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目的探讨重症肺炎时血清脑钠素(BNP)的变化及其与心脏收缩功能的关系。方法对2002年8月至2004年4月在山东省立医院确诊的70例肺炎患儿及20例正常健康儿行超声心动图检查,同时将50只大鼠制成肺炎大鼠30只和正常大鼠20只,也行上述检查;采用酶联免疫吸附法检测上述各组BNP水平。结果肺炎心衰组患儿及左室射血分数(LVEF)下降大鼠组血清BNP水平显著高于健康对照组及正常大鼠对照组,且与LVEF、左室短轴缩短率(LVFS)呈负相关(P<0.05);肺炎心衰组患儿与健康组患儿比较,LVEF下降大鼠与正常大鼠比较,主动脉血流峰值流速(PFVA)、肺动脉血流峰值流速(PFVP)、主动脉血流速度积分(Viao)、肺动脉血流速度积分(Vipa)、LVEF、LVFS显著减少(P<0.05)。结论严重肺炎可引起心衰,血清BNP测定可作为诊断心功能不全的生化指标。     

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功能性构音障碍(functional articulation disorder,FAD)是最常见的语言障碍[1],患儿常因语音不清造成人际交往困难和一系列情绪及行为问题。目前国内有关FAD的研究较少,对FAD儿童感觉统合能力的研究尚未见报道。为探讨FAD儿童的感觉统合能力发展水平及其在FAD发生中的作用,我们对FAD患儿和正常儿童进行了感觉统合能力的对照研究,现将结果报告如下。1对象和方法1.1对象病例组:以2005-01—2006-06来我院发育儿科就诊的以吐字不清为主诉的6~12岁儿童为研究对象,符合FAD诊断标准者共38例,其中男35例,女3例。FAD的诊断依据日本听力言…     

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??Abstract??Objective??To investigate alterations of circulating levels of the inflammatory markers— reflecting brain and adipose tissue inflammation—in the fetal growth restriction??FGR??fetuses and newborns??and explore its possible relation ship with adverse intrauterine development. Methods??Sixty parturients??hospitalized in Shengjing hospital of China Medical University??giving consecutively birth either to 30 appropriate for gestational-age??AGA?? singleton infants ??AGA group ?? or 30 FGR full-term singleton infants ??FGR group????were recruited.Plasm hs-CRP??PAI-1??S100B and leptin levels were determined by enzyme link immune assay??ELISA??in the umbilical cords blood ??UC ?? and venous blood from neonates on postnatal day 1 ??D1?? and day 4??D4??. Results??The birth weight??body length and the body mass index ??BMI?? of the FGR neonates were significantly lower compared with those of AGA group ??P < 0.05??.The leptin levels of UC in the FGR neonates were lower than that in the AGA groups??P < 0.05????and correlated positively with the birth weights and the BMI??P < 0.05??.Plasma hs-CRP levels did not differ significantly at all time points between AGA and FGR groups??P > 0.05??.hs-CRP levels in Umbilical cords blood were significantly decreased when compared with D1 hs-CRP in both AGA and FGR groups ??P < 0.05????and D1 hs-CRP was significantly increasedwhen compared with respective D4 hs-CRP??P < 0.05??.Plasma PAI-1 and S100B levels did not differ significantly at all time points between AGA and FGR groups??P > 0.05????and did not correlated with the birth weights and the BMI. Conclusion??Despite the lower birth weight??BMI and leptin levels in FGRs?? there was no difference for the levels of inflammatory markers hs-CRP and PAI-1 between IUGR and AGA fetuses/neonates.The CRP level in both studied groups fluctuated from fetus to neonate stage might attribute to parturition stress and adaptation recovery.     

