儿童肺炎支原体肺炎合并血管栓塞的影像学研究进展

血管栓塞是儿童肺炎支原体肺炎少见的并发症,早期预测和确诊有助于采取预防措施并进行及时治疗,可显著降低患儿死亡率和致残率。就儿童肺炎支原体肺炎合并血管栓塞的临床特征及发病机制、儿童血管栓塞成像方法的选择以及儿童肺炎支原体肺炎合并血管栓塞影像特征的研究进展予以综述,并与儿童其他原因所致血管栓塞进行鉴别。     

儿童肺炎支原体肺炎合并血管栓塞或血栓形成的影像学特征

血管栓塞是儿童肺炎支原体肺炎少见的并发症,早期预测和确诊有助于采取预防措施并进行及时治疗,可显著降低患儿死亡率和致残率。就儿童肺炎支原体肺炎合并血管栓塞的临床特征及发病机制、儿童血管栓塞成像方法的选择以及儿童肺炎支原体肺炎合并血管栓塞影像特征的研究进展予以综述,并与儿童其他原因所致血管栓塞进行鉴别。     

支原体肺炎186例

支原体感染是儿童社区获得性肺炎的常见病因,也是导致小儿支原体肺炎及多脏器受累的主要病原体之一,目前支原体肺炎仍需要支原体抗体阳性的病原学检查才能确诊。近年来支原体肺炎病例逐渐增多,症状轻重不一,冬春季节发病增高,近几年来更有增多趋势。现就我院儿科3年来支原体肺炎患儿186例的临床特点及治疗总结如下。     

D-二聚体检测在儿童肺炎中的临床应

目的 探讨儿童肺炎患者血浆D-二聚体水平的变化及其临床意义.方法 选取152名肺炎患儿,分为支原体肺炎组(n=43),细菌性肺炎(n=50),混合感染组(n=59).30名健康儿童作为对照组.采用免疫比浊法测定血浆D-二聚体水平.结果 支原体肺炎患儿、细菌性肺炎患儿、混合感染肺炎患儿血浆D-二聚体水平明显高于对照组.结论 血浆D-二聚体水平在小儿肺炎中存在不同程度升高.D-二聚体可作为肺炎患儿血液高凝状态的检测指标.     

肺炎支原体感染与儿童哮喘的关系

目的：探讨肺炎支原体感染与儿童哮喘发病的关系。方法：支气管哮喘患儿362例,肺炎患儿288例,正常对照组30例,分别采用颗粒凝集法检测血清肺炎支原体IgM（MP-IgM）抗体;同时采用同位素放射免疫法测定哮喘患儿血清总IgE。结果：（1）支气管哮喘患儿MP-IgM阳性率49.45%,显著高于肺炎患儿MP-IgM阳性率39.24%,上述两组均显著高于正常对照组6.67%;（2）在各年龄组支气管哮喘患儿MP-IgM阳性率比较中,发现学龄期儿童MP-IgM阳性率最高;（3）MP-IgM阳性的支气管哮喘患儿血清总IgE水平明显高于MP-IgM阴性哮喘患儿的血清总IgE。结论：儿童肺炎支原体感染与儿童哮喘发病密切相关。     

肺炎支原体肺炎合并血尿89例患者临床特点观察

目的探讨肺炎支原体肺炎合并血尿患者的临床特点。方法对247例肺炎支原体肺炎患儿进行常规尿检,筛选出89例合并血尿患儿,对确诊的89例患儿临床资料进行回顾性分析,对临床表现进行观察。结果247例患儿中有89例患儿患有肺炎支原体肺炎合并血尿疾病,血尿的检测率和患儿的年龄、性别没有显著性差异,P〉0．05。大多数患儿伴有发热、剧烈咳嗽等现象,少数患儿伴有肉眼血尿现象。经治疗后有84例患儿痊愈,有5例患儿病情好转。结论肺炎支原体肺炎对患儿的身体健康具有严重的影响,虽然经过规范的治疗后治愈率较高,但在临床治疗中仍需要得到关注。     

