小儿下消化道出血51例病因分析

小儿下消化道出血临床较常见,病因复杂。1987年以来我院应用纤维结肠镜对51例下消化道出血患儿进行了检查及治疗,现报告如下。 临床资料 一、对象51例患儿均来自我院门诊及部分住院患儿,男32例,女19例。年龄<1岁者2例,-3岁7例,-6岁15例,≥6岁27例,年龄最小9个月,最大12岁。 二、临床表现无痛性反复便血29例,腹痛伴便血18例,腹痛伴反复粘液脓血便4例。发病1周内检查者23例.1-2周16例,>2周12例。 三、术前准备与检查方法检查前1天进流质或无渣饮食,服番泻叶(5-10g)以导泻,检查当日晨禁食,温生理盐水反复灌肠,直至清洁为止,术前予     

SPECT美克尔憩室显像与消化道出血的病因诊断

美克尔憩宝临床表现以下消化道出血最常见，但症状和体征缺乏特异性，容易误诊或漏诊。作者采用单光子电子计算机扫描（SPECT）美克尔憩室显像诊断美克尔憩室所致消化道出血6例，并得到手术和病理检查证实，现报道如下。资料和方法一、临床资料6例中，男4例，女2例。年龄6mo～1     

应用内窥镜诊治小儿不明原因下消化道出血二例

临床资料　　自 1999年 3月～ 2 0 0 1年 7月 ,共治疗下消化道出血患儿 2 7例 ,男 2 2例 ,女 5例 ,年龄 3个月～ 12岁 ,共中肠套叠 12例 ,结肠息肉 5例 ,梅克尔憩室 6例 ,肠重叠畸形 1例 ,2例因未能找到明确器质性病变 ,出血部位虽经常规检查不能明确诊断 ,行剖腹探查 ,术中使用内窥镜检查、治疗 ,均获成功。例 1:女 ,3岁。因反复便血多次 ,外院以结肠息肉剖腹探查未成功 ,转我院经保守治疗出血停止 ,好转出院 ,1个月后再次出血 ,出血量大 ,入院查体呈急性失血貌 ,Ｈｂ 88ｇ/Ｌ ,便常规红细胞满视野 ,血压 5 0 / 30ｍｍＨｇ(1ｍｍＨｇ=0 .13…     

新生儿消化道出血312例临床分析

目的 了解新生儿消化道出血的原因,探讨防治措施。方法 对３１２例新生儿消化道出血进行临床分析,总结出血原因及防治途径。结果 ３１２例新生儿消化道出血的原因“新生儿出血症４２例（１３．５％）,坏死性小肠结肠炎（ＮＥＣ）３０例（９．６％）,应激性溃疡２４０例（７６．９％）。应激性溃疡的原因主要有胎儿宫内窘迫及出生时窒息、早产、重症感染、硬肿、休克。新生儿出血症预后好,治愈率１００％,ＮＥＣ病死率３０％     

儿童下消化道出血29例诊治体会

目的通过对儿童下消化道病例诊治的总结，提高对具有诊断价值的检查手段的认识。方法对不明原因的下消化道出血患儿采用肠镜、放射性核素显像、DSA检查。结果本文29例患儿经检查后28例明确病因。且对一例因大出血致失血性休克患儿经DSA检查，快速确定出血部位，为手术赢得时间，抢救成功。结论对下消化道出血患儿。除详细询问病史外，恰当的选择检查手段是明确病因、进行有效治疗的关键。     

小儿消化道出血的诊断及内镜治疗

小儿消化道出血原因复杂,按体重和循环血量计算,小儿消化道出血的安全系数远较成人低,对成人来说损失不多的血量也可危及小儿生命。消化道出血有很多分类方法,按出血部位可分为上消化道出血和下消化道出血。前者指食道、胃、十二指肠、胰腺、胆道即Treitz韧带以上的消化道出血,后者指Treitz韧带以下的消化道（小肠和大肠）出血。     

