纳络酮与氨茶碱交替使用治疗早产儿原发性呼吸暂停的疗效观察

观察纳洛酮加氨茶碱治疗早产儿原发性呼吸暂停疗效,对使用氨茶碱后仍出现呼吸暂停的早产儿48例,随机分为对照组和观察组。观察组加用纳洛酮治疗,对照组不用;比较两组间原发性呼吸暂停的时间和发生次数、心率、经皮血氧饱和度等的差异。结果显示:与对照组相比,观察组患儿呼吸暂停的次数为(1.7±0.9)次/d vs(3.4±2.1)次/d及呼吸暂停的日均积分为(1.9±1.1)分vs(4.8±2.3)分明显减少,P值均<0.001;呼吸暂停的时间明显缩短,为(19.7±2.6)s vs(23.3±3.5)秒,P值<0.05;呼吸暂停时SpO2的下降程度[(82.0±8.4)％vs(74.5±6.2)％]及心率下降程度[(96.4±13.8)次/min vs(87.7±14.5)次/min]均明显减轻,P均<0.05。结果提示,纳洛酮在早产儿原发性呼吸暂停的作用值得进一步的研究和推广。     

纳络酮与氨茶碱交替使用治疗早产儿原发性呼吸暂停的疗效观察

观察纳洛酮加氨茶碱治疗早产儿原发性呼吸暂停疗效,对使用氨茶碱后仍出现呼吸暂停的早产儿48例,随机分为对照组和观察组.观察组加用纳洛酮治疗,对照组不用;比较两组间原发性呼吸暂停的时间和发生次数、心率、经皮血氧饱和度等的差异.结果显示与对照组相比,观察组患儿呼吸暂停的次数为(1.7±0.9)次/dvs(3.4±2.1)次/d及呼吸暂停的日均积分为(1.9±1.1)分vs(4.8±2.3)分明显减少,P值均＜0.001;呼吸暂停的时间明显缩短,为(19.7±2.6)s vs(23.3±3.5)秒,P值＜0.05;呼吸暂停时SO2的下降程度[(82.0±8.4)%vs(74.5±6.2)%]及心率下降程度[(96.4±13.8)次/min vs(87.7±14.5)次/min]均明显减轻,P均＜0.05.结果提示,纳洛酮在早产儿原发性呼吸暂停的作用值得进一步的研究和推广.     

纳洛酮联合氨茶碱治疗早产儿原发性呼吸暂停

目的探讨纳洛酮联合氨茶碱治疗早产儿原发性呼吸暂停的疗效。方法符合诊断标准的早产儿原发性呼吸暂停78例,随机分为治疗组40例和对照组38例。在常规治疗的基础上,治疗组予纳洛酮注射液0.1mg/(kg.次),稀释后静脉滴注,12h1次;氨茶碱注射液2mg/(kg.次),稀释后静脉滴注,12h1次;对照组氨茶碱用药方法同治疗组。结果治疗组显效率和总有效率分别为60.0%、92.5%,对照组分别为36.8%、71.1%。二组显效率、总有效率比较均有显著差异(χ2=4.18,6.08Pa<0.05)。结论纳洛酮联合氨茶碱治疗早产儿原发性呼吸暂停疗效明显,优于单用氨茶碱。     

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目的观察纳洛酮联合氨茶碱治疗早产儿原发性呼吸暂停的疗效。方法2002-01—2006-01于鞍山市中心医院就诊的原发性呼吸暂停早产儿74例,分为治疗组40例和对照组34例。在常规治疗基础上,两组均常规应用氨茶碱注射液治疗呼吸暂停,首次负荷量5mg/kg,12h后予维持量2mg/kg,每12h给药1次,稀释后静滴;治疗组加用纳洛酮注射液,首次负荷量0·1mg/kg,静推,1h后按0·01mg/(kg·h)的速度经微量输液泵持续静脉注射,每日总量不超过0·4mg/kg。结果治疗组显效率和总有效率分别为67·5%(27/40)和95·0%(38/40),对照组分别为44·1%(15/34)和73·5%(25/34)。两组显效率比较差异有显著性意义(χ2=4·09,P<0·05),总有效率比较差异有非常显著性意义(χ2=6·69,P<0·01)。结论纳洛酮联合氨茶碱治疗早产儿原发性呼吸暂停疗效优于单用氨茶碱。     

