小儿白血病输血的要求,有效性及副作用观察

为了解白血病输血要求、成分血的合理应用、输血的临床效果及副作用,总结了输血治疗的３３例白血病,了解输血的指征、判断其输血的必要性、用血的适当性、不同血液成分的疗铲及副作用,分析了３３例白血病共输血３６６例次;输血原因依序为Ｈｂ、ＢＰＣ、ＷＢｃ降低,感染、出血。浓缩ＲＢＣ和ＢＰＣ输注对Ｈｂ和ＢＰＣ降低的疗效明显优于全血输注,ＩＶＩＧ、ＣＳＦ等血液成分对感染和ＷＢＣ降低有很好的疗效。小儿白血病因指征掌     

急性白血病患儿成分输血的疗效分析

白血病患儿在应用连续的强化疗后 ,可使严重骨髓抑制及其他合并症增多 ,这对输血质量的要求增加 ,总结近年我院小儿的急性白血病成分输血的效果 ,现报道如下。材料与方法一、一般资料　 2 0 0 0年 9月～ 2 0 0 2年 7月我院收治化疗期间需输血治疗的急性白血病 2 9例 ;男 17例 ,女 12例 ;年龄 1～ 15岁。急性淋巴细胞白血病 13例 ,急性非淋巴细胞白血病 10例 ,急性粒细胞白血病 6例 ,均经骨髓或病理切片确诊。二、血液来源　均由洛阳市中心血站提供库存或新鲜采集的全血、浓缩红细胞 ,机采血小板、粒细胞 ,新鲜冰冻血浆。三、输血指征及方法…     

白血病输血的合理性

临床在输血中常有不必要和不适当输血［1,2］，为总结经验，指导临床工作，特对近年小儿白血病输血进行总结，现将结果报道如下。临床资料一、一般情况33例白血病，男19例，女14例，年龄la～14a，平均5．35士2.76a。急性淋巴细胞白血病24例，急性非淋巴细胞白血病9例。二、方法     

输血技术在小儿白血病急救中的应用

目前小儿急性白血病的完全缓解率和5年无病存活率显著提高，化疗强度越来越大，骨髓抑制也加重，对支持治疗的依赖性增加。尤其是输血支持，是患儿获得缓解或延长生命的重要保证。因此，应正确掌握输血原则和方法。     

大剂量甲氨蝶呤治疗急淋白血病的副作用观察及对策

对接受大剂量甲氨蝶岭 (MTX)治疗的急性淋巴细胞性白血病患儿 ,观察及总结MTX副作用的种类、发生率 ,评价相应防治MTX副作用措施的实用性及价值。方法病例来源 :急淋患儿 33例共接受大剂量MTX治疗 1 0 7例次 ,以临床症状、体征、实验室检查为观察指标 ,总结MTX的副作用发生种类及发生率 ;采用还原型谷胱甘肽 (TAD)护肝治疗及大剂量VitB12 肌注为主的综合防治措施分别防治MTX对肝脏和粘膜的毒副作用 ,对比采用防治措施前后毒副作用的发生率及程度的变化 ,结果进行统计学处理 (t检验 ) ,评价其防治效果。结论 33例患儿接受MTX冲击治疗后副作用的发生率及种类与国外报道基本一致 ,两种综合防治措施是有效的 ,值得推广 ;甲基强的松龙治疗MTX引起的剥脱性皮炎的方法能否推广应用尚需进一步观察。     

大剂量甲氨蝶呤治疗急淋白血病的副作用观察及对策

对接受大剂量甲氨蝶岭（MTX）治疗的急性淋巴细胞性白血病患儿，观察及总结MTX副作用的种类、发生率，评价相应防治MTX副作用措施的实用性及价值。方法病例来源：急淋患儿33例共接受大剂量MTX治疗107例次，以临床症状、体征、实验室检查为观察指标，总结MTX的副作用发生种类及发生率；采用还原型谷胱甘肽（TAD）护肝治疗及大剂量Vit B12肌注为主的综合防治措施分别防治MTX对肝脏和粘膜的毒副作用，对比采用防治措施前后毒副作用的发生率及程度的变化，结果进行统计学处理（t检验），评价其防治效果。结论33例患儿接受MTX冲击治疗后副作用的发生率及种类与国外报道基本一致，两种综合防治措施是有效的，值得推广；甲基强的松龙治疗MTX引起的剥脱性皮炎的方法能否推广应用尚需进一步观察。     

