间断静脉滴注3%高渗盐水与20%甘露醇治疗小儿急性脑水肿的疗效对比

Objective To compare the clinical efficacy of 3% hypertonic saline with 20% mannitol in the treatment of acute brain edema in children.Methods Twenty children with acute brain edema were randomly divided into hypertonic saline(HS) group and mannitol group.HS group and mannitol group were given 3% HS solution or 20% mannitol respectively.Main outcome measurements included intracranial pressure(ICP),mean arterial pressure(MAP),central venous pressure(CVP),cerebral perfusion pressure (CPP),serum electrolytes,plasma osmolality,renal function and urine volume.Results Both 3% HS and 20% mannitol were effective in reducing ICP(P ＜0.05).Therapeutic effect lasted(4.5±1.2) h in HS group and(3.2±1.5) h in mannitoi group.3% HS had a longer duration of action than marmitol(P＜0.05).At the time point of 2 hours after treatment,MAP and CPP of HS group increased more than those of mannitol group(P＜0.05).Conclusion Both 3% HS and 20% mannitol could rapidly decrease ICP.3% HS has a longer duration of action in reducing ICP than 20% mannitol.3% HS is more effective in stabilizing circulation and improving CPP than 20% mannitol.     

RSV毛细支气管炎外周血嗜酸粒细胞与婴幼儿哮喘关系

目的:婴幼儿呼吸道合胞病毒(RSV)毛细支气管炎急性期外周血嗜酸粒细胞增多对预测今后发生婴 幼儿哮喘是否有意义。方法:检测60例首次患RSV毛细支气管炎婴幼儿急性期外周血嗜酸粒细胞的绝对及相对计数,并在该组患者3周岁时进行电话随访,根据毛细支气管炎发病后有无反复发作喘息将随访到的43例患儿分成3组:无喘息发作、可疑哮喘组、哮喘组,同时记录哮喘家族史。结果:哮喘组RSV毛细支气管炎急性期嗜酸粒细胞数(M,98//mm3)明显多于无喘息发作组(0/mm3)和可疑哮喘组(0/mm3),RSV毛细支气管炎急性期嗜酸粒细胞增多与无嗜酸粒细胞增多比较,今后发生婴幼儿哮喘的比率差异显著(P<0.05),而有无哮喘家族史、男女性别差异在发生哮喘的比率无明显差异(P>0.05)。结论:RSV毛细支气管炎急性期嗜酸粒细胞增多以后更易发生婴幼儿哮喘。     

间断静脉滴注3%高渗盐水与20%甘露醇治疗小儿急性脑水肿的疗效对比

Objective To compare the clinical efficacy of 3% hypertonic saline with 20% mannitol in the treatment of acute brain edema in children.Methods Twenty children with acute brain edema were randomly divided into hypertonic saline(HS) group and mannitol group.HS group and mannitol group were given 3% HS solution or 20% mannitol respectively.Main outcome measurements included intracranial pressure(ICP),mean arterial pressure(MAP),central venous pressure(CVP),cerebral perfusion pressure (CPP),serum electrolytes,plasma osmolality,renal function and urine volume.Results Both 3% HS and 20% mannitol were effective in reducing ICP(P ＜0.05).Therapeutic effect lasted(4.5±1.2) h in HS group and(3.2±1.5) h in mannitoi group.3% HS had a longer duration of action than marmitol(P＜0.05).At the time point of 2 hours after treatment,MAP and CPP of HS group increased more than those of mannitol group(P＜0.05).Conclusion Both 3% HS and 20% mannitol could rapidly decrease ICP.3% HS has a longer duration of action in reducing ICP than 20% mannitol.3% HS is more effective in stabilizing circulation and improving CPP than 20% mannitol.     

