小儿急性白血病误诊为骨科疾病2例分析

小儿急性白血病多为急性淋巴细胞性白血病，约10～23％以骨和关节疼痛等为首发症状，该类患儿因摔伤后骨和关节痛或骨折易误诊为骨科疾病，我院骨科最近收治了2例误诊为骨科疾病的患儿，现报道如下。     

小儿急性呼吸衰竭时电解质紊乱分析

目的　 总结 3 0例小儿急性呼吸衰竭患儿的电解质紊乱。 方法 　对 3 0例患儿多次进行电解质检测分析。 结果 　小儿急性呼吸衰竭时电解质紊乱依次是低氯血症 ( 5 5 8% ) ,低钾血症 ( 3 6% ) ,低钠血症 ( 2 5 6% ) ,低镁血症 ( 2 4 6% ) ,高钾血症( 19 7% )。呼衰早期以低血氯、低血钠、高血钾为主 ,呼衰纠正后以低血氯、低血钠、低血钾为主。 结论 　难治性呼衰及死亡病例10 0 %合并有一种或两种以上严重电解质紊乱。大部分电解质紊乱缺乏典型临床表现。传统补钾浓度及速度对严重低钾血症效果差 ,纠正低镁血症是呼衰治疗中必须重视的问题。严重电解质紊乱影响ARF的病情程度及预后。     

小儿急性胰腺炎3例误诊分析

小儿急性胰腺炎较成人少见，临床表现极不典型，来势凶、发展快，早期诊断有一定困难，故误诊率高。现就我院于2002～2005年收治的3例误诊病例分析如下。     

小儿急性阑尾炎误诊原因分析

急性阑尾炎是小儿最常见的急腹症,以５一１２岁为多见。由于小儿生理、病理、解剖方面的特点,误诊率较成人为高,本报道我院儿科自１９８４年４月至２００１年１２月因误诊收住儿科后转外科手术确诊为急性阑尾炎的病例５０例。     

小儿急性呼吸衰竭时电解质紊乱分析

目的 总结３０例小儿急性呼吸衰竭患儿的电解质紊乱。方法 对３０例患儿多次进行电解质检测分析。结果 小儿急性呼吸衰竭时电解质紊乱依次是低氯血症（５５．８％）,低钾血症（３６％）,低钠血症（２５．６％）,低镁血症（２４．６％）,高钾血症（１９．７％）。呼衰早期以低血氯、低血钠、高血钾为主,呼衰纠正后以低血氯、低血钠、低血钾为主。结论 难治性呼衰及死亡病例１００％合并有一种或两种以上严重电解质紊乱。大部     

肺门淋巴结结核误诊分析

由于小儿生理解剖特点 ,判断小儿肺门阴影是否正常较困难 ,并常与因其它疾病引起的淋巴结肿大相混淆。本文回顾了确诊为肺门淋巴结结核的 15 2例临床资料 ,并对其误诊原因加以分析。临床资料1991～ 1998年我院门诊和住院 0～ 14ａ儿童曾被确诊为肺门淋巴结核 15 2例 ,其中男 83例 ,女 6 9例。年龄 7个月～3ａ 2 5例 ,4～ 7ａ 5 3例 ,8～ 14ａ 74例。作回顾性调查和综合分析 ,仅 98例诊断正确。余 5 4例均为其它疾病 ,误诊为肺门淋巴结结核。 5 4例全部摄正侧位胸片并做结核菌素试验。胸片 45例未显示肺门阴影增大。结核菌素试验 35例阴性 ,1…     

小儿阑尾炎3例误诊分析

急性阑尾炎是小儿最常见的急腹症，由于小儿生理、病理、解剖方面的特点，误诊率较成人为高。我院儿科自2005年10月～2007年2月因误诊收住儿科后转外科手术确诊为阑尾炎的病例3例。现谈谈自身的心得体会。[第一段]     

儿童抗精神病药物急性中毒26例早期误诊分析

在儿科急性药物中毒原因中,以抗精神病药物居首位[1,2].由于早期表现嗜睡,不易引起家长注意,而且临床症状危重,病史述说不清,往往早期延误诊断,如不及时纠正则影响抢救治疗.本院儿科1985年5月至1999年10月共收治抗精神病药物中毒患儿49例,其中26例入院时未提供急性中毒病史致早期误诊,现作分析如下.     

