阑尾炎是儿童外科中常见疾病之一,在我国的发病率达7％ ～12％,临床可分为急性阑尾炎与慢性阑尾炎,急性阑尾炎按病理学变化又分为急性单纯性阑尾炎、急性化脓性阑尾炎、坏疽性及穿孔性阑尾炎、阑尾周围脓肿 4 种类型[1].

腺样体又常称之为咽扁桃体、增殖体,是由多种免疫细胞组成的淋巴组织,是人体免疫器官之一、咽淋巴环的一部分,咽淋巴环是上呼吸道防御的重要结构.腺样体出生后即存在,6～7岁为腺样体生殖旺盛期,10岁以后逐渐萎缩.腺样体肥大(adenoid hypertrophy,AH)是儿科常见病,本病儿童及青少年发病率高达34.46％[1],临床好发年龄为6～7岁[2].

目的 评价防喘合剂治疗婴幼儿喘息轻度急性发作的有效性和安全性.方法 采用阳性药平行对照的试验方法将60例喘息轻度急性发作患儿随机分为观察组和对照组各30例,在基础治疗上,观察组口服防喘合剂,对照组服用孟鲁司特钠颗粒,疗程7d,以疾病缓解时间、疾病治疗效果、中医证候治疗效果、单项症状及体征消失率、吸入特布他林/异丙托溴铵/布地奈德情况、静脉使用糖皮质激素率、复发次数作为有效性评价指标,临床不良反应发生率为安全性评价指标.结果 两组患儿疾病缓解时间差异无统计学意义(P＞0.05).两组患儿除中医证候疗效和单项症状(咳痰、厌食)外,疾病疗效、其他单项症状及体征消失率,吸入硫酸特布他林/布地奈德累积吸入次数、日均次数及总剂量等指标比较差异均无统计学意义(P＞0.05).两组患儿不良反应发生率差异无统计学意义(P＞0.05).结论 防喘合剂能明显改善婴幼儿喘息轻度急性发作的症状,且具有更好的化痰、增加食欲的作用,临床应用的安全性较好.

睾丸鞘膜积液分为先天性和后天性,而小儿精索鞘膜腔积液多为先天性,且常为交通性鞘膜积液,是小儿泌尿系外科的常见疾病.西医往往通过手术治疗,而家长常常担心孩子不能承受手术,因此选择传统医学进行保守治疗.任勤教授是第6批全国老中医药专家学术经验继承工作指导老师,现将任勤教授治疗小儿精索鞘膜腔积液经验介绍如下.

急性荨麻疹是儿童常见的过敏性疾病,是以皮肤出现风团样皮疹,伴有瘙痒为临床特征的皮肤病,骤起骤消、时隐时现为其特点,古称"瘾疹".通常脱离过敏源症状可缓解,但近年来慢性荨麻疹发病率逐渐增高,故针对急性期治疗并预防其转变为慢性更需要被重视,也体现中医"治未病"思想.笔者通过内外辨证治荨麻疹,屡获奇效.

肾病综合征( NS)是由多种因素引起的肾小球基底膜通透性增高,血浆内大量蛋白质从尿中丢失所致的临床综合征,主要以大量蛋白尿、高脂血症、低白蛋白血症及不同程度水肿为表现的临床症候群.激素敏感型肾病综合征( SSNS)指的是原发性肾病综合征( PNS)儿童采取足量的激素治疗4周内尿蛋白出现转阴的情况.首次复发距离肾病初次缓解时间是原发性肾病综合征频复发的相关风险因素,即初次缓解后6个月内复发者出现肾病频复发概率较大[1].中医认为肾病综合征属于中医学中"水肿"范畴,根据中医理论,认为本病多由正气不足,感受外邪而发,涉及肺、脾、肾三脏,主要病位在肾,肺脾肾功能失调,脾失健运,少阳枢机不利导致水肿,其病理因素主要为水湿、湿热、热毒、瘀血,治疗本病时应以调畅气机、疏解清化、健脾利湿为法[2].

小儿口疮是临床上常见的发生于口腔黏膜的溃疡性损伤疾病,多发生于舌、颊黏膜、口唇内侧等,发作时会引起局部烧灼感,疼痛剧烈,影响进食,易并发口臭、头痛、发热、淋巴肿大等症状,严重可见伴发热、流涎甚至全身不适[1].临床治疗常予以患儿碘甘油、锡类散及重组人表皮生长因子等药物进行口腔护理,以促进溃疡愈合,部分患儿疗效并不理想,口腔溃疡反复出现,迁延不愈.

