大剂量丙种球蛋白联合甲泼尼龙治疗小儿手足口病合并神经系统损害疗效观察

目的 探讨丙种球蛋白联合甲泼尼龙对手足口病合并神经系统损害患儿的治疗效果.方法 大剂量丙种球蛋白[1.0 g/(kg·d),用2 d)]联合甲泼尼龙[Ⅱ期病例3～5 mg/(kg·d),用3～5 d,Ⅲ期病例15～25 mg/(kg·d),用3 d]治疗小儿手足口病合并神经系统损害186例.结果 186例患儿中,治愈166例,占89.2%;好转15例,占8.1%;无效而自动出院2例,占1.1%;死亡3例,占1.6%.结论 大剂量丙种球蛋白联合甲泼尼龙治疗小儿手足口病合并神经系统损害具有明确的疗效.     

注意阿米卡星的用法

阿米卡星为临床常用的抗生素 ,由于其有耳、肾毒性 ,因此正确地应用显得尤为重要。目前临床上及文献介绍的用法有多种 ,肌肉注射或稀释后静脉滴注 :1 .成人0 .1～ 0 .2 g/次 ,2 /d;儿童 4～ 8mg/( kg· d) ,分 1～ 2次。2 .成人 0 .2～ 0 .4g/次 ,1 /d;儿童 4～ 8mg/( kg·次 ) ,1 /d。 3 .成人或儿童 7.5 mg/( kg·次 ) ,2 /d,≤ 1 .5 g/d。 4.成人或儿童 1 5 mg/( kg·次 ) ,1 /d,≤ 1 .5 g/d。 5 .儿童 1 5～ 2 0 mg/( kg·d) ,分 2～ 3次。这些用法中 ,有些值得商榷 ,理由如下 :国家卫生部编制的《常用耳毒性药物临床使用规范》[1 ]中这…     

川崎病合并类白血病反应1例

正1病例资料患儿男,1岁11个月,主因"发热8d"就诊,入院前8d患儿无明显诱因出现发热,体温最高39. 7℃,无咳嗽、吐泻及抽搐,自服对乙酰氨基酚体温可降至正常。入院前6d出现球结膜充血,唇充血,皮肤可见散在充血性斑丘疹,在外院予头孢噻肟钠静脉滴注6d,疗效差,考虑"川崎病(Kawasaki Disease,KD)",入院前2d在外院予静脉注射用免疫球蛋白(intravenous immunoglobulin,IVIG)[1g/(kg·d)×2d]冲击治疗,同时口服阿司匹林30mg/(kg·d)治疗,球结膜充血好转,仍高热,最高体温39℃。外周血白细胞计数(WBC)进行性增高达30. 39×109/L,CRP     

艾曲波帕治疗儿童慢性免疫性血小板减少症3例并文献复习

目的探讨艾曲波帕治疗儿童慢性免疫性血小板减少症(cITP)的疗效及安全性。方法收集3例应用艾曲波帕治疗cITP患儿的临床资料并复习相关文献。结果 3例cITP患儿,男2例,女1例,年龄8～10岁,反复皮肤瘀点瘀斑,血小板计数(PLT)低于20×109/L,类固醇激素依赖或无效,艾曲波帕治疗前病程均超过12个月;口服艾曲波帕25mg qd[约1mg/(kg·d)],1～2周后均出现治疗反应(PLT 50×109/L),瘀点瘀斑消失。由于经济原因,1例于治疗2个月后停药,停药2周后PLT下降至7×109/L; 1例治疗5个月后停药,继续随访1年PLT稳定于50×109/L以上。1例艾曲波帕加量[约2mg/(kg·d)]后,血小板计数恢复正常。3例在口服艾曲波帕期间均未出现不良反应。结论艾曲波帕口服方便且较为安全,能短期内提升cITP患儿的血小板水平,改善出血症状,疗效可能与疗程和剂量相关,但费用较高,在国内长期治疗受到限制。     

