儿童一过性意识丧失的基础疾病分析

目的 通过多中心、大样本的临床研究,分析儿童一过性意识丧失(transient loss of consciousness,TLOC)的基础疾病谱.方法 研究对象为1999年8月至2011年4月在北京、湖南、湖北、上海四地晕厥专科门诊就诊或住院的937例TLOC患儿,对其进行病因学分析.结果 937例TLOC患儿中,903例(96.4％)为晕厥患儿,34例(3.6％)为非晕厥患儿.903例晕厥患儿中,213例(23.6％)为血管抑制型血管迷走性晕厥(vasovagal syncope,VVS),46例(5.1％)为心脏抑制型VVS,112例(12.4％)为混合型VVS,268例(29.7％)为体位性心动过速综合征,22例(2.4％)为直立性低血压,19例(2.1％)为境遇性晕厥,21例(2.3％)为心源性晕厥,202例(22.4％)患儿为不明原因晕厥.结论 晕厥是儿童TLOC最常见的原因.在晕厥患儿中,VVS最常见,其次为体位性心动过速综合征.在VVS的3种不同血流动力学类型中,最常见的类型为血管抑制型VVS.     

北京市儿童医院10年儿童脑卒中疾病谱回顾性分析

目的 回顾性分析脑卒中患儿的疾病谱病因学及危险因素分布特征。方法 采用回顾性病历调查方法，总结分析1996年1月至2006年6月首都医科大学附属北京儿童医院251例脑卒中患儿的临床资料。结果 脑卒中患儿发病平均年龄为（3.0±3.8）岁；男性156例，女性95例。动脉缺血性脑卒中（AIS）占62.5%（157/251），出血性脑卒中（HS）占37.5%（94/251）。两者均无明显季节分布差异，但郊区（县）发病较城区更为严重。特发性脑卒中（IS）51例（32.5%，51/157）居于AIS病例各亚类首位。已明确病因的AIS病例中以感染（12.1％，19/157）、烟雾病（12.1％，19/157）、头部外伤（10.8％，17/157）和营养性缺铁性贫血（7.6％，12/157）最常见。惊厥（20.4%，25/157）和言语困难（15.9%，25/157）则是IS患儿较常见症状。颅内出血发生部位主要为大脑内（41.5%，39/94）和蛛网膜下隙（13.8%，13/94）。维生素K缺乏（76.6%，72/94）则是导致小婴儿颅内出血的重要诱发因素。 .结论 IS是儿童AIS的最常见类型；维生素K缺乏仍是我国引起小婴儿颅内出血的最常见诱发因素。     

儿童EB病毒感染首发症状及相关疾病谱分析

目的 详细了解儿童EBV感染的首发症状及疾病诊断情况,以提高临床诊断水平,并探讨EBV感染临床多样性的机制。方法 对本院经酶联免疫吸附法(ELISA)测定EBV-VCA-IgM阳性的190例EBV感染患儿的首发症状、疾病诊断及预后进行前瞻回顾性分析。结果 EBV感染患儿起病症状不一,首发症状中以发热多见(66．8％),其他依次为咳嗽(14．2％)、皮疹(7．9％)、淋巴结肿大(5．3％)、眼睑浮肿(3．2％)、咽痛(1．6％)、惊厥(1．6％)、肉眼血尿(0．5％)等。可累及全身各个系统,引起疾病多样,但以呼吸道感染最多见(4|D．5％),其次为传染性单核细胞增多症(17．9％)、川崎病(6．3％)、特发性血小板减少性紫癜(11‘P)(5．8％)、病毒性心肌炎(2．6％)、病毒性脑炎(2．6％)、噬血细胞综合征(1．6％)、类风湿性关节炎(1．0％)、急性淋巴结炎(1．0％)、面神经炎(1．0％)、Evans综合征(0．5％)、系统性红斑狼疮(SLE)(0．5％),亚急性坏死性淋巴结炎(0．5％)等。EBV感染预后不一,1例病人因患噬血细胞综合征而死亡。结论 儿童EBV感染症状多样,累及系统多,临床医生应该综合分析,及早作相应的检查才能作出正确诊断及减少误诊率,并进行合理治疗。     

