目的 观察无创高频振荡通气(NHFOV)疗法、经鼻间歇正压通气(NIPPV)疗法及经鼻持续气道正压通气(NCPAP)在早产儿呼吸窘迫综合征(RDS)治疗中的应用效果.方法 出生胎龄28～32周的RDS早产儿101例,其中NHFOV组33例、NIPPV组34例及NCPAP组34例,三组均予肺表面活性物质及枸橼酸咖啡因治疗,在此基础上NHFOV组、NIPPV组、NCPAP组分别采用NHFOV、NIPPV、NCPAP无创通气方法.观察并记录三组治疗前及无创通气治疗1、6、24 h时动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、pH值、P/F;记录三组无创通气过程中PS使用情况、无创通气时间、总氧疗时间、改用有创通气治疗及频繁呼吸暂停发生情况,观察三组患儿鼻损伤及肺气漏等并发症发生情况.结果 与NCPAP组比较,治疗1、6、24 h时NHFOV、NIPPV组患儿PaCO2降低,PaO2及P/F比值升高(P均<0.05).与NCPAP组比较,NHFOV、NIPPV组患儿PS应用情况及有创通气例数例数少(P均<0.05).三组总用氧时间及无创通气时间差异均无统计学意义(P均>0.05).三组患儿鼻损伤、肺气漏、腹胀等并发症发生情况无统计学意义(P均>0.05).结论 与NCPAP比较,NHFOV、NIPPV用于RDS早产儿无创通气治疗效果较好,可改善患儿的氧合、减少CO2潴留、减少外源性PS使用及有创通气使用,并发症发生风险低.

目的:探讨布拉酵母菌预防新生儿抗生素相关性腹泻(AAD)的疗效及安全性.方法:选取2017年8月至2018年8月在宿州市立医院新生儿病房使用抗生素治疗的新生儿298例,随机分为干预组和对照组.干预组除静脉使用抗生素外,给予布拉酵母菌散剂口服,每次0.125 g,2次/日,共14 d,对照组仅给予常规抗感染治疗.观察治疗期间两组患儿AAD发生率及相关指标变化情况,记录AAD患儿排便次数和持续时间,并根据不同日龄患儿AAD发生率评价预防效果.结果:抗生素使用期间,干预组AAD发生率(11.49％)较对照组(29.33％)降低(P＜0.01).干预组应用抗生素时间和住院时间均较对照组缩短(P均＜0.01).干预组AAD患儿在治疗第1、4、7天平均排便次数及持续腹泻时间均较对照组减少(P均＜0.01).干预组≤7 d患儿AAD患病风险降低了 47％(P＜0.05),干预组＞7d患儿降低了 78％(P＜0.05);停用抗生素后14 d内,≤7 d患儿中,干预组AAD患病风险降低了 68％(P＜0.05),＞7 d患儿中,干预组降低了 92％(P＜0.05).结论:布拉酵母菌可降低新生儿AAD发生率,减轻AAD症状,其具有延迟保护效应,可有效且安全地预防新生儿AAD.

目的 研究急性呼吸道感染(ARI)患儿病原体分布及临床特点.方法 选择2018年1月至2019年5月安徽省宿州市立医院院新生儿科收治的ARI患儿85例为研究对象,观察患儿病原体分布、在不同年龄、季节检出病原体情况、临床特征.结果 85例患儿中检出血清样本中IgM阳性35例,阳性率为41.18％;>20d且<28d患儿病原体IgM总阳性率高于≤20d(χ2=10.365,P=0.001);春、夏、秋、冬季节病原体IgM总阳性率分别为57.69％(15/26)、80.00％(20/25)、55.56％(10/18)、12.50％(2/16),差异有统计学意义(χ2=17.775,P=0.001);85例ARI患儿出现干咳50例占58.85％、咽部充血84例占98.82％、体温>38.5℃56例占65.88％、肺纹理粗乱伴有点片阴影61例占71.76％、白细胞>10.0×109/L65例占76.47％.结论 MP为ARI患儿主要病原菌.其中年龄、季节为呼吸道病原体感染重要因素,且夏季为感染高发期.

