注意缺陷多动障碍患儿孕产及家庭危险因素分析

目的 探讨注意缺陷多动障碍（ADHD）患儿非遗传危险因素。方法 选择2014年1月至2017年5月在芜湖市第四人民医院就诊的ADHD患儿137例为ADHD组,同时期芜湖某小学按照年龄分层抽样选取400名健康儿童为对照组,采用自制问卷对两组儿童进行孕期、母亲、父亲及家庭因素调查。结果 ADHD组患儿难产、孕期情绪异常、母亲酗酒、母亲类似ADHD症状、高龄孕妇、父亲类似ADHD症状、夫妻关系紧张的比例均高于对照组,差异有统计学意义（P<0.05）。logistic回归分析显示,母亲酗酒、夫妻关系紧张、母亲ADHD病史、高龄孕妇、父亲ADHD病史和难产等是儿童ADHD发病的危险因素（P<0.05）。结论 孕产史和家庭环境中的某些因素与ADHD发病密切相关。     

父母教养方式对伴与不伴对立违抗性障碍注意缺陷多动障碍患儿的影响

目的 探讨父母教养方式对伴与不伴对立违抗性障碍（ODD）的注意缺陷多动障碍（ADHD）患儿的影响。方法 选择2015年1月至2016年12月安徽省精神卫生防治中心就诊的ADHD患儿124例，根据有无ODD症状，分为单纯ADHD患儿82例，合并ODD的ADHD患儿42例，按照分层抽样的方法选取合肥某小学同时期110例健康儿童作为对照组；使用父母教养方式调查问卷（EMBU）对3组儿童目前的父母教养方式进行调查评分，比较3组对象的父亲因子、母亲因子差异。结果 3组儿童父亲因子Ⅱ、Ⅲ、Ⅴ和母亲因子Ⅱ、Ⅲ、Ⅳ的差异有统计学意义（F=32.096，11.195，10.467，13.957，7.343，29.081，P均<0.001）；单纯ADHD组患儿的父亲因子Ⅱ、Ⅲ、Ⅴ和母亲因子Ⅱ、Ⅲ、Ⅳ得分高于对照组，差异有统计学意义（t=7.481，4.479，4.406，5.252，3.847，7.292，P均<0.001）；合并ADD的ADHD组患儿的父亲因子Ⅱ、Ⅲ和母亲因子Ⅱ、Ⅳ得分高于单纯ADHD，差异有统计学意义（t=2.221，P=0.028；t=2.553，P=0.012；t=2.921，P=0.004；t=3.737，P<0.001）。结论 父母教养方式的极端化对ADHD患儿有着重要影响，惩罚严厉、过分干涉的教养方式是ADHD患儿出现ODD的危险教养方式。     

新生儿黄疸母系危险因素调查

目的 探讨新生儿黄疸母系危险因素。方法 将199例黄疸新生儿母亲和683例健康新生儿母亲分别纳入研究组和对照组。对两组新生儿母系临床资料进行回顾性分析,探讨可能与新生儿黄疸有关的各种母系危险因素。结果 相对于对照组,研究组在ABO溶血、孕期淤阻性黄疸、孕期感染人数较多,差异有统计学意义(85/683vs 103/199,P<0.001;225/683 vs 85/199,P=0.011;134/683 vs 67/199,P<0.001)。logistic回归分析显示ABO溶血、孕期感染、孕期淤阻性黄疸是新生儿黄疸的3个主要危险因素,体力劳动则是保护性因素。结论 母亲孕期ABO溶血、孕期感染及孕期淤阻性黄疸是新生儿黄疸的重要危险因素,可以采取相关措施降低发病率。     

