西沙比利治疗新生儿胃食管返流24例

胃食返流 (ＧＥＲ)是新生儿呕吐最常见原因。西沙比利治疗胃食管返流在成人和大龄儿童中已有较多报道 ,在新生儿治疗的资料少见。我们采用西沙比利混悬液口服治疗新生儿胃食管返流 ,疗效满意 ,现总结如下。1　资料和方法1·1　临床资料　⑴入选标准 :胎龄 <35周的新生儿 ,存在因动力障碍引起的胃食管返流 ,表现为溢乳 /反胃、呕吐 ,2次 /ｄ以上。排除消化道器质性疾病、胆汁性呕吐、消化道感染及应用影响胃肠动力药物 (大环类酯类、抗胆碱能药等 )。⑵来源 :本院新生儿科患儿 ,按投币法随机分成两组 ,治疗组 2 4例 ,男 13例 ,女 11例。日龄 …     

24h食管pH监测在胃食管反流病中的临床应用

胃食管反流病 (ＧＥＲＤ)是指过多胃、十二指肠内容物反流入食管引起烧心等症状 ,并可导致食管炎和口、咽、喉、气道等食管以外的组织损害。本研究应用 2 4ｈ食管ｐＨ监测仪 ,监测了ＧＥＲＤ及正常对照组食管下段的ｐＨ值 ,旨在探讨其中ＧＥＲＤ中的临床应用价值。1　材料和方法1·1　研究对象　 1998年 10月至 2 0 0 1年 3月 ,我院消化门诊及住院者 5 8例 ,其中正常对照组 2 8例 ,均符合⑴无嗳气、反酸、烧心等食管疾病及ＧＥＲＤ症状。⑵无胃肠手术及活动性消化性溃疡。⑶无糖尿病、硬皮病等全身疾病。⑷内镜及Ｘ线检查无食管及胃的形态学…     

支气管哮喘与胃食管返流之间关系的探讨

目的探讨胃食管返流(GER)与支气管哮喘之间的关系及制酸药物对GER的作用.方法采用便携式24hpH值自动记录仪对20例哮喘恶者进行六项返流指标监测,10例正常人作对照,并随机抽10例哮喘合并GER患者进行抗返流治疗.结果哮喘组六项返流指标均明显高于对照组,哮喘合并GER的发生率为70%,用H2拮抗剂对l0例合并GER者抗返流治疗,,治疗后各项返流指标明显降低.结论哮喘与胃食管返流之间有密切关系,GER是诱发哮喘发作的一个重要因素,H2拮抗剂对哮喘合并GER者有良好的治疗作用.     

窒息后新生儿胃食管返流的初步观察

目的探讨新生儿窒息对胃食管返流(GER)的影响.方法用便携式24 h pH记录仪动态监测30例不同程度窒息后新生儿和15例对照新生儿的24 h食管pH值.结果窒息组胃食管返流的各项参数均明显高于对照组,其中返流指数窒息组/对照组为7.8/1.9,返流次数为139/31,返流＞5 min的次数6.1/0.9,pH＜4总时间162/21,差异均有非常显著意义(P＜0.01).重度窒息组各项返流指数明显低于轻度窒息组和对照组(P＜0.01).结论新生儿窒息可引起胃肠运动功能紊乱,窒息后新生儿胃食管返流较对照组明显增加,应及时给予相应的处理.     

小儿胃食管返流的X线诊断价值

目的　评价小儿胃食管返流的X线诊断价值。方法　回顾30例小儿胃食管返流的X线表现,并与其它诊断小儿胃食管返流的方法进行比较。结果　造影剂返流入食管下段4例,中段19例,上段7例,合并返流性食管炎8例,合并肺部吸入性肺炎3例,食管气管瘘1例,早期食管裂孔疝1例,幽门痉挛2例。结论　应用X线造影检查是诊断小儿胃食管返流的最主要手段,并在指导临床治疗方面具有重要的应用价值。     

