新生儿耐甲氧西林凝固酶葡萄球菌败血症40例

目的：探讨耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）在新生儿缺血症中的分布、临床特征及耐药性特点。方法：应用全自动血培养系统、ATB细菌鉴定仪，从80例新生儿血培养中分离出40株MRCNS.测定青霉素等17种抗生素的耐药性。结果：分离出40株MRCNS(占50%)，其中溶血葡萄球菌17株(42.5%)，表皮葡萄球菌15株（37.5%），其他葡萄球菌8株（20%）.药敏结果显示多重耐药。结论：凝固酶阴性葡萄球菌(CNS)已成为小儿血培养的第一位检出菌。药敏结果显示MRCNS呈多重耐药，万古霉素及其他氨基糖甙类抗生素是治疗MRCNS感染的首选药物，应引起关注。     

凝固酶阴性葡萄球菌致儿童茵血症的菌种分布及耐药性监测

目的 探讨凝固酶阴性葡萄球菌(CNS)致儿童菌血症的菌种分布及耐药件现状.方法 应用BacT/AlerT 120全自动血培养仪、法国生物梅里埃公司VITEK-2微生物分析鉴定系统进行培养鉴定,采用纸片琼脂扩散法进行药敏试验,采用WHONET-5.3软件对耐药性数据进行分析.结果 2004年1月-2007年12月从儿科病房血液标本中共分离出凝固酶阴性葡萄球菌351株,其中表皮葡萄球菌235株(66.95%),沃氏葡萄球菌46株(13.11%).耐甲氧西林凝固酶阴件葡萄球菌(MRCNS)检出率为85.75%(301/351).MRCNS药敏结果显示多重耐药.结论 CNS已位居儿童血流感染病原菌的首位,MRCNS检出率高且呈多重耐药,糖肽类抗生素是治疗MRCNS感染的首选药物.     

儿童凝固酶阴性葡萄球菌感染菌种分布及耐药监测

目的 探讨浙江省湖州市妇幼保健院儿童凝固酶阴性葡萄球菌( coagulase negative staphylococcus,CNS)感染菌种分布及耐药情况.方法 应用BacT/AlerT3D全自动血培养仪、法国生物梅里埃公司API微生物分析鉴定系统进行培养鉴定,采用法国生物梅里埃公司ATB药敏系统进行药敏试验.结果 2007年1月至2010年12月从儿科病房血培养标本中共分离CNS 266株,其中表皮葡萄球菌151株(56.77％),人葡萄球菌44株(16.54％),溶血葡萄球菌30株(11.28％),其他葡萄球菌41株(15.41％);耐甲氧西林凝固酶阴性葡萄球菌(methicillin resistant coagulase negative staphylococcus,MRCNS)检出率为71.80％(191/266),MRCNS药敏结果显示多重耐药;未发现对万古霉素耐药的CNS.结论 儿童感染CNS菌种以表皮葡萄球菌和人葡萄球菌为主,MRCNS检出率高且呈多重耐药,糖肽类抗生素是治疗MRCNS感染的首选药物.     

凝固酶阴性葡萄球菌致儿童菌血症的菌种分布及耐药性监测

目的 探讨凝固酶阴性葡萄球菌（CNS）致儿童菌血症的菌种分布及耐药性现状。方法 应用BacT/AlerT 120全自动血培养仪。法国生物梅里埃公司VITEK-2微生物分析鉴定系统进行培养鉴定,采用纸片琼脂扩散法进行药敏试验,采用WHONET5.3软件对耐药性数据进行分析。结果 2004 年1月 - 2007年12月从儿科病房血液标本中共分离出凝固酶阴性葡萄球菌351株,其中表皮葡萄球菌235株（66.95%）,沃氏葡萄球菌46株（13.11%）。耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）检出率为85.75%（301/351）。MRCNS 药敏结果显示多重耐药。结论 CNS 已位居儿童血流感染病原菌的首位,MRCNS 检出率高且呈多重耐药,糖肽类抗生素是治疗MRCNS 感染的首选药物。     

