机械性肠梗阻时限和血运与细菌移位关系的动物实验研究

研究机械性肠梗阻时限和血运对细菌移位的影响，并探讨其机制。４０只ＳＤ鼠分为５组：①对照组；②６、２４、４８小时单纯性完全性机械性肠梗阻组；③３小时闭袢性绞窄性肠梗阻组。无菌操作取血和肠系膜淋巴结、肝、脾、肠内容物的匀浆培养，鉴定、计数细菌；测定血浆内毒素，光镜检查肠粘膜结构。总细菌移位率在单纯性肠梗阻２４、４８小时及绞窄性肠梗阻３小时分别为４６．８％、５９．４％和５３．１％，较对照组３．１％及单纯性肠梗阻６小时的１２．５％均有极显著性差异（Ｐ＜０．０１）。单纯性机械性肠梗阻随梗阻时间延长，细菌移位发生率升高，肠绞窄短时间即可造成严重细菌移位。细菌移位机制包括肠道内细菌过度生长，肠粘膜屏障破坏。     

多普勒超声显像技术测定新生儿肠血流

多普勒超声显像技术测定新生儿肠血流是近年来兴起的一门技术，将它用于腹腔动脉和肠系膜上动脉血流动力学各项参数的测量，有很重要的临床意义。本文就此项技术的可行性和准确性、正常新生儿肠血流及其影响因素、生理状态下肠血流的变化以及新生儿肠血流测定的临床应用进行了阐述。     

多普勒超声显像技术测定新生儿肠血流

多普勒超声显像技术测定新生儿肠血流是近年来兴起的一门技术，将它用于腹腔动脉和肠系膜上动脉血流动力学各面参数的测量，有很重要的临床意义。本文就此项技术的可行性和准确性、正常新生儿肠血流及其影响因素、生理状态下肠血流的变化以及新生儿肠血流测定的临床应用进行了阐述。     

全营养混合液稳定性的实验研究及临床应用

为探索全营养混合液经周转静脉应用合理性及解脂肪乳剂在ＴＮＡ在液中的稳定性，测定了肠外营养液中各营养成分和按临床应用不同营养液配比的ｐＨ、渗透国用透视电镜观察脂肪乳剂在ＴＮＡ中的颗粒大小、形态变化。     

彩色多普勒超声对儿童肠扭转的诊断价值

目的探讨彩色多普勒超声在筛查儿童肠扭转中的价值。方法回顾性分析137例疑诊肠扭转患者的超声声像，并与手术结果对照。结果超声疑诊肠扭转137例，手术符合率95％，其中肠旋转不良所致肠扭转119例，肿块所致肠扭转11例。超声疑合并肠壁缺血水肿64例，经手术证实62例（97％）；合并肠穿孔3例，经手术证实3例（100％），手术证实肠壁血管内径增宽6例，内径5～6mm，彩超测量与之相符。肠旋转度数B超与手术结果比较符合率55．7％。结论“漩涡征”可以作为超声提示肠扭转的依据，超声检查可提示肠扭转的病因及合并症，为临床进一步评估肠扭转患儿病情及为手术复位提供依据。     

新生儿肠闭锁118例

目的 探讨新生儿肠闭锁的外科诊断及其治疗，提高治愈率。方法 对1991－2000年外科治疗新生儿肠闭锁118例的临床资料、病理、治疗及疗效进行回顾性分析。结果 手术118例，治愈率83％，二交手术8例，术后放及死亡20例。结论 充分保留肠管的长度，裁剪端－背吻合有于肠功能的恢复，减少并发症。静脉营养的应用促进肠功能的恢复。     

血小板自身抗体的流式细胞术检测与意义

目前血小板自身抗体的测定方法较为复杂,同时需要较多的血量,因此给儿科临床应用带来一定困难。本文拟应用流式细胞术建立一种简便、快捷、敏感的检测血小板相关抗体的方法。应用荧光素化的羊抗人Ｆ(ａｂ)２段ＩｇＧ抗体结合血小板表面的抗体,应用荧光素化的羊抗鼠ＩｇＧ抗体作为阴性对照。即以直接法测定血小板表面结合的ＩｇＧ。应用流式细胞术测定血小板的平均荧光强度。血小板荧光强度(ＭＦＩ)反映血小板表面ＰＡＩｇＧ的水平。测定正常人和特发性血小板减少性紫癜患儿的血小板平均荧光强度。结果显示:正常对照组的血小板平均荧光强度(ＭＦＩ)为２３．６７±９．１０(道数)。３１例ＩＴＰ组的ＭＦＩ为１０３．６３±３１．４１(道数)。ＩＴＰ病人的血小板荧光阳性率为９０%。治疗有效的病人,随血小板计数的上升,血小板荧光强度逐渐下降。因此,流式细胞术测定血小板抗体是一种快速、简便灵敏的ＰＡＩｇＧ检测方法,可用于免疫性血小板减少性紫癜的辅助诊断和疗效观察。     

