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Diagnosis and emergency treatment of bronchial foreign body by fiberoptic bronchoscopy 纤维支气管镜下支气管异物的诊断与急救
Pub Date : 2020-01-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2020.01.001
Xuan Xu
Tracheobronchial foreign body aspirations may cause cardiopulmonary arrest and sudden death.The incidence in children is higher than in adults.Rapid diagnosis and treatment are live saving.In this paper, we aimed to present our experience in tracheal foreign body aspirations by fiberoptic bronchoscopy. Key words: Tracheobronchial foreign body aspirations; Children; Bronchoscopy
气管支气管异物入网可引起心肺骤停和猝死。儿童的发病率高于成人。快速诊断和治疗可以挽救生命。在本文中,我们旨在介绍我们在纤维支气管镜下气管异物取出的经验。关键词:气管支气管异物;孩子;支气管镜检查
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引用次数: 0
A case report of congenital hyperinsulinemia with focal hyperplasia of the pancreas and literature review 先天性高胰岛素血症伴胰腺局灶性增生1例报告及文献复习
Pub Date : 2020-01-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2020.01.015
Xiangwen Hu, S. Zeng, Yimin Zhu, Tian Yu, Bing Zhang, Tao Wang
目的 探讨先天性高胰岛素血症(CHI)患儿的临床特征、组织学分型,为儿科工作者提供诊断和治疗经验。 方法 回顾性分析我院收治的1例局灶增生型CHI患儿临床资料及预后,同时复习相关文献。 结果 患儿因反复低血糖、抽搐入院,我院诊断CHI,外院进一步18F-Dopa PET-CT及组织病理学检查,确诊为局灶增生型CHI。手术病灶切除治疗有效,随访血糖正常,但继发癫痫。 结论 CHI比较罕见,并且具有致死性及遗留神经系统后遗症,临床医生依据临床特征对高度怀疑CHI的患儿,应尽早完善18F-Dopa PET-CT检查,有助于早期确定CHI组织学分型,且能指导CHI的远期临床管理,减少神经系统损伤。
Objective: To explore the clinical characteristics and histological subtypes of congenital hyperinsulinemia (CHI) in children, and to provide diagnostic and therapeutic experience for pediatric workers. Method: A retrospective analysis was conducted on the clinical data and prognosis of a case of focal proliferative CHI admitted to our hospital, while reviewing relevant literature. The patient was admitted to the hospital due to repeated hypoglycemia and convulsions. Our hospital diagnosed CHI, and further 18F Dopa PET-CT and histopathological examinations in other hospitals confirmed the diagnosis of focal proliferative CHI. Surgical lesion resection was effective, and blood glucose levels were normal during follow-up, but secondary epilepsy occurred. Conclusion: CHI is relatively rare and has lethal and residual neurological sequelae. Clinicians should improve the 18F-Dopa PET-CT examination as early as possible for highly suspected CHI patients based on clinical characteristics, which helps to determine the histological classification of CHI in the early stage and can guide the long-term clinical management of CHI, reducing neurological damage.
