婴幼儿功能性便秘的诊断及治疗

婴幼儿功能性便秘临床并不少见,且严重影响其生活质量。2006年修订的罗马Ⅲ标准作为婴幼儿功能性便秘诊断和治疗的指南指出,婴幼儿功能性便秘的治疗应以饮食治疗为主,不提倡过多使用药物。     

儿童呼吸道疾病流行病学调查分析

为了解儿童常见呼吸道疾病的发病情况,为防治提供依据,以随机、分层、不等比、整群抽样方法,调查温州市4个街道内0～14岁儿童10293名。结果:实际接受调查人数9947名。毛细支气管炎(简称毛支)、哮喘、反复呼吸道感染(RRI)、慢性咳嗽的患病率及饲养宠物猫或狗的比例分别为6.00％、1.24％、8.16％、3.31％与10.93％,其中16.08％的毛支患儿发展为哮喘;既往被诊断为哮喘或喘息性支气管炎的比例为4.51％,与本次调查确诊的患病率差异有显著性(X2=191.30,P<0.01);哮喘、RRI、慢性咳嗽在各年龄组患病率差异均有显著性(X2=60.45～148.64,P<0.01),以幼儿组、学龄前组为高(P<0.0045)。提示毛支与哮喘有密切相关性,诊断哮喘要严格掌握诊断标准,防止扩大化。呼吸道疾病流行情况的资料为今后群防群治和相关研究提供依据。     

小儿功能性便秘临床特征与分型

为探讨小儿功能性便秘(FC)临床特征及临床分型,选择便秘患儿38例和健康儿童38名,以Bleijenberg便秘症状评分标准、Bristol粪便性状分级为依据,对两组被测者进行评估。便秘组患儿口服不透光X线标志物(ROM)72h后摄取腹部平片,计算结肠各区标志物残留数和结肠传输指数(TI)。结果显示:①FC组患儿症状评分平均值与健康对照组比较差异显著(P<0.001);②FC组患儿1、2、3级粪便分别为13.2％、73.7％及13.2％,对照组无1、2、3级粪便,4、5级粪便各占50％,两组差异显著;③FC组患儿慢传输型(STC)11例;功能性出口梗阻型(FOOC)5例,混合型(MIX)5例,未定型7例,各区标志物残留数组间比较差异显著(P<0.01);STC、FOOC、MIX型便秘患儿结肠传输指数(TI)分别为0.12±0.11、0.86±0.14、0.48±0.13,组间比较差异显著(P<0.01)。提示症状评分及粪便性状分级可协助诊断便秘,对FC初步临床分型有参考意义;口服ROM后72h一次摄片法,简易、经济、省时,易被患者接受,可用于确定FC临床分型,对指导制订分型治疗方案有实用价值。     

生物反馈治疗小儿功能性出口梗阻型便秘临床评价

功能性便秘是儿童排便障碍的常见原因，有资料报道，便秘占综合门诊总数的5％～10％，而功能性便秘占儿童便秘的90％以上。功能性便秘分为慢传输型、出口梗阻型和混合型，本文针对23例功能性出口梗阻型便秘患儿，采用生物反馈疗法进行治疗，对其疗效进行评价。     

儿童功能性便秘的研究进展

功能性便秘 (Ｆｕｎｃｔｉｏｎａｌｃｏｎｓｔｉｐａｔｉｏｎ ,ＦＣ)是儿童排便障碍的常见原因。约 2 5 %患儿在 1岁以内发病 ,多数病例为 2～4岁。本病在儿童中发病虽多 ,但由于通常并不影响其正常生长发育 ,因此对其研究不多。有资料报道[1] 功能性便秘占综合性儿科门诊总数的 5 %～ 10 % ,占小儿胃肠病门诊的2 5 % ,占小儿便秘 90 %以上。但国内对功能性便秘尚无确切定义 ,Ｔｈｏｍｐｓｏｎ等[2 ] 认为 :未使用泻剂情况下排便次数 <3次 /周 ;2 5 %以上的时间排便费力 ;2 5 %以上的时间粪便坚硬或呈球状 ;2 5 %以上的时间有排便不净感 ;体…     

