肺炎颗粒治疗小儿急性支气管肺炎临床观察

小儿急性支气管肺炎是婴幼儿常见病。 1 997年3月至 2 0 0 0年 3月 ,我们在动物实验的基础上 ,采用自行研制的肺炎颗粒治疗本病患儿 2 0 0例 ,取得满意效果 ,现报告如下。1　资料与方法1 .1　临床资料　本文共 30 0例患儿 ,均根据卫生部制定的“小儿肺炎防治方案”中的标准确诊。将其随机分为三组 ,治疗 A组 1 0 0例 ,男 64例、女 36例 ,年龄 6个月至 1 2岁 ;治疗 B组 1 0 0例 ,男 58例、女 42例 ,年龄 6个月至 1 2岁。对照组 1 0 0例 ,男 60例、女40例 ,年龄 6个月至 1 2岁。三组患儿性别与年龄有可比性。其主要临床表现为发热 ( 38～ 39…     

B超监视水压灌肠二次以上治疗肠套叠267例回顾性分析

正选择2006-2015年10年间收治的肠套叠病人856例,在B超机监视下行水压灌肠一次性复位589例(有效率68.8%);而来院较晚,病史在12~48h婴幼儿、2~3d以上儿童计267例失败,行二次以上再灌肠复位,现对治疗结果做一回顾性分析。1资料与方法1.1一般资料病例分两组统计:婴幼儿组224例,男性146例,女性78例,男女之比1.9:1。年龄:3.5个月~2岁,其中3.5个月~6个月57例,6个月~1     

喘息儿童雾化吸入治疗指导

雾化吸入治疗是以“喘息”为主要症状住院的低年龄儿童中比较重要的局部治疗,而护士在雾化吸入治疗中是否能正确指导患儿及家属正确吸入,对患儿是否能迅速缓解喘息症状尤显重要。近年来喘息患儿发病率逐年上升,以婴幼儿为多,我科开展喘息患儿雾化吸入治疗已多年,取得一定效果,现报道如下。1临床资料本组病例51例均为2005年10月至2006年10月“喘息”住院儿童。其中男27例,女24例;年龄3个月～3岁,其中3个月～1岁20例,1～2岁17例,2～3岁14例。轻度三凹征31例,鼻翼煽动22例,口周紫绀32例,均有烦躁及呼吸加快。患儿均治愈(喘息性支气管炎)或缓解(…     

喘乐宁雾化吸入治疗婴幼儿喘息320例分析

1997年5月～2001年5月,我科采用雾化吸入喘乐宁溶液治疗婴幼儿喘息320例,效果满意,现报告如下。 资料与方法;治疗组320例,其中喘息性支气管炎218例,婴幼儿哮喘102例。年龄0～6个月28例,6个月～1岁116例,1～2岁132例,2～3岁44例;按2:1选择同期住院患儿160例作为对照组。全部病例均按婴幼儿哮喘诊断标准评     

乳前牙反矫治后恒牙仍反临床分析

在儿童颅颌面的生长发育过程中,错畸形是影响颌面正常发育的主要因素,其中前牙反是儿童错畸形最常见、最严重的畸形之一,治疗不及时,影响上下颌骨的发育、咀嚼功能,且影响患儿的言貌。因此,尽早矫治、减少矫治后复发至关重要。1996年1月~2004年12月,我院治疗73例错畸形,现报告如下。临床资料:本组男31例、女42例,年龄2岁8个月~5岁6个月,平均4岁1个月。患儿均采用上颌垫活动矫治器进行矫治。时间2.5~5.5个月,平均4个月,均未作保持。结果:随访61例,其中56例未出现恒前牙反畸形,5例出现完全性或不完全性前牙反,其中2例不完全性…     

