目的 探讨基于Kinect体感交互技术的康复训练对低视力儿童感觉统合的影响.方法 采用方便抽样法,于2021年5月—2022年5月选取泉州特殊教育学校的60例低视力患儿作为研究对象.按照随机数字表法分为观察组与对照组,每组30例.2组患儿均给予常规视觉康复和感觉统合训练治疗,观察组患儿在对照组基础上加用Kinect体感交互技术强化训练.评估2组患儿训练前后儿童感觉统合能力发展评定量表(SIFS)各维度得分,并对结果进行统计学分析.结果 训练前,2组患儿SIFS中前庭感觉、触觉防御、本体感、学习能力得分比较,差异均无统计学意义(P＞0.05).训练后,观察组患儿前庭感觉、触觉防御、本体感、学习能力得分明显高于训练前,且高于同期对照组,差异均有统计学意义(P＜0.05).结论 应用Kinect体感交互技术实现的康复训练能够提高低视力儿童感觉统合水平.

目的 探讨基于"国际功能、残疾和健康分类"理念下感觉统合及残余视力感知觉联合康复训练对低视力儿童发育行为的影响.方法 选取2020年5月至2021年5月泉州盲校筛查的60名低视力儿童作为研究对象,依据随机数字表法将其分成观察组(30例)和对照组(30例).观察组儿童在使用各种助视器的同时进行感觉统合及残余视力感知觉联合康复训练,对照组仅使用助视器.所有儿童训练前后分别采用儿童感觉统合能力发展评定量表(SIFS)及Gesell发育诊断量表(GDDS)进行评估.两组儿童训练前后的SIFS及GDDS评分采用配对样本t检验对结果进行统计学分析.结果 两组儿童训练前的前庭感、触觉防御、本体感、学习能力、适应性行为、大动作、精细动作、语言、个人-社会性行为评分比较,差异无统计学意义(P>0.05).观察组训练6个月后的前庭感、触觉防御、本体感、学习能力、适应性行为、大动作、精细动作、语言、个人-社会性行为评分均高于对照组,差异均有统计学意义(P<0.05).结论 感觉统合及残余视力感知觉联合康复训练能够提高低视力儿童的发育行为.

目的 观察雾化吸入布地奈德联合特布他林对哮喘患儿肺功能及卵泡抑素样蛋白1(FSTL1)表达的影响.方法 将90例哮喘患儿按照随机数字表法分为试验组与对照组,各45例.对照组给予雾化吸入布地奈德,每次1 mg,每次15 min,每天2次,连续治疗7 d;试验组在对照组的基础上使用空气压缩泵雾化吸入硫酸特布他林吸入粉雾剂,体重≤20 kg,每次2.5 mg;体重>20 kg,每次5 mg.治疗前、治疗1 d、治疗7 d时,比较2组的肺功能[第1秒用力呼气容积(FEV1)、肺活量(FVC)]及外周血、肺泡灌洗液FSTL1表达;治疗期间,比较2组临床症状缓解时间、药物不良反应发生情况.结果 治疗1,7 d,2组FEV1、FVC水平均较治疗前升高,外周血、肺泡灌洗液FSTL1水平均较治疗前降低,且试验组治疗后各时点FEV1、FVC水平均高于对照组,外周血、肺泡灌洗液FSTL1水平均低于对照组(P<0.05).试验组咳嗽缓解时间、喘息缓解时间、胸闷缓解时间分别为(4.42±1.06),(4.28±0.98),(3.83±0.65)d,分别短于对照组的(5.24±0.98),(5.00±0.90),(4.35±0.80)d(P<0.05).试验组药物不良反应发生率为12.50％,对照组为7.50％,差异无统计学意义(P>0.05).结论 在雾化吸入布地奈德基础上联合特布他林治疗哮喘,更利于改善患儿肺功能,患儿临床症状更好更快缓解,同时有利于下调患儿FSTL1水平,且不增加药物不良反应发生率,联合用药安全可靠.

新生儿性急性肾损伤(AKI)是新生儿监护室危重症之一,其发病率和死亡率越来越高.长期以来,早期生物标志物的缺乏使AKI对新生儿造成的不利影响不能得到及时干预,因此,早期识别和防治AKI的发生发展是对新生儿临床工作者的极大挑战.血清肌酐不是AKI的及时标志物,因此在损伤仍可能可逆的阶段,它对AKI的早期治疗不能起到很好的指导作用.中性粒细胞明胶酶相关脂蛋白(NGAL)是早期检测AKI的有希望的生物标志物,研究显示,在AKI患者可检测血清肌酐增加前24～48 h,NGAL水平已显著升高.近年来,越来越多的研究表明,NGAL在新生儿AKI中高表达并对其严重程度有一定的预测性,是新生儿AKI早期识别标志物.

