8号头皮针胫骨穿刺18例

目的 探索一种安全、有效、方便、创伤小的骨髓穿刺方法.方法 我们于2004年至2005年选择有骨髓穿刺适应症的0～5岁患儿18例,用8号头皮针在胫骨粗隆下0.5～1.0cm内侧进行穿刺,抽取约0.1ml骨髓化验.结果 18例中,有16例抽取骨髓相当顺利,有2例需稍作旋转或稍退出穿刺针才抽取出骨髓,18例取材良好,术中及术后穿刺部位均无明显出血情况及其他不良反应.结论 用8号头皮针在胫骨骨穿简捷、安全、创伤小、取材好,值得在0～5岁的患儿推广应用,有望成为一种新的骨穿方法.     

9号头皮针胸骨骨髓穿刺54例体会

目的　探讨头皮针代替传统骨穿针行小儿胸骨骨髓穿刺方法的效果。方法　比较应用头皮针行胸骨穿刺 (新方法 )与传统的骨髓穿刺 (旧方法 )的成功率、取材满意率、疼痛时间。结果　新方法组成功率、取材满意率均为 10 0 % ,疼痛时间 2 .30± 0 .38h ,旧方法组成功率 88.5 % ,取材满意率 88% ,疼痛时间 2 3.0 5± 1.0 2h。结论　新方法组的成功率 ,取材满意率均高于旧方法组 ,疼痛时间短于旧方法组 ,两组差异有统计学意义 ,因此此方法值得推广应用。     

应用带针芯小儿头皮针进行小儿胸骨骨髓穿刺30例报告

自１９９７年１月以来我们应用带有针芯７号小儿头皮针连接５ｍｌ一次性灭菌注射器代替传统的小儿骨穿针行小儿胸骨骨髓穿刺３０例,无一例发生意外及局部感染,成功率９６．６％,现报告如下：资料与方法１．临床资料本文３０例为我院儿科门诊或住院患儿,其中男１７例,女１３例。年龄１０个月至１２岁。疾病分类：血小板减少性紫瘢７例,白血病１２例,再生障碍性贫血４例,营养性贫血４例,粒细胞减少、地中海贫血、骨肿瘤各１例。２．骨穿用具：７号头皮针一条,７号腰穿针芯一条（经剪短其长度与７号头皮针相等）,５ｍｌ无菌一次性注…     

造血器官及血液疾病

970268 223例小儿骨髓穿刺涂片及组织活检对血液病诊断价值的对比分析/区小冰…//广东医学一1996,17(2)一95一96 年龄从2个月一14岁,男141例,女82例。穿刺部位大部分为骼骨,少数胫骨。使用骨穿活检两用针取材、制备切片、HE染色后镜检。必要时作特殊染色及单克隆免疫组化。骨髓涂片经常规染色后镜下进行细胞分类检查。必要时作组织化学染色及单克隆抗体检查。结果:骨穿涂片确诊100例,诊断率为93 .5%。活检确诊192例,诊断率为90.1%。两者诊断一致有172例,占84 .3%,不一致32例,占巧.7%。骨髓涂片联合活检确诊221例,两者结合诊断率为99.1%。从…     

应用小儿头皮针进行小儿胸骨骨髓穿刺200例报告

应用小儿头皮针进行小儿胸骨骨髓穿刺２００例报告中国医科大学附属第二医院儿科（１１０００３）董文翰郝良纯程杰沈阳铁路局沈阳医院儿科李力平鞍山市鞍钢立山医院儿科赵文娟自１９９５年以来，我们应用７号小儿头皮针连接５ｍｌ一次性灭菌注射器，代替传统的骨穿针行小...     

