神经介导性晕厥儿童心室晚电位变化

神经介导性晕厥儿童存在自主神经功能紊乱,心室晚电位是预测恶性心律失常发生的指标,与自主神经功能密切相关,了解心室晚电位变化对临床预测神经介导性晕厥儿童的心血管事件具有一定价值。     

血管抑制型血管迷走性晕厥儿童心室晚电位变化

目的 探讨血管抑制型血管迷走性晕厥（VVS-V）儿童心室晚电位（VLP）变化。方法 收集2006年7月至2013年1月在中南大学湘雅二医院儿童晕厥专科门诊就诊, 经直立倾斜试验（HUTT）明确诊断的VVS-V儿童184例（研究组）。年龄4～14岁, 平均（10.54±2.15）岁。男85例, 平均（10.85±2.01）岁; 女99例, 平均（10.27±2.24）岁。同期按性别及年龄匹配中南大学湘雅二医院儿童保健专科门诊进行健康检查的儿童105例为对照组。采用广东中山博爱医用电子仪器厂的SR-1000A心电综合自动分析仪对受检者进行VLP检测,比较研究组和对照组儿童VLP变化。结果 研究组较对照组心率（HR）降低［（83.96±12.27）次/min对（87.28±13.75）次/min, t = -2.113, P＜0.05］、总QRS时间（TQRS）延长［（84.89±12.05） ms对（81.21±8.23） ms, t = 3.070, P＜0.05］、高频低幅时限（LAS40）延长［（62.43±19.17） ms对（56.79±1.83） ms, t = 2.442, P＜0.05］ 、均方根值（RMS40）增加［（28.73±7.23） μV对（26.89±7.36） μV, t = 2.059, P＜0.05］。结论 VVS-V儿童较健康儿童HR降低,TQRS、LAS40延长,RMS40增加,提示VVS-V儿童有可能会发生心血管恶性事件。     

重症病毒性心肌炎患儿心室晚电位临床分析

目的 观察小儿病毒性心肌炎(VM)尤其是重症心肌炎心室晚电位(VLP)与心律失常(AE)和室性心动过速(VT)的关系.方法 选择1996年5月-2007年7月收治并确诊的89例重症VM患儿[男53例,女36例;年龄(9.6±4.7)岁],同期选择健康体检儿童50例为健康对照组[男28例,女22例;年龄(6.7±4.8)岁].对二组儿奄行VLP检测,对其结果 进行统计学分析.结果 重症VM患儿VLP阳性率为78.65%(70/89例),与健康对照组(0例)比较有显著性差异(P<0.01);VLP阳性者AE和VT发生率明显增高,分别为80.77%(63/78例)和95.12%(39/41例).结论 VLP检测阳性率明显增高对重症VM患儿病情、治疗及预后特别是对预防恶性室性心律失常和猝死有重要意义.     

小儿室性心律失常心室晚电位检测及其临床意义的探讨

本文对４０例小儿性心律失常及３０例健康儿童进行心室晚电位检测（ＶＬＰ），结果表明：观察组与对照组间三项参数（ＱＲＳｒ、Ｄ４０、Ｖ４０）测值均无显著差异（Ｐ＞０．０５），两组间ＶＬＰ阳性率亦无显著差异，但病毒性心肌炎组（１３例）ＶＬＰ阳性率为２３．１％，而良性室早组（２５例）ＶＬＰ阳性率为０，经Ｘ２检验两组阳性率差异显著（０．０５＞Ｐ＞０．０１）．作者对上述检测结果加以分析，并对其临床意义进行了讨论．     

北京市2～6岁儿童血脂正常参考值研究

目的通过对部分北京市2-6岁健康儿童的血脂检测,探索此年龄段儿童血脂水平正常参考值。方法随机选取北京市海淀区2-6岁健康儿童共140人。应用日立7600型全自动生化分析仪检测其空腹血浆总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)水平,分别取血浆TC及LDL-C第75百分位(P75)及第90百分位点(P90)作为临界高限及高胆固醇血症水平,取TG P90作为高三酰甘油血症水平,取HDL-C第5百分位点(P5)作为低高密度脂蛋白水平,建立北京市2-6岁儿童血脂正常参考值。结果北京市2-6岁健康儿童血浆TC、TG、HDL-C及LDL-C水平分别为(3.56±0.78)、(0.58±0.25)、(1.30±0.31)及(2.04±0.57)mmol/L。男、女性别组血脂各项测定值比较均无统计学意义(P>0.05)。结论通过对140例北京市海淀区部分2-6岁健康儿童血脂调查,建立了该年龄段儿童血脂正常参考值,确立了临界高胆固醇和高胆固醇血症、高三酰甘油血症和低高密度脂蛋白水平。     

晚电位对估测小儿重型心肌炎的病情及预后的价值

对30例各年龄组正常小儿以及心肌炎患儿检测晚电位(LPS),其结果轻型、中型心肌炎与正常对照组无明显差异,P>0.05。重型病例有显著差异,P<0.01。结果提示LPS为估测心肌炎病情重危程度及预后的重要指标之一。     

