目的 调查重型β地中海贫血患儿照顾者的负担现状，并分析其影响因素，为医护人员制定干预方案提供依据。方法 采用便利抽样法，于2024年1月—12月选取华南地区5家医院就诊的重型β地中海贫血患儿的主要照顾者作为调查对象，采用一般资料调查表、Zarit照顾者负担量表、中文简化版家庭弹性量表和社会支持评定量表进行调查，并采用单因素分析、相关性分析及多重线性回归探究其影响因素。结果 共发放问卷242份，回收232份，回收率为95.87%。重型β地中海贫血患儿主要照顾者照顾负担的总体平均得分为（36.67±18.63）分。多重线性回归分析结果显示，患儿输血频率、输血相关性皮肤过敏和社会支持是患儿照顾负担的影响因素（P＜0.001），可解释总变异的23.9%。结论 重型β地中海贫血患儿照顾者负担程度以中重度为主。患儿曾出现输血不良反应、输血频率更高，其照顾者负担更重；而主要照顾者具有良好的社会支持水平有助于降低其照顾者负担。医护人员应针对以上因素制定干预方案，以减轻重型β地中海贫血患儿照顾者负担水平。

      Objective To investigate the current burden in caregivers of children with β thalassemia major and analyze its influencing factors，so as to provide a basis for medical staff to formulate intervention plans．Methods By using the convenience sampling method，primary caregivers of children with β thalassemia major from five hospitals in South China from January to December 2024 were selected as the survey subjects．The general information questionnaire，Zarit Caregiver Burden Scale，Simplified Chinese Family Resilience Scale and Social Support Rating Scale were used for the survey．And univariate analysis，correlation analysis and multiple linear regression were adopted to explore its influencing factors．Results A total of 242 questionnaires were distributed and 232 were retrieved，with a recovery rate of 95.87%．The overall average score of care burden for primary caregivers of children with β thalassemia major was（36.67±18.63）．The results of multiple linear regression analysis showed that the frequency of blood transfusion in children，transfusion-related skin allergy and social support were the influencing factors of the care burden（P＜0.001），which could explain 23.9% of the total variation．Conclusions The burden level in caregivers of children with β thalassemia major is mainly moderate to severe．The children with adverse reactions to blood transfusion and higher frequency of blood transfusion impose a heavier burden on its caregivers．The primary caregivers who have good social support can help reduce the burden．Medical staff should formulate intervention plans based on the above factors to reduce the burden level of caregivers of children with β thalassemia major．

    目的   探讨放血疗法对小儿发热的疗效。方法   检索包括中国生物医学文献数据库（CBM）、CNKI、万方、维普、PubMed、Embase、Web of Science、Cochrane Library等8个中、英文数据库自建库至2025年5月所发表的放血疗法治疗小儿发热的随机对照试验研究（RCT），2名研究人员根据Cochrane系统评价手册（5.1.0版）推荐的偏倚风险评估表对所纳入文献进行质量评估，采用RevMan 5.4软件对纳入文献质量进行系统分析。结果  纳入19项RCT，共2 224例患儿，其中观察组1 118例、对照组1 106例。放血疗法能够提高小儿发热的临床疗效［OR=4.18，95% CI（3.00，5.38），P＜0.001］；降低患儿24 h内高热复发率［OR=0.12，95% CI（0.05，0.34），P＜0.001］；缩短平均退热时间［MD=-1.78，95% CI（-2.56，-1.00），P＜0.001］。结论  放血疗法能够提高小儿发热的临床疗效，降低复发率，缩短退热时间，可作为小儿发热的辅助治疗方法。

       Objective  To explore the efficacy of bloodletting therapy treatment on pediatric fever by meta-analysis．Methods  The randomised controlled trials（RCTs）examining bloodletting therapy for paediatric fever were  retrieved from eight Chinese and English databases—China Biomedical Literature Database（CBM），CNKI，Wanfang，VIP，PubMed，Embase，Web of Science，and Cochrane Library—covering publications from the establishment of each database up to May 2025．Two researchers assessed study quality using the risk of bias assessment tool recommended in the Cochrane Handbook for Systematic Reviews（version 5.1.0）．RevMan 5.4 software was employed for systematic analysis of included studies．Results  Nineteen RCTs involving 2 224 patients were ultimately included，comprising 1 118 patients in the observation group and 1 106 in the control group．Results indicated that bloodletting therapy significantly improved clinical efficacy in paediatric fever（OR=4.18，95% CI［3.00，5.38］，P＜0.001），reduced the recurrence rate of high fever within 24 hours（OR=0.12，95% CI［0.05，0.34］，P＜0.001），and shortened the average time to fever resolution（MD=-1.78，95% CI［-2.56，-1.00］，P＜0.001）．Conclusions  Bloodletting therapy can improve the clinical efficacy of pediatric fever，reduce the recurrence rate and shorten the time of fever reduction，and can be used as an adjunctive treatment for pediatric fever．

