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一般资料:选择2005-02—2006-06在本院住院的下呼吸道感染的患儿85例,年龄为2个月至6岁,其中男56例,女29例,病程<5d。按入院日期分为两组,对照组42例,其中支气管肺炎22例,支气管炎15例,毛细支气管炎5例;治疗组43例,其中支气管肺炎23例,支气管炎14例,毛细支气管炎6例。两组均符合《诸福棠实用儿科学》第6版关于支气管肺炎、支气管炎、毛细支气管炎的诊断标准。两组患儿均表现有发热、咳嗽、喘息、肺部听诊可闻及干性啰音和(或)湿性啰音阶榛级谀炅洹⒉〕獭⒓膊」钩伞?病情等方面差异无统计学意义(P>0.05)。方法:对照组给予抗感染、吸氧、…     

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??Objective??To investigate the change of the platelet state and function in acute lymphocytic leukemia. Methods??The changes of platelet indices??PLT??PCT??MPV??PDW????immature platelet fraction??IPF%????immature platelet counts??IPC????granule membrane glycoprotein of platelet ??CD62p?? and PAC-1 were obtained by using automatic blood cell analyzer and whole blood flow cytometry??FCM?? respectively??in children with acute lymphocytic
leukemia??ALL????ALL in first complete remission ??ALL-CR1?? and children undergoing elective surgical procedure??control group??. Results????1??Without addition of platelet agonists ADP??expression of platelet surface activated CD62p and PAC-1 in ALL was higher than that in control group??P??0.05????while expression of platelet surface activated PAC-1 in ALL-CR1 was higher than that in control group??P??0.05????and lower than that in ALL??P??0.05??????2??With addition of platelet agonists ADP??expression of platelet surface activated CD62p and PAC-1 in ALL was lower than that in control group??P??0.05????while expression of platelet surface activated PAC-1 in ALL-CR1 was lower than that in control group??P??0.05????and higher than that in ALL??P??0.05??????3?? PLT??PCT and MPV in ALL was lower than that in control group and ALL-CR1 ??P??0.05??????4?? IPF% in ALL was higher than that in control group and ALL-CR1??P??0.05????and IPC was lower than that in control group and ALL-CR1??P??0.05??. Conclusion??The children who are newly diagnosed with acute lymphocytic leukemia have peripheral platelet reactivity and platelet function defects. Platelet indices and platelet membrane glycoprotein can be used as effective indicators to judge the effect on ALL.     

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特应性皮炎(atopic dermatitis,AD)是儿童常见皮肤病,多于婴幼儿时期发病。近三四十年,随着环境变化和全球工业化快速发展,AD患病率呈逐年上升趋势,在发达国家影响了20%～30%的儿童[1]。我国1988—1989年上海地区7～18岁中小学生AD患病率为0.46%,1998年城市6～20岁年龄段AD患病率为0.62%,2002年1～7岁儿童AD患病     

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所谓食物过敏是指由免疫机制介导的某种食物或食品添加剂等引起肠道内或全身的变态反应;而不由免疫介导的反应则称之为食物不耐受[1]。食物过敏又进一步分为IgE介导和非IgE介导的反应,前者属于Ⅰ型变态反应,常在进食后数分钟内出现症状,可以累及皮肤、呼吸道、消化道,这些症状常常同时出现,但无特异性。非IgE介导的食物过敏涉及了IgG、免疫复合物及细胞介导的免疫反应等多种机制,常于进食后数小时或数天后出现症状[2-3]。食物过敏在儿童中的发病率较成人高,据欧洲和美国的资料,7%8%3岁以下儿童曾发生过食物过敏,1岁以内婴儿牛奶过敏发生…     

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目的了解单次小剂量(0.4g/kg)静脉输注免疫球蛋白(IVIG)提升初发免疫性血小板减少性紫癜(ITP)患儿血小板至安全范围(≥30×109/L)的作用。方法研究对象为北京大学第一医院儿科2008-04-01—2011-04-01收治初发ITP患儿62例,其中2008-04-01—2009-10-01收治的30例为激素组,初始接受常规剂量醋酸泼尼松治疗;2009-10-02—2011-04-01就诊的32例为IVIG组,初始接受0.4g/(kg·d)IVIG治疗1～5d,每天复查血常规,血小板升至安全范围则规范停用。比较两组治疗第1、3、5天时血小板升至安全范围比例及长期随访结果。结果治疗前,激素组和IVIG组血小板中位值分别是10×109/L和6×109/L。治疗1d后两组血小板升至安全范围的比例分别是3.33%和43.75%,差异有统计学意义(P<0.01)。随访7～42个月后激素组和IVIG组分别有3.45%和3.23%血小板未升至正常(≥100×109/L)。所有患儿均无颅内出血发生及死亡。结论单次小剂量IVIG可使近半数初治ITP患儿血小板升至≥30×109/L相对安全范围,明显高于常规剂量醋酸泼尼松疗效。     

