大剂量Vitc和1，6―二磷酸果糖治疗新生儿窒息致心肌损害35例临床观察.DOCVIP

临床医学论文-大剂量Vitc和1，6―二磷酸果糖治疗新生儿窒息致心肌损害35例临床观察 ??????????????????????????????????? 作者:李佑民 郝玉凤 朱纯英 【关键词】? 新生儿窒息 　　with myocardial lesion with maximum dose of Vitc and FDP?? ??? 【Abstract】 Objective To observe the effects of both vitamin C and fructose1.6-diphosphate in treating asˉphyxia neonatorum combined myocardial lesion.Methods 35patients with asphyxia neonatorum combined myocardial lesion were selected from509neonates with hypoxic ischemic enchphalopathy admitted in our department of neonate from2000to2002.They were all carried through electrocardiographic monitoring and myocardial zymogram assaying and treated by vitamin C（200～250mg?kg -1? ?d -1? ）and fructose1.6-diphosphate（10ml?kg -1? ?d -1? ）.The period of treatment was7days and only one or two was10～14days.Results The severe and moderate apnea were respectiveˉly25and10in35patients with asphyxia neonatorum combined myocardial lesion among which8patients were premaˉture，5patients small for gestational age infants and1patient post term infant.31patients were healing，2patients dead，1patient quitted and1patient transferred to other hospital.The cure rate was88%and no abnormity was seen in all healing neonates in follow-up period of6months.Conclusion Both vitamin C and fructose1.6-diphosphate can effectively treat asphyxia neonatorum combined myocardial lesion. ??? Key words asphyxia neonatorum myocardial infarction vitamin C fructose1.6-diphosphate.?? 　　窒息的本意就是缺氧，可以对多系统脏器功能造成不良影响，特别是心脑对缺氧非常敏感的重要脏器的损害，若不及时抢救，甚至会造成致命性后果，窒息导致心肌损伤是缺氧缺血后损害之一。 ??? 2000～2002年儿科新生儿病区收住新生儿缺氧缺血性脑病（HIE）509例，筛选出有心肌损害者35例，应用抗氧化剂大剂量Vitc和营养心肌1，6―二磷酸果糖治疗效果进行观察。 　　1 资料 ??? 1.1 所有患儿均系新生儿病房收住院者，其中院外转来20 例，从本院产科转入15例。男19例，女17例，男∶女=1∶1.12。出生至入院时间:5min～24h30例、24h5例。 　　1.2 窒息分度 重度窒息25例，中度窒息10例。 ??? 1.3 日龄 足月儿16例，巨大儿7例，早产儿6例，足月小样儿5例，过期产儿1例。 ??? 1.4 临床表现 几乎100%有发绀，肌张力低下，哭声微弱，心音低钝;其中心率减慢30/35占86%，心律不齐12/35占34%，肝大5/35占14%。1.5 心肌酶测定 见表1。 　　表1 35例窒息心肌损害心肌酶测定略?? 　　心肌酶测定用动力学法，全自动生化分析仪VITALˉABFLexovPC设备。 　　1.6 心电监护（用日本可林） 心电监护仪，30例有不同程度S―T段和T波下移，3例有不完全性右束支传导