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引用次数: 0
A multicenter network assessment of three inflammation phenotypes in pediatric sepsis induced multiple organ failure 儿童败血症引起多器官衰竭的三种炎症表型的多中心网络评估
Pub Date : 2020-01-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2020.01.104
方伯梁, 钱素云
目的 成人脓毒症临床试验正在评估针对三种炎症表型的治疗方法,包括:(1)免疫麻痹相关;(2)血栓性微血管病变所致血小板减少相关;(3)序贯性肝衰竭相关。这三种表型尚无儿科多中心评估。本文假设这些表型与儿童脓毒症中巨噬细胞活化反应综合征发生率和病死率增加相关,并进行验证。 设计 前瞻性严重脓毒症队列研究。比较多脏器衰竭合并任一表型,多脏器衰竭无上述表型及单脏器衰竭患儿。 场所 Eunice Kennedy Shriver国立儿童健康和人类发展研究所儿科重症医学研究网络内的9家PICUs。 对象 留置动脉或中心静脉导管的严重脓毒症患儿。 干预措施 临床数据收集和每周两次血样本采集直至PICU入院第28天或离开PICU。 测量方法与主要结果 401例入选严重脓毒症病例中,112例(28%)单脏器衰竭(巨噬细胞活化反应综合征0%,0/112;病死率<1%,1/112),289例(72%)多脏器衰竭(巨噬细胞活化反应综合征9%,24/289;病死率15%,43/289)。多脏器功能衰竭且合并表型患儿总体病死率较高(24/101比20/300;RR 3.56,95%CI 2.06-6.17)。与无炎症表型的188例多脏器功能衰竭患儿相比,合并表型的101例患儿巨噬细胞活化反应综合征发生率(19%比3%;RR 7.07,95%CI 2.72-18.38)和病死率(24%比10%;RR2.35,95%CI 1.35-4.08)均增加。 结论 这三种炎症表型与脓毒症所致多脏器功能衰竭儿童巨噬细胞活化反应综合征发生率和病死率增加有关。本研究为设计针对儿童炎症表型的多中心临床试验提供了推动和必要的基线数据。
目的 成人脓毒症临床试验正在评估针对三种炎症表型的治疗方法,包括:(1)免疫麻痹相关;(2)血栓性微血管病变所致血小板减少相关;(3)序贯性肝衰竭相关。这三种表型尚无儿科多中心评估。本文假设这些表型与儿童脓毒症中巨噬细胞活化反应综合征发生率和病死率增加相关,并进行验证。 设计 前瞻性严重脓毒症队列研究。比较多脏器衰竭合并任一表型,多脏器衰竭无上述表型及单脏器衰竭患儿。 场所 Eunice Kennedy Shriver国立儿童健康和人类发展研究所儿科重症医学研究网络内的9家PICUs。 对象 留置动脉或中心静脉导管的严重脓毒症患儿。 干预措施 临床数据收集和每周两次血样本采集直至PICU入院第28天或离开PICU。 测量方法与主要结果 401例入选严重脓毒症病例中,112例(28%)单脏器衰竭(巨噬细胞活化反应综合征0%,0/112;病死率<1%,1/112),289例(72%)多脏器衰竭(巨噬细胞活化反应综合征9%,24/289;病死率15%,43/289)。多脏器功能衰竭且合并表型患儿总体病死率较高(24/101比20/300;RR 3.56,95%CI 2.06-6.17)。与无炎症表型的188例多脏器功能衰竭患儿相比,合并表型的101例患儿巨噬细胞活化反应综合征发生率(19%比3%;RR 7.07,95%CI 2.72-18.38)和病死率(24%比10%;RR2.35,95%CI 1.35-4.08)均增加。 结论 这三种炎症表型与脓毒症所致多脏器功能衰竭儿童巨噬细胞活化反应综合征发生率和病死率增加有关。本研究为设计针对儿童炎症表型的多中心临床试验提供了推动和必要的基线数据。
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引用次数: 0
Three cases of phosphine poisoning misdiagnosed as fluoroacetamide poisoning and literature review 膦中毒误诊为氟乙酰胺中毒3例并文献复习
Pub Date : 2020-01-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2020.01.014
Yujuan Wang, Youpeng Jin, C. Zhao, Zhengyun Sun, Wei Wang
目的 探讨儿童磷化氢中毒的临床特点及诊疗,进一步减少该病的误诊、漏诊率及病死率。 方法 总结2018年我院小儿重症医学科收治的误诊为氟乙酰胺中毒的磷化氢中毒病例3例,对3例患儿的临床特点、治疗情况及预后进行总结分析。 结果 3例患儿均以恶心、呕吐起病,以神经系统及心血管系统损害为主,误诊为氟乙酰胺中毒。后经详细追问病史,确诊为磷化氢中毒。经过血液净化、维生素C、甲泼尼龙、磷酸肌酸以及必要的呼吸循环支持等治疗后,2例痊愈出院,1例临床死亡。 结论 急性磷化氢中毒病死率高,对于婴幼儿,当家长提供磷化铝或磷化锌等毒物接触史或可疑接触史时,要注意是否发生磷化氢中毒,并尽早给予血液净化治疗,为救治患儿争取时间,改善预后。
Objective: To explore the clinical characteristics and diagnosis and treatment of phosphine poisoning in children, and further reduce the misdiagnosis, missed diagnosis rate, and mortality rate of the disease. Method: Three cases of phosphine poisoning misdiagnosed as fluoroacetamide poisoning admitted to the pediatric intensive care department of our hospital in 2018 were summarized and analyzed for their clinical characteristics, treatment status, and prognosis. The results showed that all 3 patients developed nausea and vomiting, with neurological and cardiovascular system damage being the main symptoms. They were misdiagnosed as fluoroacetamide poisoning. After detailed investigation of the medical history, it was diagnosed as phosphine poisoning. After treatment with blood