颅脑外伤及颅内出血

与成人相比,儿童头部占身体比例相对较大,其头部受伤较常见,而且相对概率较大.有资料显示,颅脑创伤占儿童创伤的80%.     

儿童心力衰竭过程中凝血功能变化及抗凝治疗

血栓形成是心力衰竭的常见并发症, 严重影响心力衰竭患者的生活质量。目前儿童心力衰竭的抗凝治疗仍不够规范, 抗凝剂的使用也更多地依赖成人的用药经验, 但儿童心力衰竭的病因和凝血系统发育与成人不同, 抗凝治疗策略可能有所不同。本文就儿童心力衰竭过程中凝血功能改变及抗凝治疗做一介绍, 以期对儿童慢性心力衰竭患者凝血系统管理及抗凝治疗提供参考。     

儿童起搏器植入治疗进展及若干问题思考

儿童心脏起搏器植入总量并不多,但却面临诸多问题.现有指南及植入方案大都基于成人经验,并不完全适用于儿童患者.诸如左束支起搏、无导线起搏器植入等新型植入方式及装置的儿童适应证也有待进一步探索.考虑到儿童生长发育的特性以及未来可能面临的数次起搏器升级、更换等情况,对于儿童起搏器的植入方式、起搏器导线植入部位、术后并发症的防...     

急性淋巴细胞白血病(下)

5 风险评估对病人的复发风险进行评估以确保只有高危病例才被施予极强治疗.研究表明采用成人方案治疗的青少年病人,其效果要显著差于使用儿童方案治疗的同年龄组.     

儿童叶轮式心室辅助装置的研究与临床

叶轮式心室辅助装置在心力衰竭患者的治疗和体外生命支持中的作用已获得广泛肯定。经过数十年的研究，多种类型的成人心室辅助装置已成功应用于临床，但为儿童患者开发类似装置的研究相对较少。儿童心室辅助装置不是成人装置的简单缩小，还需要符合儿童体重差别大而流量落差大、绝对流量小而容易形成血栓等特点，研发过程存在更大的困难和挑战。该文就现有的专为儿童开发的叶轮式血泵进行讨论。     

肠道微生物与儿童肥胖

肥胖是影响儿童和成人健康的一个严重的公共卫生问题,其病因复杂,是遗传、环境等多种因素共同作用的结果.越来越多的证据显示,肠道微生物参与了体重调控、能量代谢和炎症反应,在肥胖的发生中起了重要作用.自然分娩、母乳喂养和避免生命早期抗生素暴露有益于维持肠道微生物的平衡,可能降低未来发生肥胖的风险.益生元和益生菌可以改变肠道微生物构成,从而影响摄食和体重.探求肠道微生物与肥胖间的关系可为防治儿童肥胖打开新思路.     

慢性活动性EB病毒感染的研究进展

EBV感染性疾病按病程可分为急性感染和慢性感染.绝大多数感染,尤其是儿童感染,是短暂、轻微且无症状的,成人的原发感染较儿童严重,病毒可能终生潜伏,但很少留有后遗症.     

儿童心力衰竭诊治——需要关注的一些变化

儿童心力衰竭(心衰)病因与成人显著不同,儿童心衰诊治多是成人研究结果的沿用.目前应关注心衰诊断治疗领域的一些进展,尤其治疗方面由单纯血流动力学的治疗到更加注重神经内分泌的调节,以阻断延缓心衰的进展,此外人工心脏辅助装置及血液净化等治疗在心衰治疗方面日益引起重视.     

儿童急性巨核细胞白血病研究进展

急性巨核细胞白血病(AMKL)是一类以原始巨核细胞克隆增殖为特征的异质性血液系统恶性肿瘤.儿童发生AMKL的风险高于成人,占儿童急性髓系白血病的4％～15％.基因组学研究进一步揭示了 AMKL发病机制,为靶向治疗等药物的开发提供了科学基础.本文就儿童AMKL的风险分层、预后分析和治疗相关的最新研究进展进行了综述,为进一...     

儿童维生素D缺乏的研究进展

研究表明全球50%的人口存在维生素D缺乏的风险.引起维生素D缺乏的主要原因是人们误认为靠日照或通过膳食就可补充足够的维生素D,而忽略了在特殊年龄或特殊季节添加维生素D的重要性.儿童是维生素D缺乏的潜在高危人群,维生素D缺乏町使儿童易患佝偻病,引起生长迟缓和骨骼变形,并可能增加成人后骨质疏松及老年髋部骨折的危险性.维生素D缺乏还与癌症、自身免疫性疾病、内分泌系统疾病、神经系统疾病、高血压及传染病有关.     

