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1.
目的回顾性分析5岁以内儿童复杂性阑尾炎(CA)的独立危险因素并建立临床预测模型, 评价该模型在5岁以内儿童CA的临床应用价值。方法对2018年1月至2021年12月在上海交通大学医学院附属儿童医院行阑尾切除术的5岁以内患儿行回顾性分析, 根据术后阑尾组织是否存在坏疽及穿孔征象将患儿分成CA组和非CA组, 比较两组患儿间临床特征和术前实验室检查结果差异, 明确CA的独立危险因素并建立临床预测模型, 通过受试者工作特征曲线对临床预测模型进行验证。结果共纳入140例患儿, 其中CA组84例, 非CA组56例。经单因素和二元Logistic回归分析发现, 发病时间>23.5 h(OR=6.650, 95%CI 2.469~17.912, P<0.05), 腹部肌紧张(OR=3.082, 95%CI 1.190~7.979, P<0.05)和C-反应蛋白>41 mg/L(OR=3.287, 95%CI 1.274~8.480, P<0.05)为CA的独立危险因素, 通过上述3项独立危险因素构建CA临床预测模型, 经受试者工作特征曲线验证, 曲线下面积为0.881(9...  相似文献   

2.
目的 探讨微信公众号在儿童结肠镜检查前肠道准备中的宣教效果.方法 选取2019年11月至2020年5月在深圳市儿童医院首次行结肠镜检查的74例2岁以上患儿为研究对象,随机分为观察组(n=37)和对照组(n=37),观察组应用“儿童结肠镜检查相关知识”微信公众号进行肠道准备宣教,对照组运用常规口头形式肠道准备宣教,利用波...  相似文献   

3.
目的探讨儿童气道异物取出术围术期发生呼吸系统严重并发症的相关危险因素。方法入选263例行硬质支气管镜气道异物取出术患儿,根据术中及术后24 h内是否发生呼吸系统严重并发症分为并发症组和非并发症组,并通过比较两组患儿既往史、术前呼吸道感染率、异物存留时间、异物种类、手术时间、麻醉效果等差异,分析儿童气道异物取出术围术期发生呼吸系统严重并发症的独立危险因素。结果入选263例患儿中31例发生呼吸系统严重并发症,发生率为11.8%。单因素分析提示,与未发生并发症的患儿比较,发生呼吸系统严重并发症患儿的术前呼吸道感染率更高,异物存留时间更长,手术时间更长,麻醉效果不佳发生率更高,差异均有统计学意义(P均0.05)。多因素logistic回归分析显示:麻醉效果不佳(OR=11.07,95%CI:3.16~38.75)、术前有呼吸道感染(OR=2.99,95%CI:1.04~8.59)、手术时间越长(OR=1.07,95%CI:1.00~1.14)是儿童气道异物取出术围手术期发生呼吸系统严重并发症的独立危险因素(P均0.05)。结论对于麻醉效果不佳、术前合并呼吸道感染、手术时间长的患儿,需警惕气道异物取出术围手术期发生呼吸系统严重并发症,并采取相应预防措施。  相似文献   

4.
目的探讨儿童重症监护病房(PICU)发生呼吸机相关性肺炎(VAP)的危险因素。方法回顾分析2014年6月至2017年6月入住PICU且临床检查资料完整的455例患儿的临床资料。根据有无发生VAP将患儿分为VAP组和非VAP组,比较分析VAP发生的危险因素。结果 455例患儿中男311例、女144例,中位年龄11个月,其中发生VAP 43例,发生率为9.45%。发生VAP患儿的原发病最常见为先天性喉气管发育畸形合并肺部感染(23.3%),其次为先天性心脏病合并肺部感染(18.6%)。单因素分析提示,与非VAP组相比,VAP组患儿经口气管插管和再插管以及全部肠外营养的比例较高,机械通气时间长,差异均有统计学意义(P0.05);多因素非条件logistic回归分析显示,气管插管类型(经口)(OR=1.87,95%CI:1.48~9.75)、机械通气时间(OR=1.14,95%CI:1.08~2.35)、再插管(OR=3.42,95%CI:1.26~5.57)、早期用抗生素(OR=4.55,95%CI:2.21~8.77)均为影响VAP发生的独立危险因素。结论 PICU患儿发生VAP的危险因素较多,综合评价和合理使用抗菌药物等措施可减少VAP。  相似文献   

