动态监测新生儿早期休克患儿左心排量变化及临床意义

目的探讨动态监测新生儿休克患儿的左心排量变化及临床意义。方法采用USCOM技术无创监测30例休克新生儿和30例正常新生儿的左心输出量及每搏输出量,并监测休克患儿扩容及多巴胺[2～4μg/(kg·min)]治疗后的心排量变化。结果休克患儿左心输出量及每搏输出量[分别为(0.36±0.24)L/min,(3.5±1.5)cm3]与正常对照组[(0.49±0.15)L/min,(2.7±1.6)cm3]比较显著降低(P均<0.05);休克患儿经扩容及多巴胺治疗2～6h后,左心输出量及每搏输出量[(0.52±0.28)L/min,(3.8±1.8)cm3]较扩容前明显改善(P均<0.05),且治疗后尿量明显增加(P<0.05)。结论动态监测新生儿休克患儿心排量,可指导临床液体复苏。     

多谱勒超声正常新生儿左心输出量的研究

本文应用多港勒技术，采用升主动脉血流速度测定方法，结合M超主动脉直径的测量，对93例正常新生儿及早产儿左心输出量进行了测定．被检者体重1000～4750g，胎龄27～42周．结果见心输出量随体重增加而增加，两者呈上钱正相关（r=0．90，P＜0．001）．平均心输出量234．9±44．4ml/min/g（±s）。低体上者心输出量估高（＜2000g=252．1±47．9ml/min/kg,＞2000g=225．6±39．gml/min/kg,t=2．765，p＜0．01）．作为临床应用．本文提出心输出量322ml/min/kg和180ml/min/kg可分别作为应用多谱勤方法测定心输出量的上限和下限．     

便携式超声心输出量监护仪在肺炎合并心力衰竭患儿心功能状态评价中的意义

目的 研究便携式超声心输出量监护仪（ultrasonic cardiac output monitor,USCOM）在肺炎合并心力衰竭患儿的应用及其临床意义。方法 应用USCOM分别测量14例肺炎合并心力衰竭患儿、32例普通肺炎患儿（对照组）的心功能（左心室）相关指标：包括主动脉峰流速、心率、每搏输出量指数、心指数、射血时间及校正后的射血时间。结果 肺炎合并心力衰竭组心率（174±10）次/min明显快于对照组（133±14）次/min（P＜0.05）;而主动脉峰流速低于对照组[（1.246±0.234） m/s vs （1.449±0.300） m/s] （P ＜0.05）;每搏输出量指数亦低于对照组[（29.357±6.500） ml/m2 vs （40.188 ±5.337） ml/m2]（P＜0.05）;同时校正后的射血时间明显缩短[（342.560 ±8.219） ms vs （354.430±16.500） ms] （P ＜0.05）.结论 USCOM可以准确地测量心输出量,敏感地反映心功能情况,能够对重症肺炎合并心力衰竭患儿进行简单、快捷、准确的评估。     

应用超声监测小儿心输出量的方法学研究

目的 研究便携式超声心输出量监护仪(USCOM)测量儿童心输出量的准确性.方法 应用USCOM测量60例正常儿童的左室心输出量,并与M型超声Teichholz公式法、多普勒主动脉血流量法测定的数值比较.结果 USCOM测定的正常儿童左室心输出量与M型超声Teichholz公式法、多普勒主动脉血流量法测定的相应数值相关显著(r=0.88,P<0.05;r=0.83,P<0.05),t检验提示USCOM测定与M型超声Teichholz公式法、多普勒主动脉血流量法的测定数据间差异均无显著性(P>0.05).结论 USCOM可较准确地测量心输出量,并具有较强的实用性.     

应用USCOM及超声多普勒监测正常足月新生儿的左心输出量研究

目的 探讨无创心排量监测系统USCOM在正常新生儿左心输出量测定中的应用.方法 同时采用USCOM技术及超声多普勒监测35例正常新生儿的心输出量(CO)及每博输出量(SV),并将两种方法所测得结果进行比较分析.结果 两种方法测得正常新生儿的心输出量无显著性差异;且两种监测方法具有好的相关性(CO r=0.83,SV r=0.9,P均＜0.01).结论 采用USCOM技术监测新生儿的心输出量具有无创、连续、简便、准确的特点.     

