儿童先天性肺囊性病胸腔镜手术的围手术期并发症

目的:分析儿童先天性肺囊性病胸腔镜手术围手术期并发症的原因,讨论降低并发症发生率的方法。方法:收集2012年5月至2019年12月于北京儿童医院胸外科进行胸腔镜手术的672例肺囊性病患儿的病例资料。其中,男418例,女254例;中位手术年龄为14个月,手术年龄范围为1~189个月。手术方式根据病变范围选择肺叶切除或肺段...     

儿童肝移植围手术期管理

在世界范围内,肝移植已经成为终末期肝病或暴发性肝衰竭儿童的标准治疗措施。随着医学的进步,儿童肝移植技术迅速发展,移植的适应证和禁忌证不断发生变化。肝移植患儿及手术时机的选择,供、受体术前评估、受体术前用药及营养管理、术后并发症的防治等围手术期管理需要多学科参与。精细的围手术期管理是决定患儿预后的重要环节,肝移植儿童围手术期必须得到全面的照料。     

小儿围手术期的营养支持

小儿围手术期的营养支持蔡威围手术期营养支持是近年来国内外医学杂志上经常应用的名词，但尚未见有作者给其一个明确的含义。综合文献报告大致可定义为：对术前有严重营养不良的患者给予适当的营养支持以预防并发症，减少手术病死率，促使早日康复的措施称围手术期营养支...     

儿童心脏直视手术围术期血糖管理

自围术期高血糖与不良预后相关报道以来,关于围术期血糖管理问题就争论不休.虽然关于成年人的大量研究均证实危重患者高血糖发生率高,且高血糖会增加各种并发症及死亡的风险,而行胰岛素控制血糖会明显改善患者的预后.然而儿童糖代谢有别于成年人,特别是对于接受心脏直视手术的患儿,术中接受体外循环术,内环境发生改变,高血糖是否同样是危...     

小儿围手术期的体温管理

小儿围手术期的体温管理刘润玑小儿围手术期管理中，体温是重要环节之一。新生儿、婴幼儿期，体温受外环境影响很明显，其体温调节中枢功能差，要求的中性环境温度较高，体温调节限度又显然较成人差。其代偿性产热主要依靠增加氧耗和提高代谢率。减少热量损失也主要依赖血...     

小儿围手术期的循环管理

小儿围手术期的循环管理苏肇伉外科围手术期循环系统的监测项目繁多，但其基本的指标是以心排血量（心排量）为中心的各种直接或间接指标。正常儿童心排量为２．４～３．０Ｌ·（ｍ２）（－１）·ｍｉｎ（－１）。目前心排量的测定仍以ＳＷＡＮ－ＧＡＮＺ温差稀释漂浮导管...     

儿童消化道异物内镜围手术期管理原则

儿童消化道异物是儿科门诊常见的急症之一,也是儿童意外伤害的主要原因之一.随着消化内镜技术在全国儿科的普及及发展,规范的围手术期管理有助于初学者缩短学习曲线、减少并发症的发生.该文将对消化内镜下消化道异物治疗相关的设备器械、术前检查、知情同意、患者术前准备、手术室布局、术中可能遇到的困难及应对措施以及术后处理及随访等围手...     

儿童先天性心脏病围术期血制品用量分析

当前 ,先天性心脏病手术年龄不断提前 ,手术中用血量大。针对这一状况 ,我们对儿童先心病围术期血制品用量进行分析 ,探讨节约用血的方法。资料与方法一、一般资料　本组资料收集 1999年 5～ 7月 ,我院在体外循环下行先天性心脏病纠治的手术病例 14 9例。将其分为 3组 ,第一组 :1岁以下 2 8例 ,平均年龄 ( 0 .74± 0 .2 4 )岁 ,体重 ( 6.86± 1.73 )ｋｇ ;第二组 :1～ 5岁 79例 ,平均年龄( 2 .77± 1.2 9)岁 ,体重 ( 12 .94± 5 .3 9)ｋｇ ;第三组 :5～ 13岁 4 2例 ,平均年龄 ( 7.97± 2 .2 4 )岁 ,体重 ( 2 1.98± 10 .4 2 )ｋｇ。二、体外…     

周围静脉营养在消化道手术围手术期的应用

本文报道１４例行消化道手术患儿在围手术期采用周围静脉营养，应用时间为６～２１天，无并发症及病死率。通过ＴＰＮ前后监测对比，对输液途径、有关氨基酸、脂肪乳剂等问题进行讨论，认为周围静脉营养既避免了胃肠内营养，又简单方便；既能提供足够能量，还能提高患儿耐受手术打击的能力。加强围手术期营养状况监测，能预防术后并发症的发生。     

血友病患儿的围手术期治疗

血友病是儿科常见的遗传性出血性疾病,包括血友病A(凝血因子Ⅷ缺乏)和血友病B(凝血因子Ⅸ缺乏).患儿有自发出血或轻微损伤、手术后出血不止的倾向.本文简单介绍血友病患儿在手术需要时,术前诊断及分型、凝血因子动态监测、制剂选择、输注剂量和疗程等围手术期相关问题,以指导血友病患儿的手术和术后康复.     