The contribution of biomechanics to the safety of children inside motor vehicles]

Because laws mandating use of seat belts by motor vehicle drivers and front seat passengers have been passed throughout the developed world, it is becoming increasingly common to see parents protected from injuries whereas their children are abandoned to the tragic effects of chance and biomechanics. In France, the situation is especially critical. The law passed in 1975 requiring that all children use the back seat has reduced the risk of death and severe injury but nevertheless affords inadequate protection: each year, among children aged 0 to 10 years, several hundred are killed and nearly 10,000 injured in car accidents. This situation can be decisively improved, as shown by the figures in the United States and most European countries where use of child restraint devices (CRD) is mandatory. CRDs are designed to protect the child in the event of an accident by reducing the risk of injury due to ejection or projection against the inside of the vehicle: they play the same role as the seat belt for adults. France is the European country with the lowest rate of use of CRDs and the highest rate of child deaths due to motor vehicle occupant injuries. To improve this situation, regulations are being developed by the French government; use of appropriate CRDs will be mandatory for all children aged 0 to 10 years starting on January 1 st, 1992.     

Child restraint law effects on motor vehicle accident fatalities and injuries: the New Mexico experience

The New Mexico State Legislature passed a child restraint law applicable to children less than 5 years of age that became effective in June 1983. To evaluate the effectiveness of this law, we analyzed traffic accident data for New Mexico from January 1981 through September 1984. During this period, there were 20,972 children younger than 5 years of age in motor vehicle accidents. Restraint usage increased for this age group from a low of about 10% in 1981 to more than 40% in 1984 (P less than 10(-6)). Unrestrained children younger than 5 years of age were five times more likely to be killed and two times more likely to be injured than restrained children. Analysis of motor vehicle accident fatality and injury rates pre- and post-law revealed a 33% reduction in motor vehicle accident fatality rates and a 12.6% reduction in nonfatal injury rates for children younger than 5 years. We conclude that child restraint devices are effective in reducing motor vehicle accident fatalities and injuries in young children and the child restraint law has been effective in increasing child restraint usage and in reducing childhood death and injury in New Mexico.     

Seat restraint use, previous driving history, and non-fatal injury: quantifying the risks

AIMS: To quantify the increased risk of non-fatal injury when children travel unrestrained in a car, and to identify other preventable risk factors. METHODS: Case-control study of 78 children presenting to an accident and emergency (A&E) department having sustained an injury while travelling in a car, and 97 children attending an A&E outpatient clinic with conditions unrelated to road traffic accidents. RESULTS: Seat restraint was associated with a 93% lower risk of child accident injury. A driver with points on the licence was over five times more likely to have had an accident resulting in child injury than a driver without points. Child accident injury was also associated with the driver's accident history. CONCLUSIONS: These data allow the effect of achieving new target levels of seat restraint use to be estimated. Strategies aimed at reducing the risk of further accident among drivers with a history of accident may have a beneficial impact on childhood accident injuries.     

Exploring child car passenger safety practices in China: experience from a parental survey in Shanghai

Little is known about child passenger safety practice in China. This study aims to describe child passenger seating and restraint practice in Shanghai. Information on 970 children enrolled in five randomly selected kindergartens in the Songjiang and Pudong districts of Shanghai was collected from a parental survey during 2008-2009. The adjusted rate ratios for optimal (rear-seated alone) versus suboptimal seating position (including front-seated or sitting in adult laps) and restraint use versus non-use of restraints among child passengers were evaluated using multivariate binomial regression. Suboptimal seating position (16.9%) and non-use of restraints (60.8%) was common among child passengers. Younger age (≤4 years) and having parents who are licensed drivers decreased the likelihood of being rear-seated alone; whereas having a tertiary-educated mother increased the likelihood of a child being seated optimally. Compared with unlicensed parents, guardian parents who have a driver's licence were more likely to use restraints for their child passengers. This study suggests restraint non-use and suboptimal seating position are common for child passengers in the Songjiang and Pudong districts of Shanghai, and identifies risk factors influencing restraint use and seating position choice for child passengers. There is an urgent need to improve child passenger safety in China and these findings indicate potential targets for educational interventions in the absence of child restraint laws.     

Showing (motor vehicle) restraint: a primer for emergency physicians

In 2000, 1,668 child occupants under the age of 14 died in motor vehicle crashes and nearly 250,000 children were injured. When used correctly, child safety seats can dramatically reduce a child’s risk of death and serious injury in a motor vehicle crash. Emergency physicians have a unique opportunity to counsel parents and caregivers and provide recommendations on the appropriate restraint for their children as the majority of children in crashes who seek care are treated in emergency departments. The recommendations for child occupant protection are updated regularly. This paper will provide an overview of the current recommendations for restraining children in motor vehicles and identify sources for up to date information for physicians and families.     

