Objective:To evaluate the value of monitoring regional cerebral oxygen saturation (rSO 2) in the prognosis of comatose children in pediatric intensive care unit (PICU). Methods:A total of 127 coma children who admitted to PICU at Henan Children′s Hospital from January 2019 to September 2021 were collected and divided into mild[Glasgow coma score(GCS): 13-15], moderate(GCS: 9-12) and severe coma(GCS: 3-8) groups according to GCS.A cerebral oxygen monitor was used to monitor the rSO 2 of all children before treatment, and on the 3rd, 7th and 14th day after treatment.The outcomes were assessed according to the pediatric cerebral performance category (PCPC), and the children were divided into recovery group(PCPC score: 1), disability group(PCPC score: 2-4) and poor prognosis group(PCPC score: 5-6). Multiple linear regression and receiver operating characteristic(ROC) curve were used to analyze the correlation between rSO 2 and PCPC score. Results:rSO 2 in mild, moderate and severe coma groups before treatment were (78.06±3.21)%, (66.07±6.05)%, and (52.87±6.49)%, respectively ( F=209.263, P<0.05). rSO 2 before treatment was positively correlated with GCS( r=0.806, P<0.05). There were significant differences in rSO 2 among recovery group, disability group and poor prognosis group before treatment and that on the 3rd, 7th and 14th day after treatment ( P<0.05). Notably, rSO 2 in recovery group was higher than that in disability group, and rSO 2 in disability group was higher than that in poor prognosis group.The rSO 2 of three groups showed an increasing trend over time ( P<0.05). Multiple linear regression analysis showed that rSO 2 on the 7th and 14th day of treatment were independent prognostic factors ( OR -0.042, 95% CI -0.082~0.003, P<0.05; OR -0.047, 95% CI -0.094~0.000, P<0.05). ROC analysis showed that rSO 2 on the 7th day of treatment had a relatively higher prognostic value for children in coma, and the area under the ROC curve for predicting the prognosis of abnormal brain function and no wakefulness were 0.741 and 0.746, respectively. Conclusion:Monitoring rSO 2 has predictive value for the prognosis of brain function of coma children in PICU, in which the prognostic value of rSO 2 on the 7th day after treatment is relatively higher and can be used as a reference index for prognosis assessment of coma children in PICU.

目的 探讨肠内营养支持在重度肺部感染合并脓毒症儿童中的应用及对血清总蛋白(TP)、清蛋白(ALB)、前清蛋白(PA)及肠黏膜屏障的影响.方法 选择2015年1月至2020年1月在河南省儿童医院接受治疗的120例重度肺部感染合并脓毒症儿童,采用随机数表法分为试验组(n=61)和对照组(n=59).对照组给延迟肠内营养治疗,试验组给予早期肠内营养支持治疗.比较两组TP、ALB、PA、肠脂肪酸结合蛋白(IFABP)、二胺氧化酶(DAO)、炎症因子、肠道菌群水平变化情况及不耐受发生情况.结果 治疗后,试验组和对照组血清TP、ALB、PA水平均随着时间的推移而升高,且试验组高于对照组,比较差异有统计学意义(t=6.503,6.909,5.494,P<0.05);治疗后,试验组和对照组IFABP、DAO水平均随着时间的推移而降低,且试验组低于对照组,差异有统计学意义(t=23.124,5.181,P<0.05);治疗后,试验组和对照组PCT、CRP、IL-6及TNF?α水平均随着时间的推移而降低,且试验组低于对照组,差异有统计学意义(t=9.116,7.429,18.449,9.209,P<0.05);治疗后,试验组和对照组双歧杆菌、嗜酸乳杆菌水平均随着时间的推移而升高,且试验组高于对照组,差异有统计学意义(t=5.612,7.809,P<0.05);两组不耐受主要为腹胀、腹泻、呕吐及胃潴留,两组总不耐受率比较,差异有统计学意义(χ2=9.347,P<0.05).结论 在重度肺部感染合并脓毒症儿童中早期肠内营养支持有一定的治疗效果,可能与其可改善血清TP、ALB、PA及肠黏膜屏障有关.