霉酚酸酯联合甲基泼尼松龙隔日疗法治疗儿童狼疮性肾炎的疗效

目的观察霉酚酸酯(MMF)联合中小剂量肾上腺皮质激素隔日治疗在儿童狼疮性肾炎(LN)的疗效,以探讨儿童LN的最佳治疗方案。 方法回顾性分析1999—2004年在复旦大学附属儿科医院住院的LN患儿30例,男6例,女24例,处于病情的活动期,给予MMF联合中小剂量肾上腺皮质激素隔日治疗。MMF初始剂量为20~30mg/(kg·d)(总量<1.5g/d),病情好转后每3~6个月减量1次,至0.25g/d维持。甲基泼尼松龙冲击治疗15~30mg/(kg·d)(总量≤1.0g/d),初始剂量1.0~1.5mg/(kg·d)(总量≤60mg/d)。 结果(1)30例患儿MMF治疗时间不少于6个月,为(28.6±15.1)个月,在治疗过程中未见明显副反应;(2)在肾活检的24例中,狼疮性肾炎Ⅱ型者8例在加用MMF治疗的3~6个月获得缓解;狼疮性肾炎Ⅳ型者16例,12例在治疗的3~12(6.0±1.3)个月获得缓解,1例患儿部分缓解,3例患儿经过至少6个月的足量MMF治疗无效。(3)在治疗过程中有7例患儿在减量或停药后出现疾病的复发或部分复发。(4)随访终点获得缓解的27例患儿,治疗前后身高增长无明显抑制。 结论MMF联合中小剂量的泼尼松龙能有效地治疗儿童系统性红斑狼疮,较长时间应用无明显副反应。患儿可保持相对正常的生长发育。     

对含奥美拉唑三联疗法耐药的幽门螺杆菌感染的治疗

目的　探讨对含奥美拉唑三联疗法耐药的幽门螺杆菌 (Hp)感染的治疗方法。方法　选择 13 5例经13 C尿素呼吸试验 (13 C UBT)及血清Hp IgG证实为Hp感染的腹痛患儿 ;男 73例 ,女 62例 ;平均年龄 6.8± 2 .6岁。接受克拉霉素 15mg/ (kg·d) ,2次 /d ;奥美拉唑 0 .8mg/ (kg·d) ,1次 /d ;阿莫西林 3 0mg/ (kg·d) ,3次 /d ,联合治疗 1周 ,于停药后 4周复查13 C UBT ,了解腹痛治疗效果及Hp根除率 ;如果Hp仍为阳性 ,再改为胶态次枸橼酸铋钾 (CBS) 8mg/ (kg·d) ,2次 /d ,疗程 4周 ;甲硝唑 2 0mg/ (kg·d) ,3次 /d ;奥美拉唑剂量同前 ,疗程 1周。停药后 4周再复查13 C UBT。结果　 13 5例中腹痛完全消失者 56例 ,好转 71例 ,无效 8例 ,总有效率 94.1% ;119例Hp转阴 ,Hp根除率 88.2 % ;16例Hp阳性者改方案后仅 3例Hp转阴。结论　本疗法治疗儿童Hp感染临床效果显著 ,不良反应少 ;一旦Hp对某一治疗方案耐药 ,可能也对其他方案耐药 ,使其很难被根除     

起搏器置入救治川崎病并冠状动脉瘤、Ⅲ°房室传导阻滞一例

患儿,女,1岁7个月,以"间断发热20 d,口唇青紫1d"收入陆军总医院附属八一儿童医院.入院前20 d无明显诱因出现发热,体温最高39.5℃,伴眼结膜充血、口唇皲裂、杨梅舌,给予抗生素治疗6 d无效.病程第11天当地医院行心脏超声提示双侧冠状动脉增宽,诊断川崎病.给予丙种球蛋白2 g/(kg·d),连用3 d,口服阿司匹林肠溶片60 mg/(kg·d) 连用8 d,患儿体温降至正常,但维持6d再次发热.入院前1d出现口唇青紫,心电监护提示心率35次/min,心肌酶:CK-MB 14.5 U/L,cTnI 878.7 μg/L,cTnT 0.806 ng/L.心电图:Ⅲ°房室传导阻滞转入我院.     

甲泼尼龙琥珀酸钠治疗婴幼儿毛细支气管炎的疗效

目的 观察甲泼尼龙琥珀酸钠治疗婴幼儿毛细支气管炎的疗效.方法 将65例毛细支气管炎患儿随机分为2组,均采用常规抗感染、对症、吸氧等综合冶疗,治疗组在此基础上加用甲泼尼龙琥珀酸钠注射液,1～2 mg/(次·kg),1次/d;对照组加用地塞米松针[0.5 mg/(kg·次),1次/d]治疗.结果 治疗组患儿在喘憋、肺部哮鸣音和湿啰音消失、住院天数方面,与对照组比较明显缩短,差异有显著性意义(Pa＜0.05).治疗组治愈32例,好转3例,治愈率91.43%;对照组治愈21例,好转9例,治愈率70%,治疗组治愈率显著高于对照组(χ2=4.93 P＜0.05).结论 甲泼尼龙琥珀酸钠治疗毛细支气管炎疗效显著.     

