目的 分析石家庄地区新生儿同步行听力和耳聋基因联合筛查的结果及临床意义.方法 随机选取2016年6月至2017年3月疑听力损失在河北省儿童医院就诊的2 856例新生儿,对其同步行听力和耳聋基因联合筛查.对母婴同室的新生儿采取瞬间诱发耳声发射法进行听力筛查,对在重症监护室的新生儿进行瞬间诱发耳声发射法联合自动听性脑干反应法进行听力筛查;采集新生儿足跟血3滴,通过基因芯片技术检测其耳聋基因情况,并对结果进行分析.结果 全组中未通过听力初筛者共315例(11.03％),其中有31例(9.84％)新生儿携带耳聋基因突变;在2 541例通过听力初筛的新生儿中,共有101例(3.97％)携带耳聋基因突变.未通过听力初筛的新生儿耳聋基因突变携带率明显高于通过初筛者(x2 =5.46,P=0.01).全组总体耳聋基因携带率为4.62％(132/2 856),其中SLC26A4杂合突变34例,GJB2共85例,线粒体12SrRNA突变5例,GJB3杂合突变4例,GJB2合并SLC26A4突变4例.全组共5例新生儿在3个月内确诊为听力损失.结论 新生儿同步行听力和耳聋基因联合筛查利于尽早发现听力损失新生儿,特别是迟发性听力损失者,具有显著的临床意义.

目的 探讨Ⅱ型固有淋巴细胞(typeⅡinnate lymphoid cells,ILC2)相关因子在腺样体肥大伴分泌性中耳炎(OME)发病机制中的作用.方法 选择2017年3月～2017年6月在我科住院的腺样体肥大患儿,将其分为单纯腺样体肥大组和腺样体肥大伴OME组各20例,检测两组患儿腺样体组织、血清及中耳积液中IL-25和IL-13表达,并进行比较.结果 ①两组间比较腺样体组织中IL-25表达,差异有统计学意义(t=-3.101,P<0.05).两组间比较血清中IL-25表达,差异无统计学意义(P>0.05).②伴发OME组内比较IL-25的表达,腺样体组织与血清比较,差异有统计学意义(t=-8.924,P<0.05).腺样体组织与中耳积液比较,差异有统计学意义(t=-6.478,P<0.05).血清与中耳积液比较,差异无统计学意义(P>0.05).③两组间比较腺样体组织中IL-13表达,差异有统计学意义(t=-2.507,P<0.05).两组间比较血清中IL-13表达,差异无统计学意义(P>0.05).④伴发OME组内比较IL-13的表达,腺样体组织与血清比较,差异有统计学意义(t=-7.242,P<0.05).腺样体组织与中耳积液比较,差异有统计学意义(t=-7.025,P<0.05).血清与中耳积液比较,差异无统计学意义(P>0.05).结论 腺样体中Ⅱ型固有淋巴细胞相关因子IL-25的高表达,刺激Ⅱ型固有淋巴细胞大量分泌I L-13,进一步加速T h 2活化亢进,持续维系Th2过度反应,可能是腺样体伴OME发病的机制之一.

OBJECTIVE To analyse the result of mastoid abnormal MRI singals in infants without clinical symptoms and to evaluate the diagnostic value. METHODS The MRI data of abnormal signals in the middle ear and mastoid of 42 infants(62 ears) were analyzed with 1000 Hz probe tone tympanometry and oto-endoscope. RESULTS Of the infants with abnormal MRI signals of the middle ear and mastoid, 50 ears were secretory otitis media(80.7％), 10 ears had dysfunction of middle ear (16.1％), and 2 ears were not identified. CONCLUSION In the infant who had a abnormal long T2 singals MRI but without clinical symptoms, 80.7％ were caused by SOM or AOM. It is valuable for clinical efficacy evaluation and treatment planning in advance.

