简化小儿危重病例评分法在手足口病患儿中的应用

目的探讨简化小儿危重病例评分法在手足口病患儿中的应用。方法对160例手足口病患儿于入院时,入院后24、72h采用简化小儿危重病例评分法进行病情评分,根据评分分值分为非危重、病情危重和极危重患儿,并采取相应的一级护理、重点护理和特别护理,观察3种评分分值患儿的预后。结果 160例手足口病患儿中,非危重病例93例(58.13%),无1例死亡;危重病例52例(33.50%),死亡2例,病死率3.85%;极危重病例15例(8.37%),死亡5例,病死率33.33%。结论简化小儿危重病例评分法能帮助判断手足口病患儿的病情及预后,对指导临床治疗和护理具有重要意义。     

中药仙人掌外敷治疗流行性腮腺炎疗效观察及护理

目的:探讨中药仙人掌捣乱外敷治疗流行性腮腺炎,腮腺肿胀的临床疗效及护理方法:对2012年1月-2014年12月期间我科收治的52例流行性腮腺炎患儿作为观察对象我们将患儿随机分为两组,即对照组和观察组。我们使用抗病毒抗生素对对照组进行治疗,使用中药仙人掌捣碎外敷,联合抗病毒抗生素对观察组患儿进行治疗。治疗结束后,比较两组患儿腮腺肿胀及病情好转痊愈的情况:结果.经过治疗观察组的26例患儿治愈出院需要9天,治愈25例占患儿总数的96%,对照组的26例患儿中治愈出院需要11天,治愈23例,占患儿总数的90%。三例好转占患儿总数的10%。观察组的患儿较对照组患儿平均住院日明显减少,能减轻患儿的痛苦,治愈率较高,值得临床上推广使用。     

优质护理在新生儿化脓性脑膜炎中的应用

目的观察优质护理在新生儿化脓性脑膜炎中的应用效果。方法对11例化脓性脑膜炎新生儿给予病情观察、高热护理、饮食护理、腰椎穿刺护理、基础护理、心理护理及出院指导等优质护理措施。结果经过精心治疗和护理,9例患儿治愈出院,2例患儿因其他原因自动出院。结论优质护理应用于新生儿化脓性脑膜炎可提高护理质量,缩短患儿住院天数,同时也提高了家属满意度,对新生儿化脓性脑炎的康复起着重要作用。     

益生菌粉治疗和缓解便秘的机制研究分析

文章致力于研究益生菌粉治疗和缓解便秘的效果，并分析其治疗机制。汉臣氏（沈阳）儿童制品有限公司收集了2021年03月—2022年03月内共52例便秘患儿的基线资料，用益生菌粉对其进行治疗，评价治疗效果。52例便秘患儿经过益生菌粉治疗后，排便正常，平均每日1次，大便可轻松排出，患儿无痛苦感，大便不燥结，便秘症状于两周后消失；患儿均未出现用药不良反应，其中有31例患儿治愈，有19例患儿的症状得到缓解，缓解率达到了（96.15%/50%/52%），疗效显著。经分析益生菌粉治疗和缓解便秘的效果显著，主要与益生菌调节肠道屏障、免疫系统等机制作用相关。     

预见性护理在烟花炮竹致眼外伤患儿中的应用研究

目的 探讨预见性护理对眼外伤患儿预后的影响.方法 将60例符合研究条件的眼外伤患儿随机分为对照组和观察组各30例,对照组予常规的护理措施,观察组在常规护理基础上给予预见性的护理措施,并观察两组患儿治疗的依从性、满意度及视力恢复情况.结果 观察组患儿治疗的依从性、满意度、视力恢复均优于对照组(P<0.05),差异有统计学意义.结论 对眼外伤的患儿实施预见性的护理,能提高患儿治疗的依从性,提高视力及满意度,降低致残、致盲率,从而提高患儿的生活质量.     

小儿危重病护理评分法在小儿护理干预中的应用

目的:探讨小儿危重病护理评分法对于小儿护理干预的临床应用价值,提高我院的护理质量和护理水平。方法:随机选取2014年1月至2015年6月在我院住院治疗的小儿危重患儿68例,将他们随机分为观察组和对照组,每组患儿34例。观察组患儿采用小儿危重病护理评分法对小儿护理进行护理干预,对照组患儿则采用我院常规小儿危重病护理方法,分析对比两组患儿的临床护理效果。结果:观察组患儿的护理总有效率为91.17%,而对照组患儿的护理总有效率为73.52%,观察组的护理总有效率明显高于对照组(P0.05)。结论:小儿危重病护理评论法可以对患儿的病情进行科学有效的评估,为临床护理提供科学依据。通过护理评分来指导临床葫芦干预,可以有效的提高护理有效率,增强医疗服务水平和服务质量。     

