2008年至2010年某区集体儿童贫血情况分析

目的了解云龙区集体儿童营养性缺铁性贫血情况和相关因素,分析贫血原因,为防治儿童贫血提供科学依据。方法分析2008年至2010年云龙区托幼机构集体儿童"六一"前后健康体检中血红蛋白测定资料。结果儿童贫血患病率呈逐年下降趋势。3年间共检查4628例,贫血人数455例,贫血患病率为9.83%,其中轻度贫血450例,占贫血人数的98.90%,中度贫血5例,占贫血人数的1.10%,无重度及极重度贫血。结论儿童的健康应从婴幼儿期抓起,加强健康教育,平衡膳食,纠正偏食、挑食的不良习惯,对降低儿童贫血的发病率有重要意义。     

农村地区6个月~7岁儿童贫血及铁缺乏情况调查及干预

目的 了解合肥市农村地区6个月~7岁儿童的贫血及铁缺乏情况及干预效果。方法 采取随机抽样的方法抽取2 095名6个月~7岁儿童进行问卷调查并测定血红蛋白,对贫血和(或)铁缺乏的儿童进行干预。结果 2 095名研究对象中,正常儿童1 764名,检出贫血患儿331例,检出率为15.80%。其中铁缺乏检出114人,检出率为5.44%,贫血患儿中铁缺乏检出率为34.44%。在接受干预的281名儿童中有218名血红蛋白恢复到正常水平,即干预后正常儿童为1 982名,占96.92%;轻度、中度贫血检出率均明显下降。结论 合肥市农村地区儿童贫血及铁缺乏干预效果显著。加强儿童贫血相关健康教育,科学合理的喂养方法及早期正确的喂养行为可以有效防治婴幼儿贫血及铁缺乏。     

佛山市12000名幼儿贫血情况调查分析

目的了解禅城区独生子女的贫血情况,分析贫血原因。方法：对禅城区40所幼儿园12000名儿童进行体检,血常规测定。结果：12000名儿童456名贫血,贫血率为3．8％,其中轻度贫血448名,占贫血人数的98．2％,中度贫血8人,占贫血人数的1．8％,未发现重度贫血儿。结论：绝大部分贫血属于小细胞低色素性贫血,较易治疗。若及早发现,及时治疗,可提高儿童的身体健康和智力发展水平。     

Influence of beta-adrenergic antagonists on tear secretion in children

The aim of the study was to compare the results of tear film volume, conjunctival and corneal state of children eyes both treated with beta-blocker and healthy ones. We have examined 40 eyes of 20 children at the age from 7 to 17 years. Group I - 20 glaucomatous eyes treated with 0.5% timolol twice daily during at least 12 months. Group II - 20 eyes of control age-matched group. Schirmer I test without anesthesia and lissamine green staining was performed to evaluate conjunctival and corneal surface. The values of Schirmer I test were: group I from 12 to 24 mm, the mean 17.06 +/- 1.78 mm and group II from 16 to 35 mm, the mean 29.3 +/- 2.67, p = 0.000004. Keratoepitheliopathy was observed in 4 eyes (20%) of group I and was rated as 3rd and 6th degree of Franck classification. In the group II, there were only single staining points classified as 1st degree noticed in 2 eyes (10%), p = 0.37. The long-term treatment with timolol causes a decrease in tear secretion in children, which can further generate keratoepiteliopathy. Therefore, we suggest application of the artificial tears in these patients.     

