中国小儿急救医学最新文献_第4页

Etiological diagnosis and treatment of bronchoscopy in pediatric intensive care unit 儿科重症监护室支气管镜检查的病因诊断与治疗

中国小儿急救医学 Pub Date : 2020-01-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2020.01.004

B. Zhu, Xuan Xu

引用次数: 0

The BIG score and functional outcome at hospital discharge in children with traumatic brain injury 儿童颅脑损伤出院时BIG评分与功能转归

中国小儿急救医学 Pub Date : 2020-01-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2020.01.103

方伯梁, 钱素云

{"title":"The BIG score and functional outcome at hospital discharge in children with traumatic brain injury","authors":"方伯梁, 钱素云","doi":"10.3760/CMA.J.ISSN.1673-4912.2020.01.103","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-4912.2020.01.103","url":null,"abstract":"目的 \u0000探讨多发创伤患儿中合并脑外伤者入急诊科BIG评分(基础缺陷，INR，GCS)与出院时功能障碍[儿科脑功能表现分类(PCPC)≥4]之间的关系。 \u0000 \u0000 \u0000设计 \u00002001至2018年儿科创伤数据库回顾性队列研究。 \u0000 \u0000 \u0000场所 \u0000大学附属儿科医院一级创伤项目 \u0000 \u0000 \u0000对象 \u00002～17岁儿童遭受包括创伤性脑损伤(TBI)在内的重大钝性创伤，并符合创伤小组激活标准。 \u0000 \u0000 \u0000干预措施 \u0000无 \u0000 \u0000 \u0000测量方法与主要结果 \u0000由两名事先不知BIG分值的调查人员确定出院PCPC得分。到达急诊科时测量BIG分值。609例研究患儿年龄(9.7±4.4)岁，中位损伤严重程度评分为22(IQR 12)。171/609例(28%)PCPC≥4(初级结局)。校正神经外科手术需求(OR 2.83，95%CI 1.69-4.74)，瞳孔固定和扩张(OR 3.1，95%CI 1.49-6.38)，现场或转诊医院插管(OR 2.82，95%CI 1.35-5.87)和其他预后不良假定预测因子后，BIG构成了PCPC≥4的多变量预测因子(OR 2.39，95%CI 1.81-3.15)。BIG ROC曲线下面积为0.87(0.84-0.90)。使用最佳BIG拐点值≤8，出院时功能障碍的敏感度和净现值分别为93%和96%。GCS≤8的敏感度为79%，净现值为91%。GCS 3分患儿BIG评分与脑死亡相关(OR 2.13，95%CI 1.58-2.36)。BIG还预测住院患儿康复倾向(OR 2.26，95%CI 2.17-2.35)。 \u0000 \u0000 \u0000结论 \u0000BIG评分是一项简单且可快速获得的疾病严重程度评分，为TBI等创伤患儿出院时功能依赖的独立预测因子。BIG得分可能有助于创伤和神经重症监护项目在治疗窗口期确定TBI试验的理想入组对象。","PeriodicalId":68901,"journal":{"name":"中国小儿急救医学","volume":"27 1","pages":"49-49"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47864422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical study of fluid management in children with septic shock guided by ultrasound 超声引导下儿童感染性休克液体管理的临床研究

中国小儿急救医学 Pub Date : 2020-01-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2020.01.009

