Objective:To investigate the clinical characteristics of congenital esophageal atresia with gastric perforation, and to improve pediatricians′ understanding of this disease.Methods:The clinical data of five neonates with congenital esophageal atresia and gastric perforation treated in the neonatal intensive care unit of the Affiliated Hospital of Qingdao University from 2012 to 2022 were analyzed retrospectively.Results:Among the five neonates, four were boys and one was girl.The gestational age was 28 + 5 to 37 + 6 weeks, the birth weight was 1 100~2 350 g. All of them had dyspnea and feeding difficulties after birth.Gastric perforation occurred in three cases during invasive mechanical ventilation, one case during non-invasive ventilation, and one case during nasal catheter oxygen inhalation.Emergency primary gastric repair was performed, followed by secondary esophageal anastomosis.All the patients were cured and discharged from hospital. Conclusion:Gastric perforation is a rare complication of congenital esophageal atresia, which is more common in premature infants and low birth weight infants.Mechanical ventilation may promote the occurrence of gastric perforation.If gastric perforation is complicated, repair should be performed as soon as possible, and esophageal anastomosis surgery should be performed early after stability to improve the final outcome.

目的 探讨国际交流合作项目对中国临床医生医学人文精神的培养作用.方法 对62名参加意大利锡耶纳大学医院进修学习的中国临床医生进行问卷调查、分析出访报告.结果 94.4％(51/54)的医生认为对自己的医学人文精神培养起到了积极的作用,使自己重新思考医学人文精神的内涵与意义.在调查问卷中涉及到的医学人文精神主要体现在:87.0％(47/54)明确以病人为中心的服务意识,一切以患者的利益为基础;85.2％(46/54)在医疗过程中对患者关心、关怀和尊重;90.7％(49/54)加强与患者的沟通交流,积极解决患者所需及医学困惑.94.4％(51/54)积极学习最新医学知识,完善自身医学素养及伦理认知.92.6％(50/54)坚定了自己的医学信念.结论 国际交流项目对提高中国临床医生的人文医学精神的培养起到了积极的作用,对提高对患者的服务意识、尊重与关怀、沟通交流、探索最新的医学知识有积极的促进作用.

目的 分析早产儿自发性肠穿孔(SIP)的临床表现及特征,以进一步认识早产儿SIP的发病特点,为临床诊治提供参考.方法 总结2013年6月至2019年6月在青岛大学附属医院手术治疗的符合SIP诊断的5例患儿,回顾性分析肠穿孔的特点及手术特征.结果 4例患儿为体重低于1000g的超低出生体重儿,1例为体重低于1500g的极低出生体重儿.3例穿孔处位于距离回盲部10～40cm回肠位置,2例为距离T reiz韧带15～40cm空肠位置.4例患儿为单发肠穿孔,直径为0.2～1cm,1例患儿出现2处穿孔.5例患儿均进行肠修补,1例患儿术后并发肺出血死亡,其余4例均预后良好.结论 早产儿SIP多发生于超低出生体重儿,肠管病变较为局限,病变多限于穿孔及临近穿孔处肠管外,多为单发穿孔.实施肠道修补治疗,预后多数较好.

目的 :探讨在新生儿重症监护病房(NICU)住院医师规范化培训中利用思维导图结合案例教学法(Case-Based Learning,CBL)的方法 ,提升儿科专业学位研究生临床诊疗能力.方法:选取40名专业型规培研究生作为研究对象,实验组采用思维导图+CBL的教学方法,对照组采用传统教学方法,通过学生理论考试和Mini-CEX(迷你临床评价量表)进行教学评价.结果 :实验组在理论知识和Mini-CEX评价均优于对照组(P<0.05).结论 :思维导图结合CBL教学效果优于传统教学.

目的 探讨在新生儿重症监护病房(NICU)轮转的规范化培训住院医师中利用模拟情景的教学方法进行新生儿复苏培训,提升儿科规培住院医师的新生儿复苏能力.方法 选取70名专业型规培研究生作为研究对象,实验组采用模拟情景及模拟教具的教学方法,对照组则采用传统的方法进行教学,最终通过对两组学员理论考试和复苏技能考试进行教学评价.结果 实验组在理论知识方面与对照组相当(P>0.05),技能评价显著优于对照组(P<0.05).在初步复苏、正压通气、气管插管、胸外按压、药物应用及整体表现均显著优于对照组(P<0.05).结论 模拟情景的教学方法在NICU规培住院医师复苏培训中较传统教学方法具有优越性,能够有效提高规范化培训住院医师的新生儿复苏临床技能.

