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目的评价小儿心脏手术的麻醉管理技术应用于幼猪低温低流量体外循环(CPB)心脏手术的全麻效果及其安全性。方法普通幼猪42只,基础麻醉采用氯胺酮加硫酸阿托品肌肉注射,麻醉诱导和维持采用芬太尼、哌库溴铵和咪达唑仑静脉注射,并辅助吸入七氟烷;CPB全流量后停止机械通气,给予可调压力限制阀0.49 kPa压力静态膨肺,主动脉开放后吸痰,手控通气膨肺,恢复机械通气;根据动脉血气结果纠正内环境紊乱,复温期间泵入多巴胺、多巴酚丁胺维持循环稳定,心律失常根据其类型给予相应的处理;监测并记录血流动力学指标、动脉血气分析指标、呼吸参数、麻醉总时间、主动脉阻断时间、CPB转机时间。结果 1只死于CPB后心脏骤停,余41只完成至实验终点,主动脉阻断时间为(125±8)min,CPB转机时间为(184±10)min,麻醉总时间为(335±17)min。结论小儿心脏手术麻醉管理方法应用于幼猪低温低流量CPB心脏手术全麻效果满意,且安全性高。 相似文献
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Akihisa Sawada Mariko Shimizu Kanako Isaka Kouhei Higuchi Azusa Mayumi Yuri Yoshimoto 《Pediatric hematology and oncology》2014,31(8):754-764
Background. Patients with advanced malignancies in non-complete remission (CR) have a dismal prognosis after HLA-matched hematopoietic stem cell transplantation (HSCT). T-cell-replete HLA-haploidentical HSCT has remarkable anti-leukemia/tumor effects on these patients, but also a high risk of severe/extensive graft-versus-host disease (GHVD). Post-transplantation cyclophosphamide (PTCY) is regarded as a GVHD-specific immunosuppressant in adults, but its feasibility is unknown in children. Methods. We performed a prospective feasibility study of PTCY at 50 mg/kg on day 3 for children with advanced leukemias or malignant solid tumors: refractory to chemotherapy or relapsed after conventional allogeneic HSCT. Conditioning consisted of fludarabine (180 mg/m2) and melphalan (140–210 mg/m2). Results. Long-term engraftments were achieved in 11 patients (73.3%) after bone marrow transplantation (BMT, n = 13) or peripheral blood (PB) stem cell transplantation (n = 2). The incidence of severe acute GHVD was 25.0% and that of extensive chronic GVHD 0.0% after evaluable BMT. CR was achieved in 6/15 and partial response in 4/15 as the best response. Finally, 11/15 experienced disease progression/relapse, 2/15 suffered treatment-related mortality without evidence of disease, and 2/15 are alive in continuous CR. Conclusions. PTCY is feasible in children; however, for a better outcome in such patients with advanced malignancies, some modifications are anticipated. 相似文献
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We report the case of a 14-month-old male with d-transposition of the great arteries, ventricular septal defect, and pulmonary
hypertension successfully treated with long-term sildenafil following cardiac surgery. To our knowledge, this is the first
published report of long-term sildenafil treatment in a child after corrective cardiac surgery. 相似文献
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Prevalence of Symptomatic and Asymptomatic Thrombosis in Pediatric Oncology Patients With Tunneled Central Venous Catheters
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Reineke A. Schoot MD PhD Marianne D. van de Wetering MD PhD Theo Stijnen PhD Wim J.E. Tissing MD PhD Erna Michiels MD PhD Floor C.H. Abbink MD PhD Martine F. Raphael MD Hugo A. Heij MD PhD Michel Zwaan MD PhD Jan A. Lieverst MSc Hubert N. Caron MD PhD Heleen van Ommen MD PhD 《Pediatric blood & cancer》2016,63(8):1438-1444
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Caitlyn M. Alvar Jennifer A. Coddington Karen J. Foli Azza H. Ahmed 《Journal of pediatric health care》2018,32(1):43-52
Depression is a common comorbid condition experienced by children with type 1 diabetes that, if undiagnosed, can lead to deterioration in glycemic control and other serious health complications. Although it is documented that children with type 1 diabetes experience high rates of depression, a comprehensive clinical guide does not exist to help direct the pediatric provider on how to best care for these children. The purpose of this article is to synthesize current evidence to aid the pediatric primary care provider in the detection and management of depression in the school-aged child with type 1 diabetes. 相似文献
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Brooke E. Lifland Rita Mangione-Smith Tonya M. Palermo Jennifer A. Rabbitts 《Academic pediatrics》2018,18(4):376-383
Objectives
Monitoring patient-centered health outcomes after hospital discharge is important for identifying patients experiencing poor recovery after surgery. Utilizing parent reports may improve the feasibility of monitoring recovery when children are not available to provide self-report. We therefore aimed to examine agreement between parent and child reports of child pain and health-related quality of life (HRQOL) in children after hospital discharge from inpatient surgery.Methods