5.
目的 分析儿童支气管哮喘在母孕期及新生儿期的影响因素,为早期防治儿童哮喘提供依据。方法 选择306例哮喘患儿(哮喘组)和250例正常儿童(对照组),对所有儿童母孕期和新生儿期的临床资料进行调查。结果 单因素分析显示哮喘组与对照组在孕期使用抗生素、新生儿期使用抗生素、新生儿期服用益生菌、早产、剖宫产、低出生体重、母乳喂养方面比较差异有统计学意义(P0.05)。多因素logistic回归分析显示,孕期使用抗生素(OR=3.908,95%CI:1.277~11.962)、新生儿期使用抗生素(OR=24.154,95%CI:7.864~74.183)、早产(OR=8.535,95%CI:2.733~26.652)及剖宫产(OR=4.588,95%CI:2.887~7.291)为儿童哮喘的独立危险因素;而新生儿期服用益生菌(OR=0.014,95%CI:0.004~0.046)及母乳喂养6个月(OR=0.161,95%CI:0.103~0.253)为儿童哮喘的保护因素。结论 孕期减少抗生素的使用、减少剖宫产、新生儿期避免滥用抗生素、尽量母乳喂养、尽早添加益生菌可对儿童哮喘起到一定的早期预防作用。  相似文献   

6.
<正>肠道准备是结肠镜检查前的一项重要工作,肠道准备充分与否,直接影响结肠镜检查的进行,及对病变的观察,最终影响检查结果。结肠镜检查目前已广泛应用于儿童,对儿童肠道疾病的诊断起到了重要作用。儿童肠镜检查前常用的肠道准备方法有清洁洗肠法、口服潘泻叶法、口服硫酸镁加洗肠液法  相似文献   

7.
目的探讨影响儿童血管迷走性晕厥(VVS)反复发作的相关因素。方法收集125例确诊为VVS患儿的临床资料,根据晕厥首次发作至直立倾斜试验之前5年内的发作次数,分为晕厥发作次数2、3次的低频次组及≥4次的高频次组,对两组患儿资料进行统计分析。结果 125例VVS患儿中,低频次组84例(67.2%),高频次组41例(32.8%)。单因素分析结果显示,直立倾斜试验检查年龄、晕厥发作时间、发作诱因、晕车史、阳性家族史是VVS高频次发作的相关因素。非条件logistic回归分析结果显示,发作诱因(OR=3.723,95%CI:1.163~11.918,P=0.027)、晕车史(OR=5.929,95%CI:2.066~17.015,P=0.001)、阳性家族史(OR=6.794,95%CI:2.006~23.013,P=0.002)是VVS高频次发作的独立危险因素。结论非持久站立引起的其他发作诱因、晕车史、阳性家族史对预测VVS患儿高频次晕厥发作具有重要临床意义。  相似文献   

8.
目的探讨儿童癫痫持续状态(SE)近期预后不良的影响因素。方法回顾性分析SE患儿的临床资料,采用格拉斯哥预后评分量表(GOS)描述近期预后,GOS=5分为预后良好,GOS<5分为预后不良。结果1.临床资料:入选298例,其中男163例,女135例;年龄2个月7 d^14岁5个月,1~3岁106例。154例(51.68%)既往有抽搐史,98例(63.63%)确诊癫痫,新发SE共241例(占80.87%)。儿童SE病因以热性惊厥居多(92例,占30.87%),其次为远期症状性(81例,占27.18%)。治疗:109例(41.90%)抽搐发作后及时予地西泮治疗,151例(58.10%)先予苯巴比妥钠或水合氯醛等抗癫痫药物。近期预后:254例(85.23%)GOS=5分,余44例GOS<5分。2.近期整体预后影响因素:单因素分析显示年龄、入儿童重症监护病房(PICU)、气管插管、既往抽搐史、生长发育落后、新发SE、发热、全面性发作、难治性SE、脑电图异常、头颅影像学异常及病因共12个因素与预后不良有关(均P<0.05)。多因素分析显示,需要PICU监护(OR=4.306,95%CI:1.554~11.933,P=0.005)、发育落后(OR=3.054,95%CI:1.157~8.066,P=0.024)、头颅影像学异常(OR=2.110,95%CI:1.121~3.970,P=0.021)为近期预后不良的独立危险因素。全面性发作(OR=0.330,95%CI:0.139~0.782,P=0.012)、热性惊厥病因(OR=0.688,95%CI:0.480~0.987,P=0.042)为预后的非危险因素。3.入PICU组SE患儿近期预后影响因素:PICU停留时间越长、非全面性发作类型、脑电图异常、头颅影像异常、发育落后、病因这6个因素与PICU组的预后不良有关,其中PICU停留时间(OR=36.912,95%CI:5.165~263.787,P=0.000)、发育落后(OR=14.403,95%CI:1.725~120.273,P=0.014)为PICU组预后不良的独立危险因素。结论需PICU监护、发育落后、头颅影像学异常为儿童SE整体近期预后不良的独立危险因素。PICU住院时间、发育落后为入PICU儿童SE近期预后不良的独立危险因素。  相似文献   