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。     

婴幼儿先天性心脏病矫治术后芬太尼联合咪唑安定的镇痛效果观察

目的观察应用静脉持续泵注芬太尼联合咪唑安定，在小儿先天性心脏病矫治术后镇痛的效果及不良反应。方法选择40例择期行先天性心脏病矫治术婴幼儿随机分为镇痛组和对照组，各20例。镇痛组用芬太尼0.5—2μg／（kg·h）持续静脉微量泵注入；对照组给予布洛芬5—8mg／（kg·次）。两组均用咪唑安定0．01—0．2mg／（kg·h）静脉持续微量泵注入或0.05～0．1mg／（kg·次）间断静脉推注镇静。观察术后2、8、24、48h的镇静、镇痛效果同时行Ramsay、Comfort评分；观察恶心、呕吐、心率及血压下降、呼吸抑制等的不良反应情况。结果镇痛组和对照组术后2、8、24h，两组Ramsay、Comfort评分差异显著（P〈0．05），而48h两组Ramsay、Comfort评分无显著差异。镇痛组20例患儿中有1例出现一过性心率减慢、血压下降，数分钟后恢复。未用机械呼吸患儿用药期间未发现呼吸抑制、喉痉挛等不良反应。镇痛组、对照组无恶心、呕吐、消化道出血等不良反应。结论婴幼儿心内直视术后应用芬太尼联合咪唑安定持续静脉泵注在婴幼儿先心术后早期可以达到良好的镇静镇痛效果，安全有效并值得在临床推广。     

呼吸道合胞病毒毛细支气管炎免疫发病机制的研究

目的　研究呼吸道合胞病毒毛细支气管炎 (简称RSV毛支 )免疫发病机制。方法　对 12例确诊为呼吸道合胞病毒毛细支气管炎急性期患儿 (毛支组 )和 10例年龄匹配的健康婴幼儿 (对照组 )外周血T细胞亚群和单核细胞 (PBMC)分泌的细胞因子IFN -γ和IL - 4进行检测。结果　毛支组CD8+T淋巴细胞和NK细胞明显低于对照组 (P <0 0 2 ,0 0 1) ,CD3+T、CD4 +T、CD4 +T/CD8+T与对照组比较无显著差异 (P >0 0 5 )。毛支组IFN -γ水平明显低于对照组 (P <0 0 1) ,IL - 4,IL - 4/IFN -γ较对照组明显增高 (P <0 0 1,0 0 1) ,且IFN -γ与IL - 4呈负相关 (r =- 0 81,P <0 0 5 ) ;毛支组中特应征 +患儿与特应征 -比较 ,前者IFN -γ明显降低 (P <0 0 1) ,IL - 4和IL - 4/IFN -γ明显增高 (P <0 0 1,0 0 5 )。结论　RSV毛支急性期存在Th1/Th2 平衡紊乱 ,表现Th2 优势应答 ,与遗传特应征与细胞因子分泌异常有一定关系 ,同时NK和CD8+T细胞在RSV毛支免疫发病机制中也起重要作用。     

小儿死亡危险评分的临床应用

目的观察小儿死亡危险评分(PRISM评分)与PICU急性危重症患儿预后的关系。方法对2003年2-10月PICU收治急性危重症45例,回顾性评定PRISM评分,并依据评分分组,记录患儿临床资料和住院时间、预后。结果PRISM 评分<15分24例,>15分21例。两组年龄、体质量和院内感染率均无显著差异(P均>0.05)。两组死亡率分别为8.1%(2/ 24例)和38.1%(8/21例),PRISM评分<15分组死亡率明显低于>15分组(x2=4.14 P<0.05)。PRISM>15分组存活病例住院天数(13.2±6.1)d显著长于PRISM<15分组(9.7±8.5)d(t=1.74.P<0.05)。结论PRISM评分越高,死亡率随之增加。PRISM评分增高,患儿住院时间越长。PRISM评分能够准确评估急性危重症病人的严重程度和预后。     

