重症手足口病并发神经源性肺水肿相关因素分析

目的 探讨重症手足口病并发神经源性肺水肿的临床相关因素和激素及丙球药物治疗对神经源性肺水肿发生的影响.方法 将2008年4月 - 2010年9月住院治疗的重症手足口病168例,其中神经源性肺水肿68例,以是否并发肺水肿分组,对神经源性肺水肿发生前的临床特征进行单因素χ2检验和多因素Logistic回归分析;又根据重症手足口病168例的用药情况分成冲击量甲泼尼龙组、非冲击量甲泼尼龙组和无甲泼尼龙组3组,对冲击量甲泼尼龙是否加丙球组的临床资料进行χ2检验.结果 不典型皮疹、面部红斑、易激动、呕吐、心率增快、血压增高、腹痛、白细胞升高、血糖升高、脑脊液白细胞及蛋白升高、咽/肛拭子EV71-RNA阳性与手足口病并发神经源性肺水肿的发生有关(P均＜ 0.05).多因素Logistic回归分析共筛选出4项发生神经源性肺水肿影响因素,分别是不典型皮疹、呕吐、EV71(+)、血糖高.另外冲击量甲泼尼龙组、非冲击量甲泼尼龙组、无甲泼尼龙组三组的神经源性肺水肿的发生率差异无统计学意义.将62例冲击量甲泼尼龙组以是否加用丙球冲击治疗分为2组,其神经源性肺水肿的发生差异具有统计学意义(χ2 ＝ 6.738,P ＜ 0.01).结论 手足口病并发神经源性肺水肿的相关因素有不典型皮疹、呕吐、EV71(+)、血糖升高.大剂量甲泼尼龙冲击治疗对阻断神经源性肺水肿的疗效不明显,丙球冲击治疗对阻断神经源性肺水肿有一定作用.     

重症手足口病并发神经源性肺水肿的危险因素分析

目的 探讨重症手足口病并发神经源性肺水肿的危险因素.方法 根据有无并发神经源性肺水肿将79例重症于足口病患儿分为两组,分析两组在临床症状、体征、实验窒检查及脑电图检查结果之间的差异,Logistic回归分析并发神经源性肺水肿的危险因素.结果 两组患儿在肠道病毒71型的感染率,高体温、肌阵挛、肢体麻痹、眼球调节障碍、心动...     

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.     

重症手足口病神经源性肺水肿的诊治

重症手足口病可并发神经源性肺水肿,严重者导致死亡.应早期识别神经系统表现,密切关注交感神经亢进表现及神经源性肺水肿的高危因素,监测呼吸频率,及时发现呼吸困难、紫绀和肺部啰音等危重症前兆或表现.严格控制液体负荷、降低颅内压、抑制交感神经功能、保护心脏功能、积极呼吸支持、加强呼吸道管理是治疗神经源性肺水肿的关键.     

肠道病毒71型感染导致重症手足口病并发神经源性肺水肿临床高危因素分析

目的 探讨肠道病毒71型(EV71)感染导致重症手足口病并发神经源性肺水肿的临床特点,早期发现高危因素,以利于疾病早期认识、早期干预和诊断治疗.方法 收集2010年3月至6月本院重症监护室收治的42例EV71感染导致重症手足口病并发神经源性肺水肿患儿资料,分析其性别、年龄、白细胞、血小板、血糖、BE、心肌酶谱、乳酸、病程和肺出血等资料,通过生存组(n=26)和死亡组(n=16)对比,分析神经源性肺水肿发生的高危因素.结果 42例患儿中死亡16例,病死率为38.1%.16例患儿均有发热、惊跳及循环功能障碍(休克);15例患儿手足或手足臀部有针尖样散在皮疹,1例无皮疹.死亡组与生存组临床特征相比,出汗、意识障碍、指端凉、肺出血、应激性溃疡、循环衰竭发生率高,两组比较差异有显著性(P＜0.05).死亡组和生存组血糖及白细胞计数均升高,死亡组明显高于生存组,差异有显著性(P＜0.05);死亡组乳酸升高,生存组乳酸增高不明显,差异有显著性(P＜0.05);死亡组心肌酶CK、CK-MB、肌钙蛋白等指标明显高于生存组,差异有显著性(P＜0.05).结论 重症手足口病并发神经源性肺水肿病死率高,当患儿出现出汗、意识障碍、肢端凉、应激性溃疡、循环衰竭及血糖、白细胞计数明显增高,心肌酶、肌钙蛋白、血乳酸等升高现象为重症手足口病并发神经源性肺水肿的高危因素.     

