判断高阴离子间隙代谢性酸中毒时AG界限值的探讨

对６１例危重患儿同步测定血乳酸和阴离子间隙（ＡＧ）。结果表明，若以ＡＧ≥３０ｍｍｏｌ／Ｌ作为判断高ＡＧ代谢性酸中毒（代酸）的界限值，则有５８例（９５．０９％）乳酸增高的代谢漏诊，若以界限定于超过２０ｍｍｏｌ／Ｌ仍有３７例（６０．２６）漏掉。而将〉１６ｍｍｏｌ／Ｌ作为判断高ＡＧ代酸的界限，则ＡＧ与乳酸同步增高的吻合率达７３．７７％，故作者认为，在目前尚无公认的统一的标准之前，将ＡＧ〉１６ｍｍｏｌ／Ｌ     

婴儿泌尿系结石1例

患儿，男，３ｍｏ１０ｄ，因无尿６４ｈ伴抽搐１次入院。入院前有上呼吸道症状，无肉眼血尿及异常排尿情况，生后母乳喂养，未添加鱼肝油及钙剂，未接种过疫苗，其父有空洞性肺结核。体检：Ｔ３８．３℃，Ｗ４．８ｋｇ，呼吸稍促，急性病容，反应差，口唇发绀，双肺呼吸音清，心率１３２次／ｍｉｎ，节律齐，肝脾不大，神经系统阴性。血Ｈｂ１２．５ｇ／Ｌ，ＷＢＣ２１．６×１０９／Ｌ，Ｎ０．６６，Ｌ０．３０，Ｅ０．０２，Ｍ０．０１，ＢＴ３ｍｉｎ，ＣＴ４ｍｉｎ，血钾６．１ｍｍｏｌ／Ｌ，血钠１３６ｍｍｏｌ／Ｌ，血氯９８ｍｍｏｌ／…     

休克患儿磷脂酶A_2及细胞因子作用研究

目的探讨血清磷脂酶Ａ２（ＰＬＡ２）及细胞因子在休克发生发展中的作用及意义。方法采用ＥＬＩＳＡ法检测１６例休克患儿及２０例健康儿童血清ＰＬＡ２、肿瘤坏死因子（ＴＮＦ－ａ）及白细胞介素（ＩＬ～６）含量,并作临床脏器功能监测、血乳酸、血糖、动脉血气分析及血小板计数。结果休克患儿血清ＰＬＡ２（０．８９±０．６３ｍｐ／Ｌ）、ＴＮＦ－ａ（０、６３±０．２５ｍｇ／Ｌ）及ＩＬ－６（６．８４±１９７ｍｇ／Ｌ）浓度均较正常对照组（０．１７±０．０２ｍｇ／Ｌ、０．０８±０．０１ｍｇ／Ｌ、２．３２±０．６２ｍｇ／Ｌ）明显升高（Ｐ＜０．００１）;多器官功能衰竭组（ＭＳＯＦ）上述３项指标（ＰＬＡ２１．１７±０．７０ｍｇ／Ｌ、ＴＮＦ－ａ０．９１±０．２７ｍｐ／Ｌ、ＩＬ－６７．７０±１．４０ｍｇ／Ｌ）均显著高于单器官功能衰竭组（ＳＯＦ）（ＰＬＡ２０．４８±０．０７ｍｇ／Ｌ、ＴＮＦ－ａ０．４７±０．０５ｍｇ／Ｌ、ＩＬ－６５．５５±０．７０ｍｇ／Ｌ）,死亡组明显高于治愈组。结论ＰＬＡ２水平与病情轻重有关,可作为早期预测ＭＳＯＦ发生的参数、评估治疗效果及预后。选择性投用ＰＬＡ２抑制剂可能成为治疗休克的有效方法。     

顽固性反复低镁惊厥一例

病例摘要　男性,２－５岁。患儿出生后第１６天开始起病,反复出现四肢抽搐,双眼上翻,口吐白沫。先后测定电解质６次,血钠１３２～１４０ｍｍｏｌ／Ｌ,血钾３．８～５－０ｍｍｏｌ／Ｌ,血氯９６～１０６ｍｍｏｌ／Ｌ,血清总钙１－９～２－４ｍｍｏｌ／Ｌ（本院正常值２－１～２－５５ｍｍｏｌ／Ｌ）,血清总镁０－２～０－４ｍｍｏｌ／Ｌ（本院正常值０．８～１－２ｍｍｏｌ／Ｌ）。从生后１６天至本次入院先后做脑电图４次,均无异常发现。８月龄时头颅ＣＴ检查亦无异常。根据血镁测定诊断：低镁惊厥。患儿自第一次住院后一直门诊随…     

