婴幼儿腹部手术后切口裂开的处理

1998年 1月～ 2 0 0 0年 6月我科共行婴幼儿腹部手术10 2 8例 ,术后切口裂开 7例 ,总结如下。临床资料一、本文 7例中重症幽门狭窄 2例 ,胆道闭锁、十二指肠狭窄梗阻并肠旋转不良、新生儿巨结肠危象、肠套叠并肠坏死、高位无肛行腹会阴肛门成形术各 1例。月龄 1ｄ～ 6个月 ,发生在术后 3ｄ 4例 ,术后 5ｄ 1例 ,术后 7ｄ 2例。二、裂开原因　全身原因 :1.慢性营养不良、血浆蛋白低 ,切口组织持续水肿而影响愈合。 2 .各种维生素缺乏 ,影响物质代谢和组织的修复和愈合。 7例均有低蛋白血症 ,营养情况较差。局部原因 :1.切口感染。本组有明显感…     

婴幼儿阑尾炎的特点分析

婴幼儿阑尾炎发作时缺乏典型的病史及腹部体征,易误诊或漏诊,给临床诊断和治疗带来困难。本文旨在通过分析近6年28例婴幼儿阑尾炎的临床特点,以期进一步提高婴幼儿阑尾炎的诊     

新生儿原发性肠套叠临床诊治特点浅析

肠套叠是婴幼儿最常见的急腹症之一,好发于4~10个月婴儿,临床诊断相对明确,有关新生儿原发性肠套叠的报道很少。本文对新生儿原发性肠套叠的临床诊治经过进行回顾性分析,探讨新生儿原发性肠套叠的临床诊治特点,现报道如下。1资料和方法对1995~2004年我院收治的5例新生儿原发性肠套叠的出生史,临床症状与体征、客观检查、治疗方法、手术所见及临床诊治经过进行回顾性分析。其中男3例,女2例,最小年龄4 d,最大17 d,平均体重3·8 kg。回顾内容包括:出生史,临床症状与体征,客观检查以及治疗方法及手术所见。2结果5例患儿中,有窒息或宫内窘迫病史2…     

婴幼儿巨细胞病毒感染的临床特点及转归

目的研究巨细胞病毒(CMV)感染住院婴幼儿的临床发病特点及疾病转归。方法对符合CMV感染的87例婴幼儿从感染CMV后的发病时间,CMV侵袭器官所致器官相应损害的临床发病类型,实验室及相关影像学检查包括头颅B超,胸部X线及脑干视、听觉诱发电位检查及疾病转归进行综合分析。结果87例CMV感染婴幼儿中先天性CMV感染占27.6%,围生期CMV感染占62.0%,生后CMV感染占16.6%;CMV肝炎是最常见的临床类型,发生率为41.3%,其中脾大发生率10.3%,多数患儿预后好,好转率80.5%;中枢神经系统异常的发生仅见于先天性和围生期感染患儿,本组神经系统异常发生率20.4%;先天性CMV感染中全身性感染占16.7%,围生期全身性感染占1.8%,生后感染者无全身性感染发生;先天性CMV感染的死亡率12.5%,围生期感染的死亡率1.85%。结论CMV感染是导致婴幼儿肝炎综合征的重要原因,是造成婴幼儿神经系统后遗症不可忽视的因素;先天性CMV感染中全身性感染病死率高,预后差。     

新生儿腹壁切口完全性裂开的临床分析

目的探讨新生儿腹壁切口完全性裂开的病因、预防及治疗措施。方法回顾性分析本院2009年6月至2015年6月收治的211例新生儿开腹手术临床资料,其中5例发生腹壁切口完全性裂开,日龄2～28 d,体重1.9～3.5 kg,男性4例,女性1例,足月儿3例,早产儿2例,横切口2例,纵切口3例。5例均为消化道疾病的手术,其中小肠造瘘术2例,肠切除肠吻合术1例,肠修补术1例,ladd及阑尾切除术1例。结果 211例新生儿开腹手术患儿中,发生切口完全性裂开5例,切口裂开率为2.4%,且均为消化道疾病。1例肠造瘘及肠吻合、修补术患儿第1次手术中有肠内容物污染腹腔;1例行ladd及阑尾切除术患儿再次缝合切口时腹腔探查见结扎阑尾的线头脱落,腹腔内可见脓性分泌物,但未见阑尾残端瘘。5例患儿经扩创再缝合后全部治愈,无再裂开现象发生,无死亡病例。术后随访6～12个月无切口疝,切口愈合良好。结论新生儿腹壁切口完全性裂开是剖腹手术后一种严重的并发症,发生后需紧急处理。避免新生儿腹壁切口完全性裂开主要在于提高认识,积极预防,减少诱发因素。     