       目的   研究小儿面颈部皮下良性肿物的影像学特点及经头皮区域或腋窝软组织腔镜微创治疗小儿头颈部皮下良性肿物的可行性、临床疗效及安全性。方法   回顾分析2024年1月—2024年8月在广州医科大学附属妇女儿童医疗中心治疗的24例小儿面颈部皮下肿物的病例，患儿年龄为1~5岁，平均年龄1.5岁，其中男15例、女9例；分别为甲状舌管囊肿10例，鳃裂瘘5例，前额皮下肿物5例，颈淋巴结增大3例，颈部皮下肿物1例。分析其影像学特点（超声及CT检查），制定了经头皮区域软组织腔镜微创治疗前额皮下肿物和颈淋巴结活组织检查（活检）或经腋窝软组织腔镜微创治疗甲状舌管囊肿和鳃裂瘘。结果  24例小儿面颈部皮下良性肿物的共同影像学特点是位于浅层，边界清晰，圆形或者椭圆形，对周围组织轻度压迫，无侵犯。所有病例均顺利完成微创手术，出血少，无手术并发症，术后恢复好。术后病理检查均提示良性肿物，面部及颈部均无手术瘢痕。结论   小儿面颈部皮下良性肿瘤的影像学特点是位于浅层，边界清晰。经头皮区域和腋窝软组织腔镜微创治疗小儿面颈部肿物效果确切、安全性高、美观。

       Objective  To  study the imaging characteristics of  subcutaneous  benign tumors in the face and  neck of children，as well as the feasibility，efficacy，and safety of minimally invasive treatment of subcutaneous benign tumors in the head and neck of children through hair area or axillary soft tissue endoscopy．Methods  A  retrospective analysis was conducted on 24 cases of subcutaneous tumors in the face and neck of children treated in our hospital from January to August 2024．Age  range was 1-5 years old，with an average of 1.5 years old．There were 15 boys and 9 girls．There were 10 cases of thyroglossal duct cyst，5 cases of branchial fistula，5 cases of subcutaneous mass on the forehead，3 cases of enlarged cervical lymph nodes，and 1 case of subcutaneous mass on the neck．Imaging characteristics（ultrasound and CT examination）and minimally invasive treatment effects were analyzed，to determine the procedure of minimally invasive treatment of subcutaneous tumors in the forehead and cervical lymph node biopsy by soft tissue endoscopy in the scalp area，and minimally invasive treatment of thyroglossal duct cysts and branchial fistulas through axillary by soft tissue endoscopy．Results  The imaging characteristics of subcutaneous benign tumors in children’s face and neck were located in the shallow layer，with clear boundaries，round or oval shapes，mild compression of surrounding tissues，and no invasion．All cases successfully underwent minimally invasive surgery with minimal bleeding，no  surgical complications，and good postoperative recovery．Postoperative pathological examination confirmed as benign masses．There were no surgical scars on the face and neck．Conclusions  The imaging characteristics of subcutaneous benign tumors in children’s face and neck are located in the shallow layer with clear boundaries．Minimally invasive endoscopic treatment of pediatric face and neck tumors through the scalp area and axillary soft tissue is effective，safe，and aesthetically pleasing．

