小儿弥漫性轴索损伤治疗体会

目的探讨小儿弥漫性轴索损伤最佳治疗方法。方法分析总结1993年10月～2002年12月间的42例弥漫性轴索损伤患儿的临床表现及治疗方法。行多参数监测,维持体温、血氧分压及脑灌注压正常,保持水、电解质、酸碱平衡,给予综合治疗。结果随访1年,GOS1分5例,GOS2分3例,GOS3分2例,GOS4分4例,GOS5分28例。结论小儿弥漫性轴索损伤在小儿重型颅脑损伤中发病率较高,一般病情凶险,但小儿修复能力较强,通过积极治疗预后较好,大多无任何后遗症。     

小儿弥漫性轴索损伤治疗体会

目的探讨小儿弥漫性轴索损伤最佳治疗方法。方法分析总结1993年10月～2002年12月间的42例弥漫性轴索损伤患儿的临床表现及治疗方法。行多参数监测，维持体温、血氧分压及脑灌注压正常，保持水、电解质、酸碱平衡，给予综合治疗。结果随访1年，GOS1分5例，GOS2分3例，GOS3分2例，GOS4分4例，GOS5分28例。结论小儿弥漫性轴索损伤在小儿重型颅脑损伤中发病率较高，一般病情凶险，但小儿修复能力较强，通过积极治疗预后较好。大多无任何后遗症。     

小儿弥漫性轴索损伤49例

目的：探讨小儿弥漫性轴索损伤（DAI）的临床特征、早期诊断和治疗方法。方法：对49例小儿DAI病因、临床表现、CT结果、诊断和治疗方法进行分析。结果：其中伤后持续昏迷45例，有中间清醒期4例；CT显示弥漫性脑白质肿胀、点状出血，无脑中线移位。根据以上临床特征进行诊断，并采取相应的治疗措施。本组生存28例（59．1％），死亡21例（40．9％）。结论：小儿DAI伤情重、预后差，是重型颅脑损伤致死和致残的重要原因。     

儿童颅脑损伤的临床特点

目的　探讨儿童颅脑损伤的特点。方法　对儿童颅脑损伤患儿 98例临床表现及预后进行分析 ,并与成人颅脑损伤比较。结果　儿童颅脑损伤后腹痛、脑梗死、癫发生率均高于成人组 (P <0 .0 5 ) ,两组预后存在差异 (P <0 .0 5 )。结论　儿童颅脑损伤后临床表现较重 ,但预后较成人好     

儿童弥漫性肺泡出血

弥漫性肺泡出血（DAH）是以咯血、贫血、肺部弥漫性浸润影为主要表现的临床综合征，急性期死亡率高，是危及生命的急重症。与成人相比较，儿童DHA的基础疾病谱有其自身特点。既往认为儿童DAH以特发性肺含铁血黄素沉着症为主，但随着儿童DAH病例报道的增多，其病因谱在不断扩大。不同病因导致的DAH治疗及预后不尽相同，该文从广义角度评述儿童DAH，重点讨论特发性肺含铁血黄素沉着症、系统性红斑狼疮、抗中性粒细胞胞浆抗体相关性血管炎、COPA综合征、IgA血管炎引起的DAH。     

儿童同侧股骨颈合并股骨干骨折二例

儿童股骨干骨折为临床常见创伤,但股骨干骨折伴发同侧股骨颈骨折非常罕见,文献报道成人股骨干合并同侧股骨颈骨折占股骨干骨折的2％～9％,目前国内外关于儿童此类损伤的发病率尚无相关报道.国外各种文献报告至目前为止小于12岁的股骨颈伴发同侧股骨干骨折的儿童病例共14例,国内尚无相关病例报道.我院自2005年1月至2014年12月共收治此类创伤患儿2例,由于儿童该类损伤及其罕见,在治疗上仍有争议,到目前为止尚无被广泛接受的治疗方法.为提高对该类损伤的认识,回顾国内外相关文献并结合我们的病例对其受伤机制、分型、治疗及相关预后进行报道.     

