儿科监护室优质护理应用效果分析

目的探讨儿科监护室开展优质护理的效果。方法随机选取儿科监护室开展优质护理前后各100例患儿作为对照组和实验组,对照组实施常规护理,实验组实施优质护理,对比两组患儿医院感染发生率、平均住院日、患方满意度等指标的变化。结果实施优质护理后,医院感染发生率明显渐少,平均住院日明显缩短,患方满意度显著提高,与实施前比较,差异有统计学意义（P〈0.05）。结论开展优质护理活动,为患者提供了更为安全、优质、满意的护理服务,有利于全面提升临床护理质量,值得临床推广应用。     

依据儿科高级生命支持指南行气管插管的错位发生率及对插管深度公式的探讨

目的　探讨多种儿童经口气管插管深度标准技术的准确性,包括儿科高级生命支持（PALS）指南公式预测法以及听诊双肺呼吸音、观察胸廓起伏的临床评估法,并设计更准确的预测公式指导临床。方法　回顾性分析2018年1月至2019年7月中国医科大学附属盛京医院小儿重症监护病房收治的经口气管插管的177例患儿。记录入院后初次插管时患儿的年龄、性别、体重、依据PALS指南公式计算的插管深度、临床评估后的实际插入深度以及胸片显示气管导管（endotracheal tube,ETT）尖端距离第二胸椎下缘和隆突的距离,并对上述数据进行统计分析。结果　依据PALS指南计算所得气管插管深度的错位率（过深或过浅）为74.01%,结合临床评估后,ETT错位率由74.0%下降至55.9%,临床评估对ETT的调整有实际意义。推测新公式：＜2岁患儿,采用1～5月龄：11 cm,6～11月龄：12 cm,12～23月龄：13 cm作为参考插管深度。 ≥2岁患儿：插管深度（cm）＝年龄（岁）×0.7+12。结论　依据PALS指南计算的气管插管深度错位率较高,通过听诊双肺呼吸音、观察胸廓起伏等临床评估后可提高ETT位置的合适率。PALS指南低估了2岁以上儿童ETT的最佳插入深度。新的公式有待验证。     

Unexpected neurological sequelae following propofol anesthesia in infants: Three case reports

Propofol is a widely used hypnotic agent for induction and maintenance of pediatric anesthesia with a well known safety profile. Experimental in vitro studies suggest that propofol may be toxic to developing neurons. We report the cases of three infants who underwent surgery before 2 months of age for different benign pathologies. Propofol was used for induction and maintenance of anesthesia in all cases. The three patients developed convulsions with similar clinical characteristics (cluster of recurrent clinical and subclinical seizures) between the 23th and 30th hours following anesthesia. Clinical and electroencephalographic improvement was obtained between the third and fourth day of management in pediatric intensive care unit. The seizures never recurred, and the three patients underwent further uneventful general anesthesia without propofol. Follow-up of the three patients disclosed unexpected neurological dysfunction: progressive microcephaly (head circumferences were normal at birth), developmental impairment with cognitive and behavioural disturbances in two cases, and bilateral symmetrical white-matter abnormalities on cerebral magnetic resonance imaging. Conclusion: The causal relationship between propofol anesthesia and the neurological symptoms of our patients remains difficult to ascertain, but we believe that pediatricians, anesthetists and intensive care-givers should be aware of this possible adverse reaction that has never been described before.     

MRI findings in 6 cases of children by inadvertent ingestion of diphenoxylate-atropine

Purpose

Compound diphenoxylate (diphenoxylate-atropine) poisoning can cause toxic encephalopathy in children, and magnetic resonance imaging (MRI) of the brain in this condition has not been reported. This study is to analyze brain MRI findings and to investigate the relations between MRI features and possible pathophysiological changes in children.

Methods

Six children accidentally swallowed compound diphenoxylate, 4 males, 2 females, aged 20-46 months, average 33 months. Quantity of ingested diphenoxylate-atropine was from 6 to 30 tablets, each tablet contains diphenoxylate 2.5 mg and atropine 0.025 mg. These patients were referred to our hospital within 24 h after diphenoxylate-atropine ingestion, and underwent brain MRI scan within 24-72 h after emergency treatment. The characteristics of conventional MRI were analyzed.

Results

These pediatric patients had various symptoms of opioid intoxication and atropine toxicity. Brain MRI showed abnormal low signal intensity on T1-weighted images (T1WI) and abnormal high signal intensity on T2-weighted images (T2WI) and fluid-attenuated inversion recovery (FLAIR) imaging in bilateral in all cases; abnormal high signal intensity on T1WI, T2WI and FLAIR in 4 cases. Encephalomalacia was observed in 3 cases during follow-up.

