儿童意外伤害778例相关因素分析

目的探讨儿童意外伤害的原因。方法回顾性分析我院2006年1月至2009年6月急诊就诊的778例儿童意外伤害病例。结果儿童意外伤害的年龄分布有显著差异。意外伤害发生率男性高于女性。意外伤害中以误服／中毒发生率最高。结论意外伤害的发生不仅与小儿自身发育因素有关，且与社会经济的发展、家长育儿知识及社会管理密切相关。儿童意外伤害应以预防为主，加强安全管理，采取家庭与社会相结合的预防策略。     

血必净注射液治疗儿童急性胰腺炎的临床研究

目的观察血必净注射液治疗儿童急性胰腺炎的临床疗效。方法选取2013年1月—2015年9月哈励逊国际和平医院收治的儿童急性胰腺炎患者54例,所有患者随机分为对照组和治疗组,每组各27例。对照组采用常规治疗。治疗组在对照组的基础上静脉滴注血必净注射液0.5~1 m L/kg,加入0.9%氯化钠注射液50~10 m L,1次/d。两组患者均连续治疗10 d。观察两组的临床疗效,比较患者治疗前后临床体征和炎性因子的变化。结果治疗后,对照组和治疗组总有效率分别为62.96%、81.48%,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组患者的临床体症消失时间、血淀粉酶恢复正常时间、正常饮食时间和住院时间均显著小于对照组,两组比较差异具有显著性(P0.05)。治疗后,两组患者定C-反应蛋白(CRP)和降钙素原(PCT)均显著降低,同组治疗前后差异有统计学意义(P0.05);且治疗组这些观察指标的降低程度优于对照组,两组比较差异有统计学意义(P0.05)。结论血必净注射液治疗儿童急性胰腺炎具有较好的临床疗效,可改善临床体征,有效抑制炎性因子释放,安全性高,具有一定的临床推广应用价值。     

更昔洛韦联合丙种免疫球蛋白治疗婴儿巨细胞病毒感染的系统评价

目的:查系统评价更昔洛韦联用丙种免疫球蛋白治疗婴儿巨细胞病毒感染的临床疗效和安全性。方法:计算机检索Pub Med、Medline、CNKI、CBM、VIP和万方数据库,同时辅助手工检索相关文献,检索主题为以常规治疗的空白治疗和以在常规治疗基础上加用更昔洛韦为对照组,以更昔洛韦联用丙种人免疫球蛋白为试验组的治疗婴儿CMV感染的随机对照研究,检索年限均为建库开始至2015年5月,对纳入研究进行文献质量评价,采用Rev Man5.2统计软件对同质性结果进行合并分析。结果:共纳入11项研究,合计617例患者。Meta分析显示,与对照组相比,试验组能显著提高临床疗效(RR=1.50,95%CI:1.34~1.68,P<0.01)和CMV转阴率(RR=1.81,95%CI:1.59~2.05,P<0.01)。ADR发生率大于以常规治疗的空白治疗(RR=9.25,95%CI:3.19~26.83,P<0.01),但显著小于在常规治疗基础上加用更昔洛韦(RR=0.40,95%CI:0.22~0.72,P<0.01)。倒漏斗图提示本研究偏倚性较小。结论:更昔洛韦联用丙种球蛋白治疗婴儿CMV感染疗效显著,安全性较好。鉴于纳入研究文献质量偏低,准确结果尚需大样本、高质量随机对照研究进一步验证。     

复方苯乙哌啶中毒37例临床分析

复方苯乙哌啶是一种非特异性止泻剂，用于治疗急、慢性功能性腹泻。在一些乡镇卫生院或个体诊所用的较多，经常发生中毒现象。统计本科自2007年5月至2008年10月复方苯乙哌啶中毒患儿37例，现分析报告如下。     