甲氧西林耐药凝固酶阴性葡萄球菌抗生素耐药性及耐药基因的研究

目的 了解新生儿感染和携带凝固酶阴性葡萄球菌(CNS)的抗生素敏感性情况,并对耐甲氧西林CNS株(MRCNS)的mecA基因进行检测。方法 应用常规生化鉴定及微生物的微量鉴定系统(API)法进行MR-CNS分离株菌属鉴定;采用K-B纸片扩散法对114株CNS分离株进行11种抗生素敏感性检测;并建立PCR方法对MRCNS株的mecA耐药基因进行检测。结果 79.8％的CNS分离株对甲氧西林耐药;MRCNS对青霉素、红霉素、头孢唑啉、四环素、复方新诺明、庆大霉素、环丙沙星、氯霉素等8种抗生素耐药率明显高于甲氧西林敏感株(MSCNS),且多重耐药率高达92.3％。MRCNS分离株耐药率高的前三位分别是溶血葡萄球菌、表皮葡萄球菌和人型葡萄球菌,占分型总数(56例)的78.6％(44/56);在91株MRCNS中检出62株mecA基因阳性,检出率为68.1％。结论 我国新生儿感染CNS甲氧西林耐药情况同国外相似,MRCNS对多种抗生素交叉耐药现象十分严重。PCR方法检测mecA基因是一种方便、快速的检测方法,对指导临床治疗很有帮助,值得推广。     

儿科凝固酶阴性葡萄球菌的耐药性分析

目的 了解凝固酶阴性葡萄球菌(CNS)的感染现状及其耐药性,为临床合理使用抗生素提供依据。方法 BacT/Alert 120血培养仪对2000～2002年儿科送检血标本进行增菌,用VITEK 32全自动微生物分析仪进行细菌鉴定和药敏试验。结果 分离出细菌122株,阳性率为14.2％,其中CNS 75株占总分离菌株61.5％。CNS产β-内酰胺酶检出率为100％,多重耐药率达97.3％,耐甲氧西林的凝固酶阴性葡萄球菌(MR-CNS)和甲氧西林敏感(MSCNS)对抗生素耐药率差异有显著性(P<0.01),MRCNS对呋喃妥因、氧氟沙星、万古霉素耐药率较低(1.6％～7.8％)。结论 儿科感染CNS的多重耐药较严重,临床要定期做药敏试验和合理使用抗生素。     

新生儿败血症病原菌十年变迁及耐药性分析

目的 了解本院近10年来新生儿败血症病原菌及其耐药性变迁,以指导临床用药.方法 对1997年3月至2002年3月收治的新生儿败血症(第1组)血培养检出茵、药敏试验结果进行回顾性调查,并与2002年4月至2007年3月的调查结果(第2组)进行比较.结果 10年来新生儿败血症血培养阳性的患儿296例,第1组155例,第2组141例,病原菌以革兰阳性细菌为主,近5年来凝固酶阴性葡萄球菌(CNS)感染率明显增加(x2=14.15,P＜0.01),金葡茵感染率显著下降(x2=10.88,P＜0.01),对青霉素、苯唑西林及红霉素有较高的耐药率,多重耐药较明显,耐甲氧西林的凝固酶阴性葡萄球菌(MRCNS)及耐甲氧西林的金葡菌(MRSA)感染增多,对万古霉素敏感性较高.革兰阴性杆菌对氨苄西林普遍耐药,对亚胺培南、氨曲南高度敏感,对氨基糖甙类、喹诺酮类及三代头孢菌素敏感性较高,但耐药菌株有增加的趋势.结论 CNS是本院新生儿败血症最主要的病原菌,对青霉素等常用抗生素普遍耐药,多重耐药菌株增加,根据病原茵药敏结果合理使用抗生素.是有效抗感染和延缓耐药菌株产生的必要条件.     