Objective:To analyze the predictive value of serum Nesfatin-1 combined with the Status Epilepticus Severity Scale (STESS) score on the short-term prognosis of children with status epilepticus (SE).Methods:A clinical data of 145 children with SE who were admitted to the Children′s Hospital Affiliated to Zhengzhou University, Henan Children′s Hospital, Zhengzhou Children′s Hospital, from January 2016 to January 2020 were analyzed retrospectively.After admission, the serum levels of Nesfatin-1 and the STESS score were measured.According to the Glasgow Outcome Scale (GOS) score at discharge, children with SE were divided into poor prognosis group (<5 scores) and good prognosis group (5 scores). Univariate and multivariate Logisitc regression analyses were performed to analyze influence of the serum Nesfatin-1 level and STESS score on the short-term prognosis of children with SE.Receiver operating characteristic (ROC) curve was depicted to evaluate the predictive value of serum Nesfatin-1 level combined with STESS score in the short-term prognosis of children with SE. Results:Twenty-five cases out of 145 (17.24%) children with SE were discharged with a GOS score of <5 (poor prognosis group), 120 cases were in the good prognosis group.In the poor prognosis group, the overall attack (88.00% vs.66.67%), attack time of SE > 1 h (76.00% vs.27.50%), admission to child intensive care unit(PICU) (76.00% vs.37.50%), implementation of endotracheal intubation (16.00% vs.5.00%), abnormal electroencephalogram(EEG) results (73.91% vs.41.03%), abnormal proportion of head imaging results (82.61% vs.29.49%), serum Nesfatin-1 level[(3.65±1.45) μg/L vs.(2.20±0.77) μg/L] and STESS score[(3.01±0.75) points vs.(1.80±0.60) points] were significantly higher than those in the good prognosis group (all P<0.05). Logistic regression analysis showed that the attack time of SE > 1 h, admission to PICU, abnormal EEG, abnormal proportion of head imaging results, serum Nesfatin-1 level and STESS score were independent risk factors for the poor short-term prognosis of children with SE ( OR=4.217, 3.456, 2.626, 4.109, 3.040 and 2.012, respectively, all P<0.001). The cut-off value of serum Nesfatin-1 level and STESS score was 3.01 μg/L and 2.38 points, respectively.The Youden index and AUC of the combination of serum Nesfatin-1 level and STESS scores were 0.736 and 0.921 (95% CI: 0.861-0.959), respectively, which were better than those of single detection of either serum Nesfatin-1 level [Youden index 0.447; AUC 0.795(95% CI: 0.720-0.858)] or STESS scores [Youden index 0.562; AUC 0.859(95% CI: 0.792-0.911)]. Conclusions:The abnormal increases in serum Nesfatin-1 level and STESS score are risk factors for poor prognosis of SE in children, and their combination has a high predictive value for the poor short-term prognosis.

The aim of this study was to study the effect of early nutritional assessment and nutritional support on immune function and clinical prognosis of critically ill children. 90 critically ill children at the same level of severity admitted to the pediatric intensive care unit (PICU) of our hospital (June 2019-June 2020) were chosen as the research objects and were equally separated into the experimental group and the control group by the random number table method. The children in the control group were admitted to the PICU according to the routine process, and the nutritional support was provided to the malnourished ones. After admission to the PICU, the children in the experimental group were given nutritional assessment, nutritional risk screening, and nutritional support according to the screening results. The PICU stay time and total hospitalization time of the experimental group were obviously shorter than those of the control group (P < 0.05), the hospitalization expenses of the experimental group were obviously lower than those of the control group (P < 0.05), the clinical outcomes and immune function of the experimental group were obviously better than those of the control group (P < 0.05), and the nutrition indicators of the experimental group were obviously higher than those of the control group (P < 0.05). Early nutritional assessment and nutritional support can effectively improve the immune function and reduce the incidence of adverse clinical outcomes of critically ill children, which are worthy of clinical application and promotion.

Objective To explore the predictive value of urinary KIM-1 and TIMP-2 levels in pediatric patients with sepsis complicated with acute kidney injury（AKI）. Methods A total of 106 children with sepsis were collected and divided into AKI group（n=34） and non-AKI group（n=72）. The clinical and laboratory serological indexes of children were collected, and the urinary KIM-1 and TIMP-2 levels of children in each group were detected by enzyme-linked immunosorbent assay. ROC curve was used to analyze the diagnostic performance of serum creatinine（Scr） and urinary KIM-1, TIMP-2 levels for AKI. Logistic regression was used to analyze the independent influencing factors of AKI in children with sepsis. Results Compared with the non-AKI group, the levels of Scr, urinary KIM-1 and TIMP-2 levels in the AKI group were significantly higher. The difference was statistically significant（P＜0.05）. The levels of urinary KIM-1 and TIMP-2 were independent influencing factors of AKI in children with sepsis（P＜0.05）. The areas under the curve of Scr, urinary KIM-1 and TIMP-2 levels for the diagnosis of AKI were 0.741, 0.896 and 0.869, respectively, and the optimal cut-off values were 64.77 μmol/L, 97.60 ng/L and 3.80 ng/L, respectively. Conclusions Urinary KIM-1 and TIMP-2 levels have high predictive value for AKI in children with sepsis.