Objective To evaluate the clinical effect of nasal synchronized intermittent mandatory ventilation(nSIMV) in the weaning of mechanical ventilation in hyaline membrane disease(HMD).Methods 61 cases with HMD treated in NICU of Xuzhou Central Hospital and Suzhou Municipal Hospital from November 2009 to May 2012 were randomly divided into nSIMV group(n=31) and nCPAP group(n=30).Results of pH value,PaCO2,PaO2 and SpO2 as well as weaning effect were recorded and compared in two groups.Results The pH value,PaCO2,PaO2 and SpO2 between the two groups showed no statistically significant difference before weaning(P>0.05).The pH value 6 h and 24 h after weaning between the two groups both showed no statistically significant difference(P>0.05).The PaCO2,PaO2 and SpO2 6 h and 24 h after weaning between the two groups showed no statistically significant differences(P>0.05).The weaning failure cases(10%(3/31)vs.30%(9/30)) and apnea cases(19%(6/31) vs.47%(14/30)) between nSIMV group and nCPAP group showed statistically significant difference(P<0.05).The non-invasive ventilation time((69±33)h vs.(75±28)h) between the two groups showed no statistically significant difference(P>0.05).Conclusion nSIMV has higher success rate compared with nCPAP when used in the weaning of mechanical ventilation,and can reduce the incidence of apnea in preterm infants.

Objective: To evaluate the effect of prone position mechanical ventilation on the improvement of respiratory function and oxygenation index in neonatal respiratory failure.Methods: Fifty one newborn infants of respiratory failure treated by mechanical ventilation in neonatal intensive care unit(NICU) of Xuzhou Central Hospital and Suzhou Municipal Hospital from January 2011 to February 2012 were randomly divided into a supine group(n=26) and a prone group(n=25).The results within one hour and six hour ventilator parameters,Oxygenation index OI(OI=PaO2/FiO2),the lung mechanics parameters and ventilator weaning-time,arterial carbon dioxide partial pressure(PaCO2) and arterial oxygen tension(PaO2) one hour after ventilator weaning were recorded and compared in the two groups.Results: PaO2 in the prone position ventilation group within one hour(66.37±8.54) mm Hg and six hour(68.42±10.43) mm Hg were higher correspondingly than that in the supine position ventilation group within one hour(61.22±9.43) mm Hg and six hour(62.60±11.36) mm Hg;the difference was statistically significant(P<0.05).Calculation of OI within one hour and six hour was(167.88±26.97) mm Hg and(170.84±19.82) mm Hg in the prone group,which were higher than that within one hour(151.66±21.04) mm Hg and six hour(156.94±23.51) mm Hg in the supine group correspondingly;the difference was statistically significant(P<0.05).The ventilator weaning-time,and the changes of PaCO2 and PaO2 one hour after ventilator weaning of the two groups were similar and the difference was not statistically significant(P>0.05).Conclusions: Compared with traditional supine position,treating neonatal respiratory failure with prone position ventilation can improve the symptoms of respiratory failure and oxygenation index significantly.

Objective To investigate the situation of two parenteral nutrition modes on the weight of the preterm children and related complications.Methods Retrospectively reviewed 40 cases of premature infants treated in our hospital from June 2009 to 2011 in December.They were randomly divided into observation group and control group to evaluate the nutritional effects and complications.Results Part of the parenteral nutrition group were daily weight gain(52.3±12.7)g,while the control group,children with average daily weight gain(48.6±11.8)g,the two groups was statistically significant(P0.05).The transition to the time required,the enteral nutrition showed no statistically significant difference(P0.05).And two groups of children with related complications close to each other.Conclusions It has more obvious advantages of parenteral nutrition compared with total parenteral nutrition for children with nutritional effects were related complications,and no significant differences.

