43例儿童溶血尿毒综合征的输血治疗

目的 探索成分输血在儿童溶血尿毒综合征治疗中的作用.方法 通过查阅病历及输血记录了解北京儿童医院2004年5月至2008年8月收治的儿童溶血尿毒综合征患者输注成分血的品种、数量、血型分布以及预后.结果 北京儿童医院近4年共收治43例溶血尿毒综合征且有输血史的患儿.其中A型12例,B型16例,O型10例.AB型5例.共输注悬浮红细胞102.5U,新鲜冰冻血浆70 650 ml.洗涤红细胞11U.每例患儿平均输注红细胞2.51次,输血浆5.65次.4例患儿行血浆置换7次.治愈或好转37例(86.05%),死亡或自动放弃治疗6例(13.95%).结论 成分输血,尤其是血浆疗法对儿章溶血尿毒综合征的治疗具有重要作用.     

大剂量免疫球蛋白治疗重型格林-巴利综合征疗效观察

目的:观察大剂量静脉滴注免疫球蛋白(HD-IVIG)治疗重型格林-巴利综合征(GBS)的疗效.方法:选择确诊为重型GBS的病例13例,于首次发病后2周内给予HD-IVIG治疗,剂量为0.4g*kg-1*d-1,连续5天为一疗程.治疗前后采用神经功能缺损评分法进行疗效评价.结果:13例GBS患者治疗前后神经功能缺损评分分别为4.23±0.44与2.54±1.45,治疗后比治疗前降低1.69±1.18,差异有显著性(P＜0.01),同时治疗前后有很高的相关性(P＜0.01).结论:HD-IVIG 治疗重型GBS疗效出现早,人工辅助通气时间短,可作为治疗重型GBS的首选方法.     

严重急性呼吸综合征患者糖皮质激素的应用

为探讨严重急性呼吸综合征(SARS)治疗过程中糖皮质激素的应用时机、疗程和效果，对7例SARS患者(其中男4例，女3例，平均年龄31．3岁)应用糖皮质激素治疗，甲泼尼龙平均剂量为126mg／d，平均疗程7．8d；口服泼尼松平均疗程12d。结果高热患者在治疗后2d体温恢复正常，肺部进行性病变者在3～5d内有所恢复，疗程结束时病灶明显吸收，无1例患者发生呼吸衰竭。提示糖皮质激素对改善SARS中毒症状，阻止病情进展有一定疗效。     

Toxic shock syndrome in Canada.

Since 1976, 53 confirmed or suspected cases of toxic shock syndrome (TSS) have been reported in Canada. Twenty-two cases occurred in 1980, and by October 1981 another 21 had been reported. In Canada, like the United States, where nearly 1200 cases have been recorded, TSS appears to be associated with tampon use, although a few cases have occurred in males and in nonmenstruating women. Of the 53 patients 3 died. The enterotoxin produced by Staphylococcus aureus is probably responsible for TSS. Manufacturers of tampons have now placed warning labels on tampon boxes and information on TSS in the instruction inserts. Women should select tampons of appropriate absorbency for the various stages of menstruation.     

应用高频通气辅助治疗小儿重症肺炎疗效分析

目的探讨应用高频通气辅助治疗小儿重症肺炎临床疗效。方法 122例小儿重症肺炎患儿分为高频组69例和对照组53例。2组患儿均采用综合治疗,高频组在综合治疗的基础上同时使用高频喷射呼吸机,经鼻导管喷射供氧,对照组采用常频通气普通鼻前庭供氧,比较2组患儿临床疗效。结果高频组患儿平均住院时间(9.58±5.80)d,对照组患儿平均住院时间(17.13±10.93)d,高频组患儿平均住院时间短于对照组(P<0.01)。高频组患儿中治愈67例,死亡2例,对照组患儿中治愈45例,死亡8例,高频组疗效优于对照组(P<0.05)。结论应用高频通气辅助治疗小儿重症肺炎可显著提高临床治愈率,缩短疗程,是小儿重症肺炎临床治疗中有效的辅助治疗措施。     

简易血浆置换-血液滤过序贯救治重症毒蘑菇中毒

目的 观察简易血液净化救治伴肝、肾、血液等多系统严重损害的重症毒蘑菇中毒患者的疗效,提高急性中毒急救成功率。方法 简易血液净化队伍对3例重症蘑菇中毒患者采用快速用血泵、血透穿刺针、血透动静脉管建立体外循环。用P2S膜式血浆置换器行一次性血浆置换,接着用高通量血液滤过器、置换液进行血液滤过治疗4～6h,通过调节置换液、滤出液的流速控制超滤率;配合糖皮质激素、补液利尿、碱化尿液、输注洗涤红细胞等治疗。结果 3例患者完全康复,出院后追踪观察1个月未见发生任何后遗症。结论 对于伴肝肾功能损害及溶血的毒蘑菇中毒者,血浆置换可更快速更有效地清除毒蘑菇毒素及内源性毒素;快速简易血液净化队伍到达救援现场后可迅速在病人床边实施血液净化治疗。提高存活率。     

Mucocutaneous lymph node syndrome in Canada.

