1995～1999年广东省住院患儿川崎病发病情况调查

目的 了解广东省小儿川崎病发病情况、分布及流行特征。方法 采用广东省统一制定的调查表寄发至全省有儿科病床的县市级以上医院儿科，对1995年1月1日至1999年12月31日5年间住院的川崎病患儿进行登记调查。结果 调查表回收率为71.2%，5年间共报道患儿537例，5岁以下儿童发病率为5.93/10万；男性发病明显多于女性，男女之比为2.23:1；发病年龄在2岁以下者占51.8%，4岁以下占75.6%；以4－6月份为发病高峰，9－12月份发病最少；深圳、珠海、广州及珠江三角洲地区为川崎病高发区，尤以深圳、珠海特区为发病率最高地区，粤东、粤西和粤北地区发病率较低。在537例中发生心脏后遗症75例，发生率为14.0%；死亡1例，病死率为0.2%。结论 广东省川崎病发病率高于我国江苏省和陕西省，但明显低于日本，发病趋势及分布特点与日本及我国江苏省和陕西省类似。     

小儿川崎病60例临床分析

目的 探讨小儿川崎病的临床发病特点.方法 对1999年1月至2009年6月笔者所在医院儿科收治川崎病60例患儿的临床资料进行回顾性分析结果小儿川崎病发病男孩多发,无季节差异,非典型病例占20%,误诊率高.结论 早期心脏彩超检测冠状动脉内径可以早期诊断川崎病.     

川崎病60例分析

目的 通过对本院7年60例住院川崎病患儿的发病情况、临床特征、治疗及预后进行回顾性分析,了解本地区川崎病的流行病学、临床诊治水平及预后情况,规范川崎病患儿的诊断、治疗,改善预后。方法 抽调我院1995年1月至2001年12月7年间收治的60例川崎病住院病历及门诊随访病历登记。结果 我院住院患儿病人呈明显逐年增加,且该病在本地区呈现春夏交季及冬季两个发病高峰,1-5岁发病率最高,男女比例1.3:1。急性期43例病人超声心动图检查有24例出现冠脉异常,占56％。恢复期彩超随访仍有7例冠脉异常,占16％;住院患儿发病10天内静脉免疫球蛋白(IVIG)治疗为45％。结论川崎病是儿童常见疾病,5岁以下发病率高,心脏后遗症多,目前已成为儿科心血管领域研究的重要课题。应提高广大基层医师对该病的认识,做到早诊早治,降低后遗症。     

不完全川崎病35例临床分析

川崎病（Kawasaki disease，KD）自1967年由Tomleeku Kawasaki首次报道以来，全球发病有逐年增多趋势。在我国，目前KD的发病率还不清楚，上海和北京地区的发病率分别为16．8—36．8／10万和26—31／10万。川崎病为一种急性、自限性的全身血管炎，由于其缺乏特异性的临床表现和特征性的实验室检测指标，其诊断主要依据临床表现，并需排除其他疾病的可能性。随着人们对该病的认识，不典型的或不完全符合川崎病的诊断标准的病例越来越多。1999年1月-2006年6月。     

川崎病的诊断和治疗

川崎病（Kawasaki disease，KD）又称皮肤黏膜淋巴结综合征，是一种急性、自限性的全身性血管炎，多见于婴儿和年幼的儿童。其发病率在日本5岁以下儿童（1997—1998）为112／10万；我国KD的发病率还不清楚，上海16．8～36．8／10万，北京26～31／10万。     

小儿川崎病93例临床分析

[背景]总结小儿川崎病的临床特征,探讨川崎病的诊断和治疗方法.[病例报告]回顾性分析1999年1月至2009年12月间住院确诊的93例住院患儿的临床资料,川崎病发病在6岁以下儿童中多见,男多于女,静脉注射给予丙种球蛋白加阿斯匹林的治疗效果较好.[讨论]应提高对川崎病的认识,减少误诊或漏诊,而早期诊断、早期治疗可降低冠状动脉病变的发生率,改善川崎病的预后.     