新生儿败血症病原菌及其药敏分析

目的　 了解新生儿败血症病原菌及药物敏感情况 ,以减少临床上应用抗生素的盲目性 ,降低耐药菌的产生。 方法　对 2 0 0 1年 1— 12月收住我院新生儿科临床诊断败血症的 72例患儿进行细菌培养。用法国生物梅里埃微生物鉴定及药物敏感分析仪 ,做细菌鉴定及药敏试验。 结果 　共培养出细菌 73株 ,凝固酶阴性葡萄球菌 (3 0株 )及金黄色葡萄球菌 (2 5株 ) ,为主要致病菌。 结论 　几乎全部细菌对青霉素耐药 ,对红霉素及苯唑西林耐药率均超过 75 % ,对万古霉素及环丙沙星高度敏感。几株革兰阴性杆菌对庆大霉素、阿米卡星及第三代头孢菌素敏感     

新生儿血培养中凝固酶阴性葡萄球菌的脉冲电场凝胶电泳分型

目的 通过对凝固酶阴性葡萄球菌(CNS)菌株进行分型以示CNS菌种间及菌种内的异质性和亲缘性,协助新生儿败血症的诊断.方法 将本院新生儿病房2001年11月至2003年3月血培养为CNS的患儿列入本研究.对入选的CNS茵株用脉冲电场凝胶电泳方法分离菌株.结果 共有80例患儿入选,其中9例患儿分离出≥2株CNS茵株.血培养为CNS的临床分离菌株共有90株.在临床诊断的27例(33.8%)败血症中,表皮葡萄球茵18例(66.7%),溶血葡萄球茵7例(25.9%),人葡萄球菌2例(7.4%).脉冲电场凝胶电泳对90株入选菌株共分为50型,其中表皮葡萄球茵37型,溶血葡萄球茵10型,人葡萄球菌2型,华纳葡萄球菌1型.在临床分离的90株CNS菌株中,共有6组图形完全一致,属于同一菌株.其中两组(4株CNS菌株)分别来自2例患儿不同时期的血培养结果,故脉冲电场凝胶电泳可以协助临床明确诊断败血症.结论 脉冲电场凝胶电泳是一种敏感性高的CNS茵株分型方法,可协助临床诊断败血症.     

新生儿败血症病原菌及其药敏分析

目的：了解新生儿败血症病原菌及药物敏感情况，以减少临床上应用抗生素的盲目性，降低耐药菌的产生。方法：对2001年-1-12月收住我院新生儿科临床诊断败血症的72例患儿进行细菌培养。用法国生物梅里埃微生物鉴定及药物敏感分析仪，做细菌鉴定及药敏试验。结果：共培养出细菌73株，凝固酶阴性葡萄球菌（30株）及金黄色葡萄球菌（25株），为主要致病菌。结论：几乎全部细菌对青霉素耐药，对红耆素及苯唑西林耐药率均超过75％，对万古霉素及环丙沙星高度敏感。几株革兰阴性杆菌对庆大霉素、阿米卡星及第三代头孢菌素敏感。     

早产儿视网膜病的危险因素分析及随访调查

研究早产儿视网膜病(retinopathy of prematurity,ROP)的发生率、高危因素、治疗与随访情况。方法对2005年7月-2007年12月温州医学院附属第一医院NICU收治的符合ROP筛查标准的早产儿,于生后2周开始由资深眼科医师开始行间接眼底镜检查眼底,并进行随访。结果434例早产儿中ROP的发生率为5.5%(24/434例),24例ROP中Ⅰ期19例,Ⅱ期3例,Ⅲ期2例。Ⅲ期阈值病变者行激光光凝治疗,全部患儿均恢复正常。对434例早产儿行单因素分析得出,胎龄、出生体重、住院时间、吸氧、吸氧浓度、吸氧时间、呼吸暂停、新生儿肺透明膜病(RDS)、肺表面活性剂(PS)的应用、机械通气、输血、光疗时间、感染与ROP的发生有相关性(P<0.05)。Logistic回归分析显示胎龄、出生体重、胎数、吸氧时间、光疗时间、代谢性酸中毒、母亲妊高症、颅内出血是影响ROP发生的主要因素。结论早产是ROP的根本原因,防治各种并发症、合理的氧疗是预防ROP的关键。建立完善有效的ROP筛查制度,早期发现、早期治疗ROP,可改善ROP的预后。     

