安定溶液舌下给药治疗小儿惊厥疗效观察

目的探讨安定溶液舌下给药治疗小儿惊厥的临床疗效及安全性。方法选择惊厥患儿92例,随机分为治疗组46例,舌下给药0.5mg/kg;对照组46例,直肠给药0.5mg/kg。比较两组控制惊厥显效率和总有效率及控制惊厥平均起效时间。同时观察治疗组的不良反应。结果治疗组显效率高于对照组(χ2=7.38,P=0.012),总有效率与对照组差异无统计学意义(χ2=0.548,P=0.714);治疗组平均起效时间较对照组短(t=5.42,P=0.000);治疗组除止惊后嗜睡、乏力外未见其它不良反应。结论舌下给药临床应用安全方便,止惊快速有效,值得临床推广。     

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目的对促肾上腺皮质激素(ACTH)治疗的婴儿痉挛(IS)患儿进行追踪随访,了解其预后并评价影响预后的因素。方法(1)对北京大学第一医院儿科1993年1月至2003年12月住院的53例ACTH治疗的IS患儿的临床随访资料进行回顾性研究。(2)ACTH治疗方法:采用ACTH静滴,25~40IU/d,共4周。结果(1)对53例ACTH治疗患儿随访6个月至10年,ACTH治疗发作完全缓解的31例,随访2年以上,共有16例复发,复发率为51·6%,其中于停用ACTH后2~3个月复发者占50·0%(8/16),复发形式以肌阵挛发作、痉挛发作、部分运动性发作为主;(2)临床发作预后与开始用ACTH治疗时的病程、ACTH的近期疗效有关(病程≤2个月者、ACTH近期疗效好的临床发作预后好),与发病年龄、病因无关;(3)智力预后与ACTH开始治疗时的病程、病因、发作预后有关(病程≤2个月者、隐原性者、发作完全缓解者智力预后好),与发病年龄、ACTH近期疗效无关。结论(1)IS患儿临床发作预后与开始用ACTH治疗时的病程、ACTH的近期疗效有关。(2)智力预后与ACTH开始治疗时的病程、病因、发作预后有关。     

南海区婴幼儿腹泻病轮状病毒感染临床流行状况调查

目的探讨南海区婴幼儿腹泻轮状病毒感染流行状况,为防治提供依据。方法回顾性分析2002～2004年门诊、住院腹泻患儿采用酶联免疫法(ELISA)检测粪便轮状病毒的资料结果。结果3年中803例腹泻患儿检出轮状病毒457例,阳性率56.9%,其中2002年113例,阳性率63.5%(113/178),2003年240例,阳性率63.2%(240/380),2004年104例,阳性率42.4%(104/245),发病季节以每年10、11、12月及来年1月为主。结论南海区婴幼儿腹泻病病原以轮状病毒感染为主,一年四季都有发生,但流行期在10月、11月、12月及来年1月的秋冬季节,发病高峰期在11、12两个月。     

CLINICAL STUDY ON TREATMENT OF INFANTILE PRIMARY EPILEPSY WITH ACUPOINT CATGUT—IMPLANTATION THERAPY

Ｅｐｉｌｅｐｓｙｉｓａｃｌｉｎｉｃａｌｓｙｎｄｒｏｍｅａｎｄｍａｉｎｌｙｒｅｓｕｌｔｓｆｒｏｍｄｙｓｆｕｎｃｔｉｏｎｏｆｔｈｅｂｒａｉｎｄｕｅｔｏｒｅ ｐｅａｔｅｄａｔｔａｃｋｉｎｄｕｃｅｄａｂｎｏｒｍａｌｄｉｓｃｈａｒｇｅｏｆｔｈｅｃｅｒｅｂｒａｌｎｅｕｒｏｎｓ .ＩｎＴｒａｄｉｔｉｏｎａｌＣｈｉｎｅｓｅｍｅｄｉｃｉｎｅ,ｉｔｉｓｃａｌｌｅｄａｓ“ＸｉａｎＳｙｎｄｒｏｍｅ”ａｎｄｍａｎｉｆｅｓｔｅｄｂｙｐａｒｏｘｙｓｍａｌｔｒａｎｃｅ ,ｄｉｓｔｕｒｂａｎｃｅｏｒｌｏｓｓｏｆｔｈｅｃｏｎｓｃｉｏｕｓ…     

婴幼儿期肾病综合征临床特点分析

目的　探讨婴幼儿期原发性肾病综合征 (简称婴幼儿肾病 )的临床特点 ;分析婴幼儿肾病临床特点、免疫功能、病理分型和糖皮质激素 (简称激素 )疗效的关系。方法　对 31例婴幼儿肾病患儿进行临床观察 ;进行体液免疫和细胞免疫功能测定 ;14例接受肾穿刺活检 ;31例均采用激素中长程疗法 ,18例予以免疫抑制剂如环磷酰胺 (CTX)等联合治疗。结果　婴幼儿肾病临床以肾炎型肾病为主 ;体液免疫和细胞免疫功能下降 ;病理以非微小病变型为主 ;约 6 0 %患儿对激素治疗不敏感 ,需用激素与免疫抑制剂联合治疗。结论　婴幼儿肾病具有与其它儿童肾病综合征不同的特点 ,应当引起临床重视。     

