儿童室性期前收缩联律间期改变与血流动力学的关系

目的 了解儿童室性期前收缩联律间期改变特点,探讨室性期前收缩对血流动力学的影响.方法 收集经心电图诊断为室性期前收缩的102例患儿,应用心功能仪和信号处理技术对其室性期前收缩桡动脉图进行面积积分测定.结果 室性期前收缩患儿的桡动脉图面积积分在提前率>40%时最小,20%～40%时居中,<20%时最大(P<0.05).期前收缩提前率相同时,儿童室性期前收缩发生在左室与右室对应的桡动脉图面积积分有统计学差异(P<0.05).儿童室性期前收缩时的桡动脉图面积积分最小,室性期前收缩前第一个窦性心搏居中,室性期前收缩后第一个窦性心搏最大(P<0.05).结论 儿童室性期前收缩对血流动力学的影响与期前收缩的联律间期改变有关.     

46例重型肺炎心功能检测及分析

为观察重型肺炎患儿的心功能情况 ,用彩色多谱勒超声心动图测定26例重型肺炎无器质性心脏病患儿、20例重型肺炎合并器质性心脏病患儿、20例轻型肺炎患儿和30例正常健康小儿的左室收缩功能、舒张功能及右室血流参数 ,同时检查血气分析、胸片、心电图及心肌酶谱。结果显示:26例重型肺炎无器质性心脏病者的左室收缩、舒张功能及右室血流参数与一般肺炎组及正常对照组比较差异无显著性(P>0.05) ,同期测定的心胸比例、心电图正常 ,心肌酶谱基本正常 ,仅有8例AST或LDH轻度升高 ;20例重型肺炎合并器质性心脏病者 ,左室收缩功能、舒张功能及右室血流参数与肺炎组及正常对照组比较 ,差异有显著性 (P<0.01 ,P<0.05)。提示肺炎患儿若未合并器质性心脏病者 ,不易引起心衰     

期前收缩的分类及治疗策略

期前收缩是儿童最常见的心律失常。既可发生于有器质心脏病患儿，也可存在于健康儿童。期前收缩是否需要治疗由其危险程度高低决定，发生于严重器质性心脏病、室性期前收缩频发影响心排出量及复杂性室性期前收缩需积极治疗；同时需要治疗引起期前收缩的病因及诱因；功能性室性期前收缩多不需治疗，室上性期前收缩也很少需要治疗。无论治疗与否，应注意对各种期前收缩的随访观察。     

稳心颗粒对小儿期前收缩疗效的随机对照研究

[摘要] 目的 探讨中药稳心颗粒对小儿期前收缩的疗效及安全性。方法 用前瞻性单盲随机对照的研究设计,将发病一个月内的期前收缩住院患儿随机分成治疗和对照两组。对照组常规保心肌治疗3周,治疗组在常规治疗基础上加服稳心颗粒3周。治疗前、后用5分钟心电图和Holter评估期前收缩频率。疗效分显效、有效和无效三种,显效为期前收缩消失或较治疗前减少75%或以上;有效为减少50～74%;无效为无减少或较原来增加。结果 103例患儿(男59,女44例,年龄1~14岁,平均7.8±3.8岁)入选为研究对象,房性期前收缩21例(20.4%),室性期前收缩78例(75.7%),交界性期前收缩2例(1.9%),同时有房性和室性期前收缩2例(1.9%)。55例分到治疗组,48对照组,治疗后症状改善率两组间无差异,治疗组体征改善率好于对照组(P=0.05);5分钟心电图评价治疗组总有效率达70.9%,显著高于对照组(41.7%,P=0.029);Holter评价治疗组总有效率65.5%,显著高于对照组(37.5%,P=0.045);房性期前收缩疗效好于室性期前收缩。治疗组3例(2.9%)出现轻度恶心、呕吐或便秘;血、尿、肝肾功能等无改变。结论 稳心颗粒对新发现的小儿期前收缩有治疗作用,房性期前收缩疗效更好。除2.9%患儿出现轻度的消化道症状外,该药对患儿无其它副作用,适于儿科应用。     