肺炎支原体肺炎合并胸腔积液24例分析

肺炎支原体是介于病毒和细菌之间、能独立生活的最小病原微生物[1],主要通过呼吸道传播[2],每隔3~7年流行一次,平时可见散发病例,全年均可发病[3]。近年来,肺炎支原体肺炎发病率呈逐年增高的趋势,占儿童肺炎的20%~30%[4],在学龄期儿童中可占50%~70%。临床症状轻重不一,可累及多个系统,胸腔积液是其较常见的并发症。2010年1月-2013年6月,我们收治肺炎支原体肺炎并发胸腔积液24例,均给予     

肺炎患儿支原体感染592例诊断及临床分析

肺炎支原体(Mycop lasm a pneumon iae,MP)可以在人类呼吸道黏膜表面繁殖、致病,特别在儿童中引起上、下呼吸道感染,甚至是不典型肺炎的首要病因。为了解本地区MP在儿童肺炎中感染的情况,本文应用酶联免疫吸附试验(ELISA)对14岁以内的肺炎患儿进行MP抗体IgM的检测,并对其临床表现及治疗情况进行分析,现报道如下。1资料和方法1.1资料:选择2003-01~2006-12本院住院、门诊肺炎患儿592例,年龄6月~14岁(平均7.25岁),均符合肺炎的诊断标准[1]。其中2003年130例(男67例,女63例),2004年121例(男61例,女60例),2005年147例(男78例,女69例),2006…     

MSCT对儿童支原体肺炎与支原体合并链球菌感染肺炎鉴别临床价值

目的 探讨MSCT对儿童支原体肺炎(MP)与支原体合并链球菌感染肺炎(SP)鉴别临床价值。方法 选取我院70例儿童支原体肺炎与支原体合并肺炎链球菌感染肺炎患儿资料,比较两组MSCT表现特征。结果 MP组的影像表现为支气管壁增厚(100%)、磨玻璃影(73.81%)、网状影(80.95%)、支气管血管束增厚(80.95%),高于MP+SP组的42.86%、14.29%、35.71%、35.71%; MP组胸腔积液47.62%,高于MP+SP组的14.29%,肺炎胸腔积液厚度、淋巴结横径低于MP+SP组,两组差异有统计学意义(P <0.05)。结论 支原体肺炎基础上伴有淋巴结肿大及胸腔积液、肺内实变影时可考虑合并SP,MSCT具有较高图像分辨率,清晰显示出肺部组织结构,多方位、多角度显示出病变部位,可应用于儿童支原体肺炎、支原体合并链球菌感染肺炎鉴别诊断。     

儿童肺炎支原体肺炎的高分辨率CT特点

目的:探讨儿童肺炎支原体肺炎(MPP)高分辨力CT的特点.方法:回顾性分析149例MPP患儿(学龄前组70例和学龄组79例)的胸部高分辨率CT特点并归纳总结.结果:所有患儿均表现为咳嗽和/或发热.最常见的影像学征象为肺实变、支气管壁增厚、树雾征、树芽征、磨玻璃影,学龄前组分别占60.6％、34.3％、37.1％、18....     

Effect of pH and concentration on the diffusion of radiostrontium in compacted bentonite—a capillary experimental study

The effects of pH and Sr²⁺ solution concentration on diffusion and sorption of Sr²⁺ in compacted bentonite (ρ_b=1000±30 kg/m³) were studied using an “in-diffusion” method at an ionic strength of 0.1 M NaClO₄. The results (distribution coefficients, K_d, apparent and effective diffusion coefficients, D_a and D_e) derived from the capillary method are in good agreement with the literature data obtained for similar bentonite dry densities and fit Fick's second law very well. The results suggest that the diffusion of Sr²⁺ in compacted bentonite decreases slightly with increasing pH values and also increases slightly with increasing Sr²⁺ solution concentration. The distribution coefficients are weakly dependent on the solution concentrations and show a slight increase with increasing pH values. The average effective diffusion coefficient of Sr²⁺ in compacted bentonite is (1.2±0.2)×10⁻⁹ m²/s, surface diffusion effects are found for the diffusion of Sr²⁺ in compacted bentonite.     

