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 总结儿童嗜酸细胞性胃肠炎（EG）的临床表现、内镜检查和病理学特点、治疗和预后。方法 回顾性分析2019年1月—2022年12月滨州医学院附属医院儿科确诊的48例EG患儿临床资料,包括临床症状、实验室检查、影像学检查、内镜和病理学检查、治疗和随访情况。结果 48例患儿中,男26例（54.17%）,女22例（45.83%）,中位年龄7.8岁,20例（41.67%）患儿有过敏史或家族史,临床症状主要有腹痛（34例,70.83%）、腹泻（18例,37.5%）和腹胀（12例,25%）。外周血嗜酸性粒细胞（EOS）升高36例（75%）,血清总IgE升高14例（29.17%）。48例行胃镜检查,最常见的表现是黏膜充血水肿（32例,66.67%）、点状红斑（28例,58.33%）和糜烂（22例,45.83%）,28例行结肠镜检查,表现为黏膜充血水肿（18例,64.29%）、点状红斑（15例,53.57%）和结节样隆起（12例,42.86%）。黏膜组织病理表现为大量EOS浸润,主要累及十二指肠降部、胃窦和回肠末端。所有患儿均采用饮食干预的治疗,6例（12.5%）单纯饮食干预治疗后好转,16例（33.33%）孟鲁司特钠、酮替芬、奥美拉唑治疗后好转,26例（54.17%）联合泼尼松治疗后好转,随访10个月~3年,8例（16.67%）停药后复发,再次治疗后好转。结论 儿童EG临床症状和内镜表现多样化、缺乏特异性,内镜下黏膜组织病理检查有助于确诊。大多数患儿外周血EOS升高,饮食干预和糖皮质激素治疗效果显著,但存在复发的可能,需长期维持治疗和随访。

Objective To summarize the clinical manifestations,endoscopic and pathological features,treatment and prognosis of eosinophilic gastroenteritis（EG）in children．Methods A retrospective analysis was carried out on clinical data of 48 patients with EG diagnosed at the Department of Pediatrics of Binzhou Medical University Hospital from January 2019 to December 2022,including clinical symptoms,laboratory examination,imaging examination,endoscopic and pathological examination,treatment and follow-up．Results A total of 48 patients were included in the analysis,including 26 males（54.17%）and 22 females（45.83%）,with the median age of 7.8 years（7 months to 13 years）．Twenty patients（41.67%）had a history or family history of allergy．The most clinical symptoms were abdominal pain（34 cases,70.83%）,diarrhea（18 cases,37.5%）and abdominal distension（12 cases,25%）．Peripheral blood eosinophils（EOS）increased in 36 cases（75%）,and the serum total IgE increased in 14 cases（29.17%）．48 cases underwent gastroscopy,the most common manifestations were mucosal hyperemia and edema（32 cases,66.67%）,punctate erythema（28 cases,58.33%）and erosion（22 cases,45.83%）．Twenty-eight cases underwent colonoscopy,the manifestations were mucosal hyperemia and edema（18 cases,64.29%）,spotted erythema（15 cases,53.57%）and nodular eminence（12 cases,42.86%）．Mucosal histopathology showed a large number of EOS infiltration,mainly involving the descending duodenum,gastric antrum and terminal ileum．All children were treated with dietary intervention,6 cases（12.5%）were improved after simple diet intervention,16 cases（33.33%）were improved after treatment with montelukast,ketotifen,omeprazole,26 cases（54.17%）were improved after combined treatment with prednisone acetate．Followed up for 10 months to 3 years,8 cases（16.67%）relapsed after drug withdrawal and improved after retreatment．Conclusions The clinical symptoms and endoscopic manifestations of EG in children are diverse and lack of specificity,endoscopic mucosal histopathological examination is helpful for diagnosis．The EOS in peripheral blood of most children increased,diet intervention and glucocorticoid therapy are effective,but there is a possibility of recurrence,which need long-term maintenance treatment and follow-up．

