急性肺损伤发病机制研究进展

急性肺损伤/急性呼吸窘迫综合征是指非心源性的各种内外因素导致的急性、进行性、缺氧性呼吸功能不全或呼吸衰竭;肺损伤的病因多种多样,发病机制非常复杂,且尚不明确.该文对其目前相关病因及发病机制研究进行综述.     

胆道闭锁患儿亲体肝移植术后急性肺损伤风险因素分析

目的 分析胆道闭锁患儿亲体肝移植术后急性肺损伤的风险因素.方法 收集天津市第一中心医院2012年5月至2016年3月实施的112例胆道闭锁患儿亲体肝移植术临床资料,回顾性分析临床因素对患儿术后急性肺损伤的影响.结果 112例胆道闭锁患儿亲体肝移植患儿术后23例发生急性肺损伤,发生率为20.5％.单因素logistic回归分析显示肺部并发症组与对照组间年龄(P=0.010)、术前白蛋白(P=0.012)、术前总胆红素(P=0.001)、术前血清肌酐(P＜0.001)、术后1周内总胆红素峰值(P=0.035)差异有统计学意义(P＜0.05).多因素logistic回归分析显示,术前白蛋白(P=0.010,OR=0.830,可信区间为0.720～0.957)、术前总胆红素(P=0.001,OR=1.010,可信区间为1.004～1.016)及术前血清肌酐(P=0.001,OR=1.237,可信区间为1.104～1.387)是术后急性肺损伤发生的高危因素.结论 急性肺损伤是胆道闭锁患儿亲体肝移植术后的严重并发症,术前血清白蛋白、总胆红素及肌酐水平是患儿急性肺损伤发生的高危风险因素.     

小儿急性肺损伤

急性肺损伤(ALI)是由心源性以外的各种肺内外致病因素导致的急性、进行性缺氧性呼吸衰竭,是小儿常见的危重症。严重感染是小儿ALI的首位高危因素,对高危人群应加强监护,做到早期诊断、及时治疗,防止医源性肺损伤的发生。     

新生儿急性呼吸窘迫综合征的发病机制及诊断治疗进展

急性呼吸窘迫综合征是各种致病因素引起的急性、进行性、炎性肺损伤过程.新生儿急性呼吸窘迫综合征的病死率高达30％ ～ 60％.近年来随着对该病发病机制的深入研究,人们在其诊断、治疗方面也提出了很多新的观点.该文着重就新生儿急性呼吸窘迫综合征的发病机制、诊断及治疗的进展作一综述.     

谁是危重症肺-肾交互的核心：缺氧、液体、炎症因子？

急性肺损伤/急性呼吸窘迫综合征和急性肾损伤在儿科重症监护室是常见的。危重症患者的肺-肾交互作用与急性肾损伤及急性肺损伤/急性呼吸窘迫综合征患者的缺氧、液体管理、炎症反应密切相关。加强对肺-肾交互作用的认识, 有助于临床医生对危重症患者进行系统化管理。     

新生儿急性肺损伤血中内皮细胞因子变化及意义

新生儿急性肺损伤（acute lung injury／acute respiratory distress syndrome，ALI／ARDS）是指机体在遭受各种病理刺激后，发生的急性炎症反应，以进行性呼吸困难和缺氧为主要临床表现的呼吸衰竭。新生儿急性肺损伤是新生儿期常见病，慢性肺部疾病常在急性肺损伤的基础上形成。所以及时、恰当的对急性肺损伤诊治，不仅可提高患儿生存率，并且可以减少慢性肺疾病的发生。我们对诊断为新生儿急性肺损伤的新生儿血中血小板活化因子（PAF）、血栓调节蛋白（TM）进行检测，为新生儿肺损伤的进一步研究提供理论依据。     

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/     

肺泡表面活性物质对新生儿急性肺损伤氧合功能的影响

目的 研究肺泡表面活性物质（pulmonary surfactant,PS）对新生儿急性肺损伤、急性呼吸窘迫综合征氧合功能的影响.方法 纳入符合急性肺损伤、急性呼吸窘迫综合征诊断标准的新生儿98例,分为PS治疗组30例及常规治疗组68例,PS治疗组经气管插管注入PS 70 ～ 100 mg/kg,其余治疗同常规治疗组.结果 两组新生儿的性别、胎龄、出生体重、肺损伤程度差异无统计学意义;PS治疗组在急性肺损伤、急性呼吸窘迫综合征治疗后6h、12h、24 h、48 h的PaO3/FiO2、呼吸机有效指数均高于常规治疗组,而氧合指数、呼吸指数均低于常规治疗组,差异有统计学意义（P＜0.05）;PS治疗组在急性肺损伤、急性呼吸窘迫综合征治疗后机械通气时间[（66±13）h、（82 ±26）h]和用氧时间[（86±13）h、（103±25）h）]均较常规治疗组[（80 ±18）h、（101 ±36）h和（104±16）h、（125 ±29） h]缩短,差异有统计学意义（P＜0.05）.结论 应用PS治疗新生儿急性肺损伤、急性呼吸窘迫综合征可改善肺顺应性及氧合功能,缩短机械通气及氧疗时间,有利于改善预后.     

