ObjectiveTo investigate the effects of integrated blood purification on haemodynamics and oxygen metabolism in children with severe sepsis.MethodsClinical data of 12 children with severe sepsis admitted to the pediatric intensive care unit of our hospital between October 2021 and June 2022 were retrospectively analyzed. All patients were treated with integrated blood purification, and changes in haemodynamic parameters, including heart rate, blood pressure, mean arterial pressure and cardiac output, and oxygen metabolism parameters (blood lactic acid, oxygen delivery, oxygen consumption and oxygen extraction rate) were observed before and after treatment.ResultsThe heart rate (134[106,160] vs 111[101,128], p = 0.037), central venous pressure (9[7,10] vs 8[7,9], p = 0.04), stroke output (28[18,43] vs 21[15,31], p = 0.01), blood lactate (3.3[2,4] vs 2.5[1.3,3.6], p = 0.015), oxygen consumption (165.99[121.44,230.31] vs 124.18[82.51,162.86], p = 0.041) and oxygen extraction rate (38.83[31.87,44.62] vs 28.67[21.05,32.72], p = 0.019) were decreased, whereas systolic blood pressure (97[83,104] vs 107[94,116], p = 0.033) and central venous oxygen pressure (32[29, 37] vs 39[34,46], p = 0.005) were increased in the children after treatment compared with before treatment. There were no statistically significant differences in diastolic blood pressure, mean arterial pressure, cardiac output, arterial oxygen pressure and oxygen delivery before and after treatment (all p > 0.05).ConclusionIntegrated blood purification can improve haemodynamic and oxygen metabolism parameters in children with severe sepsis, with a high value in clinical application.

Introduction Mycoplasma pneumoniae pneumonia (MPP) is prevalent in paediatric patients and can progress to refractory mycoplasma pneumoniae pneumonia (RMPP). Objective To assess the predictive value of bronchoscopy combined with computed tomography (CT) score in identifying RMPP in children. Methods A retrospective analysis was conducted on 244 paediatric patients with MP, categorising them into RMPP and general mycoplasma pneumoniae pneumonia (GMPP) groups. A paired t-test compared the bronchitis score (BS) and CT score before and after treatment, supplemented by receiver operating characteristic (ROC) analysis. Results The RMPP group showed higher incidences of extrapulmonary complications and pleural effusion (58.10% and 40%, respectively) compared with the GMPP group (44.60%, p = 0.037 and 18.71%, p < 0.001, respectively). The CT scores for each lung lobe were statistically significant between the groups, except for the right upper lobe (p < 0.05). Correlation analysis between the total CT score and total BS yielded r = 0.346 and p < 0.001. The ROC for BS combined with CT score, including area under the curve, sensitivity, specificity, and cut-off values, were 0.82, 0.89, 0.64, and 0.53, respectively. Conclusion The combined BS and CT score method is highly valuable in identifying RMPP in children.

Objective:To explore the scope, mode, anticoagulation mode and complications of blood purification in children with acute and critical illness.Methods:A total of 377 times of treatment of 102 children treated with blood purification in PICU at the First Affiliated Hospital of Xinxiang Medical College from January 2018 to December 2020 were retrospectively analyzed.Results:Among 102 critically ill children treated with blood purification, acute and chronic renal failure ranked the first in terms of disease distribution, with 23 cases in total, followed by 16 cases of severe viral encephalitis (meningoencephalitis), 11 cases of septic shock, seven cases of acute poisoning, five cases of severe allergic purpura, five cases of necrotic encephalopathy.In terms of clinical prognosis, 51(50.0%) cases were cured, 29(28.4%) cases were improved, 10(9.8%) cases died, and 12 cases abandoned treatment.In 2019, the blood purification application frequency was the highest, with a total of 47 cases, which was higher than those in 2018 and 2020( P<0.05). Continuous veno-venous hemofiltration was used in the largest number of children, with a total of 56 cases.There was a statistically significant difference in the application ratio of this mode during 3 years ( P<0.05), while there was no statistically significant difference in the application ratio of other modes.In terms of the selection of anticoagulation methods, the proportions of systemic anticoagulation and extracorporeal anticoagulation had significantly difference among different years( P<0.05), and the application of extracorporeal anticoagulation had increased year by year.There was no statistically significant difference in the proportion of patients without anticoagulants.The incidence of complications of blood purification was the highest in 2019, with catheter related thrombus in the majority (30 person-times), followed by hypothermia, catheter filter coagulation, hematoma formation, catheter related infection, hypotension, heparin-induced thrombocytopenia, etc.There was statistically significant difference in the total complications among different years( P<0.05). Conclusion:Blood purification is widely used in children with acute and critical illness, with a variety of diseases.The most commonly used mode is continuous veno-venous hemofiltration and in vitro anticoagulation.Catheter-related thrombosis is the most common complication.

