培菲康预防婴幼儿肺炎继发腹泻随机、多中心临床研究

肺炎是严重威胁儿童健康和生命的常见病,占住院患儿的24．5％～56．2％,其中婴幼儿肺炎的住院数为学龄儿童的39．5倍。肺炎继发腹泻是临床常见的问题,25％～52．9％的肺炎患儿在肺炎发生同时或治疗过程中或好转后发生腹泻。随着微生态学在医学领域中的发展,应用微生态调节剂防治肠道菌群失调被越来越广泛地应用于临床,不少文献报道微生态调节剂对于小儿急性、慢性腹泻的治疗显示较好的疗效。本研究通过对婴幼儿肺炎患儿预防性地应用培菲康,观察腹泻发生率,对培菲康预防婴幼儿肺炎继发腹泻的有效性进行前瞻性研究。     

培菲康预防早产儿坏死性小肠结肠炎438例对照研究

目的 研究总结培菲康(双歧三联活菌制剂,Bifico)预防早产儿坏死性小肠结肠炎(NEC)的临床效果.方法 2002年1月～2006年6月,将住院的920例早产儿前瞻性按照配对条件、采用双盲法随机分成两组,除病因治疗、合理喂养外,治疗组加培菲康.结果 治疗组较对照组NEC的发生率明显降低(x2=9.346,P＜0.01).结论 早产儿,尤其是合并有新生儿缺氧缺血性脑病、颅内出血、新生儿呼吸窘迫综合症、新生儿败血症、新生儿肺炎、红细胞增多症等高危因素存在的早产儿,预防性应用微生态制剂培菲康,可以促进早产儿肠道正常菌群的定值和优势化,对降低新生儿NEC的发生率,具有重大的临床应用价值.     

坏死性小肠结肠炎早产儿病因及微生态制剂预防作用

目的探讨新生儿坏死性小肠结肠炎(NEC)病因及应用微生态制剂(培菲康)预防早产儿NEC的有效性及对体质量的影响。方法早产儿524例,随机分为预防组276例与非预防组248例。预防组予培菲康口服,0.5包/次,2次/d;非预防组仅予原发病治疗。观察二组NEC的发生情况及体质量变化。确诊NEC20例患儿为病例组,非NEC80例早产儿为对照组,对二组进行对照研究。结果预防组发生NEC5例,每日体质量增加(8.114±8.137)g;非预防组发生NEC17例,每日体质量增加(6.595±5.337)g。二组NEC发生率比较有显著差异(χ2=7.57P<0.01);二组每日体质量增加量比较有显著差异(t=2.497P<0.05)。Logistic多元回归分析提示:胎龄、HIE、败血症及病情危重症程度是NEC发生的危险因素,应用微生态制剂及免疫球蛋白(IVIG)是保护因素。结论避免NEC的危险因素,应用IVIG和微生态制剂能减少早产儿NEC的发生和促进体质量增长。     

微生态制剂治疗肺炎继发腹泻的效果

目的探讨应用微生态制剂预防小儿肺炎继发腹泻的疗效。方法将107例婴幼儿肺炎继发腹泻患儿随机分为二组,以住住院期间抗生素治疗同时应用微生态制剂（金双岐）的患儿为治疗组（50例）,金双岐与抗生素间隔2~3 h服用,0~1岁,1片/次,2~3岁2片/次,均为3次/d。对照组（57例）给予抗生素对症支持治疗。结果治疗组22例痊愈,24例有效,4例未愈,总有效率92.0%;对照组17例痊愈,18例有效,22例无效,总有效率61.4%,二组总有效率比较差异有显著性（P〈0.001）。结论微生态制剂可预防和减少婴幼儿肺炎继发腹泻。     

