危重患儿血糖与胰岛素水平的临床分析

Objective To analyse the changes of blood glucose and insulin levels in children with critical illness,and to investigate the mechanism of hyperglycemia in critical illness.Methods Blood glucose and insulin levels were detected among 51 critically ill children hospitalized in our PICU from January to December,2007,which were compared with those of 15 healthy children.Results (1) All the patients had hyperglycemia after admission within 2Ah,septic shock patients showed the highest level with the maximum value of 27.30 mmol/L The dally mean blood glucose levels of the first 5 days after admission peaked on the admission day.(2) Within 24 h after admission,the blood insulin levels of patients with pulmonary infection,intracranial infection,septic shock and congenital heart disease were(17.65±16.85) mU/L,(13.45±7.33) mU/L,(16.24±12.41) mU/L,(6.75±3.22) mU/L respectively.The blood insulin levels of all the patients within the first 5 days after admission wrere higher than that of healthy children[(8.70±6.57) mU/L].According to blood glucose level on admission day,the patients were divided into normoglycemia and hyperglycemia group,and the blood insulin levels of the former and the letter were(5.44 ± 3.38) mU/L and (14.22±12.29) mU/L respectively.(3) The mean of PIM Ⅱscore of the patients averaged 12.96±16.82,and the mortality rate was 15.6%.The blood glucose level and the insulin level within 24 h after admission were(10.97±5.76) mmol/L and(49.46±90.35) mU/L in dead cases and(8.73±2.58) mmol/L and(11.91±11.24) mU/L for the survivals,and both the blood glucose level and insulin level had significant difference between the dead cases and survivals(P ＜0.05).(4) The scatter graphic analysis did not show significant linear relation between blood glucose and insulin,nor did it show significant linear relation between PIM Ⅱ and insulin levei,or blood glucose.Condusion Hyperglycemia and hyperinsulinemia are common in critical illness,which reflects indirectly the severity and prognosis of the disease.Hyperglycemia may be related to relative insulin insufficiency or insulin resistance;however,the definite relationship can not be confirmed until more reliable clinical data were available in the future.     

儿科ICU中急性呼吸窘迫综合征的临床回顾性分析

目的总结我院儿科重症监护室中(PICU)收治的急性呼吸窘迫综合征(ARDS)患儿的临床流行病学特点,以期提高ARDS的诊治水平。方法回顾性总结2002年6月～2004年2月我院PICU的14例确诊为ARDS患儿的特点。结果ARDS的发病率为2.3%。诱发ARDS的因素有体外循环、肺炎、脓毒症、休克等,其中以体外循环为最多见(占发病人数的42.9%)。确诊时急性肺损伤指数和PaO2FiO2分别为(3.2±0.6)和(86.5±23.8)。机械通气时最高吸气峰压和呼气终末正压分别是(33.8±8.4)cmH2O、(8.3±4.8)cmH2O。ARDS平均住院时间为18.1d,占PICU危重病人总住院时间的21.2%。因多器官功能衰竭、呼吸衰竭死亡6例(病死率42.9%),占PICU死亡总数的21.5%。结论积极去除高危因素预防ARDS、探讨ARDS更有效的治疗方法、降低病死率仍是我们今后工作的重点。     

胆碱酯酶对重症腺病毒肺炎患儿病情评估的价值

目的探讨血清胆碱酯酶(SCHE)对重症腺病毒肺炎病情的评估价值。方法收集2016年1月至2020年9月93例重症腺病毒肺炎患儿的临床资料。依据SCHE水平,患儿分为SCHE正常组(SCHE≥4 650 U/L,39例)和SCHE降低组(SCHE 4 650 U/L,54例),比较两组患儿临床特征以及实验室指标。结果 93例患儿中男60例、女33例,中位年龄14.0(9.5～24.5)月,平均体质量(10.5±3.9)kg。61例患儿出现脓毒性休克,中位SCHE水平为4 393.0(3 475.0～5 609.5)U/L。与SCHE正常组比较,SCHE降低组脓毒性休克发生率更高,序贯器官功能衰竭评分(SOFA)以及Murray肺损伤评分更高,丙氨酸氨基转移酶更高,而白蛋白水平更低,差异均有统计学意义(P0.05)。SCHE与白蛋白水平呈正相关(r=0.35,P=0.039)。以SCHE预测重症腺病毒肺炎患儿28天生存情况,曲线下面积(AUC)为0.707,最佳截断点3 475U/L,灵敏度81.3%,特异度61.5%。结论 SCHE可反映重症腺病毒肺炎患儿病情严重程度,且对预后具有一定的评估价值。     

