嚼口香糖对腹部手术后肠动力恢复的影响及作用机制研究

目的探讨儿童腹部手术后咀嚼口香糖是否能促进肠动力的恢复，并从神经和体液两方面因素来研究其作用机制。方法将34例肠吻合手术患儿，随机分为试验组和对照组，每组各17例。试验组于术后第1天晨开始咀嚼无糖口香糖，直至开始进食，每日3次，每次1h，对照组禁食。记录两组术后第1次肛门排气时间，并于第3次咀嚼口香糖后1h抽取血液检测胃泌素和儿茶酚胺（包括去甲肾上腺素和肾上腺素），对两组术后第1次排气时间、血胃泌素及儿茶酚胺水平进行统计学分析。结果试验组术后第1次肛门排气时间为术后63h，对照组为78h，差异有统计学意义（t=5．665，P〈0．05）。试验组去甲肾上腺素水平低于对照组，差异有统计学意义（t=3．335，P〈0．05），而两组肾上腺素（t=1．201，P〉0．05）及胃泌素（t=0．418，P〉0．05）比较，差异无统计学意义。结论根据假饲原理，腹部手术患儿术后嚼口香糖有助于肠功能的早日恢复，其作用机制与血去甲肾上腺素水平降低有关。     

婴幼儿先天性心脏病体外循环术后严重低钾血症的处理策略

目的 探讨高浓度快速静脉补钾的目标性治疗小儿先天性心脏病体外循环术后严重低钾血症的有效性和安全性.方法 80例体外循环术后严重低钾血症随机分成快速组和慢速组,两组静脉补钾的浓度为1.5%～5.0%,两组的速度分别为0.75～1.0mmol·kg~(-1)·h~(-1)和0.3～0.5 mmol·kg~(-1)·h~(-1),用输液泵经中心静脉均匀输入.当血钾≥3.5 mmol/L时两组改为常规补钾治疗.测定补钾前后的血钾浓度、动脉血气分析和心电图,同时持续心电监护、经皮氧饱和度监测和动脉血压监测.结果 两组补钾前血钾浓度相似,但快速组与慢速组相比,静脉补钾时间短(0.83±0.19)h比(2.14±0.27)h,P<0.01,补钾后血钾浓度高(4.07±0.95)mmol/L比(3.49土0.77)mmol/L,P<0.05,血钾浓度增高值与补钾剂量间无显著直线相关关系,两组中均未见高钾血症及与之相关的一过性心律失常.结论 本文采用的高浓度快速静脉补钾的目标性治疗具有快速、有效和安全性,不增加输液量,对纠正婴幼儿先心病体外循环术后严重低钾血症有一定的临床应用价值.     

105例小儿急性肺炎血钾改变的临床分析

本文分析了105例小儿急性肺炎血钾的变化,发现婴幼儿肺炎易发生低血钾。小儿肺炎于起病一周内发生低血钾的较多,合并代谢性酸中毒时仍可出现低血钾,且合并低钾者心衰的发生率较高。观察到营养不良患肺炎者均产生低钾血症,肺炎的预后与低血钾有一定关系。在治疗后肺炎恢复较慢或心衰难以控制时要考虑存在低钾的可能;对有营养不良者宜于治疗开始即同时补钾,以防输液纠酸后出现严重低血钾的不良后果。     

乌司他丁对小儿重大手术后的保护作用

目的 探讨乌司他丁对小儿手术后的保护作用。方法 利用粒细胞弹性蛋白酶和纤维连接蛋白作为指标对手术患儿进行随机的分组研究。结果 粒细胞弹性蛋白酶的血清浓度在小儿手术后明显升高，在术后当天为最高峰，以后逐渐下降，乌司他丁组下降的速度明显快于对照组，在术后第3d即有显著的差异性，差异性持续到术后第7d。血清纤维连接蛋白浓度的恢复在乌司他丁组明显快于对照组，在术后第7d即有显著的差异，对照组血清纤维连接蛋白浓度在术后第14d仍未能达到乌司他丁组的水平。结论乌司他丁对小儿手术后的再创伤有保护作用，同时能促进机体的恢复，是一种能使小儿平稳度过围手术期的有效药品。     

腹腔镜诊治小婴儿肠旋转不良的探讨

目的探讨小婴儿先天性肠旋转不良的微创诊治，总结经验教训。方法同顾性分析5例小婴儿肠旋转不良的临床资料，均于全麻下脐环下方、左右上腹部作切口约0．5cm，行Ladd’s手术。结果本组5例手术均获得成功，4例术后第2d肠功能恢复，开始进食，1例65d的患儿术后3d因十二指肠梗阻再次手术，术中证实系十二指肠隔膜，经腹行隔膜切除术。全部病例随访2～6月，预后良好。结论腹腔镜手术治疗小婴儿先天性肠旋转不良具有打击轻、创伤小、恢复快的优点，可推广使用。     