鼻渊通窍颗粒联合匹多莫德治疗儿童过敏性鼻炎的临床研究

目的研究鼻渊通窍颗粒联合匹多莫德治疗儿童过敏性鼻炎的临床疗效。方法选取2015年2月—2017年2月海口市中医医院收治的86例过敏性鼻炎患者,随机分为对照组和治疗组,每组各43例。对照组口服匹多莫德口服液,1支/次,2次/d。治疗组在对照组治疗基础上口服鼻渊通窍颗粒,15 g/次,3次/d。两组均连续治疗3个月。观察两组的临床疗效,比较两组治疗前后临床症状积分、屋尘螨变应原的血清特异性IgE滴度、鼻腔气流、鼻孔解剖区面积及血清细胞因子的变化情况。结果治疗后,对照组和治疗组的总有效率分别为81.40%、93.02%,两组比较差异具有统计学意义(P0.05)。治疗后,两组临床症状积分、吸气相和呼气相气流阻力、Der p1和Der p2血清特异性IgE滴度均较治疗前显著降低,鼻孔解剖区面积明显升高,同组治疗前后差异有统计学意义(P0.05);治疗后,治疗组患者临床症状积分、吸气相和呼气相气流阻力、Der p1和Der p2血清特异性IgE滴度显著低于对照组,鼻孔解剖区面积高于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组IL-10、IL-8和sICAM-1均较治疗前显著增加,同组治疗前后差异有统计学意义(P0.05)。治疗后,治疗组IL-10、IL-8和sICAM-1显著高于对照组,两组比较差异有统计学意义(P0.05)。结论鼻渊通窍颗粒联合匹多莫德治疗过敏性鼻炎具有较好的临床疗效,可明显缓解过敏性鼻炎的临床症状,降低鼻腔气流阻力,降低过敏性IgE抗体效价,有效缓解炎症反应,具有一定的临床推广应用价值。     

Risk factors for long-term outcome of ifosfamide-induced nephrotoxicity in children

Ifosfamide is widely used in the treatment of pediatric solid tumors. Its main adverse effects are various forms of renal tubular and glomerular damage. The authors sought to determine factors that predict the risk for the development and severity of ifosfamide-induced nephrotoxicity in children and to examine the long-term outcome of this complication. A total of 174 children who had received ifosfamide for various cancers were studied. Nephrotoxicity was assessed by laboratory markers of glomerular and tubular function and a grading score (none, mild, moderate, severe). Patients were assessed 4 to 12 weeks after each ifosfamide course, 3 months after completion of chemotherapy, and 5 years later. Of 174 children, 72 (41.4%) developed tubular dysfunction, whereas only 11 (6.3%) demonstrated glomerular dysfunction; 40 (23.0%) demonstrated mild toxicity, 16 (9.2%) demonstrated moderate toxicity, and 16 (9.2%) developed severe nephrotoxicity. The four severity subgroups (none, mild, moderate, severe) received comparable doses/m2/cycle of ifosfamide and mesna. Children exhibiting severe toxicity were significantly younger compared to those with moderate, mild, or no nephrotoxicity (median age: 2.2, 7.0, 8.2, and 10.5 years, respectively; p < 0.001) and received significantly higher cumulative doses of ifosfamide (49.6 +/- 12.3, 46.0 +/- 13.1, 36.2 +/- 9.7, and 33.8 +/- 7.6 g/m2, respectively; p < 0.001). Cumulative doses of cisplatin were higher among children with severe nephrotoxicity compared to those with moderate, mild, or no toxicity, although this difference did not reach statistical significance. Of all risk factors analyzed by multiple regression analysis, age was the most significant predictor for the grade of nephrotoxicity (p < 0.001), followed by the cumulative dose of ifosfamide (p = 0.005). Seven out of 16 children (44.0%) with severe nephrotoxicity and 4 out of 16 children (25.0%) with moderate nephrotoxicity demonstrated severe chronic tubular toxicity over a follow-up period of 5 years. Since severe ifosfamide-induced renal toxicity tends to be chronic in a substantial number of treated children, it should be balanced carefully against efficacy. Cumulative ifosfamide doses of 45 g/m2 and above should be carefully considered, especially in children younger than age 3.     

