The trials were analyzed using relatire risk(RR) for dichotomous data,weighted mean difference(WMD) were used for continuous data,both kind of data were expressed by 95% confidence intervals(95%CI).For homogenous data(P≥0.10),fixed effects model was calculated,for heterogeneity data(P<0.10),random effects model was calculated.Results Five RCTs involving 284 premature infants diagnosed as respiratory distress syndrome(RDS) were included.Three studies comparing NIPPV with nasal continuous positive airway pressure(NCPAP) in the postextubation period,tHe extabation failure rate was 8.34%vs 40.79% in NIPPV group and NCPAP group,the NIPPV group had significantly lower extubation failure rates[RR 0.21(95%CI:0.10-0.45;P<0.001)].Two of the above.mentioned three studies analyzed bronchopulmonary dysplasia(BPD)rates,the incidence of BPD was 39.34%vs 54.39%in NIPPV group and NCPAP group,the NIPPV group had a trend towards lower BPD rates,but this did not reach statistical significance[RR 0.73(95%CI:0.49-1.07;P=0.11)].NIPPV was used as primary mode in two studies,one compared with conventional ventilation(CV),which detected that the NIPPV group had significantly lower BPD rates(10% vs.33.33%,P:0.04);the other compared with NCPAP,which also showed that NIPPV group had significantly lower BPD rates(2.33% vs.17.07%,P=0.03).Conclusion The primary mode NIPPV was found to be feasible as a method of ventilation in preterm infants with RDS,and Was associated with a decreased incidenee of BPD.In the postextubation period,NIPPV is more effective in preventing failure of extubation than NCPAP.     

中晚期肝癌三维适形放疗的临床观察

三维适形放疗(3-dimensional conformal radiotherapy，3DCRT)，是近年发展起来的放疗技术，使肿瘤区域得到高剂量照射的同时周围正常组织得到有效的保护。笔者自2000年12月至2003年5月期间采用3DCRT治疗中晚期原发性肝癌35例，取得较好的近期疗效，现报道如下。     

重复经颅磁刺激治疗脑卒中后抑郁的临床疗效及磁共振波谱分析

目的 探讨不同频率的重复经颅磁刺激(rTMS)对脑卒中后抑郁(PSD)的治疗效果,氢质子磁共振波谱 (1H-MRS)对于该疗效的评价价值。方法 连续选取脑卒中后抑郁患者73例,根据中国精神疾病分类方案与诊断标 准第3版,以分层区组随机化分组法,将患者分为高频刺激组(24例),低频刺激组(24例),假刺激组(25例)。前2组 分别接受rTMS高频刺激和低频刺激治疗,分别在入组时和治疗4周后给予汉密顿抑郁量表(HAMD)检查,假刺激 组给予和高频刺激组相同频率的声音,但是没有磁刺激,并在治疗4周后给予1H-MRS检查,对各组结果进行统计分 析。结果 ①治疗后,高频刺激组HAMD评分(13.5±1.6)分和低频刺激组(13.1±1.7)分降低,两组之间差异无统 计学意义,但两组与假刺激组(16.3±1.4)分比较差异有统计学意义(P <0.01),假刺激组HAMD评分改善不显著。 ②治疗后,3组患者之间双侧额叶、丘脑和海马的Cho/Cr比值差异无统计学意义(P >0.05)。结论 rTMS高频和 低频刺激均能改善PSD患者抑郁状况,未发现两者之间有显著差异。     

早产和足月新生儿血清瘦素与出生体重及胰岛素关系分析

目的研究早产和足月新生儿血清瘦素与出生体重及胰岛素关系,探讨在早产和足月新生儿中是否存在脂肪-胰岛素内分泌轴。方法共收集264例早产和足月新生儿,按胎龄进行分组,并进行出生测量,于生后第3天采血做餐前血糖、胰岛素及瘦素检查。结果足月儿血清瘦素浓度显著高于早产儿,瘦素浓度与胎龄的关系按非线性模式增加,胎龄34周以后,瘦素浓度增加明显加快。在>32周的新生儿中,血清瘦素浓度与出生体重及胰岛素呈正相关关系(r=0.240,0.227,P<0.05),在胎龄≥37周的新生儿中,瘦素不仅与出生体重及胰岛素呈正相关(r=0.198,0.253,P<0.05),还与胰岛素/血糖呈正相关(r=0.206,P<0.05),在<32周的新生儿中,未发现上述关系。结论胎龄>32周的新生儿体内可能已开始存在脂肪-胰岛素内分泌轴。     

