注意缺陷多动障碍共患数学学习困难儿童韦氏儿童智力结构特征

目的探讨合并数学困难(mathematical difficulties,MD)的注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)儿童在韦氏儿童智力量表第四版(Wechsler Intelligence Scale for Children-The Fourth Vision,WISC-Ⅳ)中的智力结构特征。方法选取根据美国《精神障碍诊断和统计手册第四版》(Diagnostic and Statistical Manual,DSM-Ⅳ)诊断标准确诊为ADHD且数学成绩低于同年级P10、语文成绩不低于同年级P50的儿童30名,并按性别、年龄匹配抽取确诊为ADHD且语文、数学成绩不低于同年级P25的30名作为对照组。使用WISC-Ⅳ对两组儿童的智力结构特点进行比较。结果研究组儿童总智商及四指数均低于对照组儿童(P0.05),两组儿童在字母-数字排序、背数、译码、矩阵推理、积木、理解等分测验的差异有统计学意义(P0.05)。结论 WISC-Ⅳ可以全面评估儿童的一般认知功能,MD-ADHD儿童有独特认知特点,应根据与数学能力相关的认知缺陷进行个体化的科学干预。     

肺表面活性物质替代治疗与支气管肺发育不良的关系

Objective To explore, the effect of different dosage of pulmonary surfactant (PS) on the inci-dence of bronchopulmanary dysplasia. Method Four hundred and three premature infants with hyaline membrane disease were divided into 3 groups according to the dose of PS: low-dose group (L-PS group, ≤ 100 mg/kg, n =188) ,high-dose group(H-PS group, > 100 mg/kg, n = 94) and no-PS group (N-PS group, n = 121). The frac-tional inspired oxygen(FiO2) and ptlmonary oxygenating function before and after 6 hours treatment were observed and the durations of oxygen therapy and mechanical ventilation, frequency of repeated intubafion, length of hospi-talization and the incidence of BPD were compared among the three groups. Results After 6 hours PS administra-tion, the FiO2,oxygen index and duration of oxygen therapy and mechanical ventilation were significantly decreased (P <0.05), while PO2 and the arterio-alveolar partial pressure of oxygen were significantly increased (P <0.05)in the H-PS and L-PS groups, compared with the N-PS group. Compared with the L-PS and N-PS groups,the H-PS group showed a decreased incidence of BPD. Conclusions PS administration could improve the pul-monary oxygenation and prevent the development of BPD, especially in high-dose.     

新生儿出生头围影响因素分析

目的 探讨新生儿出生头围的影响因素,为建立新生儿头围正常参考值范围样本筛选,制定小头畸形诊断标准提供科学依据。方法 收集2014年1月-2017年12月广东省某医院分娩新生儿信息,对48 928例活产单胎新生儿资料使用t检验/单因素方差分析和多因素广义线性回归进行统计分析。结果 新生儿的平均出生头围为(33.4±1.7)cm。新生儿胎龄越大、剖宫产分娩、男性、羊水过多和产妇年龄越大、籍贯隶属北方省份、多孕、多产、合并妊娠期糖尿病导致新生儿出生头围偏大(P<0.05)。新生儿宫内生长受限、脐带绕颈、脐带扭转、羊水过少和产妇妊娠期合并高血压疾病、胆汁淤积症、贫血导致新生儿出生头围偏小(P<0.05)。新生儿结构异常、辅助生殖受孕、羊水浑浊和产妇甲状腺功能异常、瘢痕子宫、前置胎盘和生殖道感染对头围无显著影响(P>0.05)。结论 新生儿出生头围影响因素众多,在制定出生头围正常参考值范围时,除了考虑生理因素的差异,还应排除有相关疾病因素的样本,如宫内生长受限、妊娠期合并症(妊娠期糖尿病、高血压疾病、胆汁淤积症、贫血)、羊水异常、脐带异常等,以确保参考值范围的科学性。     

