Modified Epworth Sleepiness Scale in Chinese children with obstructive sleep apnea: a retrospective study

Background and objective  The purpose of this study is to assess whether Chinese children with high apnea–hypopnea index (AHI) are sleepier by a modified Epworth Sleepiness Scale (ESS). Materials and methods  Records were retrospectively reviewed. We included children who were between 3 and 12 years old, admitted for overnight polysomnogram because of suspected obstructive sleep apnea syndrome (OSAS). A modified ESS was used to assess excessive daytime sleepiness (EDS) of the children. Results  One hundred ninety-two Chinese children were included. Children with high AHI, defined as AHI > 5.0, were sleepier than children with AHI less than or equal to 5. After adjustment by age, gender, and obesity, children with high AHI remained significantly sleepier. Modified ESS was significantly correlated with AHI (rho = 0.124, 95% CI = 0.004–0.281). Modified ESS score of >8 was the best cutoff point with the sensitivity and specificity of 0.29 and 0.91, respectively. The odds ratio of children with modified ESS > 10 having high AHI was 4.231 (95%CI = 1.248 to 14.338) and children with modified ESS > 8 had the highest odds ratio, 4.295(95%CI = 1.66 to 11.1), of having high AHI. Conclusion   Chinese children with high AHI appear to be sleepier than children with low AHI. Children with suspected OSAS and high modified ESS, i.e., ESS > 8, had significantly higher odds ratio of having high AHI. Increased sleepiness is a specific but not a sensitive symptom in snoring children with high AHI. Screening for EDS in snoring children may help us identify those with high AHI and prioritize the management of those children. All authors worked and the study was carried out in Kwong Wah Hospital in Hong Kong. There was no conflict of interest and no specific source of funding for the study.     

准分子激光原位角膜磨镶术治疗儿童远视性屈光参差

目的 评价准分子激光原位角膜磨镶术(excimer laser in situ keratomileusis,LASIK)治疗儿童远视性屈光参差的疗效.方法 使用美国Summit公司的SVS Apex plus准分子激光系统及Moria公司的微型板层角膜切割系统(LSK),对8例9～14岁远视性屈光参差患者进行LASIK手术,术后进行双眼视训练和系统的弱视治疗.结果 术后裸眼视力和矫正视力明显提高,术前平均最佳矫正视力0.23,术后6个月平均最佳矫正视力0.65;屈光度明显降低,但平均仍残留 2.81D;8例患者全部建立同时视和融合功能,6例有立体视功能.结论 LASIK治疗儿童远视性屈光参差安全有效,可明显提高视力,恢复和建立双眼视功能.     

7 小儿胆石症的诊断与治疗

目的探讨小儿胆石症的病因、诊断及治疗方法。方法分析22例小儿胆石症的临床资料,20例行手术治疗,2例行非手术治疗。14例行胆囊切除术(其中8例行腹腔镜胆囊切除术),3例行胆总管切开取石、T管引流术,2例行胆囊切除、胆总管探查、T管引流术,1例行胆总管囊肿切除、肝总管空肠Roux-en-Y吻合术。结果18例经手术治疗后症状消失,术后1例出现胆瘘,经引流后痊愈,1例右肝管内结石残留。18例(81.8%)得到随访,4例失访。随访5个月至7年,患儿生长发育正常,3例偶有腹痛、腹胀,1例行二次胆总管切开取石术,术后恢复顺利。行非手术治疗的2例病人经保守治疗后近期症状缓解,其中1例症状反复发作。结论对有腹痛者首选B超检查,对有胆总管扩张或黄疸的患儿结合CT检查可提高正确诊断率;症状明显的胆石症应早期手术治疗;腹腔镜可作为胆囊切除的首选治疗方法。     

儿童无症状尿检异常IgA肾病的临床病理和预后分析

目的 探讨儿童无症状尿检异常的IgA肾病的临床病理特征和预后。 方法 对54例IgA肾病儿童的临床和病理特征进行分析。根据起病时有无临床症状分为无症状尿检异常组和有症状肾炎组。组织病理学分级参照Lee氏和Katafuchi氏半定量积分法。 结果 无症状尿检异常组18例，有症状肾炎组36例。有症状肾炎组尿蛋白量（24 h）明显高于无症状尿检异常组[（2.3±2.2） g比（0.4±0.3） g，P < 0.05]。无症状尿检异常的IgA肾病儿童表现为镜下血尿者，87％有尿微量白蛋白增高。无症状尿检异常IgA肾病患儿病理表现以Lee 氏Ⅰ~Ⅱ级为主，2例表现为Lee氏Ⅳ~Ⅴ级和 5例发生Katafuchi Ⅱ~Ⅲ级肾小管间质病变。有症状肾炎组Lee氏病理分级以Ⅱ~Ⅲ级为主，两者病理分级分布差异无统计学意义（P > 0.05）。全组患儿平均随访（26.9±8.8）月后，1例病理为Lee 氏Ⅴ级患儿进入终末期肾衰竭，其余患儿Scr均无升高1倍以上。 结论 无症状尿检异常的儿童IgA肾病虽临床症状轻微，但可出现病理损害严重的病例，并影响其预后。     

Parental Communication Not to Smoke and Adolescent Cigarette Smokers' Readiness to Quit: Differences by Age

There is limited information on the relationship between parental practices that specifically discourage current cigarette smoking and adolescent cessation, and how this relationship varies by age. Among 1629 adolescent smokers, self-reported receipt of parental communication not to smoke was significantly and positively associated with readiness to quit. The strength and significance of this association decreased from early to middle adolescence and was not significant in late adolescence.     

