婴幼儿烧伤早期惊厥的原因分析及处理对策

目的探讨婴幼儿烧伤早期惊厥的发病原因及处理对策。方法回顾性分析中国人民解放军第159医院烧伤科2005年1月-2014年1月收治的328例烧伤早期发生惊厥患儿的病历资料,分析其原因及处理对策。结果 4890例烧伤患儿中有328例在烧伤早期发生惊厥,惊厥发生率为6.7%。惊厥发生率与病情轻重有关:中、重度烧伤早期的惊厥发生率较低,共34例,占10.4%,特重度烧伤早期的惊厥发生率较高,共294例,占89.6%;本组328例惊厥患儿以深Ⅱ度和Ⅲ度烧伤为主,而同期未发生惊厥的烧伤患儿以浅Ⅱ度和深Ⅱ度烧伤为主。惊厥的发生原因主要包括:脑水肿109例,占33.2%;低血容量休克35例,占10.7%;电解质紊乱74例,占22.6%;高热惊厥89例,占27.1%;感染13例,占4.0%;癫痫8例,占2.4%。经过积极对症治疗,除8例患儿因多种原因抢救无效死亡外,其余320例患儿均被治愈。结论烧伤的严重程度与惊厥的发生率成正相关,补液失当引起的脑水肿、电解质紊乱及低血容量休克是造成婴幼儿烧伤早期惊厥发生的最主要原因,而毒素吸收、创面感染及疼痛刺激等引起的高热是次要原因,合并破伤风及其他基础疾病时更易发生惊厥。合理补液,预防高热及积极治疗并发症是防治婴幼儿烧伤早期惊厥的关键。     

小儿烧伤惊厥病因及发病机制的研究现状

小儿烧伤惊厥是烧伤早期的严重并发症之一，临床上发生率较高，据统计其发病率国外报道为6．6％，国内为5．4％。原因是多方面的，其中高热、低血容量性休克、电解质紊乱、酸碱平衡失调、烧伤脑病以及消化道应激性溃疡出血等是小儿烧伤惊厥的常见病因，其机制尚未明了，一般认为大脑神经元异常放电所致。本文综述了近十年来有关小儿烧伤惊厥的病因及其机制。     

轻度胃肠炎合并良性婴幼儿惊厥研究进展

轻度胃肠炎合并良性婴幼儿惊厥（benigninfantileconvulsionsassociatedwithmildgastroenteritis，BICE）在1982年由日本学者Moroka首次提出。我国对该病的认识较晚，1998年调查显示，台湾高雄地区3岁以下小儿胃肠炎合并,     

婴幼儿惊厥的临床特点与相关因素分析

目的:探讨婴幼儿惊厥的临床特点,以指导治疗和判断预后.方法:回顾分析271例惊厥患儿的临床资料.结果:热性惊厥191例(70.5%),癫痫5例(1.8%),低钙惊厥10例(3.7%),中枢神经系统疾病32例(11.8%),小儿肠炎4例(1.5%).发病年龄1~3岁195例,1个月~1岁69例,0~1个月7例.全年均可发病.结论:热性惊厥是婴幼儿惊厥的主要原因,次为中枢神经系统感染.1~3岁惊厥发生率高.     

湿润烧伤膏治疗婴幼儿烧伤91例临床分析

目的:观察湿润烧伤膏(MEBO)治疗婴幼儿烧伤的临床效果.方法:将91例不同面积及深度的婴幼儿烧伤创面应用MEBO治疗,分别行暴露、半暴露或包扎疗法,观察创而愈合情况及患儿对治疗的反应.结果:除2例因Ⅲ度创面>2%久治不愈给予手术植皮愈合外,其他病例均非手术治愈,73例未留瘢痕,18例合并感染的深Ⅱ度和Ⅲ度创面遗留少许瘢痕,功能恢复良好,且治疗过程中疼痛轻,无1例发生全身感染.结论:MEBO在婴幼儿烧伤治疗中,具有止痛快、痛苦小、瘢痕轻、功能好的优点,是治疗婴幼儿烧伤的理想外用药.     

