西安市0~6岁儿童家庭手卫生情况调查分析

摘要 目的 对有0~6岁儿童的家庭手卫生现状开展调查分析,为预防控制传染病提供科学依据。方法 采用统一调查问卷对西安市有0~6岁的儿童家庭成员的手部卫生行为状况开展现况调查。结果 累计调查387人,总体上72%的被调查者知晓手卫生相关知识。60.47%的家长/照看人每日洗手7~10次,59.69%的儿童每日洗手以3~6次。家长/照看人总体的手卫生习惯报告率、正确洗手行为报告率分别为61.73%和68.19%。儿童总体的手卫生习惯报告率约为64.27%。大多数家长/照看人洗手时间为120 s(29.46%),女性家长/照看人的洗手时间显著长于男性(P<0.05)。多因素Logistic回归分析显示家庭0~6岁儿童数、与儿童亲近程度、手卫生知识知晓、手卫生习惯对家长/照看人正确洗手行为报告率有显著性影响(P＜0.05)。结论 西安市0~6岁儿童家庭的正确洗手认知和行为习惯程度不高,对普通家庭提供手卫生知识培训是改善正确洗手行为的重要方式之一。     

天津市5000名0～6岁儿童中儿童孤独症的流行病学调查

目的：了解天津市和平区现住人口中0～6岁儿童孤独症患病情况；配合2001年全国0～6岁儿童残疾儿童抽样调查。方法：调查天津市和平区现住人口中0～6岁儿童5000人，其中对2～6岁的儿童3606人采取克氏孤独症行为量表筛查。筛查阳性者进入诊断程序，采用儿童孤独症评定量表和心理教育量表评定。结果：确诊为儿童孤独症的共5名，均为男性，年龄2—4岁，时点患病率为0．1％，均有不同程度的智力障碍。孤独症儿童在母孕期和围生期有高危因素，但无特异性；父母文化程度多为初高中以上，亲子关系良好；主要表现为言语功能发育的停滞或减退，接触交往障碍和兴趣活动范围狭窄。结论：天津市和平区儿童孤独症的患病率在国内外报道的患病率范围内，应加强儿童孤独症的研究。     

190例0～3岁儿童超声骨密度结果观察分析

选取我院收治的190例0～3岁儿童进行超声检查,根据检查结果评定骨强度。不同年龄段的儿童骨强度不足检出率不同,＜6个月儿童组检出率为45.8%,6～12个月检出率为50%,12～18个月检出率为15.5%,18～24个月检出率为18.8%,24～30个月检出率为12.5%,30～36个月检出率为7.2%,女童骨强度不足检出率高于男童。骨强度不足多发生于6～12个月儿童,1岁儿童骨强度不足检出率较高,尽早进行超声骨密度检查对于儿童骨密度不足的防治有着重要意义。     

儿童先天性心脏病术后生活质量的调查分析

[目的]调查先天性心脏病患儿术后生活质量情况。[方法]选择260例行先天性心脏病手术的患儿进行调查,对其术后生活质量情况进行回顾性分析。[结果]非紫绀型患儿和紫绀型患儿在对生活质量的影响方面差异无统计学意义（P〉0．05）。先天性心脏病患儿不同年龄段的生活质量家长汇报的结果除焦虑问题及心脏疾病和治疗问题得分外,其他均存在一定的差异性（P〈0．05）,患儿汇报的结果差异无统计学意义（P〉0．05）。[结论]依据先天性心脏病患儿的心理及生理发育水平,提供优质的健康卫生服务和和谐的家庭与社会环境,可使患儿的生存质量最大限度的提高。     

