目的 观察脑性瘫痪（CP）伴营养不良患儿进行系统性饮食调整的效果。方法 2015年1月—2022年1月我院收治以CP伴营养不良患儿80例,以随机数字表法分为对照组和研究组各40例,常规护理指导用于对照组,系统性饮食调整护理用于研究组。比较2组患儿在干预前、后的生化指标（白蛋白、血红蛋白、肌酐、低密度脂蛋白水平）、身体指标（体质量、身高、体质指数、腹部皮下脂肪厚度）、肠内营养混悬液使用剂量及饮食行为能力评分和患儿监护人对干预的满意率。结果 干预后2组的生化指标可见明显变化,其中研究组与对照组相比,白蛋白、血红蛋白、肌酐指标提升更多更平稳,而低密度脂蛋白研究组较对照组相比,降低更多更平稳,（P<0.01）。在干预后两组间的身体指标可见明显变化,其中研究组与对照组相比,体质量、体质指数、腹部皮下脂肪厚度较干预前增加更多更平稳,而低密度脂蛋白研究组较对照组相比,降低更多更平稳,（P<0.01）。在干预后2组的肠内营养混悬液使用剂量及饮食行为能力评分较干预前可见明显变化,其中研究组与对照组相比,肠内营养混悬液使用剂量及饮食行为能力降低更多更平稳（均P<0.05）。研究组监护人对干预的满意率高于对照组（P<0.05）。结论 在CP伴营养不良患儿中,开展有效的系统性饮食调整干预,可有效改善患儿的生化指标,提升各项身体指标,减少肠内营养混悬液的使用剂量,改善饮食行为能力,获得患儿监护人的认可,效果理想。

Objective To observe the effect of systematic diet adjustment in children with cerebral palsy（CP）and malnutrition．Methods A total of 80 CP children with malnutrition treated in our hospital（from January 2015 to January 2022）were divided into two groups by random number table method．Control group received routine nursing guidance and study group received systematic diet adjustment nursing．The biochemical indexes（albumin,hemoglobin,creatinine,low-density lipoprotein levels）,physical indexes（weight,height,body mass index,abdominal subcutaneous fat thickness）,the dosage of enteral nutritional suspension and the score of dietary behavior ability were compared between the two groups before and after the intervention．The satisfaction rate of the children's families with the intervention was evaluated．Results After the intervention,the biochemical indexes of the two groups showed significant changes．Compared with the control group,the indexes of albumin,hemoglobin and creatinine in the study group increased more and more stably,while the index of low-density lipoprotein in the study group decreased more and more stably（P<0.01）．After the intervention,the physical indexes of the two groups showed significant changes．Compared with the control group,the weight,body mass index and abdominal subcutaneous fat thickness of the study group increased more and more stably than before the intervention,while the low-density lipoprotein study group decreased more and more stably（P<0.01）．After the intervention,the dosage of enteral nutritional suspension and the score of dietary behavior ability in the two groups showed significant changes compared with those before the intervention．Compared with the control group,the immune indexes in the study group increased more and more stably,while the dosage of enteral nutritional suspension and the score of dietary behavior ability in the study group decreased more and more stably（P<0.05）．The satisfaction rate of family members in the study group was higher than that in the control group（P<0.05）．Conclusions In children with CP and malnutrition,carrying out effective systematic diet adjustment intervention can significantly improve the biochemical indexes of children,improve various physical indexes,improve immune ability,reduce the dosage of enteral nutritional suspension,improve dietary behavior,and obtain the recognition of children's family members,which has ideal effects．

目的 检验家庭睡眠习惯调查(FISH)在评估孤独症谱系障碍(ASD)患儿睡眠评估中的信度和效度。方法 随机抽取在清远市妇幼保健院儿童语言行为科干预的199例2~6岁ASD共患睡眠障碍患儿,其照顾者同时完成FISH和儿童睡眠习惯问卷(CSHQ),2周后再次同时完成上述两个问卷,以检验FISH的信度和效度。结果 验证性因素分析的结果表明,五因素模型拟合良好(χ²=79.05,df=44,χ²/df=1.80, P<0.001,SRMR=0.06,GFI=0.94,IFI=0.89,RMSEA=0.06),总量表及各分量表有较高的内部一致性信度(0.71~0.77)和重测信度(0.79~0.88)。FISH的白天习惯分别与CSHQ的入睡延迟、夜醒呈负相关,入睡前习惯分别与CSHQ的睡眠抵触、睡眠焦虑、白天睡眠呈负相关,睡眠常规分别与CSHQ的睡眠抵触、入睡延迟、睡眠焦虑呈负相关,睡前父母行为分别与CSHQ的睡眠抵触、睡眠焦虑呈负相关,总分与CSHQ总分呈负相关,差异均有统计学意义(P＜0.05)。结论 FISH具有较好的信度和效度,可作为ASD患儿睡眠习惯的评估工具。

