危重患儿血糖与胰岛素水平的临床分析

目的 分析危重患儿血糖和胰岛素水平变化,探讨危重患儿高血糖发生相关机制.方法 检测2007年1至12月我院PICU收治的51例危重患儿入院时血糖和胰岛素水平变化,并与15例健康体检儿检测结果进行对照分析.结果 (1)各种基础疾病下的危重患儿入院24 h内血糖均值均高于正常范围,以感染性休克组为最高[(11.35±6.21)mmol/L];患儿入院5 d内每日血糖均值波动情况以入院当天为最高,其后持续高于正常.(2)人院24 h内肺部感染、颅内感染和感染性休克患儿血胰岛素水平分别为(17.65±16.85)mU/L、(13.45±7.33)mU/L、(16.24±12.41)mU/L,均高于对照组[(8.70±6.57)mU/L],而先天性心脏病组[(6.75±3.22)mU/L]略低于正常组,但各组间差异无显著性(F=0.356,P=0.127);入院当天和第3天、第5天患儿血胰岛素平均水平均高于正常对照组[(8.70±6.57)mU/L];根据血糖水平,将患儿分为血糖正常组和高血糖组,两组血胰岛素水平分别为(5.44±3.38)mU/L、(14.22±12.29)mU/L,高血糖组胰岛素水平明显高于对照组.(3)患儿危重评分(PIM Ⅱ)均值为12.69±16.82,共死亡8例,病死率为15.6%;死亡患儿血糖和胰岛素水平均明显高于存活患儿(P＜0.05).(4)血糖和血胰岛素水平间无明显线性关系;危重症评分和血胰岛素水平无线性相关性;血糖和危重症评分间线性相关性不显著.结论 危重症患儿常出现高血糖和高胰岛素血症,两者在一定程度上间接反映疾病严重程度,也是判断预后的间接指标;高血糖与胰岛素相对不足或(和)胰岛素抵抗有关,至于其确切的关系需要进一步研究证实.     

丙戊酸钠对癫(癎)患者体质量、体质量指数、血糖、血清胰岛素水平的影响

目的 探讨丙戊酸钠(VPA)对癫(癎)患儿体质量、体质量指数(BMI)、血糖、血清胰岛素水平的影响.方法 以VPA治疗3个月的30例癫(癎)患者作为研究对象,进行治疗前后自身对比研究,检测患者治疗前及治疗后3个月时体质量、BMI、身高、血糖、血清胰岛素水平,比较治疗前后体质量、BMI、血糖、血清胰岛素、胰岛素抵抗指数变化.利用放射免疫分析法检测其血胰岛素水平.采用SPSS 10.0软件进行统计学分析.结果 癫(癎)患儿治疗后体质量[(15.68±3.82) kg vs (19.64±4.75) kg,t=3.56 P＜0.01]、BMI[(18.29±2.91) kg/m2 vs (20.16±2.71) kg/m2,t=2.13 P＜0.05]、胰岛素(4.42±0.39) mU /L vs (6.89±0.41) mU /L,t=24.7 P＜0.01)、胰岛素抵抗指数(0.96±0.19 vs 1.45±0.21,t=9.4 P＜0.01)均较VPA治疗前明显增高.而血糖水平较治疗前无明显增高[(4.42±0.23) mmol/L vs (4.39±0.35) mmol/L,t=0.39 P＜0.05].结论 VPA治疗可引起癫(癎)患儿体质量、BMI、血清胰岛素水平增高,并导致胰岛素抵抗;诱导胰岛素抵抗可能是VPA患儿体质量增加的原因之一.但对其血糖无直接影响.     

危重儿糖代谢紊乱与血清胰岛素的关系

目的　 探讨危重病患儿糖代谢紊乱与胰岛素的关系。 方法 　OneTouch仪测定血糖 ,放射免疫法测定胰岛素。结果 　 2 1例危重病患儿危重期和恢复期分别检测血糖和血清胰岛素为 (13 5 7± 4 78)mmol/L、(5 2 4 2± 6 2 2 3) pmol/L ,和 (5 17± 1 10 )mmol/L、(12 6 0± 11 5 6 )pmol/L。 结论 　危重病患儿危重期高血糖和高胰岛素同时存在 ,胰岛素对血糖起重要作用。     