purification, vitamin C, methylprednisolone, creatine phosphate, and necessary respiratory and circulatory support, 2 cases recovered and were discharged, while 1 case died clinically. Conclusion: Acute phosphine poisoning has a high mortality rate. For infants and young children, when parents provide a history of exposure to toxic substances such as aluminum phosphide or zinc phosphide or a suspected history of exposure, attention should be paid to whether phosphine poisoning has occurred, and blood purification treatment should be given as soon as possible to buy time for treating the child and improve prognosis.
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引用次数: 0
Preoperative, intraoperative and postoperative nursing coordination of soft bronchoscope in pediatric intensive care unit 小儿重症监护室软支气管镜术前、术中、术后的护理配合
Pub Date : 2020-01-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2020.01.005
Xiaoli Shen, Xuan Xu
Primary and secondary airway problems directly affect mortality and disability in critically ill children in pediatric intensive care unit(PICU). Soft bronchoscope, as an important method for the diagnosis and interventional treatment of airway lesions in critically ill children in PICU, requires standardized seamless nursing cooperation throughout the whole process.This article discussed the nursing cooperation before, during and after soft bronchoscope operation in PICU. Key words: Soft bronchoscope; Perioperative; Children; Nurse
原发性和继发性气道问题直接影响儿科重症监护病房(PICU)危重患儿的死亡率和致残率。软支气管镜作为PICU重症患儿气道病变诊断和介入治疗的重要手段,需要全程规范化的无缝护理配合。探讨PICU软支气管镜手术前、中、后的护理配合。关键词:软支气管镜;围手术期;孩子;护士
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引用次数: 0
Bronchoscopy in the diagnosis and treatment of severe pneumonia in pediatric intensive care unit 支气管镜在小儿重症监护病房重症肺炎诊治中的应用
Pub Date : 2020-01-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2020.01.002
Yun-gang Yang
Severe pneumonia is a common respiratory disease in pediatric intensive care unit(PICU). Airway lesions can be observed and specimens can be obtained by bronchoscopy to help to diagnose the cause and pathogen of severe pneumonia.For severe pneumonia, bronchoscopy interventional therapy is mainly used to relieve airway obstruction, remove necrosis material in the airway, and administer locally.In addition, bronchoscopy can guide tracheal intubation in the rescue of severe pneumonia.In conclusion, bronchoscopy is used in children with severe pneumonia in PICU, which can improve the diagnosis rate, improve the function of ventilation, and shorten the hospitalization time.It is worthy of clinical promotion and application. Key words: Bronchoscopy; Severe pneumonia; Pediatrics; Interventional therapy
重症肺炎是儿科重症监护病房(PICU)常见的呼吸系统疾病。支气管镜检查可观察气道病变并获取标本,有助于诊断重症肺炎的病因和病原体。对于重症肺炎,支气管镜介入治疗主要用于缓解气道阻塞,清除气道内坏死物质,局部给药。此外,在重症肺炎的抢救中,支气管镜检查可以指导气管插管。综上所述,在PICU重症肺炎患儿中应用支气管镜检查,可提高诊断率,改善通气功能,缩短住院时间。值得临床推广应用。关键词:支气管镜检查;重症肺炎;儿科;介入治疗
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引用次数: 0
Glucocorticoid treatment of sepsis 糖皮质激素治疗败血症
Pub Date : 2020-01-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2020.01.006
Yun Cui, B. Ning, S. Zeng
