急性肠套叠和急性阑尾炎病儿肠电图

本文通过对急性肠套叠３０例、急性阑尾炎３８例患儿进行肠电图检测，结果发现，急性肠套叠病儿复位前小肠电压明显高于正常对照组，复位后则恢复至正常水平；而急性阑尾炎无腹膜炎组只有回盲部电压低于正常对照组，有腹膜炎各部位电压低于正常对照组。故对急腹症病儿检测肠电图，根据电压的升高或降低可做为判断梗阻性或炎症性疾病的参考指标。     

胃泌素水平与小儿急性肠套叠病因的探讨

近２ａ来我们测定了３０例肠套叠患儿、３０例腹泻病儿血清胃泌素,结果肠套叠儿和治疗后腹泻病儿血清胃泌素显著高于正常婴幼儿。提出高胃泌素血症和腹泻病与小儿急性肠套叠的病因有密切关系。材料与方法一、病例选择：３０例肠套叠中男１８例,女１２例,年龄４ｍｏ～６ａ,４～１０ｍｏ２４例。均有典型的临床表现,并经空气灌肠和手术证实。１２例病前有腹泻病病史。６例套叠部坏死肠管病检结果为：肠管水肿、炎性出血坏死改变,周围组织及肠系膜淋巴结呈慢性炎性改变。分别于治疗前、治疗后１０ｄ、治疗后３ｍｏ３次抽血,每次均禁食后…     

儿童手术后肠套叠29例分析

儿童手术后肠套叠较为少见,约占儿童腹部手术的0．08％,且多为小肠套叠。早期诊断、早期再手术是治疗的唯一方法。安徽医科大学附属六安医院外二科1986—2008年共收治29例,现报告如下。     

急性肠套叠67例

急性肠套叠６７例新乡医学院三附院外科，新乡医学院一附院（４５３００３）赵根隆，李绍山，刘根生我院自１９８９年２月至１９９４年２月共收治小儿急性肠套叠６７例，现报告如下。临床资料一、一般资料本组６７例中，男４２例，女２５例，年龄８个月～７岁，其中３～８...     

儿童过敏性紫癜合并肠套叠临床分析

目的探讨过敏性紫癜合并肠套叠的临床特点及外科治疗方法。方法回顾性分析本院自2006年1月至2013年6月收治的19例过敏性紫癜合并肠套叠患儿的临床资料。结果19例中,空气灌肠复位成功4例,15例行手术治疗,手术整复4例,肠坏死11例,其中行肠吻合7例,肠造瘘4例。结论肠套叠病程在6 h 内者,行空气灌肠治疗是可行、有效的;发病时间在24 h 后者,应及时手术干预。     

小儿急性肾损伤的流行病学

近年来国际肾脏病和急救医学界趋向于用急性肾损伤(acute kidney injury,AKI)来取代急性肾功能衰竭的概念.儿童AKI的病因日趋复杂,已由原发性肾脏疾病为主转变为多因素所致,且AKI不仅明显延长了PICU患儿的住院时间,也增加了PICU患儿的病死率.本文将对AKI的病因及流行病学作一简单的介绍,并对RIFLE及AKIN两个诊断标准进行分析.     

小儿急性肠套叠肠坏死相关因素分析

目的 分析肠套叠伴肠坏死的高危因素.方法 回顾性分析2007年9月至2009年9月温州医学院附属育英儿童医院收治的219例肠套叠手术患儿临床资料,其中肠坏死42例（肠坏死组）,非肠坏死177例（非肠坏死组）.对两组病程、年龄、白细胞计数等计量资料进行t 检验;对两组性别、肠套叠类型、B超提示肿块位置、套叠头部有无病变、有无肠间积液等进行x2检验;对差异有统计学意义的因素进行Logistic回归分析,了解影响肠套叠肠坏死的危险因素.结果 两组患儿在病程、年龄、肠套叠类型、B超提示肿块位置、有无肠间积液上比较差异有统计学意义;Logistic 回归分析提示肠套叠类型、病程以及B超提示肿块位置与肠坏死相关.结论 在小儿急性肠套叠的发病因素中,病程长短与B超提示肿块位置是影响肠坏死的主要因素.     

儿童继发性肠套叠38例

继发性肠套叠占肠套叠 5 %～ 10 % ,其病因、病理及临床表现和治疗与原发性肠套叠不同 ,易造成误诊而延误治疗[1] 。我院自 1986年～ 2 0 0 0年共收治肠套叠 149例 ,其中经手术及病理证实为继发性肠套叠 38例 ,现总结如下。临床资料一、一般资料　男 2 9例 ,女 9例 ,年龄 2～ 13ａ,平均4.1ａ。术前经空气灌肠Ｘ线诊断为肠套叠 2 2例 ,肠梗阻 13例 ,其他诊断行剖腹探查 3例。二、临床表现　反复发作肠套叠 3例 ,疼痛 10ｈ～ 10个月。阵发性腹痛 36例 ,呕吐 34例 ,血便 6例 ,腹部包块 17例 ,右上腹压痛 35例 ,肠梗阻 9例。三、手术治疗　 38例…     

