Interruption of blood flow and gas exchange to the fetus in the perinatal period, known as perinatal asphyxia, can, if significant, trigger a cascade of neuronal injury, leading on to neonatal encephalopathy(NE) and r...Interruption of blood flow and gas exchange to the fetus in the perinatal period, known as perinatal asphyxia, can, if significant, trigger a cascade of neuronal injury, leading on to neonatal encephalopathy(NE) and resultant long-term damage. While the majority of infants who are exposed to perinatal hypoxia-ischaemia will recover quickly and go on to have a completely normal survival, a proportion will suffer from an evolving clinical encephalopathy termed hypoxic-ischaemic encephalopathy(HIE) or NE if the diagnosis is unclear. Resultant complications of HIE/NE are wide-ranging and may affect the motor, sensory, cognitive and behavioural outcome of the child. The advent of therapeutic hypothermia as a neuroprotective treatment for those with moderate and severe encephalopathy has improved prognosis. Outcome prediction in these infants has changed, but is more important than ever, as hypothermia is a time sensitive intervention, with a very narrow therapeutic window. To identify those who will benefit from current and emerging neuroprotective therapies we must be able to establish the severity of their injury soon after birth. Currently available indicators such as blood biochemistry, clinical examination and electrophysiology are limited. Emerging biological and physiological markers have the potential to improve our ability to select those infants who will benefit most from intervention. Biomarkers identified from work in proteomics, metabolomics and transcriptomics as well as physiological markers such as heart rate variability, EEG analysis and radiological imaging when combined with neuroprotective measures have the potential to improve outcome in HIE/NE. The aim of this review is to give an overview of the literature in regards to short and longterm outcome following perinatal asphyxia, and to discuss the prediction of this outcome in the early hours after birth when intervention is most crucial; looking at both currently available tools and introducing novel markers.展开更多
目的 探讨急性缺血性脑卒中(acute ischemic stroke,AIS)患者机械取栓术时,紧急全身麻醉转化(emergency conversion to general anesthesia,EC-GA)对术后神经功能预后的影响及术中EC-GA的预测因素。方法 本研究对2017年11月至2021年5月...目的 探讨急性缺血性脑卒中(acute ischemic stroke,AIS)患者机械取栓术时,紧急全身麻醉转化(emergency conversion to general anesthesia,EC-GA)对术后神经功能预后的影响及术中EC-GA的预测因素。方法 本研究对2017年11月至2021年5月就诊于首都医科大学附属北京天坛医院行机械取栓的422例AIS患者进行回顾性分析,其中全身麻醉组(general anesthesia,GA)203例、非全身麻醉组(non-general anesthesia,non-GA)173例,EC-GA组46例。主要观察指标为患者术后90 d神经功能良好预后比例,即90 d改良Rankin量表(Modified Rankin Scale,mRS)评分≤2的患者比例(mRS分0~2表示神经功能预后良好,mRS分3~6预后不良)。次要观察指标为时间指标[发病-入室时间(T1),入室-动脉穿刺时间(T2),动脉穿刺-血流再痛时间(T3)],改良脑梗死溶栓分级(modified thrombolysis in cerebral infarction,mTICI)的良好比例(mTICI:0~2a再通不良;2b~3再通良好),病死率(出院病死率和90 d病死率),术后并发症(肺炎发生率和颅内出血发生率)及EC-GA的危险因素。结果 46例患者进行EC-GA,总体转化率为21.0%,其中前循环转化率约为19.0%,后循环转换率约为28.9%。3组患者在神经功能预后评分(90 d mRS)及良好预后比例(90 d mRS≤2)差异无统计学意义(P>0.05);EC-GA未显著增加不良预后风险:与non-GA组比较,OR=1.538(95%CI:0.792~2.984);与GA组比较,OR=1.315(95%CI:0.684~2.528)。多因素回归分析显示:入室美国国立卫生研究院脑卒中量表(National Institute of Health Stroke Scale,NIHSS)评分>15分时,术中EC-GA的风险显著增加,调整比值比(adjusted odds ratio,aOR)=2.005(95%CI:1.035~3.881)。结论 急性脑卒中患者行机械取栓治疗中,紧急全身麻醉转化未显著增加不良预后风险;入室NIHSS评分大于15分,与术中紧急全身麻醉转化风险相关。展开更多
