全身炎症反应综合征新生儿的凝血功能研究

目的　探讨全身炎症反应综合征 (SIRS)新生儿凝血功能的变化及其临床意义。方法　符合SIRS诊断标准的新生儿 12 6例 ,在入院后 2 4h内进行新生儿危重病例评分 ,并采血测定凝血酶原时间 (PT)、凝血酶时间 (TT)、部分活化凝血活酶时间 (APTT)、D 二聚体 (DD)含量和血小板 (PLT)计数。分别以SIRS符合项数及预后、疾病严重程度分组 ,观察其与凝血功能紊乱间的关系。结果　随着SIRS符合项数的增加 ,SIRS新生儿中危重病例所占百分比及病死率明显增高 ,PT、TT、APTT、DD也增高 ,具有明显的相关性。存活组与死亡组间PT、TT、APTT差异无显著性意义 (P >0 0 5 ) ,死亡组DD显著高于存活组 (P <0 0 1)。危重症组PT、TT、APTT、DD与非危重症组比较 ,差异均具显著性意义 (P<0 0 1)。结论　SIRS新生儿存在凝血机制的活化 ,符合SIRS诊断标准项数越多 ,病情越重 ,凝血功能紊乱越显著 ,病死率越高。     

全身炎症反应综合征患儿凝血功能改变及其临床意义的探讨

目的 研究全身炎症反应综合征(SIRS)患儿出凝血系统的功能改变和临床意义及其对预后的影响.方法 采用前瞻性病例对照设计,按照小儿/新生儿SIRS新定义将收住ICU的患儿分为SIRS组(24例)、非SIRS组(21例),另设正常对照组(28例).SIRS组按预后再分为死亡组(10例)和生存组(14例),监测血小板计数(PLT)、凝血酶原时间(PT)、部分凝血酶原时间(APTT)、纤维蛋白原(FBG)、凝血酶-抗凝血酶复合物(TAT)、抗凝血酶Ⅲ(AT-Ⅲ)、蛋白C(PC)、血栓调节蛋白(TM)、D-二聚体(DD)、组织型纤溶酶原激活物(TPA)共10项反映凝血系统功能的指标.结果 (1)SIRS组中PT、APTT、TAT、TM、DD、TPA水平均较非SIRS组及对照组升高(P<0.05);AT-Ⅲ、PC水平均较非SIRS组及对照组降低(P<0.05),非SIRS组PC水平较对照组降低(P<0.05);PLT、FBG水平在SIRS组、非SIRS组及对照组之间比较差异无显著性(P>0.05);(2)SIRS患儿中,死亡组与生存组各出凝血指标间比较差异无显著性(P>0.05).结论 (1)SIRS患儿存在凝血功能异常,主要表现为凝血活化、抗凝活性的降低和纤溶系统的活化;(2)出凝血分子标志物是疾病早期针对性反映患儿凝血系统所处状态的良好指标;(3)分子标志物对预后的意义尚需大样本进行评估.     

急性感染患儿危重病例评分与凝血功能紊乱的关系

目的 探讨急性感染患儿病情严重度与凝血功能紊乱的关系.方法 将收住人ICU的88例急性感染患儿进行危重病例评分后分为极危重组、危重组和非危重组,所有患儿检测血小板(PLT)、凝血酶原时间(PT)、部分凝血活酶时间(APTT),分析比较三组患儿主要凝血指标的差异.结果 危重组PT、APlT较非危重组延长,极危重组PT、APTT延长更明显(P<0.01).极危重组PLT较非危重组低,而危重组PLT较非危重组高(P<0.01).结论 急性感染患儿危重病例评分与凝血功能紊乱密切相关,随着病情加重,凝血功能紊乱更明显.     

抗凝血酶Ⅲ、D-二聚体和血小板检测在儿童脓毒症中的价值

目的探讨检测血浆抗凝血酶Ⅲ(AT-Ⅲ)活性、D-二聚体(DD)水平和血小板(PLT)数量在儿童脓毒症中的临床价值。方法选取儿科重症监护病房住院患儿103例,其中普通感染组30例,脓毒症组73例;另选择30例健康儿童为正常对照组。检测并比较血浆AT-Ⅲ活性、DD水平和PLT数量。结果与正常对照组和普通感染组比较,脓毒症组AT-Ⅲ活性和PLT数量明显降低,DD水平明显升高,差异有统计学意义(P均<0.01);而正常对照组和普通感染组间三项指标的差异无统计学意义(P均>0.05);脓毒症患儿中严重脓毒症组、DIC组和死亡组的AT-Ⅲ活性和PLT数量明显降低,DD水平明显升高,差异有统计学意义(P均<0.01),DIC组三项指标同时异常的发生率为70.37%。结论儿童脓毒症存在明显的凝血纤溶功能紊乱,血浆AT-Ⅲ活性、DD水平和PLT数量检测有助于儿童脓毒症时DIC的早期诊断,并且对患儿的病情估计和预后判断有一定的临床价值。[临床儿科杂志,2013,31(6):530-532     