2010~2014年湖南某三甲医院住院儿童疾病谱及死因分析

目的 了解湖南某三甲医院住院儿童的疾病构成及死因,为儿童疾病的预防、治疗等提供参考依据。方法 对湖南某三甲医院2010~2014年住院儿童的病历资料进行回顾性分析。结果 2010~2014年5年间,该院住院儿童人数由2010年的7 303例增长至2014年的10 902例,病死率则由0.33%下降至0.20%(P结论 该院住院儿童人数不断增长,病死率呈下降趋势;不同年龄段患儿病死率不同。肿瘤、癫癎、肺炎和先天性心脏病是儿童住院的主要病种,先天畸形为首要死因。     

儿童间质性肺疾病疾病谱探讨和诊断方法评估

为探讨引起儿童间质性肺疾病(ILD)的疾病谱及评估程序性诊断评估模式在临床的应用价值，对49例长期咳嗽和／或胸部X线有间质性病变的住院病儿，按询问病史、体格检查、非侵入性实验室检查、侵入性检查的程序评估模式进行诊断，其中明确诊断37例，疑似诊断7例，诊断不明5例。结果显示感染是引起儿童ILD的主要原因；HRCT对诊断ILD有很高的价值。表明程序性的诊断评估步骤能较全面、系统地指导临床医师进行正确诊断，同时也减少了不必要的检查对患者的负担。     

儿童髋关节一过性滑膜炎发病时间特征及与气候因素的相关性

目的探讨儿童髋关节一过性滑膜炎(TSH)发病的时间特征,及其发病情况与气候因素之间的联系。方法选取2008年至2012年收治的1 401例TSH患儿的临床资料,收集同期的月平均气温、月平均气压、月平均湿度、月平均风速、月日照总时数和月总降水量等气象资料,采用卡方-拟合优度检验分析TSH发病的时间特征,运用相关分析和逐步线性回归方法探讨TSH发病与各气象因素的关系。结果 TSH发病以春夏季为主(P0.001),3月份是发病高峰(P0.001),10月份发病数最少(P0.001)。TSH的月发病数与月平均湿度呈负相关(r=-0.466,P0.001),与月平均风速、月日照总时数呈正相关(r=0.286、0.262,P均0.05);逐步回归分析中只有月平均湿度对进入回归模型(β=-0.470,P0.001)。结论 TSH的发病具有明显的时间周期性,在低湿度的气象条件下更容易发生。     

2005~2012年中国医科大学附属盛京医院PICU疾病谱分析

目的：总结中国医科大学附属盛京医院PICU 2005~2012年间收治患儿的疾病谱及导致死亡的常见疾病种类,以指导PICU的临床治疗工作。方法：回顾性分析2005~2012年间该院PICU收治的4484例患儿的临床资料。结果：2005~2012年间4484例患儿中,急性支气管肺炎居疾病谱中第1位,占24.51%(1099/4484);颅内感染、脓毒症、手足口病、外伤等疾病有逐年上升趋势,而非创伤性颅内出血、癫癎、先天性心脏病等疾病呈下降趋势。2005~2012年间病死率呈逐年下降趋势,由2005年的11.5%下降到2012年的3.1%,其中2005~2008年与2009~2012年前后4年病死率比较差异有统计学意义（11.98% vs 4.41%;P<0.01）。急性重症支气管肺炎、重度脓毒症、复杂性先天性心脏病、重度颅脑外伤、呼吸衰竭、重症手足口病、急性中毒、循环衰竭等为患儿主要死因。结论：急性支气管肺炎等感染性疾病是2005~2012年间该院PICU的主要病种,但疾病谱随着时间的变化发生了一些改变。2005~2012年间患儿病死率呈逐年下降趋势,急性重症支气管肺炎、重度脓毒症等为患儿主要死因。     