湿润烧伤膏治疗婴幼儿烧伤60例体会

目的 观察湿润烧伤膏(MEBO)治疗婴幼儿烧伤的临床效果.方法 将60例不同面积及深度的婴幼儿烧伤创面应用MEBO治疗,其中5例深度烧伤创面采用了手术植皮治疗,并对其疗效进行观察评价.结果 随访60例患者3个月至2年,创面愈合处无瘢痕增生或仅有轻度瘢痕增生,无关节部位瘢痕挛缩所致的功能障碍,治疗过程中疼痛轻,痛苦小.结论 MEBO用于婴幼儿烧伤治疗,可以减轻痛苦,难以愈合的创面可配合手术治疗,疗效满意.     

MEBO治疗婴幼儿烧伤184例分析

本文经过１８４例婴幼儿烧伤治疗的总结分析认为，婴幼儿烧伤主要为热液烫伤，以四肢，头面部烧伤最多见，ＭＥＢＯ在婴幼儿烧伤治疗中，具有止痛快，痛苦小，感染少，疗程短，瘢前轻，功能好的优点，ＭＥＢＴ在头，面，颈，会阴等不宜包扎部位的烧伤治疗中独具优势，ＭＥＢＯ湿润减压（不加压）包扎疗法四肢等部位的烧伤治疗中效果最佳，两种办法配合使用，是目前婴幼儿烧伤治疗中较为理想的好方法。     

原位干细胞再生技术在婴幼儿烧伤创面中的应用

目的：探讨原位干细胞再生技术对婴幼儿烧伤创面的治疗效果。方法：对112例婴幼儿烧伤创面全程应用MEBO，结合全身综合治疗，根据创面所在部位不同采用暴露疗法或包扎疗法。结果：87例患儿，创面5—64天愈合，随访3个月至2年，无瘢痕增生及关节部位瘢痕挛缩畸形、功能障碍。结论：原位干细胞再生技术能加快婴幼儿烧伤创面愈合，减少手术植皮。     

严重烧伤后多器官功能衰竭综合征的防治

多器官功能衰竭综合征（MSOF）为严重烧伤的主要死亡原因之一。其治疗应以预防为主。严重烧伤后继发低血容量性休克危害甚剧,它不仅可引致广泛组织细胞缺氧,造成细胞死亡,又可诱发血凝机制的变化,而且在复苏时更可发生各器官的氧应激损伤,其中尤为突出的是肠道,其结果是肠粘膜机械屏障功能受损,肠腔内内毒素侵入血液,造成内毒素血症,激活炎症细胞,释放大量炎性介质和细胞因子,形成脓毒症。因此,治疗休克应达到及时,快速、充分补充血容量,迅速恢复肠道血供,消除氧自由基等三个目标。大量的烧伤坏死组织的存在将削弱病人的免疫功能,而且一旦发生感染,会进一步激活业已活化的炎症细胞,形成促使MSOF发生的“第二次打击”。因此,在早期就应手术切除大面积焦痂,然后用异体或自体皮覆盖创面。在防治MSOF中还应注意尽早实施经口补充营养,抗生素的合理应用、呼吸功能的支持,以及其他应急治疗。经上述治疗措施后,在TBSA＞30％的烧伤员中,可使MSOF的发生率从17．3％降至6．9％,MSOF的死亡率从87．5％降至40．0％。     

MEBO纱布条治疗婴幼儿烧伤

为了缩短换药时间,减轻婴幼儿创面疼痛及肢体躁动所致的创面再损伤。方法：采用自制的MEBO纱布条治疗婴幼儿烧伤创面76例。结果：换药过程迅速完成,患儿一般不出现躁动,创面愈合速度加快。结论：MEBO纱布条治疗婴幼儿烧伤可明显减轻患儿痛苦及创面再损伤,换药方法简便易行。为MEBO治疗婴幼儿烧伤提供了新途径。     

儿童烧伤休克期抽搐原因分析

目的：进一步了解儿童早期诱发抽搐的原因。方法：对过去１０年内（１９９０年１月￣１９９９年１２月）所治疗的５６２例５岁以下烧伤患儿的病历资料进行回顾性调查;对发生过抽搐的病历资料进行归纳分析。结果：伤后４８小时内发生抽搐者３４例（６．０５％）;他们的主要诱因为水与电解质平衡失调、低钠血症居首位（２２／３４）,其次为高热、高纳及低蛋白血症。结论：儿童烧伤休克期易发生抽搐,主要原因为水与电解质平衡失调。     

