0～7岁小儿维生素D缺乏性佝偻病的影响因素分析

目的分析0～7岁儿童群体发生维生素D缺乏性佝偻病的相关因素,为该病临床预防和控制提供理论依据。方法收集并整理本院儿科2016年10月至2018年6月0～7岁确诊为维生素D缺乏性佝偻病的患儿60例以及同期体检结果正常的儿童120例,设计表格调查并分析发病相关性因素。结果小儿维生素D缺乏性佝偻病主要相关因素包括小儿母亲孕期是否常吃鱼、孕期日照和户外活动时间、孕后期维生素D的补充,小儿7个月龄是否开始坚持补充维生素D、日照时暴露的皮肤面积等(P <0.05)。结论维生素D缺乏性佝偻病是儿童时期多发的常见疾病,分析其发生的影响因素,加强宣传教育,对早期预防和治疗有重要意义。     

3岁以内小儿佝偻病的预防及对家长的健康教育指导

维生素D缺乏性佝偻病,是一种常见的小儿全身性疾病,因体内微生素D不足引起钙、磷代谢失常和骨骼改变,同时影响神经、肌肉、造血、免疫等组织器官的功能[1].早期神经精神症状如夜惊、多汗、易激怒等.严重者产生骨骼畸形:如颅骨软化、鸡胸、漏斗胸等.佝偻病是我国儿童保健重点防治的小儿“四病“之一.0～3岁患病率约为26%.发病多在1岁以内且具有多因素[2].从3岁以内小儿患病情况来看,本市佝偻病的发病率仍高达30.98%.本病对儿童早期的生长发育影响较大,降低地区性佝偻病的发病率是目前儿童保健工作者的重点.现将对我院331例小儿佝偻病的预防及健康教育报道如下.……     

维生素D缺乏性佝偻病的护理干预

目的探讨护理干预在维生素D缺乏性佝偻病预防中的作用,降低维生素D缺乏性佝偻病发病率,促进小儿健康成长。方法选择在我院儿保门诊进行3个月体检的小儿,以2012年1月1日至2012年12月31日出生的561例为对照组,产前不予以干预,产后42 d来我院体检时予以健康宣教;以2013年1月1日至2013年12月31日出生的535例为观察组,从母亲的孕期开始叮嘱孕妇要多晒太阳,对于缺钙的孕妇要补充钙剂和适当的维生素D以及对孕妇进行健康教育的宣教,倡导母乳喂养,在婴儿出生后半个月,无异常时即可补充维生素D,在天气好的情况下多晒太阳等。结果对照组561例,检出颅软41例,维生素D缺乏性佝偻病的发病率为7.31%。观察组535例,检出颅软10例,小儿维生素D缺乏性佝偻病的发病率为1.87%。结论针对维生素D缺乏性佝偻病的发病原因,预先进行护理干预,可降低维生素D缺乏性佝偻病的发病率,有效促进儿童的健康成长。     

维生素D不同途径给药治疗活动期维生素D缺乏性佝偻病疗效观察

维生素D缺乏性佝偻病(以下简称佝偻病)是一种常见的小儿全身性疾病,属于我国儿童保健"小儿四病防治"中的病种之一,临床常用口服或肌肉注射维生素D制剂治疗.为了选择一种较为简便、有效、经济的治疗方法,笔者自1996～1999年对164年4个月～2岁的活动期佝偻病患儿进行了两种不同给药途径(口服与肌肉注射维生素D制剂)的疗效观察,现总结如下.     