护理风险管理在小儿头皮静脉输液中的应用效果观察

目的:观察护理风险管理在小儿头皮静脉输液中的应用效果。方法:选择在2011年7月-2012年7月期间在我院进行头皮静脉输液的80例儿童患者,将这80例患者随机地进行分组,分为观察组和对照组各40例。对对照组的40例患者进行常规的儿童输液护理,对观察组40例患者在进行常规护理的基础上再给予护理风险管理。对两组患者在接受不同护理后的护理效果、输液过程中患儿发生不良事件的概率以及患儿家属对护理满意度等情况进行观察对比。结果:经过一段时间观察,观察组40例患儿在接受护理风险管理后,取得了满意效果,患儿的护理效果明显提高,患儿家属对护理的满意程度也明显优于对照组,两组形成的差异大,在统计学方面具有意义(p0.05)。同时,观察组患儿在输液过程中发生不良事件的概率也明显低于对照组,两组比较形成差异大(p0.05)。结论:对需要输液的儿童患者进行护理风险管理,有助于提高护理效果,帮助提高护理的质量以及患儿家属对护理的满意度,在对患儿进行头皮静脉输液的过程中减少不良事件的发生,说明护理风险管理在小儿头皮静脉输液的过程中效果极佳,值得在临床中应用和推广。     

人文关怀在儿科护理中的应用与效果分析

目的:分析人文关怀在儿科护理中的必要性、可行性,评价实施效果。方法:取患儿400例,分为对照组、观察组各200例,前者实施常规护理,后者以人文关怀为指导开展护理,对比相关指标。结果:对照组患儿不依从率、门诊转住院率、输液率高于观察组,基础护理质量、病区管理质量、患儿家属满意度低于观察组,差异具有统计学意义(P0.05)。结论:人文关怀有助于构建和谐护患关系,取得家属信任,保障护理顺利实施,提高患儿依从。     

儿科门诊输液的细节护理及效果观察

目的:就儿科门诊输液的细节护理及效果进行观察。方法:随机选择我院2014年5月-2015年5月儿科门诊输液室收治的患儿200例,基于随机数字法将所有患儿分为两组,分别是研究组(100例)和对照组(100例)。对照组采用常规输液护理服务,而研究组给予细节化护理服务措施。结果:研究组患儿家长对护理的满意率为98%,对照组患儿家长对护理的满意率为70%,两组患儿家长对于护理满意度存在着较为明显的差异,具有统计学意义(P0.05)。结论:细节护理在儿科门诊输液中的应用极为有效,能够为患儿及其家长提供更好的护理服务,值得推广应用。     

新生儿胃肠功能障碍的护理

目的总结新生儿胃肠功能障碍的护理措施。方法对我院收治的64例胃肠功能障碍新生儿实施病情观察、胃肠减压护理、肛管排气、饮食护理和加强基础护理等积极有效的护理措施。结果 64例患儿中,治愈44例(68.75%),好转15例(23.44%),放弃治疗5例(7.81%)。结论及时有效的护理措施对控制新生儿胃肠功能障碍进展、促进患儿康复具有重要意义。     

Early Child-Care Experiences and Children's Social Competence Between 11/2 and 15 Years of Age

The primary purpose of this longitudinal study was to examine the effects of early child-care experiences on children's social development between 11/2 and 15 years of age. A subsample of 52 children was selected from the Goteborg Child Care study. These children were selected because they were continuously enrolled in out-of-home care from 11/2 to 31/2 years of age. The first assessment was conducted prior to children's enrollment in out-of-home care and these children were followed over a 14-year period. Prior to 31/2 years of age, the amount of time spent in care and the quality of home and out-of-home care shaped the children's social skills. Individual differences in social competence with peers, as observed in out-of-home care settings, then began to stabilize. Thus, early child-care experiences appeared to influence social competence by fostering individual differences that remained stable through childhood and early adolescence.     

