小儿推拿联合神经生长因子对小儿急性缺血缺氧性脑病神经功能的影响

目的探讨小儿推拿联合神经生长因子对小儿急性缺血缺氧性脑病(hypoxie-ischemic encephalopathy,HIS)神经功能的影响。方法将符合入选标准的2017年2月-2019年10月华中科技大学同济医学院附属湖北妇幼保健院96例HIS患儿,采用随机数字表法分为2组,每组48例。对照组在常规治疗基础上加用神经生长因子,观察组在对照组基础上予以小儿推拿治疗。采用新生儿行为神经评分(Neonatal Behavioral Neurological Assessment,NBNA)评估患儿的神经行为,采用智能发育指数(Mental Development Index,MDI)及精神运动发育指数(Psychomotor Development Index,PDI)评估患儿智能发育及运动协调和技巧行为能力,采用脑电图仪检测患儿脑电图棘波波幅,采用电解式组织血流计检测患儿局部脑血流量,采用ELISA法检测血清髓鞘碱性蛋白(myelin basic protein,MBP)、神经元特异性烯醇化酶(neuron-specific enolase,NSE)及VEGF,评价临床疗效。结果观察组总有效率为95.8%(46/48)、对照组为81.3%(39/48),2组比较差异有统计学意义(χ²=5.03,P=0.025)。观察组出生后28 d NBNA评分(t=-2.55,P=0.012)及出生后3个月MDI、PDI评分均高于对照组(t值分别为-3.43、-2.65,P值均<0.01)。治疗后,观察组脑电图棘波波幅[(35.02±4.16)mV比(46.92±5.81)mV,t=11.54]低于对照组(P<0.01);脑血流量[(179.36±22.25)ml/(100 g·min)比(158.30±14.92)ml/(100 g·min),t=-5.45]高于对照组(P<0.01)。观察组治疗后血清MBP、NSE、VEGF水平均低于对照组(t值分别为3.29、4.07、8.17,P值均<0.01)。结论小儿推拿联合神经生长因子可有效改善HIS患儿神经行为及智能指标,增加脑血流量,降低脑电图棘波波幅及MBP、NSE及VEGF水平,提高疗效。     

锌剂联合叶酸治疗小儿腹泻的临床价值

〔摘 要〕 目的：探讨锌剂联合叶酸治疗小儿腹泻的临床价值。 方法：选取 2019 年 1 月至 2020 年 9 月河源市妇幼保健院 收治的 100 例腹泻患儿为研究对象，根据其治疗方案分为观察组和对照组，各 50 例。对照组采取纠正水电解质失衡、抗感 染等常规治疗，观察组在对照组治疗的基础上，采用锌剂联合叶酸治疗，两组患儿均治疗 10 d 后进行疗效评价。比较两组 患儿腹泻停止时间、大便恢复正常时间、体温恢复正常时间、住院时间和不良反应发生率。 结果：观察组患儿的治疗总有 效率为 94.00 %，高于对照组的 80.00 %，差异具有统计学意义（P ＜ 0.05）；观察组患儿的腹泻停止时间、大便恢复正常 时间、体温恢复正常时间、住院时间均短于对照组，差异具有统计学意义（P ＜ 0.05）；两组患儿的不良反应发生率比较， 差异无统计学意义（P ＞ 0.05）。 结论：常规治疗基础上，锌剂联合叶酸治疗可有效改善小儿腹泻症状和提高疗效，且 安全可靠。     

复方紫草油治疗小儿湿疹的临床疗效

目的:探讨复方紫草油治疗小儿湿疹的临床疗效。方法:选取2015年1月至2017年12月黄河中心医院收治的小儿湿疹患者80例,按照随机数字表法分为对照组和观察组,每组40例,对照组应用肤轻松软膏治疗,观察组应用复方紫草油治疗。分析2组患儿的治疗效果、临床症状缓解情况以及机体免疫改善情况。结果:观察组治疗有效率为95. 0%,对照组治疗有效率为80. 0%。观察组治疗效果优于对照组(P 0. 05);观察组白细胞介素-4(IL-4)水平明显低于对照组,差异有统计学意义(P 0. 05),观察组干扰素-γ(IFN-γ)水平明显高于对照组,差异有统计学意义(P 0. 05);观察组CD8~+水平明显低于对照组,差异有统计学意义(P 0. 05),观察组CD4~+、CD4~+/CD8~+水平明显高于对照组,差异有统计学意义(P 0. 05);观察组证候积分改善优于对照组,差异有统计学意义(P 0. 05),观察组住院时间明显少于对照组,差异有统计学意义(P 0. 05); 2组均未出现严重不良反应,轻微不良反应在调整用药后缓解,2组不良反应比较,差异无统计学意义(P 0. 05)。结论:复方紫草油治疗小儿湿疹效果理想。     