CO2冷冻联合钳夹治疗婴幼儿淋巴结瘘型气管支气管结核的疗效和安全性研究

目的: 评估CO₂冷冻联合钳夹介入治疗对婴幼儿淋巴结瘘型气管支气管结核(tracheobronchial tuberculosis,TBTB)的疗效和安全性。方法: 回顾性分析2012年7月至2020年7月天津市儿童医院呼吸科接受纤维支气管镜介入治疗的7例淋巴结瘘型TBTB患儿的临床资料(包括年龄、性别、临床症状、诊断结果、CT特点、支气管镜下病灶特征),通过描述性总结分析介入治疗前后的咳嗽等级、CT及支气管镜下病灶改变。结果: 7例患儿中,男6例,女1例,年龄8个月至3岁,病程5~70d。所有患儿主要采用支气管镜下CO₂冷冻联合钳夹治疗,介入次数为1~3次。介入治疗3个月后,5例患儿咳嗽评分从2分降为0分,治疗显效,2例患儿咳嗽评分从3分降为1分,治疗有效;5例患儿复查CT显示:肺门、纵隔肿大钙化的淋巴结、支气管阻塞、肺气肿、肺不张等表现与介入治疗前比较明显改善和好转。5例患儿中,4例患儿肺部病灶吸收≥1/2,治疗显效,1例患儿肺部病灶吸收<1/2,治疗有效。7例患儿复查纤维支气管镜可见镜下瘘口基本闭合,支气管病变明显吸收好转,管腔狭窄或阻塞情况较前减轻,支气管黏膜相对光滑。7例患儿中,5例患儿支气管病变吸收≥2/3,治疗显效,2例患儿支气管病变吸收好转但<2/3,治疗有效。所有患儿术中均无呼吸困难及血氧饱和度的下降。所有患儿术后均未出现气胸、纵隔气肿、气道痉挛、管腔水肿、大出血等严重并发症。应用纤维支气管镜介入随访3~6个月,除1例患儿失访,6例患儿均未见病灶复发。结论: CO₂冷冻联合钳夹介入治疗婴幼儿淋巴结瘘型TBTB取得良好的治疗效果,未见气管支气管狭窄、软化、阻塞性肺炎、肺不张等合并症的发生,该治疗方式安全有效。     

537例婴幼儿体外循环心内直视手术后死亡病例的年龄分布

目的 :总结 5 37例婴幼儿体外循环心内直视手术患者死亡病例的年龄分布特点及死亡原因。方法 :分析 5 37例婴幼儿先天性心脏病患儿的临床资料 ,男 336例 ,女 2 0 1例 ,年龄 1～ 36 (平均 13 2± 9 4 )个月。结果 :5 37例婴幼儿体外循环心内直视术后共死亡 36例 ,死亡率 6 7% ;其中 1999年 1月至12月的 185例患儿中死亡 8例 ,死亡率 4 3%。婴幼儿的死亡率在各年龄段的分布中以 <1岁的患儿较高 ,其中 1～ 6个月的患儿最高 (16 3% ) ;7～ 12个月的患儿死亡率 (8 1% ) ,13～ 2 4个月的患儿死亡率(6 3% ) ,2 5～ 36个月的患儿术后死亡率 (3 7% )。在死亡原因方面 ,以死于低心排综合征的婴幼儿比例最高 ,占 36例死亡婴幼儿的 5 0 % (18 36 ) ,其次是死于呼吸功能衰竭的婴幼儿占 36例死亡婴幼儿的33 3% (12 36 ) ,死于肾功能衰竭的占 11 1% (4 36 ) ,死于多脏器衰竭变竭的占 5 5 % (2 36 )。结论 :婴幼儿患者体外循环心内直视术时年龄越小死亡越高 ,死于心、肺功能衰竭的患者比例较高 ;因此对婴幼儿体外循环心脏手术时应加强术中的心脏保护效果。     

哮喘性支气管炎患儿肺炎支原体抗体检测及分析

为更好地提高患儿哮喘性支气管炎的治疗效果 ,探讨该类患儿的感染病原 ,特对本院患儿及正常儿童的肺炎支原体抗体 ( Mycoplasma pneumomiaeantibody-Ig M)进行了检测 ,现将结果报告如下。1　资料和方法1 .1　资料来源观察组 :64例患儿均符合王慕狄主编的儿科学中哮喘性支气管炎的诊断标准。为本院儿科 2 0 0 0年 9月至2 0 0 3年 9月住院患儿 ,均在近期 2周内感染。男 3 6例 ,女2 8例 ;年龄 6个月～ 1岁 1 2例 ,1～ 3岁 1 8例 ,>3岁 3 4例。对照组 :正常儿童 47例 ,男 2 2例 ,女 2 5例 ;年龄 6个月～ 1岁 1 0例 ,1～ 3岁 1 6例 ,>3岁 2 1例…     

玉屏风联合阿昔洛韦治疗小儿手足口病疗效观察

2006年1月~2009年7月,我院共收治手足口病患儿136例,其中对68例患儿采用了玉屏风辅助治疗,取得满意疗效。现报告如下。临床资料：136例患儿均符合诸福棠编《实用儿科杂志》第七版手足口病诊断标准。男72例、女64例,年龄6个月~8岁。6个月~3岁86例,4岁~6岁50例;     

