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危重儿常伴应激性高血糖,这种急性一时性的高血糖可产生有害的病理生理效应。在重症监护病房已经推广应用强化胰岛素治疗应激性高血糖并取得较好的疗效,但在儿童应用仍存在争议。在儿科重症监护病房推行强化胰岛素治疗,根据不同的年龄段采用不同的血糖控制目标从而调节胰岛素的用量,较好的控制了血糖,减少了死亡率及并发症的发生率,促进疾病恢复,改善预后。 相似文献
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危重症患儿应激性高血糖的研究进展 总被引:1,自引:0,他引:1
欧少阳 《中国小儿急救医学》2010,17(2)
危重症患儿在应激状态下可出现应激性高血糖,而持续的高血糖可以引起一系列的有害后果.目前认为应激性高血糖的机制与危重症患儿在应激时神经内分泌的改变有关.危重疾病时发生胰岛素抵抗可能与胰岛素受体功能异常、受体后信号转导、葡萄糖转运及细胞内代谢障碍等因素有关.应激性高血糖治疗原则为积极治疗原发病,同时应通过严格控制补液以控制高糖性高渗状态. 相似文献
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目的探讨极化液治疗儿童应激性高血糖的疗效。方法应激性高血糖患儿30例随机分成极化液治疗组和对照组,每组各15例。在综合治疗基础上,治疗组予极化液降糖,对照组仅将葡萄糖输入量严格控制在4mg/(kg·min)以下。监测二组患儿治疗前、入院8~12h、第2、3天血糖。同时应用简化小儿危重病例评分法进行病情评估。结果入院时、入院8~12h、第2、3天血糖值,治疗组分别为(20.7±5.02)、(11.98±3.13)、(7.55±1.94)、(5.12±1.04)mmol/L,对照组分别为(19.16±4.49)、(14.89±3.42)、(10.7±2.63)、(5.95±1.33)mmol/L。与入院时血糖比较,治疗组血糖下降较快;8~12h及第2天二组血糖下降比较差异有显著性意义(Pa〈0.01);第3天,二组血糖下降比较差异无显著性意义(P〉0.05)。二组入院时危重状态及极危重状态各分别为7和8例;第2天,治疗组3例仍为危重状态,其余转为非危重,转安率为80%;对照组尚有7例危重,2例极危重,转安率为40%,二组转安率比较差异有显著性意义(P〈0.05)。第3天,治疗组均转为非危重,对照组尚有2例危重状态、1例极危重状态。二组转安率分别为100%、80%,二组比较差异无显著性意义(P〉0.05)。结论应用极化液治疗儿童应激性高血糖安全有效,经济简便,利于疾病恢复。 相似文献
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目的 了解危重儿全身炎症反应综合征 (SIRS)时高血糖发生情况。 方法 收集SIRS患儿 2 10例 ,分为应激性高血糖 (SHG)组和无应激性血糖 (NSHG)组。 结果 SHG组在SIRS严重程度、多器官功能障碍 (MODS)发生率、病死率均高于NSHG组。 结论 SHG可影响SIRS的病程进展及转归 相似文献
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应激性高血糖与胰岛素拮抗研究的进展 总被引:40,自引:0,他引:40
许峰 《国外医学:儿科学分册》1994,21(4):195-197
高血糖是危重病应激代谢变化的重要特征,新近研究发现,应激时机体除血糖升高外,同时可伴有糖耐量减低,高胰岛素症和外周细胞对胰岛素不敏感,并提出了胰岛素拮抗机制在其发病机制中的,作用本文就危重病在这方面的研究情况作一简要概述。 相似文献
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应激性高血糖与胰岛素拮抗研究的进展 总被引:10,自引:0,他引:10
高血糖是危重病应激代谢变化的重要特征,新近研究发现,应激时机体除血糖升高外,同时可伴有糖耐量减低,高胰岛素血症和外周组织对胰岛素不敏感,并提出了胰岛素拮抗机制在其发病机制中的作用,本文就危重病在这方面的研究情况作一简要概述。 相似文献
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危重病患儿心肌损伤的临床研究 总被引:5,自引:0,他引:5
目的 通过对危重病患儿血清肌钙蛋白T(cTnT)的测定 ,以了解危重患儿心肌损伤的发生率及其临床特点。方法 用ELISA法对 32例入住复旦大学附属儿科医院PICU的危重患儿分别于 2 4、4 8和 72h内测定血清cTnT水平 ,其中 2 7例患儿危重评分 (PCIS)≤ 80分 ,5例因呼吸衰竭直接插管机械通气 ,PCIS >80分。结果 危重病患儿收住PICU后 2 4、4 8、72h内血清cTnT测定值分别为 (0 4 39± 0 84 5 ) μg/L、(0 375± 0 6 15 ) μg/L及(0 2 37± 0 35 1) μg/L ,均显著高于正常对照组的 (0 0 6 2± 0 0 2 8) μg/L。心肌损伤发生率为 5 3 1% (17/ 32 ,95 %可信限CI:34 7%~ 70 9% )。心肌损伤组与非心肌损伤组的病死率差异无显著性 ,PCIS与心肌损伤发生也无相关性。结论 危重病患儿心肌损伤发生率较高 ,其与临床预后及PCIS的关系有待深入研究。 相似文献
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重症病毒性脑炎患儿内环境紊乱的临床研究 总被引:16,自引:2,他引:14
