目的 探讨降钙素原(PCT)、中性粒细胞与淋巴细胞比值(NLR)与新生儿化脓性脑膜炎(PM)预后的相关性.方法 选择2020年4月至2022年4月南阳市第一人民医院收治的122例PM新生儿为研究对象.PM患儿均接受抗生素、肾上腺皮质激素及对症支持治疗,最长治疗时间为21 d,依据21 d内患儿预后情况将122例PM新生儿分为病死组(n=23)与存活组(n=99).设计基线资料调查表,通过查阅患儿病历资料记录患儿的基线资料,包括出生日龄、性别、出生体质量、早产情况、出生方式、胎膜早破情况、羊水粪染情况.经脑脊液培养检查明确PM患儿致病菌.记录PM患儿最高体温、惊厥发生情况及治疗时间.于入院当日抽取患儿静脉血8 mL,使用全自动生物化学分析仪测定静脉血中白细胞(WBC)、血小板(PLT)、红细胞(RBC)、中性粒细胞(NEU)、淋巴细胞(LYM)水平,并计算NLR.采用酶联免疫吸附测定法检测血清C反应蛋白(CRP)、PCT水平.采用COX回归分析检验各因素对PM患儿预后的影响;绘制受试者操作特征(ROC)曲线,并计算曲线下面积(AUC),分析PCT、NLR对PM患儿预后的预测价值;采用样条函数与回归分析相结合的限制性立方样条法分析PCT、NLR与PM患儿预后的剂量反应关系.结果 病死组患儿的惊厥发生比例显著高于存活组(χ2=11.675,P<0.05);病死组与存活组患儿的日龄、性别、出生体质量、早产情况、生产方式、胎膜早破情况、羊水粪染情况、致病菌种类、最高体温、治疗时间比较差异无统计学意义(P>0.05).病死组患儿的WBC、NEU、CRP、PCT水平及NLR显著高于存活组,LYM水平显著低于存活组(P<0.05);病死组与存活组患儿的PLT、RBC水平比较差异无统计学意义(P>0.05).发生惊厥及NEU、NLR、CRP、PCT水平高是PM患儿预后的危险因素(风险比>1,P<0.05).ROC曲线分析显示,血清PCT、NLR对PM患儿预后预测的截断值分别为3.940 ng·L-1、2.370;PCT、NLR单独及联合预测PM患儿预后的AUC>0.70,均具有一定的预测价值.PCT、NLR单独预测PM患儿预后的AUC、特异度、敏感度比较差异无统计学意义(P>0.05);PCT、NLR联合预测PM患儿预后的AUC显著高于PCT、NLR单独预测(P<0.05);PCT、NLR联合预测PM患儿预后的特异度显著低于NLR单独预测,敏感度显著高于NLR单独预测(P<0.05).剂量反应曲线分析显示,PCT、NLR水平与PM患儿预后的关联强度呈"S"型非线性剂量反应关系.结论 血清PCT水平及NLR高是PM新生儿预后的独立危险因素,血清PCT水平及NLR联合检测可用于预测PM新生儿预后情况.

目的 探讨奥曲肽联合肠内营养治疗小儿急性胰腺炎的应用价值分析.方法 选取我院治疗的72例小儿急性胰腺炎患儿作为研究对象,随机分为对照组和观察组,每组各36例.对照组患儿在常规治疗基础上给予肠内营养,观察组患儿在对照组的治疗基础上联合奥曲肽进行治疗.比较两组患者症状和指标的缓解时间、临床疗效及炎性因子水平.结果 观察组患儿血尿淀粉酶恢复时间、腹痛缓解时间、腹部压痛消失时间均明显短于对照组,差异具有统计学意义(P＜0.05);观察组患儿临床总有效率为94.44％,显著高于对照组患儿77.78％,差异具有统计学意义(P＜0.05);治疗后两组患儿IL-6水平均明显低于治疗前,且观察组患儿IL-6水平降低程度明显高于对照组,差异具有统计学意义(P＜0.05);两组患儿治疗后IL-2水平明显高于治疗前,但两组患儿IL-2水平比较,差异无统计学意义(P＞0.05).结论 小儿急性胰腺炎采用奥曲肽联合肠内营养治疗可提高患儿临床有效率,更有利于改善患儿临床症状和抑制其炎性反应,加速患儿恢复.

