超声引导下幼儿骶管麻醉在小儿疝手术中的应用

目的探讨超声引导下幼儿骶管麻醉在小儿疝手术中的应用价值。 方法回顾性分析2016年1至12月,陆军特色医学中心行小儿疝手术的100例患儿的临床资料。根据麻醉方式不同,将其分为观察组（52例）与对照组（48例）。观察组患儿行超声引导下骶管麻醉,对照组患儿行阻力消失技术定位骶管穿刺,比较2组患儿的麻醉效果。 结果（1）观察组患儿穿刺时间、穿刺次数及术后苏醒时间、氯胺酮使用剂量、术毕离开手术室时间均明显低于对照组,差异均有统计学意义（P均<0.05）。（2）观察组患儿骶管阻滞成功率明显高于对照组,差异有统计学意义（P<0.05）。（3）观察组患儿术后镇痛效果明显优于对照组,差异有统计学意义（P<0.05）。（4）观察组患儿苏醒期躁动评分与术后（2、4、8 h）疼痛评分明显低于对照组,差异均有统计学意义（P均<0.05）。（5）气腹前,2组患儿心率、平均动脉压（mean artery pressure,MAP）、呼气末二氧化碳分压（end-tidal carbon dioxide partial pressure,PetCO₂）比较,差异无统计学意义（P>0.05）;气腹后,观察组心率、MAP、PetCO₂水平明显高于对照组,差异均有统计学意义（P均<0.05）。2组患儿治疗前后血压、血氧饱和度、pH值比较,差异均无统计学意义（P均>0.05）。（6）观察组不良反应发生情况明显低于对照组,差异有统计学意义（P<0.05）。 结论超声引导下幼儿骶管麻醉应用于小儿疝手术,定位准确,患儿苏醒时间短,镇痛效果好,并减少其苏醒期躁动,改善患儿血气与循环,安全有效。     

布拉氏酵母菌散与非营养性吸吮联合治疗对早产儿喂养不耐受及早期生长发育的影响

目的探讨布拉氏酵母菌散与非营养性吸吮联合对早产儿喂养不耐受及早期生长发育的影响。方法选取2014年1月～2017年12月在我院住院治疗的早产儿喂养不耐受患者74例,分为观察组(n=37)和对照组(n=37)。对照组患儿均予以非营养性吸吮,观察组患儿在对照组治疗基础上加用布拉氏酵母菌散0.125 g/次,1次/d,鼻饲或奶瓶给药。观察并比较两组患儿治疗后恢复情况及治疗效果,并比较治疗2周后生长发育(体重、头围和身长)指标的变化。结果观察组早产儿症状消失时间、胎粪排出时间、达全量胃肠内营养时间和恢复到出生体质量时间短于对照组(P0.05)。治疗1周后,观察组早产儿临床总有效率较对照组更佳(χ~2=4.16,P0.05)。治疗2周后,观察组早产儿的体重和身长等生长发育指标优于对照组(P0.05),两组头围比较差异无统计学意义(P0.05)。结论早产儿喂养不耐受患儿在非营养性吸吮基础上加用布拉氏酵母菌散的治疗效果较好,能缩短喂养不耐受症状时间,能促进早产儿的生长发育。     

早产儿视网膜病变的相关影响因素分析

目的探讨早产儿视网膜病变的相关影响因素。方法本文选择我院2016年6月～2018年6月收治的2340例住院早产儿和低出生体重儿,描述研究对象的眼底检查结果 ,将所有研究对象根据眼底检查结果分为ROP组(n=384)和无ROP组(n=1956),比较两组儿童一般情况、临床治疗、并发症、孕母情况的差异及影响早产儿视网膜病变的多因素指标。结果 2340例早产儿中,男1334例,女1006例,诊断ROP为131例(5.6%),无ROP为2209例(94.4%)。其中男70例,女61例;1期83例,2期35例,3期9例,4期3例,5期1例。性别、胎龄、出生体重、头围、Apgar评分、窒息与ROP是否发病有统计学差异(P0.05);未发现单胎与ROP是否发病有差异(P0.05)。吸氧、输血、咖啡因、动脉导管未闭、颅内出血、胎儿宫内窘迫与ROP是否发病有统计学差异(P0.05);未发现EPO、氨茶碱与ROP是否发病有差异(P0.05)。母亲年龄、产前激素、硫酸镁、妊高征、妊娠期糖尿病与ROP是否发病有统计学差异(P0.05);未发现分娩胎次、受孕方式、贫血与ROP是否发病有差异(P0.05)。多元逐步Logistic回归分析显示,胎龄、吸氧、妊高征是早产儿患有ROP的危险因素(P0.05)。结论临床中对早产儿应给予视网膜病变的普遍筛查,加强高危孕产妇的管理,积极干预并发症,进而降低ROP疾病发生风险。     