目的 探讨腺样体切除加鼓膜穿刺耳道正行吹张治疗腺样体肥大合并分泌性中耳炎患儿的疗效.方法 选择腺样体肥大合并分泌性中耳炎的患儿80例,随机分为A、B两组,A组40例(65耳),全麻下行腺样体切除加鼓膜穿刺术;B组40例(63耳),全麻下行腺样体切除加鼓膜穿刺及耳道正行吹张术.分析两组术后2周、3个月、6个月的疗效,并对A、B两组黏液性中耳积液患儿(A组25例43耳,B组32例51耳)采用两独立样本非参数秩和检验比较疗效.结果 A组术后2周、3个月及6个月有效率分别为78.46％(51/65)、84.62％(55/65)、90.77％(59/65),B组分别为80.96％(51/63)、90.48％(57/63)、95.24％(60/63),两组比较差异无统计学意义(均为P>0.05).A组中耳积液为黏液性的患儿术后2周、3个月及6个月有效率分别为69.77％(30/43)、76.74％(33/43)、86.05％(37/43),而B组中耳积液为黏液性患儿分别为76.47％(39/51)、88.24％(45/51)、94.12％(48/51),B组有效率均高于A组(P<0.05).结论 对于腺样体肥大并分泌性中耳炎的患儿,中耳积液为浆液性时选择腺样体切除加鼓膜穿刺术即可达到满意疗效,而对于中耳积液为黏液性时选择腺样体切除加鼓膜穿刺及耳道正行吹张治疗效果更好.

食管异物是儿童耳鼻喉科常见急症之一,食管穿孔伴纵膈感染或脓肿的病例临床少见,其死亡率可达15％～33.3％[1],纵膈脓肿胸外科切开引流对患儿创伤较大,且非常困难,因此引起临床的高度重视.我科收治了2例食管异物并发纵膈脓肿的患儿,通过硬性食管镜取出异物的同时在食管穿孔处充分引流纵膈内脓性分泌物,疗效佳,现报道如下.

OBJECTIVE To investigate the rescue and treatment of critical children with tracheobronchial foreign body. METHODS From June 2011 to June 2015,there were 2489 children with tracheobronchial foreign bodies treated in Children's Hospital of HeBei Province, among which 11critical children who were rescued as soon as they came to the hospital. The clinical data of the 11critical children were analyzed. RESULTS All the 11 critical cases endured dyspnea of third degree or more severe and presented severe hypoxia, in which 2 children had been performed tracheal intubation before they came to the hospital and 1 child even showed the symptom of respiratory and cardiac arrest. Among these critical cases, the foreign body was removed directly without anesthesia in 1 child. The other 2 children with severe pneumothorax, mediastinal emphysema and subcutaneous emphysema in neck and chest area were treated by excision and drainage of emphysema firstly, and then the foreign bodies were extracted through bronchoscope after general anesthesia. The another 8 children were performed operations of extraction of bronchial foreign body and then the foreign bodies were taken out. All the 11 critical children were rescued successfully and no death cases happened. CONCLUSION Rapid diagnosis and rapid removal of foreign bodies is the key to save the lives of critical children with tracheobronchial foreign bodies.

儿童先天性耳前瘘管伴耳后感染临床上较为少见,因瘘管口位于耳前,而感染灶位于耳后,与普通耳前瘘管表现不同,因此临床上极容易误诊、误治,造成耳后反复感染,迁延不愈。现将河北省儿童医院耳鼻咽喉科2009-01-2015-06期间收治的16例先天性耳前瘘管伴耳后感染患者的资料报告如下。

目的:分析X线检查(胸部正位片+胸部透视)和螺旋CT扫描在诊断小儿气管、支气管异物中的时机选择,在保证准确性的基础上,尽量减少螺旋CT的使用,从而减少患儿所接受的辐射剂量.方法:选取2013年怀疑小儿气管、支气管异物患儿734例.对于有明确异物吸入史,听诊有一侧呼吸音减低或者有呼吸困难,怀疑气管异物采用普通X线检查.对于没有异物吸入史或者有异物吸入史,但是听诊没有呼吸音减低的患儿采用螺旋CT检查.结果:经支气管镜检查证实总的阳性率96.59％ (709/734),其中采用X线检查529例,阳性率97.16％(514/529);采用螺旋CT检查205例,阳性率95.12％(195/205),两者比较没有显著性统计学差异(P＞0.05).螺旋CT在诊断中使用率27.93％(205/734).结论:对于多数的小儿气管、支气管异物诊断应尽量选择X线检查,减少患儿遭受辐射危害.

