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儿童保健医学诊断与治疗进展主要体现在健康评价、流行病学调查、早期诊断与干预等方面。本文从儿童生长发育、心理行为及疾病筛查等几个方面予以综述。1生长发育评价儿童生长发育主要应用物理学、生化学、生理学等指标。我国儿童体格生长发育呈长期增长趋势。学龄前儿童生长发育状况调查表明,儿童体格生长与地域、经济状况等因素有关。城区儿童生长发育好于农村,经济发达地区好于经济落后地区。但有些地区农村儿童身高、体重、坐高的增长幅度高于城市儿童,说明农村儿童体格生长处于长期变化阶段,反映出农村经济发展、卫生条件和教育文化的…     

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近年来儿童保健医学在与许多学科交叉的领域取得了较大的进展,特别是与内分泌学科及神经心理学科交叉的领域进展迅速。1儿童单纯性肥胖儿童单纯性肥胖已经成为危害儿童生存质量的重要疾病。近年来,肥胖相关的胰岛素抵抗-代谢综合征和如何干预儿童肥胖、预防成年疾病成为关注的重点。1.1肥胖-胰岛素抵抗-代谢综合征代谢综合征是以胰岛素抵抗为特征的疾病,主要表现为肥胖、高血压、血脂异常、高血糖和胰岛素抵抗。目前无论是从代谢综合征角度研究肥胖,还是从肥胖的角度研究代谢综合征,都有证据表明肥胖与胰岛素抵抗-代谢综合征密切相关。孙文…     

Transition to adult care in sleep medicine

More children with chronic and complex care needs are transitioned to adulthood due to advancements in medical technology including the use of non-invasive ventilation [NIV] at home and innovative medical therapies. Sleep medicine is becoming a common and at times vital component of the management plan. Various challenges are experienced in transitioning sleep patients depending on the underlying condition. These include the direct conflict between the desires of a young person for independence and their declining ability to provide self-care in neuromuscular patients, the behavioural challenges inherent in the management of children with various syndromes and the funding of equipment, care needs and multidisciplinary team input in an already resource limited adult setting. These patients should be transitioned in an early and coordinated approach following core principles of transition. Ongoing advocacy is required to raise awareness of the increased trend for technology supported young people being transitioned. Further research is required to track and assess the transition process in patients with various sleep conditions.     

Choosing a volume expander in critical care medicine

The debate concerning the choice of crystalloids or colloids for resuscitation of the critically ill child is still unsettled. Moreover, the use of albumin in critically ill patients has been increasingly questioned because of the lack of clear-cut advantages over crystalloids as well as the concern for cost and the very minor risk of infection. Despite several meta-analyses addressing these issues, there is no data that supports the use of albumin unequivocally in any specific disease states. The suggestion that the use of albumin increases mortality in critically ill patients is not supported by data. There may be niche areas such as hypoalbuminic states, cirrhosis and burns where albumin may have distinct benefits. Alternatively synthetic colloids may be useful, however, concerns about coagulation problems and organ dysfunction persists.     

Renal replacement therapy in pediatric critical care medicine

PURPOSE OF REVIEW: The use of continuous renal replacement therapy in pediatric critical care has increased in the last 10 years. Adaptive makeshift machinery has been replaced with dedicated volumetric and/or gravimetric devices that afford accurate blood flow and ultrafiltrate production rates. While renal dysfunction continues to be related to primary renal disease, the incidence of secondary causes of acute renal failure continue to grow, especially in patients following cardiothoracic surgery, bone marrow transplantation, respiratory failure and multi-organ dysfunction syndrome. RECENT FINDINGS: Although much of the outcome data for continuous renal replacement therapy has been retrospective in nature, these therapies are safe for use in the sickest of intensive care unit patients. Moreover, early data from the prospective pediatric continuous renal replacement therapy registry suggests that early intervention with continuous renal replacement therapy, as well as goal-directed fluid resuscitation may lead to improved survival in critically ill patients. In patients with sepsis and septic shock, continuous renal replacement therapy offers a means for blood purification. SUMMARY: Though randomized placebo controlled trials are lacking at this time, center-based results suggest that continuous renal replacement therapy may prove beneficial to critically ill patients with sepsis and/or septic shock.     

