Objective:To explore the indicators of pulmonary function of congenital cystic adenomatoid malformation (CCAM) before and after operation, so as to guide the clinical treatment and follow-up.Methods:The clinical data of 14 patients who underwent surgical treatment in department of pediatric thoracic surgery of our hospital due to CCAM from October 2017 to June 2018 were collected, and their lung function before and half a year after surgery was compared and analyzed.Results:All of the 14 CCAM cases were diagnosed prenatally, confirmed by enhanced CT and treated with minimally invasive thoracoscopic surgery. Among the 14 children, there were 7 cases of left CCAM and 7 cases of right CCAM, including 1 case with pleural effusion, 1 case with funnel chest, and 2 cases with both pleural effusion and funnel chest. There were 3 cases of restrictive lesions and 5 cases of obstructive lesions in preoperative pulmonary function of 14 cases, and the remaining 6 cases had basically normal pulmonary ventilation function. There were 6 cases of obstructive lesions in postoperative pulmonary function of 14 cases, and 8 cases of normal pulmonary ventilation function.Conclusions:CCAM has a good prognosis and surgery is one of the treatment methods. Due to the existence of congenital pulmonary dysplasia, some of the children have different degrees of abnormalities in preoperative pulmonary function. Although the operation removes the structural deformity, there might still be various abnormalities in a short period of time in functional recovery, among which the recovery of pulmonary function still requires long-term follow-up. The purpose of this project is to provide experiences and basis for clinical treatment through investigating the change characteristics of pulmonary function before and after surgery for CCAM.

Objective:To summarize the clinical characteristics of fetal congenital diaphragmatic hernia (FCDH) at a single center so as to explore the outcomes of integrated mode of fetal diagnosis and postnatal treatment for FCDH.Methods:Clinical data of 258 hospitalized FCDH children from January 2013 to October 2017 were retrospectively analyzed. Thirty-five cases were chosen for termination of pregnancy (TOP). Among the remaining 223 CDH cases, there were 143 boys and 80 girls with an average prenatal diagnostic gestational age of (25.4±6.2) weeks, an average birth gestational age of (38.8±4.3) weeks and an average birth weight of (3.25±0.53) kg. The involved side was left ( n=206), right ( n=51) and bilateral ( n=1). Nineteen cases were associated with other malformations. Prenatal ultrasonic severity was mild ( n=141), moderate ( n=62) and severe ( n=55). Results:The outcomes were curative ( n=184) and death ( n=39). The survival rate rose to 81.8% in 2017 from 57.7% in 2014; the rate of mini-invasive surgery from 0% in 2014 spiked to 95.6% in 2017, the recurrence rate of mini-invasive surgery decreased from 20% in 2015 to 6.15% in 2017. Among 39 deaths, 31 cases (79.5%) had severe pulmonary hypertension (24 postnatal cases non-responding after aggressive treatment, including 5 lethal surgical cases per family requests, 5 cases with postoperative pleural effusion and 2 cases with postoperative pneumothorax), 4 cases (10.3%) had severe postnatal asphyxia, 2 cases (5.1%) had lower blood blockage after surgery, 1 case (3.2%) with unilateral complete diaphragm defect gave up treatment and 1 case (3.2%) gave up treatment after twice recurrence. Conclusions:Integrated mode of prenatal diagnosis and postnatal treatment is an effective management mode for managing CDH. It may boost the survival rate for mild CDH and reduce the mortality for moderate/severe CDH.

对广东省妇幼保健院小儿胸外科收治的1例新生儿双侧先天性膈疝(CDH)患儿的临床资料行回顾性分析，患儿，男，8 d，其主要临床特点为出生后呼吸困难进行性加重；查体：面色、口唇苍灰，肢端发绀，呼吸微弱，反应极差。胸廓饱满，双肺呼吸音低，心音低钝。四肢肌张力低，原始反射未引出。胸腹片符合CDH改变。入院后给予呼吸机支持、抗感染等治疗，病情稍稳定后行手术治疗，术后给予抗感染、静脉营养等对症处理，患儿恢复好，治愈出院。提示一旦确诊为双侧CDH，手术仍是其治疗的主要手段。围术期积极改善呼吸循环功能，选择适当手术时机也相当重要。

Objective: To investigate the effect of intrauterine intervention on severe primary fetal hydrothorax. Methods: Twelve cases with severe fetal primary hydrothorax who underwent prenatal intervention from January 2014 to December 2017 in Guangdong Women and Children Hospital were retrospectively reviewed. Results: The median gestational age of prenatal diagnosis was 30.8 weeks (24.0-33.0 weeks) . All cases were excluded congenital chromosomal abnormalities by prenatal diagnosis, and had no complications of pregnancy during prenatal diagnosis and had hydrothorax. Three cases (3/12) were right hydrothorax, the other 9 cases (9/12) were bilateral. Thoracoamniotic shunting was performed in 7 cases (7/12) . Thoracentesis was performed in 5 cases (5/12) , and the hydrothorax reappeared soon after operation in 4 cases, shunt placement was performed again. The hydrothorax was dissolved in 2 cases, released in 6 cases.Tube falling off occurred in 1 case,treatment was abandoned in 1 case and intrauterine fetal death happened in 1 case, and 1 case wasn't rechecked by ultrasonic due to premature birth following thoracentesis. In 10 cases who had deliveries, 5 newborns (5/10) were premature, 6 newborns (6/10) underwent assisted mechanical ventilation, 8 newborns (8/10) underwent thoracic close drainage, all of them were discharged when hydrothorax resolved. Conclusions: Antenatal intervention may improve the chance of survival in severe primary fetal hydrothorax. Thoracoamniotic shunting is the first-choice for the primary severe fetal hydrothorax.