吸入性损伤21例

目的 探讨儿童吸入性损伤的治疗方法及其对预后影响。方法 将儿童吸入性损伤21例分为轻、中、重3组,并行气管切开10例,进行氧疗、气管内湿化、雾化吸入,吸痰及抗休克治疗,注意及时封闭创面。结果 15例临床治愈,3例死亡,3例放弃治疗。结论 早期气管切开和预防性气管切开是提高儿童吸入性损伤治愈率的有效方法。     

儿童骨髓增生异常综合征16例临床分析

目的 分析儿童骨髓增生异常综合征(MDS)患者的临床特,最及预后.方法 根据2000年世界卫生组织(WHO)造血以及淋巴组织肿瘤分类方案中关于MDS的最新分型标准对1980年1月至2005年2月于天津市儿童医院就诊的16例儿童MDs患者进行重新分型,对患儿临床表现、临床转归等情况进行分析.并对部分患儿进行随访以观察患者的临床预后.结果 部分患者于短期内迅速转化为急性白血病,绝大多数患者于诊断1年左右死亡,临床预后差.结论 儿童MDS患者病程预后与成人患者明显不同,病情进展迅速,临床预后欠佳,应进一步加强对此类患者的临床重视与研究.     

儿童暴发抑制型脑电图的病因分析及预后

目的 探讨儿童暴发抑制型脑电图的病因及预后.方法 2004-2006年武汉市儿童医院通过住院观察及脑电图、头颅CT和(或)MRI等辅助检查,对40例具有暴发抑制型脑电图患儿的临床资料进行分析.结果 在40例儿童暴发抑制型脑电图中,大田原综合征(OS)17例(40%),婴儿痉挛15例(36%),病毒性脑炎4例,急性脑梗死2例,异物导致缺氧缺血性脑病2例.其中36例(86%)伴有精神发育迟滞.结论 儿童暴发抑制型脑电图改变并无特异性,可由诸多严重的弥漫性脑部疾病引起,是预后不良的征兆;其预后情况与不同病因关系密切.     

小儿自发性脑出血九例诊治体会

小儿自发性脑出血其病因多种且与成人不同,临床上以脑动静脉畸形及血液病常见。头颅CT检查是明确诊断的主要方法。根据病因等采取相应的治疗方法,预后良好,现报告如下。1临床资料与结果1.1临床资料患儿男4例,女5例,年龄50d至15岁,其中6例有恶心及呕吐。年长儿童4例有头昏、头痛,9例都有意识障碍,癫癎发作2例。     

儿童创伤性主支气管断裂的诊断与治疗

目的：探讨儿童创伤性主支气管断裂的诊断和治疗特点,提高治愈率。方法：对８例儿童创伤性主支气管断裂的诊断和外科治疗及预后进行观察。结果：６例早期诊断急诊剖胸探查行主支气管一期吻合术,痊愈出院,无并发症。２例延误诊断,其中１例伤后３月手术行主支气管对端吻合术,术后出现肺部感染和吻合口狭窄,经多次激光切除肉芽组织,解除吻合口狭窄,恢复正常肺功能,１例伤后６月,因胸腔感染,全肺不张,试吻合支气管后肺不膨胀而被迫行右全肺切除。本组８例随访１～１０年,无死亡,７例支气管吻合术均恢复正常肺功能,１例右全肺切除者,肺功能轻到中度障碍。结论：早期诊断和手术是提高儿童创伤性主支气管断裂的疗效,减少并发症的唯一有效措施。     

重症小儿胸部损伤诊治的临床观察

目的 探讨重症小儿胸部损伤的诊断治疗原则.方法 回顾分析1998年3月～2007年10月收治的117例重症胸部损伤患儿,其中男83例(71%),女34例(29%),车祸伤50例,锐器伤46例,高处坠落伤15例,挤压伤4例,枪弹伤2例.发生休克29例(32%).92例(79%)给予胸腔闭式引流等保守治疗,25例(21%)接受剖胸手术.结果 109例(93%)患儿治疗后恢复良好,8例(7%)死亡,均为多发伤,其中手术中死亡2例,分别为合并颅脑损伤和脾破裂.结论 小儿胸部损伤病情多样,正确及时的诊治措施是抢救患儿生命的关键.     

Outcomes and management of rectal injuries in children

In the pediatric population, rectal injuries usually occur as a result of motor vehicle collisions. There has been an increased interest in selective diversion of rectal injuries in adults and increased utilization of laparoscopy both as a diagnostic and therapeutic adjunct. The aim of the study was to review our institutional experience with rectal injuries to determine if there was a subset of patients who could be managed with selective diversion. The medical records of children admitted with a rectal injury to Hospital for Sick Children, Toronto, over the last 20 years (1984–2004) were retrospectively reviewed. Data abstraction included patient demographics, mechanism of injury, injury severity score, associated injuries, presenting symptoms, methods of diagnosis, treatment and resultant complications. Nine patients with rectal injuries were identified. The average injury severity score (ISS) was 19.3. Two patients with penetrating injuries underwent laparoscopy. Laparoscopy was able to define the intraperitoneal extension of injuries and guide the colostomy. Primary repair without a diverting colostomy was performed in 3 patients (2 intraperitoneal and 1 extraperitoneal injury) without complications. Based on the limited sample size, one should avoid making any definitive recommendations but, it appears, primary repair without fecal diversion can be performed safely in select children in spite of a longer time to surgery. Laparoscopy may be used for the immediate management of the penetrating trauma patient to rule out intraperitoneal extension, repair a perforation and guide the colostomy if necessary.     

