紫绀型与非紫绀型先天性心脏病患儿心理学特征比较

目的 对比观察紫绀型与非紫绀型先天性心脏病(CHD)患儿的心理学特征.方法 采用艾森克个性问卷(儿童)手册(EPQ)、Achenbach儿童行为评定量表(CBCL)、联合型瑞文测验(CRT)、适应能力商数(SAB)量表,对113例紫绀型CHD及113例非紫绀型CHD患儿进行个性、行为、智力及适应能力的心理测试.结果 紫绀型CHD儿童神经质个性及心理行为异常检出率高于对照组(P均＜0.05),紫绀型CHD男孩在攻击方面及女孩在抑郁、社会退缩方面分别高于对照组(P均＜0.05),紫绀型CHD患儿平均智商、适应能力商数低于对照组(P均＜0.05).结论 紫绀型较非紫绀型CHD对儿童心理的影响更为严重,表现为情绪稳定性差、明显的行为异常和智商低下,应早期矫治.     

先天性心脏病患儿手术后行为问题探讨

采用Achenbach儿童行为量表，对50例先天性心脏病手术后患儿作行为问题调查，探讨先天性心脏病患儿手术后行为问题。结果：先心病患儿行为问题检出率男性为18.18%，主要表现为交往不良、体诉、敌意；女性为25%，主要表现焦虑、强迫、抑制。男、女患儿均有分裂样、社会退缩、活动情况低等行为问题。认为先心病患儿除需手术根治心血管畸形外，还需要家庭、学校及全社会给予心理支持，提高其社会适应性。     

支气管哮喘患儿心理行为问题与家庭管理方式特征研究

目的探讨支气管哮喘（简称哮喘）患儿的心理行为问题与家庭管理方式的特征及相关性。方法采取整群随机抽样方法,抽取2012年至2013年在唐山市4家三级甲等医院内就诊的哮喘患儿的母亲或父亲150名为研究对象,采用家长用儿童行为量表和家庭管理测量量表中文版进行调查。结果哮喘患儿的心理行为问题检出率为23．7％,高于国内常模（12．97％）（x^2=12．34,P〈0．05）;男孩主要表现为社交退缩、交往不良和攻击性表现,女孩主要表现为抑郁、社交退缩和分裂样;患儿的社交退缩、交往不良等行为异常表现与患儿的日常生活状况、父母疾病管理能力和父母相互支持呈负相关（r=-0．21,-0．25,-0．29,P〈0．05）,与父母对疾病担心状况、父母疾病管理困难状况和父母疾病精力消耗状况呈正相关（r=0．26,0．24,P〈0．05）。结论哮喘患儿的心理行为问题检出率较高,家庭管理方式呈忍耐型,医护人员应积极提供家庭支持,改善患儿的家庭管理方式,促进患儿的心理行为健康。     

阿曲库铵全麻联合呼吸机控制通气在小儿先心病介入治疗中的应用

目的 探讨阿曲库铵全麻联合呼吸机控制通气用于小儿先天性心脏病(先心病)介入治疗的可行性与安全性.方法 200例ASA分级Ⅰ～Ⅱ级先天性心脏病患儿介入治疗.随机分为两组,各100例.观察组静注芬太尼3 μg/kg、丙泊酚2 mg/kg、阿曲库铵0.3 mg/kg麻醉,气管插管呼吸机辅助通气;对照组氯胺酮50μg/(kg·min)、丙泊酚50 μg/(kg·min)持续微量静脉泵注入,保留自主呼吸.比较两组患儿术中屏气呛咳例数、血氧饱和度(SpO2)＜90%例数、苏醒时间、最低SpO2.结果 观察组术中无屏气呛咳和SpO2＜90%者,苏醒时间(16.8±4.5)min,最低SpO2(95.8±3.4)%;对照组屏气呛咳20例,SpO2＜90%者,8例,苏醒时间(62.0±22.1)min,最低SpO2(86.8±8.2).观察组均优于对照组(P均＜0.05).结论 阿曲库铵复合全麻配合呼吸机控制通气用于小儿先天性心脏病介入治疗,可基本消除术中呛咳屏气,避免缺氧,患儿术中安静,术后苏醒迅速,安全可行.     