纳洛酮治疗早产儿原发性呼吸暂停疗效观察

目的观察纳洛酮治疗早产儿原发性呼吸暂停的疗效。方法将诊断为原发性呼吸暂停的64例早产儿随机分为治疗组34例,用纳洛酮注射液0.1 mg/(kg.次),1次/8 h,静脉滴注;对照组30例用氨茶碱,首剂5 mg/kg,12 h予维持量2 mg/kg,加10%葡萄糖注射液20 mL,静脉滴注,1次/8 h。结果治疗组显效27例,有效5例,无效2例,总有效率94.12%;对照组显效11例,有效10例,无效9例,总有效率70.00%。两组总有效率比较有显著差异(χ2=5.02 P<0.05)。结论纳洛酮治疗早产儿原发性呼吸暂停疗效显著。     

纳洛酮联合氨茶碱治疗早产儿原发性呼吸暂停74例临床观察

目的观察纳洛酮联合氨茶碱治疗早产儿原发性呼吸暂停的疗效。 方法2002 01—2006 01于鞍山市中心医院就诊的原发性呼吸暂停早产儿74例,分为治疗组40例和对照组34例。在常规治疗基础上,两组均常规应用氨茶碱注射液治疗呼吸暂停,首次负荷量5mg/kg,12h后予维持量2mg/kg,每12h给药1次,稀释后静滴;治疗组加用纳洛酮注射液,首次负荷量0.1mg/kg,静推,1h后按0.01mg/(kg·h)的速度经微量输液泵持续静脉注射,每日总量不超过0.4mg/kg。 结果治疗组显效率和总有效率分别为67.5%(27/40)和95.0%(38/40),对照组分别为44.1%(15/34)和73.5%(25/34)。两组显效率比较差异有显著性意义(χ2=4.09,P<0.05),总有效率比较差异有非常显著性意义(χ2=6.69,P<0.01)。 结论纳洛酮联合氨茶碱治疗早产儿原发性呼吸暂停疗效优于单用氨茶碱。     

纳洛酮联合东莨菪碱治疗早产儿呼吸暂停48例

目的观察纳洛酮与东莨菪碱联合治疗早产儿原发性呼吸暂停的疗效。方法原发性呼吸暂停早产儿48例,随机分为治疗组26例和对照组22例。在常规综合治疗的基础上,对照组用氨茶碱,首次负荷量5mg/kg;12h后予维持量5mg/(kg·d),分2次静脉滴注。治疗组用纳洛酮注射液,以10μg/(kg·h)的速度经微量输液泵持续静脉注射,东莨菪碱0.01～0.03mg/(kg·次),开始1h静注1次,呼吸暂停次数减少后改为0.01mg/(kg·次),6h/次。结果治疗组显效率、总有效率分别为65.4%和88.5%,对照组分别为36.4%、59.0%。两组显效率、总有效率比较均有显著差异(χ2=4.022,5.483P均<0.05)。结论纳洛酮与东莨菪碱联合治疗早产儿原发性呼吸暂停疗效优于单用氨茶碱。     

低水平CPAP配合纳洛酮治疗早产儿原发性呼吸暂停疗效观察

目的　观察低水平(即低氧浓度及低压力)持续气道正压(CPAP)配合纳洛酮治疗早产儿原发性呼吸暂停的疗效。方法将66例患儿随机分为两组,观察组35例给予低水平CPAP及纳洛酮治疗;对照组31例给予氨茶碱治疗。比较两组用药后呼吸暂停改善情况。结果观察组显效24例,有效9例,无效2例,总有效率94.3%,对照组显效12例,有效9例,无效10例,总有效率67.7%,两组之间显效率及总有效率比较,治疗组均明显优于对照组,经统计学处理均有显著性意义(分别为x2=5.91,P<40.025及x2=10.04,P<40.005)。结论　低水平CPAP配合纳洛酮治疗原发性早产儿呼吸暂停,疗效明显优于用氨茶碱治疗     

