新生儿黄疸的诊断和治疗

新生儿黄疸（neonatal jaundice）亦称新生儿高胆红素血症（neonatal hyperbilirubinemia）,是新生儿期因胆红素在体内积聚而出现皮肤、黏膜和巩膜黄染的临床现象。     

新生儿重症监护室细菌定植和医院感染的监测

目的 观察NICU细菌定植及医院感染情况,以降低NICU医院感染发病率.方法 2009年1-12月在本院NICU住院的465例新生儿入院时行痰培养,进行定植菌检测.机械通气患儿更换或拔除气管插管时,常规留气管插管头行细菌培养.所有培养阳性结果行药敏试验.住院时间>48 h的426例新生儿纳入医院感染调查,疑似医院感染时,根据临床表现行相关病原学检查.计算医院感染发病率、日医院感染发病率、呼吸机相关性肺炎(VAP)发病率.结果 465例新生儿行痰培养,72.7%(338/465例)有细菌定植,其中38.8%为正常菌群,61.2%为致病菌.定植的致病菌主要为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌.医院感染发病率为12.4%(53/426例),日医院感染发病率为12.1‰,呼吸机使用率为2.5%,VAP发病率为65.6‰.不同出生体质量组新生儿医院感染发病率差异有统计学意义(χ2=12.35,P＜0.05),出生体质量≤1 500 g的新生儿医院感染发病率最高.有致病菌定植的新生儿医院感染发病率高于无致病菌定植的新生儿,差异有统计学意义(χ2=19.88,P＜0.05).结论 细菌(尤其是致病菌)定植在NICU很常见,革兰阴性细菌是常见定植致病菌,致病菌定植与医院感染密切相关.对NICU住院患儿进行定植菌检测,有助于减少医院感染的发生.     

热性惊厥与免疫功能异常的临床研究

热性惊厥(FC)是儿科常见急症,其复发率为25—35%,有11.3%转化为癫痫。本文检测 FC患儿血清免疫球蛋白水平,T 细胞亚群及血清可溶性白介素2受体(SIL—2R)水平,旨在了解 FC 患儿体内体液免疫及细胞免疫功能异常情况,探讨 FC 的病因和其复发的高危因素。     

后腹腔镜肾上腺肿瘤切除术(附45例报告)

目的:探讨经后腹腔镜肾上腺肿瘤切除术的安全性和疗效.方法:总结分析我院2007年5月至2008年4月45例肾上腺肿瘤经后腹腔镜切除术的临床资料.45例患者年龄42.96±2.13岁,男13例,女32例,左侧22例,右侧23例,肿瘤直径2.42±0.18 cm.45例患者中,经病理检查证实及结合临床诊断原发性醛固酮增多症23例,皮质醇增多症5例, 嗜铬细胞瘤4例,无功能腺瘤13例.结果:45例肾上腺肿瘤43例手术成功,2例转开放.手术时间76.67±5.67 min,术中失血15.85±4.56 mL,1例术后输红细胞悬液400 mL,术后镇痛7例次,总住院时间18.16±1.33天,术后住院时间5.64±0.33天.结论:经后腹腔镜肾上腺肿瘤切除术安全, 疗效好, 患者术后恢复快,是一种安全有效的治疗方式.     

胆红素对新生儿脐血单核细胞凋亡的影响

Objective To explore the effects of bilirubin on the apoptosis index(AI) of cord blood monocyte(CBMC).Methods The CBMC of normal full-term neonates selected randomly as subjects was isolated by the method of gelatin/plasma coated flasks.The CBMC was preincubated with unconjugated bilirubin dissolved in bovine albumin solution at various concentration(6 mg/dl、9 mg/dl、 12.9 mg/dl and 18 mg/dl).Bilirubin-treated CBMC was further cultured with LPS for inducing cellular activation for 48 hours,and then the CBMC was collected.The AI of CBMC after cultivation was detected by using TUNEL methods.Results No differences of AI among the normal control group,LPS group and 6 mg/dl (free-LPS) group(P ＞ 0.05) were found.In the presence of LPS,the AI of the 6 mg/dl group was similar to those of the normal control group,LPS group and 6 mg/dl(free-LPS) group(P ＞0.05),while the AIs of the 9 mg/dl group,12 mg/dl group and 18 mg/dl group were significantly higher than those of the normal control group,LPS group,6 mg/dl(free-LPS) group and 6 mg/dl group(P＜0.05).The increase of the AI of CBMC was corresponding to the raise of the bilirubin concentration.Conclusion The bilirubin can increase the AI of CBMC by destroing the configuration of the cell membrane,increasing intracellular calcium concentration and inducing the mitochondrial energy failure.     

手术治疗鹿角状肾结石45例的体会

目的:探讨不同术式治疗鹿角状肾结石的临床疗效.方法:回顾性分析1999～2007年我院采用肾盂切开取石和肾后唇中下1/3肾实质切开取石治疗各种不同形状及大小的鹿角状肾结石45例.结果:41例一次性取尽结石,术后2例出血,1例出现尿瘘.结论:针对不同结石采用不同术式,其疗效满意、安全,值得临床推广使用.     

