新生儿危重评分在新生儿转运中的应用

目的：探讨应用新生儿危重病例评分法作为危重新生儿转运的指征。方法：对1998年3月-1999年12月由我院出车转运回NICU的177例患儿,按新生儿危重病例评分法进行评分,按分值高低顺序将患儿分-100分、-90分、-80分及-69分四组,分析评分分值与新生儿转归、多器官功能不全及其损害程度的关系。结果：转运病例中主要疾病顺序为新生儿肺炎、早产儿、HIE、复杂型先天性心脏病、RDS：危重度评分分值越低,发生损害的器官数量越多、病死率越高;各系统器官损害中以神经系统损害发生率最高,其后为呼吸系统、泌尿系统、心血管系统及消化系统。结论：新生儿危重病例评分法能反映新生儿病情危重度,完全适用于基层医院作为危重新生儿转运指征,建议评分＜90分者即宜转运,若元条件开展评分者,则草案中的单项指标亦可作为转运指征。     

新生儿危重病例评分在NICU的应用分析

目的　评估新生儿危重病例评分法 (草案 )在新生儿重症监护病房 (NICU)中的应用价值。方法　对广州市儿童医院从 1998年 3月至 1999年 12月出车接回在NICU治疗的 177例新生儿按新生儿危重病例评分法进行评分 ,记录并分析有关设备利用、抗生素使用及器官损害等情况。结果　 177例新生儿危重病例评分为 <70分组 6例 (3 39% ) ,～ 80分组 2 8例 (15 82 % ) ,～ 90分组 89例 (5 0 2 8% ) ,>90分组 5 4例 (30 5 1% ) ;各组间病死率均有显著性差异 (P <0 0 5 ) ,评分与出生体重之间无明显差异 ,但≤ 15 0 0 g者病死率明显高于 >15 0 0g者(P <0 0 5 )。单项指标符合危重病例者 37例 ,单项指标或评分法评定属于危重病例的组间病死率的差异无显著性 (P >0 0 5 )。机械通气、多种抗生素的应用以及多器官功能损害发生率在评分 >90分组与～ 90分组差异有显著性 (P <0 0 1) ,但～ 80分组与～ 90分组间无明显差异。结论　危重评分能估计病情的程度 ,分值的划分是恰当的。通过评分 ,将分值低于 90分作为转入NICU加强监护、治疗以及基层医院危重新生儿转运的指标。     

新生儿危重病例评分在新生儿转运稳定性评价中的应用

目的通过应用新生儿危重病例评分评价新生儿转运的稳定性,指导转运工作,探讨安全转运的方法。方法对2002年11月至2005年10月由我院出车转回至NICU并具备完整危重病例评分资料的110例患儿,按新生儿危重病例评分法于转运前、后两次评分,分析转运稳定性及其与预后的关系。结果非危重组稳定性好,再评分值增加,(P<0.05);极危重组相对稳定,两次评分无显著性差异,(P>0.05);危重组稳定性差,再评分值下降,(P<0.05)。转运稳定性差直接影响了患儿预后。结论基层医院运用新生儿危重病例评分法不仅可作为危重新生儿的转运指征,更有助于上级医院通过评价转运稳定性指导转运工作,使新生儿转运的各个环节更加科学完善,进入良性循环。     

危重新生儿评分在新生儿双程转运中的应用分析

目的　探索新生儿安全转运的方法及新生儿危重病例评分法在新生儿转运中的应用价值。方法　对近两年由重庆医科大学儿童医院双程转运回院的 14 7例新生儿 ,按新生儿危重病例评分方法进行评分 ,分为≥ 90分、80～ 89分、70～ 79分和 <70分四组 ,分析危重儿评分与预后的关系。结果　 (1)全部病例均安全转运回NICU。(2 )非危重儿 (≥ 90分 )占 19 0 % (2 8例 ) ,危重儿 (70～ 89分 )占 72 1% (10 6例 ) ,极危重儿 (<70分 )占 8 8% (13例 )。 (3)围生儿占 95 9% (14 1例 )。 (4)转运前低体温 (T <35℃ )占 2 5 9% (38/14 7) ,入院时血pH值 <7 35占82 4 % (112 /136 ) ,血糖异常者占 4 0 1% (5 5 /137)。结论　合理保暖、维持体内环境稳定、保持呼吸道通畅、吸氧等措施在安全转运中显得极其重要 ,是成功转运的关键之一。新生儿危重病例评分法能反映转运新生儿病情危重程度 ,可以作为新生儿转运的指征。     