闭塞性细支气管炎( Bronchiolitis obliterans,BO)是小气道炎症病变引起的慢性气流受限综合征.临床症状主要为持续咳嗽、喘息、呼吸困难,常持续数周甚至数月[1].随着高分辨 CT的应用及对该病认识不断深入,对本病的准确诊断大幅提高.但该病尚无治疗准则及预后较差.本文通过对我院儿科收治的1例以间断性咳喘为临床表现的闭塞性细支气管炎患儿的诊疗经过进行报道,并结合国内外文献进行复习以进一步提高临床医生对闭塞性细支气管炎的认识.

目的:观察清宣通络方治疗儿童肺炎支原体肺炎(mycoplasma pneumoniae pneumonia,MPP)风热闭肺证临床疗效及对社区获得性呼吸窘迫综合征毒素(community-acquired respiratory distress syndrome toxin,CARDSTX)的影响.方法:采用回顾性队列研究方法,将106例MPP患儿按治疗方法分为对照组54例和治疗组52例.两组患儿均应用阿奇霉素抗感染治疗,对照组在常规治疗基础上选用银翘散合麻杏甘石汤加减治疗,治疗组在常规治疗基础上加用清宣通络方治疗,观察两组患儿治疗前后临床疗效、主要症状(发热、咳嗽、肺部啰音)消失时间、肺功能指标及CARDSTX的变化情况.结果:治疗组有效率高于对照组,差异无统计学意义(P＞0.05).治疗组主要症状消失时间均明显短于对照组,差异有统计学意义(P＜0.05).两组治疗后肺功能指标明显上升,CARDSTX水平明显下降,差异有统计学意义(P＜0.05);组间比较,治疗组肺功能指标及CARDSTX水平改善程度优于对照组,差异有统计学意义(P＜0.05).结论:清宣通络方能够明显改善MPP患儿临床症状,降低气道阻力,其机制可能与其降低CARDSTX表达有关.

目的 分析和总结穴位贴敷治疗小儿肺炎的临床选穴规律,为提高中医药治疗小儿肺炎的临床效果提供参考.方法 收集中国知网(CNKI)、万方数据知识服务平台和维普数据库中穴位贴敷治疗小儿肺炎的临床文献并建立数据库,运用中医传承辅助平台软件研究穴位贴敷治疗小儿肺炎的临床选穴规律.结果 纳入符合研究的期刊文献117条,穴位贴敷治疗小儿肺炎临床选取腧穴主要为肺俞穴、膻中穴和天突穴,选穴所属经脉主要为足太阳膀胱经和任脉,选穴所在部位主要为背腰部和胸腹部,选穴所属特定穴主要为背俞穴.结论 穴位贴敷治疗小儿肺炎的临床选穴规律具有以“局部取穴”为主的特点.本研究有利于规范穴位贴敷疗法的诊疗操作,促进中医外治法走进家庭、走进生活,在当前社会环境中更好地发挥出中医药的治疗优势,服务于人民群众的健康生活.

Background Hypokalaemia is a common condition among paediatric patients, but severe hypokalaemia is rare and can be life-threatening if not treated properly. The causes of hypokalaemia are complex. Finding the root cause is the key. Case presentation This article reports on a 2-year-old boy with severe hypokalaemia who was diagnosed with pneumonia. The child’s lab findings were low blood potassium minimum level of 1.7 mmol/L, hypomagnesemia, and metabolic alkalosis. However, he was without the common features of hypokalaemia, such as respiratory paralysis, severe arrhythmia, weakness and decreased blood pressure. After recovering from pneumonia, his potassium levels did not return to normal. This outcome was suspected to be due to chronic renal loss of potassium. After undergoing second-generation gene sequencing tests, it was discovered he carried the SLC12A3 gene mutation with an Asp486Asn mutation site, which he had inherited from his mother. The final diagnosis was made, confirming the child suffered from Gitelman syndrome. Conclusions Genetic predisposition is an important cause of hypokalaemia in children. Children with unexplained persistent hypokalaemia should be examined for the possibility of Gitelman syndrome, which should be distinguished from Bartter syndrome. Genetic testing is the gold standard.