婴幼儿多发性大动脉炎14例临床特点分析

目的通过分析总结14例婴幼儿多发性大动脉炎(TA)的临床特点,并结合文献复习总结,以提高对该病的认识及诊疗水平。方法回顾性分析2016年7月至2019年5月在首都儿科研究所附属儿童医院住院的TA婴幼儿的临床资料及随访情况,并结合文献,分析总结该病的临床特点。结果14例患儿年龄为1个月23 d^28个月,男6例,女8例。临床表现中最常见的是发热[10例(71.4%)],高血压9例(64.3%),脉弱或无脉5例(35.7%)。按照病变血管部位的临床分型,广泛型11例(78.5%),头臂动脉型3例(21.4%),本组患儿无胸腹主动脉及单纯肺动脉型。14例TA患儿中,12例有颈总动脉、颈动脉、锁骨下动脉及冠状动脉及其分支(前降支、回旋支)受累(85.7%);11例肾动脉受累(78.6%);9例腋动脉受累(64.2%);8例腹主动脉受累(57.1%);6例降主动脉受累(42.9%);6例胸主动脉受累(42.9%);6例肠系膜上动脉受累(42.9%);5例股动脉受累(35.7%);5例肺动脉受累(35.7%);4例肱动脉受累(28.6%)。14例患儿中,误诊11例,诊断不清3例,误诊时间为18 d^2个月。误诊病例中,8例误诊为不典型川崎病。14例患儿中,7例治疗后大部分病变血管范围逐渐减少,受累较轻血管甚至可以完全恢复正常血管状态。4例患儿血管影像学检查较前无明显加重或好转。9例出现高血压患儿应用降压药血压能控制在正常范围,但不能停用降压药。5例查体发现脉弱或无脉患儿均未改善。14例患儿中7例生长发育同正常同龄儿,7例落后于正常同龄儿身高体质量第25百分位。14例患儿随访2~22个月,均规律治疗,未出现复发。结论3岁以内TA累及血管较多,病情严重,误诊率高,经过治疗病情很快能够控制,但容易遗留血管病变,部分患儿预后不佳。     

婴幼儿重症肺炎的临床特点及死亡相关因素研究

目的：探讨婴幼儿重症肺炎的流行病学特点、临床特点、死亡相关危险因素,为提高婴幼儿重症肺炎的治愈率、降低病死率提供临床依据。方法采用回顾性研究的方法,收集2011年1月1日至2013年12月31日在成都市妇女儿童中心医院住院诊断为重症肺炎的婴幼儿患者,分析其流行病学特征、临床特点以及死亡高危因素等,并对临床特点及死亡相关因素进行单因素及多因素分析。结果(1)1411例婴幼儿重症肺炎患儿中,男∶女为1．8∶1；城乡比例1∶3．62；年龄29 d~3个月占总数的46．00%。冬春季节发病占62．93%,夏秋季节发病占37．07%。(2)平均住院日为(9．99±6．27) d,明显长于普通肺炎住院日。(3)64．21%的患儿患有基础疾病。(4)91．99%的患儿出现并发症。(5)细菌感染占71．44%,病毒感染占18．36%,支原体及其他病原体感染占2．48%,混合感染占7．73%。( 6 )总死亡44例,病死率3．12%,死亡患儿中小于3个月婴儿占死亡总数72．73%,3个月~3岁占死亡总数的27．27%。(7)死亡危险因素分析显示年龄小于3个月、先天性心脏病、反复感染、多重耐药菌感染、手术史、多器官功能损害以及有内环境紊乱为独立的危险因素。结论婴幼儿重症肺炎冬春季发病率较高,农村高于城市,大多数为细菌感染所致,婴幼儿多见,年龄越小发病率越高,病死率越高；大部分患儿患有基础疾病；容易出现并发症。年龄小于3个月、有先天性心脏病、反复感染、多重耐药菌感染、手术史、多器官功能损害以及有内环境紊乱是婴幼儿重症肺炎死亡的高危因素,对这类患儿应加强监护与防治,降低病死率。     

