耐甲氧西林金黄色葡萄球菌的研究现状

耐甲氧西林金黄色葡萄球菌 (Ｍｅｔｈｉｃｉｌｌｉｎ ｒｅｓｉｓｔａｎｔＳｔａｐｈｙｌｏｃｏｃｃｕｓａｕｒｕｅｓ,ＭＲＳＡ)是院内感染和社区感染中常见的致病原 ,致病力强而治疗效果差。自 196 1年发现第一株ＭＲＳＡ以来 ,其在世界各地临床分离的金黄色葡萄球菌 (简称金葡菌 )中的比例不断增加 ,耐药程度不断加深 ,目前已发展成为世界范围内存在的一个问题。现介绍ＭＲＳＡ的流行情况、流行的相关原因、耐药机制以及耐药菌感染临床治疗方案。ＭＲＳＡ出现后 ,于 2 0世纪 6 0年代中期扩展至加拿大及欧洲许多国家 ,70年代末期ＭＲＳＡ急…     

肺脏超声对早产儿长期氧依赖肺部原因的鉴别价值

目的 肺脏超声已经广泛应用于肺脏疾病的诊断与鉴别诊断,本文旨在研究肺脏超声对明确早产儿长期氧依赖肺部原因的可行性与必要性.方法 对临床上诊断为支气管肺发育不良（bronchopulmonary dysplasia,BPD）的50例患儿进行肺脏超声筛查,并记录相关所见结果.结果 50例临床诊断为BPD的患儿中,肺脏超声检查发现肺不张9例、肺炎4例、严重肺水肿2例、肺水肿伴局灶性肺实变3例.对其进行相应处理后,患儿对氧的依赖消肖失或程度明显减轻,即超过1/3（36％,18/50）患儿的氧依赖并非BPD或非单纯BPD引起.结论 肺脏超声对协助诊断与鉴别患儿长期氧依赖的肺部病因有重要价值,有助于避免诊断扩大化及指导治疗,提示有必要对目前使用的BPD诊断标准予以修订.     

高浓度氧诱导早产儿肺损伤的研究现状

<正> 氧疗是合并有心肺疾病的早产儿最常用的治疗手段。但若长时间吸入高浓度氧(如浓度为0.4～1.0),将引起不同程度的肺组织损伤,重者因肺组织纤维化,最终发展成慢性肺疾病(Chronic lung dis-ease,CLD),需长期依赖氧气或机械通气治疗。近年来,随着早产低体重儿存活率的提高,CLD的发生率有逐渐上升的趋势。为此,本文就高浓度氧(高氧)诱导肺损伤的研究进展及现状作一综述。     

高氧致慢性肺疾病早产鼠肺组织细胞周期依赖蛋白激酶-4、p21表达及其对纤维化的影响

目的 研究慢性肺疾病（CLD）早产鼠的肺组织细胞周期依赖蛋白激酶-4（CDK4）及细胞周期依赖蛋白激酶抑制因子（p21）动态表达规律及其意义。方法 将80只早产鼠随机分为模型和对照组（每组40只），采用高体积分数氧诱导CLD模型，于实验后1、3、7、14、21d分别应用酶联免疫吸附法及免疫组织化学技术检测其肺组织I型胶原和CDK4、p21蛋白表达。结果 与对照组比较，实验组14和21dⅠ型胶原水平及CDK4表达增加，而p21表达水平降低。实验组14和21dCDK4表达水平与肺纤维化程度呈明显正相关；p21与肺纤维化程度呈明显负相关。结论 高氧诱导早产鼠肺组织CDK4及p21异常表达，可能是CLD肺纤维化发生的机制之一。     

高氧对早产鼠和足月鼠肺损伤的实验研究

目的探讨高氧对早产鼠和足月鼠肺损伤的影响。方法早产和足月新生鼠分别置于常压高氧舱中(＞95％O2)和正常空气中暴露7～14d,对比观察其生存率,肺组织病理学改变以及肺组织抗氧化酶(AOE)活性。结果与空气对照组比较,高氧组均发展为肺损伤,早产鼠的肺损伤较足月鼠严重,生存率较足月鼠低。高氧暴露下足月和早产鼠其肺组织超氧化物歧化酶(SOD)活性明显增加(P＜0.05),过氧化氢酶(CAT),谷胱甘肽过氧化酶(GP)也显示增加的趋势(P＞0.05)。结论早产鼠和足月鼠对高氧均有一定的耐受力,但早产鼠更易发生肺损伤。     

