葡萄糖酸锌联合多种维生素治疗儿童反复呼吸道感染的疗效观察

目的:探讨儿童葡萄糖酸锌口服液联合小儿多维生素滴剂治疗和预防儿童反复呼吸道感染的临床效果.方法:60例反复呼吸道感染患儿,随机分成活疗组及对照组各30例.对照组单用抗生素治疗,治疗组在常规治疗基础上加用葡萄糖酸锌口服液和小儿多维生素滴剂,对两组患儿的疗效进行观察、分析.结果:治疗组急性期发热、咳嗽、肺部啰持续时间较对照组缩短,呼吸道感染复发率显著降低,总有效率为93.33％.结论:葡萄糖酸锌口服液联合小儿多维生素滴剂可有效降低儿童反复呼吸道感染的发生率,提高机体免疫能力.     

槐杞黄颗粒联合泛福舒治疗小儿反复呼吸道感染80例

目的:观察槐杞黄颗粒联合泛福舒治疗小儿反复呼吸道感染的临床疗效。方法:选择我院反复呼吸道感染患儿80例,给于口服槐杞黄颗粒和泛福舒治疗,观察用药前后呼吸道感染的情况及血清免疫球蛋白I gA、I gM、I gG和T淋巴细胞变化。结果:治疗后临床症状明显改善,总有效率达83.8%;血清免疫球蛋白IgA、IgG、IgM和T淋巴细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+均较治疗前升高,与治疗前比较差异有显著性(P<0.05)。结论:槐杞黄颗粒联合泛福舒用于小儿反复呼吸道感染可增强免疫力,对治疗小儿反复呼吸道感染有明显疗效。     

小儿膈肌膨出症33例诊断和治疗

目的总结小儿膈肌膨出症的诊断及治疗特点。方法对1990～2004年收治的33例小儿膈肌膨出症患者进行回顾性分析。结果本组33例，均行膈肌折叠手术，1例新生儿术后呼吸功能衰竭死亡，1例术后并发膈疝，32例均治愈出院，随访6个月～10年，手术治疗效果良好，无症状复发等现象。结论反复呼吸道感染是小儿膈肌膨出症的主要临床症状，早期诊断和适时手术治疗能获得良好疗效。     

芙露饮对频发感染患儿免疫力提升的疗效研究

目的探究芙露饮对频发呼吸道感染的患儿治疗效果及免疫力影响。方法选取2012年6月至2013年7月于本院就诊的反复呼吸道感染的患儿108例,依据分层随机分组法将患者分为治疗组及对照组,每组各54例;对照组给予常规抗感染等方法进行治疗;治疗组患儿在对照组治疗方案基础上加用口服芙露饮进行治疗,观察比较两组患儿治疗疗效、反复呼吸道感染的预防效果以及药物不良反应情况。结果治疗前两组患儿的免疫球蛋白G（Ig G）、免疫球蛋白A（Ig A）、免疫球蛋白M（Ig M）、C-反应蛋白（CRP）及血细胞沉降速率（ESR）比较差异均无统计学意义（P均〉0.05）;治疗1周后治疗组患儿的CRP、ESR及体温均显著低于对照组,差异具有统计学意义（P均〈0.05）;治疗2个月后治疗组患儿Ig G为（10.42±3.87）g/L、Ig A为（1.96±0.78）g/L及Ig M为（1.15±0.57）g/L,分别显著高于对照组的（8.13±3.46）g/L、（1.27±0.53）g/L和（0.82±0.46）g/L,差异均具有统计学意义（P均〈0.05）;治疗期间治疗组患者出现寒战及喘息例数显著低于对照组,差异有统计学意义（P均〈0.05）;治疗期间两组患儿出现头痛、恶心、腹泻及皮疹等不良反应的例数比较差异无统计学意义（P均〉0.05）。结论应用芙露饮辅助反复呼吸道感染患儿的治疗,可明显提高感染控制效果,提高患儿的免疫力。     

7例小儿眼科手术麻醉严重并发症分析

提高小儿麻醉的安全性一直是临床麻醉中的重要课题。本院自１９８８年至今共实施小儿眼科手术麻醉资料完整的计３８５例，其中发生严重并发症７例（占１．８％）。本文就引起严重并发症的因素进行分析，为临床工作提供借鉴。临床资料本组共７例，详见表１。回病房后出现了呼吸困难等喉水肿症状。２．小儿呼吸道内径小，呼吸道的轻微炎症或少量分泌物即可造成严重的呼吸道梗阻。因此，对手术前有合并症患儿的麻醉更应重视。例６术前有呼吸道感染，由于是急诊，匆匆上台，术中患儿有明显的痰鸣音，反复吸痰都不能保持性比成人低，普鲁卡因的清…     