骨碱性磷酸酶测定在诊断小儿维生素D缺乏性佝偻病中的应用

维生素D缺乏性佝偻病是我国北方地区小儿常见的多发病,严重影响小儿的健康发育,本病冬春二 季发病率较高,是0至3岁儿童重点防治的疾病之一。 我院从1994年以来开展骨碱性磷酸酶(BoneALkaline pnosphatase BALP)定量测定,诊断小儿维生素D缺乏性佝偻病。该方法敏感、准确、操作简便,易被患儿接受,是用于诊断及观察疗效最理想的方法。     

维生素D在防治佝偻病中的应用

佝偻病是一种小儿常见病,在预防和治疗上常用维生素D,但由于维生素 D 是一种蓄积性药物,其剂型的保存受环境条件限制,所以在预防、治疗佝偻病中安全、有效的剂量尤为重要。 1 一般资料1997年1月～2000年12月,在本院儿科,儿保科就诊儿童中系统管理1000人,从新生儿访视到4、2、1定期体检,均按佝偻病预防方案给维生素 D 预防。根据1986年下发的“婴幼儿佝偻病防治方案”诊断标准确疹活动期佝偻病150人,发病率为15%,3～9m 发病率为70%。其中134人为轻度佝偻病,16人为中度佝偻病。     

维生素D2预防佝偻病效果观察及相关措施

目的佝偻病是常见的危害儿童健康的疾病之一,尤其是我国北方地区,其发病率仍然很高。为了更好的防治此病,我们对维生素D2预防佝偻病进行了效果观察。方法把184例婴幼儿随机分为两组,一组服维生素D2丸,一组服用钙剂,观察佝偻病的发病率。结果用维生素D2丸预防佝偻病是有效果的,而投钙剂效果不明显。结论通过我们的观察,可以证明应用维生素D2预防婴幼儿佝偻病有显著效果,从新生儿起就服用维生素D2丸是完全可以预防佝偻病的。     

婴幼儿维生素D补充剂应用影响因素分析

为进一步预防和控制小儿佝偻病,笔者就我县2011年1月至2012年12月来我院就诊住院的0～3岁婴幼儿,采用自制调查问卷对儿童抚养人进行维生素D补充剂应用现状及影响因素方面的调查。1对象和方法1.1研究对象:选取2011年1月至2012年12月来我院住院就诊的0～3岁婴幼儿1784人,其中男性944人,女性840人。最早应用维生素D补充剂为生后1周,持续时间0.5～18个月,最长达1年半,应用剂量为33～600U/d。     

120名农村0～6岁儿童佝偻病发病情况调查

佝偻病(维生素D缺乏症)在我国较普遍,为了解安徽省东部地区农村儿童佝偻病的发病情况,指导预防,笔者以抽样调查的方式随机抽查了120名0～6岁的儿童,结果:(见表1)。0～6岁儿童佝偻病发病率为60％。远远高于全国平均患病率40.7％的水平,发病年龄组以2岁以内为高(见表1)。以出生季节相比较,尤以夏季出生的儿童患病率高,为84.2％(见表1)。患有长期或短期严重腹泻的小儿其佝偻病的发病率高达93.1％。上述调查结果提示我们对佝偻病的预防要     

贵阳市维生素D缺乏性佝偻病107例临床病例分析

佝偻病是维生素D缺乏引起的钙、磷代谢失常，骨样组织钙化障碍的慢性营养缺乏性疾病，是我国儿童尤其是婴幼儿的常见病、多发病。在我国尤其是地处老、少、边、穷的地区发病率较高，是儿保工作的主要任务之一，为了解佝偻病的患病情况及其相关因素，现将我所儿童保健专家咨询门诊贵阳地区1992年11月1日～12月31日的107例佝偻病病例分析如下：1资料来源1．1对象：1992年11月1日～12月31日我所儿保专家咨询门诊3岁以下儿童。1.2诊断标准：按照1986年卫生部颁发关于“小儿四病防治方案”佝偻病诊断标准；发锌测定采用WFX－2原子吸收分光光度…     

Characteristics of children with florid vitamin D deficient rickets in the Auckland region in 1998