麻疹病毒感染的研究现状

麻疹病毒为RNA病毒，只有一个血清型；目前，麻疹病毒可分为8个基因组，共18个基因型。20世纪80年代以后分离到的病毒在H和N蛋白基因上出现差异。母传麻疹病毒抗体至生后6个月已达不到保护作用。麻疹病毒与多种免疫性疾病相关。麻疹的实验室诊断以血清抗体检查较为实用。控制和消灭麻疹仍以推广和加强群众性计划免疫为主。     

体外膜氧合治疗期间拔除患儿气管插管的单中心研究

关键词体外氧合;生命支持;机械通气;拔除气管插管;呼吸机相关性肺损伤 背景随着医疗设备和技术的进步,体外膜氧合（extracorporeal membrane oxygenation,ECMO）运转时间及安全性增加,且可用于出现更复杂合并症的患者。此类复杂患者的其他治疗措施也因此而被重新评估,包括持续气管插管、机械通气和镇静对病情的影响。     

儿童肥胖症的研究现状

近年来．小儿肥胖症的发病率在全球范围内呈明显上升趋势,统计资料显示,在许多国家,近10a来,小儿肥胖症的发病率升高了50％以上。现已证实,小儿肥胖．尤其是青春期肥胖者80％将会延续为成人肥胖,而成人肥胖的治疗非常困难。由此可见,从儿童时期着手预防和治疗肥胖症十分重要川,本文就国外近年来小儿肥胖症的研究进展综述如下。儿童肥胖的定义目前,对小儿肥胖尚无完全统一的标准,所谓肥胖是指身体脂肪过多,与超重是两个不同的概念,有些儿童超重是因为肌肉和骨骼的原因。在儿童时期能用不同的方法测量超重的程度、身体脂肪的比例…     

川崎病冠状动脉病变介入疗法的研究现状

川崎病 (Ｋａｗａｓａｋｉｄｉｓｅａｓｅ,ＫＤ)是一种病因不明 ,以全身中、小动脉炎性病变为主要病理改变的急性发热性疾病 ,常见于 5岁以下的小儿 ,以冠状动脉 (简称冠脉 )病变为其最严重的并发症。ＫＤ急性期冠脉瘤 (ｃｏｒｏｎａｒｙａｒｔｅｒｙａｎｅｕｒｙｓｍ ,ＣＡＡ)的发生率约为 10 %～ 2 0 %。随访研究表明 ,约 5 0 %的ＣＡＡ于病后 1～ 2年内自行消退 ,80 %的轻、中度ＣＡＡ于病后5年内消退。ＣＡＡ直径 >5ｍｍ者可能进展为狭窄 ,且瘤体越长可能性越大。巨大ＣＡＡ(直径≥ 8ｍｍ)常不能消退 ,内膜增生伴血栓形成 ,瘤出入口产生…     

鼻病毒的研究现状

鼻病毒(Rhinovirus,RhV)是引起人类病毒性呼吸道感染的最常见病原体,自从1956年Pelon用组织培养的方法分离出第1株RhV后,先后从感冒患者中分离出多种细胞株,至今鉴定RhV已超过120个血清型,是人类病毒中血清型最多的病毒。越来越多的研究表明RhV不仅引起普通感冒,还可有其他多种临床表现,故应受到重视。现将RhV的研究进展及对儿童感染的现状综述供临床参考。     