中山市1970—1999年乳腺癌发病动态分析

【目的】探讨1970—1999年中山市乳腺癌发病状况及其趋势。【方法】收集、整理1970—1999年期间中山市肿瘤登记资料中乳腺癌的发病资料，计算其发病数、发病粗率、中国与国际标准发病率等指标。【结果】1995—1999年期间中山市乳腺癌男、女世界标化发病率分别为0．13／10万、14．32／10万，且1970—1999年期间其发病率具有明显上升趋势。【结论】中山市女性乳腺癌发病率居同期国内农村试点较高水平，且其发病率有增加和发病年龄年轻化的趋势。     

婴幼儿不完全川崎病38例诊治报告

川崎病(Kawasaki disease,KD)1967年由川崎富作首先报告,国内称皮肤黏膜淋巴结综合征(Mucocutaneous lymph nodesyndrome,MCLS),是一种近年来常见又具有潜在生命威胁的小儿全身血管炎性疾病。而不完全川崎病因各种原因发病隐匿且发病率较高。现收集我科1995年1月至2007年12月收治不完全川崎病38例患儿临床资料,进行回顾性分析,目的在提高对婴幼儿不完全川崎病的认识和早期诊断,以期减少对小儿生长发育的影响。现报分析告如下。资料与方法1临床资料我科收治38例不完全川崎病患儿,其中男25例,占65.79%,女13例,占34.21%。年龄≤1岁18例,占47.37%,1~3岁19例,占50%,>5岁1例,占2.63%。入院诊断为上呼吸道感染19例,支气管炎9例,支气管肺炎7例,腹泻病2例,风湿热1例。起病原因:受凉12例,接种疫苗8例,不明原因18例。2临床表现热型:稽留热13例,占34.21%,驰张热15例,占39.47%,不规则热10例,占26.32%。季节:春季10例,占26.3%,夏季11例,占28.95%,秋季8例,占21.05%,冬季9例,占23.68%...     

川崎病120例临床分析

我院 1998年 8月至 1999年 8月共收治川崎病 (KD)患儿12 0例 ,现就其临床表现、治疗结果报告如下。1　临床资料1.1　一般资料　根据实用儿科学的川崎病诊断标准 ,重庆医科大学儿童医院自 1998年 8月至 1999年 8月共收治川崎病患儿 12 0例 ,其中男 80例 ,女 40例。发病年龄 3月至 11岁 ,其中 3个月至 1岁 17例 ,～ 2岁 2 7例 ,～ 3岁 2 8例 ,～ 4岁 2 0例 ,4岁以上 2 8例。1.2　临床表现　 12 0例均有发热 ,入院时发热病程 2～ 11d,平均发热 6 .8d,体温高达 39.5～ 41.2℃ ,为不规则发热或弛张热 ;10 4例有皮疹 ,皮疹为猩红热样皮疹或荨麻疹…     

小儿川崎病的临床诊治进展

川崎病 (Kawasaki’sKD)又称皮肤粘膜淋巴结综合征(mucocutaneouslymphnodesyndrome ,MCLS) ,是一种以全身血管炎性病变为主的儿童急性发热出疹性疾病[1] ,上世纪6 0年代日本川崎富作首次报道以来至今日本已报道 16万该病病例 ,亚、欧、美、澳洲及南非等世界各地均有报道。我国川崎病发病亦逐年增加[2 ,3 ] ,目前在许多国家 ,川崎病已取代风湿热成为儿童后天性心脏病的主要病因[4] ,因此引起儿科医生的普遍重视 ,对本病的病因、早期诊断和防治方法的研究 ,已成为儿科心血管领域研究的重要课题[5] 。1.历史回顾　　 196 7年日本学者川崎富…     