小儿下消化道出血的介入栓塞治疗

超选择性动脉造成影及介入治疗可及时发现小儿下消化道大出血的出血部位 ,从而有效控制出血 ,挽救患儿生命。本文对 8例下消化道出血患儿采用介入栓塞治疗。取得满意疗效 ,现总结如下。临床资料1997年 8月～ 2 0 0 0年 4月因下消化道出血在我科行血管造影的 8例患儿。男 6例 ,女 2例 ,年龄 9～ 14ａ。临床表现为反复大量血便 ,腹痛 ,1例伴失血性休克 ,经内科保守治疗 48ｈ～ 5ｄ未能控制出血。使用设备为Ａｎｇｉｏｓｔａｒ数字减影血管造影机 (ＳｉｅｍｅｎｓＧｅｒｍｅｎｙ) ;导管为 5ＦＣｏｂｒａ导管和3ＦＳＰ微导管 (日本Ｔｅｒｕｍｏ…     

儿童消化道出血的诊断流程

消化道出血是指由消化道疾病及其他系统疾病所致呕血和／或血便。根据出血部位的不同，分为上消化道出血和下消化道出血。前者是指屈氏韧带以上的消化道出血，后者则是屈氏韧带以下的消化道出血。[第一段]     

83例小儿上消化道出血病因学分析

目的探讨小儿上消化道出血的病因。方法对在儿科住院的83例上消化道出血患儿临床资料进行回顾性分析。结果小儿上消化道出血的病因以应激性溃疡19例(23%)和消化性溃疡18例(22%)为最多见;其次为重度浅表性胃炎14例(17%)及新生儿出血症9例(11%)。结论小儿上消化道出血好发于新生儿期和学龄期,新生儿以应激性溃疡多见,学龄期儿童以消化性溃疡和重度浅表性胃炎多见。     

7岁以下儿童急性下呼吸道感染病原学研究

目的 探讨苏州地区7岁以下儿童急性下呼吸道感染的痛原学分布.方法 对2007年10月至2008年3月间苏州大学附属儿童医院呼吸科住院患儿中7岁以下急性下呼吸道感染住院患儿810例,采用无菌负压吸引法采集新鲜痰液,进行细茵培养,直接免疫荧光法检测病毒,酶联免疫吸附试验(ELISA)法检测血清支原体、衣原体抗体.结果 810例患儿中556例病原栓测阳性(68.6%),单纯病毒感染181例(22.3%),单纯细菌感染124例(15.3%),单纯支原体感染72例(8.9%),单纯衣原体感染10例(1.2%),混合感染169例(20.9%).病毒以呼吸道合胞病毒为主(35.8%),细菌则以肺炎链球菌为主(13.8%),其次为流感嗜血杆菌(4.6%).结论 苏州地区7岁以下儿童急性下呼吸道感染最常见痛原是病毒,其次是细菌、支原体、衣原体.支原体感染多见于1岁以上儿童,混合感染则多见于3岁以下儿童.     

Ӥ��ʳ�����������������Ѫ35������

目的研究婴儿食物过敏致上消化道出血的临床表现、内镜下特点及组织病理学改变,以提高婴儿食物过敏致上消化道出血的诊断水平。方法以江西省儿童医院2006年6月至2010年7月住院的35例食物过敏致上消化道出血患儿为研究对象,回顾分析婴儿食物过敏致上消化道出血的临床表现、内镜下特点及组织病理学改变。结果所有患儿均有呕血和轻度-中度贫血,其中嗜酸性粒细胞升高19例,轻度低蛋白血症6例,血清IgE升高20例,血清幽门螺杆菌抗体检测阳性2例;所有患儿血小板计数均正常,肝功能及凝血象检查均正常;3例患儿行血清学食物过敏原特异性IgG抗体测定,其中2例牛奶喂养患儿对牛奶高度敏感,1例母乳喂养患儿对蛋清和(或)蛋黄高度敏感。35例患儿均呈现镜下糜烂性胃炎,且为多发性病灶,其中21例患儿病变以胃底、胃体黏膜多发糜烂为主,14例为胃体、胃窦黏膜多发性糜烂,3例伴胃窦、幽门管水肿,1例食管炎。所有患儿组织病理提示胃黏膜有嗜酸性粒细胞浸润,且均经患儿和母亲食物回避治疗有效。结论婴儿食物过敏致上消化道出血的临床症状无特异性,以牛奶喂养多见,消化道出血是常见的表现之一,内镜下表现以胃黏膜糜烂为主,饮食回避是主要的诊断及治疗方法,且疗效肯定;胃黏膜病理学检查及结合嗜酸性粒细胞计数有助于诊断。     

