小儿危重病例评分在重症手足口病病情及预后评估中的作用

目的 探讨小儿危重病例评分(PCIS)在重症手足口病患儿预后及病情严重程度评估中的作用。方法 424 名重症手足口病患儿纳入该研究,其中存活390 例,死亡34 例。收集患儿PCIS 评分系统的相关生理参数及结局资料,通过受试者工作特征曲线(ROC)下面积(AUC)评估PCIS 评分系统对并发症和结局的分辨力。结果 存活组患儿PCIS 评分明显高于死亡组患儿(P结论 PCIS 对重症手足口病并发症及预后有一定预测作用,但根据现有评分体系不能充分反映重症手足口病病情的严重程度。     

小儿病情危重程度评分北大核心CSCD

正确评估患者病情严重程度对提高重症医学水平有重要意义.小儿常用的病情危重程度评分方法有小儿死亡风险、小儿死亡指数、小儿危重病例评分.正确应用小儿病情危重程度评分可评估病情严重程度、预测死亡危险性、评价医疗质量和控制研究中组间的可比性.     

第3代小儿死亡危险评分和小儿危重病例评分的应用

第3代小儿死亡危险评分(pediatric risk of mortalityⅢ,PRISMⅢscore)和小儿危重病例评分(pediatric critical illnessscore,PCIS)均为生理学危重评分法。前者发表于1996年,由原PRISM评分发展而来,有17个生理参数,26个生理参数范围,是世界上应用最广泛的儿科评估病情和预后的工具。后者公布于1995年,有10项生理指标,其简便、有效、适合国情,是国内应用最广泛、有效的儿科危重评分法。二者均经过大规模临床应用验证。除评估病情和预后,还可评估ICU工作质量和效益,对比不同ICU患者状况、资源利用和管理,进行危重症临床研究。本研究对PRISMⅢ的应用及其与PCIS的进行对比研究。     

小儿急救医学临床进展

我国小儿急救医学发展迅速,成绩显著。10年前一项调查显示,ICU住院患儿病死率为12 5 % ,现已下降至4 6 % [1] 。现将2 0 0 3年小儿急救医学临床进展简述如下。1　小儿危重病例评分客观评估患儿病情严重程度对现代医学的发展有重要意义。评估疾病严重程度是一项复杂的工作,不同种类的疾病对人体危害程度不同,相同种类的疾病病情也可有很大差别。1995年我国小儿危重病例评分法(pediatriccriticalillnessscore ,PCIS) (草案)公布后,经大规模的临床验证,证实PCIS可准确判断病情轻重。有学者为方便PCIS的应用,制作了评分查阅卡[2 ] 。但…     

小儿危重评分和死亡危险评分在监护室中的应用

目的 通过对PICU危重患儿小儿危重评分(PCIS)和小儿死亡危险评分(PRISM)的比较判断两种评分的临床应用价值.方法 对580例PICU住院患儿按照小儿危重评分标准、死亡及器官衰竭情况进行分组,根据各组PRISM评分分析比较各组问的差异性.结果 危重组、极危重组与非危重组各组间的PRISM评分差异有显著性(P<0.01);死亡组与存活组的PRISM评分值的差异也有显著性(P<0.01);PRISM评分随器官衰竭数增加而增高(P<0.05).结论 小儿危重评分和死亡危险评分对临床危重患儿的病情危重程度、死亡危险程度的判断有指导价值.     

简易制作小儿危重病例评分卡

目的　简易制作小儿危重病例评分卡。方法　将小儿危重病例评分表(PCIS)中十项指标简化在一张卡片上,卡片正面信息为十项指标的测量值、判断标准及评分,卡片背面说明评分方法及注意事项。结果简易小儿危重病例评分卡信息完整,评分简便,且动态评分,能判断预后。结论根据PCIS表格简易制作小儿危重病例评分卡,临床应用简便,有利于PCIS的推广。     

四种重症评分系统对脓毒症患儿预后预测价值的比较

目的分析儿童危重病例评分(PCIS)、儿童器官功能障碍评分2(PELOD-2)、儿童死亡风险评分Ⅲ(PRISM Ⅲ)、儿童序贯器官功能障碍评分(pSOFA)4种重症评分系统对脓毒症患儿疾病严重程度及预后的预测价值。方法回顾性分析2015年8月至2020年12月入住吉林大学第一医院儿童重症监护病房159例脓毒症患儿的病历资料。根据患儿入儿童重症监护病房后24 h内最差的生理指标计算PCIS评分、PELOD-2评分、PRISM Ⅲ评分及pSOFA评分。按照临床结局分为存活组和死亡组, 按照脓毒症严重程度分为脓毒症(无脏器损伤)组和严重脓毒症组。利用受试者工作特征(ROC)曲线评价PCIS评分、PELOD-2评分、PRISM Ⅲ评分及pSOFA评分对脓毒症患儿疾病严重程度和预后的预测价值。结果存活组97例(61.01%), 死亡组62例(38.99%);严重脓毒症组141例(88.68%)。PCIS、PELOD-2、PRISM Ⅲ、pSOFA评分预测脓毒症患儿发生严重脓毒症的ROC曲线下面积分别为0.869、0.875、0.672、0.933(均P<0.05);PCIS、PELOD-2...     

