体描箱在评估婴幼儿急性下呼吸道感染肺功能改变中的价值

摘要 目的：探讨体描箱评估婴幼儿急性下呼吸道感染（ALRTI）肺功能改变的价值。方法：收集2020年10月至2021年6月于我院收治的76例ALRTI婴幼儿,根据感染部位分为肺炎组与支气管炎组,根据有无喘息症状分为喘息性组和非喘息性组,采用体描箱测量潮气呼吸参数、体描箱特有指标,分别进行两组间肺功能比较,分析各参数之间相关性,采用受试者工作特征（ROC）曲线评估体描特有指标在婴幼儿ALRTI中的诊断价值。结果：肺炎组与支气管炎组比较,各潮气呼吸参数及功能残气量（FRCp）无明显差异（P>0.05）,而有效气道阻力（Reff）和特殊有效气道阻力（sReff）有明显差异（P<0.05）;对于喘息性组与非喘息性组,sReff有显著差异（P<0.05）;76例ALRTI患儿潮气量（VT）与每公斤体质量潮气量（VT/kg）呈正相关（P<0.05）,VT、VT/kg均与呼吸频率（RR）、达峰时间比（TPTEF/TE）呈负相关（P<0.05）, TPTEF/TE与达峰容积比（VPTEF/VE）呈正相关（P<0.05）,sReff与FRCp、Reff均呈正相关（P<0.05）;ROC曲线显示,sReff在诊断肺炎与支气管炎、喘息性和非喘息性的价值最高,ROC曲线下面积分别为0.704、0.688。结论：对于ALRTI患儿,体描箱参数Reff和sReff可帮助判断感染部位,且sReff可直接反映小气道阻塞情况,诊断价值较高,值得临床推广应用。     

国内双歧杆菌制剂预防小儿继发性腹泻临床疗效的Meta分析

目的系统评价国内双歧杆菌制剂临床预防小儿继发性腹泻的效果。方法按照系统评价的要求检索CBMd isc、VIP、CNK I以及万方数据库等,获得18篇符合纳入标准的文献,共计患儿4050例,对其进行M eta分析,并评价M eta分析结果的稳定性和发表偏倚。结果异质性检验χ^2=34.60,P=0.007〈0.05,采用随机效应模型进行M eta分析,合并RR=0.41,95%C I为0.35～0.49,总体效应检验,Z=10.39,P〈0.00001,差异具有非常显著性,固定效应模型RR值和95%C I与随机效应模型完全一致,剔除小样本报道后的合并RR=0.42,95%C I为0.35～0.50,与剔除前的结果基本一致,且本研究的发表偏倚得到了很好地控制。结论从现有的临床证据来看,双歧杆菌制剂能降低小儿继发性腹泻的发生率,对预防小儿继发性腹泻起到了满意的效果。     

雾化吸入治疗婴幼儿重度哮喘的研究

目的:比较婴幼儿哮喘重度发作时,采用布地奈德混悬液吸入治疗和全身用甲基强的松龙的效果。方法:将78例哮喘重度发作婴幼儿按就诊顺序分为2组,分别采用布地奈德混悬液+万托林雾化(布地奈德组,35例)、万托林雾化+静脉用甲泼尼龙(甲泼尼龙组,43例)治疗,对其临床症状进行比较。结果:组内不同治疗时间患儿呼吸频率、心率、哮鸣音及自我感觉评分均随时间延长而逐渐降低,与治疗前比较差异有统计学意义(q=2.89~143.87,P<0.05或0.01);组间比较,各组指标无显著性差异。结论:提示婴幼儿哮喘重度发作时,采用布地奈德混悬液吸入治疗可达到与静脉用甲泼尼龙基本相同的效果;联合吸入治疗在一定程度上可代替全身用激素。     

Skin temperatures at the nape in infants at high altitude.

Skin temperatures were measured on three Quechua Indian infants resident at 4,000 meters above sea level in Peru. Nape temperatures were warmer than other skin sites, suggesting that the brown adipose tissue associated with non-shivering thermogenesis is metabolically active despite the reduced oxygen availability at high altitude. The question of the role of non-shivering thermogenesis in infant thermoregulation under the covariant stresses of hypoxia and cold is still open.     

