小儿肾病综合征的冲击疗法

研究目的探讨小儿肾病综合征的治疗方法。研究方法小儿肾病综合征患儿共６６例，随机分为两组：冲击组（３４例）和对照组（３２例）。冲击组用地塞米松（１．５－３）ｍｇ／（ｋｇ．ｄ）加入１０％ＧＳ溶液（１００－１５０）ｍｌ静滴，每日１次，连用３ｄ，第４日停用，第５日开始隔日１次，共用６次。次日开始口服强的松（１．５－２）ｍｇ／（ｋｇ．ｄ），共４周，后渐减量。对照组仅用强的松，用法用量同冲击组。结果冲击完全缓     

氯高铁血红素抗贫血疗效及追踪调查报告

本文报告用氯高铁血红素每天３００ｍｇ／ｋｇ、１５０ｍｇ／ｋｇ、５０ｍｇ／ｋｇ治疗失血性小鼠。治疗后Ｈｂ明显高于阴性对照组；大、中剂量组疗效优于葡萄糖酸亚铁组。对１２０例缺铁性贫血小儿予氯高铁血红素口服液治疗（１－２ｍｇ／ｋｇ·ｄ），治疗后Ｈｂ明显升高，ＦＥＰ明显下降；治愈率达８７．５％，总有效率１００％；治疗结束后３月，６月及１年追踪随访示有８７．５％、７５％、６０％小儿Ｈｂ≥１１０ｇ／Ｌ。提示：     

1,6二磷酸果糖治疗新生儿缺氧缺血性脑病疗效观察及预后探讨

探讨１、６－二磷酸果糖（ＦＤＰ）治疗新生儿的缺氧缺血性脑病（ＨＩＥ）的疗效及预后。应用ＦＤＰ治疗了５２例ＨＩＥ患儿，剂量２５０ｍｇ／ｋｇ／ｄ，半小时内静脉滴入，每日１次，７天１疗程，轻者用１疗程，重重用２疗程。结果表明：临床疗效治疗组有效率４８／５２（９２．３％），对照组有效率３０／４０（７５％），两组有显著性差异Ｐ〈０．０５。患儿满３０天查脑电图及头颅ＣＴ复查，治疗组异常率分别为１０／５０（２０     

儿童特发性血小板减少性紫癜的临床观察

观察了８０例特发性血小板减小性紫（ＩＴＰ），治疗前血小板数均１９×１０＾９／Ｌ并伴有明显出血症状，选择口服醋酸泼尼松组１９例，剂量为１ｍｇ／ｋｇ，疗程６－８周。静脉丙球蛋白组２８例，剂量为０．２５－０．４０／ｋｇ，时间为２－５天，用前给地塞米松３－５ｍｇ预防过敏反应。免疫抑制组１１例为西艾克３ｍｇ／ｍ＾２／周或ＶＣＲ１．５ｍｇ／ｍ＾２／周，静脉缓慢滴注，用４－６次。切脾组１９例均选择激素无效或依赖     

氯高铁血红素抗贫血疗效及追踪调查报告

本文报告用氯高铁血红素每天３００ｍｇ／ｋｇ、１５０ｍｇ／ｋｇ、５０ｍｇ／ｋｇ治疗失血性小鼠。治疗后Ｈｂ明显高于阴性对照组；大、中剂量组疗效优于葡萄糖酸亚铁组。对１２０例缺铁性贫血小儿予氯高铁血红素。服液治疗（１—２ｍｇ／ｋｇ·ｄ），治疗后Ｈｂ明显升高，ＦＥＰ明显下降；治愈率达８７．５％，总有效率１００％；治疗结束后３月，６月及１年追踪随访示有８７．５％、７５％、６０％小儿Ｈｂ≥１１０ｇ／Ｌ。提示：氯高铁血红素治疗缺铁性贫血具有良好的疗效。     

环磷酰胺静脉冲击疗法治疗弥漫增殖型狼疮肾病疗效观察

狼疮肾是ＳＬＥ重要并发症之一，如治疗不当常发展至终末性肾病（ＥＳＲＤ），本文报告使用ＣＴＸ静脉冲击疗法（ＣＴＸ－ＰＴ）治疗弥漫增殖型狼疮肾病共７例，平均年龄７．６岁。ＣＴＸ总量〈１５０ｍｇ／ｋｇ，３例完全缓解，１例部分缓解，１例无效，经血浆置换术后缓解，１例发展为慢性肾功能衰竭，１例继续治疗中，作者结合ＬＮ临床及病理讨论ＣＴＸ－ＰＴ的作用机制及疗效。     