间断静脉滴注3%高渗盐水与20%甘露醇治疗小儿急性脑水肿的疗效对比

Objective To compare the clinical efficacy of 3% hypertonic saline with 20% mannitol in the treatment of acute brain edema in children.Methods Twenty children with acute brain edema were randomly divided into hypertonic saline(HS) group and mannitol group.HS group and mannitol group were given 3% HS solution or 20% mannitol respectively.Main outcome measurements included intracranial pressure(ICP),mean arterial pressure(MAP),central venous pressure(CVP),cerebral perfusion pressure (CPP),serum electrolytes,plasma osmolality,renal function and urine volume.Results Both 3% HS and 20% mannitol were effective in reducing ICP(P ＜0.05).Therapeutic effect lasted(4.5±1.2) h in HS group and(3.2±1.5) h in mannitoi group.3% HS had a longer duration of action than marmitol(P＜0.05).At the time point of 2 hours after treatment,MAP and CPP of HS group increased more than those of mannitol group(P＜0.05).Conclusion Both 3% HS and 20% mannitol could rapidly decrease ICP.3% HS has a longer duration of action in reducing ICP than 20% mannitol.3% HS is more effective in stabilizing circulation and improving CPP than 20% mannitol.     

镇静镇痛对先天性心脏病婴幼儿术后应激反应的影响

目的探讨小儿先天性心脏病体外循环下心内直视术后镇静镇痛对机体应激反应的影响。方法选择40例择期行先天性心脏病矫治术的患儿,随机分为镇痛组和对照组,各20例。镇痛组应用芬太尼0.5～2.0μg/(kg.h)持续静脉微量泵注入;对照组口服布洛芬5～8mg/(kg.次)。二组均用盐酸咪达唑仑0.01～0.20mg/(kg.h)静脉持续微量泵注入或0.05～0.10mg/(kg.次)间断静脉推注镇静。观察二组术后2、8、24、48h的镇静、镇痛效果,同时检测二组血皮质醇、生长激素、胰岛素和血糖的应激指标水平;观察二组恶心、呕吐、心率及血压下降、呼吸抑制等不良反应情况;评估镇静镇痛对患儿术后应激反应的影响。结果2组在术后2、8、24h行Ramsay、Comfort评分均有显著性差异(Pa<0.05)。镇痛组和对照组术后2、8、24、48h,血皮质醇、生长激素、胰岛素和血糖与术前比较均升高且差异显著(Pa<0.05)。镇痛组术后2、8、24、48h血皮质醇、生长激素、血糖水平均低于对照组。镇痛组8h血皮质醇、血糖,24h血皮质醇、生长激素和血糖,48h血糖水平与对照组相应时点指标比较均有显著性差异(Pa<0.05)。结论婴幼儿心内直视术后存在应激反应,应用芬太尼联合盐酸咪达唑仑持续静脉泵注的术后镇静镇痛可在一定程度上减轻婴幼儿心内直视术后的应激反应,且不良反应较小,有利于患儿顺利度过围术期。     

间断静脉滴注3%高渗盐水与20%甘露醇治疗小儿急性脑水肿的疗效对比

Objective To compare the clinical efficacy of 3% hypertonic saline with 20% mannitol in the treatment of acute brain edema in children.Methods Twenty children with acute brain edema were randomly divided into hypertonic saline(HS) group and mannitol group.HS group and mannitol group were given 3% HS solution or 20% mannitol respectively.Main outcome measurements included intracranial pressure(ICP),mean arterial pressure(MAP),central venous pressure(CVP),cerebral perfusion pressure (CPP),serum electrolytes,plasma osmolality,renal function and urine volume.Results Both 3% HS and 20% mannitol were effective in reducing ICP(P ＜0.05).Therapeutic effect lasted(4.5±1.2) h in HS group and(3.2±1.5) h in mannitoi group.3% HS had a longer duration of action than marmitol(P＜0.05).At the time point of 2 hours after treatment,MAP and CPP of HS group increased more than those of mannitol group(P＜0.05).Conclusion Both 3% HS and 20% mannitol could rapidly decrease ICP.3% HS has a longer duration of action in reducing ICP than 20% mannitol.3% HS is more effective in stabilizing circulation and improving CPP than 20% mannitol.