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.     

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.     

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.     

婴幼儿闭塞性细支气管炎的肺功能改变

目的 观察婴幼儿闭塞性细支气管炎的肺功能变化情况. 方法 应用婴幼儿体描仪,对46例患闭塞性细支气管炎婴幼儿于吸入沙丁胺醇前后进行肺功能检测. 结果 46例患儿吸入沙丁胺醇前潮气呼吸流速-容量环呼气降支凹陷;达峰容积比(VPEF/VE)、达峰时间比(tPTEF/tE)、吸呼气时间比(ti/te)和每千克体重呼吸系统顺应性(Crs/kg)降低;呼吸系统阻力(Rrs)和每千克体重功能残气量(FRC/kg)增加;而中期流速比(TEF50/TIF50)有18例降低,28例正常.46例患儿吸入沙丁胺醇后达峰容积比、达峰时间比等肺功能指标均无明显改善. 结论 婴幼儿闭塞性细支气管炎肺功能是以小气道为主的阻塞性通气功能障碍,舒张试验阴性.肺功能测定能很好地反映本病病情.     

儿童良性中央气道狭窄133例病因分析

目的 分析儿童良性中央气道狭窄病因构成. 方法 回顾性收集2007-01～2009-12北京儿童医院良性中央气道狭窄患儿的临床资料,分析其一般临床资料、CT气道三维重建及增强CT等影像资料及支气管镜下气道狭窄特点. 结果 共收集133例良性中央气道狭窄患儿的临床资料,男84例,女49例,其中婴幼儿占116例(87.2%,116/133).其病因构成主要依次为先天性心血管畸形(58.7%,78/133)、原发性肺结核伴或不伴有支气管结核(15.0%,20/133)、先天性肺发育不良(4.5%,6/133)等. 结论 儿童良性中央气道狭窄病因构成以先天性心血管畸形最为常见,先天性气管支气管狭窄的主要原因为血管环畸形,后天因素中以原发性肺结核所致狭窄最为常见.气管插管或气管切开后所致气道狭窄较为少见.     

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.     

儿童钡剂误吸病例分析及儿科纤维支气管镜治疗临床效果评估

目的探讨儿童钡剂误吸的原因及纤维支气管镜灌洗治疗的效果评估。方法研究对象为2002年2月至2006年10月在北京儿童医院被确诊为钡剂误吸14例患儿，对其进行回顾性分析，并进行追踪随访。结果①儿童钡剂误吸的发生以婴幼儿为主，新生儿期发生最多，其次为小婴儿，学龄儿少见；③吞咽功能不协调，胃、食管反流是造成钡剂误吸的主要原因；③儿童钡剂误吸的临床表现轻重程度与钡剂吸入量、发生误吸后与原发病的相互作用及治疗开始时间有关；④儿科纤维支气管镜灌洗治疗，可以有效洗出误吸钡剂。结论①儿童钡剂误吸的发生与年龄有关；②本组全部钡剂误吸儿童均为医源性；③早期、多次儿科纤维支气管镜灌洗治疗钡剂误吸有确切疗效。     

