前庭自旋转试验在前庭性偏头痛患者中的应用

目的探讨前庭自旋转试验（vestibular autorotation test, VAT）对前庭性偏头痛（vestibular migraine, VM）患者在前庭功能评估中的应用。方法对26例VM患者和20例正常人进行VAT检查,观察水平增益、水平相移、垂直增益、垂直相移、非对称性五项参数,≥1项异常,即评定为前庭功能异常,VAT试验阳性。结果VAT结果显示VM组21例（80.77%）前庭功能异常;对照组2例（10%）前庭功能异常,两组前庭功能异常检出率比较差异具有统计学意义（P<0.05）。VM患者增益异常18例（69.23%）,其中水平增益增高12例次,垂直增益增高4例次,水平增益降低1例次,水平增益部分增高部分降低2例次。VM患者相移延迟16例（61.54%）,其中水平相移延迟13例次,垂直相移延迟5例次。VM患者非对称性异常3例（11.54%）,提示水平通路双侧前庭功能不对称,右侧功能较弱。VM患者增益异常以2.0~2.7 Hz为主,相移异常以3.5~5.9 Hz为主。结论VM患者以增益增高、相移延迟为主要特征,水平测试比垂直测试敏感。VAT对VM患者的前庭功能评估有效,其诊断能提供有价值的参考依据。     

后囊连续环形撕囊在儿童白内障手术中的应用

目的 探讨后囊连续环形撕囊术在儿童白内障手术临床应用的价值。方法 在儿童白内障手术中采用后囊连续环形撕囊40例52眼，随访观察10-30月。结果 术后视力在0．8以上者12眼占23．1％，0．4～0．7者22眼占42．3％，0．1～0．3者10眼占19．2％，0．1以下8眼占15．4％。术中并发症主要有玻璃体脱出12眼占23．1％，术后并发症主要有前房渗出及瞳孔机化膜形成18眼占34．6％。全部病例周边后囊均有不同程度浑浊，但视轴区清晰。未出现人工晶状体移位或角膜水肿等严重并发症。结论 后囊连续环形撕囊术是降低儿童的白内障手术后后囊浑浊的一种安全、简便而效的方法。     

Tolerance of salivary gland botulinum toxin A injection under local anesthesia for the treatment of sialorrhea in children: An observational study

ObjectivesThe main objective of this study was to assess tolerance of botulinum toxin A injection into the salivary glands under local anesthesia in a pediatric population. Secondary endpoints comprised efficacy and side-effects.Material and methodsA retrospective observational study included children treated between January 2013 and March 2020 for sialorrhea and/or pharyngeal salivary congestion. Children were identified from the botulinum toxin A injection database. The study included 162 injection sessions in 55 children. Injections were performed under local anesthesia with nitrous oxide, after clinical location of the site. Epidemiological and clinical data, injection tolerance on the FLACC scale, treatment response and complications were recorded.ResultsFor submandibular gland injections, pain was absent in 81 cases, mild in 64, moderate in 4 and intense in 1. In parotid gland injections, pain was absent in 45 cases, mild in 89, moderate in 17 and intense in 1. Injection tolerance was significantly poorer (P < 0.005) in parotid than submandibular glands. Seventy-seven percent of the injections had a positive effect on sialorrhea. Fifteen patients presented transient adverse events: mainly dysphagia and paradoxical increase in sialorrhea.ConclusionSalivary gland botulinum toxin A injections in under local anesthesia were well-tolerated, safe and effective for children with sialorrhea and/or pharyngeal salivary congestion.     

捏脊疗法治疗小儿喘息性支气管炎的效果观察

目的探讨捏脊疗法治疗小儿喘息性支气管炎的临床效果。方法选取2012年2月～2012年12月本院收治的喘息性支气管炎患儿150例,随机分为观察组和对照组各75例,对照组采用常规西医对症治疗,观察组在对照组治疗的基础上应用捏脊疗法治疗。比较两组的临床疗效及患儿咳嗽、喘憋和肺部哮鸣音的消失时间。结果观察组总有效率高于对照组（P〈0.05）。观察组患儿咳嗽、喘憋、肺部哮鸣音的消失时间短于对照组（P〈0.05）。结论捏脊疗法治疗小儿喘息性支气管炎疗效满意,且操作简单易行,能极大程度上减轻家庭经济负担,应在医院及社区被广泛普及。     

甘露醇、能量合剂联合抗癫痫药治疗发作频繁的小儿难治性癫痫的疗效

目的：有效缓解小儿难治性癫痫发病症状,临床探究在使用抗癫痫药治疗同时加以甘露醇、能量合剂的效果。方法：选取我院2014年7月～2015年8月96例经诊断为难治性癫痫入院治疗的小儿患者,分为单一组、联合组,按挂号单双数进行分配,每组48例。单一组仅使用抗癫痫药,联合组在单一组用药基础上加用能量合剂以及甘露醇,观察两组疗效以及治疗前后发病次数。结果：联合组临床有效率高达91.7%,单一组仅为79.2%,联合组较单一组疗效好,P<0.05;治疗前两组癫痫发病次数差异无统计学意义, P>0.05,治疗后两组发病次数均有明显减少,联合组较单一组发病次数少,P<0.05。结论：临床在治疗小儿难治性癫痫时在使用抗癫痫药同时加以甘露醇、能量合剂辅助治疗,患儿发病次数减少,恢复情况好,疗效高。     