儿童青少年晕厥疾病谱近30年变化及卫生经济学分析单中心报告

目的 了解晕厥患儿基础疾病谱, 评价晕厥诊断程序在临床上应用的意义及卫生经济学价值。方法 选取1985年1月至2014年12月在北京大学第一医院儿科收治的晕厥患儿935例,男421 例（45%）,女 514例（55%）; 年龄1～18岁, 平均（11.2±3.1）岁。分析儿童晕厥的基础疾病谱及晕厥诊断程序的卫生经济学价值。结果 1985-1994年, 神经介导性晕厥（NMS）占6.7%, 89.3%晕厥患儿基础疾病未明;1995-2004年, NMS占62%, 其中主要包括血管迷走性晕厥（VVS）和体位性心动过速综合征（POTS）, 不明原因晕厥患儿发生率下降至28.3%; 2005-2014年, NMS成为晕厥患儿的主要基础疾病,占80.7%, 主要包括VVS及POTS等, 心源性晕厥为5.4%, 不明原因晕厥为13.9%。晕厥患儿平均住院日较2009年前显著缩短（P＜0.001）, 晕厥患儿基础疾病诊断费用降低（P＝0.048）, 住院总花费亦显著降低（P＜0.001）。结论 随着对儿童晕厥基础疾病的发现, 儿童晕厥的基础疾病确诊率不断提高。构成儿童晕厥的基础疾病为VVS及POTS。儿童晕厥诊断程序具有良好的卫生经济学价值。     

新型冠状病毒肺炎疫情前后2年儿童重症监护病房疾病谱的变化

目的 对比新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)疫情暴发前后2年内儿童重症监护病房(pediatric intensive care units,PICU)住院患儿疾病谱的变化。方法 收集济宁医学院附属医院PICU2018年1月至2019年12月(COVID-19疫情前组)和2020年1月至2021年12月(COVID-19疫情后组)所有住院患儿的疾病诊断相关信息,对2组患儿的疾病谱进行统计学分析。结果 COVID-19疫情前组纳入2 368例患儿,COVID-19疫情后组纳入1 653例患儿。COVID-19疫情后组住院人数较COVID-19疫情前组减少了30.19%。COVID-19疫情前后2组年龄构成差异有统计学意义(P<0.05)。COVID-19疫情前组病例数居前10位的疾病依次为:呼吸系统疾病、神经系统疾病、脓毒症、危重症、循环系统疾病、神经外科重症、消化系统疾病、意外伤害、内分泌系统疾病、肿瘤。COVID-19疫情后组病例数居前10位的疾病依次为:呼吸系统疾病、神经系统疾病、脓毒症、循环系统疾病、意外伤害、内分泌系统疾...     

1994～2001年我院儿科住院患儿疾病谱及死亡原因分析

目的：了解儿科疾病谱及死亡疾病的年代变化趋势,为今后儿童疾病的医疗和预防保健工作提供科学依据。方法：回顾性研究及卡方检验。结果：该资料表明从1994～2001年前后4年病死率比较差异有非常显著性意义(P<0.01),病死率下降了3.2%;支气管肺炎居疾病谱中第1位,占儿科住院总人数的12.3%,占死亡疾病的 9.8%。上呼吸道感染、支原体肺炎、原发性血小板减少性紫癜、癫痫有逐年上升趋势。结论：支气管肺炎、上呼吸道感染、病毒性脑炎、支原体肺炎、原发性血小板减少性紫癜、哮喘、癫痫、过敏性紫癜、肾病综合征、毛细支气管炎为近4年来儿科疾病谱中主要疾病。支气管肺炎、急性淋巴细胞性白血病、先天性心脏病、病毒性脑炎、败血症为主要死因,临床医生应了解儿科疾病谱的变化规律,更好地指导临床治疗。     