学龄期儿童短程心率变异性及心室复极时间变异性与成人对比分析

目的　探讨学龄期儿童与成人心率变异性 (HRV)、心室复极时间变异性 (RDV)的差异。方法　对10 0例学龄期 (6～ 14岁 )健康儿童与 10 0例健康成人 (2 0～ 44岁 )进行短程 (5min)HRV、RDV检测 ,采集时域SDNN、MSD、RMSSD、频域LH(nu)、HF(nu)、LF/HP指标 ,并进行统计学分析。结果　HRV时域中学龄期儿童SDNN(5 3 80± 32 0 0 )ms,比成人 (4 4 33± 2 8 6 4)ms大 ,P <0 0 5 ;频域LF(nu)学龄期儿童 (4 2 38± 14 75 )比成人 (37 96± 15 95 )大 ,P <0 0 5 ;RDV中时域、频域指标两组无明显差异。结论　HRV可作为自主神经功能定量测试指标 ,而RDV可能只与心肌细胞的电生理特征有关     

电阻抗法测量儿童体脂肪率正常参考值

目的 为评估肥胖儿童体脂肪率，建立身体组成成分正常参考值而进行电阻抗测儿童体脂肪率正参考值研究。方法于1999年对北京地区4～18岁男、女健康儿童1129名采用电阻抗法测量体脂肪率，从象中抽出肥胖度在-20％以上， 20％以下的为正常群组，根据其性别年龄别归纳出体脂肪率的平均值和标差作为正常参考值。结果正常人群组889名，男435名，女454名。男童9岁以前，随年龄增长，体脂肪率呈降趋势，9～11岁和15～17岁体脂肪率明显增加。女童体脂肪率总趋势是随年龄增长而增加。男童体脂肪率5、6、9、10、15和16岁时明显高于女童；女童体脂肪率在13、14、17和18岁时明显高于男童。结论儿童体脂率有明显的年龄和性别差异．体脂肪率提示青春期正常男童组有潜在发生超重或肥胖的可能。     

亚高原地区健康儿童最大呼气流速预计参考值测定

采用袖珍峰流速仪测定儿童肺功能,日益受到重视,目前国内报道正常健康儿童最大呼气流速(PEFR)正常参考值不多,我们于1996年使用江苏常州医疗器械厂生产的袖珍峰流速仪对贵阳城区1313名健康儿童测定PEFR,较好地提供患儿气道阻塞程度的客观指标,现将测定结果报告如下。     

苏州市区儿童肺通气功能正常值及预测值方程式的建立

目的建立5～14岁儿童肺通气功能的正常值范围及预测值方程式。方法对苏州市区健康儿童610名,男302名、女308名,采用肺功能仪测定用力肺活量(FVC)、1秒用力呼气容积(FEV1)等共19项指标,以实测指标采用SPSS 16.0统计软件,经多元逐步回归和多元线性回归,得出预测值方程式。结果 FVC、FEV1在各年龄组间的差异有统计学意义(P<0.01);FVC在所有年龄组均为男孩>女孩,7、12、14岁组间的差异有统计学意义(P<0.05);FEV1在11岁组女孩>男孩,但差异无统计学意义,在其他年龄组则均为男孩>女孩,7、8、14岁组间的差异有统计学意义(P<0.05)。大多数的肺功能指标(如FVC、FEV1、FEV0.5、PEF等)与儿童的身高、体质量、年龄呈正相关,其中FEV1与身高的关系最为密切,且呈指数关系。儿童平均呼气时间2.68 s,外推容积<0.12 L,外推容积占用力肺活量比<4.97%。结论大多数肺功能指标受儿童身高影响超过体质量和年龄变化;儿童肺功能的质量控制标准应与成人不同。     

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??Abstracts?? Objective To investigate the changes of ventricular late potentials ??VLP?? in children with vasovagal syncope of vasodepressor response ??VVS-V??. Methods Totally 184 children ??aged from 4 to 14 years old??the average age being ??10.54±2.15?? years old?? had been diagnosed with VVS-V by head-up tilt table test ??HUTT?? ??study group?? from July 2006 to January 2013 in the Second Xiangya Hospital of Central South University?? male 85 cases?? the average age of ??10.85±2.01?? years old?? female 99 cases?? mean age ??10.27±2.24?? years old. Totally 105 healthy children were matched as controls. All subjects underwent VLP examination. Investigate the difference in HR?? TQRS?? LAS40 and RMS40 between the study group and the control group. Results Compared with the control group?? in the study group heart rate ??HR?? decreased ???83.96±12.27?? beats/min vs??87.28±13.75?? beats/min?? t = -2.113?? P??0.05???the total QRS time??TQRS?? ???84.89±12.05?? ms vs ??81.21±8.23?? ms?? t = 3.070?? P??0.05?? and high frequency and low amplitude limit??LAS40?? ???62.43±19.17?? ms vs ??56.79±1.83?? ms?? t = 2.442?? P??0.05?? were prolonged??and the root mean square plant??RMS40?? increased ???28.73±7.23?? μV vs ??26.89±7.36?? μV?? t = 2.059?? P??0.05??. Conclusions Compared to healthy controls??in VVS-V children HR reduces??TQRS and LAS40 prolong??and RMS40 increases. It suggests that VVS-V childrenare more likely to have cardiovascular incidents.     

