Intramural esophageal hamartoma: A report of two cases and review of the literature

Intramural esophageal hamartoma is an unusual cause of distal esophageal obstruction in childhood. Two cases are reported with a review of the literature.     

Skin tears and risk factors assessment: a systematic review on evidence‐based medicine

Skin tears represent a common condition of traumatic wounds, which may be encountered in some categories of individuals at the extremes of age, such as infants and the elderly. Despite the high prevalence and cost of these lesions, there has been little investigation into the risk factors that lead to this condition. The aim of this review was to systematically evaluate the main risk factors involved in development of skin tears. We planned to include all the studies dealing with risk factors related to skin tears. Only publications in English were considered. We excluded all the studies that did not properly fit our research question and those with insufficient data. Of the 166 records found, 24 matched our inclusion criteria. After reading the full‐text articles, we decided to exclude seven articles because of the following reasons: (1) not responding properly to our research questions and (2) insufficient data; the final set included 17 articles. From a literature search, we found the following main issues related to risk factors, which have been described in detail in this section: age‐related skin changes, dehydration, malnutrition, sensory changes, mobility impairment, pharmacological therapies and mechanical factors related to skin care practices. Our findings clearly show that in frail populations (especially infant and elderly), the stratification risk, as a primary prevention strategy, is an effective tool in avoiding the development of chronic wounds. The development and the implementation of prevention strategies based on appropriate knowledge of the risk factors involved and the adoption of correct techniques during skin care practices could reduce or even avoid the onset of skin tears.     

全身麻醉复合胸椎旁神经阻滞在 婴幼儿胸腔镜手术中的应用

〔摘 要〕 目的：探讨全身麻醉复合胸椎旁神经阻滞在婴幼儿胸腔镜手术中的应用。方法：选择广东省妇幼保健院 2018 年 7 月至 2021 年 1 月收治的因肺囊腺瘤择期行胸腔镜下肺叶切除术的婴幼儿 60 例,随机分为 C 组和 N 组各 30 例。 C 组常规行全身麻醉,N 组在麻醉诱导后行椎旁神经阻滞。分别记录患儿术中舒芬太尼的用量,复苏时间,气管插管 后 30 min（T1）、60 min（T2）的心率（HR）和平均动脉血压（MAP）,拔除气管导管后 2 h（T3）和 6 h（T4）患儿 的 HR、MAP、疼痛评分。结果：N 组患儿舒芬太尼的用量明显少于 C 组,复苏时间短于 C 组,差异具有统计学意义 （P ＜ 0.05）;两组患儿在 T1 和 T2 时间点 HR 和 MAP 比较无统计学差异（P ＞ 0.05）;N 组患儿 T3 和 T4 时间点 HR 及 疼痛评分均明显低于 C 组,差异具有统计学意义（P ＜ 0.05）;两组患儿 MAP 比较差异无统计学意义（P ＞ 0.05）。结论： 全身麻醉复合椎旁神经阻滞能明显减少术中舒芬太尼的用量,促进患儿苏醒,还能降低胸腔镜手术婴幼儿的术后痛。     

内镜下切除加微波热凝腺样体联合扁桃体切除治疗儿童阻塞性睡眠呼吸暂停低通气综合征

目的：探讨内镜下切除加微波热凝腺样体联合扁桃体手术治疗儿童阻塞性睡眠呼吸暂停低通气综合衍（OSAHS）的临床疗效。方法：对42例儿童OSAHS患者一次性采用鼻内镜下微波热凝（或切除后微波热凝）腺样体，联合扁桃体手术切除，扁桃体切除后缝合腭咽弓、腭舌弓，术后随访观察3-6个月。结果：38例患者术后鼾卢、憋气情况消失，无呼吸暂停；4例肥胖患者鼾声减轻，基本无张口呼吸，憋气情况改善。手术总有效率达100％，随访观察腺样体无增生复发，无并发症发生。分泌性中耳炎者，听力提高到正常。结论：内镜下切除加微波热凝腺样体联合扁桃体切除是治疗儿童OSAHS的有效方法。     

婴儿母乳喂养与学龄前肥胖症关系的病例对照研究

目的:探讨婴儿期母乳喂养行为与学龄前期单纯性肥胖症发生之间的关系,为预防儿童单纯性肥胖症提供理论依据。方法:对1800名青岛市和滨州市四五岁儿童的婴儿期母乳喂养情况及其体重指数(BMI)发育情况等进行调查,分析母乳喂养类型和持续时间与学龄前肥胖症发生之间的关系。结果:单因素分析发现4个月内只喂母乳、主要喂母乳、母乳与配方奶量基本相同、主要喂配方奶、只喂配方奶者四五岁时肥胖发生率分别为12.6%,13.0%,17.0%,18%,30%;儿童母乳喂养持续时间0,<1,1～3,4～6,7～9,9个月以上者四五岁时肥胖发生率分别为29%,30%,33%,17%,14%,12%。母乳喂养类型和持续时间不同的儿童学龄前期单纯性肥胖症发生率不同(χ2=10.407,P<0.05;χ2=20.903,P<0.001);多因素logistic回归分析发现4个月内喂配方奶量越多,肥胖发生率越高(OR=1.120,χ2=8.233,P<0.01),母乳喂养持续时间越长,肥胖发生越少(OR=0.782,χ2=6.609,P<0.05)。结论:婴儿母乳喂养对学龄前期肥胖症的发生有预防作用;婴儿期应提倡母乳喂养,并尽可能延长母乳喂养时间至9个月以上。     