纳洛酮与氨茶碱联合治疗早产儿原发性呼吸暂停56例疗效观察

目的观察纳洛酮与氨茶碱联合治疗早产儿原发性呼吸暂停的疗效。方法原发性呼吸暂停早产儿56例，随机分为治疗组27例和对照组29例。在常规综合治疗的基础上，治疗组用纳洛酮、氨茶碱联合治疗；对照组单用氨茶碱，用法与治疗组相同。结果治疗组显效率、总有效率分别为62．96％和88．89％，对照组分别为17．24％、37．93％。两组显效率、总有效率比较差异均有统计学意义（P均〈0．05）。结论纳洛酮与氨茶碱联合治疗早产儿原发性呼吸暂停疗效优于单用氨茶碱。     

纳洛酮治疗早产儿原发性呼吸暂停的临床观察

目的 观察纳洛酮治疗早产儿原发性呼吸暂停的疗效将116例患儿随机分为治疗组72例,对照组44例.治疗组加用纳洛酮治疗,对照组采用氨茶碱治疗.结果 治疗组和对照组总有效率分别为95.8%、68.2%,显效率分别为63.9%、40.9%,两组比较差异有显著性(P＜0.01).结论 纳洛酮治疗早产儿原发性呼吸暂停疗效显著.     

Update on Cochrane data on paediatric respiratory diseases

INTRODUCTION: Systematic reviews seek to describe and summarise the best evidence for a given intervention by pooling data from relevant quality clinical trials. The Cochrane Collaboration has fostered the development and dissemination of systematic reviews throughout the world. We have identified and summarised The Cochrane systematic reviews of relevance to the paediatric pulmonologist. METHODS: We performed an expert search of the Cochrane Database of Systematic Reviews using a combination of medical subject headings and free text terms relating to paediatric respiratory disease. RESULTS: The search identified 120 systematic reviews with interventions specific to children with some relevance to pulmonary disease, and 327 reviews with interventions relating to pulmonary disease in adults and children. After pragmatic exclusions, 81 reviews were sorted by disease and 59 of these are discussed in detail. CONCLUSIONS: There are now many systematic reviews that make a positive contribution to paediatric pulmonology. The majority of reviews (69%) found evidence that either confirmed or refuted an accepted practice. The remaining reviews concluded that the evidence for an accepted practice is poor and sometimes wholly absent. Clinicians must be aware that lack of evidence of effect is not the same as evidence of lack of effect. Caution must be exercised before applying the conclusions of systematic reviews based upon adult data to childhood disease.     

不同气体条件对腹膜形态影响的实验研究

目的 在体实验研究提示,CO2气腹后,腹膜结构出现改变.本实验研究不同气体条件对腹膜形态的影响,探讨CO2气腹对腹腔肿瘤细胞影响的潜在机制.方法 在体实验:乳猪14头,年龄7～14 d,体重2～4 kg.随机分为两组:CO2气腹组(CO2组,n=7),N2O气腹组(N2O组,n=7).分别行100%CO2及100%N2O气腹,气腹时间为4 h,气腹压力为12 mm Hg.实验结束,采集腹膜标本.离体实验:C57BL/6小鼠10只,年龄4周左右,经0.125%胰酶预处理后,通过腹腔灌洗分离培养小鼠腹膜间皮细胞.离体细胞随机分为三组:对照组(5%CO2组).100%CO2组,8 cm H2O压力100%CO2组.细胞培养至连续单层后,将细胞分别暴露于5%CO2、100%CO2及8cmH2O压力100%CO2中4 h.不同气体条件下腹膜及分离培养的间皮细胞行电镜观察.结果 在体实验腹膜电镜结果提示压力12 mm Hg的100%CO2气腹维持4 h,导致腹膜间皮细胞层破坏,基底膜暴露,仅存细胞骨架;相同条件的100%N2O气腹使间皮细胞间隙增大,部分区域基底膜暴露.离体实验观察100%CO2破坏间皮细胞微绒毛,压力下的100%CO2对问皮细胞影响更加明显.结论 100%CO2使在体腹膜及离体间皮细胞超微结构发生明显改变,因此,小鼠模型中发现的CO2气腹后神经母细胞瘤转移增加可能与间皮细胞屏障削弱有关.

