目的 观察四妙勇安汤合救真汤加味辅助治疗小儿急性病毒性心肌炎(热毒侵心证)的治疗效果.方法 选择70例急性病毒性心肌炎热毒侵心证患儿按随机数字表法分为治疗组与对照组各35例.对照组予常规治疗措施;治疗组在对照组的基础上内服四妙勇安汤合救真汤加味.连续14 d后,比较两组心功能、心肌酶、心肌损伤指标、临床疗效以及血清白细胞介素-8(IL-8)和肿瘤坏死因子-α(TNF-α)水平.结果 治疗7 d和14 d后,治疗组的左室射血分数(LVEF)、左心室短轴缩短率(LVFS)、心脏指数(CI)均明显高于对照组,血清磷酸肌酸激酶(CK)、磷酸肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)以及肌钙蛋白Ⅰ(cTnⅠ)和心型游离脂肪酸结合蛋白(H-FABP)水平均明显低于对照组(P＜0.05).治疗组的总有效率为94.29％,明显高于对照组的71.43％(P＜0.05).治疗7d和14d后,治疗组血清IL-8和TNF-α水平均明显低于对照组(P＜0.05).结论 在西医常规治疗基础上,四妙勇安汤合救真汤加味辅助治疗小儿急性病毒性心肌炎(热毒侵心证)可明显改善患儿的心功能,减轻心肌损伤,提高治疗效果,且能抑制炎症反应.

Objective:To summarize the characteristics of hypertension and target organ damage in hospitalized children, so as to provide scientific basis for comprehensive prevention and management of hypertension children.Methods:The clinical data of 165 hospitalized children diagnosed with hypertension at Beijing Children′s Hospital from January 2017 to December 2019 were analyzed retrospectively.Data including medical history, clinical symptoms, signs, auxiliary examination and treatment strategy were collected and analyzed statistically.Results:Of 165 admitted hypertensive children who met the inclusion criteria, 35(21.2%)were classified as having primary hypertension, and 130(78.8%)were secondary hypertension.The body mass index(BMI)and the rate of family history of children with primary hypertension were higher than those of children with secondary hypertension, the differences were statistically significant( t=2.052, P=0.026; χ2=3.321, P=0.009). Among 165 children with hypertension, 137 had varying degrees of clinical symptoms(83.0%), only nine primary hypertension cases showed symptoms.The original etiologies of secondary hypertension included 78 cases of renal disease(60.0%), 23 cases of cardiogenic disease(17.7%), six cases of endocrine disease(4.6%)and five cases of rheumatic disease(3.8%). Of all admitted patients, the blood pressure of 158 cases(95.8%)decreased to normal with weight control, low-fat and low-salt diet, antihypertensive drugs and treatment of primary disease.Besides, the parents of seven cases gave up any treatment and left hospital. Conclusion:Secondary hypertension is the main type of hypertension in children, among which renal parenchymal disease is the most common etiology.The clinical symptoms also vary by its original etiology.The overall goal of this study is to reduce the risk of target organ damage, and get blood pressure under control relatively early and effectively.

Objective:To summarize the best evidence for the prevention and management of aspiration pneumonia in elderly patients to provide a basis for clinical nursing work.Methods:We systematically searched the domestic and foreign guide nets, websites of relevant institutions and databases on the relevant evidence for the prevention and management of aspiration pneumonia, including guidelines, expert consensus, systematic reviews, randomized controlled trials (RCT) , and the search time limit was from January 1, 2010, to June 30, 2020, and the language was not limited. Two researchers evaluated the quality of the included literature, and extracted, analyzed, and integrated evidence that met the quality evaluation criteria.Results:A total of 8 guidelines, 5 expert consensus, 10 systematic reviews, and 19 RCTs were included. The evidence was collected and extracted to form a prevention and management strategy for elderly patients with aspiration pneumonia including 11 first-level indicators and 32 second-level indicators.Conclusions:Medical and nursing staff should take effective measures in risk assessment, posture management, oral management, airway management, medication management, functional exercise and so on to reduce the risk of aspiration. Medical and nursing staff should also strengthen training for their own, elderly patients and main caregivers, and reduce the incidence of aspiration in elderly patients by applying the best evidence, so as to reduce the incidence of aspiration pneumonia.