基础麻醉下小儿先天性心脏病介入治疗术中并发症观察与护理急救

目的探讨基础麻醉下小儿先天性心脏病介入治疗术中并发症的急救和护理措施。方法:将76例接受介入治疗术治疗的小儿先天性心脏病患儿随机分为观察组(预防性护理急救)和对照组(常规护理)各38例,观察两组患儿的治疗和恢复效果。结果:与对照组相比,观察组患儿的术中并发症发生率(5.26%23.68%)以及术后疼痛VAS评分[(1.51±0.34)分(3.62±0.67)分]相对更低(P0.05),而患儿家长对于护理效果的满意度(92.11%73.68%)相对更高(P0.05),住院时间[(3.95±1.02)d(5.27±1.44)d]相对更短(P0.05)。结论:预防性护理急救措施在小儿先天性心脏病介入治疗术中的应用,可以有效降低并发症的发生风险,进而提高手术治疗的安全性和有效性,促进患儿的良好恢复。     

改良超滤术对婴幼儿体外循环围手术期肾小管功能的影响

将40例先天性心脏病患儿(体质量＜15 kg)随机分成观察组和对照组各20例,两组均于体外循环(ECC)下行房间隔或室间隔缺损修补术.观察组ECC后使用改良超滤技术,对照组予传统超滤术.测量两组围手术期不同时间点尿中视黄醇结合蛋白(RBP)、α1-微球蛋白(α1-MG)水平.结果患儿均顺利完成手术,但对照组实入量明显多于观察组(P＜0.01);两组术后第1天尿中RBP、α1-MG水平均显著升高,达峰值后下降,但对照组较观察组升高明显,持续时间长(P＜0.01或P＜0.05).提示改良超滤技术对婴幼儿体外循环心脏手术后肾小管具有保护作用.     

先天性心脏病手术后生长激素-胰岛素样生长因子轴的变化

目的 探讨先天性心脏病患儿手术后生长激素(growth hormone)和胰岛素样生长因子(insulin-like growth factor,IGF)轴的变化及意义.方法 先天性心脏病25例,采用放射免疫测定法测定治疗前、手术治疗后3个月、6个月和1年空腹血IGF-1及胰岛素样生长因子结合蛋白-3(insulinlike growth factor binding protein-3,IGFBP-3);对照组为正常儿童20名.结果 先天性心脏病患儿手术前血IGF-1和IGFBP-3浓度较正常儿童减低(P＜0.01);先天性心脏病手术治疗后患儿的IGF-1和IGFBP-3浓度随着术后时间增加而逐渐提高,至1年时与同龄儿童持平,差异无统计学意义(P＞0.05).结论 先天性心脏病患儿存在生长发育迟缓及生长激素-胰岛素样生长因子轴功能的紊乱能通过手术治疗纠正,从而改善先天性心脏病患儿生长发育.     

先天性中外耳畸形矫正术对患儿抑郁心理影响分析

目的 了解先天性中外耳畸形患儿抑郁心理与正常同龄儿童的差异,分析患儿Marx耳廓畸形分级、手术分期阶段与抑郁程度的相关性。方法 选取中山大学孙逸仙纪念医院2020年6月至2021年4月于住院部及门诊部治疗的79例先天性中外耳畸形患儿作为患病组,另选取30名正常同龄儿童作为对照组。利用Zung氏抑郁自评量表(SDS)对两组进行测试,并对患儿的Marx耳廓畸形分级、手术分期阶段与患儿抑郁程度进行相关性分析。结果 42例患儿出现不同程度的抑郁心理。患病组与对照组抑郁心理组间差异有统计学意义(Z=2.762,P=0.006)。抑郁心理与年龄不具有显著相关性(r=0.102,P=0.293),与耳廓分级具有相关性(r=0.231,P=0.040)。不同手术分期抑郁情况比较差异无统计学意义(H=5.103,P=0.164)。结论 先天性中外耳畸形患儿与正常儿童人群相比存在差异明显的抑郁心理比例,且耳廓分级越高,伴随抑郁程度重的比例越高,提示先天性中外耳畸形患儿行全耳廓再造术的必要性及早期关注该类患儿心理问题的必要性。     