Abstract：

Objective Electron microscopic studies have shown significant morphologic changes of peritoneum after CO2 pneumoperitoneum in vivo. This experiment was to assess the effect of different gas on the morphology of peritoneum and the underlying mechanism of CO2 pneumoperitoneum on tumor cells. Methods In vivo, fourteen piglets (2-4 kilogram in weight, 7-14 days of age) were equally divided into the CO2 group(n = 7) and N2O group(n = 7). 100% CO2 or 100% N2O pneumoperitoneum was infused for 4 hours. Pneumoperitoneum pressure was 12 mmHg. At the end of the experiment, the samples of peritoneum were collected. In vitro, primary murine peritoneal mesothelial cells were36 collected by peritoneal lavage from ten C57BL/6 mice (4 weeks of age) after 0. 125% trypsin pretreatment. Isolated cells were divided into three groups: control group (5% CO2),100% CO2 group and 8 cm H2O pressure &. 100% CO2 group. After monolayers of mesothelial cells were established, cells were cultured with 5%CO2, 100% CO2 and 100% CO2 with 8 cm H2O pressure for 4 hours. Peritoneum and isolated mesothelial cells were examined by scanning electron microscopy. Results Scanning electron microscopy investigation suggested in vivo, 12 mmHg 100% CO2 pneumoperitoneum for 4 hours destroyed mesothelial cells layer of peritoneum, exposing the basal lamina. In contrast, 100% N2O pneumoperitoneum leaded to an increase of intercellular gaps and the basal lamina was exposed in part areas under same pressure and duration. In vitro, 100% CO2 exposition was associated with a significant destruction of the microvilli formation of isolated mesothelial cells. 100% CO2 with 8 cm H2O pressure had more significant impact on mesothelial cells. Conclusions The peritoneal mesothelial cells lose their typical cell morphology when exposed to 100% CO2. Thus, the increased neuroblastoma metastasis observed after CO2 pneumoperitoneum in mice might be related to an impaired mesothelial barrier function.     

Passive smoking by asthmatics: its greater effect on boys than on girls and on older than on younger children

In 415 nonsmoking asthmatic children who were seen consecutively, asthma symptoms were more severe if the mother was a smoker than if she was a nonsmoker. This applied to both sexes but was more marked in boys than in girls. There were also other indications that sons were the more severely affected: the forced expiratory volume at 1 second, the forced expiratory flow rate during the middle half of the forced vital capacity, and the provocation concentration of histamine needed to result in a 20% decrease in the forced expiratory volume at 1 second were significantly decreased only in the sons, and lung function test results were significantly less in sons than in daughters of mothers who smoked. When the 415 children were stratified according to age, lung function improved significantly with increasing age in the children of nonsmokers; in children of smokers, by contrast, symptoms and lung function test results became progressively worse. As well, there was a correlation between these indications of asthma severity and the number of years the child had been exposed to the mother's smoke. It appeared that, compared with girls, boys were more sensitive to passive smoking, and that its adverse effect increased with age and with duration of exposure.     

Perspectives on dyslexia

Dyslexia, or a reading disability, occurs when an individual has significant difficulty with speed and accuracy of word decoding. Comprehension of text and spelling are also affected. The diagnosis of dyslexia involves the use of reading tests, but the continuum of reading performance means that any cutoff point is arbitrary. The IQ score does not play a role in the diagnosis of dyslexia. The cognitive difficulties of dyslexics include problems with speech perception, recognizing and manipulating the basic sounds in a language, language memory, and learning the sounds of letters. Dyslexia is a neurological condition with a genetic basis. There are abnormalities in the brains of dyslexic individuals. There are also differences in the electrophysiological and structural characteristics of the brains of dyslexics. Physicians play a particularly important role in recognizing children who are at risk for dyslexia and helping their parents obtain the proper assessment.