小儿腹部肿瘤的诊治经验的探讨

目的对小儿腹部实体肿块常见类型及肿瘤的早期诊断、外科治疗适应证及手术技巧进行深入讨论。方法总结了1993～2003年十年间我院共收治小儿腹部肿瘤患儿29例，其中22例接受手术，除1例术后死亡，其他21例预后良好。回顾性研究其相关因素。结果22例腹部肿瘤患儿，其中16例肝母细胞瘤，1例术后因凝血功能障碍死亡，2例肾母细胞瘤，3例畸胎瘤，1例神经母细胞瘤。术后恢复良好。肾母细胞瘤术后均行化疗。术后患儿未发生腹腔大出血及邻近器官损伤。结论小儿腹部肿瘤要早期诊断、及时治疗，术前要认真检查及分析，根据病理分型及患儿耐受能力进行合理的个体治疗方案。     

重组人生长激素用于先天性巨结肠症术后辅助治疗的临床研究

目的 探索rhGH应用于先天性巨结肠症手术后支持治疗的有效性及安全性.方法 选择126例先天性巨结肠症患儿,随机分成两组.实验组术后除常规治疗外,自术后第1天开始,每日20时皮下注射rhGH（0.2 U/kg）,共9d;对照组以生理盐水1 mL代替rhGH.观测血液生化指标、体质指数、心率、血压、住院时间和术后并发症.时间点选取用药前,用药后第3天、第6天、第14天,出院后3个月、12个月.结果 两组患儿年龄、手术时间及手术切除肠管长度比较,差异无统计学意义;用药后第3天、第6天及第14天白蛋白、前白蛋白较对照组有明显升高,而3个月以后上述指标无明显差异;用药期间及停药后3个月,12个月检测空腹血糖、血尿素氮、血肌酐、血甘油三酯、血胆固醇、体质指数、心率、血压等指标,均与对照组无显著差异.两组患儿术后并发症的发生率无统计学意义,但实验组肠功能恢复快、住院时间短.结论 rhGH短期应用于先天性巨结肠症术后支持治疗可改善患儿营养状态,加快术后恢复,临床应用安全.     

不同手术方法治疗肠旋转不良的疗效及对免疫功能的影响探讨

目的探讨不同手术方法治疗新生儿肠旋转不良的疗效以及对免疫功能的影响。方法对本院2010年1月到2011年12月收治的40例新生儿肠旋转不良患儿进行手术治疗,其中20例行开腹Ladd’s手术,20例行腹腔镜下Ladd’s手术;比较两组患儿手术前、手术后第1天、第5天血液中CD3^＋、CD4^＋、CD8^＋、B细胞、NK细胞和IgA、IgG、IgM、C3、C4hs—CRP水平,同时比较两组应激时间、术中出血量、肠功能恢复时间、术后住院时间及并发症等指标。结果两组患儿均痊愈出院,腹腔镜手术患儿在应激时间、出血量、肠功能恢复时间、住院时间方面比较,均优于开腹手术,差异有统计学意义;两组并发症的发生率比较,差异无统计学意义。术后第1天,两组患儿外周血CD3^＋、CD4^＋、CD8^＋活性较术前明显下降,差异有统计学意义（P〈0．05）;两组间比较,除NK细胞外（P〉0．05）,差异均有统计学意义（P〈0．05）。术后第5天,腹腔镜手术组恢复至接近术前水平（P〉0．05）,明显高于开腹组,差异有统计学意义（P〈0．05）。两组术后第1天与术前相比,免疫球蛋白IgA、IgG、IgM、C3、C4、hs-CRP比较,差异有统计学意义（P〈0．05）;两组间比较,差异有统计学意义（P〈0．05）,术后第5天,腹腔镜组恢复至接近正常水平。结论腹腔镜Ladd’s手术治疗肠旋转不良对机体干扰小,安全,创伤小,恢复快,具有一定可行性。     

小儿术后蛋白代谢的改变

小儿术后发生负氮，钾，磷平衡，其程度与手术大小有关。大手术后用稳定核素１５Ｎ甘氨酸研究患儿总体蛋白质代谢动力学，表明分解率明显增加，伴合成率轻度增加。股动，静脉氨基酸可反映下肢肌肉的蛋白质代谢情况，小儿术后表现为绝大多数氨基酸从肌肉向外释放，蛋白质的分解主要发生在肌肉。认为大手术后有必要应用静脉高营养。     