Seat restraint use,previous driving history,and non-fatal injury: quantifying the risks

AIMS—To quantify the increased risk of non-fatal injury when children travel unrestrained in a car, and to identify other preventable risk factors.METHODS—Case-control study of 78 children presenting to an accident and emergency (A&E) department having sustained an injury while travelling in a car, and 97 children attending an A&E outpatient clinic with conditions unrelated to road traffic accidents.RESULTS—Seat restraint was associated with a 93% lower risk of child accident injury. A driver with points on the licence was over five times more likely to have had an accident resulting in child injury than a driver without points. Child accident injury was also associated with the driver''s accident history.CONCLUSIONS—These data allow the effect of achieving new target levels of seat restraint use to be estimated. Strategies aimed at reducing the risk of further accident among drivers with a history of accident may have a beneficial impact on childhood accident injuries.     

Failure of hospitals to promote the use of child restraint devices

Motor vehicle accidents are the leading cause of death in children. In 1977, Tennessee adopted the nation's first law requiring the use of child restraint devices (CRDs), but despite extensive promotional efforts, a majority of young children still travel unrestrained. We surveyed all acute-care hospitals in Tennessee to determine their policies regarding CRDs. Of 109 hospitals with obstetric services, 28 (26%) had a policy calling for discharged newborns to be transported in CRDs; only seven (5%) of 128 pediatric services had such a policy. It is time for hospitals and professional organizations to adopt policies to ensure that the parents of every child discharged from an obstetric or pediatric unit are educated concerning CRD use laws and are able to comply with them. Pediatricians should consider incorporating "discharge in child restraint device" into their routine discharge orders.     

Children riding in the back of pickup trucks: a neglected safety issue

Motor vehicle-related trauma is the leading cause of death in children in the United States. All states have pediatric restraint requirements for passenger vehicles to help prevent these deaths and injuries. Only a few states, however, possess safety laws or restrictions for passengers who ride in the back of pickup trucks. A retrospective review of medical records for a 40-month period revealed 40 patients whose injuries were a direct result of being a passenger in the cargo area (bed) of a pickup truck. Their injuries and other pertinent data are discussed. Representatives from the Highway Safety Commission of each state were surveyed about their specific highway safety laws. The responses revealed that all states and the District of Columbia have child restraint requirements for passenger automobiles, 34 states have adult restraint laws, but only 17 states have any type of restriction for passengers riding in the back of pickup trucks. Seventy-one percent of the states with pickup truck regulations include only the preschool-age child. Data from the National Highway Traffic Safety Administration concerning pickup trucks and passenger fatality are presented and discussed.     

The spectrum of abdominal injuries associated with chance fractures in pediatric patients.

INTRODUCTION: With the increased use of seat belts in motor vehicles, the frequency of morbidity and mortality associated with motor vehicle accidents may have decreased but there is an associated rise in injuries. The purpose of this study was to evaluate the risk of intra-abdominal injury in children who sustained Chance-type fractures in a motor vehicle accident. MATERIALS AND METHODS: A retrospective review was conducted of pediatric patients admitted for injuries sustained in motor vehicle accidents between 1984 and 2001. Patients that sustained lumbar Chance fractures and an abdominal injury were reviewed. RESULTS: A total of 25 patients with lumbar Chance fractures were seen at our institution; twelve had associated abdominal injuries. The mean age at the time of injury was 10.9 years and the most recent follow-up was a mean of 4.8 years after injury. All patients were involved in high-speed motor vehicle collisions. Eleven patients were restrained using a 2-point restraint and only one was restrained using a 3-point restraint. CONCLUSIONS: The abdominal injury patients had a significantly higher Chance fracture index than those patients who also suffered Chance fractures but no associated abdominal injuries. Success in the management of intra-abdominal injuries is dependent on the awareness that such an injury exists.     

Serious injury is associated with suboptimal restraint use in child motor vehicle occupants

AIM: To investigate the relationship between restraint usage and injury outcome in child motor vehicle occupants aged 2-8 years. METHODS: Retrospective case review of all child occupants presenting at the Children's Hospital at Westmead between July 2002 and January 2005 subsequent to a motor vehicle crash. Injury severity was assessed in terms of the Abbreviated Injury Scale (AIS), by age and type of restraint. RESULTS: Data were collected for 152 child occupants aged 2 and 8 years. While nearly all children (94%) used some restraint, most (82%) used a suboptimal form of restraint. Injury severity between optimally restrained children and suboptimally restrained children differed significantly (Fisher's exact test, P<0.001), with suboptimally restrained children receiving a greater proportion of moderate to severe (AIS 2+) injuries. No optimally restrained child sustained an AIS 2+ injury. CONCLUSION: A total of 82% of child occupants aged 2-8 years involved in crashes were suboptimally restrained. All children who sustained serious injuries were suboptimally restrained. There is a need to encourage correct use of the most appropriate restraint for child motor vehicle occupants in order to reduce the number and severity of injuries in these road users.