1,6-二磷酸果糖联用维生素C佐治一氧化碳中毒并发心肌损害的临床研究

目的 探讨在常规治疗的基础上加用1,6-二磷酸果糖及维生素C治疗急性一氧化碳中毒并发心肌损害的有效性.方法 将40例急性一氧化碳中毒合并心肌损害的患儿分为治疗组(25例)和对照组(15例),均予以常规治疗(高压氧及对症治疗),治疗组加用1,6-二磷酸果糖及维生素C,疗程均为14 d,比较两组治疗前后血清心肌肌钙蛋白Ⅰ(cTn-Ⅰ)和肌酸激酶心型同工酶(CKMB)水平.结果 两组治疗前血清cTn-Ⅰ和CKMB水平比较差异无统计学意义;疗程结束时,治疗组血清cTn-Ⅰ和CKMB水平与对照组及治疗前比较,均显著降低,差异有统计学意义(P均＜0.05).结论 1,6二磷酸果糖联用维生素C可改善急性一氧化碳中毒患儿的心肌损害.     

1,6-二磷酸果糖治疗新生儿窒息并心肌损害

目的探讨1,6-二磷酸果糖治疗新生儿窒息后心肌损害的效果。方法新生儿窒息并血清心肌酶谱变化85例患儿,随机分为治疗组45例和对照组40例;二组患儿均采用综合治疗。治疗组予1,6-二磷酸果糖0.10~0.25g/(kg.次),2次/d,快速静脉滴注(10min内滴完),疗程7~10d,入院12h内及治疗后查血清心肌酶谱。结果治疗与对照组治疗后肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、α-羟丁酸脱氢酶(HBDH)比较差异均具有显著性意义(Pa<0.05)。结论1,6-二磷酸果糖对新生儿窒息心肌损害有一定预防及治疗作用。     

1,6-二磷酸果糖对新生儿窒息疗效及其对血清酶的影响

目的　探讨 1,6 二磷酸果糖对新生儿窒息疗效及其对血清酶的影响。方法　将 6 4例新生儿窒息伴血清酶变化患儿 ,随机分为治疗组与对照组 ,两组均采用综合治疗 ,治疗组予 1,6 二磷酸果糖 2 5 0mg/ (kg·次 ) ,2次 /d静推 ,疗程 7～ 10d ,并于入院后 12h内及治疗后检查血清酶。结果　窒息新生儿治疗前血清酶均增高 ,且与窒息程度呈正相关 ;轻度窒息治疗组与对照组治疗后门冬氨酸氨基转移酶 (AST)、乳酸脱氢酶 (LDH)相比较无显著差异 (P >0 .0 5 ) ,α 羟丁酸脱氢酶 (HBDH)、CK MB、肌酸激酶 (CK)相比较有显著差异 (P <0 .0 5 ) ;重度窒息治疗组与对照组治疗后AST、LDH、CK MB、HBDH测定比较有显著差异 (P <0 .0 5 )。结论　 1,6二磷酸果糖可使窒息新生儿升高的血清酶显著下降 ,提示其对治疗新生儿窒息及预防器官损伤有一定作用。     

毛细支气管炎患儿血清心肌肌钙蛋白Ⅰ的检测与临床意义

目的了解毛细支气管炎患儿心肌损害情况，探讨血清心肌肌钙蛋白Ⅰ（cTnⅠ）在心肌损害中的诊断价值。方法测定毛细支气管炎组（n=45）及对照组（n=42）患儿血清心肌肌钙蛋白（cTnⅠ）、肌酸激酶同工酶（CK—MB）浓度，血清心肌肌钙蛋白（cTnⅠ）采用酶联免疫法检测，CK—MB采用美国Beckman公司生产的CX4全自动生化仪检测。结果毛细支气管炎组与对照组血清cTnⅠ阳性率分别为8．89％（4例）、0，CK—MB阳性率分别为6．67％（3例）、4．76％（2例）。经统计学处理差异均无显著性（P〉0．05）。在毛细支气管炎组中，两种监测指标经统计学处理，X^2=6．71，P〈0．05，差异有显著性。结论毛细支气管炎患儿很少发生心肌损害，血清cTnI与CK—MB对诊断心肌损害均有价值，在敏感性与特异性上CTnⅠ优于CK—MB。     

血清肌酸磷酸激酶同工酶及心肌肌钙蛋白早期诊断窒息新生儿心肌损害

目的　探讨血清肌酸磷酸激酶同工酶 (CK- MB)及心肌肌钙蛋白I(cTnI)测定对窒息新生儿心肌损害的早期诊断价值。方法　窒息组 40例 (轻度窒息、重度窒息各 2 0例 )、对照组 2 0例 ,生后 1、5、1 0d测定血清CK MB及cTnI水平。结果　窒息组生后 1d血清CK- MB及cTnI明显高于对照组 (P均 <0 .0 1 ) ,重度窒息组明显均高于轻度窒息组 (P均 <0 .0 1 ) ,治疗后呈逐渐下降趋势。血清CK- MB及cTnI对心肌损害诊断的敏感性无显著差异 (P >0 .0 5)。结论　血清CK MB及cTnI可用于窒息新生儿心肌损害的早期诊断。     