小儿肠炎引起低钾危象的诊治体会(摘要)

小儿肠炎引起低钾血症在临床上比较常见,若补钾不及时,剂量不足或其他因素可诱发出现低钾危象。本文回顾了我科1982～1987年间收治低钾危象的病儿36例,现报告如下。     

Influence of gum chewing on return of gastrointestinal function after gastric abdominal surgery in children

PURPOSE: The study was designed to investigate the influence of gum chewing on the return of gastrointestinal function after gastric abdominal surgery in children and the action of neural and humoral hormones in the mechanism of gum chewing. MATERIAL AND METHODS: Eighteen patients were enrolled in our study. Each patient underwent gastrointestinal surgery and was then randomly assigned to either the gum-chewing or the control group. The patients in the gum-chewing group chewed gum three times a day in the morning, the afternoon and the evening from the first postoperative morning until the day they began oral intake. The time of first passage of flatus was recorded to evaluate the return of bowel movement. Blood samples were taken immediately after the 3rd gum chewing for the analysis of gastrin and catecholamines (epinephrine, norepinephrine). RESULTS: The first passage of flatus in the gum-chewing group was seen on average of 69 h after operation, which was significantly earlier than the average of 77 h in the control group (p < 0.05). However, in contrast to the time of first flatus, the values of blood catecholamines and gastrin showed no significant difference between the two groups. CONCLUSIONS: Gum chewing hastens the return of intestinal function after gastric abdominal surgery in children. The mechanism by which gum chewing initiates an earlier return of gastrointestinal function is still unknown, although neural and humoral hormones are presumed to be mediators in stimulating bowel motility.     

腹腔镜下幽门环肌切开术对患儿细胞免疫的影响

目的探讨腹腔镜下幽门环肌切开术围手术期CO2气腹对患儿细胞免疫的影响及临床意义。方法选择40例先天性肥厚性幽门狭窄患儿，随机分为腹腔镜组和开腹组，分别于术前及术后1d、3d监测围手术期CD3、CD4、CD4／CD8的变化。结果开腹组CD4术后1d轻微下降，术后3d明显升高，术后1d与3d比较，差异有显著统计学意义（P=0．007）；开腹组CD4／CD8术后1d下降，与术前比较，差异有统计学意义（P=0．044）；术后3d升高，与术后1d比较，差异有显著统计学意义（P=0．003）。腹腔镜组CD4术后1d下降，与术前比较，差异有显著统计学意义（P=0．023），术后3d明显升高，与术前比较，差异无统计学意义（P=0．596）；两组比较CD4／CD8腹腔镜组较高，差异有显著性（F=3．961，P〈0．05）结论新生儿及婴儿腹腔镜手术可引起机体免疫功能的改变，腹腔镜组对机体免疫功能的影响较小。     

Blood flow parameters of the superior mesenteric artery as an early predictor of intestinal dysmotility in preterm infants

Background Blood flow parameters in the superior mesenteric artery (SMA) change with vasoconstriction or vasodilatation of the intestinal vascular bed. In cases of severe growth retardation as a result of haemodynamic disturbances, the blood flow changes persist into postnatal life.Objective To assess early changes of Doppler sonographic blood flow parameters in the SMA for prediction of later intestinal motility disturbances in preterm infants and tolerance of enteral feeding during the first week of life.Materials and methods Doppler sonographic blood flow parameters in the SMA were measured on the first day of life and the following 5 days in 478 neonates with a birth weight below 1,500 g. According to the Doppler results, the neonates were divided into two groups—those with pathological parameters and those with normal blood flow parameters. Correlations between blood flow parameters, the development of intestinal dysmotility and the tolerated amount of enteral feeding were calculated.Results Pathological blood flow parameters were observed in 148 neonates (group 1) and normal blood flow parameters in 330 neonates (group 2). Intestinal motility disturbance occurred in 125 neonates (83%) of group 1 and 47 neonates (15%) of group 2. Neonates in group 2 tolerated significantly more feed by the fifth day of life than neonates in group 1. Postnatal adaptation did not differ between the two groups, although the majority of neonates with intestinal dysmotility were small for gestational age. The predictive value of blood flow parameters for prediction of intestinal motility revealed high sensitivity and specificity by the first postnatal day, 2 or 3 days before development of clinical signs of intestinal dysmotility. There was a strong negative correlation between pathological pulsatility index on day 1 and the quantity of tolerated enteral feeding on day 5.Conclusions Pathological blood flow parameters in the SMA can predict problems of intestinal motility and tolerance of enteral feeding. With the early detection of these problems a prompt start of adequate therapy to avoid complications is possible.     