目的 探讨体外受精治疗中第3天(D3)不同质量卵裂期胚胎培养至囊胚的发育潜能,为囊胚培养提供实验室依据。方法 对2015年4月—2019年4月D3移植或冷冻后剩余行囊胚培养的5 510枚胚胎进行了回顾性分析。按D3胚胎质量、卵裂球数目、均一性及碎片率分组,比较囊胚形成率,优质囊胚形成率及可利用囊胚形成率,并分析各因素与可利用囊胚形成的相关性。结果 D3优质胚胎的囊胚形成率,优质囊胚形成率及可利用囊胚形成率与非优质胚胎组相比有统计学差异(P＜0.05);4-6细胞组及＜4细胞组与7-9细胞组相比有统计学差异(P＜0.05),但融合期胚胎(CP)组及＞ 9细胞组与7-9细胞组相比差异无统计学意义;卵裂球大小差异(+)组和(++/+++)组与卵裂球大小均匀(-)相比有统计学差异(P＜0.05); 10%～25%组及碎片＞25%组与碎片≤10%组相比有统计学差异(P＜0.05)。 Logistic分析结果表明,D3胚胎质量、卵裂球数目、均一性及胚胎碎片率与可利用囊胚形成显著相关(P＜0.05)。 结论 D3胚胎质量、卵裂球数目、均一性及胚胎碎片均会影响到囊胚的形成及质量,其中胚胎质量和卵裂球数目对可利用囊胚形成的影响较大。

Objective To explore the developmental potential of day 3(D3) different quality embryos cultured to blastocyst in vitro fertilization treatment, and to provide laboratory basis for blastocyst culture. Methods A total of 5 510 embryos with blastocyst culture remained after D3 transplantation or freezing from April 2015 to April 2019 were analyzed retrospectively. They were divided into groups according to embryo quality, blastomere number, blastomere homogeneity and fragment rate in D3. And the blastocyst formation rate, high quality blastocyst formation rate and available blastocyst formation rate were compared between the groups.The correlation within each factor and available blastocyst formation was analyzed. Results The blastocyst formation rate, high quality blastocyst formation rate and available blastocyst formation rate of D3 high quality embryo group were higher than those of non-high quality embryo group (P<0.05); compared with 7- 9 cell group, 4- 6 cell group and<4 cell group were lower (P<0.05), but there was no significant difference in CP group or >9 cell group. Compared with the normal size of the blastomere (-), the difference in the size of the blastomere (+) group and the (++/+++) group decreased (P<0.05); compared with the fragment ≤ 10%, the difference in the size of the blastomere between the 10%~25% group and the fragment>25% group decreased (P<0.05). The results of logistic analysis suggested that the embryo quality, blastomere number, homogeneity and fragment rate of D3 were correlated with available blastocyst formation (P<0.05). Conclusion D3 embryo quality, blastomere number, homogeneity and embryo fragment may affect the formation and quality of blastocyst, especially the embryo quality and blastomere number.

目的 探讨35周岁以下患者行D5单囊胚移植的可行性。方法 回顾性分析2016年1月—2019年7月期间,女方年龄≤35岁,在本中心行新鲜周期全胚冻后第一冻融移植的663个周期,根据胚胎发育天数及囊胚移植数目分为三组:D3双优胚移植组(D3双优组:n=508)、D5单囊胚移植组(D5单囊组:n=47)、D5双囊胚移植组(D5双囊组:n=108),对三组的临床结局进行比较分析。结果 D5双囊组临床妊娠率高于D3双优组及D5单囊组,且差异有统计学意义(P＜0.05),但D5单囊组与D3双优组相比,无统计学差异(P＞0.05);D5单囊胚的多胎率低于D5双囊组及D3双优组,差异均有统计学意义(P＜0.001),D3双优组的多胎率也低于D5双囊组,差异亦有统计学意义(P＜0.05);D5单囊组和D5双囊组的种植率都高于D3双优组,差异都有统计学意义(分别是P＜0.05,P＜0.001),而D5单囊组合D5双囊组之间无统计学差异(P＞0.05);但三组之间的早期流产率及宫外孕率均无统计学差异(P＞0.05)。结论 年龄≤35周岁的患者全胚冷冻后第一冻融移植周期选择D5单囊胚进行移植,既能获得良好的临床妊娠率和种植率,又极大降低多胎妊娠率。

