三聚氰胺泌尿系结石住院婴幼儿一年后随访结果分析

目的 了解2008年喂养三聚氰胺污染奶粉1年后对婴幼儿泌尿系发育的影响.方法 选取178例,随访时年龄:(29.3±9.6)个月,曾住院治疗的三聚氰胺泌尿系结石(MUS)婴幼儿进行16个月随访.随访内容包括泌尿系超声、尿、血常规和肾功能检查及疗效.选取同期非纯母乳和无三聚氰胺污染奶粉喂养史正常儿童110例为对照组(CG),年龄:(29.6±10.1)个月,比较两组相关参数异同.结果 161例成功随访;89例带石出院患儿院外行保守治疗,随访时56例结石消失,25例变小,7例无明显变化,1例增大.MUS患儿补钙的比例明显低于CG、身高偏低的比例显著高于CG(P<0.05).随访未发现泌尿系占位病变.尿常规、血常规无异常,肾和膀胱功能及形态均未见明显异常.结论 食用三聚氰胺污染奶粉1年后对婴幼儿身体和泌尿系发育未产生明显影响.     

三聚氰胺污染奶粉致婴幼儿肾积水4年随访分析

目的 探讨三聚氰胺污染奶粉致肾积水对儿童泌尿系统及生长发育的影响.方法 对2008年7月至10月在郑州大学第一附属医院治疗的25例三聚氰胺肾积水患儿进行4年随访.随访内容包括泌尿系超声、肾功能、血常规、尿常规,同时记录患儿身高、体质量等发育情况.选取同期非纯母乳喂养和无三聚氰胺污染奶粉喂养史的30名健康儿童为健康对照组.结果 25例肾积水患儿成功随访,其中男15例,女10例;年龄(67.60 ±17.22)个月;双侧积水8例,单侧积水17例.4年后随访发现20例积水消失,5例减轻.患儿补钙的比例与健康对照组比较差异无统计学意义,身高和体质量与健康对照组比较差异均无统计学意义.随访时未发现泌尿系占位性病变.结论 三聚氰胺污染奶粉致患儿肾积水4年后身体生长发育正常,极少数患儿肾积水继续存在,但无恶化迹象.     

婴幼儿三聚氰胺相关泌尿系结石并发急性肾衰竭诊疗分析

目的 探讨食用受三聚氰胺污染的婴幼儿配方奶粉致泌尿系结石并发急性肾衰竭患儿的临床特点、诊断和治疗措施.方法 回顾性分析首都医科大学附属北京儿童医院和徐州市儿童医院2008年收治的34例因食用三聚氰胺污染的婴幼儿配方奶粉致泌尿系结石、梗阻发生急性肾衰竭的患儿.分析其流行病学、临床表现及影像学特点,总结4种不同的治疗方法 及疗效.结果 34名患儿均存在急性肾衰竭,血尿素氮(24.1±8.2)mmol/L,血肌酐(384.2±201.2)μmol/L.对留取的14例结石标本分析证实,结石是三聚氰胺和尿酸的合成体.膀胱镜治疗组血肌酐降至正常的平均时间为(3.5±1.9)d;切开取石组(2.7±1.1)d;透析组(3.8±2.3)d;内科保守治疗组(2.7±1.6)d.四组肾功能恢复时间差异无统计学意义(P=0.508),组问差异无统计学意义(P=0.803～1).经治疗34例患儿急性肾衰竭全部治愈,泌尿系结石完全或部分排出.肾功能恢复时间为(3.0±1.8)d.结论 三聚氰胺污染婴幼儿配方奶粉可以导致婴幼儿泌尿系结石引发的梗阻性急性肾衰竭,治疗首选药物或透析方法 纠正电解质紊乱,特别是高钾血症,尽快通过内、外科方法 解除梗阻引流尿液.患儿近期预后良好.     

