This study aims to improve the understanding of cardiovascular complications of KDSS by retrospectively analyzing the echocardiographic manifestations of children with Kawasaki disease shock syndrome(KDSS)in the acute phase.A total of 20 children diagnosed as KDSS and 41 children diagnosed as hemodynamically stable Kawasaki disease(KD)were collected as study subjects to compare their echocardiographic characteristics in the acute phase.There were no statistically significant differences in age and sex between the KDSS group and the control group;the incidence of coronary artery dilatation and mitral regurgitation in the acute phase of echocardiographic manifestation was significantly higher than that of the control group,and the differences were statistically significant(P＜0.05).KDSS is more likely to cause cardiovascular system complications and requires closer echocardiographic monitoring;mitral regurgitation is a characteristic manifestation of KDSS in the acute phase.

目的 探究川崎病(KD)患儿并发心脏损害的风险及脑利钠肽前体(pro-BNP)的预测价值,建立预测心脏损害发生的危险因素列线图模型并验证.方法 采用随机数表法选取郴州市第一人民医院2016年1月～2020年7月收治的KD患儿450例,根据患儿是否发生心脏损害将其分为未发生心脏损害组(n= 394)和发生心脏损害组(n=56).回顾性分析患者的临床信息,采用Logistic回归分析法筛选出KD患儿发生心脏损害的独立风险因素.利用R软件对筛选出的独立风险因素建立列线图预测模型,并对模型的预测性及准确度进行验证.结果 通过Logistic回归分析患者的风险因素数据可知,性别(OR= 2.856,95％CI:1.493-5.461)、发热天数(OR= 3.636,95％CI:1.636-8.083)、CRP(OR= 2.519,95％CI:1.332-4.763)、治疗时机(OR= 6.057,95％CI:2.289-16.024)、HGB(OR= 4.705,95％CI:2.474-8.947)为KD患儿并发心脏损害的独立危险因素.基于该5项风险因素,建立列线图模型,Calibration验证结果显示,预测值与实测值曲线拟合度较高,表明该预测模型较实测准确度较好;同时Bootstrap内部验证结果显示,C-index指数高达0.837(95％CI:0.786～0.888),提示该模型精准度和区分度较好.同时,本研究发现,发生心脏损害组患儿的pro-BNP含量明显高于未发生组(P＜0.05).结论 通过建立风险模型筛选出的风险因素显示:性别、发热天数、CRP、治疗时机、血色素指标(HGB)为KD患儿发生心脏损害的风险因素,针对性干预措施将减少KD患儿心脏损害的发生率,pro-BNP指标可应用于KD疾病临床诊断和心脏损害的预测.

目的 探讨应用血管塞介入栓塞异常供血动脉治疗儿童肺隔离症的临床疗效.方法 将2015年-2018年入住郴州市第一人民医院的12例诊断为肺隔离症的患儿纳入研究对象,应用血管塞行异常供血动脉介入栓塞治疗.术后1月、3月、6月、1年随诊,观察肺部感染等临床症状改善情况,术后1年复查肺部CTA检查观察异常供血动脉闭塞情况及隔离肺组织吸收情况.结果 12例病例均栓塞成功,无残余分流,术后无严重并发症,无反复肺部感染;术后1年复查肺部CTA显示血管塞远端血管及其分支血管完全闭塞,隔离肺组织明显萎缩,增强扫描无强化.结论 应用血管塞介入栓塞异常供血动脉治疗儿童肺隔离症是一种安全、疗效显著的治疗方法.

目的 探讨应用血管塞经动脉途径逆行封堵儿童细管型动脉导管未闭(PDA)的临床疗效.方法 将31例诊断为细管型PDA的患儿纳入研究对象,应用血管塞经动脉途径逆行封堵动脉导管.术中行推拉试验评估封堵器的稳固性,行降主动脉造影评估封堵效果及有无降主动脉狭窄,术后1天、1个月、3个月、6个月、1年复查超声心动图,评估封堵器稳定性及封堵效果、封堵器表面有无血栓形成、左肺动脉及降主动脉有无狭窄,术后1天评估有无溶血、血尿、穿刺血管损伤等并发症.结果 31例患儿均封堵成功,术中推拉试验及心脏彩超评估提示封堵器稳固,手推造影剂评估即时封堵效果均有微量残余分流,术后1天及远期随访封堵器无脱落及移位,无残余分流,封堵器表面无血栓形成,左肺动脉及降主动脉无狭窄,无溶血、血尿、穿刺血管损伤等并发症.结论 应用血管塞经动脉途径逆行封堵儿童细管型PDA是一种安全、疗效显著的治疗方法.