Epidemics in nonrandomly mixing populations: a simulation

Two stochastic, discrete-time simulation models for the spread of an epidemic through a population are presented. The models explore the effects of nonrandom mixing within the population and are based on an SIR epidemic model without vital statistics. They consider a population of preschool children, some of whom attend child care facilities. Disease transmission occurs both within the home neighborhood and at the child care facility used, if any. The two models differ in population size used, population density, the proportions of children using different kinds of care, and the functions used for calculating the probability of disease transmission. Results are presented for seven different variables--length of the epidemic in weeks, number of cases, number of cases in each kind of care (two day care centers, private homes, and children staying at home), and the number of private home providers affected by the epidemic. In addition, the distribution of total epidemic size and the progress of an epidemic are estimated from 25 epidemic trials. The effects of the location of homes of initial cases, the type of care used by initial cases, and the density of the population are discussed. Results from the simulation confirmed the importance of type of care on the risk for disease transmission. Results from all runs of the simulation showed that children who attended a day care center were most likely to become infected, children who went to a private home were intermediate, and children who did not use any day care facility were at the lowest risk. The size and length of the epidemics were related to the presence of the disease in day care centers, regardless of the location of the initial case, and the time at which the disease entered the center(s). The simulations also showed that the geographical distribution of the homes of children attending a particular center was a critical feature involved in the production of epidemics. The center with more widely distributed homes of students was less likely to experience a major epidemic than the center with clustering of student's homes within a neighborhood. This indicates that it is not simply attendance at a day care center that is critical for disease spread, but that the nature of the population of children attending a center is also of critical importance in the actual risk for disease spread within the center. These results are discussed with reference to the spread of hepatitis A among day care centers in Albuquerque, New Mexico.     

The evolving epidemiology of invasive meningococcal disease: a two-year prospective,population-based study in children in the area of Athens

In response to an increase in the incidence in invasive meningococcal disease (IMD) due to Neisseria meningitidis, a system of hospital- and laboratory-based surveillance was used in a prospective epidemiological and clinical assessment of IMD in children 0-13 years of age hospitalized in the Athens area between 1 January 1999 and 31 December 2000. The annual incidence of laboratory-confirmed disease was 10.2/100,000. Serogroup B strains were predominant. There was a sharp decrease in serogroup C from 19% of cases in 1999 to 3% in 2000 (P=0.013). Of note was the emergence of serogroup A responsible for 7% of the cases. The overall case fatality rate was 4.5%, but 2.8% for microbiologically confirmed cases. A remarkable decrease in disease severity assessed by admissions to intensive care units was noted during the second study year. Polymerase chain reaction-based methods for detection of meningococcal DNA were the sole positive laboratory test in 45% of the cases and the only test on which serogroup determination was based in 52% of groupable cases. The epidemiological and clinical profile of meningococcal disease appears to be rapidly evolving and close monitoring is required particularly for input into decisions regarding use of meningococcal vaccines.     

Diagnosis and management of meningococcal disease: the need for centralized care

Meningococcal infection remains a significant health problem in children, with a significant mortality and morbidity. Prompt recognition and aggressive early treatment are the only effective measures against invasive disease. This requires immediate administration of antibiotic therapy, and the recognition and treatment of patients who may have complications of meningococcal infection such as shock, raised intracranial pressure (ICP) or both. Encouragingly, its mortality has fallen in recent years. This is the result of several factors such as the centralization of care of seriously ill children in paediatric intensive care units (PICUs), the establishment of specialized mobile intensive care teams, the development of protocols for the treatment of meningococcal infection, and the dissemination by national bodies and charities of guidance about early recognition and management. We will review the pathophysiology and management of the different presentations of meningococcal disease and examine the possible role of adjunctive therapies.     

The role of healthcare delivery in the outcome of meningococcal disease in children: case-control study of fatal and non-fatal cases

Objective To determine whether suboptimal management in hospital could contribute to poor outcome in children admitted with meningococcal disease.Design Case-control study of childhood deaths from meningococcal disease, comparing hospital care in fatal and non-fatal cases.Setting National statistics and hospital records.Subjects All children under 17 years who died from meningococcal disease (cases) matched by age with three survivors (controls) from the same region of the country.Main outcome measures Predefined criteria defined optimal management. A panel of paediatricians blinded to the outcome assessed case records using a standardised form and scored patients for suboptimal management.Results We identified 143 cases and 355 controls. Departures from optimal (per protocol) management occurred more frequently in the fatal cases than in the survivors. Multivariate analysis identified three factors independently associated with an increased risk of death: failure to be looked after by a paediatrician, failure of sufficient supervision of junior staff, and failure of staff to administer adequate inotropes. Failure to recognise complications of the disease was a significant risk factor for death, although not independently of absence of paediatric care (P = 0.002). The odds ratio for death was 8.7 (95% confidence interval 2.3 to 33) with two failures, increasing with multiple failures.Conclusions Suboptimal healthcare delivery significantly reduces the likelihood of survival in children with meningococcal disease. Improved training of medical and nursing staff, adherence to published protocols, and increased supervision by consultants may improve the outcome for these children and also those with other life threatening illnesses.     