Objective To test the reliability and validity of the famity inveritory of sleep habits(FISH) in the sleep assessment among children with autism spectrum disorder (ASD). Methods A random sample of 199 children with ASD and sleep disorders intervened in the Children's Language and Behavior Department of Maternal and Child Health Hospital of Qingyuan City were selected, their caregivers completed the FISH and the children's sleep habit questionnaire(CSHQ) at the same time, and completed the above two questionnaires again 2 weeks later to test the reliability and validity of the FISH. Results The results of confirmatory factor analysis showed that the five-factor model fits well (χ²=79.05, df=44, χ²/df=1.80, P<0.001, SRMR=0.06, GFI=0.94, IFI =0.89, RMSEA=0.06), the total scale and each subscale had high internal consistent reliability (0.71~0.77) and test-retest reliability (0.79~0.88). The daytime habits of FISH were negatively correlated with sleep delay and waking up at night of CSHQ respectively, the habits before sleep of FISH were negatively correlated with sleep conflict, sleep anxiety and daytime sleep of CSHQ respectively, the sleep routine of FISH was negatively correlated with sleep conflict, sleep delay and sleep anxiety of CSHQ respectively, the parents' behavior before sleep of FISH was negatively correlated with sleep conflict and sleep anxiety of CSHQ respectively, and the total score of FISH was negatively correlated with CSHQ, with statistically significant differences (P<0.05). Conclusions The FISH had good reliability and validity, and can be used as an assessment tool for children with ASD.

目的 分析人类疱疹病毒(EBV)致传染性单核细胞增多症(IM)患儿病毒量与临床特征的关系。方法 选取我院2016年1月—2021年1月收治的EBV定量阳性的IM患儿128例,按照患儿EBV含量分为低病毒量组(n=64)和高病毒量组(n=64)。比较不同病毒含量组患儿的症状体征、实验室检查及临床特征,并分析具有统计学差异的指标与病毒量之间的相关性。结果 高EBV含量组患儿丙氨酸氨基转移酶、乳酸脱氢酶、血沉、外周血白细胞计数指标水平均高于低EBV含量组(P<0.05)。患儿的退热时间、淋巴结缩小时间、肝脾肿大消退时间及住院时间均随着EBV含量的增加而延长(P<0.05)。EBV含量与退热时间、淋巴结缩小时间、肝脾肿大消退时间及住院时间成正相关(r=0.453,0.458,0.402,0.415,P<0.05)。结论 EBV含量越高,IM患儿住院时间及临床指标恢复时间越长,因此临床治疗IM患儿时可以根据EBV含量的高低进行病情评估。

Objective To analyze the relationship between viral load and clinical characteristics in children with infectious mononucleosis (IM) caused by Epstein-Barr virus (EBV). Methods A total of 128 children with IM who tested positive for EBV and admitted to our hospital from January 2016 to January 2021 were selected and divided into low virus group (n=64) and high virus group (n=64) according to their EBV level. The symptoms and signs, laboratory examinations and clinical characteristics of two groups were compared, and the correlation between the statistically different indicators and the amount of virus were analyzed. Results In children with high EBV level, the levels of alanine aminotransferase, lactate dehydrogenase, erythrocyte sedimentation rate, and peripheral blood white blood cell count were higher than low EBV level group (P<0.05). The time of fever, lymph node shrinkage, hepatosplenomegaly to subside, and hospitalization time of the children were all prolonged with the increase of EBV level (P<0.05). The level of EBV was positively correlated with the time to allay fever, the time to shrink the lymph nodes, the time to improve hepatosplenomegaly, and the length of hospital stay (r=0.453, 0.458, 0.402, 0.415,P<0.05). Conclusions The higher EBV level, the longer hospitalization time and recovery time of clinical indicators in children with IM. Therefore, the disease assessment of children with IM can be based on EBV level.

