Objective:To study the relationship between the dynamic changes of angiopoietin-2 (Ang-2) and surfactant protein D (SP-D) in pediatric acute respiratory distress syndrome (pARDS) and the severity and prognosis of the disease.Methods:Using nested case-control study method, 80 children with pneumonia complicated with pARDS admitted to PICU at Fujian Maternal and Child Health Hospital from June 2018 to May 2021 were selected as pARDS group, and 19 healthy children with corresponding age were selected as control group.According to the oxygenation, the children in pARDS group were divided into three subgroups: mild group (23 cases), moderate group (32 cases) and severe group (25 cases). According to the prognosis at discharge, the children in pARDS group were divided into survival group (67 cases) and death group (13 cases). Ang-2 and SP-D were detected by enzyme-linked immunosorbent assay.The levels of Ang-2 and SP-D in children with pARDS of different severity on the first day were compared; The changes of Ang-2 and SP-D levels on the 1st, 3rd and 8th day of children in survival group and death group were compared, and the receiver operating characteristic (ROC) curve was plotted to compare the predictive value of Ang-2 and SP-D for pARDS prognosis.Results:(1) The levels of Ang-2 and SP-D on the first day in pARDS group were significantly higher than those in control group( P<0.001). (2) The levels of Ang-2 and SP-D on the first day in children with pARDS of different severity levels were significantly different ( P<0.001), and the levels of Ang-2 and SP-D increased gradually with the increase of disease severity.(3) The levels of Ang-2 and SP-D in death group were significantly higher than those in survival group on the 1st, 3rd and 8th day ( P<0.05). (4) Prognostic efficacy of Ang-2 and SP-D levels in pARDS group at different time points: when the areas under the ROC curve predicted by Ang-2 on the 1st, 3rd and 8th day for inpatient mortality in children with pARDS were 0.808, 0.981 and 0.989, respectively; the optimal cut-off values were 6 000 pg/mL, 6 971 pg/mL and 4 171 pg/mL, respectively; the sensitivity was 84.6%, 92.3% and 92.3%, respectively; and the specificity was 76.1%, 97.0% and 98.5%, respectively.The areas under the ROC curve predicted by SP-D on the 1st, 3rd and 8th day for inpatient mortality in children with pARDS were 0.689, 0.993 and 0.983, respectively; the optimal cut-off values were 13544 pg/mL, 16003 pg/mL and 12294 pg/mL, respectively; the sensitivity was 84.6%, 100.0% and 100.0%, respectively; and the specificity was 46.3%, 98.5% and 97.0%, respectively. Conclusion:Serum Ang-2 and SP-D levels in children with pARDS increase with the aggravation of the disease.The dynamic changes of Ang-2 and SP-D in children with pARDS with different prognosis are different during the course of disease, and monitoring serum Ang-2 and SP-D during the course of disease has a certain predictive value for clinical outcome.

目的:探讨肺部超声评分(LUS)动态改变在小儿重症肺炎病情评估及呼吸治疗指导中的应用价值.方法:回顾性分析2021年4月-2022年4月福建省儿童医院收治的重症肺炎患者116例的临床资料,依据急性生理功能与慢性健康状况评分系统Ⅱ(APACHEⅡ)分为非危重症组(64例)和危重症组(52例),随访2个月,对比两组患儿临床肺部感染评分(CPIS)、氧合指数(OI)及LUS的差异;再以患儿起始呼吸治疗结局分为失败组与成功组,分析LUS动态变化对小儿重症肺炎患者呼吸支持策略的预测价值.结果:危重组患儿LUS、CPIS评分及机械通气时间均显著高于非危重组(P<0.05),OI显著低于非危重组(P<0.05).52例危重症肺炎患儿起始呼吸治疗成功36例,失败16例;两组第1、2次LUS评分比较差异无统计学意义(P>0.05),成功组第3～5次评分均显著低于失败组(P<0.05).Pearson相关性分析显示,LUS评分与OI指标呈负相关(r=-0.751,P=0.000),与CPIS评分及机械通气时间呈正相关(r=0.562、0.370,P=0.003、0.038).LUS评分截断值19.15分,预测危重症肺炎患儿需要升级呼吸支持治疗的AUC为0.865,Youden指数为0.611,敏感度为83.3％,特异度为77.8％.结论:LUS评分能够作为小儿重症肺炎病情评估指标,并且能够帮助医生治疗呼吸治疗策略,改善患者的预后.