9.
目的探讨热性惊厥患儿24 h内惊厥反复发作的危险因素, 为早期识别有危险因素的患儿并采取干预措施提供临床依据。方法选取2019年6月至2021年6月河北省人民医院儿科收治的384例热性惊厥患儿为研究对象, 分为单次发作组和反复发作组, 回顾性分析两组患儿的临床资料及惊厥反复发作的危险因素。结果 384例热性惊厥患儿, 年龄6个月~5岁, 单次发作组296例, 反复发作组88例, 两组患儿在是否首次发作、首次发作的年龄、发作时体温、发作持续时间≥15 min、热性惊厥家族史及C-反应蛋白这6项指标, 差异均有统计学意义(P均<0.05)。多因素Logistic回归分析发现, 非首次发作(OR=2.085, 95%CI 1.232~3.529, P=0.006)、首次发作年龄小(OR=0.970, 95%CI 0.948~0.993, P=0.010)、发作持续时间≥15 min(OR=3.587, 95%CI 1.497~8.596, P=0.004)、有热性惊厥家族史(OR=1.892, 95%CI 1.126~3.180, P=0.016)是热性惊厥患儿24 h内反复出现惊厥发...  相似文献   

10.
目的分析儿童肺结核的临床流行病学特征。方法回顾分析2010年-2015年收治的920例肺结核患儿临床资料,并根据病情严重程度分为重症组及非重症组,分析引起重症结核的危险因素。结果 920例患儿的中位发病年龄为7.66岁(9天~17岁7个月)。单纯肺结核470例(51.1%),肺结核合并肺外结核450例(48.9%),其中以合并结核性脑膜炎最为多见(236/450,52.4%)。最常见症状为发热(80.4%)和咳嗽(71.3%)。T-SPOT.TB试验阳性率81.5%。胸部CT阳性率优于胸片。重症结核355例、非重症565例。与非重症相比,重症患儿中男性比例较低,农村患儿、PPD阴性以及年龄0~3岁的比例较高,差异均有统计学意义(P0.05)。多因素logistic回归分析显示,女孩(OR=1.58,95%CI:1.03~2.42)、年龄0~3岁(0~1岁:OR=6. 78,95%CI 3. 66~12. 56;1~3岁:OR=4. 90,95%CI 2. 68~8. 98)、农村患儿(OR=2. 49,95%CI:1. 54~4. 04)是重症结核的独立危险因素,PPD阳性为保护因素(OR=0. 31,95%CI:0. 19~0. 49)。结论儿童肺结核临床表现不典型,病原学阳性率低,需重视接触史、卡介苗接种情况,并强调综合分析,提高对重症结核危险因素的认识。  相似文献   

