小儿颅脑损伤急性期血糖变化的临床意义

目的　探讨小儿颅脑外伤急性期血糖变化与格拉斯哥昏迷评分 (GCS)和预后 (GOS)的关系 ,以及高血糖的处理。方法　测定并分析 1998年 1月至 2 0 0 2年 1月期间收治并从中选择的 14 5例颅脑外伤患儿的急性期血糖值。结果　按GCS评分分为三组 (GCS 3～ 8分 2 7例 ,9～ 12分 2 7例 ,13～ 15分 91例 ) ,入院时血糖平均值分别为 (16 .2 6± 2 .33)mmol/L、(10 .4 7± 2 .15 )mmol/L、(5 .92± 1.2 1)mmol/L ;按预后分为三组 (良好 12 6例 ,差 13例 ,死亡 6例 ) ,其入院时血糖值分别为 (7.73±3.2 5 )mmol/L、(12 .2 5± 2 .99)mmol/L、(2 2 .5 4± 3.97)mmol/L。随机选取 2 8例高血糖患儿予控制糖入量、使用胰岛素等降糖处理 ,并在伤后≤ 6h、2 4h、4 8h作血糖动态监测 ,血糖值分别为 (12 .70±3.0 2 )mmol/L、(8.34± 2 .71)mmol/L、(5 .6 3± 1.75 )mmol/L ,致残率、死亡率显著下降 ,预后良好。结论　血糖测定有助于评价小儿颅脑损伤的严重程度及预后 ,积极的综合治疗可改善高血糖患儿的预后     

儿童急性白血病院内感染临床观察

目的分析急性白血病(AL)患儿院内感染的临床特点及血培养阳性细菌对抗生素的敏感性,探讨其防治措施。方法回顾性分析住院AL患儿院内感染的发生率;细菌感染血培养阳性与化疗时期的关系,血培养阳性患儿与阴性患儿外周血白细胞计数、血小板计数、粒细胞计数绝对值的差异,血培养阳性细菌对抗生素的耐药性及敏感性。结果 AL患儿院内感染的发生率为45.5%(112/246),其中血培养阳性率为25.0%(28/112)。血培养阳性患儿的外周血白细胞计数为(1.05±1.17)×109/L,血小板计数为(55.57±27.57)×109/L,中性粒细胞计数绝对值为(0.13±0.33)×109/L,中性粒细胞减少持续时间为(8.46±3.40)d;血培养阴性患儿的白细胞计数为(2.72±3.00)×109/L,血小板计数为(117.80±133.60)×109/L,中性粒细胞计数绝对值为(1.02±2.34)×109/L,中性粒细胞减少持续时间为(2.48±0.62)d,各项指标在血培养阳性组与阴性组之间的差异有显著性。血培养中的葡萄球菌属、大肠埃希菌、铜绿假单胞菌对青霉素类、头孢三代抗生素、红霉素的耐药率均比较高,葡萄球菌属对替考拉宁和万古霉素相对较敏感,大肠埃希菌对亚胺培南敏感性较高,铜绿假单胞菌对亚胺培南和复方新诺明较敏感。结论本研究结果提示,AL患儿骨髓抑制易发生感染。AL患儿考虑革兰阴性菌感染可选择碳青霉烯类,考虑革兰阳性菌感染可选择替考拉宁和万古霉素,必要时进行细菌药敏物敏感试验,进一步提高治疗效果。     

低张静脉维持液体对神经系统危重症患儿影响的临床观察

目的探讨不同液体张力对神经危重症患儿血清钠和神经症状的影响。方法根据入院血清钠检查值,将22例神经系统危重症患儿分为两组:低钠血症(Na+<135mmol/L)组应用1/2～1张液体,正常血钠组(135～145mmol/L)用1/5张液体。应用张力液体后1～3d均测血清钠、Glasgow评分,比较两组液体治疗后水电解质平衡情况。结果正常血钠组患儿,输1/5张液体3d后血清钠和Glasgow显著下降,评分:(11.4±2.1)与(10.4±1.8)分(P<0.05);血清钠:(136.2±4.8)mmol/L与(131.0±6.1)mmol/L(P<0.05),神经症状恶化。低血钠组患儿应用1/2～1张液体3d后血清钠和Glasgow评分显著升高:(7.9±0.9)与(9.1±2.2)(P<0.05);血清钠:(126.3±2.8)mmol/L与(141.2±7.0)mmol/L(P<0.001),神经症状得以改善。结论神经危重症患儿急性期应用≥1/2张液体,以防止出现低钠血症,加剧颅高压而恶化神经症状。     