A total of 295 children aged 8 to 18 years and their parents reported on child pain intensity using an 11-point numerical rating scale and on HRQOL using the 0- to 100-point Pediatric Quality of Life Inventory Version 4.0 Generic Core Scales by phone or online, 4 to 8 weeks after surgery. Agreement between parent and child ratings was assessed by absolute discrepancy scores, Pearson product-moment correlations, 2-way mixed effects intraclass correlation coefficient models, and linear regression models.Results
We found good to excellent agreement between child and parent reports of pain intensity and HRQOL. Average absolute discrepancy scores of pain intensity and HRQOL were 0.6 and 7.8 points, respectively. Pearson product-moment correlation coefficients were 0.74 and 0.80, and intraclass correlation coefficients were 0.72 and 0.79, for pain intensity and HRQOL, respectively. Regression coefficients for models examining pain intensity and HRQOL were 0.93 to 0.98 and 1.0, respectively.Conclusions
Although child and parent reports may both contribute important information, parent report is a valid proxy for child self-reported pain intensity and HRQOL after discharge from inpatient pediatric surgery, which may prove important for better understanding pain experiences and intervention needs. 相似文献8.
Callie L. Brown Eliana M. Perrin Karen E. Peterson Holly E. Brophy Herb Mildred A. Horodynski Dawn Contreras Alison L. Miller Danielle P. Appugliese Sarah C. Ball Julie C. Lumeng 《Academic pediatrics》2018,18(3):334-341
Background
Picky eating is common in children. Few studies have examined predictors of picky eating, and the association of picky eating with weight status and dietary quality is inconsistent in the literature. We aimed to identify predictors of picky eating and to test the association of picky eating with child body mass index z-score (BMIz), dietary quality, and micronutrient intake.Methods
This was a cross-sectional analysis of baseline data from a randomized controlled trial to prevent obesity among 506 preschoolers attending Head Start. Parents completed questionnaires to assess picky eating and child temperament. Three 24-hour dietary recalls were collected to assess dietary intake. Multivariate regression models assessed child, parent, and family predictors of picky eating; additional models tested adjusted associations of picky eating with child BMIz, dietary quality (measured using the Healthy Eating Index-2010), and micronutrient intake.Results
Picky eating was predicted by male sex, older child age, and more difficult temperament but not race/ethnicity, maternal body mass index, maternal depressive symptoms, household food insecurity, or single parent home. Picky eating was not associated with child BMIz or micronutrient deficiencies; it was inversely associated with total Healthy Eating Index-2010 score and servings of whole fruit, total vegetables, greens and beans, and total protein foods.Conclusions
Pediatric providers should support parents in expanding the number of healthy foods the child eats to improve dietary quality, but reassure parents that picky eating is not associated with children's weight status or micronutrient deficiencies. 相似文献9.
Acute Renal Insufficiency and Renal Replacement Therapy After Pediatric Cardiopulmonary Bypass Surgery 总被引:8,自引:0,他引:8
J.E. Kist-van Holthe tot Echten C.A. Goedvolk M.B.M.E. Doornaar M.M.J. van der Vorst J.M. Bosman-Vermeeren R. Brand A.J. van der Heijden P.H. Schoof M.G. Hazekamp 《Pediatric cardiology》2001,22(4):321-326
The aim of the study was to investigate renal function and renal replacement therapy after cardiopulmonary bypass surgery
in children. Patient characteristics (sex, age, diagnosis), operation type, and death were listed. The study was performed
retrospectively using serum creatinine level before, and peak values after, cardiopulmonary bypass surgery for assessment
of renal function. Of the children on renal replacement therapy, indication, efficacy, and complications were recorded. In
a 5-year period, 1075 children had cardiopulmonary bypass surgery at the Department of Cardiothoracic Surgery at Leiden University
Medical Center and Academic Medical Center of Amsterdam. One-hundred eighty (17%) patients developed acute renal insufficiency.