目的 探究急性阑尾炎患儿采用经脐单孔腹腔镜阑尾切除术治疗的效果.方法 选取我院2016年5月至2019年3月急性阑尾炎患儿112例,根据治疗方案不同分组,各56例.对照组给予开腹阑尾切除术治疗,观察组给予经脐单孔腹腔镜阑尾切除术治疗.对比两组术中出血量、手术时间、胃肠功能、并发症及术前、术后1d、术后3d血清C反应蛋白(CRP)水平.结果 观察组术中出血量较对照组低,手术时间较对照组短;观察组术后胃肠功能恢复时间较对照组短;观察组术后1、3d血清CRP水平较对照组低;观察组并发症发生率较对照组低.结论 急性阑尾炎患儿采用经脐单孔腹腔镜阑尾切除术治疗,具有手术时间短、出血少、并发症少等优势,并可促进术后胃肠功能恢复,缩短住院时间.

目的 分析经脐单一切口治疗小儿胆总管囊肿的效果.方法 选取本院2014年3月～2018年10月期间收治的胆总管囊肿患儿56例作为研究对象,以随机数字表法分为常规组(28例,传统4孔腹腔镜治疗)、研究组(28例,经脐单一切口治疗),比较两组手术情况及并发症发生情况.结果 研究组手术时间比常规组长,首次肛门排气时间、下床活动时间、住院时间均短于常规组;研究组术中出血量、术后引流量显著比常规组低,并发症发生率低于常规组,以上组间比较均有显著差异(P<0.05).结论 经脐单一切口手术可有效缩短患儿治疗时间,减少术中引流量、术后出血量,降低并发症发生率,值得借鉴.

为探讨腹腔镜下行Soave根治术治疗先天性巨结肠患儿的临床效果,选择2016年1月至2019年1月我院收治的50例先天性巨结肠患儿作为研究对象,随机分为观察组和对照组,各25例.观察组在腹腔镜下行Soave根治术治疗,对照组行传统开腹手术治疗.比较2组患者术中出血量 、术后肠功能恢复时间 、住院时间 、术后并发症发生情况.结果显示,2组均顺利完成手术.但观察组术中出血明显少于对照组,术后肠道功能恢复明显早于对照组,住院时间明显短于对照组,并发症总发生率明显低于对照组,P<0.05.结果表明,腹腔镜下行Soave根治术治疗先天性巨结肠患儿安全有效,术中出血少,术后并发症少,患者恢复快,住院时间短,值得临床推广应用.

了解腹腔镜下囊肿切除术治疗小儿先天性胆总管囊肿的临床应用情况及术后肝功能指标变化及手术并发症发生情况.收集2014年6月—2018年6月先天性胆总管囊肿患儿60例,根据手术方式分为腹腔镜组、开放手术组.记录患儿入院第一次抽血、术后2 h、术后3 d、术后6 d的肝功能指标;记录手术时间、术中出血量、住院时间、肛门排气时间、腹腔引流时间、并发症发生情况.腹腔镜组手术时间、术中出血量、住院时间、肛门排气时间、腹腔引流时间均显著低于开放手术组(P<0.05).两组手术前后肝功能指标比较,总蛋白(TP)水平手术前后差异无统计学意义(P>0.05);谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、谷氨酰转肽酶(GGT)均较术前显著降低(P<0.05).术后2 h腹腔镜组ALT、AST、TBIL、GGT显著低于开放手术组(P<0.05).腹腔镜组并发症发生率显著低于开放手术组(P<0.05).腹腔镜下囊肿切除术治疗小儿先天性胆总管囊肿具有创伤小、恢复快、并发症少等优势,且术后可快速恢复患儿受损肝功能.