血浆cTnI,CK—MBmass及CK—MBmass／CK比值在围产期窒息后的变化及其比较研究

评价血浆心肌肌钙蛋白I（cTnI)，肌酸激酶心型同工酶质量（CK－MB－mass)肌酸激酶心型同工酶质量／肌酸激酶活性的比值（CK－MBmass/CK)对围产期窒息后心肌损伤诊断价值，对71例围产期窒息新生儿及27例对照组新生儿生后6－48小时血浆cTnI,CK-MBmass及CK水平进行测定并计算CK－MBmass/CK比值，运用Wilcoxon秩和检验等方法进行分析，结果显示：（1）新生儿窒息伴胎儿窘迫组（23例）cTnI,CK-MBmass,CK均显著高于对照组（27例），新生儿窒息伴胎儿窘迫组CK－MB－mass,CK显著高于单纯窘迫组（38例）；单纯窒息组（10例）与对照组相比，仅CK－MBmass/CK明显降低，其它指标差异无显著性。（2）围产期窒息重度心脏损害患儿（8例）cTnI,CK-MBmass,CK均明显高于该组无重度心脏损害患儿（63例），（3）重度窒息组（17）例仅CK－MBmass,CK明显高于轻度窒息组（16例），因此，新生儿严重缺氧时，血浆cTnI-MBmass，CK均明显增高，表明存在心肌伤，CTnI虽对心肌损伤有高度特性性，但敏感性低于CK－MBmass,CK，且受胎龄影响，在判断早产儿心肌损伤时有一定的局限性，CK－MBmass/CK比值不宜作为围产期窒息后心肌损伤的生化指标。     

急性豆角中毒患儿血清心肌酶谱检测及临床意义

目的 了解急性豆角中毒患儿心肌损害情况.方法 以54例急性豆角中毒患儿为研究对象,根据症状轻重分成2组(轻症组24例,重症组30例),均于中毒后第3天晨起空腹抽静脉血,进行心肌酶谱检测.同时2组患儿均常规进行心电图检查.结果 轻症组血清乳酸脱氢酶(LDH)异常率为54.1%,肌酸激酶(CK)异常率为12.5%,CK-MB异常率为4.2%;而重症组血清LDH异常率为83.4%,CK异常率为55.3%,CK-MB异常率为33.3%;重症组LDH、CK、CK-MB异常率均显著高于轻症组(P＜0.05).结论 救治急性豆角中毒患儿时不能忽视心肌损伤.患儿心肌损害程度与中毒程度有关,心肌酶谱检测和心电图检查可辅助诊断.     

急性豆角中毒患儿血清心肌酶谱检测及临床意义

目的 了解急性豆角中毒患儿心肌损害情况.方法 以54例急性豆角中毒患儿为研究对象,根据症状轻重分成2组(轻症组24例,重症组30例),均于中毒后第3天晨起空腹抽静脉血,进行心肌酶谱检测.同时2组患儿均常规进行心电图检查.结果 轻症组血清乳酸脱氢酶(LDH)异常率为54.1%,肌酸激酶(CK)异常率为12.5%,CK-MB异常率为4.2%;而重症组血清LDH异常率为83.4%,CK异常率为55.3%,CK-MB异常率为33.3%;重症组LDH、CK、CK-MB异常率均显著高于轻症组(P＜0.05).结论 救治急性豆角中毒患儿时不能忽视心肌损伤.患儿心肌损害程度与中毒程度有关,心肌酶谱检测和心电图检查可辅助诊断.     

先天性心脏病患儿血清肌酸激酶同工酶检测的意义

目的　探讨先天性心脏病患儿血清肌酸激酶同工酶 (CK MB)变化。方法　测定先天性心脏病患儿血清CK MB ,并与正常儿童对照组比较。分成 1.非心衰组和心衰组 ;2 .非青紫组和青紫组 ,比较各组血清CK MB水平。结果　 1.先心组血清CK MB显著高于正常对照组 (P <0 .0 1) ;2 .心衰组血清CK MB显著高于非心衰组 (P <0 .0 1) ;3.青紫组血清CK MB值显著高于非青紫组 (P <0 .0 5 )。结论　先天性心脏病患儿血清CK MB显著增高 ,提示先心患儿心肌受损 ,心衰加重     

