本文關(guān)鍵詞： 褪黑素 中-重度新生兒缺氧缺血性腦病 新生兒　出處：《山西醫(yī)科大學(xué)》2012年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的： 新生兒缺氧缺血性腦病(hypoxic-ischemic encephalopathy，HIE)是指在產(chǎn)前、產(chǎn)時(shí)、產(chǎn)后由于各種原因的缺氧窒息，導(dǎo)致新生兒腦的缺氧缺血性損害。因其可引起神經(jīng)系統(tǒng)的傷殘，是新生兒疾病當(dāng)中危害最大的常見(jiàn)病之一。即使在歐美等發(fā)達(dá)國(guó)家，新生兒缺氧缺血性腦病發(fā)病率約1‰～2‰，中重度HIE的死亡和嚴(yán)重傷殘率也高達(dá)53％～61％，中重度患兒如果能有幸存活下來(lái)，常常會(huì)留有程度不等、表現(xiàn)各異的神經(jīng)系統(tǒng)后遺癥，如腦性癱瘓、癲癇、智力低下等。本文研究新生兒中-重度缺氧缺血性腦病血漿褪黑素( Melatonin , MLT )水平的變化,期望為褪黑素應(yīng)用于臨床，治療新生兒缺氧缺血性腦病提供一定的實(shí)驗(yàn)證據(jù)。 對(duì)象與方法： 1.1研究對(duì)象選擇山西省兒童醫(yī)院新生兒內(nèi)科，2010年5月至2010年11月住院的0～3天足月新生兒中-重度新生兒缺氧缺血性腦病20例,其中男12例,女8例。平均體重2990±312.74g ,平均胎齡39.5土1.12周。新生兒缺氧缺血性腦病的臨床診斷，，依據(jù)2004年11月在湖南長(zhǎng)沙舉辦的“全國(guó)新生兒缺氧缺血性腦病學(xué)術(shù)會(huì)議”進(jìn)一步修訂的臨床診斷及分度標(biāo)準(zhǔn)。對(duì)照組選擇同時(shí)間住院的20例足月新生兒，該組新生兒要求母親懷孕期間健康，無(wú)妊娠期糖尿病、高血壓等合并癥，患兒自身則要求無(wú)圍產(chǎn)期窒息史、無(wú)宮內(nèi)發(fā)育遲緩、未患有感染性、代謝性疾病。其中男10例,女10例。平均體重3050±502.44g ,胎齡39.3土1.65周。實(shí)驗(yàn)組和對(duì)照組兩組新生兒在胎齡、出生體重、性別、采血時(shí)間等組成上經(jīng)過(guò)分析后差別無(wú)統(tǒng)計(jì)學(xué)意義。 1.2方法HIE患兒于入院當(dāng)天（生后0～3天、急性期）、恢復(fù)期（生后7～10天），20例對(duì)照患兒于出生后0～3天、7～10采血。所選實(shí)驗(yàn)患兒均于上午10時(shí)左右經(jīng)股靜脈采取靜脈血2ml ,所采血樣先保存于不含抗凝劑的玻璃試管中,1小時(shí)內(nèi)在低溫高速離心機(jī)下，2000轉(zhuǎn)/分鐘離心半小時(shí),然后用移液器留取上層血漿0.5毫升，保存在聚乙烯管中,放置于- 20℃冰箱中保存。采用酶聯(lián)免疫吸附試驗(yàn)選定同一時(shí)間內(nèi)檢測(cè)血漿褪黑素水平。 1.3統(tǒng)計(jì)學(xué)方法血漿褪黑素值以均數(shù)±標(biāo)準(zhǔn)差（x±s）表示。兩組數(shù)據(jù)之間比較采用SPSS13.0統(tǒng)計(jì)學(xué)軟件包，進(jìn)行兩組獨(dú)立樣本的秩和檢驗(yàn)。制定檢驗(yàn)水準(zhǔn)P0.05差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果： 新生兒中-重度缺氧缺血性腦病與對(duì)照組相比,血漿褪黑素水平在中-重度HIE急性期時(shí)與對(duì)照組差異無(wú)統(tǒng)計(jì)學(xué)意義,而在恢復(fù)期時(shí)則顯著高于對(duì)照組。正常對(duì)照新生兒組0～3天與7～10天時(shí)比較差異無(wú)統(tǒng)計(jì)學(xué)意義，而中-重度缺氧缺血性腦病新生兒恢復(fù)期時(shí)，血漿褪黑素水平明顯高于急性期。 結(jié)論： 新生兒窒息后并發(fā)中重度缺氧缺血性腦病時(shí)，在其恢復(fù)期血漿褪黑素水平升高,提示褪黑素對(duì)于缺氧缺血性大腦有一定的保護(hù)作用。
[Abstract]:Objective:
Neonatal hypoxic ischemic encephalopathy (hypoxic-ischemic encephalopathy HIE) refers to the prenatal, intrapartum, postpartum due to various reasons lead to hypoxia asphyxia, neonatal hypoxic ischemic injury of the brain. Because of the cause of neurological disability, neonatal disease is one of the common diseases harm. Even in Europe and other developed countries, the incidence of neonatal hypoxia ischemic encephalopathy rate of about 1 per thousand to 2 per thousand, moderate to severe HIE death and severe disability rate is as high as 53% ~ 61%, moderate and severe groups if lucky enough to survive, often have varying degrees of neurological sequelae, varied manifestations, such as cerebral palsy, epilepsy, mental retardation and so on. This paper studies in the newborn plasma melatonin - severe hypoxic ischemic encephalopathy (Melatonin, MLT) level of melatonin expectations for the clinical application in the treatment of hypoxic ischemic brain disease of the newborn to provide a real Proof.
Objects and methods:
1.1 study of neonatal medicine, children's Hospital of Shanxi Province, 0~3 days from May 2010 to November 2010 were full-term newborns in severe neonatal hypoxic ischemic encephalopathy in 20 cases, male 12 cases, female 8 cases. The average weight of 2990 + 312.74g, the average gestational age of 39.5 soil for 1.12 weeks. Clinical diagnosis of neonatal hypoxic ischemic encephalopathy, clinical basis the diagnosis and grading standards held in Hunan in November 2004 Changsha "National Conference on neonatal hypoxic ischemic encephalopathy" further amended. 20 cases of full-term newborns in control group with time in hospital, the neonates requirements during pregnancy health, without gestational diabetes, hypertension and other complications, the child's own requires no perinatal asphyxia. No intrauterine growth retardation, not suffering from infectious, metabolic diseases. There were 10 male and 10 female patients. The average weight of 3050 + 502.44g, gestational age of 1.65 weeks. 39.3 soil experiment There was no significant difference between the two groups of newborn infants, birth weight, sex, and blood collection time, and so on.
Methods 1.2 HIE patients on admission day (0~3 days after birth, acute period), recovery period (7~10 days after birth), 20 cases of the control group on the 0~3 day after birth, 7~10 were selected. The children were in the morning 10 when the left and right sides through the femoral vein to take blood 2ml, the blood samples stored in the first glass the tube without anticoagulant, within 1 hours under low temperature and high speed centrifuge and centrifuged at 2000 rpm for half an hour, and then use the pipette specimens from the upper plasma 0.5 ml, stored in polyethylene tubes, placed in the refrigerator. - 20 C to detect plasma melatonin levels by enzyme-linked immunosorbent assay selected at the same time.
1.3 statistical method, plasma melatonin value was expressed by mean + standard deviation (x + s). The SPSS13.0 statistics software package was used to compare two groups of independent samples rank test. The difference between the two groups was statistically significant.
Result錛

本文編號(hào)：1516376