儿童热性惊厥复发危险因素分析

目的:研究热性惊厥患儿的复发危险因素。方法:结合36例热性惊厥患儿的临床及脑电图资料,研究其复发因素情况。结果:复发共19例(53.0%),复发危险因素与惊厥家族史、初次发作体温<38.5℃、初次发作年龄<1岁及复杂型热性惊厥有关(P<0.01)。结论:对有复发危险因素儿童应密切随访,一旦发热,及早采取适当的干预措施。     

物理降温联合吸氧辅助药物治疗小儿热性惊厥临床观察

目的：探讨物理降温联合吸氧辅助药物治疗小儿热性惊厥的临床疗效。方法：选取56例小儿热性惊厥患儿为研究对象，给予吸氧、物理降温、羚黄宝儿丸止凉等常规治疗方法，观察患儿止惊、退热效果及复发率。结果：56例患儿中，止惊方面：显效21例，有效23例，无效12例，有效率78．57％；退热效果方面：显效23例，有效25例，无效8例，有效率85．71％；复发9例，复发率16．07％。结论：物理降温联合吸氧辅助药物治疗小儿热性惊厥的临床疗效显著，复发率低，应加强患儿治疗前的评估，采取早期干预措施，有效预防患儿复发。     

小儿复杂性热性惊厥59例临床特点

目的：对小儿复杂性热性惊厥临床特点进行分析,以提高临床医师对其的重视。方法：对我院2005-03～2009-02收治的复杂性热性惊厥患儿59例进行回顾性分析。结果：复杂性热性惊厥发生率占热性惊厥的19.8%,年龄分布在4个月～7岁,年龄最小4个月8d,最大7岁8个月。初发21例,复发38例。既往围生期异常者12例,既往有热性惊厥史38例,一级亲属有热性惊厥史者19例,癫痫家族史5例。惊厥为全面性发作48例,持续状态5例,持续时间〉15min21例。脑电图异常22例,发展为癫痫14例（占复杂性热性惊厥23.7%）,智力低下7例,（占复杂性热性惊厥11.8%）。结论：首发年龄小,首发体温低,有围生期异常者,复杂性热性惊厥易复发,一级亲属有惊厥史者,脑电图异常者易发展为癫痫。     

热性惊厥患儿血清cTnI和CK-MB的改变及临床意义

目的 探讨热性惊厥(FC)患儿血清心肌肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB)的改变及临床价值.方法 入院后24 h内检测98例热性惊厥(FC)患儿血清cTnI、CK-MB水平,同时选择48例有发热但无惊厥,并除外心肌炎、急性肌炎等疾病的患儿为对照组.结果 FC组血清cTnI和CK-MB水平明显高于对照组(P＜0.05).结论 FC患儿易合并心肌损害;血清cTnI、CK-MB的升高对早期发现心肌损害具有重要意义.     

以热性惊厥起病90例临床分析

目的 :探讨热性惊厥性疾病对儿童神经系统损害和智力影响的程度。方法 :对本院 1989年 2月～ 2 0 0 2年 12月收治的以热性惊厥起病的 90例随访结果进行分析。结果 :90例中 80例发育情况良好 ,智力正常 ;10例发生神经系统异常 ,占 11 1%。有热性惊厥家族史 2 8例 ,占 31 1% ;有癫痫家族史 4例 ,占 4 4 % ;严重智力低下 4例 ,占4 4 % ;智商偏低 2例 ,占 2 2 % ;其余病人智商均正常。结论 :病史、家族史和随访等对诊断有非常重要的意义 ,随着诊断和急救医学水平的不断提高 ,惊厥持续状态的预后有明显的改善     

社会环境因素对高危儿早期干预的影响

目的探讨社会环境因素对高危儿早期干预的意义。方法将在儿科NICU病房接受监护治疗痊愈出院的208例高危患儿分为家庭早期干预组和常规育儿组。家庭早期干预组107例,按鲍秀兰的《0~3岁儿童最佳的人生开端》为蓝本,制订干预计划,然后严格执行;常规育儿组101例完全依赖于医疗康复机构,回家后不进行特殊的康复指导训练。结果家庭早期干预组的大运动、精细运动、语言、个人-社交、适应性等五大能区的DQ值均显著高于常规育儿组(P均<0.01)。结论早期干预可促进高危儿的运动、认识发育。     