Approaches in the management of acute respiratory failure in children

PURPOSE OF REVIEW: Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are conditions that are associated with significant morbidity and mortality in children. There have been no advances in preventing ARDS, but this review highlights strategies directed at minimizing ventilator-induced lung injury and other new adjunctive therapies in the care of these patients. RECENT FINDINGS: High-frequency oscillatory ventilation, airway pressure release ventilation, and partial liquid ventilation are potential protective ventilatory modes for children with ALI or ARDS. Recruitment maneuvers, prone positioning, and kinetic therapy are all reported to improve oxygenation by opening the lung while positive end-expiratory pressure maintains functional residual capacity. Inhaled nitric oxide and surfactant are used to reduce inspired oxygen concentration and facilitate gas exchange, but their efficacy in ARDS continues to be investigated. Also, early investigations suggest that a specialized enteral formula can be a useful adjunctive therapy by reducing lung inflammation and improving oxygenation. When mechanical ventilation and adjunctive therapies fail, extracorporeal life support continues to be used as a rescue therapy. SUMMARY: It is likely that a combination of these therapies will maximize treatment and clinical outcomes in the future, but the only way that will be proven is through large controlled clinical trials in pediatric patients.     

小儿急性呼吸衰竭的诊断和治疗

急性呼吸衰竭 ( acute respiratoryfailure,ARF,以下简称呼衰 )是一种严重的临床综合征。凡累及呼吸器官及(或 )呼吸中枢的各种疾病 ,产生肺氧合障碍和 (或 )肺泡通气不足而影响气体交换者 ,均可以引起呼衰 ,表现为低氧血症或低氧血症与高碳酸血症并存。1　病因原发病以呼吸系统疾病为主 ,中枢神经系统疾病次之。见表 1。　　换气障碍型呼衰即 型呼衰 ,其病理生理改变以肺泡与血液间气体弥散障碍和通气血流比例 ( V/Q)失调为主 ,早期只有低氧血症而无二氧化碳游留。通气障碍型呼衰即 型呼衰 ,主要由于肺泡通气低下所致。血气测定表现为 …     

高频振荡机械通气在血液肿瘤及多种疾病并发儿童急性低氧性呼吸衰竭中的应用

目的 评估儿童急性低氧性呼吸衰竭（acute hypoxemic respiratory failure,AHRF）给予高频振荡机械通气（high-frequency oscillatory ventilation,HFOV）治疗的意义.方法 回顾2011年1月至2013年9月收入我院PICU诊断为AHRF的病例,首先给予常规机械通气（CMV）,当PIP＞ 30cmH2O（1 cmH2O =0.098 kPa）或PEEP＞ 10 cmH2O、FiO2100％时具有以下情况之一：（1）SpO2 ＜90％或PaO2 ＜60 mmHg（1 mmHg =0.133 kPa）;（2）有严重呼吸性酸中毒（PaCO2＞ 80mmHg）;（3）严重气漏（纵隔气肿或气胸）,改为HFOV通气治疗.收集患儿性别、年龄、住PICU时间、CMV通气时间、HFOV通气时间等一般资料.分别于CMV通气末（H0）及HFOV后2 h（H2）、6 h（H6）、12 h（H12）、24 h（H24）、48 h（H48）记录并比较各时间点呼吸机参数（平均气道压、振幅、频率、FiO2）、氧合指数（PaO2/FiO2、OI）、动脉血气、心率、血压变化.分别比较存活组与死亡组、血液肿瘤组及非血液肿瘤组在H0、H2、H6、H12、H24、H48时间点的指标变化.结果 HFOV通气后,H2时间点PaO2较H0升高[76.9（61.9～128.0） mm-Hg vs 50.1 （49.5 ～ 68.0） mmHg],差异有统计学意义（P=0.006）.H2、H48时间点PaO2/FiO2分别较Ho、H24升高,差异有统计学意义[94.9（66.8 ～ 138.9） mmHg vs 68.0（49.5 ～ 86.8）mmHg,P=0.039;135.0（77.6 ～240.0）mmHg vs 90.7（54.6 ～ 161.7） mmHg,P=0.023）].所有患儿收缩压、舒张压、心率在各时间点没有明显变化（P＞0.05）.存活组（n=9）与死亡组（n=14）相比,PaO2/FiO2、OI在H6、H12、H24、H48差异有统计学意义（P＜0.05）.非血液肿瘤组（n=10）与血液肿瘤组（n=13）相比,OI在H2、H6差异有统计学意义[19.2（13.9～26.6） vs 33.8（19.7 ～48.3）,P=0.049;16.0（8.4～27.1） vs28.9（20.9 ～38.9）,P=0.027）],两组的平均气道压在H2、H6、H12差异有统计学意义（P＜0.05）.两组病死率差异无统计学意义（40.0％ vs 76.9％,P=0.086）.结论     