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目的探讨弥散加权成像(DWI)、常规磁共振成像(MRI)在新生儿低血糖性脑损伤不同阶段的动态变化。方法回顾分析了2005年9月至2008年9月,中国医科大学附属盛京医院新生儿科收治的经MRI确诊的20例低血糖性脑损伤患儿(病例组)的临床资料,并随机选取同期住院MRI正常的20例单纯性低血糖患儿为对照组。结果病例组平均最低血糖值低于对照组(P<0.01),低血糖持续时间长于对照组(P<0.01)。病例组于低血糖发生后3.8(1～11)d完成首次MRI检查,受累部位主要为枕叶11例、枕顶叶8例,顶叶1例,受累部位在DWI均表现为高信号,常规MRI相应部位12例表现为T1加权成像(T1WI)、T2加权成像(T2WI)正常信号,仅6例表现为T1WI低信号、T2WI高信号;11例于首次检查后11.4(8～15)d完成第2次MRI检查,首次检查受累部位DWI7例转为正常信号,4例低信号,常规MRI均表现为T1WI低信号、T2WI高信号。3例于6个月随访,提示枕叶DWI正常信号,T1WI低信号、T2WI高信号。结论新生儿低血糖性脑损伤早期DWI表现为异常高信号的部位,与晚期常规MRI表现为T1WI低信号、T2WI高信号的部...     

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目的探讨氨溴特罗口服液改善毛细支气管炎患儿气道功能的疗效影响。方法将2009年11月至2010年9月广州市妇女儿童医疗中心93例毛细支气管炎患儿随机分为治疗组(氨溴特罗口服液组)和对照组。观察两组患儿治疗前后潮气呼吸流速-容量环(TBFV)的形态改变以及肺功能各项指标的变化。结果两组患儿治疗前TBFV环均变窄,呼气曲线升枝陡峭,高峰提前,降枝呈波谷样凹陷;治疗后明显好转。两组患儿治疗前各项主要参数比较,差异无统计学意义(P>0.05)。两组患儿治疗前后比较:呼吸频率(RR)、呼气峰流速(PEF)、呼吸系统阻力(Rrs)、每千克体重功能残气量(FRC/kg)均降低(P<0.05或P<0.01);每千克体重潮气量(VT/kg)、吸呼比(TI/TE)、呼气达峰时间(TPTEF)、达峰时间比(TPTEF/TE)、呼气达峰容积(VPTEF)、达峰容积比(PFV)、呼出75%潮气量时的呼气流速/呼气峰流速(25/PF)、潮气呼气中期流速/潮气吸气中期流速(ME/MI)、每千克体重顺应性(Crs/kg)均增加(P<0.05或P<0.01)。其中治疗组与对照组比较,反映大小气道阻塞主要指标PFV、25/PF、ME/MI及肺顺...     

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??Objective??To study the mixed infections in hospitalized children with community-acquired pneumonia ??CAP??. Methods??We retrospectively reviewed the medical records of CAP patients admitted to Children’s Hospital of Soochow University from January 2015 to December 2015. Samples were tested for multiple pathogens.Results??One or more pathogens was detected in 647??76.5%?? of 846 cases??34.63?? cases were considered mixed infection. The rates of mixed infection in ??6-month????1-year????3-year????5-year?? ≥5-year group were 24.2%??43.5%??43.8%??36.8% and 27.3% respectively. The most frequent combinations of pathogens were those of virus plus bacteria in ??6-month and ??1-year group??virus plus MP in ??3-year and ≥ 5-year group?? and MP plus bacteria in??5-year group??Rhinovirus-H.influenzae was the most commonly found combination of virus and bacteria. The most frequent etiological agent in virus coinfected with MP was rhinovirus. S.pneumoniae was the most important pathogen for bacteria coinfected with MP. No significant difference in clinical characteristics??complications??PICU admission or hospital stay was observed between the patients with mixed infections and those with monomicrobial CAP. Conclusion??Mixed infections account for certain proportion in the cause of CAP. The positivive rate in patients in??1-year and ??3-year groups is significantly higher than that in other age groups. Patients of different ages present with different combinations of pathogens. Mixed infections have no relationship with CAP patients’ mortality.     

