Objective:To investigate airway abnormalities at flexible bronchoscopy and bronchoalveolar lavage fluid (BALF) pathogen profile in children of pulmonary atelectasis.Methods:Totally 412 pulmonary atelectasis cases with bronchoscopy performance in respiratory disease center of Children's Hospital of Chongqing Medical University from December 2011 to June 2016 were analyzed retrospectively.Data of bronchoscopy abnormality and BALF pathogens were analyzed by Chi-square with Yates' correction test and Fisher's exact test.Results:①The common atelectasis was in the right middle lobe (41.0％,169/412) and right upper lobe (40.7％,168/412),and the former was found higher in ＞3 years group(115/223 vs.54/189,P=0.000),the latter was found higher mainly in ≤ 3 years group(110/189 vs.58/223,P=0.000).Airway abnormalities were observed in 155 cases including 85 cases(54.8％) of bronchial stenosis,45 cases(29.1％) of bronchial suppurative inflammation and 21 cases(13.5％) of mucus plug.②240 BALF samples(58.2％) were detected positive for pathogens including 141 (34.2％) samples positive of bacterial and 126(30.5％) samples positive of mycoplasma.74 nasopharyngeal aspiration(NPA) samples (18.0％) were detected positive for respiratory viruses.③Bronchial suppurative inflammation were found in 32 cases(18.9％) of right middle lobe atelectasis,in which positive rate of S.Pneumoniae was higher than that of patients without suppurative inflammation(13/32 vs.24/137,P=0.009).Bronchial stenosis were found in 52 case(31.0％) of right upper lobe atelectasis,in which positive rate of enterobaeteriaceae(15/52 vs.15/116,P=0.023) and rate of preterm birth(16/52 vs.18/116,P=0.039) were higher than that of patients without stenosis.Positive rate of mycoplasma in cases of mucus plug was higher than cases without mucus plug(11/21 vs.115/391,P=0.047).Conclusion:Atelectasis location is related to the age of children.Airway abnormalities as bronchial stenosis,bronchial suppurative inflammation and mucus plug could be found in patients with atelectasis.Bronchial stenosis and suppurative inflammation might indicate bacteria infection,and mucus plug might indicate mycoplasma infection.

To prospectively evaluate prednisolone treatment in children with refractory Mycoplasma pneumonia pneumonia (MPP).

Objective:To evaluate the effecacy and economic benefit of mucosolvan in the treatment of pulmonary atelectasis caused by mycoplasmal pneumonia via bronchoscopy.Method:93 mycoplasmal pneumonia(MPP) patients with pulmonary atelectasis were divided into 2 groups randomly.There were treatment group(n=50) and placebo group(n=43).All patients were treated with azithromycin.And in the placebo group,normal saline(NS) were infused via bronchoscopy.And in the treatment group,mucosolvan diluted by NS were used.Then observed the length of fever,the times of cough per day,hospital stays and treatment costs,and the CT manifestations in 2 weeks later.Results:The cough of the 93 patients was more alleviative than that before the bronchoscopy lavaging(P0.05).And cough of the treatment group was more better than that of the placebo group(18.07±4.78vs28.07±3.39)(P0.05).The cost of the treatment group was less than that of the placebo group(P0.05).The efficient rate of the treatment group was better than that of the placebo group(P0.05).But the length of the fever of the two groups was no significant difference(P0.05).Conclusion:Mucosolvan irrigation via bronchoscopy was an effective and economic method for treatment of mycoplasmal pneumonia with pulmonary atelectasis.

Objective:To explore the nursing countermeasures of Hydrogel dressings in children with chronic wound care the skin inflammation around the wound,in order to improve the quality of wound care.Methods:In 23 cases of wound,wound healing process of skin inf lammation around children and nursing methods were retrospectively analyzed.Results:All children through actively suit the processing,wounds were well healing,no lead to wound infection increase or secondary inf ection.Conclusions:Hydrogel dressings in children with chronic wound care when can provide an ideal moisture environment for wound and accelerate wound healing,butin use process t o strictly grasp indi cations and methods.

