• 主題
高級搜索  >
歷史搜索 清空歷史
您現在的位置：首頁> 中文期刊>醫藥衛生>婦產科學與兒科學>中國實用兒科雜志

中國實用兒科雜志

中國實用兒科雜志

北大核心

CSCD

CSTPCD

Chinese Journal of Practical Pediatrics
本刊為兒科專業學術期刊，辦刊宗旨“面向臨床、注重實用、提高兒科臨床醫生水平”。本刊報道兒科領域新成果、新技術、新進展、交流成熟的臨床經驗、注重臨床研究，兼顧基礎研究。
  • 發文量：6947
  • 被引量：3133
  • H指數：3
  • 開始收錄時間：1988(2)
  • CNKI綜合因子：1.063
  • 維普期刊影響因子： 1.726
  • 萬方期刊影響因子：1.55
  • 創刊時間：1986
  • 國內刊號/CN：21-1333/R
    國際刊號/ISSN：1005-2224
  • 發行周期：月刊
    郵發代號：8-171
  • 主管單位：中華人民共和國衛生部
    主辦單位：中國醫師協會、中國實用醫學雜志社
中國實用兒科雜志-聯系信息
  • 主編：薛辛東
  • 電話：024-23866457
  • 郵箱：[email protected]
  • 地址：沈陽市和平區南京南街9號
  • 郵編：110001
中國實用兒科雜志-獲獎情況
  • ? 全國優秀科技期刊
  • ? 中國期刊方陣“雙效”期刊
  • 收錄匯總
  • 刊內文獻檢索
  • 投稿信息