Epidemiologic features of Kawasaki disease in Shanghai from 2003 through 2007

Background The epidemiologic pictures of Kawasaki disease （KD） in Shanghai from 1998 through 2002 were reported while the current status of KD in the following five years remains unknown. Methods A questionnaire form and diagnostic guidelines for KD were sent to 50 hospitals providing pediatric medical care in Shanghai, China. All patients with KD diagnosed during January 2003 through December 2007 were recruited. Results In total, 1187 cases of KD were enrolled. The incidence of KD was 36.78 to 53.28 （mean 46.32±6.51） per 100 000 children under the age of 5 years between 2003 and 2007, which was higher than the year from 1998 to 2002 of （27.32±7.11） per 100 000, （t=4.406, P=0.002）. Ages at onset ranged from 12 days to 13.6 years （median 1.8 years）. It occurred more frequently in summer and spring. Coronary arterial lesions （CAL）, defined as ectasia or aneurysm, accounted for 19.8% （232 cases）. Flattened or inverted T wave was the most frequent finding （194 cases, 20.5%） by electrocardiogram. Intravenous gamma-globulin was administrated to 1028 cases （86.6%）. The occurrence of CAL seemed less frequent in the patients received gamma-globulin from day 5 to day 9 after the onset with the regimen of 1000 mg/kg once or 1000 mg/kg twice. Conclusions The incidence of KD was increasing in Shanghai. Treatment with intravenous gamma-globulin from day 5 to day 9 after the onset with the regimen of 1000 mg/kg once or 1000 mg/kg twice resulted in less coronary seauelae.     

北京市宫颈癌17年发病率变化及趋势分析

目的 分析1993-2008年北京市宫颈癌的发病率、发病趋势及发病年龄,了解北京市宫颈癌的发病特点.方法 根据北京市肿瘤登记处提供的1993至2008年全部宫颈癌病人的肿瘤登记资料,对宫颈浸润癌病历做回顾性调查.采集每份病例的流行病学数据.用统计学软件SPSS 20.0进行数据处理和统计分析.发病趋势计算采用美国国家癌症中心的Joinpoint软件进行统计分析及预测.结果 1993-2008年间,北京市平均宫颈癌粗发病率为3.54/100 000人口;WHO年龄标化发病率为2.91/100000人口.1999-2008年发病率上升明显,以每年19.58％的速度快速上升.1993年中位发病年龄是67岁,2008年下降到45岁.40～49年龄组的发病率增加最明显,60～69年龄段和70岁以上年龄段发病率持续下降.结论 宫颈癌发病率的明显上升和年轻化是北京市宫颈癌发病的主要特征.     

What is the potential for moving adult surgery to the ambulatory setting?

Data from the Manitoba health insurance program were used to analyse the patterns of outpatient surgery in patients aged 20 years or older in the eight largest hospitals in the province (all with at least 125 beds) in 1983-84. With the exception of tooth extraction, only procedures that were not done more than 86% of the time as inpatient or outpatient procedures were considered. Large differences between the hospitals and between physicians within each hospital were found in the rates of outpatient surgery, even after adjustment for patient characteristics and differences in case mix. If the standard of the hospital with the highest rate of outpatient surgery were followed by the seven other hospitals, up to 17.5 inpatient beds could be closed or freed. However, the potential savings from substituting outpatient for inpatient procedures must be realistically appraised. The appropriate place for monitoring the use of inpatient and outpatient surgery may be the individual hospital, particularly those with high occupancy rates and a large demand for inpatient beds.     

