危重患儿急性肺损伤

儿童急性肺损伤(acute lung injury,ALI)或急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)是指由心源性以外的各种肺内外因素引起的急性、进行性缺氧性呼吸衰竭。ALI和ARDS为同一疾病过程的两个阶段,即ALI为早期、病情较轻阶段,ARDS为后期、病情严重阶段。ALI/     

儿童急性肺损伤和呼吸窘迫综合征的非机械通气治疗

急性肺损伤(acute lung injury,ALI)/急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)是各种原因导致肺毛细血管内皮细胞和肺泡上皮细胞损伤造成弥漫性肺间质及肺泡水肿导致的急性低氧性呼吸功能不全或呼吸衰竭.儿童ALI/ARDS的发生率为2.2～6/10万[1],在PICU住院患儿中ARDS的发生率为8.5～16/1000[2].国内有报道ARDS的住院病死率为44.8％[3].合适的呼吸末正压与合适的小潮气量通气治疗是目前公认的可以降低病死率的治疗方法.近年来,国内儿科及重症医学工作者通过全国儿科脓毒症的调查和2009至2010年甲型H1N1流感救治工作的开展,强化了对ALVARDS诊断和治疗的认识.除机械通气外,其他救治措施中依然有很多问题没有解决,现就ALVARDS非机械通气治疗热点问题进行讨论.     

第二讲 输血相关性急性肺损伤及移植物抗宿主病

输血相关性急性肺损伤(transfusion-related acute lung injury,TRALI)和移植物抗宿主病(transfusion associated graft-versus-host disease,TA-GVHD)是日益受到重视的两种较为严重的与输血有关的副反应,现分述如下.     

间充质干细胞在急性肺损伤中的作用及机制

急性肺损伤(acute lung injury,ALI)是由感染、氧中毒、机械刺激等多种原因引起的肺部弥漫性损害,病死率高,目前尚无特效的治疗方法.研究表明间充质干细胞(mesenchymal stem cells,MSC)可通过toll样受体的调节向肺损伤部位定向移行,并通过分泌可溶性细胞因子改变组织微环境,促进肺损...     

儿童急性呼吸窘迫综合征预后相关因素回顾性分析

目的 参照2015年儿童急性肺损伤共识会议(Pediatric acute lung injury consensus con-ference,PALICC)提出的儿童急性呼吸窘迫综合征(pediatric acute respiratory distress syndrome,pARDS)诊断标准,探讨影响pARDS预后的相关因素.方法 回顾性分析2009年1月至2015年12月首都医科大学附属北京儿童医院PICU收治的pARDS患儿的临床资料,共69例.结果 69例pARDS患儿中,轻度ARDS 13例,中度ARDS 19例,重度ARDS 37例.PICU内死亡17例(轻度2例,中度3例,重度12例;14例女性,3例男性).ARDS 患儿的临床结局与性别、慢性合并症差异有统计学意义(P<0.05),有慢性合并症ARDS患儿的病死率高达69.23%.多因素分析表明,机械通气时间与PICU住院日、总住院日有相关性(相关系数分别为:0.324、0.181,P<0.01);机械通气时间与患儿的入院体重有相关性(相关系数0.491,P<0.01),提示入院体重为保护性因素.结论 pARDS是PICU内患病率低、病死率高的危重症之一,纳入本研究的ARDS患儿病死率达24.64%.女性、有慢性合并症ARDS患儿的预后可能不佳.机械通气时间决定PICU住院日及总住院日,入院体重为机械通气时间的保护性因素.     

新生儿急性肺损伤——附3例报告

1969年Adhbaugh等首次报道成人呼吸窘迫综合征(Adult respiratory distress syndrome,ARDS).20世纪90年代人们对ARDS的认识已逐步深化,并提出了急性肺损伤(Acute lung injury,ALl)的概念,但有关新生儿急性肺损伤的病例报道国内外均少见.现报道我院NICU收治的3例新生儿急性肺损伤.     

急性肺损伤和呼吸窘迫综合征的液体管理策略

急性肺损伤(acute lung injury,ALI)/急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)是指严重感染、休克、创伤及烧伤等非心源性疾病过程中,肺毛细血管内皮细胞和肺泡上皮细胞损伤造成弥漫性肺间质及肺泡水肿,导致的急性低氧性呼吸功能不全或呼吸衰竭.是小儿重症医学常见危重病症之一,病死率高[1-2].     

新生儿急性肺损伤中几个问题的思考

自1962年Ashbangh等首次报道急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)以来,随着对ARDS基础与临床研究的不断深入,人们发现ARDS是急性肺损伤(acute lung injury,ALI)连续病理过程中最严重的阶段,所有的ARDS均经过ALI,而ALI不一定都发展成ARDS,同时认识到ALI也是全身炎症反应综合征(system inflammatory respose syndrome,SIRS)的一部分.     