刊期瀏覽

相關中文期刊

相關中文會議

相關外文期刊

相關外文會議

最新期刊

熱門期刊

中國實用兒科雜志 >2021年第11期

學科

年度

全選（0）
排序：
共4384條結果
  • 摘要：目的 評價應用FLAG方案治療兒童難治及復發急性髓細胞白血病的療效及毒性反應.方法 2004年4月至2011年6月,共8例難治及復發急性髓細胞白血病患兒在中山大學孫逸仙紀念醫院兒科接受了FLAG方案治療,對患兒的臨床資料進行回顧性分析.結果 1個療程后,完全緩解率為75％(6/8),部分緩解率為25％(2/8),總有效率為100％.5例難治患兒中,3例達完全緩解,CR率60％,3例復發患兒均達完全緩解.該方案的主要毒副反應是感染、骨髓抑制和胃腸道反應.結論 FLAG方案是治療兒童難治及復發急性髓細胞白血病一個選擇,可為造血干細胞移植提供機會.
  • 摘要：2011年10月美國兒科學會(AAP)發布了新的注意缺陷多動障礙(attention deficit hyperactivity disorder,ADHD)指南——《兒童青少年ADHD診斷、評估和治療臨床實用指南》[1].AAP首次發表的臨床指南是2000年的《ADHD兒童診斷與評估指南》[2];隨后,2001年發表了《ADHD兒童治療指南》[3].ADHD是兒童時期最常見的一種神經行為障礙,美國學齡期兒童ADHD患病率為3％～5％[4].中國人群ADHD發生率也在逐漸增高,但目前尚無大樣本流行病學調查資料.ADHD患兒主要臨床表現為注意力障礙、活動過度、沖動、控制力差等,對其學業成績、適應能力、社會交往能力等造成廣泛影響,70％～80％的ADHD患兒癥狀可持續至青少年期甚至成年期,易發展為反社會人格、品行障礙、藥物或酒精濫用、青少年違法、成年期就業不良,并易發生安全事故(如車禍等),這也引起患兒家長、老師乃至全社會關注.目前針對ADHD的治療主要包括藥物治療和行為治療.近年來,隨著新的信息和證據不斷涌現,AAP依照循證醫學原理重新修訂了已發指南以指導臨床工作.本文就該指南的重點內容進行解讀如下.
  • 摘要：Objective To summarize incidence rate, clinical significance and mechanism of accelerated idioventricular rhythm (AIVR) after transcatheter closure of ventricular septal defect (VSD) in children. Methods From Oct.2002 to May 2011, 1179 children with VSD underwent percutaneous transcatheter closure. All patients received electrocardiogram and 24h dynamic electrocardiogram after transcatheter closure. Totally 1392 outpatients that received 24 h dynamic electrocardiogram examination and 988 children with ASD who underwent transcatheter closure were assigned as two control groups.The difference of AIVR incidence rate was compared between VSD transcatheter closure group and control groups. Seventeen cases developed AIVR after transcatheter closure of VSD, but no one had subjective symptoms.Nine cases were treated with methylprednisolone, albumin and creatine phosphate sodium and the other 8 cases had no therapy .All the 17 children with AIVR received follow-up study. Results The incidence rate of AIVR in transcatheter VSD closure group was higher than in control groups.Based on the first-month holter monitoring electrocardiogram, all the 17 AIVR cases after transcatheter VSD closure recovered to normal, whether they receive treatment or not.And in the follow-up study, there were no adverse medical events. Conclusion AIVR incidence with transcatheter closure of VSD is higher than other patients.The mechanism of AIVR is closely related to the procedure of transcathter'VSD closure.AIVR after transcatheter VSD closure is a benign arrhythmia that perhaps needs not treat ment.%目的 總結小兒經皮室間隔缺損(VSD)封堵術后非陣發性室性心動過速(AIVR)的發生情況,探討其臨床意義及可能的發生機制.方法 2002年10月至2011年5月,1179例VSD患兒在廣東省心血管病研究所心兒科行經皮VSD封堵術(室缺封堵組),術后檢出AIVR 17例.在我院門診進行動態心電圖檢查的1392例非介入治療患兒(非介入組)以及在我院行房間隔缺損封堵術的患兒988例(房缺封堵組)作為對照.比較室缺封堵組與對照組間AIVR的檢出情況.對室缺封堵組9例患兒進行治療,并對17例患兒進行隨訪.結果 室缺封堵組術后動態心電圖AIVR檢出率高于非介入組,差異有統計學意義(P＜0.05)；次日常規心電圖AIVR檢出率高于房缺封堵組(P＜0.05).室缺封堵組所有AIVR患兒封堵術后1個月動態心電圖均無AIVR,隨訪中無不良事件發生,隨訪心電圖無AIVR.結論 室缺封堵組封堵術后AIVR檢出率高于對照組,其發生與VSD封堵有關.該病多無自覺癥狀,預后良好,可能無須治療.
  • 摘要：目的 探討組織多普勒(TDI)、二維斑點追蹤技術(STI)和血清腦利鈉肽(BNP)評估室間隔缺損(VSD)合并不同程度肺動脈高壓(PH)患兒右心室功能的價值.方法 2008年6月至2010年6月在蘇州大學附屬兒童醫院住院的VSD合并PH患兒68例,根據三尖瓣反流壓差測得肺動脈壓力程度分為輕度組(23例)、中度組(21例)、重度組(24例).同時選擇24名健康體檢者作為正常對照組.采用GE VIVID7儀器測量右室長軸整體收縮期應變(GLS)和應變率(GLSR),三尖瓣環脈沖組織多普勒圖測量三尖瓣環收縮期峰值速度(Sa)、等容收縮加速度(IVA)、Tei指數,用M型超聲測量三尖瓣環收縮期位移(TAPSE).采用ELIASA法測血清腦鈉鈦(BNP)濃度.結果 (1) IVA和TAPSE隨著PAH升高而降低,而Tei指數隨著PAH增加而增大,3個指標除正常對照組和輕度組間差異無統計學意義外(P＞0.05),其他各組間差異均有統計學意義(P＜0.05).Sa在中、重度組間差異無統計學意義(P＞0.05),在正常對照、輕度組間差異無統計學意義(P＞0.05),其余組間有統計學意義(P＜0.05).(2)右室GLS、GLSR隨著PAH升高而減小,GLS在4組間兩兩比較差異有統計學意義(P＜ 0.05)；GLSR中度和重度組與正常對照組和輕度組差異有統計學意義(P＜0.05),中重度間及正常對照組和輕度間差異無統計學意義(P＞0.05).(3)血清BNP濃度在VSD組中隨著PAH程度的加重而升高,在4組間兩兩比較差異有統計學意義(P＜0.05).(4)BNP與Tei指數及心功能分級相關性最好.結論 TDI和STI各個參數均能反映VSD合并PH患兒右心室功能,其中BNP和Tei指數與心功能相關性最好,而BNP和GLS可以反映輕度PAH時右室功能受損.%Objective Discuss the value of TDI, STI and serum BNP in evaluating right ventricular function in children with VSD complicated by pulmonary artery hypertension (PAH). Methods A total of 68 children with VSD and 24 age-matched healthy children were involved in this research. The patients were divided into mild(n=23), moderate (n= 21) and severe (n=24) groups according to pulmonary artery pressure. Two-dimensional standard apical four-chamber image of consecutive three cardiac cycles were preserved by GE Vivid 7 to obtain GLS and GLSR. PW-TDI of tricuspid annulus motion curve was recorded to measure Sa, IVA and Tei. Tricuspid annulus plane systolic excursion (TAPSE) was measured through M-mode echocardiography.BNP was detected by ELIASA. Results (1) Tricuspid