环磷酰胺冲击治疗19例儿童难治肾病综合征用药体会

本文观察１９例难治性肾病综合征患儿在接受环磷酰胺冲击治疗后的临床疗效和近期副作用。结果表明ＣＴＸ冲击治疗ＲＮＳ近期疗效达８８．９％，８／１９例在第一疗程后显效，１２／１８例可在第二疗程后显效，１５／１８例在第三疗程后显效。每疗程剂量以≥３０ｍｇ／ｋｇ为宜，疗程用量＞３５ｍｇ／ｋｇ时副作用显著增多，而并不优越。分析表明ＣＴＸ冲击剂量，强迫水化措施与副反应密切相关，１３例冲击量≤３０ｍｇ／ｋｇ的患儿中     

环磷酰胺冲击治疗难治性肾病综合征疗效分析

目的　探讨环磷酰胺冲击疗法对难治性肾病综合征的疗效。方法　选择２０ 例难治性肾病综合征患儿,分别给予环磷酰胺（ＣＴＸ）每次１２ｍｇ／ｋｇ,加入１０ ％ 葡萄糖溶液２５０ｍｌ 中静滴,每隔３ ～４ 周１ 次,连用８～１０ 次,后改为每３ 个月１ 次,维持缓解半年至１ 年后停药。累积量１２０～１５０ｍｇ／ｋｇ,ＣＴＸ 冲击同时联合应用强的松方案常规治疗。结果　冲击治疗后,血浆总蛋白及白蛋白有不同程度的升高,２４ 小时尿蛋白定量有明显降低,冲击治疗前后有显著性差异（ Ｐ＜ ０－０１） 。血肌酐（ＳＣｒ）及内生肌酐清除率（ＣＣｒ） 冲击治疗前后无显著性差异（ Ｐ＞ ０－０５） 。随着冲击次数增加,完全及部分缓解例数增多。结论　环磷酰胺冲击疗法对难治性肾病可获较好疗效,尤其对频繁复发和激素依赖的患儿治疗效果好。     

环磷酰胺静脉冲击治疗小儿狼疮性肾炎近期疗效观察

常规激素治疗基础上加用静脉环磷酰胺冲击治疗小儿狼疮性肾炎（ＬＮ），环磷酰胺（ＣＴＸ）每２周１次，每次２日，每日８～１２ｍｇ／ｋｇ静脉给药，累积量≤１５０ｍｇ／ｋｇ，逐渐延长至每月、每３个月、每６个月１次的用药方案治疗ＬＮ１５例。观察１年内的疗效。结果：ＣＴＸ治疗后１个月贫血明显改善，补体Ｃ３恢复，血沉下降至正常，２４小时尿蛋白定量减少，３个月后显著减少，血清肌酐及尿素氮在治疗过程中逐渐下降，肾功能不全者获得改善或恢复。该法能够有效地控制ＬＮ活动，血尿和蛋白尿明显减轻，改善肾功能。临床应用时尚须注意副作用及复发问题。     

不同剂量地塞米松对新生儿缺氧缺血后脑水肿的影响

本文通过观察两种不同剂量地塞米松对新生儿缺氧缺血性脑病（ＨＩＥ）患儿脑水肿的影响，发现小剂量地塞米松（０．５－１ｍｇ／ｋｇ．ｄ）效果不显著，而大剂量组（３－５ｍｇ／ｋｇ．ｄ）患儿在用药后４８小时脑水肿情况明显改善，两绥经临床表现和脑ＣＴ结果对比分析，有显著性差异（Ｐ＜０．０５），说明大剂量糖皮质激素对ＨＩＥ患儿脑水肿的治疗有较好作用。     