连续血液净化治疗先天性代谢缺陷病重症有机酸血症

目的　分析、评价连续血液净化 (continuousbloodpurification ,CBP)对先天性代谢缺陷病 (inbornerrorsofmetabolism ,IEM )重症有机酸血症的治疗效果 ,探讨其治疗机制。方法　用BaxterBM 2 5机对 9例IEM重症有机酸血症患儿行CBP治疗 ,对比治疗前后血气、生化值 ,并比较症状、体征改善情况。结果　 9例患儿入院时 pH值 (6 87± 0 2 5 )、BB(1 6± 0 0 8)mmol/L、SB(4 0± 0 5 8)mmol/L、BE(- 2 6 1± 2 80 )mmol/L、乳酸 (15 2± 3 6 4 )mmol/L ,血氨 (2 87 5 3± 132 4 3) μmol/L ,呈重度代谢性酸中毒。经 1～ 2次 ,9～ 32hCBP治疗 ,患儿症状、体征好转 ,酸碱平衡部分纠正 ,pH(7 33± 0 18)mmol/L、BB(18 0± 2 5 6 )mmol/L、SB(19 1± 2 2 5 )mmol/L、BE(- 3 4± 1 6 2 )mmol/L、乳酸 (3 1±0 5 5 )mmol/L ,血氨 (39 2 1± 2 2 85 ) μmol/L ,较治疗前显著好转。 结论　临床观察提示 ,CBP是治疗IEM有机酸血症的一种快速有效的方法     

218例无追赶生长的小于胎龄儿儿童期糖代谢分析

目的 探索无追赶生长的小于胎龄儿在儿童期的胰岛素敏感性.方法 收集2008年8月至2016年8月于北京大学第三医院儿科门诊就诊的身材矮小患儿439例,分为小于胎龄儿组(small for gestational age,SGA)218例和特发性矮小组(idiopathic short stature,ISS)221例.比较两组之间的空腹胰岛素、空腹血糖、空腹血糖与胰岛素比值、胰岛β细胞功能(HOMA%)和胰岛素抵抗指数(HOMA-IR)特点.结果 两组患儿均根据青春期分期及性别分组,SGA组与ISS组,青春期前男性患儿的空腹血糖分别为(4.7±0.6)mmol/L和(4.8±0.6)mmol/L,P=0.678,空腹胰岛素(5.1±4.0)mU/L和(4.3±4.7)mU/L,P=0.345,血糖胰岛素比值、HOMA%及HOMA-IR的差异均无统计学意义;青春期前女性患儿的空腹血糖分别为(4.5±0.5)mmol/L和(4.6±0.5)mmol/L,P=0.828,空腹胰岛素分别为(4.7±3.5)mU/L和(4.5±3.3)mU/L,P=0.603,血糖胰岛素比值、HOMA%及HOMA-IR的差异均无统计学意义;青春期男性患儿的空腹血糖分别为(5.0±0.8)mmol/L和(4.9±0.5)mmol/L,P=0.176,空腹胰岛素分别为(5.9±4.3)mU/L和(6.0±4.5)mU/L,P=0.958,血糖胰岛素比值、HOMA%及HOMA-IR的差异均无统计学意义;青春期女性患儿的空腹血糖分别为(4.9±0.6)mmol/L和(4.8±0.4)mmol/L,P=0.141,空腹胰岛素分别为(7.5±6.4)mU/L和(7.4±8.6)mU/L,P=0.448,血糖胰岛素比值、HOMA%及HOMA-IR的差异均无统计学意义.     

手足口病患儿血糖测定的临床意义

目的 探讨手足口病患儿空腹血糖的变化及其在预测病情进展中的价值.方法 观察80例患儿空腹血糖的变化,其中普通型手足口病40例,重型手足口病40例.结果 40例普通型手足口病患儿血糖均值为(5.18 ±2.34) mmol/L;40例重型手足口病患儿血糖均值为(6.80 ±3.12) mmol/L.重型手足口病与普通型患儿比较,血糖水平明显升高,差异有统计学意义(P＜0.05).病情稳定的65例患儿血糖水平较低,为(4.52 ±2.25) mmol/L,而普通型手足口病(10例)和重型手足口病(5例)病情恶化的患儿血糖水平较病情稳定的患儿明显升高,分别为(6.32±2.34)mmol/L、(7.14±2.29) mmol/L,差异有统计学意义(P＜0.05).结论 手足口病发生时伴有应激反应增高表现,空腹血糖增高可以作为手足口病重症病例早期识别的一个危险因素.     