托莫西汀治疗儿童注意缺陷多动障碍对心血管系统的影响

目的 观察托莫西汀治疗注意缺陷多动障碍(ADHD)对患儿心血管系统的影响.方法 采用随机双盲对照方法,将46例门诊ADHD患儿分为托莫西汀治疗组和哌甲酯治疗组各23例.所有患儿均接受8周的治疗,其中托莫西汀剂量为0.8 mg/(kg·d)至1.8 mg/(kg·d),每日1次口服,哌甲酯剂量为0.2mg/(kg·d)至0.6mg/(kg·d),每日2次口服.观察患儿治疗后不良反应、心血管体征和心电图.结果 治疗中患儿无心血管系统症状出现,体检发现心率增快和血压升高,心电图提示RR间期缩短,QT间期均缩短.两组之间差异均无统计学意义,经Fridericia校正后QT间期与基线差异均无统计学意义.结论 托莫西汀治疗ADHD患儿不良反应少,耐受性好,对心血管系统的影响较小.     

小剂量甲基强的松龙、顺尔宁有效治疗儿童过敏性紫癜

目的观察小剂量甲基强的松龙(MP)、顺尔宁对儿童过敏性紫癜(HSP)的治疗作用。方法2000年12月~2007年4月我科收治HSP患儿57例,年龄3~14岁,病程3d~2年不等。所有患儿在病程中均采用常规治疗,包括:潘生丁、维生素C、钙剂、西可韦,清热凉血健脾中药汤剂治疗,有感染加抗感染治疗基础上,再将患儿随机分成3组,1组:21例,包括10例过敏性紫癜肾炎(HSPN)患儿,给予小剂量MP加顺尔宁治疗,MP1mg/(kg·d),3~5d后改为强的松1mg/(kg·d),分3次服用,每隔3d减5mg,至减完为止。顺尔宁5岁以下4mg/d,6~14岁5mg/d与激素同时服用,同时停用,HSPN患儿激素及顺尔宁均应用3个月。2组:20例,予以MP、强的松治疗,剂量用法同上,但不加顺尔宁。3组:16例,包括9例HSPN患儿,仅采用常规治疗。结果3组比较:皮疹消退时间:1组明显少于2、3组,2组明显少于3组;2腹痛缓解时间:1组和2组均明显少于3组,1、2组之间无明显差别;3关节肿痛消退时间:1组明显少于2、3组,2组少于3组。4肾脏症状消退时间:1组明显少于3组。5随访结果:首诊无肾脏症状者分别采用1组、3组治疗方案,随访1年,出现肾脏症状的例数1组明显低于3组。结论小剂量MP 顺尔宁可有效治疗儿童,且有一定的预防发生的作用。     

Ceftriaxone-associated nephrolithiasis and biliary pseudolithiasis

Biliary pseudolithiasis has been reported in patients who received ceftriaxone therapy. In addition to biliary sludge formation occasional reports of ceftriaxone-induced nephrolithiasis have been published. In general, these adverse effects will develop after seven to ten days of treatment. We report on a seven-year-old boy with ceftriaxone-associated biliary pseudolithiasis and nephrolithiasis four days after initiation of treatment. Patients receiving a high dose of ceftriaxone and developing colicky abdominal pain should be considered for ultrasound and a change in antibiotic therapy if appropriate. Received: 16 February 1999 / Accepted: 9 June 1999     

Biliary pseudolithiasis in childhood: a case report.

Cholelithiasis is uncommon in childhood and usually associated with any predisposing factors such as congenital abnormalities of biliary tract, hemolytic diseases, TPN administration and diseases of terminal ileum. Recent studies demonstrated ceftriaxone inducing reversible precipitations in gallbladder that mimic cholelithiasis. This complication is termed "biliary pseudolithiasis" or "reversible cholelithiasis". In this paper we describe a patient who developed biliary pseudolithiasis after six days of ceftriaxone therapy which completely resolved eleven days after the end of the treatment, and discuss the indication for cholecystectomy.     