annulus IVA and TAPSE decreased with the increase of PAH, but Tei index increased with the PAH (P < 0.01) .The three parameters had significant difference except those between control group and mild group. Sa had significant difference except that between control group and mild group, moderate and severe group. (2) GLS and GLSR decreased with the increase of PAH; GLS had statistically significant difference between the groups. GLSR had significant difference except that between control group and mild group, moderate and severe group, (3)Serum BNP increased in accordance with PAH and had significant difference between the groups. (4) BNP and Tei index correlated better with NYHA. Conclusion TDIand STI parameters can reflect the right ventricular function of children with VSD complicated by pulmonary hypertension. BNP and Tei index correlate with NYHA better. BNP and GLS can reflect mild inpair of the righl ventricle.
  • 摘要：Objective To explore the relationship of long-term blood transfusion, iron chelation therapy with iron overload in the patients with beta-thalassaemia major. Methods The serum ferritin (SF) , liver function, renal function, myocardial enzyme, ultrasonograph of liver and spleen, blood glucose and urine glucose were detected in the patients with beta-thalassaemia major in "Friends of thalassemia" and "Service team for thalassemia in Shenzhen" with regular long-term blood transfusion and iron chelation therapy in three months. Left ventricular ejection fraction (LVEF) , myocardial, liver, pancreas and pituitary MR imaging T2* were performed on 51 patients of them. The51 patients were divided into 3 groups. 10 cases with sufficient dose DFO and sufficient dose DFP iron chelation treatment group (sufficient dose joint group) ; 31 cases with insufficient DFO and DFP iron chelation treatment group (insufficient joint group) ; 10 cases with sufficient dose DFX iron chelation treatment group (DFX group). Results There was no difference in myocardial T2*, pituitary T2*, LVEF in every group. (P > 0.05). Liver T2* in sufficient dose joint group was higher than that in insufficient joint group (P < 0.05). Liver T2*, pancreas T2*, and pituitary T2*in DFX group was significantly higherthan that in the other two groups (P < 0.05). SF in sufficient dose joint group was significantly lower than that in insufficient joint group (P < 0.05) , SF in DFX group was significantly lower than that inthe other two groups (P < 0.05). Liver T2* and pancreas T2*in C group were significantly lower than those in A and B groups (P < 0.05).There was myocardial iron overload in 11 of 5lcases (21.6%), and there was liver iron overload in 43 of 51 cases (84.3%). SF had no correlation with myocardial T2*(r = 0.254, P > 0.05), and there was moderate negative correlation with liver T2*(r = 0.558,P < 0.01). Conclusion The sufficient dose DFO with DFP treatment, and the DFX treatment can effectively reduce SF, compared with that of insufficient DFO with DFP treatment. All iron chelation therapy can alleviate myocardial iron overload.%目的 探討重型β珠蛋白生成障礙性貧血(beta-thalassaemia,簡稱β -TM)患兒長期輸血、去鐵治療與鐵過載的關系.方法 深圳市第二人民醫院2001年成立“地貧之友”與“地貧服務隊”,對β-TM患兒進行規范性的長期輸血和去鐵治療.每3個月監測血清鐵蛋白濃度(SF)、肝腎功能、心肌酶譜、心功能、心臟和肝脾B超、血糖和尿糖.2001年2月至2010年6月對其中51例患兒進行核磁共振檢測心臟T2*、左心室射血分數(LVEF)、肝臟T2*、胰腺T2*和垂體T2*.根據治療方法分為足療程去鐵胺+去鐵酮(DFO+DFP)聯合去鐵治療組(足療程聯合組)10例、不足療程DFO+DFP聯合去鐵治療組(不足療程聯合組)31例、單用足療程地拉羅司(DFX)去鐵治療組(單用DFX組)10例.根據SF質量濃度分為SF≤2000 μg/L組(A組)12例、SF-3000 μg/L組(B組)17例、SF＞3000μg/L組(C組)22例.結果 各組LVEF、心臟T2*、垂體T2*值差異無統計學意義(P＞0.05)；足療程聯合組肝臟T2*高于不足療程聯合組(P＜0.05),單用DFX組肝臟T2*、胰腺T2*、垂體T2*均高于足療程聯合組和不足療程聯合組(P＜0.05).足療程聯合組SF低于不足療程聯合組,單用DFX組SF低于足療程聯合組和不足療程聯合組,差異均具有統計學意義(P＜0.05).C組肝臟T2*和胰腺T2*明顯低于A組和B組,差異具有統計學意義(P＜0.05).心肌鐵過載11例(21.6％),肝臟鐵過載43例(84.3％).SF與心臟T2*無相關性(r=0.254,P＞0.05),與肝臟T2*呈中度負相關(r=0.558,P＜ 0.01).結論 足療程DFO+DFP聯合去鐵治療和單用足療程DFX去鐵治療均能有效降低血清鐵蛋白濃度,動員肝臟組織鐵,效果優于不足療程DFO+DFP聯合去鐵治療.不同去鐵方式均能減輕心臟鐵過載.
  • 摘要：小兒心肌病較為常見,近年來尤其在遺傳學方面研究很多,進展很快,但有些問題爭議很多.筆者把這些問題做一剖析,使讀者有更深入了解.由于這些問題有不同意見,作者的意見為一家之言,有些學者肯定有不同意見,歡迎提出討論.既可提高對原發性心肌病的認識,又活躍了學術氣氛.