肠道病毒71型重症手足口病致神经源性肺水肿的发病机制及治疗进展

重症手足口病是一种由肠道病毒引起的急性传染病,多发生于学龄前期儿童,肠道病毒71型是其主要病原.少数重症手足口病可累及神经系统和呼吸循环系统,引起脑干脑炎、神经源性肺水肿、肺出血、心肌炎等严重并发症.神经源性肺水肿是肠道病毒71型累及中枢神经系统后出现的急性肺水肿,临床上以进行性呼吸困难和持续低氧血症为特点,早期可仅有心率增快、血压升高等非特异性表现,诊断十分困难.当出现明显气促、大量泡沫痰、双肺湿啰音时,病死率极高.尽管重症手足口病的治疗手段不断进步,但神经源性肺水肿的病因及调控网络较复杂,导致临床疗效欠佳.因此,密切观察、早期诊断、合理治疗对改善预后有重要意义.该文就肠道病毒71型重症手足口病致神经源性肺水肿的发病机制及治疗进展进行阐述.     

并发神经源性肺水肿的手足口病死亡患儿的临床特点研究

目的 研究并发神经源性肺水肿的手足口病生存患儿与死亡患儿的临床特点.方法 回顾性分析2009年至2013年我院收治的25例并发神经源性肺水肿的手足口病患儿的临床资料,对死亡和生存患儿的临床特点进行分析.结果 并发神经源性肺水肿的患儿病死率高达64％,年龄在4岁以内.死亡组患儿血乳酸水平明显高于生存组患儿（P＜0.05）,死亡组患儿pH值明显低于生存组患儿（P＜0.05）,死亡组患儿出现应激性溃疡、脑膜刺激征、肌力下降的例数明显高于生存组患儿（P＜0.05）.行血液净化治疗患儿的病死率低于未进行血液净化治疗的患儿（P＜0.05）.生存组患儿从出现神经源性肺水肿到进行呼吸机辅助通气的时间间隔要短于死亡组患儿（P＜0.05）.结论 合并神经源性肺水肿出现应激性溃疡、脑膜刺激征、肌力下降的患儿及血乳酸明显升高、pH明显下降的患儿病死率较高.患儿出现神经源性肺水肿后尽早进行呼吸机辅助通气可以在一定程度上提高生存率.血液净化治疗可能会提高合并神经源性肺水肿的危重症手足口病患儿的生存率.     

肠道病毒71型感染性疾病

肠道病毒71型感染性疾病世界各地均有发生,以粪-口、呼吸道及密切接触等多途径传播;主要临床表现为手足口病与疱疹性咽峡炎,重症者可引起神经系统感染,严重者可因神经源性肺水肿而危及患儿生命。早期认别危重状态,积极有效地治疗神经源性肺水肿是成功抢救患儿生命的关键。     

手足口病并发中枢神经系统感染216例临床分析

目的 分析手足口病并发中枢神经系统感染的临床特点、治疗方法及预后.方法 收集并分析大连市儿童医院内六病房2010年4月至10月收治的216例小儿手足口病并发中枢神经系统感染的临床资料.结果 216例患儿中,男136例,女80例,男女比例为1.7:1,3岁以下占56％ (121/216),中枢神经系统损害多发生在病程第2天.入院后给予甲泼尼龙、丙种球蛋白,采取降颅压、抗感染等对症治疗.经治疗后死亡3例,死于神经源性肺水肿和(或)肺出血;2例出院时留有神经系统损伤后遗症;其余治愈出院.结论 手足口病并发中枢神经系统感染主要发生在3岁以下幼儿,早发现、早治疗大多预后较好.并发脑干脑炎、神经源性肺水肿、脑脊髓炎提示病情危重,可导致死亡或留有后遗症.     

重症手足口病致神经源性肺水肿

神经源性肺水肿常由重症手足口病(肠道病毒EV71感染)引起,以突发呼吸困难、呼吸窘迫、咳粉红色泡沫痰、咯血及循环衰竭等为特点.同时伴意识障碍和神经系统异常表现.病情凶险,临床表现与心源性肺水肿有相似之处,需认真鉴别.对重症手足口病早发现,早诊断,早救治,可提高抢救成功率,降低病死率.实用儿科临床杂志,2009,24(10):732-733     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

�¶�֢��ϵ�ϰ���ע��ȱ�ݶද�ϰ������ڵ�ת��

孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

---

---

Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.