Yong Luo, P. Jin, Chun-yi Liu, H. Xie, Yu-ming Zhang

{"title":"Clinical study of fluid management in children with septic shock guided by ultrasound","authors":"Yong Luo, P. Jin, Chun-yi Liu, H. Xie, Yu-ming Zhang","doi":"10.3760/CMA.J.ISSN.1673-4912.2020.01.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-4912.2020.01.009","url":null,"abstract":"Objective \u0000To investigate the effects of critical care chest ultrasonic examination (CCUE) by intensive care physician on fluid management among septic shock patients in pediatric intensive care unit (PICU). \u0000 \u0000 \u0000Methods \u0000Forty children from PICU who were diagnosed as septic shock in Shenzhen Bao′an Maternal and Child Health Hospital were included in this study.Twenty-two of them who were hospitalized in PICU during January 2017 to December 2018, under the care of 4 PICU physicians who had certificates of the Chinese Critical Ultrasound Study Group(CCUSG) were defined as CCUE group.Eighteen PICU patients from January 2014 to December 2015 having no access to CCUE were recruited as control group.Both groups were treated according to the septic shock management guidelines with routine anti-shock and anti-infection therapy, as well as mechanical ventilation.Fluid management following conventional protocol was performed in the control group.While in the CCUE group, CCUE was applied to monitor the hemodynamic status for adjustment in fluid management. \u0000 \u0000 \u0000Results \u0000Compared with the control group, the CCUE group had shorter mechanical ventilation time as well as less fluid intake and output within 48 hours after admission[(4.68±2.06)d vs.(7.33±0.49)d, (6.34±1.85)ml/(kg·h) vs.(8.55±0.39) ml/(kg·h), (2.47±1.22)ml/(kg·h) vs.(6.18±1.72)ml/(kg·h)] (P 0.05). \u0000 \u0000 \u0000Conclusion \u0000Application of CCUE helps to optimize fluid management and shorten the ventilation time among children with septic shock in PICU. \u0000 \u0000 \u0000Key words: \u0000Septic shock; Fluid management; Critical care chest ultrasonic examination in emergency consultation","PeriodicalId":68901,"journal":{"name":"中国小儿急救医学","volume":"27 1","pages":"40-44"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48725620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Extrapulmonary complications of bronchopulmonary dysplasia in premature infants 早产儿支气管肺发育不良的肺外并发症

中国小儿急救医学 Pub Date : 2020-01-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2020.01.011

Lili Li, Rui Li, Guanghua Shao, Hong Jiang, Dongyun Liu

引用次数: 0

Correlation between the levels of plasma brain natriuretic peptide and coxsackie virus A6 in hand, foot and mouth disease 手足口病患者血浆脑钠肽水平与柯萨奇病毒A6的相关性

中国小儿急救医学 Pub Date : 2020-01-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2020.01.010

He Song, Yufeng Zhang, H. Deng, Jun Wang, Pengfei Xu, Juan Yuan, Ruiqing Liu, T. Tang

{"title":"Correlation between the levels of plasma brain natriuretic peptide and coxsackie virus A6 in hand, foot and mouth disease","authors":"He Song, Yufeng Zhang, H. Deng, Jun Wang, Pengfei Xu, Juan Yuan, Ruiqing Liu, T. Tang","doi":"10.3760/CMA.J.ISSN.1673-4912.2020.01.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-4912.2020.01.010","url":null,"abstract":"Objective \u0000To investigate the clinical value of plasma brain natriuretic peptide (BNP) levels in predicting the severity of hand, foot and mouth disease (HFMD) in children with coxsackie virus A6 (CV-A6) infection. \u0000 \u0000 \u0000Methods \u0000A total of 305 children with CV-A6 type HFMD admitted to Xi′an Children′s Hospital from January 2017 to December 2018 were divided into general group (200 cases) and severe group (105 cases) according to the severity of the disease.The receiver operating characteristic curve was used to calculate the value of plasma BNP levels to predict the severe CV-A6 HFMD.Multivariate logistic regression analysis was used to analyze the correlation between the related factors and the severity of CV-A6 HFMD. \u0000 \u0000 \u0000Results \u0000Compared with the normal group, children in the severe group had statistically significant differences in WBC level, BNP level, neurological symptoms, circulatory disorders, and blood glucose levels(all P 15×109/L, blood glucose> 8.3 mmol/L, and BNP>294.85 ng/L were related to the severity of CV-A6 HFMD(OR=2.275, P=0.013; OR=6.057, P=0.028; OR=1.008, P<0.001). \u0000 \u0000 \u0000Conclusion \u0000BNP>294.85 ng/L is closely related to the severity of CV-A6 HFMD and has predictive value.It is an early warning factor for the severity of CV-A6 HFMD. \u0000 \u0000 \u0000Key words: \u0000Hand, foot and mouth disease; Coxsackie virus A6; Brain natriuretic peptide; Risk factors","PeriodicalId":68901,"journal":{"name":"中国小儿急救医学","volume":"27 1","pages":"45-49"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42333949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Changes in Anesthetic and Postoperative Sedation-Analgesia Practice Associated with Early Extubation following Infant Cardiac Surgery: Experience from the Pediatric Heart Network Collaborative Learning Study 婴儿心脏手术后早期拔管相关麻醉和术后镇静镇痛实践的变化:来自儿科心脏网络协作学习研究的经验

