儿童呼吸道合胞病毒感染诊断、治疗和预防专家共识

呼吸道合胞病毒(respiratory syncytial virus,RSV)是世界范围内引起5岁以下儿童急性下呼吸道感染(acute lower respiratory tract infections,ALRTI)最重要的病毒病原[1]。RSV感染是造成婴幼儿病毒性呼吸道感染住院的首要因素,严重危害儿童健康,尤其对早产儿、患有先天性心脏病或原发免疫缺陷的婴幼儿造成的疾病更重。目前,尚无RSV疫苗及有效的抗病毒药物用于RSV的治疗,唯一可用于RSV预防的人源化特异性抗体帕利珠单抗(Palivizumab)尚未引进国内临床应用。临床上在RSV的流行、致病机制、诊断、治疗及预防等方面尚存在一些不足,为进一步规范儿童RSV感染的诊断、治疗及预防,以国内外RSV最新研究进展为参考,特制定此专家共识。     

儿童普通感冒药物治疗中的问题及规范

普通感冒是儿童最常见上呼吸道感染性疾病，也是儿科最容易滥用药物的疾病。该文阐述了普通感冒在治疗上存在滥用抗生素、抗病毒药、感冒药、中药、中成药及不规范的治疗方法等问题，从而提出规范治疗的重要性，并引导如何进行普通感冒药物规范治疗。医生、药师、家长需正确认识普通感冒，选择普通感冒药时应避免诊治误区，减少药物滥用。     

儿童新型冠状病毒感染诊断、治疗和预防专家共识(第二版)

自2019年12月新型冠状病毒感染暴发以来,我国政府采取了严格的防控措施,国内疫情已得到初步控制,但形势依然严峻,境外多个国家也相继出现疫情。根据世界卫生组织的报告:截至2020年3月5日,全球共报告95333例确诊病例(其中我国累计报告确诊病例80565例),85个国家有确诊病例报告,中国将面临输入性病例的传播风险,这为防治我国儿童的疾病疫情提出了新的挑战[1]。在这次疫情中,与成人病例相比,儿童病例相对较少、症状轻、预后较好。目前国内病例数据显示,18岁以下儿童占所有报告病例的2.4%,尚无死亡病例报告[2]。     

Change of alveolar epithelial type Ⅱ cells and pulmonary surfactant protein A in young rats with acute lung injury

Objective To study the temporal changes of alveolar epithelial type Ⅱ cells and surfactant pro-tein A in young rats with acute lung injury induced by lipopolysaecharide. Method Totally 110 SD young rats (male:53, female : 57) were randomly divided into ALI and normal control groups (six subgroups in each group).LPS(4 mg/kg) was given intraperitoneally in ALI group. The same amount of normal saline was given in the con-trol groups. Eight rats in each subgroup were sacrificed at 6, 12, 24, 36, 48 and 72 hours after the injection.Lung samples were taken for transmission electron microscope examination. RT-PCR was epmloyed for the mea-surement of SP-A mRNA. Western blot was used for the detection of SP-A in the lung tissue. ANOVA and homo-geneity of variance test were performed by SPSS 12.0. Results The microvilli disappeared at 24 hours after the injection of LPS. The number of lamellar body (LBs) was provisionality increased at 24 hours and 48 hours. The ring-like an'angement of LBs around nucleus and the giant LB with vacuole-like deformity were found as the main characteristics of AEC- Ⅱ in ALI at 48 hours. The number of LBs reduced and broken and residual LB remained at 72 hours. SP-A elevated greatly from 24 to 48 hours (P < 0.01), reached peak at 36 hours (6.94 ± 0.80, P <0.01),reached the lowest level(3.87 ±0.50, P <0.01)at 72 hours. Conclusions The pathological changes of AEC-Ⅱ and SP-A in lung tissue wiht ALI are time-dependent. The typical alterations of AEC- Ⅱ occurs at 48 hours accompanied by the compensatory increase of SP-A. AEC- Ⅱ is seriously injuried with the typical changes of LBs and the diminishing of SP-A in lung tissue.     