目的 探讨脓毒症合并急性肺损伤患儿外周血辅助性T细胞1型/辅助性T细胞2型(Th1/Th2)比值及细胞因子水平变化与病情及预后的关系.方法 选取河南省儿童医院收治的脓毒症合并急性肺损伤患儿56例(脓毒症急性肺损伤组)作为研究对象.依据小儿危重症评分标准将研究对象分为非危重组(n=26)、危重组(n=18)和极危重组(n=12);根据研究对象28 d内临床结局分为存活组(n=45)和死亡组(n=11);另选择同期未合并器官损伤的普通脓毒症患儿50例(普通脓毒症组)及健康儿童50例(对照组)作为对照.采用流式细胞术检测所有受试儿外周血Th1、Th2细胞百分比,并计算Th1/Th2比值;采用酶联免疫吸附法测定血清中γ干扰素(IFN-γ)、白细胞介素-4(IL-4)水平,并计算IFN-γ/IL-4比值.结果 与普通脓毒症组及对照组比较,脓毒症急性肺损伤组患儿血清IFN-γ水平、IFN-γ/IL-4比值及Th1/Th2比值均显著降低,IL-4水平明显升高,差异有统计学意义(P<0.05);极危重症组IL-4水平、IFN-γ/IL-4比值及Th1/Th2比值明显高于非危重组和危重组,IFN-γ水平明显低于非危重组,差异有统计学意义(P<0.05);与存活组相比,死亡组IL-4水平升高,IFN-γ/IL-4比值及Th1/Th2比值降低,差异有统计学意义(P<0.05).IFN-γ和IL-4水平及IFN-γ/IL-4比值、Th1/Th2比值预测28 d结局的曲线下面积分别为0.619、0.681、0.695及0.767.结论 Th1/Th2比值及细胞因子水平与脓毒症合并急性肺损伤患儿病情严重程度有关,且对预后评估有一定价值.

Objective To investigate the epidemiology and the effectiveness of resuscitation from cardiopulmonary arrest (CPA) among critically ill children and adolescents during pediatric intensive care unit (PICU) stay across China. Methods A prospective multicenter study was conducted in 11 PICUs in tertiary hospitals. Consecutively hospitalized critically ill children, from 29-day old to 18-year old, who had suffered from CPA and required cardiopulmonary resuscitation (CPR) in the PICU were enrolled (December 2017–October 2018). Data were collected and analyzed using the “in-hospital Utstein style.” Neurological outcome was assessed with the Pediatric Cerebral Performance Category (PCPC) scale among children who had survived. Factors associated with the return of spontaneous circulation (ROSC) and survival at discharge were evaluated using multivariate logistic regression. Results Among 11,599 admissions to PICU, 372 children (3.2%) had CPA during their stay; 281 (75.5%) received CPR, and 91 (24.5%) did not (due to an order of “Do Not Resuscitate” requested by their guardians). Cardiopulmonary disease was the most common reason for CPA (28.1% respiratory and 19.6% circulatory). The most frequent initial dysrhythmia was bradycardia (79%). In total, 170 (60.3%) of the total children had an ROSC, 91 had (37.4%) survived till hospital discharge, 28 (11.5%) had survived 6 months, and 19 (7.8%) had survived for 1 year after discharge. Among the 91 children who were viable at discharge, 47.2% (43/91) received a good PCPC score (1–3). The regression analysis results revealed that the duration of CPR and the dose of epinephrine were significantly associated with ROSC, while the duration of CPR, number of CPR attempts, ventricular tachycardia/ventricular fibrillation (VT/VF), and the dose of epinephrine were significantly associated with survival at discharge. Conclusion The prevalence of CPA in critically ill children and adolescents is relatively high in China. The duration of CPR and the dose of epinephrine are associated with ROSC. The long-term prognosis of children who had survived after CPR needs further improvement.