Objective To investigate the clinical outcomes of the single blastocyst transfer of day 5 in the women under 35 years old. Methods A retrospective study was conducted to analyze clinical outcomes of women less than 35 years old and experienced embryo transfer in the first frozen-thawed cycles from January 2016 to July 2019 in the Center of Reproductive Medicine of Guangzhou Women and Children's Medical Center. According to the embryo developmental days and transfer blastocyst numbers, all patients were divided into three groups: double high-quality cleavage embryo transfer of day 3 (n=508), single blastocyst transfer of day 5(n=47), double blastocyst transfer of day 5(n=108). The clinical outcomes were compared. Results The clinical pregnancy rate of the double blastocyst transfer of day 5 was higher than the other two groups,and the differences were statistically significant(P＜0.05). However, there was no statistical difference between the single blastocyst transfer of day 5 and the double high-quality cleavage embryo transfer of day 3(P＞0.05). The multiple pregnancy rate of the single blastocyst transfer of day 5 was lower than the other two groups, and the differences were statistically significant (P＜0.001),and that of the double high-quality cleavage embryo transfer of day 3 was even lower than that of the double blastocyst transfer of day 5,and the difference was statistically significant(P＜0.05). The implanting rate of the double high-quality cleavage embryo transfer of day 3 was lower than the other two groups, and the differences were statistically significant (P＜0.05;P＜0.001),but there was no statistical difference between the single blastocyst transfer of day 5 and the double blastocyst transfer of day 5 (P＞0.05). However, the early miscarriage rate and the ectopic pregnancy rate did not exhibit statistical differences (P＞0.05). Conclusion Single blastocyst transfer of day 5 can ensure clinical pregnancy rate and implantation rate while effectively reducing multiple pregnancy in the women undergoing the first frozen-thawed cycles of under 35 years old.

       目的  探讨晚期早产儿中小于胎龄儿（SGA）与适于胎龄儿（AGA）出生时的铁代谢状态。方法  选取2020年1—12月合肥市妇幼保健院收治的150例晚期早产儿（胎龄34～36⁺⁶周）作为研究对象。按照出生体质量和胎龄将早产儿分为SGA组（36例）和AGA组（114例），分析比较两组早产儿出生时的铁代谢状态，并应用多因素线性回归分析血清铁的影响因素。结果  与AGA组相比，SGA婴儿的更低的血清铁［14.5 μmol /L （11.4，17.1） vs 16.4 μmol /L（14.1，18.4），P=0.004］、更低的血清铁蛋白［135.6 μg/L（101.8，176.2） vs 172.5 μg/L（123.0，218.3），P=0.009］和更低的总铁结合力［30.4 μmol/L（26.8，34.9）vs 35.4 μmol/L（29.5，44.6），P=0.001］。两组早产儿的血红蛋白、平均红细胞体积、平均红细胞血红蛋白含量和平均红细胞血红蛋白浓度比较差异均无统计学意义（P＞0.05）。在早产儿围生期特征中，胎盘异常（β= –1.949，P=0.009）和母亲糖尿病的发生（β= –2.324，P=0.001）与血清铁水平呈负相关。结论  与早产AGA相比，早产SGA铁储备水平较低，适量补充铁元素对小于胎龄新生儿身体发育有促进作用。

      Objective   To explore the iron metabolism status in late preterm infants who are small for gestational age（SGA）compared to those appropriate for gestational age（AGA）at birth．Methods   A total of 150 late preterm infants（gestational age 34 to 36⁺⁶ weeks）admitted to the Maternal and Child Health Hospital of Hefei from January to December 2020 were selected as the study subjects．The preterm infants were divided into the SGA group（36 cases）and the AGA group（114 cases）according to birth weight and gestational age．The iron metabolism status at birth was analyzed and compared between the two groups of preterm infants，and multiple linear regression analysis was applied to identify the influencing factors of serum iron．Results   Compared with the AGA group，SGA infants had lower serum iron（14.5［11.4，17.1］ vs 16.4 ［14.1，18.4］，P=0.004），lower serum iron protein（135.6［101.8，176.2］ vs 172.5［123.0，218.3］，P=0.009），and lower total iron binding capacity（30.4［26.8，34.9］ vs35.4［29.5，44.6］P=0.001）．There were no statistically significant differences in hemoglobin，mean corpuscular volume，mean corpuscular hemoglobin，and mean corpuscular hemoglobin concentration between the two groups of preterm infants（P＞0.05）．Among the perinatal characteristics of preterm infants，placental abnormalities（β= –1.949，P=0.009）and the occurrence of maternal diabetes（β= –2.324，P=0.001）were significantly negatively correlated with serum iron levels．Conclusions  Compared with preterm infants appropriate for gestational age，preterm infants who are small for gestational age have lower iron reserves at birth．Adequate supplementation of iron has a promoting effect on the physical development of small for gestational age newborns．