小儿肺炎840例常见病原分析

目的　探讨小儿肺炎常见病原在不同地域、不同季节的流行情况以及常见病原的中医证候分布。方法　对2 0 0 2年3月至2 0 0 3年1 2月收治的840例肺炎患儿血清,用颗粒凝集法(PA)检测肺炎支原体(MP)抗体,ELISA法检测腺病毒(ADV)、呼吸道合胞病毒(RSV)、流感病毒(IV)的病毒抗体。结果　共测得病毒感染阳性病例3 0 3例,病毒阳性毒株3 75株,总阳性率为3 6 .1 % ( 3 0 3 / 840 ) ;肺炎支原体在3 ～7岁学龄前儿童中阳性率最高,为43. 6% ,<3岁组病毒阳性率最高,RSV、ADV、IV分别为46. 2 % ,63 . 1 %和56. 4% ;广州地区病毒阳性检出率为54 . 2 % ,上海地区为51 . 3 % ,辽宁地区的病毒阳性检出率为1 6 .0 % ;黑龙江地区为47. 5% ,成都地区为45. 6%。东北、成都地区在不同的季节病原分布无明显差异性(P >0 .0 5) ,上海、广州地区在不同的季节病原分布有明显差异性(P<0 .0 5)。不同的病原在中医证型间的分布无明显差异性(P >0 . 0 5)。结论　支原体肺炎在学龄前儿童中患病率最高,病毒性肺炎幼儿患病率最高;病毒阳性检出率南方略高于北方;上海地区MP肺炎以夏季发病较多,RSV和ADV肺炎均在冬季多见,IV肺炎在春季明显增多,广州地区MP肺炎在夏春季发病较多,RSV肺炎夏季多见,ADV肺炎多在冬季发病,IV肺炎在冬春季患病率增     

Lactose-Free Compared with Lactose-Containing Formula in Dietary Management of Acute Childhood Diarrhea

Objective

Few reports are available on some benefits, such as shortened duration of diarrhea and better weight gain, for lactose-free over lactose-containing formula in acute childhood diarrhea. We evaluated the effects of lactose-free formula in dietary management of acute diarrhea in formula-fed children.

Methods

This controlled-clinical trial was conducted on formula-fed children, aged 1 to 24 months, referring with acute non-bloody diarrhea (≤2 weeks). Those who had major systemic illness, severe malnutrition, severe dehydration, severe vomiting, or history of antibiotic therapy were not included. Children were allocated to receive lactose-free formula (intervention, n=37) or lactose-containing formula (control, n=34). Time to diarrhea relief and weight change were compared between the two groups after one week.

Findings

During the study, 32 male and 39 female children (7.1±3.7 months) were included. Those who received lactose-free formula had a significantly shorter time to diarrhea relief compared with the controls (1.7±0.7 vs. 2.6±0.7 days, P<0.001). Weight significantly increased in both groups, but there was no difference between the two groups in weight change (37±100 vs. 38±77 gr, P=0.673). Multivariate analysis showed that receiving lactose-free formula significantly predicted time to diarrhea relief (95% CI: 1.5 to 3.9, P<0.001) controlling for baseline characteristics.

Conclusion

Early administration of lactose-free formula for formula-fed children presenting with acute diarrhea can result in a more rapid relief of acute diarrhea and thus perhaps less mortality and morbidity. Trials with longer follow-ups are warranted to better evaluate long-term results such as weight change and feeding problems in this regard.     