血管内皮细胞生长因子与急性肺损伤

小儿急性肺损伤(ALI)及ALI的严重形式急性呼吸窘迫综合征的主要病理特征是弥漫性肺泡-毛细血管壁损伤.血管内皮细胞生长因子(VEGF)可以促进肺泡细胞、血管内皮细胞增殖.也可以提高血管通透性.因此,VEGF可能成为一种反映ALI病理和(或)肺损伤及修复状况的生物学指标.该文对VEGF及其受体的基本生物学特性、VEGF与ALI相关的动物及临床研究作一综述.     

小儿急性呼吸窘迫综合征的非机械通气治疗

小儿急性呼吸窘迫综合征一直是儿科重症监护病房最为重要的疾病之一.本文介绍了急性呼吸窘迫综合征的柏林定义,较为全面地综述了小儿急性呼吸窘迫综合征的非机械通气治疗,包括注意避免各种易患因素、加强营养支持、注意坚持保守补液、探制输血指征及防止输血相关性肺损伤;对肺表面活性物质治疗、吸入一氧化氮及糖皮质激素的应用方面近年的进展作了简要介绍;提出在重症ARDS中应坚持俯卧位通气等.     

A selective approach to the treatment of acute scrotum in children

To determine a reliable clinical approach to the problem of acute scrotum (AS) in children and identify patients who require emergent surgical intervention, 65 boys with the diagnosis of AS were studied. The mean age was 11 years. Acute orchitis/epididymitis was diagnosed in 42 (64.6%), torsion of the testis in 12 (18.5%), and torsion of the appendix testis in 5 (7.7%). A testicular radionuclide scan was the most reliable diagnostic tool, being positive in all 12 cases of torsion of the testis. Eighteen patients underwent scrotal exploration. Detorsion and bilateral orchidopexy was performed in 12, excision of a necrotic appendix testis in 5, and evacuation of a scrotal hematoma in 1. The outcome of the involved testis at follow-up examination was excellent, with only 1 child developing testicular atrophy. This study stresses the reliability of the selective approach for the treatment of the AS in children.     

Enteric viral infections in pre-school children in Karachi,Pakistan

A prospective study was conducted in Karachi, Pakistan on the virology of enteropathogens excreted by children with acute gastroenteritis and the results were compared with a control group of healthy children. Rotavirus and Adenovirus detection was done using ELISA techniques, while enterovirus isolation was done by virus culture. In 1990, 12.3% children with acute watery diarrhoea excreted rotavirus, as compared to 24.4% children in 1991. None of the healthy children excreted adenovirus 40 and 41. Preliminary results of 1992 revealed that rotavirus was seen in 13% of children with acute watery diarrhoea and adenovirus in 10% of children. Enteroviruses were isolated in the same frequency in all three groups i.e. children with acute watery diarrhoea, children with poliomyelitis and healthy children. Non-polio enteroviruses were excreted in 50–52% in all the 3 groups. The rate of enterovirus excretion is much higher than seen in other developed countries and is the same in children with diarrhoea and healthy children.     

Acute respiratory distress syndrome in children with acute iron poisoning: the role of intravenous desferrioxamine

The acute respiratory distress syndrome is a rare but potentially fatal complication of severe acute iron poisoning and its pathogenesis has been linked with direct and indirect iron toxicity as well as the use of the chelator drug desferrioxamine. We report a case of severe acute respiratory decompensation in a child treated according to the current protocol for chelation therapy and discuss its implications. Conclusion We believe that the efficacy and safety of chelation therapy in severe acute iron poisoning may be improved by targeting the initial high levels of readily chelatable serum iron with adequate doses of desferrioxamine without prolonging its use unnecessarily. Received: 18 December 1998 / Accepted: 2 June 1999     

急性肺损伤和急性呼吸窘迫综合征的预后评估指标

急性肺损伤、急性呼吸窘迫时机体发生一系列的病理生理变化,研究者通过对相关临床、生化指标进行研究发现其中一些指标与预后密切相关.临床指标包括年龄、病因、器官功能不全、免疫抑制等.生化指标包括心功能指标氨基末端脑钠肽前体、心肌酶;凝血纤溶相关指标蛋白C;肺表面活性物质;氧化应激产物:一氧化氮、血管假性血友病因子、炎症因子等.利用这些指标可以判断疾病进展,为指导后续治疗提供依据.     