Objective To explore the role of group play therapy in the improvement of mental coping ability in children with asthma. Methods Forty-four asthmatic children with behavior problems were randomly divided into experimental group (n=25) and control group (n=19). All children received two tests. The tools in this research were Achenbach Child Behavior Checklist (CBCL) and Coping with a Disease Questionnaire (CODI). Before intervention, both groups received pretest. Members from the experimental group were provided with counseling for 3 months, once every two weeks for a total of 6 times, while during this period the members of the control group had not any experimental intervention．After intervention, the two groups received posttest. Five patients dropped out, and 39 went through this research (20 in experimental group and 19 in control group). The effects of group play therapy on behavior problems and coping strategy of children with asthma were evaluated. Results There was no statistically significant differences in the general information (age, sex, education, parents' marriage status and family structure) and basic score of CBCL and CODI between the two groups (P > 0.05). After intervention, the scores of social problems, social withdrawal, depression, compulsive behavior, aggressive behavior and immature and total behavior problem score dropped significantly in experimental group (P < 0.05) while there were no significant changes in control group. And the scores of acceptance, avoidance and emotional reaction increased significantly in experimental group (P < 0.05) while there were no significant changes in control group. Conclusions Group play therapy can improve the children's confidence and interpersonal adaptability and emotion management capacity, thus correcting deviant behavior, ameliorate coping strategy, improving mental coping capability, and promote the development of mental health in children with asthma.

目的探讨雾化吸入3%高渗盐水(简称3%NaCl)沙丁胺醇治疗轻、中度毛细支气管炎的疗效及护理措施。方法将93例轻、中度毛细支气管炎患儿分成治疗组和对照组,治疗组50例,雾化吸入3%NaCl 1.5ml加沙丁胺醇0.5ml(2.5mg)q 8h直至出院;对照组43例,雾化吸入0.9%NaCl 1.5ml加沙丁胺醇0.5ml(2.5mg)q 8h直至出院,比较两组患儿咳嗽、喘息、肺部体征变化情况及住院时间。结果两组患儿均治愈出院,治疗组咳嗽、喘息和肺部体征缓解时间及住院日均较对照组明显缩短(P<0.01)。结论雾化吸入3%高渗盐水沙丁胺醇是治疗轻中度毛细支气管炎的安全、有效方法。

目的 探讨雾化吸入3%高渗盐水(简称3%NaCl)沙丁胺醇治疗轻、中度毛细支气管炎的疗效及护理措施.方法 将93例轻、中度毛细支气管炎患儿分成治疗组和对照组,治疗组50例,雾化吸入3%NaCl 1.5 ml加沙丁胺醇0.5 ml(2.5 mg)q 8 h直至出院;对照组43例,雾化吸入0.9%NaCl 1.5 ml加沙丁胺醇0.5ml(2.5 mg)q 8 h直至出院,比较两组患儿咳嗽、喘息、肺部体征变化情况及住院时间.结果 两组患儿均治愈出院,治疗组咳嗽、喘息和肺部体征缓解时间及住院日均较对照组明显缩短(P<0.01).结论 雾化吸入3%高渗盐水沙丁胺醇是治疗轻中度毛细支气管炎的安全、有效方法.

Objective To explore the relationship between airway mucosal lesions and prognosis in children with mycoplasma pneumoniae pneumonia.Methods The clinical data of 93 children with identified mycoplasma pneumoniae pneumonia and undergoing bronchoscopy admitted to our hospital from July 2007 to July 2010 were retrospectively reviewed.According to the prognosis of the disease,the patients were divided into persisting mycoplasma pneumoniae pneumonia group(with the process ≥1 month) and the non-persisting mycoplasma pneumoniae pneumonia group(with the process <1 month).The relationship between the airway mucosal lesions and prognosis were analyzed.Results Among the 93 children,19 patients were persisting mycoplasma pneumoniae pneumonia and 74 patients were non-persisting mycoplasma pneumoniae pneumonia.The common mucosal lesions in both groups were bronchial mucosal follicle-like hyperplasia,roughness,hyperemia,edema,microtubule reductus and increasing mucus secretion.But airway inflammatory stenosis,and mucus plug blocking were more common in the persisting group than in non-persisting group(7/19 vs 7/74,15/19 vs 12/74;P<0.05).However,the granulation proliferation,mucosal erosions and bronchial obliteration were existed only in the persisting group.Conclusion Severe airway mucosal lesions in acute stage may be the important factor causing the prolonged process of mycoplasma pneumonia pneumonia.