经纤维支气管镜确诊儿童肺曲霉病1例

患儿女，17个月，以“喘息58d，间断发热53d，咳嗽21d”为主诉入院。患儿58d前因喘息、气促就诊于当地医院，X线胸片示支气管肺炎，遂于当地医院住院治疗。期间患儿出现发热、咳嗽，并因喘息加重、呼吸困难及心衰转入ICU辅助通气，带机11d撤机。出现气胸1次，行胸腔闭式引流术后缓解。     

儿童危重肠道病毒71型脑炎及神经源性肺水肿的临床特征与救治

目的 探讨儿童重症手足口病合并中枢神经系统感染及神经源性肺水肿(NPE)的临床特征、救治经验和转归.方法 总结2008年5月至6月收入安徽省阜阳市级医院儿童重症监护病房(PICU)手足口病合并巾枢神经系统感染及NPE救治资料.结果 36例患儿中,平均年龄15.8个月(4月至4岁),死亡7例,病死率为19.4%.出现危重症状平均病程2.1 d(0.5～5.0 d).12例(33.3%)无皮疹.神经系统表现为脑干脑炎27例(75%)、脑干脑炎伴脊髓炎6例(16.7%)、腩炎3例(8.3%).NPE突出表现是突然呼吸急促、粉红色或血性泡沫液(痰)、非对称性肺水肿或肺出血,是最直接死亡原因.主要救治措施为机械通气、甘露醇、甲基强的松龙、静脉丙种球蛋白、血管活性药物,其中9例患儿(25%)进行容量复苏.结论 EV71脑炎合并NPE,发病年龄小,进展快,病死率较高.早期诊断、及时呼吸支持、积极降颅压、维护循环功能是救治成功的关键.     

Change of alveolar epithelial type Ⅱ cells and pulmonary surfactant protein A in young rats with acute lung injury

Objective To study the temporal changes of alveolar epithelial type Ⅱ cells and surfactant pro-tein A in young rats with acute lung injury induced by lipopolysaecharide. Method Totally 110 SD young rats (male:53, female : 57) were randomly divided into ALI and normal control groups (six subgroups in each group).LPS(4 mg/kg) was given intraperitoneally in ALI group. The same amount of normal saline was given in the con-trol groups. Eight rats in each subgroup were sacrificed at 6, 12, 24, 36, 48 and 72 hours after the injection.Lung samples were taken for transmission electron microscope examination. RT-PCR was epmloyed for the mea-surement of SP-A mRNA. Western blot was used for the detection of SP-A in the lung tissue. ANOVA and homo-geneity of variance test were performed by SPSS 12.0. Results The microvilli disappeared at 24 hours after the injection of LPS. The number of lamellar body (LBs) was provisionality increased at 24 hours and 48 hours. The ring-like an'angement of LBs around nucleus and the giant LB with vacuole-like deformity were found as the main characteristics of AEC- Ⅱ in ALI at 48 hours. The number of LBs reduced and broken and residual LB remained at 72 hours. SP-A elevated greatly from 24 to 48 hours (P < 0.01), reached peak at 36 hours (6.94 ± 0.80, P <0.01),reached the lowest level(3.87 ±0.50, P <0.01)at 72 hours. Conclusions The pathological changes of AEC-Ⅱ and SP-A in lung tissue wiht ALI are time-dependent. The typical alterations of AEC- Ⅱ occurs at 48 hours accompanied by the compensatory increase of SP-A. AEC- Ⅱ is seriously injuried with the typical changes of LBs and the diminishing of SP-A in lung tissue.     

哮喘患儿应用孟鲁司特后血与尿白三烯变化观察

目的探讨孟鲁司特对哮喘患儿血、尿白三烯的影响。方法选择2007年5至12月在中国医科大学盛京医院小儿呼吸内科病房及PICU住院的哮喘急性中重度发作患儿40例,采用随机数字表法随机分为两组:(1)孟鲁司特组:接受常规治疗及孟鲁司特治疗。(2)常规治疗组:只接受常规治疗。哮喘急性发作治疗前后分别留取血及尿标本,待测白三烯。另取同期儿保体检健康儿童19例作为健康对照组。结果 (1)在哮喘急性发作期,孟鲁司特组与常规治疗组白三烯质量浓度差异无统计学意义(P>0.05);在哮喘症状缓解期,孟鲁司特组白三烯质量浓度明显低于常规治疗组(P<0.01);两组白三烯水平下降值差异有统计学意义(P<0.05)。(2)健康对照组血白三烯C4(LTC4)为(105.87±17.38)ng/L,尿白三烯E4(LTE4)为(91.76±33.73)ng/L;在哮喘症状缓解期,孟鲁司特组血LTC4(152.74±31.50)ng/L,尿LTE4(129.35±42.76)ng/L;常规治疗组患儿血LTC4(188.95±39.31)ng/L,尿LTE4(170.67±52.86)ng/L。3组血与尿白三烯质量浓度差异均有统计学意义(P<0...     

上感：小儿最常见的多发病

由于小儿呼吸系统的解剖、生理及免疫特点,“上感”为小儿时期最常见的多发病,占5岁以下小儿所有疾病的50％以上。