中老年2型糖尿病患者抑郁焦虑状况调查

目的 了解中老年2型糖尿病患者抑郁及焦虑状况并对相关因素进行分析. 方法 采用Zung氏抑郁自评量表和焦虑自评量表对228例中老年2型糖尿病患者进行横断面调查,评价抑郁和焦虑患病情况,并对血糖、高血压、血脂异常、糖尿病慢性并发症等因素进行相关性分析. 结果 糖尿病组抑郁评分平均为(38.64±10.51)分,患病率为50.0%;焦虑评分为(35.10±7.65)分,患病率为21.9%,均高于对照组人群(P＜0.05或P＜0.01).40～49岁组抑郁评分明显高于60～69岁组和≥70岁组(P＜0.05),40～49岁组、50～59岁组和60～69岁组的焦虑评分均高于≥70岁组(P＜0.05或P＜0.01).40～49岁组抑郁患病率高于50～59岁组、60～69岁组和≥70岁组(P＜0.05或P＜0.01).40～49岁组焦虑患病率显著高于≥70岁组患者(P＜0.05).Pearson相关性分析显示,血糖控制差以及有慢性并发症的老年2型糖尿病患者更易罹患抑郁症.此外,焦虑与抑郁的发生密切相关. 结论 中老年2型糖尿病患者存在明显的抑郁和焦虑情绪,血糖控制差、出现糖尿病慢性并发症后,抑郁倾向更加显著;焦虑和抑郁2种负性心理状态易同时并存.     

小儿先天性心脏病室间隔缺损经导管介入治疗与外科手术治疗的对比分析

目的比较经导管介入治疗与外科手术治疗小儿先天性心脏病室间隔缺损的临床疗效。方法从2016年1月至2019年10月阶段在我院治疗的小儿先天性心脏病室间隔缺损患儿中选取80例,采取随机分组法将其分为介入组和外科组,每组40例。外科组患儿采取外科开胸手术进行治疗,介入组患儿采取经导管介入治疗。结果介入组患儿的手术成功率,与外科组患儿相当,比较差异没有统计学意义(P0.05);介入组患儿的手术时间显着短于外科组,术中输血量显着少于外科组,术后机械通气时间、术后ICU住院时间、总住院时间均显着短于外科组,比较差异有统计学意义(P0.05)。介入组患儿的心律失常发生率和新发瓣膜反流发生率,均显着低于外科组,比较差异有统计学意义(P0.05)。结论经导管介入治疗能够获得与外科手术治疗相当的治疗效果,且并发症发生率更低,术后康复更快,具有显着的应用优势。     

早期心理干预对于冠心病介入治疗效果的影响

目的：探讨早期心理干预在冠心病介入治疗的应用模式及效果。方法：选符合介入治疗的冠心病患者64例，随机分为心理干预组和常规治疗对照组，每组各32例。心理干预组患者根据制定的心理干预措施实施干预；常规治疗对照组采取常规的治疗和心理护理；评估两组患者的心理状态。结果：早期心理干预对极大部分负性情绪均有显著的缓解作用（P〈0．01），早期心理干预组的躯体化、人际关系敏感、抑郁、焦虑改善明显优于常规治疗对照组（P〈0．01）。结论：心理干预能明显缓解冠心病介入治疗患者的负性情绪。     

Prevalence of obesity among children aged 6–7 years in South-East Serbia

A cross-sectional study of the prevalence of obesity in urban and rural areas of South-East Serbia was performed on 541 children (273 boys and 268 girls), aged 6–7 years. Prevalence of obesity in urban boys and girls was 6.3% and 3.8% respectively ( P  > 0.05). Prevalence of obesity in rural boys and girls was 1.1% and 3.3% respectively ( P  > 0.05). The difference in the prevalence of obesity between urban boys and rural boys was statistically significant ( P  < 0.05), while the difference between urban and rural girls was insignificant ( P  > 0.05). Urban boys consumed more sweets and fast food compared with rural boys ( P  < 0.05). Urban children spent more time in watching TV compared with rural children ( P  < 0.05).     

