目的 本文对广州市妇女儿童医疗中心2014—2016年院间转运的神经系统患儿进行流行病学分析,探讨危重神经系统疾病患儿转运的安全性。方法 将2014年1月—2016年12月年广州市妇女儿童医疗中心神经系统疾病危重患儿转运986例进行回顾性分析。结果 986例神经系统疾病危重患儿的转运,转运途中无1例死亡,转运男女比例为1.91∶1,转诊患儿的年龄分布主要集中在1月～2岁11个月,占56.64%;转诊患儿无季节性差异,93.96%的疾病是“抽搐查因”和“颅内感染”,81.12%转诊患儿转运半径在150公里以内。结论 由于基层医院受医疗技术、医疗设备的限制,神经系统疾病危重患儿有必要转诊到三级医院进行救治;根据转运神经系统疾病危重患儿的流行病学特征,转运中心应该采取应急措施达到及时安全有效的院间转运。

Objective Children with nervous system diseases needed transfer between hospitals in Guangzhou women and children medical center from 2014 to 2016 was analyzed by the epidemiological method. To explore the safety of the critically ill children with transshipment in diseases of the nervous system. Methods 986 children with nervous system diseases needed transfer between hospitals was given a retrospective analysis. Results In 986 cases transit there were no deaths, male to female ratiowas 1.91∶1; referral of children's age distribution was mainly concentrates in 1 months to 2 years 11 months old, accounting for 56.64%; there was seasonal difference with referral children; 93.96% of the disease were “tic check for” and “intracranial infection”; 81.12% of children of the referral transfer within 150 km radius. Conclusion Critically ill children with nervous system disease referred to a tertiary hospital for treatment is necessary because of the grass-roots hospitals restricted by medical technology and equipments. According to the epidemiological characteristics of transport of critically ill children with nervous system disease, transit center should take emergency measures to arrive timely, safe and effective among hospitals.

目的 了解龙川地区肺炎支原体耐药情况,以便临床合理运用抗生素。方法 收集2014年—2015年间疑似肺炎支原体感染住院小儿患者的咽分泌物标本2 666例,同时作Mp培养及IgM检查,同为阳性者共149例进行耐药性统计分析。结果 在2 666例疑似感染患者中,培养肺炎支原体阳性149例,阳性率为5.59%,学龄前儿童(≤3岁)患者阳性率2.06%,学龄儿童(4～15岁)阳性率9.79% ,学龄儿童感染肺炎支原体与学龄前儿童比较有显著差异(P<0.05)。其中红霉素、阿奇霉素、罗红霉素、克林霉素、依托红霉素、克拉霉素、乙酰螺旋霉、交沙霉素、加替沙星、莫西沙星、环丙沙星、左氧氟沙星、多西环素、米诺环素耐药率分别为2%、12.4%、4%、22% 、2%、1%、80%、44%、2%、15%、10%、1%、61%、44%。冬季感染与在其他季节比较有差异(P<0.05)。结论 阿奇霉素,红霉素为代表大环内脂类抗生素仍可以作为临床一线经验用药,乙酰螺旋霉、交沙霉素耐药率大于40%,不建议作为经验药物使用。喹诺酮类抗生素耐药率一般小于15%,可作为肺炎支原体治疗的第二选择。四环素类抗生素在本地区耐药性高,不建议作为经验药物使用。要加强预防冬季肺炎支原体感染。

