目的 分析住院腺病毒肺炎患儿选择纤维支气管镜检查和治疗的影响因素.方法 回顾性分析114例住院腺病毒感染肺炎患儿临床资料.其中,23例实施了纤维支气管镜检查和治疗(气管镜组),91例未行支气管镜检查(非气管镜组).分析影响实施纤维支气管镜检查和治疗的因素.结果 两组患儿性别构成比、年龄、发热、咳嗽及喘息的发生率比较均无统计学意义(P＞0.05).Logistic回归分析显示,入院诊断为重症肺炎、住院时间长、CD19+比例高为住院腺病毒肺炎患儿实施纤维支气管镜检查和治疗的影响因素(P＜0.05).结论 住院腺病毒感染肺炎患儿诊治中,对重症肺炎和CD19+比例异常增高者需要考虑实施纤维支气管镜检查和治疗.

目的 获得农村及城市5～14岁健康儿童的肺通气功能指标,探讨其与性别、年龄、身高及体质量的相关性.方法 筛选1076名农村户籍5～14岁儿童,参照中国儿童正常身高、体质量范围等,选取605名健康儿童,男309名、女296名;同期以同样方法筛选城区户籍5～14岁儿童,选取540名健康儿童,男267名、女273名.采用肺功能仪测定1秒用力呼气容积(FEV1)、最高呼气峰流速(PEF)指标,经多元线性回归,检测FEV1、PEF与儿童年龄、身高及体质量相关性.并比较同性别、同年龄组城区与农村儿童的肺功能正常值.结果 605名农村儿童与540名城区儿童肺功能检测均合格.随儿童年龄增加,FEV1、PEF均逐渐增加,在各年龄组间的差异有统计学意义(P<0.01).9～10岁、14～15岁组FEV1均为男童大于女童;7～8岁、13～14岁、14～15岁组PEF均为男童大于女童,差异均有统计学意义(P<0.05).经多元线性回归分析发现,身高对所有儿童FEV1的影响最为显著(β=0.532,P<0.001).男孩中FEV1、PEF均与身高、体质量呈正相关;女孩中FEV1、PEF均与年龄、身高、体质量呈正相关,以身高影响较为显著.将各年龄段儿童农村与城区之间肺功能正常值进行比较发现仅6～7岁、8～9岁组城区男童FEV1大于农村;6～7岁、9～10岁组城区女童FEV1大于农村,差异有统计学意义(P<0.05).结论 FEV1、PEF分别与儿童的身高、体质量、年龄相关,其中身高影响最为显著,年龄影响最小.苏州城区与农村的肺功能正常值比较无明显差异.

苏州大学附属儿童医院于2018年6月收治多系统平滑肌功能障碍综合征患儿1例，女，9个月18 d，其临床特点为反复咳嗽、喘息、气促。查体：双侧瞳孔散大、固定，直接及间接对光反射消失，右侧颜面部、颊黏膜、口腔舌部及上颚可见青紫色斑块，呼吸促，双肺可闻及湿啰音及哮鸣音，胸骨左缘可闻及收缩期Ⅱ/6级杂音。腹部B超显示胆囊结石，心脏超声提示卵圆孔未闭，主肺动脉内径增宽。头颅磁共振成像提示双侧脑室体部旁及半卵圆中心区异常信号。基因检测分析发现存在ACTA2基因c.536G>A(p.R179H)杂合突变。予吸氧、抗感染、平喘治疗2周后患儿病情逐步好转，出院后继续予氧疗、小剂量泼尼松口服治疗。多系统平滑肌功能障碍综合征是一种主要由ACTA2基因p.R179H变异引起的罕见遗传病，可引起全身性的平滑肌功能障碍，本例为国内第2例通过基因确诊的患者，提示临床医师对于存在瞳孔固定散大和/或动脉导管未闭的患儿应尽早行基因检测明确诊断。在其诊断及治疗过程中，临床医师应对脑血管、心血管及肺部并发症保持高度警惕。