AIM: To describe the characteristics of children with vitamin D deficiency rickets and identify common features and predisposing factors. METHODS: A review of the clinical notes of all children less than five years of age with radiological evidence of rickets and serum 25-hydroxyvitamin D levels of less than 10 micrograms/L. Patients were identified by searching all low vitamin D levels performed at the Endocrinology laboratory at Auckland Hospital and children presenting to the Starship Childrens' Hospital with rickets in 1998. RESULTS: In 1998, there were eighteen children (ten males and eight females) with vitamin D deficient rickets. The age range was 3 to 36 months with a median of 12 months. There were twelve children of Indian ethnic origin, one Maori, one Tongan, one Western Samoan, one Ethiopian, one Moroccan and one Indonesian. All children had an elevated alkaline phosphatase level and most had very low serum 25-hydroxyvitamin D levels (< or = 5 micrograms/L), and over half were hypocalcaemic. The common presenting features were delayed walking and bowed legs, swollen wrists or ankles, hypocalcaemic seizure, incidental radiological abnormalities and failure to thrive. CONCLUSIONS: There are a significant number of children in Auckland presenting with florid clinical rickets. The majority with vitamin D deficient rickets in this survey were of Indian ethnic origin. Strategies are needed to detect children at risk of vitamin D deficiency and supplement them with vitamin D.     

A systematic review of nutritional rickets in Ethiopia: status and prospects

BACKGROUND: Nutritional rickets contributes to the high burden of illness and death among Ethiopian children below 5 years of age. Lack of adequate information appears to have negatively influenced the impact of prevention and treatment programs. OBJECTIVES: The objective of this systematic review is to review existing body of knowledge about nutritional rickets in Ethiopia and develop recommendations that will guide development of strategies for effective interventions and research. METHODS: Published and unpublished information on nutritional rickets in Ethiopia was collected systematically. The information was critically reviewed and discussed in the context of regional and global situation. RESULTS: The major cause of nutritional rickets in Ethiopian children is lack of exposure to sunshine and/or inadequate intake of vitamin D. Lack of awareness and traditional beliefs are major causes for not exposing infants to sunshine. The disease is associated with poor socioeconomic status, low birth weight, protein-energy malnutrition and common childhood infections. Severe form of rickets is commonly seen at about 18 months of age. Rickets predisposes Ethiopian children to pneumonia. Diagnostic criteria used in most studies include two or more clinical signs and a characteristic radiological or biochemical abnormality. There are critical gaps in our knowledge about the epidemiology, ecology, and potentially effective interventions to prevent and treat rickets in Ethiopian children. CONCLUSION: Most of the studies on nutritional rickets in Ethiopia have been conducted in hospital settings. There is a need for well designed epidemiological and ecological studies. The biologic basis for the striking association between PEM and active rickets seen in Ethiopia needs to be determined The role of calcium deficiency, the part played by genetic factors, the nature of the association between the duration of breastfeeding and rickets, and the role of complimentary feeds in Ethiopian children need to be explored. Studies are required to determine the amount of sunshine required to prevent rickets in Ethiopian infants. Studies are required to establish criteria for the diagnosis of clinical and sub clinical rickets, particularly in malnourished children. Prevention programs need to be pursued consistently and systematically and treatment options, including the single massive dose of vitamin D, need to be re-evaluated and optimal mode of treatment determined.     

Primary vitamin D deficiency in children

In recent years, the prevalence of vitamin D (calciferol) deficiency has increased and rickets has re-emerged in the UK and other developed countries as a public health problem. Infants, toddlers and adolescents in 'at risk' ethnic minorities (e.g. Asian, African Caribbean and Middle Eastern) are particularly likely to be vitamin D-deficient or to have rickets. Also at particular risk are babies and toddlers who have been exclusively breast-fed during infancy without receiving vitamin supplements, or whose mothers did not have vitamin D supplements during pregnancy. Here we discuss the management of children with primary vitamin D deficiency (i.e. that due to nutrient deficiency).     

