外源性五羟色胺大鼠肺出血模型及其与浓度关系

目的　通过外源性五羟色胺 (5 -HT)气管滴入建立新生大鼠肺出血模型及其与浓度关系 .方法　模型制作 :日龄 4～ 5天Wistar二级大鼠 5 0只 ,随机分为 4组 :生理盐水对照组 (A组 )及 3种不同浓度外源性 5 -HT实验组(B、C、D组 ) :经气管导管分别滴入生理盐水和不同浓度 5 -HT ,4小时后处死 ,观察肺大体及组织病理改变 ,将肺出血程度分为 5级 :Ⅰ正常 ;Ⅱ肺水肿 ;Ⅲ点状肺出血 ;Ⅳ局灶性肺出血 ;Ⅴ弥漫性肺出血 ,选择出制作肺出血模型的最佳的浓度 .结果　不同浓度 5 -HT气管内滴入均能引起不同程度肺出血 ,但随着浓度增加 ,B、C、D三组间的肺出血程度无差异 (p >0 .0 5 ) ,其中D组死亡率 30 % ,对照组及B组和C组均无死亡 ,死亡鼠肺为弥漫性出血 .结论　 5 -HT可致大鼠肺出血 ,以 1× 10 -5mol/ml浓度为宜 ,随着 5 -HT浓度增加 ,大鼠死亡率增加 ,但肺出血发生率无差异     

间断静脉滴注3%高渗盐水与20%甘露醇治疗小儿急性脑水肿的疗效对比

Objective To compare the clinical efficacy of 3% hypertonic saline with 20% mannitol in the treatment of acute brain edema in children.Methods Twenty children with acute brain edema were randomly divided into hypertonic saline(HS) group and mannitol group.HS group and mannitol group were given 3% HS solution or 20% mannitol respectively.Main outcome measurements included intracranial pressure(ICP),mean arterial pressure(MAP),central venous pressure(CVP),cerebral perfusion pressure (CPP),serum electrolytes,plasma osmolality,renal function and urine volume.Results Both 3% HS and 20% mannitol were effective in reducing ICP(P ＜0.05).Therapeutic effect lasted(4.5±1.2) h in HS group and(3.2±1.5) h in mannitoi group.3% HS had a longer duration of action than marmitol(P＜0.05).At the time point of 2 hours after treatment,MAP and CPP of HS group increased more than those of mannitol group(P＜0.05).Conclusion Both 3% HS and 20% mannitol could rapidly decrease ICP.3% HS has a longer duration of action in reducing ICP than 20% mannitol.3% HS is more effective in stabilizing circulation and improving CPP than 20% mannitol.     

儿童噬血细胞综合征4例诊治分析

目的分析儿童噬血细胞综合征病例的临床表现、实验室检查特点和诊治经过,对儿童噬血细胞综合征诊治提供临床经验。方法对2017年6—12月广州市妇女儿童医疗中心收治的4例噬血细胞综合征患儿的临床资料进行分析。结果4例患儿均诊断为噬血细胞综合征,且均为继发性噬血细胞综合征,分别继发于T细胞淋巴瘤、朗格罕斯细胞组织细胞增生症、恙虫病和马尔尼菲青霉菌性脓毒血症。其中继发于T细胞淋巴瘤和朗格罕斯细胞组织细胞增生症的患儿早期被诊断为EBV相关噬血细胞综合征,最后经浅表淋巴结病理检查得以明确原发病因。而继发于恙虫病患儿经原发病治疗及对症支持治疗后很快得以康复。结论儿童噬血细胞综合征可由多种病因导致,应及时诊断并积极寻找原发病因,根据患儿病因及机体所处状态选择个体化的治疗策略。     

外源性五羟色胺大鼠肺出血模型及其与浓度关系

目的通过外源性五羟色胺(5-HT)气管滴入建立新生大鼠肺出血模型及其与浓度关系.方法模型制作:日龄4～5天Wistar二级大鼠50只,随机分为4组:生理盐水对照组(A组)及3种不同浓度外源性5-HT实验组(B、C、D组):经气管导管分别滴入生理盐水和不同浓度5-HT,4小时后处死,观察肺大体及组织病理改变,将肺出血程度分为5级:Ⅰ正常;Ⅱ肺水肿;Ⅲ点状肺出血;Ⅳ局灶性肺出血;Ⅴ弥漫性肺出血,选择出制作肺出血模型的最佳的浓度.结果不同浓度5-HT气管内滴入均能引起不同程度肺出血,但随着浓度增加,B、C、D三组间的肺出血程度无差异(p＞0.05),其中 D组死亡率30%,对照组及B组和C组均无死亡,死亡鼠肺为弥漫性出血.结论 5-HT可致大鼠肺出血,以1×10-5mol/ml浓度为宜,随着5-HT浓度增加,大鼠死亡率增加,但肺出血发生率无差异.     

间断静脉滴注3%高渗盐水与20%甘露醇治疗小儿急性脑水肿的疗效对比

Objective To compare the clinical efficacy of 3% hypertonic saline with 20% mannitol in the treatment of acute brain edema in children.Methods Twenty children with acute brain edema were randomly divided into hypertonic saline(HS) group and mannitol group.HS group and mannitol group were given 3% HS solution or 20% mannitol respectively.Main outcome measurements included intracranial pressure(ICP),mean arterial pressure(MAP),central venous pressure(CVP),cerebral perfusion pressure (CPP),serum electrolytes,plasma osmolality,renal function and urine volume.Results Both 3% HS and 20% mannitol were effective in reducing ICP(P ＜0.05).Therapeutic effect lasted(4.5±1.2) h in HS group and(3.2±1.5) h in mannitoi group.3% HS had a longer duration of action than marmitol(P＜0.05).At the time point of 2 hours after treatment,MAP and CPP of HS group increased more than those of mannitol group(P＜0.05).Conclusion Both 3% HS and 20% mannitol could rapidly decrease ICP.3% HS has a longer duration of action in reducing ICP than 20% mannitol.3% HS is more effective in stabilizing circulation and improving CPP than 20% mannitol.     