足月新生儿呼吸窘迫综合征危险因素分析

目的 探讨足月新生儿呼吸窘迫综合征(RDS)发病的危险因素,提高对本病认识,以降低其发病的风险。方法 选取阜阳市人民医院儿科2012年1月至2014年6月收治的53例足月RDS患儿作为观察组,同期住院的106例足月非RDS患儿为对照组,两组患儿进行成组资料的单因素分析及logistic回归分析。结果 观察组患儿的男性、胎龄<39周、剖宫产、选择性剖宫产、宫内窘迫、出生窒息、羊水胎粪污染、母亲糖尿病、胎膜早破、出生体质量<2500 g比例高于对照组,差异有统计学意义(P<0.05)。logistic回归分析显示性别、胎龄、出生体质量、分娩方式、宫内窘迫、母亲糖尿病对RDS的发生有影响(P<0.05)。结论 男性、胎龄<39周、出生体质量低、剖宫产、选择性剖宫产、宫内窘迫、母亲糖尿病为足月儿发生RDS的主要危险因素。如果条件允许,足月儿选择性剖宫产应在39周以后进行,可明显降低RDS发生。     

儿童重症化脓性脑膜炎预后不良相关危险因素分析

目的 探讨化脓性脑膜炎重症患儿不良预后的危险因素,以期为临床医师及时干预提供依据。方法 对2015年1月至2019年4月中国科学技术大学附属第一医院（安徽省立医院）儿童重症监护室（PICU）收治的42例重症化脓性脑膜炎患儿的临床资料进行回顾性分析,按照Glasgow临床结局评分将42例患儿分为预后良好组（n=29）和预后不良组（n=13）,比较两组患儿的一般情况、临床症状体征以及相关实验室数据,采用logistic回归分析影响患儿重症化脓性脑膜炎预后的独立危险因素。结果 42例患儿中预后良好29例（69.04%）,预后不良13例（30.96%）,后者包含死亡患儿4例（9.52%）以及遗留不同程度功能障碍患儿9例（21.44%）。单因素分析显示预后不良组中昏迷（Glasgow昏迷评分<8分）、肌张力异常、反复抽搐和脑脊液葡萄糖（<1.5 mmol/L）等因素与预后良好组比较,差异有统计学意义（P<0.05）。logistic多因素回归分析显示,昏迷（Glasgow昏迷评分<8分）、反复抽搐、脑脊液葡萄糖<1.5 mmol/L是儿童重症化脓性脑膜炎预后不良的独立危险因素。结论 昏迷、反复抽搐、脑脊液葡萄糖<1.5 mmol/L是儿童重症化脓性脑膜炎预后不良的独立危险因素,儿童重症科医师应密切关注相应指标,尽早采取有效措施干预。     

基于倾向性评分匹配的小儿重症支气管肺炎危险因素分析

目的 探讨小儿重症支气管肺炎发生的相关危险因素,为重症肺炎的早期诊断及判断病情变化提供依据。方法 选取安徽医科大学第一附属医院儿科呼吸病区,2016年1月至2018年12月收治住院的重症支气管肺炎患儿108例和2018年1~12月住院非重症肺炎患儿204例,合计312例。运用倾向性评分匹配（PSM）法对重症组和非重症组患儿进行1∶1匹配,使组间一般人口学特征均衡。匹配后运用单因素分析和多因素logistic回归模型筛选小儿重症支气管肺炎的危险因素。结果 倾向性评分匹配后,两组患儿一般人口学资料均衡。单因素分析结果显示,发病季节、早产、免疫缺陷、先天性心脏病、血小板计数5个变量与重症肺炎存在统计关联。进一步多因素logistic回归分析结果表明,免疫缺陷（OR=19.746,95% CI：5.401～72.187）、先天性心脏病（OR=15.329,95% CI：3.098～75.851）和佝偻病（OR=5.600,95% CI：1.021～30.699）是重症肺炎的危险因素;与春天比,秋天小儿发生重症肺炎的风险降低了67.4%（OR=0.326,95% CI：0.111～0.955）。结论 合并有先天性心脏病、免疫缺陷或佝偻病三种基础疾病为重症肺炎的危险因素,同时需做好儿童冬春季肺炎的预防。     

极超低出生体质量儿临床转归及危险因素分析

目的 探讨极低出生体质量儿(VLBW)和超低出生体质量儿(ELBW)的临床转归及其危险因素。方法 回顾性分析2017年1月至2019年9月在安徽省儿童医院就诊的138例ELBW、VLBW的临床资料,分析影响患儿临床转归的危险因素。结果 患儿临床转归与胎龄、体质量、双胎或多胎、母亲围产期病史以及母亲既往病史有关(P<0.05)。患儿体质量、双胎或多胎为负性临床结局的保护因素(P<0.05),母亲围产期病史中胎膜早破是负性临床结局的危险因素(P<0.05)。结论 ELBW与VLBW的生存率较低、并发症多,临床预后影响因素多。在提高临床诊疗和护理质量的同时,应加强围生期保健治疗及护理宣教,及早发现影响ELBW与VLBW临床结局的不利因素,及时干预,改善预后。     