利肺止嗽汤治疗咳嗽118例疗效观察

目的:观察自拟利肺止嗽汤为主加减治疗咳嗽的临床疗效.方法:将就诊患者随机分为治疗组和对照组,治疗组采用利肺止嗽汤为主加减治疗,对照组采用香港产蜜炼川贝枇杷膏治疗,比较两组咳嗽症状的改善情况.结果:对咳嗽的改善治疗组疗效明显优于对照组,两组在治疗中均未发现不良反应.结论:采用利肺止嗽汤为主加减治疗咳嗽疗效满意,且见效快.     

小儿睾丸及睾丸附件扭转的诊治（附65例报告）

目的提高小儿睾丸及睾丸附件扭转的临床诊治水平。方法回顾分析我院近10年间65例小儿睾丸及睾丸附件扭转患者的临床表现、辅助检查以及诊断治疗方法。结果65例患儿中，睾丸扭转33例，睾丸附件扭转32例，58例（89％）患儿存在阴囊肿胀或疼痛表现，7例伴有恶心、发热等症状。63例进行手术治疗，行睾丸或睾丸附件切除54例（86％）。结论小儿睾丸及睾丸附件扭转是儿外科急症，早期正确的诊断和及时的手术治疗是保存睾丸的关键。     

雾化吸入布地奈德治疗小儿轻中度急性喉炎的临床观察

目的观察雾化吸入布地奈德混悬液治疗小儿轻中度急性喉炎的疗效。方法将2009年10月～2010年10月在笔者所在医院治疗的65例轻中度急性喉炎患儿随机分为治疗组33例和对照组32例。两组均给予抗病毒药物、抗生素和对症治疗等综合治疗,在此基础上,治疗组给予布地奈德混悬液雾化吸入,对照组给予地塞米松静脉滴注。观察两组症状、体征消失时间。结果治疗组显效22例,有效9例,无效2例,有效率为93.94%;对照组显效21例,有效8例,无效3例,有效率为90.63%,两组相比差异无统计学意义（P〉0.05）。治疗组喉鸣、声嘶、犬吠样咳嗽等症状消失时间明显短于对照组,差异有统计学意义（P〈0.05）。结论雾化吸入布地奈德混悬液治疗小儿轻中度急性喉炎直接作用于局部,可以提高治疗效果、缩短治疗时间。     

银花五汁饮对全麻术后患者呼吸道炎症反应的临床观察

目的:探讨银花五汁饮治疗全麻术后气管插管患者呼吸道炎症的临床效果。方法:选取2018年10月—2019年2月我院外科病区收治的行腹腔镜胆囊切除术的患者60例,分为对照组和观察组,每组30例。观察组:术后24 h采用常规治疗和银花五汁饮口服,2次/d,50 mL/次,连服3 d。对照组:术后24 h采用常规治疗和盐酸氨溴索注射液雾化吸入治疗,2次/d,连用3 d。比较手术日(治疗前)、术后第3天(治疗后)两组患者的咽喉疼痛症状积分及咳嗽咳痰症状积分,观察并比较患者的总有效率。结果:治疗前,两组的咽喉疼痛症状积分及咳嗽咳痰症状积分差异无统计学意义;治疗后,两组的咽喉疼痛症状积分及咳嗽咳痰症状积分均降低,且观察组明显低于对照组,差异有统计学意义(P<0.05)。观察组的总有效率为93.33%(28/30),高于对照组66.67%(20/30),差异有统计学意义(P<0.05)。结论:银花五汁饮具有养阴清肺、生津化痰的作用,对于全麻术后气管插管患者呼吸道炎症的治疗具有显著疗效。     

维生素K3雾化吸入佐治毛细支气管炎疗效观察

我科1995年11月至1996年五月收治毛细支气管炎患儿135例，其中70例加用维生素K3雾化吸入治疗，疗效显著。报告如下；1资料135例中男75例，女60例，年龄3个月至1岁。病程1～4d。患儿入院时均有不同程度的发热、咳嗽、气喘、肺部哮鸡音。诊断标准按全国统一制定标准[1]。接入院先后随机分为治疗组70例，对照组65例：对照组采用抗感染、呼吸道护理、给氧、镇静、激素等综合治疗。治疗组采用综合治疗加维生素K3雾化吸入，即维生素K31mg/kg加生理盐水20ml，每次10～20min，2／d。2疗效定及结果显效：雾化吸入4次后肺部障鸣音消失、气喘、咳嗽停…     