目的 探讨重症病毒性脑炎 (VE)患儿应激性高血糖 (SHG)和电解质紊乱与病情发展的关系 ,并探索重症VE患儿血糖及血清钾、钠、钙的变化及其相互关系。方法 对 1999年 10月至 2 0 0 1年 5月吉林大学第一医院 5 8例重症VE患儿进行血糖及血清钾、钠、钙动态检测 ,并以 2 0例轻症VE患儿为对照组进行比较。结果 重症VE患儿易于发生SHG、低钠血症 (HN)、低钾血症 (HK )、低钙血症 (HC)。血糖的升高 ,血钠、血钙的降低与VE患儿病情轻重关系密切 ,随VE进入恢复期 ,存活者上述指标逐渐恢复正常。结论 重症VE患儿存在应激损伤 ,机体的过度应激反应亦可引起血清电解质的改变 ,由此加重内环境紊乱 ,故控制过度应激反应、稳定内环境对重症VE患儿十分有利 相似文献
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目的通过测定各项炎症指标、检测病原体及分析预后与转归,探讨合并脓毒症对判断肺炎患儿病情轻重的意义。方法选取2008年1月至7月在中国医科大学附属盛京医院小儿呼吸急救内科病房住院的1个月至13岁的73例肺炎患儿为研究对象,将其按病情分为脓毒症组和非脓毒症组,所有患儿于入院24h内测定C-反应蛋白(CRP)、血糖、心肌酶及其他生化指标,并进行细菌培养。积极给予患儿抗生素及对症支持治疗,及时进行抗生素调整,动态观察患儿的器官衰竭情况。结果 (1)非脓毒症组器官衰竭的发生率为15.4%,其中无死亡病例,而脓毒症组患儿器官衰竭发生率为38.2%,两组之间的比较差异有统计学意义(P<0.05)。脓毒症组有4例发生了多脏器功能衰竭(MODS),1例发生了急性呼吸窘迫综合征(ARDS),且有5例为死亡病例。(2)非脓毒症组病例中,23.08%CRP升高,25.64%血乳酸升高,7.69%血糖升高。脓毒症组有85.29%CRP升高,73.53%血乳酸升高,58.82%血糖升高,两组之间炎症指标异常情况;发生率差异有统计学意义(P<0.01)。(3)非脓毒症组患者的细菌培养结果均为阴性,脓毒症组细菌培养阳性15例,其中痰细菌培养... 相似文献
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危重患儿神经系统异常回顾分析 总被引:3,自引:0,他引:3
目的 了解神经系统异常在儿科危重2患儿中的发病情况及其预后的关系。方法 对PICU113例危重患儿神经系统异常的病因、预后及临床表现特点进行回顾性分析。结果 神经系统异常发生率54%,其中原发病为神经系统疾病者占63.8%,非神经系统疾病发生神经系统合并症者占36.1%;有神经系统异常者病死率(36.1%)明显高于无神经系统异常者(5.8%),而原发病为神经系统疾病患儿病死率(33.0%)与非神经系统疾病发生神经合并症者患儿病死率(40.9%)比较,差异无显著性。结论 神经系统异常是影响儿科危重病预后的一个重要因素。 相似文献
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刘春峰 《中国实用儿科杂志》2012,27(5):352-356
1脓毒症赵莹等[1]对收住儿童重症监护室(PICU)的73例重症肺炎进行分析,发现未合并脓毒症组器官衰竭发生率为15.4%,无多脏器衰竭(MODS)及死亡病例,而脓毒症组器官衰竭发生率为38.2%,远高于非脓毒症组,脓毒症组有4例发生MODS,1例发生急性呼吸窘迫综合征(ARDS),且 相似文献
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Heying R Seghaye MC Grabitz RG Kotlarek F Messmer BJ von Bernuth G 《Acta paediatrica (Oslo, Norway : 1992)》1999,88(11):1238-1243
Multiple system organ failure after cardiac surgery in children is a severe complication with unknown mid- and long-term sequelae. We therefore evaluated 11 children (aged 20-126 mo, median: 67 mo) having survived multiple system organ failure after cardiac operations for congenital cardiac defects in a cross-sectional follow-up study 12-76 mo (median: 32 mo) after surgery. Clinical and laboratory examinations included cardiac, pulmonary, renal, hepatic, neurological and psychological function tests. All patients had adequate cardiac function. Lung mechanics were abnormal in three children and glomerular renal function was abnormal in two patients. Slight elevation of gamma-glutamyl transpeptidase and coagulation factor deficiency was present in six and seven patients, respectively (five of whom had undergone the Fontan operation). Severe neurological sequelae such as diplegia (n = 1) and mental retardation (n = 1) were observed in two patients. In addition, five children presented delayed motor, graphomotor and/or speech development. Two children were found to have abnormal intelligence. We conclude that with the exception of neurological impairment, mid-term sequelae of multiple system organ failure after cardiac surgery in children are mild. However, longer follow-up using an appropriate control group is mandatory. 相似文献