目的 回顾性分析常规放射检查中儿童胸部复合型骨折漏诊的原因,并且探讨多层螺旋CT后处理技术在儿童胸部复合型骨折中的诊断价值。方法 搜集本院2012年1月—2015年8月间因外伤行胸部照片和CT扫描的外伤患儿共123例,男81例,女42例,年龄9个月～15岁,平均年龄4.3岁。所有病例在完成胸部照片后1~3 d,进行胸部容积CT扫描,并对数据进行三维重建后处理,其结果与常规DR检查结果相比较。结果 在123例患儿中,常规胸部DR片显示明确胸部骨折39例61处,其中胸部单纯性骨折24例,胸部复合型骨折15例。可疑骨折48例;36例未见明确骨折但存在胸部合并症。CT检查显示明确的胸部骨折76例,142处,其中胸部单纯性骨折42例,胸部复合型骨折34例。与胸部DR平片相比,CT显示胸部新增骨折有18处在单纯性骨折病例中,63处在复合型骨折病例中。CT重建技术对复合型骨折的检出率高于DR平片,差异有统计学意义(P＜0.05)。结论 胸部CT容积扫描并综合运用三维重建技术处理,可以提高胸部复合型骨折的检出率,相对于常规放射照片更能提供详细和直观的信息,包括骨折部位、类型、程度以及邻近结构的损伤,并对治疗方案的选择及预后的评估有重要指导价值。

Objective To investigate the reasons for missed diagnoses of children's chest complex fractures in chest radiographs and to discuss the value of multi-slice spiral CT (MSCT) reconstruction in the diagnosis of children's chest complex fractures. Methods 123 children underwent chest digital radiography(DR) and MSCT scans after traumas were collected in our hospital between January 2012 and August 2015. This population consisted of 81 male and 42 female patients, with a mean age of 4.3 years(range from 9 months to 15 years). All participants underwent chest MSCT scans in 1-3 days after completing chest DR, and then we used 3D reconstruction to process the data and compared the results with those processed by DR. Results By chest DR tests we identified 39 cases (61 places) out of 123 participants with 24 simple fractures, 15 complex fractures. And 48 chest fractures were suspected. We also identified 36 cases had chest complications without fracture. By MSCT scans 76 cases (142 places) were identified, among which 42 were simple and 34 were complex. Compared with chest DR, MSCT scans can identified 18 more places of simple fractures and 63 more places of complex fractures. It was statistically significant higher detection rate of MSCT scan than DR. Conclusion Chest MSCT scan combined 3D reconstruction technology can increase the detection rate of chest complex fracture. Compared with DR, it provides more detailed and visualized information, including fracture position, type, severity and adjacent structure damage. It has important guiding value on the selection of therapy and prognosis evaluation.

目的 探究儿童抗NMDA受体脑炎临床特点、诊治及预后。方法 回顾性分析16例儿童抗NMDA受体脑炎的临床表现、辅助检查、治疗与预后。结果 16例患儿中,意识障碍16例, 语言障碍15例,运动障碍13例,11例惊厥发作。9例脑脊液NMDA受体抗体阳性,14例血清NMDA受体抗体阳性。16例患儿脑电图均出现背景中高波幅慢活动,头颅磁共振检查未见异常。所有患儿均接受丙种球蛋白联合激素冲击治疗,14例症状缓解,2例需加用利妥昔单抗治疗,症状缓解。结论 识别儿童抗NMDA受体脑炎多样临床表现,筛查NMDA受体抗体有助于早期诊断及治疗儿童抗NMDA受体脑炎。

Objective To investigate clinical features, diagnosis, treatment and prognosis of the patient with anti-NMDA receptor encephalitis in children. Methods The data of clinical feature,auxiliary examination of 16 cases with anti-NMDA receptor encephalitis in children were reviewed and analyzed. Results Of all 16 cases, there were 16 cases with decreased consciousness, 15 cases developed speech alteration, 13 cases developed movements disorder and 11 cases with seizure. Cerebrospinal fluid NMDA antibody were positive in 9 cases and serum NMDA antibody were positive in 14 cases. The EEG of 16 patients showed high-amplitude slow activity in the background. There were no significant abnormalities in head magnetic resonance imaging (MRI) of all children. After all children received gamma globulin combined hormone therapy, 14 cases had boen improved and another 2 cases need to be further treated combined with Rituximab. Conclusion Pediatric patients had diverse clinical manifestations. Screening of NMDA receptor antibody may help early diagnosis of anti-NMDA receptor encephalitis. And timely treatment may yield a favorable prognosis.