1920例危重患儿血淀粉酶水平分析

目的探讨危重患儿血淀粉酶升高对病情评估的意义及影响因素。方法回顾性分析2009年11月至2014年6月入住儿童重症监护病房(PICU)危重患儿临床资料,根据入PICU时的血淀粉酶水平,分为血淀粉酶正常组(≤103IU/L)、血淀粉酶升高组(103 IU/L),比较两组间的差异。结果共1 920例危重患儿入选,初发疾病以呼吸系统疾病、神经系统疾病为主;血淀粉酶正常1 470例(76.6%)、升高450例(23.4%)。血淀粉酶正常组与升高组之间器官衰竭个数和小儿危重病例评分(PCIS)分布,以及有创机械通气率和病死率的差异均有统计学意义(P均0.001),血淀粉酶升高组中器官衰竭个数≥4、有创机械通气、PCIS评分70以及死亡的比例均较高。血淀粉酶与血脂肪酶、尿淀粉酶、尿素氮和肌酐水平相关性较大(r=0.246~0.683,P均0.001)。血淀粉酶与休克指数呈正相关(r=0.111,P=0.002),与呼吸衰竭指数呈负相关(r=-0.133,P0.001)。结论血淀粉酶水平可评估危重患儿病情,血淀粉酶升高与胰腺外分泌功能、肾功能、缺血缺氧密切相关,对危重患儿血淀粉酶升高需警惕。     

脓毒症患儿抗凝血酶Ⅲ、D－二聚体与小儿危重评分的相关性

目的探讨脓毒症患儿血浆抗凝血酶Ⅲ(AT-Ⅲ)、D-二聚体(DD)与小儿危重评分(PCIS)的关系及其对病情危重程度的判断价值。方法回顾性分析61例脓毒症患儿在入院24 h内检测的血浆AT-Ⅲ和DD水平及PCIS评分等资料。将患儿按PCIS分为极危重组(≤70分)、危重组(71~80分)、非危重组(80分);将患儿按预后分为存活组和死亡组,分别比较AT-Ⅲ活性、DD水平的差异及其与PCIS的相关性。结果极危重组、危重组和非危重组的AT-Ⅲ活性和DD水平的差异均有统计学意义(P0.01);其中,以极危重组AT-Ⅲ活性降低以及DD水平升高最为明显,危重组次之,两两比较差异均有统计学意义(P0.05)。AT-Ⅲ活性与PCIS评分呈正相关(r=0.548,P0.01),DD水平与PCIS呈负相关(r=-0.657,P0.01)。死亡患儿DD水平高于存活患儿,AT-Ⅲ活性和PCIS评分均低于存活患儿,差异均有统计学意义(P0.05)。结论脓毒症患儿存在明显的凝血功能障碍,血浆AT-Ⅲ、DD与其病情危重程度密切相关,可作为判断病情的指标。     

3种儿童危重评分在重症监护室脓毒症患儿预后评估中的作用

目的探讨儿童危重病例评分(PCIS)、儿童器官功能障碍评分2(PELOD-2)、儿童多器官功能障碍评分(P-MODS)在儿童重症监护室(PICU)脓毒症患儿预后评估中的作用。方法回顾性分析2016年6月至2018年6月广东医科大学附属医院PICU收治的516例脓毒症患儿的临床资料,根据入院28 d结局将患儿分为存活组和死亡组。绘制受试者工作特征曲线(ROC曲线),采用ROC曲线下面积(AUC)评价PCIS、PELOD-2、P-MODS在PICU脓毒症患儿预后评估中的作用。结果存活组488例,死亡组28例。死亡组PCIS评分明显低于存活组[86(82,88)分比89(84,92)分],PELOD-2及P-MODS评分均明显高于存活组[PELOD-2:6.5(4.0,8.0)分比0(0,2.0)分,P-MODS:3(2,6)分比1(1,2)分],差异均有统计学意义(Z=3259.500、14.228、4.688,均P<0.05)。ROC曲线分析显示,PCIS、PELOD-2、P-MODS 3种评分评估PICU脓毒症患儿预后的AUC分别为0.761、0.916、0.761(Z=6.127、14.228、4.688,均P<0.05)。结论PCIS、PELOD-2、P-MODS均可较好地预测PICU脓毒症患儿的预后,尤以PELOD-2评分更加显著。     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

�¶�֢��ϵ�ϰ���ע��ȱ�ݶද�ϰ������ڵ�ת��

孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Overcoming surfactant inhibition with polymers

Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium-derived free fatty acids). Recent data suggest that addition of non-ionic polymers such as dextran and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near-complete restoration of surfactant function. The anti-inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.     

Understanding infant formula

The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and healthcare professionals) will experiment with the infant formula available and then attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.