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頁籤選單縮合
題名 | Perinatal Hypoxic/Ischemic Encephalopathy: Clinical Challenge and Experimental Implications=週產期之缺氧缺血腦病變 |
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作者 | 黃朝慶; Huang, Chao-ching; |
期刊 | 中華民國小兒科醫學會雜誌 |
出版日期 | 19980500、19980600 |
卷期 | 39:3 民87.05-06 |
頁次 | 頁157-165+209 |
分類號 | 417.517 |
語文 | eng |
關鍵詞 | 缺氧/缺血腦病變; 紋狀體; 多巴胺; 核磁共振氫光譜; Hypoxic-ischemic encephalopathy; Striatum; Dopamine; [fec1]H-NMR; |
中文摘要 | 週產期窒息所導致是新生兒死亡或日後神經發展遲緩重要原因之一。腦部中之紋 狀體( Striatum ),具有豐富之多巴胺,特別是容易受到週產期窒息之傷害。藉由測量大 腦皮質之氧氣濃度及紋狀體中細胞外液之多巴胺濃度, 在新生豬上研究不同程度缺氧 / 缺 血傷害之影響,我們發現紋狀體細胞外液多巴胺之濃度高低雖會受到大腦皮質氧氣濃度之影 響,但受到動脈血壓高低之影響更是顯著。窒息後呼吸不同之氧氣濃度恢復,也對大腦皮質 氧氣濃度及紋狀體中細胞外液多巴胺之濃度有不同之影響, 呼吸 100% 氧氣比呼吸 21% 氧 氣雖有更高之大腦皮質氧氣濃度, 但窒息後呼吸 100% 氧氣比呼吸 21% 氧氣更會造成紋狀 體細胞外液多巴胺濃度之顯著增加,故雖然窒息後給予 100% 氧氣恢復會有更高之大腦皮質 氧氣濃度,但同時也更會影響紋狀體中多巴胺之代謝,而累積了更多之細胞外液多巴胺,此 現象可能更會加重窒息後之腦傷害。週產期窒息所造成紋狀體不同程度之傷害可能與各種不 同程度之缺氧 / 缺血所促成之細胞外液多巴胺累積濃度有關。 另外,利用核磁共振氫光譜 研究出生 6 小時內新生兒之尿液發現會繼發為窒息腦病變之新生兒尿中乳酸 / 肌氨酸�穭� 比顯著地高於正常及窒息但無腦病變之新生兒,同時窒息但無腦病變之新生兒尿中之乳酸 / 肌氨酸�穭韙]明顯地高於正常新生兒。 以核磁共振氫光譜測量出生 6 小時內新生兒之尿可 敏感及特定地偵測出可能會繼發腦病變之窒息新生兒。 |
英文摘要 | Perinatal asphyxia is an important cause of neonatal mortality and subsequent sequelae. Striatum, richly innervated by nigrostriatal dopaminergic projections, is susceptible to perinatal insults. Measuring the cerebral cortical oxygen pressure and striatal extracellular dopamine in the striatum in piglets under different kinds and degrees of hypoxia/ischemia insult, the changes of extracellular striatal dopamine were found to be more related to the changes in blood pressure than with cortical oxygen pressure. After asphyxia, cortical oxygen pressure was significantly higher in piglets breathing 100% O �� than in those breathing 21% O �� Two hours after reoxygenation, there was a secondary release of more dopamine in piglets ventilated with 100% O �� than in those with 21% O �� Although 100% FiO �� after asphyxia increases more cortical oxygenation, it also results in poorer recovery in dopamine metablism and higher secondary release of striatal dopamine, which may exacerbate posthypoxic cerebral injury. Striatal lesions may strongly be related with levels of extracellular dopamine during different degrees and kinds of insults. The study of the urine H-NMR spectra in newborns within six hours after birth demonstrated that the lactate/creatinine ratio in newborns with subsequent hypoxic-ischemic encephalopathy was significantly higher than in thsoe with perinatal distress only and in normal newborns. The urine lactate/creatinine ratio in newborns with perinatal distress only was also significantly higher than that in normal newborns. The levels of urinary lactate/creatinine by H-NMR spectroscopy within six horus after birth correlates well with subsequent hypoxicischemic encephalopathy. The characteristics of urine H-NMR spectra can be sensitively and specifically used to identify early after birth for the asphyxiated newborns with potential subsequent hypoxic-ischemic encephalopathy. |
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