过刊目录

2005年, 第20卷, 第07期
刊出日期：2005-07-25 上一期    下一期
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专题讨论
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临床经验
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短篇报道
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文献研究
临床经验
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病案报告
国家级继续医学教育专栏


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专题讨论

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药物与肝损害 朱朝敏,刘作义 2005, 20(07): 385-387 .  摘要 ( )

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药物性肾损伤 杨霁云 2005, 20(07): 387-390 .  摘要 ( )

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药物相关的神经损害 王华 2005, 20(07): 391-393 .  摘要 ( )

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药物相关的小儿皮肤损害 赵佩云,徐哲 2005, 20(07): 393-395 .  摘要 ( )

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儿童恶性肿瘤化疗及药物相关的脏器损害 张志泉,金润铭 2005, 20(07): 395-398 .  摘要 ( )

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常用急救药物对危重病儿脏器的损害 张育才,张宇鸣 2005, 20(07): 398-400 .  摘要 ( )

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中药引起的脏器损害 王雪峰 2005, 20(07): 400-403 .  摘要 ( )

论著

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新生儿青紫型先天性心脏病156例的早期诊治分析 贝斐,步军,黄萍,孙建华 2005, 20(07): 404-406 .  摘要 ( )   目的 了解青紫型先天性心脏病在新生儿期的临床表现、分布情况、治疗和转归。方法 1999年11月至2004年7月上海儿童医学中心对156例青紫型先天性心脏病(CHD)新生儿进行临床分析。结果 (1)青紫型CHD在新生儿期主要表现为中央性紫绀、心功能不全，个别可合并心律紊乱。(2)新生儿期青紫型CHD以完全性大动脉转位(TGA)居首位，其他依次为肺动脉闭锁(PA)、完全性肺静脉异位引流(TAPVC)和肺动脉狭窄(PS)。(3)内科治疗包括强心、利尿、扩血管药物和前列腺素E1(PGE1)的运用；156例中57例施行外科手术，其中以TGA最多。结论新生儿青紫型CHD心脏畸形复杂，病情多危重，在生后尽早明确诊断并给予适当的内外科治疗有助于提高其生存率和改善预后。 Abstract Objective To investigate the clinical manifestation,distribution,treatment and prognosis of congenital heart disease in neonatal period.Methods Analyze 156 cases of neonatal cyanotic congenital heart disease clinically.Results ① Neonatal cyanotic CHD was manifested with central cyanosis,heart failure,and arrhythmia occasionally.② DTGA stand first on the list of neonatal cyanotic CHD and the others ordinal was PA,TAPVC and PS.③ Internal medical therapy included using of cardiotonic,diuretic and prostaglandin E157 patients were given surgical operations and TGA lead the first.Conclusion For complex anomaly and critical condition in most cases,neonatal cyanotic CHD should be diagnosed as soon as possible and treated appropriately in order to improve the viability and prognosis of these neonates. Key words NeonateHeart disease;Congenital

临床经验

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盐酸头孢吡肟治疗小儿急性重症支气管肺炎20例疗效观察 杨跃辉,张玉峰,高英 2005, 20(07): 406-406 .  摘要 ( )

