手足口病病原体流行特征分析及临床意义

Objective To investigate the epidemic characteristics of etiological agents in children with hand, foot and mouth disease (HFMD) and analyze the differences between the severe and mild cases with HFMD seen from 2008 to 2009 in the Children's Hospital Methods A total of 154 patients with HFMD were enrolled from May 2008 to September 2008 and from May 2009 to September 2009, including 28 severe HFMD patients. Data from 80 cases with suspected herpangina were collected as control. Enterovirus universal type, enterovirus type 71 (EV71) and coxsackie virus group A 16 (CA16) were detected by realtime RT-PCR respoctively. Results The positive rate of enterovirus universal type in the 154 patients with HFMD was 81.82% (126/154). EV71 positive rate in these 126 patients with enterovirus universal type infection was 57.14% (72/126). The positive rate of enterovirus universal type in the 80 cases with suspected herpangina was 68.75% (55/80). There was no EV71 infection in these 80 cases with suspected herpangina. EV71 infection was mainly popular in 2008. Both EV71 and CA16 were prevalent in 2009. The epidemic characteristics of enterovirus infection with HFMD between 2008 and 2009 had significant differences (X2 = 23.50, P = 0.000) ( P ＜ O.01 ). The epidemic characteristics of enterovirus infection between severe and mild HFMD patients also had significant differences (X2 = 29.85, P ＜ O. 01). There were 28 cases with severe HFMD, in whom the EV71 positive rate was 92.86% (26/28). EV71 positive rate in the mild HFMD was 36.51% (46/126) (X2 =29.22, P ＜0.01). There was no significant difference in the gender ( X2 = 0.135, P = 0.714) and virus load (t = 0.141, P = 0.889) between the mild and severe HFMD cases. But the age of mild and severe HFMD showed a significant difference ( t = 2.926, P =O.009). Patients who were less than 2 years of age had a proportion of 88.89% (8/9) with severe HFMD.The mean age of mild HFMD patients was 3.19 years. Conclusion HFMD showed different epidemic characteristics at different times of enterovirus infection. There was no significant difference in the gender and virus load between the mild and severe cases with HFMD. Children under 3 years of age with EV71 infection were at high risk for severe HFMD.     

手足口病病原体流行特征分析及临床意义

Objective To investigate the epidemic characteristics of etiological agents in children with hand, foot and mouth disease (HFMD) and analyze the differences between the severe and mild cases with HFMD seen from 2008 to 2009 in the Children's Hospital Methods A total of 154 patients with HFMD were enrolled from May 2008 to September 2008 and from May 2009 to September 2009, including 28 severe HFMD patients. Data from 80 cases with suspected herpangina were collected as control. Enterovirus universal type, enterovirus type 71 (EV71) and coxsackie virus group A 16 (CA16) were detected by realtime RT-PCR respoctively. Results The positive rate of enterovirus universal type in the 154 patients with HFMD was 81.82% (126/154). EV71 positive rate in these 126 patients with enterovirus universal type infection was 57.14% (72/126). The positive rate of enterovirus universal type in the 80 cases with suspected herpangina was 68.75% (55/80). There was no EV71 infection in these 80 cases with suspected herpangina. EV71 infection was mainly popular in 2008. Both EV71 and CA16 were prevalent in 2009. The epidemic characteristics of enterovirus infection with HFMD between 2008 and 2009 had significant differences (X2 = 23.50, P = 0.000) ( P ＜ O.01 ). The epidemic characteristics of enterovirus infection between severe and mild HFMD patients also had significant differences (X2 = 29.85, P ＜ O. 01). There were 28 cases with severe HFMD, in whom the EV71 positive rate was 92.86% (26/28). EV71 positive rate in the mild HFMD was 36.51% (46/126) (X2 =29.22, P ＜0.01). There was no significant difference in the gender ( X2 = 0.135, P = 0.714) and virus load (t = 0.141, P = 0.889) between the mild and severe HFMD cases. But the age of mild and severe HFMD showed a significant difference ( t = 2.926, P =O.009). Patients who were less than 2 years of age had a proportion of 88.89% (8/9) with severe HFMD.The mean age of mild HFMD patients was 3.19 years. Conclusion HFMD showed different epidemic characteristics at different times of enterovirus infection. There was no significant difference in the gender and virus load between the mild and severe cases with HFMD. Children under 3 years of age with EV71 infection were at high risk for severe HFMD.     