С�����׼̷���к������ط�����΢��̬�Ƽ���Ԥ������

目的探讨小儿肺炎继发腹泻的危险因素及应用微生态制剂(培菲康)预防的效果。方法调查2002年1月至2004年5月在福建医科大学附属第一医院住院治疗的小儿肺炎314例,以住院期间抗生素治疗同时应用微生态制剂(培菲康)的患儿为病例组,仅使用抗生素治疗或住院72h后因出现继发腹泻才开始应用微生态制剂(培菲康)的患儿为对照组,对肺炎患儿的临床特征、微生态制剂的应用情况与继发腹泻的关系进行单因素卡方分析和非条件Logistic回归模型多因素分析。结果病例组114例,住院治疗期间继发腹泻病21例,发生率为18.4%;对照组200例,继发腹泻79例,发生率39.5%。单因素卡方分析显示:患儿发病年龄、住院天数、住院后有无侵入性操作、微生态制剂的应用、居住地、病情严重程度、血中性粒细胞、血红蛋白数量、激素应用与小儿肺炎继发腹泻有关联。非条件Logistic多因素回归分析筛选出3个危险因素,即患儿年龄(χ2=14.120,P=0.000)、住院天数(χ2=11.532,P=0.001)、入院后接受侵入性操作(χ2=6.827,P=0.009)和1个保护因素:微生态制剂应用(χ2=12.943,P=0.000)。结论肺炎患儿年龄越小、住院时间越长或进行侵入性操作可增加继发腹泻的发生率;微生态制剂能够降低小儿肺炎继发腹泻的发生率,提示具有预防作用。     

小儿腹泻病的诊断和治疗

腹泻病是儿科第2位常见多发病,也是儿科医师每天都要面对的问题.不断更新、及时掌握小儿腹泻病诊断与治疗的最新知识十分必要.现参阅国内外最新进展,结合中国具体国情,对小儿腹泻病的诊断与治疗作一规范化的阐述,便于临床医师参考应用.     

儿童金黄色葡萄球菌肺炎52例临床分析

目的 了解金黄色葡萄球菌肺炎(SAP)在儿童中的发病现状及耐药性。方法 回顾分析了重庆医科大学儿童医院PICU1993-2003年确诊为金黄色葡萄球菌肺炎52例的发病、抗生素敏感性和预后情况。结果SAP临床表现无特殊性,SA最易致多器官感染,尚未发现万古霉素耐药的病例。结论 SAP临床表现无特殊性,容易出现并发症,细菌具有多重耐药.因此选择适当的抗生素对治疗SAP感染非常重要。     

脊髓性肌萎缩症患儿免疫规划疫苗接种率及不良反应调查

目的了解脊髓性肌萎缩症(SMA)患儿国家规定计划免疫疫苗的接种率及其不良反应的发生情况。方法2016年7月至2019年6月进行回顾性横断面调查研究。以2016年7月至2018年12月在首都儿科研究所注册登记的192例SMA患儿(1~3型,男116例、女76例)和同期朝阳区奥运村社区卫生服务中心进行接种的191名健康儿童(男115名、女76名)作为研究对象,通过问卷调查、电话随访和查阅疫苗接种记录,了解计划免疫疫苗的接种时间、接种率及不良反应的发生情况。采用t检验或χ^2检验比较不同型别的SMA患儿各疫苗接种率,SMA患儿和健康儿童的不良反应情况。结果192例SMA患儿年龄(66±43)月龄,基础计划免疫完成率为62.0%(119例);1~3型SMA患儿完成率分别为52.2%(12/23),55.7%(68/122)和83.0%(39/47),差异有统计学意义(χ^2=12.23,P=0.002);各疫苗接种率随SMA患儿年龄增长而降低:卡介苗为100.0%(192/192),第3剂乙肝疫苗为94.3%(181/192),第3剂脊髓灰质炎疫苗81.8%(157/192),第3剂百白破疫苗为88.5%(170/192),首剂A群流脑疫苗83.9%(161/192),首剂麻疹或麻风二联疫苗76.6%(147/192),首剂乙脑减毒疫苗80.2%(154/192),首剂甲肝疫苗68.2%(131/192),麻风腮疫苗69.8%(134/192),A+C群流脑疫苗54.7%(105/192)。73例未完成计划免疫的SMA患儿中78.1%(57/73)因为患儿监护人害怕加重病情而主动放弃,21.9%(16/73)是免疫接种部门因为疾病的原因而终止接种。SMA患儿疫苗接种后的一般反应发生率与健康儿童差异无统计学意义[19.8%(38/192)比18.8%(36/191),χ^2=0.055,P=0.815],均以发热和局部红肿多见;异常反应在SMA患儿和健康儿童中发生率分别为2.6%(5/192)和3.7%(7/191),差异无统计学意义(χ^2=0.355,P=0.551),主要为皮疹或神经血管水肿。SMA患儿的肺炎疫苗和流感疫苗的接种率分别为22.4%(43/192)和31.8%(61/192),接种肺炎疫苗的SMA患儿肺炎发生率从接种前的59.0%(23/39)降到41.0%(16/39),接种流感疫苗的58例SMA患儿在接种当年均未发生流感。结论SMA患儿基础计划免疫完成率低,尤以1型患儿最低,主要是由于家长主动放弃接种。SMA患儿接种疫苗后不良反应的发生率与健康儿童差异无统计学意义。肺炎疫苗和流感疫苗接种后可以预防肺炎发生或降低肺炎次数及流感的发生。     