床旁无创血流动力学监测在新生儿感染性休克诊治中的应用价值北大核心CSCD

目的探讨床旁无创血流动力学监测指标在指导新生儿感染性休克诊治中的应用价值。方法根据购买并使用超声心排出量监测仪（USCOM）进行血流动力学监测的时间作为分组条件,将上海市儿童医院新生儿科2014年5月至2016年12月收治的患儿分为3组。16例未行USCOM检测感染性休克患儿为非USCOM监测组,20例行USCOM检测感染性休克患儿为USCOM监测组。另20例患儿为对照组,该组患儿血流动力学稳定,基础疾病主要为早产、新生儿黄疸、新生儿肺炎等。对USCOM监测组和对照组患儿使用USCOM检查,记录每搏心排出量（SV）、心排出量（CO）、心率（HR）、心指数（CI）、外周血管阻力指数（SVRI）。比较USCOM监测组及非USCOM监测组患儿多巴胺、多巴酚丁胺、肾上腺素、去甲肾上腺素用量及血管活性药物使用时间。对3组结果进行比较。结果与对照组相比,USCOM监测组治疗前的CO[（0.68±0.44） L/min比（0.44±0.17） L/min,t=3.306,P=0.004]、CI[（4.40±1.88） L/（min·m^2）比（3.00±0.40） L/（min·m^2）,t=3.328,P=0.004]、SV[（3.90±2.39） cm^3比（3.08±0.31） cm^3,t=2.227,P=0.038]、HR[（166.09±26.20）次/min比（145.35±16.16）次/min,t=2.750 ,P=0.013]均升高,而SVRI[（795.88±450.19） d·s/（cm5·m^2）比（1 160.61±49.59） d·s/（cm5·m^2）,t=-2.898,P=0.009]降低,差异均有统计学意义。USCOM监测组治疗后与治疗前相比,CO[（0.56±0.28） L/min比（0.68±0.44） L/min,t=2.456,P=0.024]和CI[（3.65±1.10） L/（min·m^2）比（4.40±1.88） L/（min·m^2）,t=2.614 ,P=0.017]均显著下降,差异有统计学意义。与非USCOM监测组相比,USCOM监测组的多巴胺用量[（45.72±28.80） mg/kg比（85.83±69.33） mg/kg,t=2.352,P=0.005]、多巴酚丁胺用量[（12.81±26.18） mg/kg比（85.83±69.33） mg/kg,t=4.351,P=0.002]、肾上腺素用量[（0.11±0.33） mg/kg比（0.90±1.75） mg/kg,t=1.986,P=0.014]及血管活性药物使用时间[（68.10±34.37） h比（167.75±117.14） h,t=3.626,P=0.001]均减少,去甲肾上腺素用量[（1.91±3.79） mg/kg比（0.47±0.90） mg/kg,t=-1.481,P=0.046]增多,差异均有统计学意义。结论床旁无创血流动力学监测在新生儿感染性休克诊治中起重要作用,可以明确休克的血流动力学状态,指导合理使用血管活性药物,提高治疗成功率。     

