重型地中海贫血患儿治疗依从性状况调查

[目的]了解重型地中海贫血患儿治疗依从性状况.[方法]采取便利抽样的方法抽取104例重型地中海贫血患儿,应用重型地中海贫血患儿治疗依从性调查问卷、依从指数、血清铁蛋白浓度等方法了解重型地中海贫血患儿的治疗依从性状况并进行原因分析.[结果]重型地中海贫血患儿对治疗的主观依从率为37.50%,其中对定期检查的主观依从率只有17.31%,对治疗的客观依从率(依从指数)为22.12%,对治疗的客观依从率为55.77%.[结论]重型地中海贫血患儿的治疗依从性差,特别是对定期检查与去铁治疗依从性差.提高重型地中海贫血患儿治疗依从性的重点应放在定期检查、去铁治疗方面.     

重型地中海贫血患儿治疗依从性状况调查

[目的]了解重型地中海贫血患儿治疗依从性状况。[方法]采取便利抽样的方法抽取104例重型地中海贫血患儿,应用重型地中海贫血患儿治疗依从性调查问卷、依从指数、血清铁蛋白浓度等方法了解重型地中海贫血患儿的治疗依从性状况并进行原因分析。[结果]重型地中海贫血患儿对治疗的主观依从率为37.50%,其中对定期检查的主观依从率只有17.31%,对治疗的客观依从率（依从指数）为22.12%,对治疗的客观依从率为55.77%。[结论]重型地中海贫血患儿的治疗依从性差,特别是对定期检查与去铁治疗依从性差。提高重型地中海贫血患儿治疗依从性的重点应放在定期检查、去铁治疗方面。     

重型β-地中海贫血患儿治疗依从性及并发症发生率的影响因素分析

目的:探讨重型β-地中海贫血患儿治疗依从性及并发症发生率的影响因素分析。方法:选择2012年6月~2014年6月接受治疗的重型β-地中海贫血患儿113例为研究对象,采用查阅患者病历资料和家长问卷调查相结合的方法收集资料,并对患儿的输血和去铁治疗依从性、相关影响因素以及并发症发生情况进行总结分析。结果:患儿输血治疗依从率为52.21%,去铁治疗依从率为45.13%;输血治疗依从性与去铁治疗依从性具有一致性,患儿病程、家庭收入情况和父母信念状态是输血和去铁治疗依从性的共同影响因素;输血和去铁治疗依从性患儿的心率衰竭/心律失常、肝纤维化、贫血、生长发育障碍以及总并发症发生率方面均明显低于不依从患儿(P0.05),而在肺部感染方面,输血和去铁治疗两依从性患儿和非依从性患儿无明显差异(P0.05)。结论:重型β-地中海贫血患儿治疗依从性与并发症发生率密切相关,而当前重型β-地中海贫血患儿治疗依从率很低,为此,医护人员可围绕患儿病程、家庭收入情况和父母信念状态三个危险因素制定个性化的健康教育和随访方案以帮助患者提高其治疗依从性,降低并发症的发生率。     

治疗依从性对重型β-地中海贫血儿童并发症发生的影响

目的探讨治疗依从性对重型β-地中海贫血儿童并发症发生的影响。方法收集2011年9月~2014年3月我院接受治疗重型β-地中海贫血患儿264例,根据患儿对治疗依从程度分为输血治疗依从组82例和非依从组55例,去铁治疗依从组76例和非依从组51例。比较重型β-地中海贫血患儿对输血、去铁治疗依从性情况及其与并发症发生的关系。结果输血依从组患儿生长发育停滞、特殊面容、肝脾肿大并发症发生率明显低于输血治疗非依从组(P0.01)。去铁治疗依从组肝脏、心脏、内分泌功能损害并发症发生率明显低于去铁治疗非依从组(P0.01)。结论重型β-地中海贫血患儿对输血治疗依从性较低,对预后影响较大,治疗非依从性患儿其并发症发生率较治疗依从性患儿高。因此,治疗依从性对长期规范的输血、除铁治疗仍然是重型β-地中海贫血的关键性措施。     

以家庭为中心的护理模式对提高重型地中海贫血患儿治疗依从性的影响

目的探讨家庭为中心的护理模式对提高重型地中海贫血患儿治疗依从性的影响。方法选取2008年1月至2009年12月在我院接受治疗的重型地中海贫血患儿31例为对照组,选取2010年1月至2011年12在我院接受治疗的重型地中海贫血患儿38例为实验组。对照组患儿实施一般的常规护理,实验组患儿采用以家庭为中心的优质护理模式进行护理。观察两组患儿HB依从性、SF依从性及并发症的发生率。结果实验组HB依从性及SF依从性均明显高于对照组（P〈0．05）,并发症发生率明显低于对照组（P〈0．05）。结论以家庭为中心的护理模式可以提高HB依从率为及SF依从率,降低心脏并发症、肝脏疾病、脾脏并发症、减少呼吸道感染、保证患儿正常生长发育,对提高重型地中海贫血患儿生活质量具有重要意义。     