红原县0～3岁儿童家长喂养知识及喂养状况的调查

目的通过对红原县0~3岁儿童的家庭成员进行问卷调查,了解该区域婴幼儿喂养状况及家长对喂养知识的掌握情况。方法在红原县各乡镇按比例随机抽样288例,自行设计问卷调查表对家长进行问卷调查,收集到的数据录入Excel表格,并进行相关的统计分析。结果对喂养知识完全不知的62人(21.53%),部分知道的198人(68.75%),完全知道的28人(9.72%),喂养知识的来源主要来自电视节目,亲属等;母亲文化程度高者喂养知识掌握情况优于文化程度低者。母乳喂养率为52.08%,但母乳喂养持续时间超过一个月的只有52人,占调查对象的18.05%。1~6月龄实行人工喂养的以牦牛鲜奶为主,191人(89.67%),配方奶仅16人(7.51%),71.88%的家庭都未给应加辅食的小儿添加辅食,添加辅食者也不尽合理。结论 0~3岁儿童喂养状况不乐观,家长缺乏喂养知识,应对婴幼儿家长及看护人进行形式多样的喂养指导,促进婴幼儿健康成长。     

昌平区1100例2～12岁儿童睡眠障碍调查分析

目的了解2～12岁儿童睡眠障碍患病情况，为儿童睡眠障碍的干预提供依据。方法本次共抽取幼儿园及小学2～12岁1100例儿童（每个年龄组100例）对儿童家长进行问卷调查。结果2～12岁儿童睡眠障碍患病率为34．27％，其中8岁组患病率明显高于其它组占17．51％，各类睡眠障碍症状中以睡眠多汗、磨牙、打鼾、梦呓、睡眠不安为多，其中以睡眠多汗所占比例最高，占28．12％。结论睡眠是人体生命的重要生理过程，儿童睡眠质量的好坏直接关系到孩子的身体、智力发育和心理的健康成长，进一步探讨儿童睡眠障碍的影响因素，以便采取措施开展儿童睡眠障碍的干预对促进儿童健康成长是至关重要的。     

萍乡市0～7岁儿童3000例末梢全血微量元素含量的分析

目的了解本地区0．7岁儿童近期微量元素含量情况,为儿童保健工作采取合理营养治疗提供依据。方法选择2007年1月～2008年8月间来做健康体检的0～7岁儿童3000例．用原子吸收分光光度法测定末梢全血中铜、锌、钙、镁、铁的含量。结果铜、钙、镁三种元素在0-7岁问差异无显著性。锌和铁在0～1岁间的含量与其它各年龄段间差异有显著性。结论本地0～1岁儿童7、铁的缺乏较严重,6～7岁组儿童缺钙较常见,铜和镁元素缺乏的儿童只有2％。提示儿童保健工作者应根据不同年龄段间采取不同的干预措施。     

三河市0～6岁儿童维生素D营养状况调查

目的通过对600例体检儿童的血清25-羟维生素D[25-(OH)D]水平的检测,了解三河市0~6岁儿童维生素D营养状况。方法选择2018年3月至2019年3月正常体检的600例健康儿童作为研究对象,其中男300例,女300例。按照年龄,分为0~<1岁、1~<2岁、2~<3岁、3~<4岁、4~<5岁、5~6岁6组;按照季节分为春季、夏季、秋季、冬季4组。比较各组儿童血清25-(OH)D和维生素D总体营养状况。结果600例儿童中,严重维生素D缺乏17例,维生素D缺乏53例,维生素D不足119例,维生素D充足411例,分别占总数的2.8%、8.8%、19.8%、68.5%,其中男性和女性儿童血清25-(OH)D水平和严重维生素D缺乏、维生素D缺乏、维生素D不足、维生素D充足比例之间比较,差异无统计学意义(P>0.05)。3~<4岁、4~<5岁、5~6岁儿童血清25-(OH)D水平均明显低于0~<1岁、1~<2岁、2~<3岁儿童,差异有统计学意义(P<0.05),0~<1岁、1~<2岁、2~<3岁、3~<4岁、4~<5岁、5~6岁儿童严重维生素D缺乏、维生素D缺乏、维生素D不足、维生素D充足比例之间比较,差异有统计学意义(P<0.05)。夏季、秋季儿童血清25-(OH)D水平均明显高于春季、冬季儿童,春季、夏季、秋季、冬季儿童严重维生素D缺乏、维生素D缺乏、维生素D不足、维生素D充足比例之间比较,差异有统计学意义(P<0.05)。结论检测25-(OH)D是评估维生素D营养状况的最佳方法,用于评价儿童是否存在维生素D缺乏,以及诊断维生素D缺乏所导致的营养性佝偻病具有重要价值。     

