83例6个月以下婴儿室间隔缺损的外科治疗

目的 总结外科手术治疗小婴儿期室间隔缺损(VSD)的临床经验.方法 对2000-2005年83例＜6月龄VSD患儿,年龄12 d至6(4.3±1.2)个月,体重3～6.5(5.1±0.8)kg.膜周部VSD 74例,干下型VSD 8例,膜周部并肌部VSD1例.术前中、重度肺动脉高压69例(83.1%).所有患儿均在浅低温体外循环下手术.结果 全组手术死亡4例,手术病死率为4.8%.术后主要并发症为肺动脉高压危象、肺部感染和心律失常.结论 随着麻醉、体外循环、手术技术和围术期监护处理措施的进步,在小婴儿期施行VSD的外科手术已成为安全的治疗方式.术后对肺高压的处理是手术成功的关键.     

生理盐水肠道冲洗辅助治疗真菌性肠炎效果观察

目的 探讨生理盐水肠道冲洗辅助治疗真菌性肠炎的疗效。方法 将72例真菌性肠炎患者随机分为观察组和对照组各36例，对照组行常规治疗，观察组在此基础上予以温生理盐水（38～41℃）500～7000ml持续肠道冲洗，3～6h／次，1次／d，治疗1～3次。结果 观察组治疗后肠道pH值显著低于治疗前及对照组治疗后（均P〈0．01），治愈率显著高于对照组（P〈0．01）。结论 对真菌性肠炎腹泻患者在常规治疗的基础上，辅以温生理盐水肠道冲洗可显著改善肠道环境，提高治愈率。     

小儿全合一肠外营养液的配制和临床应用

目的 介绍一种新生儿、婴儿和儿童兼用的全合一肠外营养液。 方法 将葡萄糖、电解质、7%凡命 (17-氨基酸 )、20%脂肪乳剂和维生素等配制成可兼用于新生儿、婴儿和儿童的全合一肠外营养液 ,脂肪供热占非蛋白热量的45% ,总热量247kJ(60kcal)/100ml,用量按小儿液体生理日需量公式计算。研究其理化性状和稳定性 ,并对新生儿、婴儿和儿童各10例临床应用1周 ,观察副作用和血浆蛋白变化。结果 该全合一液在22℃室温下放置24h无理化性状变化。临床应用并发轻度静脉炎2例 (2/30) ,血甘油三酯一过性增高1例 (1/30) ,无其他代谢并发症。血浆前白蛋白明显增高 (P<0.05)。结论 本配方全合一肠外营养液计算简便 ,使用安全 ,可用于各年龄组小儿短期全肠外或部分肠外营养支持     

High-frequency ventilation (HFV) in hyaline membrane disease —a preliminary report

Eight premature babies affected by hyaline membrane disease and needing mechanical respiratory support were ventilated by means of a VDR 1 (Bird Space Technology) respirator at 10 Hz during a mean time of 51 h. Before HFV 7 infants had been on conventional mechanical ventilation (CMV) and one on nasal CPAP. The values of mean airway pressure (MAP) and oxygenation index (PaO₂/FIO₂) on CMV and HFV were (mean and range): 1. CMV: MAP 15 (4–29) mm Hg, ox. index 15.47 (5.07–23.19) kPa; 2. HFV after 1 h: MAP 15 (10–19) mm Hg, ox. index 24.13 (9.07–46.12) kPa. Improved oxygenation allowed rapid reduction of FIO₂ in the following hours. Only 3 infants were weaned directly from VDR 1, 5 were switched back to CMV mainly because of technical failures of the respirator. The change from HFV to CMV was associated with a fall of PaO₂/FIO₂ from 35.99 (15.86–74.52) to 22.39 (7.33–31.46) kPa. The mean time of artificial ventilation (CMV+HFV) was 121 h (range 46–166). Except for 1 pneumothorax no medical complications were seen during HFV, and all patients survived. Despite impressive improvements in oxygenation it is cautioned against the use of the VDR 1 because of the high incidence of technical problems.     

