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一般资料:选择2005-02—2006-06在本院住院的下呼吸道感染的患儿85例,年龄为2个月至6岁,其中男56例,女29例,病程<5d。按入院日期分为两组,对照组42例,其中支气管肺炎22例,支气管炎15例,毛细支气管炎5例;治疗组43例,其中支气管肺炎23例,支气管炎14例,毛细支气管炎6例。两组均符合《诸福棠实用儿科学》第6版关于支气管肺炎、支气管炎、毛细支气管炎的诊断标准。两组患儿均表现有发热、咳嗽、喘息、肺部听诊可闻及干性啰音和(或)湿性啰音阶榛级谀炅洹⒉〕獭⒓膊」钩伞?病情等方面差异无统计学意义(P>0.05)。方法:对照组给予抗感染、吸氧、…     

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??Objective??To investigate the change of the platelet state and function in acute lymphocytic leukemia. Methods??The changes of platelet indices??PLT??PCT??MPV??PDW????immature platelet fraction??IPF%????immature platelet counts??IPC????granule membrane glycoprotein of platelet ??CD62p?? and PAC-1 were obtained by using automatic blood cell analyzer and whole blood flow cytometry??FCM?? respectively??in children with acute lymphocytic
leukemia??ALL????ALL in first complete remission ??ALL-CR1?? and children undergoing elective surgical procedure??control group??. Results????1??Without addition of platelet agonists ADP??expression of platelet surface activated CD62p and PAC-1 in ALL was higher than that in control group??P??0.05????while expression of platelet surface activated PAC-1 in ALL-CR1 was higher than that in control group??P??0.05????and lower than that in ALL??P??0.05??????2??With addition of platelet agonists ADP??expression of platelet surface activated CD62p and PAC-1 in ALL was lower than that in control group??P??0.05????while expression of platelet surface activated PAC-1 in ALL-CR1 was lower than that in control group??P??0.05????and higher than that in ALL??P??0.05??????3?? PLT??PCT and MPV in ALL was lower than that in control group and ALL-CR1 ??P??0.05??????4?? IPF% in ALL was higher than that in control group and ALL-CR1??P??0.05????and IPC was lower than that in control group and ALL-CR1??P??0.05??. Conclusion??The children who are newly diagnosed with acute lymphocytic leukemia have peripheral platelet reactivity and platelet function defects. Platelet indices and platelet membrane glycoprotein can be used as effective indicators to judge the effect on ALL.     

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特应性皮炎(atopic dermatitis,AD)是儿童常见皮肤病,多于婴幼儿时期发病。近三四十年,随着环境变化和全球工业化快速发展,AD患病率呈逐年上升趋势,在发达国家影响了20%～30%的儿童[1]。我国1988—1989年上海地区7～18岁中小学生AD患病率为0.46%,1998年城市6～20岁年龄段AD患病率为0.62%,2002年1～7岁儿童AD患病     

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所谓食物过敏是指由免疫机制介导的某种食物或食品添加剂等引起肠道内或全身的变态反应;而不由免疫介导的反应则称之为食物不耐受[1]。食物过敏又进一步分为IgE介导和非IgE介导的反应,前者属于Ⅰ型变态反应,常在进食后数分钟内出现症状,可以累及皮肤、呼吸道、消化道,这些症状常常同时出现,但无特异性。非IgE介导的食物过敏涉及了IgG、免疫复合物及细胞介导的免疫反应等多种机制,常于进食后数小时或数天后出现症状[2-3]。食物过敏在儿童中的发病率较成人高,据欧洲和美国的资料,7%8%3岁以下儿童曾发生过食物过敏,1岁以内婴儿牛奶过敏发生…     

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小儿功能性便秘(FC)诊断及治疗研究在国内已开展数年,但进展缓慢,其主要原因系儿科临床医师对儿童功能性胃肠病(FGID)认识尚不够充分,未引起足够重视。目前FGID已达成全球性共识,自1994年罗马标准Ⅰ问世以来,历经十余载,2006年罗马标准Ⅲ业已出台[1-2],共列出28项成年人及17项儿童FGID以症状为依据的诊断标准。其中有关新生儿/婴幼儿功能性便秘(G7)及儿童和青少年功能性便秘(H3a)的诊断标准极为详尽,较罗马标准Ⅱ更接近临床实际,更具操作性。罗马标准Ⅲ的实施、推广对儿童FGID的临床研究极为重要,在此基础上讨论FC有关问题更易深入…     

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十余年来,射频导管消融(RFCA)广泛用于根治预激综合征、房室结折返性心动过速、房性心动过速、心房扑动、特发性室性心动过速和频发性室性早搏,取得极好的疗效。由于其成功率高、创伤小及相对安全,已成为根治上述心律失常的首选方法。RFCA用于治疗小儿快速型心律失常国内外均有     