中国小儿急救医学 Pub Date : 2020-01-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2020.01.101

方伯梁, 钱素云

{"title":"Changes in Anesthetic and Postoperative Sedation-Analgesia Practice Associated with Early Extubation following Infant Cardiac Surgery: Experience from the Pediatric Heart Network Collaborative Learning Study","authors":"方伯梁, 钱素云","doi":"10.3760/CMA.J.ISSN.1673-4912.2020.01.101","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-4912.2020.01.101","url":null,"abstract":"目的 \u0000儿科心脏网络赞助了多中心协作学习研究，该研究实施了一项临床实践指南以促进孤立性主动脉缩窄和法洛四联症修复术后婴儿早期拔管。本文试图比较在实施早期拔管指南前后手术室麻醉和ICU镇静镇痛管理的差异。 \u0000 \u0000 \u0000设计 \u0000对2013年1月至2015年4月一项多中心研究的数据进行二次分析，比较指南实施前后麻醉、镇静和镇痛暴露的预定义变量。倾向评分加权Logistic回归分析确定术中使用右美托咪啶对早期拔管的独立影响。 \u0000 \u0000 \u0000场所 \u00005家儿童医院 \u0000 \u0000 \u0000对象 \u0000240例接受主动脉缩窄或法洛四联症修复术患儿(指南实施前119例和指南实施后121例)。 \u0000 \u0000 \u0000干预措施 \u0000无 \u0000 \u0000 \u0000测量方法与主要结果 \u0000临床实践指南实施后阿片类药物(49.7 mg/kg比24.0 mg/kg芬太尼等效物，P<0.001)和苯二氮卓类(1.0 mg/kg比0.4 mg/kg咪达唑仑等效物，P<0.001)术中总剂量降低，但中位挥发性麻醉剂暴露没有变化(1.3比1.5 MAC-hrs，P＝0.25)。校正其他协变量后，术中使用右美托咪啶与早期拔管相关(OR2.5，95%CI：1.02-5.99，P＝0.04)。ICU中更多患者接受右美托咪啶(43%比75%)，但同时苯二氮卓类暴露频率(66%比57%，P<0.001)和累积中位剂量(0.5 mg/kg比0.3 mg/kg，P＝0.003)在指南执行后均降低。 \u0000 \u0000 \u0000结论 \u0000早期拔管临床实践指南减少了阿片类药物和苯二氮卓类药物剂量，而不改变手术室使用的挥发性麻醉剂。术中使用右美托咪啶与早期拔管独立相关。术后早期苯二氮卓类暴露总量减少。","PeriodicalId":68901,"journal":{"name":"中国小儿急救医学","volume":"27 1","pages":"4-4"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41897551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The lower respiratory tract microbiome in pediatric patients with ventilator-associated pneumonia 儿童呼吸机相关性肺炎患者的下呼吸道微生物组

中国小儿急救医学 Pub Date : 2020-01-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2020.01.012

Chunying Peng, G. Lu

引用次数: 0

A case of pyruvate dehydrogenase complex deficiency with sudden respiratory and cardiac arrest 丙酮酸脱氢酶复合物缺乏伴呼吸和心脏骤停1例

中国小儿急救医学 Pub Date : 2020-01-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2020.01.016

Moling Wu, H. Xie, Juan Chen, Yong Luo, Gang Zhou, Yuqiong Luo, P. Jin, Jin-ji Xu