Objective To investigate the clinical characteristics, chest radiographic features, lung function and bronchoscopic changes in children with mycoplasma pneumonia, and to explore the interventional therapeutic effects of mycoplasma pneumonia by bronchoscopy. Methods Clinical data of 207 children (age 7.1±2.5) with mycoplasma pneumonia who were admitted in our center from Jan. 2007 to Jan. 2009 were retrospectively analyzed. Among them, 135 whose X-ray film presented subtotal lung infiltration or atelectasis were followed up. Sixty-one patients of them were given bronchoscopy examination and local interventional therapy and macrolide antibiotic treatment (treatment group), and 74 of them were only given macrolide antibiotic treatment (control group). The absorption of lesions between the treatment and control groups were compared. Results The common clinical manifestations were cough (100%, 207/207), fever (89.4%, 185/207), tachypnea (23.7%, 49/207), wheeze (14.0%,29/207), chest pain (13.5%, 28/207), and rash (6.3%,13/207). Seventy-three cases had positive physical signs (35.3%), 93 cases had peripheral leukocytes normal (44.9%), while 97 had mild increased (46.9%), and most had increased serum concentration of CRP. The most common signs in X-ray films were the shadows of lung parenchyma (57%, 118/207). Ninety-eight cases had large segment shadows (47.3%), and 37 cases had atelectasis (17.9%). One hundred and thirty-nine cases had ventilation disorders (75.1%), presenting the functional changes of small airway. Under flexible bronchoscope, 46 patients had section bronchial ventilation stagnation (75.4%), 28 patients had tube debouchement inflammatory stenosis (45.9%), 13 patients had tube occlusion(21.3%), 33 patients showed blood vessel becoming gross (54.1%), 20 patients had mucosal longitudinal folds (32.8% ), 11 patients had mucosa piebald shape (18%), 6 patients had mucosa crypts nodule (9.8%), and 3 patients had mucosa anabrosis (4.9%). After 2 weeks' treatment, the rate of pulmonary infiltration in the treatment group was significantly higher than in the control group (100% vs 88.7%, P=0.02). The rate of atelectasis disappearance in the treatment group was significantly higher than in the control group (87.5% vs 52.4%, P=0.024). Conclusion It is beneficial to shorten course of disease by applying flexible bronchoscopy to treat patients with mycoplasma pneumonia.

The objective of this study was to determine the efficacy and safety of frequently inhaled nebulized hypertonic saline (HS) in infants with moderate to severe bronchiolitis. One hundred and twenty-six infants were randomized to receive either nebulized 3% hypertonic saline (HS) or 0.9% normal saline (NS), but only 112 patients completed the whole study. Cough, wheezing, pulmonary physical signs, clinical severity scores and the hospital length of stay (LOS) were recorded. The wheezing remission time was 4.8 ± 1.0 days in the NS group and 3.6 ± 0.9 days in the HS group (p <0.01). The cough remission time was 5.5 ± 0.9 days in the NS group and 4.3 ± 0.7 days in the HS group (p <0.01). The moist crackles disappeared at 6.2 ± 0.7 days in the NS group and at 4.4 ± 0.9 days in the HS group (p <0.01). The clinical severity scores decreased more significantly in the HS group than in the NS group on each day within 96 h after enrolment (p <0.01). The LOS decreased from 6.4 ± 1.4 days in the NS group to 4.8 ± 1.2 days in the HS group (p <0.01). The treatment was well tolerated, with no adverse effects attributable to nebulized HS. The conclusions are that frequently inhaled HS relieved symptoms and signs faster than NS, and shortened LOS significantly for infants with moderate to severe bronchiolitis, without apparent adverse effects.

Objective:To investigate the treatment effects of nebulized hypertonic saline(hereinafter referred to as 3% NaCl) combined with salbutamol on mild to moderate bronchiolitis and to analyse the cost in health economics,hence,to provide some references in improving nursing measures.Methods: One hundred and forty-three cases of mild to moderate bronchiolitis children were divided into two groups.The infants received inhalation of 2.5 mg(0.5 mL) salbutamol dissolved in either 4.0 mL normal(0.9%) saline(control group,n=70) or 4.0 mL hypertonic(3%) saline(treatment group,n=73).Patients in each group received 3 treatments every day,delivered at intervals of 8 hours until discharge.Cough,wheezing,pulmonary physical signs,and the length of hospital stay were recorded and compared.Results: The two groups of patients were cured and discharged from the hospital.Compared with the control group,the curative effect was increased and the length of hospital stay was decreased in the treatment group(P0.05).Conclusions: Inhalation of hypertonic saline solution and salbutamol is a safe and effective therapy to patients with mild to moderate bronchiolitis and it can reduce the cost.

