健康新生儿的胃电图特征

目的比较不同日龄新生儿空腹和餐后胃电慢波的主频、功率比、不同慢波节律百分比、主频不稳定系数,以确定健康新生儿胃电慢波的特征。方法20名健康足月新生儿胎龄37～39周,男11名,女9名,出生时阿氏评分平均为(9.3±0.4)分,无窒息、母乳喂养、无器质性疾病。采用体表胃电图,分别于出生后第1(第12小时)、7、14、21、28天记录空腹和餐后体表胃电图各30min。计算胃电图的以下参数:主频、不同慢波节律的百分比、主频不稳定系数、功率比。结果在所有新生儿均可记录到清晰的胃电图波形,新生儿出生后第0、7、14、21、28天餐前的正常节律百分比分别为38.1±4.9、38.2±4.3、38.5±3.7、39.2±3.9、39.7±3.5,胃动过速节律百分比分别为23.8±5.4、24.3±3.6、23.8±3.8、23.7±4.1、23.5±4.3,胃动过缓节律百分比分别为38.1±5.5、37.5±4.8、37.7±4.1、37.1±3.6、36.8±3.9,不同日龄餐前与餐后相比,差异无统计学意义(P>0.05)。新生儿出生后第1～28天餐前主频为(2.38±0.5)cpm～(2.59±0.1)cpm,餐后与餐前相比,差异无统计学意义(P>0.05),第14、21、28天餐前、餐后的主频较第1、7天高(P<0.05);生后第21、28天餐前、餐后的主频不稳定系数较第1、7、14天低(P<0.05),餐后与餐前相比,差异无统计学意义(P>0.05),生后第1～28天餐后餐前功率比,差异无统计学意义(P>0.05)。结论健康新生儿的胃电慢波尚不成熟,其特征为主频和正常节律百分比较低,而胃动过速节律和胃动过缓节律百分比较高,进餐后各参数无明显变化。这一特征在评价新生儿的胃电生理学和胃运动功能紊乱的诊断方面有一定的参考价值。     

健康新生儿的胃电图研究

目的：研究健康新生儿的胃电图。方法：20个健康足月新生儿胎龄37～39周,男11例,女9例,出生时阿氏评分平均为9.3±0.4分,无窒息,无器质性疾病,母乳喂养。采用体表胃电图,分别于出生后第1（第12小时）,7,14,21,28 天记录空腹和餐后体表胃电图各30 min。计算胃电图的以下参数: 主频、不同慢波节律的百分比、主频不稳定系数、功率比。结果：在所有新生儿均可记录到与成人类似的体表胃电图波形,新生儿出生后第1~28天餐前的正常胃电节律为（38. 2±4.9）%～（39.7±3.5）%,胃动过速节律为（23.7±5.4）%～（23.5±4.3）%,胃动过缓节律为（38.1±5.5）%～（36.8±3.9）%,不同年龄时期餐前与餐后相比无明显差别（P>0.05）。新生儿出生后第1~28天餐前主频为2.38±0.5 cpm～2.59±0.1 cpm ,餐后与餐前相比差异无显著性（P>0.05）,第14,21,28天餐前、餐后的主频较第1,7天高(P<0.05);生后第21,28天餐前、餐后的主频不稳定系数较第1,7,14天低(P<0.05),餐后与餐前相比差异无显著性（P>0.05）,生后第1～28天餐后餐前功率比差异无显著性（P>0.05）。结论：健康新生儿的胃电图参数与健康成人、儿童明显不同,胃电主频、正常胃电节律百分比较低,胃电主频随年龄增长逐渐升高。［中国当代儿科杂志,2007,9（4）：364-366］     

功能性消化不良患儿多导胃电与胃排空的关系研究

目的 探讨功能性消化不良(FD)患儿的胃电图异常与胃排空的相关性.方法 使用Polygraf ID 四导胃电分析系统和核素法固体胃排空测定51例FD患儿和25例健康体检儿童的胃电活动和胃排空情况.结果①FD组与对照组相比,正常慢波百分比(N%)明显低于对照组(P＜0.01);FD组患儿有较高的胃电异常发生率,主要表现为餐前餐后混合性胃电节律紊乱,共32例,占62.7%.②FD组与对照组相比,4个导联餐后/餐前功率比差异有统计学意义(P＜0.05),显示FD组餐后主功率不增加.③FD组患儿餐前主频不稳定系数,餐前与餐后主功率不稳定系数增高;FD组患儿餐前、餐后慢波耦联率(%)分别为26.95±13.69,26.93±12.63,对照组为69.02±5.15,70.18±4.68,FD组慢波耦联率低于对照组(P＜0.01).④FD组患儿胃排空延迟占23.5%,经Logistic多因素相关分析胃排空延迟与餐前、餐后慢波耦联率存在负相关(偏回归系数分别为-0.513,-0.296).结论 FD患儿有较高的胃电异常发生率,主要表现为胃电节律紊乱和餐后主功率不增加,餐前主频不稳定系数,餐前与餐后主功率不稳定系数增高,慢波耦联率降低;胃排空延迟与慢波耦联率存在负相关.提示胃电异常在FD的发病中有一定意义.     