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??Objective To investigate the predictive value of lipopolysaccharide binding protein ??LBP?? in early diagnosis of preterm infection with premature rupture of membrane??PROM??. Methods Totally 93 preterm infants with PROM were enrolled in this study?? and were divided into infection group ??45 cases?? and non-infection group ??48 cases?? according to the discharge diagnosis. Their serum LBP levels were detected within 24 hours after birth. High-sensitivity C-reactive protein ??hs-CRP???? procalcitonin ??PCT?? and interleukin-6 ??IL-6?? levels were compared with LBP. Receiver operator characteristic curve ??ROC?? was drawn and the area under the curve ??AUC?? was calculated. Each parameter was evaluated for the diagnosis of early-onset infection in preterm infants with PROM. In addition?? according to the severity of the disease infection group was further divided into severe infection group??21 cases?? and general infection group??24 cases??. LBP levels were detected in two groups of premature infants to assess the value of LBP in the diagnosis of premature infants with premature rupture of membranes. Results The serum levels of IL-6?? PCT and LBP in the infection group were significantly higher than those in the non-infection group. There was no significant difference on serum levels of hs-CRP between the two groups. The level of LBP in the severe infection group was higher than that in the general infection group?? and the difference between the two groups was statistically significant. The AUC of ROC for LBP ??0.974?? in early-onset bacterial infection of preterm infants with PROM was the highest?? PCT ??0.694?? second?? IL- 6 ??0.588?? third?? and hs-CRP ??0.478?? was the lowest. Conclusion Serum level of LBP is superior to hs-CRP and PCT in the diagnosis of early-onset bacterial infection in preterm infants with PROM. LBP can be used as a useful index for the early diagnosis of bacterial infection in preterm infants with PROM. LBP levels can evaluate the severity of premature premature infection in preterm premature rupture of membranes.     

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目的了解儿童乙型肝炎病毒(HBV)基因型与临床分度的关系。方法选择甘肃省人民医院儿科和兰州大学第一医院感染科2008年4月至2010年4月门诊和住院患儿中HBV-DNA阳性的124例乙型肝炎患儿,其中男84例,女40例。HBV携带者65例,慢性乙型肝炎59例(轻度31例、中度18例、重度10例),对以上患儿进行基因分型、同时检测肝功、术前出凝血、HBV-DNA载量。结果 124例肝病患儿中,C基因型62例(50.0%),B基因型48例(38.7%),B/C混合型9例(7.3%),非B/C型5例(4.0%);HBV携带者和轻度组中,以B基因型为主,分别为47.7%和45.2%;中度和重度组中,以C基因型为主,分别为72.2%和80%;在C、B基因型分布方面,HBV携带者和轻度组与中度和重度组比较差异有统计学意义;C基因型患者的HBV-DNA载量、丙氨酸转氨酶(ALT)、天冬氨酸转移酶(AST)、总胆红素(TBIL)均高于B基因型;C基因型患者与B基因型比较,凝血酶原时间(PT)延长、凝血酶原活动度(PTA)下降、纤维蛋白原(FIB)减少。B、C型通过母婴传播的比例差异无统计学意义。结论甘肃省儿童乙型肝炎病毒基因...     

不同血源对ABO溶血病外周动静脉同步换血疗效的比较

目的 　探讨不同血源对ABO溶血病外周动静脉同步换血的疗效。方法　对 2 3例ABO溶血病患儿依时间分为二组 ,同型血组和混合血组。同型血组采用与患儿血型相同的血为血源换血 ,混合血组采用AB型血浆和O型洗涤红细胞混合血为血源换血。换血途径均采用外周动静脉。结果　同型血组和混合血组换血后总胆红素下降显著 ,4 50 0± 1 4 4 2 4 μmol/L ,2 54 56± 87 58μmol/L ,393 4 8± 1 6 7 4 6vs2 36 6 0± 97 79μmol/L ;两组的换出率分别是 :4 2 2 5± 1 3 91 % ,38 4 6± 1 3 1 6 % ,t =0 70 ,P >0 0 5。换血后两组的血细胞 ,红细胞压积 (HCT) ,电解质 ,白蛋白改变相同。换血后无明显不良反应。结论　同型血和混合血为血源换血疗效相同 ,在紧急情况下采用同型血换血可以节约时间。     