Objective To compare the clinical effects of the nasal synchronized intermittent mandatory ventilation(nSIMV) and nasal continuous positive airway pressure(nCPAP) in hyaline membrane disease(HMD).Methods Seventy-nine neonates with hyaline membrane disease(HMD) treated in NICU from January 2009 to October 2011 were randomly divided into nSIMV group and nCPAP group.Results of arterial blood gas analysis,the occurrence of failure of noninvasive mechanical ventilation and the apnea occurrence were recorded and compared in two groups.Results The arterial blood gas analysis in the nSIMV group was statistically significantly improved than that of the nCPAP;The incidence of failure of noninvasive mechanical ventilation in nSIMV group were significantly fewer than that in the nCPAP group;The incidencec of apnea occurrence in nSIMV group was statistically significantly fewer than that in CPAP group.Conclusions Compared with nCPAP,nSIMV treatment of HMD,can further reduce the use of invasive mechanical ventilation and may be more effective for apnea in preterm infants.

Objective To study the curative effect of ursodeoxycholic acid used for premature parenteral nutrition associated cholestasis(PNAC).Methods 40 premature children with PNAC born in our hospital from June 2008 to December 2011 were randomly divided into control group(12 male,8 female)and treatment group(11 male,9 female),20 cases in each group.The improvement of relevant indicators of children′s curative effect was observed.Results At 10th and 20th day,the total bilirubin(TB),direct bilirubin(DB),total bile acid(TBA)of treatment group were significant lower than those of control group(P<0.05).The liver and kidney function tests showed no drug-related adverse reaction.Conclusion Ursodeoxycholic acid treatment for premature PNAC is safe and effective,and it is worthy of clinical use.

Objective:To study the clinical effect of two different doses of pulmonary surfactant combined with nasal continuous positive airway pressure(nCPAP) in newborns with respiratory distress syndrome(RDS).Methods:Sixty four cases of RDS were randomly divided into an observation group and a control group from January 2009 to January 2012 in Suzhou Municipal Hospital.Both groups were treated with nCPAP,and the observation group was given 100 mg/kg of pulmonary surfactant with endotracheal administration,the control group was given 200 mg/kg of Curosurf with endotracheal administration.The clinical efficacy of the two groups was compared.Results:In both groups the differences in the mechanical ventilation rate,intraventricular hemorrhage rate,duration of assisted ventilation,oxygen time and length of hospital stay were not significant(P>0.05).There were no statistical differences in PaO2,PaCO2,a/APO2,PaO2/FiO2 index within 72 hours in the two groups of children(P>0.05).Conclusions:Curosurf of 100 mg/kg or 200 mg/kg combined with nCPAP in newborns with RDS can improve children's clinical symptoms,reduce complications and death,the efficacy of the two treatments has no obvious difference.

甲氧氯普胺是儿科门诊常用止吐药物,由于儿童药物代谢能力不足,导致甲氧氯普胺中毒病例时有发生.我院对门诊收治的甲氧氯普胺中毒致锥体外系反应患儿加用东莨菪碱治疗,取得满意疗效,现报告如下.

Aim To study the curative effect and side effect of salmeterol and fluticasone propinate combined in a new powder inhalation device(company's product name is Seretide, GlaxoSmithKline campany produces) on children asthma. Method 62 asthmatic children are divided into two groups.Children in the treatment group inhale seretide 50/100, 100/200, 150/300 μg~-~1 respectively based on difference in seriousness,while those in the control group inhale fluticasone propinate inhalant(Company's product name is flxiotide, GlaxoSmithKline company produce)125, 250, 375 μg~-~1 respectively.Asthma symptom during the day and at night and PEFR value are evaluated in 4 , 8 , 12 weeks after treatmant. Results In 4,8,12 weeks of treatmant, compared with the control group,score of the day and night asthma symptom of the theatment group decreased obviously(-P-0.01); The number of PEFR occupies its percentage of antilipate of the treatment group improves obviously (- P-0.05).The difference is very obvious.And there is no obvious side effect in both groups during the treatment. Conclusions Application of both the sugar skin quality hormone and β_2-adrenoceptor receptor excited can be anti-inflammatory and quell pant and uniting usage can reduce dosage of the sugar skin quality hormone, and the side effect caused by large dosage of hormone. Seretide is an admixture powder inhalant including salneterol and fluticasone propionate.The curative effect is obvious and better than flxiotide in treating treatment children asthma of different degrees.