论著

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新生儿血培养中凝固酶阴性葡萄球菌细胞间粘附基因A和D的检测及临床意义 王亚娟,沈叙庄,高薇,胡翼云,俞桑洁,林影,王慧欣,何建平,杨永弘 2005, 20(07): 407-409 .  摘要 ( )   目的 探讨细胞间粘附基因(ica)A和icaD在新生儿凝固酶阴性葡萄球菌(CNS)败血症中的诊断意义。方法 收集北京儿童医院新生儿病房2001年11月至2003年3月间血培养为CNS的患儿为研究入选病例。通过应用聚合酶链反应(PCR)方法检测icaA及icaD的存在。结果 在80例入选患儿中，血培养均分离出CNS。根据新生儿败血症的诊断标准，临床诊断败血症27例(33.8%)，其中早产儿7例，足月小样儿2例。在菌种的分布上，表皮葡萄球菌18例(66.7%)，溶血葡萄球菌7例(25.9%)，人葡萄球菌2例(7.4%)。对90株CNS菌株应用PCR方法检测icaA及icaD，共有8株阳性，均为表皮葡萄球菌，并且icaA和icaD同时阳性。在经PCR扩增后所产生的图谱中，icaA在814bp，icaD在282bp。在ica阳性的8例病例中，临床诊断为败血症7例，一致率为87.5%，在临床排除败血症的53例患儿中，仅有1例ica阳性(1.8%)。ica的阳性预测值为259%，阴性预测值为981%。结论 ica基因PCR检测是临床诊断CNS败血症或导管相关感染的一种潜在的实验室方法。 Abstract Objective The purpose of this study was to assess whether the person making the clinical decision may benefit from the detection of icaA and icaD genes encoding putative virulent factors.Methods From Nov.2001 to Mar.2003,we detected the icaA and icaD genes in 80 neonates with a collection of clinical isolates from blood cultures by using a simple,rapid,and reliable PCR method.Results An overall total of 80 neonates with CNS strains from blood cultures were identified.There were 27 cases(33.8%)diagnosed neonatal sepsis clinically according to the standard,of which 7 were premature,2 were small for gestational age of full term infants.The distribution of species among the clinical CNS strains,18(66.7%)cases were Staphylococcus epidermidis,which was the leading cause,and then S.hemolyticus (n=7),S.hominis (n=2).There was a statistical difference in them.Of the 90 strains,eight were positive to icaA and icaD genes,with PCR products being obtained for the icaA and icaD genes in all of these strains,a 814bp band for the icaA gene and a 282bp band for the icaD gene.All of them were Staphylococcus epidermidis.Among 8 cases with positive ica genes,7 were diagnosed as sepsis clinically.The coincidence rate was 87.5%.Positive predictive value of the ica genes were 25.9%，and negative predictive value were 98.1%.Conclusion Ica genes may potentiate the clinical criteria used for the diagnosis of neonatal sepsis,and may discriminate between contamination and infections. Key words Coagulasenegative staphylococcus;PCR;Newborn

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早产儿支气管肺发育不良危险因素分析及防治措施 刘美娜,庄思齐,覃肇源,张红宇,李晓瑜 2005, 20(07): 410-412 .  摘要 ( )   目的 分析早产儿支气管肺发育不良(BPD)的发生率和危险因素，探讨防治BPD的措施。方法 回顾性分析中山大学第一附属医院新生儿科1999年6月至2004年6月期间胎龄≤32周且出生体重≤2000g，存活时间>28d的早产儿72例，比较机械通气治疗中15例BPD(BPD组)和31例非BPD(对照组)患儿性别、胎龄、出生体重、生前使用糖皮质激素、生后使用肺表面活性物质、肺透明膜病、机械通气时间、呼吸支持条件、胃食管反流、动脉导管未闭、生后早期液体摄取量、反复肺部感染情况。结果早产儿BPD的总发生率为20.83%(15/72)，其中<1500g早产儿BPD的发生率为38.71%(12/31)；BPD组FiO2、PIP、PEEP和MAP与对照组差异无显著性意义(P>0.05)；多因素Logistic回归显示，胎龄<30周、体重<1250g、机械通气≥10d和反复肺部感染是发生BPD的独立危险因素(P<0.05)，而性别、生前使用糖皮质激素、生后使用肺表面活性物质、肺透明膜病、胃食管反流、动脉导管未闭、生后早期液体摄取量没有统计学意义(P>0.05)。结论 避免低体重早产、长时间机械通气和有效控制肺部感染是防治BPD的关键。 Abstract Objective To study the incidence,risk factors,prophylaxis and treatment for bronchopulmonary dysplasia (BPD) in premature.Methods From June 1999 to June 2004 seventytwo prematures with gestational age less than 32 weeks,birth weight less than 2000 grams and surviving more than 28 days were enrolled in the study.Fifteen prematures with BPD were compared to thirty one prematures without BPD in terms of sex,gestational age,birth weight，usage of prenatal steroids,usage of postnatal surfactant,hyaline membrane disease,duration of mechanical ventilation,supportive conditions for ventilation,gastroesophageal reflux,patent ductus arteriosus,fluid intake in the first few days and recurrent pneumonia.Results The overall incidence of BPD in preterm newborns was 20.83%,and 38.71% in those infants weighting <1500g at birth；Fio2,PIP,PEEP and MAP were all not statistically significant between BPD group and control (P>0.05)；Multivariate logistic analysis revealed that gestational age less than 30 weeks,birth weight less than 1250 grams,prolonged mechanical ventilation (≥10days) and recurrent pneumonia were independent risk factors for BPD (P<0.05).Other factors including sex,usage of prenatal steroids,usage of postnatal surfactant,hyaline membrane disease,gastroesophageal reflux and excessive fluid intake in the first few days of life were not statistically significant (P>0.05).Conclusion Preventing small gestational age and low birth weight prematurity,shortening the duration of mechanical ventilation and controlling pneumonia were effective in preventing BPD. Key words Premature;Bronchopulmonary dysplasia;Risk factors