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儿童炎症性肠病53例临床分析 总被引:11,自引:2,他引:11
目的 探讨儿童炎症性肠病 (IBD)的临床特点 ,以提高儿童IBD的诊治和管理水平。方法 对 1992~2 0 0 2年 5 3例IBD患儿的临床资料进行回顾性分析。结果 IBD的患病率逐渐增加 ,5 3例IBD中克罗恩病 (CD)2 6例 ,溃疡性结肠炎 (UC) 2 7例。 2 7%的CD和 4 5 %的UC发病在 6岁以下 ,有 5例 (19% )UC发病在 1岁以内 ;男女性别无显著性差异 (P >0 0 5 ) ;发病至确诊平均时间CD为 5 0周 ,UC为 4 8周。临床表现CD以发热、腹痛为主要表现 ,UC以腹泻、便血为主要表现 ;胃肠外表现CD可见口腔溃疡、关节炎等 ,UC可见肛周病变、口腔溃疡等 ,两组患儿生长发育障碍的发生率均较高 (CD 6 5 % ,UC 5 9% ,P >0 0 5 )。病理改变CD以破坏和慢性增殖改变并存为特点 ,病灶均累及回肠末端及回盲部 ;而UC以急性炎症和渗出为主 ,病灶均累及直肠。外科合并症的发生率CD为 15 4 % ,UC为 14 8% ;儿童IBD治疗效果不满意 ,短期缓解率CD为 5 9% ,UC为 5 6 %。结论 IBD可以累及包括婴幼儿在内的各年龄组儿童 ,诊断的滞后以及缺乏系统的管理是临床亟待解决的问题。 相似文献
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Effects of prior hypoglycemia and hyperglycemia on cognition in children with type 1 diabetes mellitus 总被引:1,自引:0,他引:1
Perantie DC Lim A Wu J Weaver P Warren SL Sadler M White NH Hershey T 《Pediatric diabetes》2008,9(2):87-95
Objective: Despite the general consensus that youth with type 1 diabetes mellitus (T1DM) can experience modest cognitive impairment, debate continues over the role of severe hypoglycemia (Hypo) and/or hyperglycemia (Hyper) in producing such impairment. Our aim was to determine how Hypo and Hyper experienced during brain development predict patterns of subsequent cognitive performance in youth with T1DM.
Methods: We tested youth aged 5–16 yr (T1DM, n = 117; non-diabetic sibling controls, n = 58) on cognitive tasks (verbal and spatial intelligence, verbal and spatial memory, and processing speed). T1DM participants were categorized as having experienced 0, 1–2, or 3 or more (3+) Hypo episodes, as having their first Hypo episode before or after 5 yr of age and as having early (before age 5) or late (after age 5) diabetes onset. Hyper exposure was estimated with median hemoglobin A1c, adjusted for diabetes duration for each subject.
Results: The group with T1DM had lower estimated verbal intelligence than sibling controls. Within the T1DM group, verbal intelligence was reduced with increased exposure to Hyper, not to Hypo. In contrast, spatial intelligence and delayed recall were reduced only with repeated Hypo, particularly when Hypo episodes occurred before the age of 5 yr. Age of onset did not explain these results.
