区域性危重新生儿转运系统建立的意义

目的探讨建立区域性危重新生儿转运系统的意义。方法3年来危重新生儿转运系统共转运新生儿1462例,其中早产儿533例,足月儿929例;出生体质量850~1500 g 164例,1500~2500 g 276例,2500~4000 g 948例,4000~4500 g 74例;病种以新生儿窒息和新生儿肺炎为主。结果转诊人数逐年增多,2002年7月~2003年6月转诊271例,2003年7月~2004年6月转诊460例,2004年7月~2005年6月转诊731例,无1例在转运途中死亡,治愈1352例(治愈率92.5%),放弃治疗75例(占7.1%),死亡35例(占2.4%)。结论建立区域性危重新生儿转运系统是降低新生儿死亡率、减少伤残及改善患儿预后的重要措施。     

区域性危重新生儿转运系统的研究和实践

一、目的 :我国新生儿死亡占 5岁以下儿童死亡的 5 8.4% ;要将 1 990年婴儿和 5岁以下儿童死亡率下降 1 /3,就要降低新生儿死亡率。区域性危重新生儿转运是新生儿急救医疗工作的重要组成部分 ,是提高危重新生儿存活率中极为重要的一环。开展危重新生儿转运非常必要。因为 :1 .我国大部分基层医院缺乏新生儿学科专业人员和各种急救及治疗设备。2 .转运多通过当地医院转送或由家人自行转送。转运人员多不具备新生儿急救知识和技术 ,途中不能治疗及护理有需要的患儿。3.即使是通过“1 2 0”转送 ,但具备整套新生儿抢救、监护系统的转运系统仍不…     

危重新生儿院前急救转运203例分析

为了降低危重新生儿病死率 ,发挥NICU病房的优势 ,在辖区内建立危重新生儿急救转运网络系统 ,对提高危重新生儿抢救成功率 ,减少致残率 ,降低病死率起到了积极的作用。现将我院2 0 0 1年 1月— 2 0 0 2年 9月转运危重新生儿 2 0 3例报告如下。1　资料及方法1 1　一般资料　男 170例 (83 74%) ,女 33例 (16 2 6 %)。转运日龄 :≤ 12h79例 (38 92 %) ,≤ 2 4h 36例(17 73%) ,≤ 48h 2 1例 (10 34 %) ,≤3d 13例 (6 4 0 %) ,≤ 7d 2 9例(14 2 9%) ,>7d 2 5例 (12 32 %) ,其中～ 2 4h 115例 (5 6 6 5 %)。出生体重 :<15 0 0 g2 7例 (13 3…     

50例危重新生儿转运实际运作及护理

危重新生儿转运工作是新生儿医疗工作的重要环节 ,是将危重新生儿从基层医院转到条件更好的医院的ＮＩＣＵ ,进行进一步监护、诊断及治疗的过程 ,是将移动的ＮＩＣＵ包括人员、设备 ,送到危重新生儿身旁的医疗项目。我院自 1999年 11月— 2 0 0 0年 11月建立危重新生儿转运项目以来 ,共转运危重新生儿 5 0例 ,现结合我院新生儿转运的临床观察 ,谈谈护理体会。1　临床资料我院ＮＩＣＵ转运危重新生儿 5 0例 ,其中男 2 9例 ,女 2 1例 ,转运日龄 <1ｄ 36例 ,～ 3ｄ 8例 ,～ 10ｄ 6例 ;胎龄<37周 2 4例 ,～ 42周 2 6例 ;出生体重<2 5 0 0ｇ 2 4…     