目的 对儿童化学发光免疫检验中标本量过少时的稀释方法分析。方法 选取我院2013年5月—2015年5月儿童常规筛查项目50例血清三碘甲状腺原氨酸(TT3)检测为例,其稀释介质分别采用TT3定制液S0、医用蒸馏水以及0.9%氯化钠,对其实施手工2倍(1∶1)和4倍(1∶3)稀释后,对比分析稀释后结合和原始数据差异。结果 结果和原始数据对比,2倍、4倍稀释S0组以及2倍医用蒸馏水稀释结果差异不大,对比没有统计学意义(P＞0.05),其与各组均差异显著(P＜0.05)。结论 在儿童血清三碘甲状腺原氨酸检测中对其实施2倍、4倍稀释S0以及2倍医用蒸馏水稀释能够满足医学检验需求,值得推广应用。

目的 探讨鼻—空肠营养管在小儿急性胰腺炎中的疗效观察及护理。方法 采用回顾性分析法,选取2013年2月—2015年5月期间我院收治的116例急性胰腺炎患儿的临床资料,按照营养支持方法的不同将患儿分为对照组和观察组,每组58例。对照组患儿肠功能恢复后给予经口进食,观察组给予鼻—空肠营养管进行营养支持;并给予患儿针对性的护理措施。比较分析两组患儿的治疗效果。结果 观察组患儿平均住院时间、平均花费、并发症发生率、手术率及死亡率等指标均低于对照组(P＜0.05),差异有统计学意义。结论 鼻—空肠营养管应用于小儿急性胰腺炎具有较好的效果,降低患儿并发症发生率、手术发生率,缩短住院时间,减少住院消费,促进患儿康复。

Objective To observe the clinical efficiency of nasal jejunal nutrition in children with acute pancreatitis and explore the effective nursing. Methods The clinical characteristics of 116 children with acute pancreatitis from February 2013 to May 2015 in our medical center were retrospectively analyzed. Based on nutritional support, the patients were divided into two groups: the control group consisted of 58 patients receiving oral feeding after the recovery of bowel function, and the experiment group consisted of 58 patients with nasal jejunal nutrition. And all the patients were treated with special care on case-by-case. The efficiency was then compared between the two groups. Results Compared with the control group, the length of hospital stay, cost of care, the incidence of complications, the surgical proportion and the mortality were significantly decreased in the experiment group (P<0.05). Conclusion In the children with acute pancreatitis, application of nasal jejunal nutrition is more effective, leading to decrease incidences of complications and surgical proportion, shorten the length of hospital stay, reduce patients' cost, and finally help rehabilitation.

目的 对比腹腔镜疝囊高位结扎术及无张力疝修补术治疗小儿腹股沟疝的临床疗效。方法 选取2012年1月—2014年1月在本院住院手术治疗纳入研究的52例腹股沟疝患儿为研究对象,研究对象随机分为两组,A组为(腹腔镜疝囊高位结扎术),B组为(无张力疝修补术),各组均为26例,对比两组术中出血量、术后康复相关指标及术后1天与3天的VRS疼痛评分。结果 A组术中出血量明显少于B组,且术后康复相关指标优于B组,疼痛评分较B组低。结论 腹腔镜疝囊高位结扎术较无张力疝修补术治疗小儿腹股沟疝临床效果更优,值得推广。

Objective To compare the clinical effect of laparoscopic high ligation of hernial sac and non-tension herniorrhaphy in the children with inguinal hernia. Methods 56 children with inguinal hernia in our hospital from January 2012 to January 2014 were analyzed, they were randomly divided into 2 groups, 26 cases in group A were treated with laparoscopic high ligation of hernial sac, 26 cases in group B were treated with traditional non-tension herniorrhaph, and to compare the peri-operative bleeding,hospital stays, postoperative complications and postoperative VRS score between two groups. Results The peri-operative bleeding amount, hospital stays, postoperative complications and postoperative VRS score in group A were remarkable less than those of group B(P<0.01). Conclusion The advantages of laparoscopic high ligation of hernial sac is more obvious than that traditional open non-tension herniorrhaphy, and worth of being generalized.