目的 研究基于儿童早期预警评分（PEWS）的分级干预模式促进重症肺炎患儿康复进程及对呼吸功能的影响。方法 回顾性分析2021年4月—2023年4月我院收治的100例重症肺炎患儿临床资料。将其按照干预方式的差异分为研究组（n=50）及对照组（n=50）。对照组选用常规干预,研究组则于对照组基础上增加基于PEWS的分级干预。对比两组康复进程（相关指标涵盖症状持续时长及住院天数）、呼吸功能（涵盖通气流速、每分钟最大通气量、肺活量、用力肺活量及深吸气量）、并发症发生情况（涵盖呼吸机相关性肺炎、肺大疱及胸膜炎）、患儿家属满意度。结果 研究组各项症状持续时长及住院天数均短于对照组（均P<0.05）。研究组各项呼吸功能指标水平均高于对照组（均P<0.05）。两组各项并发症发生率对比差异无统计学意义（P>0.05）。研究组患儿家属满意度高于对照组（96.00% vs 82.00%,P<0.05）。结论 基于PEWS的分级干预模式促进重症肺炎患儿康复进程的效果较佳,且能改善呼吸功能,提高患儿家属满意度。

Objective To study the effect of graded intervention mode based on Pediatric Early Warning Score（PEWS）on the recovery process and respiratory function of children with severe pneumonia．Methods The clinical data of 100 children with severe pneumonia treated in our hospital from April 2021 to April 2023 were retrospectively analyzed．Those children were divided into study group（n=50）and control group（n=50）according to the difference of intervention methods．Conventional intervention was used in the two groups,and PEWS-based graded intervention was added to the study group．The two groups were compared with each other in terms of recovery process（including duration of symptoms and length of stay）,respiratory function（including ventilation velocity,maximum volume per minute,vital capacity,forced vital capacity and deep inspiratory capacity）,complications（including ventilators associated pneumonia,bullosa and pleurisy）,and family member satisfaction．Results The duration of symptoms and hospitalization days in the study group were shorter than those in the control group（all P<0.05）．The levels of respiratory function indexes in study group were higher than those in control group（all P<0.05）．There was no significant difference in the incidence of complications between the two groups（P>0.05）．The satisfaction of family member in the study group was higher than that in the control group（96.00% vs 82.00%）（P<0.05）．Conclusions The PEWS based graded intervention model has a good effect on promoting the rehabilitation process of children with severe pneumonia,and can improve respiratory function,and increase the satisfaction of family member of children with severe pneumonia．

目的 探讨以多媒体教学法、标准患者教学法、案例教学法、手术观摩教学法等多种教学方法相结合的多样化教学,在小儿外科临床见习的教学实施效果评价。方法 以2022年、2023年参加小儿外科临床见习的儿科学生为研究对象,随机分为试验组和对照组,每组分别45人。试验组采用多样化教学进行临床带教,对照组采用传统教学法进行带教。对比两组儿科学生的理论知识分数、技能操作分数、临床知识评分及总成绩,师生满意度及家属对儿科学生的满意度。结果 试验组的理论知识分数（85.69±4.59）、技能操作分数（86.36±4.35）、临床知识评分（87.71±4.01）及总成绩（86.59±2.85）均高于对照组,差异有统计学意义（P<0.05）。在满意度评价中,试验组在教学方式、学习兴趣、自我评价、团队协作能力及对小儿外科的专业认可度分别为（4.84±0.37）（4.87±0.34）（4.89±0.32）（4.84±0.37）（4.91±0.29）,均高于对照组,差异有统计学意义（P<0.01）;而试验组及对照组对带教教师的理论知识水平分别为（4.80±0.46）（4.64±0.53）,带教教师的积极性评分分别为（4.89±0.32、4.75±0.43）,比较差异无统计学意义（P>0.05）;带教教师在试验组专业知识掌握情况、临床实践操作能力、学生学习积极性及团队协作能力评分分别为（4.82±0.39）（4.87±0.34）（4.91±0.29）（4.93±0.25）,均高于对照组,差异有统计学意义（P>0.05）。患儿家属对试验组在医师尊重孩子、医师非常关注孩子及医师鼓励孩子提问并积极解决问题方面评分分别为（4.91±0.29）（4.93±0.25）（4.91±0.29）,均高于对照组,差异有统计学意义（P<0.05）。结论 在小儿外科临床见习采用多样化教学不仅能提高儿科学生的理论、技能、临床知识水平,还能提高师生满意度及儿科学生对小儿外科的专业认可度。