  • 摘要：Objective To investigate the relationship between clinical characteristics and renal pathological types. Methods Renal biopsies were performed on 172 children. The patient' s history, physical examination, routine biochemical tests, including immunological analyses [immunoglobulin, complement, renal function, liver function, hepatitis virus markers], kidney ultrasound, Doppler ultrasonography and routine urine cultures were obtained to exclude urinary tract infection, urinary calculi, renal tumor and secondary glomerulonephritis. Apart from light microscopy of the urine sediment, phase-contrast microscopy was also performed for the detection of dysmorphic erythrocytes. Results In 172 children who were investigated, 149 cases (86.6% ) had isolated haematuria (IH) , 7 cases (4.1% ) had isolated proteinuria (IP) and 16 cases (9.3%) had combined haematuria and proteinuria (CHP). In total of 172 patients, minor abnormalities were in 66.9% cases;focal segmental glomerulosclerosis (FSGS) was in 12.8% cases;IgA nephropathy was in 7.6% cases; focal glomerulosclerosis (FGS) was in 6.4% cases; Thin basement membrane nephropathy (TBMN) was diagnosed in 2.3% cases. While in patients with CHP, minor abnormalities were in 31.3% cases; IgA nephropathy was diagnosed in 50% cases. In patients with gross haematuria, minor abnormalities were in 56.3% cases and FSGS was diagnosed in 25% cases. Conclusion A school urine screening program can detect chronic renal disease in its early stage. A regular follow-up for those children with microhematuria is certainly warranted. Renal biopsy is recommended to those children with combined hematuria and proteinuria and massive haematuria.%目的 分析無癥狀尿檢異?；純旱哪I臟病理,了解無癥狀尿檢異?；純旱牟±砀淖兒团R床表現的關系.方法 回顧性分析上海交通大學醫學院附屬新華醫院兒內腎臟科2004年1月至2010年12月172例無癥狀尿檢異?；純号R床資料,根據尿檢結果分為單純性血尿組(149例,86.6％)、單純性蛋白尿組(7例,4.1％)和血尿合并蛋白尿組(16例,9.3％),所有患兒排除感染、結石、腫瘤及繼發性腎炎并進行腎活檢作光鏡、免疫病理和電鏡檢查.結果 172例患兒的病理分型顯示:腎小球輕微病變115例(66.9％)、局灶節段性腎小球硬化22例(12.8％)、IgA腎病13例(7.6％)、局灶球性腎小球硬化11例(6.4％)、薄基膜病4例(2.3％)、其他7例(4.1％).血尿合并蛋白尿組中腎小球輕微病變占31.3％,IgA腎病占50％.單純性血尿組中肉眼血尿患兒的腎臟病理中腎小球輕微病變和局灶節段性腎小球硬化分別占56.3％和25.0％.結論 幼兒園入園尿檢和入學尿檢有利于早期發現慢性腎臟疾病.尿檢異常中單純性血尿需要密切隨訪,血尿合并蛋白尿和肉眼血尿患兒的應盡早進行腎組織穿刺活檢.
  • 摘要：目的 探討實驗室指標在不完全性川崎病(iKD)診斷中的臨床意義.方法 回顧性分析2006年1月至2010年12月93例在鄭州大學第三附屬醫院住院的KD患兒臨床資料,其中iKD36例,完全KD(cKD)57例,對比研究美國心臟病學會(AHA)提出的8項iKD診斷中增補的實驗室指標在iKD和cKD患兒的檢測結果.結果 (1)iKD組患兒的確診時間和確診時病程均大于cKD組[(3.58±2.94)d vs (1.73±2.02)d,(14.53±9.87)d vs(8.59±3.65)d,P均＜0.05]；iKD組患兒冠狀動脈損害(CAL)的發生率為58.33％,高于cKD組(17.54％,P＜0.05).(2)C-反應蛋白(CRP)、紅細胞沉降率(ESR)、白細胞(WBC)、血小板(PLT)及血漿白蛋白(ALB)等8項實驗室指標的檢測結果在iKD和cKD兩組間比較,差異無統計學意義(P均＞0.05).(3)8項實驗室指標陽性率的比較,iKD組患兒只有CRP的陽性率低于cKD組(47.22％ vs 71.93％,P＜0.05),其余各項指標及≥3項指標均陽性的患兒數在兩者之間均差異無統計學意義.結論 AHA提出的iKD診斷中增補的實驗室指標在iKD和cKD患兒間差異無統計學意義.關注這些實驗室指標的變化,有助于iKD的早期診斷.
  • 摘要：顯微鏡下多血管炎(microscopic polyangiitis,MPA)是一種主要累及小血管的系統性壞死性血管炎.可侵犯腎臟、皮膚和肺等臟器的小動脈、微動脈、毛細血管和微小靜脈.常表現為壞死性腎小球腎炎和肺毛細血管炎.因其主要累及包括靜脈在內的小血管,故現多稱為MPA.男女比約2:1,國外發病率為(1～3)/10萬,我國的發病率尚不清楚[1].本文報道1例以急性腎功能衰竭起病伴皮疹、肺炎的兒童重癥腎型顯微鏡下多血管炎.
  • 摘要：座談內容1.近年來國外關于心肌病的定義和分類有哪些變化和進展?最新的心肌病的定義是什么?當前國外對心肌病有幾種分類方法?對各類方法如何評價?2根據國外研究進展,結合中國國情,對我國小兒心肌病應如何進行分類?采用該種分類方法的理由是什么?
  • 摘要：Objective To investigate the effectiveness, safety and influencing factors of radiofrequency catheter ablation for atrioventricular reentrant tachycardia combined with Ebstein' s anomaly. Methods Clinical data of 8 patients diagnosed with Ebstein' s anomaly combined with atrioventricular reentrant tachycardia, who received radiofrequency catheter ablation in our hospital between Jan 2009 and Jun 2011, were retrospectively analyzed, including electrocardio-graphic presentation, numbers and lo-cations of accessory pathways, mapping strategies and therapeutic effects. Results Pre-operative electrocardiograms showed dominant preexcitation in 5 patients, incessant preexcitation in 1 and no obvious preexcitation in the other 2 patients. Nine accessory pathways were detected by electrophysiological study, including 5 located at right posterior wall, 2 at right mid-septum and the remaining 2 at right posterior septum. Totally 8 accessory pathways (88.9%) were successfully ablated. A posterior septal pathway was unsuccessfully ablated due to difficulty for the ablating catheter tip to adhere closely to the tricuspid ring. Swartz sheaths were used for 4 patients due to unstability of catheter tip while intending to adhere to target site. Five patients received corrective operation for Ebstein' s anomaly after ablation. Conclusion Accessory pathways complicated by Ebstein' s anomaly are usually located at right posterior wall and right posterior septum. It is safe and effective for children with Ebstein' s anomaly complicated by atrioventricular reentrant tachycardia to be treated by radiofrequency catheter ablation before surgical correction of cardiac structural anomaly.lt is more reliable and effective to map VA fusion during ventricular pacing or tachycardia than to map AV fusion during sinus rhythm.%目的 探討射頻消融治療小兒Ebstein畸形合并房室折返性心動過速的療效、安全性及其影響因素.方法 分析2009年1月至2011年6月在清華大學第一附屬醫院接受射頻消融治療的8例Ebstein畸形合并房室折返性心動過速患兒臨床資料,總結體表心電圖表現、旁路數量及部位、射頻消融標測方法及療效.結果 8例患兒射頻消融前體表心電圖表現為顯性預激者5例,間歇性預激者1例,未見典型預激波2例.心內電生理學檢查共發現9條房室旁路,其中右后壁旁路5條、右中間隔旁路2條、右后間隔旁路2條.9條房室旁路中共8條被成功消融(88.9％),1例右后間隔旁路因消融電極難以穩定貼靠三尖瓣環消融未能成功.4例患兒因消融電極貼靠不穩定而選用Swartz鞘輔助.5例患兒于射頻消融術后接受了Ebstein畸形矯治手術.結論 Ebstein畸形合并的房室旁路主要位于右后壁及右后間隔；對于小兒Ebstein畸形合并房室折返性心動過速患兒,矯治術前選擇射頻消融是安全而有效的治療手段.對比顯性預激竇性心律下標測AV融合點作為消融靶點,消融術中采用心室起搏或心動過速下標測VA融合點更為可靠和有效.