新生儿疾病危重度评分系统的临床应用

目的　评估新生儿疾病危重度评分系统的准确性。方法　应用该评分系统对 1992～ 1996年间在NICU住院的 767例新生儿进行评分。所有病例均在入院 2 4h内根据 10项测量、总分 10 0分的评分方法做第一次评分后 :①病情无加重者隔天评分 ;②病情加重时即予评分 ,至病情稳定后按①执行 ;③病情加重并继续恶化者 ,每天评分至死亡为止。全部病例按不同分值 ,划分为非危重组 (>90分 )、危重组 (70～ 90分 )及极危重组 (<70分 )。另对符合“危重病例单项指标”者亦将指标与分值进行比较。结果　非危重组无一例死亡 ,危重、极危重组中 ,分值越低其病死率越高 ,各组间病死率均有显著差异。 10项测量中 ,虽只做 9项测量 ,亦能将 81 5 8%的危重病例和 87 94%的死亡病例检出 ,若只做 8项测量 ,则只能将 40 71%的危重病例及 5 7 79%的死亡病例检出。10项测量项目中心率、血压、pH、红细胞压积比 (φRBC)、胃肠道损害在 4、6、10分值间病死率均有显著差异。符合“危重病例单项指标”的 2 69例中 ,91 45 %评分均属危重。结论　评分系统能把所有危重病例包括在内 ,非危重组无一例死亡 ,说明评分系统准确 ;如条件所限 ,10个测量项目中只做 9项 ,亦可把绝大多数危重病例检出 ;危重病例单项指标亦能反映疾病危重度。建议条件     

桂(东)北地区危重新生儿转运系统的探索与实践(附265例临床分析)

目的本着资源共享,努力降低基层医院危重新生儿的病死率及伤残率,探索危重新生儿转运过程中的注意事项以达到安全转运的目的。方法以本院新生儿科NICU为中心,与桂林市及周边16个市县等地的37家医院组成转运网络,建立桂(东)北地区危重新生儿转运系统。对近4年转运回院的265例新生儿按新生儿危重病例评分方法进行评分,分析评分和预后的关系。结果265例患儿全部转运成功。不同分值的病死率有显著性差异。使用良好的专业设备配置成移动的NICU,使转运半径可达到250 km。结论评分法能评估患儿能否安全转运,可较好地判断预后,转运系统的建立和运转提高了本地区危重新生儿诊疗的整体水平。     

新生儿危重评分在NICU的应用

中华急诊医学会儿科学组与中华医学会急救学组制订了新生儿危重病例评分草案 (简称草案 ) ,现将我们采用此草案对我院需出车接回ＮＩＣＵ治疗的病例试行评分法的结果报道如下。对象与方法一、对象　 1998年 3月～ 1999年 12月由我院ＮＩＣＵ出车接回ＮＩＣＵ治疗者共 177例 ,男 14 3例 ,女 34例 ,年龄 1ｈ～ 2 8ｄ ,体重 0 .75～ 4ｋｇ。患儿主要疾病　见表 1。二、方法　患儿入ＮＩＣＵｄ1、ｄ3、ｄ7、出院前按新生儿危重病例评分法 (草案 ) [1] 作危重度评分 ,同时准确详细记录有关设备利用、抗生素使用 ,以及有否单或多器官功能损害等住院情况 ,器官损害标准参考评分草案并予以补充。统计资料采用ｔ检验 ,卡方检验进行分析。表 1　患儿主要疾病顺位表 (第一诊断 )疾病名称ｎ死亡ｎ (% )死亡率 (% )新生儿肺炎 62 9(1 4 .51 ) 36 .0早产低出生体重或极低出生体重 35 1 (2 .0 5) 4 .0新生儿缺氧缺血性脑病 2 0 3(1 5 .0 0 ) 1 2 .0复杂型先天性心脏病 1 93(1 5 .78) 1 2 .0新生儿肺透明膜病 1 6 4(2 5...     