小儿巨幼细胞性贫血患者52例临床分析

目的分析小儿巨幼细胞性贫血患者的临床特点。方法回顾性分析52例小儿巨幼细胞性贫血患者的临床资料。结果20～30d恢复正常者有29例,占55．8％;31～40d恢复正常者有17例,占32．7％;41～50d恢复正常者有6例,占11．5％。引起小儿巨幼细胞性贫血的最重要的原因是营养不良,与本地区的饮食结构有关。新鲜蔬菜及肉类的摄人不足,导致小儿患巨幼细胞性贫血的比例升高。另外,偏食也是引起小儿巨幼细胞性贫血的原因之一。结论小儿巨幼细胞性贫血应早诊断、早治疗、早预防。     

芪血颗粒联合二维亚铁治疗小儿缺铁性贫血的临床研究

《儿童湿疹/特应性皮炎中药临床试验设计与评价技术指南》为中华中医药学会标准化项目《儿科系列常见病中药临床试验设计与评价技术指南》之一。其目的是以临床价值为导向,在病证结合模式下,讨论具有湿疹/特应性皮炎、儿童和中药特点的临床定位、试验设计与实施等相关问题,为中药治疗儿童湿疹/特应性皮炎临床试验设计与评价提供思路和方法。制定过程中先后成立指南工作组、起草专家组和定稿专家组,采用文献研究和共识会议的方法,最终形成指南送审稿定稿。该《指南》的主要内容包括临床定位、试验总体设计、诊断标准与辨证标准、受试者的选择与退出、干预措施、有效性评价、安全性观察、试验流程、试验的质量控制9部分。希望其制定和发布,能为申办者/合同研究组织、研究者在中药治疗湿疹/特应性皮炎的临床试验设计,提供借鉴与参考。     

高原地区小儿贫血68例临床分析

目的:了解高原地区住院小儿贫血的临床特点.方法:回顾性分析2005年1月～2010年12月高原地区住院68例小儿贫血的临床资料.结果:重度贫血12例(17.6％),中度贫血23例(33.8％),轻度贫血33例(48.6％).大细胞性贫血6例(8.8％),小细胞低色性贫血55例(90.9％),正细胞性贫血7例(10.3％).合并上呼吸道感染21例(30.9％),合并支气管肺炎23例(33.9％),合并腹泻8例(10.2％),合并其他疾病4例(5.9％),无合并疾病12例(19.1％).结论:高原地区小儿贫血程度重,且贫血未引起家长的高度重视,因此科学喂养指导及健康教育应引起各级各类卫生人员的高度重视.     

140例小儿咽拭子肺炎支原体特异性DNA的PCR检测

应用聚合酶链反应(PCR)枝术对140例小儿咽拭子标本进行了肺炎支原体(MP)特异性DNA检测。结果显示:(1)患有呼吸道感染病儿中MP阳性检出率(33％)显著高于对照组(7.5％)(P<0.01),小儿肺炎及喘息性疾患与MP感染有密切相关性;(2)以4～6岁年龄组MP阳性检出率最高(41.67％),表明MP感染的好发年龄有提早趋势;(3)患呼吸道感染后病程在2～3周以上者MP阳性检出率显著高于病程小于1周者(P<0.01),显示其病程长短与MP的感染呈正相关。     