区域内危重新生儿转运体系的应用研究

目的：了解区域内危重新生儿转运现状及存在的问题,为建立区域内完善的新生儿转运体系提供参考。方法：选取2009年1月至2010年9月北京海淀区4所医院所有转诊新生儿为研究对象,并收集2所接诊医院的相关临床资料进行研究。结果：转诊疾病以早产儿、需外科急诊处理的疾病和呼吸系统疾病为前3位疾病（33.1%、18.3%、14.8%）。主动转诊95例（66.9%）,被动转诊47例（33.1%）。转诊时年龄＜6 h者占 24.1%,6 h~者占9.3%,12 h~者占25.9%,>24 h者占40.8%。从医院乘救护车至接诊病房时间为28.0±11.1 min。转诊后死因以需外科急诊治疗的疾病占第1位,占死亡病例的53.8%。转诊时年龄<6 h组和≥6 h 组的死亡率差异无统计学意义。结论：本研究区域内4所医院以主动转运为主。需手术治疗的外科疾病患儿转诊后死亡率高,应重视新生儿外科疾病患儿的转运工作。     

深圳市龙岗区新生儿转运模式及其应用研究

目的探索深圳市龙岗区的危重新生儿转运模式与方法，降低新生儿死亡率。方法对我院转运的256例危重新生儿进行回顾性研究，并对我院新生儿转运系统（NETS）起动前后3年来龙岗区新生儿死亡率进行分析。结果本组病例转运单程多在10～60km；往返时间一般0．5～2．0h。转运成功率、转运途中病死率、转运病死率、总治愈率和病死率分别为98．4％、0％、1．6％、93．8％和5．1％。全区新生儿死亡率由2002年的10．54‰降低至2004年的4．84‰。结论在建立二级NICU基础上，建立NETS，配备专职训练有素的队伍采用地面双程转运方式进行新生儿转运，是适合本地区的危重新生儿转运模式。     

气管内给凝血酶治疗新生儿肺出血疗效分析

新生儿肺出血是新生儿危重症之一 ,死亡率极高 ,凝血酶气管内给药可直接作用于出血部位 ,有助于出血减轻或停止。 1997年 1月— 2 0 0 0年 9月共收治 76例 ,其中 30例采用气管内给药取得了较好的疗效 ,现报告如下。1　临床资料1 1　一般资料　男 5 3例 (6 9 74% )、女 2 3例 (30 2 6 % ) ;入院日龄 :～ 12ｈ2 6例、～ 2 4ｈ 2 8例、～ 36ｈ 16例、>36ｈ 6例 ;早产儿 42例 :2 8～ 32周 2 4例、～ 36周 18例 ,足月儿 2 4例 ;体重 90 0ｇ～ 15 0 0ｇ 2 7例 ,～ 2 490 ｇ 2 6例 ,>25 0 0 ｇ 13例 ;原发病 :硬肿症 30例、羊水吸入综合征 2 4例、…     

β-七叶皂甙钠治疗新生儿硬肿症疗效观察

新生儿硬肿症是引起新生儿死亡的重要原因,微循环障碍和凝血机制异常是其关键。为降低死亡率,提高治愈率,我院儿科在综合治疗基础上采用β七叶皂甙钠治疗新生儿硬肿症36例,取得了较好的临床效果,现报告如下。1　资料与方法1 .1　对象选择1 999年1月至2 0 0 2年1 2月住院的新生儿硬肿症病例,随机分为两组:治疗组36例,其中足月儿1 6例,足月小样儿8例,早产儿1 2例;体重<2 5 0 0 g1 6例(其中体重<1 5 0 0 g 2例) ;轻度硬肿1 4例,中度1 7例,重度5例;硬肿面积达5 0 %以上者4例,2 5 %～5 0 %者1 7例,<2 0 %者1 5例;体温不升30例,并发窒息1 0例,肺炎…     

危重新生儿转运不当教训分析

由于基层医疗机构缺少诊断或救治、监护危重新生儿的必要设备和技术力量 ,危重新生儿需转运至三级医院进一步的治疗和护理。但由于转运不当 ,增加了危重新生儿的死亡率和致残率。本文收集 1999年 1月— 12月转入我科危重新生儿 12 8例 ,分析如下。1　临床资料1 1　一般资料　男 75例 ,女 5 3例 ,其中早产儿 34例 ,足月儿 94例。转运时间与地点 ,最长 10ｈ ,最短 30ｍｉｎ ,平均(4± 0 5 )ｈ。来源 :本市市级医院 15例 ,县级医院 44例 ,乡镇医院 6 9例 ,转送人员 :家属 98例 ,当地医疗机构医护人员 17例 ,新生儿专业人员 13例。1 2　到院情…     

