小儿危重病例评分和死亡指数在急性呼吸窘迫综合征中的应用

目的探讨小儿危重病例评分（PCIS）和小儿死亡指数（PIM）在急性呼吸窘迫综合征（ARDS）的中适用性。方法应用PCIS及PIM对临床流行病学调查中符合1994年欧美联席会议定义的ARDS患儿进行评分，选取4个时段，即入PICU1h、在PICU病情最重时、入选ARDS1h、ARDS病情最重时的评分结果。PIM直接通过因特网（http：／／www．sfar．org／scores2／pim22．html）进行计算，根据存活或死亡的临床结果进行分组，比较PCIS及PIM评分结果。统计学处理使用SPSS软件。两组间人口学资料、住院时间及评分的比较使用曼-惠特尼U检验，组间病死率的比较使用χ^2检验，以P〈0．05为差异具有统计学意义。同时分别建立两种评分法相应的受试者工作特征曲线（ROC curve），该曲线下的面积（AUC）是评估评分法分辨能力的重要参数，该值≥0．75被认为有临床意义。结果存活组与死亡组ARDS病情最重时PCIS（P=0．006）及PIM（P=0．013）评分之间差异具有统计学意义。入选ARDS1h的PIM评分差异具有统计学意义（P=0．031）。各时段PCIS与PIM的ROC曲线下面积均小于0．75。结论PCIS和PIM虽然对评估ARDS病情的严重程度及发展趋势有一定帮助，也可初步判断预后好坏，但对预测死亡风险的价值仍然有限。     

Associations of Participation-Focused Strategies and Rehabilitation Service Use With Caregiver Stress After Pediatric Critical Illness

Objective(s)

Determine the associations between having participation-focused strategies and receiving rehabilitation services in the pediatric intensive care unit (PICU) with caregiver stress over 6 months post-PICU discharge.

Ectopic supernumerary kidney: Another cause of a pelvic mass

Ectopic supernumerary pelvic kidney is a rare cause of a pelvic mass in the adolescent populations. We present a case of an ectopic supernumerary pelvic kidney, found incidentally, on a computed axial tomographic (CT) examination.     

Temporal artery and axillary thermometry comparison with rectal thermometry in children presenting to the ED

Background

Accurate temperature readings, often obtained rectally, are an important part of the initial evaluation of pediatric patients in the Emergency Department. Temporal artery thermometry (TAT) is one way to noninvasively measure temperature. We sought to compare the accuracy of axillary and temporal artery temperatures compared to rectal.

Increased Mortality of Patients With Childhood-Onset Inflammatory Bowel Diseases,Compared With the General Population

1. Download high-res image (294KB)
2. Download full-size image

     

Sustained ventricular tachycardia after repair of tetralogy of Fallot: New electrophysiologic findings

Ventricular arrhythmia originating from the outflow tract of the right ventricle is a presumed cause of late sudden death in patients after repair of tetralogy of Fallot. Exercise testing has been shown to enhance detection, and phenytoin has been shown to control ventricular arrhythmias in these patients. This study reports new findings in 3 patients who underwent electrophysiologic studies at postoperative cardiac catheterization; in each, sustained ventricular tachycardia was induced and found to originate from the inflow-septal area of the right ventricle. Using serial studies, the same sustained ventricular tachycardia was induced during therapeutic serum concentrations of phenytoin but not after propranolol. No patient had ventricular arrhythmia during a 24-hour electrocardiogram or during exercise. Although no patient had normal hemodynamic function, only 1 patient had right ventricular pressure greater than two-thirds systemic pressure. Each patient had undergone initial intracardiac repair at a relatively late age (3, 9, and 9 years).     

Diagnostic and therapeutic role of endoscopic retrograde cholangiopancreatography in biliary rhabdomyosarcoma

Biliary rhabdomyosarcoma （BRMS） is an uncommon childhood malignancy which has been managed surgically. We present a case of a 3-year-old boy with BRMS, in whom endoscopic retrograde cholangiopancreatography （ERCP） was successfully used both diagnostically and therapeutically, thus obviating the need for surgery and its attendant risks of morbidity and mortality. We conclude that ERCP is an effective alternative to surgery for BRMS in some patients.     

Pediatric sand aspiration managed using bronchoscopy and extracorporeal membrane oxygenation

Sand aspiration is a rare but potentially fatal occurrence to consider in near-drownings, accidental burials or cave-ins. Optimal management is not well defined.