三聚氰胺与婴幼儿尿路结石

目的 探讨三聚氰胺污染奶粉喂养史婴幼儿泌尿系结石临床特点.方法 回顾性分析165例三聚氰胺污染奶粉喂养史泌尿系结石住院婴幼儿的临床资料.患儿按照卫生部推荐的<诊疗方案>进行治疗.另选30例无三聚氰胺污染奶粉喂养史住院病例作为对照组.结果 患儿发病年龄2岁以内占83.6%(138/165),其中6～12个月患儿占41.2%(68/165).患儿中49.7%(82/165)有临床症状,主要表现为排尿困难16.9%(28/165)、不明原因哭闹14.6%(24/165)、少尿无尿10.9%(18/165)及血尿7.3%(12/165).共发现233处结石,肾结石患儿比例高达79.5%(131/165),尿道结石仅1.2%(2/165).结石直径为2～16 mm,其中4～10mm占63.5%(148/233),>10mm者9.9%(23/233).除1例双肾结石尿路梗阻行逆行输尿管插管手术治疗外,其他患儿均采用保守治疗.治疗(9±5)d后患儿症状均消失,结石排出率为43.0%.结论 三聚氰胺污染奶粉喂养能引起婴幼儿泌尿系结石,多在喂养6～12个月后发病.非手术治疗效果好.     

食用三聚氰胺污染奶粉相关泌尿系结石患儿的随访

目的：了解食用三聚氰胺污染奶粉相关泌尿系结石患儿的预后情况。方法：用B型超声检查泌尿系统,对北京大学第三医院儿科食用三聚氰胺污染奶粉相关泌尿系结石患儿共47例进行定期随访。结果：研究随访至6个月时,36例（77%）患儿的泌尿系结石自行排出,仅有7例泌尿系结石仍然存在,失访4例,随访中患者均未出现合并症;泌尿系结石的排出与暴露于污染奶粉中三聚氰胺量和时间无关,但与结石部位有关;男童泌尿系结石自行排出时间比女童长,但差异无统计学意义。结论：食用三聚氰胺污染奶粉相关泌尿系结石患儿的预后良好,大多数患儿的泌尿系结石可以自行排出。［中国当代儿科杂志,2010,12（4）：278-279］     

超声筛查三聚氰胺污染奶粉致婴幼儿泌尿系结石112例

目的通过超声筛查曾食用受三聚氰胺污染奶粉的婴幼儿泌尿系统,证实食用受三聚氰胺污染的食品可使人类特别是婴幼儿产生泌尿系结石。方法回顾性分析2008年9月至11月因食用受三聚氰胺污染奶粉在本院B超检查确诊为泌尿系结石的婴幼儿临床资料,分析其超声影像学特点。结果共筛查9224人次,确诊为婴幼儿泌尿系结石112例,占总筛查人数的1．21％;其中双肾结石21例,左肾结石46例,右肾结石44例;肾盂输尿管交界处7例,输尿管膀胱交界处5例;超声检查显示4mm左有结石中,31例呈彗星尾征,8mm以上结石中,2例后方声影不明显;随访确诊为结石的婴幼儿58例,发现11例为5mm左右结石,1例输尿管结石,1例8mm以上结石消失,5例结石变小或数量减少,4例结石发生位移。结论食用受三聚氰胺污染的食品可使人类特别是婴幼儿发生泌尿系结石;此类结石质地疏松,以小结石和泥沙样结石为主,累及范围较广。     

有三聚氰胺污染奶粉喂养史的112例3岁内患儿泌尿系结石内科治疗效果

目的 总结3岁内有三聚氰胺污染奶粉喂养史泌尿系结石患儿内科治疗效果,为临床诊治提供参考.方法 有三聚氰胺污染奶粉喂养史的结石患儿112例[男73例,女39例;年龄(14.43±8.63)个月],入院后主要行补液、碱化尿液治疗(静脉滴注50 g/L碳酸氢钠0.5 mL/kg),并同时检测患儿尿液pH值,根据其变化调整用药量.对肾衰竭患儿予血液透析治疗.以内科治疗结束时情况判定疗效.结果 112例患儿住院治疗3～25 d,痊愈56例,有效49例,无效7例.痊愈、有效及无效组患儿入院时B超测定结石直径分别为(4.77±3.16) mm、(8.13±3.79) mm和(6.92±2.65)mm,尿pH值分别为5.64±0.11、5.75±0.10和6.38±0.31.无效组尿pH平均值与痊愈组比较有明显差异(P<0.05).排出的结石最大直径为6 mm.0～3个月、4～6个月、7～12个月和13～36个月组间疗效比较无显著差异(P>0.05).结论 3岁内有三聚氰胺污染奶粉喂养史泌尿系结石患儿内科治疗效果较好.疗效与治疗前结石大小和尿液pH值有关,与年龄无关.     