经胸壁穿刺持续负压吸引法解决胸腔镜手术烟雾问题的效果

 目的 探讨经胸壁穿刺持续负压吸引法解决胸腔镜手术烟雾问题的效果。方法 选择2021年3－6月北京世纪坛医院接受单孔胸腔镜肺叶切除术的患者103例,根据患者意愿分为两组,其中A组48例,B组55例。术中应用经胸壁穿刺持续吸引法的患者归为A组,未使用该方法的归为B组。比较两组患者的年龄、性别、体质指数、肿瘤部位、肿瘤直径、TNM分期、手术时间、术中出血量、术中镜头擦拭次数、术后住院时间以及术中手术室PM 2.5。结果 A组手术时间为(105.14±35.27)min,短于B组[(130.15±38.36)min] (P＜0.001);A组术中镜头擦拭次数为 2.43±2.55,明显少于B组(7.33±4.12) (P＜0.001);A组术中出血量为(85.58±33.45)ml, 少于B组[(106.43±34.23)ml] (P＜0.001)。在手术室空气质量改善方面,A组术中PM2.5 浓度为(55.43± 25.12)μg/m³,远小于B组的(654.34±108.76)μg/m³ (P＜0.001);关胸10 min后两组手术的手术室PM 2.5仍然表现出明显的差异 (P＜0.001)。而两组患者的性别、年龄、体质指数、TNM分期以及术后住院时间无统计学差异。结论 经胸壁穿刺持续吸引法操作简单,效果良好,可减少镜头模糊、缩短手术时间、减少术中出血量、减少手术烟雾造成的手术室环境污染。     

珠海市儿童社区获得性肺炎的病原学研究

目的探讨珠海市儿童社区获得性肺炎（CAP）的病原学分布,为合理使用抗生素提供临床依据。方法2012年10月～2013年9月在我院住院确诊的CAP患儿1793例,入院当天取下呼吸道分泌物进行病原菌培养,采用间接免疫荧光法检测人血清中的呼吸道感染主要病原体的IgM抗体,采用被动凝集法测定血清MP特异性IgM。结果1793例CAP患儿中病原学检测阳性者1380例（77．0％）：细菌感染635例（35．4％）,病毒感染385例（21．5％）,肺炎支原体感染521例（29．0％）,肺炎衣原体感染33例（1．8％）,混合感染223例（12．4％）。肺炎链球菌位居细菌感染首位,共216例（12．0％）,呼吸道合胞病毒病毒感染首位,共183例（10．2％）。≤1岁组肺炎链球菌、流感嗜血杆菌、葡萄球菌、卡他莫拉菌、呼吸道合胞病毒、腺病毒的感染病例数的构成比均高于〉1岁组（P〈0．05）,而≤1岁组肺炎支原体的感染病例数构成比低于〉1岁组（P〈0．05）。结论肺炎链球菌、呼吸道合胞病毒、肺炎支原体是儿童CAP的主要病原体。肺炎链球菌及呼吸道合胞病毒在≤1岁组多见。肺炎支原体在〉1岁组多见。     

X线摄片诊断儿童支原体肺炎的价值分析

目的：总结儿童支原体肺炎的临床表现特点,分析X线摄片诊断儿童支原体肺炎的临床价值。方法回顾性分析2013年1月至2014年1月63例儿童支原体肺炎的临床资料,其中男性36例,女性27例,年龄2个月至1岁5例（8％）,～3岁11例（17％）,3～6岁32例（51％）,7～12岁15例（24％）,平均年龄（5±3）岁。采用美国GE公司计算机X线摄影（CR）行胸部正侧位片,曝光条件根据患儿体厚设定,靶片距100～160 cm,患儿安静时曝光拍摄,尽可能避免再次拍摄和降低射线剂量。总结X线图片质量、临床表现,分析X线摄片的影像学特点。结果126张胸片图像中,一级片120张（95．2％）,二级片5张（4．0％）,三级片1张（0．8％）,废片0张。临床症状主要是咳嗽、发热、咽部发红、喘息、呼吸音粗糙等。63例患儿肺部均存在影像学改变,双侧肺病变23例（37％）,单侧肺40例（63％）,其中右侧肺27例（68％）,左侧肺13例（32％）。 X线表现为间质浸润型阴影35例（56％）、肺泡浸润型阴影19例（30％）、肺门增浓型阴影8例（13％）和混合型阴影2例（3％）。结论儿童支原体肺炎临床表现主要是咳嗽、发热等,X线表现主要是间质浸润型阴影、肺泡浸润型阴影等,确诊应结合临床表现和实验室检查。     

Theoretical basis for long-term measurements of equilibrium factors using LR 115 detectors