重症手足口病并发神经源性肺水肿机械通气治疗特点及死亡高危因素分析

目的 探讨重症手足口病并发神经源性肺水肿患儿机械通气治疗特点和死亡高危因素分析.方法2010年3月至6月我院重症监护室收治42例重症手足口病并发神经源性肺水肿患儿,根据患儿预后分为死亡组(A组)26例和存活组(B组)16例,对两组患儿的机械通气参数及临床资料进行分析.结果A组呼吸机参数呼气末正压、吸入氧浓度及氧合指数分别为(15.68 ±2.26)cm H2O、0.89±0.25、(216.7±156.3)mm Hg,而B组为(9.60±0.98)cm H2O、0.76±0.27、(349.8±120.9)mm Hg.A组呼气末正压、吸入氧浓度明显高于B组(P=0.007,P=0.037),氧合指数明显低于B组(P=0.009).小儿危重病例评分、白细胞计数、血糖、心率、乳酸水平、CK-MB、肺出血、循环衰竭是重症手足口病并发神经源性肺水肿死亡的高危因素(P＜0.05).结论重症手足口病并发神经源性肺水肿死亡组患儿机械通气参数较高,提示预后不良.小儿危重病例评分低,心率快,白细胞计数高,血糖、乳酸、CK-MB水平高,肺出血、循环衰竭发生率高是重症手足口病并发神经源性肺水肿死亡的高危因素.     

危重儿糖代谢紊乱与血清胰岛素的关系

目的　 探讨危重病患儿糖代谢紊乱与胰岛素的关系。 方法 　OneTouch仪测定血糖 ,放射免疫法测定胰岛素。结果 　 2 1例危重病患儿危重期和恢复期分别检测血糖和血清胰岛素为 (13 5 7± 4 78)mmol/L、(5 2 4 2± 6 2 2 3) pmol/L ,和 (5 17± 1 10 )mmol/L、(12 6 0± 11 5 6 )pmol/L。 结论 　危重病患儿危重期高血糖和高胰岛素同时存在 ,胰岛素对血糖起重要作用。     

血乳酸在脓毒症患儿病情及预后评价中的意义

目的 探讨脓毒症患儿血乳酸水平对病情严重程度和预后的评价作用。方法 收集脓毒症患儿484例,其中普通脓毒症组310例、严重脓毒症组105例、脓毒症休克组69例,治疗前测动脉血乳酸值,对乳酸>2 mmol/L的脓毒症休克患儿,收集其早期液体复苏后血乳酸复查值。结果 随脓毒症严重程度增加,血乳酸值逐渐增加。ROC曲线分析发现,区别脓毒症休克和非脓毒症休克的血乳酸值为2.25 mmol/L时,其诊断灵敏度为82.6%,特异性为79.8%。乳酸≤1 mmol/L、乳酸~2 mmol/L、乳酸~4 mmol/L和乳酸>4 mmol/L患儿的病死率分别为8.5%、9.4%、27.2%、67.6%,乳酸>4 mmol/L的死亡风险为乳酸≤1 mmol/L的22.4倍。治疗前血乳酸>2 mmol/L的脓毒症休克患儿复苏后血乳酸水平≤2 mmol/L和>2 mmol/L的病死率分别为33.3%、69.2%。结论 血乳酸可作为脓毒症患儿病情严重程度及预后的评价指标,血乳酸值2.25 mmol/L对脓毒症休克具有较高的诊断价值;早期复苏使血乳酸水平恢复至正常可改善脓毒症休克患儿的预后。     