Twenty-five (2.3%) patients required renal replacement therapy. Peritoneal dialysis is a safe and effective treatment for
children after cardiopulmonary bypass surgery. However, 15 (60%) of 25 children on renal replacement therapy died of nonrenal
causes. In 9 out of 10 surviving children, renal function was normal at time of discharge from hospital. Acute renal insufficiency
is a frequent complication after open-heart surgery, although renal replacement therapy was infrequently necessary. Peritoneal
dialysis is a safe and effective therapeutic measure for children after cardiac bypass surgery. 相似文献
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A 2-year-old boy underwent surgical repair of tetralogy of Fallot. Topical cooling of the heart with ice slush was used during the operation. Diaphragmatic paralysis occurred after the operation, inducing severe respiratory distress. To avoid repeated intubation and tracheostomy, the patient was placed on nasal mask bilevel positive airway pressure (BiPAP) ventilation. After ventilatory support with BiPAP for 40 days, the patient recovered spontaneously from the paralysis. No sedation was required during this time. This report illustrates the usefulness of BiPAP for a pediatric patient with diaphragmatic paralysis after cardiac surgery. 相似文献
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Woo Sung Jang Woong-Han Kim Kwangho Choi JinHae Nam Jin-Tae Kim Jeong Ryul Lee Yong Jin Kim Gi Beom Kim 《Pediatric cardiology》2014,35(6):914-921
Bronchoscopy-guided aortopexy is a surgical management option for patients with central airway obstruction after congenital heart surgery. This study aimed to evaluate the usefulness of bronchoscopy-guided aortopexy based on midterm follow-up evaluation with computed tomography (CT) and clinical outcome. From January 2004 to August 2011, bronchoscopy-guided aortopexy was performed for 16 patients (median age 0.5 years, M:F = 10:6) who had central airway obstruction caused by extrinsic compression (13 in the left main bronchus, 2 in the trachea, 1 in the diffuse trachea and bronchus) after congenital heart surgery. The surgical site for aortopexy was determined by the anatomic relationship between the aorta and the compressed bronchus according to preoperative CT and intraoperative bronchoscopy. The median follow-up period was 2.3 years. The ratios of the diameter and area of stenosis at the narrowed point were estimated using pre- and postoperative CT. Almost all the patients (15/16) showed relief of their preoperative symptoms. The median extubation time was 18 h. The stenosis diameter and area ratios significantly improved, as shown by with the immediate postoperative CT (7.7–48.5 %, p = 0.003; 54.8–80.5 %, p = 0.006). Airway stenosis of more than 75 % (p = 0.013), immediate diameter ratio improvement of <50 % (p = 0.015), preoperative severe respiratory insufficiency (p = 0.038), and male sex (p = 0.024) were associated with recurrent minor respiratory susceptibility. Bronchoscopy-guided aortopexy is a safe and reliable surgical management choice for central airway obstruction after congenital heart surgery. Furthermore, airway improvement after aortopexy was maintained during the midterm follow-up evaluation, according to CT measurements. 相似文献
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L. M. E. Massimo 《Pediatric hematology and oncology》1995,12(5):431-438
Pediatric hematology and oncology has been a well-organized specialty throughout Italy only since 1974. However, it seemed interesting and fitting to review some of the milestones lying at the base of the development of this field of medicine: the first Italian Children's Hospital created in Florence in the fifteenth century; the first textbook of pediatrics, De Morbis Puerorum, by G. Mercuriale of Bologna; the first hematologic breakthroughs in the seventeenth, eighteenth, and nineteenth centuries; and the paramount achievements in pediatric hematology and oncology over the last 50 years. 相似文献
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《Academic pediatrics》2020,20(5):600-608