静脉注射丙种球蛋白应用时间对川崎病疗效的影响

目的 探讨不同静脉注射丙种球蛋白(IVIG)应用时间对IVIG无反应性及冠状动脉并发症的影响.方法 回顾性总结北京45家医院2000-2004年有IVIG治疗资料的川崎病患儿,按IVIG使用时间分成早期组(病程1～4 d)、常规组(第5～9天)及晚期组(≥10 d)3组.疗效评价参考MG无反应性及急性期(发病1～2周)和亚急性期(发病3～6周)冠状动脉并发症发生率.结果 共有1052例(男680例、女372例)患儿纳入研究,年龄2个月～13.8岁,其中早期、常规及晚期组各有108例、763例和181例.早期组IVIG无反应性发生率(28.7%,31/108)显著高于常规组(11.9%,91/763)和晚期组(7.2%,13/181,均P<0.01).早期组和常规组相比,急性期及亚急性期冠脉并发症发生率差异均无统计学意义[17.6%(19/108)比18.3%(140/763),5.9%(4/68)比5.5%(25/452),均P>0.05],晚期组急性期及亚急性冠脉并发症发生率则显著高于早期和常规组[33.7%(61/181)和12.8%(15/117),均P<0.01)].结论 川崎病病程1～4 d应用IVIG增加了患儿IVIG无反应性的发生率,发病≥10 d应用则增加了冠脉并发症的发生率,第5～9天可能是最好的IVIG使用时间.     

The need for acute, subacute, and nonacute care at 105 general hospital sites on Ontario

BACKGROUND: Previous studies of hospital utilization have not taken into account the use of acute care beds for subacute care. The authors determined the proportion of patients who required acute, subacute and nonacute care on admission and during their hospital stay in general hospitals in Ontario. From this analysis, they identified areas where the efficiency of care delivery might be improved. METHODS: Ninety-eight of 189 acute care hospitals in Ontario, at 105 sites, participated in a review that used explicit criteria for rating acuity developed by Inter-Qual Inc., Marlborough, Mass. The records of 13,242 patients who were discharged over a 9-month period in 1995 after hospital care for 1 of 8 high-volume, high-variability diagnoses or procedures were randomly selected for review. Patients were categorized on the basis of the level of care (acute, subacute or nonacute) they required on admission and during subsequent days of hospital care. RESULTS: Of all admissions, 62.2% were acute, 19.7% subacute and 18.1% nonacute. The patients most likely to require acute care on admission were those with acute myocardial infarction (96.2% of 1826 patients) or cerebrovascular accident (84.0% of 1596 patients) and those admitted for elective surgery on the day of their procedure (73.4% of 3993 patients). However, 41.1% of patients awaiting hip or knee replacement were admitted the day before surgery so did not require acute care on admission. The proportion of patients who required acute care on admission and during the subsequent hospital stay declined with age; the proportion of patients needing nonacute care did not vary with age. After admission, acute care was needed on 27.5% of subsequent days, subacute care on 40.2% and nonacute care on 32.3%. The need for acute care on admission was a predictor of need for acute care during subsequent hospital stay among patients with medical conditions. The proportion of patients requiring subacute care during the subsequent hospital stay increased with age, decreased with the number of inpatient beds in each hospital and was highest among patients with congestive heart failure, chronic obstructive pulmonary disease and pneumonia. INTERPRETATION: In 1995, inpatients requiring subacute care accounted for a substantial proportion of nonacute care days in Ontario's general hospitals. These findings suggest a need to evaluate the efficiencies that might be achieved by introducing a subacute category of care into the Canadian health care system. Generally, efforts are needed to reduce the proportion of admissions for nonacute care and of in-hospital days for other than acute care.     

Invasive Haemophilus influenzae infection in the Australian Capital Territory region.

OBJECTIVE: To investigate the pattern of invasive Haemophilus influenzae disease in the Australian Capital Territory (ACT) region with a view to assessing the possible benefits of vaccination in this community. SETTING AND DESIGN: The microbiology department of Royal Canberra Hospital processes all specimens from the three public hospitals in the ACT. Together these hospitals provide all paediatric medical and approximately 80% of adult inpatient beds available in the ACT. We identified all laboratory isolates of H. influenzae obtained from normally sterile sites from 1984 to 1990, and reviewed the clinical records of these patients. Also included in this analysis were all cases of acute epiglottitis identified in hospital discharge summaries, intensive care and coroners' records. Epidemiological, clinical and microbiological data were gathered and assessed. RESULTS: We identified 138 cases of infection. Forty per cent (36 of 66 cases of meningitis, 5 of 44 cases of epiglottitis, 10 of 12 cases of cellulitis) occurred in children aged less than 18 months. Meningitis (48%), epiglottitis (32%), cellulitis (9%) and primary bacteraemia (4%) were the most common syndromes seen. The annual incidence of invasive H. influenzae disease in Canberra was 63.2 per 100,000 children aged under five years. Approximately 1 in 225 children under five years of age and resident in Canberra developed invasive H. influenzae disease. Ninety-eight per cent of isolates serotyped were type b. CONCLUSION: A vaccination program effective in preventing H. influenzae type b infection, completed in infants before 6 months of age, could prevent upwards of 80% of invasive H. influenzae disease in our population. Such a program should be cost effective although precise assessment is hampered by the lack of accurate data on the acceptance rate, costs and efficacy of the current childhood vaccination schedule in our region.     

