69 (CK) (UREA) (Ca) (P) (K) (UA) 0~48h (I) 0~7d (III) CK-I 10 CK 21.7%~51.7% CK-I CK-I CK-I Ca-I CK-I Ca-I CK P=0.022 P=0.001 CK-I -I CK-II -II CK-II

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2 69 (CK) (UREA) (Ca) (P) (K) (UA) 0~48h (I) 0~7d (III) CK-I 10 CK 21.7%~51.7% CK-I CK-I CK-I Ca-I CK-I Ca-I CK P=0.022 P=0.001 CK-I -I CK-II -II CK-II -I r=0.819 P=0.013 CK CK 1

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4 THE STUDY OF STRIATED MUSCLE INJURY AND RHABDOMYOLYSIS IN SEVERE ASPHYXIATED NEONATES Postgraduate student BAION David E Tutor. QI FENG Department of Pediatrics, First Hospital, Peking University. [Abstract] Objective To investigate the incidence, affecting factors and effects of striated muscle injury and rhabdomyolysis in severe asphyxiated neonates, to raise the attention of perinatologists to this problem, and to improve medical care to this group of infants. Methods Multiple regression analysis, t-test, and Pearson correlation test were used to analyze serum levels of creatine kinase (CK), UREA, calcium(ca), potassium(k), phosphorus(p) and uric acid(ua) performed on 69 neonates admitted to our hospital within 48hours(I) and 5-7days(II) after birth. The highest or lowest values of each determinant within the entire study period was designated(iii).the highest or lowest value was determined by its clinical significance in rhabdomyolysis. Factors affecting determinants I and III, and the effects of CK-I on each determinant were investigated. Concurrently, serum myoglobin measurements were performed prospectively on 10 neonates within 24 3

5 hours(myoglobin-i) and 5-7days(myoglobin-II) after birth, to determine its relationship with CK-I and their dynamic changes. Results (1) Using different reference values for CK, rhabdomyolysis was confirmed in 21.7%~51.7% of patients studied. (2) The level of CK-I was directly related to the method of delivery and the presence or absence of intrauterine distress. CK values were higher in neonates with intrauterine distress. Neonates delivered by Cesarean section had lower CK-I values than those delivered vaginally. (3) CK-I affected the value of Ca-I, the higher the value of CK-I, the lower the value of Ca-I. (4)There was a significant decrease in both CK and myoglobin values as the conditions of our patients improved (p=0.022, p=0.001). This study also revealed a relationship between CK-II and myoglobin-i, r=0.819, p=0.001, it shows that the higher the value of myoglobin, the longer it took for CK to recover. No relationship however existed between CK-I and myoglobin-i, and CK-II and myoglobin-ii. Conclusion Rhabdomyolysis occurs in severely asphyxiated neonates, especially in neonates with intrauterine distress and those delivered vaginally. Striated muscle injury and rhabdomyolysis affects the biochemistry and metabolism of the neonate, the higher the level of CK-I, the lower the serum Ca-I. Renal function was not found to be affected. Muscle injury and rhabdomyolysis improved as our patients recovered. Keywords Neonate, Asphyxia, Rhabdomyolysis, Creatine kinase, 4

6 Myoglobin 1881 Fleischer Galeopsis ladanum [1] 1911 Mayer-Betz Mayer-Betz Bywaters [2] 5

7 - / Mc Ardle s ATP ATP (Ca) [3~6] Ca [7] 2 ATP Ca- ATP ATP Ca ATP Ca-ATP Ca 6

8 Ca ATP Ca Ca Na-K-ATP ATP Na Na Na-Ca Na Ca Ca ATP Ca Ca Ca Ca ( A 2 PLA 2 ) [7] Ca K Ca (P) (UREA) UA [8~10] 7

9 [11] Grossman [12] 50%~75% [4] [11] [13] 2 [14] [15,16] D [17] 24 [18] I ( ) 1g 0.4mg 1g 3-4mg 27 1g 0.05mg [18] 5 ~30 D 8

10 [19] 20mg/dl(200ng/ml) [13] 80 [20,21] Stone [22] 1975 [23] CK 12 [17] 1-6 CK 2~12 24~72 [4] 17 13~24 CK [23] (GFR) Nathan [4] 300ng-2mg/L 250mg/L [14,24] <10µg/L [23] 9

11 [8,13,25] 2 CK 2-12 CK [4] 5-7 CK 3-5 [26] Gabow [6] CK 5 CK 5 CK- (CK-MM) 98% [11] CK 3 Lofberg [27] Poels [28] [2 ] Gabow [6] % Curry [26] D Ca 1.25 OH 2 [12,29] 20% 10

12 [26] Chaikin [30] UA UREA UA Knochel [31] UA 50mg/dl(3000µmol/L) CK UREA UA [1] 1 [28,11] Saad [11] 10 UREA/ Saad SWAN-GANZ 2 [12] Gabow [6] 43% 5.5mmol/L 11

13 [8] [11] 3 DIC DIC [32] [11] DIC DIC 4 (ARF) ARF [2] ARF Bywater Stead [33,34] Heyman [36] 17%~33% ARF 3%~15% [3] Nathan [4] ARF [3,40] 2 [35,36] [3] Heme-Protein 50% 12

14 - NO [41] [42] NO [43,44] NO Maree [45] NO NO NO ARF ARF ARF [46,47] Zager [3] A. B. ph 8 78% 32% [48] ARF TAM HORSFALL [49] TAM HORSFALL [3,50,51] [50] 13

15 (DFO) Pallar [52] 3 - ARF / DFO Shah [51] DFO OH ARF ARF ATP 50 Lowe [53] [35] ARF Trifillis [54] ARF ATP ARF 1945 Corcoran Zager [55] C Zager [56] ATP 25% 14

16 ATP DFO ATP ATP 1 >6.0mmol/L [11] ARF UA>20mg/dl 1200µm0l/L 2 ARF ARF Better [5] ARF ARF Eneas [57] 3 15

综合报道

综合报道 55 doi:10.3969j.issn.1000-3606.2014.01.01 论著不同围生因素对妊娠的影响赵玉祥岳虹霓杨占华江苏省淮安市保健院新生儿科 ( 江苏淮安 223002) 摘要 : 目的探讨妊娠期高血压疾病胎膜早破等围生因素对妊娠的影响方法回顾性