肝素对新生儿应用外源性脂肪的降血脂作用

在新生儿全肠外营养（ＴＰＮ）中，通过对肝素组及非肝素组连续１周应用外源性脂肪期间，血甘油三酯、总胆固醇、磷脂、高密度脂蛋白－胆固醇、低密度脂蛋白－胆固醇、载脂蛋白Ａ＿１、载脂蛋白Ｂ、总游离脂肪酸等指标的动态观察及比较，证明肝素在新生儿应用外源性脂肪时确有降血脂作用。通过血小板计数、凝血酶原时间的监测，认为１ｍｌ１０％脂肪乳剂用肝素２Ｕ的剂量是安全的。     

巨结肠根治术后小肠结肠炎：有关高危因素分析

１９８２～１９９２年采用根治术治疗先天性巨结肠１０３例，其中１６例（６．４３％）发生术后小肠结肠炎。分析有关因素，发现性别、手术时年龄、无神经节细胞肠段长度及根治术类型等对其发生影响不大，但与吻合口狭窄及术前小肠结肠炎的发生、肠炎发作与再根治术之间间隔的时间密切有关。观察术中拖出结肠段的病理组织学改变，提示拖出肠段明显炎性改变是发生术后小肠结肠炎的病理基础，并对有关因素进行了讨论。     

新生儿肠外营养(上)

静脉营养是指当小儿不能耐受经肠道营养时，完全由静脉输入各种人体所需的营养素来满足机体代谢及生长发育需要的营养支持，又名肠道外营养(parenteral nutrition，PN)，过去曾称静脉高营养(intravenous hyperalimentation)。自1968年Dudrick首次报道经中心静脉营养救治1例先天性肠闭锁小儿获正氮平衡以来，静脉营养的临床应用     

Comparison of methods for the determination of viability of ischemic rabbit intestine

Accurate evaluation of bowel viability and anastomotic healing remains a common problem confronting the surgeon. A rabbit model was established to compare the accuracy of standard clinical criteria (SCC), intravenous fluorescein (FLF), laser Doppler flowmetry (LDF), and pulse oximetry (POX) in determining bowel viability. The diagnostic efficiency of SCC was 73%, of POX 68%, of FLF 78%, and of LDF 95%. The latter two techniques are simple, rapid, and more accurate than SCC and POX, and may be best suited for the intraoperative assessment of clinically ischemic intestine. Correspondence to: X. P. Liao     

The pediatric risk of mortality score in infants and children with fulminant liver failure

The pediatric risk of mortality (PRISM) score as a severity scoring system has never been assessed in infants and children with fulminant liver failure (FLF). A retrospective case study of 109 infants and children admitted in a 22-bed pediatric and neonatal intensive care unit of a tertiary university hospital, National Referral Center for Pediatric Liver Transplantation, from March 1986 to August 1997 was carried out. PRISM score was not significantly different within etiologic FLF categories, or between infants and children. However, PRISM score (mean +/- SD) showed significant difference (p = 0.001) between the 27 patients who spontaneously recovered with supportive care (8.8 +/- 5.0) and 82 patients who underwent emergency liver transplantation (ELT) or those who died before (14.9 +/- 7.7). PRISM score-based probability of mortality was underestimated when compared with observed mortality. A death probability higher than 20% had a 24% sensitivity and 95% specificity for severe outcome. Reciever operating characteristic curve for PRISM score showed elevated discriminative power (Az = 0.91) for discerning children with severe outcome from those who spontaneously recovered with supportive care. A PRISM score more than 10 showed an odds ratio of 2.69 for predicting severe outcome (95% CI: 1.11-6.55; p = 0.038). In conclusion, the PRISM score is an accurate means of severity assessment in pediatric FLF. However, PRISM score-based mortality was of low predictive value.     

Fulminant liver failure in a child with invasive group A streptococcal infection

Liver involvement is mentioned in streptococcal toxic shock syndrome, but never as fulminant liver failure (FLF). We report the case of a 2-year-old child who developed isolated FLF secondary to invasive group A streptococcal infection without shock due to a M1T1-type strain expressing speA, speB and speC toxin genes. On antibiotics, he recovered rapidly without liver transplantation. CONCLUSION: A streptococcal pyrogenic exotoxin likely constituted the initial insult leading to FLF. This etiology can be included in the differential diagnosis of FLF and would support early introduction of antibiotics.     