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引用次数: 0
Implement of flexible bronchoscopy in diagnosis and management of pediatric upper airway obstruction 柔性支气管镜在小儿上呼吸道阻塞诊断和治疗中的应用
Pub Date : 2020-01-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2020.01.003
Ying Zhao, Wei Xu
Acute upper airway obstruction is a very common urgent situation in pediatric emergency.It includes several types of disease, mostly classified as infectious and noninfectious.Children are dying with delayed diagnosis and airway clear.Except traditional techniques and rigid bronchoscopy, flexible bronchoscopy would be a very convenient and handable way in diagnosis and management of upper airway obstruction in children.Herence, we presented etiologies of upper airway obstruction and how could flexible bronchoscopy reveal and(or) manage them. Key words: Children; Upper airway obstruction; Flexible bronchoscopy; Diagnosis; Management
急性上气道阻塞是儿科急症中非常常见的急症。它包括几种类型的疾病,主要分为传染性和非传染性。儿童因诊断延误和气道通畅而死亡。除了传统的方法和刚性支气管镜检查外,柔性支气管镜检查是诊断和治疗儿童上气道阻塞的一种非常方便易行的方法。因此,我们提出了上气道阻塞的病因,以及柔性支气管镜如何发现和(或)处理它们。关键词:儿童;上呼吸道阻塞;灵活的支气管镜检查;诊断;管理
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引用次数: 0
Nephrotic syndrome and atopic diseases in children 儿童肾病综合征与特应性疾病
Pub Date : 2020-01-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2020.01.013
Yue-zhong Zheng, Xiuli Wang, L. Hou, Chengguang Zhao, Yang Yang, Yue Du
Nephrotic syndrome is a common glomerular disease in childhood and easy to recur.It has been found that children with nephrotic syndrome are often accompanied by atopic manifestations and there is high co-morbidity between nephrotic syndrome and atopic diseases.This article reviewed the pathogenesis, cytokines and treatment of nephrotic syndrome and atopic diseases in children to explore the similarity between them to provide new clues and methods for the treatment of nephrotic syndrome in children. Key words: Children; Nephrotic syndrome; Atopic diseases; Similarity
肾病综合征是儿童常见的肾小球疾病,易复发。研究发现,肾病综合征患儿常伴有特应性表现,肾病综合症与特应性疾病合并发病率高。本文综述了儿童肾病综合征和特应性疾病的发病机制、细胞因子和治疗方法,探讨它们之间的相似性,为儿童肾病综合症的治疗提供新的线索和方法。关键词:儿童;肾病综合征;特应性疾病;相似性
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引用次数: 0
Epidemiological characteristics of acute paraquat poisoning in children in southwest Shandong and related factors of pulmonary interstitial fibrosis 鲁西南地区儿童急性百草枯中毒的流行病学特征及肺间质纤维化的相关因素
Pub Date : 2020-01-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2020.01.007
Mengxiao Shen, Jinlong Liu, Lei Han, Xuemei Sun, S. Dong, Cheng-jun Liu, Baohai Shi, Hongfeng Zhu, Liping Chen, Tong Chen, Liwen Li, Bo Li, Zhaohua Zhang, Youpeng Jin
Objective To analyze the epidemiological characteristics of acute paraquat(PQ)poisoning in children in southwest Shandong, and the risk factors for pulmonary interstitial fibrosis. Methods This retrospective study was performed on the clinical data of children with acute PQ poisoning admitted from January 2013 to December 2017 in 12 hospitals in southwest Shandong.All participants were divided into pulmonary interstitial fibrosis group and no pulmonary interstitial fibrosis group on the basis of the chest CT 14 days after