热性惊厥患儿血清cTnI和电解质的变化及临床意义

目的探讨热性惊厥(FC)患儿血清心肌肌钙蛋白I(c Tn I)和电解质(钠、钾、氯、钙)的变化及临床意义。方法选择46例符合诊断标准的上呼吸道感染合并FC患儿为观察组,观察组内依据一次热程中惊厥发作的次数分为A(1次)组和B(≥2次)组。另选择40例有发热症状但无热性惊厥的上呼吸道感染患儿为对照组,分别检测两组血清c Tn I及电解质水平,并进行比较分析。结果观察组血清c Tn I水平明显高于对照组(P<0.01),血钠、血钙水平明显低于对照组(P<0.05),而血钾、血氯水平两组无明显差异。观察组中,B组血清cT nI水平明显高于A组(P<0.05),血钠水平明显低于A组(P<0.01),而血钙、血钾、血氯水平,A组与B组无明显差异。结论热性惊厥可引起患儿心肌受损,抽搐次数越多,心肌损害越严重。电解质紊乱可能是热性惊厥的重要诱因,低血钠可能是热性病程中惊厥多次发作的诱因之一。     

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。     

热性惊厥患儿血钠、血钙及血糖的临床观察

热性惊厥是儿科常见急症，占各类惊厥的30％，在我国的发生率为4％-5％。惊厥如持续时间长，反复发作，可引起脑组织器质性损害。本文对2003年2月-2007年12月4年多本院儿科收治的197例热性惊厥患儿的血清钠、血清钙及血糖值测试资料进行分析．以探讨其与小儿热性惊厥的关系。     

小儿热性惊厥不可忽视

小儿热性惊厥又称高热惊厥，中医称为“火风”或“热惊风”，是小儿时期最常见的一种惊厥。小儿发生惊厥时，呼吸停止，有时先叫一声，随后全身发硬，头向后背，脸色发青，两眼上翻，随后四肢抽动，少数患儿表现为半侧肢体抽动或部分肢体抽动，此时患儿意识丧失，呼之不应。由于部分患儿在惊厥后会留下不同程度的后遗症，故对小儿热性惊厥应积极防治，不可掉以轻心。小儿热性惊厥的发生因素年龄热性惊厥的发生与年龄有着密切关系，它只在某个年龄段出现。热性惊厥首次发作年龄多见于６个月至３岁之间，１～２岁是发病的最高年龄组，这与此年…     

脑梗死复发的危险因素对比分析

目的探讨引起脑梗死复发的相关危险因素。方法对2007年1月～2008年1月期间我科收治的103例复发脑梗死患者和同期收治的122例初发脑梗死患者的危险因素进行对比分析。结果通过Logistic回归分析发现年龄（OR=1.015）、脑血管病家族史（OR=1.139）、高血压（OR=1.333）、高纤维蛋白原（OR=1.366）、脑白质疏松（OR=1.488）是增加脑梗死复发的危险因素。复发脑梗死组的危险因素种类明显多于初发脑梗死组（P〈0.05）。复发脑梗死组与初发脑梗死组梗死灶大小比较无明显差异（P〉0.05）。复发的时间多在初发后1年内和5年后。结论脑梗死的复发与多种因素共同作用有关,危险因素越多,复发的机率越大。     

The mammographic parenchymal patterns of nulliparous women and women with a family history of breast cancer

One-hundred-and-thirteen mammograms of nulliparous women and 44 mammograms of women with a family history of breast cancer were graded according to Wolfe's parenchymal pattern classification. These were compared to 437 mammograms of women without these risk factors. Mammograms were read by two independent observers in order to evaluate inter- and intra-observer variation. The interobserver variation was reduced from 17% to 5% by combining high risk patterns (P2 and DY) and low risk patterns (N1 and P1). A significantly higher proportion of high risk patterns was found in nulliparous women compared to parous women (P less than 0.01). The proportion of high risk patterns decreased significantly with the number of children (P less than 0.01). Women with a family history of breast cancer had almost the same parenchymal patterns as women without a family history. In conclusion, while nulliparity and family history are recognized risk factors for developing breast cancer, only nulliparity would appear to influence the mammographic parenchymal pattern. This probably reflects the different mechanism by which the two factors affect breast tissue.     