96例危重新生儿高血糖症及胰岛素治疗

目的　 观察危重症新生儿高血糖的发生及胰岛素治疗的临床意义。 方法 　对 16 8例危重症新生儿进行血糖监测。轻中度高血糖患儿采用限糖治疗 ,重度高血糖患儿随机分为限糖治疗组 ( 30例 )及小剂量胰岛素治疗组 ( 2 9例 ) ,观察血糖下降速度及预后。 结果 　发生高血糖症 96例 ,患病率为 5 7 1%,且危重症评分越高 ,其血糖值也越高。轻中度高血糖症患儿 ,限糖治疗后第 2天血糖下降正常者达 75 7%,而重度高血糖症患儿应用胰岛素组与未用胰岛素组相比 ,入院 2 4h时血糖控制情况分别为 ( 5 2 3± 1 5 )mmol/L与 ( 7 79± 1 38)mmol/L(P <0 0 1) ,病死率明显下降 ,分别为 13 8%与 40 0 %(P <0 0 5 )。 结论 　危重症新生儿病情越重 ,血糖水平越高。轻中度高血糖症经限糖治疗即可有效控制血糖水平 ,而重度高血糖症应用小剂量胰岛素治疗后可有效阻止血糖的进一步升高 ,减少危重症新生儿的病死率。     

丙戊酸钠对癫患者体质量、体质量指数、血糖、血清胰岛素水平的影响

目的探讨丙戊酸钠(VPA)对癫患儿体质量、体质量指数(BMI)、血糖、血清胰岛素水平的影响。方法以VPA治疗3个月的30例癫患者作为研究对象,进行治疗前后自身对比研究,检测患者治疗前及治疗后3个月时体质量、BMI、身高、血糖、血清胰岛素水平,比较治疗前后体质量、BMI、血糖、血清胰岛素、胰岛素抵抗指数变化。利用放射免疫分析法检测其血胰岛素水平。采用SPSS10.0软件进行统计学分析。结果癫患儿治疗后体质量[(15.68±3.82)kgvs(19.64±4.75)kg,t=3.56P<0.01]、BMI[(18.29±2.91)kg/m2vs(20.16±2.71)kg/m2,t=2.13P<0.05]、胰岛素(4.42±0.39)mU/Lvs(6.89±0.41)mU/L,t=24.7P<0.01)、胰岛素抵抗指数(0.96±0.19vs1.45±0.21,t=9.4P<0.01)均较VPA治疗前明显增高。而血糖水平较治疗前无明显增高[(4.42±0.23)mmol/Lvs(4.39±0.35)mmol/L,t=0.39P<0.05]。结论VPA治疗可引起癫患儿体质量、BMI、血清胰岛素水平增高,并导致胰岛素抵抗;诱导胰岛素抵抗可能是VPA患儿体质量增加的原因之一。但对其血糖无直接影响。     

53例危重新生儿高血糖症

目的：　报道53例危重新生儿血糖监测结果,对危重新生儿高血糖的发生因素及与预后进行分析。方法：　 53例按有无器官功能衰竭分为单衰组,多衰组,无衰组;微量全血血糖>7mmol/L诊断高血糖。对检出的高血糖病例,在控制原发病的同时,降低葡萄糖输入浓度及速度,复查血糖,如未恢复正常予正规胰岛素治疗,直至血糖水平恢复正常。并对高血糖症的新生儿行头颅B超检查。结果：　单衰组与多衰组患儿血糖水平明显高于无衰组,多衰组血糖为(22.4±3.78)mmol/L ,单衰组血糖为(19.9±9.53)mmol/L ,无衰组血糖为(11.1±2.73)mmol/L ,单衰组、多衰组与无衰组比较均P<0.05。血糖越高,死亡率亦越高。 43例高血糖患儿中血糖24h之内恢复正常的有31例,其中24例治愈或好转,好转率77.4%,>24h恢复的有12例,5例好转,好转率41.7%,两者比较P<0.05。共有11例患儿发生颅内出血,其中1例血糖>10mmol/L,10例血糖>15mmol/L。结论：　危重症患儿血糖的变化可作为判断其病情及预后的辅助指标。     