新生儿重症监护病房早产儿血管紧张素转化酶水平变化及其与基因插入/缺失多态性的关系

目的检测新生儿重症监护病房早产儿血管紧张素转化酶（ACE）基因型、血清ACE水平在出生1周内的变化，探讨ACE基因插入／缺失多态性与血清ACE水平和病情变化的关系。方法早产儿85例，出生第3天取其末梢血提取DNA，确定ACE基因型，出生第1、3、7天分别采用紫外分光光度计法检测早产儿血清ACE水平，并进行危重病例评分。结果早产儿85例中，DD基因型19例，ID基因型34例，Ⅱ基因型32例。出生第1天DD基因型早产儿血清ACE水平[（33．42&#177;7．93）U／L]显著高于Ⅱ基因型早产儿[（25．97&#177;8．32）U／L]（P〈0．01），高于ID基因型早产儿[（31．53&#177;7．56）U／L]，但差异无统计学意义（P〉0．05）；ID基因型早产儿血清ACE水平显著高于Ⅱ基因型（P〈0．01）；在出生第3天和第7天，3种基因型早产儿血清ACE水平均逐渐下降，DD基因型早产儿高于ID基因型，二者显著高于Ⅱ基因型。出生第1天DD基因型的危重病评分[（87．37&#177;8．30）分]低于1D基因型[（95．82&#177;5．85）分]和Ⅱ基因型[（95．88&#177;6．85）分]，差异非常显著（Pa〈0．01），ID和Ⅱ基因型间无差异；出生第3天，DD基因型的危重病评分[（92．95&#177;7．10）分]显著低于ID基因型[（96．94&#177;5．85）分]，而与Ⅱ基因型[（96．44&#177;6．87）分]无差异，ID和Ⅱ基因型间亦无差异；出生第7天，3种基因型间危重病评分均无差异。结论重症疾病时DD基因型携带者的病情相对重，血清ACE水平相对高，虽然疾病可能影响血清ACE水平，但是决定ACE水平的根本因素是个体间基因型的差异。     

早产儿ACE水平和其基因多态性与危重病评分的关系

目的：探讨血管紧张素转化酶（angiotensin converting enzyme，ACE）基因插入/缺失（I/D）多态性与ACE水平、危重病评分的关系。方法：确定新生儿重症监护病房（Neonatal Intensive Care Unit，NICU）早产儿ACE基因型，生后第1天、3天、7天分别检测ACE水平并进行危重病例评分。结果：85例早产儿中，DD基因型19例，ID基因型34例，II基因型32例，临床特征差异无显著性。第1天DD基因型和ID 基因型ACE水平分别为33.42±7.93 U/L和31.53±7.56 U/L，显著高于II基因型的25.53±7.56 U/L（P<0.01）；第3天和第7天，三者ACE水平逐渐下降，但仍是DD高于ID，两者显著高于II。比较危重病评分，生后第1天 DD 基因型为87.37±8.30，低于ID基因型的95.82±5.85和II基因型95.88±6.85，差异有显著性，ID和II间差异无显著性；第3天，DD基因型显著低于ID基因型(92.95±7.10 vs 96.94±5.85，P<0.05)，与II无差异，ID和II间也无差异；第7天，三者间无差异。结论：ACE基因插入/缺失多态性与新生儿危重症有相关性，DD基因型携带者的病情相对重，血清ACE水平相对高，虽然疾病会对血清ACE水平有所影响，但决定ACE水平的根本因素是个体间基因型的差异。     

吉西他滨治疗70岁以上晚期非小细胞肺癌疗效观察

目的观察吉西他滨单药治疗70岁以上晚期非小细胞肺癌的疗效、临床受益反应(CBR)及毒副反应。方法将晚期非小细胞肺癌患者分为2组,吉西他滨组采用吉西他滨1 250 mg/m2第1天、第8天静滴,每21 d为1个周期,共4个周期;对照组给予单纯支持对症治疗。结果吉西他滨组总有效率为23%,CBR率为88%,对照组分别为0%和22%。吉西他滨组毒副反应很轻。结论吉西他滨单药治疗70岁以上晚期非小细胞肺癌安全有效。     

右心发育不全综合征一例报告

患儿，女，43小时，因紫绀29小时入院。患儿2胎1产，孕38周，顺产，阿氏评分1分钟，5分钟均10分。生后14小时发现患儿颜面部口唇、四周、甲床发组、哭闹后加重，吸氧后缓解不显，无呼吸困难及呻吟等。妊娠早期否认感冒史及其它疾病史。第一股孕3个月时行人工流产。查体：T36．4℃、R36次／分，P128次／分，体重：2200g，发育中等，全身皮肤无黄染，未见皮疹、出血点及硬肿。呼吸平稳，口周、口唇发组，头颅无畸形，五官无异常。心前区无隆起，心界叩诊不大，心率128欢／分，律齐，无杂音，两肺呼吸音清。腹部无异常。四肢末梢发组，胸片：…