Gallbladder and urinary tract precipitations associated with ceftriaxone therapy in children: a prospective study

The incidence and outcome of gallbladder and urinary tract complications in children receiving ceftriaxone therapy were evaluated prospectively. The subjects were given intravenous ceftriaxone, 100 mg/kg/day, in two divided doses infused over 20-30-minute periods, for 5-14 days. Serial abdominal ultrasonography revealed gallbladder and urinary tract precipitations in five of 35 children, three of whom had gallbladder pseudolithiasis, one gallbladder sludge and one gallbladder pseudolithiasis and urinary bladder sludge. The children who had gallbladder sludge and gallbladder pseudolithiasis with urinary bladder sludge had abdominal pain, nausea and vomiting. Three children remained symptom-free. The gallbladder precipitations were found after 4-9 days of ceftriaxone therapy, and resolved completely 7-19 days after the end of treatment. The urinary tract precipitation was found on the 5th day after cessation of ceftriaxone therapy and resolved 7 days later. Ceftriaxone-associated gallbladder pseudolithiasis, gallbladder sludge and urinary bladder sludge usually resolve spontaneously and physicians should be aware of these complications so as to avoid unnecessary therapeutic procedures.     

Incidence of ceftriaxone-associated gallbladder pseudolithiasis

We prospectively evaluated the incidence of gallbladder pseudolithiasis in children treated with high doses of ceftriaxone for a variety of serious infections. We also monitored the time interval needed for this phenomenon to develop and resolve completely after initiation and cessation of treatment, respectively. Included in this study are 44 children treated with ceftriaxone 100 mg/kg/d divided into 2 equal intravenous doses and followed by serial abdominal sonography. Eleven children developed pseudolithiasis of gallbladder 2-9 d after initiation of ceftriaxone therapy. Six children (54.5%) developed this complication within the first 3 d. Lithiasis completely resolved 8-23 d after the end of treatment. In conclusion, pseudolithiasis of the gallbladder developed in 25% of sick children and completely resolved in all patients. Early development of this complication was not exceptional. It occurred in more than half of these children.     

Ceftriaxone-associated nephrolithiasis and biliary pseudolithiasis in a child

Ceftriaxone is a widely used third-generation cephalosporin. It is generally very safe, but complications of biliary pseudolithiasis and, rarely, nephrolithiasis have been reported in children. These complications generally resolve spontaneously with cessation of the ceftriaxone therapy; however, they may symptomatically mimic more serious clinical problems, such as cholecystitis. We report a case of both ceftriaxone-induced biliary pseudolithiasis and nephrolithiasis.     

Ceftriaxone-associated biliary sludge and pseudocholelithiasis during childhood: A prospective study

BACKGROUND: Cholelithiasis is a rare condition seen during childhood. The aim of this study was to determine frequency of biliary sludge and cholelithiasis with ceftriaxone therapy. METHODS: Thirty-eight children aged between 1 month and 17 years were evaluated with ultrasonographic examination at the initiation of the ceftriaxone therapy and 10th day of therapy, consecutively. If biliary sludge or cholelithiasis were demonstrated, scans were repeated monthly until pathology disappeared. RESULTS: Abnormal gallbladder sonograms were demonstrated in 36.8% (n = 14) of patients at the 10th day of therapy. Cholelithiasis was detected in 28.9% (n = 11) of patients and biliary sludge was detected in 7.9% (n = 3). Two children still had cholelithiasis at the 30th day after therapy and one had cholelithiasis after the 60th day. The 9-year-old girl who still had cholelithiasis after 60 days of therapy also had nausea, vomiting and abdominal pain at 7 days after cessation of therapy. Her 90th day sonographic examination was normal. CONCLUSION: Reversible biliary sludge or pseudocholelithiasis due to ceftriaxone treatment is not a rare condition. Therefore it is benign, spontaneously resolved and clinical signs are usually absent.     

Ceftriaxone-induced pseudolithiasis in children treated for perforated appendicitis

Purpose

Ceftriaxone has been associated with development of pseudolithiasis. In our institution, it is used for treatment of perforated appendicitis in children. This study evaluated the occurrence of ceftriaxone-related pseudolithiasis in this population.

Methods

After obtaining IRB approval, we performed a retrospective chart review over 51 months. We included patients undergoing laparoscopic appendectomy for perforated appendicitis. All patients were treated with ceftriaxone post-operatively. Patients without initial or post-treatment gallbladder imaging available for review were excluded.

Results

There were 71 patients who met inclusion criteria with a mean (±SD) age of 10.8 ± 3.8 years. Of these, 14 % (n = 10) developed stones or sludge in the gallbladder. The mean duration of ceftriaxone therapy was 8.7 ± 3.8 days. The average time to post-antibiotic imaging was 11.5 ± 10.3 days from initiation of antibiotics. There was no significant difference in duration of ceftriaxone therapy in the children that developed pseudolithiasis or sludge (10.0 ± 4.9 days) compared to those that did not (8.5 ± 3.6, p = 0.26). One child (10 %) with pseudolithiasis went on to become symptomatic, requiring a laparoscopic cholecystectomy.