11.
OBJECTIVE: To assess safety, efficacy, and acceptance of polyethylene glycol 3350 without electrolytes (PEG) for bowel preparation for colonoscopy in children.Study design In a prospective study, 46 children (mean age, 11.2 years; range, 2.8-17.8) were given PEG at a dose of 1.5 g/kg/day for 4 days before colonoscopy. Patients were allowed to mix PEG in the beverage of their choice. Stool frequency and adverse effects were monitored during PEG therapy. Compliance, tolerance, and quality of colonic preparation were assessed. Serum electrolytes were measured before and after PEG therapy in 29 children. RESULTS: Daily stool frequency increased with PEG therapy from baseline of 2.6+/-0.3 to 3.0+/-0.5 on day 1, 4.6+/-0.4 on day 2, 5.5+/-0.7 on day 3, and 6.0+/-0.6 on day 4 (days 2, 3, and 4, P<.001 for difference vs baseline). The colonic preparations were rated as excellent or good in 91% and 95% in the right and left colon, respectively, at endoscopy. Adverse effects were mild nausea (13%), abdominal pain (11 %), and vomiting (11%). Electrolyte profile revealed small, clinically insignificant changes with PEG therapy. Compliance and tolerance were rated as excellent by 89% and 85% of patients, respectively. CONCLUSIONS: Electrolyte-free PEG 3350 can be used as an effective and safe bowel preparation that is well accepted by children for colonoscopy.  相似文献   

12.
OBJECTIVE: The inability of children to comply with bowel preparation regimens can result in inadequate visualization of the colon. This study compares the safety, efficacy, and patient acceptance of a prepackaged diet kit plus a magnesium citrate/bisacodyl bowel cleansing regimen with a clear liquid diet and sodium phosphate solution regimen in children undergoing colonoscopy. METHODS: Children scheduled for a diagnostic colonoscopy, were randomly assigned to receive a prepackaged diet kit and a magnesium citrate/bisacodyl laxative (group 1), or clear liquids and sodium phosphate solution (group 2). The patients and their parents completed a questionnaire to evaluate acceptance of their assigned regimen before colonoscopy. The endoscopists, blinded to the type of bowel preparation, rated bowel cleansing. RESULTS: Sixty two children (28 males, 34 females) with mean age 12.5 years participated. Thirty six and 26 patients were in groups 1 and 2 respectively. Overall cleansing was rated significantly superior in group 1 compared to group 2 as was amount of retained feces (P = .013 for both). The overall frequency of reported side-effects was lower in group 1 than (83.3%, 30/36) than in group 2 (100.0%, 26/26) (P = 0.03). The preparations were otherwise equivalent in regards to compliance and patient tolerance. CONCLUSIONS: Although both regimens were comparable in adequacy of colon visualization, preparation tolerance, side effects and compliance profile in this pilot study, the prepackaged diet kit with magnesium citrate/bisacodyl laxative resulted in superior colon cleansing.  相似文献   

13.
目的 探讨自适应式生物反馈疗法联合口服复方聚乙二醇4000电解质散在儿童出口梗阻型便秘治疗中的临床疗效,为出口梗阻型便秘患儿寻找合理而有效的治疗方法。方法 前瞻性选取168例出口梗阻型便秘患儿为研究对象,按来院就诊次序随机分成试验组和对照组(n=84),试验组采用自适应式生物反馈疗法联合口服复方聚乙二醇4000电解质散治疗,对照组仅采用口服复方聚乙二醇4000电解质散治疗。最终因无法坚持治疗试验组退出11例,余73例;对照组退出2例,余82例。通过临床症状总积分和总有效率比较两组患儿治疗4周和8周时的疗效。结果 治疗前和治疗4周时两组临床症状总积分比较差异无统计学意义(P>0.05),治疗8周时试验组临床症状总积分低于对照组(P<0.05);治疗4周时两组临床总有效率比较差异无统计学意义(P>0.05),而治疗8周时试验组临床总有效率高于对照组(P<0.05)。结论 在口服复方聚乙二醇4000电解质散的基础上加用自适应式生物反馈训练治疗儿童出口梗阻型便秘能明显提升疗效,且效果持久稳定。  相似文献   

14.
AIMS: To undertake a prospective, single blind, randomised trial comparing the efficacy and tolerance of two outpatient colonoscopy bowel preparation regimens. METHODS: Patients aged between 18 months and 16 years being admitted for day case colonoscopy were allocated randomly to receive either Picolax (an oral, sugar free powder containing sodium picosulphate 10 mg/sachet with magnesium citrate) and clear fluids or bisacodyl tablets with an unrestricted diet and a phosphate enema just before colonoscopy. Patient compliance, bowel frequency, and associated symptoms were recorded, and the adequacy of the bowel preparation was assessed in a blinded manner. RESULTS: 63 of 66 patients completed the trial. Mean age, mean weight, extent of colonoscopy, and distribution of underlying pathology were similar in both groups. Bowel preparation was good or excellent in all of the patients in the Picolax group (n = 32) compared with 22 patients in the bisacodyl/phosphate enema group (n = 31). The latter group experienced more abdominal discomfort during bowel preparation but three of the Picolax group vomited and the lack of solid food distressed some children. CONCLUSIONS: All bowel preparation methods have limitations and unpleasant side effects but the use of Picolax and clear fluids proved superior to bisacodyl tablets and a phosphate enema in children undergoing day case colonoscopy.  相似文献   