Pneumonia in young children with homozygous sickle cell disease: risk and clinical features

The incidence and clinical features of pneumonia have been examined in children with homozygous sickle cell (SS) disease and in age/sex matched control children with a normal haemoglobin (AA) genotype followed in a cohort study of sickle cell disease from birth.Survival curve analysis indicated a similar incidence of pneumonia in the two genotypes up to the ages of 8 months after which pneumonia became significantly more prevalent in SS disease, the relative risk exceeding a factor of four by 4 years of age. Children with SS disease were also more prone to multiple episodes. Comparison of clinical features in the two genotypes yielded no difference in sex or seasonal involvement, or in the results of bacteriological and radiological investigations. Children with SS disease and pneumonia had an increased frequency and increased duration of hospital admission, and mortality was confined to this group.It is concluded that children with SS disease have an increased prevalence of single and multiple attacks of pneumonia and that these events run a more serous clinical course than in control children.Abbreviations SS sickle cell disease - AA normal haemoglobin genotype     

婴幼儿肺炎呼吸衰竭患儿血浆NO和ET含量的变化和意义

目的　探讨血浆一氧化氮（ＮＯ） 和内皮素（ＥＴ） 在婴幼儿肺炎呼吸衰竭发生发展中的作用。方法　本题采用生化Ｇｒｉｅｓｓ 法和放免法测定ＮＯ 和ＥＴ 的含量变化以及研究了二者与小儿危重评分的关系。结果　肺炎呼衰患儿血浆ＮＯ 值减少,血浆ＥＴ 值增加,Ⅱ型呼衰ＥＴ 值增加较Ⅰ型呼衰更为显著;小儿危重评分的分值越小,血浆ＮＯ 的水平越低,血浆ＥＴ 的水平就越高。结论　血浆ＮＯ 和血浆ＥＴ 参与肺炎呼吸衰竭的发生发展,二者与疾病的危重程度一致     

Prevention and Management of Childhood Obesity

Childhood obesity has been recognized as a global pandemic. Preventive strategies have proven to be the most effective public health intervention in curbing this pandemic. A multi-component approach involving dietary modification and advocacy for a healthy lifestyle comprising of regular physical activity, minimizing screen time and behavioral interventions have been found beneficial in preventing obesity. A life-cycle approach has been recommended where preventive interventions go as far back as affecting maternal, fetal and early childhood nutrition and lifestyle. Family, school and community involvement is important for long term results, so is the involvement of government in developing policies that help create an environment and opportunities for healthy diet and physical activity. Management of childhood obesity is challenging. It involves following a structured weight reduction programme individualized for every child, along with adoption of a healthy diet and life style. Anti-obesity drugs have a limited role in childhood years and are not recommended in younger children. Bariatric surgery is reserved for morbidly obese older adolescents but its long term safety data is limited in this age group.     

肺炎链球菌抗原/抗体检测及其在肺炎/脑膜炎病原学诊断中的应用

肺炎是小儿的常见疾病,是导致儿童死亡的主要原因。细菌性脑膜炎是儿童重症感染性疾病,具有发病率高、病死率高、后遗症发生率高等特点。肺炎链球菌(SP)是引起儿童社区获得性肺炎、中耳炎、脓毒症、细菌性脑膜炎等细菌感染性疾病的主要病原菌。明确SP病原是临床合理应用抗生素的前提。细菌分离培养法仍是目前明确SP感染的"金标准",但培养阳性率低,耗时较长,不利于SP快速检测。免疫层析试验、酶联免疫吸附试验、胶乳颗粒凝集试验等免疫学方法具有快速、特异性强、灵敏性较高、操作简便、不受抗菌药物影响等优点,是检测SP感染细菌培养之外的一种补充。     