床旁无创血流动力学监测在新生儿感染性休克诊治中的应用价值北大核心CSCD

目的探讨床旁无创血流动力学监测指标在指导新生儿感染性休克诊治中的应用价值。方法根据购买并使用超声心排出量监测仪（USCOM）进行血流动力学监测的时间作为分组条件,将上海市儿童医院新生儿科2014年5月至2016年12月收治的患儿分为3组。16例未行USCOM检测感染性休克患儿为非USCOM监测组,20例行USCOM检测感染性休克患儿为USCOM监测组。另20例患儿为对照组,该组患儿血流动力学稳定,基础疾病主要为早产、新生儿黄疸、新生儿肺炎等。对USCOM监测组和对照组患儿使用USCOM检查,记录每搏心排出量（SV）、心排出量（CO）、心率（HR）、心指数（CI）、外周血管阻力指数（SVRI）。比较USCOM监测组及非USCOM监测组患儿多巴胺、多巴酚丁胺、肾上腺素、去甲肾上腺素用量及血管活性药物使用时间。对3组结果进行比较。结果与对照组相比,USCOM监测组治疗前的CO[（0.68±0.44） L/min比（0.44±0.17） L/min,t=3.306,P=0.004]、CI[（4.40±1.88） L/（min·m^2）比（3.00±0.40） L/（min·m^2）,t=3.328,P=0.004]、SV[（3.90±2.39） cm^3比（3.08±0.31） cm^3,t=2.227,P=0.038]、HR[（166.09±26.20）次/min比（145.35±16.16）次/min,t=2.750 ,P=0.013]均升高,而SVRI[（795.88±450.19） d·s/（cm5·m^2）比（1 160.61±49.59） d·s/（cm5·m^2）,t=-2.898,P=0.009]降低,差异均有统计学意义。USCOM监测组治疗后与治疗前相比,CO[（0.56±0.28） L/min比（0.68±0.44） L/min,t=2.456,P=0.024]和CI[（3.65±1.10） L/（min·m^2）比（4.40±1.88） L/（min·m^2）,t=2.614 ,P=0.017]均显著下降,差异有统计学意义。与非USCOM监测组相比,USCOM监测组的多巴胺用量[（45.72±28.80） mg/kg比（85.83±69.33） mg/kg,t=2.352,P=0.005]、多巴酚丁胺用量[（12.81±26.18） mg/kg比（85.83±69.33） mg/kg,t=4.351,P=0.002]、肾上腺素用量[（0.11±0.33） mg/kg比（0.90±1.75） mg/kg,t=1.986,P=0.014]及血管活性药物使用时间[（68.10±34.37） h比（167.75±117.14） h,t=3.626,P=0.001]均减少,去甲肾上腺素用量[（1.91±3.79） mg/kg比（0.47±0.90） mg/kg,t=-1.481,P=0.046]增多,差异均有统计学意义。结论床旁无创血流动力学监测在新生儿感染性休克诊治中起重要作用,可以明确休克的血流动力学状态,指导合理使用血管活性药物,提高治疗成功率。     

应用无创心输出量测定技术动态监测新生儿心力衰竭的心输出量及临床意义

目的 探讨采用无创心输出量测定技术(ultrasonic cardiac output monitoring,Uscom)动态监测心力衰竭新生儿的心输出量及临床意义.方法 采用Uscom无创监测40例心力衰竭新生儿心力衰竭治疗前及治疗后12h、24h、48h和40例正常新生儿的左右心输出量变化.结果 心力衰竭新生儿的左、右心输出量分别为(0.38±0.15)L/min、(0.65±0.26)L/min ,较正常新生儿的左、右心输出量明显下降[(0.59±0.25)L/min、(0.88±0.41)L/min(P均<0.05)].经抗心力衰竭治疗后12h,左、右心输出量分别为(0.45±0.21)L/min、(0.75±0.25)L/min,较治疗前无明显改善(P>0.05);治疗后24h、48h,左、右心输出量分别为(0.61±0.28)L/min、(0.62±0.22)L/min和(0.92±0.36)L/min、(0.93±0.24)L/min,较治疗前比较明显改善,差异有统计学意义(P均<0.05).结论 采用Uscom技术监测心力衰竭新生儿的心输出量是方便可行的,可指导临床治疗.     

超声心输出量监护仪在重症肺炎患儿心功能评价中的应用

目的 研究便携式超声心输出量监护仪 （ultrasonic cardiac output monitor,USCOM）在重症肺炎患儿的临床应用。方法 应用USCOM分别测量29例重症肺炎患儿 （观察组）及43例轻症肺炎患儿 （对照组）心功能相关指标,将两组结果进行比较分析差异,并比较观察组治疗前后心功能指标变化。结果 观察组较对照组相比心率、心输出量、每搏输出量、速度峰值差异有统计学意义 （P < 0.05）,心脏指数、外周血管阻力差异无统计学意义 （P > 0.05）。观察组治疗后心率、心输出量、每搏输出量、速度峰值、心脏指数、外周血管阻力较治疗前改善,差异有统计学意义 （P < 0.05）。结论 应用USCOM可快速、简便、准确、动态了解重症肺炎患儿的心功能状态及患儿整体循环状态,为诊断、治疗及评估病情提供依据,具有很强的实用性。     