A scoring system to predict chronic oxygen dependency

Introduction Chronic oxygen dependency (COD) is a common adverse outcome of very premature birth. It is, therefore, important to develop an accurate and simple predictive test to facilitate targeting of interventions to prevent COD. Our aim was to determine if a simple score based on respiratory support requirements predicted COD development. Methods A retrospective study of 136 infants, median gestation age (GA) 28 weeks (range: 23–33 weeks) and a prospective study of 75 infants, median GA 30 weeks (range: 23–32 weeks), were performed. The score was calculated by multiplying the inspired oxygen concentration by the level of respiratory support (mechanical ventilation: 2.5; continuous positive airway pressure: 1.5; nasal cannula or head box oxygen or air: 1.0). Scores were calculated on data from days 2 and 7, and their predictive ability compared to that of the maximum inspired oxygen concentration at those ages and (retrospective study) the results of lung volume measurement. Results Infants that were oxygen dependent at 28 days and 36 weeks post-menstrual age (PMA) had higher scores on days 2 (p<0.0001, p<0.0001, respectively) and 7 (p<0.0001, p<0.0001, respectively) than the non-oxygen dependent infants in both the retrospective and prospective cohorts. Construction of receiver operator characteristic curves demonstrated the score performed better than the inspired oxygen level and lung volume measurement results. A score on day 7 >0.323 had 95% specificity and 78% sensitivity in predicting COD at 28 days, and 80% specificity and 73% sensitivity in predicting COD at 36 weeks PMA. Conclusion Chronic oxygen dependency can be predicted using a simple scoring system.     

Inhaled versus systemic steroids in chronic oxygen dependency of preterm infants

The speed of action and side-effects of systemic versus inhaled steroids was compared in infants with mild-moderate oxygen dependency. Forty infants (median gestational age 27 weeks) were randomized to receive either 10 days of dexamethasone (systemic group) or budesonide (100 μg qds) (inhaled group). At randomization, there was no significant difference in the gestational or postnatal age, inspired oxygen requirements or compliance of the respiratory system of the two groups. After 36 h of treatment, there were significant changes (P < 0.01) in both the inspired oxygen concentration and compliance of the respiratory system in the systemic but not the inhaled group. Only after 1 week of inhaled therapy were improvements in respiratory status noted but, even at that time, the inspired oxygen requirement was significantly lower in the systemic versus the inhaled group. In the systemic group only, however, were there significant increases in blood pressure. Conclusion Systemically administered rather than inhaled steroids appear to have a faster onset of action.     

Inhaled versus systemic steroids in chronic oxygen dependency of preterm infants

The speed of action and side-effects of systemic versus inhaled steroids was compared in infants with mild-moderate oxygen dependency. Forty infants (median gestational age 27 weeks) were randomized to receive either 10 days of dexamethasone (systemic group) or budesonide (100 μg qds) (inhaled group). At randomization, there was no significant difference in the gestational or postnatal age, inspired oxygen requirements or compliance of the respiratory system of the two groups. After 36 h of treatment, there were significant changes (P < 0.01) in both the inspired oxygen concentration and compliance of the respiratory system in the systemic but not the inhaled group. Only after 1 week of inhaled therapy were improvements in respiratory status noted but, even at that time, the inspired oxygen requirement was significantly lower in the systemic versus the inhaled group. In the systemic group only, however, were there significant increases in blood pressure. Conclusion Systemically administered rather than inhaled steroids appear to have a faster onset of action. Received: 22 December 1995 / Accepted: 27 May 1996     

改变传统窒息复苏用氧观念合理选择新生儿复苏氧源

目前在我国新生儿产房急救,特别是窒息复苏过程中,围产界关注较大且尚未统一的问题之一是复苏氧源的选择.传统应用纯氧的窒息复苏概念已逐渐被近期的多中心研究成果打破,但至今尚有较大争论.     

Chronic oxygen dependency in infants born at 24–32 weeks' gestation: The role of antenatal and neonatal factors

Objectives: To study the incidence of chronic oxygen dependency (COD) among ventilated survivors born at 24–32 weeks gestation from 1986 to 1994 and to identify antenatal and neonatal factors that may have changed with time; and to identify antenatal and neonatal factors that could contribute to the development of COD in infants born at 24–32 weeks gestation using a case control model. Methodology: Infants born at 24–32 weeks gestation in one tertiary referral centre between 1986 and 1994 and admitted to the neonatal intensive care unit for respiratory support were studied. Data accumulated prospectively since 1986 in survivors of ventilation were analyzed to identify antenatal and neonatal factors that could have changed with time. The cohort of infants who developed COD were matched for gestation and time of birth with a control group of infants who did not have COD. Significant factors that could have contributed to the development of COD were identified using forward logistic regression analysis. Results: The number of mothers admitted for threatened premature labour (TPL), and pregnancy induced hypertension decreased with time while the use of antenatal steroids and maternal antibiotics increased. More infants were delivered by Caesarean section during the later years. There was an increase in neonatal septicaemia with time while there were decreases in hyaline membrane disease, pneumothorax, pulmonary interstitial emphysema, use of high peak inspiratory pressures (PIP) and high inspired oxygen. The incidence of COD decreased. The case controlled study revealed a significant positive association between COD and male gender, birthweight less than the 10th percentile for gestation, PIP over 30 cm H₂O, septicaemia and significant patent ductus arteriosus (PDA) requiring indomethacin. There was a negative association with TPL. Conclusions: Further decrease in COD can be achieved only if septicaemia, PDA and the use of high PIP can be avoided. The most effective way of reducing the incidence of COD is by reducing the incidence of prematurity.     