小儿特重度烧伤惊厥的原因及救护

目的：探讨小儿特重度烧伤惊厥发生的原因，为临床提供有效的救护措施。方法：回顾分析56例小儿特重度烧伤并发惊厥病人的临床资料。结果：56例患者中入院时发生休克33例，其中发生惊厥15例(占45．5％)，另23例未发生休克患者中无1例出现惊厥。15例惊嗍病人中有13例伴有高热(占86．7％)。结论：小儿特重度烧伤多在合并休克时发生惊厥；惊厥与高热密切相关。镇静、解痉治疗是抢救惊厥的关键措施，针对发生惊厥原因进行治疗护理是抢救成功的有力保证。     

苯巴比妥联合地西泮治疗小儿热性惊厥37例分析

目的：探讨苯巴比妥联合地西泮治疗小儿热性惊厥的临床治疗效果。方法：选择我院2007-10～2009-10,热性惊厥患儿73例,随机将上述患者分为两组,观察组和对照组。对照组给予地西泮0.3～0.5mg/kg,静脉注射,注射速度为1mg/min,最大剂量〈10mg。观察组应用地西泮0.3～0.5mg/kg,静脉注射,注射速度为1mg/min,最大剂量〈10mg。同时给予苯巴比妥,10mg/kg,肌内注射。根据两组患者情况,如果复发,可行10%水合氯醛0.5mL/kg灌肠治疗。结果：两组患者在用药后30min内、30～60min内有效率比较,差异无统计学意义,P〉0.05;两组患者复发率比较,差异有统计学意义（P〈0.05）。结论：地西泮与苯巴比妥联合应用治疗小儿热性惊厥,具有起效快、复发率低等特点,并且易于操作,值得借鉴。     

大面积烧伤病人输液渗漏的防治及其护理

目的：探讨大面积烧伤救治过程中输液渗漏的原因、危害及防治。方法：观察、护理、治疗了９例出现输注销参漏的大面积烧伤病人（烧伤面积〉６０％ ＴＢＳＡ）,并进行分析总结。结果：输液渗漏引起局部肿胀６例,局部组织坏死３例;渗漏原因包括药物、血管和感染等因素;可通过加强护理、提高护理技能、充分稀释药物、使用静脉留置针等措施预防;可采用局部冷敷、热敷、外用湿润烧伤膏等方法治疗。结论：大面积烧伤病人输液渗漏是可以防治的。     

Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors

Soccer is the most commonly played sport in the world, with an estimated 265 million active soccer players by 2006. Inherent to this sport is the higher risk of injury to the anterior cruciate ligament (ACL) relative to other sports. ACL injury causes the most time lost from competition in soccer which has influenced a strong research focus to determine the risk factors for injury. This research emphasis has afforded a rapid influx of literature defining potential modifiable and non-modifiable risk factors that increase the risk of injury. The purpose of the current review is to sequence the most recent literature that reports potential mechanisms and risk factors for non-contact ACL injury in soccer players. Most ACL tears in soccer players are non-contact in nature. Common playing situations precluding a non-contact ACL injury include: change of direction or cutting maneuvers combined with deceleration, landing from a jump in or near full extension, and pivoting with knee near full extension and a planted foot. The most common non-contact ACL injury mechanism include a deceleration task with high knee internal extension torque (with or without perturbation) combined with dynamic valgus rotation with the body weight shifted over the injured leg and the plantar surface of the foot fixed flat on the playing surface. Potential extrinsic non-contact ACL injury risk factors include: dry weather and surface, and artificial surface instead of natural grass. Commonly purported intrinsic risk factors include: generalized and specific knee joint laxity, small and narrow intercondylar notch width (ratio of notch width to the diameter and cross sectional area of the ACL), pre-ovulatory phase of menstrual cycle in females not using oral contraceptives, decreased relative (to quadriceps) hamstring strength and recruitment, muscular fatigue by altering neuromuscular control, decreased “core” strength and proprioception, low trunk, hip, and knee flexion angles, and high dorsiflexion of the ankle when performing sport tasks, lateral trunk displacement and hip adduction combined with increased knee abduction moments (dynamic knee valgus), and increased hip internal rotation and tibial external rotation with or without foot pronation. The identified mechanisms and risk factors for non-contact ACL injuries have been mainly studied in female soccer players; thus, further research in male players is warranted. Non-contact ACL injuries in soccer players likely has a multi-factorial etiology. The identification of those athletes at increased risk may be a salient first step before designing and implementing specific pre-season and in-season training programs aimed to modify the identified risk factors and to decrease ACL injury rates. Current evidence indicates that this crucial step to prevent ACL injury is the only option to effectively prevent the sequelae of osteoarthritis associated with this traumatic injury.     

Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 2: A review of prevention programs aimed to modify risk factors and to reduce injury rates

Soccer is the most commonly played sport in the world, with an estimated 265 million active soccer players participating in the game as on 2006. Inherent to this sport is the higher risk of injury to the anterior cruciate ligament (ACL) relative to other sports. ACL injury causes a significant loss of time from competition in soccer, which has served as the strong impetus to conduct research that focuses to determine the risk factors for injury, and more importantly, to identify and teach techniques to reduce this injury in the sport. This research emphasis has afforded a rapid influx of literature aimed to report the effects of neuromuscular training on the risk factors and the incidence of non-contact ACL injury in high-risk soccer populations. The purpose of the current review is to sequence the most recent literature relating the effects of prevention programs that were developed to alter risk factors associated with non-contact ACL injuries and to reduce the rate of non-contact ACL injuries in soccer players. To date there is no standardized intervention program established for soccer to prevent non-contact ACL injuries. Multi-component programs show better results than single-component preventive programs to reduce the risk and incidence of non-contact ACL injuries in soccer players. Lower extremity plyometrics, dynamic balance and strength, stretching, body awareness and decision-making, and targeted core and trunk control appear to be successful training components to reduce non-contact ACL injury risk factors (decrease landing forces, decrease varus/valgus moments, and increase effective muscle activation) and prevent non-contact ACL injuries in soccer players, especially in female athletes. Pre-season injury prevention combined with an in-season maintenance program may be advocated to prevent injury. Compliance may in fact be the limiting factor to the overall success of ACL injury interventions targeted to soccer players regardless of gender. Thus, interventional research must also consider techniques to improve compliance especially at the elite levels which will likely influence trickle down effects to sub-elite levels. Future research is also needed for male soccer athletes to help determine the most effective intervention to reduce the non-contact ACL injury risk factors and to prevent non-contact ACL injuries.     

新生儿缺氧缺血性脑病的MRI评价

目的：评价MRI对新生儿缺氧缺血性脑病（HIE）的诊断价值。资料与方法：采用SE序列对61例（65例次）HIE患儿进行了MRI检查，分析MRI表现。结果：56例新生儿期检查中脑水肿42例，内囊后肢信号异常22例，脑出血11例，脑室出血4例，脑室旁白质软化2例。9例婴儿期检查者中表现有脑室扩大7例，脑外间隙增宽9例，髓鞘发育延迟3例。结论：MRI有助于明确HIE的脑损伤情况，对于预后的评估有价值。     