婴幼儿定期实施血常规检查对预防儿童贫血的价值分析

目的分析婴幼儿定期实施血常规检查对预防儿童贫血的应用价值。方法选取73例儿童贫血婴幼儿作为病例组,另选取73例体检健康婴幼儿作为参照组。两组儿童均行血常规和血细胞形态检查,对比两组儿童血红蛋白(Hb)、平均红细胞血红蛋白含量(MCH)、平均红细胞血红蛋白浓度(MCHC)、平均红细胞体积(MCV)、红细胞分布宽度(RDW)水平;以血常规联合血细胞形态检查诊断结果为金标准,评价血常规检查、血细胞形态检查对儿童贫血的诊断效能。结果病例组Hb(101.74±12.89)g/L、MCH(23.08±1.95)pg、MCHC(274.58±21.77)g/L、MCV(71.29±6.90)fl均低于参照组的(115.40±11.71)g/L、(28.62±3.06)pg、(325.41±25.43)g/L、(82.47±4.02)fl,RDW(18.14±1.16)%高于参照组的(13.72±1.53)%,差异有统计学意义(P<0.05)。血常规检查诊断146例婴幼儿中阳性71例,阴性75例,诊断敏感度为95.89%,特异度为98.63%,准确率为97.26%;血细胞形态检查诊断146例婴幼儿中,阳性70例,阴性76例,诊断敏感度为86.30%,特异度为90.41%,准确率为88.36%;血常规检查诊断儿童贫血的敏感度、特异度、准确率均高于血细胞形态检查,差异具有统计学意义(P<0.05)。结论儿童贫血婴幼儿Hb、MCH、MCHC、MCV等血常规指标会出现明显降低,而RDW水平升高,血常规检查对儿童贫血的诊断准确率较高,定期实施检查有助于疾病检出与预防。     

Oral montelukast versus inhaled beclomethasone in 6- to 11-year-old children with asthma: results of an open-label extension study evaluating long-term safety, satisfaction, and adherence with therapy.

This 6-month, open-label extension study of a previously described base study compared oral montelukast with inhaled beclomethasone in terms of safety, forced expiratory volume in one second (FEV1) measurements, parent and patient satisfaction with treatment, asthma-related medical resource utilization, school absenteeism, and parental work loss in children with asthma. A total of 124 of 266 asthmatic children, 6 to 11 years of age, who enrolled in the base study entered a 6-month open-label extension study (74 boys, 50 girls) and were re-randomized (2:1 ratio) to receive once-daily oral montelukast (n = 83) or inhaled beclomethasone 100 mcg three times daily (n = 41). Children were evaluated in the clinic prior to re-randomization (Month 0) and at regular visits at 1, 3, and 6 months. Children and their parents showed a significantly higher overall satisfaction for montelukast at 6 months than for inhaled beclomethasone (p = 0.001 and p < 0.05, respectively). According to parents, montelukast was more convenient (p < 0.001), less difficult to use (p = 0.005), and was used as instructed more of the time (p = 0.006) compared with beclomethasone. Oral corticosteroid use was similar in the montelukast (13% of patients) and beclomethasone (17%) treatment groups. The montelukast treatment group was more adherent with their regimen than the inhaled beclomethasone treatment group; almost twice as many children on montelukast compared with inhaled beclomethasone were highly compliant (82% versus 45%). The two study groups were similar with respect to overall safety, change in FEV1, asthma-related medical resource utilization, school absenteeism, and parental work loss. Montelukast represents a safe and effective asthma treatment regimen to which children with asthma are more likely to adhere.     

A comparative study of the usefulness of toki-shakuyaku-san and an oral iron preparation in the treatment of hypochromic anemia in cases of uterine myoma

We prospectively studied and compared the usefulness of Kampo medicine (Sino-Japanese traditional herbal medicine) "Toki-shakuyaku-san" and an oral iron preparation in the treatment of hypochromic anemia associated with uterine myoma. The study subjects consisted of 25 patients who were diagnosed as having hypochromic mild to moderate anemia associated with menorrhagia attributable to uterine myoma. They were divided into the Toki-shakuyaku-san group (n = 10) and the oral iron group (n = 15). We monitored the blood counts, subjective symptoms, and occurrence of side effects after oral administration of either preparation for 4 and 8 weeks in these subjects. In regard to the blood counts and improvements of the laboratory parameters of anemia, while marked improvement was observed in the oral iron group, no significant improvement was noted in the Toki-shakuyaku-san group. On the other hand, in terms of improvement of the signs and symptoms of anemia, such as facial pallor, spoon-shaped nails and dizziness, the latter group also showed significant improvement. In addition in the Toki-shakuyaku-san group, resolution of symptoms such as hypermenorrhea, dysmenorrhea, feeling cold, dizziness, headache and shoulder stiffness was also noted. While side effects were encountered in 80.0% of patients in the oral iron group, no significant side effects were observed in the Toki-shakuyaku-san group. From these findings, it is considered that Toki-shakuyaku-san may be useful for resolving the symptoms of mild or moderate anemia associated with uterine myoma.     