Objective:To analyze the changes of myocardial damage markers during ventricular tachycardia (SVT) onset and efficacy of various therapeutic approaches.Methods:The clinical data of 256 children with SVT admitted to Beijing Children′s Hospital Affiliated to Capital Medical University from October 2018 to October 2019 were retrospectively analyzed.According to the age of onset, children were divided into groups of 0~3 years old, >3-6 years old, and >6 years old.According to the different heart rates at the time of attack, patients were divided into the groups of <180 times/min, 180~260 times /min, and >260 times /min.According to the treatment methods, children were divided into physical therapy group, drug therapy group and radiofrequency ablation group.Frequency of SVT attacks, heart rate at the onset, serum creatine kinase isoenzyme (CK-MB), troponin (cTn) I, and brain natiuretic peptide(BNP) were collected within 2 h after the onset stop.The recovery rate of each treatment group was counted.Results:Among the 256 cases, there were 135 males and 121 females, which aged from 1 month to 18 years, mean age was (10.2±2.2) years and SVT attacked from 1 to 8 times.The faster the heart rate during SVT attack, the higher CK-MB, cTnI and BNP ( P<0.05). The recovery rate was 27.6% in the mechanical stimulation group, 98.0% in the drug treatment group and 100% in the radiofrequency ablation group, respectively.Successful recovery rate was 47.2%(34 cases)with ATP, 71.7%(109 cases)with Propafenone, 67.3%(64 cases)with Cediland, 59.6%(31 cases)with Verapamil, 61.5%(24 cases)with Sotalol and 54.7%(29 cases)with Amiodarone.Eithty-two cases were successfully converted by two drugs(32.7%) and 38 cases were successfully converted by three drugs(15.1%). Conclusion:When SVT attacks, most children have myocardial damage.The faster the heart rate, the greater the damage in the heart muscle; The treatment of SVT in children should still be the first choice of physical therapy in older children, and if it is not effective, drug therapy should be selected.Radiofrequency ablation is the most effective method to cure tachyarrhythmia.

目的 探明冠心病患者戒烟的意愿和戒烟的需求,为临床专业人员进行戒烟指导提供依据.方法 通过整群抽样,选自2018年3-9月期间入住北京某三甲医院心脏科确诊为冠心病的201例吸烟患者为研究对象,调查其吸烟状况及尼古丁依赖程度、既往戒烟情况及复吸原因、戒烟意愿及戒烟需求情况.结果 25例患者因疾病已戒烟,176例正在吸烟的冠心病患者当中,61.9％的患者存在中重度尼古丁依赖,67.6％的患者有戒烟意愿,有超1/2的患者尝试过戒烟,但因复吸导致戒烟失败.11.9％的患者采用过电子烟产品来帮助戒烟,少有患者寻求戒烟专业人员的帮助.结论 冠心病患者戒烟的意愿较强,但缺少戒烟的应对措施,寻求戒烟专业人员帮助的行为较少,在临床戒烟工作中应扩大戒烟专业人员帮助范围,为患者提供个性化的戒烟方案和应对措施,提高戒烟的成功率.

Objective:To summarize the best evidence for prevention and management of aspiration in neurosurgical ICU patients and provide evidence for clinical nursing work.Methods:Relevant evidence on prevention and management of aspiration in neurosurgical ICU patients, including guidelines, consensus, system reviews, and randomized controlled trials (RCTs) which were published from 1st January, 2010 to 30th June, 2019 in any language was retrieved from guideline websites, relevant websites and databases. Two researchers evaluated the quality of the included literature and performed evidence extraction on those literatures that met the quality standards.Results:Totally 9 clinical practice guidelines, 8 expert consensus, 13 Meta analysis / systematic reviews and 10 RCTs were included, which were collected and extracted to form the final version of best evidence for aspiration prevention and management including 10 primary indicators and 29 secondary indicators.Conclusions:Medical staff should take effective measures in early assessment of aspiration risks, artificial airway management, position management, enteral nutrition management, sedation and analgesia management, etc., and reduce the incidence of aspiration in neurosurgical ICU patients by applying the best evidence. In addition, hospitals should provide various forms of education and training to medical staff, form transdisciplinary cooperation teams, and strengthen the prevention and management of aspiration.