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目的探讨难治性癫癎持续状态(RSE)的临床特征,提出可能早期预测RSE的因素。方法回顾性对比分析2001-01—2004-03重庆医科大学附属儿童医院52例癫癎持续状态(SE)住院患儿的临床资料。结果(1)52例SE中,29例呈RSE。(2)23例SE中22例为强直-阵挛(GTCS)发作,1例为混合发作;29例RES中14例为GTCS发作,2例强直性发作,4例部分运动性发作,1例复杂部分性发作,8例混合性发作。(3)52例中,23例非RSE病例对安定和(或)苯巴比妥治疗有效。RSE组中,药物治疗有效19例,其中对安定和(或)苯巴比妥治疗有效15例(78·9%);安定+硫喷妥钠1例(5·3%);氯硝安定1例(5·3%);利多卡因2例(10·5%)。结论(1)在儿童SE中,RSE发生率高。(2)局限性发作、强直发作、混合性发作多提示SE可能呈RES。(3)安定静脉注射联合苯巴比妥肌注是治疗SE的首选用药。对首次使用安定不敏感的RSE,重复使用的有效率低,可尽早考虑换用二线抗癫癎药物,利多卡因不失为治疗RSE的有效方法。     

儿童化脓性脑膜炎108例临床分析

目的探讨化脓性脑膜炎(化脑)的临床特点,为进行更好的临床治疗提供依据。方法对本院2006年9月—2008年9月收治的108例化脑患儿的临床资料进行回顾性分析。结果化脑多数表现典型,但年龄较小的婴儿易出现非特异性表现而延误诊断。脑脊液和血培养阳性49例,以葡萄球菌及肺炎链球菌为主,其中耐青霉素菌株较多,对三代头孢、万古霉素、氯霉素等敏感。应用联合抗生素、地塞米松及对症治疗,化脑好转、治愈率高,但后遗症仍较多。结论对患儿病情进行全面分析并结合脑脊液检查,可早期诊断化脑;采用敏感有效的抗生素、辅以地塞米松等治疗,是好转的关键,需警惕并发症及后遗症的发生。     

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??Objective??To explore the clinical characteristics of hydrocephalus in children with purulent meningitis. Methods??The children??aged??14 years??treated for purulent meningitis at the Shengjing Hospital of China Medical University during the period from January 2010 to December 2016??were retrospectively enrolled in the study. The clinical data of every child who fulfilled the criteria were obtained and analyzed. Data were analyzed using the Statistical Package for Social Sciences??SPSS??13.0. Results??The morbidity of hydrocephalus in children with purulent meningitis was 9.36%??25/267??. In these cases with hydrocephalus??the ageofonset was mainly under 6 months old??and the period from onset to diagnosis of hydrocephalus was mainly 1-4 weeks. Fifteen cases of hydrocephalus had a confirmed bacterial etiology as follows??Escherichia coli??n??6????Streptococcus pneumoniae??n??2????staphylococcus??n??2????Group B beta-hemolytic streptococcus??n??2????acinetobacter??n??2??and Listeria monocytogenes??n??1??. The incidence of obstructive hydrocephalus was 48%??12/25??. About 56% patients received a previously treatment with antibiotics. The prognoses of these children were??survival in 12 cases??death in 1 case and loss of follow-up in 11 cases. The related factors of the development of hydrocephalus included??a rural living situation??OR??17.64??95%CI 1.23??252.86????altered level of consciousness??OR??7.59??95%CI 1.09??52.86????CSF protein??2.0 g/L??OR??177.02??95%CI 3.53??8866.51????C-reactive protein??100 mg/L??OR??52.29??95%CI 3.26??840.19????initial therapy with dual-agent antibiotic??OR??0.06??95%CI 0.01??0.62????dexamethasone use??OR??149.47??95%CI 2.56??8713.78?? and previous treatment with antibiotics??OR??36.28??95%CI 2.84??462.78??. Conclusion??Hydrocephalus is a serious complication of purulent meningitis. The severe clinical manifestations and significantly abnormal laboratory indexes represent the most important predictor of hydrocephalus in children with purulent meningitis.     