儿童先天性心脏病术后康复训练

目前手术治疗仍是儿童先天性心脏病的主要治疗手段。它能使患儿解剖学恢复或接近正常,但患儿术后血流动力学指标(特别是运动状态下)仍明显异常且整体运动耐量低下。康复训练可弥补这一不足。现就先天性心脏病术后运动耐量的影响因素及康复训练的理论基础、目标、方式、禁忌证、方法及效果予以综述。     

0～6岁小儿贫血患病情况调查

贫血是儿童期的一种常见病，患病率高，可直接影响到儿童的生长发育，防治儿童贫血是儿童保健工作的重要任务。为了掌握我地区儿童贫血患病规律，我们对我地区285名0～6岁小儿作个贫血调查。     

Self-concept: comparison between school-aged children with congenital heart disease and normal school-aged children

Aims and objectives. The aim of this study was to evaluate and compare the self‐concept of school‐aged children with congenital heart disease to those of normal school‐aged children. The primary objective was to analyse results of the Self‐Concept Scale questionnaire administered to children with congenital heart disease aged 9–12 years. Sixty‐four children with congenital heart disease (study group), and 71 without congenital heart disease (control group), completed the questionnaire. Background. Little attention has focused on school‐aged children with congenital heart disease who are in the important stages of developing self‐concept. Results. The mean score on the Physical self‐concept of the Self‐Concept Scale was significantly lower for the study group than the control group (P < 0.05). No significant differences were observed between children with congenital heart disease and normal children in terms of family self‐concept, school self‐concept, appearance self‐concept, emotional self‐concept and general self‐concept for the Self‐Concept Scale. Conclusions. Nurses should use the study findings to encourage positive self‐concept development and improve their patient education about physical activity before the child is discharged. Thus, children with congenital heart disease could leave the hospital with a clear understanding of their body and condition, and how it affects daily life. Relevance to clinical practice. The results of this study may provide more holistic views on self‐concept for clinical nurses working with children who have congenital heart disease and their families and for school nurses working with elementary school children.     

Growth and development of children with congenital heart disease

BACKGROUND: Children with congenital heart disease (CHD) commonly experience delayed growth. Because growth and development are closely related, both should be considered when a child's progress is examined. PURPOSE: This paper reports a study to evaluate and compare the growth and development of preschool children with CHD to those of normal preschool children. METHODS: The heights and weights of 42 preschool children with CHD and 116 normal preschool children were compared with standard growth curves. Differences in development of personal and social skills, fine motor skills and adaptability, language, and gross motor skills were evaluated. Developmental skills were assessed using the Denver Developmental Screening Test II. RESULTS: A significant difference was found in both body height (P < 0.05) and weight (P < 0.05) between the two groups. More preschoolers with congenital hear disease were below the 50th percentile in height (P < 0.05) and weight (P < 0.001). Preschoolers with CHD had more suspicious interpretations than non-CHD preschoolers, specifically in the language (P < 0.01) and gross motor sections (P < 0.001). Nevertheless, there were two items in the personal-social section and one in the language section on which the children with heart disease passed in the range of 55.6-63.2%. Problems were encountered with the Denver II test because of differences in language, culture and childrearing methods between Taiwanese and Western societies. These cultural differences must be considered when the test is used to assess development. CONCLUSIONS: Learning about the growth and developmental differences between children with CHD and normal children may help parents of the former to detect problems associated with delayed growth and development earlier. These children and their families should have the opportunity to participate in a long-term, follow-up programme that provides information and encourages developmental progress. The results could serve as a reference for those in both clinical and community workers who provide nursing care to children with CHD.     