微生态制剂防治新生儿坏死性小肠结肠炎病例对照研究

目的：探讨新生儿坏死性小肠结肠炎(NEC)的危险因素及应用微生态制剂(培菲康)预防NEC发生的有效性。方法：对2002年1月至2005年5月住院治疗的2528例新生儿分为微生态制剂预防组与非预防组,观察两组NEC的发病率;以确诊NEC的患儿为病例组,非NEC新生儿为对照组进行病例对照研究。结果：预防组1182例中6例诊断为NEC,发病率0.51%;非预防组1346例中19例发生NEC,发病率为1.41%,两组差异具有显著性(P<0.05)。条件Logistic回归分析提示:胎龄、新生儿缺氧缺血性脑病、败血症及病情危重程度是危险因素;微生态制剂的应用是保护因素。结论：避免NEC的危险因素,预防性应用微生态制剂能够降低NEC发病率。     

双歧三联活菌胶囊预防小儿肺炎继发腹泻的临床观察

目的探讨应用双歧三联活菌胶囊（贝飞达）预防小儿肺炎继发腹泻的临床疗效。方法2005年9月～2007年4月住院治疗的小儿肺炎150例随机分为预防组（80例）与对照组（70例）。预防组在入院后即给予口服贝飞达，用药时间在72h以上；对照组入院后一直未用或住院72h以上因继发腹泻而给予口服贝飞达。结果预防组80例住院期间继发腹泻的发生率为11．25％（9／80），对照组70例患儿住院治疗期间继发腹泻的发病率为31．4％（22／70），两组间差异具有统计学意义（P〈0．01）。结论预防性应用贝飞达能降低肺炎患儿继发腹泻的发生率。     

妈咪爱预防小儿肺炎继发腹泻的临床观察

目的探讨预防性应用妈咪爱对小儿肺炎继发腹泻的防治效果。方法2005年1月-2006年11月住院治疗的肺炎患儿210例随机分为预防组与对照组。预防组在入院后即给予口服妈咪爱，用药时间在72h以上；对照组入院后始终未用或住院72h以后因继发腹泻而给予口服妈咪爱。结果预防组110例住院治疗期间继发腹泻病发病率为11．82％（13／110）：对照组100例住院治疗期间继发腹泻病的发病率为31．00％（31／100），两组间差异具有非常显著性（x^2=11．64，P〈0．01）。结论预防性应用妈咪爱能降低肺炎患儿继发腹泻的发生率。     

布拉氏酵母菌预防小儿肺炎继发腹泻的临床研究

目的 探讨布拉氏酵母菌(亿活,Bloflor)预防小儿肺炎继发腹泻的疗效.方法 肺炎患儿265例,分为预防组150例,对照组115例,两组均给予抗生素及对症支持治疗,其中预防组在治疗的同时加用亿活.对两组继发腹泻的发病率、疗效,腹泻总疗程以及止泻时间进行统计分析.结果 预防组继发腹泻33例,发病率为22.00%,对照组腹泻41例,发病率为35.65%(χ2=6.03,P＜0.05).预防组小儿肺炎继发腹泻的止泻时间、腹泻总疗程亦明显短于对照组(t=5.71、6.54,P均＜0.05).结论 亿活能降低小儿肺炎继发腹泻的发病率,预防性应用具有积极的临床意义.     

阿奇霉素对儿童水样便性空肠弯曲菌肠炎的疗效评价

目的 研究阿奇霉素对水样便性空肠弯曲菌肠炎的疗效.方法 31例水样便空肠弯曲菌肠炎住院患儿,经乳胶凝集试验鉴定粪便空肠弯曲菌,随机分成2组.治疗组17例,应用阿奇霉素(因培康)联合黏膜保护剂(思密达)及微生态制剂(培菲康)治疗;对照组14例,仅用黏膜保护剂及微生态制剂.比较两组治疗前后病程、总病程及粪便空肠弯曲菌转阴时间.结果 入院前2组临床资料及生化指标差异均无统计学意义.两组病例均取得良好治疗效果,阿奇霉素组在入院后病程、总病程及粪便空肠弯曲菌转阴时间上均短于对照组,差异有统计学意义(P＜0.01).结论 应用阿奇霉素治疗水样便性空肠弯曲菌肠炎可以缩短病程及粪便空肠弯曲菌转阴时间.     

��ƿ�����С����ʳ֢���ٴ���Ч�۲�

本研究采用微生态制剂培菲康治疗小儿厌食症,观察培菲康散剂治疗小儿厌食症的疗效.     