小儿肠缺血时血清肝、肠脂肪酸结合蛋白变化的研究

目的 探讨小儿肠缺血时血清肝、肠脂肪酸结合蛋白的变化.方法 取机械性肠梗阻患儿46例,分为实验一组（手术切除肠管组）11例,实验二组（未手术切除肠管组）23例,实验三组（未手术组）12例,对照组10例,为正常儿童.正常对照组采取外周静脉血1次,肠梗阻患儿分别于入院时、术后（有效治疗）第1天、术后（有效治疗）第3天采取外周静脉血3次.采用酶联免疫吸附测试法检测肠脂肪酸结合蛋白（IFABP）和肝脂肪酸结合蛋白（LFABP）.结果 所有实验组患儿入院时IFABP、LFABP较对照组显著增高,以肠坏死组升高最明显;术后第1天、第3天所有实验组IFABP、LFABP全部达到对照组水平;同一时期,相同实验组LFABP水平均较IFABP高.结论 IFABP、LFABP是检测肠缺血、肠坏死较为灵敏的指标,以LFABP更为敏感.     

Milk bolus obstruction in the neonate.

Seventeen cases of neonatal intestinal obstruction due to inspissated milk curds were seen at this hospital in the 9 years 1964-1972. The obstruction started on the 2nd to 10th day of life. Half the babies passed blood from the rectum and in most the x-rays were diagnostic. All survived, 14 after operation and 3 after medical treatment with a Gastrografin enema. Incomplete absorption of solids, particularly the fat from cows'' milk feeds, is suggested as the cause.     

轮状病毒感染对新生大鼠肠上皮屏障的影响

目的探讨轮状病毒感染对大鼠肠上皮屏障的影响。方法 7日龄清洁级SD大鼠30只,随机分为对照组和轮状病毒感染组,每组15只,予以人工喂养。轮状病毒感染组在喂养的第4天(即10日龄)给予轮状病毒1×106PFU灌胃,观察其腹泻病程,并分别于感染后第1、4、7天处死,采集血液及小肠组织,观测肠黏膜形态,检测血浆D-乳酸、肠道黏蛋白mucin2、细胞间连接蛋白claudin-1表达量及肠上皮细胞凋亡。结果轮状病毒感染组较对照组大鼠的D-乳酸水平升高,以感染后第4天最显著,在第1、4、7天的差异均有统计学意义(P均<0.01);轮状病毒感染组较对照组mucin2表达量在感染后第1天增多(P<0.05),感染后第4天减少(P<0.05),第7天两组无差异(P>0.05);轮状病毒感染组较对照组claudin-1表达量在感染后第1天无差异(P>0.05),感染后第4天及第7天增加(P<0.05),以第4天最显著;轮状病毒感染组较对照组感染后第4天肠上皮细胞凋亡明显增加。结论轮状病毒感染性腹泻可能与肠上皮屏障受损有关。     

Metabolic changes in newborn infants following surgical operations. II. Acid-base status of whole blood and erythrocytes, blood lactate and electrolytes.

In 29 newborn infants subjected to surgery for congenital anomalies, the extracellular and intracellular acid-base status, and the sodium, potassium and plasma lactate levels were observed from the second to the seventh postoperative days. During anaesthesia and surgery metabolic acidosis developed but improved spontaneously by the end of the first postoperative day. The metabolic acidosis gradually developing during the postoperative phase was due probably to hypoalimentation. The plasma lactate level decreased on the first days, then increased slightly; the level showed no statistically significant correlation with the acid-base equilibrium. In the postoperative period the sodium level decreased gradually in the plasma while in the erythrocytes it was relatively constant. The diminished plasma sodium/potasium ratio was mainly a result of the decreased plasma sodium concentration.     

Xylose absorption before and after surgical correction of atrial septal defect (ASD) and ventricular septal defect (VSD)

The aim of the study was to ascertain whether the acceleration of physical development in children after surgery for ASD or VSD is due to improved intestinal absorption. There were 17 patients with ASD and 9 patients with VSD (aged 5–15 years) examined.Significantly incrased values of the xylose test after surgery were found in both groups. The authors suggest that the improvement in intestinal absorption is due to an increase of systemic blood flow after operation. Simultaneously, the study confirms, on natural human model, the known dependence between blood flow and the intestinal absorption rate.