A chest radiograph scoring system to predict chronic oxygen dependency in low birth weight infants

The usefulness of a chest radiograph scoring system to predict chronic oxygen dependency (oxygen dependency at 36 weeks post conceptual age) was determined in 40 infants with a median gestational age 27 weeks (range 24-32 weeks). The scoring system assessed the appearance of the preterm infant's chest radiograph taken at one month of age, and graded the radiograph according to lung volume, the presence of opacification, cystic elements and interstitial change (maximum score 24). Infants who were chronically oxygen dependent had significantly higher scores (median 9, range 7-20) than those not oxygen dependent (median 3, range 0-13, P less than 0.01). All nine chronically oxygen dependent infants had a score greater than 6, in comparison with only two of 31 infants not chronically oxygen dependent (P less than 0.01). A chest radiograph score of 6 thus had a sensitivity of 100% and specificity of 93.5% in predicting chronic oxygen dependency.     

反映体内供氧/缺氧相关指标的意义与临床应用

氧是维持生命活动所必需的重要物质,临床上很多疾病都会引起氧供需失衡,导致组织脏器受损。临床医生如何应用反映供氧、缺氧的相关指标,早期判断机体有无缺氧及其程度,对于指导治疗、改善预后至关重要。该文就反映供氧和肺氧合功能,以及组织氧代谢的相关指标进行了介绍。     

郎格罕细胞组织细胞增生症的病理诊断

探讨病理检查在郎格罕细胞组织细胞增生症的诊断中的作用。收集我院 1991～ 2 0 0 1年间收治的诊断为小儿郎格罕细胞组织细胞增生症共 76例住院病人的资料总结分析。结果 ,76例病人 67例依据皮疹印片或病理活检诊断 ( 88 2 % ) ,1例依据骨髓检查诊断 ,其余依据临床和依据临床和影像学检查诊断。皮疹印片 18例 ,12例阳性 ;5 5例行病理检查 ,取材自皮肤、淋巴结、肿物 (包括腹腔、头部、纵隔肿物 )及骨损处穿刺或刮除物检查 ,找到郎格罕组织细胞 ;2 5例行S 10 0检查 ,2 4例阳性 ( 96% )。 3 9例行骨髓检查仅 1例示组织细胞明显增加 ,其余示增生骨髓象或增生减低。结果表明 :病理检查是郎格罕细胞组织细胞增生症的确诊的唯一手段。皮疹印片对LS病的诊断有特殊意义 ,骨髓检查诊断价值有限。HSC及EGB的病人诊断有赖于病灶局部肿物、淋巴结活检或病损骨组织的病理检查 ,S 10 0阳性有助于对不确定病例的诊断及提高诊断的可信度。     

The pathologic anatomy of the G syndrome

A detailed anatomic study of the organs of a stillborn male infant with the G syndrome was made.The malformations consisted of a subtle physiognostic appearance with severe micrognathia, penoscrotal hypospadias with descended testes, and failure of closure of the laryngotracheal groove. In addition, respiratory tract defects included lack of lung fissures, short trachea with a high carina and a symmetrical bronchial tree. Minor cardiac malformations of systemic and cardiac venous drainage, and urinary tract anomalies were also present. Developmental, clinical and genetical aspects of the G syndrome were discussed.Contributed in part as Paper No. 1509 from the University of Wisconsin Genetics Laboratory, and contribution VIC: Studies of Human Malformation Syndromes from the Birth Defects Research Center, Department of Pediatrics, University of Wisconsin Medical School.Supported in part by NIH Grants GM 15422, GM 08217, 5 KO 4 HD 18982, and by a Grant from the National Foundation-March of Dimes.