[目的]了解北京和贵州地区儿童维生素A缺乏(vitamin A deficiency,VAD)的现状和影响因素. [方法]从两地区各选择一市二县共1 236名儿童,其中北京随机选择城区儿童202名、农村儿童426名;贵州随机选择城区儿童207名、农村儿童401名.各地调查儿童年龄范围均为0～71个月.采用自行设计的膳食频率问卷表对每位被调查儿童询问调查前1周儿童的饮食摄入情况,并采集儿童指血200 μl,用微量荧光法检测血清VA值. [结果]城区儿童血清VA水平(平均1.27 μmol/L)明显高于农村(平均1.02 μmol/L);北京地区儿童血清VA水平(平均1.17 μmol/L)明显高于贵州地区(平均1.03 μmol/L).各地区被调查儿童家庭收入也呈现贵州低于北京、农村低于城区的状况,儿童血清VA水平和家庭收入呈正相关(r=0.239,P＜0.01).在所有调查地区中,贵州农村地区儿童血清VA水平最低(平均0.92μmol/L),家庭收入也最低(年收入平均1 800元).在调查的所有年龄组儿童中,婴儿组血清VA水平最低(28.8 μmol/L),可疑亚临床VAD发生率最高(50.0%),血清VA水平与年龄呈正相关(r=0.132,P＜0.01).儿童饮食摄入呈现明显的地区差异,动物性食品高摄入频率的比例北京地区高于贵州地区,城区高于农村;食物摄入频率较高的儿童中,可疑亚临床VAD的发生率明显低于食物摄入频率较低的儿童. [结论]儿童VAD状况与经济水平、年龄和饮食摄入有关,落后的经济状况和动物性食物摄入不足可能是导致儿童VAD的重要原因,婴儿是VAD的高危人群.

婴儿维生素K缺乏(VKD)是造成婴儿出血的主要原因,是我国婴儿的主要死因之一.死亡率1.13‰,据此估算我国每年颅内出血2万人,相当于婴儿传染性疾病死亡的总和.VKD主要死因是颅内出血,全国5岁以下儿童死亡监测资料表明,颅内出血死亡率1.13‰,据此估算我国每年颅内出血死亡2万人,相当于婴儿传染性疾病死亡的总和.

Objective:To understand the status of supplementary food among infant in Nanshan.Methods:Questionnaire survey among 861 infants were conducted in Child Health Care from August to November.Results:Among the infants aged 6 month,the feeding rates of grain food,fruit/vegetable,and protein food were 90%?85%?79%,respectively..There was an obvious improveed compared to the result in the whole country in 2000.There wasn't an obvious difference between the regional residents and those of immigrants.A close relation of infant supplementary food feeding to the education level of their mothers was found also.No relation of infant supplementary food feeding to the family income and whether attended by mother.Conclusions:The health education should be strengthened.The special guidance to the parents will be the priority of solving the problem of infant supplementary food feeding.

[目的]了解维生素A(VA)缺乏和贫血之间的关系.[方法]全国分层抽取14个省42个市县的8 699名6岁以下儿童,血清维生素A和血红蛋白的测量,分别采用荧光法及Hemocue System血红蛋白测定仪.[结果]血红蛋白正常、轻度、中度和重度贫血组儿童VA缺乏率分别为10.8%,18.7%,23.2%,42.9%,随血红蛋白水平下降显著增加.VA正常、VA可疑缺乏及VA缺乏组儿童贫血患病率分别为6.1%,12.7%,17.1%.随血清VA水平下降不仅贫血患病率增加,而且贫血严重度增加.[结论]VA和铁之间可能存在着相互影响.

OBJECTIVE:The survey will reveal current status of subclinical vitamin A deficiency (SVAD) and explore its affecting factors in children of China.METHODS:Totally 8 669 children aged under 6 years were randomly selected from 14 provinces for clinical examination, health and dietary questionnaire and serum level of vitamin A measurement with fluorescence method. The cut-off value for SVAD was defined as </= 0.70 micro mol/L.RESULTS:Prevalence of SVAD was 11.7% and that of suspected SVAD 39.2% in all subjects, which decreased with the increase of gross domestic product, average annual family income, mother's schooling and children's age. Prevalence of SVAD and suspected SVAD higher in rural areas (15.0%) than in urban areas (5.2%), and higher in children with a minority mother (22.6%) than in those with a Han nationality mother (8.7%). Prevalence of SVAD and suspected SVAD was higher in children whose blood samples were collected within one week in-taking vitamin A-rich food (12.6%-22.6%) than those in-taking vitamin A daily (4.1%-10.0%), and higher in children suffering from respiratory infection, fever and diarrhea two weeks before their blood collection (15.2%-20.3%) than in those without those diseases (10.1%-11.1%). Logistic regression analysis showed that poor family economic status, living in rural areas, children with a minority mother, younger age, no-dairy milk products intake, and respiratory infection and fever all were risk factors for SVAD.CONCLUSIONS:More than half of children under six years old in China (50.9%) had vitamin A nutrition problem. Varied factors played roles to different extent in SVAD in children.

