小儿急性肺损伤的短期肺功能随访

Objective To study the pulmonary functions of pediatric ALI/ARDS(acute lung injury/acute respiratory distress syndrome) survivors. Method A prospective cohort study of all survivors of ALI/ARDS in the PICU of Beijing Children's Hospital was performed. Patients were divided into three groups(0-3 years of age,3 ～ 7 years of age, and over 7 years of age) and followed up three months after diagnosis. Results There were 36 survivors in total of 44 ALl patients, three patients lost follow-up, 12 died and 21 survived. Five survivors refused to participate in the study because of asymptomatic, and one was unable to participate because of lymphoma com-bined with sepsis. A total of 15 children completed the whole survey (11 patients were less than 3 years old, andfour were over 7 years of age). Twelve patients had no discomfort in their respiratory tracts. Three months after be-ing enrolled, the pulmonary functions of all children improved, especially in terms of tidal volume and respiratory compliance (P<0.05). Conclusions The abnormal respiratory symptoms and signs in most children disap-peared three months after discharge. Most survivors still have pulmonary dysfunction at 3 monthes after discharge, but better than discharge.     

儿科急重症医学:挑战与未来

2008年,对我国儿科急重症医学工作者来说是极不平凡的一年.手足口病[1]、汶川大地震、三聚氰胺[2-3]事件的序贯出现,都无可置疑地将儿科急重症医学工作者推上抗击儿童突发公共卫生事件及灾难性事件的前沿.     

儿茶酚胺类药物对感染性休克兔胃肠灌注的影响

Objective To assess the effects of dopamine,dobutamine and norepinephrine on the P(g-a)CO2 and superior mesenteric blood flow in septic shock.Methods Rabbit septic shock model was established by challenging with intravenous injection of lipopolysaccharides from Escherichia coil(2 mg/kg).The rabbits with septic shock were randomly assigned to 3 groups-dopamine group(n = 8),dobutamine group(n = 8) and norepinephrine group(n = 8).Apart from volume resuscitation with normal saline solution [20 ml/(kg· h)]，dopamine[5μg/(kg·min)],dobutamine[(5μg/(kg·min)]and norepinephrine [(1μg/(kg·min)]were infused in dopamine group,dobutamine group and norepinephrine group respeclively.Cardiac index(CI) and superior mesenteric blood flow index(SMBFI) were continuously monitored by doppler flowrneter.Gastric mucosal PCO2 was evaluated by gas tonometry every 10 min.Arterial and venous blood gas analyses and lactate levels were measured every 1 h.Results MAP,CI,and SMBFI significandy decreased and P(g-a) CO2 increased after lipopolysaccharides infusion in three groups.After 2-hour treatment,MAP in norepinephrine group[(70 +3) mm Hg]was higher than that of dopamine group[(66±4) mm Hg]and dobutamine group[(65±4) mm Hg](P ＜0.05).SMBFI in norepinephrine group [(18.7±2.9) ml/(kg·min)]was higher than that of dopamine group[(16.2±1.6) ml/(kg·min)]and dobutamine group[(15.8±1.9) ml/(kg·min)](P＜0.05).P(g-a) CO2 in norepinephrine group [(30±6) mm Hg]was lower than that of dobutamine group[(23±5)mm Hg](P＜0.05).Condnsion As an adjuvant therapy of volume resuscitation,norepinephrine is more effective than low dose dopamine and dobutamine in improving splanchnic perfusion.     