小儿颅脑损伤的临床特点及治疗

目的探讨小儿颅脑损伤的临床特点及治疗。方法回顾性分析我院收治的60例颅脑损伤患儿的临床资料,结合相关文献探讨小儿颅脑损伤的临床特点及各阶段治疗。结果本组60例患儿治疗后23例痊愈出院,34例好转出院,1例植物生存,2例死亡;随访6~12个月4例有后遗症。结论小儿颅脑损伤多发生于8~14岁儿童,多为闭合性颅脑损伤,需要及时采取合理有效的治疗,预后较好。     

Aluminum Phosphide Poisoning-Related Deaths in Tehran,Iran, 2006 to 2013

Metal phosphides such as aluminum phosphide are potent insecticides. This highly toxic substance is used for rice and other grains protection in Iran. Due to its high toxicity potential and easy availability, it is widely used as a suicide poison. This substance has no effective antidote and the incidence of deaths due to its poisoning is increasing day by day in Iran.The present study was conducted to show the increasing incidence of fatal aluminum phosphide poisoning and its toxicological and forensic aspects in an 8-year study, 2006 to 2013. Autopsy sheets were reviewed and cases with the history of aluminum phosphide poisoning were selected. Toxicological analysis results, demographic and necroscopic examination findings were studied. A total of 51.8% of studied cases were female. Most of the cases were between 10 and 40 years old. The manner of death was self-poisoning in 85% of cases. Morphine, ethanol, and amitriptyline were the most common additional drugs detected in toxicological analysis. The incidence of fatal aluminum phosphide poisoning cases referred for phosphine analysis was 5.22 and 37.02 per million of population of Tehran in 2006 and 2013, respectively. The results of this study showed that in spite of ban and restrictions, there was a dramatic increase in the incidence of fatal aluminum phosphide poisoning in Tehran from 2006 to 2013. Safety alert should be highlighted in training program for all population groups about the toxic effects of aluminum phosphide tablets.     

Esophageal Complications Following Aluminium Phosphide Ingestion: An Emerging Issue Among Survivors of Poisoning

Aluminium phosphide ingestion is the most common agricultural poisoning in suburban and rural India and with a high mortality rate. Among survivors of acute poisoning there are recent sporadic reports of esophageal complications such as esophageal strictures and tracheo-esophageal fistula. The present study was carried out to determine the incidence, natural history, and treatment outcome of local esophageal complications in survivors of aluminium phosphide poisoning with complaints of dysphagia. All confirmed cases of poisoning with aluminium phosphide ingestion were admitted in Hamidia Hospital, Gandhi Medical College, Bhopal, Madhya Pradesh, India, from October 2007 to October 2008. Survivors with complaints of dysphagia underwent a barium study and upper gastrointestinal endoscopy to determine site and nature of esophageal complications. All cases of strictures were treated with fluoroscopy-guided Savary–Gilliard bougie dilation, and patients with tracheo-esophageal fistula underwent surgery. Of 104 confirmed cases, 31 survived. Ten survivors with dysphagia were found to have single short-segment esophageal stricture and two patients with odynophagia and swallow–cough sequence had tracheo-esophageal fistula. All cases of esophageal strictures responded successfully to Savary–Gilliard dilation in six to ten sessions without any major complications. Patients with tracheo-esophageal fistula were treated successfully via surgery. Nearly one-third of survivors of aluminium phosphide ingestion developed esophageal complications. Hence, we conclude that all survivors of aluminium phosphide poisoning must undergo barium swallow and endoscopic examination for early detection of esophageal complications. Prevention of esophageal complications after aluminium phosphide ingestion needs to be given adequate attention because tracheo-esophageal fistula and esophageal stricture are associated with high morbidity. When one finds esophageal stricture or fistula, the possibility of aluminium phosphide ingestion should always be considered.     

Cardiovascular complications of aluminum phosphide poisoning

Aluminum phosphide is widely used as a grain preservative. Recently some reports have appeared in the literature in which serious toxic effects of this agent have been reported, and a number of fatal complications, including shock and cardiac dysrhythmias, have been increasingly seen. Of 25 cases of aluminum phosphide poisoning the authors observed over a period of two years, 16 cases (64%) had evidence of cardiac dysfunction. Despite adequate treatment, 40% of the patients died. A plea is being made for recognition of these fatal complications and for early institution of adequate treatment.     