目的 探讨感觉统合训练联合助视器对低视力患儿生活质量的影响.方法 选取2018年9月至2019年6月在该院眼视光门诊筛查低视力患儿40例,随机分为观察组和对照组,各20例.对照组采用助视器进行助视训练,观察组在对照组基础上进行感觉统合训练.比较两组训练前后儿童感觉统合能力发展评定量表(SIFS)及Achenbach儿童行为量表(CBCL)评分情况.结果 两组训练前SIFS评分及CBCL评分比较,差异均无统计学意义(P>0.05).观察组训练后SIFS评分明显高于对照组,而CBCL评分明显低于对照组,差异均有统计学意义(P<0.05).结论 感觉统合训练联合助视器能够改善低视力患儿康复效果,提高其生活质量.

OBJECTIVE:To study the effect of epigallocatechin-3-gallate (EGCG) on liver lipid metabolism in rats with intrauterine growth restriction (IUGR) and related mechanism. METHODS:A rat model of IUGR was established by food restriction during entire pregnancy, and then the rats were randomly divided into an IUGR group and an EGCG group (n=8 each). The rats in the EGCG group were fed with water containing EGCG from after weaning to 10 weeks. Eight pup rats born from the pregnant maternal rats without food restriction were used as the control group. At the age of 13 weeks, body weight was measured. Blood and liver tissue samples were collected to measure fasting total cholesterol (TC), triglyceride (TG), free fatty acid (FFA), fasting plasma glucose (FPG), fasting insulin (FINS), and liver lipids. Homeostasis model assessment of insulin resistance (HOMA-IR) and adipose insulin resistance (adipo-IR) were calculated. Pathological sections of the liver were observed and quantitative real-time PCR was used to measure the mRNA expression of related genes in the liver. RESULTS:At the age of 13 weeks, there was no significant difference in body weight between groups (P=0.067). There were significant differences between groups in FPG, FFA, FINS, HOMA-IR, and adipo-IR (P<0.05). There were no significant differences in the serum levels of TC and TG between groups (P>0.05), while the IUGR group had significantly higher levels of TC and TG in the liver than the EGCG group (P<0.05). Oil red staining showed that the IUGR group had a significant increase in hepatic lipid accumulation, while the EGCG group had certain improvement after EGCG treatment. PCR results suggested that compared with the control group, the IUGR group had significant reductions in the mRNA expression of Ampk and Adipor1 and a significant increase in the mRNA expression of Srebf1 (P<0.05), while EGCG increased the mRNA expression of Ampk and reduced the mRNA expression of Srebf1, with no significant differences in the two indices between the EGCG and control groups (P>0.05). CONCLUSIONS:Early EGCG intervention can down-regulate the de novo synthesis of fatty acids through the Ampk/Srebf1 signaling pathway and reduce hepatic lipid accumulation in IUGR rats by improving insulin resistance of hepatocytes.

目的 探究经鼻间歇正压通气(nIPPV)与经鼻持续气道正压通气(nCPAP)联合肺表面活性物质(猪肺磷脂注射液)在新生儿呼吸窘迫综合征(NRDS)中的临床疗效,以期为NRDS提供一种安全有效的治疗方法.方法 选取2017年6月至2018年10月本院NICU收治的100例NRDS早产儿,随机分为观察组和对照组,各50例.在给予猪肺磷脂注射液治疗的同时,观察组和对照组分别予nIPPV和nCPAP辅助通气,比较两组患儿临床疗效及不良反应的发生情况.结果 观察组和对照组治疗后1、12 h血气分析指标pH、PaO2、PaCO2均较治疗前明显改善,差异有统计学意义(P<0.05);观察组与对照组相比,差异有统计学意义(P<0.05).在不良反应发生率方面,观察组患儿呼吸暂停情况明显改善,与对照组相比差异有统计学意义(P<0.05),在呼吸机相关性肺炎、腹胀、气胸等方面,两组比较差异无统计学意义.结论 nIPPV联合猪肺磷脂注射液治疗早产儿NRDS的临床疗效明显优于nCPAP联合猪肺磷脂注射液,且安全性高,值得临床推广.

