纤维支气管镜在小儿难治性肺炎诊治中的价值

目的评价纤维支气管镜和支气管肺泡灌洗术在小儿难治性肺炎诊治中的作用。方法对常规抗感染治疗超过2周仍无效的54例难治性肺炎患儿进行纤维支气管镜检查,对其中41例进行支气管肺泡灌洗,灌洗液作细胞学检查和细菌定量培养。结果镜检结果示单纯炎症病变27例(50%),异物吸入12例(22%),支气管肺发育异常5例(9%),肺部出血性疾病4例(7%),气管支气管软化3例(6%),支气管内膜结核2例(4%),Kartagener综合征1例(2%)。难治性肺炎患儿中3岁以内婴幼儿多见,为38例(70%)。41例行支气管肺泡灌洗者的灌洗液细胞数中位数515×109/L[(55～3900)×109/L];中性粒细胞比例中位数63%(0～98%),其中27例(66%)>25%。27例单纯炎症与14例伴其他病变(异物、支气管肺发育异常和出血性病变)患儿灌洗液的细胞数和中性粒细胞比例差异无统计学意义。灌洗液致病菌培养阳性者中性粒细胞比例高于寄生菌阳性者(P<0.05)。细菌培养阳性15例(37%),定量培养菌落≥104cfu/ml9株(≥105cfu/ml仅1株)。吞噬细菌中性粒细胞阳性2例。3例经纤支镜行支气管黏膜活检,其中支气管内膜结核2例,Kartagener综合征1例。结论纤支镜检查和支气管肺泡灌洗术是小儿难治性呼吸系统疾病诊断的一种非常有效的措施。镜检、灌洗液细胞学检查、细菌定量培养以及活检病理检查相结合可提高诊断的正确性。在小儿难治性肺炎中,灌洗液培养以细菌生长≥104cfu/ml为界,作为致病菌,而呼吸机相关肺炎(VAP)时,≥103cfu/ml也应考虑为致病菌。     

纤维支气管镜术在反复喘息性疾病诊断及治疗中的应用

目的 探讨纤维支气管镜(纤支镜)术对小儿反复喘息性疾病的诊断及治疗价值.方法 收集本院2006年4月-2011年4月因反复喘息住院并应用纤支镜诊疗的72例患儿的临床资料.病例均在局部表面麻醉下行纤支镜术,通过镜下直视、支气管内膜刷检、支气管肺泡灌洗液病原学检查进一步明确病因,行支气管肺泡灌洗及注药等局部治疗,并评判其疗效和并发症发生情况.结果 72例反复喘息患儿镜下表现:支气管内膜炎改变45例(62.5％),支气管异物11例(15.3％),支气管软化10例(13.9％),支气管狭窄4例(5.6％),支气管内膜结核2例(2.8％).45例患儿支气管肺泡灌洗液病原学检查阳性5例(11.1％),其中肺炎克雷伯杆菌1例,肺炎支原体和支气管内膜结核各2例.镜下炎症改变重、分泌物黏稠、痰栓阻塞患儿经纤支镜支气管冲洗,咳喘明显减轻,取得较好疗效.11例支气管异物经纤支镜成功取出9例.12例行纤支镜术的患儿出现术中或术后轻微一过性并发症,经相应对症处理后均消失.结论 小儿反复喘息的病因以炎症、先天性发育异常及呼吸道异物多见,婴幼儿反复喘息应警惕心肺发育异常及呼吸道异物.纤支镜检查对儿童反复喘息的病因诊断具有重要价值.     

纤维支气管镜术在小儿慢性咳嗽诊断及治疗中的价值

目的 探讨纤维支气管镜(纤支镜)术在小儿慢性咳嗽诊断及治疗中的价值.方法 对2006年8月-2011年3月在本院应用纤支镜进行检查和(或)治疗的61例慢性咳嗽患儿的临床资料进行回顾性分析.病例均采用局部麻醉的方法,而且患儿均经临床程序排除咳嗽变异性哮喘和胃食管反流.通过镜下直视、支气管刷检及肺泡灌洗液,明确病因诊断;应用支气管肺泡灌洗、局部注药和钳取异物进行治疗,并对疗效做出评价.结果 61例患儿中男36例,女25例;年龄8个月～13岁.61例患儿镜下炎性改变21例(34.5％),先天性心肺发育畸形12例(19.7％),支气管异物10例(16.4％),上呼吸道咳嗽综合征8例(13.1％),支气管内膜结核7例(11.5％),未见异常3例(4.9％).气管黏膜刷检涂片找到革兰阳性细菌和(或)革兰阴性细菌12例(12/31例,38.7％),肺泡灌洗液细菌培养阳性5例(5/40例,12.5％),未找到抗酸杆菌和癌细胞.对镜下炎性改变重、有痰栓阻塞者经纤支镜行支气管灌洗治疗,取得较好疗效.10例支气管异物经纤支镜成功取出8例.结论 小儿慢性咳嗽经纤支镜检查发现以炎症及支呼吸管异物多见,婴幼儿期慢性咳嗽应警惕心肺发育异常及呼吸道异物.纤支镜检查对儿童慢性咳嗽的病因诊断与治疗具有重要价值,尤其对先天性心肺发育畸形及支气管细小异物的诊断有独特价值.     