儿童麻疹的临床特征和分子流行病学分析

目的 对上海地区儿童麻疹的临床特征及分子流行病学进行分析,了解儿童麻疹的临床特点和麻疹病毒的优势基因型.方法 对2005年11月-2006年6月在本院传染科住院治疗的39例麻疹患儿进行临床特征分析,包括发病年龄、发病人群、流行病学资料,以及血常规、肝功能和胸片检查结果;对于经影像学检查明确存在支气管炎或支气管肺炎患儿行痰病原学检测;同时采集出疹3 d内咽拭子送上海市疾病预防控制中心(CDC)分离麻疹病毒,并由该单位将分离出的麻疹病毒送至中国CDC进行基因型分析.结果 39例患儿中外来儿童29例(占74.36%),≤9月龄者24例(占61.54%);39例患儿中未接种麻疹疫苗者35例(占89.74%),而其中8月龄以下患儿20例(占57.14%);仅5例患儿发病前有明确的麻疹接触史;临床表现为发热、皮疹、麻疹黏膜斑及卡他样症状;39例患儿中23例并支气管炎或支气管肺炎,其中8例患儿痰病原学检测阳性.咽拭子分离的麻疹病毒,经基因型分析显示均为H1a.结论 儿童麻疹的临床表现较典型,但在发病年龄及人口分布等方面出现了一些变化,表现为发病年龄小,外来人口占相当大比例.麻疹病毒的优势基因型仍为H1a,目前无证据表明麻疹发病率的增加与病毒的基因变异有关.实用儿科临床杂志,2009,24(10):751-753     

小儿急性中毒的特点和诊治进展

儿童急性中毒的发生与周围环境密切相关.我国儿童急性中毒以农药、药物和灭鼠药为主,主要因误服误食所致,重症急性中毒的病死率仍较高.加强对药物和上述毒物的管理,可以从源头减少中毒机会.对疑似中毒的患儿,除详细询问病史和查体外,多数情况下毒物鉴定是明确有元中毒和病情严重程度最直接、客观的方法.及时诊断、合理使用解毒药物、普及血液净化治疗技术、重视支持疗法是成功救治的关键.准确而全面的临床流行病学资料有助于对地区性、年龄阶段性及不同性别的中毒起到警示作用.     

Epidemiological evaluation and survival of children with acute myeloid leukemia

ObjectiveThis study aims to describe the epidemiological characteristics and survival rates of children with acute myeloid leukemia treated in hospitals in southern Brazil and compare them with international data.MethodsA multicenter cohort study was conducted with retrospective data collection of all new patients with acute myeloid leukemia under 18 treated at five referral centers in pediatric hematology-oncology in southern Brazil between January 2005 and December 2015.ResultsOf the 149 patients with acute myeloid leukemia, 63.0% (n = 94) were male. The median age at diagnosis was 10.5 years (range 0–18 years) and 40.3% (n = 60) had a white blood cell count below 50,000/mm². The most common Franco-American-British (FAB) subtype was M3 (n = 43, 28.9%). Nine (6.0%) patients had central nervous system disease. In M3 patients, overall survival (OS) was 69.2% and 3-year event-free survival was 67.7%; in non-M3 patients, these rates were 45.3% and 36.7%, respectively. In non-M3 patients, OS was significantly different between transplanted (61.8%) and non-transplanted (38.2%) patients (p = 0.031).ConclusionsThese results show a higher prevalence of the Franco-American-British M3 subtype than that reported in the international literature, as well as a decreased OS compared with that of developed countries. Further multicenter Brazilian studies with a larger sample size are encouraged to better understand the characteristics of acute myeloid leukemia, and to improve the treatment and prognosis in this population.     

儿童急性中毒影响因素及治疗研究进展

急性中毒在儿童各年龄段均可发生,威胁儿童的生命健康.在发达国家,儿童中毒有完善的中毒监测网络,可以准确地反映儿童中毒的相关因素,对中毒做出及时迅速的干预和救治.我国儿童中毒的病死率高,缺乏完善的监测网络.本文就儿童急性中毒的相关因素及治疗做一综述.     

Jejunal intussusception in children

Jejunal intussusception in children is an uncommon form of intussusception often presenting with chronic intermittent abdominal pain and weight loss. Two cases of jejunal intussusception caused by enteric duplication are presented. It is concluded that in the absence of generalized small bowel disease, enteric duplication is the most likely cause of jejunal intussusception in children.     

