Pediatric heart transplantation is limited by donor avail-ability with those needing transplantation often requiring prolonged mechanical circulatory support.

The purpose of this study was to investigate the risk factors for delayed chemotherapy-induced vomiting (DCIV) in pediatric oncology patients. We collected data on pediatric patients from a tertiary care pediatric hospital in an Asian urban center. We analyzed the risk factors for DCIV in patients by univariate analysis and logistic regression. Patients were grouped according to age by the Youden index, and differences in clinical features between the high-risk and low-risk groups were calculated. In the univariate analysis, the number of chemotherapy days, pH, and blood glucose levels were significantly associated with DCIV. In the logistic regression analysis, patient age was an independent risk factor (odds ratio [OR] = 1.013, 95% confidence interval [CI] = 1.005-1.021, P = .002). Children in the high-risk group had a higher grade of vomiting (P < .05). Age is an important risk factor for DCIV in pediatric patients, with older children tending to experience more frequent and more severe vomiting.

总结1例在完全胎盘支持下产时运用胸腔镜行胎儿膈疝修补的护理体会.护理要点:术前多学科联合制订手术方案,术中维持胎盘循环的稳定、产科组和儿科组人员明确分工并密切配合、母婴多模式体温管理、预防感染,加强术后转运及护理等确保产妇和胎儿安全.该例患儿成功完成产时手术,手术时间60 m in,术后产妇和患儿生命体征平稳,产妇剖宫产术后第6天出院,患儿术后转至新生儿重症监护室,术后第11天痊愈出院.

总结 48 例达芬奇机器人手术治疗儿童动脉导管未闭日间手术的围手术期护理体会.护理要点:术前缩短禁食禁饮时间,合理布局手术间各仪器、设备,选择合适的机器人操作模式;术中加强体位的管理,预防压力性损伤;术后做好并发症的观察与护理,严密观察神经系统损伤症状,制定个性化的功能锻炼及出院指导,并加强随访.本组 48 例患儿均顺利完成手术,无一例中转开胸手术,术后复查动脉导管残余漏 1 例,喉返神经损伤、声音嘶哑 1 例,随访 3 个月后好转,无其他近期并发症.

总结 1例妊娠合并胸腹联体双胎行古典式剖宫产术的护理.护理要点包括制定围手术期诊疗和新生儿抢救方案,做好术前访视,重视术中大出血的预防与管理,做好低体温、感染的预防,落实新生儿抢救和转运措施等.经治疗和护理,患者手术经过顺利,母婴结局良好.

经外周静脉穿刺中心静脉置管(PICC)是小儿临床诊疗过程中增加患儿依从性、减少患儿穿刺机会、提高患儿医疗质量的重要辅助手段,但由于患儿年龄较小,配合性差、小儿PICC管路直径较小、护士对小儿护理经验不足等原因常会导致PICC发生非计划性拔管(UE).预防UE对PICC患儿的临床治疗和生活质量具有重要意义.本文就UE的定义及小儿PICC发生UE的影响因素作一综述,建议在今后小儿PICC护理过程中增加针对性、干预性护理,为临床小儿PICC的护理提供理论依据和实践指导.

骶尾部畸胎瘤是胎儿期常见肿瘤之一,巨大畸胎瘤可能增加胎儿心脏负荷,导致胎儿水肿、心功能衰竭等严重问题.宫外产时处理最初应用于胎儿严重膈疝(fetoscopic endoluminal tracheal oc-clusion,FETO)手术后气管内堵塞物的取出,之后应用范围逐步扩大,对胎儿气道梗阻或心肺功能不全发挥了重要作用.本文报告1例应用宫外产时处理技术治疗的胎儿巨大骶尾部畸胎瘤合并心功能衰竭,探讨骶尾部畸胎瘤宫外产时处理的应用指征,总结宫外产时处理的围术期管理要点.

总结1例ECMO联合左心减压治疗儿童暴发性心肌炎的护理体会.护理措施包括ECMO治疗时的液体出入量管理、抗凝管理、活性药物使用管理,做好左心减压护理,给予合理的营养支持和恢复期康复训练等.患儿ECMO治疗20 h后行左心减压治疗,经治疗和护理,ECMO运行8d顺利撤除,住院27 d,康复出院.