poisoning.The epidemiological characteristics and risk factors of pulmonary interstitial fibrosis were analyzed. Results During the study period, a total of 307 children with acute PQ poisoning were admitted to 12 hospitals, of which 61 (19.87%) were suffering from acute PQ poisoning.Forty-nine cases with complete clinical data were analyzed, including 26 male and 23 female patients poisoned by oral.The age distribution ranged from 8 months to 14 years.Poisoning mainly occured from July to September of each year.The mortality of acute PQ poisoning was 8.2%(4/49), and the incidence of pulmonary interstitial fibrosis in survival patients was 44.4%(20/45). Statistical differences (P<0.05) were found between the pulmonary interstitial fibrosis and no pulmonary interstitial fibrosis, with regard to the times of blood purification, the time from poison exposure to blood purification, the application rate of glucocorticoids, the concentration of PQ in urine, the pediatric critical illness score, the time from poison exposure to gastric lavage, the white blood count at admission, serum creatinine, arterial blood lactate, PaO2, PaCO2, and PaO2/FiO2; however, there was no significant difference in the proportion of blood purification treatment, the mode of blood purification treatment, alanine aminotransferase, aspartate aminotransferase, urea nitrogen, creatine kinase and troponin.Stepwise logistic regression analysis showed that the time from exposure to poison to gastric lavage(OR=0.683, 95%CI 0.210-2.222)and to blood purification(OR=0.0133, 95%CI 0.004-0.042), the times of blood purification(OR=2.862, 95%CI 1.450-5.648), concentration of PQ in urine(OR=1.435, 95%CI 1.085-1.898), and the use of glucocorticoids(OR=0.190, 95%CI 0.048-0.757) were the risk factors for pulmonary interstitial fibrosis(P<0.05). Conclusion Early gastric lavage and blood purification, increasing the frequence of adminitrating purification appropriately, using low-dose glucocorticoids can reduce the incidence of pulmonary interstitial fibrosis of children with acute PQ poisoning. Key words: Paraquat poisoning; Children; Blood purification; Pulmonary interstitial fibrosis; Glucocorticoids
目的分析鲁西南地区儿童急性百草枯(PQ)中毒的流行病学特征及肺间质纤维化的危险因素。方法回顾性分析鲁西南地区12家医院2013年1月至2017年12月收治的急性PQ中毒患儿的临床资料。根据中毒后14天的胸部CT结果将所有参与者分为肺间质纤维化组和无肺间质纤维化组。分析肺间质纤维化的流行病学特点及危险因素。结果12家医院共收治急性PQ中毒患儿307例,其中急性PQ中毒患儿61例(19.87%)。分析临床资料完整的49例,其中男性26例,女性23例。年龄分布为8个月~ 14岁。中毒主要发生在每年的7 - 9月。急性PQ中毒死亡率为8.2%(4/49),存活患者肺间质纤维化发生率为44.4%(20/45)。肺间质纤维化组与非肺间质纤维化组在血液净化次数、中毒接触至血液净化时间、糖皮质激素使用率、尿中PQ浓度、小儿危重症评分、中毒接触至洗胃时间、入院时白细胞计数、血清肌酐、动脉血乳酸、PaO2、PaCO2、PaO2/FiO2等方面差异均有统计学意义(P<0.05);但在血液净化治疗比例、血液净化治疗方式、丙氨酸转氨酶、天冬氨酸转氨酶、尿素氮、肌酸激酶、肌钙蛋白等方面差异无统计学意义。逐步logistic回归分析显示,从中毒到洗胃时间(OR=0.683, 95%CI 0.210 ~ 2.222)、血液净化时间(OR=0.0133, 95%CI 0.004 ~ 0.042)、血液净化次数(OR=2.862, 95%CI 1.450 ~ 5.648)、尿PQ浓度(OR=1.435, 95%CI 1.085 ~ 1.898)、使用糖皮质激素(OR=0.190, 95%CI 0.048 ~ 0.757)是肺间质纤维化的危险因素(P<0.05)。结论早期洗胃和血液净化,适当增加给药净化次数,使用小剂量糖皮质激素可降低急性PQ中毒患儿肺间质纤维化的发生率。关键词:百草枯中毒;孩子;血液净化;肺间质纤维化;糖皮质激素
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引用次数: 0
期刊
中国小儿急救医学
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