以社区婴幼儿保健服务为突破口 拓展社区卫生服务

１９９６年５月我们对广州市社区卫生服务（主要是妇幼卫生）基本情况进行了调查。根据对调查资料的分析，我们认为在当前卫生服务朝着社区化发展的趋势下，在没有成功经验参照情况下，以社区婴幼儿保健服务为突破口，摸索社区卫生服务的内容、形式和经验，进而将卫生服务拓展到社区妇幼卫生服务和社区卫生服务中，不啻是一条开拓社区卫生服务的途径。     

不同超滤对先心病婴幼儿胶体渗透压的影响

目的探讨婴幼儿心脏手术中应用常规超滤（CUF）、改良超滤（MUF）及其联合应用对血浆胶体渗透压（COP）及围术期恢复时间的影响。方法60例在体外循环（CPB）下行心脏直视手术（体重〈10kg）的婴幼儿，随机分为常规超滤组（CUF组，n=20）、改良超滤组（MUF组，n=20）、联合超滤组（CM组，n=20），观测不同时间点（麻醉诱导前、麻醉诱导后、转机前、CPB5min、主动脉阻断后、CPB30min、停机时、CPB结束15min、入ICU即刻、ICU2h、ICU6h、ICU12h、ICU24h）的血浆COP，对比三组患儿的呼吸机辅助时间、ICU停留时间、住院时间。结果CM组和CUF组的COP水平在CPB30min、停机时均高于MUF组（P〈0．05）；MUF组和CM组在CPB结束15min、入ICU即刻、ICU2h时的COP水平显著高于CUF组（P〈0．05）；MUF组和CM组无显著性差异（P〉0．05）。CM组较其他两组显著缩短了呼吸机辅助时间、ICU停留时间和住院时间。结论联合应用CUF和MUF不仅在一定程度上提高了患儿CPB进行时的COP水平，而且进一步改善了CPB后的COP水平，患儿术后脱机拔管时间提前，监护室和医院停留时间缩短。     

不同时间抚触对新生儿睡眠及体格发育的影响

目的：观察沐浴后不同时间抚触对正常新生儿睡眠及体格发育的影响。方法：根据母乳在新生儿胃内排空的时间,将120例纯母乳喂养的足月正常新生儿随机分为沐浴后立即抚触组（I组）,沐浴后2～3 h抚触组（Ⅱ组）,沐浴后3～4 h抚触组（Ⅲ组）,每组40例。三组均按新生儿常规护理,出生后24 h进行全身抚触,15 m in次/,每天1次,直至28 d。结果：三组新生儿出生后3 d体重、身长、头围及睡眠指标比较,差异无显著性意义（均P〉0.05）;Ⅲ组新生儿28 d体重、身长、头围较I组、Ⅱ组增长快（均P〈0.05）;Ⅲ组新生儿也较I组、Ⅱ组新生儿安静,睡眠时间长,睡眠-觉醒节律形成早（均P〈0.05）。结论：最佳时间抚触有助于提高新生儿睡眠质量,较早地建立睡眠-觉醒节律,有利于新生儿生长发育,为婴幼儿期抚触奠定了基础。     

Brainstem auditory evoked responses in infants at risk of sudden infant death

Brainstem auditory evoked responses (BAERs) were recorded from 63 near-miss Sudden Infant Death Syndrome (NMSIDS) infants, 26 siblings of SIDS (SSIBS) infants and 67 control infants between 0 and 30 weeks post-term. The majority of BAERs recorded from the NMSIDS and SSIBS infants had normal form and interpeak intervals (V-I and V-IIn) within normal limits for their age. However, 15% of these infants had interpeak intervals outside the normal range, suggesting abnormal neural function in these cases. The distributions of interpeak intervals for all NMSIDS and SSIBS infants were skewed towards longer times compared to control infants. The distributions of V-IIn intervals for both groups of at risk infants were significantly different to that of control infants. While the observations confirm that the recording of BAERs is not suitable for identifying infants at risk of SIDS, they suggest, however, that maturation of neural processing in the brainstem of these infants may be delayed.     

Infant astigmatism and meridional amblyopia

The orientation preferences of 70 infants aged 7 to 53 weeks with significant astigmatism [1.0 or more diopters (D)] were measured using a preferential looking procedure with paired gratings. The preference data show the consequences of the blurring effects of astigmatism when these are not compensatable by accommodation. Data from infant astigmats tested with optical correction look like those of nonastigmats. We have found no evidence for the development of meridional amblyopia during the first year of life.     