与食用受三聚氰胺污染配方奶粉相关儿童泌尿系统结石的现况调查

目的 探讨食用受三聚氰胺污染配方奶粉与儿童泌尿系统结石发生的关系.方法 对0～14岁食用受三聚氰胺污染配方奶粉的儿童,通过其家长填写调查问卷、临床问诊、体格检查、尿常规、泌尿系统B超、肾功能、肝功能及其他血、尿生化指标等检查,筛查是否存在泌尿系统结石及其他损害.将受三聚氰胺污染的配方奶粉分为三聚氰胺高含量组和三聚氰胺低含量组,将食用受三聚氰胺污染配方奶粉的时间分为≤30 d和>30 d,依据年龄分为≤1岁、～2岁、～3岁、～6岁和～14岁组.分析性别、年龄、配方奶粉中不同三聚氰胺含量和用奶时间对泌尿系统结石发生的影响.分析泌尿系统结石患儿的临床表现、实验室检查结果及病情转归.结果 接受筛查儿童22 091名,患泌尿系统结石374名,其中男性223名,女性151名,男:女约为1.5∶1.①泌尿系统结石发生率:≤3岁各年龄组,三聚氰胺高含量组均高于三聚氰胺低含量组(P<0.001);～6岁组,三聚氰胺高含量组高于三聚氰胺低含量组(P<0.05);～14岁组,三聚氰胺高含量组与三聚氰胺低含量组差异无统计学意义(P>0.05).三聚氰胺高含量组各相邻年龄组儿童泌尿系统结石发生率差异均无统计学意义(P>0.05);三聚氰胺低含量组除≤1岁组与～2岁组泌尿系统结石发生率差异有统计学意义外(P<0.05),其余各相邻年龄组差异均无统计学意义(P>0.05).②单侧肾结石309例,双侧肾结石60例,单侧输尿管结石6例,双侧输尿管结石2例,膀胱结石4例,尿道结石2例.③93例住院治疗的泌尿系统结石患儿中,血尿8例(8.6%)、脓尿7例(7.5%)、蛋白尿3例(3.2%)、尿痛或尿哭5例(5.4%)、少尿或无尿2例(2.2%)、水肿2例(2.2%)、血β<,2>-微球蛋白(β<,2>-MG)增高25例(26.9%)、尿β<,2>-MG增高4例(4.3%);BUN和SCr增高各2例(2.2%),均无磷酸激酶同工酶和ALT升高.9例需外科治疗,其余内科保守治疗.治愈34例,好转55例,未愈2例,自动出院或转院2例.结论 食用受三聚氰胺污染配方奶粉与儿童泌尿系统结石的发生有关,泌尿系统结石发生可能与年龄无关,与食用受三聚氰胺污染配方奶粉相关的泌尿系统结石可能对肾脏有一定损害.     