冠心病家族史儿童血压水平的研究

目的：了解有冠心病（CHD）家族史儿童的血压水平。方法：对83例有冠心病家族史的儿童测量血压，以83例无CHD家族史的健康儿童作为对照。结果：与健康对照组比较，有CHD家族史的儿童收缩压和舒张压明显增高，高血压检出率明显增高（P＜0．01）。男童与女童血压水平无明显差异（P＞0．05）。有早发CHD家族史（父母于45岁以前患CHD）的儿童与非早发CHD家族史儿童比较，收缩压和舒张压更高，高血压检出率更高（P＜0．01）。结论：有CHD家族史儿童血压水平升高，以有早发CHD家族史儿童为更明显。提示成年后发生CHD的危险性显增高。     

西地那非治疗先天性心脏病相关性肺动脉高压的有效性与安全性

目的:探讨磷酸二酯酶抑制剂西地那非治疗先天性心脏病（congenital heart disease,CHD）所致重度肺动脉高压（pulmonary arterial hypertension,PAH）的有效性及安全性。方法: 对体-肺分流型CHD所致重度PAH患者33例给予西地那非治疗6个月。以6分钟步行距离试验、心电图、心脏X线、彩色多普勒超声心动图、右心导管、血细胞和血生化检查检测评估治疗效果和不良反应。结果: 西地那非治疗6个月后,所有患者6分钟步行距离显著改善(P<0.01),18例（54%）患者自觉症状明显改善,左心室射血分数明显增加（P<0.05)。右心导管检查示肺/体循环血流量比值明显提高(P<0.01),肺血管阻力（P<0.05),肺/体循环压力比值（P<0.01)和血管阻力比值（P<0.01)明显下降,但有8例（24%）患者肺/体循环血流量比值下降同时肺/体循环血管阻力比值增大。不良反应事件包括脸红（n=3）、头痛（n=2）、鼻充血（n=1）,异常阴茎勃起（n=1）等。实验室检查显示红细胞和血红蛋白较治疗前显著降低(P<0.01),而肌酐轻度升高(P<0.05)。结论: CHD并发PAH患者接受西地那非治疗6个月耐受性良好,大部分患者运动耐量和血流动力学明显改善。     

Behavioral Outcomes among Children of Alcoholics During the Early and Middle Childhood Years: Familial Subtype Variations

This study examined early behavioral outcomes among young children of alcoholics (COAs) as a function of differences in subtype of paternal alcoholism. Participants were 212 children (106 girls and 106 boys, ages 3 through 8) and both of their biological parents. Families were characterized as antisocial alcoholics, nonantisocial alcoholics, and nonalcoholic controls. There were significant familial subtype group differences on parent report measures of children's total behavior problems, externalizing behavior, and internalizing behavior, and on measures of children's intellectual functioning and academic achievement. In all instances, COAs had poorer functioning than controls. In the behavior problem domain, but not for the domain of intellectual functioning, children from antisocial alcoholic families had greater problems than children from nonantisocial alcoholic families. In addition to the subtype effects, boys had higher levels of behavior problems than girls in all three areas, and older children had more internalizing problems than younger children. Maternal functioning pertaining to lifetime alcohol problem involvement and antisocial behavior also contributed to child subtype differences in internalizing behavior. Results indicate that, even at very early ages, male and female COAs are heterogeneous populations that are distinguishable by way of familial subtype membership, as well as distinguishable from their non-COA peers. Thus, findings underscore the need to consider the heterogeneity of alcoholism when looking at its effects on child development     

Endocrine and radiological studies in patients with molecularly confirmed CHARGE syndrome