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儿童心脏起搏器的应用始于20世纪60年代初期,通过开胸手术植入单腔起搏系统,治疗心脏传导阻滞和晕厥发作[1]。20世纪70年代中末期至80年代初期,由于起搏导线及程控技术的发展,小儿心内膜起搏应用于临床[2],双腔起搏器的问世,使心房和心室能够顺序起搏,较好地符合“生理性起搏”     

24小时食管动态pH-阻抗联合监测评估小儿胃食管反流性咳嗽的临床特征

目的 探讨24 h食管动态pH-阻抗联合监测对以慢性咳嗽为主要表现的胃食管反流病（GERD）患儿的临床表现及反流特征的评估价值。方法 对2012年2月至2013年7月40例南京医科大学附属南京儿童医院门诊及住院的可疑胃食管反流性咳嗽（RERC）患儿,利用24 h食管pH-阻抗联合监测GERD患者的各项指标。结果 40例慢性咳嗽患儿中,单纯用24 h食管pH监测符合GERD的患儿有23例（57.5%）,利用24 h食管动态pH-阻抗联合监测符合GERD的患儿有34例（85.0%）,明显高于单纯用24 h食管pH监测的结果。且在小儿慢性咳嗽中主要是在直立时弱酸反流和酸反流为主（P＜0.05）,同时发生频率最高的在直立状态下的混合反流（P＜0.05）,而食团清除时间在直立与仰卧时差异无统计学意义（P＞0.05）,近端反流是以仰卧位为主（P＜0.05）。总反流次数与症状指数（SI）呈正相关（r = 0.818,P＜0.05）。结论 利用24 h食管动态pH-阻抗联合监测技术可以检出酸反流、弱酸反流和非酸反流,使GERD的诊断更精确,对以慢性咳嗽为主要表现的GERD有着重要的诊断价值,具有较好的临床应用前景。     

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??Objective To discuss the changes of ambulatory blood pressure monitoring??ABPM?? in children with vasovagal syncope ??VVS??.Methods A total of 72 children ??VVS group??32 males??40 females??mean age ??10.98±1.86??years?? were enrolled in this study??who came from Children Syncope Outpatient Department or Inpatient Department of the Second Xiangya Hospital of Central South University from Sep 2008 to Feb 2010.After confirmed diagnosis of VVS by positive head-up tilt test ??HUTT????each patient was given ABPM.Forty healthy children ??19 males??21 females??mean age 10.24 ± 2.01 years?? were as controls ??control group??.Parameters of ABPM in children were analyzed.SPSS 17.0 software was used for the statistical analysis of these data.Results ??1??Mean pressure??24-hour mean systolic pressure ??24hSBP????24-hour mean diastolic pressure ??24hDBP????daytime mean systolic pressure ??DSBP?? and nighttime mean systolic pressure ??NSBP?? in VVS group were higher than those of the control group ??P??0.05??.??2??Blood pressure pattern??the ratio of non-spoon pressure pattern was higher than that of spoon pressure pattern with VVS ??67%vs.18%??P ??0.05??.NDBP ??P??0.05?? and NSBP ??P ??0.05?? were decreased and the systolic pressure differences and diastolic pressure differences in the daytime and at nighttime were higher in spoon pressure pattern than those of non-spoon pressure pattern with VVS ??P??0.05??.??3??Diagnostic experimental evaluation??the specificity??sensitivity??diagnostic coincidence??positive predict value and negative predict value of non-spoon pattern of ambulatory blood pressure pattern to VVS was 82.5%??66.67%??72.32%??87.27% and 57.89%??respectively.The Youden index was 45.28%.Conclusion There is autonomic nerve adjustment imbalance in children with VVS during asymptomatic time periods??especially the sympathetic nerve.The non-spoon pattern rate of fluctuation curve of ambulatory blood pressure in VVS children is higher??which is of diagnosis value to VVS children.     

Bile in the esophagus: a factor in the pathogenesis of reflux esophagitis in children