食用含三聚氰胺奶粉致婴幼儿泌尿系统结石的危险因素

目的探讨食用含三聚氰胺奶粉致婴幼儿泌尿系统结石的危险因素。方法2008年本院在对食用含三聚氰胺奶粉婴幼儿进行泌尿系统结石筛查的基础上,对242例泌尿系统结石患儿[病例组。男149例,女93例;年龄(19.092±9.903)个月;食用三聚氰胺污染奶粉时间(14.960±9.055)个月]和242例无尿路结石的婴幼儿[对照组。男149例,女93例;年龄(18.682±9.558)个月;食用三聚氰胺污染奶粉时间(15.240±9.356)个月]进行病例对照研究,以年龄、性别、城乡区域、喂养方式相同作为配比条件。从既往研究和已有文献中选取7项可能影响泌尿系统结石形成的相关危险因素,采用SPSS12.0软件对数据进行χ2检验、单因素及多因素条件Logistic回归分析。结果食用含三聚氰胺高的三鹿奶粉患儿165例,其中结石患儿151例,占总数的62.40%;食用非三鹿奶粉319例,泌尿系结石91例,占37.60%。单因素分析显示,在选取的7种危险因素中,仅食用不同品牌含三聚氰胺奶粉、平均每日饮水量在病例组与对照组间比较差异有统计学意义(Pa<0.01),但饮用水来源、出汗量、补充钙剂、奶粉冲服方式和奶粉食用时间比较差异...     

3108例食用三聚氰胺污染奶粉儿童筛查结果分析

目的 探讨佛山地区食用三聚氰胺污染奶粉小儿泌尿系结石的分布情况.方法 对因食用三聚氰胺污染奶粉就诊的小儿进行尿常规及B超检查,经临床及B超确诊为泌尿系结石的患儿进一步检查肝、肾功能及腹部平片,并进行临床埘比分析.结果 3 108名就诊小儿中,B超结果提示肾脏强光团51例(1.64%),符合国家卫生部颁发的.肾结石诊断标准8例.B超检查结果异常以食用三鹿奶粉儿为主(P<0.05),且泌尿系B超有无强光团与患儿年龄相关(X2=12.43,P<0.05).结论 食用三聚氰胺污染奶粉引起泌尿系异常与三聚氰胺的含量相关,与年龄相关.     

Renal replacement therapies in pediatric intensive care patients: Experiences of one center in Turkey

BACKGROUND: Despite constant improvements in caring for critically ill neonates and infants with congenital cardiac disease, sepsis, bone marrow and solid organ transplantation, acute renal failure (ARF) is an important problem in these children. ARF, severe fluid overload and inborn errors of metabolism are some of the indications for acute dialysis in infants and children. METHODS: The authors had retrospectively evaluated the medical records of Pediatric Intensive Care Unit, Ankara University School of Medicine, Ankara, Turkey patients who had required acute renal replacement therapy between the dates of January 2002 to February 2005. RESULTS: Medical records of 332 patients were reviewed. Acute renal replacement therapy was performed in 21 patients (6.3%; mean age, 9.6 +/- 7.4 years). Dialysis modalities were peritoneal dialysis in 15 patients (71.4%; mean age, 3.9 +/- 5.6 years) and hemodialysis in six patients (28.6%; mean age, 12.1 +/- 3.2 years). A total of 90% of patients had severe systemic disease leading to ARF. A total of 95% of patients had multiple organ dysfunction syndrome. The most common cause of ARF was refractory shock. At the beginning of renal replacement therapy, 10 patients were anuric, nine patients had volume overload, seven patients had decompensated metabolic acidosis and nine patients had hypotension. The average dialysis period was 4.7 +/- 6.4 days. Mortality rate was 66.7%. Eight patients recovered from ARF and chronic renal failure had developed in one patient. CONCLUSION: In the Pediatric Intensive Care Unit, ARF is frequently seen together with multiple organ dysfunction syndrome and the mortality rate is high. Both peritoneal dialysis and hemodialysis are important renal replacement treatment modalities in patients with ARF. The age and hemodynamic status of the patients are important when choosing treatment modality; generally peritoneal dialysis is preferred in infants and toddler, while hemodialysis is preferred in older children.     

