目的:探讨基于移动医疗的个案管理模式改善青少年1型糖尿病病人血糖控制、糖尿病相关知识掌握程度和自我管理能力的效果.方法:选取2021年5月—2022年6月就诊于北京儿童医院的74例新发青少年1型糖尿病病人为研究对象,随机分为对照组38例和干预组36例.对照组采用常规居家自我管理模式,干预组采用基于移动医疗的个案管理模式.采用中文版青少年糖尿病行为评定量表(DBRS)、密歇根糖尿病知识测试问卷(DKT)和满意度调查表评估病人出院后的血糖控制情况、自我管理能力和病人/家长的糖尿病知识掌握情况.结果:出院后3个月和6个月,干预组空腹血糖和餐后2 h血糖值均低于对照组;重复测量方差分析显示,两组糖化血红蛋白(HbAlc)在时间效应差异有统计学意义(P<0.05),两组空腹血糖值的时间效应、组间效应和交互效应比较差异均有统计学意义(P<0.05),两组餐后2 h血糖值在组间效应和交互效应比较差异均有统计学意义(P<0.05).出院后3个月和6个月,干预组病人DKT得分高于对照组;重复测量方差分析显示,两组病人DKT得分的时间效应、组间效应和交互效应比较差异均有统计学意义(P<0.05),两组家长DKT得分时间效应和交互效应比较差异均有统计学意义(P<0.05).出院后3个月和6个月两组病人低血糖发生次数比较差异无统计学意义(P>0.05).出院后6个月干预组家长满意度得分高于对照组(P<0.05).结论:基于移动医疗的个案管理模式可以提高血糖控制效果,提高青少年糖尿病病人的糖尿病知识掌握情况及病人家长满意度.

目的 总结儿童囊性纤维化相关糖尿病的护理经验.方法 回顾性分析 1 例囊性纤维化相关糖尿病患儿的临床资料,总结临床护理要点.结果 在积极抗感染、气道管理、血糖控制和营养支持等治疗的基础上,实施气道廓清相关护理、个体化糖尿病管理等措施后,患儿呼吸道症状缓解,血糖控制平稳.结论 囊性纤维化相关糖尿病患儿病史长,目前无有效的治疗方法,呼吸道管理和血糖管理是护理的关键.

目的 观察集束化护理方案对高原地区肺炎患儿雾化吸入的效果。方法 选取2020年7月至2021年7月期间就诊于西藏自治区拉萨市某三甲医院儿科的100例肺炎患儿作为研究对象，将研究对象随机分为观察组和对照组，给予两组肺炎患儿相同雾化吸入治疗方案的同时，对照组50例患儿接受一般护理干预，观察组50例患儿接受集束化护理干预，对比两组肺炎患儿症状缓解时间、临床疗效、患者满意度。结果 经统计，观察组患儿肺啰音消失时间、退热时间、咳嗽停止时间均比对照组患儿所用时间短，两组症状缓解时间对比有统计学意义（P<0.05）；两组患儿治疗有效率差异有统计学意义（P<0.05）；观察组护理满意度96%，对照组护理满意度78%，两组满意度差异有统计学意义（P<0.05）。结论 高原地区肺炎患儿接受雾化吸入治疗的同时给予集束化护理干预，可有效促进患者症状尽快缓解，提高临床疗效的同时，减少不良反应产生，促进患儿满意度提升，是一项值得积极推广的应用。

Objective:To review the length of neonatal urethral catheter insertion and provide a reference for clinical practice and related research. Methods:We followed the JBI scoping review methodology for this study. Websites and databases were searched to obtain literature on the length of neonatal urethral catheter insertion. Two researchers then screened the literature and extracted data independently using a standardized data extraction form. We performed descriptive analysis for the extracted data. Results:A total of 10 papers were included. "Urine outflow" was reported as a standard indicator for the length of catheter insertion in most literature; a few hospitals used a fixed length as the standard; some literature suggested that we should insert the catheter a further distance after the urine flows out. Conclusion:At present,there is no consensus on the length of neonatal urethral catheterization in the literature. Multi-center and large-sample studies are needed to establish the specification of neonatal urethral catheter insertion length.