24小时食管pH监测对胃食管反流病的诊断意义研究

目的探讨24h食管pH值与胃食管反流之间的关系,为临床诊治胃食管反流病提供科学依据。方法用CTD-svnectics公司便携式动态pH监测仪,对52例有胃食管反流症状者进行24h食管pH监测。采用Johson和DeMeester6种参数指标．对患者进行综合评分以反映病人的反流程度。结果监测病例组6种参数指标均显著高于对照组（P〈0．01）;DeMeester评分〉14．72．总阳性率为57．7％;以pH〈4的反流次数诊断阳性率最高（57．7％）,卧位pH〈4的总时间诊断阳性率最低（15．4％）。结论24h食管pH监测给反流性疾病的诊断和药物治疗提供了依据,提高了对胃食管反流疾病的认识和治疗效果。     

窒息后新生儿胃食管返流的初步观察

目的:探讨新生儿窒息对胃食管返流(GER)的影响。方法:用便携式24 h pH记录仪动态监测30例不同程度窒息后新生儿和15例对照新生儿的24 h食管pH值。结果:窒息组胃食管返流的各项参数均明显高于对照组,其中返流指数窒息组/对照组为7.8/1.9,返流次数为139/31,返流>5 min的次数6.1/0.9,pH<4总时间162/21,差异均有非常显著意义(P<0.01)。重度窒息组各项返流指数明显低于轻度窒息组和对照组(P<0.01)。结论:新生儿窒息可引起胃肠运动功能紊乱,窒息后新生儿胃食管返流较对照组明显增加,应及时给予相应的处理。     

食管粘膜胃全层吻合——贲门成形术后抗胃食管返流功能的临床流行病学研究

作者设计并在临床上了一种新的手术方法以预防食管贲门癌手术后的胃食管返流。１９９４年４月－１９９５年１２月随机抽取３４例作实验研究组，同期使用吻合器吻合的２７例为对照组，术后进行了观察，监测和随访。研究组病例无胃食管返流症状，食管镜检查，钡餐造影无明显返流。     

食管粘膜胃全层吻合——贲门成形术后抗胃食管返流功能的临床流行病学研究

作者设计并在临床上开展了一种新的手术方法以预防食管贲门癌手术后的胃食管返流。 1994年 4月～ 1995年 12月随机抽取 34例作实验研究组 ,同期使用吻合器吻合的 2 7例为对照组 ,术后进行了观察、监测和随访。研究组病例无胃食管返流症状 ,食管镜检查、钡餐造影无明显返流。对照组中 10例病人 ( 37.0 % )伴有烧心、返酸等症状 ,食管镜下、钡餐 X线检查有炎症和明显的胃食管返流。研究组和对照组吻合口近测 p H的标准差依次为 7.0 2 4 9± 0 .9996、4 .6667± 2 .4 573,经 t检验两者差异有非常显著性 ( P<0 .0 1)。作者强调手术方法的改进是预防食管、贲门癌术后胃食管返流的关键。     

抗返流治疗对胃—食管返流相关性哮喘患者肺功能的影响

目的：观察抗返流治疗对胃—食管返流（ＧＥＲ） 相关性哮喘患者肺功能的影响。方法：２５ 例ＧＥＲ 相关性哮喘患者,在常规哮喘治疗基础上均给予抗返流治疗８ 周,并于治疗前后作肺功能测定。结果：抗返流治疗后,肺功能比治疗前均有明显改善,其中ＦＥＶ１ 和ＰＥＦＲ 的改善最明显;１２ 例临床控制（４８－０ ％） ,１３ 例好转（５２－０ ％ ）;２１例需长期服用支气管扩张剂的患者,１３ 例完全停用（６１－９ ％） ,８ 例用量减少一半以上（３８－１ ％） ;１３ 例需长期吸入糖皮质激素的患者,８ 例停药（６１－５ ％） ,５ 例减量（３８－５ ％ ）。结论：抗返流治疗ＧＥＲ 相关性哮喘,无论ＧＥＲ 先于哮喘或哮喘先于ＧＥＲ,均能明显改善患者的肺功能。     