安多霖对微波辐射致大鼠脑损伤的预防作用研究

目的 探讨安多霖对微波辐射致大鼠脑损伤的预防作用.方法 140只二级雄性Wiser大鼠随机分为5组:健康对照组、辐射对照组、低浓度(0.75 g·kg～·d-1)预防组、中浓度(1.5 g·kg～·d-1)预防组及高浓度(3 g·kg～·d-1)预防组.预防组每日1次灌胃给予安多霖溶液,连续给药工2周.给药结束后采用30 mW/cm.微波辐射大鼠15 min.于处理后6 h、7 d和14 d,采用Morris水迷宫检测大鼠学习和记忆能力,高效液相色谱检测海马氨基酸类神经递质含量,光镜和电镜观察海马组织学和超微结构变化.结果 微波辐射后7 d内,大鼠学习和记忆能力下降(F=0.000～0.043,P<0.05);微波辐射后6 h,4种氨基酸类神经递质含量均降低,其中谷氨酸、甘氨酸及γ-氨基丁酸降低明显(F=0.000～0.007,P<0.01);微波辐射后6 h、7 d,海马组织水肿,神经元变性;神经元线粒体肿胀、空化,内质网扩张,突触间隙模糊,血管周间隙增宽.低浓度预防组上述变化与辐射对照组相似.中浓度和高浓度预防组微波辐射后7 d内,大鼠学习和记忆能力损伤不明显,两者与辐射对照组相比,差异有统计学意义(F=0.015～0.028,P<0.05);微波辐射后6 h,4种氮基酸类神经递质含量均无明显下降,其中谷氨酸含量接近正常,两者与辐射对照组比,差异有统计学意义(F=0.000-0.042,P<0.05);微波辐射后6 h、7 d,海马组织无明显损伤.结论 30 mW/cm.微波辐射可引起大鼠学习和记忆能力下降、海马氨基酸类神经递质代谢紊乱及海马组织学和超微结构损伤;1.5和3 g·kg-1·d-1安多霖对微波辐射致大鼠脑损伤有预防作用.1.5 g·kg-1·d-1安多霖为预防微波辐射致大鼠脑损伤的有效剂量.

Abstract：

Objective To study the prevention effects of AduoLa Fuzhenglin(ADL)Oll the brain injury induced by microwave radiation in rats.Methods A total of 140 male Wismr rats were divided randomly into 5 groups,including control group,microwave exposed group,low dosage(0.75 g·kg-1·d-1)group.middle dosage(1.5 g·kg-1·d-1)group and high dosage(3 g·kg-1·d-1)group.Rats in three ADL groups were lavaged with ADL per day for 2 weeks before radiation.After administration,rats were exposed to microwave at 30 mW/cm2 for 15 min.The abilities of learning and memory were detected by Morris water maze,and the contents of amino acids neurotransmitter of hippocampus were detected by HPLC, then the histology and uhrastrncture of hippocampus were observed with light and electron microscope at 6 h,7 and 14 d after exposure.Results The abilities of learning and memory were declined(F=0.000-0.043,P<0.05)from 6 h to 7 d after exposure,and the contents of four kinds of amino acid neurotransmitter in hippocampus were decreased,of which GLU,GLY and GABA were decreased significantly(F=0.000-0.007,P<0.01)at 6h after exposure,then tissue edema,neuronal degeneration,neuron mitoehondria swelling and cavitation,endocytoplasmie rotieulum broaden,synaptic cleft blurred,and perivascular space widen were found in the hippocampus at 6 h and 7 d after exposure.The changes in low dosage group were similar to those of the radiation group.However,in middle and high dosage groups,the abilities of learning and memory were normal to some extent with the significant differences compared to the radiation group from 6 h to 7 d after exposure(F=0.015-0.028.P<0.05).The contents of four kinds of amino acid neurotransmitter were not decreased,especially GLU contents close tO normal level.There were significant differences between middle and high dosage groups and radiation group at 6 h after exposure(F=0.000-0.042,P<0.05).Moreover,no obvious injury in the hippocampus was observed in middle and high dosage groups at 6 h and 7 d after exposure.Conclusions Exposure to 30 mW/cm2 microwave radiation could decrease the abilities of learning and memory,induce amino acid neurotransmitter turbulence,and injure the histology and uhrastructure of hippocampus.ADL at the dosages of 1.5 and 3 g·kg-1·d-1 would have preventive effects on the injury induced by microwave exposure.The concentration of 1.5 g·kg-1 ·d-1 of ADL might be the effective dosage to prevent the brain damage after microwave exposure.     

婴幼儿先天性血管环的MSCT诊断及分析

目的:探讨MSCT对婴幼儿先天性血管环的诊断及分析。方法:回顾性分析本院2012-2018年间60例先天性血管环患儿的MSCT的表现,记录其组成、形态及病变与周围结构的关系。结果:9例双主动脉弓;1例右弓合并左动脉导管未闭或动脉韧带;2例左弓合并右位、中位降主动脉;18例左位主动脉弓伴迷走的右锁骨下动脉;1例无名动脉后位;21例右弓伴迷走左锁骨下动脉;7例肺动脉吊带;1例无名静脉形成静脉环。结论:MSCT能明确血管环的组成及与周围结构的关系,对外科手术有重要意义。