目的 探讨清肠通便胶囊联合双歧杆菌乳杆菌三联活菌片治疗小儿功能性便秘(FC)的疗效及对其肠神经递质[P物质(SP)、生长抑素(SS)及一氧化氮(NO)]水平的影响,为临床治疗提供参考依据.方法 选取94例FC患儿作为研究对象,随机分为对照组和观察组各47例,两组均给予基础治疗,对照组在此治疗基础上给予双歧杆菌乳杆菌三联活菌片治疗,观察组在对照组治疗基础上加用清肠通便胶囊,观察两组临床疗效,检测血清SP、SS、NO水平,并观察两组患者症状改善情况及肠道菌群变化情况,统计不良反应发生率及复发情况.结果 观察组临床疗效明显高于对照组,差异有统计学意义(P＜0.05);治疗后两组便秘症状评分明显下降,粪便性状分级明显升高,与治疗前比较差异有统计学意义(均P＜0.05),且观察组改善情况明显优于对照组,差异有统计学意义(均P＜0.05);治疗后两组SP水平明显升高,SS及NO水平均明显降低,与治疗前比较差异有统计学意义(均P＜0.05),且观察组SP水平明显高于对照组,SS、NO水平明显低于对照组,差异有统计学意义(均P＜0.05);治疗后两组肠道菌群(肠杆菌、葡萄球菌、乳杆菌、双歧杆菌、酵母菌)优于治疗前,且观察组优于对照组,差异有统计学意义(均P＜0.05);治疗期间两组不良反应发生率比较,差异无统计学意义(P＞0.05);随访1个月后观察组复发率明显低于对照组,差异有统计学意义(P＜0.05).结论 清肠通便胶囊与双歧杆菌乳杆菌三联活菌片联合治疗小儿FC疗效显著,能够明显提高血清SP水平,同时降低SS及NO水平,改善患儿临床症状及肠道菌群失调情况,具有很高的临床应用价值.

Objective:To explore the application value of asthma prediction index (API) in the management of young wheezing children in primary hospitals.Methods:From July 2014 to December 2016, 137 children with recurrent wheezing diagnosed and treated in the People's Hospital of Qidong were selected for API evaluation.Forty-six children with positive API (treatment group) were given standardized treatment for childhood asthma, 43 patients with API positive (observation group) and 48 patients with API negative (control group) were given routine treatment (intermittent anti-inflammatory and antiasthmatic treatment). All children were given breathing nursing education and management, followed up to observe breathing control.Results:One child in the treatment group was withdrawn from the cohort, and the complete remission rates in the treatment group, observation group and control group were 86.7% (39/45), 9.3% (4/43) and 43.8% (21/48), respectively.The complete response rate in the treatment group and control group was higher than that in the observation group, and the differences were statistically significant (χ 2=53.39, 14.78, all P<0.05). Conclusion:API can effectively help pediatricians in primary hospitals to manage young wheezing children and improve the complete remission rate.

根据最新报道,尽管全球范围内的5岁以下儿童病死率(under-5 mortality rate, U5MR)出现了53％的明显下降,但仍低于全球"千年发展目标"制定的U5MR在1990—2015年下降2/3的总目标[1]. 为评估本地区的U5MR变化趋势以及达标情况,本研究分析启东市从1991年至2018年的U5MR变化趋势以及主要死因的构成,现报告如下.

Objective: To measure health-related quality of life score with patients of obstructive sleep apnea-hypopnea syndrome(OSAHS) associated with ischemic heart disease(IHD), and to estimate the clinical value of noninvasive continuous positive airway pressure(CPAP) ventilation by SF-36 survey. Methods:71 cases of OSAHS associated with IHD were randomly divided into two groups: group A is the combined treatment group, group B is the basic treatment group. Group A got a basic medical treatment combined with overall night CPAP treatment(every night>7 hours), and group B only got a basic medical treatment. Health-related quality of life measurements were taken by SF-36 survey before treatments and post-one-year treatment. The test, analysis of variance, rank sum test. were taken as statistical methods by data processing software SPSS 18.0. Results:There were no significant differences in age composition ratio and body mass index(BMI) between two groups(P>0.05). Eight dimensions of SF-36 survey there was no significant differences(P>0.05) between two groups before treatment. Eight dimensions of SF-36 survey of group A between before treatment and post-one-year treatment were significant differences, which physical health score, mental health score and the total score were significantly improved (P<0.01). Between before treatment and post-one-year treatment of group B seven dimensions of SF-36 survey, physical health score, mental health score and the total score were significantly differences(P<0.01), except mental health score. The group A between before treatment and post-treatment, the improvement rate of physical health score, mental health score and the total score respectively was 67 . 66%( 74 . 22%) , 26 . 67%( 51 . 01%) , and 44 . 62%( 51 . 57%) , and those of group B respectively was 2.71%(13.22%), 5.00%(9.71%) , 3.34%(10.21%), three indicators of both groups were statistically significant differences(P<0.01). Conclusion: A basic medical treatment combined with overall night CPAP treatment to OSAHS associated with IHD can improve the quality of life and provide a scientific basis for future clinical attention to further strengthen the CPAP treatment, which is worthy of clinical application.