Objective To assess the impact of multimedia teaching methods,standard patient teaching methods,case teaching methods,and surgical observation teaching methods on clinical probation in pediatric surgery．Methods Pediatric students participating in clinical probation in pediatric surgery in 2022 and 2023 were randomly assigned to either the experimental group or the control group,with 45 students in each group．The experimental group received diversified teaching methods,while the control group received traditional teaching methods．A comparison was made between the two groups regarding theoretical knowledge scores,skill operation scores,clinical knowledge scores,total scores,teacher-student satisfaction levels,and family satisfaction levels of pediatric students．Results The experimental group demonstrated significantly higher theoretical knowledge scores（P<0.05）,skill operation scores（P<0.05）,clinical knowledge scores（P<0.05）,and total scores compared to the control group．In terms of satisfaction evaluation criteria such as teaching style,learning interest,self-evaluation ability,teamwork skills and professional recognition of pediatric surgery（P<0.01）,the experimental group showed significantly higher levels than the control group．There was no significant difference between the two groups regarding teachers’ theoretical knowledge level and enthusiasm score（P>0.05）．However,the teachers in the experimental group scored significantly higher than those in the control group when it came to professional knowledge mastery,clinical practice ability,student learning enthusiasm,and teamwork skills（P>0.05）．Conclusions Implementing diversified teaching approaches during pediatric surgery clinical probation not only enhances theoretical understanding,skills development,and clinical expertise among pediatric students,but also improves overall satisfaction levels for both teachers and students as well as enhances professional recognition of pediatric surgery students．

目的 探讨高频超声对小儿梅克尔憩室所致肠梗阻的诊断价值。方法 选取广州市妇女儿童医疗中心2018年1月—2023年12月经手术证实的由梅克尔憩室引起的肠梗阻患儿41例作为研究对象,回顾性分析患儿临床资料及超声表现,并与术中所见和病理结果进行对照。结果 41例患儿,发病平均年龄为（3.97±3.69）岁,其中男32例、女9例。术前超声诊断肠梗阻38例,诊断符合率为92.7%;诊断梅克尔憩室所致肠梗阻9例,诊断符合率为21.9%。术中诊断梅克尔憩室索带卡压肠管24例,腹内疝8例,肠扭转1例;肠套叠10例;梅克尔憩室炎症、粘连6例,粘连穿孔1例;憩室内异物并穿孔1例。结论 高频超声对小儿肠梗阻有重要的诊断价值,仔细探查可以明显提高梅克尔憩室所致肠梗阻的临床诊断率,为临床尽早手术提供重要依据。

Objective To investigate the diagnostic value of high frequency ultrasound for intestinal obstruction caused by Meckel's diverticulum in children．Methods From January 2018 to December 2023,41 children with intestinal obstruction caused by Meckel's diverticulum were selected as the study objects．The clinical data and ultrasound images of the children were analyzed retrospectively,and compared with the intraoperative and pathological results．Results In 41 patients,the average age of onset was（3.97±3.69）years ,including 32 males and 9 females．Preoperative ultrasonic diagnosis of intestinal obstruction in 38 cases,diagnosis coincidence rate was 92.7%．Intestinal obstruction caused by Meckel's diverticulum was diagnosed in 9 cases,the diagnosis coincidence rate was 21.9%．During the operation,24 cases of Meckel's diverticulum intestinal compression were diagnosed,8 cases of abdominal hernia,1 case of intestinal torsion,and intussusception of 10 cases．Meckel's diverticulum had inflammation and adhesion in 6 cases and adhesion perforation in 1 case．A case of foreign body in diverticulum with perforation．Conclusions High-frequency ultrasound has an important diagnostic value for intestinal obstruction in children．Careful exploration can significantly improve the clinical diagnosis rate of intestinal obstruction caused by Meckel's diverticulum,and provide an important basis for early clinical operation．