红细胞免疫抗体引起的新生儿溶血病4例报告

目的探讨红细胞免疫抗体引起的新生儿溶血病病例的母婴实验室检测结果、临床表现及治疗。方法回顾性分析4例红细胞免疫抗体引起的新生儿溶血病患儿及母亲产前相关实验室及临床资料。结果 4例患儿的母亲在孕期分别检测出IgG性质的红细胞抗E、抗D、抗Jkb及自身抗体;效价分别为16、2 048、1及16。患儿均足月分娩,但生后6 h~3 d出现不同程度的皮肤黄染,伴或不伴贫血。患儿红细胞放散试验发现存在与母体相同的抗体,效价分别为4、512、0及2。患儿均予光照治疗,2例重症患儿予换血及输血治疗,均预后良好。结论孕妇产前免疫血液学检查有助于及早发现红细胞不规则抗体以评估胎儿及新生儿溶血病风险。     

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目的探讨全自动换血术对高胆红素血症新生儿血液学指标的影响,评估其疗效与安全性以及间接胆红素和白蛋白比值的临床意义。方法 2008年1月至2010年5月南方医科大学南方医院对74例重症高胆红素血症患儿均采用周围动静脉同步换血术,监测换血前后胆红素、白蛋白、间接胆红素与白蛋白比值、电解质、血常规。结果血中胆红素、白蛋白、间接胆红素与白蛋白比值、电解质(Na+、K+、Cl-、Mg2+)、血常规换血后均较换血前明显下降,但Ca2+、P3+浓度换血后较换血前升高,差异均有统计学意义。换血术后无患儿发生不良反应。结论换血对胆红素、白蛋白、间接胆红素与白蛋白比值、Na+、K+、Cl-、Mg2+、Ca2+、P3+、白细胞、红细胞、血红蛋白、红细胞压积、血小板均有影响,应注意监测。特别要注意监测间接胆红素与白蛋白比值,该比值是评估胆红素毒性的危险指标。比值越高,其危险性越高,越需要输注白蛋白。     

新生儿不同浓度红细胞换血治疗疗效及对内环境的影响

目的探讨新生儿换血治疗时不同红细胞和血浆比例对疗效及内环境(血细胞计数、电解质、血糖及酸碱平衡)的影响。方法回顾分析2015年1月至2018年12月经换血治疗的149例高胆红素血症新生儿的临床资料,根据换血时红细胞与血浆的比例分为2:1组(红细胞2 U﹕血浆100 mL,62例)和3:1组(红细胞3 U﹕血浆100 mL,87例)。探讨两组换血当时至12小时的血清总胆红素(TSB)下降程度、换血后继续光疗时间及再次换血比例的差异,比较换血前后两组新生儿血常规、电解质、血糖及血气分析的变化。结果两组新生儿的胎龄、出生体质量、性别及换血日龄等差异均无统计学意义(P0.05);两组在换血结束时及换血后12小时TSB的下降程度,继续光疗时间及再次换血比例的差异均无统计学意义(P0.05)。换血后,3:1组的RBC(3.7±0.4 vs 4.7±0.3)与Hb(118.9±12.1 vs 157.8±14.3)显著上升;同时,换血后两组新生儿的WBC、PLT、血清钠、HCO~-_3水平降低,而血清钾、血清钙、血糖浓度升高,差异均有统计学意义(P0.05);但两组间各指标的变化差异均无统计学意义(P0.05)。两组新生儿间常见换血并发症以及急性胆红素脑病和核黄疸的发生率差异无统计学意义(P_均0.05)。结论红细胞与血浆以2:1或3:1混合均可有效治疗新生儿高胆红素血症。3:1比例混合血可有效纠正贫血,且未加重换血后机体内环境的紊乱。     