193例危重病患儿血糖变化分析

目的：通过分析193例危重患儿的血糖变化,探讨应激性高血糖对病情进展和预后的影响。方法：对2002年1月-2007年12月在我院PICU住院的193例危重患儿的资料进行回顾性分析,运用t检验、x^2检验、方差分析和相关分析的统计学方法进行比较。结果：①193例危重病患儿中高血糖组有123例,高血糖的发生率为63．7％;血糖最小值为0．9mmol／L,最大值为30．5mmol／L,均值为8．2mmol／L;②123例高血糖患儿中,G3岁组87例（63．0％）,3～7岁组17例（60．7％）,7～10岁组9例（64．3％）,〉10岁组10例（76．9％）,各年龄组高血糖发生率接近（P〉0．05）,均高于正常血糖发生率。③肺炎组发生高血糖有46例,颅内感染组24例,腹泻组11例,心肌炎组2例,感染性休克组11例,非感染性疾病组11例,其他组5例,意外组13例,不同原发病的血糖均数：肺炎为（7．075±2．900）mmol／L,颅内感染（8．259±3．840）mmol／L,腹泻（8．545±5．600）mmol／L,心肌炎（9．052±9．100）mmol／L,感染性休克（11．154±8．000）mmol／L,非感染性疾病（7．358±3．930）mmol／L,其他为（7．246±2．940）mmol／L,意外（12．329±7．890）mmol／L,经方差分析,不同的原发病其血糖升高的水平存在差异（PG0．05）;④正常血糖患儿平均住院时问14．94d,平均住PICU时间9．5d,平均机械通气时间6．472d,而高血糖患儿的平均住院时间18．32d,平均住PICU时间12d,平均机械通气时间10．1901d,经t检验,高血糖组机械通气时间和住PICU时间长于正常血糖组（均P〈0．05）;⑤正常血糖组发生单个脏器损害的有31例,2个脏器损害的14例,3个以上脏器损害的18例,而高血糖组分别为27、41、55例（P〈0．05）,提示高血糖组脏器损害更严重;⑥高血糖组患儿住院7d内死亡人数31例,高于血糖正常组的8例（P〈0．05）,说明高血糖组患儿住院7d内的死亡率高于正常血糖组。结论：危重病患儿常出现高血糖,血糖升高与疾病严重程度有密切联系,血糖水平升高会导致预后不良,是导致死亡率增加和住院时间延长的重要因素,在治疗过程中应严格检测血糖的变化,尽可能将其控制在正常范围内。     

小儿急性肺损伤的呼吸功能与炎症的研究

目的:探讨儿科急性肺损伤(ALI)的病理生理和发病机制。方法:比较小儿ALI与呼吸功能正常儿的呼吸功能与炎症因子的变化。结果:(1)ALI患儿血气分析显示氧合或通气功能不同程度的恶化。氧合功能(PaO2/FiO2)下降有47例;指标PaCO2上升有27例。(2)机械通气所需气道峰压(PIP)和呼气末正压(PEEP)呈不同程度的上升,PIP上升26例,ALI患儿与呼吸功能正常儿为(28.62±6.38)cmH2O比(20.90±3.60)cmH2O,P<0.05;PEEP为(5.0±1.6)cmH2O比(2.0±0.6)cmH2O,P<0.01。(3)ALI患儿血清TNF-α较正常对照组升高,分别为(32.60±8.62)pg/mL和(8.54±3.04)pg/mL,P<0.001。结论:(1)ALI的肺病理生理变化特点除氧合功能下降或肺泡有效通气减少外,还有小气道阻力升高;(2)全身炎症反应可能参与小儿ALI。     