15.
AIMS—To undertake a prospective, single blind, randomised trial comparing the efficacy and tolerance of two outpatient colonoscopy bowel preparation regimens.METHODS—Patients aged between 18 months and 16 years being admitted for day case colonoscopy were allocated randomly to receive either Picolax (an oral, sugar free powder containing sodium picosulphate 10 mg/sachet with magnesium citrate) and clear fluids or bisacodyl tablets with an unrestricted diet and a phosphate enema just before colonoscopy. Patient compliance, bowel frequency, and associated symptoms were recorded, and the adequacy of the bowel preparation was assessed in a blinded manner.RESULTS—63 of 66 patients completed the trial. Mean age, mean weight, extent of colonoscopy, and distribution of underlying pathology were similar in both groups. Bowel preparation was good or excellent in all of the patients in the Picolax group (n = 32) compared with 22 patients in the bisacodyl/phosphate enema group (n = 31). The latter group experienced more abdominal discomfort during bowel preparation but three of the Picolax group vomited and the lack of solid food distressed some children.CONCLUSIONS—All bowel preparation methods have limitations and unpleasant side effects but the use of Picolax and clear fluids proved superior to bisacodyl tablets and a phosphate enema in children undergoing day case colonoscopy.  相似文献   

16.
The purpose of this study was to evaluate the feasibility of single scan CT colonography (CTC) using polyethylene glycol electrolyte solution with contrast medium (PEG-C) bowel preparation in children. Seven patients suspected of colorectal elevated lesions were subjected to CTC. All patients underwent bowel preparation using polyethylene glycol electrolyte solution (PEG) at a dose of 32 ± 3 ml/kgBW before the day of CTC. The water-soluble contrast agent was given to the patients at a dose of 0.6 ± 0.1 ml/kgBW the next morning. After colonic air insufflation, the patient was scanned axially with a single run. After evaluation of multiplanar reformation images, 3-dimensional images (CT enema and virtual endoscopy image) were reconstructed. CT enema image was composed from air image and contrast-medium image. All studies were performed without complications. CTC showed the entire colon without blind spots in all patients with only single scan. In conclusion, the single scan CTC using PEG-C preparation is safe and less invasive compared to conventional CTC due to the shorter examination time and lower radiation dose.  相似文献   

17.
BACKGROUND: Children with functional constipation and encopresis benefit from behavior modification and from long-term laxative medication. Polyethylene glycol without electrolytes has become the first option for many pediatric gastroenterologists. METHODS: Twenty-eight children treated with polyethylene glycol without electrolytes were compared with 21 children treated with milk of magnesia to evaluate the efficiency, acceptability, side effects, and treatment dosage of polyethylene glycol in long-term treatment of functional constipation and encopresis. Children were rated as "doing well," "improved," or "not doing well," depending on resolution of constipation and encopresis. RESULTS: At the 1-, 3-, 6-, and 12-month follow-ups, bowel movement frequency increased and soiling frequency decreased significantly in both groups. At the 1-month follow-up, children on polyethylene glycol were soiling more frequently (P < 0.01) and fewer were improved (P < 0.01). At the 3- and 6-month follow-ups, both groups had similarly improved. At the 12-month visit, 61% of children on polyethylene glycol and 67% of children on milk of magnesia were doing well. Children on polyethylene glycol soiled more frequently (P < 0.01). None refused polyethylene glycol, but 33% refused to take milk of magnesia. The mean initial treatment dosage of polyethylene glycol was 0.6 +/- 0.2 g/kg daily. Polyethylene glycol had no taste, and no loss of efficacy occurred. Polyethylene glycol did not cause clinically significant side effects. CONCLUSIONS: Polyethylene glycol without electrolytes is an alternative for long-term management of children with constipation and encopresis.  相似文献   