目的:系统评价孕酮治疗急性颅脑损伤的有效性和安全性,为临床治疗提供参考。方法:计算机检索Cochrane图书馆、ClinicalTrials、Web of Science、PubMed、Embase、中国生物医学文献数据库、中国知网数据库和万方数据库,收集孕酮(试验组)...目的:系统评价孕酮治疗急性颅脑损伤的有效性和安全性,为临床治疗提供参考。方法:计算机检索Cochrane图书馆、ClinicalTrials、Web of Science、PubMed、Embase、中国生物医学文献数据库、中国知网数据库和万方数据库,收集孕酮(试验组)对比安慰剂或空白对照(对照组)治疗急性颅脑损伤的随机对照试验(RCT),筛选文献、提取资料并采用Cochrane系统评价员手册5.1.0提供的偏倚风险评估工具评价文献质量后,采用RevMan 5.3软件进行Meta分析。结果:共纳入10项RCT,共计2 652例患者。Meta分析结果显示,两组患者病死率[RR=0.77,95%CI(0.56,1.07),P=0.12]、败血症发生率[RR=1.11,95%CI(0.77,1.60),P=0.59]、肝酶升高发生率[RR=1.30,95%CI(0.68,2.50),P=0.43]比较,差异均无统计学意义;试验组神经功能预后良好患者例数显著多于对照组[RR=1.23,95%CI(1.05,1.43),P=0.008]。病死率亚组分析结果显示,两组GCS≤8分患者病死率[RR=0.79,95%CI(0.57,1.10),P=0.16]、GCS≤12分患者病死率[RR=0.69,95%CI(0.23,2.10),P=0.52]、GCS 9～12分患者病死率[RR=0.78,95%CI(0.26,2.35),P=0.65]比较,差异均无统计学意义。神经功能预后亚组分析结果显示,两组GCS≤8分神经功能预后良好患者例数[RR=1.18,95%CI(0.98,1.43),P=0.09]、GCS≤12分神经功能预后良好患者例数[RR=1.15,95%CI(0.87,1.51),P=0.32]、GCS 9～12分神经功能预后良好患者例数[RR=2.07,95%CI(0.24,17.71),P=0.51]比较,差异均无统计学意义。结论:孕酮可改善急性重度颅脑损伤患者的神经功能预后,安全性较好,但不能降低病死率。展开更多
基金Supported by The Health Research Board CSA/2012/40a Science Foundation Ireland Research Centre Award(INFANT-12/RC/2272)
文摘Interruption of blood flow and gas exchange to the fetus in the perinatal period, known as perinatal asphyxia, can, if significant, trigger a cascade of neuronal injury, leading on to neonatal encephalopathy(NE) and resultant long-term damage. While the majority of infants who are exposed to perinatal hypoxia-ischaemia will recover quickly and go on to have a completely normal survival, a proportion will suffer from an evolving clinical encephalopathy termed hypoxic-ischaemic encephalopathy(HIE) or NE if the diagnosis is unclear. Resultant complications of HIE/NE are wide-ranging and may affect the motor, sensory, cognitive and behavioural outcome of the child. The advent of therapeutic hypothermia as a neuroprotective treatment for those with moderate and severe encephalopathy has improved prognosis. Outcome prediction in these infants has changed, but is more important than ever, as hypothermia is a time sensitive intervention, with a very narrow therapeutic window. To identify those who will benefit from current and emerging neuroprotective therapies we must be able to establish the severity of their injury soon after birth. Currently available indicators such as blood biochemistry, clinical examination and electrophysiology are limited. Emerging biological and physiological markers have the potential to improve our ability to select those infants who will benefit most from intervention. Biomarkers identified from work in proteomics, metabolomics and transcriptomics as well as physiological markers such as heart rate variability, EEG analysis and radiological imaging when combined with neuroprotective measures have the potential to improve outcome in HIE/NE. The aim of this review is to give an overview of the literature in regards to short and longterm outcome following perinatal asphyxia, and to discuss the prediction of this outcome in the early hours after birth when intervention is most crucial; looking at both currently available tools and introducing novel markers.
文摘目的 探讨急性缺血性脑卒中(acute ischemic stroke,AIS)患者机械取栓术时,紧急全身麻醉转化(emergency conversion to general anesthesia,EC-GA)对术后神经功能预后的影响及术中EC-GA的预测因素。方法 本研究对2017年11月至2021年5月就诊于首都医科大学附属北京天坛医院行机械取栓的422例AIS患者进行回顾性分析,其中全身麻醉组(general anesthesia,GA)203例、非全身麻醉组(non-general anesthesia,non-GA)173例,EC-GA组46例。主要观察指标为患者术后90 d神经功能良好预后比例,即90 d改良Rankin量表(Modified Rankin Scale,mRS)评分≤2的患者比例(mRS分0~2表示神经功能预后良好,mRS分3~6预后不良)。次要观察指标为时间指标[发病-入室时间(T1),入室-动脉穿刺时间(T2),动脉穿刺-血流再痛时间(T3)],改良脑梗死溶栓分级(modified thrombolysis in cerebral infarction,mTICI)的良好比例(mTICI:0~2a再通不良;2b~3再通良好),病死率(出院病死率和90 d病死率),术后并发症(肺炎发生率和颅内出血发生率)及EC-GA的危险因素。结果 46例患者进行EC-GA,总体转化率为21.0%,其中前循环转化率约为19.0%,后循环转换率约为28.9%。3组患者在神经功能预后评分(90 d mRS)及良好预后比例(90 d mRS≤2)差异无统计学意义(P>0.05);EC-GA未显著增加不良预后风险:与non-GA组比较,OR=1.538(95%CI:0.792~2.984);与GA组比较,OR=1.315(95%CI:0.684~2.528)。多因素回归分析显示:入室美国国立卫生研究院脑卒中量表(National Institute of Health Stroke Scale,NIHSS)评分>15分时,术中EC-GA的风险显著增加,调整比值比(adjusted odds ratio,aOR)=2.005(95%CI:1.035~3.881)。结论 急性脑卒中患者行机械取栓治疗中,紧急全身麻醉转化未显著增加不良预后风险;入室NIHSS评分大于15分,与术中紧急全身麻醉转化风险相关。