儿童肺结核支气管肺泡灌洗液Xpert MTB/RIF检测的诊断准确性研究

目的探讨支气管肺泡灌洗液的Xpert MTB/RIF检测对儿童肺结核的诊断价值。方法有疑似活动性结核病的临床症状和体征，行纤维支气管镜检查并留取了支气管肺泡灌洗液的患儿为研究对象。以支气管肺泡灌洗液作为病原学检测标本，分别以病原学诊断活动性结核病和临床诊断活动性结核病为金标准，以Xpert MTB/RIF为待测标准，考察Xpert MTB/RIF对病原学和临床诊断结核的诊断价值。基于样本中结核分枝杆菌（MTB）的Ct值反映所检测样本中MTB的载量；通过对利福平耐药位点的检测，对MTB菌株进行药物敏感性检测。结果符合本文纳入标准的疑似结核病患儿351例，男198例，女153例，年龄（5.9±3.9）岁。肺结核患儿125例，其中病原学诊断结核43例（34.4%），临床诊断结核82例（65.6%）；肺结核合并支气管结核51例（40.8%），单纯肺结核74例（59.2%）；非结核呼吸道感染性疾病226例，肺炎支原体肺炎187例（82.7%），细菌性肺炎39例（17.3%）。Xpert MTB/RIF在病原学诊断和临床诊断结核的敏感度分别为79%(95%CI：63%~89%)和51%(95%CI：40%~62%)，差异有统计学意义（χ2=9.18，P=0.002）；肺结核合并支气管结核的敏感度为80%（66%~90%),单纯肺结核的敏感度47%(35%~59%)；病原学诊断和临床诊断结核、合并支气管结核和单纯肺结核特异度均为100%(95% CI：97.9%~100%)。Xpert MTB/RIF检测病原学诊断结核敏感度高于临床诊断结核，肺结核合并支气管结核敏感度高于单纯肺结核，差异有统计学意义（χ2=13.88，P<0.001）；支气管肺泡灌洗液的MTB核酸检出载量病原学诊断结核高于临床诊断结核，差异有统计学意义（χ2=7.37，P=0.025）。76例Xpert MTB/RIF检测阳性患儿中，利福平耐药2例（2.6%）。结论支气管肺泡灌洗液的Xpert MTB/RIF检测在儿童肺结核诊断中具有较高价值，可在缺乏细菌学诊断证据的临床诊断结核病儿童中发现MTB，具有较高的敏感度，有助于提高儿童结核病病原学检出率。     

������ͯ��������ͯ˯������״������Ƚ�

目的初步调查北京地区2~12岁健康儿童和哮喘儿童中睡眠呼吸障碍常见症状的发生率,比较二者的差异。方法2002年6月至2003年6月间对北京6个近郊区县随机整群抽取6193例2~12岁健康儿童和北京儿童医院呼吸疾病专业门诊随机抽取的200例2~12岁缓解期哮喘儿童,由专人负责对家长进行儿童睡眠状况问卷调查。结果哮喘儿童睡眠障碍症状发生率为47·0%(94例)。其中睡眠频繁鼾症发生率为11·0%(22例),喉头哽咽1·5%(3例),张口呼吸13·0%(26例),睡眠呼吸暂停1·5%(3例),磨牙8·0%(16例),梦呓7·0%(14例),梦游0·5%(1例),睡眠中肢体抽动4·0%(8例),睡眠不安28·5%(57例)。哮喘儿童睡眠障碍发生率较无呼吸道疾病的正常儿童高,其中睡眠频繁打鼾、睡眠不安、张口呼吸和睡眠呼吸暂停的发生率差异存在显著性意义(P<0·05)。结论哮喘儿童睡眠障碍发生率高于无呼吸道疾病的正常儿童,其中睡眠频繁打鼾、睡眠不安、张口呼吸和睡眠呼吸暂停的发生率差异存在显著性意义,应引起重视。对哮喘儿童睡眠障碍的防治应进行进一步研究。     

��Ѫ����104���ٴ��ع˷���

目的分析儿童咯血病因构成、临床特点及支气管镜表现。方法收集2002年1月至2011年3月于北京儿童医院住院治疗的104例咯血患儿临床资料,分析其临床特点、影像学特点和支气管镜表现,总结儿童咯血的病因构成。结果 104例中特发性肺含铁血黄素沉着症24例、支气管炎29例、肺炎11例、支气管扩张症7例、支气管内膜结核3例、支气管异物5例、支气管动脉肺动脉瘘6例、肺静脉闭塞或缺如3例、疑诊支气管-肺血管发育异常10例(未行血管造影确诊)、肺囊性腺瘤样畸形1例、支气管黏液表皮样癌1例、支气管炎性假瘤1例、韦格纳肉芽肿1例、未分化结缔组织病1例、抗中性粒细胞胞浆抗体(ANCA)相关性小血管炎1例。结论儿童咯血病因复杂,需要结合咯血特点、影像学和支气管镜检查进行诊断和鉴别诊断,急慢性下呼吸道感染、特发性肺含铁血黄素沉着症和先天性支气管肺血管发育异常是引起儿童咯血主要病因。