In this paper, we propose a method to determine the equilibrium factor using a bare LR 115 detector. The partial sensitivities ρ_i of the LR 115 detector to ²²²Rn and its alpha-emitting short-lived progeny, ²¹⁸Po and ²¹⁴Po, were investigated. We first determined the distributions of lengths of major and minor axes of the perforated alpha tracks in the LR 115 detector produced by ²²²Rn, ²¹⁸Po and ²¹⁴Po through Monte Carlo simulations. The track parameters were calculated using a track development model with a published V function, by assuming a removed active layer of 6.54 μm. The distributions determined for different alpha emitters were found to completely overlap with one another. This implied equality of partial sensitivities for radon and its progeny, which was also confirmed through analytical considerations. Equality of partial sensitivities makes possible convenient measurements of the proxy equilibrium factor F_p, which is defined in the present work as (F₁+F₃) and is equal to the ratio between the sum of concentrations of the two alpha emitting radon progeny (²¹⁸Po+²¹⁴Po) to the concentration of radon gas (²²²Rn). In particular, we have found F_p=(ρ/ρ_itC₀)−1, where ρ (track/m²) is the total track density on the detector, ρ_i=0.288×10⁻² m, t is the exposure time and C₀ (Bq/m³) is the concentration of ²²²Rn. If C₀ is known (e.g. from a separate measurement), we can obtain F_p. The proxy equilibrium factor F_p is also found to be well correlated with the equilibrium factor between radon gas and its progeny through the Jacobi room model. This leads to a novel method for long-term determination of the equilibrium factor.     

细菌性、病毒性及支原体肺炎的高分辨率CT征象分析与鉴别

 目的 分析细菌性肺炎、病毒性肺炎及支原体肺炎的高分辨率CT征象特征及鉴别要点。方法 对192例经病原学证实的单一病原体肺炎患者的高分辨率CT影像学资料进行回顾性分析。根据病原学将其分为细菌性肺炎组(n=84,43.8%)、病毒性肺炎组(n=58,30.2%)和支原体肺炎组(n=50,26.4%),对三组肺炎的临床资料、病变部位和CT征象进行比较。结果 细菌性肺炎的白细胞计数、C反应蛋白和降钙素原均显著高于病毒性和支原体肺炎(P＜0.05);支原体肺炎白细胞计数高于病毒性肺炎(P＜0.05);在病变分布上,病毒性肺炎多呈多肺叶(40/58,69%,P＜0.05)和肺外周分布(39/58,67.2%,P＜0.05);支原体肺炎多呈多肺叶(28/50,56%,P＜0.05)和肺下叶分布(31/50,62%,P＜0.05)。在CT征象上,细菌性肺炎肺实变(48/84,57.1%,P＜0.05)和含气支气管征(41/84,48.8%,P＜0.05)多见;在磨玻璃影和碎石征方面,病毒性肺炎(分别为30/58,51.7%和26/58,44.8%)和支原体肺炎(分别为31/50,62%和19/50,38%)无统计学差异(P＞0.05),但两者上述征象均较细菌性肺炎多见(P＜0.05);另外,病毒性肺炎间质增厚多见(32/58,55.2%,P＜0.05);支原体肺炎支气管壁增厚多见(29/50,58%,P＜0.05)。结论 细菌性肺炎主要表现为片状实变影常伴含气支气管征,病毒性肺炎主要表现为多叶外周性分布的磨玻璃影伴碎石征及间质增厚,支原体肺炎主要表现为双下肺分布为主的间质性炎性反应伴细支气管壁增厚。     

热毒宁注射液联合阿奇霉素治疗小儿支原体肺炎的临床研究

 目的 观察热毒宁注射液联合阿奇霉素治疗小儿支原体肺炎的疗效及对炎性介质、免疫功能的影响。方法 将我院2011-2012年收治的104例支原体肺炎患儿按随机数字表分为联合组和对照组,每组52例。对照组采取阿奇霉素序贯治疗,联合组采取热毒宁联合阿奇霉素序贯治疗,两组均以14 d为观察节点。比较两组的疗效和X线消失时间,检测两组CRP、IL-6、免疫球蛋白水平并进行比较。结果 (1) 联合组显效率(88.5%)与对照组(59.6%)比较,差异有统计学意义(χ²=11.260, P＜0.01);(2)联合组X线消失时间为(10.23±1.82)d,短于对照组的(13.35±2.21)d(t=6.022,P＜0.01);(3) 治疗前联合组和对照组比较,炎性介质及免疫功能指标均无统计学差异;治疗后两组比较,CRP、IL-6、IgM、IgG、IgA均有统计学差异(P＜0.01)。结论 热毒宁注射液联合阿奇霉素能够协同控制炎性反应,增强免疫功能,提高临床疗效。     