目的 了解广州市属医院儿科医生职业倦怠的现状及其社会支持的相关性,对儿科医生的职业倦怠干预提供参考依据。方法 采用职业倦怠量表和社会支持评定量表对广州市属医院儿科医生进行方便抽样调查,并运用Excel和SPSS 25.0对调查结果进行统计描述、方差分析和相关分析。结果 广州市属医院370名儿科医生中共有272人(73.51%)出现不同程度的职业倦怠,中度倦怠者居多,为117人(31.62%)。职业倦怠三个维度中情感耗竭维度得分最高,为(21.64±7.17)分;社会支持总分为(37.68±8.24)分,客观支持、主观支持、支持利用维度得分分别为(7.71±3.23)、(22.53±5.03)、(7.44±1.92)分。其中社会支持处于水平低者居多,为227人(61.35%)。职业倦怠各维度和社会支持各维度两两之间均呈负相关。结论 广州市属医院儿科医生存在较严重的职业倦怠状况,社会支持状况大多处于低水平,尤其客观支持状况较差。社会支持水平越高,职业倦怠程度越轻,提示在缓解职业倦怠时应当充分考虑社会支持对其职业倦怠的影响作用。

Objective By understanding the current situation of job burnout of pediatricians in Guangzhou municipal hospitals and the correlation of social support, to provide reference basis for pediatricians to intervene in job burnout. Methods The Burnout Inventory and the Social Support Rating Scale were used for pediatricians in Guangzhou municipal hospitals, and Excel and SPSS 25.0 were used to conduct statistical description, variance analysis and correlation analysis of the survey results. Results There were 272 pediatricians (73.51%) showed different degrees of job burnout of the 370 pediatricians in Guangzhou municipal hospitals, among which 117 pediatricians (31.62%) showed moderate burnout. Among the three dimensions of job burnout, the highest score was emotional exhaustion (21.64±7.17). The total score of social support was (37.68±8.24), and the dimensions of the objective support, the subjective support and the utilization of support were (7.71±3.23), (22.53±5.03), (7.44±1.92), respectively. Among them 227 (61.35%) had low level of social support. Additionally, there was a negative correlation between each dimension of job burnout and each dimension of social support. Conclusion Pediatricians in Guangzhou municipal hospitals have more serious job burnout, and most of them have low level of social support, especially poor objective support. The higher level of social support will have the lower degree of job burnout. It suggests that the impact of social support on job burnout should be fully considered for alleviating job burnout.

目的 对比小儿肠套叠的开腹手术与腹腔镜手术治疗的临床价值。方法 选定本院2017年1月—2020年1月收治的50例肠套叠患者,以双盲随机抽样法分组(每组样本容量25例),对照组采纳开腹手术治疗,观察组采纳腹腔镜手术治疗,对比两组手术指标、术中合并疾病探查率、并发症发生率、复套率。结果 观察组手术时间、下床活动时间、胃肠功能恢复时间及住院时间均比对照组短,观察组术中出血量比对照组低,观察组术中合并疾病探查率(68.00%)比对照组(40.00%)高,观察组并发症发生率(0)比对照组(32.00%)低,差异均有统计学意义(P＜0.05)。观察组复套率(0)与对照组(4.00%)比较,P>0.05。结论 腹腔镜手术治疗小儿肠套叠,创伤性较小、住院时间较短、术后炎症反应较轻、并发症发生率较低,且术中对合并疾病的探查率较高,值得借鉴。

Objective To compare the clinical value of laparotomy and laparoscopy in the treatment of intussusception in children. Methods 50 cases of intussusception patients in our hospital from January 2017 to January 2020 were selected and divided into two groups by double-blind random sampling method (25 cases in each group). The control group was treated with open surgery, and the observation group was treated with laparoscopic surgery. The operation indexes, intraoperative detection rate of combined diseases, incidence of complications and recurrence rate were compared between the two groups. Results The operation time, ambulation time, gastrointestinal function recovery time and hospitalization time in the observation group were shorter than those in the control group. The intraoperative blood loss in the observation group was lower than that in the control group. The detection rate of intraoperative diseases in the control group (68.00%) was higher than that in the observation group (40.00%), and the incidence of complications in the observation group (0) was lower than that in the control group 32.00%. The difference was statistically significant (P<0.05). The repetition rate of observation group (0) was higher than that of control group (4.00%), P>0.05. Conclusion Laparoscopic surgery in the treatment of pediatric intussusception has the advantages of less trauma, shorter hospitalization time, less postoperative inflammatory reaction, lower incidence of complications, and higher exploration rate of complications during operation, which is worthy of reference.