Acute renal failure in Congolese children: a tertiary institution experience

Aim: Published data on acute renal failure in children from the Democratic Republic of Congo are rare. The objective of this study was to review clinical manifestations, aetiologies and outcome in hospitalized children with acute renal failure. Methods: A retrospective study at Pediatric Nephrology Unit of University Hospital of Kinshasa was carried out. Results: Fifty‐six children with acute renal failure were eligible. There were 31 boys (55.4%) and 25 girls (44.6%) with a sex ratio of 1.24. The median age was 6.7 years (range 1–13 years). Fever (80.3%), oligo‐anuria (73.2%), jaundice (67.9%) were the common clinical presentation. Blackwater fever (42.8%) was the leading cause of Acute Renal Failure. The incidence of severe dehydration because of gastroenteritis was low (5.3%). Around 12.5% of patients’ misused herbal plants. Acute Peritoneal Dialysis was indicated in 15/56 children and only performed in four patients. Fourteen children (25%) died. Conclusion: A wide spectrum of features was seen in hospitalized Acute Renal Failure children and limited access to Acute Peritoneal Dialysis remained an important mortality risk factor.     

Sweet syndrome in early childhood

A 21-month-old child with acute febrile dermatosis, leukocytosis and skin biopsy showing intradermal neutrophil infiltrate was diagnosed as suffering from Sweet syndrome. This syndrome is rare in children, described heretofore in only seven pacdiatric patients. The clinical and histological features, differential diagnosis, as well as the potential association with more widespread systemic diseases are discussed.     

Clinical and microbiological analysis of six children with acute suppurative parotitis

Six children including two neonates with acute suppurative parotitis are described. They presented typical symptoms and signs of fever (4/6) and swelling (6/6), tenderness (6/6), erythema (4/6) and local warmness (4/6) of the parotid gland affected. Leucocytosis and an elevated erythrocyte sedimentation rate and serum amylase level may be seen. The presence of purulent discharge from the Stensen duct when the parotid gland is externally compressed is pathognomonic of the disease, and the microbiological diagnosis can be made by culture of the pus. Microbiologically, this series highlights the polymicrobic nature and importance of Streptococcus viridans in paediatric suppurative parotitis, indicating, therefore, that the causative bacteria entered the gland from the oral cavity. Our data also suggest that initial antibiotic therapy for such patients should provide adequate coverage for streptococci and staphylococci as well as for anaerobic bacteria.     

儿童急性淋巴细胞白血病并发急性胰腺炎的危险因素分析北大核心CSCD

目的分析儿童急性淋巴细胞白血病(ALL)并发急性胰腺炎(AP)的危险因素。方法回顾性研究。选取2018年5月至2020年12月首都医科大学附属北京儿童医院血液病中心收治的ALL并发AP患儿39例作为病例组, 同期按照同年龄、同性别1∶2完全匹配的方式随机选取78例ALL患儿作为对照组。2组计量资料比较采用秩和检验(Mann-Whitney U检验), 计数资料比较采用χ^(2)检验, 并进一步行多因素Logistic回归分析寻找ALL并发AP的危险因素, 同时探究各指标与严重程度的关联。结果 ALL并发AP的发病率为8.55%(39/456例), 3~10岁为高发年龄段。64.9%(24/37例)发生在早期化疗阶段, 66.7%(26/39例)与门冬酰胺酶相关。2组患儿的ALL危险分层(χ^(2)=21.404, P<0.001)、C反应蛋白(CRP)(U=232.000, P<0.001)、降钙素原(PCT)(t=3.950, P<0.001)、红细胞比容(t=3.981, P<0.001)、血钙(t=-9.609, P<0.001)、未结合胆红素(U=1 142.000, P<0.05)、三酰甘油(t=3.600, P=0.001)、白蛋白(t=-6.296, P<0.001)比较差异均有统计学意义。病例组腹部CT敏感性为70.8%, 腹部超声敏感性为81.6%, 胰腺磁共振成像(MRI)敏感性为100.0%。多因素Logistic回归分析显示, 白蛋白(OR=11.444, 95%CI:3.240~40.423)、三酰甘油(OR=18.047, 95%CI:5.020~65.074 )及危险分层(OR=8.894, 95%CI:1.889~41.885)的差异有统计学意义。重度胰腺炎患儿与轻度或中度重症胰腺炎患儿之间的PCT(U=3.000、2.000, 均P<0.05)、血钙(U=4.500、8.500, 均P<0.05)差异显著。结论 ALL并发AP多发生在化疗早期, 主要由门冬酰胺酶所致。影像学检查中胰腺MRI敏感度最高, 腹部超声次之。危险分层、白蛋白下降、三酰甘油升高是ALL并发AP的危险因素, 有助于对ALL并发AP的高危患儿进行早期识别。PCT与血钙水平可能对重度胰腺炎有提示作用。