正常新生儿,婴幼儿的食管及胃电图

作者对正常新生儿及婴幼儿１５０例进行了食管、胃电图测定。结果正常新生儿及婴幼儿体表电极所测到食管、胃电图频率不因年龄、所测部位及性别的不同而发生变化，均为３次／分左右；食管、胃电图的电压在生后１￣２个月内不稳定，从２个月开始明显上升，于１￣３岁时达最高。     

Comparison of cerebrospinal fluid in newborns and in infants ≤2 months old with or without meningitis

Background: The aim of the present study was to evaluate the characteristics and accuracy of cerebrospinal fluid (CSF) parameters for neonatal meningitis, by comparing CSF data in newborns and in infants ≤2 months of age, with or without meningitis. Methods: This case–control study was performed on 120 newborns and infants ≤2 months old. 60 patients with meningitis were considered as the case group and 60 ill patients without meningitis were defined as the control group. Each of the two groups was divided into 0–1 months and 1–2 months old. CSF characteristics were compared in newborns in the case and control groups; in infants ≤2 months old in the case and control groups; and in healthy newborns and healthy infants ≤2 months old. Results: The mortality rate was 16.7% in the case group. The differences of CSF parameters in the case and control groups were mostly not significant, except for CSF glucose only in term newborns <7 days old (P= 0.04), and white cell count (WBC) only in 0–7‐day‐old term and preterm neonates (P= 0.04 and P= 0.01, respectively). Polymorphonuclear leukocyte (PMNL) level in the case group was significantly higher than in the control group (P= 0.02). CSF characteristics in healthy newborns were nearly the same as in healthy infants ≤2 months old. Prevalence of positive CSF culture was 31.7% in the case group. The most common pathogen was Neisseria meningitidis in the two age groups. The concomitant positive blood culture in the case group was 26.3%. Conclusion: In the case of meningitis with negative CSF culture and Gram stain, diagnosis can be made on CSF parameters, clinical and laboratory findings and suspicion of meningitis. Therefore, a clinical prediction rule to classify risk for bacterial meningitis on evaluation of CSF parameters in any region should be established. More regional trials are needed to enhance the probability of diagnosis according to CSF parameters.     

An unusual domestic accident: a penetrating abdominal wound with intestinal evisceration in a child

We report a penetrating abdominal injury due to a piece of glass, a very unusual domestic accident, in a 2-year-old boy who was admitted to the emergency department with an evisceration through the umbilicus. His mother reported that she was asleep when the boy came to her room, and did not know how it had happened. We primarily suspected child abuse, but the presence of a piece of glass in the boy's heel led us to think of a domestic accident. He had poured himself a glass of water, and then fell on the glass. We could not find a similar case in the literature on domestic accidents. Accepted: 25 June 1997     

Dosage regimen of arbekacin for methicillin-resistant Staphylococcus aureus infection in newborns and infants

BACKGROUND: Arbekacin (ABK) is an aminoglycoside antibiotic that has a dose-dependent bactericidal action. Because it inhibits the production of toxic shock syndrome toxin-1 (TSST-1) by methicillin-resistant Staphylococcus aureus (MRSA), it has attracted attention as a therapeutic drug for MRSA infection. In this study, the authors investigated the pharmacokinetics of ABK based on therapeutic drug monitoring (TDM), in order to establish an effective dosage regimen with minimal adverse reactions in MRSA infected newborns and infants. METHODS: Arbekacin was administered to nine MRSA infected newborns and infants between October 2000 and March 2002. Following the initial ABK administration, blood was collected and the blood concentration of ABK was measured. The blood concentrations of ABK were analyzed by the two-compartment model or by a model-independent method in order to elucidate the pharmacokinetics of ABK. Pharmacokinetic analysis was performed using WinNonlin Professional V3.1. RESULTS: The mean age at initial ABK administration was 24.0 +/- 26.0 days (postconceptional age: 39.2 +/- 3.9 weeks). The increase in the peak blood concentration of ABK was 2.40 +/- 0.20 microg/mL per mg ABK per kg bodyweight, showing great consistency among cases. The elimination half-life of ABK was 0.22-3.52 h in the alpha phase (T(1/2alpha)) and 2.42-33.44 h in the beta phase (T(1/2beta)), showing great variation among cases. The distribution volume was 0.75 +/- 0.13 L/kg, and systemic clearance was 0.054 +/- 0.012 L/h/kg. ABK alleviated clinical symptoms and inflammations in all cases. CONCLUSION: Nine newborns and infants with MRSA infection and various underlying diseases were successfully treated with TDM-based administration of ABK with no severe adverse reactions.     