抗链球菌溶血素O阳性为小儿过敏性紫癜复发的危险因素

目的 明确抗链球菌溶血素O阳性是否为小儿过敏性紫癜复发率的危险因素，以期为预防其复发提供临床指导依据。方法 选择2014年1月-2015年12月绵阳市中医医院收治的过敏性紫癜患儿136例，回顾性分析其临床资料，根据患儿出院后12个月内是否复发，将患儿分为复发组（n=48）和未复发组（n=88），统计两组患儿入院时抗链球菌溶血素O的阳性率，采用多因素logistics回归分析探讨过敏性紫癜患儿复发的危险因素。结果 复发组患儿抗链球菌溶血素O的阳性率显著高于未复发组，差异有统计学意义（66.67% vs 32.95%，P=0.000）。多因素logistics回归分析显示消化道出血、关节炎和抗链球菌溶血素O阳性均为过敏性紫癜患儿复发的危险因素（P<0.05）。对于抗链球菌溶血素O阳性的患儿，未接受抗链球菌治疗者的复发率显著高于接受抗链球菌治疗的患儿（44.00% vs 23.26%，P=0.036）。结论 抗链球菌溶血素O阳性为过敏性紫癜患儿复发的危险因素，通过加强对抗链球菌溶血素O阳性患儿的抗链球菌治疗可降低其复发率。     

川崎病静脉内注射丙种球蛋白治疗耐药的危险因素积分的临床意义

目的 探讨川崎病患儿大剂量静脉内注射丙种球蛋白(IVIG)耐药的危险因素积分的临床意义。方法 回顾性分析2009年至2014年收治的256例川崎病患儿的临床资料,通过IVIG耐药的危险因素加权积分,统计分析危险因素加权积分对IVIG疗效及冠状动脉损伤的影响。结果 与IVIG治疗有效的患儿相比,IVIG治疗无效的患儿具有更高的谷草转氨酶(AST)、谷丙转氨酶(ALT)、乳酸脱氢酶(LDH)、总胆红素和C反应蛋白(P均<0.05);相反,IVIG治疗无效的患儿血小板和血钠均降低(P均<0.05);危险因素积分 ≥3更容易发生IVIG治疗无反应(OR=10.470,P < 0.05);并且IVIG耐药的危险因素积分 ≥3的患儿更容易并发冠状动脉损伤(OR=7.941,P=0.003)。结论 IVIG耐药的危险因素加权积分可更好地预测川崎病患儿的IVIG无反应性和并发冠状动脉损伤情况。     

宜宾市6~12岁儿童阻塞性睡眠呼吸暂停低通气综合征患病情况及生活质量调查

目的 调查宜宾市6~12岁儿童阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患病情况,了解患病特征和OSAHS患儿生活质量,为OSAHS防治和开展健康宣教提供指导依据。方法 于2018年1~6月采用分层整群抽样方法,抽取宜宾市6~12岁儿童1 903例,采用Berlin问卷进行OSAHS初筛,初筛阳性儿童94例,纳入OSAHS组,1 825例正常儿童纳入非OSAHS组。对初筛阳性的儿童进行多导睡眠监测（PSG）确诊,了解OSAHS患病情况,将初筛阳性的儿童根据体型分为体型正常组（51例）和超重肥胖组（43例）,用睡眠呼吸障碍儿童生活质量问卷（OSA-18）量表评估两组患儿生活质量,分析不同体型患儿的PSG监测指标和生活质量的差异。结果 Berlin问卷初筛阳性94例,阳性率4.94%,男性高于女性,差异有统计学意义（P<0.05）,PSG确诊78例,OSAHS总体患病率4.10%。超重肥胖组呼吸暂停指数、低通气指数、呼吸暂停低通气指数、阻塞性呼吸暂停指数均高于正常体型组,而平均血氧饱和度和最低血氧饱和度均低于正常体型组,差异均有统计学意义（P<0.05）。OSAHS患儿体质指数、颈围、收缩压和舒张压均高于非OSAHS儿童（P<0.05）。超重肥胖组OSA-18总分,睡眠问题、情绪问题及日间问题3个维度高于正常体型组,差异有统计学意义（P<0.05）。结论 宜宾市6~12岁儿童OSAHS患病率约4.10%,超重肥胖者PSG指标和生活质量明显差于正常体型者,应重视健康教育和行为干预。     