目的 概述儿童血培养采血量的现有文献,总结采血量的现行标准及采血量对血培养细菌检出率或污染率的影响.方法 采用范围综述的研究范式,检索相关数据库及政府或指南网站,从研究类型、研究对象、研究目的、采血量、样本量、结局指标、结果描述等方面进行系统总结.结果 共检索文献1442篇,最终纳入28篇.国外医院采血量多数以体重或年龄作为依据,部分医院采用固定采血量作为标准.结论 儿童采血量标准差别较大,对结果的解读也不一致,且目前文献中多为观察性研究,缺乏中国儿童的数据,有必要进行多中心大样本的研究以确立适合我国儿童的采血量标准.

目的 观察儿童腰椎穿刺(lu1m1bar puncture,LP)前局部外用药物麻醉对术后疼痛(腰痛/头痛)的影响.方法 选取2015年3月至2016年4月首都医科大学附属北京儿童医院感染科收治的200例需行LP检查的患儿,分为麻醉组和非麻醉组.麻醉组LP前于穿刺部位局部涂抹复方利多卡因乳膏,lh后进行操作.主要观察指标为腰痛、头痛.结果 麻醉组和非麻醉组穿刺成功率为100％.两组术后即刻面部、腿、活动、哭喊、可安慰性(face legs activity cry consolability,FLACC)评估量表评分分别为1.5(0,10)分和1.3(0,9)分,术后4 h分别为0.2(0,4)分和0.3(0,6)分,差异无统计学意义(P = 0.860).麻醉组和非麻醉组术后即刻腰痛发生率分别为9％和11％(x2 = 0.222,P = 0.637)、头痛发生率分别为4％和9％(x2 = 0.082,P = 0.774).均未发生脑疝和LP过程需要终止操作的事件.麻醉组未发生药物不良反应.结论 术前局部麻醉不降低LP后疼痛(腰痛/头痛)的发生率.

目的:检索、评价和整合儿童血流感染患儿血培养采集的最佳实践证据.方法:按照6S模型,检索BMJ best practice,UpToDate、英国国家卫生与临床优化研究所指南网(NICE Guidance)、苏格兰院际指南网(SIGN)、安大略注册护士协会(RNAO)、国际指南协作网(GIN)、美国国立指南库(NGC)、医脉通、美国临床和实验室标准协会(CLSI)、世界卫生组织官网(WHO)、PubMed、CINAHL、Cochrane Library英文数据库、中国期刊全文数据库(CNKI)、万方数据库(Wanfang Data)、Sinomed中关于血培养标本采集管理的相关指南、标准、临床决策,补充检索最新指南发表时间之后发表的系统评价.由2名研究者对纳入的文献进行质量评价,对符合质量标准的文献进行证据提取和汇总.结果:共纳入文献7篇,包括临床决策1篇、指南4篇、系统评价2篇,最终从采血时机、采集前消毒、采集工具、采血途径、采血量、管理策略6个方面总结证据22条.结论:所总结的关于儿童血培养采集的证据可用于临床实践,促进儿童血培养采集的规范化管理,提升检出率.

Objective To explore the influence factors of adverse blood transfusion reactions in children.Methods A total of 4 960 children who had blood transfusion from January 2017 to January 2018 in Beijing Children's Hospital,Capital Medical University were retrospectively analyzed.Incidence and types of adverse reactions were analyzed.Results There were 23 cases (0.46％) of adverse transfusion reactions,including 12 cases of fever(52.17％),6 cases of allergy(26.09％),3 cases of elevated serum bilirubin (13.04％) and 2 cases of dyspnea and chest tightness (8.70％).There were significant differences of the incidence of adverse transfusion reactions between children with and without history of transfusion,with and without history of allergy,times of transfusion ＞ 2 and ≤ 2,duration time of transfusion ≥ 30 min and ＜ 30 min [0.62％ (19/3 045) vs 0.21％ (4/1 915),1.87％ (15/803) vs 0.19％ (8/4 157),0.74％ (16/2 167) vs 0.25％ (7/2 793),0.80％ (15/1 874) vs 0.26％ (8/3 086)] (all P ＜0.05).Multivariate logistic regression analysis showed that history of transfusion,history of allergy,times of transfusion and duration time of blood transfusion were independent risk factors of adverse reactions in children (odds ratio =1.874,2.197,3.061,2.485;95％ confidence interval:1.162-3.265,1.254-3.671,1.437-4.896,1.309-3.987;all P ＜ 0.001).Conclusions Adverse blood transfusion reactions in children can be influenced by many factors.Preventive measures should be taken to reduce the adverse reactions.