小儿骨髓穿刺术的改进

我院儿科自1988年12月至1990年5月对50例患儿采用了较细的头皮针进行骨髓穿刺,取得了满意效果,现报道如下。临床资料50例中年龄2个月～12岁,根据年龄大小,采用6、7、8号头皮针。选择部位有:脊突、髂前上棘及髂后上棘,对50例患儿穿刺58次,其中     

小儿再障骨髓细胞形态学特点

再生障碍性贫血 (再障 )是一种以骨髓造血功能衰竭为主要表现的难治性血液病。骨髓细胞学检查是诊断再障的重要检测方法之一。现将我科近两年来 5 8人 81例次小儿再障、2 4例正常对照骨髓细胞形态学检查结果分析如下。对象和方法一、对象 :再障组 (Ⅰ组 ) :5 8人 (男 4 0人 ,女 18人 ) ,年龄 1～ 12岁 ,均符合全国再障诊断标准[1] 。对照组 (Ⅱ组 ) :无影响血液系统疾病且年龄匹配的同期住院患儿 2 4人(男 19人 ,女 5人 )。二、方法 :两组患儿入院后 ,均以头皮针穿刺取材。穿刺点选择胸骨、脊突、髂前或髂后上棘。抽吸骨髓约 0 .2ｍｌ涂片。…     

头皮针骨穿法与传统骨穿法的比较

传统的骨穿如髂后上棘穿刺,由于有损伤大、费时、骨髓易稀释或凝固、患儿不易接受等缺点。因此,我们采用头皮针腰椎棘突穿刺（简称改良法）,与用16号骨穿针骼后上棘穿刺（简称传统法）进行比较,现报告如下。对象与方法一对象1996年6月～1997年9月在本院儿科行骨髓穿刺的病人二共212例次,随机行改良法（110例次）和传统法（102例次）。其中男127例次,女85例次。1a以下（最小7d）10例次;～3a27例次;～6a78例次;～9a67例次;～14a30例次。二、方法1．改良法操作步骤及注意点：取腰穿时体位,取腰椎最突出棘突为穿刺点。常规消毒、铺巾…     

应用自体骨髓骨膜移植修复小儿良性骨肿瘤切除后骨缺损

本文介绍一种应用自体游离骨骨膜复合移植 ,修复小儿四肢良性骨肿除后骨缺损的新方法。资料与方法1997年 1月～ 1999年 6月 ,临床应用自体骨髓骨膜移植 11例 ,男 8例 ,女3例。年龄 4～ 14岁。肿瘤分类 :骨纤维异常增殖症 7例 ,骨囊肿 3例 ,动脉瘤样骨囊肿 1例。其中 2例为其他方法治疗后复发的患儿。肿瘤部位 :股骨上段5例 ,肱骨中上段 3例 ,胫骨上段 2例 ,股骨下段 1例。病灶清除后腔洞性骨缺损范围 :5 .0～ 7.0ｃｍ× 3.5～ 4.0ｃｍ×2 .0～ 3.0ｃｍ。无菌条件下 ,用 12号骨穿针在髂前或髂后部位穿刺 ,抽取骨髓备用。抽取骨髓量在 2 0～ 3…     

使用一次性注射器或头皮针进行小儿骨髓穿刺

目的探讨新的骨髓穿刺方法，减轻小儿的不良反应。方法对73例具有骨髓穿刺适应证，并征得家长同意小儿进行胸骨椎体使用一次性5ml空针或7ml头皮针进行骨髓穿刺。结果均获成功，无不良反应。结论此方法简单易行。     