儿童热性惊厥与缺铁性贫血相关性分析

目的 对儿童热性惊厥与缺铁性贫血之间的关系进行探究.方法 对热性惊厥212例患儿的平均红细胞血红蛋白浓度、平均红细胞血红蛋白含量、平均红细胞容积、血红蛋白及红细胞计数进行检测,同时以同期188例无惊厥、肠道感染及呼吸道感染的患儿作为对照组,并详细分析检测结果.结果 观察组患者的贫血发病率比对照组患儿明显要高,并且绝大多数为小细胞性贫血,与缺铁性贫血的相关血液特征相符合.结论 儿童缺铁性贫血可能是导致热性惊厥的一项重要原因.     

Some family social background, developmental, and behavioural characteristics of nine year old children with asthma

Children with moderate and severe, mild, and trivial asthma were compared with a group of children who did not have asthma on a range of measures including family social background (socioeconomic status, family adversity, family environment), intelligence, reading, spelling, and behaviour. None of the background measures significantly differentiated among the groups. The group of children with moderate and severe asthma was found to have a significantly lower mean score for verbal intelligence, full scale intelligence, and spelling than those with mild asthma, but did not differ significantly from the remainder of the sample. Children with mild asthma were found to have slightly higher reading scores.     

Prevalence of pneumococcal bacteremia among children <36 months of age presenting with moderate fever to pediatric emergency rooms of the Metropolitan Region (Santiago), Chile

Blood culture collection from outpatients < age 36 months with high fever (>40 degrees C, rectal) became a standard of ambulatory care in Emergency Rooms (ERs) of the government Children's Hospitals in Chile's Metropolitan Region (MR) in 1999; thereafter, invasive pneumococcal disease (IPD) incidence doubled over preceding years' estimates limited to hospitalizations. We studied IPD among children with moderate (>39 degrees C but <40 degrees C, rectal) rather than high fever visiting Pediatric ERs. Recruitment ensued Monday to Friday, 1-5 PM, September 1, 2002 through August 31, 2003. Age <36 months; rectal temperature >39 degrees but <40 degrees C; outpatient management; parental consent for hemoculture were inclusion criteria. Thirteen-thousand five hundred seventy-seven children < age 36 months with moderate and 3,214 children with high fever sought ER care. Of 1,134 moderate fever children seen in ERs during the enrollment, parents of 837 consented (73.8%). During these days and hours, 714 children < age 36 months presented with high fever and 651 (91.2%) had a "routine" blood culture. Pneumococcemia was detected among 0.7% with moderate and 1.2% with high fever (6/837 vs 8/651, p > 0.05). Extrapolating these rates to all ER outpatients < age 36 months with moderate and high fever, we estimate the true burden as 95 and 39 cases, respectively. The burden of pediatric IPD in the MR is currently underestimated because bacteremias among ER outpatients with moderate fever are not detected. If blood cultures were systematically collected from outpatients with moderate fever, recorded pediatric IPD burden would rise >2-fold. However, economic and logistical constraints preclude such a practice.     