儿童感染性腹泻病原学研究

目的 研究儿童感染性腹泻病原学组成与流行病学特征。方法 按《临床检验操作规程》定点逐月检测0～6岁腹泻患儿大便标本中轮状病毒、痢疾杆菌、致病性大肠埃希菌（EPEC）与沙门菌,并分析病历。结果 全年共检测693份标本,检出病原326份,检出率为47.0%;轮状病毒、EPEC、痢疾杆菌及沙门菌的检出率依次为30.2%,8.4%、7.2%与1.3%;轮状病毒与细菌性病原构成比为64.1：35.9;轮状病毒以秋冬季（10、11月与次年1、2月）、水样便标本、2岁以内年龄组以及人工和混合喂养婴儿检出率较高;细菌性病原以夏秋季（6～10月）与脓血便检出率较高;痢疾菌群中以福氏菌占优势（70%）,次为宋内杆菌（28.0%）;EPEC菌型复杂,共检出11个“O”群;检出的沙门菌有4种,即阿哥纳、德尔串、鼠伤寒与肠炎血清型。结论 开展儿童感染性腹泻病原学研究能即时发现病原,并为制定防治对策提供依据。     

秦岭川金丝猴一周岁内个体的行为发育

2003年3月至2004年5月在陕西周至国家自然保护区的玉皇庙地区,采用目标动物取样法(Focal ani-mal sampling)对2003年出生的5只金丝猴个体行为发育进行了观察,应用全事件记录法(All-occurrences record-ing)进行数据的收集。结果表明23日龄婴儿首次从母亲怀内爬出在树枝上活动,68日龄开始在树上攀爬跳跃,5月龄主动采食树叶和啃投食区食物,6月龄跟随社群迁移。依据婴幼儿主要行为首次出现时间及其变化,把1周岁内个体发育分为5个时期,即完全依赖期、探索外部世界期、融入社群期、适应生存期和逐步独立期。1周岁内婴幼儿活动和休息的地方是母亲怀里、其它个体怀里、树枝上和地面上。随着发育,婴幼儿在这些地方停留的时间也在变化。1周岁内婴幼儿在母亲怀中的时间与年龄存在明显的负相关,在其它个体怀里的时间与年龄也呈显著负相关。虽然独自在树上的时间与年龄相关性不显著,但在地面上停留的时间与年龄呈正相关。     

Plasma cortisol responses to stress in lactating and nonlactating female rhesus macaques

Lactating female rats without their pups exhibit lower HPA responsiveness to stress than nonlactating females. However, responsiveness to stress is similar when lactating females are tested with their pups and the stressor involves a potential threat to the offspring. This study constitutes the first comparison of stress responsiveness in lactating and nonlactating female nonhuman primates. Subjects were 53 multiparous female free-ranging rhesus macaques. Approximately half of the females were lactating and half were nonpregnant/nonlactating. Blood samples were obtained after capture and after overnight housing in an individual cage. Lactating females were tested with their infants. Lactating females had significantly higher plasma cortisol levels than nonlactating females on both days. Having or not having an infant was also a better predictor of plasma cortisol levels among all females than their age, dominance rank, group of origin, time of day at which the sample was obtained, and time elapsed since beginning of the sampling procedure or since anesthesia. Plasma cortisol levels of lactating females were not significantly correlated with post-partum stage or with the cortisol levels of their infants. Capture, handling, and individual housing in a cage are powerful psychological stressors for free-ranging primates. We suggest that the higher plasma cortisol levels exhibited by lactating females reflect greater responsiveness to stress associated with perception of risks to infants. Hyporesponsiveness to stress may not be a general characteristic of lactation in all mammalian species, but a short-term effect of infant suckling that is most apparent with stressors unrelated to the offspring.     

Assessment of Circadian Rhythms of Both Skin Temperature and Motor Activity in Infants During the First 6 Months of Life

