小潮气量肺保护通气策略在急性低氧性呼吸衰竭中的应用

目的探讨小潮气量(VT)和传统VT机械通气在急性低氧性呼吸衰竭(AHRF)治疗中的安全性的差异,评估小VT通气策略的疗效。方法将133例AHRF患儿分为传统VT通气组32例和小VT通气组101例,根据VT调整呼气末正压(PEEP),监测肺动态顺应性(Cdyn)、呼吸功(WOB)、呼吸道阻力(Raw)、呼吸道闭合压(P0.1)、肺泡气-动脉血氧分压差[p(A-a)(O2)]、氧合指数(OI)、血气分析等指标变化,观察患儿氧合改善情况、机械通气并发症发生、撤机情况以及患儿转归情况。结果 1.小VT组与传统VT组,Cdyn、Raw在上机1 d、3 d,WOB在上机3 d、5 d,P0.1在上机5 d、7 d比较差异均有统计学意义(Pa<0.05)。小VT通气24 h氧合改善较传统VT通气明显,pa(O2)、p(A-a)(O2)、OI比较差异均有统计学意义(Pa<0.05)。2.小VT组呼吸机相关性肺损伤发生率明显低于传统VT组,差异有统计学意义(P<0.05)。3.危重患儿病死率比较无明显差异。结论 Cdyn、Raw、WOB、P0.1等呼吸力学指标有助于判断机械通气过程中患儿肺部病变情况,及时调整呼吸机参数并判断撤机时机。在降低呼吸机相关性肺损伤的发生方面,小VT通气优于传统VT通气。小VT通气在降低AHRF患儿病死率方面,并不优于传统VT通气。     

肺炎支原体肺炎患儿IL-6、IL-10、TNF-α的变化

目的探讨细胞因子IL-6、IL-10、TNF-α在肺炎支原体肺炎(MPP)患儿急性期支气管肺泡灌洗液(BALF)和血清中的变化及临床意义。方法采用双抗体夹心ELISA法对30例MPP患儿急性期和20例无肺部病变的对照组患儿BALF和血清中IL-6、IL-10、TNF-α水平进行测定。结果 MPP患儿BALF和血清中IL-6、IL-10、TNF-α水平在发病的急性期明显高于对照组(P均<0.05),并且BALF中IL-6、IL-10、TNF-α浓度高于血清中相应细胞因子浓度(P均<0.05),血清IL-6、IL-10、TNF-α与相应的BALF中IL-6、IL-10、TNF-α有相关性(r=0.953～0.992,P均<0.05)。结论 MPP患儿BALF和血清中有明显的细胞因子变化,IL-6、IL-10、TNF-α可能参与了MPP的发病。     

选择性头部亚低温治疗对缺氧缺血性脑病新生儿血清细胞因子的影响

目的 探讨选择性头部亚低温治疗对缺氧缺血性脑病(HIE)新生儿血清IL-1β、IL-2及肿瘤坏死因子-α(TNF-α)的影响.方法 将50例中重度HIE患儿随机分为选择性头部亚低温治疗和常规治疗对照组各25例.二组均采用常规治疗,治疗组出生6 h内采用选择性头部降温方法,维持鼻咽部温度(34.0±0.5)℃,肛温(35.5±0.5)℃,持续72 h.采用酶联免疫吸附法(ELISA)检测二组血清IL-1β、IL-2及TNF-α在生后6、24 h及72 h的动态变化.采用独立样本t检验进行统计学分析.结果 中度HIE治疗组血清IL-1β、IL-2和TNF-α在24和72 h均低于对照组(Pa<0.05),重度HIE患儿血清IL-1β和TNF-α在72 h与对照组比较有显著差异(Pa<0.05),重度组血清IL-2在24 h与对照组比较有显著性差异(P<0.05).结论 选择性头部亚低温可通过抑制急性期损伤性细胞因子的释放、减轻HIE患儿的炎性级联反应而起到脑保护性作用.     