��Ĥ͸����9������������˥�߻����е�Ӧ��

目的分析和评价腹膜透析在终末期肾衰竭(ESRD)患儿中的应用情况。方法对复旦大学儿科医院肾脏科2001-11—2005-04收治的9例(男7例,女2例)ESRD患儿腹膜透析前后尿毒症症状改善情况和营养、生长发育状况进行回顾分析。结果腹膜透析模式持续性非卧床腹膜透析(CAPD)3例,持续性循环腹膜透析(CCPD)5例,夜间间歇性腹膜透析(NIPD)1例,透析时平均年龄(11.6±3.0)岁,平均腹透(9.8±7.1)个月(2~36个月)。透析后,尿毒症症状均有改善,胃肠道症状消失,血尿素氮由透析前(31.4±7.4)mmol/L下降至透析后(19.6±3.4)mmol/L(P<0.01);平均血红蛋白及红细胞压积比由透析前的(77.1±19.9)g/L和(22±6)%上升至(98.4±40.2)g/L和(34±4)%;平均血压由透析前18.9/11.7kPa下降至透析后14.6/9.6kPa(P<0.01);透析前血钙(2.0±0.2)mmol/L,血磷(2.2±0.5)mmol/L,甲状旁腺素(PTH)(602.7±332.2)pg/mL,透析后血钙2.5±0.2mmol/L,血磷(1.59±0.3)mmol/L,PTH(258.6±273.2)pg/mL,与透析前比较差异均有显著性(P<0.05),钙磷代谢紊乱纠正,高PTH改善。透析后血白蛋白(41.0±3.2)g/L、Pre-A>400mg/L,Tf>2g/L,身高、体重增加,身高平均增长(0.67±0.59)cm/月。腹膜炎发生率为1次/11.1病人月。结论长期腹膜透析可以很好地改善ESRD患儿的尿毒症症状,纠正贫血、高血压、钙磷代谢紊乱,改善营养和生长发育状况,是ESRD患儿进行肾替代治疗的有效手段。但腹膜透析也有一定的并发症,应引起重视。     

小儿危重病例评分在重症手足口病病情及预后评估中的作用

目的 探讨小儿危重病例评分(PCIS)在重症手足口病患儿预后及病情严重程度评估中的作用。方法 424 名重症手足口病患儿纳入该研究,其中存活390 例,死亡34 例。收集患儿PCIS 评分系统的相关生理参数及结局资料,通过受试者工作特征曲线(ROC)下面积(AUC)评估PCIS 评分系统对并发症和结局的分辨力。结果 存活组患儿PCIS 评分明显高于死亡组患儿(P结论 PCIS 对重症手足口病并发症及预后有一定预测作用,但根据现有评分体系不能充分反映重症手足口病病情的严重程度。     

Oxidized LDL metabolites with high family risk for premature cardiovascular disease

Objective: Considering the importance of primary prevention of Cardiovascular Disease (CVD) from childhood, especially in children with high family risk for premature atherosclerosis, and also the importance of oxidized LDL in the process of atherosclerosis, the main metabolites of ox-LDL i.e. Malondialdehyde (MDA) and Conjugated diene (CDE) have been measured in children of high risk families and compared with a control group.Methods: Children and adolescents (6–18 years) of parents with premature myocardial infarction (Ml ≤ 55y in men and ≤ 65y in women), were selected as the case group. The control group included neighbors of the case group matched for age and socioeconomic status. All samples have been selected by simple random sampling. Both the case and control groups were divided in two subgroups : those with a total cholesterol and/or LDL-C ≥95th centile and those with normal lipid levels. Each subgroup consisted of 32 subjects, so 128 subjects were studied (64 in the case and 64 in the control group). MDA and CDE were measured by spectrophotometry using molar absorbivity. Data were analyzed by SPSS_v10/Win software using ANOVA, Bon-ferroni, Scheffe-Duncan, Tukey-HSD, and the Student’s t-test.Result: The mean MDA value in the case and control groups was significantly different (1.84 ± 0.43 vs. 1.67 ± 0.41 Μmol/L, p=0.03), but this difference was not significant regarding the mean CDE level (0.50 ± 0.05 vs. 0.47 ± 0.04 Μmol/ L, p>0.05). The mean MDA level in the case group with hyperlipidemia was significantly higher than that in the case group without hyperlipidemia (1.985 ± 0.516 vs. 1.690 ± 0.366, Μmol/L, P=0.02) and also higher than control group with or without hyperiipidemia (1.985 ± 0.516 vs. 1.720 ± 0.389,1.615 ± 0.429 Μmol/L respectivety, P<0.05). The mean CDE level in the case group with hyperiipidemia was significantly higher than the case group without hyperlipidemia (0.542 ± 0.034 vs. 0.494 ± 0.049 Μmol/L, P=0.04) and higher than the control group with or without hyperiipidemia (0.542 ± 0.034 vs. 0.464 ± 0.051, 0.484 ±0.048 Μmol/L respectively, p<0.05). In case boys with hyperiipidemia, the mean MDA (2.03 ± 0.2 Μmol/L) and the mean of CDE (0.56 ± 0.04 Μmol/L) was significantly higher than other subgroups (P<0.05).Conclusion: Considering the increased susceptibility of LDL to oxidation in children with high family risk for premature CVD, special attention should be paid to consumption of foods and seasoning containing antioxidants from childhood especially in high risk families.     