2003至2007年昆明地区儿童肺炎支原体感染流行病学研究

目的 了解昆明地区5年中儿童肺炎支原体(MP)感染状况及MP病原流行病学特点.方法 对2003年1月至2007年12月我院收治的急性下呼吸道感染(ALRJ)住院患儿采用间接免疫荧光法测定血清中MP-IgM抗体;分析儿童MP感染的年龄、性别分布特点,对5年监测结果进行流行病学调查.结果 2003至2007年昆明地区ALRI儿童MP感染率分别为20.9%、14.3%、17.5%、15.7%、19.5%,感染率各年间比较存在显著性差异(P＜0.01).各年龄组MP感染率分别为～1岁10.7%、～3岁20.5%、～6岁21.5%、～14岁21.7%,婴儿组低于其他年龄组;女性MP感染率高于男性;儿童MP感染存在年龄、性别差异性.流行病学调查结果表明,昆明地区2003年、2007年MP感染率高于其他年份,不同年份MP感染率比较差异存在显著性(P＜0.01).2003年4至9月、2007年7至12月出现MP感染流行趋势.5年问夏、秋、冬不同季节MP感染率差异存在显著性(P＜0.01).除2005年外,每年中不同季节MP感染率均存在季节差异性.结论 MP是昆明地区1岁以上儿童ALRJ的重要病原,病原流行无季节规律,5年间出现两次流行趋势.     

Four-country surveillance of intestinal intussusception and diarrhoea in children

Aim:   Establishment of baseline epidemiology of intussusception in developing countries has become a necessity with the possibility of reintroduction of rotavirus vaccine. The current study assessed the seasonal trend in cases admitted with intussusceptions and dehydrating acute watery diarrhoea in children aged 2 months to 10 years.
Methods:   In a prospective surveillance study, teaching and research hospital sites in India (Lucknow and Nagpur), Brazil (Fortazela), Egypt (Ismailia) and Kenya (Nairobi) established a surveillance where a network of hospitals with surgical facilities catered to a reference population of about 1–2 million for reporting of intussusception. One large hospital per site also recruited admitted cases of acute watery diarrhoea.
Results:   From April 2004 to March 2006, 173 and 2346 cases of intussusception and diarrhoea, respectively, were recruited. Cases of intussusception had no apparent seasonality. Most cases of intussusception (61.3%) (107/173) were in the ≤1 year age group, with males comprising 68.8% (119/173) of all cases. Hospital mortality of intussusception was 4.2% (4/96). Cases of diarrhoea peaked in March, with 56.6% (1328/2346) of admitted cases being males. Majority (83.1%) of cases of diarrhoea had received antibiotics, and the hospital mortality was 0.8% (18/2280).
Conclusion:   Intussusception in the four participating countries exhibited no seasonal trend. We found that it is feasible to establish a surveillance network for intussusception in developing countries. Future efforts must define population base before the introduction of rotavirus vaccine and continue for some years thereafter.     

儿童肺炎支原体肺炎流行病学特征

目的：了解儿童肺炎支原体肺炎流行病学特点,为临床诊治提供参考。方法：对2011年2月至2012年1月确诊为社区获得性肺炎的3156例住院患儿应用酶联免疫吸附法检测血清肺炎支原体抗体IgM,同时对肺炎支原体肺炎患儿的鼻咽分泌物进行7种呼吸道病毒抗原检测。结果：（1）3156例患儿中,肺炎支原体抗体IgM阳性检出427例,阳性率为13.53%,其中女性患儿感染率高于男性（16.30% vs 11.70%, P<0.01）。（2）＜1岁、1岁～、3岁～、6～14岁肺炎支原体抗体IgM检出率分别为3.6%、12.5%、19.2%、24.4%（P<0.01）,其中≥3岁者总检出率高于<3岁者（P<0.01）。（3）不同季节肺炎支原体抗体IgM检出率不同,夏秋季节明显高于冬春季节（19.18% vs 9.61%,P<0.01）。（4）427例肺炎支原体抗体IgM阳性患儿中,合并呼吸道病毒感染 60例（14.1%）,合并比例最高的呼吸道病毒为呼吸道合胞病毒。结论：儿童肺炎支原体肺炎呈全年散发,以夏秋季节多见,学龄前及学龄期儿童高发,同时还存在混合感染现象。     

Recurrent intussusception in infants

Aim: Clinical features to identify infants at increased risk of recurrence after a primary episode of intussusception (IS) are poorly defined. Methods: Prospective study of the clinical presentation, treatment and outcome in infants <2 years presenting with acute IS to the National Hospital of Pediatrics, Hanoi, over a 14‐month period (1 November 2002 to 31 December 2003). A retrospective review of medical records was performed to verify complete patient ascertainment. Results: Five hundred ninety‐eight children were recruited, including 513 (86%) with a primary episode only and 53 (9%) with ≥1 recurrent episodes. Another 32 (5%) infants presented with recurrent IS, but the primary episode of IS occurred outside the study period. Estimated recurrence risk at 6 months following a primary episode was 14%. A pathological lead point was rare in primary (n= 1) and recurrent IS (n= 1). Most infants were successfully treated with enema reduction. Conclusions: This study describes the natural history of recurrent IS in infants and may assist in interpreting data from post‐marketing surveillance following introduction of rotavirus vaccines.