目的:分析经喉罩下支气管镜异物取出术的临床应用情况.方法:对2015年7月～2019年12月于福建省妇幼保健院就诊的226例气管支气管异物患儿的临床资料进行分析.所有患儿行喉罩下纤维支气管镜检查,明确有异物者行异物取出术,对术中、术后并发症的原因和处理方法进行总结.结果:1～3岁(64.60％)是儿童异物高发人群;男女比例约为2:1,异物以坚果类(83.18％)尤其花生为主;异物位置为支气管(87.17％)较多;咳嗽(93.81％)、气喘(59.73％)是其主要临床表现.本组患者中有39例(17.26％)患儿曾被误诊为支气管肺炎或其他呼吸系统疾病.224例患儿在经喉罩支气管镜异物取出术均1次成功,2例进行第2次手术后取出.并发症最常见为呼末CO2增高及低氧血症,在操作过程中3例行心肺复苏术,术后应因喉水肿气管插管机械通气4例.结论:经喉罩支气管镜异物取出术为相对安全的手术方式,但应注意相关并发症并做好应急预案.

目的 对重症脓毒血症患儿血乳酸水平变化及其与凝血功能异常的关系进行研究.方法 对我院在2017年2月—2019年5月收治的50例重症脓毒血症患儿进行研究(n=50),随机抽取同期非重症脓毒血症患儿50例作为对照组(n=50),分析两组患儿入院后不同时间点的血乳酸水平,分析两组患儿不同时间点的APTT、纤维蛋白原以及D-二聚体水平.结果 重症组患儿入院后不同时间点的血乳酸水平均高于非重症组,有统计学意义(P<0.05);非重症组患儿治疗后APTT、纤维蛋白原以及D-二聚体水平均好于重症组,有统计学意义(P<0.05).结论 血乳酸水平是临床医护人员判断重症脓毒血症患儿疾病程度的重要性指标,这对于医护人员的后续临床治疗方案的拟定有着重大意义.

目的 研究儿童脓毒血症临床诊断中应用血清降钙素原的临床价值.方法 利用随机数表法对我院在2017年1月—2019年12月收治的30例儿童脓毒血症患儿(研究组)进行研究,按照患儿住院期间死亡情况将其分为死亡组10例,存活组20例,同时选取同期我院的非儿童脓毒血症(对比组)30例进行研究,分析两组儿童的血清降钙素原PCT(procalcitonin)水平.结果 非脓血毒症儿童PCT水平低于存活组和死亡组,存活组脓毒血症儿童PCT水平低于死亡组脓毒血症儿童PCT水平低,P<0.05,差异具有统计学意义;非危重症患儿PCT水平均低于危重患儿和极危重患儿PCT水平,危重患儿PCT水平低于极危重患儿PCT水平,P<0.05,差异具有统计学意义.结论 血清降钙素原可作为儿童脓毒血症疾病诊断以及预后的重要性参考指标.

目的 探讨中西医结合延续性团体教育干预对早产儿神经心理发育和亲职压力的影响.方法 采用临床随机对照研究,选取2017年6～12月就诊的早产儿及家长120例,随机分为试验组和对照组,共117例全程参与研究.对照组接受常规门诊护理,试验组采用中西医结合延续性团体教育干预.比较两组早产儿实际月龄12月龄的神经心理发育测评得分和短式亲职压力量表得分.结果 试验组早产儿0～6岁小儿神经心理发育量表总得分和各维度得分高于对照组;短式亲职压力量表总得分和各维度得分低于对照组.结论 中西医结合延续性团体教育干预可促进早产儿的神经心理发育,降低亲职压力,提高早产儿的生存质量.

门诊输液是医疗行为的重要组成部分，是不可或缺的临床医疗手段。本院是三甲专科儿童医院，平均每日输液人数400人左右，由于病床紧张，许多患者无法入院治疗，滞留在门诊输液治疗，每日输液人数仍有持续增加趋势。门诊病种多，输液量大，患儿对输液普遍存在恐惧心理，依从性差，且目前患儿多为独生子女，陪诊家属多在3个左右，甚至“6+1”模式也不在少数，传统的输液流程中，患者从挂号就诊到输液，中间要经过多个环节，导致门诊输液环境拥挤嘈杂。反复长时间排队等待、输液穿刺失败、对疾病及输液缺乏了解、期待值过高等因素，使家属容易出现烦躁情绪，甚至殴打辱骂医护人员，增加门诊输液的安全隐患[1]。而在另一方面医护人员配备不足，医疗资源相对不足，护理人员工作繁重、琐碎，心理压力大，从而导致与患者缺乏足够的交流，巡视力度不够，健康教育不到位，使得护理差错发生率增加。

优先经鼻持续呼吸道正压(ncPAP)是上个世纪70年代开始用于新生儿的一种给氧方法,其特点是无创、设备简单、操作容易,通常对患儿无损伤,且能保证有效的通气量.国内既往应用持续气道正压通气(CPAP)大多取得满意效果,但还不够普遍,远未最大限度地发挥其特有的作用.儿科重症监护病房(PICU)中大多数患儿都存在轻度呼吸功能不全或潜在性呼吸衰竭,故早期呼吸支持是治疗的重点.2006年1月～2006年8月我科PICU有44例病人早期应用nCPAP进行呼吸支持,取得了满意的临床效果,现报告如下.