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早产儿甲状腺功能检测及分析 陈志红,李堂 2005, 20(07): 413-415 .  摘要 ( )   目的 研究早产儿甲状腺功能。方法 将青岛大学医学院附属医院2004年10月至2005年10月收治的早产儿60例按胎龄分成两组：小胎龄早产儿组(A组，胎龄<34周，n1=30)，大胎龄早产儿组(B组，胎龄≥34周，n2=30)。对照组为我院出生的正常足月儿30例，应用放免法对3组新生儿生后第1，7天血清游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)水平进行测定。结果 A、B组及对照组血清FT3、FT4生后1~7d呈下降趋势；对照组生后第1，7天血清FT3、FT4明显高于A、B组，B组明显高于A组；血清TSH在A、B及对照组生后呈下降过程；生后第1天对照组TSH>A组>B组；生后第7天，血清TSH A组高于B组和对照组，而B组与对照组差异无显著性。结论 早产儿生后甲状腺功能有暂时性低下，胎龄越小，功能越低，生后应激反应持续时间越长。 Abstract ObjectiveTo investigate the thyroid function in the premature infants.MethodsFrom Oct.2004 to Oct.2005 serum free triodothyrorine (FT3),free thyroxine (FT4) and thyrotropin (TSH) in 60 premature infants on the 1st,7th days after birth were detected by radioimmunoassay (RIA) and were compared with those in 30 normal neonate controls.The 60 premature infants were divided into two groups according to the gestational age:the very premature infants (the group A,less than 34 weeks of gestational age,n1=30) and the older gestational age infants (the group B,34~41 weeks of gestational age,n2=30).ResultsThe serum concentrations of FT3,FT4,TSH showed a declining tendency in all neonates from the 1st day to the 7th day after birth.The serum concentrations of FT3，FT4 on the 1st and 7th day after birth were significantly higher in the controls than those in group A and group B,and those in group B were also significantly higher than those in group A.The serum TSH on the 1st and 7th day after birth were significantly higher in the controls than those in both group A and B,and those in group A were also significantly higher than those in group B.On the 7th day after birth,the serum TSH in group A were higher than those in group B and controls,whereas the serum TSH were not significantly different between group B and controls.ConclusionThe thyroid function in the premature infants is transiently low.The shorter the gestational age,the lower the thyroid function and the longer the stress reaction. Key wordsPremature infants;Thyroid function