肺炎支原体肺炎患儿血清巨噬细胞移动抑制因子、肿瘤坏死因子-α、白细胞介素-6表达的意义

目的 探讨巨噬细胞移动抑制因子(MIF) 、TNF-α及IL-6在肺炎支原体肺炎(MPP)患儿血清中的表达水平及意义.方法 采用ELISA法测定42例急性期和26例恢复期MPP患儿、25例细菌性肺炎患儿(细菌性肺炎组)及30例健康儿童(健康对照组)血清MIF、TNF-α及IL-1β水平,并对急性期和恢复期MPP患儿血清MIF水平与血清TNF-α 、IL-6水平进行相关性分析.结果 MPP急性期患儿血清MIF、TNF-α、IL-6水平明显高于MPP恢复期、细菌性肺炎组及健康对照组,差异均有统计学意义(P均＜0.01,0.05);MPP恢复期与对照组比较差异无统计学意义(P＞0.05);细菌性肺炎组MIF、TNF-α及IL-6水平亦高于健康对照组(P均＜0.05);MPP急性期MIF与TNF-α、IL-6呈正相关(r=0.76、0.82,P均＜0.05);恢复期MIF与TNF-α、IL-6无相关性(r=0.26、0.31,P均＞0.05).结论 MIF 、TNF-α及IL-6可能参与MPP发病过程,联合检测对MPP病情判断及预后评估具有重要的参考价值.     

血清炎症因子与新生儿窒息后脑损伤的关系

目的探讨窒息新生儿生后血清高迁移率族蛋白B1(HMGB1)、S100B蛋白(S100B)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)水平变化与新生儿窒息后脑损伤的关系。方法采用酶联免疫吸附法检测25例窒息新生儿和16例健康新生儿生后3～7天血清HMGB1、S100B、IL-6、TNF-α水平,同时对窒息患儿生后第3～7天进行头颅CT检查,比较轻度窒息组、重度窒息组和对照组血清炎症因子水平,以及窒息组患儿头颅CT异常组和正常组血清炎症因子水平的差异。结果 (1)轻度、重度窒息组血清HMGB1、S100B水平(ng/L)均高于对照组[HMGB1:(15.15±0.13)、(15.30±0.07)比(11.99±0.05),P均<0.01,S100B:(141.65±17.82)、(148.93±26.08)比(126.74±12.97),P均<0.05],重度窒息组血清IL-6水平(ng/L)高于对照组[(0.94±0.22)比(0.72±0.12),P<0.01];轻度与重度窒息组间血清HMGB1、S100B、TNF-α、IL-6比较差异均无统计学意义(P>0.05)。(2)窒息新生儿头颅CT异常患儿出生后3～7天血清HMGB1、S100B、TNF-α、IL-6浓度(ng/L)均明显高于CT正常患儿[HMGB1:(17.14±0.14)比(13.24±0.04),S100B:(147.65±14.03)比(132.16±17.55),TNF-α:(38.46±0.14)比(30.60±0.06),IL-6:(0.89±0.16)比(0.73±0.18),P<0.05]。结论血清HMGB1、S100B、TNF-α、IL-6水平与新生儿窒息后脑损伤密切相关,有助于新生儿窒息后脑损伤的判断。     

机械通气方式对新生猪支气管肺泡灌洗液炎性因子及肺表面活性物质相关蛋白A的影响

目的 观察常频机械通气(CMV)、高频振荡通气(HFOV)、部分液体通气(PLV)3种机械通气方式对急性肺损伤(ALI)新生猪BALF炎性因子及肺表面活性物质相关蛋白A(SP-A)水平的影响.方法 出生1～3 d健康新生猪24只,用9 g/L盐水(38 ℃,35 mL/kg)灌洗制备ALI模型.随机分为4组:对照组(6只,模型制备成功后不予通气,直接处死)、CMV组(6只)、HFOV组(6只)、PLV组(6只),行机械通气24 h后处死动物,用ELISA法检测BALF中TNF-α、IL-8、IL-1及SP-A水平.结果 3种方式机械通气24 h后,BALF中3种炎性因子及SP-A总体均数比较差异均有统计学意义(P均=0.000),PLV组、HFOV组SP-A水平较CMV组高(P均＜0.05),PLV组IL-8、IL-1、TNF-α水平较CMV组低(P均＜0.05),PLV组IL-8、TNF-α水平较HFOV组低(P均＜0.05),HFOV组IL-8、TNF-α水平较CMV组低(P均＜0.05).结论 不同机械通气方式致肺部炎性反应不同,PLV致肺部炎性反应最轻.PLV较CMV、HFOV更能增加SP-A表达,降低SP-A的降解.     