输血和去铁治疗依从性对重型β-地中海贫血患者心脏功能的影响分析

目的探讨输血和去铁治疗依从性对重型β-地中海贫血患儿心脏功能的影响。方法选取2014年1月至2016年6月该院收治的重型β-地中海贫血患儿82例为研究对象。根据患儿治疗依从性分输血依从组、输血非依从组、去铁依从组、去铁非依从组,分析输血和去铁依从性对重型β-地中海患儿心脏功能相关指标的影响。结果与输血非依从组对比,输血依从组患儿的血红蛋白(Hb)明显升高,铁蛋白(SF)、脑钠肽(BNP)水平、左室收缩末期内径(LVES)、左室舒张末期内径(LVED)、左房容积指数(LAVI)及左室质量指数(LVMI)均明显降低,差异有统计学意义(P0.05);与去铁非依从组对比,去铁依从组患儿的Hb明显升高,SF、BNP水平均显著降低,LVES、LVED、LAVI及LVMI均明显降低,差异有统计学意义(P0.05),FS、EF对比差异无统计学意义(P0.05)。结论输血和去铁治疗依从性较好的患儿心功能相关指标改善效果更显著,因此提高患儿治疗依从性,更有助于改善患儿心功能。     

重型β-地中海贫血患儿治疗依从性与并发症发生关系分析

目的探讨重型β-地中海贫血患儿治疗依从性与并发症发生关系。方法调查108例在本院治疗的重型β-地中海贫患儿输血、去铁治疗依从性情况及其与并发症发生的关系。结果输血依从性组66例患儿,非依从性组42例患儿;去铁治疗依从组73例患儿,非依从性组35例患儿。输血依从性组患儿生长发育停滞、特殊面容、肝脾肿大并发症发生率明显低于输血治疗非依从组,去铁治疗依从组患儿肝脏并发症、心脏并发症、内分泌功能损害并发症发生率明显低于去铁治疗非依从组,组间比较,均P0.01,差异具有统计学意义。结论重型β-地中海贫血患儿输血及去铁治疗依从性较低,治疗非依从性患儿其并发症发生率较高。     

图文式健康教育对学龄重型地中海贫血患儿治疗依从性及并发症发生率的影响

[目的]探讨图文式健康教育对学龄重型地中海贫血患儿治疗依从性及并发症发生率的影响。[方法]选取本院血液内科收治的重型地中海贫血患儿45例,根据随机数字表法将患儿分为对照组22例及观察组23例,对照组治疗期间行常规性健康教育,观察组治疗期间实施图文式健康教育,比较两组患儿干预前后自我效能、心理状况及疾病知识水平的变化,并记录两组治疗依从率、并发症发生率及家属满意率情况。[结果]观察组患儿干预后自我效能及疾病知识评分高于对照组(P0.05),而患儿抑郁自评量表(CDI)评分、儿童焦虑量表(SCAS)评分较对照组明显下降(P0.05)。观察组治疗依从率、家属满意率明显高于对照组(P0.05),而并发症发生率明显低于对照组(P0.05)。[结论]图文式健康教育能有效提高学龄重型地中海贫血患儿自我效能及疾病知识水平,减轻患儿焦虑感及抑郁感,提高患儿遵医行为,降低患儿并发症,有利于促进患儿预后,提高家属满意率。     

健康教育对重型地中海贫血患儿治疗依从性及预后的影响

[目的]探讨健康教育对重型地中海贫血患儿治疗依从性及预后的影响。[方法]将85例重型地中海贫血患儿随机分为对照组和观察组,两组均给予常规治疗和护理干预,观察组患儿在此基础上加强健康教育,比较两组患儿的治疗依从性及预后情况。[结果]与对照组比较,观察组患儿治疗依从性较好(P<0.05),随访18个月病死率较低(P<0.05)。[结论]重型地中海贫血患儿治疗依从性对疾病预后影响较大,在今后的临床工作中应重视健康教育,可提高患儿治疗依从性、改善预后。     