多巴酚丁胺负荷心电图试验对单纯室性早搏的定性研究

目的　探讨多巴酚丁胺负荷心电图试验对小儿单纯室性早博的定性评估价值。方法　应用多巴酚丁胺使 38例不能配合运动试验的Lown 2～ 3级室性期前收缩患儿的心率达到亚极量运动负荷水平 ,对比观察十二导心电图变化与2 0 1铊核素心肌灌注成像和室性早搏临床疗效的关系。结果　 38例中 8例阳性 (2 1% ) ,30例阴性 (79% ) ,2 6例配合SPECT检测的患儿 ,9例有心肌核素局灶性稀疏或缺失 ,17例心肌灌注正常 ,关联性检验　χ2 =1.1　P >0 .0 5 ;治疗 3个月后复查动态心电图显示 ,多巴酚丁胺负荷试验阳性的患儿室性期前收缩显著减少 (t=5 1.5　P <0 .0 0 5 ) ,阴性患儿的室性早搏无显著变化 (t =1.7　P >0 .0 5 )。结论　多巴酚丁胺负荷心电图试验安全 ,简便 ,受试者阳性提示心肌有活动性炎症     

室性期前收缩心电图分析

目的　探讨病理性与非病理性室性期前收缩的心电图特征。方法　对比分析 31例病理性室性期前收缩 (Ⅰ组 )、2 8例非病理性室性期前收缩 (Ⅱ组 )心电图特征。结果　Ⅰ组室性期前收缩起源于右心室 /右束支上部居多。结论　病理性室性期前收缩多起源于右心室 /右束支上部 ,提示此标准可作为病理性期前收缩的重要辅助诊断标准     

小儿良性室性心动过速7例报告

室性心动过速(VT)多见于器质性心脏病。近年来国内外已报道一些良性VT,可见于有或无器质性心脏病患者。有关小儿报道较少,现将我院收治7例报告如下。 资料和结果 一、临床资料 7例均为男性,年龄5～12岁,均经体表心电图(ECG)或食道心电图确诊为VT。YT发作期间均无血液动力学改变。根据病史、体检、胸部x线、心电图、超声心动图及心肌酶谱等检     

抗心律失常药物临床应用的进展(三)

特殊临床情况下快速心律失常的处理一、先天性心脏病[3 0 ]有数种先天性心脏病可在病程晚期发生猝死 ,特别是法洛四联症、主动脉瓣狭窄与完全型大动脉转位等。其中法洛四联症是最常见的发绀型先天性心脏病。法洛四联症手术后患者中孤立性室性期前收缩和非持续性室性心动过速的发生率较高 ,所以孤立性的室性期前收缩或频发并不能作为患者高危因素的指标。如果患者无室性期前收缩 ,则能够作为患者发生室性心律失常危险性低的标志。人们对血流动力学、病史及心电图方面的指标进行研究 ,试图发现能够筛查出具有潜在危险因素的患者。这些指标包括…     

75例有短阵发作症状儿童的动态心电图监测

目的　探讨动态心电图对儿童短阵发作症状的诊断价值。方法　75例有短阵发作症状儿童分为病毒性心肌炎组(n=40)和对照组(n=35),分别监测动态心电图和常规心电图。结果　病毒性心肌炎组动态心电图阳性率925%,对照组228%,两者有显著性差异(χ2=377,P<005),病毒性心肌炎的动态心电图阳性率(925%)显著高于常规心电图(575%)(χ2=131,P<001)。结论　症状发作时动态心电图改变对病毒性心肌炎有诊断意义,对有短阵发作症状患儿应作动态心电图监测。     

Tp-Te间期对于儿童室性早搏的意义

目的：探讨Tp-Te间期对于儿童室性早搏（VPC）危险分层的意义。方法：将120例VPC患儿按病因分成良性室早组、室性并行心律组和器质性室早组，每组各40例，另选取40例行健康体检儿童为正常对照组。比较4组间心电图V3、V4、V5导联的Tp-Te间期、Tp-Te/QT比率的差异。结果：V3导联显示器质性室早组Tp-Te间期较其余各组均延长（P<0.05）；V4导联显示良性室早组Tp-Te间期仅较正常对照组与器质性室早组缩短（P<0.05）；V5导联显示器质性室早组Tp-Te间期仅较良性室早组延长（P<0.05）。V3~V5导联均显示器质性室早组Tp-Te/QT比率较其余各组明显升高，差异均有统计学意义（均P<0.05）；同时V4和V5导联显示Tp-Te/QT比率在室性并行心律组与良性室早组之间差异均有统计学意义（均P<0.05）。结论：Tp-Te间期容易受心率的影响，在儿童时期用于VPC危险分层时，价值不大；而Tp-Te/QT比率可以作为临床儿童VPC危险分层的重要无创指标，值得进一步研究。     

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.     

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   

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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.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

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.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.