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新生儿感染时CD分子变化及临床意义 张金萍,陈超,杨毅 2005, 20(07): 415-417 .  摘要 ( )   目的 探讨不同胎龄新生儿感染时T、B、NK细胞及中性粒细胞表面CD分子变化及临床意义。方法 2004年2~6月复旦大学儿科医院用流式细胞仪检测34例早产儿及33例足月儿CD表达。结果(1)足月感染组CD3［(76.89±2.52)%］高于足月非感染组［(64.40±5.69)%］，早产非感染组［(80.93±9.13)%］高于足月非感染组；早产非感染组CD4［(61.20±2.21)%］高于足月非感染组［(47.60±4.27)%］，早产感染组［(53.63±3.23)%］低于早产非感染组；CD8各组间无统计学差异性。(2)CD19各组间无统计学差异性。(3)足月感染组CD56CD16［(5.88±0.62)%］低于非感染组［(13.00±5.31)%］，足月非感染组高于早产非感染组［(6.13±1.25)%］。(4)足月感染组CD64［(5056.92±1255.58)分子/单位］高于足月非感染组［(2112.60±1157.21)分子/单位］，早产感染组［(4619.67±1395.99)分子/单位］高于早产非感染组［(2407.45±1247.16)分子/单位］。(5)败血症、肺炎及其它感染组CD64高于非感染组。以CD64大于3000分子/单位为阳性，CD64诊断感染灵敏度为79.6%，特异度为75.1%；以CD64大于2000分子/单位为阳性，CD64诊断感染灵敏度为88.9%，特异度为60%；CRP诊断感染灵敏度为65.3%，特异度为86%。结论早产儿细胞表面CD3、CD4、CD16CD56变化不同于足月儿，可能与早产儿免疫功能低下有关；CD64可能会成为一种新型感染诊断指标。 Abstract ObjectiveTo evaluate the change and the clinical significance of the cell CD on the surface of T,B,NK and Neutrophils cells.MethodsFrom Feb. to June 2004,50 preterms and 49 terms with infection or noninfection were sturied.The level of peripherical blood CD3,CD4,CD8,CD19,CD16CD56 and CD64 were measured by flow cytometry.Results① The level of CD3 in terms(76.89±2.52)% with infection was higher than that in terms without infection(64.40±5.69)%.The level of CD3 in preterms without infection(80.93±9.13)%was significantly higher than that in terms without infection.The level of CD4 in preterms without infection(61.20±2.21)% was significantly higher than that in terms without infection(47.60±4.27)%.The level CD4 in preterms with infection (53.63±3.23)% was significantly lower than that in preterms without infection ；The level of CD8 was not different in all groups.②The level of CD19 has no difference in all groups.③The level of CD56CD16 in terms with infection(5.88±0.62)% was significantly lower than that in terms without infection(13.00±5.31)%，the level of CD56CD16in terms without infection was significantly higher than that in preterms without infection(6.13±1.25)%.④ The level of CD64 in terms with infecton (5056.92±1255.58)Molecule/Unit was higher than that in terms without infection (2112.60±1157.21)M/U.The level of CD64(4619.67±1395.99)M/U in preterms with infection was significantly higher than that in the preterms without infection(2407.45±1247.16)M/U.⑤The level of CD64 in patients with sepsis,pneumonia and other infections were higher than that in those patients without infection.If the positive standard of CD64 was over 3000 M/U,then the sensitivity was 79.6% and the specificity was 75.1%.If the positive standard of CD64 was over 2000 M/U,then the sensitivity was 88.9% and the specificity was 60%.The sensitivity of CRP was 65.3% and the specificity was 86%.Conclusion The level of CD3、CD4、CD16CD56 in preterms with or without infection differs from those in terms,which is probably due to the low immunity function of preterms.CD64 may be a kind of new diagnosis guideline. Key wordsTerms;Preterms;CD molecule;CD64

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新生儿肺部疾病支气管肺泡灌洗液肺表面活性蛋白A的检测及意义 吕回,黄晓虹,赵宁,陈晓文,陆玲,周伟,赖剑蒲,顾晓琼,赵小朋 2005, 20(07): 418-420 .  摘要 ( )   目的 探讨新生儿常见肺部疾病支气管肺泡灌洗液肺表面活性蛋白A(BAL SP-A)水平及其与临床的关系。方法 收集2000年1月至2003年2月在广州市儿童医院新生儿重症监护室住院的需行机械通气治疗的新生儿重症肺炎、胎粪吸入综合征(MAS)、急性呼吸窘迫综合征(ARDS)以及新生儿呼吸窘迫综合征(RDS)患儿共57例。测定其BAL SP-A水平，监测血气、PaO2/FiO2水平。结果重症肺炎组与MAS组患儿BAL SP-A水平无明显差异，但MAS组患儿PaO2、PaCO2及PaO2/FiO2水平较重症肺炎组明显降低(P值<0.01,<0.05,<0.05)；ARDS及RDS组患儿BAL SP-A水平均较上述两组低(P值均<0.001)，而RDS组患儿BAL SP-A水平较ARDS组低(P<0.001)，但ARDS组患儿PaO2水平较RDS组患儿低(P<0.05)。PS治疗组患儿的病死率较非PS治疗组明显降低(P=0.049)，其PaO2/FiO2与BAL SP-A水平密切相关(r=0.741,P=0.000)。结论 与重症肺炎患儿比较胎粪吸入综合征患儿BALSP-A水平无明显降低；ARDS及RDS患儿BAL SP-A水平明显降低；BAL SP-A水平能反映新生儿肺损伤的严重程度，对于新生儿肺部疾病预后的判断有一定意义。 Abstract ObjectiveTo investigate the bronchoalveolar lavage (BAL) SP-A concentrations from newborn infants with lung disease,and to study the relationship between BAL SP-A and clinical outcome.Methods 57 cases of newborn infants with lung disease were admitted in our NICU between Jan.2000 and Feb.2003.BAL SP-A concentrations,PO2 value,PCO2 value,and PaO2/FiO2 ratio were measured.ResultsBAL SP-A concentrations did not differ between severe pneumonia group and MAS group,but the value of PaO2、PaCO2 and PaO2/FiO2 ratio in MAS group were significantly lower than that in severe pneumonia group (p respectively<0.001,<0.05,<0.05).BAL SP-A concentrations in RDS and ARDS groups were significantly lower than that in aforesaid groups ( all P<0.05).BAL SP-A concentrations in RDS group were significantly lower than that in ARDS group,but PaO2 value in ARDS group was lower significantly than that in RDS group( P<0.05).The mortality of infants treated with PS was significantly lower than that of infants treated without PS (P=0.049).PaO2/FiO2 ratio for the cohort was related to their BAL SPA concentrations ( r=0.741,P=0.000).Conclusion Surfactant protein A content in MAS is not different from that of severe pneumonia.BAL SP-A concentrations of neonates with ARDS or RDS decrease significantly.BAL SP-A concentrations can evaluate the severity of lung injury and the prognosis of neonatal lung disease. Key wordsInfant,newbornLung disease;Bronchoalveolar lavae;Surfactant protein A