先天性膈疝患儿围手术期处理

目的探讨先天性膈疝(CDH)围手术期处理,以期提高CDH患儿生存率。方法回顾性分析2004年5月-2008年12月本院收治的确诊CDH的17例病例。比较其中新生儿与非新生儿患儿电解质平衡、酸碱平衡紊乱的发生率,取二组手术病例对比手术后呼吸支持需要率以及呼吸支持时间。应用SPSS10.0软件进行统计学分析。结果新生儿组酸碱平衡紊乱的发生率明显高于非新生儿组(100.0%vs37.5%,χ2=6.561,P<0.05)。术后,新生儿组呼吸支持需要率明显高于非新生儿组(100.0%vs28.6%,χ2=5.238,P<0.05),新生儿组呼吸支持时间(222.75h)较非新生儿组(8.50h)明显延长。结论新生儿与非新生儿相比,手术前酸碱平衡紊乱较明显,术后可能更加需要呼吸支持。细致的围手术期处理有助于提高治疗效果。     

Assessing the Validity of Western Measurement of Online Risks to Children in an Asian Context

Before the advent of the Internet, television and film was the only audio-visual medium to which most children were exposed. The risks were primarily limited to children being exposed to sexual and violent materials, the nature of which were known and easy to control. Nowadays, children are surrounded by a variety of digital media and are exposed to different risks, many of which are still unknown. The Internet is fully integrated into children’s daily lives, along with the potential risks. The present study aimed to (i) describe the level of risks children are exposed to, and (ii) test the measurement validity of a total of 45 items assessing nine scales of online risk to children that were adapted from studies carried out in Europe and the United States. The study comprised 420 schoolchildren. The results showed that children were more exposed to ‘unwanted exposure to pornography’ and less to ‘conduct risk’ (e.g., accidental illegal downloading; creating profiles on inappropriate websites). Boys and older children were more exposed to the risks compared to girls and younger children. The study validated five dimensions (inappropriate materials, sexting, contact-related risks, risky online sexual behavior, and bullying/being bullied) assessing online risk to children by using exploratory and confirmatory factor analyses. The study found that scales developed in Europe and the United States are not wholly suitable to an Asian context and needed to be modified. Further investigation to classify online risks to children and offer a solutions to reducing the online risks.     

经食管超声心动图对儿童室间隔缺损的围术期评价

目的探讨运用经食管超声心动图(TEE)对儿童室间隔缺损(VSD)进行围术期的作用。方法 VSD患儿205例,年龄3个月～17岁(平均3.4岁),术前均由经胸超声心动图(TTE)作出诊断。体外循环前后分别行TEE探查,比较TFE及TTE 变化。结果 1．术前TEE和TTE对VSD位置的诊断准确率分别为99.0％和97．6％,膜部瘤检出率分别为93．8％和43．8％, VSD直径测量与手术探查结果相关系数分别为0．958和0．898;2．术后TFE发现残余分流38例(18．5％),其中9例(4.4％)立即再次修补。结论术前TEE可准确诊断VSD;术后TEE可发现残余分流,立即干预,以免再次开胸。     

The Relationship Between Social Risks and the Mental Health of School-Age Children in Primary Care

Background and ObjectiveThe study's goal was to measure the association between social risks and the mental health of school-age children in primary care.MethodsWe conducted a cross-sectional study in an urban safety-net hospital-based pediatric clinic using data collected from 2 standardized screening tools administered at well-child care visits for children age 6 to 11. Psychosocial dysfunction was measured with the Pediatric Symptom Checklist-17 (PSC-17), and 6 social risks (caregiver education, employment, child care, housing, food security, and household heat) were measured with the WE CARE screener. Multivariable linear and logistic regression analyses were conducted to measure the association between scores while controlling for sociodemographic characteristics.ResultsAmong N = 943 patients, cumulative social risks were significantly associated with a positive PSC-17 total score (adjusted odds ratio [aOR] 1.2; 95% confidence interval [CI] 1.1–1.5; P = .02), indicating psychosocial dysfunction. Children with ≥3 social risks were 2.4 times more likely to have a positive PSC-17 total score compared to children with <3 social risks (95% CI 1.5–3.9; P < .001). Of the individual social risks measured, only food insecurity significantly predicted a positive PSC-17 total score (aOR 1.9; 95% CI 1.1–3.2; P = .02) and attention score (aOR 1.9; 95% CI 1.1–3.4; P = .03).ConclusionNumber of risks on a social risk screener was associated with psychosocial dysfunction in school-age children. Food insecurity was the only individual risk associated with psychosocial dysfunction, in particular attention problems. Screening tools for social risks could be used to identify at-risk children whose mental health may be adversely impacted by their social conditions.     

Burkitt's Lymphoma in 63 Turkish Children Diagnosed Over a 10 Year Period

Sixty-three Turkish children with Burkitt's lymphoma (BL) diagnosed over a 10-year period in a single institution were retrospectively analyzed. Burkitt's lymphoma included 41.7% of non-Hodgkin's lymphomas and 17.2% of all childhood malignant solid tumors diagnosed in our department in this duration. The patients studied with BL were aged between 3 and 14 years (mean 5.9 years), with a male to female ratio of 2:1. While the age distribution in our patients was similar to that in African BL (endemic), the predominance of abdominal involvement and the frequency of bone marrow infiltration and pleural effusion were reminiscent of American BL (sporadic). The incidence of jaw involvement (15.9%) in our group was higher than in American BL, however, and was not as high as in African BL. Most of the patients were of a lower socioeconomic status. Significant growth retardation was found in the children with BL compared with 40 age-matched children without malignancy, nor chronic or endocrinologic disorders, who were of a similar socioeconomic status. A serological study for Epstein-Barr virus (EBV) was performed in 18 children, and the IgG-type antibody to the viral capsid antigen of EBV was found to be positive in all of them. As a result, BL seems to include a considerable proportion of all childhood malignant solid tumors in Turkey. The epidemiological and clinical presentation and course indicate that BL appears in Turkish children in a form that is between the African and American types of the disease. Further molecular and chromosomal studies in Turkish children with BL are needed.