部分液体通气对急性肺损伤幼猪心肺功能的影响

目的 研究部分液体通气对急性肺损伤幼猪心肺功能的影响.方法 12只上海小白猪,随机分为对照组(n=6)和治疗组(n=6).内毒素60 μg/kg静脉维持诱导肺损伤.治疗组成模后予高氟化碳(C10F18)10 ml/kg灌入气管.于基础状态,成模时,成模后1、2、4 h分别行血气分析、记录心率、血压、呼吸、肺动态顺应性、气道阻力、脉搏轮廓心输出量、全身血管阻力.结果 两组动物成模时氧合指数、肺动态顺应性、脉搏轮廓心输出量均明显下降,各参数组间比较无统计学差异.2 h后对照组氧合指数193.8±47.5,肺动态顺应性(0.8±1.7) ml/(cm H2O·kg),4 h后心输出量(2.1±0.7) L/min;治疗组2 h后氧合指数为261.5±25.8,肺动态顺应性(1.2±0.7) ml/(cm H2O·kg),4 h后心输出量(3.1±0.2) L/min,较对照组均有改善,差异有显著性(P＜0.05).结论 部分液体通气可明显改善肺损伤动物心肺功能.     

生物标记物粪便胆汁酸的测定在过敏性紫癜患儿诊治中的意义

目的 探讨生物标记物粪便胆汁酸浓度在过敏性紫癜(HSP)患者中的变化及其在诊治中的临床意义。方法 选取2014~2016年确诊为HSP的19例患儿为HSP组,另选取27例健康儿童为健康对照组。采集HSP组患儿急性期、恢复期及健康对照组儿童粪便标本,应用液相质谱技术检测各组儿童粪便胆汁酸水平。结果 HSP组患儿恢复期胆酸水平均高于健康对照组和HSP组急性期 (P < 0.016)。HSP组患儿恢复期鹅脱氧胆酸水平高于健康对照组 (P < 0.016)。HSP组患儿急性期和恢复期脱氧胆酸、石胆酸水平均低于健康对照组 (分别P < 0.05、P < 0.016)。各组间熊去氧胆酸水平比较差异均无统计学意义 (P > 0.05)。结论 HSP患儿急性期粪便次级胆汁酸脱氧胆酸和石胆酸低于健康对照组,这可能与HSP的发病或转归有关。     

霉酚酸酯和环磷酰胺治疗儿童大量蛋白尿型过敏性紫癜性肾炎的前瞻性随机对照研究

目的 探讨霉酚酸酯（MMF）和环磷酰胺（CTX）分别治疗具有大量蛋白尿[24 h尿蛋白定量≥50 mg/kg或晨尿蛋白/肌酐（mg/mg）≥2.0]的过敏性紫癜性肾炎（HSPN）患儿的疗效和安全性。方法 前瞻性纳入2016年8月至2019年11月在首都儿科研究所附属儿童医院肾脏内科住院并诊断为有大量蛋白尿的HSPN患儿68例,随机分为MMF组（n=33）、CTX组（n=35）,比较两组患儿完全缓解率、有效（完全缓解+部分缓解）率、尿蛋白转阴时间及不良反应等指标。结果 治疗3个月、6个月、12个月,MMF组与CTX组完全缓解率、有效率差异无统计学意义（P > 0.05）。两组尿蛋白转阴时间差异无统计学意义（P > 0.05）。两组患儿治疗期间不良反应发生率差异无统计学意义（P > 0.05）。结论 MMF和CTX治疗具有大量蛋白尿的HSPN患儿的疗效和安全性相当。     

EFFECT OF CYPROTERONE ACETATE (CA) ON GROWTH AND ENDOCRINE FUNCTION IN PRECOCIOUS PUBERTY

Abstract. Stahnke, N., Ilicki, A. and Willig, R. P. (Department of Paediatrics, University Hospital, Hamburg, West Germany). Effect of cyproterone acetate (CA) on growth and endocrine function in precocious puberty. Acta Paediatr Scand, Suppl. 277: 32, 1979.–16 girls with precocious puberty have been studied. Following low dosage cyproterone acetate (CA) therapy (mean daily dosage 65 mg/m² BSA) a beneficial effect on growth and skeletal maturation was observed. During high dosage therapy (150 mg/m² per day) endocrinological studies were performed in 10 of these patients. There was no significant difference in HGH levels (insulin-and arginine-test), T₃ and TSH values (TRH-test) between patients and controls, T₄ concentration was significantly increased. Basal prolactin levels and prolactin response to TRH was definitely elevated. Oral glucose load and arginine infusion resulted in a significantly enhanced insulin release. There was a significant reduction in basal LH levels and an increase in FSH response to LH-RH. Basal and diurnal plasma cortisol values were markedly reduced and the cortisol release due to corticotrophin injection, (lsinevasopressin (LVP) injection and insulin-hypoglycemia as well. A definite increase in basal ACTH levels was observed, during LVP-and insulin-hypoglycemia test ACTH concentrations were within or significantly above normal range. In our patients a primary adrenocortical insufficiency due to CA treatment was evident.     