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喷托维林引起儿童精神症状1例 白海兰,张洁 2005, 20(07): 420-420 .  摘要 ( )

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新生儿重症感染降钙素原检测的诊断价值 赵美健,王丹,郭静,张宏艳,徐琦新 2005, 20(07): 421-423 .  摘要 ( )   目的 探讨降钙素原(PCT)在新生儿重症感染时的诊断价值。方法 将自2002年3~12月于天津市儿童医院新生儿科住院的229例新生儿分别归入无感染对照组(116例)，全身感染组(39例)，局部感染组(51例)和病毒感染组(23例)。检测入院时血清PCT和C-反应蛋白(CRP),白细胞计数及分类。用SPSS 10.0 For Windows进行数据分析。结果 在全身感染时，血清PCT和CRP质量浓度升高均有显著性，但PCT显著性更高(P<0.001)。PCT≥2μg/L作为全身感染的诊断依据，其敏感度(0.804)和特异度(0.824)均优于CRP。结论 与CRP和白细胞计数相比,PCT是一个较好的新生儿全身细菌感染的诊断指标。 Abstract Objective The aim of this research is to evaluate the diagnostic value of PCT in neonates with severe bacterial infectious disease.Methods 229 neonates admitted to Neonatology Department,Tianjin Children’s Hospital since March to December 2002 were divided into 4 groups:noninfection control(116),systemic bacterial infection (39),localized bacterial infection (51) and viral infection (23).Serum PCT and CRP were measured on admission;leucocyte count and differentiation was measured within 24 hours after admission.A serial measurement of PCT and CRP were taken during the course when necessary.Analyze data using SPSS 10.0 for Windows.Results Although both PCT and CRP significantly elevated in neonates with systemic bacterial infection,PCT revealed more sensitivity in systemic bacterial infection (P<0.001).The sensitivity and specificity of PCT to diagnose neonatal systemic bacterial infection using a cut off level 2 (μg/L) was 0.804 and 0.824,respectively.Conclusion PCT is a better diagnostic marker of neonatal systemic bacterial infection than CRP and leucocyte count. Key words Procalcitonin;Infection;C-reactive protein;Infant,neonate

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儿童IgA肾病红细胞和白细胞免疫粘附功能的检测分析 顾岚,蒋瑾瑾,何威逊 2005, 20(07): 424-424 .  摘要 ( )