目的 了解2014年广州地区儿童专科医院的病原菌分布及耐药情况与全国细菌耐药监测网(CARSS)公布数据的异同点,并提出相关用药建议,为儿童临床合理应用抗生素提供科学依据。方法 将2014年本中心儿童院区检测的儿童细菌耐药数据与同期国家卫生计生委合理用药专家委员颁布的CARSS数据进行比较。结果 儿童医院与CARSS数据比较,革兰阳性菌比例较高(49.8% vs 28.5%),革兰阴性菌比例较低(50.2% vs 71.5%);肺炎链球菌、化脓性链球菌及流感嗜血杆菌检出率较高;耐药率明显升高的是肺炎链球菌对青霉素耐药率(33.2% vs 4.3％),耐药率明显降低的是鲍曼不动杆菌对碳青霉烯类耐药率(10.3% vs 57.0％),大肠埃希菌对喹诺酮类耐药率(27.6% vs 54.3％)。结论 广州地区儿童病原菌分布及耐药情况与CARSS数据比较有一定差异,特别是儿童主要致病菌肺炎链球菌对青霉素耐药的形势严峻,经验性抗感染治疗时需考虑本地及儿童的病原菌特殊性。

目的 探讨儿童肾病综合征(NS)的红细胞分布宽度(RDW)与肾功能损害的关系。方法 收集168例NS患者作为观察组,根据eGFR分期分为三组,按照起病时长4月为界限分为两组;选健康儿童100例为对照组。检测各组血常规、肝肾功能等,采用SPSS 21.0软件进行统计分析。结果 ①与对照组相比,NS患儿的RBC[(4.86±0.69)vs(4.32±0.48)],RDW[(13.39±1.69)vs(12.99±1.04)]升高,差异有统计学意义(P<0.05);②RDW在肾功能3期(14.60±1.36)较2期(12.84±0.79)升高,在起病时长≤4月患儿(13.66±1.78)较健康儿童(12.99±1.04)上升,差异有统计学意义(P<0.05);红细胞平均容积(MCV)在起病时长≤4月较对照组下降,起病时间>4月组较起病时长≤4月上升,差异有统计学意义(P<0.05)。结论 儿童NS患者的RBC、RDW较健康儿童升高,RDW在肾功能3期较2期升高。

Objective To investigate the relationship between red cell distribution width(RDW) and renal function damage in children with nephrotic syndrome(NS). Methods 168 NS patients were chosen as the observation group, divided into three groups by eGFR level, while also divided into two groups by onset duration of 4 months. 100 healthy children were included as the control group. The blood routine, biomedical function of liver and kidney were detected. Data were analyzed by SPSS 21.0. Results ① Compared to control group, NS patients have higher levels of RBC[(4.86±0.69) vs (4.32±0.48)] and RDW[(13.39±1.69) vs (12.99±1.04)], P<0.05; ② RDW is higher in the third phase of renal function than the second [(14.60±1.36) vs(12.84±0.79)], and also higher in the onset duration of less than 4 months group than the control group [(13.66±1.78) vs (12.99±1.04)], P<0.05; Mean corpuscular volume is lower in the onset duration group of less than 4 months than the control group, and higher in the onset duration group more than 4 months than the onset duration group of less than 4 months, P<0.05. Conclusion The RBC, RDW are higher in children NS patients than in the healthy children; RDW is higher in the third renal function than the second renal function.

目的 观察以“五物甘草生摩膏”为介质的膏摩法对小儿外感咳嗽的疗效及其社区应用价值。方法 90例符合纳入、诊断标准的患儿随机分观察组与对照组,观察组以“五物甘草生摩膏”为介质膏摩法干预;对照组服用玉屏风颗粒;疗程均为2个月,观察服药后1个月(治疗)以及停药后1年内(预防)的疗效。结果 不论是从近期疗效还是远期疗效观察,观察组的疗效更显著;观察组儿童外感咳嗽症状的发生率也明显低于对照组。结论 “五物甘草生摩膏”为介质的膏摩法对小儿外感咳嗽的疗效影响显著,值得在家庭和基层医疗机构中推广应用。