Two Edmonton children recently had a disease seemingly new to North America but a common problem in young children in Japan in the last few years. Named "mucocutaneous lymph node syndrome", it is an acute febrile condition with massive focal cervical lymphadenopathy, conjunctivitis and indurative edema of the hands and feet progressing to desquamation. It may have an infectious basis and therefore may become common in Canada.     

联合免疫抑制治疗儿童重型再生障碍性贫血并发毛细血管渗漏综合征的护理

目的 探讨联合免疫抑制治疗(IST)儿童重型再生障碍性贫血(SAA)并发毛细血管渗漏综合征(CLS)的护理经验.方法 对儿童重型再生障碍性贫血患者采用抗胸腺细胞免疫球蛋白(ATG)、环孢素(CsA)和大剂量丙种球蛋白(HDIVIG)方法 治疗.结果 2例患者发生毛细血管渗漏综合征,对患儿做好密切观察及积极科学的护理,可提高治疗效果.结论 CLS是一组突发的、可逆性毛细血管高渗透性,血浆外渗所引起的临床综合征.IST治疗SAA过程中可发生CLS,及时正确的护理干预极为重要.     

Plasma exchange in Canada. The Canadian Apheresis Study Group.

Since 1982 the Canadian Apheresis Study Group (CASG) has collected data on plasma exchange activities in Canada. In 1987, 5907 such procedures were carried out on 700 patients for more than 22 different diseases; this represented an increase of 28% over the figure for 1982. A shift in activity has occurred over the years; originally hematologic disorders accounted for most of the procedures; however, in 1987, 60% of the exchanges were done to treat neurologic disorders, mainly myasthenia gravis and acute and chronic Guillain-Barré syndrome. Several prospective randomized clinical trials have recently been completed by the CASG in the hope of determining the optimal application of plasma exchange. These studies, currently under review, include 168 patients with multiple sclerosis, 100 with thrombotic thrombocytopenic purpura and 43 with rapidly progressive glomerulonephritis. Reactions occur in 12% of cases; they are usually minor and are limited to circumoral paresthesia, mild hypertension or hypotension and hives.     

Horner's syndrome in severe tetanus.

A 66 year old man was admitted with a left Horner''s syndrome, and trismus due to tetanus. Three days later he had respiratory arrests, classical tetanic spasms and was ventilated. He had associated severe autonomic dysfunction, tachyarrhythmias, hypotension, sweating and constipation. There was complete resolution of the left Horner''s syndrome with recovery from tetanus.     

Harmonized sales tax a taxing issue for MDs in Atlantic Canada

Physicians in 3 atlantic provinces say the linking of provincial sales taxes with the GST exacerbates the inequity physicians face because it yet again adds to their overhead costs. Physicians in Nova Scotia have already won an annual rebate to compensate them for the heavier tax burden. Doctors in the Maritimes warn that heavier taxes make recruiting there even more difficult.     

Vidarabine therapy for severe herpesvirus infections. An unusual syndrome of chronic varicella and transient immunologic deficiency.

Six patients with severe herpesvirus infections were successfully treated with vidarabine. One patient had a previously undescribed syndrome of chronic cutaneous varicella infection of eight months' duration, associated with transient but complete duppression of lymphocyte response to conconavalin A. Other diagnoses were severe varicella pneumonia, progressive cytomegalovirus pneumonia associated with acute lymphocytic leukemia, herpes simplex encephalitis, severe zoster associated with stage IV lymphoma, and disseminated herpes simplex in a patient receiving high doses of steroids. All patients showed cessation of new lesions or abrupt clinical improvement between days 2 and 4 after initiation of therapy, and all were cured of their clinical infection. Dramatic improvement in all of our patients and the minimal toxicity observed make vidarabine suitable for use in severe herpesvirus infections.     

Oral hydration therapy for children in Florida.