骨碱性磷酸酶在佝偻病早期诊断中的应用

目的分析研究骨碱性磷酸酶(BALP)测定对维生素D缺乏性佝偻病早期诊断的临床意义。方法收集体检诊断为维生素D缺乏性佝偻病的0～3岁儿童520例,采用骨碱性磷酸酶(BALP)试剂盒进行检测,对比分析其中部分病例的血清钙磷及碱性磷酸酶含量。结果骨碱性磷酸酶早期诊断佝偻病阳性率达90.8%,与血清钙磷、ALP检测差异有统计学意义(P<0.01)。结论 BALP检测简便、快捷、特异性高、结果可靠、可减少漏诊率,对佝偻病早期诊断具有重要的指导价值,基层医院应推广。     

肌内注射维生素D2预防婴幼儿佝偻病疗效观察

目的 观察肌内注射维生素D2预防佝偻病的疗效.方法 200例佝偻病患儿随机分为治疗组103例,对照组97例,治疗组给予肌内注射维生素D2及口服葡萄糖酸钙治疗;对照组给予口服维生素AD滴剂每天1粒及口服葡萄糖酸钙治疗.观察2组治疗效果.结果 治疗组总有效率为95.15%高于对照组的87.63%,差异有统计学意义（P〈0.05）.结论 肌内注射维生素D2预防婴幼儿佝偻病疗效确切.     

Persistent limb pain and raised serum alkaline phosphatase the earliest markers of subclinical hypovitaminosis D in Kashmir

The present study was an attempt to assess the cause of persistent pain in lower limbs among children from Kashmir. The study was conducted on one hundred children attending Paediatric out-patient department of Sher-i-Kashmir Institute of Medical Sciences, Srinagar. All the children were in the age group of 5 to 14 years. They showed markedly raised levels of serum alkaline phosphatase, whereas serum phosphorus, serum calcium levels and antistreptolycin O-titres were normal in 93% cases. None of them had any rheumatic or rheumatoid pathology. Among 15 suspected clinical rickets only three were established radiologically. Dietary and socio-economic history revealed deficient vitamin D intake and less exposure to sun. It was hypothesized that sub-clinical vitamin D deficiency could be a major cause of persistent pain in lower limbs and raised serum alkaline phosphatase could be the earliest marker of vitamin D deficiency. It was confirmed by injecting single dose of vitamin D (3 lac I. U.) which relieved bone pain and lowered the levels of serum alkaline phosphatase to normal within 14 weeks of initiation of therapy.     

骨密度检查对维生素D缺乏性佝偻病的诊断价值

目的分析超声骨密度检查对维生素D缺乏性佝偻病的诊断价值。方法选取2016年1月-2018年1月于铁岭县中心医院儿科健康体检的0~3岁小儿300例为研究对象,所有患儿均采取超声骨密度和血清25羟维生素D检查,对比并分析检查结果。结果超声骨密度组总异常率高于血清25羟维生素D组,差异有统计学意义(P<0.05)。随着年龄的递增,骨密度结果异常率随之降低,早产儿的骨密度结果异常率高于足月儿,差异均有统计学意义(P<0.05)。结论超声骨密度检查可有效诊断维生素D缺乏性佝偻病,值得推广。     

婴幼儿反复呼吸道感染与维生素D缺乏性佝偻病相关性探讨

目的探讨婴幼儿反复呼吸道感染与维生素D缺乏性佝偻病的关系。方法对2006年1月至2008年12月在本院儿科门诊及住院的72例反复呼吸道感染婴幼儿为观察组,同期儿保门诊体检的87例婴幼儿为对照组,进行骨碱性磷酸酶（BALP）检测,临床评估,必要时作腕骨X线摄片检查。依据病史,临床表现,结合BALP,判定有无佝偻病及是否为维生素D缺乏亚临床状态。用维生素D及钙剂治疗佝偻病及维生素D缺乏亚临床状态患儿,并进行半年随访。结论反复呼吸道感染组佝偻病患病率明显高于对照组（P〈0.01）。结论婴幼儿反复呼吸道感染与佝偻病有密切临床相关性,防治佝偻病是反复呼吸道感染防治的重要措施之一。     