目的 总结胎儿神经母细胞瘤(NB)的临床特点,探索胎儿NB的产前诊断和治疗.方法 收集2014年1月至2016年12月在广东省妇幼保健院就诊,经病理确诊的10例胎儿NB患儿的临床资料,并进行回顾性分析.结果 10例患儿中,男7例,女3例;中位产前诊断胎龄为31+1周.原发肿瘤6例位于右侧肾上腺,2例位于左侧肾上腺,1例位于双肾上腺,1例位于左侧胸腔,其中3例并肝脏转移.临床分期:1期6例,4S期4例.产前超声提示囊性包块6例,混合性包块2例,实性包块2例.其中2例家长选择终止妊娠,8例选择继续妊娠,均于新生儿期行原发肿瘤切除,未行放化疗.3例并肝脏转移患儿,仅行原发肿瘤切除+肝脏活检,其中2例肝脏病灶经影像学证实消失,1例患儿肝脏病灶缩小,带瘤生存10个月;余5例患儿均完全缓解.结论 产前诊断NB预后良好,手术切除是首要治疗方案,术后是否需要化疗仍需进行长期追踪.

目的 分析剖腹产术中寒战发生的原因,并提出护理干预方法.方法 把我院在2016年10月——2017年10月进行剖腹产的48例产妇纳入本次研究中来,并按照护理方法的不同随机进行分组,其中24例予以常规手术护理,作为对比组,另外24例按照可能会发生寒战的原因做针对性的护理干预及预防,作为研究组,比较两组产妇寒战发生情况.结果 研究组产妇寒战发生率26.3％要比对比组的52.6％低(P<0.05);急诊手术产妇寒战的发生率88.9％要比择期手术的发生率46.7％高(P<0.05);研究组产妇护理满意度显著要比对比组高,数据比较差异有统计学意义(P<0.05).结论 影响到剖腹产产妇术中发生寒战的原因有环境、麻醉、胎儿等多种,针对原因进行总结,实施针对性的护理干预举措,可降低寒战的发生,提高手术质量.

目的 探讨坐式分娩在矫正持续性枕横位﹑枕后位孕妇中的应用效果. 方法 选取2014年1~12月在本科住院并要求阴道试产且活跃晚期经阴道检查确诊为持续性枕横位﹑ 枕后位的120例足月妊娠孕妇作为研究对象,随机分成观察组和对照组,各60例. 观察组在第二产程采用坐式分娩,对照组采用传统仰卧位分娩,比较两组的临床效果. 结果 观察组的经阴道分娩率显著高于对照组,差异有统计学意义(P<0.05).观察组的第二产程时间显著短于对照组,产后2 h阴道出血量显著少于对照组,1 min新生儿Apgar评分显著高于对照组,差异有统计学意义(P<0.05). 结论 在持续性枕横位﹑枕后位孕妇第二产程中采用坐式分娩有利于纠正胎方位,能够减少母婴并发症,提高阴道分娩率.

Objective To compare the uterine contraction pain,lactation,urination and lochia situation between multipara and primipara,to improve maternal postpartum rehabilitation interventions.Methods With Visual Analogue Scale(VAS),pain intensity in postpartum 1~3 days of 100 cases of primipara of vaginal delivery in hospital and multipara who had induction of labor after 28 weeks or had delivery history was assessed and their lactation,urination and lochia situation at the same time were observed.Results The pain score was 3.5 points at the first day in multipara group and there were more lactation and lochia discharge in multipara group than those in primipara group,which were statistically significant(P0.05).Conclusion In first day of postpartum,there is obvious uterine contraction pain among multipara,and less lactation in primipara.Early effective measures to relieve pain of multipara and promote milk secretion for primipara should be taken.

Objective To improve the screening rate of blood test technique, propa-gandizing related knowledge and strengthening nursing treatment. Methods Cases had been studied in Guangdong Women and Children Hospital (Haizhu Branch). Results 1 445 cases among 1 412 infants were tested, by which the testing rate was 97.71%. The result comes that 23 case load committed glucose-6-phosphate dehydrogenase (G-6PD) deficiency,5 with inborn hypothyroidism, none with phenyketonuria(PKU). Conclusion The control methods of infant medical check up can do crucial impact on early diagnoses and treatment of infant diseases. Among of them, methods of blood check, database setup, lab analysis, and information management are recommended.