The late positive potential: a neurophysiological marker for emotion regulation in children

Background:  The ability to modulate emotional responses, or emotion regulation, is a key mechanism in the development of mood disruptions. Detection of a neural marker for emotion regulation thus has the potential to inform early detection and intervention for mood problems. One such neural marker may be the late positive potential (LPP), which is a scalp-recorded event-related potential reflecting facilitated attention to emotional stimuli. In adults, the LPP is reduced following use of cognitive emotion regulation strategies such as reappraisal. No studies to date have examined the LPP in relation to cognitive emotion regulation in children, and whether the LPP is related to parent-report measures of emotion regulation and mood disruptions.
Methods:  To examine this question, high-density electroencephalograph (EEG) was recorded from 20 children ( M age = 87.8 months, SD  = 18.02; 10 girls) while they viewed unpleasant emotional pictures following either a directed negative or neutral interpretation of the picture.
Results:  As predicted, the LPP was smaller following neutral versus negative interpretations at posterior recording sites, except for younger girls (aged 5–6). The timing of this effect was later than that reported in studies with adults. For all children, greater modulation of the LPP by neutral interpretations was associated with reduced anxious-depressed symptoms, whereas larger LPPs for both interpretation types were associated with greater mood symptoms and worse parent-reported emotion regulation.
Conclusions:  Results suggest that the LPP may represent a clinically relevant neural marker for emotion regulation and mood disruptions.     

T波电交替预测法洛四联症术后室性心律失常的价值

目的探讨T波电交替（TWA）预测法洛四联症（TOF）术后室性心律失常的价值。方法回顾性分析36例TOF术后儿童及120例年龄相仿正常儿童的TWA特点及持续TWA与室性心律失常发生的关系。结果TOF术后患儿持续TWA发生率（36.1%）明显高于正常对照儿童（15.8%）,差异有统计学意义（χ2=6.98,P<0.05）;TOF术后出现持续性TWA患儿在运动过程中室性心律失常的发生率（76.9%）远高于TOF术后无持续TWA患儿（21.7%）,差异有统计学意义（χ2=10.41, P<0.05）。结论TOF术后患儿存在发生室性心律失常的电生理基础,持续TWA对预测TOF术后室性心律失常具有重要价值。     

Reference range for serum cortisol in well preterm infants.

AIM: To establish a reference range for serum cortisol concentrations in preterm infants with a gestational age of less than 30 weeks during the first two weeks of life. METHODS: Infants were prospectively classified by the following exclusion criteria: surfactant administration, arterial hypotension, acute or uncontrolled infection, ventricular haemorrhage II degrees or above, serum glucose < 2.2 mmol/l, exchange transfusion, stress as a result of any kind of examination or nursing for at least 4 hours before blood sampling. The cortisol value was measured once using radioimmunoassay in each infant. RESULTS: In appropriate for gestational age (AGA) infants (n = 37, median gestational age 27.7 weeks, median birthweight 1030 g) the distribution of the cortisol concentrations was non-Gaussian. These had a nearly normal distribution, when log(10) values of the data were used. The points determined by mean (2 SD) on the logarithmic scale were transformed back to the original units to provide a reference range: 73-562 nmol/l. Gestational age was significantly (p = 0.033) associated with cortisol values (log(10)) with a regression coefficient (standard error) of -0.045 (0.020). Small for gestational age (SGA) infants (n = 8) had significantly higher cortisol values (median 357 nmol/l) than AGA infants (median 199 nmol/l) (p=0.028). CONCLUSIONS: There is a strictly defined reference range of serum cortisol concentrations in AGA preterm infants.     

Exercise-induced ventricular tachycardia in children

Two children with exercise-induced tachycardia, one with idiopathic long-QT syndrome, are presented. The patients were evaluated by exercise testing and electrophysiologic study. From the onset of treatment with the beta-blocking agent, pindolol, the patients have been symptom-free. These findings emphasize that children with syncope must be evaluated by ECG, exercise testing, 24-h Holter-monitoring, and finally, electrophysiological study.     

儿童心肌致密化不全

心肌致密化不全(NVM)是一种少见的先天性遗传性心肌病,以心腔内异常粗大的肌小梁和小梁间深陷的隐窝为特征。其临床表现多样且无特异性,以心功能不全、心律失常、血栓形成为主要特征。超声心动图和心脏磁共振成像在NVM诊断中具有重要意义。治疗上主要是对症治疗,内科治疗无效者可行心脏移植。本病预后差异大,病死率高,但无症状者预后相对较好。