The effect on hospital admission profiles of establishing an emergency department observation ward

OBJECTIVE: To determine the effect of establishing an emergency department observation ward (OW) on admission numbers, average length of stay (ALOS) for the entire hospital and overall bed days for conditions commonly treated in the OW. SETTING: Sir Charles Gairdner Hospital (SCGH), Perth, a tertiary referral teaching hospital. DESIGN: Retrospective analysis of routinely collected hospital data for the 10 most common diagnosis-related group (DRG) categories of patients discharged from the OW for the financial years 1995-96 to 1998-99. Comparison of these data with those for adult patients at the other Perth teaching hospitals over the same period. MAIN OUTCOME MEASURES: For patients in the 10 most common DRGs: numbers of admissions to the OW compared with other inpatient wards; total number of patients admitted to the hospital compared with total bed days; ALOS at SCGH compared with other Perth teaching hospitals. RESULTS: Increased admissions to the OW were paralleled by a decrease in admissions for the same DRG codes to other inpatient wards. ALOS remained approximately the same from 1995-96 to 1998-99 for patients in the OW (one day) and other inpatient wards (4.38 to 4.20 days). However, overall ALOS for patients in these DRGs fell by over a third (from 3.97 to 2.59 days) over this time. The total number of patients in these DRGs treated by the hospital increased by 19% over the four years, but the total number of bed days fell by 23%. By contrast, the ALOS for patients in the same DRGs treated at the other Perth teaching hospitals rose 8% (from 2.12 to 2.28 days). CONCLUSION: Establishment of a formal emergency department OW results in the more efficient management of certain groups of patients, with a decrease in overall hospital bed days and length of stay.     

川崎病及其合并冠脉损伤的早期诊断

OBJECTIVE: To explore the possibility of early diagnosis of Kawasaki disease (KD) complicated by coronary artery lesions (CAL). METHODS: Medical records of 84 children with KD (2 months to 8 years of age) were reviewed retrospectively. Diagnosis of KD was based on current diagnostic criteria of KD. Laboratory examinations were performed for white blood cells (WBC), hemoglobin (HB), platelet counts (Plt), and C-reactive protein (CRP), along with electrocardiography (ECG) and echocardiography within 7 days after the onset of the disease. The Pearson correlation and multivariate analysis (logistic) were used for statistical analysis. RESULTS: During the first 7 days, clinical manifestations of the patients included fever (100%), conjunctivitis (71.46%), skin rash (66.7%), extremity change (54%), oral mucosa change (80%), and cervical lymphadenopathy (25%). Laboratory examinations revealed elevated WBC, CRP, and ECG (P<0.05, 0.05,0.01, respectively) in patients with CAL. Multivariate logistic regression analysis indicated that ECG positivity (P<0.01) and WBC increases (P<0.01) were independently correlated with CALs in acute KD. CONCLUSIONS: CRP (+), ECG (+), WBC count increase during the acute phase of KD are important indicators to predict CAL caused by KD.     