Pre-auricular tags and pits in the newborn: the role of renal ultrasonography

OBJECTIVE: To determine the role of renal ultrasonography in the evaluation of healthy newborn infants with isolated pre-auricular tags and pits.Study design: During the 4 years of prospective study, 108 of 17,286 infants were born with isolated pre-auricular tags or pits (6.2 per 1000 live births): 92 were assessed for urinary tract abnormalities by performing renal ultrasonography at 1 to 3 months of age. The study group was compared with a control group of 95 consecutive healthy infants without pre-auricular tags or pits born during the same period who underwent renal ultrasonography on the second day of life. RESULTS: The study and control groups were comparable in birth weight, gestational age, and sex ratio. Renal ultrasonography was abnormal only in 2 infants with pre-auricular tags (2.2%); both had mild left pyelectasis. The prevalence did not differ significantly from that in the control group, in which 3 infants had mild pyelectasis (3.1%, P = 1.0) and 1 infant had a renal calculus. The prevalence of renal abnormalities in infants with isolated pre-auricular tags or pits in our study (2.2%) was also comparable to the prevalence in the general population (all abnormalities 0.2%-8.1%; significant abnormalities 0.2%-1.4%). CONCLUSIONS: We conclude that renal ultrasonography is not indicated in the routine evaluation of the newborn infant with isolated pre-auricular tags or pits.     

儿童急性肾衰竭透析疗法比较

目的　为探讨儿童急性肾衰竭透析疗法效果 ,对我院腹膜透析和血液透析情况进行比较。方法　总结 1994年至 2 0 0 2年在我院行PD或HD的急性肾衰竭患儿的临床资料。结果　PD与HD改善肾功能、电解质紊乱和酸中毒的近期效果无显著性差异 (P >0 0 5 ) ,但HD组的肾功能、电解质和HCO3 -复常时间短于PD组 (P <0 0 5 )。结论　HD奏效快 ,ARF患儿病情紧急或合并多脏器衰竭时选用HD较适合 ,小年龄儿童HD治疗亦有可行性。但PD与HD对于改善肾功能、电解质紊乱和酸中毒同样有效 ,且适合基层医院开展     

Ultrasonographic screening for renal abnormalities in three-year-old children

We report the results of ultrasonographic screening to determine the prevalence of renal abnormalities in children. This study was conducted simultaneously with a regular health check using portable realtime ultrasound equipment, from July 1988 to June 1989. Of 2920 three-year-old children resident in Kurume City, 2351 (80.5%) were screened. Abnormalities were detected in 11 (0.47%) of these, involving six cases of pelvic dilatation, three cases of unilateral renal agenesis, and two cases of a unilaterally small kidney. However, the simultaneous urinalysis of these 11 children did not disclose these abnormalities. Our results indicate that ultrasonography is an efficient tool for screening for a silent renal abnormality.     

婴儿癫痫与TORCH 感染的关系

目的 探讨婴儿癫痫与TORCH感染之间的关系.方法 采用ELISA法对40例婴儿癫痫患儿(癫痫组)和30例同龄健康婴儿(健康对照组)进行血清弓形虫(TOX)、风疹病毒(RV)、巨细胞病毒(CMV)和单纯疱疹病毒(HSV-Ⅰ、HSV-Ⅱ)抗体IgM、IgG水平检测.结果 癫痫组TORCH-IgM抗体阳性7例,其中CMV-IgM阳性7例,TOX-IgM、RV-IgM、HSV-Ⅰ-IgM和HSV-Ⅱ-IgM阳性例数均为0,健康对照组TORCH-IgM抗体阳性例数为0,癫痫组CMV-IgM检出阳性率高于健康对照组(P<0.05),其他TORCH系列抗体的检出阳性率与健康对照组比较差异无统计学意义(Pa>0.05).≤6个月癫痫患儿CMV-IgG抗体阳性24例(82.76%),7~12个月的癫痫患儿CMV-IgG抗体阳性5例(45.45%),≤6个月癫痫患儿CMV-IgG抗体阳性率高于7~12个月患儿(P<0.05).≤6个月癫痫患儿CMV-IgM抗体阳性6例(20.69%),7~12个月的癫痫患儿CMV-IgM抗体阳性1例(9.09%),≤6个月和7~12个月癫痫患儿CMV-IgM抗体检出阳性率比较差异无统计学意义(P>0.05).结论 婴儿癫痫与CMV感染有一定关系.     