运用模拟器械替代活体病人进行技能训练的探讨

运用模拟器械替代活体病人进行技能训练的目的是为了寻求医学生临床阶段基本技能训练难题的解决办法。主要是应用人体模型和模拟器械替代在活体病人身上进行临床技能训练和临床能力培训,为学生创造练习及掌握基本操作技能的机会。该方法适应了医学模式的转化,体现了以人为本的理念,是临床技能培训改革的方向。     

糖皮质激素在呼吸系统危重症中的应用现状

自从1949年Hench应用可的松治疗类风湿性关节炎获得成功以来，糖皮质激素在临床许多疾病的治疗中起到举足轻重的作用。但激素是一组具有多种生理功能的活性物质，对机体各脏器机能均有广泛的作用和影响。因此，严格掌握应用适应证、选择合适的激素制剂、剂量和疗程对强化治疗效果、减少不良反应非常重要。本文就近年来激素在呼吸系统危重症治疗中的应用现状作一介绍。     

第七届全国儿科危重症研讨会会议纪要

中华医学会急诊医学分会儿科学组和中华医学会儿科学分会急诊学组于 2 0 0 2年 9月 12— 15日在四川省成都市召开了第七届全国儿科危重症研讨会。来自全国 2 2个省、市、自治区(含台湾 )及新加坡的 2 0 0余名代表参加了会议。会议共收到论文 30 0余篇 ,大会发言 30篇 ,12位专家作了 13项专题讲座。会议期间广泛探讨了儿科各系统危重症的诊治 ,同时也对“循证医学”及当前普遍关心的医疗体制改革、医患关系问题进行了交流。论文涉题范围广 ,质量较往年明显提高 ,某些研究直指国际医学发展前沿。本次会议就以下问题做了重点讨论。1　我国ＩＣ…     

急性颅内压增高与应激反应

急性颅内压增高是小儿常见的严重症侯 ,可由多种原因引起。颅高压不仅直接造成脑缺血缺氧 ,甚至脑疝 ,作为一种强应激原 ,还可引发全身应激反应 ,导致神经内分泌、血浆蛋白、甚至细胞分子水平的变化。目前关于颅高压应激反应的报道多偏重于脑外伤所致颅内压增高。适度应激反应对机体有保护作用 ,但应激反应过度则对机体有害 ,可能导致上消化道出血等并发症 ,一些患者甚至死于应激反应。本文重点讨论急性颅高压时常见的应激反应及处理原则。1　应激性胃肠道出血急性颅内压增高尤重度脑损伤所致颅高压患儿多伴有下丘脑和脑干损伤〔1〕,早期应…     

液体平衡状态与儿童脓毒性休克预后的关系

目的研究液体平衡状态与儿童脓毒性休克预后的关系,以便指导治疗并帮助判断预后。方法44例脓毒性休克患儿,开始抗休克治疗时进行小儿危重症评分,监测每日液体平衡状态,比较不同液体平衡状态与患儿预后的关系。结果开始抗休克治疗的5 d内发生液体负平衡组27例,25例存活;液体正平衡组17例,9例存活,液体负平衡组存活率明显高于正平衡组(P<0.01)。存活患儿有5例液体负平衡出现在治疗第1天,12例出现在第2天,5例出现在第3天,1例出现在第4天,2例出现在第5天,存活患儿液体负平衡多数发生在抗休克治疗的前3 d。结论脓毒性休克患儿抗休克治疗的前5 d内发生液体负平衡提示预后良好。     

儿科医生应重视儿童非意外伤害问题

儿童伤害是儿科医生,尤其是急诊、外科和儿童重症监护病房(pediatric intensive care unit,PICU)医生常见的临床问题之一.按伤害发生意图可以分为意外伤害、非意外伤害两大类.临床上,对儿童意外伤害关注较多,对非意外伤害的临床研究相对较少.近年来,儿童非意外伤害案件频繁曝光,国家为此也修订相关法律,对相关问题讨论的必要性愈显突出.有鉴于此,笔者以儿科医生的视角围绕儿童非意外伤害流行病学、发生原因及危险因素、早期诊断、可疑病例的临床处理流程等展开阐述,并希望抛砖引玉,引起同道更多关注并进行更深入而全面的研究.     

6例集体重度氯气中毒患儿的多学科救治与护理

总结6例集体重度氯气中毒患儿的多学科救治与护理经验。包括成立多学科救护小组,实施肺通气保护策略,做好气道管理、眼部护理及有针对性的心理护理。通过专业的护理措施保证了重度氯气中毒患儿的治疗效果,6例患儿均痊愈出院。