针刺为主治疗小儿脑瘫200例临床研究

目的　探讨针刺、穴位注射、推拿、运动训练综合康复治疗小儿脑瘫的方法和疗效。方法　将 35 6例 0～ 9岁脑瘫患儿随机分为治疗组和对照组 ,两组均接受常规药物治疗和功能训练 ,治疗组在功能训练前或后施术针刺、穴位注射、推拿 ,并在治疗前后进行综合评价 ,观察整体康复疗效 ,进行统计学处理。结果　治疗组整体疗效明显优于对照组 (P<0 .0 5 )。结论　针刺、穴位注射、推拿、运动为主的综合康复方法是治疗小儿脑瘫的最佳方法之一 ,是具有中国特色的综合康复体系 ,值得推广应用。     

Infantile spasms in Down syndrome: good response to a short course of vigabatrin

PURPOSE: To evaluate the efficacy of vigabatrin (VGB) in the treatment of infantile spasms (ISs) associated with Down syndrome (DS) and to assess the feasibility of early discontinuation to reduce the possible retinal toxicity. METHODS: Five children with ISs with DS were treated with vigabatrin as first-line monotherapy in an open prospective study. The short-term response was evaluated, and VGB was continued in responders. The treatment was stopped after 6 months in children who were still spasm free. RESULTS: Four children of five became spasm free with VGB, three of them responding within 1 week. This response was maintained during the 6 months of VGB treatment. After VGB discontinuation, and with a follow-up ranging from 2 to 4 years, none of the responders experienced spasm recurrence or other types of seizures. CONCLUSIONS: This study confirms the efficacy of VGB in ISs associated with DS. Moreover, it shows that the duration of VGB treatment can be reduced to 6 months without relapse of ISs. This short treatment might reduce the risk of developing visual field constriction.     

The role of vigabatrin in childhood seizure disorders: results from a clinical audit

PURPOSE: The emergence of visual field defects attributed to vigabatrin (VGB) treatment and intramyelinic edema in animal experiments has raised concerns about its future role in the treatment of childhood seizures. METHODS: We evaluated our experience with this antiepileptic agent with retrospective analysis of database and chart audit. RESULTS: Of 73 patients, 43 girls and 33 boys were treated with VGB over a 7-year period. The mean age of patients at the introduction of VGB was 87 months (range, 5-257 months). In 12 of 73 cases, VGB was used as monotherapy; in 61 of 73 cases, it was used as an add-on drug. Seizure types included secondarily generalized seizures (21), mixed seizures (21), partial seizures (18), and generalized seizures (13). Seizure etiology was idiopathic/cryptogenic in 22 patients, symptomatic in 50, and undetermined in a single patient. The mean duration of therapy was 16 months (median, 10 months; range, 1-144 months). VGB was effective in 30 (seven seizure free, 23 with >90% reduction in seizures), partially effective in four (50-90% reduction in seizures), and ineffective in 38 (<50% reduction in seizures). Nearly 50% of patients with infantile spasms responded to VGB. All patients underwent ophthalmic evaluation; two (16%) of 12 patients who could undergo static threshold perimetry were demonstrated to have the characteristic visual field constriction. CONCLUSIONS: VGB is effective in producing a significant reduction in seizure frequency in nearly half the patients with childhood seizures, including refractory epilepsy. Despite emerging concerns regarding visual side effects, this drug retains an important role in the medical management of childhood epilepsy.     

Early infantile pertussis; increasingly prevalent and potentially fatal

We report nine cases of severe early pertussis in infants less than 7 weeks of age. Clinical features at this age are atypical and may be confused with more common illnesses such as bronchiolitis. All were very difficult to manage. Ventilation was required for apnoeas in five cases, seizures in two or respiratory failure in two. Complications included hypotension in seven cases, pulmonary hypertension in one, pneumothoraces in two, seizures in five and co-infection in five. Two cases were referred for extracorporeal membrane oxygenation and six died. Infection was confirmed either at post mortem or by culture from pernasal swabs. The mother or other close family members were symptomatic at the time and thought to be the source of infection. Conclusion The nine cases suggest a significant resurgence of the infection, which may be fatal in early life. If reporting continues to increase, the immunisation schedule will need to be reviewed and secondary transmission prevented where possible, to protect this vulnerable pre-immunisation group. Received: 5 October 1999 / Accepted: 22 May 2000     

消旋卡多曲颗粒治疗婴幼儿腹泻的疗效观察

目的观察消旋卡多曲治疗婴幼儿腹泻病的临床疗效。方法将119例婴幼儿腹泻病患儿随机分为2组：对照组（54例）和治疗组（65例）。对照组采用常规治疗；治疗组在常规治疗的基础上加用消旋卡多曲颗粒治疗，消旋卡多曲颗粒剂量1．5mg／（kg·次），3次／d，治疗3d后观察总有效率。结果治疗组总有效率（89，22％）明显高于对照组（61．11％），差异有统计学意义（P〈0．005）。结论消旋卡多曲颗粒治疗婴幼儿腹泻疗效显著，且安全，惠儿易接受，依从性好。