婴幼儿复杂重症先心病围手术期治疗

目的通过回顾性分析我院住院治疗的1180例小于36个月患有重症先心病患儿的临床资料,总结婴幼儿重症先心病患者围手术期的治疗方法。 方法采用回顾性分析的方式,分析我院自2016年5月~2017年6月收集的1180例重症先心病,年龄小于36个月的患者的临床资料、术前检查、手术方式、术后监护。结果术后发生：肺高压危象12例,其中死亡1例;低心排量11例;心功能差、低氧3例,其中死亡1例;肺部感染32例,其中死亡1例;肺不张9例;脑萎缩4例;多器官功能衰竭5例,其中死亡1例;其余均治愈出院,随访时间为6~12个月,生长发育改善,无远期并发症。总的并发症例数为159例,并发症发生率为13.47%,死亡率为0.34%。其余均治愈出院,随访时间为6~12个月,生长发育改善,无远期并发症。结论婴幼儿复杂重症先心病患者应选择适当的手术时间,尽早完善围手术期的处理,提高手术存活率,改善和提高患儿预后。     

Aluminium phosphide poisoning.

Aluminium phosphide is a solid fumigant pesticide widely used in the Indian subcontinent as a grain preservative. Over the last 5 years there has been a dramatic increase in the number of cases of aluminium phosphide poisoning in India. Ninety-two patients with aluminium phosphide poisoning due to ingestion were studied over a period of 3 years. Abdominal pain, vomiting and restlessness were the common initial features followed by alteration in sensorium and shock unresponsive to conventional treatment. Electrocardiographic abnormalities were very common and highly variable. Routine serum biochemistry was usually unremarkable. Severe metabolic acidosis was common and mortality high (49%). The survivors recover completely without any residual organ damage. There is no known antidote.     

社区儿童保健体检272例心脏杂音结果分析

目的初步探讨社区卫生中心针对0～6岁散居婴幼儿及儿童保健体检对疾病尤其心脏疾病筛查的重要性,以及心脏杂音体征在0～6岁散居婴幼儿和儿童心脏疾病诊断中的重要性。方法：对2009年7月-2013年6月本社区卫生服务中心所属辖区进行0-6岁散居儿童保健大体检中听诊到心脏杂音的272名婴幼儿及儿童进行专案管理登记并尽快转至上级专科医院进行心脏彩超、心肌酶等检查以明确产生心脏杂音的原因及疾病。结果：转诊的272名查体有心脏杂音的0-6岁儿童上级心血管专科医院的诊断结果为病理性杂音124例,占45．6％,生理性杂音148例,占54．4％,其中病理性杂音包括先天性心脏病85例（占31．3％）,即室间隔缺损（VSD）62例（占22．8％）、房间隔缺损（ASD）13例（占4．8％）、房室间隔缺损（AVSD）2例（0．7％）,动脉导管未闭（PDA）10例（3．7％）;继发性心脏病37例（占13．6％）,包括感染性心肌损害27例（9．9％）、心肌炎2例（0．7％）、感染性心内膜炎I例（0．4％）,贫血性心脏病7例（25．7％）;生理眭杂音148例,包括左室假腱索42例（15．4％）、瓣膜反流及瓣膜脱垂42例（15．4％）,心脏无异常64例（23．5％）。先天性心脏血管病〈1岁年龄组所占比例显著高于1-岁组,更高于2-岁以上组（均P〈0-01）。而继发性心脏病和生理性杂音〈1岁组所占比例显著低于1．岁组和2．岁组（均P〈0-01）。在〈1岁组中先天性心脏血管病所占比例显著高于继发性心脏病和生理性杂音。结论：本社区儿童保健体检查体中对发现的异常体征如心脏杂音的婴幼儿及儿童进行及时专科转诊后发现先天性心脏病和继发性心脏病的比例较高,是引起心脏杂音的主要原因。社区卫生中心针对散居婴幼儿及儿童每年定期免费保健大体检可对散居儿童的生长发育和疾病筛查有重要意义和积极作用,认真做好基层医疗儿童保健工作可使散居儿童得到疾病的早发现、早治疗。     

Present activity of BCG and LTBI treatment for infants in Japan

I analyzed the BCG vaccination and treatment of latent tuberculosis infection (LTBI) for infants notified in 2008 in Japan. BCG was not recommended and treatment of LTBI was the main activity for prevention of TB in infants from birth to age 2 months. The majority of notified LTBI cases were detected by contact surveys. Out of the estimated number of TB infected (148), only 2 cases were notified based on the outcome of LTBI treatment for 89 infants. When the infants were 3-5 months old, both BCG vaccination and LTBI treatment were implemented. BCG coverage was 61.5-97.7%, and LTBI treatment for non-vaccinated individuals was applied for a larger number of infants (1.04 to 7.82 times as many) than the estimated number of infants infected with TB. The majority of infants were BCG vaccinated when they were 6-11 months old. Although LTBI treatment coverage was low, only 5 cases developed among those receiving BCG vaccination. During 1-2 year, BCG coverage was high and breakdown rates of BCG-vaccinated children were much lower than those of non-vaccinated children. This difference might be due to not only the preventive effect of BCG but also risk difference of TB infection between BCG-vaccinated and BCG non-vaccinated individuals. The number of notified LTBI treatment cases was lower than the estimated number of children infected with TB during 1-2 year. To prevent infant TB, reinforcement of contact surveys to identify LTBI for treatment, improvement of BCG coverage, and attention to BCG non-vaccinated infants older than 6 months might be effective.     