目的 探讨中西医结合治疗对恶性实体瘤患儿5年生存情况的影响.方法 研究对象为2005年1月～2009年12月首都医科大学附属北京儿童医院收治的恶性实体瘤患儿167例,持续回访5年,回访时间截至2015年1月.将符合纳入标准的患儿采用随机数字表法分为治疗组83例,对照组84例,其中治疗组脱落16例为67例,对照组脱落20例为64例.治疗组常规进行化疗、手术治疗及中药治疗;对照组常规进行化疗及手术治疗.比较两组患儿生存时间、生存情况、复发情况.结果 治疗组5年生存率为69.0％,对照组5年生存率为46.7％.两组患儿平均生存时间比较差异有高度统计学意义(P＜0.01).两组患儿复发率比较差异无统计学意义(P＞0.05).两组患儿无病生存情况比较差异有统计学意义(P＜0.05).结论 扶正健脾中药结合西医治疗实体瘤患儿能通过减轻化疗不良反应,顺利完成化疗,延长生存时间,提高其存活率,改善其生存质量.

Objective To observe the clinical efficacy and safety of Peramivir in the treatment of influenza among children with cardiac insulfficiency.Methods Based on the prospective study design,the children patients with cardiac insulfficiency and influenza at the same time were divided into the treatment group and the control group according to whether they accepted voluntarily peramivir injection.These patients were admitted to the cardiology department of Beijing Children's Hospital from January 2016 to January 2017 and all cases were treated with conventional symptomatic treatment.Both groups were evaluated for fever remission time,symptom relief time,adverse reactions,complications,antibiotic use and so on.Results There were 30 cases in treatment group,and 30 cases in control group.The average fever remission time was (19.9±10.6) h and (57.6 ± 33.7) h in the treatment group and control group,respectively.The mean symptom relief times were (39.9 ± 39.8) h and (60.7 ± 33.3) h in the two groups.The relief time of main symptoms such as fever,cough,sore throat,nasal obstruction / nasal catarrh in the treatment group were significantly less than that of the control group (P＜0.05).The incidence rates of complications were 10.0％ (3/30) and 40.0％ (12/30) in the two groups,respectively,and the rates of antibiotics usagewere 30％ (9/30) and 66.7％ (20/30).The complications,the use of antibiotics and the time of medication in the treatment group were significantly less than those in the control group after treatment (P＜0.05).The average costs was 658 yuan and 792 yuan in the two groups respectively with no significant difference between the two groups (P＞0.05).Conclusions The use of peramivir in children with cardiac insulfficiency can significantly shorten the remission time of fever,quickly relieve symptoms,reduce complications and the use of antibiotics,without increasing of the total cost.

Objective To observe the clinical characteristics and prognosis in children with high take -off coronary artery.Methods The clinical characteristics,laboratory examinations and prognosis were retrospectively ana-lyzed in 49 children with high take -off coronary artery who had been admitted to Beijing Children′s Hospital Affiliated to Capital Medical University from April 2009 to December 201 2.Results Among 49 medical records of children with high take -off coronary artery,34 cases were male and 1 5 cases were female,with a mean age of (9.28 ±4.42)years old,and the youngest patient was 1 3 months old,and the oldest patient was 1 7 years and 2 months old.The 64 -section multidetector CT angiography of all patients showed one or both coronary arteries originated from 1 .0 cm higher than the junction area of sinus and aorta,including 38 high take -off of the left coronary artery,7 high take -off of the right coronary artery and 4 high take -off of both coronary arteries.The chief complaints of the patients included chest pain (22 cases,44.90%),chest tightness(1 3 cases,26.53%),declining of exercise tolerance(7 cases,1 4.29%),fatigue (5 cases,1 0.20%),palpitation(3 cases,6.21 %),syncope(1 case,2.04%).Electrocardiogram(ECG)of those pa-tients showed ST -T changes,atrioventricular block,sinus tachycardia,pathological Q -wave,proiosystole and bundle branch block.Ultrasonic cardiogram(UCG)indicated 1 4 patients with the enlarged left ventricle,including 2 patients with ejection fraction lower than 60%.After 1 0 days hospitalization,the anesis of chest pain and chest tightness were significantly different statistically(P <0.05),but there was no significant difference in ECG and UCG.Thirty -nine out of 49 children were followed for 1 year.After 3 months,6 patients with ST -T problem showed normal ST -T segment. After 6 months,1 0 patients with ST -T problem showed normal ST -T segment.After 1 year,1 7 patients with ST -T problem showed normal ST -T segment.Conclusions High take -off coronary artery is a rare malformation of the coronary artery,which can cause myocardial ischemic,leading to multiple clinical manifestations and may result in ECG changes and the left ventricle enlargement.High take -off coronary artery can be confused with myocarditis and myocar-dial lesion clinically.Patients receiving systemic treatment may have their symptoms released,but ECG and UCG may not relieve in a short term.Patients with high take -off coronary artery need long -term observation.