Approach to the pre-school child with sudden loss of consciousness

There are several causes for sudden loss of consciousness in pre-school children. These include Transient Loss of Consciousness (T-LOC), which encompasses a group of disorders with the following characteristics: abnormal motor control, loss of responsiveness, amnesia for the period of unconsciousness, and a short duration. There are three main categories of T-LOC in pre-school children: syncope, resulting from a sudden and reversible lack of oxygenated blood supplied to the brain, often caused by transient impairment of cardiac output or systemic arterial hypotension. Secondly, epileptic seizures due to excessive and hypersynchronous cortico-neuronal electrical activity in the brain, and thirdly, “unexplained T-LOC,” which includes cases not yet diagnosed fully, and those for which a pathophysiological mechanism has not yet been identified, despite thorough investigations. Reflex Anoxic Seizures (RAS) are important in the differential diagnosis of non-epileptic paroxysmal events in infants and pre-school children. Parents and carers who witness these episodes are understandably anxious, and the mainstay of management is ensuring that the correct diagnosis is made, reassurance is given, and both the patient and parents are educated about the condition. Diagnosis can be made based off a detailed history, including an eyewitness account of the episode, as well as clinical examinations. This review aims to describe an approach to the diagnosis and management of T-LOC in pre-school children.     

Hearing loss in children with osteogenesis imperfecta

Osteogenesis imperfecta (OI) is a genetic disorder of connective tissue. Progressive hearing loss is one of the principal symptoms of OI, affecting about 50% of adult patients. Hearing loss may also occur in childhood and results in additional disability in education and psychosocial adaptation and aggravates the physical handicap. This can be avoided by appropriate otological and audiological treatment. In a nationwide search, 254 Finnish patients with OI were identified indicating a prevalence of 4.9/100 000. Of the 60 children, 45 aged between 4 and 16 years accepting to participate the study on hearing, were evaluated by a questionnaire and clinical audiometry. Hearing loss was defined as pure tone average (PTA_{0.5–2 kHz}) more than 20 dB hearing level (HL). A clinical geneticist determined the type of OI among the 45 patients. Two sporadic OI cases with conductive hearing loss were ascertained (4.4%): An 11-year-old girl with type IV OI with a PTA_{0.5–2 kHz} of 35/40 dB HL and a 15-year-old boy with type IV OI with a PTA_{0.5–2 kHz} of 27/18 dB HL. In addition, a 6-year-old girl with familial OI type I had either a congenital sensorineural deafness or early progressive deafness with PTA_{0.5–2 kHz} of 97/103 dB HL, probably of unrelated aetiology. Conclusion Hearing loss in children with osteogenesis imperfecta is less frequent than generally suspected. Nevertheless, it is recommended that audiometry is performed in children with osteogenesis imperfecta even without symptoms of hearing loss at the age of 10 years, and repeated every 3 years thereafter. Received: 13 October 1999 and in revised forms: 20 December 1999, 13 January 2000 and 24 January 2000 / Accepted: 25 January 2000     

Primary preventive health care in children with heart disease

Summary In order to evaluate the preventive health care practices in children with heart disease, 499 families were surveyed in outpatient settings. Data were collected on 215 children with heart disease and 284 control children without known chronic illness. There was no significant difference between the groups in the type of primary physician utilized or frequency of visits to the primary care physician. Immunizations were incomplete in 32.7% of the children with heart disease compared to only 2.5% in the control group (P<0.0001). Among the children over 3 years of age with heart disease, 29% had not received routine dental care within the past year compared with 23.4% in the controls (P=NS). The parents of children with heart disease were found to pay less money out-of-pocket for their child's health care than the parents of control children (P<0.0001). The data suggest that important aspects of primary health care were neglected in a large group of children with heart disease and that cost was not a major cause for the inadequate preventive care delivery. An educational program directed at health care professionals and parents is proposed.     