控制成分输血输注速率提高新生儿换血疗效

目的探讨序贯调节悬浮红细胞和血浆输注速率进行新生儿换血的有效性及安全性。方法选择2006年10月至2013年9月我科收治的需要进行换血治疗的严重高胆红素血症患儿,随机分为对照组和观察组,对照组将所需红细胞与血浆按1∶1等速输注进行换血;观察组换血总量前1/3时,输注血浆速率为红细胞的两倍,中1/3时二者输注速率相等,后1/3时输注红细胞速率为血浆的两倍。换血前、中、后检测血常规、电解质、血糖及血胆红素等指标,并密切观察和记录患儿生命体征及经皮血氧饱和度(Sa O2)。结果对照组纳入40例,观察组纳入42例。两组患儿换血治疗后胆红素水平均明显降低[对照组:(222.1±30.3)μmol/L比(455.5±52.3)μmol/L,观察组:(207.3±27.8)μmol/L比(451.2±48.6)μmol/L,P<0.001],与对照组比较,观察组换血后胆红素水平更低,差异有统计学意义(P<0.05);观察组换血后血红蛋白含量明显高于对照组[(151±22)g/L比(135±26)g/L,P<0.01]。两组患儿换血相关并发症,如高血糖、血小板减少、低钙血症和低钠血症等均可在短时间内恢复正常。结论采用序贯调节悬浮红细胞和血浆的输注速率进行换血,在不增加用血量基础上,能明显降低胆红素水平和贫血的发生,且安全有效。     

ABO溶血病患儿应用丙种球蛋白的胆红素阈值探讨

目的 探讨选择应用丙种球蛋白治疗新生儿ABO溶血病的适宜胆红素阈值.方法 将我院新生儿科2011年7月至2012年9月收治的新生儿ABO溶血病患儿随机分为两组,试验1组患儿胆红素值达到Bhutani曲线第75百分位、试验2组达到第95百分位时,应用1次丙种球蛋白1 g/kg.比较两组患儿总光疗时间、治疗2天后胆红素下降幅度、住院时间、住院费用、血红蛋白值、应用丙种球蛋白的比例等资料.结果 试验1组(66例)和试验2组(63例)患儿总光疗时间、胆红素下降幅度、住院时间、住院费用、生后42天血红蛋白值差异均无统计学意义(P＞0.05),试验2组应用丙种球蛋白比例(34/63)小于试验1组(53/66),差异有统计学意义(P＜0.01),两组均没有需要换血或发生胆红素脑病的病例.结论 以Bhutani曲线第95百分位水平胆红素值作为应用丙种球蛋白治疗新生儿ABO溶血病的胆红素阈值更为合理.     

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目的探讨换血治疗对高胆红素血症新生儿血清白细胞介素(IL-1b)、IL-6,肿瘤坏死因子α(TNF-α)及皮质醇(Cor)含量的影响,旨在判断换血治疗是否将引起患儿应激反应,影响疾病的恢复。方法 2009年8月至2009年12月在湖南省儿童医院新生儿科住院诊断为新生儿高胆红素血症,并进行了外周动静脉双通道同步换血治疗的足月新生儿共56例,均留取换血治疗前所抽出的第一管血以及换血治疗结束后24h、168h的血标本,测定血清IL-1b、IL-6、TNF-α及Cor含量。结果治疗后24h与治疗前比较,血清Cor浓度明显下降,差异有统计学意义(P<0.01);血清IL-1b、IL-6、TNF-α浓度差异无统计学意义(P>0.05)。治疗后24h与治疗后168h比较,各细胞因子血清浓度差异无统计学意义(P>0.05)。治疗后168h与治疗前比较,血清IL-6、TNF-α浓度差异无统计学意义,IL-1b浓度增高,差异有统计学意义(P<0.05);Cor浓度降低,差异有统计学意义(P<0.01)。结论换血治疗技术成熟,严格规范操作的换血治疗对机体不会产生重大的应激,是治疗新生儿高胆红素血症比较安全有效的方法。     

Increased fetal iron load in rhesus hemolytic disease

There is little information about the iron overload caused by hemolysis in fetuses affected with rhesus hemolytic disease (RHD). The authors therefore studied the iron load in RHD by measuring cord blood ferritin levels in babies affected with RHD and gestational age- and weight-matched controls. Cord blood ferritin levels were higher in babies with RHD. Intrauterine transfusions did not affect the ferritin status of the babies with RHD and there was no correlation between hemoglobin and ferritin levels. The results indicate that there is an increased intrauterine iron load in babies with RHD, independent from intrauterine transfusions and rate of hemolysis.