幼年大鼠溺水应激后胰岛素信号传导变化及外源胰岛素治疗反应

Objective To explore the alteration of insulin signal transduction in drowning-induced stress hyperglycemia and to investigate therapeutic effect of insulin on it.Methods Stress hyperglycemia model was induced by drowning.Thirty-two infant rats were randomized into control,drowning,air resuscitation and air-insulin resuscitation groups.Insulin was injected abdominally into the air-insulin resuscitation rats.Fasting serum glucose and insulin were determined routinely,and protein expressions and serine phosphorylation levels of insulin receptor substrate 1(IRS-1) in muscle tissue were detected by Western blot and immunoprecipitation.The expressions of glucose transporter 4(GLUT4) in the intracellular and plasma membranes of muscle tissue were detected by Western blot.Results In the drowning group,insulin resistance index(HOMA-IR) increased significantly as compared with that of the control group,but the level of IRS-1 had no significantly change as compared with the other three groups.As compared with that of the drowning group(0.71±0.12),IRS-1 serine phosphorylation levels of the two resuscitation groups decreased significantly(0.56±0.13 and 0.46±0.08 respectively).The intracellular GLUT4 expression in the two resuscitation groups(1.82±0.11 and 1.96±0.28 respectively)increased significantly in contrast to that of the drowning group(1.45±0.15),and the air-insulin resuscitation groups showed an especially high increase of intracellular GLUT4 expression.Conclusion During the drowning-induced stress hyperglycemia,the alteration of serine phosphorylation and GLUT4 distribution is one of the important mechanism of insulin resistance.Insulin may decrease the blood glucose through decreasing serine phosphorylation levels of IRS-1 and increasing the intracellular GLUT4 expressions.     

危重症应激性高血糖患儿胰岛功能与TNF-α变化的研究

在各种危重症发生过程中,在应激原和损伤因子强烈刺激下,内分泌系统在维持机体的自稳性的同时,又常常导致了应激性高血糖的发生。目前认为,胰岛素抵抗是应激性高血糖发生的重要原因。有研究表明,血糖水平与多器官功能衰竭的发生及病死率有相关关系。而在危重症发展过程中,炎症反应与血糖、胰岛素之间的变化关系尚不十分清楚。本研究通过动态监测危重症患儿在极期与恢复期的血糖、血胰岛素及TNF-α含量变化,探讨危重症患儿应激性高血糖、胰岛素抵抗及其变化规律。1对象与方法1·1对象2003年10月~2005年6月我院PICU收治的56例危重症患儿,按…     

幼年大鼠溺水应激后胰岛素信号传导变化及外源胰岛素治疗反应

Objective To explore the alteration of insulin signal transduction in drowning-induced stress hyperglycemia and to investigate therapeutic effect of insulin on it.Methods Stress hyperglycemia model was induced by drowning.Thirty-two infant rats were randomized into control,drowning,air resuscitation and air-insulin resuscitation groups.Insulin was injected abdominally into the air-insulin resuscitation rats.Fasting serum glucose and insulin were determined routinely,and protein expressions and serine phosphorylation levels of insulin receptor substrate 1(IRS-1) in muscle tissue were detected by Western blot and immunoprecipitation.The expressions of glucose transporter 4(GLUT4) in the intracellular and plasma membranes of muscle tissue were detected by Western blot.Results In the drowning group,insulin resistance index(HOMA-IR) increased significantly as compared with that of the control group,but the level of IRS-1 had no significantly change as compared with the other three groups.As compared with that of the drowning group(0.71±0.12),IRS-1 serine phosphorylation levels of the two resuscitation groups decreased significantly(0.56±0.13 and 0.46±0.08 respectively).The intracellular GLUT4 expression in the two resuscitation groups(1.82±0.11 and 1.96±0.28 respectively)increased significantly in contrast to that of the drowning group(1.45±0.15),and the air-insulin resuscitation groups showed an especially high increase of intracellular GLUT4 expression.Conclusion During the drowning-induced stress hyperglycemia,the alteration of serine phosphorylation and GLUT4 distribution is one of the important mechanism of insulin resistance.Insulin may decrease the blood glucose through decreasing serine phosphorylation levels of IRS-1 and increasing the intracellular GLUT4 expressions.     