  • 摘要：目的 探討允許性高碳酸血癥通氣法在治療新生兒呼吸窘迫綜合征(NRDS)中動脈血二氧化碳分壓(PaCO2)的適宜范圍.方法 選擇2004年1月至2009年12月福建醫科大學附屬三明第一醫院需機械通氣治療的NRDS患者共90例,分3組,每組30例.對照組:PaCO2維持在35 ～45 mmHg(1 mmHg=0.133 kPa)；觀察Ⅰ組:PaCO2維持在46～60 mmHg;觀察Ⅱ組:PaCO2維持在61～75 mmHg.對3組呼吸機參數設置、血氣分析、并發癥及療效等進行對照分析.結果 觀察組(Ⅰ組和Ⅱ組)呼吸機參數平均氣道壓(MAP)、吸氣時間(Ti)、吸氣峰壓(PIP)顯著低于對照組(P＜0.01),吸入氧濃度(FiO2)低于對照組(P＜0.05),呼吸頻率(RR)高于對照組(P＜0.05)；觀察組pH值低于對照組(P＜0.05),PaCO2顯著高于對照組(P＜0.01)；觀察Ⅰ組PaCO2顯著低于觀察Ⅱ組(P＜0.01)；而觀察組機械通氣相關性肺損傷(VALI)的發生率低于對照組(P＜0.05),機械通氣時間明顯較對照組短(P＜0.01),療效高于對照組(P＜0.05).3組住院時間和腦室內出血(IVH)和腦室周圍白質軟化(PVL)發生率的比較,差異無統計學意義(P＞0.05),但對照組和觀察Ⅱ組IVH程度嚴重.結論 應用允許性高碳酸血癥通氣法治療NRDS,可降低VALI的發生率,減少機械通氣時間,不影響氧合、心率、血壓及循環灌注狀況,不增加IVH和PVL的發生率,療效可能更優于傳統通氣策略,PaCO2維持中等水平增高范圍(46～60mmHg),發生顱內出血的程度輕,是較適宜的范圍.%Objective To study the appropriate range of arterial blood partial pressure of carbon dioxide (PaCO2) in permissive hypercapnia ventilation in the treatment of neonatal respiratory distress syndrome (NRDS). Methods From Jan.2004 to Dec.2009 in Sanming First Hospital Affiliated to Fujian Medical University, 90 cases of infants who were treated with mechanical ventilation were randomly divided into three groups; control group(PaCO2 range 35 ~45 mmHg) (1 mmHg = 0.133 kPa) .treatment I group (PaCO2 range 46-60 mmHg) .treatment II group (PaCO2 range 61-75 mmHg). Data relevant to the neonates were collected and analyzed , including the ventilator' s parameter , blood gas , complications and therapeutic effectiveness. Results Mean airway presure (MAP) .inspiratory time (Ti) and peak in-spiratory presure (PIP) in the treatment group were significantly lower than those in the control group respectively (P < 0.01); fraction of inspiration O2 (FiO2) was lower than that in the control group (P < 0.05 ); respiratory rate ( RR) was higher than that in the control group (P < 0.05) ;pH in treatment group was lower than that in the control group (P < 0.05); PaC02 was significantly higher than that in the control group(P < 0.01) ; PaCO2 in the treatment I group was significantly lower than that in the treatment Ⅱ group (P < 0.01) ; the incidence of ventilator associated lung injury (VALI) in treatment groups was lower than that in the control group (P < 0.05), and mechanical ventilation time was significantly lower than that in the control group (P < 0.01) ; the therapeutic effectiveness was better than that of the control group (P <0.05). There were also no differences in the length of hos-pitalization , incidence of intraventricular hemorrhage (IVH) and peri ventricular leukomalacia (PVL) (P >0.05) , but consequence of IVH in the control group andthe treatment II group was very serious. Conclusion Permissive hypercapnia ventilation in the treatment of NRDS can markedly decrease the incidence of VALI and mechanical ventilation time,without affecting oxygenation,heart rate,blood pressure and without increasing the incidence of IVH and PVL;the therapeutic effectiveness is better than that of the conventional mechanical ventilation.Moderate range of PaCO2(46 ~ 60 mmHg) is appropriate because of slight IVH .
  • 摘要：目的 總結6例兒童先天性Ⅲ度房室傳導阻滯長期隨訪結果并探討是否必需安裝起搏器治療.方法 1984年1月至2007年6月,南京軍區福州總醫院收治的6例先天性Ⅲ度房室傳導阻滯患兒,回顧性分析患兒的臨床資料及隨訪結果.結果 6例患兒中,男3例,女3例.年齡3～11歲,平均(7.8±2.9)歲.主要臨床特征為心動過緩,均為體檢時發現,均未安裝起搏器,隨訪5 ～27年,未發生猝死,1例隨訪27年發現已有心臟擴大.結論 兒童先天性Ⅲ度房室傳導阻滯無癥狀時不需藥物治療,但何時安裝起搏器尚需探討,安裝起搏器與否和是否會發展成擴張型心肌病也需探討.
  • 摘要：小兒慢性腎臟病(chronic renal disease,CKD)已經成為危害我國兒童健康的重大疾病之一.2006年K/DOQI指出:肌酐清除率低于50 mL/min的臨床穩定患者蛋白質的攝入量下降,表現出營養水平的衰退[1].既往學者認為,低蛋白飲食可以延緩CKD進展,但近年研究提出慢性腎衰竭(chronic renal failure,CRF)早期應用低蛋白飲食并不一定妥當[2],因為有充分的證據顯示,兒童的生長與營養攝入有關,營養不良及生長發育遲緩是CKD患兒最常見的并發癥,也是預后不良的重要指標[3].因此,對CKD患兒進行營養評價以便及時發現并糾正營養不良尤為重要.美國、歐洲各國、澳大利亞、日本、新加坡制定了各自的CKD患兒營養指導意見,我國尚欠缺這些方面的研究[4],到目前為止,還沒有兒童CKD營養評價的數據報道[5].很多治療方案和指南還是參照成人研究結果[6],本文綜述了現在國內外用于CKD兒童營養狀況評估的方法,以做臨床工作中的參考.
  • 摘要：1維生素D(vitaminD)研究顯示,維生素D缺乏在世界各地廣泛存在,嚴重影響人們身體健康,特別是嬰幼兒和老年人群.因此,合理補充維生素D具有重要意義[1].1.1來源 人體維生素D來源有3條途徑:一是同源性,由日光中波長296 ～ 310 nm的紫外線,照射皮膚基底層內貯存的7-脫氫膽固醇(7-dehydrocholesterol)轉化為膽骨化醇即維生素D3.但目前尚無法確定獲得足量維生素D所需要的陽光照射時間.植物中麥角固醇經紫外線照射后可形成維生素D2(骨化醇,calciferol).另一條途徑為外源性,即攝入食物中含維生素D.