纤维支气管镜在PICU中的应用

Objective To explore the efficacy and safety of clinical application of bronchofibroscope (BFS) in PICU. Methods Seventy-nine critically ill children in our PICU were operated with BFS in 89 cases and the etiology of these children was analyzed. The blood-gas analysis and oxygenation index both before and after the treatment had been compared, and syndrome was observed as well. For 40 cases in which critically ill children received bronchoalveolar lavage in addition to mechanical ventilation, and the index of respiratory mechanics was analyzed. Analysis and summary had been performed on the culture results of bronchoalveolar lavage fluid in 74 cases. Results The primary disease in these cases was mainly respiratory diseases (64/79). There was no major change in oxygenation index and blood pH ( P ＞0. 05 ) before and after operation with BFS. No severe syndrome,such as sudden cardiac arrest and pneumothorax, was recorded. However,transient decrease in SpO2 was most frequently observed in minor syndromes (15/79). The children treated with mechanical ventilation were recorded with significant decrease in air way resistance ( P ＜ 0. 05 ) after bronchoalveolar lavage. However,dynamic compliance and work of breathing only changed slightly (P ＞0. 05 ). The culture positive rate of bronchoalveolar lavage fluid was 29. 1% (23/79) ,mainly gram-negative bacteria, which coincided with disease spectrum of PICU. Conclusion The application of BFS in PICU can improve salve and tracheobronchial management for critically ill children. The diagnosis and treatment is safe and reliable by strictly grasping the examination indication by BFS under the custody of PICU.     

胆道闭锁Kasai术后早期并发症的分析

Objective The purpose of this study was to evaluate the relation between early complications of Kasai operation and high-dose steroids and antibiotics and to demonstrate the prognosis of biliary atresia(BA). Methods 281 patients diagnosed with biliary atresia(BA) type Ⅲ,admitted from Aug. 1994 to Aug 2008 were retrospectively reviewed and followed up for two years. The patients were divided into two groups. Patients in Group A were controls while patients in Group B were treated with high-dose steroids and antibiotics. We evaluated the relation between early complications and age at operation (days), baseline bilirubin, different treatments and 2 year survival. Results 93 patients had early complications,and cholangitis is the most common, There is no statistics difference of complications in age at operation and baseline bilirubin. The complication rate was 63. 6% in group A, and 25. 7% in group B(P＜0. 01). The cholangitis rate was 56. 4% in group A and 23. 9% in group B (P＜0. 01). Two groups showed no significant difference in digestive tract bleeding. The visit frequency rate was 92. 5%, while 2 year survival rate was 51. 2%. Patients with early complications or cholangitis have a 34. 4% or 32. 9% 2 year survival rate, while those without have a 59. 6% or 59. 2%(P＜ 0. 01). Patients with high-dose treatment in group B have a better 2 year survival rate (54. 0% vs 40. 0% ,P＜0. 05). Conclusions Early cholangitis was the risk factor of outcome after Kasai operation. These data implied that the use of high-dose steroids and antibiotics can lower the occurrence of cholangitis and elevate 2 year survival rate.     

