清热化湿安肠法治疗小儿秋季腹泻临床研究

目的：观察清热化湿安肠法治疗小儿秋季腹泻的临床疗效。方法：将200例患者按照随机数字表法分为观察组120例与对照组80例。对照组给予西药常规治疗,观察组在对照组治疗基础上加服中药清热化湿安肠汤治疗。结果：观察组的有效率为97．5％,对照组有效率为75．O％,两组有效率比较,差异有统计学意义（P〈O．05）。便轮状病毒转阴率观察组明显优于对照组;呕吐、腹胀消失时间观察组短于对照组,差异均有统计学意义（P〈0．05）。结论：中西医结合治疗小儿秋季腹泻疗效确切。     

Short and long term impact of adenotonsillectomy on the immune system

Palatine and pharyngeal tonsils are immune reactive lymphoid organs that manifest specific antibodies and B/T-cell activity to respond to a variety of antigens. They perform humoral and cellular immune functions. The possible effects of adenotonsillectomy upon the immune system remain controversial.ObjectiveTo study the short and long-term impacts of tonsillectomy upon the cellular and humoral immunity of children.MethodThis longitudinal prospective study included 29 children referred to adenotonsillectomy for adenotonsillar hypertrophy. Serum IgA, IgM, and IgG and lymphocyte counts were analyzed at three points in time: before surgery, 1-2 months after surgery (short term), and 12-14 months after surgery (long term).ResultsTCD4+ cell counts were significantly increased shortly after surgery. IgA and IgG values were significantly reduced in the long run, but were within normal ranges for this age group.ConclusionThis study indicated that adenotonsillectomy does not pose negative short or long term impacts upon the cellular and humoral immunity of children submitted to the procedure.     

儿童分泌性中耳炎的外科治疗

  目的  比较儿童分泌性中耳炎常用手术方式的临床疗效。  方法  选取北京协和医院2009年1月至2011年9月收治的儿童分泌性中耳炎临床资料完整患者36例(63耳), 按手术方式分为3组, 分别为鼓膜置管、腺样体切除和鼓膜置管+腺样体切除, 分析不同手术方式患儿术后听力康复情况。  结果  术后36例患儿、63耳听力均有提高, 44耳治愈, 19耳改善。行鼓膜置管、腺样体切除或鼓膜置管+腺样体切除3种手术方式, 治愈率差异无统计学意义。  结论  鼓膜置管是分泌性中耳炎的首选外科治疗方法, 腺样体切除和鼓膜置管+腺样体切除治疗在适应证恰当时也有很好的效果, 外科治疗方式的选择需要个体化。     

依托咪酯用于小儿腺样体吸割术麻醉诱导效果观察

目的：研究依托咪酯用于小儿鼻内镜下腺样体吸割术的麻醉诱导效果,并与丙泊酚作对照方法：60例ASAⅠ～Ⅱ级2～8岁患儿随机分为依托咪酯0.2mg·kg^-1组、依托咪酯0.3mg·kg^-1组和丙泊酚2mg·kg^-1组,每组20例,观察麻醉诱导期血流动力学、麻醉深度的动态变化,以及注射痛、肌阵挛等不良反应。结果：诱导后依托咪酯0.3mg·kg^-1组和丙泊酚2mg·kg^-1组血压下降较明显,抑制插管后血压反跳较好;依托咪酯0.3mg·kg^-1组的心率在整个诱导期间最为平稳;依托咪酯0.3mg·kg^-1组脑电双频指投值下降幅度最大,能提供比丙泊酚2mg·kg^-1组更深的镇静程度;丙泊酚2mg·kg^-1组发生4例（20%）注射痛,依托咪酯0.2mg·kg^-1组和依托咪酯0.3mg·kg^-1组各发生6例（30%）肌阵挛。结论：0.3mg·kg^-1依托咪酯较0.2mg·kg^-1依托咪酯更适用于小儿腺样体吸割术的麻醉诱导,能提供和丙泊酚2mg·kg^-1相似的效果     