胆红素对新生儿脐血单核细胞凋亡的影响

Objective To explore the effects of bilirubin on the apoptosis index(AI) of cord blood monocyte(CBMC).Methods The CBMC of normal full-term neonates selected randomly as subjects was isolated by the method of gelatin/plasma coated flasks.The CBMC was preincubated with unconjugated bilirubin dissolved in bovine albumin solution at various concentration(6 mg/dl、9 mg/dl、 12.9 mg/dl and 18 mg/dl).Bilirubin-treated CBMC was further cultured with LPS for inducing cellular activation for 48 hours,and then the CBMC was collected.The AI of CBMC after cultivation was detected by using TUNEL methods.Results No differences of AI among the normal control group,LPS group and 6 mg/dl (free-LPS) group(P ＞ 0.05) were found.In the presence of LPS,the AI of the 6 mg/dl group was similar to those of the normal control group,LPS group and 6 mg/dl(free-LPS) group(P ＞0.05),while the AIs of the 9 mg/dl group,12 mg/dl group and 18 mg/dl group were significantly higher than those of the normal control group,LPS group,6 mg/dl(free-LPS) group and 6 mg/dl group(P＜0.05).The increase of the AI of CBMC was corresponding to the raise of the bilirubin concentration.Conclusion The bilirubin can increase the AI of CBMC by destroing the configuration of the cell membrane,increasing intracellular calcium concentration and inducing the mitochondrial energy failure.     

胆红素对新生儿脐血单核细胞凋亡的影响

Objective To explore the effects of bilirubin on the apoptosis index(AI) of cord blood monocyte(CBMC).Methods The CBMC of normal full-term neonates selected randomly as subjects was isolated by the method of gelatin/plasma coated flasks.The CBMC was preincubated with unconjugated bilirubin dissolved in bovine albumin solution at various concentration(6 mg/dl、9 mg/dl、 12.9 mg/dl and 18 mg/dl).Bilirubin-treated CBMC was further cultured with LPS for inducing cellular activation for 48 hours,and then the CBMC was collected.The AI of CBMC after cultivation was detected by using TUNEL methods.Results No differences of AI among the normal control group,LPS group and 6 mg/dl (free-LPS) group(P ＞ 0.05) were found.In the presence of LPS,the AI of the 6 mg/dl group was similar to those of the normal control group,LPS group and 6 mg/dl(free-LPS) group(P ＞0.05),while the AIs of the 9 mg/dl group,12 mg/dl group and 18 mg/dl group were significantly higher than those of the normal control group,LPS group,6 mg/dl(free-LPS) group and 6 mg/dl group(P＜0.05).The increase of the AI of CBMC was corresponding to the raise of the bilirubin concentration.Conclusion The bilirubin can increase the AI of CBMC by destroing the configuration of the cell membrane,increasing intracellular calcium concentration and inducing the mitochondrial energy failure.     

先天性肾病综合征合并甲状腺功能减低症1例报告

先天性肾病综合征是以出生时或生后3个月内出现水肿、蛋白尿、高胆固醇血症及低蛋白血症为特征的一种少见的常染色体隐性遗传病。我院2000年4月收治先天性肾病综合征合并甲状腺功能减低症1例，报道如下。     

新生儿感染性肺炎时IL-18、IFN-γ与免疫球蛋白关系探讨

目的探讨新生儿感染性肺炎白细胞介素_18(IL_18)和γ_干扰素 (IFN_γ)与免疫球蛋白 (IgG、IgA和IgM )的关系。方法采用免疫酶法 (ELISA)和速率散射比浊法检测111例感染性肺炎患儿血清IL_18、IFN_γ、IgG、IgA和IgM含量。以CRP≥20mg/L作为诊断细菌感染的界限值 ,结合其他临床资料 ,将肺炎患儿分为4组进行分析。结果①肺炎组111份血清中 ,8型常见病毒及支原体特异性IgM阳性40份 (36.0 % ) ,对照组30份血清均阴性 ;病毒及支原体感染23例 (20.7% ) ,细菌感染45例 (40.6 % ) ,病毒及支原体与细菌混合感染17例 (15.3% ) ,其他不明病原感染26例 (23.4% )。②肺炎组IgA、IgM含量>对照组 (P<0.05)。其中 ,病毒及支原体感染组IgA含量>其他不明病原感染组和对照组 (P<0.05) ;细菌感染组IgM含量>对照组 (P<0.05)。肺炎各组IgG、IL_18和IFN_γ含量与对照组比较 ,差异无统计学意义 (P>0.05)。③对照组IgM与IFN_γ呈正相关 (P<0.01)。病毒及支原体感染组IgA和IgM分别与IFN_γ呈正相关 (P<0.01) ;IgA和IgM分别与IL_18呈正相关 (P<0.05) ;IFN_γ与IL_18呈正相关 (P<0.05)。细菌感染组IgA与IL_18呈正相关 (P<0.01)。结论新生儿发生病毒或细菌感染时 ,体内抗感染免疫和免疫调节的机制不同 ,不同种类免疫球蛋白含量也不相同