危重病儿甲状腺激素T3,rT3变化的临床意义

目的探讨危重病患儿甲状腺激素的变化及其临床意义。方法危重症患儿共４５例，包括重症肺炎、病毒性脑炎、格林巴利综合征，颅内出血、病毒性心肌炎、食物中毒等。２０例健康儿童为对照组。用美国ＰＡＣＫＡＲＤ公司生产的γ免疫自动计数器测定危重病儿和健康儿童血中Ｔ３及ｒＴ３含量。结果２０例健康儿童和４５例危重病患儿血中Ｔ３分别为（２．８８±０．５２）ｎｍｏｌ／Ｌ和（１．４０±０．７１）ｎｍｏｌ／Ｌ（ｔ＝１３．９８，Ｐ＜０．０１），ｒＴ３分别（为０．７２±０．０８）ｎｍｏｌ／Ｌ和（１．１９±０．７３）ｎｍｏｌ／Ｌ（ｔ＝４．３６，Ｐ＜０．０１），Ｔ３／ｒＴ３分别为２．７４±０．８５和１．６１±０．７９（ｔ＝６．３８，Ｐ＜０．０１）．４例临终状态病儿Ｔ３和ｒＴ３均值分别为０．８６和１．４８ｎｍｏｌ／Ｌ，Ｔ３／ｒＴ３为０．６３。４５例患儿，治愈３７例，好转４例，死亡４例。结论危重病患儿血中Ｔ３、ｒＴ３及Ｔ３／ｒＴ３均显著低于健康儿童．４例临终状态病儿血中Ｔ３、ｒＴ３及Ｔ３／ｒＴ３更低。提示甲状腺激素降低的程度与病情严重程度呈正相关。     

以扩张型心肌病为首发症状的婴儿维生素D缺乏性佝偻病一例报告

［英］／Ｍｕｓｔａｆａ　Ａ…／／ＣａｎＪＣａｒｄｉｏｌ－１９９９,１５（６）－６９９－７０１男,５个月．因食欲不振、尿量减少４天、易激惹、呼吸困难２天入院。足月产,出生体重３０００ｇ,母乳喂养,少晒太阳。查体：体温３８．３℃,脉搏１６０次／分,呼吸６０次／分,血压１０．７／５．３３ｋＰａ。呼吸微弱,三凹征,双肺有捻发音;心音正常,奔马律．肝肋下４ｃｍ,脾未及;手足发冷．实验室检查：血总钙１．１４ｍｍｏｌ／Ｌ,离子钙０．５３ｍｍｏｌ／Ｌ,镁０．４ｍｍｏｌ／Ｌ（０．７—０．９５ｍｍｏｌ／Ｌ）,磷酸盐…     

婴儿完全性大动脉转位外科根治术前血液动力学的内科调整研究

为探讨球囊房隔造口术（ＢＡＳ）及前列腺素Ｅ１（ＰＧＥ１）对婴儿完全性大动脉转位（ＴＧＡ）外科根治术前血液动力学的调整作用，对３２例年龄２～５６天，平均２６天的ＴＧＡ患儿行ＢＡＳ，对其中１１例于ＢＡＳ前给予ＰＧＥ１，然后进行血液动力学观察。结果：ＢＡＳ后动脉血氧饱和度（ＳａＯ２）由０．５３±０．１４上升至０．７４±０．１１。３０例患儿左右心房压差均＜０．２７ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）。单纯ＴＧＡ术后２４个月内左室压力＜５．３０ｋＰａ。ＰＧＥ１应用后ＳａＯ２由术前０．６０±０．１９上升至０．８６±０．０５。心导管检查测得左右室压力比为０．８６。提示，ＢＡＳ和ＰＧＥ１的应用可缓解新生儿ＴＧＡ低氧血症及维持其左右心室良好的压力比值，从而为ＴＧＡ解剖转位术作准备     