18.
Bowel preparation methods for total colonoscopy in children generally involve whole gut irrigation with electrolyte lavage solutions, which in most children will require hospitalisation for nasogastric tube administration. The aim of the study was to determine the efficacy of oral bisacodyl combined with a single phosphate enema as a bowel preparation regimen in children. In an open prospective trial, 30 children (aged 18 months-15 years) were given oral bisacodyl on each morning of the two days before colonoscopy. The children were maintained on a normal diet. A phosphate enema was administered on the morning of the procedure. The adequacy of bowel preparation was graded as grade I if no faecal material was encountered, grade II if small amounts of faecal material were present in scattered locations, and grade III if there was poor preparation with faecal material precluding satisfactory visualisation of the bowel mucosa. Eight children (26.6%) had minor abdominal cramps when taking bisacodyl, but all had a previous history of similar pain. Five children (16.6%), all under 5 years of age, cried during the administration of phosphate enema. Bowel preparation was considered excellent (grade I) in 26 (86.6%) and good (grade II) in four (13.3%). In all patients adequate visualisation of the bowel mucosa was obtained. Oral bisacodyl combined with a single phosphate enema provides an ideal method of preparing the bowel for total colonoscopy. This preparation allows colonoscopy to be carried out as a day case procedure in children while maintaining them on a normal diet.  相似文献   

19.
Severely constipated children with encopresis in whom outpatient management has failed frequently require several days of hospitalization, as well as conventional treatments involving cathartics and enemas. A balanced electrolyte solution of the nonabsorbable polymer polyethylene glycol (GoLytely, Braintree [Mass] Laboratories Inc) offers a safe and efficient method for clearing the intestine. Twenty-four patients with a mean age of 8.1 years (range, 0.8 to 17.6 years) and an average weight of 31.5 kg received polyethylene glycol-electrolyte solution: eight patients with encopresis were given it as treatment for severe fecal retention unresponsive to outpatient management; the other 16 were being prepared for colonoscopy. Weight, complete blood cell count, and serum electrolyte, serum urea nitrogen, and serum creatinine levels were measured before solution administration and two hours afterward. Abdominal roentgenograms were obtained from the encopretic patients. The two groups were comparable in age and weight. Polyethylene glycol-electrolyte solution was given at a rate of 14 to 40 mL/kg/h until clear fluid was excreted through the rectum. Intestines were cleaned out successfully in all patients, and side effects were minimal. Children with encopresis required an average of 11.8 L (574 mL/kg) given over 22.5 hours, while the other children needed only 4.0 L (128 mL/kg) given over 7.5 hours. Weight and serum electrolyte and creatinine levels did not change significantly in any patient. The hematocrit decreased only in encopretic patients (0.38 to 0.36 [37.6% to 35.8%]) and the serum urea nitrogen level decreased in the patients undergoing colonoscopy (3.6 to 2.0 mmol/L [10 to 8 mg/dL]).  相似文献   

20.
目的分析特应性皮炎(atopic dermatitis,AD)患儿食物致敏的危险因素,以及食物致敏对生活质量及临床体征的影响。方法回顾性收集241例AD患儿人口学特征、发病年龄、病情严重度、生活质量、体格检查、食物过敏原检查、血清总IgE和嗜酸性粒细胞计数等资料。根据过敏原检测结果分为食物致敏组(n=127)和无食物致敏组(n=114)。采用多因素logistic回归分析评估AD患儿食物致敏的危险因素。结果AD患儿食物致敏率为52.7%(127/241)。多因素logistic回归分析显示食物致敏危险因素为:秋季/冬季出生、AD发病年龄<12个月、重度AD、总IgE>150 IU/mL(P<0.05)。与无食物致敏组比较,食物致敏组生活质量较差(P=0.008),非特异性手足皮炎及掌纹症发生率较高(P<0.05)。与单种食物致敏组相比,多种食物致敏组AD病情较重,纯母乳喂养及总IgE>150 IU/mL者占比较高(P<0.05)。结论秋季/冬季出生、AD发病年龄<12个月、严重AD,或总IgE>150 IU/mL的AD患儿更易发生食物致敏。食物致敏AD患儿生活质量更差,更易出现非特异性手足皮炎及掌纹症。[中国当代儿科杂志,2022,24(8):887-893]  相似文献   

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