Effect of probiotic Lactobacillus strains in young children hospitalized with acute diarrhea

BACKGROUND: Oral bacteriotherapy promotes recovery from acute childhood diarrhea, but few strains have been shown to have therapeutic potentials. We examined the effect of two newly identified probiotic Lactobacillus strains in acute childhood diarrhea. METHODS: Sixty-nine children were randomized during hospitalization for acute diarrhea to receive a mixture of Lactobacillus rhamnosus 19070-2 and Lactobacillus reuteri DSM 12246, 10(10) colony-forming units of each strain or placebo twice daily for 5 days. Before selection of these stains their potential probiotic characteristics were demonstrated in vitro and in healthy volunteers. RESULTS: In patients receiving probiotics, the diarrheal phase was reduced by 20%. The duration of diarrhea was 82 h in the treatment group vs. 101 h in the control group (not significant, P = 0.07). However, 3 of 30 patients from the treatment group vs. 13 of 39 from the control group still had loose stools at the end of the study period (P = 0.03). In patients with diarrhea for <60 h before start of treatment (early intervention), a clear effect of the probiotics was demonstrated (80 h in the treatment group vs. 130 h in the control group, P = 0.003). After early intervention, the length of hospitalization was reduced by 48% (3.5 vs. 1.7 days, P = 0.03). At the end of the intervention, rotavirus antigen was found in 12% of patients from the treatment group vs. 46% from the control group (P = 0.02). CONCLUSIONS: The two probiotics, L. rhamnosus 19070-2 and L. reuteri DSM 12246, ameliorated acute diarrhea in hospitalized children and reduced the period of rotavirus excretion. Oral bacteriotherapy was associated with a reduced length of hospital stay. The beneficial effects were most prominent in children treated early in the diarrheal phase.     

��ͯ�����Է���֧ԭ�����ҽԺ��Ⱦ��ԭ���ص㼰Σ�����ط���

??Objective??To explore the pathogen characteristics and risk factors of nosocomial infection in children with refractory pneumonia caused by Mycoplasma pneumoniae. Methods??A total of 160 children??nosocomial infection??45 cases?? as observation group??no nosocomial infection??115 cases?? as control group?? with refractory MPP who were admitted from January 2015 to January 2018 were selected for pathogen detection and pathogen species analysis. Analyze the differences of two groups to detect the risk factors of hospital infection by means of univariate and multivariate logistic analysis. Results??According to the analysis of the pathogens??32 of them were bacterial infections??71.1%????and Gram-negative bacteria were the main pathogens??including Haemophilus influenza??9 cases????Klebsiella pneumonia??7 cases????Escherichia coli ??5 cases?? and Legionella pneumophila??2 cases????13 of them were viral infections??28.9%????including influenza B virus??6 cases????respiratory syncytial virus??5 cases??and adenovirus??2 cases??. After univariate and multivariate logistic analysis??no differences were found in sex??age??congenital heart disease or anemia between observation group and control group??P??0.05??. However??the length of hospitalization??season of onset??invasive procedures??non-single ward??and the irrational use of antibiotics in the two groups had significant differences??P??0.05??. Conclusion??The main infection pathogen of children with refractory MMP in nosocomial infection is Gram-negative bacteria. The risk factors of nosocomial infection are the length of hospitalization?? season of onset??invasive procedures??non-single ward??and the irrational use of antibiotics.     