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??Objective??To investigate the risk factors of purulent meningitis complicated with subdural effusion in infants and young children. Methods??The clinical data of the infants and young children who were diagnosed with purulent meningitis in PICU of Shengjing Hospital of China Medical University from January 2014 to December 2017 were analyzed retrospectively. All of them were divided into 2 groups according to whether there was complication of subdural effusion. The statistical data were analyzed by SPSS 20.0 software. Results??There were significant differences in hemoglobin??C reactive protein and protein in cerebrospinal fluid between control group and subdural effusion group??P??0.05??. Logistic regression analysis showed that hemoglobin??OR??0.940??95%CI??0.899—0.998????C reactive protein??OR??1.015??95%CI??1.004—1.028?? and protein in cerebrospinal fluid??OR??2.490??95%CI??1.151—6.315?? were independent risk factors for purulent meningitis complicated with subdural effusion??P??0.05??. Conclusion??Infants and young children diagnosed with purulent meningitis are with lower hemoglobin. Higher C reactive protein and higher protein in cerebrospinal fluid are likely to be complicated with subdural effusion.     

新生儿不同病原菌化脓性脑膜炎临床分析

目的探讨新生儿不同病原菌化脓性脑膜炎的临床特征。方法回顾性分析2011年1月1日至2012年12月31日172例新生儿化脓性脑膜炎患儿的临床资料。结果脑脊液外观浑浊和脓性54例(31.4%);脑脊液培养阳性70例(40.7%),以大肠埃希菌、葡萄球菌为主;并发症31例(18.0%),其中脑积水14例(8.1%)。大肠埃希菌脑膜炎组与其他病原菌组、不明病原菌组比较,脑脊液外观异常比例、脑脊液白细胞计数、脑脊液白细胞计数500×106/L比例、脑脊液糖和蛋白水平、发热持续时间、脑脊液恢复正常时间、住院时间和费用、并发症和死亡的比例差异有统计学意义(P均0.05)。结论对于脑脊液外观呈浑浊和脓性,尤其脑脊液白细胞数500×106/L时,需重点考虑大肠埃希菌感染可能,其并发症多、病死率高,预后相对较差。     

小儿化脓性脑膜炎临床和病因学分析

目的探讨化脓性脑膜炎的病因,为诊治提供科学依据。方法收集住院化脓性脑膜炎患儿371例,男252例,女119例;平均年龄(2.67±3.32)岁。对患儿临床表现及血液和脑脊液(CSF)相关参数进行分析。结果 371例中≤1岁患儿占46.36%,<3岁占80.59%,以发热(90.29%)、抽搐(52.56%)等症状就诊。82.21%患儿白细胞计数(WBC)>10×109/L,74.42%患儿中性粒细胞比率>50%,85.44%患儿脑脊液WBC≥500×106/L。血培养革兰染色阳性(GSP)37例,革兰阳性菌(GPB)24例,革兰阴性菌(GNB)13例。脑脊液培养阳性34例,GPB 19例,GNB 15例。脑脊液检测出肺炎链球菌8例,流感嗜血杆菌3例,奈瑟菌1例。死亡7例(1.88%)中,脑脊液2例GNB阳性,5例化脓性/混浊,4例蛋白>150 mg/dl和葡萄糖<1 mg/dl。结论化脓性脑膜炎的发病年龄多在婴幼儿阶段,临床表现多种多样,血液和脑脊液相关参数分析,能较好的提供病因诊断依据,并为临床治疗及预后提供参考。     

小儿病毒性脑膜炎病原诊断与临床分析

应用酶联免疫吸附（ELISA）方法，对88例临床诊断病毒性脑膜炎患儿急性期及恢复期脑脊液进行了单纯疱疹病毒（HSV－I、HSV－Ⅱ）、柯萨奇B组病毒（CoxBV）、埃可病毒（ECHO）、EB病毒（EBV）、腺病毒（AdV)及流感病毒（IFV）特异性IgM抗体检测。结果表明：HSV、CoxBV、ECHO、EBV、AdV、IFV病毒感染率分别为9．09％、18．18％、22．72％、3．41％、4．54％、5．68％；HSV及EBV感染致残率及病死率分别为87．5％（7／8）和100％（3／3）。提示脑脊液中病毒特异性IgM抗体检测可作为早期病原诊断的指标之一；CoxBV及ECH病毒是本地区小儿中枢神经系统病毒感染的主要病毒；HSV及EBV感染致残率及病死率较其它病毒高，预后不良；早期阿昔洛韦治疗，可大大降低病死率。     

伤寒沙门氏菌化脓性脑膜炎1例报告

临床资料患儿,男,3个月。因解稀烂便伴反复发热4d于2004年10月9日晚入院。入院前4d无明显诱因出现大便次数增多,由原来2～3次／d增至3～4次／d,为黄色稀烂便或泡沫样便,初有1次带少量血丝,无粘液、脓液,伴反复发热,体温波动在38℃～39℃间。曾诊断上呼吸道感染（胃肠型）给予磷霉素抗感染等治疗2d后上述症状未好转,转入本院前半天出现阵发性哭闹,吃奶减少,尿量减少,大便次数无增加。起病以来无鼻塞、流涕、咳嗽、气促、抽搐、意识障碍、腹胀等症状,精神、食欲欠佳,体重无明显改变。     