两广地区重型地中海贫血患者家庭护理状况调查

目的:调查两广地区重型地中海贫血患者的家庭护理状况,为医院或相关机构进行下一步干预提供理论依据。方法:采用方便抽样的方法,应用自行设计的问卷对两广地区290例重型地中海贫血患者家庭进行调查。结果:定期输血依从率为81.38%,去铁酮不良反应发生率为46.9%;能做到少食含铁量高的食物患者占40.0%,少食甜食患者占26.21%;定期检测血清铁蛋白浓度依从率为45.17%;坚持做治疗日记占9.66%;79.31%的家属鼓励患者参加社交活动。结论:两广地区重型地中海贫血患者的家庭护理中存在去铁酮不良反应发生率高、日常生活护理依从率低、缺乏病情观察和记录等问题,应加强这些方面的健康教育和护理知识指导。     

互动健康教育模式在儿童白血病经外周静脉置入中心静脉导管中的应用

目的:研究互动健康教育模式在儿童白血病经外周静脉置入中心静脉导管(peripherally inserted centralcatheter,PICC)中的应用效果。方法:选择2018年1月至2019年10月在南京市儿童医院行P I CC的儿童白血病患者8 4例,按照随机数余数分组方法将其分为研究组(互动健康教育模式)及对照组(传统健康教育),各42例。比较两组患者健康知识掌握情况、置管效果、依从性及并发症发生情况。结果:拔管后,研究组健康知识达标人数明显高于对照组。研究组首次穿刺成功率、24 h穿刺点未出血、置管依从性主动、置管前肘部血管保护及置管时体位配合主动的人数均明显高于对照组(P<0.05)。研究组并发症总发生率明显低于对照组(P<0.05)。结论:互动健康教育模式在儿童白血病PICC中应用效果良好,能够有效促进患儿家属对健康知识的掌握,提升患儿置管依从性及置管效果,降低并发症发生率。     

电话随访对心脏瓣膜置换术后患者治疗依从性的影响

目的 探讨电话随访对心脏瓣膜置换术患者治疗依从性的影响.方法 将104例心脏瓣膜置换术患者随机分为观察组和对照组,每组各52例.两组患者在住院期间均接受系统的健康教育和出院指导,观察组在此基础上采取电话跟踪随访,1年后比较两组患者抗凝治疗依从性和并发症的发生率.结果 1年后观察组患者抗凝治疗依从性明显高于对照组,差异具有统计学意义（P＜0.01）,各项并发症的发生率明显低于对照组,差异具有统计学意义（P＜0.05）.结论 电话随访可以满足心脏瓣膜置换术后患者的健康需求,提高患者抗凝治疗依从性,减少并发症.     

Complications of apheresis in children

BACKGROUND: Although the frequency of complications in adults undergoing therapeutic apheresis is low, there are little data in children. STUDY DESIGN AND METHODS: A retrospective study of 186 children who had undergone a total of 1632 apheresis procedures between 1994 and 2002 was conducted. Adverse reactions were prospectively documented. The procedures were plasma exchange (67%), hematopoietic progenitor cell collection (18%), red blood cell exchange (6.9%), leukodepletion (0.7%), and plasma exchange with immunoadsorption (6.7%). RESULTS: Adverse reactions, most minor, were reported in 55 percent of procedures in 82 percent of patients. The most frequent complications, per procedure and per patient during an entire course of therapy, were hypotension (14 and 48.4%), hypotension requiring fluid bolus (4.8 and 26.9%), symptomatic hypocalcemia (9.7 and 28.5%), allergic reactions (4.4 and 5.9%), catheter-related thrombosis (1.7 and 12.4%), catheter-related infection (2.1 and 16.1%), and severe anemia (hemoglobin [Hb] level, <7 g/dL; 2.5 and 17.2%). There were two deaths (1% of patients). Risk factors for complications by multivariate analysis were lower body weight, lower preapheresis Hb level, apheresis in a critical care unit, and number of procedures per patient. The 55 percent incidence of complications per procedure in our pediatric cohort is much higher than the 4.3 to 28 percent incidence reported in adults. The excess of adverse reactions in children are mostly related to citrate toxicity, higher relative vascular volume shifts, and the need for vascular access. CONCLUSION: Pediatric apheresis presents unique challenges and is associated with higher complication rate compared to adults. It is recommended that this procedure be performed in specialized centers.     