Effectiveness of craniosacral therapy in the treatment of infantile colic. A randomized controlled trial

ObjectivesTo determine the effectiveness of Craniosacral Therapy (CST) for the treatment of infantile colic.Material and methodsThis randomized controlled trial was conducted on 58 infants, aged 0–84 days, diagnosed with infantile colic. The babies received a 30–40 minute CST session once a week (experimental group) or no treatment (control group). Babies in the CST group received either 1, 2 or 3 CST sessions over a 14-day period. Data were collected at 4 different times over the 24-day period, day 0 (baseline), day 7, day 14 and day 24. Crying (primary outcome) and sleep (secondary outcome) were evaluated using a crying and sleep diary, and colic severity was measured using the Infant Colic Severity Questionnaire (secondary outcome).ResultsThere was a statistically significant difference between groups (CST and control) in crying hours (F = 188.47; p < 0.0005; η2 = 0.78), sleep hours (F = 61.20; p < 0.0005, η2 = 0.54) and colic severity (F = 143.74; p < 0.0005, η2 = 0.73) across all the time points. In comparison with the control group, CST babies reported significant and clinically relevant effects in crying hours on day 7 (−2.47 h (95%CI, −2.95 to −1.99); p < 0.0005; d = 1.73), on day 14 (−3.29 h (95%CI, −3.7 to −2.8); p < 0.0005; d = 2.87) and on day 24 (−3.20 h (95%CI, −3.7 to −2.6); p < 0.0005; d = 2.54); in sleep hours on day 7 (−2.47 h (95%CI, −2.95 to −1.99); p < 0.0005; d = 1.73) on day 14 (-3.29 h (95%CI, −3.7 to −2.8); p < 0.0005; d = 2.87) and on day 24 (−3.20 h (95%CI, −3.7 to −2.6); p < 0.0005; d = 2.54).ConclusionsCraniosacral therapy appears to be effective and safe for infantile colic by reducing the number of crying hours, the colic severity and increasing the total hours of sleep.     

Treatment of infant colic with craniosacral therapy. A randomized controlled trial

ObjectiveTo evaluate the number of craniosacral therapy sessions that can be helpful to obtain a resolution of the symptoms of infantile colic and to observe if there are any differences in the evolution obtained by the groups that received a different number of Craniosacral Therapy sessions at 24 days of treatment, compared with the control group which did not received any treatment.MethodsFifty-eight infants with colic were randomized into two groups of which 29 babies in the control group received no treatment and those in the experimental group received 1–3 sessions of craniosacral therapy (CST) until symptoms were resolved. Evaluations were performed until day 24 of the study. In this study crying hours served as primary outcome. The secondary outcome were the hours of sleep and the severity, measured by an Infantile Colic Severity Questionnaire (ICSQ).ResultsSignificant statistical differences were observed in favor of experimental group compared to the control group on day 24 in crying hours (mean difference = 2.94, at 95 %CI = 2.30–3.58; p < 0.001) primary outcome, and also in hours of sleep (mean difference = 2.80; at 95 %CI = − 3.85 to − 1.73; p < 0.001) and colic severity (mean difference = 17.24; at 95 %CI = 14.42–20.05; p < 0.001) secondary outcomes.Also, the differences between the groups ≤ 2 CST sessions (n = 19), 3 CST sessions (n = 10) and control (n = 25) were statistically significant on day 24 of the treatment for crying, sleep and colic severity outcomes (p < 0.001).ConclusionBabies with infantile colic may obtain a complete resolution of symptoms on day 24 by receiving 2 or 3 CST sessions compared to the control group, which did not receive any treatment.     

43 例婴儿痉挛症认知运动发育特点及相关因素研究

〔摘 要〕 目的：探讨婴儿痉挛症（IS）认知运动发育特点及其相关因素。方法：收集 2016 年 1 月至 2020 年 12 月于 福建省立医院儿科住院治疗的 43 例 IS 患儿的临床资料，回顾性分析其认知运动发育特点及相关因素。结果：患儿各能区 发育商（DQ）平均值均较低。多元线性回归分析显示起病年龄、病程、发作频率对　Griffiths 心理发育评估量表 – 中文版 （GDS–C）能区 DQ 有影响。结论：IS 患儿存在认知运动发育落后，起病年龄、病程、发作频率与认知运动发育水平相关。     

Stenting for infantile adult aortic coarctation with successful conception of zygomatic twins at 4 years’ post-intervention