OBJECTIVES: Bile reflux has been postulated to be an important factor contributing to gastroesophageal reflux disease in adults. The purpose of this study was to investigate its role in children. METHODS: Sixty-five children with symptoms of gastroesophageal reflux disease were classified on the basis of the endoscopic grade of reflux esophagitis: no esophagitis (n = 26), mild to moderate esophagitis (n = 26), and severe esophagitis (n = 13). Simultaneous 24-hour esophageal pH and bilirubin monitoring with Bilitec 2000 was performed. RESULTS: Both bile and acid reflux increased with the severity of esophagitis. The differences between all groups were significant for the percentage of total (P < 0.0005), upright (P < 0.05), and supine time (P < 0.0005) bilirubin absorbance > or = 0.14, as well as for the percentage of total and supine time pH < 4, and DeMeester score (P < 0.0005). Combined pathologic acid and bile reflux was found in 11% of children with mild esophagitis and in 70% of children with severe esophagitis, while isolated bile reflux was found in 31% and 7.5%, respectively. Combined pH and bilirubin monitoring, compared with ph-monitoring alone, increased the sensitivity from 56% to 79%, and the accuracy from 69% to 83%. CONCLUSIONS: Both bile and acid reflux increase stepwise with the severity of esophagitis. Combined acid and bile reflux is associated with severe esophagitis. Isolated acid or bile reflux is usually present in mild esophagitis. Simultaneous esophageal pH and bilirubin monitoring has a higher sensitivity, as well as predictive values and accuracy than ph monitoring alone.     

24 h食管pH监测在婴儿难治性肺炎中的临床应用研究

目的探讨24h食管pH监测在婴儿难治性肺炎中的临床应用及其意义。方法对57例难治性肺炎患儿进行24h食管pH监测,监测指标包括食管pH〈4.0的次数、反流时间≥5min的次数、最长反流时间、卧位pH值〈4的时间占总监测时间的百分比和Biox-Ochoa评分。结果57例中存在胃食管反流（GER）28例（占49.1%）;有呕吐与无呕吐症状患儿各项反流指标比较差异有统计学意义;伴有胃食管反流患儿经促动力剂治疗者,肺部罗音消失时间和咳嗽持续时间均较未用促动力剂治疗者短,差异有统计学意义（P〈0.05）。结论难治性肺炎患儿经正规抗炎治疗效果不佳者,应考虑是否合并胃食管反流,进行24h食管pH监测,以确定病因并指导治疗。     

胆汁和胃泌素在小儿胃食管反流病中的作用

目的：探讨酸和胆汁反流在小儿胃食管反流病(GERD)中的发生情况以及胆汁和胃泌素在小儿GERD中的作用。方法：根据内镜检查结果将GERD分为反流性食管炎(RE)组和非糜烂性反流病(NERD)组,共检测42例。同时应用便携式食管pH监测仪及胆汁监测仪对其进行24hpH监测及胆汁联合监测,对相应病例采用放射免疫测定法进行空腹血清胃泌素(GS)测定,同期检测13例无胃食管反流症状并排除了消化道及严重全身器质性疾病的儿童作为对照。结果：42例患儿中24例为RE(内镜检查存在食管下段黏膜充血等病损),18例为NERD(内镜检查黏膜正常)。GERD患儿pH<4及胆红素吸收值≥0.14的总时间百分比、酸及胆汁反流的总次数和反流>5min的次数均明显高于正常对照组(P<0.05),RE组的食管酸暴露时间(pH<4)及胆红素吸收值≥0.14的时间百分比较NERD组明显增高(P<0.05)。NERD组6例(33.3%)、RE组16例(66.7%)出现酸和胆汁混合反流(P<0.01)。RE组和NERD组血清GS浓度均明显高于正常对照组(P<0.01,P<0.05),且RE组的血清GS浓度明显高于NERD组(P<0.05)。结论：小儿GERD中以混合反流为主,胆汁反流在小儿GERD的发病中起一定作用,GS的分泌异常可能参与了小儿GERD的发病过程。在小儿GERD的发展过程中,GS和胆汁反流可能起正性协同作用。     

Application and development of pH monitoring technology in gastroesophageal reflux disease北大核心CSCD

Gastroesophageal reflux disease (GERD) is a common digestive system disease with various symptoms or complications.Currently, pH monitoring is the most powerful technology to diagnose GERD, generally including the 24-hour dynamic esophageal pH monitoring, Bilitec bile reflux monitoring, 24-hour multichannel intraluminal impedance-pH monitoring, wireless capsule pH monitoring and oropharyngeal pH monitoring.This study aims to review the development and clinical application of pH monitoring technology in GERD. © 2022 Chinese Medical Journals Publishing House Co.Ltd. All rights reserved.     

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??Objective??To investigate the incidence and clinical characteristics of orthostatic hypertension??OHT??in children. Methods??Totally 1348 children with syncope??dizziness??etc??were collected in Peking University First Hospital between 2009 and 2015??24 of whom were diagnosed with OHT. Demographic characteristics??the occurrence frequency of various clinical manifestations and its inducing factors??course of disease and the changes of the blood pressure at the lying position were analysed. Results????1??Among 1348 children??OHT was in 24 ??male 14??female 10??. The case proportions of those at or under 12 years old to those beyound 12 years old and the ratio of male to female showed no significant differences.??2??There was no difference between those at or younger than 12 years old and those older than 12 years old??χ2??0.411??P??0.521????or the ratio of males to females in sOHT and dOHT. ??3??The most common clinical manifestations were syncope??dizziness??chest tightness??and so on. Syncope and chest tightness mostly appeared in dOHT children. The incidence of dizeiness in sOHT and dOHT was similar. In children??common inducements were sudden postural changes??from supine to upright and standing position????41.7%????persistent standing??37.5%????or persistent seating??37.5%??. Persistent standing and persistent seating were the main cause of sOHT. Sudden postural changes were the main cause of dOHT. Conclusion??There is no age or gender difference in the incidence and typing of OHT in children. Syncope??dizziness and chest tightness are the main clinical manifestations. Persistent standing and persistent seating are the main cause of sOHT. Sudden postural changes are the main cause of dOHT.     