Objective: To observe the curative effect of seretide on moderate and severe child astham. Methods: Sixty children between 5 and 14 years old who suffered from moderate and severe asthma were divided randomly into two groups. According to the patients' condition, the group under observation breathed in 200 μg to 300 μg seretide for twelve weeks, while the control subjects breathed in fluticasone of equal amounts. The numbers of the patients in each group whose condition got well controlled or completely controlled were observed, and the time needed was also observed for half of them. Results: The number of the group under observation was 29 (96.7%) and 27 (90%) respectively, which differs greatly with that of the control group (P 0.05). The time needed for that in the group under observation was shorter than that of the control group. There was an obvious difference between two groups (P 0.01). Conclusions: Seretide is one of the main drugs in treating moderate and severe child astham.

Objective To investigate the effect of inhaling pulmicort respules and salbutamol on treating infant bronchiolitis. Methods 76 patients with bronchiolitis were divided into treatment group and control group. The treatment group was treated with inhalation of pulmicort respules and salbutamol and the control group were given routine treatment. The lasting time of symptom and sign were compared before and after treatment. Results The treatment groups were better than control group on curative ratio, releiving dyspnea, reducing the lasting time of rale and cough ( P <0.05). Conclusions Inhaling Pulmicort respules and salbutamol is a safe and effective method for treating infant bronchiolitis, it can increase the curative ratio and shorten the course of this disease.

Objective To evaluate the CT diagnostic value of hypoxic ischemic encephalopathy(HIE) in new born. Methods CT findings of HIE in 44 cases were analysed retrospectively. Results Brain edema of difference degree was found in all cases. Conclusion CT plays an important role in the diagnosis and prognostic of HIE.

本院1997年1月～1998年12月共收治婴幼儿重症肺炎125例(不包括毛细支气管炎),其中并发微循环障碍78例,发生率为62.4%.现报告如下.

【病例】男，9岁。因皮肤粘膜黑色斑8年余，于1999年11月7日就诊。患儿出生后8个月，下唇粘膜即出现点状黑色斑，无不适，后渐增多，波及面部及手足皮肤，以口周为主。2岁时曾因腹痛、便血诊断为肠套叠，住我院外科行手术治疗。6岁时因腹痛、腹胀、呕吐伴肛门停止排便、排气，在本院以粘连性肠梗阻行保守治疗后缓解。7岁时因便血就诊，肛检发现直肠腔内多个大小不等的息肉，取其中两枚病理检查，报告为直肠腺瘤性息肉。家族史中其父亲及祖父均有腹痛、便血史，当地医院疹为痔疮。其母亲及妹妹健康，无类似病史。查体：体重22 kg，身高126 cm，发育营养欠佳。皮肤较黑。唇周、双眼周、双食指端、双拇趾端掌面皮肤和上、下唇粘膜、双颊粘膜散在点状黑色素沉着斑，分布对称，不高出皮肤粘膜。轻度杵状指(趾)。浅表淋巴结未触及，心肺腹未见异常。血、尿、粪常规、X线胸片和心电图检查正常。腹部B超无异常。纤维结肠镜检查示直肠、结肠多发性息肉。诊断为皮肤粘膜色素沉着-胃肠道多发性息肉综合征。 该综合征是一种少见的遗传性疾病。主要临床特点是色素沉着、胃肠多发性息肉和阳性家族史。文献报道，息肉多发于小肠，占90%以上，极少数发生于胃、十二指肠和结肠［1］。患者常因多发性肠息肉的并发症而就诊，如痉挛性腹痛、便血等。痉挛性腹痛多为肠套叠引起。本征恶变倾向虽低，但应一生随诊。本例曾孤立地诊断处理肠套叠，没有把肠道的病变与色素沉着联系起来。提示对小儿腹痛、便血、肠套叠及多发肠息肉者，应重视皮肤、粘膜色素斑的检查及阳性家族史，防止本综合征漏诊、误诊。