新生儿机械通气并发下呼吸道感染的易感因素及病原分析

目的分析新生儿机械通气并发下呼吸道感染的易感因素、致病菌的变迁,以寻求防治措施.方法1996～1999年行机械通气1天以上的133例患病新生儿按照胎龄、体重及插管时间分组,分析发生下呼吸道感染有无差异.所有病原学分析全部采取插管内采气道分泌物培养.结果新生儿机械通气插管时间大于3天,下呼吸道感染的发生率明显增高,低出生体重儿、早产儿其机械通气后下呼吸道感染的发生率和足月、正常出生体重儿比较,有升高的趋势,但统计学无显著意义.致病菌以克雷伯杆菌、大肠埃希菌、绿脓杆菌、不动杆菌为主.结论临床上合理应用机械通气,及早撤机,根据致病菌的变化合理应用抗生素,能有效地预防及治疗新生儿因气管插管、机械通气并发的下呼吸道感染.     

Upper gastrointestinal bleeding in children in Southern Iran

Objective  To find out whether the causes of upper GI bleeding in our center in a developing country differed from developed countries. Methods  Children presenting to our center with upper GI bleeding from March 2002 to March 2007, were retrospectively evaluated. Informations were retrieved from patient’s history and physical examination and results of upper GI endoscopy regarding etiology of bleeding, managements, use of medications which might predispose patient to bleeding, and the mortality rate. Results  From 118 children (67 boys; with age of 7.7±4.7 yrs) who underwent upper GI endoscopies, 50% presented with hematemesis, 14% had melena and 36% had both. The most common causes of upper GI bleeding among all patients were gastric erosions (28%), esophageal varices (16%), duodenal erosions (10%), gastric ulcer (8.5%), Mallory Weiss syndrome tear (7.8%), duodenal ulcer (6.8%), esophagitis (1.7%) and duodenal ulcer with gastric ulcer (0.8%). The causes of bleeding could not be ascertained in 20.5% of cases. No significant pre-medication or procedure related complications were observed. Endoscopic therapy was performed in 13.5% of patients. In 14.4% of patients, there was a history of consumption of medications predisposing them to upper GI bleeding. Two deaths occurred (1.7%) too. Conclusion  The findings in the present study showed that half of upper GI bleedings in pediatric patients from south of Iran, were due to gastric and duodenal erosions and ulcers. This study concludes that the causes of upper GI bleeding in children in our center of a developing country, are not different from those in developed ones.     

急性上消化道出血105例

目的　了解以急性上消化道出血为主要表现患儿的病因、出血程度、病理改变及与Hp感染的关系。方法　对 10 5例患儿进行生命体征评估及行相应实验室检查 ,并进行胃镜和 (或 )胃肠钡餐检查 ,胃镜检查同时送病理及Hp检测。结果　临床出现血容量不足或失血性休克表现 4 8例 ,占 4 5 .71% ;出血导致中重度贫血 5 4例 ,占 5 1.4 3% ;出血病因有消化性溃疡 4 7例 ,胃十二指肠炎 39例 ,占总数 81.9%。溃疡组病理改变炎症严重程度 (P <0 .0 0 1)及Hp感染率 (P <0 .0 5 )均较炎症组高。结论　儿童发生急性上消化道出血出血量大 ,导致血容量不足和中重度贫血的发生率高 ,病因以消化性溃疡和胃十二指肠炎症为最多见。其病理改变以胃窦部炎症为主。Hp感染率以消化性溃疡较高     

Relationships between cotinine, lower respiratory tract infection, and eosinophil cationic protein in children

Introduction The aim of this study was to investigate the effect of passive smoking on urine eosinophil cationic protein (u-ECP) in children with lower respiratory tract infections (LRTI). Method This was a case-control study. The study cohort consisted of 150 children with LRTI (case group) and 150 healthy children (control), all from a urban setting. The statistical parameters were: a minimum of 139 children for a 95% confidence interval (95% CI), 80% power, and a possible exposure prevalence of 50%. The u-cotinine and u-ECP levels were measured by radioimmunoassay and fluoroimmunoassay methods, respectively. Data were analyzed by the McNemar chi-square test, t-test, and Pearson correlation. Results When the generally accepted cut-off level of 30 ng/mg urinary cotinine/creatinine was applied, 87.3% of the children with LRTI and 84.7% of healthy children were passive smokers. Using a cut-off level of 60 ng/mg, passive smoking increased the prevalence of LRTI by 4.7-fold (p=0.000). The mean u-ECP values were significantly higher in the case group than in the healthy control group (p=0.018). A positive association was found between u-cotinine and u-ECP values in children with LRTI (p=0.034). Conclusion The results of this study indicate that passive smoking may play an important role in the development of respiratory infections and can cause airway inflammation in children with existing LRTI.     

