儿童重型渗出性多形红斑体液免疫状态及治疗

目的 探讨儿童重型渗出性多形红斑发病的体液免疫水平和治疗效果.方法 回顾性分析46例儿童重型渗出性多形红斑的f临床资料,对血清免疫球蛋白水平及静脉注射免疫球蛋白(IVIG)应用的效果进行分析.结果 IVIG大剂量患儿皮损开始减轻时间、皮损完全消退时问、热退时间、住院时间[分别为(2.30±0.47)、(6.80±0.71)、(4.30±0.47)、(7.00±0.76)d]均短于无应用IVIG患儿[分别为(5.50±1.95)、(13.20±1.05)、(9.70±0.67)、(15.10±0.99)d]、IVIG普通剂量患儿[分别为(2.70±1.23)、(8.90±1.07)、(6.4JD±0.54)、(11.10±0.69)d],差异有统计学意义(P＜0.01).结论 儿童重型渗出性多形红斑常伴有IgA水平降低,治疗上需去除病因,控制感染,早期应用糖皮质激素联合大剂量丙种球蛋白可以提高疗效.     

“基于问题的学习”教学方法在儿科临床见习教学中的应用

为提高医院教学管理水平,更好地与医学教育国际趋势接轨,我校儿科见习教学中应用了“基于问题的学习（PBIL）”床边教学法。与传统床边教学法相比,此法在提高学生学习自觉性、提高沟通技能、促进基础与临床知识相结合,建立批判性思维和循证医学观念等方面取得了更好效果。     

手足口病病原体流行特征分析及临床意义

Objective To investigate the epidemic characteristics of etiological agents in children with hand, foot and mouth disease (HFMD) and analyze the differences between the severe and mild cases with HFMD seen from 2008 to 2009 in the Children's Hospital Methods A total of 154 patients with HFMD were enrolled from May 2008 to September 2008 and from May 2009 to September 2009, including 28 severe HFMD patients. Data from 80 cases with suspected herpangina were collected as control. Enterovirus universal type, enterovirus type 71 (EV71) and coxsackie virus group A 16 (CA16) were detected by realtime RT-PCR respoctively. Results The positive rate of enterovirus universal type in the 154 patients with HFMD was 81.82% (126/154). EV71 positive rate in these 126 patients with enterovirus universal type infection was 57.14% (72/126). The positive rate of enterovirus universal type in the 80 cases with suspected herpangina was 68.75% (55/80). There was no EV71 infection in these 80 cases with suspected herpangina. EV71 infection was mainly popular in 2008. Both EV71 and CA16 were prevalent in 2009. The epidemic characteristics of enterovirus infection with HFMD between 2008 and 2009 had significant differences (X2 = 23.50, P = 0.000) ( P ＜ O.01 ). The epidemic characteristics of enterovirus infection between severe and mild HFMD patients also had significant differences (X2 = 29.85, P ＜ O. 01). There were 28 cases with severe HFMD, in whom the EV71 positive rate was 92.86% (26/28). EV71 positive rate in the mild HFMD was 36.51% (46/126) (X2 =29.22, P ＜0.01). There was no significant difference in the gender ( X2 = 0.135, P = 0.714) and virus load (t = 0.141, P = 0.889) between the mild and severe HFMD cases. But the age of mild and severe HFMD showed a significant difference ( t = 2.926, P =O.009). Patients who were less than 2 years of age had a proportion of 88.89% (8/9) with severe HFMD.The mean age of mild HFMD patients was 3.19 years. Conclusion HFMD showed different epidemic characteristics at different times of enterovirus infection. There was no significant difference in the gender and virus load between the mild and severe cases with HFMD. Children under 3 years of age with EV71 infection were at high risk for severe HFMD.     

小儿伴呼吸衰竭危重型甲型H1N1流感临床分析

本文通过探讨有呼吸衰竭的甲型H1N1流感患儿的临床特点及诊疗.得出结论 :良好呼吸支持是降低呼衰甲流患儿病死率的关键.     

儿童急性肝衰竭的重症监护和治疗进展

儿童急性肝功能衰竭（PALF）是一种危及生命的疾病,发病率低,死亡率高,需要在儿童重症监护病房进行监护及治疗。由于本病起病急,进展快,病因复杂,常常给临床医生带来一定的挑战。本病诊治难点在于明确病因及凝血功能障碍、肝性脑病等方面的管理。为防止病情迅速恶化,有条件情况下需提供紧急肝移植作为抢救治疗。本文着重就PALF的重症监护要点及凝血功能障碍和肝性脑病等方面的治疗进展作一评述。     

流感相关性脑病的研究进展

流感相关性脑病（IAE）是儿童急性脑病综合征的重要原因，它包括一系列罕见的临床-放射学综合征或急性脑病综合征。本病进展快、病死率高，因此需要提高优化性预防、早期识别和经验管理水平。     

儿童呼吸道病原的获取与解读

呼吸道感染是儿童常见的疾病,引起呼吸道感染的病原十分复杂,包括病毒、细菌、肺炎支原体、真菌等。呼吸道病原学的分析研究对儿童呼吸道感染的临床诊断及治疗具有重要意义。本文就儿童呼吸道病原体的获取和解读做一简单的介绍。     

机械通气病人气道管理进展

机械通气是一种依赖于人工气道为患者提供有效支持的技术,而正确有效的气道管理则是提高治疗疗效和降低死亡率的重要环节.因此在运用机械通气的同时必须确保人工气道的通畅,正确处理气道分泌物,防止气道损伤及误吸.