The authors developed a method useful for home measurement of temperature, activity, and sleep rhythms in infants under normal-living conditions during their first 6 mos of life. In addition, parametric and nonparametric tests for assessing circadian system maturation in these infants were compared. Anthropometric parameters plus ankle skin temperature and activity were evaluated in 10 infants by means of two data loggers, Termochron iButton (DS1291H, Maxim Integrated Products, Sunnyvale, CA) for temperature and HOBO Pendant G (Hobo Pendant G Acceleration, UA-004-64, Onset Computer Corporation, Bourne, MA) for motor activity, located in special baby socks specifically designed for the study. Skin temperature and motor activity were recorded over 3 consecutive days at 15 days, 1, 3, and 6 mos of age. Circadian rhythms of skin temperature and motor activity appeared at 3 mos in most babies. Mean skin temperature decreased significantly by 3 mos of life relative to previous measurements (p?=?.0001), whereas mean activity continued to increase during the first 6 mos. For most of the parameters analyzed, statistically significant changes occurred at 3–6 mos relative to 0.5–1 mo of age. Major differences were found using nonparametric tests. Intradaily variability in motor activity decreased significantly at 6 mos of age relative to previous measurements, and followed a similar trend for temperature; interdaily stability increased significantly at 6 mos of age relative to previous measurements for both variables; relative amplitude increased significantly at 6 mos for temperature and at 3 mos for activity, both with respect to previous measurements. A high degree of correlation was found between chronobiological parametric and nonparametric tests for mean and mesor and also for relative amplitude versus the cosinor-derived amplitude. However, the correlation between parametric and nonparametric equivalent indices (acrophase and midpoint of M5, interdaily stability and Rayleigh test, or intradaily variability and P₁/P_ultradian) despite being significant, was lower for both temperature and activity. The circadian function index (CFI index), based on the integrated variable temperature-activity, increased gradually with age and was statistically significant at 6 mos of age. At 6 mos, 90% of the infants' rest period coincided with the standard sleep period of their parents, defined from 23:00 to 07:00?h (dichotomic index I?<?O; when I?<?O?=?100%, there is a complete coincidence between infant nocturnal rest period and the standard rest period), whereas at 15 days of life the coincidence was only 75%. The combination of thermometry and actimetry using data loggers placed in infants' socks is a reliable method for assessing both variables and also sleep rhythms in infants under ambulatory conditions, with minimal disturbance. Using this methodological approach, circadian rhythms of skin temperature and motor activity appeared by 3 mos in most babies. Nonparametric tests provided more reliable information than cosinor analysis for circadian rhythm assessment in infants. (Author correspondence: elvirada@um.es)     

遵义地区婴幼儿重症肺炎细菌病原学分析

目的 监测遵义地区3岁以下婴幼儿重症肺炎的细菌病原学种类分布和耐药情况,指导本地区临床医师合理选择抗生素.方法 对313例PICU病房重症肺炎婴幼儿用一次性无菌吸痰管负压吸取下呼吸道痰液,将合格痰标本进行细菌培养和药敏分析.结果 155例(49.52％)痰培养阳性,检出细菌197株(62.93％);其中革兰阴性菌128株(64.97％),以肺炎克雷伯菌、大肠埃希菌为主;超广谱B-内酰胺酶(ESBLs)阳性检出率为35.93％;革兰阴性菌(ESBLs阳性)对氨苄西林/舒巴坦、头孢唑啉、头孢曲松、头孢吡肟、复方新诺明耐药率较高,对亚胺培南、哌拉西林/他唑巴坦、环丙沙星耐药率低.革兰阳性菌65株(32.99％),以肺炎链球菌、金黄色葡萄球菌为主;对红霉素、克林霉素耐药率较高,对万古霉素、利奈唑胺、替加环素、呋喃妥因、利福平耐药率低.真菌4例.革兰阳性菌组与革兰阴性菌组比较,微循环障碍发生率差异有统计学意义(17.95％VS5.17％,P＜0.05).结论 遵义地区婴幼儿重症肺炎以革兰阴性菌居多,主要病原依次为肺炎克雷伯杆菌、大肠埃希菌、肺炎链球菌、金黄色葡萄球菌,ESBLs阳性率高,革兰阴性菌对抗菌药物的耐药性较普遍,抗生素的合理使用是降低感染和细菌耐药的重要保证.     

21例奶蛋白过敏患儿临床特征分析及诊治方法

目的：探讨奶蛋白过敏患儿的临床特点及诊治方法。方法：收集2012年2月-2013年2月我院接诊的21例奶蛋白过敏患儿的临床资料,将临床表现、特异性皮肤点刺试验、回避试验等结果进行总结分析。结果：患儿皮肤粘膜、消化道等症状出现时间较早,湿疹症状出现最多（71．43％）,仅有1例患儿出现发育迟缓（4．76％）;皮肤点刺试验奶蛋白阳性者12例（57．14％）,回避试验阳性率为100．00％;经过改善饮食及对症治疗,21例患儿皮肤粘膜、消化道、呼吸道系统等症状一般在4周内消失,发育迟缓在正规治疗2．4周开始缓解,8周内消失。结论：奶蛋白过敏缺乏特异症状表现,临床在出现症状后加强实验室检查。结合详细病史进行确诊,才能减少误诊的发生,及时治疗,保证患儿的正常生长发育。