一氧化氮吸入治疗小儿急性呼吸衰竭

为观察一氧化氮（ＮＯ）治疗小儿急性呼吸衰竭的疗效，应用我院自行研制的ＮＯ吸入装置，对１５例急性呼吸窘迫综合征（ＡＲＤＳ）和急性呼吸衰竭（简称急性呼衰）患儿进行ＮＯ吸入治疗。结果：７例有效，ＮＯ吸入前后比较氧分压与吸入氧浓度比值上升４．１±２．３ｋＰａ（３０．５±１７ｍｍＨｇ，１ｋＰａ＝７．５ｍｍＨｇ）（ｔ＝４．５２，Ｐ＜０．０５），氧合指数降低９±３（ｔ＝４．６３，Ｐ＜０．０５）。对２例肺动脉导管压力监测显示，肺动脉压和肺血管阻力明显下降，体动脉压和心率无显著性变化。结论：ＮＯ吸入疗法对部分急性呼衰患儿有效，宜在急性低氧性呼衰、心功能未受严重损害时应用。     

新型冠状病毒肺炎儿童重症急性呼吸衰竭的呼吸支持策略建议

The recent ongoing outbreak of severe pneumonia associated with a novel coronavirus (SARS-CoV-2), currently of unknown origin, creates a world emergency that has put global public health institutions on high alert. At present there is limited clinical information of the SARS-CoV-2 and there is no specific treatment recommended, although technical guidances and suggestions have been developed and will continue to be updated as additional information becomes available. Preventive treatment has an important role to control and avoid the spread of severe respiratory disease, but often is difficult to obtain and sometimes cannot be effective to reduce the risk of deterioration of the underlining lung pathology. In order to define an effective and safe treatment for SARS-CoV-2-associated disease, we provide considerations on the actual treatments, on how to avoid complications and the undesirable side effects related to them and to select and apply earlier the most appropriate treatment. Approaching to treat severe respiratory disease in infants and children, the risks related to the development of atelectasis starting invasive or non-invasive ventilation support and the risk of oxygen toxicity must be taken into serious consideration. For an appropriate and effective approach to treat severe pediatric respiratory diseases, two main different strategies can be proposed according to the stage and severity of the patient conditions:patient in the initial phase and with non-severe lung pathology and patient with severe initial respiratory impairment and/or with delay in arrival to observation. The final outcome is strictly connected with the ability to apply an appropriate treatment early and to reduce all the complications that can arise during the intensive care admission.

     

Obstructive bronchitis syndrome in acute viral respiratory diseases in young children

External respiratory function was explored in 39 children aged 1.5 months to 2 years presenting with the bronchoobstructive syndrome (BOS) in the presence of acute respiratory virus infection. The development of the BOS was accompanied by disorders of bronchial patency and alveolar ventilation. The maintenance of adequate ventilation is reached at the expense of hurried breathing with the respiratory volume being lowered. During convalescence, bronchial patency rises, hyperinflation drops and the respiratory volume increases. Uniformity of the ventilation-perfusion relations in the lungs declines. The use of total body plethysmography and oxycapnography makes it possible to objectively estimate respiratory function and to control the efficacy of the treatment in infants.