Eighty-six children in Florida died of complications associated with diarrhea between 1985 and 1990, deaths which constituted an important preventable fraction of infant mortality. The state will support health professionals in reducing the number of hospitalizations and deaths due to diarrheal complications, Governor Lawton Chiles announced in September 1991, and the Florida Department of Health and Rehabilitative Services is being awarded a $100,000 grant from the Centers for Disease Control for a three-year study on the effectiveness and utilization of oral rehydration therapy. During the last 20 years, a worldwide experience has developed indicating that sodium-glucose cotransport is preserved in both secretory diarrhea (cholera) and diarrhea produced by loss of surface area. This experience indicates that almost no one would die (adult or infant) if oral rehydration solutions and someone with knowledge in their use were readily available. This presentation has three objectives: (1) increase physicians' awareness regarding the state's oral rehydration therapy project; (2) provide a ready practical guide for those using oral rehydration therapy; and (3) promote use of the therapy as treatment for infantile dehydration rather than the more expensive intravenous therapy.     

小儿推拿治疗多发性抽动症的Meta分析

目的:系统评价推拿或推拿联合其他疗法与药物治疗在治疗小儿多发性抽动症临床疗效的区别。方法:通过数据库[主要包括中国生物医学文献数据库(CBM)、中国维普全文数据库(VIP)、中国期刊全文数据库(CNKI)、万方数据库、Pubmed、Cochrane Library、Web of Science和EMbase等]检索,搜集有关推拿或推拿联合其他疗法治疗小儿多发性抽动症的随机对照试验(RCT)。由2名评价者独立提取资料并进行方法学的质量评估,质量评价参照Cochrane系统评价员手册5.0.1标准,数据分析采用Stata 15.1软件。结果:最终纳入25项RCTs,其Meta分析结果显示,治疗组小儿抽动症的临床总有效率、中医症候疗效、复发率、不良反应率均优于药物疗法对照组,差异具有统计学意义(P<0.05)。结论:推拿或推拿联合其他疗法治疗小儿多发性抽动症较药物治疗有一定优势,但确切的结论尚需要设计更为严谨的大样本临床试验进行验证。     

常规联合呼吸机辅助治疗小儿重症毛细支气管炎的疗效及其安全性

目的 探讨常规联合呼吸机辅助治疗小儿重症毛细支气管炎的疗效及其安全性。方法 选择2015年6月~2017年6月于我院治疗的110例小儿重症毛细支气管炎患者,按数字随机法分为对照组与观察组,每组55例,对照组采用常规止咳平喘、抗感染、雾化吸痰及糖皮质激素治疗,观察组在此基础上加用呼吸机辅助治疗。治疗前后进行血气分析,比较两组患儿各项症状、体征消退时间、血清炎性因子水平,评价临床疗效,并观察并发症发生情况。结果 观察组治疗总有效率为9273%,显著高于对照组的8182%,组间差异有统计学意义（P＜0.05）;两组治疗前后动脉血氧分压（PaO2）、血二氧化碳分压（PaCO2）、氧合指数（PaO2／FiO2）差异均有统计学意义（P＜0.05）;治疗后6h及1、2d时观察组与对照组间差异亦有统计学意义（P＜0.05）,而血液PH值差异无统计学意义（P＞0.05）;观察组呼吸、心率恢复正常时间,肺部啰音、喘憋、咳嗽消失时间均显著低于对照组,差异有统计学意义（P＜0.05）;两组并发症发生情况差异无统计学意义（P＞0.05）;两组治疗后血清炎性因子水平均显著降低,且治疗后观察组血清TNFα、IL-4、IL-8水平均显著低于对照组,差异均有统计学意义（P＜0.05）。结论 小儿重症毛细支气管炎采用常规治疗联合呼吸机辅助治疗能显著改善高碳酸血症,缩短咳嗽、喘憋等呼吸症状体征,降低炎症反应,提升临床疗效,治疗安全有效。     

环磷酰胺联合治疗儿童原发性肾病综合征复发

目的 探讨应用环磷酰胺联合疗法治疗儿童原发性肾病综合征复发的临床价值。方法 采用病例对照方法，将９３例肾病患儿随机分为环磷酰胺联合治疗组和单用激素治疗组。观察两组病例在合同时间内的复发次数、部分病例的肾脏组织病理形态变化及毒副反应。并对ＣＴＸ疗效与病理类型的关系进行分析。结果 ①ＣＴＸ治疗组复发次数明显低于单用激素组（Ｐ〈０．００１）；②治疗组在使用ＣＴＸ前后的自身对比中发现，ＣＴＸ治疗后复发次数明显减少（Ｐ〈０．００１）；③在微小病变及系膜增殖性肾炎病例的重复肾活检发现，ＣＴＸ有助于减轻病理形态学的改变；④ＣＴＸ联合疗法能明显提高微小病变及系膜增殖性肾炎的临床基本治愈率；⑤在４４例ＣＴＸ联合治疗中仅有２例有轻微脱发和胃肠道反应。结论 ＣＴＸ联合疗法能确实有效地防止和减少原发性肾病综合征患儿复发的机会，从而达到