不同年龄化脓性脑膜炎临床特点及致病菌分析

了解不同年龄阶段儿童化脓性脑膜炎临床表现和致病菌的差异,为临床诊治提供依据。方法 　回顾分析天津市儿童医院2004年1月至2008年12月诊 断的173例儿童化脓性脑膜炎的临床资料,并按发病年龄分为4组,第1组为生后5～28 d的新生儿48例（27.8%）,第2组为＞28 d～12月龄婴儿73例（42.2%）,第 3组为＞1～5岁幼儿22例（12.7%）,第4组为>5岁儿童30例（17.3%）,比较4组临床特点及主要致病菌差异。结果　第1组66.7%患儿表现低热或中等程度发热,症 状体征不典型。第2组抽搐、前囟膨隆、更改经验治疗、合并症发生率高于其他3组（P <0.01）。第3组临床特点介于婴儿期和儿童期之间。第4组脑膜刺激征、头 疼发生率高于其他各组,均为93.3%（P <0.01）,且第4组伴发身体解剖结构的缺陷所致脑脊液漏或外科手术后患者多达27.3%。63例脑脊液致病菌培养阳性,总 阳性率36.4%,各组第1位致病菌分别为大肠埃希菌、凝固酶阴性葡萄球菌、脑膜炎奈瑟菌和肺炎链球菌。结论　儿童化脓性脑膜炎不同年龄阶段的临床表现各有 特点,致病菌谱也存在一定差异。临床诊治应根据发病年龄区别对待,提高针对性。     

新生儿无乳链球菌败血症合并脑膜炎12例临床分析

目的探讨无乳链球菌(GBS)败血症合并脑膜炎新生儿的临床表现、治疗及预后情况。方法回顾性分析2012年1月至2015年5月收治的12例无乳链球菌脑膜炎新生儿的临床资料。结果 12例患儿中,男女各6例,均为足月儿,早发型4例、晚发型8例,顺产7例、剖宫产5例,母亲均无明显感染病史,亦未行常规GBS筛查。新生儿血降钙素原均升高。头颅磁共振(MRI)可见脑膜强化,5例硬膜下积液,3例脑实质受累。1例单用青霉素,1例应用美罗培南之后降阶梯单用青霉素效果良好,大部分患儿需联合用药。随访20~29个月,1例语言发育落后,2例运动发育落后,其余9例发育正常。结论新生儿无乳链球菌败血症合并脑膜炎病情危重,需及时应用敏感抗生素,必要时联合用药。建议完善产前筛查。     

新生儿化脓性脑膜炎并发脑白质损伤危险因素分析

目的探讨新生儿化脓性脑膜炎并发脑白质损伤(WMD)的临床特点及高危因素。方法回顾分析2008年1月至2018年1月收治的诊断为新生儿化脓性脑膜炎的足月新生儿的临床资料。结果 170例足月化脓性脑膜炎新生儿中,32例(18.82%)合并WMD(WMD组),其中男20例、女12例,平均胎龄(38.71±1.14)周,出生体质量(2.94±0.26)kg;另138例患儿未并发WMD(对照组),男80例、女58例,平均胎龄(38.62±1.04)周,出生体质量(2.97±0.25)kg。两组患儿性别、胎龄、出生体质量的差异无统计学意义(P0.05)。170例患儿中60例(35.29%)明确细菌病原学诊断,其中革兰阴性杆菌25例、革兰阳性球菌35例。WMD组的洋葱伯克霍菌阳性率高于对照组,差异有统计学意义(P0.05)。两组间革兰阳性球菌及阴性杆菌的阳性率差异无统计学意义(P0.05)。WMD组同年龄组异常脑电图以及听力损害发生率均高于对照组,差异有统计学意义(P0.05)。惊厥(OR=5.28,95%CI:1.80～15.56)、脑脊液白细胞升高(OR=4.22,95%CI:1.47～12.07)、脑脊液乳酸脱氢酶升高(OR=3.64,95%CI:1.11～11.99)、细菌培养阳性(OR=3.12,95%CI:1.13～8.62)为足月新生儿化脓性脑膜炎并发WMD的独立危险因素。ROC曲线显示,脑脊液白细胞(AUC=0.707)、脑脊液乳酸脱氢酶(AUC=0.672)对于预测化脓性脑膜炎并发WMD有一定准确性。结论新生儿化脓性脑膜炎惊厥表现,脑脊液白细胞、乳酸脱氢酶升高可能为并发WMD的高危因素。