目的 探讨儿童支原体肺炎(MPP)支气管镜下气道黏膜改变与中医证型、舌象的相关性.方法 选取2016年5月至2018年1月就诊于天津中医药大学第一附属医院儿科住院部的MPP患儿76例,观察患儿支气管镜下黏膜微观病理改变以及患儿中医证型、舌象的特点,采用SPSS 19.0软件分析数据.结果 MPP患儿镜下气道黏膜表现在各中医证型间分布的差异有统计学意义(P＜0.05),Cramer's V系数为0.397,P＜0.01,说明MPP的中医证型与镜下黏膜表现呈中等相关性.舌质分布经Fisher精确概率检验法,Fisher值=2.446,P=0.319＞0.05,说明MPP患儿舌质分布与镜下气道黏膜表现之间无相关性.MPP患儿舌苔与镜下黏膜表现之间的差异有统计学意义(P＜0.05),同时Cramer's V系数为0.428,P＜0.01,说明MPP舌苔与镜下气道黏膜表现在一定程度上具有相关性.结论 儿童MPP的中医证型、舌象与其支气管镜下气道黏膜征象的分型具有相关性.

目的观察“宣肺清热，化瘀通络”法治疗小儿肺炎支原体肺炎风热闭肺证患者的临床疗效。 方法采用回顾性队列研究方法，选取肺炎支原体肺炎证属风热闭肺证病例513例，按照治疗方法不同分为两组。两组均采用中西医结合方法治疗，在西医治疗基础上，对照组247例采用传统辨证法组方的中药方剂加减治疗，治疗组266例采用“宣肺清热，化瘀通络”法，予清宣通络方加减治疗。观察两组治疗后的临床疗效。 结果治疗组患儿住院病程（8.76±2.38）d与对照组患儿住院病程（10.31±2.44）d比较，差异具有统计学意义（P 结论“宣肺清热，化瘀通络”法可以提高肺炎支原体肺炎证属风热闭肺证的临床疗效。

儿童炎症性肠病表现的缓解期和活动期交替出现的临床特点,与“休息痢”的寒热错杂的病机特点相吻合,中药治疗儿童炎症性肠病有特殊的作用.因此,笔者认为儿童炎症性肠病的核心病机为脾肾不足,湿热留恋肠道,肠络气血不和,其治疗大法以理脾温肾、理气和血、消积化滞为主,重视“消积化滞”、“理气调血”、“寒.热并用”的复方组合思路.

[目的]评价冬病夏治哮喘膏联合孟鲁司特防治儿童支气管哮喘的疗效及安全性.[方法]110例儿童支气管哮喘患者随机均分为研究组与对照组,两组患者均采用常规治疗,在此基础上,对照组采用孟鲁司特钠片治疗3个月,研究组在对照组基础上加用冬病夏治哮喘膏,一伏、二伏、三伏每次贴敷均2～3 h,每年三伏结束为1个疗程,均接受1个疗程治疗,且随访1 a.比较两组治疗效果,采用肺功能仪测定两组用力肺活量(FVC)、第1秒用力呼吸容积(FEV1)的变化;采用酶联免疫吸附法测定治疗前后两组核因子κB(NF-κB)、白介素-6(IL-6)、白介素-8(IL-8)水平的变化;记录治疗前后哮喘症状积分;并监测两组治疗的安全性,统计复发率.[结果]1)研究组患者总有效率为96.36％,高于对照组的80.00％,差异有统计学意义(P<0.05).2)治疗后,两组患者治疗6个月及8个月后FVC、FEV1均高于治疗前,且治疗12个月高于治疗6个月后,研究组高于对照组,差异均有统计学意义(P<0.05).3)治疗后,两组患者治疗6个月及8个月后NF-κB、IL-6、IL-8均低于治疗前,治疗12个月后低于治疗6个月后,研究组各指标下降幅度均高于对照组,差异均有统计学意义(P<0.05).4)研究组随访期间复发1例(1.82％),对照组复发9例(16.36％),两组复发率对比差异有统计学意义(P<0.05).[结论]采用冬病夏治哮喘膏联合孟鲁司特防治儿童支气管哮喘,可改善患者肺功能,降低炎性因子水平,降低哮喘复发率,且安全性较高.