Headache-related circuits and high frequencies evaluated by EEG,MRI, PET as potential biomarkers to differentiate chronic and episodic migraine: Evidence from a systematic review

BackgroundThe diagnosis of migraine is mainly clinical and self-reported, which makes additional examinations unnecessary in most cases. Migraine can be subtyped into chronic (CM) and episodic (EM). Despite the very high prevalence of migraine, there are no evidence-based guidelines for differentiating between these subtypes other than the number of days of migraine headache per month. Thus, we consider it timely to perform a systematic review to search for physiological evidence from functional activity (as opposed to anatomical structure) for the differentiation between CM and EM, as well as potential functional biomarkers. For this purpose, Web of Science (WoS), Scopus, and PubMed databases were screened.FindingsAmong the 24 studies included in this review, most of them (22) reported statistically significant differences between the groups of CM and EM. This finding is consistent regardless of brain activity acquisition modality, ictal stage, and recording condition for a wide variety of analyses. That speaks for a supramodal and domain-general differences between CM and EM that goes beyond a differentiation based on the days of migraine per month. Together, the reviewed studies demonstrates that electro- and magneto-physiological brain activity (M/EEG), as well as neurovascular and metabolic recordings from functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), show characteristic patterns that allow to differentiate between CM and EM groups.ConclusionsAlthough a clear brain activity-based biomarker has not yet been identified to distinguish these subtypes of migraine, research is approaching headache specialists to a migraine diagnosis based not only on symptoms and signs reported by patients. Future studies based on M/EEG should pay special attention to the brain activity in medium and fast frequency bands, mainly the beta band. On the other hand, fMRI and PET studies should focus on neural circuits and regions related to pain and emotional processing.     

葛根芩连汤治疗轮状病毒腹泻20例

目的评价葛根芩连汤治疗小儿秋季腹泻的临床疗效。方法按随机对照原则,将60例湿热型的小儿秋季腹泻（轮状病毒阳性）患者分为治疗组和中药对照组、西药对照组,每组2D例,均为上海中医药大学附属曙光医院儿科门诊患者。治疗组口服葛根芩连汤中药汤剂,中药对照组使用龙胆泻肝汤中药汤剂治疗,西药对照组口服思密达治疗。治疗72小时后观察。评价3组患者治疗前及治疗72小时后排便周期、大便性状、发热症状及伴随症状,根据证候积分判定疾病疗效。结果与治疗前比较,治疗结束时各组排便周期、大便性状比较,葛根芩连汤组疗效优于抗病毒口服液组（P〈0.01）;发热症状比较,葛根芩连汤组疗效优于思密达组（P〈0.01）;证候总积分疗效评价比较,葛根芩连汤组疗效优于思密达组（P〈0.01）,抗病毒口服液组疗效优于思密达组（P〈0.05）。各组均无严重不良反应发生。结论葛根芩连汤和抗病毒口服液均能显著退热,改善大便性状及伴随症状,但葛根芩连汤在治疗腹泻方面效果更好,并兼顾全身症状的改善。     

罗比卡因与布匹卡因在小儿骶管部麻醉的临床观察

目的探讨0．8％利多卡因加0．25％罗比卡因合剂用于小儿骶管麻醉的临床效果，并与0．8％利多卡因加0．2％布匹卡因合剂进行对照观察。方法选择60例男性小儿骶管麻醉的临床资料进行分析，60例患儿随机分成罗比卡因——利多卡因组（A组）和布匹卡因——利多卡因组（B组）各30例。结果两组患儿麻醉镇痛均完善，但A组患儿的麻醉阻滞完善时间明显短于B组，而麻醉维持时间长于B组p〈0．01；A组患儿术后第一次排尿时间明显短于B组P〈0．01（t=24．305）。结论小儿骶管阻滞适宜于小儿下腹部及会阴部手术，局麻药以0．8％利多卡因加0．25％罗比卡因较佳。     

七氟醚与氯胺酮在小儿麻醉维持中的荟萃分析

目的系统评价七氟醚和氯胺酮在小儿麻醉维持中的效果及其并发症,为其临床决策提供依据。方法以七氟醚或氯胺酮、小儿麻醉维持为检索词,检索Pubmed、中国知网和维普等数据库,文献起止时间均从建库至2011年12月,纳入所有采用七氟醚吸入或氯胺酮静脉维持小儿麻醉的研究文献,用RevMan 5.1.1软件进行Meta分析。结果共纳入17个随机对照试验,3 771例患儿。Meta分析结果示,①呼吸道分泌物：七氟醚麻醉口腔分泌物明显少于氯胺酮[RR=0.03,95%CI（0.01,0.09）];②术中躯体运动：氯胺酮全麻术中体动高于七氟醚全麻[RR=0.06,95%CI（0.03,0.12）];③术后睁眼或体动时间：七氟醚的苏醒时间明显短于氯胺酮[WMD=-29.84,95%CI（-36.61,-23.07）];④出手术室或PACU时间：七氟醚的出室或PACU的时间少于氯胺酮[WMD=-21.41,95%CI（-29.99,-12.84）];⑤术后躁动：七氟醚术后躁动发生率显著高于氯胺酮[RR=0.07,95%CI（0.04,0.11）];⑥术后呕吐：两者之间差异无统计学意义[RR=0.75,95%CI（0.61,0.93）]。结论小儿氯胺酮麻醉后分泌物明显多于七氟醚,术中七氟醚维持较少出现体动,七氟醚麻醉苏醒更快,但七氟醚麻醉术后躁动明显高于氯胺酮。