Objective To study the role and influence of coinfection factor to refractory Mycoplasma pneumoniae(MP) pneumonia (RMPP) in children.Methods Clinical data and sputum specimen of 286 hospitalized children of RMPP were collected from January, 2013 to December, 2015. According to the results of pathogen detection, children were divided into RMPP coinfection group and simple MP infection group. Clinical features and laboratory tests were compared between the two groups.Results The durations of fever and hospitalization of the RMPP coinfection group were 12.5(11.0-14.0)days and 12.0 (9.0-14.0)days, respectively, which were significantly longer than those of simple MP infection group, 11.0(9.0-13.0)days and 10.0(8.0-12.0)days (Z=3.947,P<0.001,Z=3.519,P<0.001). In the RMPP coinfection group, white blood cell count, the percentage of neutral granulocytes, pleteltes count, lactate dehydrogenase and the incidence of C-reaction protein (CRP) greater than 40 mg/L, and CRP greater than 100 mg/L, elevated CK-MB of were higher than those of simple MP infection group (all P<0.05), but the incidence of CRP greater than 8 mg/L and elevated ALT in the two groups showed no signiflcant difference (both P>0.05). The incidence of pneumothorax and respiratory failure in children of RMPP coinfection group were higher than those in the simple MP infection group (χ2=5.873,P=0.015,χ2=11.995,P=0.001), but the incidence of lobar pneumonia, pleural effusion, atelectasis in the two groups had no signiflcant difference (all P>0.05). The incidence of blood system damage, myocardial damage, skin and joint damage and electrolyte disorders in RMPP coinfection group were higher than those of simple MP infection group (all P<0.05).Conclusions Children with RMPP coinfection tend to be with prolonged duration of fever, increased systemic inflammation, higher incidence of pulmonary and extrapulmonary complications, and longer duration of hospitalization.

Objective To analyze the changes of lymphocyte subsets in children with acute respiratory syncytial virus lower respiratory tract infection. Methods Multi-pathogen detection using direct fluorescence antibody test(DFA), clear etiology diagnosis. Lymphocyte subsets in peripheral blood in part of patients(<6 months) were examined by flow cytometry. Results The amount of CD3+ and CD3+CD8+T lymphocyte of RSV patients in the eruption stage was signiifcantly lower than those in healthy controls(P<0.05). The amount of CD3-CD19+, CD19+CD23+, CD4+/CD8+and CD3+CD25+T lymphocyte of RSV patients in eruption stage was significantly larger than that of healthy controls(P<0.05). The amount of CD3+CD4+ and CD16+CD56+T lymphocyte was not significantly different between RSA patients and healthy controls(P>0.05). Conclusion Cellular immunity function is in disorder in children with acute respiratory syncytial virus lower respiratory tract infection. T lymphocytes are extensively depressed early in the course;B lymphocytes are involved in the virus clearance;NK cells have no signiifcant change with those critical cases.

Objective To establish reference value and predicted equations of normal lung function for children of 5 to 14 years old in Suzhou.Methods A survey in 610 healthy children(302 boys,308 girls)was carried out in Suzhou,19 testing parameters including forced vital capacity(FVC)and forced expiratory volume at one second(FEV1)were observed.Data was analyzed by software SPSS16.0.Stepwise multiple regression and non-liner regression were applied to build the predicted equations of lung function.Results FVC and FEV1 were significantly different among age groups in both genders(P 0.01).Between different genders,FVC was higher in boys than that in girls for all age groups;the significant differences were showed in 7,12 and 14-year-old groups(P 0.05).FEV1 was higher in boys than that in girls for all age groups except 11-year-old group;the significant differences were observed in 7,8 and 14-year-old groups(P 0.05).Most of lung function parameters(FVC、FEV1、FEV0.5、PEF)were correlated positively to children's height,weight and age.And FEV1 presented exponential relationship with height.The average expiratory time of children was 2.68 seconds,volume of back extrapolation was less than 0.12 L,and the ratio of back extrapolative volume to forced vital capacity was less than 4.97%.Conclusions Most of lung function parameters are correlated with height rather than with weight or age.The standard of children's lung function should be set up separately from that of adults.

Objectives The aim of this study was to establish FeNO reference values for healthy school-aged children in Suzhou according to the international guidelines, and to assess the determinants of FeNO. Methods Children aged 6-14 years were recruited from two public schools in Suzhou. The subjects completed a respiratory questionnaire, and were examined with measurements of FeNO, spirometry and blood eosinophil. Healthy children were screened to establish reference values of FeNO. FeNO was measured with a chemiluminescence analyzer according to American Thoracic Society guidelines (single breath online, exhalation flow 50 mL·s-1). The associations between different determinants (sex, age, height, weight, BMI, peripheral blood EOS count, FEV1/FVC, lung function) and FeNO were analyzed. Results Finally, a total of 450 children participated in the study, and 225 children fulfilled the inclusion criteria of healthy subjects (107 boys and 118 girls). FeNO data were skewed, and met normal distribution after natural logarithm transformation. The geometric mean of FeNO in 225 children was 11 parts per billion (ppb) (95%CI: 5-28 ppb), the minimum value was below 5 ppb, and the maximum value was 83 ppb. The mean value was 11 ppb (95% CI:5-31 ppb) for boys and 11 ppb (95%CI: 5-25 ppb) for girls. In stepwise multiple regression analysis, peripheral blood EOS count was found to be the best independent variable for the regression equation for FeNO (r=0.291, P0.000 1). Height (r=0.148, P=0.027) and FEV1 (r=0.138, P=0.038) were significantly correlated with FeNO. FeNO in children aged 9 years was significant higher than that in children aged ≤ 9 years(P=0.002). Sex, weight, BMI and FEV1/FVC were not associated with FeNO. Conclusions FeNO reference values of healthy children aged 6 to 14 years in Suzhou should be considered to fall between the following ranges: 5-28 ppb, which is slightly higher than European and American children. FeNO levels in healthy school-aged children appear to be affected by EOS count and height significantly, followed by FEV1, and not influenced by sex, age, weight, BMI and FEV1/FVC.