小儿输尿管开口异位的诊断和治疗(附22例报告)

目的 提高小儿输尿管开口异位的诊治效果。方法 总结22例输尿管开口异位患儿临床资料。男1例，女21例。年龄1个月～12岁，平均4岁。单侧17例，双侧5例。21例女童中，有正常分次排尿伴异常漏尿18例，完全持续性漏尿3例；1例男童有上尿路梗阻及泌尿系感染。异位开口于阴道14例、尿道4例、前庭3例、膀胱颈1例。结果 手术治疗20例，其中肾切除者11例、半肾切除者7例，术后漏尿症状消失，3例合并输尿管残端综合征；1例双输尿管膀胱再植术后仍有尿失禁；1例直肠化膀胱术无漏尿症状。结论 明确诊断，选择合理手术是小儿异位输尿管口治疗成功的关键。     

心先安佐治小儿病毒性心肌炎临床疗效分析

目的:分析心先安佐治小儿病毒性心肌炎的临床疗效。方法:136例病毒性心肌炎患儿随机分为治疗组及对照组,在相同的 基础治疗条件下,治疗组应用心先安2～5mg kg,加液静滴,每天2次。结果:心先安组;痊愈51例(75%),好转12例(17.65%),无效5例(7. 35%),总有效92.65%。对照组痊愈41例(60.29%),好转14例(20.59%),无效13例(19.12%),总有效80.88%。两组相比、差异有显著性 (x2=4.09,P<0.005)。结论:心先安治疗小儿病毒性心肌炎疗效确切,且安全、可靠。     

小儿阻塞性睡眠呼吸暂停低通气综合征的诊断及治疗

目的探讨基层医院小儿阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的诊断和治疗。方法对临床疑似患儿,用多功能监测仪行夜间持续脉搏氧饱和度和呼吸监测、头颈侧位摄片、纤维鼻咽镜检查,确诊后行手术治疗。结果患儿多有睡眠粗响鼾声、扁桃体和(或)腺样体肥大,呼吸道感染、中耳炎、发育不良及中枢系统并发症的发生率较高。最低氧饱和度(85±7)%,睡眠呼吸暂停指数(apneaindex,AI)≥1者22例,睡眠呼吸暂停低通气指数(apneahypopneaindex,AHI)≥5者30例。在全麻下行扁桃体和腺样体切除术,同时行改良悬雍垂腭咽成形3例,双侧鼓膜切开引流术15例。术后症状及相关指标改善明显。结论便携式多功能监测仪可精确诊断OSAHS,扁桃体和腺样体切除是有效的治疗方法。     

经皮双针囊内注射类固醇治疗小儿孤立性骨囊肿

目的探讨经皮双针囊内注射类固醇治疗小儿孤立性骨囊肿的疗效. 方法 1996年1月～2004年1月,对28例小儿孤立性骨囊肿,在X线透视下,将2根细的骨穿针或腰穿针分别自囊腔顶部和底部刺入骨囊肿内,抽去囊液,冲洗囊腔后注入类固醇. 结果 27例随访10～62个月,平均28个月,无并发症发生.根据Chigira等X线骨囊肿愈合评价标准,Ⅳ级20例,Ⅲ级5例,Ⅱ例1例,Ⅰ级1例,治愈率92.6%(25/27).25例骨囊腔愈合时间3～10个月,平均4.5个月. 结论经皮双针囊腔内注射类固醇适合于小儿孤立性骨囊肿,简单,安全,治愈率高.     

多根骨圆针内固定治疗踝关节开放爆裂骨折7例

目的:探讨和分析手术方法治疗儿童陈旧性孟氏骨折的临床效果。方法:36例儿童,男28例,女8例;年龄4~14岁,平均9岁。按Bado分类法:Ⅰ型(伸直型)19例,Ⅱ型(屈曲型)9例,Ⅲ型(内收型)5例,Ⅳ型(特殊型)3例。根据不同病情分别行单纯切开复位治疗19例,尺骨截骨治疗10例,尺骨延长术治疗7例。结果:36例术后随访1~5年,平均3.5年,根据朱玉奎等评定标准,本组优24例,良6例,可3例,差3例,优良率83%。结论:恢复并维持正确的肱桡关系是手术后取得良好效果的关键,环状韧带可以不行修补或重建。