[目的]探究阶梯式护理联合全程优化护理模式在细菌性脑膜炎患儿中的应用效果。[方法]随机选取我院158例细菌性脑膜炎患儿,随机分为研究组和对照组各79例,给予对照组患儿常规护理,研究组患儿采用阶梯式护理联合全程优化护理模式,比较两组患儿临床症状改善情况、临床治疗效果以及生活质量评分。[结果]护理后,研究组患儿外周白细胞恢复时间、脑脊液白细胞恢复时间、体温恢复时间、症状消失时间、住院时间等均明显低于对照组患儿（P＜0.05）;研究组患儿的治疗有效率（94.9%）明显高于对照组（77.2%）（P＜0.05）;研究组生活质量评分高于对照组（P＜0.05）。[结论]采用阶梯式护理联合全程优化护理模式有助于缩短细菌性脑膜炎患儿的临床症状消失时间,加快患儿恢复进程,提高患儿的生活质量。

Objective To evaluate the effect of two-site blood cultures on detection rate in pediatric patients. Methods The data were retrospectively analyzed of 1 985 hospitalized children with blood cultures from January 2013 to February 2015 in Department of Infectious Diseases, Beijing Children′s Hospital, Capital Medical University, including blood culture collection, the administration of antibiotics prior to obtaining blood cultures and positive condition of blood culture.It was divided into 3 stages according to blood culture collection.Blood culture of a single bottle referred to the blood culture in an aerobic bottle.Double bottles transition stage referred to two blood samples taken from the same skin puncture point and the aerobic bottle culture was carried out at the same time.Two-site blood cultures referred to two blood samples taken from the different skin puncture point and the aerobic bottle culture was carried out at the same time.The interval time between the two blood cultures should be less than 5 minutes.The positive rates of three stages were analyzed by Pearson χ2 test.The change tendency of positive rates in three stages were analyzed by Cochran-Armitage test.Bilateral P<0.05 was considered as statistically significant difference in all test analysis. Results More than 80% of the children in the three stages were given antibiotics.There was no significant difference in the true positive rate (χ2=1.343, P>0.05). There was no significant difference in the change tendency of positive rates (P>0.05). False- positive strains were common for coagulase-negative staphylococci.In terms of false positive rate, blood culture of single bottle was higher than two-site blood culture (χ2=6.051, P<0.05). Conclusion For children (non-neonates), two-site blood cultures can reduce the false positive rate of blood culture and play a role in distinguishing between true positives and false positives in blood culture. Key words: Two-site blood cultures; Pediatrics; Positive rate

隐球菌性脑膜炎是由新型隐球菌感染脑膜和脑实质所致的中枢神经系统的亚急性或慢性炎症疾病,是深部真菌病中较为常见的一种类型.该病可见于任何年龄,在我国各地均有散在发病,病情重,症状明显,治疗周期长,恢复缓慢,针对性护理干预对促进疗效亦有举足轻重的作用.细致入微的基础护理使患儿及家长舒适,有助于改善病情.本文重点介绍了儿童新型隐球菌脑膜炎患儿的临床护理干预进展.

目的 分析儿童深静脉置管导致股静脉血栓的原因,探讨有效的预防护理干预措施.方法 对北京儿童医院感染内科2015年1月-2016年12月收治的6例深静脉置管导致股静脉血栓患儿的临床护理资料进行回顾性分析,分析静脉血栓形成的原因,提出有效的预防护理干预措施.结果 6例深静脉置管导致股静脉血栓的患儿接受针对性的护理,采取相应措施,症状得到缓解.结论 通过对患儿深静脉置管导致股静脉血栓形成原因的充分认识和分析,对导管相关危险因素进行评估,使护理干预措施得以有效的实施,保证各项护理操作的规范化,从而预防血栓的发生.