  • 摘要：1發育診斷與病因診斷發育行為兒科最常見的慢性疾病是發育和行為障礙,而發育行為兒科醫生是最能證實兒童發育和行為障礙,同時又能將這些兒童于最早期轉診至適當教育和治療機構的專業人員.發育行為兒科在臨床診斷上通常有2個層面:一個是描述性發育行為診斷層面,如腦癱、智力受限、注意缺陷多動障礙(ADHD)、孤獨癥等;另一是尋找適當的實驗室檢查層面,如染色體分析、遺傳代謝檢查、頭顱影像學檢查等,以病因學診斷說明兒童發育和行為異常.例如,對于1例持續全面發育落后的患兒,采用描述性發育行為診斷為智力受限,而實驗室檢查可能提示患兒為染色體缺失綜合征,特定染色體缺失是該智力不足患兒的病因;同理,對于1例孤獨癥患兒,實驗室檢查結果發現為脆性X綜合征,而脆性X綜合征就是該孤獨癥患兒的病因.
  • 摘要：哮喘是一種多基因遺傳與環境因素共同作用的疾病[1-2].解整合素-金屬蛋白酶(a disintegrin and metalloproteinase,ADAM)33是一種新近發現的哮喘易感基因,是ADAM家族成員之一,該基因具有高度多態性,其單核苷酸多態性(single nucleotide polymorphisms,SNPs)與支氣管哮喘的發生及氣道高反應性可能存在相關性,是近年來的研究熱點.本文就ADAM33與哮喘發病關系綜述如下.
  • 摘要：目的 觀察尿白三烯(LTs)E4(LTE4)在兒童典型川崎病(KD)中的變化,探討是否可以將LTs作為KD后的監測指標.方法 東南大學附屬鹽城醫院兒科2007年10月至2010年9月收治68例完全性KD患兒,采用競爭性酶聯免疫吸附技術檢測其在治療前后尿LTE4水平,55名正常兒童尿LTE4作為對照組,同時對KD急性期患兒行心臟彩超檢查,分為有冠狀動脈損害組(8例)和無冠狀動脈損害組(60例).結果 KD患兒治療前尿LTE4均高于正常對照組,差異有統計學意義(P＜0.01)；恢復期與正常對照組比較,差異無統計學意義(P＞ 0.05)；KD合并冠狀動脈損害組尿LTE4明顯高于無冠狀動脈損害組,差異有統計學意義(P＜0.01)；所有KD患兒治療前后比較,LTE4均明顯降低(P ＜0.01).結論 KD尤其是合并冠狀動脈損害的患兒LTs水平明顯增高,尿LTE4可作為KD后臨床監測指標,可以考慮通過早期應用LTs受體拮抗劑干預采達到預防合并冠狀動脈病變發生、促進冠狀動脈損傷修復的目的.%Objective To investigate whether leukotriene can be used as KD monitoring index.. Methods Urinary leu-kotriene E4 (LTE4) level of 68 children with typical KD was detected by enzyme-linked immunosorbent assay (ELISA) before and after treatment, and the Urinary LTE4 level of 55 healthy children was detected by the same methods, and then was a mutual comparison made. Meanwhile ultrasonographic examination was made in KD children. According to the results of ultrasonographic examination, all the 68 KD children were divided into two groups: KD with coronary artery damage in one group (n=8), KD without the damage in the other group (n=60). Results The Urinary LTE4 level of KD group was significantly higher than that of healthy control group (P < 0.01) , but after treatment, there were no significant difference between two groups (P > 0.05). The urinary LTE4 level of KD with coronary artery damage was significantly higher than that of KD without (P < 0.01). The urinary LTE4 level of all KD before treatment was significantly higher than that after treatment (P < 0.01). Conclusion In KD patients especially those with coronary artery damage, LTs level is much higher. Urinary leukotriene E4 level can be used as KD clinical monitoring index.It can be considered that through the early intervention by leukotriene receptor antagonist we may prevent KD coronary artery pathological changes from happening and so promote the repair of coronary artery damage.
  • 摘要：病例1資料:患兒女,6歲.反復咳嗽、咯血,而色蒼白;血紅蛋白66 g/L,小細胞低色素性貧血;痰涂片檢查可見含鐵血黃素巨噬細胞.影像表現：兩肺透光度減低，廣泛磨玻璃征，肺內彌漫分布密度較淡、輪廓模糊的小結節，小葉間隔增厚呈細網狀影。
  • 摘要：維生素D(vitamin D)是大家熟知的脂溶性維生素,維生素D對人類健康特別是兒童健康具有重要意義.維生素D缺乏性佝僂病是南于缺乏維生素D引起體內鈣磷代謝異常,鈣鹽不能正常沉著在骨骼生長部分,骨骼鈣化不良而致骨骼病變,多見于嬰幼兒,影響小兒生長發育,是我國兒科重點防治的四病之一.臨床發現維生素D缺乏性佝僂病除導致骨骼病變外,同時也可影響神經、肌肉、造血及免疫等組織器官的功能,此引起了人們對維生素D生理作用及臨床意義的極大興趣,近年來對維生素D的研究取得了重大進展[1-6].
  • 摘要：“鈣缺乏”一直是我國兒科領域熱議的課題,有關鈣缺乏、維生素D缺乏性佝僂病等的診斷、治療等方面也一直爭論不休.近期隨著歐美國家對人群維生素D缺乏研究的興起,國內相關報道也明顯增加.然而,由于檢測血清25-羥維生素D[25-(OH)D]受限及缺少簡便、可靠的判斷人體鈣營養的生物學指標,目前我國總體缺乏有效的流行病學資料以全面了解兒童青少年維生素D、鈣營養狀況.
  • 摘要：幼年皮肌炎(juvenile dermatomyositis,JDM)是發生在小兒的慢性自身免疫性炎性肌病.以系統性免疫介導的血管病變(vasculopathy)為基礎,由遺傳和環境因素觸發共同作用而發生.近端肌無力和多樣性皮膚病變是主要臨床特征.國外文獻[1-5]資料顯示,本病16歲以下兒童相對少見,發病率為每年(2～5)/10萬.在過去50年間臨床轉歸逐漸得到很大改善,明顯的致殘率不足10％,但兒科標準化死亡率比(standardized mortality ratios,SMRs)卻僅次于系統性紅斑狼瘡,位居小兒風濕性疾病第2位.初始治療3年內仍約有半數患兒呈持續疾病活動性[1-5].目前國內還缺少小兒風濕性疾病病例系統管理.因此,早發現和規范化治療是兒童患者改善預后的關鍵.下面將對JDM診斷的特殊性或熱點問題及治療進展予以重點介紹.
  • 摘要：兒童維生素D缺乏性佝僂病(vitamin D deficiency,Rickets)是由于維生素D缺乏導致的可預防性疾病,與維生素D和鈣營養密切相關.近年來,研究發現非肌肉骨骼系統的疾病,包括癌癥、代謝綜合征、感染和自身免疫性疾病與維生素D水平不足密切相關[1-3].由于許多觀察性研究證實維生素D不足在世界許多地區普遍存在,包括工業性國家[4-5].因此,兒童維生素D、鈣營養與營養性維生素D缺乏性佝僂病再次受到關注,國內外對兒童維生素D、鈣營養與維生素D缺乏性佝僂病的判定和評價也有了新認識.
  • 摘要：Objective To report the first JAK3 deficiency patient in China and to have literature review. Methods On April 25,2011, the blood samples of 1 case of suspected SCID child, his parents and grandparents were detected with PCR amplification and sequencing of JAK3 gene, single nucleotide polymorphism(SNPs) and TCRVB analysis in Children's Hospital of Chongqing Medical University. Results The mutation of this patient was a compound heterozygous mutation, both alleles being missense mutations. One allele (1308G>A: R403H) was located in the eighth exon of JAK3, which came from her father, the other (3354G> A:R1085Q) located in the twenty-third exon of JAK3, which came from her mother.Her parents and grandmother were carries.We confirmed these mutations were disease-caused