肺表面活性物质替代治疗与支气管肺发育不良的关系

Objective To explore, the effect of different dosage of pulmonary surfactant (PS) on the inci-dence of bronchopulmanary dysplasia. Method Four hundred and three premature infants with hyaline membrane disease were divided into 3 groups according to the dose of PS: low-dose group (L-PS group, ≤ 100 mg/kg, n =188) ,high-dose group(H-PS group, > 100 mg/kg, n = 94) and no-PS group (N-PS group, n = 121). The frac-tional inspired oxygen(FiO2) and ptlmonary oxygenating function before and after 6 hours treatment were observed and the durations of oxygen therapy and mechanical ventilation, frequency of repeated intubafion, length of hospi-talization and the incidence of BPD were compared among the three groups. Results After 6 hours PS administra-tion, the FiO2,oxygen index and duration of oxygen therapy and mechanical ventilation were significantly decreased (P <0.05), while PO2 and the arterio-alveolar partial pressure of oxygen were significantly increased (P <0.05)in the H-PS and L-PS groups, compared with the N-PS group. Compared with the L-PS and N-PS groups,the H-PS group showed a decreased incidence of BPD. Conclusions PS administration could improve the pul-monary oxygenation and prevent the development of BPD, especially in high-dose.     

早产儿血钙,磷,镁,铁变化的临床意义初探

本文通过测量早产儿血微量元素钙、磷、镁、铁，并将足月儿与不同孕周、不同体重的早产儿进行比较，结果发现早产儿血钙高于足月儿，提示临床如无症状，可无需补钙；而早产儿血磷、镁、铁明显低于足月儿，提示应常规监测血微量元素，必要时及时补充镁及铁剂。     

新生儿神经行为评分的围产期影响因素研究

目的 探讨新生儿神经行为能力及其相关围产期影响因素.方法 应用鲍秀兰等建立的新生儿神经行为评定法（neonatal behavioral neurological assessment,NBNA）对298例足月儿进行新生儿神经行为能力评定,使用自编的“基本资料调查问卷”收集新生儿及其家庭资料.以NBNA总分为因变量,19项围产期影响因素为自变量,采用Logistic回归分析筛选影响因素.结果 新生儿NBNA评分的合格率为99.33％,孕周及孕期情绪为新生儿NBNA得分的有利因素,偏回归系数分别为-0.41和-0.33,而孕妇年龄则为新生儿NBNA得分的不利因素.结论 孕周长和孕期情绪好可促进新生儿神经行为发育,而孕妇年龄大则对其神经行为发育造成影响.     

面罩储雾罐经鼻吸入糖皮质激素同步治疗小儿变应性鼻炎并哮喘

Objective To assess the effixacy of a nasally inhaled corticosteroid(ICS) through a spacer with mask aiming at simultaneou treatment of allergic rhinitis and asthma in children and make an analysis on the costs.Method A total of 72 children with allergic rhinitis (AR) and asthma were randomized into two groups.Experimental group received budesonide inhaler(400 μg/d) through the nose using a spacer attached to a face mask,control group children orally inhaled budesonide dry powder (400μg/d) plus a nasal spray of budesonide aquae(256μg/d).Result The patients were obsenred for 12 weeks.The symptom scores of rhinitis of both experimental group and control group declined(F=6.529 and 7.014,all P<0.01),symptom scores of asthma in both group were also reduced(F=4.132 and 4.950,P<0.01).The pulmonary function PEF(L/win)in both groups continuously increased(F=2.750 and 3.282,P<0.05).But the clinical scores,PEF value and FEVl all did not differ between the two groups at admission or at nearly all follow-up visits(P>0.05 for all).The proportion of dry nose was lower in experimental group than in the control group(5.6% vs.19.4%),but the difference was not statistically significant.The cost in the experimental group was lower than that in the control group(P<0.01).Condusion Nasal inhalation of ICS provides a therapeutic strategy for controlling AR and asthula in children,especially it result in higher compliance,lower costs,and fewer side effects.     