呼吸道合胞病毒毛细支气管炎血清维生素A水平的变化

为探讨血清维生素Ａ水平与呼吸道合胞病毒（ＲＳＶ）所致下呼吸道感染之间的关系，采用对照研究方法，对４６例确诊为ＲＳＶ感染的毛细支气管炎患儿的急性期（０，７天）和恢复期（≥１５天）血清维生素Ａ值进行动态观察，并比较急性期轻症与重症患儿血清维生素Ａ水平的差异。结果：急性期维生素Ａ值为０．９４±０．１５μｍｏｌ／Ｌ（ｘ±ｓ）与对照组比较（１．４７±０．３０μｍｏｌ／Ｌ）差异有极显著意义（ｔ＝９．９２，Ｐ＜０．０１）；恢复期维生素Ａ值为１．３８±０．３０μｍｏｌ／Ｌ，与对照组比较差异无显著意义（ｔ＝１．３１，Ｐ＞０．０５）；急性期重症患儿２０例中有１２例（６０．０％）血清维生素Ａ低于正常对照组血清维生素Ａ均值减２个标准差，而轻症患儿２６例中仅５例（１９．２％）低于此值，两组比较差异有极显著意义（χ２＝８．０６，Ｐ＜０．０１）。提示：ＲＳＶ毛细支气管炎急性期血清维生素Ａ水平明显低于正常对照组，疾病恢复期血清维生素Ａ呈回升趋势；急性期血清维生素Ａ下降程度与疾病严重程度呈平行关系。     

I型糖尿病患者酮症酸中毒时乳酸水平的研究

目的 旨在了解小儿Ｉ型糖尿病酮症酸中毒（ＤＫＡ）时血乳酸水平的变化。方法 １９９６年２月￣１９９７年１２月对天津儿童医院内分泌科住院的２５例ＤＫＡ患者进行血乳酸水平的临床观察。结果 Ｉ型ＤＭ在发生ＤＫＡ时仍可以发生乳酸酸中毒，其发生率为４％。结论 ＤＫＡ时血乳酸可升高，并可发生乳酸性酸中毒，其血乳酸水平与血糖、尿糖、酮体尿、ｐＨ值、ＢＥ变化无相关性。在充分的病因、对症治疗和积极的胰岛素治疗，ＤＫＡ     

早产儿晚期代谢性酸中毒33例临床分析

早产儿晚期代谢性酸中毒 (ｌａｔｅｍｅｔａｂｏｌｉｃａｃｉ ｄｏｓｉｓ，ＬＭＡ)是早产儿常见代谢紊乱之一。我们对３３例ＬＭＡ患儿的临床表现、血气分析及治疗结果分析如下。资料与方法一、临床资料我院自１９９８年２月至１９９９年８月共收治单纯早产儿８９例 ,均于生后１０天～２１天查血气分析。诊断标准 :①单纯因生活能力低下、无并发症早产儿 ;②血气分析示ＰＨ＜７．３０，ＢＥ＞ -７．０ｍｍｏｌ／Ｌ［１］。符合ＬＭＡ诊断标准者３３例 ,占同期住院单纯早产儿的３７．１ %。男２２例 ,女１１例 ;孕周２８周～３２周１８例 ,～…     

Lactic acid bacteria population in children diagnosed with human immunodeficiency virus

Aim:   To determine the effect of trimethoprim/sulphamethoxazole treatment on the natural population of lactic acid bacteria in the intestinal tract and to determine if any of the strains developed resistance to antibiotics.
Methods:   Lactic acid bacteria were isolated from stool samples of 100 children. The isolates were identified based on biochemical characteristics and DNA profiles obtained from polymerase chain reaction with genus- and species-specific primers. Resistance to sulphamethoxazole, streptomycin, compound sulphonamides, chloramphenicol and vancomycin was tested using the paper-disk method.
Results:   The lactic acid bacteria were identified as Lactobacillus acidophilus , Lactobacillus brevis , Lactobacillus paracasei , Lactobacillus pentosus , Lactobacillus rhamnosus , Leuconostoc mesenteroides subsp. mesenteroides , Enterococcus spp. and Weissella spp. Lactobacillus plantarum and Bifidobacterium spp. were not isolated. All strains, except two, were sensitive to chloramphenicol and streptomycin. Thirty-five percent of the isolates were resistant to vancomycin, 50% to compound sulphonamides and 66% to sulphamethoxazole.
Conclusion:   Treatment with trimethoprim/sulphamethoxazole repressed a large number of lactic acid bacteria normally present in the intestinal tract of children. A number of strains were resistant to sulphamethoxazole and may be used as probiotics to correct the imbalance in lactic acid bacteria.     