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目的探讨纤维支气管镜(纤支镜)术在小儿呼吸道疾病诊治中的价值和安全性。方法回顾性分析贵阳儿童医院呼吸科2004年8月至2011年3月期间,对病因不明或疗效不佳肺不张、反复喘息和慢性咳嗽及咯血等小儿呼吸系统疾病567例,应用纤支镜进行检查及治疗,通过镜下直视、支气管肺泡灌洗、支气管黏膜刷检、组织活检明确病因,肺泡灌洗及注药进行局部治疗,并评判其疗效和并发症发生情况。结果 567例患儿共进行纤支镜诊治术593例次,镜下表现最多的为支气管内膜炎,其次为气管-支气管异物和先天性支气管-肺-血管发育畸形。引起197例肺不张患儿的病因主要为气道炎症或肿胀阻塞115例(58.4%),其次为气道异物73例(37.1%)及支气管内膜结核和(或)干酪样改变3例(1.5%)。115例炎性肺不张经过支气管肺泡灌洗治疗2周79例(68.7%)肺大部分或全部复张,1月105例(91.3%)肺大部分或全部复张。在164例反复喘息/慢性咳嗽病例中气道炎症及黏液栓形成73例(44.5%),其次支气管异物34例(20.7%),先天性心肺发育畸形25例(15.2%)及支气管内膜结核7例(4.4%)。119例发现支气管异物,其中98例(82.4%)用纤支镜取出。气管黏膜刷检涂片找到革兰阳性和(或)阴性细菌127例(127/26448.1%),肺泡灌洗液细菌培养阳性59例(59/30219.5%)。593例次行纤支镜术的患儿中共有151例/次(25.5%)出现术中或术后并发症,均为一过性。大多并发症轻微、短暂。经相应对症处理后各不良反应均消失,无心跳、呼吸骤停及麻醉过敏等影响预后的严重并发症。结论纤支镜术是儿童肺部疾病鉴别诊断和治疗的重要手段之一,可为临床诊断及治疗提供可靠依据。虽然可有轻微并发症,但总体安全可靠。     

纤维支气管镜在儿童肺不张病因诊断及治疗中的应用价值

目的 探讨纤维支气管镜在儿童肺不张病因诊断及治疗中的应用价值.方法 回顾分析经一般治疗无效而行纤维支气管镜检查的110例肺不张患儿的临床资料.结果 110例中以异物最多,共45例,占40.9%;其次为炎症40例,占36.4%;结核15例,占13.6%居第三位.异物多见于1～3岁的幼儿,结核、哮喘、支扩多见于较大儿童.40例炎性肺不张支气管肺泡灌洗液及刷检涂片病原学检查阳性16例,阳性率为40.0%,炎性肺不张经支气管肺泡灌洗治疗,2周复张率79.6%;45例异物所致肺不张经纤支镜取出异物18例.结论 小儿肺不张的病因以异物、炎症、结核最多见,纤维支气管镜检查不仅能最大限度地有助明确病因,而且在肺不张的治疗中有重要作用.     

纤维支气管镜术在儿童肺炎支原体肺炎诊治中的应用

目的探讨纤维支气管镜术(纤支镜)在儿童肺炎支原体肺炎(MPP)中的应用价值。方法回顾性分析204例行纤支镜术的MPP患儿的临床资料。结果 204例患儿中共进行了286例次纤支镜术。血清MP-IgM抗体阳性患儿121例(59.3%)支气管肺泡灌洗液(BALF)中FQ-MP-DNA阳性,BALF细菌培养阳性菌株25株(12.3%)。纤支镜镜下所见病变部位黏膜充血水肿,支气管开口痰堵54例(26.5%),形成痰栓29例(14.2%),炎性狭窄21例(10.3%),小结节样突起13例(6.4%);20例支气管黏膜组织电镜检查纤毛超微结构均有不同程度的纤毛柱状上皮损害。全部病例均进行肺泡灌洗治疗,合并肺不张的109例患儿经1～4次灌洗治疗,1个月后复查106例(97.2%)完全或部分复张。结论对于难治性MPP、合并肺不张者,早期应用纤支镜进行支气管肺泡灌洗治疗,能促进肺复张,改善预后,减少后遗症的发生。     