D-二聚体和凝血功能状态与川崎病并发症的关系探讨

目的 了解川崎病患儿急性期凝血功能状态及其与并发症的关系.方法 68例川崎病患儿根据入院时冠状动脉超声检查结果,分为冠状动脉病变组18例(A组)、未伴冠状动脉病变组50例(B组),同时设健康对照组30例.三组均检测D-二聚体(D-dimer)和凝血功能,即凝血酶原时间(PT)、凝血时间(TT)、活化的部分凝血活酶时间(APTT),并对结果进行比较分析.结果 川崎病组患儿PT、TT、APTT均比对照组缩短(P<0.01),而D-dimer较对照组增高(P<0.01).A组与B组比较,PT、TT缩短(P<0.05),D-dimer增高(P<0.01).结论 川崎病患儿急性期凝血功能处于高凝状态,较易合并冠状动脉病变,推测与血管炎症活动有关.     

重症肺炎对极低出生体重儿血小板及凝血功能的影响

目的探讨重症炎症对极低出生体重儿血小板及凝血功能的影响。方法重症肺炎极低出生体重儿17例为重症肺炎组,选取同期住院的极低出生体重儿12例为对照组,检测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、血小板,并进行比较。结果重症肺炎组早产儿PT、APTT、TT均高于对照组,血小板低于对照组,差异有统计学意义(P<0.01)。结论重症肺炎患儿存在凝血系统功能紊乱,对有明显病理性凝血功能障碍者应积极进行病因治疗。     

危重症患儿血乳酸水平与病情的关系

目的：探讨危重症患儿血乳酸水平与病情的关系。方法：回顾性分析2010年9月至2010年12月232例危重症患儿的临床资料。根据入院后患儿的血乳酸水平分为乳酸水平正常组（n=146）、高乳酸血症组（n=72）和乳酸酸中毒组（n=14）,比较3组危重症患儿循环功能、小儿危重病例评分及预后。结果：不同乳酸水平患儿间脓毒血症程度的比较差异有统计学意义（χ2=13.592,P<0.01）。乳酸酸中毒组脓毒症休克发生的比例（42.9%）较乳酸水平正常组（7.5%）、高乳酸血症组（11.1%）明显升高。不同乳酸水平患儿小儿危重病例评分也不同,3组比较差异有统计学意义（χ2 =12.854,P<0.05）。全血乳酸水平与小儿危重病例评分呈明显负相关（r=-0.405,P=0.002）。不同乳酸水平患儿预后亦不同（χ2=25.599,P<0.01）。乳酸酸中毒组的治愈率明显低于乳酸水平正常组（7.1% vs 23.3%,P<0.05）;乳酸酸中毒组的好转率亦明显低于乳酸水平正常组（28.6% vs 58.2%,P<0.05）,而其病死率（28.6%）明显高于乳酸水平正常组（5.5%）及高乳酸血症组（6.9%）,差异有统计学意义（P<0.05）。结论：患儿血乳酸水平越高,病情越危重,预后越差。     

儿童重症肺炎凝血指标与降钙素原变化及分析

目的探讨重症肺炎患儿凝血指标与降钙素原(PCT)的变化。方法选取重症肺炎患儿76例,根据PCT升高的程度分为2组,PCT2.00 ng/ml组和PCT≥2.00 ng/ml组;另选择30例健康儿童作为正常对照组。检测并分析比较各组的PCT、血小板计数(PLT)、抗凝血酶Ⅲ(AT-Ⅲ)活性和D-二聚体(DD)水平。结果与对照组比较,重症肺炎组PCT、PLT、DD水平明显升高,AT-Ⅲ活性明显降低,差异均有统计学意义(P0.05);PCT≥2.00 ng/ml组的AT-Ⅲ活性和PLT水平相比PCT2.00 ng/ml组更低,而DD水平更高,差异均有统计学意义(P0.05);PCT≥2.00 ng/ml组的DIC发生率(33.33%)高于PCT2.00 ng/ml组(9.09%),差异有统计学意义(校正χ2=5.02,P=0.025)。结论重症肺炎患儿易发生凝血纤溶功能障碍,PCT水平越高,凝血纤溶功能紊乱越明显,越容易并发弥散性血管内凝血。     