Effects of stimulant medications on the EEG of children with attention-deficit/hyperactivity disorder

Abstract Rationale. Stimulant medications are the most commonly used treatments for attention deficit/hyperactivity disorder (ADHD) in North America and Australia, although it is still not entirely known how these medications work. Objectives. This study aimed to investigate the effects of stimulant medications on the EEG of children with the Combined subtype of ADHD. Method. An initial EEG was recorded during an eyes-closed resting condition and Fourier transformed to provide absolute and relative power estimates for the delta, theta, alpha and beta bands. Theta/alpha and theta/beta ratios were also calculated. Subjects were placed on a 6-month trial of a stimulant and a second EEG was recorded at the end of the trial. Results. The ADHD group had significantly greater absolute delta and theta, less posterior absolute beta, more relative theta, and less relative alpha than the control group, which is typical of EEG studies of children with ADHD. The use of stimulant medications resulted in normalisation of the EEG, primarily evident in changes in the theta and beta bands. Conclusions. These results suggest that stimulants act to increase cortical arousal in children with ADHD, normalising their brain activity. Electronic Publication     

Childhood trauma exposure in substance use disorder patients with and without ADHD

BackgroundChildhood trauma exposure (CTE) is frequently reported by those with substance use disorders (SUDs). SUDs also frequently co-occur with attention deficit hyperactivity disorder (ADHD).ObjectiveTo investigate the role of childhood trauma exposure (CTE) in the presence and the persistence of ADHD in treatment seeking SUD patients.MethodData was derived from the International ADHD in Substance Use Disorder Prevalence (IASP) study. A structured interview was administered to 1274 treatment-seeking SUD patients aged 18 to 65.ResultsCTE was present in 53.5% of the patients and comorbid adult ADHD in 14.1%. CTE was significantly associated with ADHD: the prevalence of adult ADHD with and without CTE was 19.4% and 8.5% (OR adjusted for age, gender, main substance of abuse, BPD, and ASPD 1.91 [95% CI 1.29–2.81]). CTE was not associated with the severity of adult ADHD or with the persistence of childhood ADHD into adulthood.ConclusionsCTE is common in SUD patients and associated with adult ADHD but not with the persistence of childhood ADHD into adulthood. These findings suggest that the increased rate of adult ADHD in SUD patients with CTE is not the consequence of a negative effect of CTE on the persistence of childhood ADHD into adulthood, but a direct expression of the high rate of childhood ADHD in SUD patients with CTE.     

Review of lisdexamfetamine dimesylate in children and adolescents with attention deficit/hyperactivity disorder

Abstract

Objective

Lisdexamfetamine dimesylate is a stimulant prodrug with low abuse and diversion potential that is used in treatment of attention deficit hyperactivity disorder (ADHD) in children, adolescents and adults. This current literature review article aims to examine safety and efficacy of LDX in children and adolescents for the treatment of ADHD based on currently available data.     

小儿智力糖浆对儿童注意缺陷多动障碍疗效分析

目的观察小儿智力糖浆治疗儿童注意缺陷多动障碍的临床疗效。方法将39例轻中度多动症儿童应用小儿智力糖浆进行为期3个月一个疗程的治疗。结果治疗后儿童在品行、冲动多动、多动指数方面有显著疗效(P<0.01),另反应控制商、注意商也表现出显著进步(P<0.01)。结论小儿智力糖浆治疗轻中度儿童多动、注意力缺陷症疗效明显。     

Background,clinical features and treatment of attention deficit hyperactivity disorder in children

Introduction: Attention deficit hyperactivity disorder (ADHD) is an early onset, clinically heterogeneous, complex neurobiological disorder, defined by symptoms of inattention and hyperactivity/impulsivity and has been associated with a broad range of impairments for those affected. Additionally, ADHD in children and adolescents is frequently associated with psychiatric comorbidities. This review provides an overview of the epidemiology, neurobiology, genetics, diagnosis and most recent pharmacological approaches for treatment with a focus on safety and efficacy and describes the use of medications used to treat ADHD in special populations.