{"title":"A case of pyruvate dehydrogenase complex deficiency with sudden respiratory and cardiac arrest","authors":"Moling Wu, H. Xie, Juan Chen, Yong Luo, Gang Zhou, Yuqiong Luo, P. Jin, Jin-ji Xu","doi":"10.3760/CMA.J.ISSN.1673-4912.2020.01.016","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-4912.2020.01.016","url":null,"abstract":"目的 \u0000探讨以呼吸心跳骤停为首发表现的丙酮酸脱氢酶复合物缺乏症患儿的临床、影像学特点及基因分析。 \u0000 \u0000 \u0000方法 \u0000对2017年深圳市宝安区妇幼保健院因突发呼吸心跳骤停就诊的1例丙酮酸脱氢酶复合物缺乏症患儿的临床特征、影像学资料进行总结，以\"丙酮酸脱氢酶复合物缺乏症\"、\"PDHA1\"等为关键词，查阅PubMed数据库、中国知识基础设施工程(CNKI)数据库、万方数据库建库至2019年3月相关文献，对国内报道的病例进行总结。 \u0000 \u0000 \u0000结果 \u0000先证者男，2个月10 d，感染后突发呼吸心跳骤停，伴高乳酸血症，难以纠正的代谢性酸中毒。头颅MRI检查提示：(1)双侧大脑基底节区异常信号，符合Leigh病影像学改变；(2)左侧室管膜下少许出血。脑电图提示异常放电。线粒体病相关基因检测提示PDHA1基因存在c.1132C>T，p.H378C半合突变。患儿于1岁时死亡。 \u0000 \u0000 \u0000结论 \u0000丙酮酸脱氢酶复合物缺乏症多以神经系统症状起病，以心跳呼吸骤停为突发表现的报道罕见，及时心肺复苏、呼吸机支持能暂时挽救生命，为原发病治疗争取时间，但最终预后差，病死率高。PDHA1基因c.1132C>T，p.H378C变异是其致病原因。","PeriodicalId":68901,"journal":{"name":"中国小儿急救医学","volume":"27 1","pages":"71-74"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45193726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Epidemiology of pediatric severe sepsis in main pediatric intensive care unit centers in Southwest China 西南地区主要儿科重症监护中心儿童严重脓毒症流行病学研究

中国小儿急救医学 Pub Date : 2020-01-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2020.01.102

方伯梁, 钱素云

{"title":"Epidemiology of pediatric severe sepsis in main pediatric intensive care unit centers in Southwest China","authors":"方伯梁, 钱素云","doi":"10.3760/CMA.J.ISSN.1673-4912.2020.01.102","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-4912.2020.01.102","url":null,"abstract":"目的 \u0000评估中国西南地区主要PICUs内儿童严重脓毒症的发病率、诊治及预后情况。 \u0000 \u0000 \u0000设计 \u0000前瞻性观察性多中心研究 \u0000 \u0000 \u0000场所 \u0000中国西南部8家PICUs，拥有19(13～24)张床位和1 322(1 066～1 452)年入院人数。 \u0000 \u0000 \u0000对象 \u00002016年9月1日至2017年8月31日共10 598例患者(29 d～18岁)连续入院。筛查和评估所有患者是否符合严重脓毒症或脓毒性休克。其中10 353例患者因数据不完整或不符合严重脓毒症或脓毒性休克共识标准而被排除；纳入245例数据完整患者。 \u0000 \u0000 \u0000干预措施 \u0000无 \u0000 \u0000 \u0000测量方法与主要结果 \u0000最终纳入245例诊断为严重脓毒症或脓毒性休克的患者，纳入率2.3%，其中男性占64.0%，<5岁占80.8%，农村患者占60.8%，呼吸系统是观察到功能不全的最常见器官(76.7%)，也是最常见的感染部位(37.6%)。主要治疗方法为抗生素(99.0%)，免疫球蛋白(88.3%)，机械通气(78.4%)，血管活性药物输注(59.6%)和皮质类固醇(46.1%)。188例呼吸功能不全患者中，173例(92%)需要机械通气，39例(20.7%)符合儿童急性呼吸窘迫综合征诊断标准。儿童急性呼吸窘迫综合征患者死亡7例(7/39，17.9%)。机械通气和血管活性药物中位持续时间分别为123.5(35.25～226.00)h和2(1～5)d。86%患者在脓毒症被识别时已合并多脏器功能障碍综合征，31%的患者合并基础疾病。住院病死率为18.8%。 \u0000 \u0000 \u0000结论 \u0000本研究首次报道了中国西南地区主要PICUs儿童严重脓毒症的发病率，治疗和预后。病死率仍然很高。因此改善临床诊治和实施大规模临床试验以提高早期诊断和治疗水平十分必要。","PeriodicalId":68901,"journal":{"name":"中国小儿急救医学","volume":"27 1","pages":"20-20"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43683843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Consistency of blood gas results of different arterial blood volume in the pediatric intensive care unit 小儿重症监护病房不同动脉血容量血气结果的一致性

中国小儿急救医学 Pub Date : 2020-01-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2020.01.017

Jie Zhang, Xiaohui Wang, Suyun Qian

引用次数: 0