儿童危重型手足口病死亡的危险因素分析

目的 探讨儿童危重型手足口病死亡的危险因素。方法 以2010 年5 月至2012 年9 月监护室住院治疗的164 例危重型手足口病患儿为研究对象,根据预后分为死亡组（33 例）和存活组（131 例）。比较两组在基本情况、临床症状、体征、辅助检查方面的差异;采用非条件logistic 回归分析死亡的危险因素。结果 死亡组和存活组在不典型皮疹、持续高热（≥ 3 d）、呼吸困难、肺出血、心率增快、血压异常、冷汗、毛细血管再充盈时间>3 s、频繁抽搐发生率及血糖、血清肌酸激酶同工酶、血清乳酸水平方面存在明显差异（P<0.05）。多因素logistic 回归分析显示：肺出血（OR=9.466,95%CI：1.786~21.256）、血压异常（OR=5.224,95%CI：1.012~28.985）、血清乳酸增高（OR=2.154,95%CI：1.020~8.253）是危重型手足口病死亡的独立危险因素。结论 肺出血、血压异常、血清乳酸增高是危重症手足口病患儿死亡的主要危险因素。     

Urinary sodium excretion: Association with hyperinsulinaemia,hypertension and sympathetic nervous system activity in obese and control children

The aim of the present study was to evaluate the association between 24 h urinary excretion of sodium and blood pressure, fasting plasma insulin, renin, aldosterone and serum norepinephrine concentrations in 45 obese and 15 control children. Urinary sodium excretion was significantly lower in obese subjects (1.3 ± 0.6 mmol/kg/24 h, P < 0.01) than in controls (2.8 ± 1.3 mmol/kg/24 h). Hyperinsulinaemia did not affect sodium excretion of obese children. Plasma renin and aldosterone levels did not correlate with sodium excretion and were significantly higher in overweight children. Serum norepinephrine levels were also significantly higher in the obese group (0.66 ± 0.89 μg/100 ml) as compared to the controls (0.11 ± 0.03 μg/100 ml, P < 0.01) and showed significant negative correlation with urinary sodium excretion (r = 0.43, P < 0.05). Conclusion Hyperinsulinaemia and the consequently increased sympathetic nervous system activity might be involved in the development of high blood pressure in obese children by decreasing urinary sodium excretion. Received: 17 January 1995 Accepted: 28 March 1996     

Cardiopulmonary interaction during partial liquid ventilation in surfactant-treated preterm lambs

Gas ventilation following instillation of perfluorochemical (PFC) liquid, partial liquid ventilation (PLV), improves gas exchange and pulmonary mechanics in neonatal animals and humans with severe respiratory distress. The effect of PLV on cardiac contractility, performance, pulmonary blood flow and ductal shunt has not been fully described. To this end, we evaluated these indices of cardiopulmonary function in eight conventionally gas ventilated, surfactant-treated premature lambs (125 days gestation) before and during PLV. Animals were instrumented with central venous and aortic lines. Serial evaluation of arterial blood chemistry/pressure, and pulmonary mechanics was performed; cardiac contractility, performance, pulmonary blood flow and ductal shunts were serially assessed by echocardiography. As compared to conventional gas ventilation, during PLV there was a significant decrease in left ventricular meridian (22.5 ± 6.6 SE vs 8.1 ± 1.4 SE g/cm², P < 0.02) and circumferential wall stress (54.1 ± 16.5 vs 24.4 ± 3.8 SE g/cm², P < 0.04) at end systole. The fall in wall stress at end systole was associated with a significant decrease in left ventricular internal diameter (1.2 ± 0.05 SE vs 1.04 ± 0.045 SE cm; P < 0.01). There were no significant changes in heart rate, systemic arterial and central venous pressures, systemic vascular resistance, left ventricular shortening and ejection fractions during PLV. The decrease in wall stress was associated with a significant decrease in mean airway pressures (15.9 ± 1.1 SE vs 9.9 ± 0.2 SE cmH₂O; P < 0.05) and ostensibly a change in intrathoracic pressures during PLV. There were no significant differences in blood flows (pre vs during PLV; ml/min/kg): pulmonary (226 ± 62 SE vs 293 ± 65 SE), aortic (237 ± 36 SE vs 204 ± 21 SE), and left to right ductal (119 ± 25 SE vs 105.5 ± 26 SE) measured before and during PLV. Conclusion Cardiac output and pulmonary blood flow do not change significantly during PLV and therefore do not appear to contribute to improved gas exchange. This stable cardiac performance occurs at lower wall stress and thereby more advantageous energetic conditions. Received: 18 July 1996 and in revised form: 28 May 1997 / Accepted: 31 May 1997     