Palliative care and paediatric respiratory medicine

Progressive respiratory failure is a common modality of death in children with a terminal illness. The management of respiratory failure, and in particular symptoms of dyspnoea and musculoskeletal chest pain in children receiving palliative care, remains challenging. The emergence of palliative care paediatricians and the application of non-invasive ventilation to children with progressive respiratory failure are the two major advances in the care of children with respiratory complaints in the palliative care setting. This article outlines current approaches to palliative care in children with progressive respiratory symptoms.     

Opportunities and challenges in linking information across databases in pediatric cardiovascular medicine

Multicenter databases are increasingly utilized in pediatric cardiovascular research. In this review, we discuss the rational for using these types of data sources, provide several examples of how large datasets have been utilized in clinical research, and describe different mechanisms for linking databases to enable studies not possible with individual datasets alone.     

儿童保健医学进展

儿童保健医学是促进儿童生长和维护儿童健康 ,保障儿童生命质量和生活质量的医学学科。为促进医学信息的交流和儿童保健医学的发展 ,本文就 2 0 0 2年我国儿童保健医学的主要进展作一简述。1　生长发育生长发育是儿童期基本的生命现象 ,是一个连续、动态的发展过程。现阶段 ,我国儿童生长发育水平的地区不平衡性仍较明显。北京市双榆树地区 0～ 3岁婴幼儿的年龄别体重 (WFH )、年龄别身高 (HFA)的均值及其增长值与WHO的标准值基本一致。刘黎明等的研究表明 ,农村 0～18个月婴幼儿的WFA、HFA、身高别体重 (WFA)的Z值随年龄的增长呈下…     

Critical care of the pediatric hematopoietic stem cell recipient in 2005

Abstract:  Among the most challenging patients cared for in critical care medicine are the recipients of hematopoietic stem cell transplantation (HSCT). HSCT is now widely used as a definitive therapy for the treatment of pediatric malignancies and inborn errors of metabolism. Critical care services are required for treatment of complications of HSCT. Formerly thought to have an essentially futile prognosis, outcomes from critical care of HSCT patients have demonstrated steady improvement in many areas during the past two decades. Improvements in the management of respiratory failure, sepsis, and multiple organ system failure have resulted from improvement in oncology and critical care practices. Herein, we review the methods available for outcomes prediction, recent advances in critical care of HSCT patients, and possible directions for future investigation.     

A history of pediatric critical care medicine

Critical care medicine developed out of other subspecialties' need to provide care for their most critically ill patients. Advanced technologies, the understanding of the pathophysiology of critical illness, and the development of the multidisciplinary team have made this care possible. Pediatric critical care medicine emerged in the 1960s and has expanded dramatically since then. The field has made major advances in the areas of lung injury, sepsis, traumatic brain injury, and postoperative care. We review here the evolution of modern pediatric critical care medicine from its roots in general pediatric and cardiac surgery, adult respiratory care medicine, neonatology, and pediatric anesthesiology to its current state as a unique discipline.     

小儿心脏性猝死的预防与急救处理

心脏性猝死可突然发生在任何时候，较难预测，对心脏性猝死的预防目前尚十分有效的措施，但严密监测高危人群，及时发现并及时正确的施救，有助于提高心搏骤停儿童的存活率。     

Psychosocial care in medicine and the social code V]

Principles of psychosocial care in medical settings are outlined and will be critically compared with those lawful clinical services, which are well-established and described in the amendment on legal health insurance. This comparison reveals conceptual differences between the integrative and interdisciplinary approach of psychosocial care on the one hand, and the conventional approach on the other, which ins presupposed compulsory by the amendment. Arguments in favour of psychosocial care as a legal part of public health insurance should refer to sections section 70 (2), section 112 (2), section 43 (2), section 40 and section 119 of the amendment. Nevertheless these arguments will remain dependent on benevolent consent.