目的 探究质控预警系统在重症患儿连续性血液净化治疗的应用效果。方法 随机选取于2020年1月—2021年12月在我院进行连续性血液净化治疗的共80例重症患儿作为本次研究对象,将80例患儿随机分成研究组和对照组,对照组进行常规护理,研究组则在常规护理的基础上行预警系统质量控制,对比2组患儿连续性血液净化治疗时长及报警频次、2组患儿在不同治疗时间段内滤器凝血发生率、2组非计划下机发生情况及2组患儿家属的护理满意度。结果 研究组平均报警频次为(8.60±3.35),低于对照组(16.52±7.41)的报警频次。而研究组的治疗时长(32.54±6.73 h)较对照组(21.38±5.61 h)延长,研究组患儿在进行连续性血液净化治疗的过程中,在8小时至24小时之间及大于24小时滤器的凝血发生率低于对照组,研究组和对照组护理满意度分别为92.50%和75.00%,对比差异显著。结论 在对重症患儿进行连续性血液净化治疗过程中应用质控预警系统具有较高的临床使用价值,不仅可以有效降低报警频次及滤器凝血发生率,而且对延长治疗时间有显著的促进作用,值得在今后的治疗过程中大力推广。

Objective To explore the application effect of quality control early warning system in continuous blood purification treatment of critically ill children.Methods A total of 80 critically ill children who underwent continuous blood purification treatment in our hospital from January 2020 to December 2021 were randomly selected as the research object, and were randomly divided into observation group and control group.The control group received routine nursing,and the observation group received early warning system quality control on the basis of routine nursing.The duration and alarm frequency of continuous blood purification treatment,the incidence of filter coagulation in different treatment periods,the occurrence of unplanned quitting and nursing satisfaction of the two groups were compared.Results The average alarm frequency of the observation group was (8.60±3.35),which was significantly lower than that of the control group (16.52±7.41).However,the treatment duration of the observation group (32.54±6.73 h) was significantly longer than that of the control group (21.38±5.61 h).During continuous blood purification treatment,the incidence of blood coagulation in the observation group was lower than that of the control group,and the nursing satisfaction of the observation group and the control group were 92.50% and 75.00% respectively,with significant differences.Conclusions The application of quality control early warning system in the continuous blood purification treatment of critically ill children has a high clinical value,which can not only effectively reduce the alarm frequency and the incidence of filter coagulation,but also significantly prolong the treatment time,and it is worth promoting in the future treatment process.

目的 探讨沙丁胺醇与M胆碱受体阻断剂应用于支气管哮喘患儿对其症状改善及肺功能的影响。方法 选择我院2018年9月—2019年9月收治的88例支气管哮喘患儿,采用随机数表法分为观察组(n=44)和对照组(n=44)。在对症治疗基础上,对照组给予沙丁胺醇治疗,在对照组基础上,观察组加入M胆碱受体阻断剂(异丙托溴铵气雾剂)治疗。比较两组患儿治疗效果、症状表现、肺功能指标、生活质量及不良反应发生率。结果 与对照组总有效率77.27%(34/44)相比,观察组93.18%(41/44)较高,差异有统计学意义(P＜0.05);治疗7 d后,观察组咳嗽消失时间(5.12±1.88)d、憋喘消失时间(1.88±0.95)d、肺啰音消失时间(5.45±1.21)d均较对照组[(8.03±1.22)d、(3.65±1.04)d、(7.02±1.62)d]短,差异有统计学意义(P＜0.05);治疗7 d后,观察组FVC、FEV₁、PEF水平[(3.38±0.42)、(2.13±0.48)、(435.79±40.75)L/min]均高于对照组[(2.67±0.46)、(1.75±0.43)、(388.94±35.93)L/min],差异有统计学意义(P＜0.05)。治疗7 d后,观察组SGRQ评分(34.11±4.25)分低于对照组(42.52±4.48)分,差异有统计学意义(P＜0.05)。两组不良反应发生率比较[13.64%(6/44),9.09%(4/44)],差异无统计学意义(P＞0.05)。结论 沙丁胺醇与M胆碱受体阻断剂应用于支气管哮喘患儿,可提高其治疗效果,可缩短咳嗽消失、憋喘消失及肺啰音消失时间,改善其肺功能,提高生活质量,降低不良反应发生率,值得临床推广应用。