黑热病亦称内脏利什曼病［1］，是由杜氏利什曼原虫（黑热病原虫）所引起通过媒介白蛉叮咬传染的慢性地方性传染病。经我国开展防治工作以来现已基本消灭［2］，仅个别地区（四川川北、新疆）有少数发生。杜氏利什曼原虫病属人兽共患疾病，临床上以长期不规则发热、进行性脾脏肿大、消瘦、贫血、全血细胞减少及血浆球蛋白增高为特征［3］。杜氏利什曼病共有3种类型，即皮肤型、内脏型、黏膜皮肤型［4］。儿童黑热病北京地区极为罕见，感染病内科于2014年3月25日首次收治了1例儿童黑热病患儿，本患儿黑热病属于内脏型黑热病，由杜氏利什曼原虫侵害内脏器官（肝脏、脾脏）而致病，在积极治疗和精心护理后，患儿病情治愈出院，家长满意，现将护理体会报道如下。

小柳原田综合征(Vogt Koyanagi Harada’s syndrome,VKHS)[1]临床上十分罕见,也很难确诊,是一种病因尚不完全清楚,累及眼、耳、皮肤和脑膜等全身多器官性的病变[2]。主要表现为脉络膜炎、视乳头炎、神经视网膜炎和肉芽肿性全葡萄膜炎,常伴有脑膜刺激征。通常急性发病,双眼可同时或短期先后出现葡萄膜炎(包括渗出性视网膜脱离、视盘充血、水肿及晚霞状眼底)[3],2013年2月感染科收治1例小柳原田综合征伴人类疱疹病毒(EB病毒)感染的患儿,现将护理体会报告如下。

<正>护理标识是指医院为预防病人在住院过程中,由于生理、病理、心理、社会、环境等诸多不确定因素或难以预料的意外事件或风险事件发生,而特殊制作的各种有针对性、科学性的标识记号,以防范护理缺陷的发生[1]。使用规范的护理标识,是降低护理风险的最直观的方法之一,我院将护理标识应用于临床,取得

目的讨论小儿化脓性脑膜炎合并脑室管膜炎侧脑室引流术的护理体会。方法回顾分析2011年1～12月10例小儿化脓性脑膜炎合并脑室管膜炎侧脑室引流术患儿的临床资料。结果 10例患儿均获得满意的疗效,好转出院。结论认真做好侧脑室引流术前心理护理及术后病情观察、基础护理、引流管的护理,是治疗化脓性脑膜炎合并脑室管膜炎的关键,可以有效提高患儿生活质量。

Objectives To investigate clinical features and risk factors for an adverse outcome of childhood bacterial meningitis.Methods A total of 148 bacterial meningitis patients admitted in Beijing Children's Hospital from January 2007 to December 2008 were retrospectively analyzed.According to Glasgow prognostic score,all cases were divided into two groups,favorable and adverse outcome groups.All risk factors including disease history,clinical manifestations,complications,laboratory examinations,and treatment were studied statistically and compared with two different groups.Results The most common clinical characteristics were fever,lethargy and convulsion.Of all studied risk factors,the length of stay in hospital,retardation of papillary reflex and anisocoria,the white blood cell count( 4 × 109 /L or 12 × 109 /L),the cerebrospinal fluid sugar( 1.5 mmol/L)and protein( 1 000 mg/L),serum sodium 135 mmol/L and serum calcium were significantly different between two groups.Conclusions The risk factors for an adverse outcome of bacterial meningitis were anisocoria,abnormal blood white cell count at admission,cerebrospinal fluid low sugar and high protein level,and low serum sodium level.

目的:探讨6例儿童药物超敏综合征(DHS)患儿的护理体会。方法:回顾2009年1月~2010年11月DHS患儿的临床护理资料。结果:对6例DHS患儿进行皮肤护理、用药护理、发热护理、饮食护理、心理护理等精心的治疗及护理,6例患儿均获得满意的疗效。结论:DHS患儿的护理涉及内科、外科、皮肤科等多个相关专业,护士应加强对皮肤、口腔、眼部、会阴部的护理,并熟悉与其专业相关的疾病知识及相关药物的药理作用,细致观察患儿的病情变化及药物的治疗效果、不良反应等,这对药物超敏患儿的临床康复起到至关重要的作用。

对11例结核性脑膜炎患儿在侧脑室引流术前及术后进行监测及护理。术前宜做好患儿家长的心理护理,以取得家长的理解与配合,术后宜监测颅内压,保持引流管通畅,仔细观察并记录引流液的量及颜色,严格无菌操作,注意消毒隔离,以减少颅内感染,提高治愈率。

随着科学技术的不断进步,医疗器械也在不断的改进和提高.在临床工作中静脉留置针输液已广泛应用于儿科[1,2],此操作不但可以减少患儿痛苦,而且提高护理工作质量,因此受到患儿家长及临床护理人员的一致认可.儿科静脉血管选择一般为手背静脉、桡静脉、肘正中静脉、足背静脉、头皮静脉(颞浅静脉和额正中静脉等).