一氧化氮在急性肺损伤中的研究进展

急性肺损伤 ( Acute lung injury,ALI)是由于各种原因引起的肺组织结构发生特征性的病理改变而出现的临床综合征 ,是导致患儿死亡率最高的严重肺疾病 ,重度的 ALI即急性呼吸窘迫综合征 ( acute respiratory distresssyndrome,ARDS)〔1〕。大量动物实验和临床研究表明感染、创伤     

输血相关性急性肺损伤研究进展

输血相关性急性肺损伤(transfusion-related acute lung injury,TRALI)是一种临床综合征,表现为输血时或输血后出现的低氧血症及非心源性的肺水肿[1].TRALI是导致与输血相关的死亡的主要原因,由于其定义不确切,至今还未被临床医生所真正认识,尤其在儿科领域更少见有类似报道.     

Bronchoalveolar lavage cellular composition in acute asthma and acute bronchiolitis

OBJECTIVE: To compare cellular inflammation in the airways between acute bronchiolitis and asthma. STUDY DESIGN: Using a bronchoalveolar lavage with flexible bronchoscopy procedure, we investigated the cellular constituents of BAL fluid in children with acute exacerbation of asthma (n = 18) and infants with acute bronchiolitis caused by respiratory syncytial virus (n = 20). These results were compared with those of healthy control subjects (n = 14). RESULTS: Total lavage fluid recovered was similar in all groups. The total cell numbers were highest in the bronchiolitis group. The BAL cellular profile in the asthma group was characterized by a higher median (interquartile range) ratio of eosinophils (2.4% [1.6%-9.5%]; P <.01) than in the bronchiolitis group (0% [0%-0%]) or the control group (0% [0%-0%]). Neutrophil ratio was higher in the bronchiolitis group (40.0% [26.5%-50.0%]; P <.01), with no difference found between the asthma group (3.3% [2.0%-7.9%]) and the control group (2.0% [0.8%-5.5%]). CONCLUSIONS: Asthma and acute bronchiolitis are characterized by an elevated cellular percentage of eosinophils and neutrophils, respectively, in bronchoalveolar lavage fluid.     

Imaging in acute abdomen

Objective The present study aims at establishing the exact role and limitation of ultrasound in pediatric acute abdomen.Methods Fifty children less than 14 years of age presenting with acute abdomen were evaluated by US and other imaging modalities. The mean age of presentation was 312 years. Maximum number of cases were seen in less than two years of age. There were 17 cases of intussusception with US sensitivity and specificity of 88.2% and 100% respectively and positive and negative predictive values of 100% and 94.5% respectively. There were 13 cases of appendicitis. US was diagnostic in 11 with sensitivity and specificity of 91.6% and 97%; the positive and negative predictive values were 91.6% and 97% respectively.Results : There were two cases each of congenital bands, adhesive intestinal obstruction, malrotation of bowel with volvulus, incarcerated inguinal hernia, hypertrophic pyloric stenosis, duplication cyst and pseudopancreatic cyst, one case each of trichobezoar, Meckel’s diverticulum, ureteric calculus and worms as a cause of intestinal obstruction. The sensitivity of US for diagnosing specific cause of acute abdomen was found to be 77.5%. The main limitation of US was in the diagnosis of acute intestinal obstruction such as congenital bands and adhesions.Conclusion. US should now be considered as imaging modality of choice in pediatric acute abdomen. However, at times, plain radiography, conventional contrast studies and CT may be vital to reach the true diagnosis     

Septicemia in acute leukemia

We have surveyed septicemic episodes occurring in individuals with acute leukemia and have found two factors favorably influencing survival, mainly granulocyte counts over 1,000 mm³ and gram-positive bacteremias. In contrast, blood cultures persistently positive for longer than 48 hours were a bad prognosticator. Significantly, patients with gram-positive bacteremia had received less antibiotics. in the week prior to septicemia than had patients with gram-negative bacteremia.     

Non-Q wave acute myocardial infarction in acute meningococcemia in a 10-year-old girl

INTRODUCTION: Children with acute meningococcemia may have impaired myocardial function resulting in low cardiac output despite normal intravascular volume. Severe meningococcal infection has been associated with acute interstitial myocarditis, endocarditis, and pericarditis, but not with myocardial infarction. CASE: We present the case of a 10-year-old girl with positive family history for premature myocardial infarction who sustained an acute myocardial infarction temporally related to meningococcemia. DISCUSSION: This is the first pediatric case of non-Q wave acute myocardial infarction associated with purpura fulminans in meningococcemia. Similarly, the association of high troponin I levels and meningococcemia has not been described previously. Although, the patient's genetic predisposition for myocardial infarction might have been a potential contributing factor, there was no angiographic evidence of coronary artery disease in this patient. Thereby, other factors related to shock, endotoxin, microthrombi of meningococcemia, and their treatment might have been also contributing. We propose possible mechanisms for this rare but serious complication of meningococcemia and review the literature.