48例儿童急性白血病出凝血检测结果及临床意义

为探讨儿童急性白血病 (AL)出凝血检测的临床意义。检测了 48例初诊AL患儿的血小板 (PLT)、血浆凝血酶原时间 (PT)、活化部分凝血活酶时间 (APTT)、凝血酶时间 (TT)、鱼精蛋白副凝试验 ( 3P)及纤维蛋白原定量 (Fg) ,并对其结果进行分析。结果 ,有出血和无出血组 ,PLT均值的比较差异有极显著性 (P <0 0 1) ,3P试验阳性的差异也有显著性 (P <0 0 5 ) ,而APTT、TT、PT及Fg异常的比较差异均无显著性 (P >0 0 5 )。急淋组中 ,标危急淋 (SR ALL)同高危急淋 (HR ALL)相比较 ,PLT均值、APTT、TT、3P、Fg的异常差异均无显著性。急性淋巴细胞白血病 (ALL)和急性非淋巴细胞白血病 (ANLL)相比较 ,PT和 3P试验阳性结果的比较差异有显著性 (P值各为 <0 0 5和 <0 0 1) ) ,而PLT均值、APTT、TT、Fg异常差异均无显著性。结果提示 :AL患儿多由PLT减少而表现有出血 ,有、无出血者的PLT均值差异极具显著性。即使临床无典型弥漫性血管内凝血 (DIC)表现 ,也可出现各种出凝血指标异常。检测PT、APTT、TT、3P、Fg简便易行 ,在儿童AL出凝血诊断上 ,仍具有一定的临床意义。     

新生儿缺氧缺血性脑病血小板参数的变化及意义

为探讨新生儿缺氧缺血性脑病(HIE)血小板参数的变化及临床意义。对1t2例HIE患儿进行临床分度,于急性期进行血小板参数测定,并于恢复期复查,了解其动态变化情况。并以60例正常足月新生儿作为对照。(l)HIE患儿急性期血小板总数(PLT)较正常儿明显降低(P<0.01),平均血小板体积(MPV)和血小板体积分布宽度(PDW)较正常儿明显增高(P<0.01)。恢复期PLT、MPV、PDW与正常组之间无明显差异(P>0.05)。(2)HIE患儿PLT随HIE病情加重而降低(P<0.01)。而MPV、PDW则随病情加重而增大(P<0.01,P>0.05)。结果提示,动态观察HIE患儿血小板参数,可作为判断HIE病情严重程度的指标。     

Capillary refilling time in newborns–optimal pressing time, sites of testing and normal values

Aspects of capillary refilling time (CRT) in newborns, such as pressing time, sites of testing, normal values and difference between observers were assessed. CRT was measured in 280 term newborns, divided into 7 groups of 40 each, varying pressing time (from 1 to 7 s) was applied. CRT was measured in midpoints of forehead and sternum and plantar surface of heel (defined as head, chest and heel). No statistically significant difference was found between 3 and 7 s pressing time groups. The data points of the CRT of the head and chest approached normality, whilst those of the heel were widely scattered. Normal CRT in newborns is <3 s. No significant difference between two observers in head and chest CRT values was found.     

The effect of 2% CO2, 100% O2, theophylline and 15% O2 on ‘inspiratory drive’ and ‘effective’ timing in preterm infants

We studied 20 preterm infants (B.W. 1440 ± 80 g (S.E.); G.A. 33 ± 1 wk) to determine the effect of respiratory stimulants and depressants on respiratory output as measured by V_E = V_T · f and V_E = V_T/T_i · T_i/T_tot. These 20 infants were divided in four groups of five infants. Each group received a respiratory stimulant (2% CO₂, 100% O₂ or theophylline) or a respiratory depressant (15% O₂). V_T/T_i is mean inspiratory flow and represents a mechanic translation of neuronal output. T_i/T_tot is a dimensionless number and has been defined as effective timing. Each study consisted of 3–5 min while the infant breathed 21% O₂, followed by 5 min breathing 2% CO₂, 100% O₂ or 15% O₂. The effect of theophylline was assessed 48–72 h after the initial dose. The respiratory stimulants caused an increase in V_T with little or no change in f 15% O₂ produced a decrease in f primarily. According to the newer approach, 2% CO₂, 100% O₂ and theophylline produced an increase in ‘inspiratory drive’ with little or no change in ‘effective’ timing; 15% O ₂ decreased ‘effective’ timing primarily via an increase in T_e. These findings suggest that the paradoxical decrease in ventilation during hypoxia in preterm infants may not be solely dependent on the central depressant effects of O₂. At least in part, the mechanism may be due to a direct action of low O₂ on elements controlling expiratory time.     