儿童功能性便秘:罗马Ⅲ诊断标准临床评介

小儿功能性胃肠病（functional gastrointestinaldisorders，FGIDs）在国内儿科界已受到普遍关注。2006年5月20～25日洛杉矶国际会议中心召开美国消化疾病周（DDW-2006），会议上专家小组发布了最新修订的FGIDs罗马Ⅲ诊断标准，其中建立2个儿科分类。小儿FGIDs是按照患儿或父母报告的主要症状进行分类，而不是以病变器官为基础，且强调FGIDs前必须先排除器质性疾病。本文仅就新生儿／幼儿和儿童／青少年功能性便秘（functionalconstipation，FC）罗马Ⅲ诊断标准进行讨论。     

儿童功能性便秘与慢性传输型便秘

儿童功能性便秘 (functionalconstipation ,FC)在罗马Ⅱ标准关于儿童功能性胃肠病 (functionalgastrointestinaldisorders ,FGIDs)分类中已被列入排便紊乱中[1],借以区分胃肠动力疾病 (disorderofgastrointestinalmotility ,DGIM)中由于结肠运动障碍、结肠移行时间延迟而导致的     

自贡市川崎病流行病学调查研究

目的了解自贡市川崎病发病情况、流行病学及治疗现状。方法按日本川崎病研究课题组“川崎病诊断标准”制定统一调查表，在自贡市县、市级医院选择1997年1月-2001年12月儿科住院川崎病患者进行调查，对发病年龄、性别、地区、季节、心血管并发症等进行分析。结果5年间川崎病发病共152例，未发生流行现象，男性发病占58．55％，其年龄：＜1岁占4．6％，1～4岁占58％，以3～5月份为高峰，9～12月份发病最低，有冠状动脉病变占19．48％。结论川崎病在我市春季发病率高于秋季，男性略高于女性，发病年龄高于日本及国内报道，冠状动脉病变率与各家报道相似，农村发病占65．13％。提示我市农村发病高于城市，是否与农村经济、营养状况、免疫功能低下、医疗卫生条件较差有关。由于川崎病导致心脏病发病率仍较高，作为基层医师不但要重视早诊早治，还要重视定期随访。     

河北省儿童医院新生儿呼吸衰竭的前瞻性临床流行病学调查

目的：新生儿呼吸衰竭（NRF）是导致新生儿死亡的重要原因之一。该文对2004~2005年河北省儿童医院新生儿重症监护室（NICU）中呼吸衰竭的临床发病及治疗、预后等情况进行资料搜集及分析,以反映目前新生儿呼吸危重病的救治状况,并为今后进行大规模、前瞻性的队列研究奠定基础。方法：对2004~2005年收入NICU的304例呼吸衰竭患儿进行前瞻性资料收集及统计分析。结果：在连续12个月间,304例NRF患儿占同期NICU收治危重患儿的35.7%;新生儿呼吸窘迫综合征,羊水吸入性肺炎,社区感染性肺炎等是NRF的主要构成疾病;NRF患儿的院内病死率为5.6%（17例）,放弃治疗比例达31.6%（96例）;治愈和好转出院的191例NRF患儿中,住院总天数平均为14.9±7.1 d,住院总费用平均为7 977±3 426元。结论：新生儿呼吸衰竭是本地区NICU一个高发病率、高病死率以及高住院费用的严峻问题,提示加强围生期的保健以及出生后呼吸救治新技术以及新模式的应用,提高NRF的救治成功率,可能有利于降低与围产关系密切的新生儿危重呼吸疾病的发病率及死亡率。     

儿童孤独症的流行病学调查分析

目的分析儿童孤独症的流行病学结果，以有助于诊断与治疗。方法按照美国精神障碍诊断的统计手册（ABC测量表）儿童孤独症的诊断标准，于2a内随机抽查10412人，对儿童孤独症的流行病学予以调查。结果6名儿童诊断为孤独症，患病率为0．56‰。经过心理干预与药物综合治疗，6名儿童孤独症的症状改善，可以上课回答老师提出的问题，与同学进行语言交流，刻板动作消除。结论应多关注儿童孤独症的流行病调查，对孤独症儿童予及时的治疗，可改善症状。     