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围生期窒息新生儿二氧化碳分压和pH值改变与神经系统损害的关系 肖春香 2005, 20(07): 425-426 .  摘要 ( )   目的 探讨围生期窒息新生儿PaCO2及pH快速变化及其与神经系统损害之间的关系。 方法 2002年1月至2003年12月南华大学第一附属医院将55例足月窒息新生儿分为3组：组Ⅰ，pH>7.00，无神经系统异常，无需呼吸支持；组Ⅱ，pH≤7.00，余同组Ⅰ；组Ⅲ，pH≤7.00，神经系统异常，需辅助呼吸支持。采集脐动脉血、产后1h和2h桡动脉血进行血气分析并观察Apgar评分和临床经过。 结果 脐动脉血pH值和PaCO2各组间差异有显著性；产后1h动脉血pH组Ⅰ、Ⅲ间和组Ⅱ、Ⅲ间差异有显著性；产后1h动脉血pH、PaCO2分别和脐动脉血pH、PaCO2比较，差异有显著性；三组间有不同的神经系统表现；Apgar评分组Ⅲ较低。 结论 在严重酸中毒时，胎儿出生后pH、PaCO2会发生显著改变，需持续辅助机械通气的患儿有不良的神经系统预后。 Abstract Objective To explore the relationship between the rapid changes in CO2 and pH value and neurologic injury in asphyxia infants in presence of severe academia. Methods Umbilical arterial blood and radial arterial blood at postnatal 1,2h were checked in 55 infants.These infants were categortized in three groups:Ⅰ,pH>7.00,normal neurologic examination without respiration support;Ⅱ,identification to Ⅰexcept pH≤7.00;Ⅲ,pH≤7.00,abnormal neurologic examination with mechanical ventilation. Results Umbilical arterial blood pH was significantly different in Ⅲ vs Ⅰ and in Ⅱ vs Ⅲ.PaCO2 was significantly different in Ⅲ vs Ⅱ vs Ⅰ.At postnatal 1h pH increased and PaCO2 decreased in all groups,significant differences in three group remained.At postnatal 2h,no differences were observed for pH and PaCO2 in Ⅱand Ⅲ,there was different neurologic prognosis among groups.Apgar score was lower in Ⅲ. Conclusion After delivery pH and PaCO2 have rapid changes in presence of severe academia.Lower pH and Apgar score with mechanical ventilation are poor prognosis factors of neurologic result. Key words Asphyxia;Acidosis;Blood gas;Newborn infants

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小剂量持续滴注芬太尼在早产儿机械通气中的镇痛作用 杨杰,刘瑛,吴开锋 2005, 20(07): 427-428 .  摘要 ( )   目的 评价小剂量芬太尼持续滴注对机械通气早产儿的镇痛作用、神经行为以及短期预后的影响。 方法 2000年10月至2003年10月，将广东省妇幼保健院新生儿科行机械通气治疗的36例早产儿随机分为实验组与对照组，实验组18例早产儿滴注芬太尼,平均剂量为(1.10±0.06)μg/(kg·h)，平均滴注时间为(65±5)h，对照组18例患儿，以相同滴注速度滴注注射用水。应用镇静行为评分评价患儿的镇静效果，并记录各患儿的通气指标以及预后数据。 结果 实验组的镇静行为评分显著低于对照组，2组的机械通气参数及短期预后无显著差异。 结论 短时间小剂量滴注芬太尼可降低机械通气的早产儿行为评分，并能取得良好的镇痛效果。 Abstract Objective To evaluate the effects of low dose fentanyl infusion analgesia on behavioural and neuroendocrine stress response and short term outcome in ventilated preterm infants.Methods From Oct.2000 to 2003,18 ventilated preterm infants were randomly assigned to receive a mean fentanyl infusion of (1.1±0.06)μg/(kg·h) for (65±5) hours,and 18 untreated infants were considered as the control groupA behavioural sedation score was used to assess the infants' behaviour.Outcome data and ventilatory indexes were recorded for each infant.Results The fentanyl group showed significantly lower behavioural stress scores than controls.The two groups showed no significant difference in ventilatory variables or short term outcome.Conclusion A short course of low dose fentanyl infusion reduces behavioural sedation scores and neuroendocrine stress response in preterm ventilated infants. Key wordsFentanyl;Pulmonary hyaline membrane disease;Stress response;Mechanical ventilation