儿童先天性心脏病介入术后随访依从性调查

[目的]调查先天性心脏病介入术后患儿门诊随访依从性的现状,分析其影响因素及探讨提高随访依从性的方法。[方法]回顾性分析2017年5月—2019年5月在医院行先天性心脏病介入治疗并成功出院的患儿152例,通过门诊病历系统收集患儿随访信息,按照其是否达到理论随访次数将其分为失访组和未失访组,对术后患儿门诊随访依从性进行评判并分析其影响因素。[结果]实际到本院随访132例(86.9%),其他医院随访16例(10.5%),失访4例(2.6%)。132例在本院随访的患儿中52例未达到理论随访次数纳入失访组,80例达到理论随访次数纳入未失访组。经分析结果显示影响患儿随访依从性的因素有:家庭收入、对疾病的了解程度、父母亲学历。[结论]儿童先天性心脏病介入术后随访依从性较低,可通过对其影响因素的干预来提高患儿随访依从性。     

儿童先天性心脏病康复研究进展

文章归纳了国内外有关儿童先天性心脏病康复护理的相关研究,指出了常用的康复评估方法,论述了康复干预措施,并对护士的角色与要求进行分析,在此基础上指出存在的问题及今后发展的方向。     

儿童先天性心脏病经导管封堵术后死亡的影响因素分析

目的 分析儿童先天性心脏病（CHD）经导管封堵术后死亡的影响因素,以期为临床诊疗提供科学依据。方法选取2019年12月至2021年3月就诊于我院的222例CHD患儿作为研究对象,根据术后死亡情况将其分为死亡组（36例）和生存组（186例）。比较两组患儿手术前、后的右心房直径（RAD）、右心室内径（RVD）、左心室间隔厚度（LVST）、二尖瓣口血流速度（MV）、左心房内径（LAD）、左心室内径（LVD）、主动脉瓣口流速（AV）、左心室射血分数（LVEF）;采用单因素、多因素Logistic回归分析CHD患儿经导管封堵术后死亡的影响因素;建立CHD患儿术后死亡风险预测模型,并给予模型校准和ROC曲线评价。结果 手术前,两组的RAD、RVD、LVST、MV、LAD、LVD、AV、LVEF比较,差异均无统计学意义（P>0.05）;手术后,两组的RAD、RVD、LAD、LVD均减小,且死亡组小于生存组,差异具有统计学意义（P<0.05）;手术后,两组的LVST、MV、AV、LVEF均增大,且生存组大于死亡组,差异具有统计学意义（P<0.05）。经导管封堵术后死亡36例,占比为1...     

Clinical indicators of ineffective airway clearance in children with congenital heart disease

Aims and objectives. To analyse the sensitivity and specificity of clinical indicators of ineffective airway clearance in children with congenital heart disease and to identify the indicators that have high predictive power. Background. The precise establishment of nursing diagnoses has been found to be one of the factors contributing to higher quality of care and cost reduction in healthcare institutions. The use of indicators to diagnose ineffective airway clearance could improve care of children with congenital heart disease. Design. Longitudinal study. Methods. Participants consisted of 45 children, ≤1 year of age, with congenital heart disease, who had not had definitive or palliative surgical correction. Six assessments were made at 2‐day intervals. Each clinical indicator was defined based on previously established operational criteria. Sensitivity, specificity and positive and negative predictive values of each indicator were calculated based on a model for the longitudinal data. Results. A nursing diagnosis of ineffective airway clearance was made in 31% of patients on the first assessment, rising to 71% on the last assessment, for a 40% increase. Sensitivity was highest for Changes in Respiratory Rates/Rhythms (0·99), followed by Adventitious Breath Sounds (0·97), Sputum Production (0·85) and Restlessness (0·53). Specificity was higher for Sputum Production (0·92), followed by Restlessness (0·73), Adventitious Breath Sounds (0·70) and Changes in Respiratory Rates/Rhythms (0·17). The best positive predictive values occurred for Sputum Production (0·93) and Adventitious Breath Sounds (0·80). Conclusions. Adventitious Breath Sounds followed by Sputum Production were the indicators that had the best overall sensitivity and specificity as well as the highest positive predictive values. Relevance to clinical practice. The use of simple indicators in nursing diagnoses can improve identification of ineffective airway clearance in children with congenital heart disease, thus leading to early treatment of the problem and better care for these children.     