Areas covered: PubMed, Cochrane database, Essential Evidence and Uptodate were searched for relevant articles about stimulant and non-stimulant pharmacological approaches in ADHD.

Expert opinion: Data supporting the safety and efficacy of both stimulant and non-stimulant formulations have significantly grown over the past decade and more efforts are being made to tailor medications to the needs of the patients and their families. Pharmacogenomics research is evolving, but predictors of treatment response and side effects remain largely unknown. Other unmet clinical needs include long-term follow-up studies of the safety and efficacy of medications for those with ADHD alone, or with comorbidities and in special populations including preschoolers.     

小儿黄龙颗粒对注意缺陷多动障碍亚型的疗效分析

目的:探讨小儿黄龙颗粒对注意缺陷多动障碍(ADHD)不同亚型的治疗效果。方法:回顾性分析2018年12月至2020年10月江西省儿童医院诊治的90例注意缺陷多动障碍患儿临床资料,根据注意缺陷多动障碍亚型不同进行分类,将注意力障碍为主型的患儿纳入A组(n=30)、将多动/冲动型患儿纳入B组(n=30)、将混合型患儿纳入C组(n=30)。比较三组治疗前、治疗8周后症状(采用SNAP-Ⅳ评定量表)、临床疗效[采用Conners简明症状问卷(ASQ)]及中医证候主症积分。结果:治疗后,三组SNAP-Ⅳ症状评分、ASQ评分均较治疗前降低,差异有统计学意义(P<0.05);三组神思涣散、多动不宁、性急易怒、多言多语评分均较治疗前降低,差异有统计学意义(P<0.05)。结论:小儿黄龙颗粒对各分型ADHD患儿均有一定疗效,可显著改善患儿临床症状,降低中医证候主症积分。     

Attention Deficit/Hyperactivity Disorder (ADHD) Symptoms Predict Alcohol Expectancy Development

ABSTRACT

Objective: Positive alcohol expectancies and attention deficit/hyperactivity disorder (ADHD) are independent risk factors for adolescent alcohol problems and substance use disorders. However, the association of early ADHD diagnostic status, as well as its separate dimensions of inattention and hyperactivity, with alcohol expectancies is essentially unknown. Method: At baseline (i.e., Wave 1), parents of 139 6- to 9-year-old children (71% male) with (N = 77; 55%) and without (N = 62; 45%) ADHD completed structured diagnostic interviews of child psychopathology. Approximately two years later (i.e., Wave 2), children completed a Memory Model-Based Expectancy Questionnaire (MMBEQ) to ascertain their positive and negative expectancies regarding alcohol use. All children were alcohol naïve at both baseline and follow-up assessments. Results: Controlling for age, sex, IQ, as well as the number of Wave 1 oppositional defiant disorder (ODD) and conduct disorder (CD) symptoms, the number of baseline hyperactivity symptoms prospectively predicted more positive arousing (i.e., MMBEQ “wild and crazy” subscale) alcohol expectancies at Wave 2. No predictive association was observed for the number of Wave 1 inattention symptoms and alcohol expectancies. Conclusions: Childhood hyperactivity prospectively and positively predicted expectancies regarding the arousing properties of alcohol, independent of inattention and ODD/CD symptoms, as well as other key covariates. Even in the absence of explicit alcohol engagement, youths with elevated hyperactivity may benefit from targeted intervention given its association with more positive arousing alcohol expectancies.     