Postoperative serious adverse events in a teaching hospital: a prospective study

OBJECTIVE: To assess the incidence and nature of postoperative serious adverse events (SAEs) among inpatients having surgery in a tertiary hospital, and to determine which subgroups of patients might be at greatest risk. DESIGN: Prospective observational study from 1 December 1998 - 31 March 1999. SETTING: Tertiary teaching hospital in Melbourne, Victoria. SUBJECTS: 1,125 subjects having inpatient surgery during the study period. MAIN OUTCOME MEASURES: Inhospital mortality, length of hospital stay, and SAEs (myocardial infarction, pulmonary embolism, acute pulmonary oedema, unscheduled tracheostomy, respiratory failure, cardiac arrest, stroke, severe sepsis, acute renal failure, and emergency admission to intensive care unit [ICU]). RESULTS: There were 414 SAEs in 190 of the 1,125 patients (16.9%); 80 patients died (7.1%). The most common adverse events were emergency admission to ICU (95), respiratory failure (52) and readmission to ICU (37). In patients without SAEs, mean duration of hospital stay was 18.4 days (95% Cl, 15.4-21.4), while in those with SAEs it was 38.5 days (95% CI, 35.3-41.7) (P < 0.0001). SAEs, including deaths, were more common after unscheduled surgery and in patients over 75 years of age. The combination of these two factors carried a 20% mortality. There were no differences in the incidence of SAEs among the major surgical specialties. CONCLUSIONS: SAEs are common and result in high mortality, especially in older surgical inpatients and those having unscheduled surgery. These findings raise important issues of optimal perioperative management in tertiary hospitals.     

中国先天性心脏病疾病负担三十年变化分析

目的：分析1990—2019年中国先天性心脏病（先心病）的疾病负担变化趋势。方法：采用2019年全球疾病负担（GBD）研究数据,分析中国1990—2019年先心病发病人数、标化发病率、死亡人数、标化死亡率、伤残调整生命年（DALY）、标化DALY率的变化趋势。采用Joinpoint回归模型对以上指标进行时间趋势分析;采用年龄-时期-队列模型进行先心病死亡率的年龄、时期和出生队列效应分析;采用Pearson相关性分析分析以上指标与人类发展指数（HDI）的相关性。结果：1990—2019年,中国先心病标化发病率、死亡率及DALY率年平均变化百分比（AAPC）分别为–0.1%（95%CI：–0.7%~0.4%）、–3.5%（95%CI：–3.7%~ –3.2%）及–3.5%（95%CI：–3.7%~–3.2%）。先心病发病主要集中在1岁之前：新生儿平均发病率为2497.9/10万;1岁以下儿童平均发病率为2626.6/10万。1995—2000年新生儿及1岁以下儿童的发病率呈指数级上升,随后呈平稳下降趋势,但2010—2013年与2014—2015年1岁以下儿童的发病率有两次呈指数级上升,随后呈指数级下降,在2019年下降至近三十年最低值。先心病死亡率随年龄增长呈下降趋势,5岁以下儿童先心病死亡率为101.67/10万人年,5岁及以上人群死亡率下降;但55~<60岁人群死亡率呈短暂上升。1995—2019年,先心病患者的相对死亡风险呈下降趋势,与1995—1999年比较,2015—2019年先心病患者死亡的率比（RR）下降了24%;1945年以后的出生队列相对死亡风险呈下降趋势,与1945—1949年出生队列比较,2015—2019年出生队列先心病患者RR值下降了75%。当HDI小于0.58时（1999年以前）,先心病标化发病率与HDI呈正相关（r=0.74,P<0.05）;当HDI为0.58及以上时（1999年及以后）,先心病标化发病率与HDI呈负相关（r=–0.76,P<0.01）。标化死亡率、标化DALY率与HDI均呈负相关（r=–0.95和 –0.93,均P<0.01）。结论：我国先心病1990—1999年标化发病率上升,与社会发展程度呈正相关;1999—2019年标化发病率下降,与社会发展程度呈负相关。先心病疾病负担下降,与社会经济发展程度呈负相关。先心病防控虽取得了一些进展,但低龄先心病患儿的疾病负担仍较重。