Obesogenic home food availability,diet, and BMI in Pakistani and White toddlers

Individuals of South Asian ethnicity have an increased risk for obesity and related diseases. Foods available in the home during the first 1000 days (conception to 24 months old) are an important determinant of diet, yet no study has examined the association of early‐life home food availability (HFA) with later diet and obesity risk in South Asian households. We examined whether obesogenic HFA at 18 months of age is associated with dietary intake and body mass index (BMI) at 36 months of age in low‐income Pakistani and White households in the United Kingdom. In this prospective birth cohort study (Born in Bradford 1000), follow‐up assessments occurred at 18 (n = 1032) and 36 (n = 986) months of age. Variety and quantity of snack foods and sugar‐sweetened beverages (SSBs) in the home and consumed were measured using the HFA Inventory Checklist and food frequency questionnaires, respectively. BMI was calculated using measured length/height and weight. Multinomial logistic regression models examined associations between HFA and tertiles of dietary intake, and multivariable linear regression models assessed associations between HFA and BMI. Pakistani households had a greater variety and quantity of snack foods and SSBs available compared with White households. Variety and quantity of snack foods and SSBs in the home at 18 months were positively associated with children''s intake of these items at 36 months, but associations between HFA and BMI were null. Reducing obesogenic HFA during the first 1000 days may promote the development of more healthful diets, though this may not be associated with lower obesity risk during toddlerhood.     

Prenatal dietary diversity may influence underweight in infants in a Ugandan birth‐cohort

Growth faltering in early childhood is prevalent in many low resource countries. Poor maternal dietary diversity during pregnancy has been linked with increased risk of fetal growth failure and adverse birth outcomes but may also influence subsequent infant growth. Our aim is to assess the role of prenatal maternal dietary diversity in infant growth in rural Uganda. Data from 3291 women and infant pairs enrolled in a birth cohort from 2014 to 2016 were analysed ({"type":"clinical-trial","attrs":{"text":"NCT04233944","term_id":"NCT04233944"}}NCT04233944). Maternal diets were assessed using dietary recall in the second or third trimesters of pregnancy. Maternal dietary diversity scores (DDS) were calculated using the FAO Minimum Dietary Diversity for Women (MDD‐W). Cox regression models were used to evaluate associations of the DDS with the incidence of underweight, stunting and wasting in infants from 3 to 12 months, adjusting for confounding factors. The median DDS for women was low, at 3.0 (interquartile range 3.0–4.0), relative to the threshold of consuming five or more food groups daily. Infants of women in highest quartile of DDS (diverse diets) were less likely to be underweight (adjusted hazard ratio: 0.70, 95% confidence interval: 0.61, 0.80) compared with infants of women in Quartile 1 (p for trend <0.001) in models controlling for maternal factors. There was no significant association between DDS and stunting or wasting. Our findings suggest a relationship between higher maternal dietary diversity and lower risk of underweight in infancy. These findings suggest that programmes to improve infant growth could additionally consider strengthening prenatal dietary diversity to improve child outcomes globally.     

Factors associated with adverse nutritional status of children in sub‐Saharan Africa: Evidence from the Demographic and Health Surveys from 31 countries

Undernutrition is linked to almost half of all deaths in under‐five children. In 2019, 144 million under‐five children suffered from stunting and 47 million suffered from wasting. This study examined the factors that influence adverse nutritional status of children in sub‐Saharan Africa. The study used data from the Demographic and Health Surveys (DHS) of 31 countries, which involved 189,195 children under age 5. Binary logistic regression was used to examine the relationships between the independent variables and adverse nutritional status of children. About 26% of the children in the 31 countries in sub‐Saharan Africa considered in this study are stunted, 6% are wasted and 21% are underweight. Close to 31% of children whose mothers have no education are stunted, 9% are wasted and 28% are underweight. Adverse nutritional status of children is significantly associated with maternal age, education, household wealth, residence, antenatal care attendance, mass media exposure, child''s sex and size of child at birth. This study has shown that adverse nutritional status of children is a major challenge in sub‐Saharan Africa. Efforts at improving nutritional status of children should include poverty alleviation initiatives at individual and household levels, increase in women''s educational level and improvement in living conditions in rural areas.