Clinical efficacy and bacteriological studies of clarithromycin and cefdinir against group A beta-hemolytic streptococcal tonsillopharyngitis

The clinical efficacy and safety of clarithromycin (CAM) and cefdinir (CFDN) were evaluated in 65 pediatric outpatients with group A beta-hemolytic streptococcal tonsillopharyngitis. Treatment was "effective" or better in 26 (78.8%) children receiving CAM and in 27 (87.1%) receiving CFDN based on antigen clearance and the "Criteria for Evaluation in Clinical Trials of Antibacterial Agents in Children" proposed by Japan Society of Chemotherapy (p = NS). The causative organisms were eradicated in 94.7% and 93.8% of subjects in the CAM and CFDN groups, respectively (p = NS). Adverse drug reactions were limited to moderate diarrhea in one patient in each group, and subsided during treatment. Causative organisms exhibited good susceptibility to CAM and CFDN. These results suggest excellent efficacy, safety and usefulness of CAM and CFDN in the treatment of group A beta-hemolytic streptococcal tonsillopharyngitsis in children.     

外周血CD19~+CD23~+B细胞在不同严重程度哮喘患儿中的表达

目的探讨哮喘轻、中、重度急性发作患儿外周血CD19+CD23+B细胞的表达与意义。方法收集2011年2月至2012年2月山西省儿童医院门诊及住院哮喘急性发作患者56例为试验组,依据哮喘急性发作程度分级标准,根据其发病情况,将其分为重度(A组)、中度(B组)、轻度组(C组);并收集参与山西省哮喘发病率流行病学调查的健康儿童36名作为对照组,采用流式细胞技术检测其外周血CD19+CD23+B细胞比率,采用酶联免疫吸附法(ELISA)检测其血清总IgE水平。结果①哮喘急性发作患者外周血CD19+CD23+B细胞水平高于健康儿童,同时,A组>B组>C组,差异有统计学意义(P<0.05);且A组与B组均高于健康对照组(P<0.05);C组高于健康对照组,但差异无统计学意义(P>0.05);②血清总IgE水平A组>B组>C组>健康对照组,差异有统计学意义(P<0.05)。③CD19+CD23+B细胞与总IgE水平呈正相关(r=0.538,P<0.05)。结论哮喘患者外周血CD19+CD23+B细胞升高,并随病情加重而升高。外周血CD19+CD23+B细胞阳性表达率联合血清总IgE水平可用作哮喘病情评估的辅助手段。     

儿童阑尾炎病原学特点及抗菌药物使用分析

目的:回顾性分析我院阑尾炎患儿的病原学特点及致病菌分布情况,分析抗菌药物使用的合理性。方法:选取河北省儿童医院2013年1月至2017年12月收治的1383例确诊阑尾炎患儿,分析患儿病历资料及治疗效果,并随访出院患儿的预后情况。结果:患儿平均发病年龄5岁9个月,男女比例1.88∶1。共分离出719株致病菌,其中G-菌683株(95.0%),G+菌35株(4.9%);检出菌排序居前3位的依次为大肠埃希菌589株(81.9%)、铜绿假单胞菌56株(7.8%)、肺炎克雷伯菌12株(1.7%)。大肠埃希菌对亚胺培南、美罗培南、阿米卡星、多粘菌素、哌拉西林/他唑巴坦均有较高敏感率,敏感率>95.0%。结论:儿童阑尾炎主要致病菌以大肠埃希菌为主,不同病原菌对抗菌药物的敏感性不同,因此对脓液进行细菌培养和耐药性分析有利于临床的合理用药。     

八珍汤与自拟补血膏序贯治疗小儿缺铁性贫血60例疗效观察

目的探析八珍汤与自拟补血膏序贯治疗小儿缺铁性贫血的疗效及药学机制。方法120例缺铁性贫血患儿随机分为2组,治疗组采用八珍汤及补血膏序贯治疗,对照组给予硫酸亚铁口服,3月后统计2组的临床疗效。结果治疗组治愈54例,有效4例,无效2例,治愈率90．00％,总有效率96．67％;对照组治愈39例,有效3例,无效18例,治愈率65．00％,总有效率70．00％。2组治愈率、总有效率经统计学分析,差异均有统计意义（P〈0．05）。结论八珍汤与自拟补血膏序贯治疗小儿缺铁性贫血疗效显著,且不良反应小,患儿易于接受。