A case-control study on mixed infection in infants with pertussis北大核心CSCD

Objective To examine whether the mixed infection rate in pertussis infants is significantly higher than that in non-pertussis infants with respiratory tract infection, to explore the mixed infection pathogen distribution in pertussis infants, and to provide reference for clinical diagnosis and treatment. Methods A case-control study was conducted on 118 nasopharyngeal swabs collected from infants who applied for clinical pertussis etiological testing (culture and specific nucleic acid detection of Bordetella pertussis) in Beijing Children′s Hospital, Jiaxing Maternity and Child Health Care Hospital and Wuhu No.1 People′s Hospital from August 2018 to January 2021.According to the pertussis etiological testing results, the patients were divided into the pertussis group (65 cases) and non-pertussis group (53 cases). Thirty-three pairs of cases were matched according to age, onset season and city.All nasopharyngeal swabs were tested for infections of other pathogens using FilmArray RP2, which can detect 21 respiratory infection pathogens.The mixed infection rate was compared between groups by Chi-square test. Results According to the FilmArray RP2 test results, 56.9%(37/65) cases in pertussis group and 15.1%(8/53) cases in the non-pertussis group were positive for multiple pathogens, and the difference was statistically significant (χ2=21.651, P<0.001). The top 5 mixed infection pathogens in pertussis infants were human rhinovirus/enterovirus (HRV/EV) (38.5%, 25/65), parainfluenza virus (PIV) (18.5%, 12/65), respiratory syncytial virus (RSV) (10.8%, 7/65), coronavirus (Cov) (10.8%, 7/65), and adenovirus (ADV) (7.7%, 5/65). The mixed infection rates of the pertussis group in spring, summer, autumn and winter were 46.2% (6/13), 58.3%(14/24), 55.6%(5/9), and 63.2%(12/19), respectively.Comparison of matched and unmatched cases achieved similar results. Conclusions Among clinical suspected pertussis infant specimens, the mixed infection rate in confirmed cases is tremendously higher than that in non-pertussis infants.The main mixed infection pathogens in pertussis infants are HRV/EV, PIV, RSV, Cov, and ADV.Mixed infection in pertussis children commonly occurs in four seasons, with the highest incidence in winter. © 2023 Journal of Chinese Agricultural Mechanization. All rights reserved.     

新生儿局部脑组织氧检测的多中心研究

Objectives To understand the value of measuring neonatal cerebral regional oxygen ‘saturation(rSO2)using near infrared spectroscopy (NIRS) in assessing cerebral oxygenation,to establish the normal range of neonatal cerebral rSO2,and to collect data of the changes of cerebral rSO2 under certain disease status.Methods Nine large hospitais participated in the multicenter randomized clinical trial from Jan 2007 to Apr 2008.Using the NIRS human tissue oximeter(TSAH-100)independently developed in China.tIle cerebral rSO2 of 223 normal full-term and 95 otherwise healthy preterm neonates without any stmcial disease,Was detected at 1.2 and 3 days after birth,respectively.The cerebral rSO2 of 102 neonates with diseases which may affect the cerebral oxygenation.Was also detected during the severe phases.The pulse oxygen saturation(SpO2)measured at the finger tip,and also the arterial oxygen saturation(SaO2) measured by blood gas analysis,which could indicate the oxygen supply of the whole body,were obtained simultaneously.The correlations among cerebral rSO2,putse SpO2 and arterial SaO2 were analyzed.Results (1)The cerebral rSO2 of the normal full-term neonates wag(62±2)%.Cerebral hypoxia Was deftned as rSO2 lower than 58%. The cerebral rSO2 of the normal full-terms was steady at 1, 2 and 3 days after birth respectively, without any significant differences among them (F = 0. 610, P >0. 05 ). The cerebral rSO2 of the neonates with diseases was ( 55 + 7 ) %, which was significantly lower that that of the normal full-term neonates (t = 15.492,P <0. 05). (2) The cerebral rSO2 was positively correlated with the SpO2(r =0. 74,P < 0. 01 ) and the SaO2 ( r = 0. 71, P < 0. 01 ). ( 3 ) Under some special diseases, the changes of cerebral relatively low hemoglobin concentration, the cerebral rSO2 was significantly low (50%～58% ), but the cerebral rSO2 was lagged as compared with that of pulse SpO2. Especially, during the severe phases of 6 cases with multi-organ failure, the SpO2 and the cerebral rSO2 were both significantly low (55%～80% for SpO2, and 44%～50% for cerebral rSO2 ) ; when the diseases were alleviated, although the SpO2 recovered phases of serious hypoxic-ischemic encephalopathy (HIE), the cerebral rSO2 significantly increased to 70%～72%, which was significantly higher than the normal value (62%). Condusions The range of cerebral rSO2 of the normal full-term neonates was (62 + 2) %. Cerebral oxygenation can be externally indicated by the rSO2 noninvasively and continuously measured by NIP, S, which was positively correlated with traditional pulse SpO2 and arterial SaO2. In some special diseases, the rSO2 measured by NIRS can be helpful for clinical diagnoses and treatments.     