危重患儿血糖与胰岛素水平的临床分析

Objective To analyse the changes of blood glucose and insulin levels in children with critical illness,and to investigate the mechanism of hyperglycemia in critical illness.Methods Blood glucose and insulin levels were detected among 51 critically ill children hospitalized in our PICU from January to December,2007,which were compared with those of 15 healthy children.Results (1) All the patients had hyperglycemia after admission within 2Ah,septic shock patients showed the highest level with the maximum value of 27.30 mmol/L The dally mean blood glucose levels of the first 5 days after admission peaked on the admission day.(2) Within 24 h after admission,the blood insulin levels of patients with pulmonary infection,intracranial infection,septic shock and congenital heart disease were(17.65±16.85) mU/L,(13.45±7.33) mU/L,(16.24±12.41) mU/L,(6.75±3.22) mU/L respectively.The blood insulin levels of all the patients within the first 5 days after admission wrere higher than that of healthy children[(8.70±6.57) mU/L].According to blood glucose level on admission day,the patients were divided into normoglycemia and hyperglycemia group,and the blood insulin levels of the former and the letter were(5.44 ± 3.38) mU/L and (14.22±12.29) mU/L respectively.(3) The mean of PIM Ⅱscore of the patients averaged 12.96±16.82,and the mortality rate was 15.6%.The blood glucose level and the insulin level within 24 h after admission were(10.97±5.76) mmol/L and(49.46±90.35) mU/L in dead cases and(8.73±2.58) mmol/L and(11.91±11.24) mU/L for the survivals,and both the blood glucose level and insulin level had significant difference between the dead cases and survivals(P ＜0.05).(4) The scatter graphic analysis did not show significant linear relation between blood glucose and insulin,nor did it show significant linear relation between PIM Ⅱ and insulin levei,or blood glucose.Condusion Hyperglycemia and hyperinsulinemia are common in critical illness,which reflects indirectly the severity and prognosis of the disease.Hyperglycemia may be related to relative insulin insufficiency or insulin resistance;however,the definite relationship can not be confirmed until more reliable clinical data were available in the future.     

儿科早期全身炎症反应综合征的治疗

为探讨儿科全身炎症反应综合征 (ＳＩＲＳ)早期的干预治疗 ,采用化学发光酶免疫检测法 (ＣＬＥＩＡ)测定血清肿瘤坏死因子 (ＴＮＦ)和皮质醇的含量 ;用双侧ｔ检验比较实验组与对照组之间的计量数据。用多元线性回归求ＴＮＦ血清浓度与ＳＩＲＳ四项指标相关关系。配对ｔ检验比较干预措施前后ＳＩＲＳ早期的四项指标变化。结果 :1.实验组与对照组的血清ＴＮＦ、皮质醇比较 (前者 12 .6 0± 10 .73ｐｇ/ｍｌ比 8.5 4± 3.0 4ｐｇ/ｍｌ,Ｐ <0 .0 5 ;后者 5 99.73± 32 9.2 8ｎｍｏｌ/ｍｌ比 2 1.6 6±172 .96ｎｍｏｌ/ｍｌ,Ｐ<0 .0 0 1) ,均具有…     

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。     

危重患儿血糖与胰岛素水平的临床分析

Objective To analyse the changes of blood glucose and insulin levels in children with critical illness,and to investigate the mechanism of hyperglycemia in critical illness.Methods Blood glucose and insulin levels were detected among 51 critically ill children hospitalized in our PICU from January to December,2007,which were compared with those of 15 healthy children.Results (1) All the patients had hyperglycemia after admission within 2Ah,septic shock patients showed the highest level with the maximum value of 27.30 mmol/L The dally mean blood glucose levels of the first 5 days after admission peaked on the admission day.(2) Within 24 h after admission,the blood insulin levels of patients with pulmonary infection,intracranial infection,septic shock and congenital heart disease were(17.65±16.85) mU/L,(13.45±7.33) mU/L,(16.24±12.41) mU/L,(6.75±3.22) mU/L respectively.The blood insulin levels of all the patients within the first 5 days after admission wrere higher than that of healthy children[(8.70±6.57) mU/L].According to blood glucose level on admission day,the patients were divided into normoglycemia and hyperglycemia group,and the blood insulin levels of the former and the letter were(5.44 ± 3.38) mU/L and (14.22±12.29) mU/L respectively.(3) The mean of PIM Ⅱscore of the patients averaged 12.96±16.82,and the mortality rate was 15.6%.The blood glucose level and the insulin level within 24 h after admission were(10.97±5.76) mmol/L and(49.46±90.35) mU/L in dead cases and(8.73±2.58) mmol/L and(11.91±11.24) mU/L for the survivals,and both the blood glucose level and insulin level had significant difference between the dead cases and survivals(P ＜0.05).(4) The scatter graphic analysis did not show significant linear relation between blood glucose and insulin,nor did it show significant linear relation between PIM Ⅱ and insulin levei,or blood glucose.Condusion Hyperglycemia and hyperinsulinemia are common in critical illness,which reflects indirectly the severity and prognosis of the disease.Hyperglycemia may be related to relative insulin insufficiency or insulin resistance;however,the definite relationship can not be confirmed until more reliable clinical data were available in the future.     

放血法治疗带状疱疹疼痛54例临床观察

近年来，笔者采用放血法治疗带状疱疹疼痛54例，并设针刺法进行疗效比较观察，现报告如下。