目的 探讨不同方式门静脉左支分流术在小儿肝外门静脉高压(EPH-PVT)中的治疗价值.方法 选取2013年2月至2018年2月收治的EPH-PVT患儿60例,根据手术方式将其分成A组32例,B组28例.其中A组行移植门静脉系统血管间置、门静脉主干-门静脉左支分流术(iPV-LPV),B组行胃冠状静脉-门静脉左支分流术(CV-LPV).比较两组患儿围手术期指标,分别在术前及术后2、6周检测两组患者肝动脉、门静脉血流量的变化,并于术前、术后6周采血测定血清蛋白S、蛋白C、抗凝血酶Ⅲ(A TⅢ)水平,记录并发症发生率.结果 A组手术时间、术后下床活动时间及住院时间分别为(174.32±43.65)min、(46.24±5.19)h、(8.64±1.15)d,均小于B组的(207.15±53.76)min、(49.25±6.42)h、(9.42±1.38)h(P<0.05).A组术后2周、6周的肝动脉血流量分别为(524.31±68.27)mL/min、(536.57±73.15)mL/min,高于B组的(458.82±71.38)mL/min、(462.43±79.61)mL/min,且A组术后2周、6周的门静脉血流量分别为(1108.32±116.25)mL/min、(1115.31±109.75)mL/min,低于B组的(1221.63±107.04)mL/min、(1208.18±105.42)mL/min,差异有统计学意义(P<0.05).A组术后6周血清蛋白S、蛋白C水平分别为(2.48±0.13)μg/mL、(5.12±0.63)μg/mL,均高于B组的(2.36±0.17)μg/mL、(4.68±0.59)μg/mL(P<0.05).A组并发症发生率为6.25％,与B组的14.28％ 比较,差异无统计学意义(P>0.05).结论 与CV-LPV术相比,iPV-LPV术能促进患儿术后身体机能恢复,进一步改善肝动脉、门静脉血流量,从而上调血清蛋白S、蛋白C水平,手术安全性高.

Objective To compare the clincial therapeutic effects between laparoscopic surgery and conventional surgery in the treatment of pediatric indirect inguinal hernia in children . Methods According to the willing of family members , a total of 100 children with indirect inguinal hernia from January 2014 to May 2015 were divided into two groups: laparoscopic surgery group ( 62 cases) and conventional surgery group (38 cases).The amount of blood loss, duration of surgery, and length of hospital stay were compared between the two groups , and the complications such as incision bleeding , knotting reaction under incision , pneumoderm , and scrotum swelling were observed after surgery . Results There was no difference between the two groups in regard to the duration of surgery [(24.3 ±6.5) min vs.(21.4 ±7.5) min, t=1.972, P=0.051].However, the blood loss was less in the laparoscopic surgery group than that in the conventional surgery group [(6.8 ±2.7) ml vs.(13.2 ±4.6) ml, t=8.777, P=0.000], and the length of hospital stay was shorter in the laparoscopic surgery group than that in the conventional surgery group [(4.5 ±0.8) d vs. (6.9 ±1.2) d, t=12.002, P=0.000].There was no difference between the two groups in complications [3.2%(2/62) vs.7.9%(3/38),χ2 =0.322, P=0.571]. Conclusions Laparoscopic surgery presents advantages of minimal invasion in blood loss and length of hospital stay , and is similar to conventional surgery in the duration of surgery and complications .It can achieve satisfactory clinical effects in the treatment of pediatric indirect inguinal hernia .

Objective To investigate the clinical value of laparoscopic high ligation combined with autologous tissue repair for indirect inguinal hernia in children . Methods We selected 322 in-hospital cases of pediatric indirect inguinal hernia as the objects of study from August 2013 to August 2014 in our department .According to different surgical options performed by different doctors , the patients were divided into 2 groups:laparoscopic and autologous tissue repair group ( group A, n=168) or laparoscopic group ( group B, n=154).The clinical data of the two groups were compared and analyzed . Results In this study, we found contra-lateral occult hernia in 21 patients in the group A and 16 patients in the group B .No statistical differences were found in the operation time [(26.9 ±7.6) min vs.(25.9 ±8.1) min, t=1.097, P=0.273], postoperative visual analogue scale (VAS) score [(22.6 ±8.0) points vs.(22.4 ±8.0) points, t=0.179, P=0.858], postoperative hospital stay [(2.9 ±1.3) d vs.(2.8 ±1.6) d, t=0.502, P=0.616], and postoperative complications [2.4% (4/168) vs.4.5% (7/154), χ2 =1.141, P=0.285] between the group A and the group B .In one year of follow-up, there was no recurrence in the group A and 8 cases of recurrence in the group B , the recurrence rate being significantly lower in the group A than the group B [0 (0/168) vs.5.2%(8/154), P=0.002]. Conclusion Laparoscopy combined with autologous tissue repair surgery can effectively reduce the rate of recurrence of indirect inguinal hernia in children, being worthy of clinical popularization .