Identification of high-risk group and therapeutic options in children with liver abscess

The outcome of children with liver abscess (LA) depends upon prompt diagnosis and intervention. We evaluated the etiology, clinical profile, various interventional modalities of management and outcome of children with LA. A total of 39 hospitalized children (mean age 7.2 ± 3.9 years) with radiologically proven LA were analyzed. Parenteral antibiotics, percutaneous drainage (PD) or open surgical drainage (OSD) was done as required. Cases with ruptured or impending rupture of LA, upper gastrointestinal bleed, jaundice, pleural effusion or consolidation were labeled as “high risk” cases. Triad of fever, pain and hepatomegaly was the most common presentation. Single abscess was present in 66.7% and right lobe was involved in 69.2% of cases. Majority of LA were pyogenic (PLA, 25/39). Amebic liver abscess (ALA) and PLA had similar clinical and laboratory profile except that multiloculated abscess on ultrasonography was a feature of PLA (12/25 vs. 0/11; p = 0.006). Cases with ALA settled significantly more often with antibiotics alone (5/11 vs. 3/25; p = 0.04) than PLA and none required surgery (0/11 vs. 7/25; p = 0.03). Subjects with “high-risk” LA (n − 26) had significantly larger abscesses, more polymorphonuclear leucocytosis (74 ± 15% vs. 61 ± 13%; p = 0.01) in peripheral blood and need of drainage (24/26 vs. 7/13; p = 0.03) than patients with average-risk LA. Based on the results, 38/39 children recovered, with complete abscess resolution in 28, over 48 ± 63.8 days. In conclusion, ALA, although similar in presentation, are uniloculated, and patients with ALA recover more often without drainage than patients with PLA. Patients with “high risk” LA are more common and have a good outcome with drainage. PD, being safe, efficacious and less invasive than OSD, should be the preferred drainage procedure.     

以胸闷为主诉的不典型支气管哮喘患儿激发试验前后的肺功能特点

目的 了解以胸闷为主诉的不典型支气管哮喘患儿在支气管激发试验前后的肺功能特点。方法 选取2010 年1 月至2013 年12 月在我院肺功能室进行支气管激发试验的不典型哮喘患儿34 例为研究对象(不典型哮喘组),同期选取典型哮喘患儿34 例为对照,检测不典型哮喘组患儿支气管激发试验前后的肺功能,以及典型哮喘组患儿发作期和缓解期肺功能。结果 不典型哮喘组激发前肺功能指标用力肺活量(FVC)、第1 秒最大呼气量(FEV1)、FEV1/FVC、呼气峰流速(PEF)、用力呼气25 %、50 %、75%肺活量时的呼气峰流速(FEF25、FEF50、FEF75)、最大呼气中期流量(MMEF75/25)分别为105%±12%、104%±12%、100%±7%、88% ±13%、90% ±14%、81% ±17%、73% ±25%、80%±17%,明显高于典型哮喘组患儿发作期肺功能各指标(PP>0.05)。不典型哮喘组激发后肺功能各指标与典型哮喘组发作期相比差异无统计学意义(P>0.05),但均低于典型哮喘组缓解期和不典型哮喘组激发前水平。结论 支气管激发试验有助于不典型哮喘患儿的诊断。     