Surgical treatment of complete atrioventricular canal. Value of the "composite double patch" technic

Between January 1, 1982 and January 1, 1988, 49 complete corrections of complete atrioventricular canal were performed in children aged from 4 months to 8 years. 41 were infants less than 2 years' old and 31 were less than one year old. In the last 35 patients the "composite double patch" technique was used, consisting of closure of the interventricular septal defect with a dacron patch, followed by closure of the ostium primum with a pericardial patch. The mitral cleft was left intact in the last 6 operations. The overall mortality rate was 35 p. 100 (17 patients). It was 23 p. 100 in infants under 1 year and 17 p. 100 in infants aged from 6 to 12 months at the time of surgery (p less than 0.01). Seven of the 35 children in whom the "composite double patch" technique was used died (20 p. 100). Only one early death was recorded among the last 15 children operated upon. Two reoperations were performed: one within one month of the first operation, the other 4 months later for residual mitral regurgitation with haemolysis. 32 children were followed up for periods of 2 months to 6 years, 10 of them for more than 3 years. Two late deaths occurred during the follow-up. Grade 2 or 3/4 residual regurgitation was found in 14 patients who have regular clinical and echocardiographic examinations.(ABSTRACT TRUNCATED AT 250 WORDS)     

小儿川崎病冠状动脉病变的临床探究

目的探讨小儿川崎病冠状动脉病变的临床治疗方法与治疗效果。方法选取2003年6月~2013年6月来我院接受治疗的川崎病冠状动脉病变患儿30例,采用超声心动图对这些患者冠状动脉受伤的情况进行检查,并采用Cubens的方式测定患儿左心室收缩功能的情况,采用二尖瓣多普勒血流图测定这些患者的左心室舒张功能,同时与30例正常儿童的心功能状况进行对比分析。结果在30例冠状动脉受到损伤的患儿中,有21例患儿的冠状动脉扩张情况在治疗4个月的时间内得到了控制并逐渐好转,有8例患儿的冠状动脉扩张情况在治疗6个月时间内逐渐得到好转,只有1例患儿在6个月的随访调查中发现其病情并未出现好转。结论川崎病患儿在发病时冠状动脉很容易受到影响,尤其出现在急性期,而对心功能的改变影响则不明显,临床诊断中应用超声心动图诊断效果显著,值得广泛推广和应用。     

Our experience with flecainide acetate in resistant arrhythmias in children. Apropos of 35 cases

Thirty-five patients aged 6 days to 18 years (average 7.5 +/- 5.2 years) were treated for an average period of 16 months (range 8 days to 50 months) with flecainide acetate at an average dose of 4.8 +/- 1.4 mg/kg (2.9 to 10 mg/kg) or 130 +/- 30.5 mg/m2 administered twice daily. The cardiac arrhythmia was a resistant paroxysmal junctional tachycardia due to a Wolff-Parkinson-White syndrome in 27 cases, intranodal reentry in 6 cases and a chronic reciprocating rhythm in 2 cases. Treatment was successful with complete suppression of the tachycardia in 24 cases. Partial success with a good clinical result was obtained in 4 cases and there were 7 failures, 6 due to inefficacy of the drug, and 1 because of an extracardiac secondary effect. One case of incessant junctional tachycardia was observed in a 9 month old child in whom the preexcitation disappeared. Atrioventricular preexcitation persisted in 20 out of 24 cases. The duration of the non-preexcited QRS complexes increased significantly from 73.6 +/- 13.8 to 82.2 +/- 15.2 ms; n = 14, p less than 0.01. The minimal effective plasma concentration was 347 +/- 147 ng/ml. The plasma concentration/dose ratio of children over 4 years of age was the same as in adults. It was significantly higher in babies and infants suggesting a progressive acquisition of the capacity to metabolise flecainide during the first year of life. In conclusion, flecainide acetate was easy to use with respect to administration and follow-up, and seems to be a drug of choice for the treatment of junctional tachycardia in children.