总结1例体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)辅助非体外循环下患儿行冠状动脉去顶手术的护理配合经验.护理要点如下:术前病情讨论、手术间准备、ECMO下患儿的院内转运,术中护理配合和应急预案制订以及术后管理.该例患儿成功完成心脏手术,术后继续ECMO支持,14 d后顺利脱机,术后27 d出院.

总结1例持续性室性心动过速患儿在体外膜肺氧合支持下行射频消融术的手术配合.主要护理措施是术前根据病情做好各类物品准备,提前规划转运路径;术中合理有序放置各类管路和仪器设备,严密监测并积极配合手术医生快速消融;术后配合体外膜肺氧合团队做好管路管理和转运.本例患儿射频消融术顺利,心率、心律恢复正常,住院34 d后痊愈出院,出院后门诊随访2个月,心率控制在正常范围.

The prevention and control of 2019 novel coronavirus (2019-nCoV) is currently the primary task of all industries in China. The virus infection is mainly transmitted by respiratory droplets, airborne and close contact. Pediatric foreign body in the respiratory tract is a common otorhinolaryngology emergency, especially occurred in 1-3 years old children, and usually causes airway obstruction, suffocation and pneumonia, which may become an acute threat to life. The principle treatment in otorhinolaryngology emergency room is direct laryngoscope, bronchoscope and foreign body removal. Due to the close contact between the relevant medical staff and child during the operation, a large number of droplets and aerosols can be produced during the reactive cough of the child. Combined with the characteristics of the operation, this article intends to provide advices on diagnosis and treatment of airway foreign body removal for pediatric otorhinolaryngology colleagues during the prevention and control of 2019-nCoV. Adjustments could be made subsequently due to changes of the epidemic situation and the recognition of 2019-nCoV.

The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread to more than 100 countries. Children approved to be susceptible to SARS-CoV-2 infection. Preventing and controlling the epidemic while ensuring orderly flows of pediatric surgery clinical work has proven to be a big challenge for both patients and clinicians during the epidemic. Based on the transmission characteristics of SARS-CoV-2 and the requirements for prevention and control of COVID-19, the authors proposed some concrete measures and practical strategies of managing emergency, limited-term, and elective pediatric surgeries during the epidemic period.

总结138例新生儿直肠肛门畸形行腹腔镜下肛门成形术术后并发症的护理.术中及术后给予综合保温措施,避免术后低体温发生;加强肛门切口护理,妥善固定各类导管,保持引流通畅,密切观察肛门局部形态及皮肤黏膜,保持肛门局部清洁干燥,预防直肠回缩、直肠黏膜外翻、肛周狭窄和大便失禁,促进切口愈合;严密观察病情,监测体温变化,重点关注腹部体征,合理选择抗生素,预防腹腔感染;同时嘱出院后规律护肛.经治疗和护理,本组患儿生命体征正常,病情稳定,于术后7～12 d出院,1例大便失禁的患儿于术后1年恢复排便功能,并继续扩肛治疗.

The pneumonia caused by the novel coronavirus (2019-nCoV), which began in December 2019, has become the most serious public health problem, threatening people's health and life. This threat is posing a severe challenge on the diagnosis and treatment of 2019-nCoV infection, the prevention and control of hospital cross infection of medical staff. It is suggested that in addition to strengthening the organization and leadership of the abovementioned work, establishing and improving the prevention and control mechanism deserve greater attention. Furthermore, special attention should be given to the safety of the medical staff, strengthening their infection monitoring and outbreak management. Medical staff in different work areas and positions should be placed under careful protection, cleaning and disinfection measures. The protection during specimen collection, transportation and medical waste management should also be prioritized. This paper also put forward management suggestions for the outpatient department, isolation ward and other key departments. These measures are proposed to provide a guidance for the prevention and control of 2019-nCoV nosocomial infection in the pediatric outpatient and ward. Key words: Children’s hospital; Pediatrics; 2019 novel coronavirus; Nosocomial infection; Prevention and control

The epidemic of COVID-19 has become the topmost public health threat worldwide. The authors suggested that in addition to strengthening the organization and leadership of the abovementioned work, greater attention be paid to establishing and improving the prevention and control mechanism.Furthermore, special efforts should be given to the safety of the medical workers, by strengthening their infection monitoring and outbreak management. Medical workers in different work areas and positions should be placed under careful protection with due cleaning and disinfection measures. The protection during specimen collection, transportation and medical waste management should also be prioritized. Such special issues in the management of pediatric patients, as allocation of nurses, the screening and management of caregivers, the problem of breastfeeding, and the disinfection of children′s toys and diapers were discussed. This paper also put forward management suggestions for the outpatient department, isolation ward and other key departments, which aim to guide the prevention and control of COVID-19 nosocomial infection in the pediatric outpatient and ward.