吗替麦考酚酯治疗儿童难治性肾病综合征

目的：观察吗替麦考酚酯（MMF）分散片联合泼尼松治疗难治性肾病综合征（RNS）的疗效性及安全性。方法：采用前瞻性多中心对照方法，10个中心共142例患者入选。治疗组87例，对照组55例。治疗组以MMF分散片（每日30～40 mg/kg）联合泼尼松（每日0.5～1 mg/kg）治疗，服MMF 6个月后，如无效应者停药，有效者减量维持治疗6个月，维持剂量每日10～20 mg/kg；对照组以环磷酰胺（CTX）冲击，每2周连用2 d，每日10 mg/kg 联合泼尼松治疗，疗程3个月，随后第4，7，10个月的第1天分别给予CTX 500 mg/m2，静脉点滴1次。泼尼松服用2～3个月开始减量。定期检测尿蛋白、肝肾功能及药物副作用。观察随访期共1年。结果：MMF治疗组87例中58例获完全效应，16例部分效应，9例表现为早期效应，4例治疗失败，治疗总有效率95.4％，尿蛋白转阴67例（77％）；CTX组55例中35例获完全效应，9例部分效应，1例早期效应，10例治疗失败，治疗总有效率81.8％，尿蛋白转阴36例（65.4％）。两组尿蛋白转阴率统计学差异无显著性，有效率MMF治疗组较CTX组高，而且有统计学意义(P<0.01)。尿蛋白转阴天数、低蛋白血症恢复天数、尿量恢复时间、高脂血症、水肿消退时间等方面MMF明显优于CTX。MMF治疗组用药期间主要副作用有一过性转氨酶升高3例次、感染32例次、消化道症状11例次、月经紊乱、肌肉颤动各1例次；对照组发生转氨酶升高9例次、感染30例次、消化道症状15例次、血红蛋白降低4例次、白细胞降低2例次、脱发7例次。结论：结果表明，推荐MMF每日20～35 mg/kg联合泼尼松0.5～1 mg/kg治疗难治性肾病综合征，尿蛋白转阴率不劣于CTX，而且起效时间较CTX短，药物副作用少。     

Pulsed methylprednisolone therapy compared to high dose prednisone in systemic lupus erythematosus nephritis

This study was done to determine whether intravenous methylprednisolone therapy given concomitantly with low-dose daily, oral prednisone would be as effective as highdose daily prednisone in the treatment of patients with active systemic lupus erythematosus (SLE) nephritis.Thirteen patients with active SLE nephritis were started on 2 mg/kg prednisone per day, considered the high prednisone phase. Therapy was continued until remission was achieved. Prednisone administration was then tapered to less than 0.5 but more than 0.2 mg/kg per day. On later relapse, these patients received three doses of methylprednisolone (20 mg/kg per dose) on alternate days and continued on the same daily dose of prednisone (<0.5 >0.2 mg/kg per day) prior to pulse therapy; this was the methylprednisolone phase. The 13 patients were studied in both phases, serving as their own controls.After 1 month of therapy, no significant differences were observed between treatment phases as to improvement in clinical and laboratory findings. A significant increase in the serum concentration of C₃ and C₄ was seen both in the highdose prednisone and methylprednisolone phases, while the serum concentration of anti-ds DNA antibody significantly decreased.Methylprednisolone therapy seems as effective as highdose prednisone in patients with relapse of SLE nephritis. Because side effects are minimal, methylprednisolone administration may be tried as the therapy of choice for these patients.Abbreviation SLE systemic lupus erythematosus     

儿童膜增生性肾炎5例临床病理分析

目的：进一步提高对膜增生性肾炎的病理及临床的认识,探讨治疗方法。方法：对5例病理诊断为膜增生性肾炎患儿的病理、临床表现特点、治疗转归进行分析。结果：①5例临床表现为肾病水平的蛋白尿及血尿, 4例有高血压, 2例肾功不全;②病理改变肾小球系膜细胞增生及系膜基质扩张, 3例肾小球呈分叶状, 2例有新月体形成, 4例基膜“双轨征”,肾间质有不同程度的损害,免疫荧光均以C3 沉积为主;③5例均应用了泼尼松治疗,其中3例应用了甲基泼尼松龙冲击, 4例联合应用了环磷酰胺静脉冲击治疗。3例获部分缓解, 1例完全缓解, 1例呈持续肾病状态。结论：儿童膜增生性肾小球肾炎临床表现以肾炎型肾病为主。病理以系膜细胞增生基质扩张和基膜“双轨征”为其特征性改变,免疫荧光检查以C3沉积为主。大剂量激素联合环磷酰胺静脉冲击治疗对短期内缓解病情、改善肾功能是有效的。     

Phenobarbitone dosage in neonatal convulsions.

In order to find the optimal dosage schedule of phenobarbitone for neonatal convulsions, four groups of patients were studied. Twelve infants (group 1) received a mean phenobarbitone dose of 9.5 mg/kg a day given intramuscularly for 3 days followed by 5.8 mg/kg a day given intramuscularly and then orally. Six infants (group 2) received a mean intravenous loading dose of 9.5 mg/kg followed by 6.8 mg/kg a day given intramuscularly or orally. Nine infants (group 3) received a mean loading dose of 14.9 mg/kg intravenously followed by a maintenance dose of 5.9 mg/kg a day. Thirteen patients (group 4) received a mean intramuscular loading dose of 15.2 mg/kg followed by 5.9 mg/kg a day. Blood samples were taken regularly and phenobarbitone levels were determined by gas liquid chromatography. A mean intravenous or intramuscular loading dose of 15 mg/kg of phenobarbitone safely achieved therapeutic levels within 2 hours of injection and high therapeutic levels were maintained with a dose of 6 mg/kg a day.     