ObjectiveTo determine the prevalence of anxiety and depression and examine their association with adverse childhood experiences (ACEs) among children and adolescents ages 8 to 17 years old.MethodsUsing data from the 2016-2017 National Survey of Children's Health, we conducted a cross-sectional study design with a total sample of 39,929. Our exposure and outcome variables included caregiver report of 9 ACE exposures and current anxiety or current depression. Survey sampling weights and SAS survey procedures were implemented to produce nationally representative results.ResultsOur study found that 9% of children had current anxiety while 4% had current depression. Multivariate analysis concluded that all ACE measures were associated with significantly higher odds of both anxiety and depression. Children exposed to 4 or more ACEs had higher odds of anxiety (adjusted odds ratio [aOR] = 1.7; 95% confidence interval [CI], 1.4–2.1) and depression (aOR = 2.2; 95% CI, 1.7–2.9) than children with exposure to fewer than four ACEs. Assessment of the outcomes of anxiety and depression separately showed differential impacts of ACE exposures as associations were stronger with depression for almost all ACE categories.ConclusionsOur study demonstrates a differential association between ACEs and anxiety and depression. This highlights the importance of assessing the impact of ACEs on internalizing behaviors separately. These findings are significant for pediatric providers as diagnosis and treatment for mental health disorders are vital components of pediatric care and further support the American Academy of Pediatrics' recommendation to screen for ACEs. 相似文献
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Vered Molina Hazan Yael Gonen Amir Vardi Ilan Keidan David Mishali Marina Rubinshtein Yusim Yakov Gideon Paret 《Pediatric cardiology》2010,31(7):952-960
This study aimed to examine the association between lactate levels in the first hours after surgery for congenital heart defects
and the results of Risk-Adjusted Classification for Congenital Heart Surgery (RACHS-1) scoring and to evaluate serial lactate
levels over time to determine whether they can serve as a supplementary tool for postoperative assessment within the same
RACHS-1 group of patients. A retrospective cohort study was performed using data retrieved from a clinical database of 255
children who had surgery for congenital heart defects between 1999 and 2001 at Sheba Medical Center. Lactate levels were measured
postoperatively four times (mg/dL units). The last sample was taken at the end of the surgical procedure, and lactate levels
were measured at admission to the pediatrics critical care unit, then 6 and 12 h after admission. The lactate level was measured
via arterial blood gases. A total of 27 deaths occurred, yielding a mortality rate of 7.4% when Norwood operations were excluded
and 10.16% when they were included. The mean initial postoperative lactate level was significantly lower for survivors (42.2 ± 32.0 mg/dL)
than for nonsurvivors (85.4 ± 54.1 mg/dL) (p < 0.01). The serial mean lactate levels decreased progressively for all surviving patients (r
2 = 0.96) compared with nonsurvivors (r
2 = 0.02). The lactate levels correlated with the RACHS-1 subgroups at each time point (r
2 > 0.96 for all). The Pearson correlations between postoperative lactate levels (last lactate measurement taken in the operating
room) and cardiopulmonary bypass (CPB) duration (r = 0.549), clamp duration (r = 0.586), and the inotropic score (r = 0.466) (p < 0.001 for all) were significantly positive. The correlations between the maximum lactate levels (during the first 12 postoperative
hours) and CPB duration (r = 0.496), clamp duration (r = 0.509), and the inotropic score (r = 0.633) (p < 0.001 for all) were extremely positive. The early elevation of lactate levels in RACHS-1 subgroups 1 to 3 were highly correlated
with poor prognosis and death (p < 0.03). In addition, the lactate levels differed significantly between survivors and nonsurvivors within the same RACHS-1
subgroup. The survivors in RACHS-1 subgroups 1 to 3 had lower mean lactate levels than the nonsurvivors in this group (P = 0.011), and this also held true for the survivors and nonsurvivors in RACHS-1 subgroups 4 to 6 (P = 0.026). Lactate levels differed significantly between survivors and nonsurvivors within the same RACHS-1 subgroup. This
combination allows the targeting of appropriately intensive interventions and therapies toward the sickest patients. 相似文献