1，6二磷酸果糖治疗新生儿窒息致心肌损害

目的：探讨1,6二磷酸果糖（FDP）治疗新生儿窒息致心肌损害的疗效和预后,方法：随机分为治疗组和对照组,均予综合治疗,治疗组应用FDP250mg/(kg.d)0.5h内静脉滴入,每日一次,7d一个疗程。两组治疗前后分别做心肌酶谱测定。结果：治疗组临床有效率显著高于对照组（P＜0．05）。治疗后复查心肌酶谱,治疗组心肌酶谱恢复正常病例显著高于对照组（P＜0．01）。结论：外源性FDP能显著改善新生儿窒息致心肌损害患儿的临床表现,并可改善预后,减少后遗症的发生。     

Comparison of patients with Kawasaki disease with retropharyngeal edema and patients with retropharyngeal abscess

Kawasaki disease with retropharyngeal edema (KD with RPE) is a rare complication, and it is diagnosed by neck CT. Most reported cases had a delayed diagnosis because those patients' conditions were misdiagnosed as retropharyngeal abscess (RPA). The purpose of this study was to differentiate KD with RPE from RPA. We performed a retrospective case–control study comparing children with KD with RPE to those with RPA hospitalized at the tertiary pediatric hospital in Tokyo between 2005 and 2011. The 39 patients revealing RPE on neck CT were divided into two groups: group A was classified as KD (n?=?21) and group B was classified as non-KD (n?=?18). Patients in group B were finally evaluated as having RPA clinically and were treated with antibiotic therapy. A significantly higher proportion of patients in group B complained of dysphagia (11 patients vs. 5 patients; p?=?0.0170) and neck pain (17 patients vs. 12 patients; p?=?0.0106). Neck CT revealed a ring enhancement (16 patients vs. no patients; p?<?0.0001) and mass effect in a greater proportion of patients in group B (11 patients vs. 1 patient; p?<?0.0003). Conclusion: Careful attention to manifestations and close analyses of CT imaging may allow clinicians to differentiate KD with RPE from RPA.     

Patients with moyamoya disease presenting with movement disorder

Moyamoya disease is a rare cerebrovascular disease characterized by idiopathic bilateral stenosis or occlusion of bilateral internal carotid arteries and the development of characteristic leptomeningeal collateral vessels at the base of the brain. Typical presentations include transient ischemic attacks or stroke, and hemorrhage. Presentation with movement disorders is extremely rare, especially in the pediatric population. The authors describe the cases of 4 children with moyamoya disease who presented with movement disorders. Among 446 patients (118 pediatric) with moyamoya disease surgically treated by the senior author, 4 pediatric patients had presented with movement disorders. The clinical records, imaging studies, surgical details, and postoperative clinical and imaging data were retrospectively reviewed. The initial presenting symptom was movement disorder in all 4 patients: chorea in 2, hemiballismus in 1, and involuntary limb shaking in 1. All the patients had watershed infarcts involving the frontal subcortical region on MR imaging. Additionally, 1 patient had a ganglionic infarct. Single-photon emission computed tomography studies showed frontoparietal cortical and subcortical hypoperfusion in all patients. Three patients had bilateral disease, whereas 1 had unilateral disease. All the patients underwent superficial temporal artery-middle cerebral artery bypass. Postoperatively, all 4 patients had complete improvement in their symptoms. The SPECT scans revealed normal perfusion in 3 patients and a small residual perfusion deficit in 1. Movement disorders are a rare presenting feature of moyamoya disease. Hypoperfusion of the frontal cortical and subcortical region was seen in all patients, and the symptomatology was attributed to ischemic dysfunction and imbalance in the cortical-subcortical-ganglionic-thalamic-cortical circuitry. Combined revascularization with superficial temporal artery-middle cerebral artery bypass and encephaloduroarteriosynangiosis leads to excellent results.     

Treatment with probucol of children with familial hypercholesterolaemia

Nine children with familial hypercholesterolaemia, age range 2 to 12 years, were treated with a low cholesterol diet and probucol (10 mg/kg/day). The year before, the children received, as only treatment, a low fat-cholesterol diet. During this period their mean plasma total cholesterol level fell from 8.2 +/- 1.45 mmol/l to 7.17 +/- 0.84 mmol/l (12.6%). This level was further reduced to 5.92 +/- 0.63 mmol/l (17.1%) after the addition of probucol. Plasma high density lipoprotein cholesterol levels were lowered in absolute terms but not in relation to total cholesterol. No apparent side effects were observed. However, the use of probucol should be restricted for the moment to severe cases of hypercholesterolaemia as the long-term excretion of the drug in children is not yet known.     

双胞胎同患儿童良性癫癎伴中央颞区棘波

例1,女,6岁6个月,双胎之小,因间断抽搐2年就诊.近2年出现入睡10 min后一侧嘴角及面部抽动,继之四肢抽动,每次持续2～10 min不等,共3次,无发热.1年前在当地医院予妥泰抗癫癎并加量至4 mg/(kg·d),仍控制不满意,再次抽搐入院.