Conclusions

In our experience, ceftriaxone use for perforated appendicitis is associated with a significant incidence of biliary pseudolithiasis, and is unrelated to duration of ceftriaxone therapy.     

Early biliary pseudolithiasis during ceftriaxone therapy for acute pyelonephritis in children: a prospective study in 34 children.

The prolonged biological half-life of Ceftriaxone, allowing once-daily dosing, has contributed to the large diffusion of this third-generation cephalosporin in children. Ceftriaxone is known to induce reversible precipitates in the gallbladder of adults and children. A prospective study was conducted during 1997 in 34 children admitted for the treatment of acute pyelonephritis. Ceftriaxone (intravenous daily single-dose of 50 mg/kg under 2g/day) was initially used. A first gallbladder sonogram, performed before the first or second injection, was normal in all cases. A second evaluation was performed before the fifth and last injection. On this second evaluation the presence of one (n = 3) or two gallstones was recorded in 5 children (15%) on a sonogram made after 3 (n = 4) or 5 (n = 1) injections. Their median age was 7 years (range 4 months to 11 years). All five children remained symptom-free and the normalization of the sonographic patterns was constant on the last sonogram performed 2 (n = 1), 3 (n = 2) and 5 months (n = 2) after discontinuation of Ceftriaxone. This study confirms the possibility of precocious biliary lithiasis under Ceftriaxone therapy in childhood and their spontaneous dissolution after discontinuation of the drug. They seem unpredictable and independent of the age, sex in a cohort homogeneous for the nature of the infection, modality of a short- and low-dose therapy. Clinicians and radiologists should be aware of this complication as an etiology of a so-called primary cholelithiasis and to prevent anxiety or unnecessary cholecystectomy. The antibacterial and pharmacokinetic benefits of Ceftriaxone outweigh the problem of reversible biliary pseudolithiasis with this drug.     

Nephrolithiasis associated with ceftriaxone therapy: a prospective study in 51 children.

BACKGROUND: Ceftriaxone, a third generation cephalosporin, is widely used for treating infection during childhood. The kidneys eliminate approximately 33-67% of this agent, and the remainder is eliminated via the biliary system. Ceftriaxone may bind with calcium ions and form insoluble precipitate leading to biliary pseudolithiasis. The aim of this study was to assess whether ceftriaxone associated nephrolithiasis develops by the same mechanism, and whether this condition is dose related. METHODS: The study involved 51 children with various infections. Of these, 24 were hospitalized with severe infection and received 100 mg/kg/day ceftriaxone divided into two equal intravenous doses. The other 27 patients received a single daily intramuscular injection of 50 mg/kg/day. Serum and urine parameters were evaluated before and after treatment, and abdominal ultrasonographic examinations were also carried out before and after treatment. RESULTS: Serum urea, creatinine, and calcium levels were normal in all patients before and after treatment. Post-treatment ultrasound identified nephrolithiasis in four (7.8%) of the 51 subjects. The stones were all of small size (2 mm). Comparison of the groups with and without nephrolithiasis revealed no significant differences with respect to age, sex distribution, duration of treatment, or dose/route of administration of ceftriaxone. The renal stones disappeared spontaneously in three of the four cases, but were still present in one patient 7 months after ceftriaxone treatment. CONCLUSIONS: Conclusions: The study showed that children taking a 7 day course of normal or high dose ceftriaxone may develop small sized asymptomatic renal stones. The overall incidence of nephrolithiasis in this study was 7.8%.     

儿童肾移植21例报告

目的 探讨肾移植对儿童终末期肾病(ESRD)的疗效及其手术处理、免疫抑制剂应用方法。方法 总结肾移植患儿的临床资料、植肾手术方法、免疫抑制剂应用和随访情况。结果 患儿术后早期平均肾功能恢复时间为5．6d。1、3、5年人／肾存活率分别为95、2％／95．2％、86．7％／73．3％,72．7％／63．6％。最长存活12年。其中1例发生超急性排斥反应,5例发生急性排斥反应,3例出现移植物功能延迟恢复,3例死亡。术后采用了免疫抑制治疗。术后主要并发症有：高血压(48％)、糖尿病(19％)、感染(19％)、药物性肝损害(14％)。结论 肾移植是治疗儿童：ESRD最为理想的方法。儿童可以适应成人肾脏的移植。术后免疫抑制治疗建议联合应用泼尼松 霉酚酸酯 他克莫司。