金黄色葡萄球菌(Staphyloeoccus aureus)感染后形成播散性感染,病情凶险,进展迅速,早期反复排查潜在迁徙性病灶,是提高治愈率的关键.以腰痛为首发症状的金黄色葡萄球菌脑膜炎较少见,因临床表现不典型常被误诊、漏诊.现报道1例金黄色葡萄球菌引起的化脓性脑膜炎,早期仅表现为腰痛,随后出现发热伴意识障碍,经利奈唑胺联合头孢曲松治疗,后降阶梯为利奈唑胺抗感染治疗,并以地塞米松减少炎性渗出,防止脑膜粘连,胰岛素控制血糖,患者接受上述治疗后,腰痛等症状好转,复查脑脊液基本正常,腰椎病灶基本消失.通过分析此病例,旨在提高临床工作者对早期临床表现不典型的金黄色葡萄球菌感染的认识.

Objective To evaluate the efficacy of the combined therapy of ReDuNing injection and acyclo-vir on children with infectious mononueleosis(IM). Methods From October 2012 to July 2015 in the emergency ward of Children′s Hospital of Nanjing Medical University ,167 cases diagnosised with infectious mononucleosis were enrolled in this study. Ninety-five cases received acyclovir treatment were recruited in the conventional treat-ment group,72 cases received the combined thrapy of ReDuNing injection and acyclovir of children were recruited in the observation group. The clinical symptoms ,clinical manifestation and blood routine ,liver and kidney func-tion,myocardial enzymes,temperature recovery time,reduce lymph node,liver function recovery time and hospi-talization time of patients were recorded and compared between the two groups. Results No significant differences were observed in the clinical course and general fever,pharyngitis,lymphadenopathy,hepatosplenomegaly,rash and eyelid edema in children of the observation group (ReDuNing + Acyclovir) and routine treatment group (Acyclovir). No significant differences were found in blood routine ,blood biochemical indexes of liver ,kidney function and myocardial enzymes in patients of the two groups before and after treatment. The white blood cells , ALT and LDH were significantly reduced in patients of the two groups after treatment(P<0.05). However,LDH was still high in patients of the two groups before discharge ,with the level of(355.63 ± 116.89)U/L and(347.79 ± 106.74)U/L,respectively. The pyretolysis time(2.97 ± 2.56)d,lymph node reduced time(9.08 ± 1.54)d,liver function recovery time(8.67 ± 2.35)d,white blood cell recovery time(6.76 ± 2.96)d,hospitalization time (11.10 ± 3)d in the observation group were significantly shortened than those in the conventional treatment group ((4.38 ± 2.70)d,(10.48 ± 3.62)d,(11.50 ± 3.71)d,(9.15 ± 3.24)d,12.32 ± 3.62)d,respectively)(P<0.05, respectively). Conclusions The fever,lymphadenopathy,leukocytosis,liver damage and LDH were relieved and reduced at different degrees in patients of both the observation group and the routine treatment group after treat-ments. Reduning combined with acyclovir treatments lead to better clinical efficacy in children ,with shortening the duration of fever,Lymph node reduction time,and white blood cell recovery time. In particularly,the combined therapy can shorten the recovery time of patients with liver function damage ,which is a safe clinical application and can be used as one of the effective treatment measures for children with infectious mononucleosis.

Objective To evaluate the effect of fluid load on the prognosis of severe hand , foot and mouth disease in children. Methods The patients with severe hand foot and mouth disease in the emergency department of PICU in our hospital were enrolled as the research object. We would collect demographic characteristics , labora-tory tests and clinical data: age, gender, focus, basic disease, and simplified acute severity score (SAPS)Ⅱ and record the cumulative amount of fluid balance at 24, 48, 72 hours after admission. Results There was a signifi-cant difference on fluid balance at 48 and 72 hours between the survival group and the death group , the death group appeared the positive liquid balance , and there were significant differences in PICU retention time , mechani-cal ventilation rate, MODF involved organs, mortality and other prognostic indicators between the negative fluid balance group and the positive fluid balance group. Conclusion Fluid balance is an important treatment for severe hand foot and mouth disease, and positive liquid balance is related to mortality and other adverse prognosis.