早产儿胃肠功能障碍的临床研究

目的 探讨早产儿胃肠功能障碍的发生率、发病因素及预后.方法 分析206例早产儿不同出生体质量及胎龄与胃肠功能障碍发生率的关系.比较早产儿在合并窒息、感染情况下胃肠功能障碍的发生率.检测早产儿胃肠功能障碍组及非胃肠功能障碍组乳酸(LAC)水平,计算2组病死率.结果 206例早产儿胃肠功能障碍的发生率为21.36%(44/206例).低出生体质量儿与极低出生体质量儿胃肠功能障碍的发生率比较差异有统计学意义(χ2=13.598,P=0.000 2);胎龄≤32周的早产儿与胎龄>32周的早产儿胃肠功能障碍的发生率比较差异有统计学意义(χ2=6.904,P=0.009 0);出生后有窒息史及合并感染的早产儿胃肠功能障碍的发生率均明显升高(Pa<0.01).胃肠功能障碍组早产儿LAC水平明显高于非胃肠功能障碍组(t=32.849,P<0.001),且2组病死率比较差异有统计学意义(χ2=6.032,P=0.014 0).结论 早产儿胃肠功能障碍的发生率较高,尤其是极低出生体质量及胎龄≤32周的早产儿,且与窒息、感染等因素有关.血LAC参数的变化可作为早产儿发生胃肠功能障碍的警示参数及诊断参考指标.早产儿出现胃肠功能障碍病死率明显增加,应重视对其早期干预.     

儿童肺炎支原体性胸腔积液特点分析

目的探讨肺炎支原体性胸腔积液临床特点。方法回顾性分析肺炎旁胸腔积液(PPE)患儿的临床资料,比较支原体感染与非支原体感染患儿的差异,并对单因素分析中有统计学差异的指标行多因素logistic回归分析,绘制受试者工作特征(ROC)曲线,得出各指标的诊断界值及回归模型的诊断准确度。结果支原体感染与非支原体感染患儿的年龄、外周血白细胞数、血清乳酸脱氢酶(LDH)、免疫球蛋白IgA及IgM,胸腔积液中多核粒细胞比例、葡萄糖及乳酸,以及胸腔积液纤维分隔形成、胸膜增厚的差异均有统计学意义(P均0.05);多因素logistic回归分析示,年龄、血清IgM及LDH,胸腔积液中乳酸(LAC)在支原体感染组及非支原体感染组间的差异也有统计学意义(P0.05),其诊断界值分别为ROC曲线下面积(AUC)=0.887(95%CI:0.830~0.944,P0.001)。结论对于病原不明确的PPE患儿,若存在年龄3.92岁,血清IgM1.29 g/L及LDH367 U/L,胸腔积液LAC4.02 mmol/L时,应高度怀疑支原体感染的可能。     

Community-based survey of paediatric diarrhoeal morbidity and home treatment practices in Finland

To determine total diarrhoeal morbidity and current home case management practices, a recall study was conducted among 345 mothers whose 406 children under 5 y of age had had diarrhoea in the past 4 months. The seasonally adjusted annual diarrhoea incidence rate was 0.48 episodes/child/y. For home treatment, increased amounts of fluid were given in 93% and oral rehydration solution (ORS) in 37% of cases. However, when given, ORS was diluted with other fluids in 41% of cases. More than half (55%) of the children received increased or normal amounts of food during the diarrhoeal episode, but 7% of the children were kept fasting for at least 1 d. Use of antidiarrhoeal drugs was minimal (0.7%), but products containing lactic acid bacteria were given in 44% of cases. Case management practice in cases of diarrhoea at home have much improved during the last 20 y, but are still not optimal.     