纳络酮治疗早产儿呼吸暂停30例

为了解纳络酮抢救早产儿呼吸暂停的疗效 ,随机将 5 4例早产儿呼吸暂停分成治疗组 30例 ,对照组 2 4例。均予常规抢救措施 ,治疗组给纳络酮 0 .0 5～ 0 .1ｍｇ/ (ｋｇ·次 ) ,加入5 %葡萄糖 2ｍｌ中静推 ,1次 / 0 .5ｈ× 3次。 1、2ｈ重复一次。呼吸稳定后予纳络酮 0 .1ｍｇ/ (ｋｇ·ｄ)加入 5 %葡萄糖 15～2 0ｍｌ中维持静滴 5～ 7ｄ。对照组用氨茶碱 4～ 6ｍｇ/(ｋｇ·次 ) 加入 5 %葡萄糖 2 0～ 30ｍｌ中静滴 ,不少于 15～2 0ｍｉｎ。 8～ 12ｈ后重复一次 ,以后 5ｍｇ/ (ｋｇ·ｄ)维持静滴 3～ 5ｄ。结果治疗组总有效率 93.3% ,对照组 75 …     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.     

Psychopathologie du syndrome d’Asperger et « aspérigisation » de la société contemporaine

The author has attempted here to point out, just for a start, the characteristics of Asperger syndrome from the point of view of psychopathology through a rereading of Hans Asperger's original paper (1944). This thesis merits reevaluation, if for no other reason than to fill the gaps in operational diagnostics based on the DSM. It is found by rereading that Asperger's view of the principal disturbances of autistic psychopathy include a “disturbance of natural evidence” or a “crisis of common sense”. This question of natural evidence that he evokes with regard to autistic psychopathy corresponds to W. Blankenburg's natural evidence, which constitutes a key concept for comprehending schizophrenia in the form poor-symptom (“symptomarme Schizophrenie”) that he observes in the speech of his patient Anne Rau. One can deduce from this that in terms of fundamental disturbances, Asperger syndrome and this “symptom-poor” schizophrenia overlap at the level of loss of natural evidence. It is moreover possible to classify Asperger syndrome among the disturbances of spacing in the sense meant by the evolutionary psychiatry of A. Stevens and J. Price. The author then develops our comprehension of Asperger syndrome from the point of view of the perspective proposed by the notion of resilience in people with Asperger syndrome and of the possibility for them, through these mechanisms of adaptation, to find in the organization of the personality of the “as if” type a position of relative equilibrium. They concur or overlap in the creation of crutches, of borrowed personalities secondarily legitimated by the reaction of the socius. This will end up in the production of inventions and œuvres (works). Clearly, one rarely encounters several cases that one could consider pertinently to be “successful” Asperger syndrome. Finally, the author notes that one can find a sort of isomorphism between Asperger syndrome and contemporary society when he proposes the term “asperigisation” to characterize our society, given that the equilibrium between emotion and logic is strongly disturbed in these patients, in whom logic undergoes hypertrophy while emotion is impoverished. From this perspective, the author hopes to suggest reasons for the increase in the number of cases of Asperger syndrome in the clinical setting and in society in general in our contemporary era.     

Bibliometric data: a disaster for many non-American biomedical journals

Bibliometric data published by the Institute of Scientific Information in Philadelphia (ISI), and which was previously discussed in Acta Paediatrica , has increasingly been used despite all the relevant and severe criticism that has been raised against this method of evaluating individual research results and grading scientific journals. It is obvious that the present trend regarding the use of bibliometric data as a basis for priorities and funding of research and for the promotion of individual scientists favours American-oriented research projects at the expense of those that are based on concepts of predominantly European relevance.

Conclusion: For the future of non-American research, it is important that no single super-power, i.e. the USA, should dominate scientific priorities. The condition for efficient European competition is that European Centres with high levels of competence for creative research and training of scientists from all over the world are established. In addition, it is important that the results of European research are published in prestigious European journals, as was the situation before World War II.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.