[目的]根据1998年中国活产儿出生体重调查数据,分析影响出生体重的各种因素.[方法]采用分层抽样方法,对1998年7～10月期间在抽样地区出生的孕周≥28周的活产儿进行出生体重测查.同时调查抽样地区育龄妇女贫血率,收集海拔高度、1998年人均国民生产总值等数据.[结果]不同胎龄活产儿出生体重一般是男性高于女性,但在孕29周和31周时女性出生体重略高于男性.不论男女,在孕42周以后胎儿体重已经停止增长并出现下降趋势.孕32周后男女活产儿出生体重随胎龄增长的趋势一致,并分别于孕34周和孕37周出现2次增重高峰.出生体重受产次影响,第4产或更高产次活产儿的出生体重明显下降.出生体重随海拔高度升高而明显下降,海拔高度每升高100m,出生体重下降6.1g.随海拔高度的升高,宫内发育迟缓儿的发生率和占低出生体重儿的比例均显著升高.低出生体重发生率随同地区育龄妇女贫血率增加而显著升高(χ2=81.4,P＜0.001).年人均国民生产总值2 000元以下地区活产儿的出生体重显著低于2 000元以上地区,相差达120g.[结论]本次调查发现,男女胎儿体重增长有2个高峰,分别出现在孕34和37周.平均出生体重与同一地区的海拔高度、育龄妇女贫血率和社会经济状况密切相关.

目的了解北京儿童哮喘的患病率、发病规律及影响因素,并进行10年前后的对比研究.方法采取整群抽样调查方法,按照10年前的调查范围,在北京市朝阳区及西城区2～4个街区内,向家长发放初筛问卷,筛选出相关疾病的可疑患者,再经哮喘中心医师统一问诊查体,填写调查表.所有数据经sas/pc统计软件分析.结果实际调查人数10 163人,2年内有喘息发作的哮喘现患率为2.05%,男女患病率分别为2.80%及1.24%,既往有哮喘的累计患病率为2.69%.性别、首次发作年龄、呼吸道感染、过敏及遗传因素与哮喘发作有关.早期正确诊断及应用吸入治疗的比率仍较低.对比1990年哮喘现患率的0.78%,2000年哮喘现患率是10年前的2.6倍.结论本次调查0～14岁儿童哮喘的患病率较10年前显著升高,且主要发生于学龄期.哮喘发作受诸多因素的影响,目前按GINA方案在哮喘的规范化治疗上仍有明显差距.

There was no available basic data on serum vitamin A(VA) content among children in China.The survey will reveal serum VA status in 0～6 years children of China. Randomly selected 8 669 children aged under 72 months in 14 provinces for questionnaire and serum VA content measured.The cut off for subclinical vitamin A deficiency(SVAD) being≤0.70μmol/L. The serum VA mean levels of children were(1.06±0.33)μmol/L.The prevalence of SVAD were 11.7% in subjects.The younger(0.84μmol/L),the worse diet(0.93～1.04μmol/L),the higher incidence of diseases(0.87～1.23)μmol/L,the lower family and local annual income(0.90～0.97μmol/L) were,the lower serum VA levels were.In addition,the children of their mothers with low education(0.93μmol/L) and minority nationality(0.91μmol/L) had lower serum VA levels. [Conclusions] The serum VA content were lower among 0～6 years children in China.Multiple factors need to be considered together for them,such as age,diet,illness,annual income,education status and nationality of mother.

OBJECTIVE:To understand the distribution of live birth weight in China.METHODS:A national survey on live birth weight was performed during July-October, 1998 in China, with stratified sampling. Totally, 22 350 live newborns (11 584 males and 10 766 females) with 28 weeks or more of gestation were measured for their birth weight in the sampling sites during 1998.RESULTS:The ratio of male to female newborns measured was 1.08. The rates of multiple birth and preterm birth (< 37 weeks of gestation) were 1.8% and 3.5%, respectively. Live birth weight was higher in the urban areas (3 301 g) than that in the rural area (3 225 g) (t = 9.4. P < 0.001), the highest in the coastal areas (3 262 g), middle in the inland areas (3 254 g) and the lowest in the remote areas (3 115 g) (F = 177.9, P < 0.001), with a decreasing trend. Live birth weight in the first-class rural areas approximated to that in the urban areas, and that in the second-class, third-class and fourth-class rural areas decreased significantly. The average live birth weight in the fourth-class rural areas was 200 g lower than that in the urban areas.CONCLUSIONS:Generally, the average live birth weight in China was closed to that in the developed countries. But, a big difference in the average live birth weight between regions with varied economic development and health care condition was observed. An intervention measure should be implemented in the poverty-stricken rural areas to increase their average live birth weight.