660例小儿肺炎病原学和耐药性分析

目的:探讨小儿肺炎的病原学及耐药性。方法:采用无菌吸痰管连接负压吸引器吸取660例小儿肺炎咽部的痰液,对标本进行细菌学培养,测定药物敏感性。结果:分离菌中,以革兰阴性细菌居首位,占62.99%,大肠埃希菌及肺炎克雷伯菌为主要菌种,美洛培南、亚胺培南、环丙沙星最敏感;其次为革兰阳性细菌,占37.11%,以链球菌及金黄色葡萄菌为主,对万古霉素、头孢哌酮、头孢噻肟最敏感。结论:结果显示小儿肺炎革兰阴性细菌为主,并出现多重耐药。抗生素治疗应根据细菌学指导选择敏感的抗生素,在未获得明确病原菌之前,应根据感染流行趋势,根据小儿的特点经验性选择合适的抗生素治疗。     

小儿急性上呼吸道感染3种治疗方案的成本-效果分析

目的:评价3种用药方案治疗小儿急性上呼吸道感染的成本-效果。方法:将96例患儿随机分成3组,A组(34例)给予莪术油治疗,B组(32例)给予双黄连治疗、C组(30例)给予银黄清治疗,观察其疗效并进行成本-效果分析。结果:3组成本分别为61.50元、80.40元、18.00元,总有效率分别为73.53%、96.88%、86.67%,成本-效果比分别为0.84、0.83、0.21,A、B组相对于C组的增量成本-效果比分别为-3.31、6.11。结论:C组方案是小儿急性上呼吸道感染的最佳治疗方案。     

轮状病毒致婴幼儿腹泻的血清心肌酶谱分析

目的探讨轮状病毒致腹泻的婴幼儿血清心肌酶谱的变化与病情的关系。方法肌酸激酶同工酶（CKMB）采用NAC-免疫抑制法测定，天冬氨酸氨基转移酶（AST）、乳酸脱氢酶（LDH）、磷酸肌酸激酶（CPK）、羟丁酸脱氢酶（HBDH）采用酶动力法测定。测定327例腹泻婴幼儿血清心肌酶谱含量，并根据病情将婴幼儿分为轻症组（166例）和重症组（161例），非轮状病毒腹泻婴幼儿243例为对照组。结果发现对照组心肌酶谱异常率明显低于观察组（P〈0．01）。心电图和心肌酶谱同时异常的患儿心肌酶升高水平较单纯，心肌酶谱异常患儿差异有统计学意义（P〈0．01）。结论轮状病毒腹泻性肠炎婴幼儿伴心肌损害。心肌损害的轻重与病情的轻重有关。心电图和心肌酶谱同时改变者心肌酶水平显著增高。提示心肌酶谱变化有助于临床判断心肌有无损害及心肌损害的程度。     

益气通督手法治疗小儿脾虚泻的多中心随机对照研究

目的:对益气通督手法治疗小儿脾虚泻的疗效进行评价。方法:将275例患儿采用多中心、随机、对照方法分为观察组(n=137)和对照组(n=138),观察组采用益气通督手法治疗,对照组采用中医院校教材《推拿学》中所规定手法治疗。治疗7天后比较两组疗效。结果:观察组治愈率为83.2%,对照组治愈率为69.6%,差异有统计学意义(P<0.05),观察组疗效优于对照组。两组平均治愈时间比较,观察组平均治愈时间(3.22±1.04)天,对照组平均治愈时间(4.20±1.11)天,差异有统计学意义(P<0.05),观察组短于对照组。结论:益气通督手法治疗小儿脾虚泻疗效确切,起效快,适宜普及推广应用。     

中西结合治疗小儿秋季腹泻80例疗效观察

目的 观察温阳健脾法治疗小儿秋季腹泻的临床效果.方法 160例秋季腹泻患儿随机分为治疗组和对照组各80例,治疗组运用附子理中汤加味口服:对照组口服思密达和整肠生;中重犁均加静脉补液.3d后统计疗效.结果 治疗组痊愈50例、好转24例、无效6例,总有效率92.5%;对照组痊愈28例、好转32例、无效20例,总有效率75%.两组比较有显著性差异(P＜0.05).结论 中西结合治疗小儿秋季腹泻疗效肯定.操作简单易行,值得临床推广.     