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网织红细胞平均血红蛋白质量检测在小儿缺铁性贫血中的诊断价值 吕萍,张美和,宋文琪 2005, 20(07): 429-430 .  摘要 ( )   目的 探讨网织红细胞平均血红蛋白质量在小儿缺铁性贫血中的诊断价值。 方法 采用拜耳ADVIA120全自动血液分析仪检测50名健康儿童和59例临床诊断为缺铁性贫血患儿的外周血细胞和网织红细胞血红蛋白质量，同时用BeckmanCx9测定血清铁蛋白质量浓度，将所得数据进行统计学分析。 结果 血红蛋白(Hb)、平均红细胞体积(MCV)、单个网织红细胞平均血红蛋白(CHr)质量、血清铁蛋白(SF)在缺铁性贫血患儿明显低于健康儿童，而平均红细胞体积分布宽度(RDW)在缺铁性贫血患儿明显高于健康儿童。 结论 CHr质量作为诊断儿童缺铁性贫血的指标，具有重要的临床价值。 Abstract Objective To discuss the clinical value of reticulocyte hemoglobin content in children’s iron deficiency anemia. Methods Blood cell and CHr were counted by automated hematology analyzer (ADVIA120) in 50 healthy children and 59 IDA children,SF were tested by automated biochemistry analyzer (BeckmanCx9).Results Hb,MCV,CHr and SF were lower in IDA children than healthy children;RDW were higher in IDA children than healthy children.Conclusion CHr has important clinical value in diagnosing children’s iron deficiency anemia. Key wordsReticulocyte hemoglobin content;Iron deficiency anemia;Automated hematology analyzer

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圆锥动脉干畸形室间隔缺损的三维超声定量研究 陈国珍,孙锟,陈树宝,张玉奇 2005, 20(07): 431-432 .  摘要 ( )   目的 探讨三维超声心动图(3DE)在圆锥动脉干畸形(CTD)室间隔缺损(VSD)定量研究中的准确性及其临床意义。 方法 2000年5月至2003年11月在上海儿童医学中心住院且二维超声心动图(2DE)、经胸3DE、心血管造影及手术等定量测量结果完整的CTD患儿共63例，将3DE测量结果与2DE、造影及手术测值对比。 结果 方差分析、SNK均数间两两比较及相关分析显示，3DE VSD长径测值为1.69cm(从右室面)和1.63cm(从左室面)，虽较手术测值(1.84cm)低估，但低估程度小于2DE测值(1.27cm)及造影测值(1.12cm)；3DE与手术测值的相关性(r=0.74)明显高于2DE(r=0.39)及造影测值(r=0.25)。3DE VSD短径测值与造影测值相接近，两者比较无统计学差异(P＞0.05)。3DE VSD短径测值与2DE及造影测值的相关性(r=0.45，r=0.54)高于3DE VSD长径测值与2DE及造影测值的相关性(r=0.37，r=0.44)。3DE VSD面积测值与手术测值呈良好相关(r=0.57)。 结论 3DE可作为CTD VSD定量分析的又一无创手段，能提供较2DE更准确的定量诊断。 Abstract Objective To evaluate the accuracy and clinical value of transthoracic threedimensional echocardiographic (3DE) quantitative analysis in ventricular septal defect (VSD) of conotruncal defects (CTD).Methods From May 2000 to November 2003 in Shanghai Children Medical Center,there were 63 inpatients of CTD with all quantitative findings measured by 3DE,twodimensional echocardiography (2DE),angiocardiography and surgical findings.Their measurements of VSD sizes and areas with 3DE were compared with those with 2DE,angiocardiography and surgical findings.Results From the analysis of variance,StudentNewmanKeuls (SNK) test and correlation analysis,the measurements of VSD long diameter (mean 1.69cm in enface view of ventricular septa from right ventricle and 1.63 cm in enface view of ventricular septa from left ventricle) with 3DE was less than the measurements of VSD diameter (mean 1.84 cm) with surgical findings,but they were better correlated with those with surgical findings (r=0.74) than the measurements of VSD diameter (mean 1.27 cm) with 2DE (r=0.39) and those (mean 1.12 cm) with angiocardiography (r=0.25).However,the measurements of VSD short diameter with 3DE was close to those with angiocardiography,and there was no significant difference (P>0.05) between them.The measurements of VSD short diameter with 3DE were better correlated with those with 2DE and angiocardiography than the measurements of VSD long diameter with 3DE.Meanwhile,the measurements of VSD area with 3DE were well correlated with the measurements of VSD diameter with surgical findings (r=0.57).Conclusion 3DE can provide more accurate quantitative diagnosis in CTD VSD than 2DE. Key words Conotruncal defects;Threedimensional echocardiography;Twodimensional echocardiography;Ventricular septal defect