新生儿区域转运与NICU

目的：探讨区域转运与NICU的关系。方法：通过转运危重新竽儿的数字,病种分布及其抢救成功率,对区域转运与NICU进行分析。结果：4年间NICU收治危重患儿1080例,其中从外院转运的患儿占923例（85.46%）;抢救成功991例（91.76%),死亡17例（1.58%）,放弃72例（6.66%)。结论：建立有效的区域转运,可使NICU资源得到充分利用,大大提高危重患儿的抢救成功率;同时建立NICU也为转运提供了坚实的后盾。     

危重新生儿转运系统运作945例临床分析

１９９３年下半年起,广东省妇幼保健院在国内率先成立危重新生儿抢救网络,ＮＩＣＵ与附近３２家医院建立了有关的业务联系,并配置整套抢救设备前往各基层医院,负责接收和转运危重的新生儿。几年来共接运病儿９４５人次,占同期总住院病人的６３．５１％。接运病人中占前３位的病种分别为新生儿窒息、呼吸系统疾病和早产儿（共占８５．７１％）。广东省妇幼保健院与基层医院共同拟定转运标准,然后各医院再根据院况修改转运标准。体会：①开展转运工作成功的关键在于转运途中的技术保证;②提高转运的治疗成功率需各方面的通力协作,转运前的各种处理同样很重要;③设立区域性新生儿重症监护中心（ＮＩＣＵ）对降低新生儿死亡率和致残率非常有效,各基层医院应重视危重病人的转运工作;④要提高产科监护技术,大力推广新法复苏,降低窒息发生率;⑤提倡宫内转运到有较高水平的ＮＩＣＵ的医院产科分娩对降低早产和窒息的发病率和死亡率都将非常有意义。     

比色卡提高医生对陶土色大便识别的调查研究

目的了解大便比色卡能否提高医生对陶土色大便的识别率及医生对胆道闭锁的认知情况。方法采用自行设计的电子问卷对儿童保健科医生进行问卷调查。问卷中列出12张大便照片,包括5张正常婴儿大便和7张胆道闭锁患儿的陶土色大便,提供大便比色卡比对前后,请医生辨认颜色正常大便或不正常大便,同时调查胆道闭锁相关知识。结果共收集问卷200份,参与问卷调查者来自国内24个省市的医疗单位,90名(45. 0%)医生首次能正确识别出所有陶土色大便。仅有113名(56. 5%)医生接诊黄疸患儿时关注大便颜色,87名(43. 5%)医生接诊黄疸患儿较少或不关注大便颜色,96名(48. 0%)医生对胆道闭锁这个疾病不熟悉,50名(25. 0%)医生错误地认为胆道闭锁以间接胆红素升高为主,104名(52. 0%)医生未听说过大便比色卡。在提供大便比色卡比对后,儿童保健科医生识别陶土色大便照片为异常大便的总体比例从81. 9%提高到93. 8%,并且对于图1中的2号、3号、6号、9号、11号陶土色大便照片正确识别率均有明显提高(P 0. 05)。经过大便比色卡对比后,三级医院儿童保健科医生识别陶土色大便照片为异常大便的总体比例从83. 7%提高到93. 1%(P 0. 05);一、二级医院儿童保健科医生识别陶土色大便照片为异常大便的总体比例从80. 3%提高到94. 4%(P 0. 05)。按医生职称分为主治医师及以下组和副主任医师及以上组,经过大便比色卡对比后,两组医生对陶土色大便正确识别率明显升高(P 0. 05)。结论儿童保健科医生对胆道闭锁认识和警惕性不足,大便比色卡能提高医生对陶土色大便的正确识别率,推广大便比色卡的应用及加强对于胆道闭锁基础知识的宣传及学习非常必要。