武警某部士兵中轴型脊柱关节炎发病相关因素分析

 目的 评价不同的发病因素对武警部队士兵中轴型脊柱关节炎(axial spondyloarthritis,axSpA)的危险性。方法 选取2010-01至2017-06确诊为axSpA的士兵87例为研究对象,以同期在医院住院和门诊就诊的非风湿免疫性慢性关节疼痛患者102例为对照组,分析年龄、兵龄、职务、工作性质、家族史、吸烟史、遗传因素等多项内容与axSpA发病的关系。结果 对各种因素进行单因素Logistic回归分析后,年龄、吸烟史、工作性质、遗传背景与axSpA的发病有相关性,将上述因素纳入多因素Logistic回归模型分析,最后结果提示年龄、工作性质和遗传背景是axSpA发病的危险因素。结论 除强直性脊柱炎(ankylosing sponylitis,AS)患者外,部队有相当一部分放射学阴性中轴型脊柱关节炎(non-radiographic axSpA,nr-axSpA)患者。遗传因素是导致axSpA发病的绝对主导因素,工作性质亦与发病有关。     

Breast-conserving therapy in young women with invasive carcinoma of the breast

Higher local recurrence rates have been reported in young women with invasive carcinoma of the breast treated with breast-conserving therapy (BCT). However, age itself may not be responsible for this increased risk of recurrence. To investigate this further, a computerized literature search of MEDLINE was performed using data from 1996 to May 2003. The research was limited to female patients with localized, invasive adenocarcinoma of the breast but also included patients of young age with ductal carcinoma in situ. Women of young age with breast cancer, treated with BCT are at an increased risk of recurrence ranging from 7.5 to 35%. However, the data would suggest that the increased risk is secondary to the association of young age with more aggressive tumours and a positive family history of breast cancer. Other factors that may explain the adverse prognosis in women of a young age include associated genetic abnormalities and the lack of mammographic screening programmes for women of young age. Young age is a risk factor for breast recurrence after BCT. However, management decisions should be based on tumour stage, grade and other related prognostic features rather than on young age alone.     

高压氧预暴露对急性氧中毒大鼠模型惊厥潜伏期影响的实验研究

目的 研究高压氧预暴露对大鼠急性氧中毒潜伏期的影响并探讨其机制.方法 将40只Sprague-Dawley(SD)大鼠随机分为对照组和高压氧预暴露组,每组20只,其中高压氧预暴露组于高压纯氧(0.3 MPa)下暴露20 min,然后减至常压行空气通风20 min,如此循环4次.24 h后,将2组大鼠暴露于高压纯氧(0.5 MPa),观察40 min.检测指标包括惊厥潜伏期变化、大鼠脑组织中超氧化物歧化酶(SOD)活性和一氧化氮(NO)含量变化,进行HE染色以观察脑组织病理改变.结果 高压氧预暴露后,大鼠惊厥潜伏期[(29.79±2.13)min]比对照组[(24.25±3.76)min]延长,脑组织NO含量[(2.93±0.39)nmol/g]比对照组[(7.46±1.11)nmol/g]减少,而SOD活性与HE染色结果 显示2组差异无统计学意义.结论 高压氧预暴露可以延长大鼠惊厥潜伏期,其机制可能是高压氧降低了脑组织中的NO含量.     

中风家族史与中风的相关性研究

 目的研究中风家族史对中风发生的影响.方法随机抽取武警部队35岁以上干部3 853名,通过问卷形式进行中风家族史及其他潜在危险因素的调查,中风的诊断依据CT征象、临床表现和体格检查.结果病例对照研究结果显示:中风家族史与中风的发生相关(P＜0.01,OR=3.504,95%CI 1.960-6.264).控制年龄和性别两个主要混杂因素的影响后,中风家族史与中风的联系强度变化不大(OR=3.144,95%CI 1.634-6.049);Logistic回归分析也证实了中风家族史是中风发生的独立危险因素(OR=2.629,95%CI 1.406-4.13).结论中风家族史在中风的发生中发挥着重要的作用.     