ֱ����б����Զ�ͯѪ�����������ʷ���������Ԥ��

目的探讨直立倾斜试验(HUTT)对儿童血管迷走性晕厥(VVS)反复发作的预测价值。方法2001-01—2006-08在中南大学湘雅二医院晕厥专科门诊就诊或住院的不明原因晕厥患儿251例,男112例,女139例,年龄418(12.25±3.27)岁。依临床晕厥发生频次分A组(晕厥发作仅1次,n=54)、B组(晕厥发作24次,n=137)与C组(晕厥发作≥5次,n=60)。HUTT在取得知情同意后采用基础直立倾斜试验(BHUT,n=251)及舌下含服硝酸甘油倾斜试验(SNHUT,n=92)。结果(1)HUTT阳性率与晕厥频次关系:BHUT阳性率随晕厥频次增加而递增(χ2=4.285,P>0.05),SNHUT阳性率与晕厥频次不呈线性关系(χ2=1.316,P>0.05),HUTT总阳性率(指BHUT阳性率+SNHUT阳性率)亦随晕厥频次增加而递增(χ2=3.809,P>0.05)。(2)HUTT反应类型与晕厥频次关系:无论是BHUT还是SNHUT,反应类型以血管抑制型为主,BHUT或SNHUT在不同晕厥频次组间比较无明显差异(分别为χ2=3.008,P>0.05;χ2=2.426,P>0.05)。结论HUTT与儿童VVS临床晕厥反复发作频次无明显关系,对儿童VVS临床反复晕厥发作没有预测价值。     

����С��̥�����Ѫ��Ѫ��������ø��1�Ī��ⶨ��������Ѫ���ϵı��

目的 探讨HO-CO系统与小于胎龄儿(small for gestational age,SGA)发病的关系及相关机制,为SGA的病因学防治开辟新思路.方法 选择2004年11月至2005年11月间正常分娩的非匀称型SGA50例(其中母亲无妊高征为SGA1组30例,母亲患中重度妊高征为SGA2组20例),并以健康足月适于胎龄儿(appropriate for gestational age,AGA组)20例为对照.于新生儿娩出后立即采集脐动脉血标本并留取近胎盘处脐带标本,分别用双波长分光光度法测定新生儿脐血中血红素氧合酶-1(heme oxygenase-1,HO-1)的活性,用Chalmers血红蛋白结合及连二亚硫酸钠还原法测定脐血中碳氧血红蛋白(HbCO)百分含量,并通过免疫组化法观察新生儿脐血管上HO-1的表达.结果 (1)SGA1组及SGA2组脐血HO-1活性、HbCO百分含量均显著低于AGA组(P＜0.01).而SGA1组与SGA2组脐血HO-1活性、HbCO百分含量比较差异无统计学意义(P＞0.05).(2)AGA组、SGA1组及SGA2组脐血HO-1活性与新生儿出生体重均呈正相关(P＜0.05).(3)脐血管上HO-1的表达SGA1组和SGA2组与AGA组比较HO-1表达强度高,差异有统计学意义(P＜0.01);SGA1组与SGA2组之间比较差异无统计学意义(P＞0.05).结论 脐血HO-1活性与胎儿宫内发育及新生儿营养状况密切相关     

�º�����ϸ����Ⱦ��Ӥ�׶�������Ϣ��ϵ����������Ч����

??Objective??To investigate the relevance of bacteria infection of the lower respiratory tract with persistent wheezing of infants and young children??and further evaluate the effect of antibiotic therapy on them. Methods??We collected the medical records of the infants and young children hospitalized for persistent wheezing in Children’s Hospital of Chongqing Medical University from January 1?? 2005 to January 1?? 2016?? and analyzed the pathogen in BALF culture??including bacteria culture?? the seven kinds of viral antigen of nasopharyngeal aspirate?? MP-PCR and CP-PCR. Further??we divided the cases with positive bacterial isolates into two groups based on whether they were administered with antibiotics. The population proportion of symptom improvement and the mean days of hospital stay were recorded. Results??Among the 136 children who underwent BALF??there were 67??49.3%?? children with positive bacterial isolates??and the most common bacteria were Pneumococcal pneumonia??Klebsiella pneumoniae pneumonia subspecies??and Haemophilus parainfluenzae. The population proportion of symptom improvement of antibiotic group was higher than control group??P??0.05????and the mean days of hospitalization was shorter in antibiotic group compared with control group ??P??0.05??. For Streptococcus pneumoniae??a high prevalence of resistant strains was found to Meropenem??81.82%????Macrolide erythrocin??63.64%?? and Cefoxitin resistence??54.55%??. Conclusion Bacterial infection of the lower respiratory tract maybe relevant in some infants and young children with persistent wheezing??and antibiotic treatment may improve the rate of symptom improvement in these children and shorten the mean days of hospitalization. Therefore??some of infants and young children with persistent wheezing can be improved after antibiotic treatment.     