Prolonged after-effects of pneumonia in children

Sixty-two black children were prospectively followed up for 1-7 years after pneumonia contracted at a median age of 17 months. In 55% of cases the pneumonia was measles-associated and 27% had serological evidence of infection with other respiratory viruses. Recurrence of cough or wheeze for more than 6 months occurred in 85% with just over 50% having recovered during the follow-up period. While the highest incidence of persistent symptoms occurred in children after measles superinfected with another virus, this was not significant. Abnormal radiographic features persisted in 53% of children and consisted of peribronchial and/or parenchymal lesions. Abnormal large and small airway calibre and/or bronchial hyperreactivity were found in one-third of children, and were significantly more common in those children whose main symptom was recurrent wheezing. Clinical and lung function abnormalities years after lower respiratory tract infection in this group of disadvantaged children compare with reports from more privileged groups. Recognition that long-term sequelae occur may prevent inappropriate subsequent management of symptomatic children.     

反复呼吸道感染患儿锌治疗前后红细胞CD35分子表达和血清炎性因子的变化

目的检测反复呼吸道感染（recurrent respiratory tract infection,RRTI）患儿红细胞表面CD。分子的表达,研究循环免疫复合物（CIC）和血清炎性因子在感染反复发生中的机制,并观察锌治疗的临床效果。方法将116例RRTI患儿根据不同感染部位分为上呼吸道感染组和下呼吸道感染组,随机选择同期发病的急性呼吸道感染患儿40例和50名健康儿童作为对照,检测红细胞膜CD35分子表达、CIC阳性率,以及IL-6、IL-8和TNF-α的含量。从116例RRTI患儿中选取68例患儿,随机分成锌治疗组（38例）和对照组（30例）,治疗结束时和结束后12周再次检测上述指标。结果RRTI患儿（上呼吸道感染组和下呼吸道感染组）红细胞膜CD35分子表达明显低于健康对照组（t值分别为6．17和6．46,P值均〈0．01）,而CIC阳性率及其他炎性因子则较健康对照组明显升高,且这些指标在下呼吸道感染中变化更为明显。感染缓解期的RRTI患儿较急性呼吸道感染患儿红细胞CD35表达明显降低（t=20．307,P〈0．01）。经过锌治疗后,RRTI患儿的各项指标明显改善。结论红细胞膜CD,,分子表达低下和CIC等血清炎性因子的过量产生可能是RRTI患儿反复呼吸道感染的重要免疫病理机制之一。锌治疗对上述指标的改善有一定的作用。     

Parainfluenza Virus Infection in Adult Lung Transplant Recipients: An Emergent Clinical Syndrome with Implications on Allograft Function

Parainfluenza virus is a common cause of seasonal upper respiratory tract infections in children and adults. Studies indicate that parainfluenza virus may play an important role in the etiology of respiratory tract infections in lung transplant recipients with an estimated incidence of 5.3 per 100 patients. Parainfluenza virus type 3 is the most frequent serotype in lung transplant patients. The rate of lower respiratory tract infections with parainfluenza virus among lung transplant recipients is between 10 and 66% of cases. In addition, trans-bronchial biopsy at the time of parainfluenza infection shows signs of acute allograft rejection. Subsequently, 32% of patients have been found to have active bronchiolitis obliterans at a median time of 6 months (range 1-14) postviral infection. These findings indicate that parainfluenza virus infections may have long-term implications for lung transplant recipients. Further studies are required to identify the mechanisms of immunomodulation of parainfluenza virus among these patients. In addition, controlled studies are needed to evaluate the efficacy of aerosolized ribavarin in the treatment of parainfluenza virus infection and to determine whether vaccines may be effective in these high-risk patients.     