Gastrooesophageal reflux in children with cerebral palsy

Summary Feeding difficulties, vomiting and recurrent chest infections associated with poor growth and nutrition are common in children with cerebral palsy (CP). However, the role of gastrooesophageal reflux as a possible cause has been little studied. We therefore investigated 23 children with cerebral palsy (median age 2–3 years, range 0–6-11-8) whose symptoms were consistent with gastrooesophageal reflux (severe feeding difficulties 70%, failure to thrive 52%, anaemia 31% and recurrent chest infections 31%). Using 24-hour ambulatory oesophageal pH monitoring, we determined the relationship between gastrooesophageal reflux and: (a) developmental age (Griffith's scales); (b) feeding behaviour skills score; (c) nutritional status and (d) clinical assessment of cerebral palsy (type and severity). Abnormal gastrooesophageal reflux (i.e. reflux index > 5%) was detected in 16 (70%) patients (median reflux index 11–4%; range 5·4–59%).
Reflux was unrelated to chronological or developmental age, but there was a significant, unexplained association with male gender ( P < 0·01). No correlation was found with feeding behaviour skills score, malnutrition (which was commonly severe) and type and severity of cerebral palsy. We conclude that gastrooesophageal reflux is common and should be sought in symptomatic, neurologically handicapped children as effective treatment is likely to improve quality of life.     

脑瘫儿童胃肠道问题的研究进展

脑性瘫痪是一组持续存在的中枢性运动和姿势发育障碍、活动受限症候群,这种症候群是由于发育中的胎儿或婴幼儿脑部非进行性损伤所致。胃肠道问题是脑瘫儿童常见的伴随症状,主要包括口咽吞咽障碍、胃食管反流病和便秘。本文对脑瘫儿童主要的胃肠道问题进行综述,以期提高家长及医务人员对脑瘫儿童胃肠道问题的认识。     

脑性瘫痪儿童合并视功能障碍临床分析

【目的】对脑性瘫痪儿童视功能障碍的发生及相关因素进行探讨。【方法】对347例脑性瘫痪儿童进行常规眼科检查,并对其中合并视功能障碍的患儿的病因、其他并发症及脑瘫类型进行统计分析。【结果】脑瘫患儿视功能障碍的发病率为14.41%,其中主要的视功能障碍为斜视,发病率为11.53%。【结论】视功能障碍的康复是脑性瘫痪患儿整体康复的重要内容之一。     

脑瘫患儿的社区管理

目的:通过对脑瘫患儿进行社区化管理,提高脑瘫患儿的康复效果。方法:2010年1月～2012年1月选取某社区25例脑瘫患儿作为研究对象,将患儿进行分组,其中观察组患儿15例,对照组患儿10例。观察组患儿进行社区化管理康复培训,对照组患儿进行普通家庭式康复训练。利用GMFM级别评分对患儿进行粗运动评分,比较两组患儿的康复效果。结果:两组患儿治疗前GMFM评分不存在统计学差异(P>0.05),而观察组患儿经过6个月的个体化社区管理康复化训练后,其GM-FM的评分明显高于对照组患儿(P<0.05)。结论:有效的社区化脑瘫患儿康复管理有助于脑瘫患儿身体功能的恢复,目前越来越受到社区脑瘫家庭的重视。     

Energy intakes of children with cerebral palsy

The energy intakes of 13 children [seven girls, six boys, mean age 10 years (s.d. 4; range 4–15 years)] with cerebral palsy attending a residential school were measured by 3-day weighed dietary record. Energy intake averaged 340 kj/kg per day (s.d. 93; range 102–424) which was higher than the group mean estimated energy requirement (271 kj/kg per day, s.d. 70; range 144–395). The mean coefficient of variation for day to day energy intake was 14%, and food energy not consumed (plate waste and food unsuccessfully ingested) averaged 22% of energy intake. Within the group there was little evidence of marked differences in energy intake between different diagnostic types of cerebral palsy or between children of different feeding/eating ability, although the sample size was too small to detect small between-group differences in intake. Energy intake was somewhat higher than that reported in some other studies, but there was no evidence of the unusually high energy intakes which have been reported previously in some groups of children with cerebral palsy.     