Outcome of the Treatment of Inborn Errors of Metabolism

The use of specific dietary restrictions, cofactor administration, mobilisation of insoluble substances, environmental modifications, product replacement and selective enzyme inhibition are now established for the treatment of some inborn errors of metabolism. There is no generally accepted application for enzyme administration, cytopharmacology (manipulation of the cytoskeleton) or for cell transplantation except for bone marrow transplantation in disorders where the bone marrow is primarily at fault. The other uses of bone marrow transplantation which have been proposed require further evaluation. Results of recent research suggest that the scope of this approach is gradually being widened. There is also scope for development in the field of organ transplantation taking advantage of recent technical¹ and immunological progress. The treatment of inborn errors of metabolism by genetic modification is not yet on a practical clinical level; more laboratory and animal studies are needed before this can be attempted in man. Adenosine deaminase deficiency appears to be the disease in which this will be first attempted using a retroviral vector to insert the gene into the genome of pluripotential bone marrow cells.     

婴幼儿法乐四联症手术治疗近期疗效的影响因素

目的 探讨影响婴幼儿法乐四联症手术治疗近期疗效的各相关因素.方法 将2003年8月至2011年2月经作者一期手术纠治的117例年龄≤3岁的法乐四联症患儿分为疗效良好、疗效较差两组.分析手术时患儿年龄、体重、术前HCT值、McGoon指数、EDVI、主动脉阻断时间、转流时间、室间隔缺损大小、升主动脉与肺动脉干直径比、...     

术中判断肠活力三种方法的比较

术中准确地评价肠活力是外科医师面临的一个普遍问题。应用兔肠缺血模型，比较静脉荧光素、表面血氧测定和激光多普勒三种技术判断肠活力的精确性。结果：诊断效率静脉荧光素法为７８％，表面血氧测定为６８％，激光多普勒为９５％。后者精确度显著优于前二者，且操作简便、迅速，具有临床应用前景。     

Treatment of retinopathy of prematurity

Retinopathy of prematurity is a potentially blinding disorder of premature infants. Retinal ablation of the avascular retina originally described using cryotherapy but now most commonly undertaken with laser photocoagulation, reduces the unfavourable structural outcomes and improves the functional visual acuity outcome. The CRYO-ROP study showed the long-term benefit of treatment of threshold disease compared with no treatment, however even with cryoablation 44.4% of treated eyes had a visual acuity of 6/60 or worse at 10 year follow-up. The ETROP study of earlier treatment for high-risk pre-threshold disease, rather than treatment at threshold, has shown that pre-threshold treatment of type 1 disease produces a significantly improved outcome. Despite treatment some infants develop retinal detachment for which various surgical treatments have been described, although not always with a good functional outcome. Future treatment modalities may include the use of anti-VEGF therapies.     

Spectrum of clinical presentations of vein of Galen aneurysm

Aneurysm of the vein of Galen is a rare intracranial vascular malformation. It is known to have diverse manifestations and varying severity. Four cases with different modes of presentation and outcome are reported. A mortality of 50 per cent was encountered. Among the survivors, one had neurologic sequelae whereas the other had attained age-appropriate developmental milestones. The former was a rare case of spontaneous thrombosis of the aneurysm while the latter was a boy who underwent therapeutic embolization.     