Persistent high plasma levels of interleukins 18 and 4 in children with recurrent infections of the upper respiratory tract

The aim of this study was to examine whether children with recurrent infections of the upper respiratory tract might have alterations in the systemic immune response to viral infections as compared with healthy control children. We quantitated plasma levels of interferon-gamma, interleukin-12, interleukin-18, interleukin-4, lymphocyte subpopulations, serum immunoglobulins, and subclasses of immunoglobulin G in 30 children under the age of 6 years with recurrent infections of the upper respiratory tract, both during the acute phase of the infection and 4 weeks later, when clinical symptoms had resolved, as well as in 20 normal controls. We found elevated levels of immunoglobulin G primarily due to increased levels of immunoglobulin G(1). Moreover, significantly higher levels of interleukin-18 and interleukin-4 were noted during the acute phase of infection among children with an increased incidence of respiratory infections as compared with the controls (P =.022 and P =.0001, respectively), while plasma levels of interferon-gamma and interleukin-12 were significantly lower (P =.034 and P =.0001, respectively) than in controls. We suggest that an imbalance between T-cell helper type-1 and T-cell helper type-2 immune responses might be responsible for the perpetuation of recurrent infections of the upper respiratory tract.     

肝移植术后细菌性感染的病原学特征及分布特点

目的研究肝移植术后细菌感染的流行病学规律。方法回顾性分析451例患者原位肝移植术后细菌学资料。结果肝移植术后239例患者出现细菌感染,细菌感染率为53．0％,共分离出菌株304株,其中革兰阳性（G^＋）球菌占59．9％（182／304）,革兰阴性（G^-）杆菌占40．1％（122／304）。易感器官依次为呼吸道和胆道,感染发生率分别为81．5％（248／304）,15．1％（46／304）。呼吸道感染以G^＋菌为主,占65．3％,胆道感染以G^-为主,占60．9％,两者有显著性差异（P〈0．01）。结论肝移植术后细菌感染率高,主要以G^＋球菌感染为主,条件致病菌及多重耐药菌株较多见。肝移植术后细菌感染的菌群与部位间有明显相关关系,在预防或治疗感染时应针对不同感染部位采取不同措施。     

中西医结合治疗红皮病型银屑病的临床比较研究

目的:观察中西医结合方法治疗红皮病型银屑病的临床效果.方法:单纯西医治疗组36例采用阿维A口服和复方甘草酸注射液静脉滴注治疗.中西医结合治疗组32例在西药治疗的基础上根据中医辩证分为两个证型:毒热型方选清营汤加减,伤阴型方选养血解毒汤加减,并均用中药泡洗.比较治疗4周后两组愈显率,红皮病型银屑病症状开始消退、明显消退、...     

百日咳鲍特菌合并呼吸道病毒感染患儿的实验室指标及临床特征

目的探讨百日咳鲍特菌和呼吸道病毒共感染患儿与百日咳鲍特菌单纯感染患儿实验室相关指标临床特征的差异。 方法采集首都医科大学附属北京地坛医院2016年11月至2017年5月临床确诊为百日咳患儿的咽拭子标本共42份,利用自动巢式多重PCR系统对42份标本定性检测百日咳鲍特菌及其他17种呼吸道病毒,回顾性分析患儿的检测结果和病例资料,按照病原体检出结果分为百日咳鲍特菌单检出组（简称单检出组）和百日咳鲍特菌合并其他呼吸道病毒共检出组（简称共检出组）。 结果42份标本中百日咳鲍特菌单检出16份（38.10%,16/42）,百日咳鲍特菌伴1种及以上呼吸道病毒共检出26例（61.90%,26/42）;呼吸道病毒共计检出32例次,其中以人鼻病毒检出为主,共16例次（50%,16/32）,呼吸道合胞病毒6例次（18.75%,6/32）,副流感病毒和腺病毒各检出4例次（12.50%,4/32）,甲型流感病毒检出2例次（6.25%,6/32）。共检出组患儿白细胞计数较单检出组差异无统计学意义（t =－0.445,P = 0.661）,而共检出组患儿淋巴细胞比例增高（t =－2.913,P = 0.019）;与单检出组患儿影像学改变相比,共检出患儿影像学改变以肺炎为主（15/26、57.69% vs. 2/16、12.50%,P = 0.010）。共检出组患儿最高体温更高（t =－3.348、P = 0.030）、咳嗽持续时间（t =－3.141,P = 0.005）和咳嗽加重期更长（t =－4.748、P < 0.001）,同单检出组患儿比较差异均具有统计学意义。共检出组患儿住院时间（t =－4.123、P < 0.001）与抗菌疗程（t =－4.292、P < 0.001）均长于单检出组患儿,差异具有统计学意义。 结论相较于百日咳鲍特菌单检出的患儿,伴有其他呼吸道病毒检出的患儿临床症状更严重,恢复时间更长。在百日咳尤其是症状较重的百日咳患儿救治过程中需注意同时合并其他呼吸道病毒感染的可能。     