Assessment of proadrenomedullin as diagnostic or prognostic biomarker of acute appendicitis in children with acute abdominal pain

BackgroundAcute appendicitis (AA) is one of the most frequent surgical pathologies in pediatrics.ObjectivesTo investigate the utility of proadrenomedullin (pro-ADM) for the diagnosis of AA.MethodsProspective, analytical, observational, and multicenter study conducted in 6 pediatric emergency departments. Children up to 18 years of age with suspected AA were included. Clinical, epidemiological, and analytical data were collected.ResultsWe studied 285 children with an average age of 9.5 years (95% confidence interval [CI], 9.1–9.9). AA was diagnosed in 103 children (36.1%), with complications in 10 of them (9.7%). The mean concentration of pro-ADM (nmol/L) was higher in children with AA (0.51 nmol/L, SD 0.16) than in children with acute abdominal pain (AAP) of another etiology (0.44 nmol/L, SD 0.14; p < 0.001). This difference was greater in complicated cases compared with uncomplicated AA (0.64 nmol/L, SD 0.17 and 0.50 nmol/L, SD 0.15, respectively; p = 0.005). The areas under the receiver-operating characteristic curves were 0.66 (95% CI, 0.59–0.72) for pro-ADM, 0.70 (95% CI, 0.63–0.76) for C-reactive protein (CRP), 0.84 (95% CI, 0.79–0.89) for neutrophils, and 0.84 (95% CI, 0.79–0.89) for total leukocytes. The most reliable combination to rule out AA was CRP ≤1.25 mg/dL and pro-ADM ≤0.35 nmol/L with a sensitivity of 96% and a negative predictive value of 93%.ConclusionChildren with AA presented higher pro-ADM values than children with AAP of other etiologies, especially in cases of complicated AA. The combination of low values of pro-ADM and CRP can help to select children with low risk of AA.     

心理干预和视听联合分散对静脉穿刺患儿疼痛的影响

目的 探讨心理干预和视听联合分散对静脉穿刺患儿疼痛的影响.方法 将200例静脉穿刺患儿随机分为心理干预组(A组)和视听联合分散组(B组)各100例.A组患儿接受表扬、激励、暗示等心理干预措施;B组患儿在穿刺过程中观看喜爱的DVD光盘.统计、分析2组的治疗依从性、穿刺成功率和疼痛评分[视觉模拟评分法(VAS)].结果 2组的治疗依从性和穿刺成功率差异无统计学意义(P＞0.05).2组的治疗依从性与穿刺成功率均呈显著正相关(r=0.34和0.38,P＜0.01) .A组与B组的疼痛评分差异无统计学意义(t=0.52,P＞0.05).结论 心理干预和视听联合分散均能有效减少静脉穿刺患儿的疼痛.     

超声引导肝穿刺活检并发症及处理对策

目的 探讨超声引导肝穿刺活检的并发症及处理对策.方法 对我院175例超声引导下经皮肝穿265针次活检病例资料进行回顾性分析,总结术后出现的并发症及处理对策,并随访疗效.结果 肝穿刺后出现并发症16例(9.1%),其中迷走神经反射5例(2.9%),需要药物缓解的疼痛4例(2.2%),肝包膜下出血3例(1.7%),低血糖反应3例(1.7%),严重腹腔内积血1例(0.6%).前4项一般并发症经对症处理均能缓解,1例腹腔大量积血经超声造影发现肝出血点,即刻行微波消融治疗止血.结论 超声引导肝穿刺活检并发症发生率低;腹腔大量积血为严重并发症,经超声造影引导下肝局部微波消融可有效止血.

Abstract：

Objective To investigate the features,prevention and treatment of complications of ultrasound-guided hepatic puncture biopsy.Methods One hundred and seventy-five cases underwent ultrasound-guided hepatic puncture biopsy were retrospectively analyzed.Results The incidence of complications was 16 cases (9.1%),including 5 cases with vasovagal episodes(2.9%),4 cases with ache which needed medicine treatment (2.2%),3 cases with hemorrhage in liver capsule(1.7%),3 cases with hypoglycemia(1.7%),1 case with serve hemorrhage in abdominal cavity(0.6%).Hemorrhage limited in liver capsule,vasovagal episodes,hypoglycemia and ache were relieved with corresponding treatments.One case with hemorrhage in abdominal cavity was handled with percutaneous microwave ablation therapy guided by contrast-enhanced ultrasound.Conclusions Ultrasound-guided hepatic puncture biopsy has good value and low complication.The most severe complication is hemorrhage,which can be handled with percutaneous microwave ablation therapy guided by contrast-enhanced ultrasound.     