Diarrhea training and treatment unit: Experience from a teaching hospital

Case management of children with diarrhea has been evaluated after the establishment of a Diarrhea Training and Treatment Unit (DTU) in Kalawati Saran Children's Hospital, New Delhi. Our one year experience has shown a decrease in hospital admissions on account of diarrhea by 13%. With the help of proper treatment protocol, 69.5% of total cases have been managed with home available fluids/ORS after educating the mothers on home management of diarrhea. Majority of admitted cases (80.7%) were managed in the ORT area and rehydrated under proper monitoring and supervision between 3–8 hours (mean duration of stay 4.28±1.8 hours). Out of 1951 cases with dehydration, 1585 patients (81.2%) were rehydrated with ORS and only 366 cases (18.8%) received intravenous fluids. In more than 85% of cases with associated vomiting, successful oral rehydration was achieved with ORS. Use of ORS and early feeding even in those patients who initially received intravenous fluids for rehydration significantly reduced the average duration of stay in the diarrhea ward (P=<0.001). During the first year of its inception the average cost of rehydrating one patient of diarrhea in the DTU came down to Rs. 18.54 from Rs. 31.69 in the preceding year. Rationalising drug therapy in the case management helped to significantly reduce the consumption of antibiotics (P=<0.001) and antiemetics (P=<0.001), which has helped to reduce the expenditure on drugs on an average from Rs. 17.60 to Rs. 4.92 per patient.     

中国儿童感染性腹泻诊治进展

儿童感染性腹泻是一组广泛存在并严重危害儿童健康的胃肠道传染病,也是当今世界重要的公共卫生问题之一。虽然诊断方法日新月异,但仍没有真正广泛应用于临床尤其是农村和城市社区的诊断方法。WHO和联合国国际儿童紧急救援基金会推荐的儿童腹泻病治疗指南的推广任务仍然是任重而道远。低渗口服补液盐和补锌治疗方法的广泛应用将为腹泻病儿童及其家庭带来安全、有效、方便和经济实惠,为千年计划的实现作出贡献。     

儿童肺炎常见病原学分析及中医证候演变规律的多中心随机双盲安慰剂对照试验研究

目的探讨儿童肺炎常见病原的流行情况以及儿童肺炎的中医证候演变规律,同时探讨中西医内外综合治疗方案治疗儿童肺炎的疗效。方法按照最佳临床试验原则开展规范化临床试验研究,通过840例儿童肺炎的RCT研究,对患儿血清用颗粒凝集法检测肺炎支原体抗体,ELISA法检测腺病毒、呼吸道合胞病毒和流感病毒的病毒抗体。跟踪观察患儿在入院当天(基线点)、用药后第3、5、7和10天的临床表现,确定各观察点中医证型。应用证候的演变概率法对儿童肺炎中医证候在不同观察点和不同地域的演变规律进行系统分析。同时,对治疗组和对照组做总体疗效、证候疗效及临床各单证改善情况对比。结果共测得病毒感染阳性病例303例,支原体肺炎在3~7岁儿童中阳性率最高,<3岁组病毒阳性率最高,东北、成都地区在不同季节的病原分布差异无统计学意义(P>0·05),上海、广州地区在不同季节的病原分布差异有统计学意义(P<0·05)。不同的病原在中医证型间的分布差异无统计学意义(P>0·05)。儿童肺炎初期以风热闭肺证、痰热闭肺证为主;中期是由实证向虚证转移的关键时期;肺炎初期,南方与北方证型分布差异无统计学意义;肺炎后期,南方与北方肺炎虚证分布差异有统计学意义。中西医内、外综合治疗法可明显提高儿童肺炎总体疗效及证候疗效,对临床各单证的改善情况明显优于对照组。结论支原体肺炎在3~7岁儿童中患病率最高,病毒性肺炎患病率在1~3岁儿童最高;病毒阳性检出率南方略高于北方。儿童肺炎中医证候在不同观察点、不同地域有着不同的演变规律。同时证明,本研究采用的中西医内、外综合治疗法可缩短儿童肺炎疗程,是治疗儿童肺炎合理有效的治疗方案。