新生儿局部脑组织氧检测的多中心研究

Objectives To understand the value of measuring neonatal cerebral regional oxygen ‘saturation(rSO2)using near infrared spectroscopy (NIRS) in assessing cerebral oxygenation,to establish the normal range of neonatal cerebral rSO2,and to collect data of the changes of cerebral rSO2 under certain disease status.Methods Nine large hospitais participated in the multicenter randomized clinical trial from Jan 2007 to Apr 2008.Using the NIRS human tissue oximeter(TSAH-100)independently developed in China.tIle cerebral rSO2 of 223 normal full-term and 95 otherwise healthy preterm neonates without any stmcial disease,Was detected at 1.2 and 3 days after birth,respectively.The cerebral rSO2 of 102 neonates with diseases which may affect the cerebral oxygenation.Was also detected during the severe phases.The pulse oxygen saturation(SpO2)measured at the finger tip,and also the arterial oxygen saturation(SaO2) measured by blood gas analysis,which could indicate the oxygen supply of the whole body,were obtained simultaneously.The correlations among cerebral rSO2,putse SpO2 and arterial SaO2 were analyzed.Results (1)The cerebral rSO2 of the normal full-term neonates wag(62±2)%.Cerebral hypoxia Was deftned as rSO2 lower than 58%. The cerebral rSO2 of the normal full-terms was steady at 1, 2 and 3 days after birth respectively, without any significant differences among them (F = 0. 610, P >0. 05 ). The cerebral rSO2 of the neonates with diseases was ( 55 + 7 ) %, which was significantly lower that that of the normal full-term neonates (t = 15.492,P <0. 05). (2) The cerebral rSO2 was positively correlated with the SpO2(r =0. 74,P < 0. 01 ) and the SaO2 ( r = 0. 71, P < 0. 01 ). ( 3 ) Under some special diseases, the changes of cerebral relatively low hemoglobin concentration, the cerebral rSO2 was significantly low (50%～58% ), but the cerebral rSO2 was lagged as compared with that of pulse SpO2. Especially, during the severe phases of 6 cases with multi-organ failure, the SpO2 and the cerebral rSO2 were both significantly low (55%～80% for SpO2, and 44%～50% for cerebral rSO2 ) ; when the diseases were alleviated, although the SpO2 recovered phases of serious hypoxic-ischemic encephalopathy (HIE), the cerebral rSO2 significantly increased to 70%～72%, which was significantly higher than the normal value (62%). Condusions The range of cerebral rSO2 of the normal full-term neonates was (62 + 2) %. Cerebral oxygenation can be externally indicated by the rSO2 noninvasively and continuously measured by NIP, S, which was positively correlated with traditional pulse SpO2 and arterial SaO2. In some special diseases, the rSO2 measured by NIRS can be helpful for clinical diagnoses and treatments.     