目的 分析肺炎支原体RNA实时荧光恒温扩增技术(MP-SAT)作为肺炎支原体肺炎(MPP)患儿疗效监测指标的可行性。方法 选择2017年10月—2018年10月我院儿科收治的因CAP住院的患儿178例为研究对象,其中MPP组80例,非MPP组98例,分别检测血清MP抗体(MP-Ab)和咽拭子MP-RNA,对两种方法检测结果进行统计学分析,以MP-Ab检测为诊断MPP的参照试验,分析MP-SAT诊断MPP的准确性,对MP-SAT和MP-Ab均阳性的MPP病例行动态观察,比较MP-SAT和MP-Ab在患儿不同治疗时间点的检出率,分析MP-SAT转阴时间与临床痊愈时间的相关性,分析MP-SAT转阴时间与MPP患儿临床症状、实验室指标及X线胸片的相关性。结果 MP-SAT和MP-Ab结果不一致的比例在MPP组和非MPP组分别为60.00% (48/80)和19.39%(19/98);MP-SAT、MP-Ab在特异性和阳性预测值方面,差异有统计学意义(P＜0.05);MP-SAT、MP-Ab在敏感度和阴性预测值方面,差异无统计学意义(P＞0.05);MP-SAT、MP-Ab均为阳性28例(35.00%),MP-SAT阳性检出率随治疗时间的延长降低(P＜0.05),MP-Ab阳性检出率随治疗时间的延长升高(P＜0.05);28例临床痊愈时间为(3.11±0.88)周,MP-SAT转阴时间为(3.25±0.74)周,差异无统计学意义(P＞0.05);MP-SAT转阴时间越长的病例表现为发热持续时间越长,X线胸片肺大片实变比例越高,CRP水平越高,LDH水平越高,中性粒细胞百分比越高,淋巴细胞百分比越低(P＜0.05)。结论 MP-SAT作为新一代RNA活菌检测技术在支原体肺炎患儿疗效监测中有较高的价值,值得推广。

Objective To investigate the feasibility of Mycoplasma pneumoniae-simultaneous amplification and testing (MP-SAT)as a monitoring index for children with Mycoplasma pneumoniae pneumonia (MPP). Methods 178 hospitalized children with community-acquired pneumonia (CAP)in our hospital from October 2017 to October 2018 were selected and divided into two groups, namely MPP group (n=80)and non-MPP group (n=98). Serum MP antibody (MP-Ab)and throat swab MP-RNA were detected separately. The MP-Ab test was used as a reference for the analysis of accuracy of MP-SAT for MPP diagnosis. The MPP patients with positive MP-SAT and positive MP-Ab were observed dynamically. The detection rates of MP-SAT and MP-Ab in different treatment time points were compared. The correlation of MP-SAT negative time with clinical recovery time, clinical symptoms, laboratory parameters and chest X-ray was analyzed. Results The ratio of inconsistent MP-SAT and MP-Ab results was 60.00% (48/80)and 19.39% (19/98)in the MPP group and the non-MPP group, respectively. The MP-SAT and MP-Ab were statistically different in terms of specificity and positive predictive value (P<0.05), while no difference was found in the sensitivity and negative predictive value (P>0.05). Both MP-SAT and MP-Ab were positive in 28 cases (35.00%). The positive rate of MP-SAT was decreased with the prolongation of treatment time (P<0.05), meanwhile the positive rate of MP-Ab was increased with the treatment time (P<0.05); the clinical recovery time of 28 cases was (3.11±0.88)weeks, and the MP-SAT negative time was (3.25±0.74)weeks, with no statistical difference (P>0.05). The long-term duration of MP-SAT was characterized by long duration of fever, high consolidation rate of X-ray chest radiograph, high CRP level, high LDH level, high percentage of neutrophils, and low percentage of lymphocytes (P<0.05). Conclusion MP-SAT, as a new generation of RNA live bacteria detection technology, has high value in monitoring the efficacy of Mycoplasma pneumonia in children, and it is worth promoting.