335例患儿成分输血的临床观察

目的了解成分输血的适应症、临床意义及副作用。方法取９６年开展成分输血后的３３５例已行成分输血治疗的患儿为治疗组及９６年前同种疾病的全血治疗为对照组。结果红细胞输注效果等于同等量全血输注效果,但大大减少副作用。血小板、血浆输注效果明显优于全血输注。结论成分输血显著提高疗效,减少输血反应,而且节省血源,减轻社会、个人的经济负担。     

小儿血液病成分输血的临床分析

目的：探讨成分输血的输注指征，以便指导临床合理输血。方法：回顾性分析1997年1月—2001年12月小儿血液病经输血治疗的临床资料。对成分输血率、输血适当性及输血效果、输血不良反应进行统计分析。结果：近5年来小儿血液病成分输血率为95．31％；输血适当性为85．78％。全血输注有效率为67．86％，不良反应发生率为9．65％；红细胞输注总有效率为89．86％，不良反应发生率为0．98％；血小板输注治疗恶性血液病有效率为72．41％，治疗特发性血小板减少性紫癜的有效率为36．00％，不良反应发生率为1．85％；粒细胞输注治疗恶性血液病有效率为25．00％，不良反应发生率达100．00％；血浆输注治疗恶性血液病有效率为37．50％，治疗血友病有效率为79．66％，不良反应发生率为3．60％。结论：成分输血(除外粒细胞输注)的输注效果好，不良反应少，并能节约血源。严格掌握成分输血的输注指征，可更好的提高成分输血效果，减少输血不良反应的发生。     

大剂量氨甲喋呤治疗儿童急性淋巴细胞白血病毒副作用观察

儿童急性淋巴细胞白血病（ＡＬＬ）处于完全缓解（ＣＲ）期的２２例患儿,在不同时期分别采用三种不同的大剂量氯甲喋呤（ＨＤＭＴＸ）治疗,观察毒副反应,对不同剂量的毒副反应进行了对比分析,结果显示不同剂量的氨甲喋呤（ＭＴＸ）毒副作用相似,认为采用３．０ｇ／（ｍ２·次）的剂量能够耐受,有利于提高疗效。     

铁缺乏症患儿血清甲状腺素、生长激素

本文没测定了57名铁缺乏症患儿。铁剂治疗前后血清T3、T4、TSH、GH和INS含量、并与健展对照组进行比较。结果表明，铁缺乏患儿血清T3、T4、GH含量明显低于对照组者，血清TSH、INS水平则显著升高。铁剂治疗后随着铁营养状况的改善，上述各指标均恢复正常。表明铁缺乏可影响体内某些激素的代谢，其原因可能与参与激素代谢的含铁酶活性在铁缺乏时减低有关。     

EFFECT OF PHOTOTHERAPY AND EXCHANGE TRANSFUSION ON PRIMARY BILE ACIDS IN THE SERUM OF HYPERBILIRUBINAEMIC NEWBORNS

ABSTRACT. Serum primary bile acid (cholic (CA) and chenodeoxycholic (CDCA) acid) concentrations were measured in 14 preterm and 11 full-term hyperbilirubinaemic newborns at the beginning and end of, and 24 and 72 hours following phototherapy. Only in the preterm newborns with gestational ages of 35-38 weeks there was a significant decrease of mean serum bile acid concentrations which could be shown 72 hours after the beginning of phototherapy. It can be hypothesized that the decrease was a result of a direct effect of light on the excretory liver function. Serum CA and CDCA concentrations were also measured in 5 hyperbilirubinaemic newborns at the beginning and end, and 24, 48 and 72 hours after the end of exchange transfusion. Exchange transfusion caused a clear immediate decrease in the mean serum primary bile acid concentrations. However, on day 2 after exchange transfusion the mean serum concentration of CA was about 150% and that of CDCA about 110% of the initial values. The most hyperbilirubinaemic newborns had extremely high primary bile acid serum concentrations before therapy. As bile acids compete with bilirubin for albumin binding it should be considered whether high bile acids in the serum of hyperbilirubinaemic newborns presuppose exchange transfusions.     