目的：通过检测腺样体肥大患儿淋巴细胞亚群的变化，探讨免疫功能检测在腺样体肥大患儿诊断及治疗中的作用。方法采用流式细胞仪，检测各组儿童血清淋巴细胞亚群的含量。结果中度腺样体肥大组血清CD4＋、CD8＋、CD4＋／CD8＋及CD5＋6与正常对照组比较无明显下降或升高，差异无统计学意义（ P ＞0 k．05）；CD3＋高于正常对照组，CD19＋低于正常对照组，且差异有统计学意义（ P ＜0．05）；重度腺样体肥大实验组患儿血清CD4＋、CD4＋／CD8＋及CD3＋高于正常对照组，CD1＋9低于正常对照组，差异有统计学意义（ P ＜0．01）；CD5＋6及CD8＋低于正常对照组，但差异无统计学意义（ P ＞0．05）；结论中重度腺样体肥大患儿淋巴细胞亚群表达出现紊乱，与机体体液免疫不协调。提示应用免疫调节剂对于改善腺样体肥大患儿的临床症状及减少并发症具有重要临床意义。

气管、支气管异物中的植物性异物,因含有游离脂酸,更具刺激性,故可引起严重的呼吸道黏膜急性弥漫性炎性反应[1],有的还能引起炎性肉芽肿[2].多数情况下,随着异物取出,解除了异物对支气管黏膜的持续刺激,术后同时给予抗炎治疗,黏膜炎症反应很快消失,肉芽组织也会消失.但我科曾遇到两例异物取出后炎性肉芽肿反而增生的病例,现报道如下.

腺样体也称咽扁桃体或增殖体,属于淋巴组织,表面呈桔瓣样。正常生理情况下,儿童6~7岁时腺样体发育至最大,青春期后逐渐萎缩,成人后基本消失~[1]。腺样体位于鼻咽顶后壁处,病理性肥大易引起鼻堵、张口呼吸、耳闷、听力下降等症状,最终造成慢性鼻-鼻窦炎、阻塞性睡眠呼吸暂停低通气综合征及分泌性中耳炎等疾病,给儿童的颌面骨发育、智力发育造成严重影响。国内外正在不断的探

OBJECTIVE:To analyze the distribution and drug susceptibility of the pathogenic bacteria in the airway secretions in children with tracheobronchial foreign bodies so as to assist physicians in clinical prescription.METHODS:Sputum specimens of 1 125 children with tracheobronchial foreign bodies were collected in removal of the foreign bodies by rigid bronchoscope, and the drug susceptibility test was performed.RESULTS:Pathogenic bacteria were detected in 218 (19.4%) of 1 125 sputum specimens. Among the pathogenic bacteria, 126 (57.79%) strains were gram-negative bacilli, consisting of 76 (34.86%) strains of Haemophilus influenzae, 10 (4.59%) strains of Escherichia coli, 7 (3.21%) strains of Sewer enterobacter, 7 (3.21%) strains of Pseudomonas aeruginosa, and 6 (2.75%) strains of Klebsiella bacillus; and 92 (42.21%) strains were gram-positive bacilli, consisting of 80 (36.69%) strains of Streptococcus pneumonia and 10 (4.59%) strains of Escherichia coli. Most of detected gram-negative bacilli were highly sensitive to cefepime, ceftazidine, imipenem and amikacin, no strains were resistant to meropenem and ciprofloxacin. None of the detected gram-positive bacilli were resistant to cefepime, vancomycin, levofloxacin and teicoplanin.CONCLUSIONS:The Haemophilus influenzae of gram-negative bacilli and the Streptococcus pneumonia of gram-positive bacilli are the main pathogenic bacteria existing in the airway secretions of children with tracheobronchial foreign bodies. The Haemophilus influenzae were highly sensitive to cephalosporin, imipenem and amikacin, and the Streptococcus pneumonia to cefepime, vancomycin, levofloxacin and teicoplanin.