温州地区儿童急性下呼吸道感染病原学及细菌耐药性检测

目的：了解温州地区儿童急性下呼吸道感染(LRTI)的病原学特点及细菌耐药情况。方法：454例急性LRTI患儿(年龄1个月~10岁,中位年龄6.0个月)入院24h内抽取下呼吸道分泌物送细菌培养,药敏试验采用K-B法,同时应用直接免疫荧光法检测呼吸道病毒。结果：297例(65.4%)病原检测阳性,其中病毒阳性229例(50.4%),以呼吸道合胞病毒(RSV)最多见(39.6%),其次为副流感病毒3型(PIV3)(6.6%)、腺病毒(2.2%)、流感病毒A型(0.9%)及流感病毒B型(0.7%)。共分离出19种135株(29.7%)致病菌,以肺炎克雷伯杆菌(K.pn)最多见(9.9%),其次为大肠杆菌(E.coli)(4.4%),K.pn和E.coli产ESBLs株分别占42.2%和65.0%;肺炎链球菌(SP)占4.2%。混合感染率为14.8%。6个月以下患儿前5位病原为RSV,K.pn,PIV3,E.coli及SA;而RSV,PIV3,SP,K.pn及E.coli则是6个月至3岁患儿常见的病原。K.pn和E.coli对氨苄西林的耐药率分别达97.8%和75.0%,产ESBLs株的K.pn和E.coli对头孢菌素普遍耐药;SP对红霉素的耐药率高达100%,对青霉素的耐药率亦达68.4%,而SA对红霉素和青霉素的耐药率分别为94.7%和89.5%。结论：RSV是温州地区儿童急性LRTI最常见的病原,其次为K.pn和PIV3。常见细菌的抗生素耐药性及革兰阴性杆菌产ESBLs的比率均相当高。     

Fetal lower urinary tract obstruction

Fetal lower urinary tract obstruction affects 2.2 per 10 000 births. It is a consequence of a range of pathological processes, most commonly posterior urethral valves (64%) or urethral atresia (39%). It is a condition of high mortality and morbidity associated with progressive renal dysfunction and oligohydramnios, and hence fetal pulmonary hypoplasia. Accurate detection is possible via ultrasound, but the underlying pathology is often unknown. In future, magnetic resonance imaging (MRI) may be increasingly used alongside ultrasound in the diagnosis and assessment of fetuses with lower urinary tract obstruction. Fetal urine analysis may provide improvements in prenatal determination of renal prognosis, but the optimum criteria to be used remain unclear. It is now possible to decompress the obstruction in utero via percutaneous vesico-amniotic shunting or cystoscopic techniques. In appropriately selected fetuses intervention may improve perinatal survival, but long-term renal morbidity amongst survivors remains problematic.     

Uroflowmetry in the management of lower urinary tract symptoms of children and adolescents with cerebral palsy

ObjectiveTo evaluate uroflow measurements in the initial management of lower urinary tract dysfunction in children and adolescents with cerebral palsy.Materials and methodsA total of 54 patients was enrolled in this study. All patients reported their urinary symptoms and underwent a physical examination, renal and urinary tract ultrasonography, and uroflow assessment.ResultsTwenty-three patients were female. Mean age was 9 years and 6 months (SD: 2 years and 10 months), with a range of 5–18 years. Twenty-eight of the patients (51.8%) were symptomatic. Urgency (42.6%), urge incontinence (40.7%), and enuresis (16.7%) were the most frequently observed symptoms. No association was found between gender, ambulatory status, or distribution of the paralysis and uroflow parameters. Symptomatic patients presented a statistically lower maximum flow (Q_max) than asymptomatic patients (17.2 ± 7.8 ml/s vs 22.6 ± 7.5 ml/s, p = 0.013, respectively). Normal bell-shaped curves were observed more frequently in asymptomatic patients, while abnormal curves were observed more frequently in symptomatic patients (p = 0.022).ConclusionsGender, ambulatory status, and the distribution of the paralysis do not affect Q_max rate or flow pattern. Symptomatic patients present lower Q_max and may also have an abnormal uroflow curve. Uroflowmetry may be useful in the initial urological evaluation.