布拉氏酵母菌预防儿童肺炎继发性腹泻的多中心随机对照研究

目的　评价布拉氏酵母菌在预防儿童肺炎继发性腹泻的临床疗效。方法　采用多中心、 随机、 开放、空白对照的研究方法, 纳入499例1月龄～6周岁因肺炎于2014年8月至2017年12月间在浙江省18家医院住院治疗的患儿。采用随机数字表将患儿随机分成对照组与研究组。对照组接受常规抗生素+对症治疗, 研究组在常规抗生素+对症治疗基础上, 加用布拉氏酵母菌口服（1月龄～3周岁： 1包/次, 1次/d; ＞3～6周岁, 1包/次, 2次/d）, 并随访至停用抗生素后14 d。观察并记录患儿每日排便次数、 大便性状, 统计腹泻发生率、 住院时间、住院费用、 抗生素使用时间及药物相关不良反应等指标。结果　符合纳入标准的肺炎患儿499例, 回收病例报告表434例, 纳入疗效分析的患儿370例, 其中研究组192例, 对照组178例, 两组患儿一般资料差异无统计学意义; 研究组的继发性腹泻发生率低于对照组（P＝0.017＜0.05）, 两组患儿在抗生素使用时间、 住院时间、 住院费用上差异无统计学意义; 年龄分层分析发现患儿年龄≤1岁时两组腹泻发生率差异无统计学意义, 年龄＞1岁时研究组患儿腹泻发生率明显低于对照组（P＝0.006＜0.05）; 抗生素分层分析发现两组患儿腹泻发生率差异无统计学意义; 多因素Logistic回归分析结果显示, 患儿日龄、 抗生素使用时间是危险因素, 布拉氏酵母菌的应用为保护因素; 两组患儿均未观察到药物相关不良事件。结论　布拉氏酵母菌可以预防儿童肺炎继发性腹泻, 且安全性好。     

��ͯ�����º������ϰ�������һ��Ⱦ���ϸ�Ⱦ�����о�

??Objective To investigate the clinical relevance of multiple viral infections in children with acute lower respiratory disease. Methods A total of 1722 children with clinical diagnosis of lower respiratory tract infection ??ALRTI?? during the period of October 2007 to September 2011 were involved in our study. One nasopharyngeal aspirate specimen was collected from each patient. ??RT?? PCRs were performed to detect common respiratory tract viruses including respiratory syncytial virus ??RSV?? ?? rhinovirus ??RV?? ?? influenza virus type A and B?? parainfluenza virus ??PIV?? type 1-4?? adenovirus ??enterovirus?? human coronavirus?? human metapneumonia virus and human bocavirus. Results Totally 206 children had single RSV infection?? 124 children had dual infections ??RSV co-infected with an additional virus?? and 40 children had multiple infections along with a RSV infection. Out of the 124 patients?? 68??54.8%?? were co-infected with RV?? 24 with PIV. There was a statistically significant difference between the dual viral infections group and the RSV-infected group in hospital stay??P??0.001??. Compared to patients in the single RSV infected group?? patients in the multiple viral infection group had significantly more frequency in fever ??P??0.017???? duration of fever longer??P??0.015???? hospital stay also longer??P??0.001????and they received more intravenous steroid therapy during hospitalization??P??0.005??. There was no significant difference in oxygen therapy?? respiratory support and use of bronchodilators. Conclusion Multiple viral infections are linked to more frequency in fever?? longer fever days?? longer hospital stay?? and more frequent use of intravenous steroid therapy during hospitalization. Mixed respiratory virus infection may affect the patient's disease severity and prognosis.     