早产儿视网膜病的影响因素

目的 探讨早产儿视网膜病(ROP)的影响因素.方法 选择本院患ROP早产儿为观察组,32周以下的早产儿为对照组,对2组患儿胎龄、出生体质量、出生方式、性别、多胎、使用呼吸机时间、休克、呼吸暂停、新生儿寒冷损伤综合征、肺透明膜病(Ⅲ级以上)、严重感染、肺出血及并发症合计数等临床资料进行单因素分析,并对有意义的因素进行多因素Logistic分析.结果 本资料共有早产儿358例,胎龄均小于32周.ROP 34例,其中Ⅰ期13例,Ⅱ期18例,Ⅲ期3例.二组患儿窒息、呼吸暂停、新生儿寒冷损伤综合征、肺透明膜病、严重感染、肺出血等并发症的发生率比较差异均有统计学意义(Pa<0.05),并发症合计数(OR=2.152,P=0.048)、使用呼吸机时间(OR=1.514,P=0.009)是危险因素.结论 早产儿ROP的发生率和发生并发症的多少及使用呼吸机的时间长短有关.在临床工作中要更多关注并发症的情况.     

Reaction Time and Movement Time in Children with a Developmental Coordination Disorder

The Test of Motor Impairment (TOMI) was used to select 12 children with a Developmental Coordination Disorder (DCD) and 12 age-matched controls. In an aiming task, movement latency, movement duration and its variability were significantly prolonged in the DCD group. In a coincidence timing version of the task, absolute timing error was significantly greater in the DCD group. The most robust chronometric effect for differentiating the two groups seemed to be the duration of movement when the target was small. Multiple regression showed that TOMI was a powerful indicator of movement duration.     

朝鲜族儿童睡眠时间调查分析

目的 了解朝鲜族儿童的睡眠状况,探讨提高少数民族儿童睡眠质量的措施.方法 应用一般情况调查问卷和澳大利亚悉尼大学儿童睡眠中心临床问卷的中国修订版,对1 183名3～12岁朝鲜族儿童少年的睡眠时间进行调查分析,并比较不同年龄、不同城市儿童睡眠时间.结果 朝鲜族儿童全天睡眠时间为(10.06±1.29)h;睡眠时间随年龄的增长逐渐减少,各年龄组睡眠时间差异非常显著(Pa＜0.01);城市儿童睡眠时间少于农村儿童;抚养人睡眠习惯、母亲学历、儿童睡眠环境、独自睡眠、呼吸系统疾病等是睡眠时间的主要影响因素.结论 朝鲜族儿童全天睡眠时间偏少,可能与朝鲜族的遗传和生活习俗有关;提高母亲的睡眠质量,为儿童提供良好的生活、睡眠环境,可有效保障其充足的睡眠时间.     

INSPECTION TIME AND INTELLIGENCE IN DYSLEXIC CHILDREN

Dyslexics and normal readers aged 9-11 were compared on an inspection time task. Results indicated that dyslexics required significantly longer inspection times. The findings suggested, however, that there was greater individual variation among dyslexics than among normal readers and that the dyslexics benefited from practice to a considerable extent. Inspection times were not significantly related to IQ as measured by a non-verbal test.     

Factors that affect television viewing time in preschool and primary schoolchildren

BACKGROUND: Excessive viewing of television (TV) has been linked to aggressive behavior, violence and childhood obesity. METHODS: A cross-sectional study was conducted among preschool children and primary schoolchildren in Ankara during March and April 1999 to detect the factors that affect TV viewing time and to evaluate their parents' knowledge, attitudes and practices with regard to TV. The parents were asked to fill out a questionnaire about TV habits of their family, the number and location of TVs in the household and the effect of TV on children. Of 400 questionnaires, 350 answered the questions appropriately for this study. Children were divided into two groups, preschool children and primary schoolchildren. Television viewing time was given daily, as a mean of weekday. RESULTS: The mean age for becoming a TV viewer was 2.7 +/- 1.6 years. Of all, 62% of children spent >/= 2h/day watching TV and 8.3% of children spent > 4 h. The TV viewing time of child was significantly and positively correlated with that of siblings, mother and father for both groups. Age and sleeping time of the child, age and the education level of mother, presence of TV in the child's room and the starting age watching TV did not affect the viewing time. One-half of parents reported that the TV programs watched included violence, and one-third thought TV depicts child abuse, especially emotional abuse. CONCLUSIONS: It was found that the TV watching habits of parents had an influence on those of their children. Therefore, pediatricians should take 'TV histories' of children and their parents and educate parents how to become good TV viewers.