小儿先天性心脏病术后机械辅助通气管理体会

笔报道1997年1月－2000年4月，对36例小儿先天性心脏病术后行机械辅助通气的管理体会。根据小儿呼吸道解剖及生理特点设置通气参数，如呼吸频率、潮气量，并因人而异加用呼气末正压通气（PEEP）等。在辅助通气过程中密切观察患儿生命体征变化，定时了解血气变化，做好气道护理和患儿心理护理，努力做到人机协调，掌握撤机指征，以保证患儿安全脱机。本组患儿在辅助通气过程中无并发症发生。     

Heart rate variability following neonatal heart surgery for complex congenital heart disease

BACKGROUND: Altered cardiac autonomic control may play a role in the morbidity and mortality suffered by neonates who undergo surgery for complex congenital heart disease (CHD). The purpose of this study was to evaluate cardiac autonomic activity, as measured by spectral indices of heart rate variability (HRV), prior to and early after infant surgery for CHD and attempt to correlate HRV indices with clinical outcome. In addition, we assessed the hypothesis that single-ventricle physiology and surgical interruption of the great arteries negatively affects HRV. METHODS: Sixty neonates prospectively wore 24-hour Holter monitors at three time points: before and early after CHD surgery, and at 3- to 6-month follow-up. Standard spectral indices of HRV were measured. RESULTS: In the early postoperative time point, patients with single-ventricle physiology had lower low-frequency power (LF) compared to patients with two ventricles (P=0.040). Surgical interruption of the great arteries did not affect HRV in this cohort. For the entire cohort, LF (P=0.004) and high-frequency power (HF) (P<0.001) increased over the three time points, while LF/HF (P=0.119) did not significantly change. In the multivariable linear regression model, significant predictors of longer postoperative hospital stay included longer total support time (P=or<0.001), longer duration of inotrope support (P=0.012), elevated mean heart rate at postoperative time point (P=0.002), and lower LF/HF ratio at the postoperative time point (P=0.014). CONCLUSION: Patients with single-ventricle physiology have a significant physiologic reduction in LF in the early postoperative period compared to patients with two ventricles. Diminished cardiac autonomic control is associated with longer hospitalization following neonatal cardiac surgery.     

The safety and efficacy of ibutilide in children and in patients with congenital heart disease

BACKGROUND: The safety and efficacy of ibutilide in the cardioversion of atrial flutter and atrial fibrillation in children and in patients with congenital heart disease (CHD) is unknown. METHODS: Data from 19 patients (age 6 months to 34 years, median 16 years) who received ibutilide for atrial flutter or atrial fibrillation between 1996 and 2005 was retrospectively reviewed. There were 15 patients with CHD (14 had prior heart surgery); four children had normal heart structure. RESULTS: There were 74 episodes of atrial flutter and four episodes of atrial fibrillation (median episodes per patient was one, range 1-31). Ibutilide converted 55 of all the episodes (71%). Ibutilide was successful during its first-ever administration in 12 of 19 patients (63%). Fourteen episodes in six patients required electrical cardioversion after ibutilide failed. There were no episodes of symptomatic bradycardia. One patient went into torsade de pointes and one patient had nonsustained ventricular tachycardia. CONCLUSION: With careful monitoring, ibutilide can be an effective tool in selected patients for cardioversion of atrial flutter.