室息新生儿器官功能损害的临床研究

目的　了解窒息新生儿器官功能损害的发生率及程度 ,探讨与之有关的高危因素 ,为降低窒息患儿病死率寻求新途径。方法　将 2 2 2例窒息患儿分为轻度窒息、重度窒息组进行研究。并将主要器官的功能损害分为轻度与重度加以分析。结果　窒息后器官损害发生率达 90 .1% ,多器官损害发生率为 71.6 %。重度窒息组器官受损率明显高于轻度窒息组 (P <0 .0 5 )。而各器官损害均以轻度为主。重度窒息 5minApgar评分≤ 6分、入院时即刻血气分析 pH≤ 7.2 0、入院晚及需用机械通气治疗患儿多器官损害发生率均明显高于对照组 (P均 <0 .0 5 )。结论　器官损害的发生与窒息程度、复苏效果及接受治疗的早晚有关 ;提示加强围生期母子保健、提高医护人员复苏水平、及时转运危重患儿及采取合理有效的综合治疗等措施均有利于降低窒息新生儿的器官损害发生率及病死率。     

新生儿肠穿孔危重评分及预后分析

目的对新生儿肠穿孔进行危重评分与预后分析,探讨新生儿肠穿孔危重评分与预后的关系。方法对我院1999年～2007年治疗的90例新生儿肠穿孔进行回顾性分析,采用7分制评分系统对术前患儿病情进行危重评分,并结合预后进行分析。结果危重评分值高的患儿病死率较高;早产儿病情重,危重评分值高,病死率高,预后较差;出生体重、手术方式及肠穿孔部位对预后影响不大。结论出生时是否足月、合并感染及内环境是否稳定是影响预后的重要因素。     

新生儿疾病危重评分与美国新生儿紧急生理学评分的比较

目的　 比较新生儿疾病危重评分法和美国新生儿紧急生理学评分 (SNAP)的优越性 ,探讨更适合我国NICU应用的评分方法。 方法 　对我院NICU39例病危新生儿分别用两套评分系统进行评分 ,将结果进行对比分析。 结果 　新生儿危重病例评分结果显示 ,非危重组无一例病情转重或死亡 ,危重组病死率为 30 4 7%,极危重组病死率为 10 0 %。随分值下降 ,具备单项指标的病例增多 ,各组间差异经卡方检验有显著性意义。SNAP结果显示 ,≤ 10分组无一例病情加重或死亡 ,10～ 2 0分组病死率为 2 7 78%,≥ 2 0分组病死率为 85 71%,随分值增加 ,具备单项指标的病例增多 ,各组间差异均有显著性意义。两套评分方法高度相关 ,r=-0 86 16 ,P <0 0 1。 结论 　新生儿危重病例评分及SNAP对危重病例的检出率均可达 10 0 %,但前者仅有 10个项目 ,更为简便经济 ,更符合我国国情。单项指标与两套评分方法均平行 ,可作为一个可靠的分辨危重病病例的方法在基层医院推广。     

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.     

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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.     

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   

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.     

Overcoming surfactant inhibition with polymers

Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium-derived free fatty acids). Recent data suggest that addition of non-ionic polymers such as dextran and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near-complete restoration of surfactant function. The anti-inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.     

Understanding infant formula

The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and healthcare professionals) will experiment with the infant formula available and then attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.