Feeding problems in a child with cerebral palsy

This case study describes the feeding problems that occurred in a child with cerebral palsy as a result of severe gastro-oesophageal reflux, oral-motor dysfunction and behavioural aversion. Nutritional management over the first(r)2 years of life is discussed. It illustrates the benefit of working in a multi-disciplinary team.     

脑性瘫痪患儿共患癫痫的危险因素

目的 了解脑瘫患儿高危因素、临床特点及其与癫痫发生的关系,探讨脑瘫患儿共患癫痫的危险因素。方法 回顾性收集从2019年1月—2022年2月在郑州大学第三附属医院住院治疗的脑瘫患儿的病例资料,将患儿分为脑瘫共患癫痫组和未共患癫痫组,采用χ²检验分析两组间高危因素、临床特点等资料,应用多因素Logistic回归对共患癫痫的危险因素进行分析。结果 共纳入630例脑瘫患儿,其中男421例,女209例;脑瘫共患癫痫组患儿155例,未共患癫痫组患儿475例,癫痫发生率24.6%。脑瘫共患癫痫组患儿在宫内窘迫、窒息、多胎及新生儿先天性畸形史方面的发生率高于未共患癫痫组患儿(χ²=4.788、9.368、5.255、12.111,P<0.05),两组患儿在脑瘫分型、头颅MRI分类、粗大运动功能分级方面差异有统计学意义(χ²=213.686、14.640、481.531,P<0.05)。多因素Logistic回归结果显示,痉挛型四肢瘫(OR=14.090,95%CI:1.950～101.813)、新生儿先天性畸形史(OR=1....     

Health status of caregivers of children with cerebral palsy

Background and Aims While a ‘Family‐Centered’ approach to care is accepted as best practice in the context of childhood disability, it may lead to increased demands on family members by requiring them to be active participants in their child's care. This may impact upon the physical and mental health of the caregiver and therefore needs to be investigated. This study aimed to assess the health status of caregivers of children with cerebral palsy (CP) in Ireland and to identify vulnerable subgroups. Methods A cross‐sectional postal survey was conducted using a questionnaire incorporating the SF‐36v2.0. The sample consisted of male and female caregivers of children with CP, representing all levels of ability. Two questionnaires were sent to each child's home; a total of 312 questionnaires were sent to the homes of 156 children. Results Completed questionnaires were returned by 161 caregivers (100 women, 61 men) of 101 children, giving a response rate of 65%. Caregivers of children with CP were found to have poorer health than the Irish general population, for whom normative data exist. Female caregivers had poorer health than male caregivers in both the physical (P < 0.05) and mental health (P < 0.001) domains of the SF‐36. Caregivers spending more time caring had significantly poorer mental health than those spending less time caring (P < 0.05). There was no difference in the health of caregivers of ‘more independent’ versus ‘more dependent’ children, apart from the latter group reporting higher levels of bodily pain (P < 0.05). Conclusion This study provides evidence of the inferior health status of caregivers of children with CP in Ireland, particularly that of women.     

神经节苷脂对脑瘫患儿疗效的Meta分析

目的 评价神经节苷脂对脑瘫患儿的疗效及安全性,为其临床应用提供参考。方法 检索Pubmed、Embase、Cochrane图书馆、中国生物医学文献数据库、中国期刊全文数据库及万方数字化全文期刊数据库,检索时间为建库至2015年10月。纳入有关神经节苷脂治疗脑瘫患儿的随机对照试验,对显效、有效率进行有序分类变量的Meta分析;对总有效率进行二分类变量的Meta分析;对患儿发育商评分(developmental quotient,DQ)进行连续变量的Meta分析。结果 共纳入10个随机对照试验,共计806例患儿,对显效、有效率分析,其相对危险度(odds ratio,OR)为2.63,95%CI:1.95~3.53;对总有效率进行分析,其OR值为4.74,95%CI:2.99~7.52;神经节苷脂使DQ评分提高,SMD=1.30,95%CI:0.33~2.27。结论 神经节苷脂对脑瘫患儿治疗效果良好,可改善患儿的症状。