mutations not SNPs by sequencing the 9th and 24th exon of JAK3 gene of twenty common people. Unfortunately, we failed to detect The TCRVβ of this patient because of the limited number of circulating T cells. Up to 2007, thirty mutations and thirty-five patients had been registered for JAK3 deficiency in JAK3base. Their immunophenotype was uniformly TB+ NK-SCID, but the clinical phenotype of them varied from classical SCID to almost normal immune function. Conclusion JAK3 deficiency is a rare autosomal recessive severe combined immunodeficiency disease (SCID),characterized by recurrent bacteria and virus infection,absence of T and NK cells but normal number of poorly functioning B cells in the peripheral blood. The diagnosis depends on stat5 phosphorylation,sequencing of JAK3 gene and detect the JAK3 protein by western blot or flow cytometry, when JAK3 deficiency is suspected. The most effective treatment for JAK3 deficiency is hematopoietic stem cell transplantation (HSCT) ,and patients who don't receive HSCT will usually die in infancy.%目的 報道我國首例JAK3突變致嚴重聯合免疫缺陷(SCID)患兒資料并文獻復習.方法 2011-04-25重慶醫科大學附屬兒童醫院對1例疑似SCID患兒血標本(患兒、患兒父母及外祖母)進行JAK3基因PCR擴增、基因測序、單核苷酸多態性(SNPs)及TCRVβ亞家族克隆多態性分析.結果 患兒免疫表型符合T-B+NK-,主要表現為反復呼吸道、消化道感染.JAK3基因突變為復合雜合突變,兩個等位基因均為錯義突變,分別來自父系第9外顯子(1308G＞ A:R403H)和母系的第24外顯子(3354G＞A:R1085Q),患兒父母和外祖母分別為上述突變攜帶者.患兒T細胞抗原受體庫未能檢出.查閱文獻截止2007年,國內外共35例患兒30種JAK3基因突變在JAK3base注冊,免疫學表型均符合T-B+NK-SCID,但臨床表現從經典SCID到基本正常均有報道.結論 JAK3缺陷患者外周血T細胞及NK細胞嚴重減少,B細胞數量正?；蛏詼p少但存在功能障礙,免疫球蛋白水平明顯降低,故臨床表現為反復細菌和病毒感染,對臨床癥狀及實驗室檢查高度懷疑JAK3缺陷的患者,可通過STAT5磷酸化分析、基因測序、蛋白印跡或流式測定JAK3蛋白含量等技術進一步明確診斷.主要治療方式為千細胞移植,若不及時進行免疫重建多數死于嬰兒期.
  • 摘要：目的 探討兒童感音神經性耳聾(SNHL)內耳多層螺旋CT(MSCT)特點及其對診斷的價值.方法 選取2008年1月至2010年12月中國醫科大學附屬盛京醫院經腦干聽覺誘發電位(BAER)診斷兒童SNHL患兒65例,均行內耳MSCT掃描,然后行冠狀面多平面重建(MPR).結果 20例(33只耳,45例次)存在內耳畸形,其中12只耳多種畸形并存,包括耳蝸畸形伴內耳道畸形5只耳；耳蝸畸形伴前庭導水管擴大3只耳；前庭畸形伴內耳道畸形2只耳；半規管畸形伴前庭導水管擴大1只耳；內耳道畸形伴前庭導水管擴大1只耳.45例次畸形中耳蝸畸形10例次[包括Michel型1例次、共同腔畸形2例次、耳蝸未發育1例次、耳蝸發育不全1例次、不完全分隔Ⅰ型2例次、不完全分隔Ⅱ型(Mondini畸形)3例次]、前庭畸形7例次、半規管畸形5例次、內耳道畸形8例次、前庭導水管擴大15例次.結論 根據MSCT檢查結果顯示多數SNHL患兒存在內耳畸形.內耳橫斷面MSCT掃描和冠狀面MPR可對兒童先天性SNHL內耳畸形進行全面評估,從而為進一步指導治療及預后提供有力依據.%Objective To evaluate the characteristics of inner ear multi-slice computed tomography (MSCT) in pediat-ric sensorineural hearing loss (SNHL) and feasibility and usability of diagnosis of SNHL. Methods Sixty-five patients have been diagnosed with sensorineural hearing loss (SNHL) by Brainstem Auditory Evoked Response (BAER). Inner ear MSCT scan and coronal multiplanar reformation (MPR) reconstruction were done in all cases. Results This study showed that 20 cases (33 ears,45 case times) were with inner ear malformations and 12 ears with two different malformations, including 5 ears with cochlear and internal auditory canal (IAC) malformations, 3 ears with cochlear and vestibu-lar malformations, 2 ears with vestibular and IAC malformations, 1 ear with semicircular canal and vestibular malformations, 1 ear with internal auditory canal and IAC malformations; 10 ears with cochlear malformations in 45 cases [including 1 ear with Michel deformity, 2 ears with common cavity deformity, 1 ear with cochlear aplasia, 1 ear with hypoplas-tic cochlear, 2 ears with incomplete partition types I (IP-I) and 3 ears with incomplete partition types II (IP-II) (Mon-dini deformity) ] ,7 ears with vestibular malformations, 5 ears with semicircular canal malformations, 8 ears with internal auditory canal malformations, and 15 ears with vestibular malformations. Conclusion The study shows most children with SNHL have inner ear malformations by MSCT. The inner ear MSCT scan in axial view with 2D MPR for coronal view allows a comprehensive assessment of various congenital ear malformations and provides powerful evidence for further direct therapy and prognosis.
  • 摘要：據統計,以癲癇發作及癲癇持續狀態(seizures and status epilepticus,S&SE)為主要病因和并發癥入重癥監護室(intensive care unit,ICU)患者占ICU總數3.3％,其中病死率為30％[1].死亡的直接原因包括腦缺血缺氧、腦水腫、腦疝、進行性血壓下降和心跳驟停.一項ICU臨床評價提示,S&SE是ICU最常見的神經系統急診,僅次于代謝性腦病神經系統并發癥.非驚厥性癲癇持續狀態(nonconvulsive status epilepticus,NCSE)約占全部癲癇持續狀態(status epilepticus,SE)的25％～50％,占神經性ICU昏迷患者的8％～34％[2].
  • 摘要：肝臟是人體內具有多種生理功能的器官.兒童時期肝臟儲備功能發育尚未完善,患病時易合并肝功能障礙.因此,肝功能化驗是臨床最常做的檢查之一,屬疾病診療常規檢查項目.另外,肝臟富含多種生化代謝酶如丙氨酸轉氨酶等,肝細胞病變時,會釋出至血液循環,故可用以反映肝細胞受損情況.一般醫院的肝功能生化檢測包括如下項目:反映肝細胞損害的酶學檢查——丙氨酸轉氨酶(ALT)和天冬氨酸轉移酶(AST);提示膽汁淤積的血清總膽紅素(TB)、間接膽紅素(DB)和直接膽紅素(IB)測定,血清膽汁酸及堿性磷酸酶(ALP)、γ-谷氨酰轉肽酶(y-GT或GGT)和5’-核苷酸酶(5’-NT);反映肝細胞合成功能指標,如血清白蛋白(Alb)、前白蛋白(PA)、膽堿酯酶(CHE)等.但是肝功能生化檢測異常有時提示的不僅僅是肝功能異常,亦可反映出其他器官疾病.下面通過幾個臨床典型病例,了解如何通過化驗單評估兒童肝功能異常.

