Influence of Long Term Inhalation of Beclomethasone Dipropionate on Pituitary Adrenal Axis Function in Asthmatic Children

目的　通过检测相关激素水平 ,探讨哮喘患儿吸入二丙酸倍氯米松后对垂体 肾上腺轴功能的影响。方法　将研究对象分成 4组 :正常对照组、哮喘组、短期吸入二丙酸倍氯米松组和长期吸入二丙酸倍氯米松组。应用放射免疫法 ,测定上述 4组儿童的促肾上腺皮质激素 (ACTH)和皮质醇 (cortisol)水平 ,以评估垂体 肾上腺轴功能状态及吸入二丙酸倍氯米松后对其的影响。结果　 4组儿童的血清ACTH和cortisol水平之间无明显差别 ;ACTH兴奋实验短期吸入治疗组和长期吸入治疗组与正常对照组和哮喘组比较皮质醇基础值无明显降低 ,与哮喘组比较反应值 (刺激值 -基础值 )则明显降低 (P <0 .0 5 )。结论　吸入治疗一定时间后可使肾上腺皮质功能达到轻度抑制状态 ,但并不随吸入时间延长而产生累积抑制效应。     

休克新生儿血浆儿茶酚胺,皮质醇变化及其临床意义

为观察新生儿休克时血浆儿茶酚胺（CA）中去肾上腺素（NE）、肾上腺素（E）和皮质醇（CT）的动态变化，采用高效液相色谱-电化学法检测36例休克新生儿血浆NE、E的浓度，用放射免疫法测定血浆CT。结果，NE、E及CT的浓度明显高于对照组，分别为：NE16．0±3．0，2．9±1．1；E3.7±3.4，0.8±1．2，CT801±4，105±4（单位均为nmol／L，P均＜0．01）。感染性休克组NE高于非感染组（23．9±2．9nmol／L，10．7±2．7nmol／L，P＜0．05）。血浆NE、E浓度随病情加重而增高，提示抢救休克时血管活性药物应以扩血管为主．血浆NE、E值与毛细血管再充盈时间里显著正相关（P＜0·01），与血pH值是非常显著的负相关（P＜0.01），与血压无相关性，提示毛细血管再充盈时间及pH值是判所休克程度的较好指标。血浆CT增高可能系分泌增加和结合减少之故，提示休克时应及早应用糖皮质激素。     

周期性呕吐综合征30例

目的探讨周期性呕吐综合征的临床特征及诊断、治疗。方法对1998年1月~2003年1月我院确诊的周期性呕吐综合征30例的临床特征、治疗与预后的临床资料进行回顾性分析。结果本组患儿发病年龄3~12岁,男18例,女12例,平均年龄7.9岁;临床表现为反复发作性呕吐;有明显诱因21例,无明显诱因9例;采用赛庚啶、阿米替林治疗均未再发作。结论对反复呕吐发作患儿经对症治疗无效,排除代谢性、胃肠道、中枢神经系统器质性疾病后应考虑周期性呕吐综合征,予塞庚啶、阿米替林治疗。     

再发性呕吐综合征的预后与偏头痛的关系

目的了解再发性呕吐综合征(CVS)发展为偏头痛的比例,探讨两者之间的关系。方法电话回访38例曾诊断为再发性呕吐的有效病例28例,为每位患儿选一正常对照,用同一标准问题进行问卷调查。结果19例仍有持续周期性呕吐发生或偏头痛,余无症状。患病组曾有或现有偏头痛的发生率(46%)远远高于对照组(10.7%),差异有统计学意义(P=0.003)。结论CVS的预后与偏头痛密切相关,部分CVS患儿可发展成为偏头痛,两者间可能有相同的易患基础。     

Cyclic vomiting syndrome and food allergy/intolerance in seven children: a possible association