三氧化二砷对内皮细胞增殖和一氧化氮分泌的影响

 目的 通过观察不同浓度三氧化二砷(As₂O₃)对内皮细胞增殖及分泌一氧化氮(NO)的影响, 初步从内皮细胞角度评价As₂O₃防治PTCA术后再狭窄的作用。方法 以不同浓度As₂O₃溶液(0.01、0.1、0.5、1、5、10 μmol/L)作用于传代培养的EVC-304细胞, 分别培养24、48、72 h测定内皮细胞对 3H-TdR摄取量, 以硝酸还原酶法测定内皮细胞培养液NO含量。结果 As₂O₃浓度低于1 μmol/L时对内皮细胞摄取3H-TdR无抑制作用。As₂O₃浓度低于0.1 μmol/L时对内皮细胞分泌NO无明显抑制作用;As₂O₃浓度0.5~10 μmol/L时抑制内皮细胞分泌NO。结论 As₂O₃ 浓度低于0.1 μmol/L对内皮细胞增殖及分泌NO均无明显抑制作用;0.1~1 μmol/L范围内只对内皮细胞分泌NO的功能有轻度影响, 但不抑制内皮细胞的增殖;而较高浓度的As₂O₃对内皮细胞增殖及分泌NO均有明显抑制, 而且抑制作用随浓度增高而增强。As₂O₃ 用于防治PTCA术后再狭窄应采取低较浓度。     

Longitudinal profiles of oxygen uptake during treadmill walking in able-bodied children: the locomotion energy and growth study

The purpose of this study was to document age-related changes in walking V_O2 in able-bodied boys and girls. Beginning at age 6 and ending at age 10, 23 children (14 girls, 9 boys) performed six 5-min bouts of level treadmill walking at 0.67, 0.89, 1.12, 1.34, 1.56, and 1.79 m s⁻¹ on an annual basis. Prior to data collection, subjects received 60 min of treadmill walking practice. During the last 2 min of each walking bout, a 2-min sample of expired air was collected in a meteorological balloon and analyzed to determine V_O2. Averaged across age, interindividual variation in V_O2 ranged from 32 to 41%. Repeated-measures analysis of variance demonstrated a speed by age interaction for V_O2, such that mean V_O2 rose (P≤0.05) across the five fastest speeds for 6-, 7-, 8-, and 10-year olds and increased over the entire speed range for 9-year olds. For all speeds, V_O2 decreased yearly from the ages of 6 to 8. When averaged across speeds, V_O2 was 27% higher for 6-year olds compared with 10-year olds. From a clinical perspective, access to longitudinal measurements of walking V_O2 in able-bodied children should be helpful in interpreting gait energy use in children with movement disorders and evaluating treatment strategies designed to reduce the aerobic demand of locomotion in youth with impaired mobility.     

The influence of training intensity, airway infections and environmental conditions on seasonal variations in bronchial responsiveness in cross-country skiers

The influence of physical training, airway infections and environmental conditions on changes in bronchial responsiveness to methacholine during a training and competitive season was studied in 19 high-performance male cross-country skiers 19–21 years old. The longitudinal changes in the methacholine concentration required for a 10% fall in FEV₁ (PC₁₀) were negatively correlated with the changes in the volume of physical activity at an intensity level above 90% of maximal heart rate. The variation in physical activity at this intensity level accounted for 54.8% of the change in PC₁₀. No association was found, however, with regard to physical activity at lower intensity levels. Seasonal variation in PC₁₀ was not associated with the changes in occurrence or duration of airway infections provided that the PC₁₀ measurement was postponed for 3–6 weeks after the onset of a recent infection. Seasonal variation in PC₁₀ seemed not to be associated with variations in ambient levels of air pollutants or aeroallergens. PC₁₀ was lowest at the end of the coldest part of the year. In conclusion, seasonal variation in bronchial responsiveness in high-performance crosscountry skiers could to a great extent be explained by changes in the volume of physical activity at a very high intensity level.