目的:探讨在新生儿重症监护病房(NICU)住院医师规范化培训中利用PBL结合EBM的方法,提升儿科专业学位研究生临床诊疗能力.方法:选取70名专业型规培研究生作为研究对象,实验组采用PBL与EBM相结合的教学模式,对照组则采用传统教学模式,最终通过学生理论考试和Mini-CEX(迷你临床评价量表)考试进行教学评价.结果:实验组在理论知识方面与对照组相当,Mini-CEX评价优于对照组,在沟通技能、临床判断、组织效能优于对照组.结论:在NICU住院医师规范化培训中应用PBL结合EMB的教学方法较传统教学方法具有优越性,能够有效提高儿科专业学位研究生临床诊治能力.

双胎之一胎死宫内是双胎妊娠较为复杂的并发症之一.一胎胎死宫内可致存活胎儿早产、死亡、脑部损伤,以及胃或肾等多器官损伤.本病例中存活儿有多脏器功能损害,其中以肾梗死合并脑梗死为主要临床特点,极为少见.因此,一旦发生双胎之一胎死宫内,要加强对存活胎儿的监测,采取个体化处理的原则,进行适当的期待治疗,以改善妊娠结局.

Objective To identify iron nutritional status in very low birth weight infants (VLBWI) and its influence factors.Methods A total of 115 babies admitted from January to December 2014 were included in the study.Serum ferritin of new born infants was analyzed.The clinical data of gestational age,birth weight,hemoglobin,iatrogenic blood loss,cumulative volume of blood transfusion and pregnancy maternal diseases(diabetes,hypertension and anemia) were analyzed.Results The serum ferritin of 115 VLBWI were 100.8 to 210.3 μg/L,the average were(140.32 ± 13.21) μg/L;the minimum serum ferritin of babies born ＜ 32 weeks gestational age were(124.5 ± 31.3) μg/L.Smaller the VLBWI gestational age,the lower the basic baby serum ferritin(F =14.367,P =0.000).More severe the maternal anemia,the lower the basic baby serum ferritin levels [no anemia:(230.9 ± 68.7) μg/L,mild anemia:(189.5 ± 75.3) μg/L,moderate anemia:(133.5 ± 88.1) μg/L,severe anemia:(122.2 ± 56.8) μg/L;P ＜ 0.05].Lower the level of hemoglobin,the lower the basic level of serum ferritin(P ＜ 0.05).Volume of blood transfusion had a huge impact on the last serum ferritin levels (P ＜ 0.05).Conclusion Improvement of the basic baby serum ferritin level in the early stage is useful to ensure the VLBWI iron reserves.It is necessary to regularly monitor serum ferritin during hospitalization and even after discharge.

Objective To study the anti-apoptosis effects and the proper time window of Baxinhibitor peptide(BIP) in neural cells of neonatal rats with hypoxia-ischemia brain injury(HIBD).Methods A total of 182 Wistar rat pups(7-day-old,P7) were randomly assigned into sham-operated group(Sham Group,n = 14),saline group(NaCl Group,n = 84) and BIP group(BIP Group,n = 84).HIBD models were established ligating the left carotid artery along with 8%oxygen exposure for 2 hours in NaCl Group and BIP Group.Left carotid arteries were dissected in Sham Group without further hypoxia-ischemia exposure.Normal saline(5 μl) and 5 μg BIP(5 μl) were injected through the left lateral ventricular in NaCl and BIP Group separately.Both NaCl and BIP Group were further divided into six sub-groups as 0 h,6 h,12 h,24 h,48 h and 72 h subgroups(n=8) according to the time when saline and BIP were given.Sham Group received no drugs.All rats were sacrificed at day 7 after HIBD model establishment.The brain tissue pathology,alterations of Caspase-3 protein and Caspase-3 mRNA were studied.Results The pathological injury of BIP Group ameliorated comparing with NaCl Group in0 h、6 h、12 h、24 h and 48 h sub-groups,and without obvious differences in 72 h subgroup.Expression of Caspase-3 protein and mRNA in BIP Group were significantly decreased than NaCl Group among 0 h,6 h,12 h,24 h and 48 h sub-groups[Caspase-3 protein:0 h(0.164±0.308)vs.(0.473±0.088),6 h(0.262±0.304) vs.(0.473±0.054),12 h(0.339±0.020)vs.(0.472±0.119),24 h(0.379±0.181)vs.(0.481±0.068),48 h(0.417±0.026)vs.(0.478±0.081);Caspase-3 mRNA:0 h(0.220±0.008)vs.(0.245±0.019),6 h(0.285±0.018)vs.(0.365±0.027),12 h(0.300±0.017)vs.(0.398±0.045),24 h(0.565±0.026) vs.(0.850±0.080),48 h(0.546±0.028) vs.(0.651±0.023),P 0.05).Conclusions BIP can reduce the level of active Caspase-3 protein and Caspase-3 mRNA and alleviate neuronal apoptosis after HIBD.The effective time window for BIP treatment is within 48 h after HIBD.The sooner the BIP is given,the better the outcome of HIBD in neonatal rat.