新生儿腹部急症救治体会:附37例报告

为探讨新生儿腹部急症的诊断和治疗。对1999年6月－2001年12月收治的37例患儿进行回顾性分析，其中男24例，女13例；入院年龄为生后1－27天，平均10天；发病时间为出生当天－20天。根据临床表现、腹部直立位平片及有关影像学检查分为消化道梗阻19例，消化道穿孔3例，腹腔脏器外露4例，外科性呼吸窘迫2例，腹部巨大肿块1例，消化道功能紊乱8例。其中11例经综合对症治疗症状缓解，21例进行手术治疗，3例放弃手术探查，2例暂缓手术回家随访。经临床、手术及病理提示，25例为先天性畸形。资料显示：新生儿腹部急症大多有胚胎发育异常造成先天性畸形的基础，肠梗阻发生率高，常伴多发性畸形；需对临床病情动态观察，及时予以辅助检查，重视把握保守治疗和手术指征及手术原则，予以综合对症治疗。提示了解新生儿腹部急症的特点，早期诊断和及时治疗是提高生存率的关键。     

围产期窒息对新生儿脑组织血流灌注的影响及意义

目的了解围产期窒息对新生儿脑血流(CBF)的影响及意义.方法对140例有围产期窒息的新生儿进行单光子发射型计算机断层(SPECT)脑显像.结果①围产期发生的胎儿窘迫或出生时窒息,有可能使CBF减少;②有胎儿窘迫和(或)出生时窒息时,新生儿CBF异常的发生率相似.结论围产期发生了胎儿窘迫或出生时窒息,虽经复苏抢救或去除了某些直接影响因素,这些新生儿仍然存在着发生缺氧缺血性脑损伤(HIBD)的高度危险.     

Staged approach for abdominal wound closure following combined liver and intestinal transplantation from living donors in pediatric patients

Abstract:  Primary closure of the abdominal wall after combined liver and intestine transplantation from a living donor into a pediatric patient is usually not possible, because of the size of the donor organ, graft edema, and preexisting scars or stomas of the abdominal wall. Closure under tension may lead to abdominal compartment syndrome with vascular compromise and necrosis of the transplanted organ. We describe our experience of abdominal wound closure after liver and intestinal transplant in the pediatric patient using a staged approach. From February 2003 to June 2006, we managed five pediatric liver and intestinal living donor transplant recipients. Because of the large post-transplantation abdominal wall defect, a staged technique of abdominal wound closure was utilized. Initially, an absorbable Polygalactin mesh was sutured around the layer of the defect. As soon as adequate granulation tissue was formed over the mesh a STSG was applied. From the wound stand point all five patients were managed successfully with staged wound closure after transplantation. Granulation tissue filled and covered the mesh within 7.6 wk. A STSG was then used to cover the defect. All infants recovered well and none had a significant wound complication in the immediate post-operative period following STSG. At a mean follow-up of 24 months only one patient developed an entero-cutaneous fistula five months post-transplant. Staged abdominal wall coverage with the use of Polygalactin mesh followed by STSG is a simple and effective technique. A closed wound is achieved in a timely fashion with protection of the viscera. Residual ventral hernia will need to be managed in the future with one of several reconstructive techniques.     

新生儿血、尿抗菌物质的检测及其临床意义

目的了解我国住院新生儿使用抗生素前血、尿中存在抗菌物质的情况,并探讨其对血培养结果的影响。方法用微球菌琼脂扩散法检测血、尿标本中是否存在抗菌物质,出现任何抑菌环均认为应用过抗生素。结果123例血标本中抗菌物质检测阳性73例(59.3％),34例尿标本中32例(94.1％)阳性。家长承认入院前用过抗生素者仅35例(28.4％)。临床疑有败血症40例,其中血抗菌物质检测阳性23例(57.5％)中血培养阳性仅5例(21.7％);而血抗菌物质检测阴性17例(42.5％)中血培养阳性12例(70.6％),两者比较有显著差异(P＜0.01)。瑞典新生儿8例尿抗菌物质检测均为阴性。结论抗生素在我国新生儿疾病中广泛应用,家长提供的病史并不可靠,血、尿中存在抗菌物质会降低血培养的阳性率。血、尿抗菌物质检测可作为判断血培养结果的辅助方法。