不同年龄段患儿七氟烷全凭吸入喉罩通气麻醉的应用效果比较

目的:比较七氟烷全凭吸入喉罩通气麻醉用于不同年龄段患儿的麻醉效果及安全性。方法:选取168例行肱骨髁上骨折经皮克氏针内固定术的患儿,根据患儿年龄将其分为4组:0^<1岁为A组(45例),1<1岁为A组(45例),1^<4岁为B组(42例),4<4岁为B组(42例),4^<7岁为C组(48例),7<7岁为C组(48例),7¹0岁为D组(33例)。采用七氟烷联合笑气吸入喉罩通气,然后行肌间沟、腋路二点臂丛神经阻滞,术中不应用肌松药,患儿行自主呼吸。术毕后拔除喉罩,送患儿至麻醉后复苏室。比较各组患儿手术、麻醉诱导、喉罩置入、复苏、拔除喉罩等过程耗费的时间和不同时间点麻醉后恢复评分(Aldrete评分),并记录患儿不良反应及并发症发生情况。结果:4组患儿手术、麻醉诱导、喉罩置入、复苏、拔除喉罩等过程耗费的时间和不同时间点Aldrete评分比较,差异均无统计学意义(P>0.05)。A组患儿高CO2血症、躁动发生率高于其余3组(P<0.05),C组患儿躁动发生率高于B、D组(P<0.05);A组和B组患儿屏气发生率高于其余2组(P<0.05);4组患儿恶心、呕吐、低氧血症、咳嗽、喉罩拔除后舌后坠等发生率比较,差异均无统计学意义(P>0.05)。结论:年龄因素不会影响患儿应用七氟烷全凭吸入喉罩通气麻醉的效果,但可影响患儿的不良反应及并发症发生率,其中1岁以下的患儿易发生躁动及呼吸系统抑制,410岁为D组(33例)。采用七氟烷联合笑气吸入喉罩通气,然后行肌间沟、腋路二点臂丛神经阻滞,术中不应用肌松药,患儿行自主呼吸。术毕后拔除喉罩,送患儿至麻醉后复苏室。比较各组患儿手术、麻醉诱导、喉罩置入、复苏、拔除喉罩等过程耗费的时间和不同时间点麻醉后恢复评分(Aldrete评分),并记录患儿不良反应及并发症发生情况。结果:4组患儿手术、麻醉诱导、喉罩置入、复苏、拔除喉罩等过程耗费的时间和不同时间点Aldrete评分比较,差异均无统计学意义(P>0.05)。A组患儿高CO2血症、躁动发生率高于其余3组(P<0.05),C组患儿躁动发生率高于B、D组(P<0.05);A组和B组患儿屏气发生率高于其余2组(P<0.05);4组患儿恶心、呕吐、低氧血症、咳嗽、喉罩拔除后舌后坠等发生率比较,差异均无统计学意义(P>0.05)。结论:年龄因素不会影响患儿应用七氟烷全凭吸入喉罩通气麻醉的效果,但可影响患儿的不良反应及并发症发生率,其中1岁以下的患儿易发生躁动及呼吸系统抑制,4^<7岁患儿易发生躁动,4岁以下患儿易发生屏气,因此对不同年龄段患儿进行麻醉时应谨慎处理。     

维生素D滴剂预防早产儿维生素D缺乏性佝偻病的效果观察

目的:观察维生素D滴剂预防早产儿维生素D缺乏性佝偻病的效果。方法:137例早产儿按分层随机分组法分为观察组与对照组。对照组51例,给予乳酸钙颗粒0.25 g、bid,连续用药6个月以上;观察组86例,在对照组用药基础上加用维生素D滴剂400 U、bid。随访2年,比较两组早产儿给药前、后血清生化指标如血清25-羟维生素D3(25OHD3)、钙、磷、骨钙素(BGP)、碱性磷酸酶(ALP)及骨源性碱性磷酸酶(BALP)的含量变化和骨密度及佝偻病的发生率。结果:观察组早产儿在给药前,各项血清生化指标的检查结果与对照组比较差异均无统计学意义(P>0.05);给予相应治疗并随访2年后,观察组的各项血清生化指标及骨密度、佝偻病发生率均显著优于对照组(P<0.05)。结论:维生素D滴剂能显著降低早产儿维生素D缺乏性佝偻病的发生率,对预防佝偻病和促进骨质形成有重要的临床应用价值。