<正>肺炎支原体(MP)是儿童呼吸道感染的常见病原,近年MP感染发病率呈不断上升的趋势。国内资料其发病率占社区获得性肺炎的10%～30%,国外文献报道为50%[1]。同时重症MP感染的发病率也有上升的趋势,重症MP感染的临床表现是由于MP感染后机

目的 了解我院医院感染现状,为医院感染管理工作提供参考.方法 根据前瞻性调查的结果,对我院2005年1月1日至2009年12月31日出院患者发生的医院感染发病情况进行分析.结果 112 390例出院患者中,发生医院感染4 506例,感染率4.0%,各年的感染率波动在3.4%～4.4%之间;医院感染部位前3位的是上、下呼吸道和胃肠道,分别占34.2%、14.7%和15.8%;各年医院感染病原体送检率波动在76.4%～86.6%;医院感染率位居前两位的分别是血液科和ICU,分别是15.5%和8.7%.结论 通过医院感染管理专职人员进行前瞻性监测,管理干预工作取得实效.

OBJECTIVE To investigate the efficacy and safety of Robitussin in the treatment of the pediatric patients with chronic sinusitis.METHODS A total of 68 pediatric patients with chronic sinusitis were randomly divided into 2 groups.All cases were treated with amoxicillin and clavulanate potassium dispersible tablets,myrtol standardized enteric coated soft capsules,and budesonide nasal spray.The treatment group was treated with Robitussin.While the control group was treated with Bidouyan oral solution.The clinical therapeutic effect and ADRs of two groups were observed after treatment for 1 week.RESULTS Outstanding clinical therapeutic effect was found in the treatment group as compared with the control groups.The effective rate of the treatment group was 85.29%,while the control group was 52.94% respectively (P0.01).There were no obvious ADRs in 2 groups,the rates of ADRs in treatment group was 4.41%,the rates of control group was 5.58% respectively (P0.05).CONCLUSION The clinical therapeutic effect of Robitussin on the treatment of pediatric chronic sinusitis is better than that of control group.The safety of Robitussin is equivalent to Bidouyan oral solution.

近年来支原体致儿童肺部感染逐渐增多,使红霉素在儿科肺部感染治疗中有较大的应用价值.但由于其不良反应,特别是胃肠道反应使其在儿科临床使用受到限制.为此,我们对34例各种原因感染住院后使用静滴红霉素治疗期间出现腹痛、呕吐、恶心等胃肠道反应的患儿用中成药肠胃康枫蓼冲剂解除其胃肠道反应,取得了明显的效果,现报道如下.

目的研究学习困难儿童运动、认知、师生关系、同学关系的特征,运用适宜技术训练学习困难儿童,以寻求改善学习困难儿童学习能力的有效措施,促进儿童身心健康成长.方法对62例学习困难儿童及38名正常儿童进行智能测验、基本运动能力测验、注意和记忆能力测试.对其中32例学习困难儿童运用适宜技术训练一周期,复查基本运动能力、注意和记忆能力,并调查在学校与教师、同学的相处关系变化.结果基本运动能力测试,学习困难组儿童运动能力得分低于正常儿童,在平衡木、单杠、仰卧起坐、前滚翻、拍球、蹦床、方向感等七个方面比较,表现出显著的差异(皆P<0.05).在注意、记忆特征方面比较存在显著差异(P<0.05).32例学习困难儿童经适宜技术训练,运动能力(平衡、仰卧起坐、拍球、方向感)、短时记忆能力比较,差异有显著性(P<0.05).训练前后与教师的关系比较,差异无显著性(P>0.05),与同学的关系比较,差异有显著性(P<0.05).结论运动与认知能力是学习过程中的基本能力,基本学习能力不足,不仅影响学习成绩,还会产生自卑心理,造成在学校与老师、同学的关系不融洽.运用适宜技术可改善学习困难儿童的学习能力,同时改善与教师、同学的关系,是促进儿童身心健康成长的有效措施.