目的 总结Gilbert综合征(GS)的临床特点、诊断和治疗.方法 回顾性分析11例GS患者的临床、实验室检查、肝组织病理以及胆红素-尿嘧啶二磷酸葡萄糖醛酸转移酶(UGT)基因的检测资料.结果 11例GS患者中,有皮肤、巩膜黄染9例,无自觉症状4例,纳差伴乏力7例,右上腹不适5例,恶心呕吐2例.20岁以前发病患者的平均总胆红素(TBil)和间接胆红素(IBil)分别为123.85 μmol/L和52.74 μmol/L,均高于20 40岁发病者的111.85 μmol/L和41.83 μmol/L(P＜0.05).对1例患者行基因测序,其UGT1A1基因1号外显子存在686 C＞A杂合突变.结论 GS患者表现为慢性反复轻度升高的IBil,临床症状轻微.临床诊断无特异性方法,UGT1A1基因检测对于GS的诊断、治疗和遗传咨询具有重要意义.

<正>1病例资料患儿,孙某某,男,4岁6个月,江苏泗洪人,因"误服百草枯8h"于2012年5月28日入院。2012年5月27日20:00,患儿误服百草枯约7mL,20min后在当地卫生院洗胃,并予维生素C及法莫替丁等治疗;28日4:55,收入本院PICU。病程中患儿无抽搐、呕血、

目的探讨小儿中毒发生的相关因素,并提出相应的防范对策以及治疗体会。方法对184例小儿急性中毒的原因以及治疗进行回顾性分析。结果小儿急性中毒的发生:农村高于城市;男孩多于女孩;发生的高峰年龄是0-6岁;中毒的主要原因是药物(58.2%)、化学制剂(13.6%)、农药(9.8%)、灭鼠药(5.9%)。结论加强儿童及其家长的相关知识教育是预防小儿急性中毒的重要措施,及早予洗胃及应用解毒剂等综合治疗可有效抢救中毒患儿。

Objective:To explore the risk factors for acute poisoning in children and search the:preventive measures.Methods: The retrospective study was performed on 268 cases of acute poisoning which were treated in the emergency department of Nanjing chil- dren hospital during a three-year period.Result:The percentage of boy in the 268 cases of acute poisoning was 60.45%,and that of chil- dren of 1-3 years age was 49.25%.61.19% of the total cases were rural children.Poisoning in digestive system accounted for 90.67 % of the total.142 cases were the poisoning with drug predominating.224 cases were indoor poisoning.Conclusions:Acute poisoning was more common in the boys than the girls and children of 1-3 years age group were more susceptible to acute poisoning.It occurred more frequently in rural areas than in cities;and the indoor poisoning was more frequent than the outdoor poisoning.It was recommended that more preventive measures and health education should be popularized and propagated in society.

目的:探讨小儿惊厥持续状态的病因和预后。方法:对32例患儿的年龄、惊厥类型、病因、临床转归进行分析。结果:32例患儿中22例好转,10例死亡或放弃治疗。其中强直-阵挛性发作、以毒鼠药中毒等预后差。安定、鲁米那钠和氯硝基安定治疗该病疗效较理想。结论:能够引起惊厥的各种原因都可导致惊厥持续状态,其预后各有不同。惊厥患儿处理原则是维持生命功能、尽快止惊、控制发作、治疗病因及预防复发,早期有效地控制惊厥是关键。

Gilbert综合征由于发病率低,起病隐匿,临床表现无特异性,患者常以"黄疸待查"求医,加之多数医生对该病认识不够,故误诊及漏诊率较高.2002年1月～2005年6月,我科经饥饿试验[1]及肝活检等明确诊断15例,并经苯巴比妥治疗有效.

复方苯乙哌啶(又名复方地芬诺酯)是治疗急慢性腹泻的常用药[1],由于个体敏感性、剂量使用不妥或保存不善造成小儿误服易出现中毒.2000年1月至2007年1月,我院儿科共收治复方地芬诺酯中毒患儿32例,现报告如下.