Cyclic vomiting syndrome (CVS) is characterized by repeated unpredictable, explosive and unexplained bouts of vomiting. The episodes have a rapid onset, persist over a number of hours or days, and are separated by symptom-free intervals. Despite the recent interest in this disorder, its aetiology, pathogenesis and even its target organ remain unknown. The purpose of this study is to investigate the role played by food allergy in CVS. The report concerns eight children (five male, three female), mean age 8 years (3–13 years), suffering from CVS for 2 years at least. The diagnosis of CVS was based on characteristic history, normal physical examination and negative laboratory, radiographic, neurological and endoscopic studies. Despite the absence of clinical signs typical of food allergy, skin prick tests were positive in six of the eight patients (75%). Specific IgE were present in 4/8 (50%) of the patients. Skin tests and specific IgE were positive for cow's milk proteins, egg white and soya. IgE levels were higher than the mean + 2SD in 5/8 (63%) of the patients. A double blind placebo controlled food challenge (DBPCFC) was carried out on seven of the eight patients who displayed clinical improvement after an elimination diet for cow's milk (and other foodstuffs indicated by positive skin tests). The DBPCFC was positive in all seven children. Clinical follow-up revealed a state of well-being over the 6 months of observation. Conclusion It appears reasonable to suggest that food allergy plays a role in cyclic vomiting syndrome. Received: 21 June 1999 and in revised form: 1 December 1999 / Accepted: 1 December 1999     

ACTH in Normal Children and Children with Pituitary and Adrenal Diseases

ABSTRACT. During insulin hypoglycaemia (IH) reference values for plasma ACTH are 10 to 88 pg/ml at 0 min and 50 to 300 pg/ml at 40 min. Plasma Cortisol reference values are above 400 nmol/l at 40 min. A negative correlation between age and ACTH response was found in normal children. ACTH response during IH in 43 children and adolescents with deficient production of one or several pituitary hormones was significantly lower (median 81 pg/ml at 40 min), than the response in normal children (median 149 pg/ml). Thirty-six patients with idiopathic hypopituitarism could be grouped into 21 with normal, 6 with borderline (50 to 70 pg/ml at 40 min), and 9 with abnormal ACTH response. In 7 patients with intracranial tumour 2 had normal, 3 borderline, and 2 abnormal ACTH response. A good correlation between the ACTH peak at 40 min and the Cortisol value at 40 min was found in patients with idiopathic hypopituitarism. ACTH response also correlated well with the plasma growth hormone (GH) response in the patients. It is recommended to study ACTH together with GH when IH is performed, multiple disturbances are often found in children with GH deficiency and demonstration of an ACTH defect has therapeutic implications.     

ACTH in Normal Children and Children with Pituitary and Adrenal Diseases

ABSTRACT. During insulin hypoglycaemia (IH) reference values for plasma ACTH are 10 to 88 pg/ml at 0 min and 50 to 300 pg/ml at 40 min. Plasma Cortisol reference values are above 400 nmol/l at 40 min. A negative correlation between age and ACTH response was found in normal children. ACTH response during IH in 43 children and adolescents with deficient production of one or several pituitary hormones was significantly lower (median 81 pg/ml at 40 min), than the response in normal children (median 149 pg/ml). Thirty-six patients with idiopathic hypopituitarism could be grouped into 21 with normal, 6 with borderline (50 to 70 pg/ml at 40 min), and 9 with abnormal ACTH response. In 7 patients with intracranial tumour 2 had normal, 3 borderline, and 2 abnormal ACTH response. A good correlation between the ACTH peak at 40 min and the Cortisol value at 40 min was found in patients with idiopathic hypopituitarism. ACTH response also correlated well with the plasma growth hormone (GH) response in the patients. It is recommended to study ACTH together with GH when IH is performed, multiple disturbances are often found in children with GH deficiency and demonstration of an ACTH defect has therapeutic implications.     

格拉司琼联合地塞米松预防小儿单孔法腹腔镜阑尾切除术后恶心呕吐

目的 探讨预防性应用格拉司琼（Gra）联合地塞米松（DEX）预防小儿脐部单孔法腹腔镜阑尾切除术后恶心呕吐（PONV）的效果。方法 年龄2～10岁小儿，全麻下行脐部单孔法腹腔镜阑尾切除术60例，随机分为3组，每组20例。对照组（C组）术中腹腔外阑尾切除后静脉注入9g／L盐水5mL；Gra组阑尾切除后静注Gra40μg／kg；Gra＋DEX组静注Gra4μg／kg和DEX0.2mg／kg。观察术后24h内恶心、呕吐发生次数和发生率。结果 术后24h恶心、呕吐发生率Gra组和Gra＋DEX组均显著低于对照组（Pa〈0．01），Gra＋DEX组发生率最低，与Gm组比较有统计学意义（P〈0.05）。结论 Gra合用DEX和单用Gra均能有效预防小儿脐部单孔法腹腔镜阑尾切除术后PONV的发生，Gra与DEX合用的效果优于单用Gra。     