沙盘游戏治疗注意缺陷多动障碍儿童的临床价值研究

目的探讨沙盘游戏对注意缺陷多动障碍(ADHD)儿童的治疗价值及临床意义。方法68例ADHD患儿,根据治疗意愿不同分为研究组与对照组,各34例。研究组进行为期12周的沙盘游戏治疗,对照组不接受沙盘游戏治疗。比较两组治疗前后Conners父母症状问卷(PSQ)评分、Achenbach儿童行为量表(CBCL)评分。结果治疗后,对照组品行问题、学习问题、心身障碍、冲动-多动、焦虑、多动指数评分与治疗前比较差异无统计学意义(P>0.05);研究组冲动-多动、焦虑、多动指数评分均低于治疗前,差异有统计学意义(P<0.05);研究组冲动-多动、多动指数评分低于对照组,差异有统计学意义(P<0.05)。治疗后,研究组CBCL总粗分(44.18±8.97)分、社交退缩(2.18±0.88)分、攻击(9.53±8.15)分、违纪(2.24±2.76)分均低于治疗前,且均低于对照组的(50.19±6.53)、(3.13±0.98)、(14.24±8.82)、(4.41±2.93)分,差异有统计学意义(P<0.05)。结论沙盘游戏治疗能改善ADHD儿童的焦虑情绪及注意缺陷、多动冲动等行为,可作为ADHD儿童综合治疗方案的非药物治疗措施。     

The impact of digital interventions on medication adherence in paediatric populations with attention deficit hyperactivity disorder,depression, and/or anxiety: A rapid systematic review and meta-analysis

BackgroundThe growing prevalence of mental health disorders in children and adolescents coupled with poor medication adherence in the paediatric population is a major problem within healthcare systems affecting patient outcomes. Digital health interventions (DHIs) are primed to optimise medication adherence given the expansion of digital health markets and the increased usage of digital technologies by children and adolescents.ObjectiveThis rapid systematic review evaluates the impact of DHIs on optimising medication adherence amongst children and adolescents with mental health disorders compared to treatment as usual (TAU).MethodsA rapid systematic search in electronic databases CINAHL Plus, Cochrane Library, MEDLINE, PubMed, and Scopus was conducted. The scope of the rapid systematic search included randomised controlled trials and quasi-experimental studies (non-randomised controlled trials) evaluating DHIs optimising medication adherence in children and adolescents with attention deficit hyperactivity disorder (ADHD), depression and/or anxiety. Meta-analyses were conducted based on estimating pooled odds ratio (OR) and mean difference (MD) with 95% confidence interval using a random-effects model. Thematic analysis identified key avenues DHIs offer to optimise medication adherence.ResultsFour studies were found, with 502 participants included in the meta-analysis. An improvement in medication adherence was observed following DHIs for studies measuring dichotomous and continuous outcomes. However, the effect was not significant for the former. DHIs were shown to help bridge the gaps between patients and healthcare professionals, allowing for more frequent monitoring, communication, and assessments.ConclusionsMedication adherence amongst children and adolescents with acute or chronic ADHD, anxiety or depression may be positively impacted by DHIs, but better-powered studies with a lower risk of bias are necessary. The evidence currently remains inconclusive on DHIs improving medication adherence in children and adolescents.     

托莫西汀联合脑电生物反馈治疗儿童注意缺陷多动障碍疗效观察

目的：研究托莫西汀联合脑电生物反馈治疗儿童注意缺陷多动障碍（ADHD）的疗效。方法：对46例ADHD惠儿给予托莫西汀与脑电生物反馈治疗4个月,于治疗前后详细记录患儿注意力商数与反应控制商数中视觉、听觉商数以及进行Conners儿童行为量表父母问卷并进行评估。结果：与治疗前比较,观察组注意力商数与反应控制商数中视觉、听觉商数较治疗前明显升高,差异有统计学意义（P〈0．05）;Conners量表评分较治疗前均明显下降,差异有统计学意义（P〈0．05）。与对照组比较,治疗后注意力商数与反应控制商数中视觉、听觉商数差异均无统计学意义（P〉0．05）;治疗后Conners量表评分在多动指数、学习问题、冲动一多动、品行问题等4个方面差异均无统计学意义（P〉0．05）,而在心身障碍、焦虑两个方面评分明显下降,差异有统计学意义（P〈0．05）。结论：托莫西汀联合脑电生物反馈治疗ADHD可以更好的改善患儿的注意缺陷、多动和冲动等核心症状。