Esophageal motor activity in children with gastro-esophageal reflux disease and esophagitis

OBJECTIVE: To evaluate esophageal body motor contractions occurring during esophageal reflux in pediatric patients with gastro-esophageal reflux disease (GERD). METHODS: Patients referred for the evaluation of GERD who were evaluated with combined 24-hour pH probe and esophageal manometry test (MP24) were included. Patients were separated into the following groups: Group C -- normal pH probe and normal EGD; Group 1 -- abnormal pH probe and normal EGD; and Group 2 -- abnormal pH probe and EGD with histologic esophagitis. Esophageal motor function during reflux episodes was analyzed. RESULTS: Twenty-five patients were included. All had a normal stationary esophageal manometry. Patients in Groups 1 and 2 had significantly more gastroesophageal reflux by pH probe than Group C (P < 0.01). During the MP24, patients in Group 1 and 2 had significantly fewer contractions per minute pre-, during, and post-GER (P < 0.05). There were significant differences in the number of isolated and prolonged contractions (>7 sec) during prolonged GERD episodes >5 minutes (P < 0.05). CONCLUSION: Children with GERD have a decreased number and abnormal esophageal body contractions with esophageal reflux. This suggests that children with GERD with and without esophagitis have impaired esophageal body acid clearance.     

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??Analysis of correlation between sleep postures and sleep disorders among children.????WENG Xue-hua*??LI Jie-min??JIANG Yan??LIU Ji-hong??LUO Xue-mei??CAI Yi-min. *Department of Pediatrics??the Second Xiangya Hospital?? Central South University?? Changsha 410011??China
Abstract??Objective??To investigate the relationship of sleep posture with sleep disorder among children. Methods??Totally 2706 parents of 3 to 12-year old children in five administrative districts of Changsha were randomly selected for questionnaire research from Jun. 2006 to Apr. 2007. Results??As to various sleep positions?? 50.92% of children belonged to the lateral position group?? 26.42% to the prone position group?? and 22.65% to the supine position group respectively. The mean age of children in the lateral position group was ??7.83 ± 2.69?? yrs????6.35 ± 2.49??yrs in the prone position group?? and ??7.79 ± 2.63?? yrs in the supine group?? with significant difference among the 3 groups ??F = 82.871?? P < 0.05??. The incidence of sleep disorders was 50.6%??37.6% and 29.9% in the prone position group??lateral position group and the supine group respectively??and the difference among these 3 groups was statistically significant ??χ2 = 63.101??P < 0.05??. Incidence of related symptoms of sleep disorders?? including hyperhidrosis?? bruxism?? squirm?? body twitching and awakening??in the prone position was higher than that in supine position ??χ2 = 61.828??8.973??8.946??8.614??7.154??P < 0.0125???? while the rates of hyperhidrosis?? sleep snoring?? squirm and breathing by mouth in prone position were still higher than those in the lateral position group ??χ2 = 6.553??11.176??9.693??9.552??P < 0.0125??. Conclusion??There is a correlation between sleep postures and sleep disorders among children?? which should be concerned about by the health care workers and parents. Children should be accustomed to supine position rather than the prone position.     

联合食管多通道腔内阻抗-pH监测婴幼儿胃食管反流病

目的 评价24 h 联合食管多通道腔内阻抗-pH 监测（24 h MⅡ-pH）在婴幼儿胃食管反流病中的诊断价值,分析伴有反复肺炎的胃食管反流婴幼儿的反流特点。方法 疑诊胃食道反流的反复肺炎婴幼儿17 例,行24 h MⅡ-pH 监测,分析反流物性质和特点。结果 17 例患儿中阳性11 例（65%）,共监测到853 次反流周期,其中65.3% 为酸反流,以餐后2 h 以内发生为主（69.5%）;71.6%为混合反流;反流发生的体位从多至少依次为直立位、仰卧位、侧卧位和俯卧位;反流物的高度以远端反流为主。根据Biox-ochoa 评分,重度反流的患儿占73%（8/11）。结论 联合食管MⅡ-pH 监测可分析反流物性质,增加胃食道反流病的检出率。