Dzieci jako dawcy szpiku

Donors are key component in transplantation. There are no transplantations without donors. As in any medical procedure, donors are subject to risk of medical complications. An increasing number of stem cell transplantations is observed continuously. In the middle of 2013, a total number of almost 22 million unrelated donors have been registered worldwide, including 440 thousand Polish citizens. In 2012, the ratio of transplants from Polish donors reached 50% among all unrelated transplants performed in our country. Before the stem cell collection, the donor has to be assessed for risk of disease transmission to recipient, safety of stem cell collection for donor and full understanding of stem cell donation. There are 2 methods of stem cell collection: bone marrow harvest and peripheral blood stem cell apheresis. Bone marrow harvest is a standard of care in children, while peripheral blood stem cell collection in adults. Donation of stem cell is a safe procedure for donor. Nevertheless, mild adverse events are relatively frequent, however disappearing in most cases within several days after the collection. The number of requests for stem cell donation is increasing, also for the second or third donation from the same donor. It results in growing medical experience and donors’ safety. Although medical progress and standards of patients care contribute to systematic decrease of adverse events for donors, the risk still exists. This should not be the reason for anyone to withhold an agreement for stem cell donation for the sick patient waiting for stem cell transplantation. This analysis presents new insight on safety and prophylaxis of risk of adverse events in children undergoing bone marrow harvest.     

Safe and efficacious use of procedural sedation and analgesia by non-anesthesiologists in a pediatric hematology-oncology unit

BACKGROUND: Children often require relief of pain and anxiety while undergoing diagnostic and therapeutic procedures. Procedural sedation and analgesia (PSA) is the safe and effective control of pain, anxiety and motion so as to allow a necessary procedure to be performed and to provide an appropriate degree of memory loss or decreased awareness. OBJECTIVE: To prospectively describe procedural sedation and analgesia as performed in the pediatric oncology unit and to report the success of sedation and the incidence of complications. METHODS: IV Midazolam and IV Ketamine were used for PSA in pediatric oncology patients undergoing painful procedures. RESULTS: Between June 2004 and December 2004, 55 diagnostic and therapeutic procedures were performed using PSA in 16 children. There were 9 boys and 7 girls with a median age of 11 years. Twelve patients had hematolymphoid malignancies and 4 patients had solid tumors. The indication for PSA were bone marrow aspiration and or biopsy in 7 patients, therapeutic lumbar puncture in 43 patients, bone marrow aspiration and lumbar puncture in 4 patients and skin biopsy in 1 patient. All 55 procedures were successfully completed. Adverse events occurred in 15 (27%) episodes and included transient drop in oxygen saturation, vomiting, dizziness and disinhibition with crying spells. Average time to arousable state and full recovery was 22 minutes and 31 minutes respectively. None of the patients complained of post procedure pain nor recalled the procedure at the follow up visit. CONCLUSION: Procedural sedation and analgesia using midazolam and ketamine is a safe and efficient method of limiting anxiety and procedure related pain and can be successfully administered by non-anaesthesiologists. The complication rate is low and can be easily managed.     

Needle aspiration for suppurative cervical lymphadenitis

In a 10-year prospective study, we used needle aspiration as the treatment of suppurative cervical lymphadenitis that required drainage procedure in 35 consecutive children aged 4 months to 13 years (mean 2.2 years). Twenty-seven patients underwent 1 puncture, 7 patients had 2 punctures, and 1 had 3 punctures. There were no major complications. Patients were followed up for 2-6 months. None required an open drainage of the cervical abscess. There was complete regression of the nodes in all patients within 21 days, with no relapse or scar formation. Needle aspiration seems to be an effective and safe treatment of suppurative cervical lymphadenitis that may avoid open drainage.     

Tissue expansion for correction of baldness in aplasia cutis congenita

Aplasia cutis is a congenital absence of the skin, usually presenting on the scalp. In 20% of all cases, part of the skull is also absent. A residual area of baldness may still be present some years after surgical or conservative treatment. It is possible to excise the scarred hairless region and cover that area with expanded hair-bearing skin from the rest of the skull. We present three patients who underwent tissue expansion and discuss the indications and pitfalls of this procedure. Conclusion: Tissue expansion can be used to cover a residual alopecia defect in young children with aplasia cutis congenita and associated bone abnormalities. The quality of the bone appears to be normal in our three patients. We demonstrate that even in young children with aplasia cutis and an underlying bony defect, tissue expansion is a safe and effective modality as a second stage reconstruction procedure.     