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法洛四联症根治术后急性肺损伤的治疗 朱丽敏,徐卓明,陈玲,史珍英,周燕萍,蔡及明,李志浩 2005, 20(07): 433-435 .  摘要 ( )   目的 分析法洛四联症(TOF)根治术后急性肺损伤(ALI)的原因，总结治疗体会。 方法 2003年7月至2004年6月，上海第二医科大学附属新华医院上海儿童医学中心心胸外科共行TOF根治术161例，发生ALI 5例。记录5例ALI患儿术前经皮氧饱和度(SpO2)、红细胞压积比(HCT)、McGoon比值、肺动脉指数(PAI)和手术、体外循环(CPB)资料，以及ALI发生时间、ALI发生后各项治疗措施、各治疗阶段肺功能指标、计算其肺损伤分数。 结果 5例ALI患儿，年龄7~24(13.8±3.1)个月，体重7.0~9.5(8.2±0.5)kg，均在静吸复合麻醉CPB下进行，术毕给予改良超滤，平均CPB时间(67.2±5.9)min，主动脉阻断时间(43.6±2.4)min，ALI发生率为3.1%，发生时间为术后8~60h，死亡2例。5例均施行腹膜透析术(PD)，2例给予一氧化氮吸入，1例给予肺表面活性物质替代治疗。各治疗阶段肺功能指标逐步改善，至治疗后期，肺功能指标在统计学上有显著性差异(P<0.05)。 结论 TOF术后ALI治疗困难，合理机械通气、尽早维持体液平衡、改善肺通气和氧合功能有利于及时阻断低氧酸中毒导致的恶性循环。 Abstract Objective To analyse the reasons of acute lung injury (ALI) after the surgical correction of tetralogy of Fallot (TOF) and summarize the postoperative treatment skill.Methods There were 161 cases of patients with TOF who underwent corrective repair operation in the Department of Cardiovascular Surgery of Xinhua Hospital/ Shanghai Children’s Medical Center from Jul.2003 to Jun.2004,in which there were 5 patients who developed ALI after the surgical correction of TOF.The mean age was 13.8±3.06 months (7~24 months) and the mean body weight was (8.20±0.46)kg (7~9.5kg).Before operation,their mean SpO2 was (72.8±2.2)% (67%~80%),mean HCT was (49.0±5.5)%,mean McGoon ratio was (1.27±0.05) and mean PAI was (136.0±16.8)mm2/m2.The total cardiopulmonary bypass (CPB) time and aortic clamp time were (67.2±3.9) min and (43.6±2.4) min,respectively.The modified ultrafiltration was used throughout the CPB.The treatment and the blood analysis were recorded when the ALI developed.The parameters of pulmonary function and lung injury score were calculated.Results ALI developed (30.0±9.7) hrs after the operation and the incidence of ALI after the surgical correction of TOF was 3.1%.Two cases died within 48 hrs.Peritoneal dialysis (PD) was performed on all the cases.Meanwhile,2 cases were given inhaled nitric oxide (NO) and 1 case was given pulmonary surfactant (PS).The parameters of pulmonary function were improved step by step and the differences were statistically significant at the latest stage of treatment (P<0.05).Conclusion The treatment of ALI after surgical correction of TOF includes reasonable mechanical ventilation and maintaining the balance of fluid.Inhaling NO and using PS will be benefitial to improve the pulmonary function and to stop the vicious circle which results in the hypoxemia and refractory acidosis. Key wordsTetralogy of Fallot;Acute lung injury;Cardiopulmonary bypass

文献研究

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儿童系统性红斑狼疮相关纯红细胞再生障碍性贫血1例报告并文献复习 张丽,邹尧,陈玉梅,赵辉,王书春,陈鲁宁,竺晓凡 2005, 20(07): 436-438 .  摘要 ( )

临床经验

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化疗联合免疫治疗对儿童非霍奇金淋巴瘤TNFα和细胞氧化作用的影响 徐翠琼,费世暖,黄佩 2005, 20(07): 438-438 .  摘要 ( )

讲座

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影像学检查对联体儿的诊断价值 刘艳,朱铭,金彪 2005, 20(07): 439-440 .  摘要 ( )

综述

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早产儿视网膜病 刘俐,. 2005, 20(07): 441-443 .  摘要 ( )

病案报告

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家族遗传性小儿红斑性肢痛综合征2例 钟迅 2005, 20(07): 444-444 .  摘要 ( )

国家级继续医学教育专栏

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儿童腹部影像学诊断;第7讲 儿童先天性食管和胃肠畸形影像诊断(二) 邵剑波,叶滨宾 2005, 20(07): 445-447 .  摘要 ( )