Conclusion

In the early stage of compound diphenoxylate poisoning in children, multiple extensive edema-necrosis and hemorrhagic-necrosis focus were observed in basic nucleus, pallium and cerebellum, these resulted in the corresponding brain dysfunction with encephalomalacia. MRI scan in the early stage in this condition may provide evidences of brain impairment, and is beneficial for the early diagnosis, treatment and prognosis assessment.     

1995-2005年天津市儿童医院PICU死亡病例分析

目的 总结并探讨近10年来天津市儿童医院PICU危重症患儿的死亡原因变化情况和死亡相关因素的特点.方法 对1995-07-2005-07于天津市儿童医院PICU病房死亡的119例患儿资料进行回顾,运用统计学方法进行Ridit分析,u检验,χ2检验.结果 对不同年龄段死亡患儿的性别采用Ridit分析,经u检验,提示死亡患儿不同年龄段的性别构成差异有统计学意义(P＜0.01).将1995-2000、2000-2005的死亡患儿按病因分为感染因素、非感染因素与未明诊断3组,经χ2检验,提示PICU近5年死亡患儿的疾病病因与既往5年差异有统计学意义(P＜0.05).将10年间每个年龄段的死亡患儿病因细分为感染因素、非感染因素、未明诊断3种,经χ2检验,提示PICU死亡患儿不同年龄组的疾病病因差异有显著性意义(P＜0.05).结论 近10年来,天津市儿童医院PICU的死亡疾病构成及死亡原因发生了较为显著的变化,感染性疾病的发生相对减少,非感染性疾病的比率相对增高.1个月至1岁的婴儿患者以及农村患儿的病死率相对较高,且以感染性因素为主.意外伤害造成的死亡相对集中于1～4岁年龄组,且高发于农村.     

儿科ICU中急性呼吸窘迫综合征的临床回顾性分析

目的总结我院儿科重症监护室中(PICU)收治的急性呼吸窘迫综合征(ARDS)患儿的临床流行病学特点,以期提高ARDS的诊治水平。方法回顾性总结2002年6月～2004年2月我院PICU的14例确诊为ARDS患儿的特点。结果ARDS的发病率为2.3%。诱发ARDS的因素有体外循环、肺炎、脓毒症、休克等,其中以体外循环为最多见(占发病人数的42.9%)。确诊时急性肺损伤指数和PaO2FiO2分别为(3.2±0.6)和(86.5±23.8)。机械通气时最高吸气峰压和呼气终末正压分别是(33.8±8.4)cmH2O、(8.3±4.8)cmH2O。ARDS平均住院时间为18.1d,占PICU危重病人总住院时间的21.2%。因多器官功能衰竭、呼吸衰竭死亡6例(病死率42.9%),占PICU死亡总数的21.5%。结论积极去除高危因素预防ARDS、探讨ARDS更有效的治疗方法、降低病死率仍是我们今后工作的重点。     

Growth of pediatric intensive care units in the United States from 1995 to 2001

OBJECTIVE: To describe the growth and distribution of pediatric intensive care unit (PICU) beds in the United States from 1995 to 2001 and the characteristics of PICUs in 2001. STUDY DESIGN: This was a cross-sectional survey of PICUs in 1995 to 1996 and 2001 to 2002. RESULTS: There were 306 general PICUs in the United States in 1995 and 349 in 2001 (13.7% growth). In both survey periods, approximately half of the PICUs had PICUs with >or=15 beds. There were 3899 PICU beds in 2001 (23.9% increase from 1995), with a mean number of PICU beds per pediatric population (age <18 years) of 1/18542 in the United States (17.5% increase from 1995). There was an increase in the number of annual admissions, occupancy rate, length of stay, percentage intubated, mortality rate, and number of intensivists per PICU with increasing bed size. In 2001, 94% of PICUs had a pediatric intensivist on staff, and these specialists were in-house at night in 17% of all PICUs and in 30% of PICUs with >or=15 beds. CONCLUSIONS: The number of PICU beds is growing more rapidly than the rate of pediatric population growth. The impetus for this growth is unclear.     

Airway eicosanoids in acute severe respiratory syncytial virus bronchiolitis

We prospectively studied the levels of eicosanoids in intubated patients with severe bronchiolitis and compared them to electively intubated non-infected infants. LeukotrieneE(4) (LTE(4)), leukotrieneB(4) (LTB(4)), and prostaglandinE(2) (PGE(2)) levels were significantly increased (P <.01) from endotracheal (ET) aspirates of infants with bronchiolitis compared with controls, as were urinary LTE(4) levels (P <.001). We conclude that eicosanoids are increased in the tracheal aspirates and urine of children with bronchiolitis.