INTRODUCTIONAortic coarctation is a congenital defect which rarely presents in adulthood but results in significant morbidity and mortality. Endovascular techniques present novel therapeutic options for managing this anomaly with comparable results to traditional open surgical repair.PRESENTATION OF CASEWe convey a case of postductal aortic coarctation in a symptomatic 31-year-old woman, undetected, despite 27 years history of congenital bicuspid valve with aortic incompetence. We staged a successful endovascular repair following presentation with hypertension, abdominal pain, and worsening lower limb claudication. This lady recovered well, eventually giving birth to twins after a successful caesarean section delivery. The anatomical, clinical and technical features of the case are appraised.DISCUSSIONAortic coarctation is classified anatomically as preductal (infantile) or postductal (adult) and the morphological spectrum of abnormality ranges from a discrete stenosis distal to the left subclavian to a hypoplastic transverse arch and aortic isthmus presenting in infancy. Its incidence is 0.2–0.6 per 100 live births. Traditional open surgical repair of aortic coarctation is associated with high morbidity and mortality. Advances in endovascular techniques with their associated shorter hospital time and lower costs, reduced short term morbidity and mortality mean that they are likely to become mainstays of treatment.CONCLUSIONThe presentation of aortic coarctation for the first time in an adult is extremely unusual. Error and delayed diagnosis can never be fully exempted in the practice of medicine even with the most advanced diagnostic tools. Follow-up is mandatory by trans-oesophageal echo in all endovascular patients.     

口服盐酸普萘洛尔治疗婴幼儿外阴血管瘤7例临床分析

目的：探讨口服盐酸普萘洛尔治疗婴幼儿外阴血管瘤的效果。方法：选取2013年3月至2014年2月来我院儿科门诊就诊的外阴血管瘤患儿7例，包括溃疡型2例和非溃疡型5例，均给予盐酸普萘洛尔：首日剂量0.5 mg/（kg·d），分2次口服；第二天剂量增加为0.75 mg/（kg·d），分2次口服；第三天剂量调整为1 mg/（kg·d），分2~3次口服；服药1周后复诊观察患儿皮损变化情况及对药物的敏感程度，酌情加量至1.5~2.0 mg/（kg·d）维持，连续服用6~12个月，每天分2~3次口服。服药期间每月复诊1次，复查血常规、血糖、血压、心电图、B超，每2~3个月复查心肌酶谱、肝肾功能、电解质等。撤药时逐渐减量，每月减量0.5 mg/（kg·d）。患儿治疗前均完善影像学、生化检查及眼底检查，治疗过程中进行多普勒超声检查并观察皮损大小等以监测疗效。观察临床疗效及转归情况。结果：2例溃疡型血管瘤在服药1周后溃疡面逐渐愈合，1个月后完全愈合，形成瘢痕，溃疡外周红色斑块颜色逐渐变暗、消退。5例非溃疡型血管瘤患儿中4例疗效较好，另1例为多发性血管瘤患儿，B超示其肝脏10余个零星占位，服药1个月后复查B超示肝脏占位减少、缩小，2个月后完全消失，躯干及外阴皮损部位颜色明显变暗，但2个月后服药时有不规律，4个月后自行停药。患儿服药期间定期的血常规、血糖、血压、心功能和肝肾功能检查均未发现明显异常。结论：口服盐酸普萘洛尔对各类型婴幼儿外阴血管瘤均有明确疗效。     

Is foot reflexology effective in reducing colic symptoms in infants: A randomized placebo-controlled trial

ObjectivesInfantile colic and its accompanying crying represent a major source of stress and have negative physiological, emotional and psychological effects on infants and parents. The aim of this study was to examine the efficacy of foot reflexology for reducing symptoms of infantile colic.DesignThe study was conducted as a single-blind, randomized, placebo-controlled trial with a sample population of 45 infants diagnosed with infantile colic.MethodsSimple randomization was used to select a reflexology (study) group (n = 20) and a placebo group of infants with colic (n = 25). The parents and biostatistician were blinded to group assessment. Foot reflexology, or stimulating reflex points on the foot, was implemented with the reflexology group. Placebo foot reflexology, or noneffective touch, was used with the placebo group. Over a two-week period, both interventions were performed four times for 20 min each time by the researcher. The researcher collected data using the information form, the Infant Colic Scale (ICS), and a diary of daily crying duration.ResultsThe trial ended with the completion of the data. In each group, 20 infants were studied. The means of the Infant Colic Scale scores and daily crying duration were significantly lower in the foot-reflexology group than in the placebo foot-reflexology group (p < .001). Infants with colic in the reflexology group cried less and experienced fewer symptoms than before treatment.ConclusionsFoot reflexology is a non-invasive and safe nursing intervention that is effective for reducing crying duration and symptoms in infants with colic.