小儿心内直视手术后急性呼吸窘迫综合征的危险因素与防治对策

目的 分析小儿心内直视手术后发生急性呼吸窘迫综合征(ARDS)的危险因素及探讨其防治对策.方法 以2001年1月至2008年10月间连续1 408例施行先天性心脏病(先心病)手术患儿为研究对象,进行术后ARDS危险因素的单因素分析和多因素Logistic回归分析.结果 术后发生ARDS 32例,发生率为2.27%.术后ARDS患儿病死率为46.9%.单因素分析显示:紫绀型先心病、体外循环时同、主动脉阻断时间、呼吸机通气时间、每公斤体质量引流液总量、围手术期意外、术后并发症与术后ARDS有关.经多因素Logistic回归分析显示:体外循环时间超过180 min、每公斤体质量引流液总量超过18 ml、围术期发生意外、术后多器官功能衰竭为小儿心内直视手术后ARDS的危险因素.结论 对于具有ARDS高危因素的心内直视手术患儿,应采取积极的防治措施,这对防止心内直视手术后发生的ARDS具有重要的意义.     

先天性心脏病术后近期严重神经系统异常的相关因素分析

目的总结先天性心脏病(简称先心病)体外循环术后近期(1个月内)发生神经系统异常患儿的临床特征, 分析术后近期发生严重神经系统异常的高危因素。方法回顾性分析2016年2月至2020年4月浙江大学医学院附属儿童医院心脏重症监护室(cardiac intensive care unit, CICU)收治的73例因先心病行体外循环下心脏手术, 术后1个月内发生神经系统异常患儿的临床资料。根据是否需要接受抗癫痫治疗、外科手术干预及高压氧康复治疗将患儿分为严重神经系统异常组(n=15)和非严重神经系统异常组(n=58), 对比两组患儿先心病类型、年龄、体重、体外循环时间、主动脉阻断时间、CICU滞留时间、住院时间、是否存在撤机后再插管以及围手术期心肺复苏(cardiopulmonary resuscitation, CPR)史等资料, 采用单因素分析和二元Logistic回归分析先心病患儿手术后近斯发生严重神经系统异常的影响因素。结果经单因素分析发现, 体外循环时间和主动脉阻断时间长、应用体外膜肺氧合(extracorporeal membrane oxygenation, ECMO)、合并气道狭...     

影响完全性肺静脉异位引流术病死率的危险因素

目的 分析完全性肺静脉异位引流(TAPVC)纠治术的手术结果,探讨影响其病死率的危险因素.方法 对比分析郑州大学第三附属医院河南省小儿先心病诊疗中心2001年9月至2011年9月收集的TAPVC患儿临床资料.其中男37例,女20例;年龄15 d～6.5岁[(4.27±8.63)个月];体质量4.0 ～21.0(6.33 ±2.70) kg.收集患儿住院病历、超声心动图和手术记录等资料.应用x2检验和Logistic多变量回归分析对患者的手术年龄、体质量、TAPVC分型、术前急症、主动脉钳夹时间、手术时间、体外循环时间及术后呼吸机辅助时间、监护时间、住院时间等因素进行分析,分析影响病死率的危险因素.结果 57例TAPVC患儿纠治术中,围手术期死亡7例(12.2％).单变量分析结果表明,与TAPVC纠治术病死率相关的因素有体质量(P =0.035)、TAPVC分型(P=0.037)、术前急症(P=0.021)、主动脉钳夹时间(P =0.046).Logistic多变量回归分析结果表明,术前急症是影响TAPVC纠治术病死率的独立危险因素(P =0.003).结论 TAPVC患儿术前急症会增加患儿术后的病死率.     