Objective To investigate the infection status and clinical features of common viruses in acute lower respiratory infection (ALRI) among the hospitalized children 0 to 7 years old in Nantong of Jiangsu.Methods 1 376 swab samples from pharynx nasalis in the ALRI inpatients 0 to 7 years old were collected.The human respiratory syncytial virus (RSV),adenovirus (ADV),influenza virusA,B (IVA,B),parainfluenza virus Ⅰ ～ Ⅲ (PIV Ⅰ ～ Ⅲ)were detected by direct immunofluorescence assay,and the results were analyzed.Results In 1 376 respiratory tract samples,there were 577 cases(41.93％) of positive samples.In all positive samples,there were 376 cases of RSVpositive (65.16％),42 ADV-positive (7.28％),63 IVA-positive (10.92％),24 IVB-positive (4.16％),20 PIV Ⅰ-positive(3.47％),19 PIV Ⅱ-positive (3.29％),108 PIV Ⅲ-positive (18.72％),68 cases with mixed infection (11.79％) [two virus-positive ones in 59 cases (86.76％),three virus-positive ones in 9 cases (13.24％)].In different age group,the highest positive rate was in 0 ～ 6-month-old group(53.32％),with the lowest in 5-7 years old group(6.90％).Virus detection rate was higher in March 2012 (58.67％),December 2012 (53.33％),and January 2013(53.63％)than the rest months,including the lowest June 2012(33.33％).Bronchiolitis virus detection rate was the highest(69.23％)among ALRI.Conclusion The virus is major pathogen of children 0 to 7 years old with ALRI in Nantong of Jiangsu,and with difference among different ages,seasons and diseases.Infants and young children are the main affected population.

目的:探讨儿童哮喘急性发作的相关影响因素,并为减少急性发作制定早期干预手段提供科学依据。方法:选择在本院儿科确诊为哮喘的儿童100例,根据哮喘调查问卷,对相关影响因素进行Logistic回归分析,并将所有患儿随机分为干预组和对照组,干预组患儿根据实际情况进行有效干预,比较两组患儿干预后的急性发作情况的差异。结果:39例患儿在冬春哮喘急性发作(39.0%),33例在秋冬急性发作(43.0%),在其他季节发病(18.0%),与气候变化和季节交换明显相关者75例(75.0%)。发病与天气情况明显相关者53例(53.0%)。81例在上呼吸道感染后导致哮喘急性发作(81.0%),63例有哮喘家族史(63.0%),73例同时伴有过敏性鼻炎(73.0%),13例患有特异性皮炎(13.0%)。53例因空气过敏诱发哮喘发作(53%),25例因药物过敏诱发急性发作(25%)。多因素Logistic多元回归分析显示,儿童哮喘急性发作与气候、天气情况、上呼吸道感染、哮喘家族史、年龄、过敏性鼻炎或特异性皮炎、空气过敏、药物过敏等因素显著相关。比较12个月内的患者哮喘的急性发作率,发现患儿<6岁的急性发作率明显高于其他年龄组,经过干预后,干预组急性发作人数明显降低,且具有显著性差异(P<0.05)。结论:100例患儿均有不同程度的哮喘急性发作,主要与气候、空气湿度、上呼吸道感染、哮喘家族史、患儿年龄、过敏性鼻炎或特异性皮炎、空气过敏、药物过敏等有关。有效干预可显著降低患儿哮喘的急性发作。

目的 为避免某些医源性因素对新生儿造成伤害,确保新生儿健康成长.方法 作者对近年在临床遇见的因服用"深海鱼油",而发生的新生儿不良临床表现和处理进行了回顾总结,同时对其可能的疾病诊断、发病机理作了探讨.结果 发现新生儿服用"深海鱼油"后分别出现的皮肤、消化道、呼吸道等不同程度的症状和体征,其最大可能的诊断为新生儿过敏,但造成过敏的确切成分有待进一步研究.结论 新生儿服用深海鱼油可产生某些潜在疾病,在新生儿也可存在过敏性疾病,且随着社会发展,新的过敏原会不断增加,作为保健品的"深海鱼油"并不适合作为新生儿维生素AD的补充.

支气管哮喘(简称哮喘),是儿童期最常见的慢性呼吸道疾病.2000年国内城区儿童哮喘患病率调查统计显示儿童哮喘患病率1.97%, 2年现患病率1.54%[1].近年随着对哮喘发病机制认识的不断深入,治疗药物和方法不断更新和增加,但临床治疗效果仍不满意,未能达到2006版全球哮喘防治创议(GINA)提出的治疗目标[2].