儿童急性肾功能衰竭进展

急性肾功能衰竭(ARF)是指肾脏在各种致病因子作用下,短期内肾功能急剧降低或丧失,失去维持机体内环境稳定的能力而出现的临床综合征。本病的病死率仍高,约在36％左右,故在ICU占重要地位。本文不包括新生儿ARF。     

危重患儿急性肾功能衰竭病因和预后分析

急性肾功能衰竭(ARF)是指。肾脏在短时间内发生调节水、电解质和酸碱平衡功能的丧失并伴随血液含氮质代谢废物迅速堆积为特点的一类临床综合征。文献报道国外成人ARF发生率约占住院患者的5％、重症监护室(ICU)患者的25％，死亡率仍高达50％以上。国内尚无儿科ICU(PICU)资料可循。现总结近5年来我院PICU病区收治58例ARF患儿的病因和预后，兹报道如下。     

小儿急性肾衰竭的治疗对策

急性肾衰竭(acuterenalfailure,ARF)是指肾脏本身和(或)肾外各种原因在短时期内(几天或几周)引起的急性肾功能严重损害,肾小球滤过率(GFR)降至30ml/(min·1.73m2)以下,临床主要表现为尿量显著减少,出现少尿或无尿、水电解质紊乱、酸中毒和氮质血症等。部分病例尿量可不减少甚至可增多,称为非少尿性ARF。临床常将ARF分为肾前性(约占70%)、肾性(约占25%)和肾后性(≤5%)三种。需要透析治疗的ARF的病死率高达50%～70%[1],如能早期诊断,合理治疗,可明显降低病死率。1肾前性ARF的治疗肾前性ARF系由血容量急速降低,肾血流量减少,致使GFR…     

急性肾衰竭的血液净化疗法

急性肾衰竭 (ARF)是儿科临床的危重症。腹膜透析、血液透析技术挽救了无数ARF患者 ,现已远远超出了肾脏替代的治疗范畴 ,统称为血液净化技术。但在儿童特别是婴幼儿中应用血液净化技术治疗ARF ,需要肾脏专科医生与ICU医生的协作和共同努力 ,以提高救治成功率[1] 。1　常用血液净化方法ARF时 ,肾脏作为重要排泄器官而言已丧失功能 ,因而需通过透析 (弥散和对流 )及超滤排除体内代谢废物及潴留的水 ,保持内环境的稳定。儿科治疗ARF的常用方法有腹膜透析 (PD)、血液透析 (HD)、连续性肾脏替代治疗 (CR RT) [2 ,3 ] 。1.1　PD　PD仍…     

间断性血浆置换术加自血光量子疗法治疗儿童急性肾功能衰竭5例报告

我科采用间断性血浆置换术(DPE)加自血光量子疗法(UBIO)成功抢救5例危重急性肾功能衰竭(ARF)患儿,男3例,女2例;年龄10～13岁。1例为急性非链球菌感染后肾小球肾炎所致原发性ARF,4例为继发性ARF,原发病为系统性红斑狼疮2例,败血症、痛风各1例。临床表现为典型的ARF经过,血尿素氮(BUN)36.7～96.0mmol/L(正常值     

新生儿急性肾功能衰竭

急性肾功能衰竭(ARF)在新生儿发病率高于儿童,导致ARF的多数原因是肾前性的,也可由肾实质性损伤或肾后性梗阻引起。据报道,新生儿ARF病死率高达25%～50%,有实质性肾损害患儿     

小儿急性肾功能衰竭的病因与治疗

急性肾功能衰竭(ARF)是儿科危重疾病之一。近10余年以来,对本病的发病机理与治疗方面有不少进展,但重症病例死亡率依然很高,国内报告在36%左右,国外在24～27%。ARF的分类与病因ARF是指肾脏因各种原因在短期内(几天至几周)出现显著的功能损害(GFR<30ml/分/1.73m~2),表现水电解质紊乱,酸中毒和氮质血症。少尿或无尿是ARF突出的临床表现,然而部分病例尿     

腹膜透析在儿童急性肾功能衰竭的临床应用

腹膜透析(peritoneal dialysis)于20世纪60年代首先用于治疗儿童急性肾功能衰竭(ARF),逐步成为肾替代疗法的重要形式之一,主要用于儿童的急、慢性肾功能衰竭,并可应用于急性药物或毒物中毒救治.本文主要讨论儿童ARF时的腹膜透析治疗.     

儿童急性肾损伤常用血液净化疗法

<正>近年来,以急性肾损伤(AKI)的概念代替急性肾功能衰竭(ARF)[1]。目前对AKI患者进行肾脏替代治疗最佳时机尚无统一标准。国内文献报道在AKI1期或2期即行连续性静脉-静脉血液滤过(CVVH)可明显改善预后,而在     

急性肾功能衰竭的处理

急性肾功能衰竭(ARF)是指由于肾脏自身和(或)肾外各种原因引起的肾功能在短期内(数小时或数天)急剧下降的一组临床综合征,患儿出现氮质血症、水及电解质紊乱和代谢性酸中毒.     

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.