功能性消化不良及厌食患儿的胃电节律变化

目的：厌食是儿科门诊特别是消化专科门诊中常见的主诉,小儿厌食可能与多种因素有关,该文通过对部分诊断为功能消化不良,伴有或不伴有厌食的病人进行体表胃电图监测,探讨胃电活动改变是否与厌食存在一定关系。方法：32例病人均有消化道症状,包括腹痛、腹胀、恶心、呕吐、反酸,呃逆、早饱等,根据有无厌食被分为厌食组(n=18)和非厌食组(n=14) ,所有病人进行餐前30 min,餐后120 min的体表胃电图检查,记录两组餐前餐后正常胃电主频,胃电节律过缓,胃电节律过快的百分比,主频不稳定系数,餐前/餐后主功率比。比较两组胃电图结果的各项参数。结果：①厌食组和非厌食组病人的胃电节律异常检出率分别为餐前77.8%（14/18）和78.6%（11/14）,P>0.05,餐后77.8%（14/18）和57.1%（8/14）P>0.05; ②两组胃电过缓百分比分别为餐前31.6% (10.18~45.33),48.9% (31.7~62.93),P>0.05,餐后33.4% (12.95~62.17),27.8% (7.4~48.1),P>0.05; ③厌食组餐前餐后胃电节律过速的百分比高于非厌食组,6.2% (2.78~19.43),0%(0~4.63),P<0.01, 和14.8% (4.73~28.85),1.9% (0~18.5),P<0.05; ④两组餐前餐后主频不稳定系数差异均无显著性; ⑤两组餐后/餐前主功率比差异无显著性。结论：功能性消化不良患儿发生胃电节律紊乱的比例较高,功能性消化不良伴厌食的患儿餐前餐后胃电节律过速的百分比高于不伴厌食患儿,而以餐前更明显。     

新生儿胃肌电变化的研究

目的 观察新生儿胃肌电发育过程，并初步探讨其变化规律。方法 对23例健康新生儿生后1周、2周及1月进行胃肌电描记。采用皮肤表面电极，从腹壁体表用PCPOLYGRAP-HR多功能胃肠检测仪记录胃电，观察主频率(DF)、主频率不稳定系数(DFIC)、正常胃慢波百分比(PNSW)。结果 餐前、餐后正常呈随周龄增大而增加的趋势，餐后PNSW明显高于餐前。DF和DFIC各阶段无明显差异，但自身比较，餐后DF高于餐前，餐后DFIC低于餐前。结论 研究显示出新生儿胃电肌运动的发育过程。     

新生儿缺氧缺血性脑病患儿胃电活动的监测

目的探讨HIE患儿胃电活动的变化 ,我们对50例HIE患儿和20例正常新生儿胃电图进行了动态观察和分析。方法根据B超结果将胃电图 (EGG)记录仪电极放置在胃窦和胃体部的腹壁上投影位置 ,参考电极放置在下腹部外侧 ,记录时间为10～18h ,检测结束后将EGG记录仪接到计算机上 ,通过Synectics公司的EGGVersion6.40软件分析系统 ,采用运行频谱分析法对采集的EGG信号进行数据处理。分析胃电图主频 (DF)、主功频率不稳定系数 (DFIC)、喂奶后/喂奶前主功率比值 (PR)、正常慢波节律百分比和胃电节律紊乱百分比的变化。结果HIE组32例 (轻度组8例 ,中度组11例 ,重度组13例 ) ,对照组12例 ,成功记录到EGG。HIE轻度组与对照组比较 ,喂奶前后胃电活动无明显变化 ;中、重度组与对照组比较 ,喂奶前胃动过缓明显增多 (P<0.01) ,喂奶后胃电节律更加紊乱 ,正常慢波百分比明显降低 ,胃动过缓和胃动过速均明显增多 (P<0.01)。重度HIE组喂奶前后、中度组喂奶后DF不在正常慢波范围内 ,其余各组DF均在正常慢波范围内 ;与对照组比较 ,HIE组喂奶前后DFIC与PR的变化均无显著意义。结论轻度HIE对新生儿胃电活动无明显影响 ,中、重度HIE能造成新生儿胃电活动异常 ,出现胃电节律紊乱 ,开始肠道喂养时要注意其对胃电活动的影响 ,必要时可酌情     