DEFIBRINATION SYNDROME IN A NEWBORN, AND ITS TREATMENT WITH EXCHANGE TRANSFUSION

A male infant was born asphyxiated, but after few minutes of artificial respiration, spontaneous breathing was established. During the next few hours he developed a severe bleeding tendency with signs of intracranial hemorrhage. In the palms of the hands and soles of the feet there were symmetrical large ecchymoses with a sharp border to normal skin. Coagulation studies showed the characteristics of a defibrination syndrome. He was treated with one exchange transfusion of heparinised blood, and corticosteroids for one week. After the exchange transfusion a rapid and marked improvement was noted. He was followed up during his first year of life, and the development has been quite normal. No permanent disabilities have been found. It is possible that asphyxia was the trigger mechanism for the defibrination syndrome in this case. Early recognition of the acute defibrination syndrome and immediate start of therapy may be lifesaving.     

ULTRASOUNDCARDIOGRAPHY IN INFANTS AND CHILDREN

Ultrasoundcardiography (UCG) studies have been performed in about three hundred children. The age of the children varied between 1 day and 16 years. Most of the studies have been performed without premedication and all without discomfort. The UCG-technique has been found valuable for demonstration of dilatation of the right ventricle both in cyanotic and acyanotic congenital heart disease. In studies of lesion affecting the tricuspid valve pathological UCG-findings have been obtained in patients with tricuspid atresia and Ebsteins anomaly. The method has also been found useful in evaluation of the state of the mitral valve. Pathological findings have been obtained in congenital mitral stenosis, mitral atresia and other forms of hypoplastic left heart syndrome, in endocardial cushion defects and in mitral regurgitation. The UCG-technique also provides information about the outflow tract of the left ventricle. Pathological findings have been obtained in cases with membraneous subvalvular aortic stenosis and hypertrophic obstructive cardiomyopathy. Pericardial effusion and thrombosis in the right atrium may be demonstrated by this technique. No complications have been observed.     

PROTEOLYTIC ACTIVITY IN DUODENAL JUICE IN INFANTS, CHILDREN, AND ADULTS

ABSTRACT. Lindberg, T. (Department of Paediatrics, Malmö General Hospital, Malmö, Sweden). Proteolytic activity in duodenal juice in infants, children, and adults. Acta Paediatr Scand, 63: 805, 1974. The capacity of duodenal juice to hydrolyse casein to trichloroacetic acid-soluble peptides was investigated: in a control group (11 infants and children and 7 adults); in 5 children with pancreatic disease; in 10 children with entero-genic malabsorption (coeliac disease and cow's milk protein intolerance). The proteolytic activity per ml duodenal juice in fasting condition was as great in healthy infants and children as in healthy adults (500–600 mg casein/ml/hour). There was a good correlation between trypsin content and proteolytic activity of duodenal juice. In pancreatic insuffciency, the proteolytic activity was extremely low (not measureable in 3 patients) as was the trypsin activity whereas in enterogenic malabsorption, it was within the ranges of the controls.     

THE EFFECT OF DIETARY RESTRICTION ON INSULIN SECRETION AND GLUCOSE TOLERANCE IN OBESE CHILDREN

A study of 6 obese children was made to test the effect on glucose tolerance and insulin response to glucose of two diets commonly used in therapy. Glucose tolerance was studied after one week on each of three consecutive regimes, a normal diet, a sugar restricted diet and a severe calorie restricted diet. After a normal diet the obese children had slightly impaired glucose tolerance and a very variable insulin response. After restriction of sugar in the diet, insulin response to glucose was diminished without further impairment of glucose tolerance. After a 300 k calorie diet, the children had severe glucose intolerance associated with increased insulin response, and high plasma insulin levels in the latter part of the test.     

SUICIDE IN CHILDREN IN ENGLAND AND WALES

Reported suicide rates for children aged 10-14 yrs in England and Wales remain at low levels. There has been a decrease in rate for males in this age group between the 1940's and the 1980's and an increase for females, so that both sexes now have similar suicide rates. The increase in suicide by poisoning with solids and liquids (including "overdosing") which occurred up until the 1970's has not continued into the 1980's.