纤维支气管镜在呼吸系统疾病的应用

目的　提高纤维支气管镜在儿科呼吸系统疾病的诊断和治疗水平。方法　对行纤维支气管镜 (纤支镜 )术 15 4例患儿的临床资料进行总结。结果　共进行 165例次纤支镜术 ,治疗 68例肺部感染、14例肺不张、10例吸入性肺炎 ;为 3 9例疑为支气管异物者明确诊断 ,取支气管异物 12例 ;对 2 3例反复咳喘的患儿检查 ,发现 7例支气管软化症 ,3例为支气管结构异常。结论　纤支镜术有助于儿科呼吸系统疾病的诊断和治疗。     

纤维支气管镜在呼吸系统疾病诊治中的应用

目的提高纤维支气管镜(纤支镜)肘小儿呼吸系统疾病的诊断和治疗水平,拓宽纤支镜在儿科的应用范围。方法对110例患儿行纤支镜检查,应用“边麻边进”利多卡因气管内黏膜表面局部麻醉方法行镜下诊断和治疗。对110例患儿进行肺泡灌洗及病原学和细胞学检查。结果直视下发现异常73例,其中异物42例,内膜炎症24例,肿物3例,气管狭窄2例,气管软化、鼻后滴漏各1例。支气管肺泡灌洗(BAL)92例次,BAL液病原学培养30例次,其中阳性4例次,灌洗液肺炎支原体(MP)抗体检查IgM阳性3例,灌洗液细胞学检查发现大量含铁血黄素细胞1例。成功钳取异物11例,对于内膜感染通过纤支镜直接到达病变部位冲洗,清理脓苔及肉芽,清除梗阻,局部注药治疗,取得良好疗效。结论纤支镜术有助于提高呼吸系统疾病的诊断及治疗水平。     

无痛性纤维支气管镜术在儿科难治性肺部疾病中的应用

目的 探讨无痛性纤维支气管镜(纤支镜)术在儿童难治性肺部疾病诊治中的应用.方法 回顾分析221例行纤维支气管镜术患儿的临床资料,全部病例均采用异丙酚静脉复合麻醉.结果 221例患儿共行241例次纤支镜术.75例反复或持续喘息的患儿中气管支气管软化、狭窄30例(40.O%),炎性渗出、黏液栓子堵塞26例(34.7%),气道发育畸形9例(12.0%).72例肺不张患儿中炎症49例(68.1%),气道异常23例(31.9%).经局部灌洗及用药,68例术后复查,1个月内部分或完全复张57例(83.8%),3个月内复张63例(92.7%).17例气道异物中经纤支镜取出11例,仅6例有明确异物吸入史(35.3%).结论 无痛性纤维支气管镜术在儿童难治性肺部疾病的诊断和治疗中发挥重要作用,值得临床推广.     

儿童气管支气管异物临床诊治探讨

目的探讨儿童气道不同部位异物的临床特征、诊治方法及应用硬气管镜、纤维支气管镜或开胸等治疗方法的最佳时机.方法回顾性总结首都医科大学附属儿童医院纤维支气管镜(纤支镜)室1990年12月至2003年12月间诊治的下气道异物临床资料;应用纤支镜对硬气管镜难以取出、又无开胸指征的气道异物进行治疗;追踪临床转归.结果经纤支镜诊断下气道异物192例,位于Ⅱ级以下支气管159例;年龄12d至14岁;病程4h至8年,3d内仅24例.食物性异物146例,小塑料制品异物22例,仅18例可通过X线检查确诊异物.临床特点45例无确切异物史,41例有反复呼吸道感染,5例因植物性及硬果壳类异物致咯血,滞留达7个月至3年.X线表现肺炎113例(58.9%),肺不张50例(26.0%),肺透光增强及支气管阻塞征各37例(19.3%),纵隔摆动或心影反常大小28例(14.6%),胸膜炎或胸腔积液12例(6.3%),异物远端支气管扩张7例(3.6%),25例(13.0%)X线正常.转归取出异物175例开胸14例(其中6例病肺叶、段切除);硬气管镜取异物47例56次(3例未取出);纤支镜取118例并灌洗吸入性肺炎14例,共380次.治愈149例,好转41例,2例未愈.结论支气管异物临床过程不同于气管异物,是慢性肺疾患的病因之一;纤支镜检查直观、操作灵巧,可以发现硬气管镜和X线检查所不能发现的支气管异物,在治疗上弥补硬气管镜和单纯药物治疗的不足,避免慢性肺疾患的发生和发展.     

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.