Experience with intravenous enoxaparin in critically ill infants and children

OBJECTIVE: Subcutaneous administration of enoxaparin is often difficult in special populations, such as premature infants and critically ill children with severe edema. The difficulty achieving adequate anticoagulation in these patients has led to the employment of intravenous enoxaparin in some cases. However, little pharmacodynamic data are available for determining the appropriate dosing and monitoring (by anti-Factor Xa levels) of intravenous enoxaparin. The objective of this study is to report our experience with the use of intravenous enoxaparin in pediatric patients in the intensive care unit. DESIGN: Retrospective review of medical records. SETTING: Single institution pediatric intensive care unit. PATIENTS: All pediatric patients receiving intravenous enoxaparin in the pediatric intensive care unit at Children's Medical Center Dallas between April 1, 2005 and March 31, 2006 were identified using hospital pharmacy records. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Seven patients were identified as having received intravenous enoxaparin while in the intensive care unit. Higher anti-Xa levels were found at 1-2 hrs after administration of intravenous enoxaparin rather than at the 4-6 hrs documented with subcutaneous administration and these levels decreased substantially 6-8 hrs after an intravenous dose. Mean therapeutic dose for children <1 yr of age was 2.40 mg/kg/dose (+/-sd 0.58). For children > or =1 yr of age, the mean therapeutic dose was 1.11 mg/kg/dose (+/-sd 0.13). The mean prophylactic dose for the two children was 0.93 mg/kg/dose (+/-sd 0.43). CONCLUSIONS: Our data show that the pharmacodynamics of intravenous administration is different from subcutaneous administration and deserves further study.     

用尿脱氧吡啶啉及羟脯氨酸排泄率评价肾病综合征患儿骨吸收功能状况

目的　观察糖皮质激素（激素）对肾病综合征(肾病)患儿骨吸收功能的影响。方法　采用酶联免疫竞争法和分光光度比色法,对68例泼尼松治疗不同阶段的肾病患儿及同龄健康儿童16例尿脱氧吡啶啉（DPD）及羟脯氨酸（HOP）进行检测。结果　（1）激素足量治疗组DPD/肌酐(Cr)为（30±17）nmol/mmol,较正常对照组［（21±5）nmol/mmol］、初发激素治疗前组［(20±8)nmol/mmol］及激素减量治疗组［(20±11)nmol/mmol］均有升高（P均<0.05);（2）与DPD/Cr值变化趋势一致,激素足量治疗组HOP/Cr为［(5.3±2.7)mg/mmol］,与正常对照组［(3.2±1.2)mg/mmol］、初发激素治疗前组［(3.5±0.9)mg/mmol］及激素减量治疗组［(3.7±1.7)mg/mmol］比较差异均有显著意义(P＜0.05,<0.01,<0.05);（3）DPD/Cr与HOP/Cr两指标在正常对照组及肾病各组均呈明显正相关(r=0.64、0.65、0.76、0.78,P均<0.01)。结论　超生理剂量的泼尼松治疗能使肾病患儿骨吸收功能增强,易导致骨质疏松。     

环磷酰胺在难治性肾病综合征治疗中的应用——30年文献Meta分析

目的 明确环磷酰胺能否有效治疗难治性肾病综合征,以及不同的环磷酰胺应用方案中何种最佳,为临床用药以及进一步大规模、多中心的临床流行病学研究提供指导。方法 通过MEDLINE、AHRQ、Cochrane、ACP Journal Club计算机检索系统,以nephrotic syndrome和cyclophosphamide为主题词,检索1970－2000年的前瞻性临床、随机、对照研究的英文文献及上述文献中符合条件的参考文献,以有效率（肾病综合征完全缓解率＋部分缓解率）作为统计指标,采用加权百分率法进行Meta分析。结果 应用环磷酰胺（口服）与泼尼松联合治疗肾病综合征的有效率为49．1％,单纯应用泼尼松治疗的有效率为16．2％,两者比较差异有显著意义（P＜0．05）;大剂量环磷酰胺（累积剂量为168－192mg/kg）与泼尼松联合口服治疗的有效率为44％,小剂量环磷酰胺（累积剂量为42－168mg/kg）与泼尼松联合口服治疗的有效率为25％,两者比较差异有显著意义（P＜0．05）;应用环磷酰胺冲击治疗的有效率为76％,应用环磷酰胺口服治疗的有效率为59％,两者比较差异无显著意义（P＞0．05）。结论 环磷酰胺能有效治疗难治性肾病综合征,且以大剂量环磷酰胺和泼尼松同时口服治疗的效果最佳。     