危重新生儿应激性高血糖的临床特征

危重新生儿因应激常存在广泛的高代谢状态 ,高血糖症是其中之一。本文总结我院 1999年 3月～ 2 0 0 3年 3月 89例危重新生儿应激性高血糖患儿的临床资料 ,以探讨血糖水平与临床病情、治疗及预后的关系。对象与方法一、对象　选择危重新生儿应激性高血糖患儿 (血糖≥7mmol/L) 89     

减肥对单纯性肥胖儿童糖耐量及胰岛素分泌功能的影响

目的探索单纯性肥胖儿童糖耐量减低(IGT)的干预方法。方法测定14例单纯性肥胖儿童经日服葡萄糖耐量实验(OGTT),诊断为IGT,男10例,女4例;年龄8-15岁;体质量(57.7-114.0)kg,体质量指数(BMI)(30.18±1.71)。给予中医循经推拿和行为矫正及饮食、运动调整综合减重治疗2个月。结果14例IGT肥胖儿童减肥治疗2个月后9例OGTT恢复正常,体质量下降至(49-95)kg;BMI下降至(25.30±1.35)kg;治疗后空腹胰岛素、餐后2 h胰岛素、餐后2 h血糖[(14.23 ±2.35)mIU/L、(47.20±10.26)mIU/L、(5.63±0.91)mmol/L]较治疗前[(32.54±7.13)mIU/L、(164.53±33.60)mIU/ L、(8.75±1.09)mmol/L]明显下降(P<0.05,<0.01,<0.05);空腹血糖(4.80±0.52)mmol/L和治疗前(5.36±1.59) mmol/L比较无明显差异(P>0.05)。结论减肥是干预单纯性肥胖儿童IGT、改善胰岛素抵抗及预防2型糖尿病的最好方法。     

强化胰岛素治疗对体外循环手术后患儿近期预后的影响

目的 探讨强化胰岛素治疗对体外循环手术后患儿近期预后的影响.方法 2009年1月至2010年12月成都心血管病医院在体外循环下行心内畸形矫治手术患儿320例,其中男192例,女128例;年龄3个月-12岁.根据胰岛素给药时间和血糖控制的程度不同,将320例患儿分为两组:A组165例,术后给予胰岛素,将血糖控制在4.4 ～6.1 mmo/L;B组155例,当血糖超过11.1 mmol/L时,给予胰岛素,将血糖控制在6.1～11.1 mmo/L;比较分析两组患儿术后血糖控制情况和并发症.结果 对320例患儿的4 800次血糖值进行分析.A、B两组平均血糖分别为(5.58±0.54) mmol/L和( 7.73±0.85) mmol/L,差异有统计学意义(P＜0.01),均在血糖控制目标范围内.A、B两组低血糖( ＜3.3 mmol/L)发生率分别为1.65％ (38/2 310)和1.04％( 26/2 490),严重低血糖(＜2.2 mmol/L)发生率分别为0.13％ (3/2 310)和0.08％ (2/2 490),A组低血糖、严重低血糖发生率明显高于B组(P＜0.01).A组院内感染发生率低于B组[3.03％ (5/165) vs 9.68％ (15/155),P＜0.05],而两组心律失常、循环衰竭或休克、多器官功能障碍的发生率和住院病死率比较差异无统计学意义(P＞0.05).结论 现有数据尚不足以证实强化胰岛素治疗能改善体外循环手术后患儿的近期预后.     

新生儿低血糖临床干预阈值探讨

目的 探讨新生儿低血糖临床干预的阈值.方法 选择我院2007年1月至2009年1月收住的新生儿共128例,分为4组:正常对照组:入院后血浆血糖一直稳定维持在3.30～6.10 mmol/L;观察组Ⅰ组:入院后即刻血浆血糖2.60～3.29 mmol/L,经常规处置后一直在此范围且持续2h,入院4h即稳定维持在正常范围;观察组Ⅱ组:入院后即刻血浆血糖2.20～2.59 mmol/L,经常规处置后一直在此范围且持续2h,入院4h即稳定维持在正常范围;观察组Ⅲ组:入院后即刻血浆血糖＜2.20 mmol/L,经常规处置后一直在此范围且持续2h,入院3h即稳定维持在正常范围.对128例新生儿行闪光视觉诱发电位(flash visual evoked potential,F-VEP)检测,分析主波潜伏期改变.结果 128例新生儿F-VEP主波无一缺失,与正常对照组[ (199.2±14.3)ms]比较,观察组Ⅱ组[(212.9±18.9) ms]和Ⅲ组[(223.1±20.4)ms]主波潜伏期延长,差异有统计学意义(P＜0.01);观察组Ⅲ组与Ⅱ组比较,主波潜伏期明显延长(P＜0.01);而观察组I组[(203.3±15.4) ms]主波潜伏期与各组间比较差异无统计学意义(P＞0.05).当观察组Ⅱ组和观察组Ⅲ组新生儿的血浆血糖经治疗稳定维持在3.30 -6.10 mmol/L后,与正常新生儿比较,其主波潜伏期差异无统计学意义[(202.9±15.2) ms,(203.1±15.5) ms vs (199.2±14.3) ms](P＞0.05).结论 无论是否有临床表现,临床医生应当考虑进行临床干预的低血糖水平,即可能引起脑功能障碍的血糖阈值是＜2.60 mmol/L,而非传统的＜2.20 mmol/L,也许是较适宜的.     