小剂量芬太尼在机械通气中的应用

目的　 了解机械通气患儿以小剂量芬太尼持续静脉滴注的作用。 方法 　观察用药前后呼吸顺应性 (Cdyn)、气道阻力 (Raw)及呼气末二氧化碳分压 (PetCO2 )的变化。 结果 　 1个月～ 3岁患儿用药前后Raw及PetCO2 明显下降 ,肺部感染患儿指标变化显著大于非感染患儿 ,Cdyn用药前后均未发现显著差异。 结论 　提示机械通气中用小剂量芬太尼可以减轻人机对抗 ,降低气道压 ,改善肺气体交换及肺功能 ,有利于患儿顺利地渡过危险期     

高压氧治疗对脑性瘫痪儿童血清白细胞介素6和肿瘤坏死因子水平的影响

目的观察高压氧治疗对脑性瘫痪(简称脑瘫)患儿血清中白细胞介素-6(IL-6)和肿瘤坏死因子(TNF-α)含量的影响。方法将40例脑瘫患儿随机分为对照组和脑瘫观察组各20例,两组均给予康复治疗,脑瘫观察组在康复治疗的基础上加用高压氧治疗,另选40例正常儿童作为正常对照组。治疗前分别测定脑瘫患儿及正常儿童的血清IL-6、TNF-α含量,治疗3个月后测定脑瘫对照组和脑瘫观察组患儿血清中IL-6、TNF-α含量的变化。结果治疗前脑瘫组患儿血清IL-6、TNF-α含量较正常儿童明显增高,差异有统计学意义(P<0.05)。治疗3个月后脑瘫观察组和脑瘫对照组患儿血清中IL-6、TNF-α含量较治疗前降低,脑瘫观察组较脑瘫对照组下降明显,差异有统计学意义(P<0.05)。结论高压氧治疗通过降低脑瘫患儿血清中IL-6、TNF-α的水平,发挥治疗作用。     

小剂量芬太尼在机械通气中的应用

目的 了解机械通气患儿以小剂量芬太尼持续静脉滴注的作用。方法 观察用药前后呼吸顺应性(Cdyn)、气道阻力(Raw)及呼气末二氧化碳分压(PetCO2)的变化。结果 1个月--3岁患儿用药前后Raw及PetCO2明显下降，肺部感染患儿指标变化显著大于非感染患儿，Cdyn用药前后均未发现显著差异。结论 提示机械通气中用小剂量芬太尼可以减轻人机对抗，降低气道压，改善肺气体交换及肺功能，有利于患儿顺利地渡过危险期。     

肝素结合蛋白对儿童重症腺病毒肺炎的诊断价值

目的 探讨血清肝素结合蛋白(heparin-binding protein,HBP)对儿童重症腺病毒肺炎早期诊断的价值。方法 前瞻性纳入2019年2月至2021年8月南华大学附属长沙中心医院儿科收治的确诊为腺病毒肺炎的80例患儿为研究对象,按照重症肺炎标准分为重症腺病毒肺炎组(40例)和非重症腺病毒肺炎组(40例),比较2组入院24 h内的血清HBP、白细胞介素-6 (interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor alpha,TNF-α)、白细胞计数、血小板(platelet,PLT)、C反应蛋白等炎症指标水平的差异,并采用受试者工作特征(receiver operating characteristic,ROC)曲线分析其对重症腺病毒肺炎的早期诊断价值。结果 重症腺病毒肺炎组血清HBP水平[(46±16)ng/mL]高于非重症组[(28±13)ng/mL](P<0.05);重症腺病毒肺炎组TNF-α、IL-6、PLT水平也更高(P<0.05)。HBP对重症腺病毒肺炎的早期诊断ROC曲线下面积为0.804,取最佳截断值...     