Graves-Basedow disease and potential risk factors

BACKGROUND/AIM: Graves-Basedow disease is a common multifactorial genetic syndrome, which is determined by several genes and environmental factors. The aim of the present study was to investigate the presence of risk factors for developing Graves-Basedow disease between the groups of individuals with and without Graves-Basedow disease, and to compare the presence of risk factors between the affected individuals with or without positive family history for Graves-Basedow disease. METHODS: This cross-sectional study was conducted in Cuprija (central Serbia) during a period from December 2001 to April 2002. The case group comprised 132 individuals diagnosed with Graves-Basedow disease. The control group comprised 130 subjects without any of endocrine diseases. All participants were interviewed at the Medical Center Cuprija using structural questionnaire. Data were collected on basic demographic characteristics, exposure to various chemical and physical agents, stress, smoking and family history of Graves-Basedow disease. In statistical analysis chi-square test was used. RESULTS: The individuals with Graves-Basedow disease were statistically significantly older (above 50) (p = 0.020), exposed to stress (p = 0.024) and to physical agents (p = 0.031), and had significantly (p = 0.000) more relatives with Graves-Basedow disease than those without the disease. Among the affected individuals with positive family history of Graves-Basedow disease the number of women was significantly higher (p = 0.000), than the affected individuals without positive family history of Graves-Basedow disease. CONCLUSION: In our study, as in many other, gender, age, positive family history of Graves-Basedow disease and exposure to physical agents were identified as potential risk factors for the increased incidence of Graves-Basedow disease. Different risk factors are probably responsible for developing Graves-Basedow disease among the affected individuals with or without positive family history of Graves-Basedow disease.     

Hippocampal alterations in children with temporal lobe epilepsy with or without a history of febrile convulsions: evaluations with MR volumetry and proton MR spectroscopy

BACKGROUND AND PURPOSE: The causal effect of early febrile convulsions (FC) on later-onset temporal lobe epilepsy (TLE) remains unclear. In this study, we sought to examine the hippocampal alterations in epileptic children with or without FC history by using MR spectroscopy and volumetry. METHODS: Fifty-five children ranging in age from 18 months to 15 years were enrolled in this study. Subjects were divided into three groups: the control group without either TLE or history of FC (n = 16), the TLE group with early history of FC (TLE + FC; n = 22), and the TLE group without FC history (n = 17). Measurement of hippocampal volume (HV) was performed on thin section T1-weighted images acquired with a 3D gradient echo MR image and normalized by the intracranial volume. Each individual subject had two measures of lateralization; one gives the smaller side of HV and the other the contralateral larger side of HV, assuming that the side with smaller HV is the possible primary site of seizure focus and the contralateral larger HV the secondary or normal site. Single-voxel proton MR spectroscopy of the hippocampi was performed, with metabolic ratio n-acetylaspartate (NAA)/choline (Cho) + creatine plus phosphocreatine (Cr) calculated and grouped separately as were with volumetry. RESULTS: The overall mean HV for the control group was 2.61 +/- 0.21 cm(3) at an average intracranial volume of 965 +/- 241 cm(3), and the asymmetry index for hippocampal volume was (2.32 +/- 1.58)%. The overall mean HV was 2.30 +/- 0.33 cm(3) for TLE + FC group and 2.34 +/- 0.33 cm(3) for TLE group. Mean HV differed significantly for the three groups (P < .01). When the small and large sides were analyzed separately, significant differences were found between control and TLE as well as between control and TLE + FC for the smaller side (P < .05), whereas for the larger side significant differences were found only between control and TLE + FC. In MR spectroscopic measurements, the mean NAA/(Cr + Cho) of bilateral hippocampi was 0.77 +/- 0.06 for control group, 0.62 +/- 0.12 for TLE + FC group, and 0.66 +/- 0.11 for TLE group. In terms of statistically significant difference between groups, spectroscopic results were similar to volumetric measurements, except that there was no significant interaction effect between groups and measures of asymmetrical indices (P = .272). CONCLUSION: Children with TLE and early history of FC tend to have lower hippocampal volumes and NAA/(Cr + Cho) ratios than do TLE children without FC history. The TLE + FC group seems to have increased vulnerability of the contralateral hippocampus as compared with TLE group. MR volumetry and spectroscopy are equally capable of showing the trends of hippocampal alternations in children with TLE with or without FC history.     

30例急性脊髓损伤病人合并霉菌尿分析

对３０例急性脊髓损伤出现霉菌尿的病人进行分析，发现有长期留置导尿、使用抗生素不合理、使用糖皮质固醇类激素和血糖升高等诱发霉菌尿的危险因素存在。笔者还就急性脊髓损伤病人出现霉菌尿的病理机制、临床意义、预防和治疗进行了讨论。