目的:探讨支气管肺泡灌洗(Bronchoalveolar lavage,BAL)在儿童大叶性肺炎诊治的临床应用价值及肺功能检查在儿童大叶性肺炎疗效评估中的应用.方法:将我院儿童呼吸科2014年1月-2015年12月期间收治的78例大叶性肺炎患儿纳入研究,将其分为实验组(n=46)与对照组(n=32),对照组接受抗感染、雾化、祛痰等儿童呼吸内科常规治疗;实验组在以上基础上联合纤维支气管镜肺泡灌洗治疗.观察两组肺功能改善情况.结果:两组治疗后肺功能测定均较治疗前有明显改善(P<0.001);实验组治疗后的肺功能测定较对照组治疗后改善更明显(P<0.001).结论:在儿童呼吸内科常规治疗基础上联合纤维支气管镜肺泡灌洗治疗儿童大叶性肺炎,有利于促进临床症状的缓解及肺部炎症的吸收,改善肺功能,促进疾病恢复,治疗效果明显提升.

目的 :评估吸入布地奈德治疗儿童哮喘对肺功能的改善及其安全性.方法 :选择2012年1月 -2015年10月155例6~36个月的哮喘患儿(平均病程3个月)持续(6个月)吸入布地奈德 ,500mg ,Bid ,治疗前及治疗6个月后分别测定各项肺功能指标(PTEF 、PTVT 、% V-PF 、Tp/Te 、25/PF 、50/PF)、血皮质醇及骨密度.结果 :与治疗前相比 ,治疗6个月后哮喘患儿肺功能有明显改善(P<0 .000 1) ,而血皮质醇及骨密度分析无明显变化(P>0 .05).结论 :持续吸入布地奈德治疗儿童哮喘 ,能改善哮喘患儿肺功能 ,降低气道高反应性 ,且具有一定安全性.

目的：了解病毒感染与儿童重症社区获得性肺炎之间的相关性。方法：收集我院2013年1月－2015年12月200例重症社区获得性肺炎的支气管肺泡灌洗液（BALF），采用直接免疫荧光法（DIF）进行7种常见病毒抗原检测。结果：200例标本中，77例检出病毒（38．50％），其中检出率最高为RSV ，其次为ADV、IFA、PIVⅠ、PIVⅢ，其中IFB、PIVⅡ未检出。2种及2种以上病毒共感染3例，占阳性标本的3．90％。结论：病毒感染与儿童重症社区获得性肺炎有密切相关性，RS V感染是引起婴幼儿重症社区获得性肺炎的主要病毒，主要集中在春冬季节。

Objective:To observe and evaluate the results of tidal breathing flow volume with infants before and after treatment of pneumonia,and provide the evidence for clinical diagnosis and prognosis.Methods:92 cases of infants with pneumonia were selected.Tidal breathing flow volume was measured by lung function testing instrument for children before or after treatment.At the same time,80 cases of healthy children were selected to determinate the value of tidal breathing.And these indexes of lung function would be compared and analyzed.Results:The lung function of pneumonia group present significant decreased(P<0.01 or P<0.05)in the ratio of tidal volume to kilogram(V_T/kg),the ratio of mean tidal expiratory flow to mean tidal inspiratory flow(ME/MI),peak tidal expiratory flow(PTEF),the ratio of time taken to reach peak expiratory flow to expiratory time(t_PTEF/t_E),the ratio of peak expiratory volume to total expiratory volume(VPTEF/V_TE),the ratio of 25% tidal volume of expiratory flow to peak tidal expiratory flow(TEF25/PTEF).It suggested that big airway and small airway are both obstruction but lesion occur mainly in small airway.After treatment of big airway obstruction improved significantly,the ratio of mean tidal expiratory flow to mean tidal inspiratory flow(ME/MI)index had no significant difference(P>0.05).But the reflection of small airway obstruction of lung function index is still lower than those in healthy children.And the index of PTEF,t_PTEF/t_E,VPTEF/V_TE,TEF25/PTEF is significant difference(P<0.01)that means the infants need to be track observation.Conclusion:The testing of lung function with tidal breathing can accurately reflect the infant airway obstruction,airway spasm,asthma and other symptoms of the pathological characteristics.It has an important role in infantile pneumonia treatment evaluation and used as important supplement index for clinical diagnosis and prognosis of respiratory diseases.So it should be used in clinic widely.

目的 探讨雾化吸入布地奈德对哮喘儿童肺功能的改善及安全性.方法选择95例6～48月的哮喘患儿持续(6月)吸入布地奈德,每日250 μg,2次/d,治疗前及治疗6月后分别测定各项肺功能指标、血皮质醇及骨密度.结果 治疗6月后,肺功能有明显改善,血皮质醇及骨密度无明显变化.结论 吸入布地奈德能改善哮喘患儿肺功能,降低气道高反应性,对患儿肾上皮质功能及骨密度未见显著影响.