小儿急性阑尾炎腹腔镜手术后切口感染危险因素分析及列线图预测模型的构建

目的探讨影响小儿急性阑尾炎腹腔镜手术后切口感染的危险因素, 构建预测术后切口感染的列线图模型, 并评估模型的区分度和一致性。方法选取2016年1月至2021年3月在安徽医科大学附属亳州医院小儿外科行腹腔镜下阑尾切除术的480例患儿作为研究对象, 其中手术后发生切口感染65例(65/480, 13.54%), 未发生切口感染415例(415/480, 86.46%)。收集所有患儿年龄、病理、手术时间、术前体温、阑尾穿孔以及是否留置腹腔引流等临床资料, 采用单因素及多因素Logistic回归分析筛选影响小儿腹腔镜急性阑尾炎术后切口感染的危险因素;采用R软件构建预测术后切口感染的列线图模型, 并使用受试者操作特性曲线(receiver operating characteristic curve, ROC)及校准曲线验证列线图模型的区分度和一致性。结果小儿腹腔镜急性阑尾炎术后切口感染发生率为13.54%(65/480)。单因素分析显示, 年龄、病程、手术操作时间、术前发热、阑尾穿孔、留置腹腔引流是小儿腹腔镜急性阑尾炎术后切口感染的影响因素(P<0.05);多因素Logistic回归分析...     

小儿先天性心脏病术后脓毒症发生的危险因素

目的：探讨小儿先天性心脏病（先心病）术后脓毒症发生的危险因素,以利于疾病早期认识和诊断,改善临床转归。方法回顾性分析我院胸外科重症监护室2012年1月至2015年4月间发生的52例先心病术后合并脓毒症患儿和1∶2配对的104例非脓毒症患儿的临床资料。对患儿年龄、性别、术前感染、延迟关胸、膈肌麻痹、二次开胸、长时间体外循环、留置多个有创导管方面进行Logistic回归分析,分析脓毒症发生的危险因素,计算OR值及其95％CI。结果先心病术后合并脓毒症患儿休克发生率高、功能受累脏器数目多,住院及ICU滞留天数长,病死率高,较非脓毒症患儿差异有统计学意义[25.32％vs.6.73％,（3.5±1.1）个vs.（1.1±0.7）个,（35.1±11.2）d vs.（11.3±3.1）d,（21.3±7.1）d vs.（7.1±2.3） d,19.23％ vs.4.81％,P＜0.05]。 Logistic回归分析显示术前合并感染、延迟关胸、二次开胸、留置多个有创导管,膈肌麻痹是小儿先天性心脏病术后脓毒症发生的危险因素, OR值（95％CI）分别为10.53（1.73,64.22）、26.66（2.69,263.83）、19.47（1.87,203.02）、4.99（1.361,8.31）、8.32（0.12,16.46）（P＜0.05）。结论小儿先心病术后脓毒症发生的危险因素有术前合并感染、延迟关胸、二次开胸、留置多个有创导管及膈肌麻痹。脓毒症患儿较非脓毒症患儿临床转归差。     

小儿体外循环心脏术后呼吸机相关性肺炎的危险因素分析

目的 探讨小儿体外循环心脏术后呼吸机相关性肺炎(ventilator-associated pneu monia,VAP)的危险因素.方法对2003年1月至2010年6月连续体外循环(cardiopulmonany bypass,CPB)心脏术后机械通气时间超过48 h的116例患儿的临床资料进行回顾性分析,根据发生VAP与否进行分组,并进行术后VAP的单因素和多因素Logistic回归分析.结果CPB心脏术后VAP总发病率为4.18％(57/1 365),发生VAP患儿病死率为26.32％(15/57).单因素分析显示:重度肺动脉高压、CPB时间、主动脉阻断时间、二次体外循环支持、白蛋白、术后PaO2/FiO2、机械通气时间、每千克体质量引流液总量、二次气管插管、气管切开、留置胃管、应激性溃疡预防用药与术后发生VAP有关.经多因素Logistic回归分析显示:CPB时间≥150m in、机械通气时间≥4 d、每千克体质量引流液总量≥18ml和气管切开为小儿CPB术后发生VAP的危险因素.57例VAP患儿中共培养病原菌90株,其中革兰阴性菌54株(60.0％),革兰阳性菌32株(35.6％),真菌4株(4.4％).结论临床上可根据VAP的危险因素预先采取措施,以减少VAP的发生.     