Postoperative paediatric pain prevalence: A retrospective analysis in a university teaching hospital

BackgroundOverall pain prevalence in paediatric patients is well documented, but relatively little attention has been paid to pain prevalence and intensity on specific postoperative days within the first week following an operation.ObjectivesTo evaluate reported pain prevalence on the day of surgery and each day during the following week and to analyse pain trajectories.DesignRetrospective study.SettingSingle centre university hospital.Participants815 postoperative children and adolescents (age ≤ 18 years) were included (female: 36%, age 9.8 ± 5.8). Children with ear, nose, throat (e.g. tonsillectomy), eye (e.g. strabismus repair) or dental surgery (e.g. dental extraction) were treated at other departments and therefore were not included in this study.MethodsRetrospective analysis of the overall and clinically relevant (pain score ≥4/10) postoperative pain prevalence in children and adolescents during the first week after surgery. Possible influencing factors (age, sex, body mass index, type of anaesthesia, type of surgery and duration of surgery) on pain trajectories are analysed using mixed model techniques.ResultsOverall, 36% of 815 analysed children and adolescents suffered from pain ≥4 during their entire hospital stay. Compared to the day of surgery, the number of patients with pain ≥4 was slightly higher on day 1 after surgery (21% vs. 25%, respectively). In self-reported pain intensity rating (done for patients age ≥ 4 years) the type of surgery (p < .001) was the only significant variable influencing pain intensity. In observational pain assessment (age < 4 years) pain scores increased with patient's age (p = .004). In this patient group, pain intensity ratings did not differ between types of surgery (p = .278).ConclusionType of surgery is an important predictor for self-reported pain intensity ratings in children but not for observational pain assessment in younger children. In younger children observational pain assessment ratings increase with age.     

综合干预对特应性体质婴幼儿生活质量的影响

目的 探讨综合干预对改善特应性体质婴幼儿生活质量的影响.方法 采用随机、双盲法对106例6个月至1岁有特定遗传背景且患有湿疹、喘息的特应性体质患儿开展过敏原检测及综合干预对照研究,18个月后比较症状发作、免疫功能测定情况.结果 18个月后治疗组血清IgG和IgA升高（均P＜0.05）,喘息、湿疹发作明显减少（均P＜0.01）,睡眠、情绪改善明显（均P＜0.05）;牛奶、鸡蛋是婴幼儿最常见的过敏原.结论 特应性体质与环境因素是变应性疾病的危险因素,婴幼儿期是影响儿童是否发生变应性疾病的关键时期,及早采取干预措施可降低儿童过敏性疾病的发生,改善特应性体质婴幼儿生活质量.     

骶管阻滞在婴幼儿下腹、会阴、下肢手术中的应用

目的:探讨一种适合婴幼儿下腹、会阴、下肢手术更为安全有效的麻醉方法。方法:随机选择100例行下腹、会阴、下肢手术的婴幼儿分为观察组(A组)和对照组(B组),每组各50例,A组在氯胺酮复合异丙酚基础麻醉下行骶骨管阻滞,术中持续微量泵泵注异丙酚维持基础麻醉;B组选择氯胺酮复合异丙酚行全凭静脉麻醉。结果:A组异丙酚用量小于B组(P<0.01),麻醉效果A组优于B组。结论:基础麻醉下骶骨管阻滞是一种适合婴幼儿下腹、会阴、下肢手术更为安全有效的麻醉方法。     

婴幼儿抗菌药物相关性腹泻的影响因素分析

目的探讨婴幼儿抗菌药物相关性腹泻的影响因素及预防措施。方法选取2002年6月-2009年6月我院应用抗菌药物治疗的婴幼儿1120例,按症状的不同分为两组：抗菌药物相关性腹泻婴幼儿组（观察组,60例）和无抗菌药物相关性腹泻婴幼儿组（对照组,1060例）。对比两组患儿的影响因素。结果观察组患儿多为单纯性腹泻,引起腹泻的抗菌药物：头孢三代类17例、青霉素类13例、碳青酶烯类12例、头孢二代类10例、克林霉素8例。禁食、应用抗菌药物种类、抗菌药物应用时间、采用干预措施（气管插管、气管切开、泌尿道插管等）、住院时间两组患儿间比较差异均有统计学意义（P〈0．05）;而给药途径、年龄、预防应用抗菌药物两组患儿间比较差异无统计学意义（P〉0．05）。结论婴幼儿中抗菌药物相关性腹泻的发生率较高,应合理选用抗菌药物、减少联合用药、减少侵袭性操作、缩短住院时间,早期肠内营养或经口进食、应用抗菌药物的同时口服微生态制剂。