Successful treatment of a child with fulminant liver failure and coma caused by Amanita phalloides intoxication with albumin dialysis without liver transplantation

FLF is a life-threatening disease. Hepatic coma exerts dramatic impact on patient survival. At present, LTx is the treatment modality of choice that provides significant improvement in outcome of most patients with FLF. Multiple attempts have been made to reduce mortality and improve the patient's condition. One of the new options is AD - MARS. We present the case of a 11-yr-old boy with FLF and hepatic coma who avoided the scheduled LTx because of rapid neurological and biochemical improvement immediately after three MARS sessions.     

Simplified method to assay total plasma peroxidase activity and ferriheme products in sickle cell anemia, with initial results in assessing clinical severity in a trial with citrulline therapy

A method using dianisidine is described to measure promptly the total plasma peroxidase (POX) activity of methemoglobin and other ferrihemes. Methemoglobin (35 mg/dL) is used as POX standard. Three-minute POX activities and total POX concentrations measured by a classic benzidine method were compared in a three-patient trial with citrulline supplementation. High POX values became progressively lower. In two of the patients, 3-minute POX activities were reduced more than total concentrations. Oral citrulline reduced harmful plasma ferriheme levels. Free ferriheme also exhibited POX activity. POX levels may be useful to judge severity in sickle cell anemia and to monitor therapeutic efficacy.     

Can pulse oxymetry be used for measuring intestinal blood flow?

AIM: When studying intestinal blood flow (IBF) using radiolabeled erythrocytes in the rabbit intestinal volvulus model, we also evaluated whether a pulse oxymeter (POX) could be used for the measurement of intestinal blood flow. METHODS: IBF was measured with radiolabeled erythrocytes and POX in the rabbit intestinal volvulus model. The study was performed on 3 groups: 1) baseline, 2) volvulus, 3) volvulus plus devolvulus. RESULTS: The POX and scintigraphic measurements were in correlation and showed that IBF stopped for 6 hours following volvulus. IBF was significantly decreased in the volvulus plus devolvulus group compared to the baseline group (p < 0.01). IBF measured with POX correlated with scintigraphic measurements. CONCLUSION: POX is useful for the measurement of IBF and thus may be a cheap and reliable alternative to other intestinal blood flow measurement methods.     

新生儿危重症先天性心脏病筛查的卫生经济学系统评价

背景：新生儿危重症先天性心脏病（mCHD）筛查技术日臻成熟，然而成熟的技术要具有较好的经济性才可能被广泛接受和应用，目前相关研究不多，且大部分数据来源于发达国家。 目的：探讨mCHD筛查的有效性和经济性。 设计：系统评价。 方法：通过构建P（新生儿）、I［脉搏血氧饱和度（POX）］、R［心脏超声检查（ECHO）、手术］、O（新生儿mCHD）、S（成本分析法、成本效果分析、成本效用分析、成本效益分析）建立检索式，在Medline、Embase、Web of Science、The Cochrane Library、SinoMed、中国知网、万方数据库检索2000年至2022年4月28日的文献。通过阅读题目、摘要和全文筛选，提取文献基本信息，卫生经济学指标（评价方法、研究视角、成本收集范围、敏感性分析类型、贴现率），卫生经济学评价结果［挽救1个生命年（LYS）的成本、获得1个质量调整生命年（QALY）的成本、避免1个伤残调整生命年（DALY）的成本、增加1例及时诊断出病例的成本和增量成本效果/效用比］。文献的质量评价采用卫生经济学评价质量评分量表（QHES）。 主要结局指标：筛查成本和成本效果。 结果：纳入2007至2020年11篇文献，能提取单纯POX筛查数据的文献7篇，能提取单纯CE和POX+CE筛查数据的文献各4篇，能提取POX+MUR筛查的文献1篇。社会角度2篇，医疗系统角度9篇；基于人群4篇，基于模型7篇；收集了直接成本和间接成本1篇，收集了直接成本10篇。基于2022年6月汇率折算美元，POX筛查的成本为2～24.5美元，其中人工成本为2.53～7.4美元，一次性探头成本为13.4～22美元，重复性探头成本为0.1～0.9美元。CE筛查的成本为 0.5~4.5美元。MUR筛查的成本为1.3~2.0美元。筛查阳性的病例行ECHO费用30~1 300美元。8篇文献采用CEA/CUA（成本效果/效用分析）进行筛查的成本效果分析，其中2篇评价POX筛查、5篇POX+CE筛查和1篇POX+MUR，不考虑人工成本的基础上使用一次性探头和ECHO费用是主要筛查成本；POX、POX+MUR和POX+CE具有成本效果，POX+MUR与ECHO相比更具有成本效果，ECHO+CE与POX+CE相比还能检出其他先天性缺陷则具有成本效果。 结论：mCHD筛查成本主要体现在是否使用一次性探头和超声检查费用；POX、POX+MUR和POX+CE具有成本效果；不同经济发展水平mCHD筛查的经济性可接受。     