住院新生儿1 434例分析

目的：了解我院2005年产科出生新生儿的出生状况和新生儿科住院病人的疾病谱。方法：对我院2005年1月至12月期间出生或住院的1 434例新生儿的流行病学资料进行回顾性分析,并与同期全国资料作比较。结果：①该时期在我院产科出生的新生儿共1 100例,早产儿比率为2.3％;剖宫产比率为54.2%,高于全国资料（49.2%,P<0.01）;新生儿死亡率为0.2％;早产儿的母亲中产前出血、先兆流产及孕期感染的发生率明显高于分娩足月儿的母亲。②该时期在我院儿科住院新生儿共有334例,早产儿占38.0%。与全国资料比较,住院新生儿中早产儿、窒息、呼吸窘迫综合征（RDS）、败血症、颅内出血等疾病的比例明显高于全国资料。住院新生儿病死率为 0.9％。结论：①我院过高的剖宫产率有待于控制;②做好孕期保健和胎儿监测工作,减少早产儿、RDS、败血症和颅内出血的发生率有助于进一步降低我院新生儿死亡率。［中国当代儿科杂志,2009,11（9）：736-739］     

Magnetic resonance imaging of the small bowel in children with idiopathic inflammatory bowel disease: evaluation of disease activity

Background  Examinations using ionizing radiation are frequently used in the evaluation of disease activity in children affected by idiopathic inflammatory bowel disease (IBD). Objective  To develop an MR imaging protocol without the need for fluoroscopic insertion of an enteral tube and to assess the disease activity in children with IBD. Materials and methods  Included in the study were 37 children (22 girls and 15 boys; age range 7–15 years, mean 11.67 years) with IBD who underwent MR imaging of the small bowel. Of these 37 children, 32 had Crohn disease and 5 had indeterminate colitis. A water solution containing herbal fibres was administered orally or through a nasogastric tube. Patients were imaged on a 1.5-T MR scanner with T1-weighted and Τ2-weighted sequences followed by a dynamic study using 3-D T1-W images after intravenous administration of gadolinium. Results  The percentage enhancement of the bowel wall was significantly increased in patients with abnormal C-reactive protein (CRP) values compared to patients with CRP values in the normal range (P<0.001). A relatively weak but significant correlation between percentage enhancement of the bowel wall and CRP values was noted during all phases of enhancement. Conclusion  This MR imaging protocol is a safe and well-tolerated method for evaluating disease activity and extraintestinal manifestations of IBD in children.     

The relationship between language development and behaviour problems in children with hearing loss

Background:  There are well-replicated findings that link poor development on a range of communication skills with increased behavioural problems. This paper examines this relationship in children with hearing loss.
Method:  One hundred and twenty children with hearing loss (67 boys, 53 girls) and 63 hearing children (37 boys, 26 girls) with a mean age of 8 years from eight districts in Southern England were assessed for receptive and expressive language skills. The relationships between these measures and an aggregate of parent- and teacher-reported behaviour problems in the children were investigated.
Results:  Children with hearing loss had higher levels of behaviour problems compared to hearing children. Once the language abilities of children with hearing loss are taken into account, the negative effects of hearing loss on behaviour disappear.
Conclusions:  Behaviour problems are found more commonly in children with hearing loss and the level of behaviour problems is highest amongst those children with hearing loss with the least developed language capabilities.     

褪黑素治疗孤独症谱系障碍儿童睡眠障碍有效性的荟萃分析

目的 探讨褪黑素治疗孤独症谱系障碍(autism spectrum disorder,ASD)儿童睡眠障碍的有效性.方法 采用计算机检索与ASD睡眠障碍和褪黑素相关的文献,检索时间从建库起至2018年10月31日.纳入标准:随机对照试验(randomized controlled trials,RCT);研究对象为AS...