目的 分析院际转运紫绀型先天性心脏病患儿中的流行病学特征,评价院际转运在患儿救治过程中的作用及效果。方法 回顾性分析2016年1月—2019年12月我院院际转运的145例紫绀型先天性心脏病患儿的性别、年龄、体质量、生命体征、转运期间检测指标、支持治疗等资料。结果 145例紫绀型先天性心脏病男105例,女40例,73.1%(106/145)的转诊患儿是新生儿,59.3%(86/145)的转诊患儿来自三级医院,55.9%(81/145)的转诊患儿转诊距离在200 km以上,仅有10.3%(15/145)的转诊患儿转诊距离在50 km以内。转诊过程中44.1%(64/145)的患儿给予呼吸机辅助通气,33.1%(48/145)的患儿给予吸氧处理,仅22.1%(32/145)的患儿无需呼吸支持,所有患儿安全转运到接诊医院,入院后138例接受外科手术治疗手术康复,7例放弃治疗。结论 安全、有效的院际转运紫绀型先天性心脏病是救治的关键环节,为紫绀型先天性心脏病的救治提供前提。

Objective To analyzed the epidemiological characteristics of interhospital transport of cyanotic congenital heart disease in children and evaluate the effect of interhospital transport on treatment. Methods 145 children with cyanotic congenital heart disease from January 2016 to December 2019 transported in our hospital were analyzed retrospectively. Epidemiological data such as sex, age, weight, vital signs, detection indexes during transport and supportive treatment were collected. Results Among 145 children with cyanotic type of congenital heart disease there were 105 male, 40 female. 73.1% (106/145) children were newborn, 59.3% (86/145) children were from tertiary hospitals, 55.9% (81/145) children were transported over 200 km, only 10.3% (15/145) children were within 50 km. 44.1% (64/145) were given assisted ventilation during transporting, 33.1% (48/145) children were given oxygen treatment, only 22.1% (32/145) of the children did not need respiratory support. All children were transferred to the receiving hospital successfully. After admission, 138 of them received surgical treatment successfully, and 7 of them gave up treatment. Conclusion Safe and effective interhospital transport is the key to treating cyanotic congenital heart disease, which provides the basis for the treatment of cyanotic congenital heart disease.

目的 探讨Sysmex-2100全自动血液分析仪检测β-地中海贫血(β-地贫)患儿血小板参数显示不全的原因。方法 收集2017年4月—2020年4月期间本院确诊β-地贫患儿301人,其中重型病例204例,非重型97例。对301例患儿均采用希森美康Sysmex-2100血细胞分析仪进行血细胞分析,标本制作血涂片充分干燥后经瑞氏-吉姆萨染色,由主管技师及以上检验人员进行人工镜检。结果 301例β-地贫患儿血细胞分析结果出现血小板参数不显示者102例,占33.89％;其中有小红细胞、红细胞碎片、血小板聚集97例(95.10％);血小板直方图异常93例(91.18％)。重型β-地贫患儿血小板参数显示不全者75例,非重型β-地贫患儿血小板参数显示不全者27例,两组间血小板参数显示不全比例差异无统计学意义(P= 0.126)。血小板参数全显示病例的平均红细胞体积高于血小板参数显示不全病例,差异有统计学意义(P< 0.0001)。结论 小细胞低色素性红细胞及红细胞碎片化是β-地贫患儿血小板参数显示不全的主要原因,通过血小板直方图正常与否可大致判断血小板参数的可信度,采用PLT-O通道检测及涂片镜检查找原因,可提高结果的准确性。