病理性黄疸新生儿巨细胞病毒感染的临床研究

目的 分析病理性黄疸患儿巨细胞病毒(CMV)感染情况,探讨母乳CMV-DNA检测的临床意义。方法 选取庆阳市人民医院住院的病理性黄疸新生儿300例,用FQ-PCR方法检测患儿血浆、外周血单个核细胞(PBMC)、尿液和母乳的CMV-DNA,ELISA法检测患儿血清CMV-IgM和IgG,分析CMV感染患儿的临床数据。结果 300例病理性黄疸新生儿中,CMV感染的阳性率为13.33%(40例),其中患儿血清CMV-IgM阳性率为4.33%(13例),CMV-IgG阳性率为80.85%(228例)。母乳CMV-DNA阳性率为46.00%(138例),患儿血浆CMV-DNA阳性率为4.00%(12例),PBMC CMV-DNA阳性率为6.67%(20例),患儿尿液CMV-DNA阳性率为10.00%(30例)。患儿尿液CMV-DNA的阳性率与乳汁CMV-DNA的阳性率有显著相关性(P<0.01)。40例CMV感染患儿中,婴儿肝炎综合症为13例(32.50%),新生儿肺炎12例(30.00%),缺血缺氧性脑病6例(15.00%),听力损伤5例(12.50%),腹股沟斜疝2例(5.00%)。结论 CMV感染是新生儿病理性黄疸主要原因之一;检测产妇母乳中CMV-DNA对母乳喂养具有临床指导意义,有助于预防CMV感染。     

A pilot study on early home-based intervention through an intelligent baby gym (CareToy) in preterm infants

BackgroundCareToy is an intelligent system, inspired by baby gyms, aimed to provide an intensive, individualized, home-based and family-centred early intervention (EI) program.AimsA pilot study was carried out to explore the feasibility of CareToy intervention in preterm infants, aged 3–9 months of corrected age.MethodsTwenty low-risk preterm infants, without brain lesion or other clinical complications (14 allocated to CareToy intervention and 6 to Standard Care) were recruited. The Infant Motor Profile (IMP) was predefined as the primary outcome measure and Alberta Infant Motor Scale and Teller Acuity Cards as secondary measures. Moreover, 202 pre-programmed training scenarios were developed and instructions for the management of CareToy intervention were defined as general guidelines.Outcomes and resultsAll infants received 4 weeks of their allocated intervention and were evaluated with the selected tests before and immediately after the 4 weeks. The mean difference changes in IMP total score and Teller Acuity Cards over the intervention period were higher in the CareToy group than in the Standard Care group.Conclusions and implicationsCareToy seems a feasible device for providing EI. An adequately powered randomized clinical trial is warranted.     

Displacement of the common carotid artery after laryngeal mask airway placement in infants and children

Background: In adults, placement of the laryngeal mask airway causes increased overlapping of the internal jugular vein (IJV) and common carotid artery (CCA). However, few studies in children have been reported. The aim of this study was to describe the degree of overlap of the IJV and the CCA before and after laryngeal mask airway placement in infants and children. Method: There were 160 children scheduled to undergo Protex^® SoftSeal^® and Ambu^® placement. Patients were initially positioned in the 15° Trendelenburg position with their heads rotated 30° to the left. The ultrasound probe was placed perpendicular to the skin, and the images of the right IJV and CCA were collected at the level of the cricoid cartilage. Following laryngeal mask airway placement, images were collected in the same manner. Results: No statistically significant changes were observed in the overlap index before and after laryngeal mask airway placement. By inflating the laryngeal mask airway cuff, migration of the vessel forward was 24.38% and outward migration was 13.99%. Conclusion: There was no remarkable change in the overlap index before and after laryngeal mask airway placement in children.     