超声引导下经皮穿刺无水酒精注射治疗儿童单纯肾囊肿

目的 探讨超声引导下经皮穿刺尤水酒精注射治疗儿童单纯性肾囊肿的疗效.方法 我院采用超声引导下经皮穿刺尤水酒精注射治疗14例单纯性肾囊肿患儿(男6例.女8例).术后随访1～24个月,观察患儿症状改善情况,并复查B超.结果 14例患儿治疗1个月后囊肿体积均较治疗前减少;治疗6个月后,7例患儿8个囊肿完全消失.3例体积缩小50%以上;治疗12个月后,10例患儿11个囊肿完全消失.2例体积缩小50%以卜.随访期问.患儿的症状均得到不同程度的缓解.结论 对于有症状的儿童单纯性肾囊肿,超声引导下经皮穿刺无水洒精注射治疗具有安全、有效、经济和微创的特点.     

Anesthesia for diagnostic and therapeutic procedures in pediatric outpatients

Appropriate sedation of pediatric oncology patients during painful diagnostic and therapeutic procedures is a recognized problem. At the Memorial Sloan-Kettering Cancer Center the pediatric oncologists and anesthesiologists have developed a cooperative program that has provided safe and effective sedation of outpatients. The experience with 100 consecutive outpatients is reported. Patients ranged from 3 months to 17 years of age. Procedures included lumbar puncture and/or intrathecal chemotherapy, multiple bone marrow aspirations, bone marrow biopsies, and removal of indwelling central vein catheters. Monitoring of patients during the procedures as well as various pharmacologic techniques to provide adequate working conditions are described.     

Opiates

Children experience pain as a direct result of injuries (eg, burns, sprains, fractures), medical illness (eg, sickle cell anemia), and medically required procedures (eg. lumbar puncture, bone marrow biopsy). In addition, medical procedures needed to correct an injury (eg, burn debridement, fracture reduction, wound irrigation mud repair) may cause a great deal of pain and anxiety as well. It has been shown that with similar injuries and for similar procedures, children receive far less medicine for pain than adults, and younger children receive the least of all. Fortunately, opiates are very effective for analegsia, and in combination with a benzodiazepine, they can be effective for pain relief, anxiolysis, and sedation for painful procedures. With proper monitoring, side effects can be detected early and interventions can be initinted before significant cardiac or respiratory compromise occur. Thus, opiates (alone or in combination with a benzodiazepine) are very useful and safe medications for the relief of pain and discomfort associated with injuries, medical illnesses, and invasive procedures.     

Post-dural puncture headaches in children. A literature review

Post-dural puncture headache (PDPH) is a well recognised complication of spinal and epidural anaesthesia. It can also occur after diagnostic or therapeutic lumbar puncture. Few cases have been reported in children. We reviewed the literature regarding definition, aetiology, incidence, risk factors, prevention and treatment, in order to provide some recommendations. Significant factors include age, gender, needle diameter, needle tip design, orientation of the tip during puncture, previous PDPH, history of migraine and repeated attempts to achieve puncture. There is no evidence for the use of increased fluids or bed rest to prevent PDPH. Once the diagnosis is made, conservative therapy is recommended for 48 h. Persistent PDPH can be treated in several ways; an epidural blood patch is one of the most effective methods. CONCLUSION: occurrence of post-dural puncture headache after lumbar puncture in children is rare. There are conflicting data about risk factors, prevention and treatment.     

甲状腺细针吸取细胞学检查对儿童甲状腺疾病的诊断价值

目的探讨细针吸取细胞学检查对儿童甲状腺疾病诊断的价值。方法甲状腺肿大患儿１６例，男２例，女１４例，用细针吸取甲状腺组织，放在玻片上经特殊染色后，于光学显微镜下观察细胞形态学的改变。结果１６例患儿共行２０次穿刺，１９次为一次穿刺成功。于光学显微镜下直接作出细胞组织学的诊断。２０次穿刺均无不良反应。结论细针吸取细胞学检查的方法同样可应用于儿童甲状腺疾病的诊断，而且这种方法操作简便，安全。