儿童急性淋巴细胞白血病合并阿萨希毛孢子菌感染致脓毒性休克一例

阿萨希毛孢子菌(Trichosporon asahii)为酵母样真菌的一种, 感染后的临床表现广泛[1]。在免疫功能正常的宿主, 表现为毛发、皮肤等浅表感染;在免疫抑制患者中, 会发展成侵袭性疾病, 可迅速导致休克、呼吸衰竭、肾功能衰竭以及弥散性血管内凝血, 从而使得治疗难度大, 病死率高[2]。本研究报道1例急性淋巴细胞白血病患儿合并阿萨希毛孢子菌致脓毒性休克的救治过程, 该患儿在诱导化疗过程中出现脓毒性休克, 血培养、外周血宏基因组二代测序(metagenomic next-generation sequencing, mNGS)和痰液mNGS确定病原为阿萨希毛孢子菌。     

小儿唇腭裂术后不同方法镇痛的临床观察

目的探讨不同镇痛方式在小儿唇腭裂手术后应用的效果。方法择期唇腭裂手术患儿40例。随机分为布洛芬混悬液口服组和对乙酰氨基酚栓塞肛组,每组20例。应用视图疼痛评分（LPS）观察术后镇痛效果。记录两组患儿术前、术后6、12、24h的HR、MAP、RR、SpO2等临床指标。观察并记录术后恶心呕吐、胃肠道出血、皮疹、水肿、血尿及呼吸抑制等不良反应。结果口服组和塞肛组术后镇痛效果无差异（P〉0.05）。两组患儿HR、MAP、RR、SpO2术后各时点之间、各时点与术前比较差异无统计学意义（P〉0.05）。塞肛组较口服组不良反应发生率少（13%vs33%）。结论小儿唇腭裂手术后,布洛芬混悬液口服和对乙酰氨基酚栓塞肛的给药方式都有满意的镇痛效果,但对乙酰氨基酚栓塞肛方式不良反应少,更安全和可行。     

镇静镇痛对先天性心脏病婴幼儿术后应激反应的影响

目的探讨小儿先天性心脏病体外循环下心内直视术后镇静镇痛对机体应激反应的影响。方法选择40例择期行先天性心脏病矫治术的患儿,随机分为镇痛组和对照组,各20例。镇痛组应用芬太尼0.5～2.0μg/(kg.h)持续静脉微量泵注入;对照组口服布洛芬5～8mg/(kg.次)。二组均用盐酸咪达唑仑0.01～0.20mg/(kg.h)静脉持续微量泵注入或0.05～0.10mg/(kg.次)间断静脉推注镇静。观察二组术后2、8、24、48h的镇静、镇痛效果,同时检测二组血皮质醇、生长激素、胰岛素和血糖的应激指标水平;观察二组恶心、呕吐、心率及血压下降、呼吸抑制等不良反应情况;评估镇静镇痛对患儿术后应激反应的影响。结果2组在术后2、8、24h行Ramsay、Comfort评分均有显著性差异(Pa<0.05)。镇痛组和对照组术后2、8、24、48h,血皮质醇、生长激素、胰岛素和血糖与术前比较均升高且差异显著(Pa<0.05)。镇痛组术后2、8、24、48h血皮质醇、生长激素、血糖水平均低于对照组。镇痛组8h血皮质醇、血糖,24h血皮质醇、生长激素和血糖,48h血糖水平与对照组相应时点指标比较均有显著性差异(Pa<0.05)。结论婴幼儿心内直视术后存在应激反应,应用芬太尼联合盐酸咪达唑仑持续静脉泵注的术后镇静镇痛可在一定程度上减轻婴幼儿心内直视术后的应激反应,且不良反应较小,有利于患儿顺利度过围术期。     

间断静脉滴注3%高渗盐水与20%甘露醇治疗小儿急性脑水肿的疗效对比

Objective To compare the clinical efficacy of 3% hypertonic saline with 20% mannitol in the treatment of acute brain edema in children.Methods Twenty children with acute brain edema were randomly divided into hypertonic saline(HS) group and mannitol group.HS group and mannitol group were given 3% HS solution or 20% mannitol respectively.Main outcome measurements included intracranial pressure(ICP),mean arterial pressure(MAP),central venous pressure(CVP),cerebral perfusion pressure (CPP),serum electrolytes,plasma osmolality,renal function and urine volume.Results Both 3% HS and 20% mannitol were effective in reducing ICP(P ＜0.05).Therapeutic effect lasted(4.5±1.2) h in HS group and(3.2±1.5) h in mannitoi group.3% HS had a longer duration of action than marmitol(P＜0.05).At the time point of 2 hours after treatment,MAP and CPP of HS group increased more than those of mannitol group(P＜0.05).Conclusion Both 3% HS and 20% mannitol could rapidly decrease ICP.3% HS has a longer duration of action in reducing ICP than 20% mannitol.3% HS is more effective in stabilizing circulation and improving CPP than 20% mannitol.