C-reactive protein and bacterial meningitis

We have studied prospectively the C-reactive protein values in the cerebrospinal fluid of 54 patients with bacterial meningitis, tuberculous meningitis, and severe malarial infection and convulsions without infections of the central nervous system. CSF CRP above 1 mg/l was observed in 23 out of 28 patients with bacterial meningitis (sensitivity of 82%). The specificity was 73% at the 1 mg/l level. Five out of 19 patients with severe malarial infection had CSF CRP levels above 1 mg/l. Two patients with TB meningitis were also studied. Both of them had CSF CRP above 1 mg/l. Five patients with febrile convulsions or sepsis without meningitis had CSF CRP below 1 mg/l. It is concluded that CSF CRP would not be used as a useful discriminatory test in areas where malaria and TB meningitis are common.     

Circadian variations in serum eosinophil cationic protein, and serum and urine eosinophil protein X

Biochemical evaluation of inflammation may be a useful adjunct to measures of pulmonary function and symptoms in children with asthma. However, little data have been provided to validate the markers in children. The aim of the present study was to assess circadian variations in serum eosinophil cationic protein (ECP), and serum and urine eosinophil protein X (EPX) in children. Five girls and two boys aged 10–14 years were studied. The first sample of urine consisted of urine collected from 24.00 hours the night before until 08.00 hours on the morning of the day of investigation. Thereafter urine was collected at 4-h intervals until 24.00 hours and in another 8-h interval from 24.00 to 08.00 hours. Blood samples for assessment of serum ECP and serum EPX were collected every 2 h during the 24 h. Statistically significant circadian variations in serum ECP (F=3.2, p=0.002), serum EPX (F=3.1, p=0.002) and in urine EPX/creatinine (F=5.4, p=0.003) were detected. The concentrations were higher during the night compared to daytime. Peak levels of serum ECP (mean [± SEM]) were found at 06.00 hours (16.3 [5.3] µg/l), trough levels at 08.00 hours (3.9 [0.7] µg/l) (p=0.01). Peak levels of serum EPX were seen at 06.00 (43.7 [9.5] µg/l) with trough levels at 12.00 hours (22.0 [3.5] µg/l) (p=0.01). Peak levels of urine EPX/creatinine occurred in urine collected from 24.00 to 08.00 hours (90.0 [27.7] µg/mmol), trough levels in the 16.00–20.00 hours sample (29.7 [8.9] µg/mmol) (p=0.02). Serum ECP, serum EPX and urine EPX exhibit a circadian variation in children with nocturnal and early morning peak levels. To avoid confounding influence from circadian variations in ECP and EPX in clinical studies blood or urine should be sampled at consistent times.     

Varicella and thrombotic complications associated with transient protein C and protein S deficiencies in children

We report six cases of protein S deficiency secondary to varicella. Five cases were complicated by thrombotic and vascular events, namely purpura fulminans and necrotic vasculitis, deep vein thrombosis and stroke. Two cases were associated with protein C deficiency and one case revealed a heterozygous factor XII deficiency. The underlying mechanism of this acquired protein S deficiency is unclear but could be related to a direct effect of zoster virus.     

Surfactant protein A and D gene polymorphisms and protein expression in victims of sudden infant death

Aim: To investigate the innate immune components surfactant protein A (SP-A) and D (SP-D) in victims of sudden infant death syndrome (SIDS).
Methods: Ten common single nucleotide polymorphisms (SNPs) in the exons of SP-A1, SP-A2 and SP-D genes were analysed in 42 cases of SIDS and 46 explained sudden infant deaths. SP-A and SP-D protein expression in tissue from the aerodigestive tract was semi-quantitatively evaluated by immunohistochemistry.
Results: SP-D immunoreactivity was found in lungs and tissue from submandibular gland, palatine tonsils and duodenum. Positive SP-A immune staining was found exclusively in lung tissue. Neither the allele nor the haplotype distribution of the SP-A and SP-D genes was significantly different in SIDS compared to explained deaths. The most common SP-A haplotype, 6A2/1A0, tended to be overrepresented in the cases with low immunohistochemical SP-A expression (61%) compared to cases with high expression (49%), p = 0.08. The SP-D expression was not influenced by the 11 C/T or 160 A/G polymorphisms.
Conclusion: No significant association between the common genetic variants of SP-A and SP-D and SIDS is disclosed by the present study. However, low SP-A protein expression may possibly be determined by the 6A2/1A0 SP-A haplotype, this should be subject for further investigation.