目的 探讨小儿肺咳颗粒结合硫酸特布他林雾化液对急性支气管肺炎患儿的疗效.方法 对2017年9月至2019年9月于新乡市妇幼保健院就诊的60例急性支气管肺炎患儿的临床资料进行回顾性分析,按照治疗方案将患者分为对照组和观察组,每组30例.对照组接受硫酸特布他林雾化液治疗,观察组接受硫酸特布他林雾化液联合小儿肺咳颗粒治疗.对两组患儿临床症状消失时间(咳嗽咳痰消失时间、体温恢复正常时间、肺部音消失时间)、治疗前后肺功能指标[第1秒用力呼气容积(FEV1)、用力肺活量(FVC)和最大呼气流量(MEF)]、炎症因子[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)]水平及不良反应发生情况进行比较.结果 观察组咳嗽咳痰消失时间、体温恢复正常时间及肺部音消失时间均短于对照组(P<0.05).治疗后,两组FEV1、FVC、MEF均高于治疗前,观察组FEV1、FVC、MEF均高于对照组(P<0.05).治疗后,两组IL-8、TNF-α、CRP水平均低于治疗前,观察组IL-8、TNF-α、CRP水平均低于对照组(P<0.05).两组不良反应发生率比较,差异无统计学意义(χ2=0.268,P=0.605).结论 对急性支气管肺炎患儿采用小儿肺咳颗粒结合硫酸特布他林雾化液治疗效果显著,能明显改善患儿肺功能、临床症状及炎症反应.

目的:分析清热化痰、平喘宣肺方联合常规西医治疗对小儿支气管哮喘肺通气功能以及免疫功能的影响.方法:随机选取新乡医学院第一附属医院于2017年12月至2018年12月期间收治的92例小儿支气管哮喘,采用双盲法将所有患儿平均分为观察组(46例,采用清热化痰、平喘宣肺方剂联合常规西医治疗)与对照组(46例,采用常规西医治疗).分别比较两组患儿的免疫功能以及肺通气功能情况.结果:治疗前两组患儿的1 s用力呼气容积(FEV1)、最大呼气流量(PEF)比较,差异无统计学意义(P＞0.05);治疗后观察组患儿的FEV1、PEF均较对照组高,差异具有统计学意义(P＜0.05).治疗前两组患儿的免疫球蛋白E(IgE)、CD4+、CD8+比较,差异无统计学意义(P＞0.05);治疗后观察组患儿的IgE、CD4+、CD8+均较对照组低,差异具有统计学意义(P＜0.05).结论:通过给予小儿支气管哮喘实施清热化痰、平喘宣肺方剂联合常规西药治疗,可有效改善患儿免疫功能,并提升其肺通气功能.

1 病例资料患儿,男,1岁2月,因“跌倒致上唇裂伤、出血不止7h余”入院.既往史:患儿6个月龄时抓挠左耳致出血,在当地医院检测凝血功能,未见异常.查体:心率220次/分,嗜睡状,面色苍白,皮肤无淤点,除外伤处无明显瘀斑,四肢末梢凉,上唇系带牙龈附着区断裂,见长约0.5cm撕裂伤,伤口渗血较多,周边粘膜淤青,水肿,口内可见凝血块.

目的:探讨幼儿肺炎支原体肺炎(MPP)中MP-DNA载量与临床特征之间的关系.方法:收集40例2017年10月至2019年3月在我院儿科住院并诊断为MPP的1～3岁幼儿的临床资料,回顾性分析MP-DNA载量与临床特征之间的关系.结果:MP-DNA载量与幼儿MPP血清LDH水平、肺部X线/CT表现程度均呈正相关(P＜0.01),与CRP、WBC、PLT均有一定相关性.结论:幼儿MPP病例中MP-DNA载量越高可能导致肺部影像表现越严重;MP-DNA载量与血清中LDH水平呈正相关,提示MP-DNA载量可能与疾病严重程度存在正相关.

目的 探讨治疗重症手足口病患儿采用重组人干扰素α2b的临床疗效.方法 选取本院2018年4月～2019年5月收治30例重症手足口病患儿,随机数字表法将患儿分为观察组和对照组各15例,对照组患儿实施常规抗病毒感染治疗以及皮肤、口腔护理等,观察组在此基础上给予重组人干扰素α2b治疗.观察比较两组患儿的临床疗效、临床症状改善时间及不良反应发生情况.结果 观察组患儿的临床治疗总有效率高于对照组(P<0.05);观察组患儿体温、心率恢复时间以及手、足、口腔疱疹消退时间明显短于对照组(P<0.05);两组不良反应发生率比较无统计学意义(P>0.05).结论 对重症手足口病患儿给予重组人干扰素α2b临床疗效好,可明显改善患儿的临床症状,促进患儿健康恢复,安全性好.

1儿科重症血液净化技术 儿科血液净化(blood purification,BP)技术是指将患儿体内血液引出外经过1种净化装置,通过弥散、对流、吸附等方式清除血液中的有害物质,达到净化血液治疗疾病的目的.儿科血液净化技术起步较晚,直至20世纪70年代儿科血液净化技术在世界范围内逐渐普及,是治疗儿童急性肾衰竭有效手段,随着血液净化技术和装置的发展,血液净化应用的领域逐步扩大.我国儿科血液净化技术始于20世纪80年代,2011年中国医师协会儿科医师分会儿科血液净化学组成立,标志着我国儿科血液净化事业进入了新的历史阶段[1].

患儿以消化系统为首要症状起病,因血氨过高导致颅内出血、脑死亡.住院期间行基因检测结果提示由c.1006-3C＞G突变所致.本病临床表现缺乏特异性,主要依靠血尿的串联质谱分析,以及本病诊断金标准基因检测进行诊断.鸟氨酸氨甲酰基转移酶缺乏症(OTCD)患者病死率高,预后很差,目前尚无临床标准治疗方案,临床医师需提高对其认识和诊断、治疗水平,早期发现高血氨,早期进行血液净化技术可能会缓解症状.