目的 研究喘憋性肺炎合并脓毒症患儿血清降钙素原(PCT)、C反应蛋白(CRP)水平的临床意义。方法 回顾性分析本院80例喘憋性肺炎患儿临床资料,根据是否合并脓毒症将80例患儿分为观察组(合并脓毒症,38例)和对照组(未合并脓毒症,42例)。比较两组患儿血清PCT、CRP水平,根据脓毒症严重程度将观察组患儿分为脓毒症组(14例)、严重脓毒症组(13例)及脓毒症休克组(11例),比较三组患儿血清PCT、CRP水平,记录患儿2周死亡率。分析血清PCT和CRP诊断喘憋性肺炎合并脓毒症患儿的准确性,探讨其判断预后的价值。结果 观察组患儿血清CRP和PCT水平高于对照组,差异均有统计学意义(P<0.05)。脓毒症休克组患儿血清CRP、PCT水平高于脓毒症组和严重脓毒症组,差异有有统计学意义(P<0.05)。严重脓毒症组患儿血清CRP和PCT均高于脓毒症组,差异有统计学意义(P<0.05)。80例患儿中死亡7例,死亡率8.75%,血清CRP与PCT早期诊断喘憋性肺炎患儿合并脓毒症的AUC分别为0.729和0.743(95%CL=0.617~0.841,0.637~0.849,P均<0.001),联合诊断的AUC分别为0.876(95%CL=0.792~0.960,P<0.001)。血清CRP和PCT判断患儿预后的AUC分别为0.794和0.813(95%CL =0.584~1.000,0.000~1.000,P =0.012,0.007),联合检测判断患儿预后的AUC为0.832(95%CL=0.638~1.000,P<0.001)。结论 喘憋性肺炎合并脓毒症患儿血清CRP和PCT均异常升高,监测血清CRP和PCT有助于脓毒症的早期诊断和患儿预后判断。

目的 通过对43种融合基因在儿童白血病中的结果分析,探讨融合基因阳性的儿童急性B淋巴细胞白血病(acute B-lymphoblastic leukemia,B-ALL)的免疫表型特征。方法 应用实时荧光探针PCR法对2016年10月—2018年12月在深圳市儿童医院就诊的初发或复发B-ALL患儿进行融合基因检测,采用多参数流式细胞术(flow cytometry,FCM)对B-ALL患者进行免疫表型检测。结果 120例B-ALL患儿融合基因筛选总阳性率为37.5%(45/127),包括TEL/AML1 27例、E2 A/PBX1 7例、BCR/ABL1 6例、MLL 4例、TLS/ERG 1例;不同年龄段白血病融合基因阳性率差异有统计学意义(P<0.01),性别分布差异无统计学意义(P>0.05)。各融合基因阳性组CD19阳性率为100%,TEL/AML1阳性表达患者普通-B-ALL表型占比最高(77.8%),干/祖细胞抗原CD34的阳性率为81.5%;E2 A/PBX1阳性表达患者以前-B-ALL表型为主,不表达已知的T系及髓系抗原;各融合基因阳性组及阴性组患儿髓系抗原阳性率比较差异有统计学意义(P<0.01),以BCR/ABL1基因表达组阳性率最高(100%)。结论 5种融合基因在患者年龄构成及免疫表型中具有一定的分布特点;B-ALL特征性免疫表型的改变可用于融合基因表达的预测,提高融合基因结果判读的准确率。

Objective To investigate the immunophenotype features of children with acute B-lymphoblastic leukemia(B-ALL) combined with fusion gene expressing after to analyze the results of the 43 fusion genes. Methods Real-time fluorescent probe PCR assay was used for the detection of fusion genes in 120 cases of children from Shenzhen Children's Hospital with B-ALL newly or recurrently diagnosed from Oct 2016 to Dec 2018. Multi-parameter flow cytometry(FCM) was used for the detection of the immunophenotype in children with B-ALL. Results Of all the 120 cases, the fusion genes were detected at positive rate of 37.5%(45/120), included TEL/AML1 27 cases, E2 A/PBX1 7 cases, BCR/ABL1 6 cases, MLL 4 cases, TLS/ERG 1 cases. The positive rate of leukemia fusion gene had statistically difference among fusion genes positive groups based on age(P<0.01). There was no statistically difference in the gender distribution(P>0.05). The expressing of CD19 was at positive rate of 100% in all of the groups. The rate of the common-B-ALL was the highest B-ALL subtype in the TEL/AML1 positive groups(77.8%). The stem /progenitor associated antigen CD34 was at positive rate of 81.5%. The pre-B-ALL was the main subtype in the E2 A/PBX1 group, which was no expression of the known T-ALL associated antigen MyAg antigen. There was statistically difference in the positive rate of MyAg expression among all of the groups(P<0.01), with the highest rate in the BCR/ABL1 group(100%). Conclusion There were certain distribution features in age composition and immunophenotype of children with B-ALL carrying five kinds of common fusion genes. The characteristic changes of the immunophenotype of B-ALL may be used to predict the expression of fusion genes and improve the accuracy of fusion genes by the supplementary role of immunophenotype analysis.