OBJECTIVE To explore the feasibility of enhanced recovery after surgery (ERAS) in treatment of children with congenital choledochal cyst. METHODS One hundred and thirty children with congenital choledochal cysts admitted in the Children's Hospital of Zhejiang University from June 2017 to June 2019 were divided into ERAS group (n=65) and control group (n=65) according to admission order. The intestinal tract condition during operation, time of operation, surgical results, time for eating after operation, abdominal drainage after operation, length of hospital stay after operation, total hospital expenses and complications were compared between two groups. RESULTS Compared with the control group, the satisfaction of intestinal operation field, recovery of gastrointestinal function after operation,time required for the volume of peritoneal drainage fluid to be less than 50 mL,time of abdominal drainage tube removal, and length of hospital stay were all improved in ERAS group (P<0.05 or P<0.01).ERAS group had more peritoneal effusion after removal of abdominal drainage tube (P<0.01), but the incidence of edema after operation was lower (P<0.05). The satisfaction of parents in the two groups was similar, but the cooperation of parents in the ERAS group was improved (P<0.05) and the total cost of hospitalization was reduced (P<0.01). CONCLUSIONS ERAS has advantages over the traditional scheme and can be used in the clinical treatment of children with congenital choledochal cyst.

Objective The study attempted to improve the existing intravenous chemotherapy drug delivery method so as to reduce disagreeable response of the body to the therapy.Method In accordance with the new scientific knowledge obtained from meticulous clinical observation,the existing arrangement of drug delivery was re-ordered and the infusion rate was adjusted,which was made on the condition that the efficiency of the drugs remained as sound.Result Chemotherapy drugs can improve immunity,reduce the toxicity of anticancer drugs,and warrants a smooth progress of chemotherapy.The re-ordered drug delivery can not only reduce uncomfortable reactions resulting from the chemotherapy,lengthen the time for rest at night,but also reduce the nursing staff's workload.Conclusion Adjusting the intravenous chemotherapy drug order can control the infusion rate.It helps to improve chemotherapy drug safety,to ensure chemotherapy to be conducted smoothly and thus reduce the suffering of patients.

Objective To evaluate effects of perioperative nursing in 105 children treated by Ilizarov frames.Methods A retrospective survey was performed in children with Ilizarov frames from December 2009 to October 2011 in our hospital and the reulst was retrospectively analyzed.Result Total 105 cases were treated by Ilizarov frames in our hospital,which included clubfoot(n=53),limbs fractures(n=33),double-leg length(n=7),knee turned inside and outside(n=7) and cubitus varus(n=5).All of children were treated carefully and no care-related complications occurred among children.Conclusion Ilizarov frame technology is widely accepted as minimally invasive method of external fixation.Sufficient preoperative preparation and careful nursing after surgery,were important factors to make the operation successfully.

Objective To investigate the status of protective training and implement of protective measures received by nurses contacting ionizing radiation. Method Investigate 50 nurses on protection knowledge on ionizing radiation by self-designed ionizing radiation injury questionnaire.Result Only 2 in 50 nurses have received protection related training and education.No one can take protective measures completely.25 nurses have symptoms of ionizing radiation injury.Conclusion Nursing staff have poor self-protection from ionizing radiation.Nursing managers should enhance training and education on job injury knowledge.

Objective To analyze why the sterilization cycle of hydrogen peroxide plasma sterilization system was cancelled and found its countermeasure.Methods All data about the sterilization cycle and the cancelled cycle from 2007.1 to 2011.10 were analyzed retrospectively.Results The sterilization cycle was cancelled 49 times during all 1104 sterilization cycles.Conclusion Factors such as drying and cleaning equipments,loading methods can impact the function of hydrogen peroxide gas plasma sterilization system.Attentions on these factors are critical to the success of sterilization.