气管、支气管异物是小儿急危重症之一，如不及时、正确的救治，可引起严重并发症，甚至危及患儿生命，支气管镜检查术取出异物是唯一有效的治疗途径。明确的异物吸入史是诊断气管、支气管异物的核心指标[1]，然而对于有些家长疏于监护不能提供明确异物吸入史的病例，就极容易发生漏诊及误诊，导致病情迁延不愈或加重。因而尽早的明确诊断十分关键。

腺样体也称咽扁桃体或增殖体，属于淋巴组织，表面呈桔瓣样。正常生理情况下，儿童6~7岁时腺样体发育至最大，青春期后逐渐萎缩，成人后基本消失[1]。腺样体位于鼻咽顶后壁处，病理性肥大易引起鼻堵、张口呼吸、耳闷、听力下降等症状，最终造成慢性鼻-鼻窦炎、阻塞性睡眠呼吸暂停低通气综合征及分泌性中耳炎等疾病，给儿童的颌面骨发育、智力发育造成严重影响。国内外正在不断的探讨腺样体肥大的机制，本文主要研究腺样体肥大患儿机体免疫功能的变化，为腺样体肥大患儿的诊断及免疫治疗提供理论依据。现将结果报道如下。

Objective To analyze the distribution and drug susceptibility of the pathogenic bacteria in the airway secretions in children with tracheobronchial foreign bodies so as to assist physicians in clinical prescription.Methods Sputum specimens of 1 125 children with tracheobronchial foreign bodies were collected in removal of the foreign bodies by rigid bronchoscope,and the drug susceptibility test was performed.Results Pathogenic bacteria were detected in 218 (19.4％) of 1 125 sputum specimens.Among the pathogenic bacteria,126 (57.79％) strains were gram-negative bacilli,consisting of 76 (34.86％) strains of Haemophilus influenzae,10 (4.59％) strains of Escherichia coli,7 (3.21％) strains of Sewer enterobacter,7 (3.21％) strains of Pseudomonas aeruginosa,and 6 (2.75％) strains of Klebsiella bacillus; and 92 (42.21％) strains were gram-positive bacilli,consisting of 80 (36.69％) strains of Streptococcus pneumonia and 10(4.59％)strains of Escherichia coli.Most of detected gram-negative bacilli were highly sensitive to cefepime,ceftazidine,imipenem and amikacin,no strains were resistant to meropenem and ciprofloxacin.None of the detected gram-positive bacilli were resistant to cefepime,vancomycin,levofloxacin and teicoplanin.Conclusions The Haemophilus influenzae of gram-negative bacilli and the Streptococcus pneumonia of gram-positive bacilli are the main pathogenic bacteria existing in the airway secretions of children with tracheobronchial foreign bodies.The Haemophilus influenzae were highly sensitive to cephalosporin,imipenem and amikacin,and the Streptococcus pneumonia to cefepime,vancomycin,levofloxacin and teicoplanin.

Objective:To analyze the children listening test results and explore the test method and measurement for development disorder of speech,to a-chieve early diagnosis,early intervention. Methods:180 cases with developmental disorder of speech were examined from inquiry of medical history,aural ex-amination,acoustic immittance,otoacousticemission,auditory steady-state response,auditory brainstem evoked potential. Results:Among the180 cases of children,68 cases hearing results were normal,112 cases hearing results were abnormal with 100 cases of severe hearing loss and 12 cases of mild or moder-ate hearing loss. Conclusion: Parents respond to the children sound good,can not speak,most of these children with normal hearing,the hearing on the screening method for these children,for diagnostic tests fail. Prelingual deafness children most severe and very severe deafness. Hearing disorder is the main cause of developmental disorders of speech,but it is not the only reason.

目的：探讨吉诺通治疗鼻后滴漏导致儿童慢性咳嗽的临床疗效。方法选取鼻后滴漏导致儿童慢性咳嗽120例，将其随机分为治疗组及对照组各60例，对照组予以敏感抗生素、糖皮质激素、抗组胺药物治疗；治疗组在对照组治疗的基础上加服吉诺通(规格：120mg/粒*10粒/盒）；急性患者1粒/次，3次/日；慢性患者1粒/次，2次/日。结果疗程结束后观察治疗组总有效率100%，对照组为88.3%，两组比较有显著性差异（P﹤0.05）。结论吉诺通治疗鼻后滴漏导致的儿童慢性咳嗽疗效显著，值得临床推广。

儿童慢性咳嗽是儿科门诊常见症状,病因复杂多样.鼻后滴漏是引起儿童慢性咳嗽的主要原因之一,由于对该病认识不足,临床上易发生误诊及漏诊.由于在临床治疗过程中忽视了针对鼻后滴漏的病因治疗,而使整体的治疗效果不十分令人满意.现将2009年1月至2012年1月在我院门诊及住院118例鼻后滴漏综合征患儿的临床资料、治疗结果分析报告如下.