Effect of probiotic Lactobacillus strains on acute diarrhea in a cohort of nonhospitalized children attending day-care centers

BACKGROUND: Certain strains of lactobacilli have been shown to promote recovery from rotavirus enteritis in hospitalized children. Few studies have examined the effect of probiotics in nonhospitalized children with mild diarrhea. METHODS: We studied in a randomized placebo-controlled trial the effect of lyophilized Lactobacillus rhamnosus 19070-2 and Lactobacillus reuteri DSM 12246, 10(10) colony-forming units of each strain twice daily for 5 days, on acute diarrhea in children in a cohort of children recruited from local day-care centers. The duration of diarrhea and assessment of stool consistency were recorded by the parents. RESULTS: In patients treated with the selected Lactobacillus strains, the mean duration of diarrhea after intervention was reduced (76 h in patients treated with probiotics vs. 116 h in the placebo group; P = 0.05). In patients with diarrhea for <60 h before start of treatment (early intervention), a more pronounced effect of probiotics was found. The time to recovery after early treatment was 79 h vs. 139 h in the placebo group (P = 0.02); 1 of 17 patients treated early vs. 6 of 13 in the control group still had loose stools 120 h after start of treatment (P = 0.03). CONCLUSIONS: In children from day-care centers with mild gastroenteritis, the combination of L. rhamnosus 19070-2 and L. reuteri DSM 12246 was effective in reducing the duration of diarrhea.     

Evaluation of yogurt effect on acute diarrhea in 6-24-month-old hospitalized infants

Yogurt helps in treatment and prevention of diarrhea. The aim of this study was to determine the efficacy of consumption of local factory yogurt, which is made with pasteurized milk, on moderately dehydrated hospitalized infants aged 6-24 months with acute non-bloody and non-mucoid diarrhea. Eighty moderately dehydrated breast-feeding children aged between 6-24 months with acute non-bloody and non-mucoid diarrhea for fewer than four days were included in the study. Patients were randomly separated into two groups according to their treatment. Infants in the case group received at least 15 ml/kg/day of pasteurized cow milk yogurt orally plus routine hospital treatment. Infants in the control group received routine hospital treatment as in the case group. Weight gains, period of hospitalization, and reduction in diarrhea frequency during hospitalization period of the two groups were compared. Mean duration of hospitalization (days), weight gain, and reduction in diarrhea frequency were 2.7 +/- 0.91 vs 3.1 +/- 0.74 days, 435 +/- 89.20 vs 383 +/- 98.9 g, and 4.30 +/- 1.74 vs 3.60 +/- 1.23 times for case and control groups, respectively. Significant differences were observed in mean hospitalization days (p=0.035), reduction in diarrhea frequency (p=0.049) and weight gain (p=0.017). This study recommends universal use of yogurt in acute non-bloody diarrhea.     

סԺ��ͯӦ�ø�������Ӫ����������ɸ�鹤�ߵ��ٴ�����

??Objective??To use the modified pediatric malnutrition risk screening tool to investigate the prevalence of malnutrition in hospitalized children and assess the clinical effectiveness of the screening tool??to provide the basis for nutritional assessment and reasonable nutrition support. Methods??Choose hospitalized children in Xinhua Hospital Affiliated to Shanghai Jiao Tong University of Medicine from August 2014 to September 2015 as the investigation subjects. The modified pediatric malnutrition risk screening tool was used to further explore the relationship between results of nutritional risk screening and the clinical outcome. Results??The screening results showed that the total incidence of malnutrition in 2632 hospitalized children was 53.2%. The younger the hospitalized children were??the higher the incidence of malnutrition risk was??χ2??59.89??P??0.05??. There was statistical difference among children with different diseases in incidence of malnutrition risk??χ2??425.12??P??0.05????and the incidence of malnutrition was higher in the alimentary system disease group??70.1%?? and hematological malignancies group??86.7%?? than in other disease groups. In the absence of nutritional support??the lengthof hospital stay of children with malnutrition was significantly longer??Z??-9.293??P??0.05????and there was a significant difference in the outcome of the disease??χ2??4.937??P??0.05????the incidence of complications during hospitalization had a rising trend??but the difference was not statistically significant??χ2??2.203??P??0.05??. Conclusion??The results suggest that the modified pediatric malnutrition risk screening tool can effectively screen out the risk of malnutrition in hospitalized children?? with better clinical predictability.