183例早产儿围产期高危因素及并发症分析

目的：探讨早产儿发生的围产期高危因素及并发症。方法：收集我院2006．1—2009．12出生的早产儿183例的临床资料,总结其早产的相关围产期高危因素及并发症。结果：胎膜早破、多胎妊娠、妊娠高血压综合征是早产发生的主要原因;早产儿的主要并发症为肺炎和颅内出血等。结论：加强围生期保健,早期干预各种围产期高危因素,积极防治早产儿各种并发症,是提高早产儿存活率降低致残率的关键。     

TnT-Hs和NSE在手足口病患儿中的表达水平及临床意义

目的：探讨TnT-Hs和NSE水平在手足口病患儿中的表达及临床意义。方法：选择我院2012年6月-2013年6月确诊为手足口病的住院患儿68例作为观察组,选择同期入院健康体检的68例正常儿童作为对照组,对比两组心肌钙蛋白T（TnT—Hs）与血清神经元特异性烯醇化酶（NSE）水平;并对观察组EV71阳性患儿与阴性患儿TnT-Hs与NSE水平进行比较。结果：①相比健康对照组,观察组TnT-Hs与NSE水平均较高,差异有统计学意义（P〈0．01）。②EV71阳性患儿46例,阴性患儿22例,阳性患儿相比阴性患儿TnT-Hs与NSE水平较高,差异均有统计学意义（P〈0．05）。结论：Tn—T-Hs和NSE水平可反映手足口病患儿病情进展变化,其可作为早期预测手足口病患儿心肌损害及脑损伤的依据及重症病例的预警指标。     

Why Children with Severe Bacterial Infection Die: A Population–Based Study of Determinants and Consequences of Suboptimal Care with a Special Emphasis on Methodological Issues

Introduction

Suboptimal care is frequent in the management of severe bacterial infection. We aimed to evaluate the consequences of suboptimal care in the early management of severe bacterial infection in children and study the determinants.

Methods

A previously reported population-based confidential enquiry included all children (3 months- 16 years) who died of severe bacterial infection in a French area during a 7-year period. Here, we compared the optimality of the management of these cases to that of pediatric patients who survived a severe bacterial infection during the same period for 6 types of care: seeking medical care by parents, evaluation of sepsis signs and detection of severe disease by a physician, timing and dosage of antibiotic therapy, and timing and dosage of saline bolus. Two independent experts blinded to outcome and final diagnosis evaluated the optimality of these care types. The effect of suboptimal care on survival was analyzed by a logistic regression adjusted on confounding factors identified by a causal diagram. Determinants of suboptimal care were analyzed by multivariate multilevel logistic regression.

Results

Suboptimal care was significantly more frequent during early management of the 21 children who died as compared with the 93 survivors: 24% vs 13% (p = 0.003). The most frequent suboptimal care types were delay to seek medical care (20%), under-evaluation of severity by the physician (20%) and delayed antibiotic therapy (24%). Young age (under 1 year) was independently associated with higher risk of suboptimal care, whereas being under the care of a paediatric emergency specialist or a mobile medical unit as compared with a general practitioner was associated with reduced risk.

Conclusions

Suboptimal care in the early management of severe bacterial infection had a global independent negative effect on survival. Suboptimal care may be avoided by better training of primary care physicians in the specifics of pediatric medicine.     

苄星青霉素与头孢曲松钠联合治疗早期梅毒的疗效比较

目的:观察苄星青霉素与头孢曲松钠联合应用治疗早期梅毒的临床疗效及血清学变化。方法:113例早期梅毒患者,随机分成苄星青霉素联合头孢曲松钠治疗组(A组)58例和苄星青霉素单一治疗组(B组)55例。结果:A组有效随访例数为55例;B组有效随访数为52例。1周内皮损消退率,A组为89.7%(35/39),B组为64.9%(24/37)。3个月TRUST阴转率,A组为40.0%(22/55),B组为21.2%(11/52),二组差异有统计学意义(x2=4.451,P=0.039)。6个月TRUST阴转率,A组为67.3%(37/55),B组为42.3%(22/52),二组差异有统计学意义(x2=6.735,P=0.012)。9个月TRUST阴转率,A组为90.9%(50/55),B组为73.1%(38/52),二组差异有统计学意义(x2=5.820,P=0.022)。12个月TRUST阴转率,A组为94.5%(52/55),B组为82.7%(43/52),二组差异无统计学意义(x2=3.771,P=0.068)。血清固定率,A组为1.8%(1/55),B组为9.6%(5/52)。结论:苄星青霉素联合头孢曲松钠治疗早期梅毒效果较单一使用苄星青霉素显著,表现在皮损消退时间快、梅毒血清阴转时间缩短,血清固定率降低。