幼年大鼠溺水应激后胰岛素信号传导变化及外源胰岛素治疗反应

Objective To explore the alteration of insulin signal transduction in drowning-induced stress hyperglycemia and to investigate therapeutic effect of insulin on it.Methods Stress hyperglycemia model was induced by drowning.Thirty-two infant rats were randomized into control,drowning,air resuscitation and air-insulin resuscitation groups.Insulin was injected abdominally into the air-insulin resuscitation rats.Fasting serum glucose and insulin were determined routinely,and protein expressions and serine phosphorylation levels of insulin receptor substrate 1(IRS-1) in muscle tissue were detected by Western blot and immunoprecipitation.The expressions of glucose transporter 4(GLUT4) in the intracellular and plasma membranes of muscle tissue were detected by Western blot.Results In the drowning group,insulin resistance index(HOMA-IR) increased significantly as compared with that of the control group,but the level of IRS-1 had no significantly change as compared with the other three groups.As compared with that of the drowning group(0.71±0.12),IRS-1 serine phosphorylation levels of the two resuscitation groups decreased significantly(0.56±0.13 and 0.46±0.08 respectively).The intracellular GLUT4 expression in the two resuscitation groups(1.82±0.11 and 1.96±0.28 respectively)increased significantly in contrast to that of the drowning group(1.45±0.15),and the air-insulin resuscitation groups showed an especially high increase of intracellular GLUT4 expression.Conclusion During the drowning-induced stress hyperglycemia,the alteration of serine phosphorylation and GLUT4 distribution is one of the important mechanism of insulin resistance.Insulin may decrease the blood glucose through decreasing serine phosphorylation levels of IRS-1 and increasing the intracellular GLUT4 expressions.     

幼年大鼠溺水应激后胰岛素信号传导变化及外源胰岛素治疗反应

目的 探讨溺水应激大鼠的胰岛素信号转导变化及外源胰岛素治疗反应.方法 采用溺水的方法建立应激性高血糖动物模型,32只幼年大鼠随机分为对照组、溺水窒息组、空气复苏组、空气复苏联合胰岛素治疗组.空气复苏联合胰岛素治疗组在复苏时注射胰岛素.在溺水并复苏过程中测定大鼠血糖、胰岛素、骨骼肌胰岛素受体底物1(IRS-1)及其丝氨酸磷酸化水平,检测骨骼肌内外膜的葡萄糖转运体4(GLUT4)蛋白含量.结果 溺水组胰岛素抵抗指数升高,产生严重的胰岛素抵抗,IRS-1含量无显著改变;空气复苏组与空气复苏联合胰岛素治疗组的IRS-1丝氨酸磷酸化水平(分别为0.56±0.13、0.46±0.08)均低于溺水窒息组(0.71±0.12),差异有显著性(P＜0.05);外膜的GLUT4蛋白含量(分别为1.82±0.11、1.96±0.28)显著高于溺水窒息组(1.45±0.15),尤以空气复苏联合胰岛素治疗组的变化更为显著.结论 在溺水窒息导致的应激性高血糖过程中,IRS-1丝氨酸磷酸化、GLUT4表达异常是胰岛素抵抗的重要调控点之一.胰岛素能改善IRS-1丝氨酸磷酸化及GLUT4内外膜分布,达到降低血糖的作用.     

重症肺炎患儿凝血功能变化的临床研究

重症肺炎居儿科住院疾病中死亡的首位。先天性心脏病合并肺炎的患儿由于肺血流量增多,肺动脉高压导致的通气／血流比例失调等原因易出现心肺功能衰竭心。同时由于低氧血症、感染及毒素等可引起全身小动脉痉挛、高黏滞血症和微循环障碍,最终可引起弥散性血管内凝血（DIC）,