Pubertal growth and development and prenatal and lactational exposure to polychlorinated biphenyls and dichlorodiphenyl dichloroethene

OBJECTIVES: Polychlorinated biphenyls (PCBs) and dichlorodiphenyl dichloroethene (DDE) are ubiquitous toxic environmental contaminants. Prenatal and early life exposures affect pubertal events in experimental animals. We studied whether prenatal or lactational exposures to background levels of PCBs or DDE were associated with altered pubertal growth and development in humans.Study design: Follow-up of 594 children from an existing North Carolina cohort whose prenatal and lactational exposures had previously been measured. Height, weight, and stage of pubertal development were assessed through annual mail questionnaires. RESULTS: Height of boys at puberty increased with transplacental exposure to DDE, as did weight adjusted for height; adjusted means for those with the highest exposures (maternal concentration 4+ ppm fat) were 6.3 cm taller and 6.9 kg larger than those with the lowest (0 to 1 ppm). There was no effect on the ages at which pubertal stages were attained. Lactational exposures to DDE had no apparent effects; neither did transplacental or lactational exposure to PCBs. Girls with the highest transplacental PCB exposures were heavier for their heights than other girls by 5.4 kg, but differences were significant only if the analysis was restricted to white girls. CONCLUSIONS: Prenatal exposures at background levels may affect body size at puberty.     

Prevention and treatment of overweight and obesity in children and adolescents

Increasing numbers of obese children and adolescents all over the world demand an investment in the primary and secondary prevention of obesity and overweight in this age group. The goal of preventive measures in children is to avoid the negative short- and long-term health problems associated with obesity. Primary prevention aims at establishing a healthy, active lifestyle and keeping children and adolescents within a range of body weight which is considered to be healthy. Constant availability and affordability of palatable and energy-dense food in the affluent society of the western world demands preventive strategies. Universal or public health prevention seems to be the most suitable form because several other cofactors of morbidity and mortality of affluent societies can also be prevented. However, in most European countries there is a lack of awareness of the necessity of prevention programmes, not only among the general population but also among the medical society. More awareness and consciousness to the problem of obesity must be generated in order to lead to effective therapeutic programmes. For those children and adolescents who are already obese, secondary prevention is mandatory. Therapeutic intervention programmes for the obese aim at long-term weight maintenance and normalisation of body weight and body fat. They have to modify eating and exercise behaviour of the obese child and establish new, healthier behaviour and lifestyle. Treatments programmes must include behavioural components in order to permanently change nutrition and physical exercise of the obese children and adolescents. However, long-term results of treatment programmes in European countries are scarce and the reported results, even of multidisciplinary regimens, are not impressive. Conclusion In most European countries there is an urgent need not only for a growing awareness of the problem of obesity in children and adolescents but also for development of new comprehensive approaches in treating this group.     

Hypokalemia and Hyperkalemia in Infants and Children: Pathophysiology and Treatment

Potassium is the second most abundant cation in the body. About 98% of potassium is intracellular and that is particularly in the skeletal muscle. Electrical disturbances associated with disorders of potassium homeostasis are a function of both the extracellular and intracellular potassium concentrations. Clinical disorders of potassium homeostasis occur with some regularity, especially in hospitalized patients receiving many medications. This article will review the pathophysiology of potassium homeostasis, symptoms, causes, and treatment of hypo- and hyperkalemia.