ADRENOCORTICAL FUNCTION IN PUBERTY Serum ACTH, Cortisol and Dehydroepiandrosterone in Girls and Boys

Abstract. Serum ACTH, Cortisol and dehydroepiandrosterone (DHEA) were determined in 200 girls and 80 boys. In girls, serum DHEA showed significant increases between all bone age groups from the youngest one, 7.5 years, to 12.5 years. A plateau was then seen up to 15.5 years of age, followed by a continuous increase to the oldest group (18.5 years). In boys, a progressive increase in DHEA was also seen from the youngest age group (8.5 years), but a period of a more rapid increase did not commence until after 12.5 years of age and it then continued to the oldest group. The level of DHEA in boys was significantly lower than in girls until the oldest group, in concert with the earlier pubertal development in girls. The importance of DHEA in initiating the early physical signs of normal puberty seems also to be different in the two sexes, since serum DHEA in girls was almost double that seen in boys, when compared according to the stage of pubic hair growth. Serum Cortisol showed a small progressive increase in girls, the concentrations postmenarche being significantly higher than premenarche. In boys, a decrease was seen up to 12.5 years of age and an increase occurred from 16.5 years onwards. In both sexes, ACTH and Cortisol levels showed an inverse but nonsignificant relationship to each other. Serum ACTH levels in the different age groups showed no significant changes.     

Effect of Growth Hormone on Lipoprotein Metabolism in Male Pituitary Dwarfs: Changes in Lipoprotein Lipase Activity and Cholesterol Level in HDL Subfractions

To determine the effect of a chronic therapeutic dose (0.24 IU/kg/week) of growth hormone on the cholesterol concentration in serum lipoproteins and postheparin plasma lipase activities in previously untreated children with idiopathic growth hormone deficiency, seven male patients under 10 years of age were studied before and three months after the initiation of growth hormone therapy. Lipase activity was measured by an immunochemical method. The cholesterol concentration in high-density lipoprotein subfractions was determined, using a micromethod for ultracentrifugation. Serum total cholesterol and triglyceride levels did not change significantly during treatment, while the high-density lipoprotein cholesterol level decreased significantly after treatment to 79% of the baseline level, with an equal decrease of cholesterol concentration in both high-density lipoprotein₂ and ₃. Lipoprotein lipase, but not hepatic triglyceride lipase, activity decreased significantly after treatment. These were not associated with changes in either thyroid status as determined by serum triiodothyronine levels or insulin responsiveness after oral glucose challenge, suggesting that these changes may be induced by a direct action of growth hormone.     

Oral Ondansetron: An Effective Ambulatory Complement to Intravenous Ondansetron in the Control of Chemotherapy-Induced Nausea and Vomiting in Children

One hundred children with non-central nervous system malignancies received ondansetron at initiation of chemotherapy and every 8 hours for 5 days after cisplatin-containing therapy and for 3 days after other chemotherapy. Ondansetron was administered orally except with the intravenous chemotherapy. For the chemotherapy days, 72 of 93 children (76%) had complete or major control of vomiting on their worst day, 25% with cisplatin-containing protocols, 60% with ifosfamide-containing protocols, and 82% with other protocols. For the overall period, 71 of 93 children (76%) reported complete or major control of vomiting on the worst day, 14% with cisplatin, 60% with ifosfamide, and 83% with other chemotherapy. All had mild or no nausea. Of the 355 chemotherapy days, 228 children (64%) were emesisfree, 40% with cisplatin, 60% with ifosfamide, and 68% with other regimens. Of the overall period (541 days), 393 days were emesisfree, 45% with cisplatin, 71% with ifosfamide, and 86% with other regimes. Sixty-nine patients were not hospitalized, and oral ondansetron was given when chemotherapy was completed. Of the 241 ambulatory chemotherapy days, 178 (74%) were emesisfree. No significant toxicity was encountered. Oral ondansetron reduced hospitalization without reducing antiemetic efficiency in children.     