CONTEXT: CHARGE syndrome is a complex of congenital malformations, and CHD7 has been reported as a major gene involved in the etiology. OBJECTIVE: We performed endocrine and radiological studies to determine whether endocrinological disorders such as hypogonadotropic hypogonadism, GH deficiency, or hypothyroidism are involved and also whether olfactory bulb hypoplasia and semicircular canal aplasia are major signs in patients with molecularly confirmed CHARGE syndrome. DESIGN: Clinical features, endocrinological assessments, and radiological abnormalities in eight children (five boys and three girls) whose molecular analyses were available were evaluated among 15 children clinically diagnosed with CHARGE syndrome at our institute. RESULTS: We identified heterozygous CHD7 mutations in all patients screened for mutations. Four boys had micropenis and/or cryptorchidism. One was diagnosed with GH deficiency, and the other was diagnosed with hypothyroidism. Computed tomography findings revealed aplasia of the semicircular canals. Magnetic resonance imaging studies of the olfactory bulb region revealed abnormal olfactory sulci and bulb development in all children. CONCLUSION: We suggest that hypogonadism, GH deficiency, and hypothyroidism could be possible endocrinological defects in patients with CHD7 mutations and that olfactory bulb hypoplasia as well as semicircular canal aplasia should be considered as a major sign for CHARGE syndrome and recommend a computed tomography scan of the temporal bone and magnetic resonance imaging study of the olfactory bulb region.     

脂蛋白相关磷脂酶A2基因R92H多态性与汉族人群冠心病易感性的关系

目的探讨脂蛋白相关磷脂酶A2基因R92H多态性与冠心病遗传易感性及冠状动脉病变程度的关系。方法采用单荧光标记探针技术检测261例冠心病患者及263例正常人脂蛋白相关磷脂酶A2基因R92H多态性。结果冠心病组RH基因型和H等位基因频率显著高于对照组(P<0.05和<0.01)。RH基因型、H等位基因人群冠心病风险增高(P均<0.01)。Logistic回归分析显示,R92H多态性是冠心病的独立危险因素(P<0.05)。冠心病组中RH和HH基因型者总胆固醇和低密度脂蛋白胆固醇水平高于RR基因型者(P<0.05和<0.01),高密度脂蛋白胆固醇水平显著低于RR基因型者(P<0.05)。冠心病组中,RH和HH基因型者多支血管病变率比RR基因型者明显升高(P<0.05)。结论脂蛋白相关磷脂酶A2基因R92H多态性与中国汉族人群冠心病相关,携带RH、HH基因型人群发生冠心病风险较高,且与更严重的冠状动脉病变有关。     

It's harder for boys? Children's representations of their HIV/AIDS-affected peers in Zimbabwe

This study examines whether children in rural Zimbabwe have differing representations of their HIV/AIDS-affected peers based on the gender of those peers. A group of 128 children (58 boys, 70 girls) aged 10–14 participated in a draw-and-write exercise, in which they were asked to tell the story of either an HIV/AIDS-affected girl child, or an HIV/AIDS-affected boy child. Stories were inductively thematically coded, and then a post hoc statistical analysis was conducted to see if there were differences in the themes that emerged in stories about girls versus stories about boys. The results showed that boys were more often depicted as materially deprived, without adult and teacher support, and heavily burdened with household duties. Further research is needed to determine whether the perceptions of the children in this study point to a series of overlooked challenges facing HIV/AIDS-affected boys, or to a culture of gender inequality facing HIV/AIDS-affected girls – which pays more attention to male suffering than to female suffering.     

小儿血清苗勒抑制物质水平变化及其临床意义

通过测定非泌尿生殖系统疾病及隐睾患者的血清苗勒抑制物质 (MIS)值 ,观察年龄与MIS的相关性。结果男性非泌尿生殖系统疾病患儿血清MIS值随年龄增长而下降 ,女性儿童血清MIS值明显低于男性 ,且不随年龄变化 ,青春发育前期隐睾儿童血清的MIS值高于同龄儿。MIS测定可以作为反映隐睾患儿的睾丸功能及成熟程度的指标