Experience with using radionuclide methods for evaluation of the lungs and hepatobiliary system in children with allergic diseases

A total of 25 children with bronchial asthma and 40 children with cutaneous and dermato-respiratory + manifestations of allergy and concomitant injury to the gastrointestinal tract were under observation at an allergological clinic. In addition to the general clinical and allergological examination, radionuclide studies were performed by means of scintipneumography with 99mTc and hepatobiliscintigraphy with 99mTc HIDA. The data obtained indicate that radionuclide methods can be used in childhood allergological practice in the capacity of screening diagnosis as well as in the capacity of adjuvant + methods of examination, making it possible to perform investigations necessary for diagnosis establishment in a more precise and atraumatic manner.     

Is diffuse axonal injury on susceptibility weighted imaging a biomarker for executive functioning in adolescents with traumatic brain injury?

Traumatic brain injury (TBI) is a heterogeneous disorder in which diffuse axonal injury (DAI) is an important component contributing to executive dysfunction. During adolescence, developing brain networks are especially vulnerable to acceleration-deceleration forces. We aimed to examine the correlation between DAI (number and localization) and executive functioning in adolescents with TBI.We recruited 18 adolescents with a mean age of 15y8m (SD = 1y7m), averaging 2.5 years after sustaining a moderate-to-severe TBI with documented DAI. Susceptibility Weighted Imaging sequence was administered to localize the DAI lesions. The adolescents performed a neurocognitive test-battery, addressing different aspects of executive functioning (working memory, attention, processing speed, planning ability) and their parents completed the Behavior Rating Inventory of Executive Function (BRIEF) – questionnaire. Executive performance of the TBI-group was compared with an age and gender matched control group of typically developing peers. Based on these results we focused on the Stockings of Cambridge test and the BRIEF to correlate with the total number and location of DAI. Results revealed that the anatomical distribution of DAI, especially in the corpus callosum and the deep brain nuclei, may have more implications for executive functioning than the total amount of DAI in adolescents. Results of this study may help guide targeted rehabilitation to redirect the disturbed development of executive function in adolescents with TBI.     

Total severance of renal pedicle caused by blunt trauma in children

In two children complete severance of the renal vascular pedicle was the consequence of falling from a considerable height. Pre-operative diagnosis was established by retrograde aortography. In both these children there were additional injuries; one child had a splenic injury, the other a liver injury. One child survived but the other died. The importance of utilising retrograde aortography to define the nature of the injury is discussed in the context of a critical clinical situation necessitating emergency surgery.     

急性肾损伤121例临床与病理分析

目的 探讨儿童急性肾损伤(AKI)发病情况、病因、病理改变及病程转归情况.方法 回顾性分析2005年9月-2010年9月本院儿肾科收治的所有AKI患儿发病情况、临床诊断、病理诊断、住院天数及预后资料.采用SPSS 13.0软件进行分析.结果 共收治AKI患儿121例,每年儿童AKI人数/每年因肾脏疾病住院人数呈递增趋势,其中70例患儿进行了肾活检.121例AKI患儿中,男79例,女42例,发病年龄1~14岁[(7.6±3.8)岁],临床诊断前4位分别为急性感染后肾炎,肾病综合征,溶血尿毒综合征和急性间质性肾炎;病理诊断前4位分别为系膜增生性肾小球肾炎,毛细血管内皮细胞增生性肾小球肾炎,间质性肾炎和狼疮肾炎.所有AKI患儿中61例行血液透析,5例行腹膜透析,其余患儿对症保守治疗后好转.治疗后完全康复95例(78.51%),部分康复24例(19.83%),维持性透析治疗2例(1.66%).AKI衰竭期患儿住院时间(25.6±6.8) d,明显长于AKI危险期和损伤期患儿,且预后差.结论 儿童AKI的病因以感染性疾病为主,尤以感染后肾小球肾炎和间质性肾炎为主,但狼疮肾炎有逐年增多趋势,易并发肾功能不全.肾实质性AKI患儿均应行肾活检以明确病因,进行有效治疗.早期诊断、及时治疗是改善AKI预后的关键.     