Treatment of Status Asthmaticus—Hormone Changes before and after Aminophylline i.v. Drip Therapy

The treatment of status asthmaticus is one of the most important factors in controlling the patient with asthma attacks. We have studied hormone changes in status asthmaticus and considered what is the best treatment in the asthma attack condition in children. Antidiuretic hormone (ADH), renin activity, and aldosterone activity are elevated in severe asthma attack conditions, and these high levels are correlated with high levels in Wood's clinical score. It is theoretical that patients with dehydration and respiratory failure show such elevation in hormones, and it is well known that under such conditions β₂-stimulant enhances renin production. From our study, it is concluded that β₂2 -stimulant subcutaneous injection must be considered in status asthmaticus. In children, amminophylline i.v. drip therapy may be one of the best treatments in status asthmaticus.     

Guideline for the Treatment of Breakthrough and the Prevention of Refractory Chemotherapy‐Induced Nausea and Vomiting in Children With Cancer

This clinical practice guideline provides an approach to the treatment of breakthrough chemotherapy‐induced nausea and vomiting (CINV) and the prevention of refractory CINV in children. It was developed by an international, interprofessional panel and is based on systematic literature reviews. Evidence‐based interventions for the treatment of breakthrough and prophylaxis of refractory CINV are recommended. Gaps in the evidence used to support the recommendations made in this clinical practice guideline were identified. The contribution of these recommendations to breakthrough and refractory CINV control in children requires prospective evaluation.     

艾司洛尔在危重型手足口病中的应用价值

目的 探讨艾司洛尔治疗危重型手足口病(HFMD)的临床疗效其作用机制。方法 102例危重型HFMD患儿随机分为常规治疗组和艾司洛尔组,每组51例患儿。常规治疗组按照HFMD诊疗指南予以常规治疗,艾司洛尔组在常规治疗组基础上加用艾司洛尔。两组患儿均持续监测心率(HR)、收缩压(SBP)、呼吸频率(RR)。两组患儿分别于治疗前及治疗后1 d、3 d、5 d采血检测外周血去甲肾上腺素(NE)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)及单核细胞NF-κB p65含量。在治疗前和治疗5 d后采血检测血清心肌酶及氨基末端脑钠肽前体(NT-pro BNP)的水平。结果 治疗前两组患儿HR、SBP、RR、NE、TNF-α、IL-6、NF-κB p65、心肌酶、NT-pro BNP水平差异均无统计学意义。与治疗前相比,治疗后2组患儿各时间点检测的以上各指标均明显降低(P0.05)。与常规治疗组相比,艾司洛尔组治疗1 d、3 d后上述各项指标改善更明显(P0.05)。治疗5 d后艾司洛尔组患儿血清心肌酶和NT-pro BNP水平较常规治疗组改善更显著(P0.05)。结论 早期应用艾司洛尔能有效地稳定危重型HFMD患儿生命体征,其可能的作用机制为降低血清儿茶酚胺浓度,减轻心肌损伤,改善心功能,减轻炎性反应。     

婴幼儿手术应激后瘦素水平变化的临床研究

目的探讨瘦素水平在婴幼儿大手术应激时的变化及意义。方法选择择期手术患儿17例,分先心组(10例)和非先心组(7例),分别于术前、术中、术后2h、术后24h、术后48h采集外周静脉血,离心后,测定血清中瘦素和皮质醇的水平。结果先心组和非先心组瘦素水平在术中均明显下降(术前分别为3．48±0．23、4．50±0．24．术中为2．12+0．14、3．09±0．21,P＜0．05)。术后24h又恢复至基础水平(3．78±0．19、4．89±0．43．P＞0．05)。皮质醇水平先心组术中显著升高(术前为25．39±1．74,术中为50．87±3．59,P＜0．05),非先心组术中升高(术前为28．61±1．69,术中为31．90±2．02,P＞0．05)；术后24h先心组恢复至基础水平(30．95±1．77,P＞0．05),非先心组水平仍高(37．48±1．92,P＜0．05)。结论在手术应激的早期,瘦素的下降和皮质醇的上升是平行的,瘦素在手术应激早期发挥作用。