血液透析治疗小儿急性肾功能衰竭61例次报告

目的　 研究血液透析 (HD)治疗小儿急性肾功能衰竭 (ARF)的特点及其方法。 方法 　对 2 2例患儿 61次HD的策略、HD前后血尿素氮、肌酐、电解质水平监测 ,HD的并发症及处理、抗凝及血管通道建立等进行观察和分析。 结果 　HD疗效满意。痊愈 17例 ,好转 5例。HD的主要并发症为低血压 ( 2 0 2 % )。 结论 　HD能减少ARF并发症的发生 ,促使肾功能较快恢复 ,降低病死率。掌握小儿HD的特点及方法是透析成功的关键。     

Management of acute renal failure

Acute renal failure (ARF) is defined as an abrupt decline in the renal regulation of water, electrolytes, and acid-base balance. It continues to be an important factor contributing to the morbidity and mortality of critically ill infants and children. The frequency of specific diseases that result in ARF differs among different age-groups and geographical areas. The common causes in Indian children include hemolytic uremic syndrome, acute tubular necrosis, glomerulonephritis and urinary tract obstruction. Though the hallmark of renal failure is oliguria, there is increasing recognition of non-oliguric ARF often associated with the use of nephrotoxic drugs. The basic principles of management are avoidance of life-threatening complications, maintenance of fluid and electrolyte balance and nutritional support. Specific management of the underlying disorder is possible only in a minority of cases. All the major dialysis modalities—peritoneal dialysis (PD), hemodialysis (HD) and continuous hemofiltration—can be used to provide equivalent solute clearance and ultrafiltration. Peritoneal dialysis requires minimal equipment and infrastructure, and is easy to perform; this makes it the favoured modality in developing countries where resources for HD or continuous therapies may not be accessible. However, continuous hemofiltration is an excellent alternative to PD in patients with ARF and severe fluid overload. The prognosis of children with renal failure depends on the underlying condition and associated medical complications.     

儿童尿路结石及其致急性肾功能衰竭临床分析

目的 探讨儿童尿路结石的高危因素、临床特点及其导致急性肾功能衰竭的诊断及处理方法 .方法 回顾分析2002至2007年我院收治的35例尿路结石病例,分析其临床表现、治疗及转归,以总结出儿童尿路结石的临床特点及治疗方法 .结果 所有患儿均采用腹部B超及腹平片检查确诊;24例患儿并发急性肾功能衰竭,病程与血尿素氮、肌酐水平正相关(r=0.549,P=0.007:r=0.575,P=0.004);肾功能衰竭组X线阳性结石少于非肾功能衰竭组(X2=8.70,P=0.006);尿酸水平高于非肾功能衰竭组(t=3.04,P=0.009);肾功能衰竭组予内科保守或血液透析治疗,同时行膀胱镜逆行引流术,解除梗阻后患儿尿量增加,尿毒症症状消失,肾功能恢复正常.结论 小儿尿路结石临床表现不典型,腹部B超是最好的诊断方法 ;结石导致急性肾功能衰竭需早期诊断及治疗,及时解除结石梗阻至关重要,同时应注意纠正水电解质紊乱及对症治疗;应长期随访,预防结石复发.     

小儿多囊肾19例临床分析

目的探讨小儿多囊肾的临床特点及诊断情况。方法回顾性分析1978年1月～2003年11月收治的19例多囊肾患儿的临床特点及诊疗情况。结果19例中男12例，女7例，年龄中位数为6．5岁，均无父母多囊肾证据。起病时的临床表现为尿异常6例、发热6例、腹部包块2例，余为苍白伴鼻衄、纳差、乏力、腹痛、多发畸形及抽搐。明确诊断时11例已存在不同程度的肾功能异常。均经影像学（主要是B超）诊断为多囊肾。6例经长期随访，2例死亡，3例因终末期肾病而接受透析，1例肾功能正常。结论多囊肾患儿多为常染色体隐性遗传多囊肾，临床表现多样，明确诊断时多已有不同程度的肾功能损害。对尿常规异常的患儿应行B超以及早发现多囊肾。