Conclusions: Hypo and Hyper have qualitatively different effects on cognitive function in T1DM that depend in part on the timing of exposure during development, independent of onset age. This information extends the known benefits of avoiding both Hypo and chronic Hyper during childhood to include preservation of specific cognitive skills. 相似文献
Methods: We tested youth aged 5–16 yr (T1DM, n = 117; non-diabetic sibling controls, n = 58) on cognitive tasks (verbal and spatial intelligence, verbal and spatial memory, and processing speed). T1DM participants were categorized as having experienced 0, 1–2, or 3 or more (3+) Hypo episodes, as having their first Hypo episode before or after 5 yr of age and as having early (before age 5) or late (after age 5) diabetes onset. Hyper exposure was estimated with median hemoglobin A1c, adjusted for diabetes duration for each subject.
Results: The group with T1DM had lower estimated verbal intelligence than sibling controls. Within the T1DM group, verbal intelligence was reduced with increased exposure to Hyper, not to Hypo. In contrast, spatial intelligence and delayed recall were reduced only with repeated Hypo, particularly when Hypo episodes occurred before the age of 5 yr. Age of onset did not explain these results.
Conclusions: Hypo and Hyper have qualitatively different effects on cognitive function in T1DM that depend in part on the timing of exposure during development, independent of onset age. This information extends the known benefits of avoiding both Hypo and chronic Hyper during childhood to include preservation of specific cognitive skills. 相似文献
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小儿纤维胃镜1200例检查分析 总被引:10,自引:2,他引:8
为了探讨小儿上消化道疾病的发病率及儿童胃病的HP感染率,进行了临床1200例小儿纤维胃镜检查分析及855例胃粘膜HP检测总结,结果表明,1200例中疾病检出率为84.3%,其中以浅表性胃炎,十二指肠炎,消化性溃疡发病率最高,855例HP检测者中,HP阳性率为,浅表性胃炎64.4%,十二指肠炎69.4%,胃溃疡81.0%,十二指肠球部溃疡90.3%,且儿童HP感染情况多随着年龄的增长而增加。 相似文献
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目的 总结危重患儿并发胰腺坏死的临床特点和生物学标志.方法 分析本院2003年至2009年病理解剖证实胰腺发生坏死的5例患儿的临床表现、病理学检查结果.结果 5例患儿均为急性起病,均有发热,2例出现腹痛,2例有腹部膨隆、腹腔大量胀气、消化道出血等表现.4例患儿肝功能异常,以白蛋白降低明显,3例C反应蛋白升高.腹部超声无一例显示胰腺异常声像.尸检证实5例患儿的胰腺存在不同程度的坏死,并伴肾上腺、肝、肺、心、脾、肾、肠、胸腺、纵隔和肠系膜淋巴结等损害表现.5例患儿均在病情变化后36 h内死亡,2例死于胰腺急性出血坏死,3例在胰腺坏死的基础上发生多器官功能衰竭.结论 危重患儿并发胰腺坏死时,起病急,来势凶猛,病程短,易发生休克和多器官功能损害或衰竭.Abstract: Objective To summarize the clinical features and biological markers of critically ill children with pancreatic necrosis. Methods The clinical data of 5 ill children whose autopsy confirmed pancreatic necrosis in our hospital from 2003 to 2009 were collected and the pathological results were analyzed.Results Five cases appeared as acute onset and fever. Clinical manifestation of 2 cases included abdominal pain and 2 cases represented abdominal bulging,lots of flatulence and gastrointestinal bleeding. Four cases represented abnormal liver function and significant decrease of albumin,3 cases with increase of C-reactive protein. No case showed abnormal pancreas acoustic image of abdominal B-ultrasonography. Autopsy confirmed that 5 cases represented varying degrees necrosis of the pancreas, which complicated with the damage of adrenal gland,liver,lung,heart, spleen, kidney,intestine, thymus, mediastinal and mesenteric lymphnodes. All died in 36 hours after the children'conditions were changed. Two cases died of acute hemorrhagic necrosis of the pancreas,3 cases died of multiple organ failure based on pancreatic necrosis. Conclusion Pancreatic necrosis in critically ill children presents acute onset and short course,is prone to result in multiple organ damage or failure. 相似文献
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镇痛和镇静治疗是重症患儿综合治疗的重要组成部分,随着镇痛镇静理念的发展,新的镇痛、镇静药物也不断推出,瑞芬太尼由于具有半衰期短、不产生蓄积、对患儿重要器官影响较小、可控性较好、镇痛效果较好及起效快等特点,现已较多的应用于重症患儿。本文探讨瑞芬太尼在重症患儿中的应用优势。 相似文献