Treatment of perennial allergic rhinitis with lactic acid bacteria

Probiotics are perceived to exert beneficial effects in the prevention and treatment of allergic diseases via modifying the gut ecosystem. The aim of this study was to assess whether ingestion of fermented milk containing Lactobacillus paracasei-33 (LP-33), a strain newly isolated from the human intestinal tract, can improve the quality of life of patients with perennial allergic rhinitis. In a randomized, double-blind, placebo-controlled trial, we gave patients fermented milk with (n = 60) or without (n = 20) the addition of LP-33 (2 x 10(9) colony-forming units per bottle) for 30 days. A modified questionnaire concerning pediatric rhinoconjunctivitis quality of life was administered to all subjects or their parents at each clinical visit. Scores for the overall quality of life significantly decreased in the LP-33 group as compared with the placebo group, in both frequency (-16.02 +/- 2.14 vs. -7.27 +/- 3.55, respectively; p = 0.037) and level of bother (-16.35 +/- 2.33 vs. -6.20 +/- 3.13, respectively; p = 0.022) after the 30-day treatment. Subjects reported no severe adverse effects such as fever, abdominal pain, or diarrhea. The results suggest that ingestion of LP-33-fortified fermented milk for 30 days can effectively and safely improve the quality of life of patients with allergic rhinitis, and may serve as an alternative treatment for allergic rhinitis.     

动态监测血乳酸与小儿危重病例评分的相关性

目的 探讨动态监测PICU患儿血乳酸与小儿危重病例评分(PCIS)的相关性.方法 对77例入住南通大学附属常州儿童医院儿科重症监护病房的患儿立即进行PCIS,根据评分结果分为极危重组(23例)、危重组(32例)、非危重组(22例).并检测患儿动脉血乳酸水平,每6 h监测1次,并测出乳酸峰值.比较各组间乳酸监测指标(入PICU乳酸水平、乳酸峰值)和PCIS,进行相关性分析,探讨其与患儿预后的相关性.结果 极危重组血乳酸水平:入PICU时乳酸[(5.28±3.69) mmol·L-1]、乳酸峰值[(8.54±4.32) mmol·L-1]明显高于危重组和非危重组(F=3.98,3.12,Pa<0.01),而PCIS[(65.79±2.34) 分]明显低于其他2组(F=4.23,P<0.01);死亡组 PCIS[(62.35±4.22) 分]低于存活组[(89.21±5.36) 分](t=3.15,P<0.01),而血乳酸水平[(5.31±4.05) mmol·L-1]高于存活组[(3.22±2.13) mmol·L-1](t=2.32,P<0.05);PCIS与血乳酸水平呈负相关(r=-0.889,P<0.01).结论 血乳酸升高的PICU危重患儿病情更重、预后更差,PCIS评分可有效评估患儿的病情和预后,并与乳酸水平存在显著负相关.动态监测血乳酸水平是反映危重病患儿病情严重程度和预测患儿转归的较好指标.     

The efficacy and safety of heat-killed Lactobacillus paracasei for treatment of perennial allergic rhinitis induced by house-dust mite

Live Lactobacillus paracasi 33 (LP33) may effectively improve the quality of life for patients with perennial allergic rhinitis. It has been demonstrated that heat-killed lactic acid bacteria (LAB) suppress specific immunoglobulin E synthesis and stimulate interleukin-12 production in animals. The aim of this study was, therefore, to evaluate the efficacy of heat-killed LP33 in the treatment of allergic rhinitis induced by house-dust-mite in human subjects. A total of 90 patients were enrolled in a randomized, double blind, placebo-controlled trial and assigned to three treatment groups. Patients in groups A and B received two capsules per day of live or heat-killed LAB (5 x 10(9) colony-forming units/capsule), respectively, over a period of 30 days while those in Group C received placebo capsules. A modified questionnaire on pediatric rhinoconjunctivitis-related quality of life was administered to all subjects or their parents during each clinical visit. The overall quality of life score decreased for groups A and B, as compared with the placebo group, in terms of both frequency (9.47 +/- 2.89, 6.30 +/- 2.19, vs. -3.47 +/- 1.53, respectively; p < 0.0001) and level of bother (5.91 +/- 3.21, 6.04 +/- 2.44, vs. -2.80 +/- 1.64, respectively; p = 0.004) after the 30-day treatment. The efficacy of the heat-killed LP33 was not inferior to the live variant. No obvious side effects were reported for either active treatment group during the study period. Our results suggest that heat-killed LP33 can effectively improve the overall quality of life for patients with allergic rhinitis, and that it may be efficacious as an alternative treatment.