Objective To describe the clinical characteristics of a case of Kawasaki disease(KD)combined with multiple systematic artery lesions.Methods A case was confirmed to have KD as well as multiple systematic artery lesions by clinical manifestations and ultrasonography.Results A girl of five months old was diagnosed of KD and coronary aneurysms,and she met the criteria for intravenous immunoglobulin(IVIG)-resistant KD.The B-ultrasound examination of systematic artery showed that there were multiple artery lesions.Conclusions KD combined with multiple systematic artery lesions was rare in childhood.Long-term follow-up is needed to further investigate.

目的:探讨不完全川崎病(IKD)的早期诊断和临床特征,以提高川崎病(KD)的早期诊断率,减少KD延迟诊断及冠状动脉病变(CAL)的发生.方法:对2010年3月至2010年12月收治的41例IKD患儿和175例典型性KD进行回顾性分析.分别对IKD和典型性KD患儿的临床特点、实验室特点、心脏彩色超声心动图等临床资料进行比较.结果:IKD临床诊断指标中的症状发生率较典型性组低,2组差异有统计学意义.2组实验室检查指标白细胞、C-反应蛋白、血小板及血沉等差异无统计学意义.IKD组二维超声提示冠状动脉受累率35.8％,典型性组为23.2％,差异有统计学意义.结论:IKD冠状动脉病变发生率高,临床应重视早期诊断和早期治疗.

应用中药改善化疗不良反应的研究,已在成人肿瘤患者进行化疗时起到了很好的作用[1-3],近年来,我们应用扶正健脾中药对不同类型实体瘤化疗患儿不良反应的临床观察,证实扶正健脾中药可减轻其化疗不良反应,改善贫血、白细胞减低,提高生活质量[4],现报道如下.

目的 研究中药对恶性实体瘤患儿化疗疗程的影响.方法 将146例恶性实体瘤患儿随机分为治疗组68例和对照组76例,治疗组在对照组化疗方案基础上加入中药,观察化疗延长时间及化疗完成率.结果 治疗组化疗延长时间较对照组短,差异有统计学意义(P<0.05).治疗组化疗完成率83.8%,对照组化疗完成率为65.8%,两组比较差异有统计学意义(P<0.05).结论 中药能有效辅助恶性实体瘤患儿按时完成化疗,提高化疗完成率.

Objective To study the effect of traditional Chinese medicine on survival time in children solid tumors with chemotherapy. Methods 76 children with solid tumors, which were collected from January 2005 to March 2006, were randomly divided into treatment group (35 cases), control group (41 cases). The treatment group was treated with chemotherapy + self-dispensing Fuzheng Jianpi Chinese medicine. The control group was treated with chemotherapy alone. Results The survival rate of the treatment group was higher than that of the control group, the difference was statistically significant (P = 0.0024). The average survival time after chemotherapy in the treatment group was (31± 2) months (95 % CI 27-34 months), the control group was (21±2) months (95 % CI 16-25 months), which was shorter than the treatment group.Conclusion Chinese medicine and chemotherapy can prolong the survival time of children with solid tumors.

为临床更好掌握预防和治疗骨质疏松的治疗药物,检索国内外文献报道、分析并加以归纳.按药理作用分类分别对促骨形成药物、抗骨吸收药物、骨矿类药物、雌激素和中药制剂等各种药物作用机制、特点和不良反应等进行介绍和评价,如氟化物、双膦酸盐类、钙制剂、雌激素和中药淫羊藿.多种类药物联合使用以及中西医结合治疗骨质疏松效果更好.