排便习惯训练与儿童功能性便秘发病相关分析

为探讨排便习惯训练(DHP)对小儿功能性便秘(FC)发病的影响，并确定DHP。在预防、治疗小儿FC的作用，自行拟订DHP情况调查问卷，由经专题培训的人员，对38例FC患儿观察组及92名健康对照组小儿家长依据问卷内容进行详细调查，有关数据经U检验行统计学处理。结果表明，观察组未进行DHP者占42．10％，不规范DHP者57．90％。对照组小儿自6个月开始全部进行规范DHP，其中排软便者84．78％，条形干便14．13％，球形干便1．09％，患FC者仅1例。两组小儿膳食结构差异无显著性。表明小儿FC的发病与未曾进行或不规范的DHP高度相关，DHP在预防和治疗小儿FC时有重要作用。     

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??Functional constipation is a common functional disease of digestive system that arises in children of all ages. The symptoms include infrequent defecation??hard?? painful stools that are difficult to pass??fecal incontinence and abdominal pain. These symptoms are known to have a significant impact on the mood??appetite and life quality of children. The pathogenesis underlying FC remains unclear??but with the development of the research in micro-ecosystem of intestines?? more and more evidences support that an alteration of the gut microbiota may be a possible mechanism for the development of FC. Probiotics are live microorganisms that can enrich microorganism species?? lower intraluminal pH and regulate intestinal immune function??which make it a good prospect in the treatment of FC. Then??this paper will make a brief introduction to the application of probiotics in children with FC by referring to its domestic and abroad research progresses.     

不同型别的功能性便秘患儿肛门直肠测压对照研究

目的探讨功能性便秘（FC）患儿与健康儿童肛门直肠动力学差异,为其临床分型诊断及治疗提供依据。方法采用功能性胃肠病罗马Ⅲ诊断标准,收集2008年1月至2009年1月在第四军医大学唐都医院儿科门诊及住院的FC患儿为FC组。选取同期无消化系统症状,平日排便正常的健康儿童为正常对照组。采用不透光X线硫酸钡条测定结肠传输指数（TI）,依据TI将FC组分为出口梗阻型（OOC）亚组、慢传输型（STC）亚组和混合型（MIX）亚组。通过肛门直肠测压法分析FC各亚组与正常对照组肛门直肠动力学差异。结果研究期间FC组纳入25例,其中STC亚组10例,OOC亚组15例,未发现MIX患儿;正常对照组纳入10名。FC组与正常对照组肛门括约肌静息压差异无统计学意义（P＞0.05）。STC亚组肛门括约肌最大收缩压与正常对照组差异无统计学意义（P＞0.05）,OOC亚组肛门括约肌最大收缩压显著高于正常对照组及STC亚组（P＜0.05）。FC组直肠最低敏感量及最大耐受量均显著高于正常对照组（P均＜0.05）。STC亚组与OOC亚组直肠最低敏感量及最大耐受量差异均无统计学意义（P均＞0.05）。结论FC患儿存在明显的肛门直肠动力和感觉异常;OOC和STC患儿的肛门直肠动力学存在差异。肛门直肠测压检查对协助诊断FC有一定价值。     

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便秘是儿科临床最常见的胃肠功能不良的症状之一[1-6],涉及范围达全世界儿童的0.7%～29.6%[5-7]。儿童便秘常可起始于婴儿及新生儿期[7],且约1/3患儿的症状会持续至成人期[5],表现为慢性顽固性便秘,有些甚至需要外科手术治疗,漫长的病程和复杂的病情严重影响了患儿和家庭成员的身心健康和生活质量。近十余年来,符合循证医学要求的相关便秘病理生理基础的深入研究以及采用现代临床管理策略的长期研究结果,已明确显示临床治疗效果和预后的改善[5,8-9]。董梅,主任医师。现工作于北京协和医院儿科。兼任卫生部卫生专业技术资格考试专家委员会委员,中华医学会儿科学分会消化学组委员。担任多种儿科核心期刊编委。参编专著十余部,发表专业论文30余篇。     