Objective To explore the effects of extremity salvage surgery of osteosarcoma in children of different ages.Methods A total of 57 children aged under 11 years with malignant osteosarcoma from June 2008 to June 2011 were selected into children group.And 38 cases underwent biological reconstruction while another 19 cases received prosthesis.For control group,60 adolescent patients aged above 12 years with malignant bone tumors during the same period were designated as control group.And 42 cases had biological reconstruction while 18 cases received prosthesis.The postoperative survival rates of three groups were observed.And the optimal extremity salvage surgery was summarized with statistical processing.Results During follow-ups,the mortality rate was 33.3％.And 1,2,3 and 5-year survival rates were (86.2 ± 4.9) ％,(70.2 ± 6.8) ％,(66.2 ± 5.0) ％ and (57.4 ± 4.3) ％ respectively.Significant differences existed with control group (P ＜ 0.05).However,the prognoses of groups A and B showed no statistical significance (P＞0.05).And the overall incidence of postoperative complications had no significant difference between groups A and B (23.7％ vs 31.6％,P＞0.05).Conclusions Age is a major prognostic factor for osteosarcoma.And extremity-sparing surgery and prosthetic reconstruction are effective treatments for children with osteosarcoma.

Increasing numbers of children undergo surgery and are exposed to anesthesia that raises concerns regarding the safety of frequently employed anesthetics. Isoflurane, often used in pediatric anesthesia, has been reported to cause neurodegeneration in animal models. The study investigates the effectiveness of pterostilbene on neurodegeneration caused by isoflurane. Separate groups of neonatal mice were administered with pterostilbene at 10, 20 or 40 mg/kg from post natal day 1 (P1) to P15. On P7, rats received isoflurane at 0.75% for 6 hours. Control rats received no anesthesia or pterostilbene. Neuroapoptosis following isoflurane exposure were markedly reduced by pterostilbene, further pterostilbene down-regulated the expressions of caspase-3, Bad, phospho-JNK and phospho-c-Jun and as well improved the expressions of Bcl-xL, JNK, phospho-Bad and phospho-Akt. Pterostilbene enhanced the performance of rats in Morris water maze tests. The observations suggest that pterostilbene was able to effectively reduce isoflurane-induced neurodegeneration.

目的 探讨温阳活血化湿法治疗小儿胆道闭锁术后的临床效果.方法 选取胆道闭锁术后的患儿 56例,随机分为两组,每组28例.两组惠儿均给予手术后的西医常规抗炎、保肝利胆治疗,治疗组在此基础上给予温阳活血化湿中药辨证治疗,3个疗程后,观察比较患儿的一般临床症状体征、肝功能指标,生长发育状况.结果 两组惠儿在治疗后,治疗组的总有效率达89.29％,对照组的有效率仅为60.71％,两组比较治疗组的疗效优于对照纽,差异有统计学意义(P＜0.05).在治疗后,两组患儿的各项肝功能指标均较前降低差异有统计学意义(P＜0.05),但是,治疗组明显优于对照组,P＜ 0.05,差异有统计学意义.结论 对小儿胆道闭锁术后患儿采用温阳活血化湿法辨证治疗可以明显的改善患儿的临床症状,改善肝功能,且无明显的不良反应,临床效果满意.

Objective To investigate the effects of dl-3n-butylphthalide on learning and memory ability of cerebral Infarction in rats with dementia.Methods SD Rats were randomly divided into normal group,sham-operation group,model group,treatment group and control group.Models of infarction rats with dementia were established on injection of concretionary self-blood into internal carotid artery.Treatment group treated by dl-3nbutylphthalide,Control group treated by nimodipine.The learning and memory ability were tested with Morris water maze experiment and the changes of cell morphology were detected by HE staining.Results In Morris water maze experiment,compared with normal group,the escape latency in model group was significantly longer(P0.05).The average number of exploration was reduced significantly(P0.05).Compared with the model group,the escape latency in treatment group and control group were significantly shorter(P0.05).The average exploration number was increased significantly(P0.05).Light microscope showed that hippocampal CA1 fields of rat neurons close neatly without loss of neurons in the normal control group.Conclusion NBP could improve the learning and memory ability in rats with vascular dementia.Its mechanism might relate to alleviating the injury of neurons on CA1 field in hippocampus.

Objective To explore the therapy effects of Xuebijing injection on severe tuberculous meningitis patients.Methods 72 patients with severe tuberculous meningitis were divided into two groups(treatment group and control group) at random.The treatment group was treated by Xiebijing injection apart from the conventional therapy;the control group received treatment with conventional therapy.Results As compared to the control group,the treatment group was significantly superior with regard to the degree and time of symptomatic relief(P<0.05).There were significant differences(P<0.05) in total effective rates between treatment group and control group,which stood at 93.8% and 86.4%,respectively.Conclusion Xiebijing injection could reduce the time of symptom improving of severe tuberculous meningitis and had a good effect in treatment of it.