新生儿局部脑组织氧检测的多中心研究

Objectives To understand the value of measuring neonatal cerebral regional oxygen ‘saturation(rSO2)using near infrared spectroscopy (NIRS) in assessing cerebral oxygenation,to establish the normal range of neonatal cerebral rSO2,and to collect data of the changes of cerebral rSO2 under certain disease status.Methods Nine large hospitais participated in the multicenter randomized clinical trial from Jan 2007 to Apr 2008.Using the NIRS human tissue oximeter(TSAH-100)independently developed in China.tIle cerebral rSO2 of 223 normal full-term and 95 otherwise healthy preterm neonates without any stmcial disease,Was detected at 1.2 and 3 days after birth,respectively.The cerebral rSO2 of 102 neonates with diseases which may affect the cerebral oxygenation.Was also detected during the severe phases.The pulse oxygen saturation(SpO2)measured at the finger tip,and also the arterial oxygen saturation(SaO2) measured by blood gas analysis,which could indicate the oxygen supply of the whole body,were obtained simultaneously.The correlations among cerebral rSO2,putse SpO2 and arterial SaO2 were analyzed.Results (1)The cerebral rSO2 of the normal full-term neonates wag(62±2)%.Cerebral hypoxia Was deftned as rSO2 lower than 58%. The cerebral rSO2 of the normal full-terms was steady at 1, 2 and 3 days after birth respectively, without any significant differences among them (F = 0. 610, P >0. 05 ). The cerebral rSO2 of the neonates with diseases was ( 55 + 7 ) %, which was significantly lower that that of the normal full-term neonates (t = 15.492,P <0. 05). (2) The cerebral rSO2 was positively correlated with the SpO2(r =0. 74,P < 0. 01 ) and the SaO2 ( r = 0. 71, P < 0. 01 ). ( 3 ) Under some special diseases, the changes of cerebral relatively low hemoglobin concentration, the cerebral rSO2 was significantly low (50%～58% ), but the cerebral rSO2 was lagged as compared with that of pulse SpO2. Especially, during the severe phases of 6 cases with multi-organ failure, the SpO2 and the cerebral rSO2 were both significantly low (55%～80% for SpO2, and 44%～50% for cerebral rSO2 ) ; when the diseases were alleviated, although the SpO2 recovered phases of serious hypoxic-ischemic encephalopathy (HIE), the cerebral rSO2 significantly increased to 70%～72%, which was significantly higher than the normal value (62%). Condusions The range of cerebral rSO2 of the normal full-term neonates was (62 + 2) %. Cerebral oxygenation can be externally indicated by the rSO2 noninvasively and continuously measured by NIP, S, which was positively correlated with traditional pulse SpO2 and arterial SaO2. In some special diseases, the rSO2 measured by NIRS can be helpful for clinical diagnoses and treatments.     

新生儿局部脑组织氧检测的多中心研究

Objectives To understand the value of measuring neonatal cerebral regional oxygen ‘saturation(rSO2)using near infrared spectroscopy (NIRS) in assessing cerebral oxygenation,to establish the normal range of neonatal cerebral rSO2,and to collect data of the changes of cerebral rSO2 under certain disease status.Methods Nine large hospitais participated in the multicenter randomized clinical trial from Jan 2007 to Apr 2008.Using the NIRS human tissue oximeter(TSAH-100)independently developed in China.tIle cerebral rSO2 of 223 normal full-term and 95 otherwise healthy preterm neonates without any stmcial disease,Was detected at 1.2 and 3 days after birth,respectively.The cerebral rSO2 of 102 neonates with diseases which may affect the cerebral oxygenation.Was also detected during the severe phases.The pulse oxygen saturation(SpO2)measured at the finger tip,and also the arterial oxygen saturation(SaO2) measured by blood gas analysis,which could indicate the oxygen supply of the whole body,were obtained simultaneously.The correlations among cerebral rSO2,putse SpO2 and arterial SaO2 were analyzed.Results (1)The cerebral rSO2 of the normal full-term neonates wag(62±2)%.Cerebral hypoxia Was deftned as rSO2 lower than 58%. The cerebral rSO2 of the normal full-terms was steady at 1, 2 and 3 days after birth respectively, without any significant differences among them (F = 0. 610, P >0. 05 ). The cerebral rSO2 of the neonates with diseases was ( 55 + 7 ) %, which was significantly lower that that of the normal full-term neonates (t = 15.492,P <0. 05). (2) The cerebral rSO2 was positively correlated with the SpO2(r =0. 74,P < 0. 01 ) and the SaO2 ( r = 0. 71, P < 0. 01 ). ( 3 ) Under some special diseases, the changes of cerebral relatively low hemoglobin concentration, the cerebral rSO2 was significantly low (50%～58% ), but the cerebral rSO2 was lagged as compared with that of pulse SpO2. Especially, during the severe phases of 6 cases with multi-organ failure, the SpO2 and the cerebral rSO2 were both significantly low (55%～80% for SpO2, and 44%～50% for cerebral rSO2 ) ; when the diseases were alleviated, although the SpO2 recovered phases of serious hypoxic-ischemic encephalopathy (HIE), the cerebral rSO2 significantly increased to 70%～72%, which was significantly higher than the normal value (62%). Condusions The range of cerebral rSO2 of the normal full-term neonates was (62 + 2) %. Cerebral oxygenation can be externally indicated by the rSO2 noninvasively and continuously measured by NIP, S, which was positively correlated with traditional pulse SpO2 and arterial SaO2. In some special diseases, the rSO2 measured by NIRS can be helpful for clinical diagnoses and treatments.