A patient with infantile spasms and low homovanillic acid levels in cerebrospinal fluid: l-dopa dependent seizures?

We report a 3-month-old female with infantile spasms that responded transiently to pyridoxine and permanently to oral l-dopa. Initial CSF levels of homovanillic acid were low, suggesting disturbed turnover of dopamine. These findings suggest that disturbed brain monoamine metabolism may be causally related to infantile spasms.Abbreviations CSF cerebrospinal fluid - HVA homovanillic acid - 5-HIAA 5-hydroxyindoleacetic acid This report is dedicated to Professor Yukio Fukuyama on the occasion of the 20-year anniversary of his chairmanship at the Department of Paediatrics, Tokyo Women's Medical College     

Changes in pyloric tumor of infantile hypertrophic pyloric stenosis before and after pyloromyotomy

Sixteen of 24 infants with vomiting were examined by real-time sonography, which established the diagnosis of hypertrophic pyloric stenosis (HPS); 12 underwent surgery. Of the three parameters measured, pyloric muscle wall thickness was the most reliable and accurate for the diagnosis of HPS. We suggest that a muscle wall thickness of 4 mm or more and stenosis index greater than 50% are standard findings in patients with HPS. Serial real-time sonography following pyloromyotomy showed that the pyloric tumor changed significantly during the 1st postoperative week and returned to normal size by the end of the 4th week. Offprint requests to: Z. X. Shen     

Major malformations in a case of infantile myofibromatosis

A case of infantile myofibromatosis associated with oesophageal atresia, annular pancreas, additional sacral vertebra and hypoplatic right kidney in a male neonate is reported. The possibility of associated malformations in this rare disease is outlined.     

Lower esophageal sphincter function in infantile hypertrophic pyloric stenosis

Esophageal manometry was performed in 18 infants between 29 and 105 days of age with hypertrophic pyloric stenosis. Continuous 24-h esophageal pH monitoring was also carried out in 9 cases before and after pyloromyotomy in order to study lower esophageal sphincter (LES) function in infantile hypertrophic pyloric stenosis (IHPS). The mean preoperative pressure and length of the LES in IHPS were 9.30 mmHg and 1.30 cm respectively, which were significantly lower and shorter than those in controls (P <0.01), and gastroesophageal reflux was highly significant. The esophageal manometric studies showed that LES pressure increased markedly on the 7th postoperative day to 12.58 ± 2.56 mmHg and returned to normal values within 2 to 11 months after operation. The pH monitoring indicated that in most cases reflux had disappeared on the 7th postoperative day and the reflux parameter decreased from 8.34% to 3.34%. Our data suggest that most cases of IHPS (12/18) were accompanied by LES incompetence, but LES competence as a pressure barrier at the gastroesophageal junction became normal after operation. Offprint requests to: Y. X. She     

The role of the duodenal microflora as a determinant of persistent diarrhoea

It has been suggested that proliferation of enterobacteriaceae and/or anaerobes in the duodenum of some children with acute diarrhoea determines whether the episode becomes persistent. A review of published studies and the comparison of cultures of duodenal aspirates from Peruvian children with acute and persistent diarrhoea and diarrhoea-free children did not support this hypothesis. Although many children had enterobacteriaceae and/or anaerobes cultured there was no correlation with clinical and nutritional outcome. Age, nutritional status, the environment and the aetiology of the episode were determinants of the duodenal microflora independent of diarrhoea. Culture of the duodenal aspirates did not increase the yield of enteropathogens which were isolated more frequently from stools than from the duodenum. Despite the presence of a single strain or serotype of enterobacteriaceae suggesting that these bacteria were colonizing the duodenum, we were unable to demonstrate any adherence mechanisms in the majority of them. Two often bacteria with no other evidence of virulence caused diarrhoea in the RITARD rabbit model.