目的 了解郴州市健康婴幼儿潮气流速-容量(TFV)环形态特点及呼吸生理意义.方法 研究对象为56例1～24月健康婴幼,分1～9月和10～24月两组,应用德国康讯儿童肺功能仪记录其在安静睡眠状态下的TFV环及有关参数.结果 TFV环近似椭圆形,呼气高峰位置靠前,呼气曲线降支倾斜.随月龄增长,呼气高峰略后移,降支抬高,呼气曲线渐趋圆滑.吸气曲线各月龄组均呈半圆形.有关参数FIEF、%V-PF、Tp/Te、25/PF值在1～9月与10～24月两月龄组间有显著差异.结论 健康婴幼儿TFV环近似椭圆形.潮气呼吸功能在婴幼儿阶段发育迅速,潮气呼气过程气道阻力不恒定,小婴儿在下呼吸道感染时易出现呼气阻力增加及流速受限.

Objective:To investigate the safety and improvement young children with asthma inhalation fluticasone continued.Methods:We selected 95 cases children with asthma and the age were between 6~48 months.The patients were inhalated fluticasone for 6 months,100μg,Bid.We detected the pulmonary function,hydrocortisone in blood plasm and bone density.Results:After accept the treatment for 6 months the pulmonary function were improved obviously and the hydrocortisone in blood plasm and bone density did not make change.Conclusion:In inhalation fluticasone continued for 6 months,100μg,Bid can improve the children's pulmonary function,decrease airway hyperreactivity and do not influence hydrocortisone and bone density.

目的 探讨肺功能测定对可必特(沙丁胺醇和异丙托溴胺联合制剂)雾化治疗婴幼儿喘息性疾病的意义.方法 应用婴幼儿肺功能测试仪对360例喘息性疾病婴幼儿雾化治疗前后进行肺功能测定,选择潮气状态下的通气功能-呼吸频率(RR)、每公斤体重潮气量(VT/kg);潮气流速容肇环的形态-吸气时间/呼气时间(Ti/Te)、到达潮气峰流速的时间/总呼吸时间(T-PF/Te)、呼出75%潮气量时的呼气流速/潮气呼气峰流速(TEF25/PTEF)作为观察的指标.结果 患儿雾化前后各项肺功能指标存在显著性差异(P<0.05).结论 肺功能测定可以了解喘息性疾病的气道阻塞情况和气道的可逆性,为该病的诊断、病情判断和疗效判断提供量化依据.

目的 观察8种细菌溶解物(泛福舒)治疗反复呼吸道感染前后免疫指标的变化.方法 将117例反复呼吸道感染儿童口服泛福舒,每日1次,每次3.5 mg,连用10 d,停20 d,3月为疗程. 结果治疗前后免疫指标改变有显著性差异(P＜0.01).结论 口服泛福舒可提高儿童体液免疫和细胞免疫,可作为治疗儿童反复呼吸道感染的有效方法.

为了解郴州市儿童肠道蛔虫感染情况,为今后开展防治提供科学依据,于2007年进行了郴州市儿童肠道蛔虫感染调查和集体驱虫效果分析,结果报告如下.

Objective:To observe the clinical effect of budesonide and ventolin inhalation in treating childhood acute asthma outbreak.Methods:136 children suffered from asthma were divided into two groups.In the control group(64 cases) aminophylline and hydrocortisone were dripped intravenously,and such measures were taken,as relief of bronchiospasm,oxygen inhalation, and antibiotics were included,if necessary.While the other 72 children(observed group) were treated with budesonide and ventolin inhalation 3 times per day and 5～10 minutes each time,besides those treatments of control group.Results:The clinical symptoms of the observed group disappeared more quickly than that of the control group,and the difference has statistical significance(P0.01).Conclusion:Budesonide and ventolin inhalation is an effective therapy for asthma outbreak.

目的探讨普米克令舒空气压缩泵驱动雾化吸入治疗小儿毛细支气管炎(毛支)的疗效。方法将54例毛支患儿随机分为两组,均采用综合治疗,观察组加入普米克令舒空气压缩泵驱动雾化吸入,对治疗前后症状、体征持续时间、治疗效果进行比较。结果观察组在治愈率、缓解喘憋症状、缩短哮鸣音及咳嗽持续时间等方面均明显优于对照组(P<0.05)。结论普米克令舒空气压缩泵驱动雾化吸入治疗毛支有明显的优越性,疗效确切,方便、安全。

目的观察沙丁胺醇加吸入用布地奈德混悬液雾化吸入治疗喘息性支气管炎的临床疗效。方法选取我院2005年1月~2007年1月诊治的喘息性支气管炎患儿178例,随机分两组,对照组86例,采用常规治疗加氨茶碱及肾上腺皮质激素静脉点滴;观察组92例,在常规治疗基础上加沙丁胺醇及吸入用布地奈德混悬液混合雾化吸入。结果观察组在治愈率、症状消失时间、肺部罗音消失时间均明显优于对照组。结论沙丁胺醇加吸入用布地奈德混悬液混合雾化吸入治疗喘息性支气管炎疗效明显。