不同胎龄新生儿空腹体表胃电图特点

目的 分析不同胎龄新生儿体表胃电图的临床特点.方法 收集不同胎龄新生儿的体表胃电图资料.将收入我科不同胎龄的新生儿分为4组:Ⅰ组为胎龄≥37周;Ⅱ组为胎龄34～36 6周;Ⅲ组为胎龄32～33周;Ⅳ组为胎龄＜32周,在生后1周内进行体表胃电图检测,记录并分析胃电图参数.应用ANOVA方法对各组间的差异进行统计学分析.对其中部分早产儿在生后1周内、2、4周分别进行胃电图检测,应用配对t检验检测同一病例的胃电图参数的前后差异.结果 对141例新生儿进行了胃电图检测,Ⅰ组25例;Ⅱ44例;Ⅲ组33例;Ⅳ组39例.与成人和儿童相比所有新生儿的正常胃电慢波百分比均较低,平均为30.6%,而胃电节律紊乱百分比较高.各组间正常胃电慢波百分比、胃电节律过缓百分比及胃电节律过速百分比差异无统计学意义.24例早产儿生后4周及生后2周的胃电图参数与生后1周内相比差异无统计学意义.结论 与成人和儿童相比,新生儿的胃肌电活动不成熟,生后1周内不同胎龄的早产儿与足月儿的胃电形式比较,差异无统计学意义,新生儿的胃肌电活动在生后4周时仍处于发育成熟阶段.     

窒息新生儿胃电节律改变及普瑞博思的疗效观察

目的探讨窒息对新生儿胃电活动的影响及普瑞博思的疗效。方法利用体表胃电图(EGG)对50例窒息新生儿和20例正常新生儿哺乳前后进行30min至1h的胃电活动监测。对胃肠症状明显的7例窒息儿使用普瑞博思乳剂治疗7天,治疗前后监测EGG。结果70例新生儿有39例(56％)成功记录到EGG。轻度窒息组较对照组哺乳前胃动过缓[＜2周/分(cpm)]百分比增多,差别具有统计学意义(P＜0.01)。重度窒息组正常慢波百分比较对照组及轻度窒息组明显降低,胃动过速(＞4cpm)百分比明显增多,P＜0.01。重度窒息组比轻度组及对照组主频率不稳定系数增高,P＜0.01。普瑞博思治疗后窒息儿胃肠症状消失,正常慢波百分比较治疗前增高,胃动过速明显减少,P＜0.01。结论可通过胃电图观察窒息新生儿的胃电活动,进而研究新生儿消化道动力;国产期窒息的新生儿出现拒乳、腹胀、呕吐等症状,可能与其胃电活动异常有关;普瑞博思可以再建正常的胃电节律而有效改善窒息儿胃肠症状。     

不同胎龄新生儿空腹体表胃电图特点

目的分析不同胎龄新生儿体表胃电图的临床特点。方法收集不同胎龄新生儿的体表胃电图资料。将收入我科不同胎龄的新生儿分为4组：Ⅰ组为胎龄≥37周；Ⅱ组为胎龄34～36^＋6周；Ⅲ组为胎龄32～33^＋6周；Ⅳ组为胎龄〈32周，在生后1周内进行体表胃电图检测，记录并分析胃电图参数。应用ANOVA方法对各组间的差异进行统计学分析。对其中部分早产儿在生后1周内、2、4周分别进行胃电图检测，应用配对t检验检测同一病例的胃电图参数的前后差异。结果对141例新生儿进行了胃电图检测，Ⅰ组25例；Ⅱ44例；HI组33例；Ⅳ组39例。与成人和儿童相比所有新生儿的正常胃电慢波百分比均较低，平均为30．6％，而胃电节律紊乱百分比较高。各组间正常胃电慢波百分比、胃电节律过缓百分比及胃电节律过速百分比差异无统计学意义。24例早产儿生后4周及生后2周的胃电图参数与生后1周内相比差异无统计学意义。结论与成人和儿童相比，新生儿的胃肌电活动不成熟，生后1周内不同胎龄的早产儿与足月儿的胃电形式比较，差异无统计学意义，新生儿的胃肌电活动在生后4周时仍处于发育成熟阶段。     

新生儿胃肌电变化的研究

目的观察新生儿胃肌电发育过程,并初步探讨其变化规律.方法对23例健康新生儿生后1周、2周及1月进行胃肌电描记.采用皮肤表面电极,从腹壁体表用PCPOLYGRAP-HR多功能胃肠检测仪记录胃电,观察主频率(DF)、主频率不稳定系数(DFIC)、正常胃慢波百分比(PNSW).结果餐前、餐后正常呈随周龄增大而增加的趋势,餐后PNSW明显高于餐前.DF和DFIC各阶段无明显差异,但自身比较,餐后DF高于餐前,餐后DFIC低于餐前.结论研究显示出新生儿胃电肌运动的发育过程.     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Overcoming surfactant inhibition with polymers

Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium-derived free fatty acids). Recent data suggest that addition of non-ionic polymers such as dextran and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near-complete restoration of surfactant function. The anti-inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.     

Understanding infant formula

The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and healthcare professionals) will experiment with the infant formula available and then attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.