Duration of fever prior to onset of a simple febrile seizure: a predictor of significant illness and neurologic course

This study tested the hypothesis that the duration of fever prior to the onset of a simple febrile seizure may be an important clinical variable with respect to patient outcome. The duration of fever prior to seizure according to patient history was defined as either long (greater than or equal to 24 hours) or short (less than 24 hours). We hypothesized that simple febrile seizures which occur with a history of a fever of long duration (LDF) are more likely to be associated with a significant illness at presentation or a subsequent neurologically abnormal course than are simple febrile seizures which occur with a history of a fever or short duration (SDF). Of 100 cases which met study criteria for simple febrile seizures, nine had a LDF and 91 had a SDF prior to the development of a seizure. No statistical differences in age, sex, maximum fever recorded in the emergency department, duration of seizure, WBC, or electrolytes were found between patients with SDF and LDF (P less than 0.01). Of the nine patients with a LDF, all had either a significant illness at the time of initial visit or a subsequent neurologically abnormal course. Of the 91 patients with a SDF, 88 had a good outcome, while two had a significant illness at the time of visit, and one had a subsequent neurologically abnormal course. These results suggest that children with a history of LDF prior to the occurrence of a simple febrile seizure are more likely to have a serious illness at presentation or a subsequent neurologically abnormal course than are children with seizures which occur with a history of SDF.     

Noninvasive Determination of Endothelial Cell Function in the Microcirculation in Kawasaki Syndrome

The aim of the study was to noninvasively assess endothelial cell (EC) function in the microcirculation using laser Doppler fluximetry (LDF) in acute and convalescent Kawasaki syndrome (KS) patients and healthy controls. KS is an acute, self-limited vasculitis of childhood that affects the EC of medium-sized arteries. No studies have addressed EC function in the peripheral microcirculation. LDF preacetylcholine and postacetylcholine (ACh) iontophoresis estimates microcirculation EC nitric oxide production leading to smooth muscle relaxation and vasodilatation, which are blunted in EC dysfunction. We studied a total of 97 subjects: 36 acute and 27 convalescent KS patients and 34 normal children. Change in blood flow was measured by LDF for 10 min post-ACh iontophoresis. Acute KS patients had significantly lower average flux when compared to convalescent KS patients and controls in the first 5 min postiontophoresis. However, there was no difference in flux or area under the curve (AUC) between convalescent KS patients and healthy controls. Despite a reduced response of the microvascular EC to ACh in acute KS patients, convalescent patients with and without coronary aneurysms had microvascular EC function similar to normal controls. This suggests that the EC injury in KS is confined to the endothelium of medium-sized arteries and that microvascular EC function is normal after acute KS.     

Transient hyperoxia and residual cerebrovascular effects in the newborn rat

Unrestricted use of oxygen in the delivery room after preterm birth has been associated with reduced cerebral blood flow (CBF) 2 h later. To further investigate residual cerebrovascular effects of transient hyperoxia, we developed a newborn rat model in which laser-Doppler flowmetry (LDF) and near-infrared spectroscopy (NIRS) were used to monitor changes in cerebral perfusion. The hypothesis to be tested was that hyperoxic exposure limits cerebral vasodilation in response to increase in carbon dioxide tension (Pco(2)). Twenty-four 3- to 5-d-old rats were kept on spontaneous breathing with doxapram under light isoflurane anesthesia, randomized into two groups, and exposed to either room air or 100% oxygen for 30 min. Then, after 15 min of stabilization in normoxia, 8% CO(2) was given for 5 min. No significant differences in CO(2) responses were observed between the two groups: mean CBF-CO(2) reactivity as measured by NIRS was 13.3 +/- 3.9 %/kPa in the normoxia-group versus 8.8 +/- 4.1 %/kPa in the hyperoxia group (NS). The oxygenation index [(HbO(2) - Hb)/2] increased by 0.67 +/- 0.17 micromol/L/kPa in the normoxia group compared with 1.18 +/- 0.19 micromol/L/kPa in the hyperoxia group (NS). Cortical perfusion, monitored by LDF, increased by 7.3 +/- 1.5 %/kPa versus 6.8 +/- 1.8 %/kPa in the normoxia and hyperoxia groups, respectively (NS). We conclude that in newborn rats the CBF-CO(2) reactivity remains intact after 30 min of oxygen exposure.