Evaluation of the Efficacy of Treatment of Kawasaki Disease before Day 5 of Illness

We evaluated the efficacy of treating Kawasaki disease earlier than Day 5 of illness with a standard dose of immunoglobulin and aspirin. We performed a case–control study of patients with Kawasaki disease admitted to Princess Margaret Hospital from 1994 to 1999. Patients with pretreatment coronary aneurysm or those treated after day 10 of illness were excluded. All patients received immunoglobulin (2 g/kg) and aspirin (80–100 mg/kg/day) until fever subsided for 48 hours. Immunoglobulin retreatment was given for persistent fever 48 hours after the first dose of immunoglobulin or recrudescent fever. The case group consisted of 15 patients who received treatment earlier than day 5 of illness, and the control group consisted of 66 patients who were treated on or after day 5. Patients sex, age, duration of posttreatment fever, need for additional immunoglobulin, and coronary artery status were noted. Treatment efficacy was assessed by the duration of posttreatment fever and the prevalence of coronary artery aneurysms. Eighty-one patients were included in this study. There were 15 patients in the case group and 66 in the control group. No significant difference was noted in age and sex between the case and control groups. Thirty-three percent (5/15) and 8% (5/66) of the case and control groups, respectively, had persistent/ recrudescent fever 48 hours after the first dose of immunoglobulin that required retreatment (p = 0.017). Thirteen percent (2/15) and 5% (3/66) of the case and control groups, respectively, had coronary aneurysms (p = 0.158). Treatment of Kawasaki disease before day 5 of illness was associated with persistent/recrudescent fever that required retreatment. However, there was no significant increase in the prevalence of coronary aneurysm if retreatment was given. Poster presented at the third World Congress of Pediatric Cardiology and Cardiac Surgery, Toronto, Ontario, Canada, 2001     

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目的探讨脑性瘫痪的诊断以利防治。方法对南京市儿童医院早期干预门诊确诊的640例脑患儿[早产儿258例(早产儿组),足月儿382例(足月儿组)]分析其病因、早期临床表现及头颅CT征象,进行体格神经系统检查并智测。结果(1)高危因素,两组在颅内出血、肺部疾病早产儿组明显高于足月儿组,缺氧缺血性脑病组足月儿明显高于早产儿组,P均<0·05外余P均>0·05。(2)6个月以内确诊早产儿、足月儿两组各为28、90例的临床表现,反应差、嗜睡、少吃、少哭、少动,肌张力低下,早产儿组明显高于足月儿组,而不停啼哭,护理困难,肌张力增高,足月儿组明显高于早产儿组,P均<0·01及0·05余P均>0·05。(3)早产儿、足月儿两组的身长、体重、头围、MDI和PDI各为73·24±9·82、73·58±11·64(cm),9·12±2·31、9·23±2·80(kg),44·15±3·47、42·99±4·23(cm),44·42±6·09、41·99±7·28(分),43·81±4·95、40·80±4·51(分)。(4)头颅CT表现。早产儿、足月儿两组CT异常率各为95·4%及89·8%,P<0·05。(5)发育落后早产儿组言语落后明显高于足月儿组外,足月儿组身长<2SD明显高于早产儿组P均<0·05,余P均>0·05。结论当患儿具有高危因素、异常临床表现与神经症状、发育明显落后,应结合头颅CT密切随访可早期诊断脑性瘫痪及早干预。     

早产儿脑病研究进展

早产儿脑病是复杂的原发性脑损伤和继发性脑发育异常疾病.过去几年对该病有了较为深刻的认识,该文就最新的有关早产儿脑病概念演变,脑损伤后的细胞分子机制和损伤后发育障碍,尤其是活化小胶质细胞介导的少突胶质细胞损伤机制、神经/髓鞘受损和丘脑、板层下神经元及大脑皮层的受损机制或发育成熟障碍进行综述,以便对该病有更深刻的认识.     

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??Inhaled corticosteroids??ICS?? are the most effective medicine for chronic airway inflammation nowdays. Atomization inhalation has been widely applied in clinics because of its efficacy??fewer side-effects and convenience. Here??we focused on some points which should be paid attention to??including how to choose appropriate patients??how to ensure the effectiveness of inhaled steroids and how to reduce possible side-effects.