目的 探讨经鼻间歇正压通气(NIPPV)和经鼻持续气道正压通气(NCPAP)作为早产儿气管插管拔管后无创呼吸支持模式的临床应用疗效对比.方法 选取2016年1月～2017年6月在我院治疗的新生儿呼吸窘迫综合征65例,采用随机数字表法将患儿随机分为NIPPV组(n=32)和NCPAP组(n=33),观察两组撤机失败率、无创呼吸支持时间、无创后吸氧时间及总用氧时间,同时检测治疗前后二氧化碳分压(PaCO2)、氧分压(PaO2)和氧合指数(OI),两组并发症的发生情况.结果 NIPPV组和NCPAP组撤机失败率、无创后吸氧时间和总用氧时间比较,差异无统计学意义(P>0.05);NIPPV组无创呼吸支持时间为2(1,3)d,明显短于NCPAP组(P<0.05);NIPPV组和NCPAP组治疗前后PaO2、PaCO2比较,差异无统计学意义(P>0.05);NIPPV组治疗后12 h、24 h OI分别为(240.100±31.140)％和(260.040±38.890)％,明显高于NCPAP组(P<0.05);NIPPV组和NCPAP组支气管肺发育不良、早产儿视网膜病、新生儿坏死性小肠结肠炎和总发生率的比较,差异无统计学意义(P>0.05).结论 相比较NCPAP,早产儿气管插管拔管后应用NIPPV可缩短无创呼吸支持时间,值得临床使用.

呼吸窘迫综合征是导致新生儿死亡的主要疾病之一,肺泡表面活性物质（PS）的缺乏是引起NRDS的主要原因。2019年更新的欧洲NRDS防治指南 [1] 指出,无创通气呼吸支持联合PS使用是目前NRDS最优治疗方案。NIPPV和NCPAP是两种常见的无创呼吸支持模式。虽然目前对于NIPPV和NCPAP治疗NRDS报道越来越多 [2] ,但是纳入研究的NRDS患儿一般较少。本文选取经NIPPV治疗和经NCPAP治疗的NRDS患儿各50例,对比两组患儿治疗前后各时间点血气指标、预后,比较两种无创通气方式治疗NRDS患儿的临床效果。

Beckwith-Wiedemann综合征(又称脐疝-巨舌-巨体综合征)是一罕见疾病,其常见临床表现包括巨舌,产前或产后的过度生长,腹壁缺损,耳窝的窝状皱褶或凹陷,肾脏畸形及面部的红斑胎记等[1].现将我院收治的1例Beckwith-Wiedemann综合征患儿临床资料报道如下.

OBJECTIVE To investigate the preventive effect of comprehensive intervention program on neonatal ventilator-associated pneumonia (VAP) ,so as to provide reference for clinical application .METHODS A total of 106 neonatal received mechanical ventilation (MV) in neonatal intensive care unit (NICU) from Jan .2014 to Dec . 2015 were enrolled in the study and randomly divided into observation group and control group ,with 53 cases in each group .Patients in control group were given conventional nurse while in observation group were given com-prehensive intervention program including closed wetting method and meticulous oral nursing .Pathogen distribu-tion and composition ratio were recorded in all patients with VAP .The incidence of VAP ,duration of MV ,length of NICU stays ,total hospital stays ,mortality and the satisfaction of children families for oral care were compared between the two groups .RESULTS Of all 106 patients ,VAP occurred in 23 cases ,with the total incidence rate was 21 .7% .Gram-negative bacteria were the most common pathogenic bacteria (94 .4% ) .The incidence of VAP , duration of MV ,length of NICU stays ,and total hospital stays of observation group were significantly lower than those of control group (P< 0 .05) .The satisfaction children families and total satisfaction rate of observation group were significantly better than those of control group (P<0 .05) .CONCLUSION For children receiving MV in NICU ,comprehensive intervention program can significantly reduce the risk of VAP ,shorten the duration of MV and hospital stay ,and improve the satisfaction of children families ,so it is worthy of clinical application .

Objective To investigate the clinical feasibility of early intervention for high-risk newborns with cerebral palsy.Methods A total of 104 cases of newborns with high risk of cerebral palsy were selected as observation group,and 105 cases of newborns with high risk of cerebral palsy were selected as control group;the control group only received basic newborn parenting guidance,the observation group received early intervention.Incidence of neonatal cerebral palsy in the two groups were observed,and major risk factor of cerebral palsy were analyzed.Results The overall incidence of cerebral palsy in high-risk newborns was 3.9％ in control group and 18.2％ in observation group,the difference was statistically significant (P ＜ 0.05).There was no significant difference among the incidences of cerebral palsy in newborns caused by each high-risk factors (all P ＞ 0.05).Conclusions Early intervention can significantly reduce the incidence of cerebral palsy in the newborns with high-risk of cerebral palsy;premature birth,asphyxia,hypoxic-ischemic encephalopathy and other factors have almost equal pcthogenic risk,with which newborns need to be given full attention clinically.

随着医学教学改革的不断进行,案例导入式教学被越来越多地被应用于国内外院校中.为了探索提高医学本科生在儿科临床实习中学习效率的方法,笔者选取福建医科大学第二临床医学院五年制临床医学本科学生60人,并把他们随机分为实验组(案例导入式教学法)和对照组(传统教学法)进行对比分析.结果发现:案例导入式教学法在提高学生学习成绩及各种综合能力方面较传统教学法具有较大优势.