Magnesium therapy in birth asphyxia

Objective: Glutamate plays a critical role in the hypoxic ischaemic neuronal death. Two mechanisms of glutamate-induced neuronal death have been identified. One is rapid cell death that occurs in minutes and the second is delayed cell death that occurs over hours and is initiated principally by the activation of the N-methyl D-Aspactate (NMDA) receptor. Magnesium (Mg) is an NMDA receptor blocker. Systemic administration of Mg after a simulated hypoxic ischaemic insult has been shown to limit neuronal injury in several animal models. However, before embarking on to the use of Mg for neuronal protection in the human neonate, it is important to study the safety and side effects of Mg administration.Methods: Forty terms, appropriate for gestational age babies with severe birth asphyxia (1 min Apgar score <3 and 5min Apgar score <6), were randomly assigned to either the study group or the control group. Infants in both groups were treated as per unit protocol except that babies in the study group received intravenous injection of magnesium sulphate 250 mg/kg within half an hour of birth, and subsequently 125 mg/kg at 24 and 48 hours of life.Results: The mean cord blood serum Mg levels were 0.78 (±0.047) mmol/L in the control group and 0.779 (±0.045) mmol/L in the study group. The serum Mg levels at 3, 6, 12, 24, 48 and 72 hours of life were 1.87 (±0.6), 1.65(±0.059), 1.468 (±0.91), 1.881 (±0.053), 1.916 (±0.053) and 1.493 (±0.084) mmol/L respectively in the study group. All these values were significantly higher than those obtained in the control group (p<0.001). No significant alterations in heart rate, respiratory rate, oxygen saturation and mean arterial pressure were seen, following magnesium infusion with either 250 mg/kg or 125 mg/kg dose. The serum Mg levels in the study group ranged between 1.493 (±0.084) and 1.916 (±0.053) mmol/L, which are considered to be in the neuroprotective range.Conclusion: Injection MgSO₄ administered in a dose of 250 mg/kg and 125 mg/kg as an intravenous infusion is safe, and the Mg levels obtained are in the range considered to be neuropropective.     

Cardiometabolic risks vary by weight status in pediatric kidney and liver transplant recipients: A cross‐sectional,single‐center study in the USA

There is an increasing need to understand long‐term metabolic changes and resultant comorbidities because life expectancy is increasing after pediatric kidney and liver transplants. We evaluated differences in classic and novel cardiometabolic biomarkers among obese and normal weight adolescent transplant recipients. We enrolled a total of 80 adolescent (mean±SD, 14.8 years ±3.0) transplant recipients (63 kidney, 17 liver) with mean duration from transplantation of 6.0 (±4.1) years. Among kidney transplant recipients, overweight and obese individuals had higher leptin (16.7 vs 7.5 μg/mL, P<.001), lower HDL (1.1 vs 1.3 mmol/L, P=.02), higher free fatty acid (0.6 vs 0.5 mmol/L, P=.03), higher apoB‐to‐apoA1 ratio (0.8 vs 0.6, P=.03), and higher glucose (5.8 vs 4.3 mmol/L, P=.03) concentrations compared to normal weight individuals. Regardless of obesity status, over half of all participants (57.5%) were considered at high cardiometabolic risk using consensus guidelines, and this was more pronounced for kidney transplant recipients (61.9%). Post‐transplantation adolescents have increased cardiometabolic risk characterized by traditional risk factors of obesity and diabetes. The presence of obesity significantly worsens biomarkers of cardiometabolic risk. Future studies should explore whether treatment of obesity can improve the health and long‐term outcomes for children undergoing solid organ transplant.     

Changes in attention with hypo- and hyperglycaemia in children with insulin dependent diabetes mellitus

We compared the results of a computerized attention test (TOVA) in 38 children with insulin dependent diabetes mellitus in relation to various spontaneously occurring blood glucose levels. Testing was performed at the following blood glucose levels: <3.3 mmol/l (hypoglycaemia), 3.3–8.3 mmol/l (normoglycaemia) and >8.3 mmol/l (hyperglycaemia) . The attention (sum of errors and response time) varied significantly with the blood glucose level (P=0.002). The highest number of errors of omission and the longest response time was observed during the test run with hypoglycaemia. Age, sex, age at manifestation of the disease, metabolic control and the results of the intelligence test had no significant influence on these results. We found that attention in children with diabetes was significantly reduced compared to TOVA norms especially during mild hypoglycaemia (P<0.001). Irrespective of the blood glucose levels, reaction time and the variability of the reaction time differed significantly between TOVA norms and diabetic children (P<0.01). Conclusion In children with diabetes mellitus a significant reduction in attention was found at mild hypoglycaemia but as well at low normal blood glucose levels. Attention deficits due to transient lowering of blood glucose may therefore occur in diabetic children even before they are aware of hypoglycaemic symptoms. Received: 24 November 1997 / Accepted: 2 March 1998