    中國實用兒科雜志的期刊信息

    • 曾用名：實用兒科雜志
    • 創刊時間：1986
    • 地區：CN
    • 語言：中文
    • 熱門主題：中國醫師協會;中國醫科大學
    • 學科分類： 兒科學;

    中國實用兒科雜志的獲獎情況

    • ? 全國優秀科技期刊
    • ? 中國期刊方陣“雙效”期刊

    中國實用兒科雜志的收錄情況

    • ? 北大核心期刊（1996版）
    • ? 北大核心期刊（2000版）
    • ? 北大核心期刊（2004版）
    • ? 北大核心期刊（2008版）
    • ? 北大核心期刊（2011版）
    • ? 北大核心期刊（2014版）
    • ? 北大核心期刊（2017版）
    • ? 農業與生物科學研究中心文摘
    • ? 中國科學引文數據庫（2011-2012）
    • ? 中國科學引文數據庫（2013-2014）
    • ? 中國科學引文數據庫（2015-2016）
    • ? 中國科學引文數據庫（2017-2018）
    • ? 中國科學引文數據庫（2019-2020）
    • ? 哥白尼索引
    • ? 日本科學技術振興機構數據庫
    • ? 中國科技核心期刊

    中國實用兒科雜志的投稿信息

    • 投稿方式：在線投稿
    • 期刊官方網站：點擊前往
    • 通訊地址：沈陽市和平區南京南街9號
    • 郵編：110001
    • 聯系電話：024-23866457
    • 郵箱：[email protected]
    • 期刊欄目：指南.標準.共識；述評；專題筆談；論著；短篇論著；綜述；病例報告

    客服郵箱：[email protected]

    京公網安備：11010802029741號 ICP備案號：京ICP備15016152號-6 六維聯合信息科技 (北京) 有限公司?版權所有 出版物經營許可證

    • 客服微信

    • 服務號

    澳门三肖三码期期准精选反板块