目的 分析我院2011—2015年我院儿科住院患者下呼吸道病原菌分布及其耐药性。方法 采用全自动生化鉴定仪对痰标本分离株进行鉴定,用全自动微生物药敏系统和纸片扩散法对病原菌的耐药性进行检测,并用头孢硝噻吩纸片法对β-内酰胺酶进行检测。结果 2011—2015年共分离得到下呼吸道病原菌518株,包括肺炎链球菌(21.62%)、金黄色葡萄球菌(16.99%)、流感嗜血杆菌(14.48%)、肺炎克雷伯菌(11.97%)、大肠埃希菌(8.11%)、卡他莫拉菌(5.41%)、鲍曼不动杆菌(3.86%)和铜绿假单胞菌(3.86%)等。药敏结果显示,肺炎链球菌对克林霉素(90.18%)、红霉素(92.86%)和复方新诺明(87.50%)的耐药率较高,金黄色葡萄球菌则对青霉素G(90.91%)和红霉素(68.18%)有较强耐药性,未发现对万古霉素或利奈唑胺耐药的革兰阳性球菌。流感嗜血杆菌对氨苄西林耐药率为32%,与其β-内酰胺酶阳性率较一致,肺炎克雷伯菌和大肠埃希菌对头孢类药物(17.33%~45.33%)和喹诺酮类药物(34.67%~50.67%)耐药性较高,并发现1株碳青霉烯耐药的肺炎克雷伯菌。结论 本院下呼吸道感染病原菌谱较广,主要包括多种革兰阳性球菌和革兰阴性杆菌,并对多种抗菌药物表现出较强耐药性,临床应注重合理应用相关抗生素,严格防控病原菌的医院感染及传播。

Objective To analyze the antimicrobial resistance and the profile of pathogens from lower respiratory tract infections in pediatric in patients. Methods Sputum bacterial isolates were identified by an automated biochemical identification system. Antimicrobial resistance was detected by an automated drug susceptibility detection system and the disc diffusion method. The β-lactamases was tested by the nitrocefin disc detection method. Results Five hundred and eighteen bacterial pathogens were isolated from sputum samples during 2011-2015, including streptococcus pneumoniae(21.62%), staphylococcus aureus(16.99%), haemophillus influenzae(14.48%), klebsiella pneumoniae(11.97%), escherichia coli(8.11%), moraxelle catarrhalis(3.8%), acinetobacter baumanii(3.86%) and pseudomonas aeruginosa(3.86%). High resistant rates were detected for S. pneumoniae to clindamycin(90.18%), erythromycin(92.86%) and sulfamethoxazole (85.50%), while S. aureus was highly resistant to penicillin G(90.91%) and erythromycin(68.18%). Resistance to vancomycin and linezolid was not detected for gram positive cocci. The resistant rate to ampicillin was 32% for H. influenzae, which was in concordance with the production of β-lactamases. Relatively high resistance was detected for K. pneumoniae and E. coli to cephalosporins and quinolones. A carbapenem-resistant K. pneumoniae isolate was also detected. Conclusion Multiple bacterial species were isolated from lower respiratory tract infections in our hospital, including different species of gram positive cocci and gram negative bacilli, and these isolates exhibited high resistance to antibiotics tested. The clinical use of antibiotics and hospital infection and transmission of these pathogens should be controlled.

目的 观察并分析小儿肝门静脉海绵样变性者核因子-κB(NF-κB)活性在手术前后的变化。方法 以2005年2月—2013年7月我院收治的43例小儿肝门静脉海绵变性者为研究对象,以40例正常儿童为对照组,检测对照组以及观察组儿童在手术前后血清单个核细胞(PBMC)中的NF-κB p65/Lamin B1的相对含量和NF-κB活性。结果 观察组术前、术后PBMC中NF-κB p65的相对含量分别为(1269.3±349.8)ng/mg、(884.5±154.8)ng/mg,均高于正常对照组(106.1±12.7)ng/mg(P＜0.05);与术前相比,术后相对含量降低(P＜0.05);观察组术前、术后PBMC中NF-κB的活性分别为(2194.5±471.3)ng/mg、(1376.9±203.7)ng/mg,均高于正常对照组(221.1±33.6)ng/mg(P＜0.05);与术前相比,术后相对含量降低(P＜0.05)。结论 经手术治疗后,小儿肝门静脉海绵样变性者PBMC中NF-κB p65的相对含量、NF-κB的活性均显著降低,表明手术在一定程度上有效缓解了肝门静脉高压的病症。