案例式教学法是目前国内外院校普遍采用的一种教学方式,但其较少被用于儿科实习中.本研究在儿科医学本科生的实习阶段引入案例式教学方法,分析案例式教学法与传统实习带教方法相比存在的优点及不足,旨在寻找一种提高医学实习生学习效率及临床能力的教学方法.

目的 了解本院儿科住院患儿抗菌药物整治前后的用药情况,评价应用的合理性.方法 将本院2012年1月1日-2012年6月30日收治的患儿设为整治前组,2012年7月1日-2012年12月31日收治的患儿设为整治后组,采用WHO推荐的限定日剂量(DDD)、用药频度(DDDs)等方法对2组患儿使用抗菌药物的情况进行比较与分析.结果 经过整治,本院儿科的抗菌药物使用率从整治前66.33％下降到55.96％,抗菌药物费用所占总金额比例由64.77％下降到44.36％;整治前后的抗菌药物使用强度(AUD)分别为53.4 DDDs/100人/天和36.6 DDDs/100人/天,呈下降趋势.结论 通过采取行政、药学干预等相关措施,可使儿科抗菌药物使用日趋合理.

Objective To study the effects of the early trace feeding on premature infants.Methods Seventy cases of premature infants were randomly divided into two groups,with 36 cases as the observation group and 34 cases as the control group.The premature infants in both groups were injected with liquid nutrient formulation via peripheral vein at a constant rate using a minimal infusion pump right after birth.The infants in the observation group were fed with baby diary formula via mouths or noses within 24 hours after birth.In contrast,the babies in the control group were not fed with baby diary formula until 48 hours after birth.The tolerance to feeding,the time took to resume their birth weights,and the serum bile acid and bilirubin concentration about 3 days after birth were examined between the two groups.Results The incidence of feeding intolerance,necrotizing enterocolitis and hyperbilirubinemia were significantly lower in the observation group than those in the control group(P0.05).The average daily weight gain in the observation group was significantly higher than that in the control group(P0.05).The average time took to resume their birth weights in the observation group was shorter than that in the control group(P0.05).The average concentrations of serum bile acid and bilirubin in observation group were significantly lower than those in control group(P0.05).Conclusion The parenteral nutrition support therapy supplemented with early trace feeding can improve tolerance to feeding,shorten the time that take to resume their birth weights,stimulate gastric movement,reduce the enterohepatic circulation and the serum bilirubin concentration.This method is benefitial for the growth of low birth weight infants and can be recommended in clinic.

随着新生儿医学的不断进步，低出生体质量儿日渐增多，低出生体质量儿由于宫内营养储存不足和不能立刻适应宫外生存条件，如不能及时供给合理而足够的营养，会发生严重的营养缺乏。营养缺乏早期可增加低体质量儿的死亡率，远期则会导致身材矮小、智力下降及神经发育不良等，因此应注意加强低出生体质量儿的营养支持。福建医科大学第二临床医学院儿科自2003年起加强对低出生体质量儿的管理，采用早期静脉高营养、早期微量喂养及非营养性吸吮等方法治疗低出生体质量儿，取得较好的效果，报道如下。

对我科先天性膈疝误诊4例分析如下. 1 临床资料 本组男3例,女1例,胎龄均>37周,体重>2 500 g.阴道分娩3例,剖宫产1例.母孕期健康无接触放射线或有毒物质,无妊高征、产前子痫等合并症,分娩前B超提示羊水过多2例.本组均有出生窒息史,其中轻度窒息3例,重度窒息1例.临床表现均为气促、反复紫绀,症状于生后6 h内出现2例,24 h后始症状出现2例,伴有呕吐2例.体征方面包括紫绀、三凹征、胸部饱满、呼吸音减弱,腹部较平坦,胸部可闻及肠鸣音1例.

极低出生体重儿由于其解剖生理特点,各脏器发育不成熟,易发生各种并发症,死亡率极高,减少极低出生体重儿死亡及并发症的发生是降低围产儿死亡率及提高儿童生存质量的重要环节,为了加深对本病的认识,本文回顾性分析近年来我科22例极低出生体重儿的死亡原因及相关因素,报告如下.

目的探讨头颅CT扫描对出生时无窒息史的早产儿缺氧性脑损伤的诊断意义.方法对2000年1月～2002年12月在本院产科出生,出生时无窒息史的早产儿93例进行头颅CT检查.结果 93例早产儿CT扫描,56例显示缺氧性脑损伤,阳性率为60.2%,其中<32周组为75%,32～35周组为69.4%,>35周组为35.7%.经统计学分析,<35周组与>35周组比较,缺氧性脑损伤的发生率有极显著性差异(P<0.01).结论早产儿发生缺氧性脑损伤时多数缺乏典型症状或无明显症状,尤其是出生时无窒息史的早产儿易被临床所忽视,头颅CT扫描对早期诊断早产儿缺氧性脑损伤具有积极意义.