In the background of integration of Chinese and Western medicine, the extension and connotation of traditional Chinese medicine in children with nephrotic syndrome have changed.The author thinks that the cardinal deficiency of shaoyang and triple-jiao is the core pathogenesis of modern children's nephrotic syndrome. Shaoyang cardinal disadvantage, clear and regulate triple energize, gasification division loss,formation of deficiency of yin and yang of qi,dampness and heat of water and dampness heat and toxic heat sink. Reconciling Shaoyang, sparse distribution triple energizer and qi-lift is the key to the treatment and to divide and conquer the pathological products at the same time.

小儿“外感发热”泛指因感受“六淫”之邪或“疫疠”之气而致的发热,大体与西医学急性呼吸道感染相对应.本文总结近十五年中医外治法在治疗小儿外感发热的应用,比较各外治法的优缺点及相关理论支持,证明中医外治法在治疗小儿外感发热方面方法多样,疗效显著,部分优于西医对症治疗.

大青龙汤首见于张仲景的《伤寒论》[1] 38条:“太阳中风,脉浮紧,发热恶寒,身疼痛,不汗出而烦躁者,大青龙汤主之”;39条:“伤寒脉浮缓,身不疼但重,乍有轻时,无少阴证者,大青龙汤发之.”主要治疗有恶寒、身热、烦躁、身疼痛等外寒内热证,临床上常用此方治疗上呼吸道感染、儿童哮喘、肺炎、鼻炎等属外寒内热证者.现将临床采用本方治疗儿童不明原因发热验案1则介绍如下.

Objective To evaluate the efficacy and safety of different dosages ofPudilan Xiaoyan Oral Liquid (PXOL) in treatment of infantile acute pharyngitis-tonsillitis with lung-stomach excess-heat syndrome.Methods A randomized controlled,double-blind,positive drug parallel controlled,and multi-center clinical trial was conducted.Totally 324 children from seven research centers were included,108 cases in experimental high dose group (A Group),108 cases in experimental low dose group (B Group),54 cases in positive medicine group (Xiaoer yanbian Granula,C Group),and 54 cases in placebo group (D Group),with the ratios of 2 ∶ 2 ∶ 1 ∶ 1.5 in a course.Results ① Totally 317 cases were in full analysis set (FAS),284 cases in per-protocol set (PPS) and 324 cases in Safety Set (SS).② Evaluation on effectiveness:There was significant difference (P ＜ 0.001) between each two groups in the total effective rate ofpharyngalgia and pharyngeal swelling.A Group and B Group were both superior to D Group,and were non-inferior to C Group.B Group was non-inferior to A Group.There was significant difference (P ＜ 0.001) between each two groups in total effective rate of syndrome of traditional Chinese medicine.There was significant difference (P ＜ 0.05) between each two groups in the median time of improving pharyngalgia syndrome.There was significant difference (P ＜ 0.001) between each two groups in the median time of pharyngalgia syndrome disappearing.There were significant differences (P ＜ 0.05) between each two groups in total effective rate of halitosis,cough,thirst,deep-colored urine,and dry stool.The analysis on PPS agrees with that ofFAS.③ Evaluation on safety:No adverse reactions in clinical significant laboratory examination were found during the trial.Conclusion High and low dosages of PXOL show advantages over placebo and are non-inferior to the positive medicine Xiaoer Yanbian Granula.High dose group does not show advantage comparing with low dose group.No adverse reactions are found during the trial.Low dose therapy is recommended.

哮喘是一种以慢性气道炎性反应为特征的异质性疾病,小儿哮喘早期表现可有湿疹、食物过敏、慢性腹泻、药物过敏、反复喘息等,全身慢性变应性炎性反应是本病的致病机制.肠道黏膜屏障破坏和Th1/Th2细胞网络发育失衡被视为哮喘致敏的“窗口期”,促进全身炎性反应的形成和持续存在,着眼于“窗口期”的早期干预可以减慢或阻断炎性反应级联效应,具有积极意义.笔者认为,致敏“窗口期”以“浊气留伏”为病机特点,浊邪有源于脾胃重浊黏滞、留滞胃肠、弥散三焦的特点,因此,以“扶脾化浊”为大法,注重运脾、条畅气机、利湿化浊,截断浊邪向伏痰的转变,防止哮喘的发生.