Aggressive therapy of infants with renal failure

Nine infants, who presented with renal failure within the first 3 months of life, were treated with continuous ambulatory peritoneal dialysis (CAPD). Seven infants survived to an age of 12–15 months, when they received transplants. Two patients died while on CAPD. Six infants are alive with a functioning renal allograft, at an average age of 35.5 months and an average of 22 months post-transplant. Neurological development is normal in four of the six infants tested. The mean current height of the six transplant recipients is just below 2 SD from the mean.     

腹泻灵外敷治疗急性肠炎的临床观察和实验研究

以丁香、肉桂、细辛等组成的腹泻灵外敷脐部(神阙穴)治疗急性肠炎106例,痊愈率为91.5%。并随机设立痢特灵、庆大霉素、山莨菪碱西药对照组100例,痊愈率为88%。两组相比,腹泻灵组对各项观察指标的改善情况均明显优于西药组(p<0.01)。动物实验证明,腹泻灵内用无急性毒性反应及过敏反应,长期外用无蓄积性毒性作用,对球结膜与完好皮肤及破损皮肤均无刺激作用。     

HM增菌液对沙门氏菌属与志贺氏菌属增菌效果的观察

报道HM增菌液对150例临床诊断为肠炎患者大便标本的增菌效果,并与革兰氏阴性杆菌增菌培养液(GN增菌液)和亚硒酸钠增菌液(SF增菌液)进行对比观察。结果显示HM增菌液对沙门氏菌属与志贺氏菌属增菌效果均较好,检出率明显高于GN和SF增萌液(p<0.01和p<0.05),有较好的实用价值。     

Imaging of constipation in infants and children

The aims of this review article are to present epidemiology, important definitions, clinical considerations, and etiologic and pathogenetic aspects of constipation in infants and children. Anatomy, physiology, and pathophysiology of the the anorectum are described. Special attention is given to the indications for diagnostic imaging, imaging techniques, and imaging findings with different causes of constipation. Other diagnostic modalities, such as anorectal manometry, electromyography, and biopsy techniques are briefly discussed. The central question as to whether diagnostic imaging is needed for the diagnostic workup of infants and children suffering from constipation can be answered affirmatively. Especially the combination of barium enema or defecography and anorectal manometry allows definition of those infants and children who do not need biopsy and surgery for Hirschsprung's disease. The special role of defecography in this context is underlined. Received 16 May 1997; Revision received 5 August 1997; Accepted 6 August 1997     

Measurement of post-operative pain and narcotic administration in infants using a new clinical scoring system

We developed a clinical neurologic and behavioral scoring system composed of 10 items to measure the post-operative pain levels in infants: (1) sleep during preceeding hour, (2) facial expression of pain, (3) quality of cry, (4) spontaneous motor activity, (5) Spontaneous excitability, (6) flexion of fingers and toes, (7) sucking, (8) global evaluation of tone, (9) consolability and (10) sociability. Using this system, a group of infants ranging from one to seven months in age and undergoing minor surgical procedures was studied. The infants were randomly assigned to two groups: Group I received Fentanyl intravenously (3 g/kg) prior to surgery, and Group II received a placebo. The infants then were studied post-operatively in the recovery room at 30, 60, 90 and 120 min intervals. Over the entire post-operative observation period, 54% of the infants in Group I had satisfactory analgesia compared to 18% in Group II. There were no significant differences in Group I and Group II in oxygenation, carbon dioxide elimination, blood pressure, heart rate or temperature.     

Longitudinal Study of Infant Sleep: Results of 14 Subjects Studied at Monthly Intervals

The sleep of 14 normal infants was studied every month throughout the first year. A computer program incorporated an analysis of multiple variables from polygraphic data as recommended by a recently standardized new born scoring manual. Under our recording conditions, quiet sleep increased during the first 3 months but indeterminate sleep did not decline over the year as expected. This finding is incompatible with the notion that indeterminate sleep reflects immaturity or “undifferentiation” in sleep organization.