全麻剖宫产对新生儿评分及神经行为的影响

目的　探讨气管插管全麻剖宫产对新生儿Apgar评分和神经行为能力的影响。方法　选择足月妊娠剖宫产 60例 ,分为硬膜外麻醉组 3 0例 (硬膜外组 )和气管插管全麻组 3 0例 (全麻组 ) ,评定新生儿第 1min、5min和10min的Apgar评分 ,并测定第 3天、第 14天和第 2 8天新生儿神经行为能力。结果　全麻组与硬膜外组之间的Ap gar评分差异无显著性 (P >0 .0 5 ) ,两组第 2 8天神经行为能力测定及其测定总分的差异都有统计学意义 (P <0 .0 5 )。结论　气管插管全麻剖宫产不影响新生儿Apgar评分 ,对新生儿的神经行为能力影响小。     

Management of brain abscess in children: review of 130 cases over a period of 21 years

The data on 130 children with brain abscesses treated over 21 years (1970–1990) were analyzed retrospectively. The whole group included four infants. Chronic ear infection and cyanotic congenital heart disease were the most common predisposing factors. In infants, meningitis and/or ventriculitis were dominant in the etiopathogenesis. Cases were evaluated according to the treatment received and also according to time periods. More than half of the patients (n=74) in this series were treated by primary or secondary excision. Computed tomography (CT) facilitated the diagnosis and helped the planning of treatment. Aspiration gained increasing credit after the advent of CT. Microorganisms could be identified in 54% of the cultured specimens. Staphylococci, streptococci and Proteus were the dominating microorganisms. Penicillin and chloramphenicol have long been the mainstay of antimicrobial therapy but have recently been replaced by third-generation cephalosporins and sulbactam-ampicillin combinations. Overall mortality was 15.5% but showed a decline from 30% in the pre-CT era to 6% in the last 5 years and to zero in the last three. Neither the location nor associated heart disease contributed to the mortality, but mortality among infants was as high as 50%.     

低体重儿和早产儿先天性心脏病的外科治疗

目的评价低体重儿和早产儿先天性心脏病外科治疗的效果。方法2001年1月至2005年3月、完成36例低出生体重儿心脏手术。孕期31~40周,平均34周,其中24例为早产儿,出生体重700~2500g,平均2010g。手术时日龄4~68d,平均15·5d;手术时体重900~2500g,平均2120g。动脉导管未闭15例,室间隔缺损10例,肺动脉闭锁5例,主动脉缩窄3例,完全性肺静脉异位引流2例,完全性大动脉错位1例。18例需要在体外循环下手术。结果4例(11·1%)术后早期死亡。体外循环72~198min,平均(99±31)min;主动脉阻断46~158min,平均(76±18)min;深低温停循环6~35min,平均(19±8)min;术后机械通气12~240h,平均(74·4±96·2)h。8例术后并发症,2例需再手术或介入治疗。结论早产儿或低体重儿实施简单或复杂的先心病手术都是安全和有效的;低体重儿可实施早期手术治疗;对强心、利尿等心功能支持治疗效果不佳的病例早期实施根治性手术效果优于延期手术或减状手术。     

Dietary energy and nutrient intakes and growth of healthy Australian infants in the first year of life

A prospective study of growth and nutrition in Australian infants has shown a high rate of breast-feeding, which was continued past 6 months in almost two-thirds. This trend back to breast-feeding was most pronounced in the highest social class. Protein intakes dominantly artificially fed infants. Intakes of sodium were less than recent reported figures. Body weight increases in this group when artificial feeding prevailed.     

Infantile subdural fluid collection: diagnosis and postoperative course

The authors reviewed 47 cases of infantile subdural fluid collection with regard to diagnosis and postoperative course after placement of a subdural-peritoneal shunt. CT scan with contrast enhancement proved to be an important diagnostic modality, showing vessels in the subarachnoid space as high-density spots. Utilizing this technique, we were able to differentiate the following varieties of fluid collection: (1) subdural fluid collection, in which enhancing vessels were seen on the brain surfae, (2) subarachnoid fluid collection, in which vessels were on the inner table of the cranium, and (3) coexistence of subdural and subarachnoid fluid collections, in which vessels were between the inner table of the cranium and the brain surface. The postoperative course of subdural fluid collection was characterized as follows: (1) the subdural fluid collection decreased first, with increased subarachnoid fluid collection; (2) the subarachnoid fluid collection remained after the disappearance of subdural fluid collection; and (3) the brain expanded again later. Subdural fluid collection disappeared about 1 month after the shunt operation, which could lead occlusion of the shunt system. Postoperative enlargement of the subarachnoid space was an early indicator of the efficacy of the subduralperitoneal shunt.