舒芬太尼复合七氟烷麻醉在小儿扁桃体切除术中的应用

目的：探讨舒芬太尼复合七氟烷麻醉在小儿扁桃体切除术中的麻醉效果、术后麻醉恢复质量及其可行性。方法：选择择期进行扁桃体和腺样体切除术患儿40例,随机分为舒芬太尼组（S组）和瑞芬太尼组（R组）。S组以舒芬太尼0.2μg/kg快速诱导,手术开始前5min追加0.2μg/kg舒芬太尼,以2%~3%的七氟醚吸入术中维持。手术结束停用七氟醚。R组以瑞芬太尼2μg/kg快速诱导,以瑞芬太尼每小时6~10μg/kg复合丙泊酚每小时6~12mg/kg术中维持,手术结束时停用丙泊酚和瑞芬太尼。分别观察两组术中术后血流动力学指标及术后患儿镇痛镇静程度。结果：两组在术中血流动力学指标无明显差异（P〉0.05）。拔管后5min时S组MAP、HR较R组明显降低（P〈0.05）。Ramsay镇静评分S组高于R组（P〈0.05）且评分适宜,躁动评分S组低于R组且有显著差异（P〈0.05）,术后需要镇痛的比例S组明显低于R组（P〈0.05）。结论：舒芬太尼复合七氟烷麻醉在小儿扁桃体切除术中的麻醉效果和术后麻醉恢复质量方面具有优势因此具有可行性。     

鼻内镜下应用鼻动力系统行腺样体切除术168例

[背景]探讨鼻内镜下应用鼻动力系统切除腺样体肥大的手术方法及治疗效果.[病例报告]回顾性分析鼻内镜下应用鼻动力系统行腺样体切除手术168例的临床资料,腺样体均为一次性彻底切除,无并发症及残留发生.[讨论]鼻内镜下应用鼻动力系统行腺样体切除术微创,安全,有效.     

腺样体的不同形态与分泌性中耳炎的关系的研究

目的探讨腺样体的不同形态同分泌性中耳炎（OME）间的关系以及充分切除咽鼓管咽口周围的腺样体组织对OME患儿预后的影响。方法 2009年1月～12月行低温等离子射频消融手术腺样体的患儿,均行听力测试,手术中根据腺样体与咽鼓管圆枕间接触的紧密程度,作者将腺样体的形态依次分为以下4组：Ⅰ组（无压迫型）、Ⅱ组（挤压型）、Ⅲ组（紧贴型）及Ⅳ组（混合型）,伴OME的患儿术后1个月行听力复查,分析各种分型在伴OME和不伴OME的患儿中的差异以及手术对OME预后的影响。结果 191例患儿中有145侧（包括54例双侧OME患儿和37例单侧OME患儿）伴OME,另237侧（100例）无OME;Ⅰ组无压迫型腺样体伴发OME比例较低（P〈0.05）,而Ⅱ组、Ⅲ组及Ⅳ组腺样体是否伴发OME无显著性差异;进一步对37例单侧OME的患儿进行比较,3侧无压迫型腺样体都位于无OME侧,Ⅱ组伴发OME的比例较低（P〈0.05）,而Ⅳ组以伴发OME为显著（P〈0.05）,Ⅲ组在两侧间无明显差异;OME患儿术后1个月复诊,痊愈率85.5%,总有效率92.4%。结论腺样体与咽鼓管咽口间存在的不同毗邻关系,压迫越严重越易导致与OME,有效切除压迫咽鼓管咽口的腺样体可有效治疗OME。     

Parenteral ketoprofen for pain management after adenoidectomy: comparison of intravenous and intramuscular routes of administration

BACKGROUND: Different parenteral routes of administration of NSAIDs such as ketoprofen have not been properly compared in children. This study was designed to compare the analgesic efficacy of intravenous and intramuscular ketoprofen for pain management in children after day-case adenoidectomy. METHODS: A total of 120 children, aged 1-9 years, who were scheduled to undergo adenoidectomy, were randomized to receive ketoprofen 2 mg/kg either intravenously with intramuscular placebo (n = 40) or ketoprofen 2 mg/kg intramuscularly with intravenous placebo (n = 40), or both intravenous and intramuscular placebo (n = 40) at induction of anesthesia. The study design was prospective and double-blind with parallel groups. Pain was assessed at rest and during swallowing using the Maunuksela pain scale during 3 h after surgery, and fentanyl i.v. was given for rescue analgesia. RESULTS: Children in the Placebo group needed significantly more doses of fentanyl (72 doses) than either children in the intravenous group (47 doses) or children in the intramuscular group (51 doses) (P = 0.021). In addition, a higher proportion of children in the Placebo group than in the two ketoprofen groups (P = 0.03) demanded rescue analgesic. No difference in the need for rescue analgesia or in pain scores was found between the two ketoprofen groups. Children in the intravenous group had less pain than children in the Placebo group. The difference was significant during swallowing at 1 h after surgery (P = 0.046) and for the worst pain observed during swallowing for 3 h after surgery (P = 0.022). There were no differences between the three groups with respect to operation times, amount of perioperative bleeding, or rate or extent of adverse events. CONCLUSION: The efficacy of intravenous and intramuscular ketoprofen was similar, and they both differed from placebo.