Surgical management of major pancreatic injury in children.

INTRODUCTION: Major or complicated pancreatic trauma in children is uncommon and management strategies remain controversial. The aim of this study was to evaluate our experience with both early and delayed surgery in these pediatric cases. METHODS: We carried out a retrospective analysis of data of pediatric patients with major or complicated pancreatic injury operated on between January 1994 and December 2005 in our pediatric trauma center. RESULTS: Thirteen children (9 boys and 4 girls) with a mean age of 8.5 years (range 3 - 16 years) were operated for major or complicated pancreatic injury. The extent of injury was: grade II (major contusion without duct injury or tissue loss) in 4 children; grade III (distal transection) in 5 children and grade IV injury (proximal transection) in four patients. Pseudocyst developed in 8 children: 4 with grade II injury, 2 with grade III injury and 2 with grade IV injury (one with abdominal pseudocyst and one with an abdominal and a mediastinal pseudocyst). Early diagnosis and operation was achieved in 5 cases, while delayed diagnosis and operation occurred in 8. Three children underwent cystogastrostomy; 6 had a spleen-sparing distal pancreatectomy and 4 had resection with Roux-en-Y jejunostomy drainage. Endoscopic retrograde cholangiopancreaticography (ERCP) was the most useful diagnostic tool in assessing ductal injury. There were no deaths or long-term morbidity in our group of patients. CONCLUSIONS: Our results support the view that early operation is important in ductal pancreatic injury. We recommend transferring children with a suspected ductal injury to a tertiary center with experience in both pediatric ERCP and pancreatic surgery.     

儿童腹部损伤的诊断与治疗

目的 探讨儿童腹部损伤的保守治疗及手术探查的指征,提高儿童腹部损伤的诊疗水平.方法 回顾性分析我院89例腹部损伤患儿的临床资料,根据损伤部位情况进行分类,并逐一对其进行分析.结果 (1)89例腹部损伤患儿中,25例肝损伤,1例行剖腹探查;48例脾损伤,46例保守治疗,1例行脾切除术,1例予修补;14例胃肠道损伤,4例急诊剖腹探查,1例住院4 d后出现迟发穿孔;8例胰腺损伤,6例肾、肾上腺挫伤,予保守治疗;1例子宫、膀胱损伤,急诊手术治疗.(2)与成人不同,肝脾损伤患儿绝大多数经保守治疗能治愈,静脉补液后输血仍超过40 ml/kg,且血压不稳定者应及时手术探查.(3)CT检查对怀疑有胃肠道损伤,而不宜行腹部X线立位平片者有重要临床意义,合并气腹或腹胀明显加重,或出现腹膜炎表现的患儿,应及时手术探查,尤其注意迟发消化道穿孔的可能.(4)排除有胰腺横断的患儿,胰腺损伤多应保守治疗.(5)膀胱及子宫损伤患儿,外伤多较严重,需及时剖腹探查.结论 基层医院儿童腹部损伤应高度重视,实质脏器损伤导致的内出血是患儿死亡的最主要原因,空腔脏器损伤延误诊治是导致患儿死亡的另一重要原因,因此,早期准确诊断,积极治疗,以及综合处理其他严重的合并伤、并发症是成功救治该类患儿的关键.     

Sternal fractures as a manifestation of abusive injury in children

BACKGROUND: Sternal fractures are rare injuries in children. The rarity of this injury is likely due to both the relative plasticity of the pediatric thorax and to the difficulty in establishing a radiographic diagnosis without dedicated views. Current literature suggests that this injury in young children is highly specific for abusive injury. HYPOTHESIS: Sternal fractures are not highly specific for abusive injury. MATERIALS AND METHODS: This was a retrospective radiographic and clinical chart review of all documented sternal fractures over an 11-year period at a large pediatric hospital. RESULTS: Of 12 children with sternal fractures identified, four were < or = 2 years of age and eight were > or = 3 years of age. The mechanism of injury was suspicious for child abuse in two children. Both of these children were < or = 2 years of age. In one toddler, an unwitnessed injury resulted in extensive initial familial anxiety until abusive injury was excluded. CONCLUSION: Sternal fractures are unusual injuries, yet they, in themselves, are not highly specific for abusive injury.