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便秘(constipation)是最常见的儿童排便功能障碍症候群之一,多数隶属于功能性便秘(functional constipation,FC)范畴。我国北方5市一项多中心流行病学调查结果显示,儿童FC的群体患病率为4.73%,为儿童胃肠门诊最常见的病症之一[1-2]。随着现代分子生物学、影像学以及生物物理学的快速发展,人们对儿童便秘的认识和研究不断深入,如先天性巨结肠及其同源病、肠神经发育不良、肛门括约肌失迟缓等,在此基础上针对病因的个体化治疗逐步获     

儿童功能性便秘的危险因素分析

目的了解儿童功能性便秘的危险因素。方法采用横断面调查方法,调查2013年3月至2014年2月期间消化专科门诊确诊的182例功能性便秘患儿的便秘相关危险因素。结果功能性便秘以男性患儿多见,并以学龄前期为主;患儿主要存在不喜食蔬菜水果(52.2%),饮水少(44.0%),未养成每天排便习惯(39.5%),存在排便恐惧(36.3%),食物摄取不足(25.8%)等危险因素;不同年龄阶段的危险因素有所不同。结论功能性便秘与性别、年龄、饮食生活习惯和精神心理相关。     

Dietary fibre intake and constipation in children with severe developmental disabilities

OBJECTIVE: Constipation is a common problem in children with severe developmental disabilities (DD). This study aimed to evaluate fibre intake of severe DD children living in a residential institution, and the possibility of reducing the use of laxatives by increasing their fibre intake. METHODOLOGY: A baseline study was performed to evaluate the fibre and macronutrient intake in a group of severe DD children. Nutrients including fibre for a standard serving in each meal were calculated and daily macronutrients and fibre intake were estimated. An intervention study was then carried out to evaluate whether increasing fibre intake could relieve constipation. A total of 20 children aged between 3 and 17 years were assessed over a 4-month period. In a residential unit for severe DD children, laxatives were routinely prescribed if there was no spontaneous bowel motion for two consecutive days. Fibre intake was increased in stages by adding All-Bran(R) (Kellogg Company, Battle Creek, MI, USA) and desserts. The mean number of laxative usage per week per child in the different stages were then compared. RESULTS: The baseline fibre intake was found to be approximately 2 g/day. The mean number of laxatives required per week per child decreased significantly from a baseline value of 1.22 (about 5 laxatives/month) (standard deviation (SD) = 0.36)) to 0.90 (about 3. 5 laxatives/month) (SD = 0.75) in the first stage, and 0.71 (about 3 laxatives/month) (SD = 0.40) in the second stage. Using paired t-test, the difference was statistically significant when compared with the baseline: P < 0.05 for the first, and P < 0.01 for the second stage of fibre supplementation. CONCLUSION: Very low daily intake of fibre of 2 g/day was documented. Relief of constipation and a significant reduction in the usage of laxatives was demonstrated by increasing fibre intake to 17 g/day (stage 1). Increasing fibre intake further to 21 g/day (stage 2), showed a further reduction in the use of laxatives. There was, however, no statistical significance between stage 1 and stage 2 of fibre supplementation. Alternative ways to further relieve constipation in severe DD children require further studies.     

Psychological evaluation of children with idiopathic constipation and their parents

BACKGROUND: Constipation is one of the most common problems in childhood. In idiopathic constipation it is not possible to identify primary cause in every case. Child behavioral problems and disturbances in parent-child relationships have been cited as causes of constipation. Constipation is a source of anxiety to the child and to the family. The purpose of the present study was to evaluate psychological characteristics of constipated children and their parents. METHODS: Thirty-two otherwise healthy children with idiopathic constipation over 4 years old were prospectively evaluated between January 2002 and June 2003. The Child Behavior Checklist (CBCL) and Symptom Checklist-90 revised (SCL-90-R) were used to assess the psychological profiles of the children and the parents, respectively. Thirty children with inguinal hernia who had no constipation or other problems, and their parents were asked to complete the checklists as controls. The scores of the constipation group were compared statistically with those of the control group. RESULTS: In the constipation group there were 19 boys and 13 girls with a mean age of 7.3 years (4-14 years). All the patients responded to medical treatment. Constipated children and their parents were not found to have more behavior problems than the control group (P > 0.05). CONCLUSIONS: Children with idiopathic constipation and their parents do not show significant behavioral and emotional problems. Their psychological profiles are not different from the general population.