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目的 探讨咪达唑仑鼻腔给药治疗儿童急性惊厥的疗效及安全性.方法 2004年12月至2006年12月将天津市儿童医院收治的93例急性惊厥患儿随机分为治疗组49例和对照组44例,治疗组鼻腔滴入咪达唑仑0.16～0.32mg/kg,平均(0.24±0.05)mg/kg;对照组静脉推注氟硝西泮0.04～0.10mg/kg,平均(0.077±0.021)mg/kg.现察两组疗效及安全性.结果 治疗组43例有效,有效率87.76%;对照组39例有效,有效率88.64%.两组比较差异无统计学意义(P>0.05).治疗组惊厥控制时间为1～7 min,平均(2.13±1.30)min;对照组惊厥控制时间为1～5min,平均(1.96±1.08)min,两组比较,差异无统计学意义(P>0.05).治疗组与对照组在全面性发作及局灶泛化全面性发作两种不同类型发作的治疗方面,有效率及惊厥控制时间比较差异无统计学意义(P>0.05).治疗组未发现明显副反应,对照组1例患儿在用药30min后出现呼吸抑制.结论 咪达唑仑鼻腔给药可有效控制儿童急性惊厥,与静脉推注氯硝西泮疗效相当.且更安全方便.     

Intravenous paracetamol overdose: two case reports and a change to national treatment guidelines

Two cases of 10-fold accidental overdose with intravenous paracetamol are presented. Case 1: A 5-month-old child with intussusception received 90 mg/kg intravenous paracetamol over an 8 h period. She was not initially treated with an antidote and developed hepatic impairment. Case 2: A 6-month-old child received a single dose of 75 mg/kg intravenous paracetamol. The child was treated with N-acetylcysteine and remained well without hepatic impairment. Therapeutic errors such as 10-fold overdosing are relatively common in children. Case 1 demonstrates that intravenous paracetamol is a potentially dangerous drug. This should be taken into consideration when prescribing the intravenous formulation. The concentration-time nomogram used following oral paracetamol overdose should be used with caution following intravenous overdose. Significant overdose should be discussed with the National Poisons Information Service whose guidance suggests intervention with antidote following an overdose above 60 mg/kg.     

Treatment of cerebral malaria in African children by intravenous quinine: comparison of a loading dose regimen to a regimen without a loading dose]

OBJECTIVE: To compare in a randomized study the efficacy and the toxicity of the new WHO intravenous quinine treatment of cerebral malaria including a loading dose regimen to a regimen without loading dose. PATIENTS AND METHODS: Seventy-two children eight months to 15 years of age with cerebral malaria were included. Quinine formiate was administered to a group of 35 patients in an initial loading dose of 20 mg salt/kg (equivalent to 17.5 mg/kg of the base) in 10 mL/kg of 5% glucose over four hours, followed eight hours later by a maintenance dose quinine of 10 mg salt/kg (equivalent to 8.7 mg/kg of the base) dissolved in 15 mL/kg of 5% glucose over and every 12 hours. The second group of 37 patients received intravenous quinine 15 mg salt/kg (13.1 mg of base) dissolved in 15 mL/kg of 5% glucose infused over 6 to 8 hours, every 12 hours. In both groups this treatment was continued until the patient could swallow, then quinine tablets were given to complete seven days treatment. The assessment of cardiovascular side effects was made by an ECG at admission, the 4th hour, the 24th hour and at the end of treatment for each patient. RESULTS: Coma mean durations were similar in the two groups: 35.5 +/- 17.8 hours and 28.6 +/- 14.4 hours respectively for the loading dose group and the group without loading dose. The two groups were comparable also for the decrease evolution of parasitemia. Case-fatality rates were also similar: 95% of healing at the 72nd hour and a lethality rate between 5 and 6% in the two groups. But a significant increase of the body temperature was noted between the 51st and the 63rd hour in the group without loading dose. No significant cardiovascular toxicity was noticed in the two groups. The mean cost of the loading dose regimen was less than that of the second regimen. CONCLUSION: The loading dose regimen of quinine is well tolerated and it seemed slightly more effective than the regimen without loading dose. In cases of contra-indications (patients who recently received quinine, mefloquine or halofantrine), regimens without loading dose, which remains effective, should be used.