Prospective risk assessment of endoscopic retrograde cholangiography in patients with primary sclerosing cholangitis. Dutch PSC Study Group

BACKGROUND AND STUDY AIMS: Direct endoscopic retrograde cholangiopancreatography (ERCP) has become the standard for establishing the diagnosis of primary sclerosing cholangitis (PSC), while endoscopic procedures play an increasingly important therapeutic role. However, many believe that this procedure carries a significant risk of infection and other complications. We assessed the incidence of complications within 1 week of ERCP in patients with PSC. PATIENTS AND METHODS: In a multicenter study, patients who underwent ERCP for (suspected) PSC were prospectively followed for the occurrence of complications after the procedure. RESULTS: A total of 106 ERCPs performed in 83 patients were evaluated. Complications occurred on ten occasions (9%): pancreatitis (n = 3), cholangitis (n = 2), increase of cholestasis (n = 2), postsphincterotomy bleeding (n = 1), cystic duct perforation (n = 1), and venous thrombosis (n = 1). All complications resolved quickly with proper therapy. Complications were more likely when ERCP was done to evaluate specific complaints such as jaundice or recurrent cholangitis (9/59) than after a purely diagnostic ERCP (1/47 relative risk [RR] 7.2, 95% confidence interval [CI] 1.00 to 153). Therapeutic interventions performed during ERCP (e.g. placement of endoprosthesis, dilation of strictures) also increased the risk of postprocedural complications (RR 4.5, 95 % CI 0.94 to 30). CONCLUSIONS: ERCP is a safe method for establishing the diagnosis of PSC in asymptomatic patients (2 % complication rate). Although ERCP in symptomatic patients carries a higher risk (14%), this can be justified by the benefits of endoscopic therapy.     

两种血小板制剂应用于儿科血液病的临床观察

目的观察并比较机器单采法及手工法分离制备血小板制剂用于儿科血液病输注的效果。方法输注机器单采血小板患儿463例次为机采制剂组,输注手工分离血小板制剂患儿155例次为手工制剂组,分别在输注后24、48及72h作外周血血小板计数,观察临床止血效果、有无输血反应发生,计算血小板计数增加校正指数(CCI)、血小板回升率(PPR)、输注无效率、输血反应发生率等指标。结果输注后24、48、72h,机采制剂组:CCI分别为18.9、15.4、14.1,PPR分别为33.4%、27.8%、25.0%;手工制剂组:CCI分别为11.3、9.4、2.9,PPR分别为20.3%、10.3%、3.8%;机采法制剂组均明显高于手工制剂组(P<0.01)。机采制剂组输注无效率10.58%、输血反应发生率3.02%,手工制剂组相应为32.90%及11.61%,机采组虽都明显低于手工组,但两组均达到较好的临床止血目的,组间无差异。结论输注机器单采血小板制剂能更有效地提高血液病患儿的血小板值,减少其血小板输注无效及输血反应的发生。     

固尔苏在肺透明膜病患儿中的应用及护理

目的 探讨固尔苏治疗肺透明膜病患儿的效果和护理方法.方法 选择2008年6月至2010年6月新生儿病房收治的肺透明膜病患儿56例,将其随机分为对照组26例和治疗组30例.对照组单用机械通气治疗及相应常规护理,治疗组在此基础上联合固尔苏治疗及系统的护理干预.观察2组患儿症状缓解时间、机械通气时间、住院时间、并发症发生率、死亡率以及治疗前后PaO2和PaCO2.结果 治疗组症状缓解时间、机械通气时间、住院时间、并发症发生率均明显低于对照组;治疗组PaO2和PaCO2改善情况明显优于对照组.结论 对肺透明膜病患儿尽早应用固尔苏和系统的护理干预,能快速改善缺氧症状,有效减少并发症,降低病死率,加速疾病的治愈.

Abstract：

Objective To investigate the effect of curosurf in treatment of children with hyaline membrane disease and the nursing. Methods 56 cases of children patients with hyaline membrane disease from June 2008 to June 2010 admitted to neonatal wards were selected. The control group (26 cases)treated with mechanical ventilation alone and corresponding conventional care, on this basis, the treatment group (30 cases) was treated with curosurf and give systemic nursing intervention. Symptomatic relief time, mechanical ventilation time, length of stay, complication incidence rate, death rate, PaO2 and PaCO2 before and after treatment were observed in two groups. Results Symptomatic relief time, mechanical ventilation time, length of stay, complication incidence rate in the treatment group was significantly lower than that in the control group; PaO2 and PaCO2 amelioration in the treatment group was better than the control group. Conclusions Children with hyaline membrane disease should be treated with curosurf and given systemic nursing intervention as early as possible, it can rapidly improve the symptoms of hypoxia, reduce complications, decrease mortality, accelerate the recovery of disease.