Double balloon positive pressure urethrography is a more sensitive test than voiding cystourethrography for diagnosing urethral diverticulum in women

PURPOSE: We determined the relative sensitivity of double balloon positive pressure urethrography and voiding cystourethrography for diagnosing urethral diverticula in women, and for evaluating which presenting symptoms should be considered clinically suspicious for even smaller diverticula. MATERIALS AND METHODS: The series comprised 32 women, including those with new onset urinary tract infections not related to intercourse, menopause or catheters, those with urethral symptoms, such as point urethral tenderness or a mass, urethral pain, dysuria, dyspareunia or post-void dribbling, and those with new onset urgency and frequency. All patients underwent a history and physical examination by the same physician. Each patient underwent double balloon urethrography and voiding cystourethrography on the same day at a single radiology department. RESULTS: Of the 32 women 30 (94%) were diagnosed with at least 1 diverticulum by double balloon urethrography. In 22 of these cases voiding cystourethrography failed to show the diverticulum. Only 11 of these patients (37%) had a palpable mass on clinical examination. The most common presenting symptoms in patients diagnosed with a diverticulum were recurrent urinary tract infection (52%), dysuria (52%), urgency (41%), frequency (38%), stress incontinence (38%) and urge incontinence (34%). Only 3 patients (9%) presented with 1 symptom. Diverticulectomy was performed in 16 patients. Double balloon urethrography had greater sensitivity (100%) than voiding cystourethrography (44%) relative to a confirmed surgical diagnosis (z test p = 0.002). Of 9 diverticula missed by voiding cystourethrography in the surgery group the maximum diameter was less than 15 mm. in 5. Average followup in the surgery cases is 34 months (median 35, range 17 to 50). None of these patients has had new symptoms suggestive of recurrent diverticulum, failure, new urethritis or new stress urinary incontinence. Conservative therapy consisted of long-term antibiotics in 6 patients and symptomatic treatment with short-term antibiotics in the remaining 8. Conservative therapy offered symptomatic relief in most cases but did not prevent recurrent symptoms. CONCLUSIONS: A diverticulum should be suspected in patients with new onset urinary tract infection, urgency and frequency as well as dyspareunia, post-void dribbling and dysuria. Double balloon urethrography is a more sensitive diagnostic test than voiding cystourethrography for diagnosing urethral diverticula. Patients with mild symptoms may be treated with conservative therapy, although we believe that satisfactory long-term treatment of diverticula is best achieved by surgical excision.     

Detrusor instability in children with recurrent urinary tract infection and/or enuresis. I. Clinical conditions and symptomatology

Forty-one children, aged 5-15 years, were referred because of recurrent urinary infections and/or enuresis. They were examined prospectively by means of cystometry. CO2 cystometry revealed detrusor instability in 18 children (44%), but if complete reproducibility were to be requested in repeated tests, only 7 children (17%) would have presented instability. Detrusor instability was not significantly related to definite pathological changes in the urinary tract or to irritative bladder symptoms.     

Hypercalciuria and recurrent urinary tract infections: incidence and symptoms in children over 5 years of age

Hypercalciuria is an important and common risk factor in the formation of renal stones. In this study we evaluated the incidence and the clinical presentation of hypercalciuria in 75 children over 5 years of age with the diagnosis of recurrent urinary tract infection (UTI). We measured random urinary calcium/creatinine value (three times), 24-h urinary calcium excretion, serum calcium, phosphorus, electrolytes, blood gas, blood urea nitrogen and creatinine levels. Hypercalciuria was found in 32 patients (43%). The mean urinary calcium/creatinine ratio for hypercalciuric patients was 0.50±0.21 mg/mg (min: 0.24, max: 2.60). The mean urinary calcium/creatinine ratio for the rest of the study population—those without hypercalciuria—was 0.10±0.04 mg/mg (min: 0.01, max: 0.18). Presenting symptoms of the hypercalciuric patients and normocalciuric patients were similar. History of familial urolithiasis was positive in 19 patients (59%). Predisposing urinary tract abnormalities in recurrent UTI was shown in 12 of the hypercalciuric patients (12/32, 37.5%) and 8 of the normocalciuric patients (8/43, 19%) without a statistically significant difference between. We conclude that hypercalciuria is not a rare finding among recurrent UTI cases in Turkish children. Hypercalciuria does not modify the clinical presentation of UTI, and we suggest the investigation of urinary calcium excretion in children with recurrent UTI.