小婴儿心内直视术后撤离呼吸机失败相关因素分析

目的：分析小婴儿心内直视术后撤离呼吸机气管插管拔管失败的相关风险因素。方法回顾性分析2012年1月至2014年1月本院行先天性心脏病（先心病）纠治术后计划性气管插管拔管失败、再插管的271例小于3月龄患儿临床资料。结果271例患儿中,32例（11．81％）术后拔管失败,失败组术后膈肌麻痹、NO 吸入、术后肺炎、肺不张的发生率较对照组升高,差异均有统计学意义（P值均＜0.05）,Logistic 回归多因素分析显示术后肺炎、肺不张（Odds Ratio：11．2,95％ CI ＝1．36～98．26）的发生与拔管失败的发生显著相关（P 值均＜0．05）。结论术后肺部感染、肺不张是小婴儿心内直视术后撤离呼吸机失败的主要相关因素,小婴儿先心病纠治术后应注意呼吸道管理,加强胸部理疗,防治肺部感染,以提高拔管成功率,缩短监护室滞留时间。     

右腋下小切口在小儿心内直视手术中的应用研究

目的比较小儿右腋下小切口与胸骨正中切13行心内直视手术的临床资料,探讨右腋下小切口先心病手术的临床效果。方法我们自2012年12月至2013年12月实施右腋下小切口小儿心内直视手术102例,与同期胸骨正中切口手术主要诊断类似患儿102例比较,进行回顾性分析。结果两组主动脉阻断时间、体外循环时间及手术时间比较,差异无统计学意义（P〉0．05）。呼吸机辅助通气时间、术后24h引流量以及术后住院时间比较,右腋下小切口优于胸骨正中切口,差异有统计学意义（P〈0．01）。结论采用右腋下小切口能安全有效地完成先心病心内直视手术,治疗效果好,术后恢复快,切口美观。     

小儿心内直视手术后上消化道出血的急救

小儿心内直视手术后上消化道出血的急救中国医科大学第二临床学院（１１０００３）王文生，郑有仁小儿心内直视手术后并发上消化道出血虽然较为少见，但其临床经过凶险，死亡率较高［１］。１９９３年～１９９４年间我院共有３例先天性心脏病患儿于体外循环术后并发上消化...     

小儿法洛四联症根治术后早期死亡的危险因素分析

目的 探讨小儿法洛四联症(tetralogy of Fallot,TOF)手术后早期死亡的危险因素,以提高手术成功率,降低手术病死率.方法 2003年1 月至2010年12月期间在成都心血管病医院行TOF根治术患儿191例,其中男142例,女49例;年龄4个月～12岁.收集所有患儿术前、术中和术后的临床资料,分析影响TOF手术后早期死亡的危险因素.结果 191例患儿,围术期死亡6例(3.14％),死于手术后感染合并多器官功能衰竭3例,低心排血量综合征2例,脑部并发症1例.其中≤6个月患儿病死率6.67％(2/30),6个月～3岁患儿病死率1.41％ (1/71),3～12岁患儿病死率3.33％ (3/90).多因素Logistic回归分析结果表明,年龄≤6个月(OR=4.606,95％CI 1.811 ～11.719,P＜0.05)、术前血氧饱和度＜70％(OR=0.982,95％ CI 0.501 ～ 1.932,P＜0.01)、Nakata指数＜140mm2/m2(OR=16.960,95％CI 1.414 ～ 150.390,P＜0.01)、体外循环时间＞150 min(OR=4.398,95％CI2.091 ～9.216,P＜0.01)及术后多器官功能衰竭(OR=4.872,95％CI 2.583 ～ 9.192,P＜0.05)是小儿TOF根治术后早期死亡的危险因素.结论 临床上可根据患儿年龄、术前血氧饱和度、Nakata指数、体外循环时间及术后并发症预测TOF根治术后早期死亡的危险性.     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.