The Size 1 ProSeal™ laryngeal mask airway in infants: a randomized,noncrossover study with the Classic™ laryngeal mask airway

Background: In recent years, numerous scientific publications have endorsed the superiority of the ProSeal? laryngeal mask airway (PLMA) over the Classic? laryngeal mask airway (cLMA) in adults, children, and infants. The PLMA forms a better seal for both the respiratory and gastrointestinal tracts, provides easier access to the gastrointestinal tract, and exerts lower mucosal pressures for a given seal pressure. This study aims to determine whether this superiority can also be observed for the size 1 PLMA used in anesthetized neonates and infants with positive pressure ventilation. Methods: Sixty consecutive neonates and infants undergoing elective surgical procedures were randomized to airway management with the size 1 PLMA or cLMA. For all patients, we recorded ease of insertion, effective airway time, number of placement attempts, oropharyngeal leak pressure, fiberoptic position, audible leaks, mask displacement, number of reinsertions during maintenance, gastric insufflation, and frequency of blood stain. Results: Ease of insertion, successful insertion in <3 attempts, fiberoptic position of the airway tube, and frequency of blood stain were similar in both groups. Effective airway time was lower for the PLMA group (30.5 vs 35.6 s). Oropharyngeal leak pressure was higher with the PLMA (32.9 vs 22.2 cm H₂O, P < 0.001) and gastric insufflation less common (0% vs 6%, P = 0.492). There were fewer mask displacements during maintenance of anesthesia with the PLMA (0% vs 26.7%, P < 0.001). Mask reinsertion was not necessary during maintenance of anesthesia with the PLMA, although it was necessary in 14 cases in the cLMA group (0% vs 46%, P < 0.001). Audible leaks were less common with the PLMA (0% vs 46%, P < 0.001). Conclusions: We conclude that the size 1 PLMA is a stable, safe, and efficacious airway control device during neonatal and infant anesthesia, allowing higher peak airway pressure during positive pressure ventilation, with fewer mask displacements and gastric insufflations than the cLMA.     

异氟醚对新生鼠齿状回神经前体细胞发育动力学的影响

目的 探讨异氟醚对新生鼠齿状回神经前体细胞发育动力学的影响。方法 将出生7日龄（P7）SD大鼠随机分为两组：异氟醚组（I组,n = 8）和对照组（C组,n = 7）。I组吸入1.5%异氟醚维持4 h,C组只吸入室内空气4 h。两组P7大鼠分别在麻醉暴露前及结束后腹腔注射5-溴脱氧尿苷（BrdU,100mg/kg）以标记海马齿状回的神经前体细胞及其子细胞,然后在暴露结束后1 w,利用BrdU和DCX（未成熟神经元标志物）或GFAP免疫荧光双标的方法观察两组齿状回神经前体细胞的迁移、分化及存活的情况。结果 与C组比较,I组P7大鼠齿状回颗粒细胞层BrdU+细胞的数量减少（P＜0.05）。两组齿状回新生细胞迁移至颗粒细胞层或门区的比例,以及分化为神经元或神经胶质细胞的比例均无统计学差异（P＞0.05）。结论 异氟醚减少新生鼠齿状回新生颗粒细胞的早期存活,但并不影响神经前体细胞的早期迁移及分化。     

微创肺表面活性物质及无创持续性气道压力在低体重早产儿呼吸窘迫综合征治疗中的应用

目的 探讨微创肺表面活性物质(LISA)及无创持续性气道压力(ncpap)在低体重早产儿呼吸窘迫综合征(NRDS)治疗中的应用效果.方法 回顾性选取2019年1月至2020年12月中山市博爱医院新生儿科收治的50例NRDS低体重早产儿为研究对象,根据治疗方案分为研究组(ncpap+LISA,n=22)和对照组(ncpa...     

新生儿高胆红素血症484例临床分析

目的了解住院新生儿高胆红素血症的发病情况及探讨采用间歇性蓝光照射治疗新生儿高胆红素血症的疗效。方法总结分析我院2002年1月至2007年8月收治的484例高胆红素血症患儿临床资料。结果高胆红素血症发病率占同期新生儿的40．5％，引起本组高胆红素血症的病因中，围产期因素占37．4％，感染占21．6％，母乳性黄疸占18．5％，新生儿溶血占6．2％。其中发病日龄在7天以内占69％。435例治愈，49例好转。结论加强围产期保健，对所有新生儿特别是7天内新生儿应进行每天至少1次的临床评估。对所有24小时内出现黄疸的新生儿应进行经皮测胆红素及血清总胆红素的监测。对耶些在血总胆红素达到高峰水平前离院的新生儿应随访。对于出生24小时内出现黄疸，早产儿低于正常值但有高危因素，健康足月儿总胆红素〉256μmol／L，无高危因素，都应积极治疗以降低高胆红素的发病率、死亡率和伤残率。