目的 探讨脑氧饱和度(rScO 2)及脑血流参数氧合血红蛋白浓度(ΔO 2 Hb)、还原血红蛋白浓度(ΔHHb)和血红蛋白浓度指数(THI)在判断脓毒性休克患儿预后中的价值.方法 选择2017年10月—2019年10月收治的脓毒性休克患儿50例.入重症监护病房(ICU)即刻开始监测患儿血流动力学参数,包括平均动脉血压(MAP)、中心静脉压(CVP)、中心静脉血氧饱和度(ScvO 2)和血乳酸,同时监测脑血氧参数rScO 2、ΔO 2 Hb、ΔHHb和THI.根据入ICU后28天的预后情况将患儿分为生存组和死亡组,分析两组脑血氧与血流动力学参数.结果 共纳入50例脓毒症休克患儿,男31例、女19例,中位年龄4岁;生存组30例,死亡组20例.死亡组APACHEⅡ评分及SOFA评分显著高于生存组,差异均有统计学意义(P<0.05).初始复苏治疗6小时后,与生存组相比,死亡组MAP、CVP和ScvO 2均显著降低,差异有统计学意义(P<0.05).生存组及死亡组患儿脑血氧参数rScO2、ΔO2Hb、ΔHHb、THI随治疗时间变化的差异有统计学意义(P<0.05),均呈上升趋势.初始复苏治疗后,生存组患儿rScO 2和THI随时间上升较快,显著高于死亡组(P<0.05).治疗6小时时的rScO 2、ΔO 2 Hb与ScvO 2呈显著正相关(P<0.05),而THI与血乳酸水平呈显著负相关(P<0.05).rScO 2、ΔO 2 Hb、ΔHHb、THI诊断脓毒性休克患儿预后的AUC分别为0.765、0.642、0.608和0.718.结论 利用近红外光谱技术监测早期脑血氧参数rScO 2、ΔO 2 Hb、ΔHHb、THI对判断脓毒性休克患儿的预后有一定价值.

Objective:To investigate the expression and clinical significance of serum S100B protein, neuron specific enolase(NSE), neuropeptide Y and brain-derived neurotrophic factor(BD-NF)in children with status epilepticus disease.Methods:A total of 36 children with epilepsy, including 19 males and 17 females, were admitted to the department of Internal Intensive Care Unit in Henan Children′s Hospital from January 2016 to October 2020 as the epilepsy group, aged(5.76±2.37)years old, ranging from 3 to 12 years old.At the same time, 36 healthy children from Henan Children′s Hospital were selected as the healthy group, 18 males and 18 females, aged(5.56±2.41)years old, ranging from 3 to 13 years old.The serum S100B protein, NSE, neuropeptide Y, and BD-NF levels of the two groups were compared, and the levels of the children in the epilepsy group were compared before and after treatment and correlation analysis was performed to predict the value of status epilepticus.Results:The epilepsy group serum S100B protein[(0.89±0.17)μg/L], NSE[(29.33±5.42)μg/ml], neuropeptide Y[(287.59±29.41)ng/L], BD-NF[(1.38±0.22)μg/L] level is significantly higher than the healthy group[(0.15±0.02)μg/L, (5.73±5.73)μg/ml, (169.43±28.24)ng/L, (0.68±0.13)μg/L] , The difference was statistically significant( P<0.001). Serum S100B protein[(0.43±0.11)μg/L], NSE[(12.65±2.71)μg/ml], neuropeptide Y[(226.17±26.42)ng/L], BD-NF[(1.09± 0.21)μg/L] level was significantly lower than before treatment, the difference was statistically significant( P<0.001). Serum S100B protein level was positively correlated with NSE level( r=0.646, P<0.001); it was positively correlated with neuropeptide Y level( r=0.486, P=0.003); it was positively correlated with BD-NF level( r=0.508, P=0.002). The area under curve(AUC)value of S100B protein was 0.763, the AUC value of NSE was 0.788, the AUC value of neuropeptide Y was 0.719, and the AUC value of BD-NF was 0.724, the difference was statistically significant( P<0.05). Conclusion:The serum levels of S100B protein, NSE, neuropeptide Y and BD-NF were highly expressed in children with status epilepticus.The higher the levels of S100B protein, NSE, neuropeptide Y and BD-NF, the higher the risk of status epilepticus, all four indicators contribute to the diagnosis of status epilepticus.

目的 探讨视频脑电图(VEEG)对儿童重症病毒性脑炎合并癫痫持续状态的临床价值.方法 回顾性分析2017-03—2020-07河南省儿童医院郑州儿童医院内科重症监护室收治的重症病毒性脑炎合并癫痫持续状态患儿94例,分析其临床资料、视频脑电图结果.结果 94例中,<1岁40例(42.5％),死亡9例(22.5％);1～3岁14例(14.9％),死亡4例(21.1％);>3～6岁21例(22.3％),死亡4例(19.0％);>6岁19例(20.2％),死亡5例(26.3％).<1岁者SE发病率最高,但各年龄段病死率差异不显著.94例中CSE组65例,死亡17例,NCSE组29例,死亡9例.CSE组和NCSE组病死率比较差异无统计学意义(P=0.911).VEEG结果:背景活动为弥漫性慢波和(或)局灶性慢波88例,交替图形3例,低电压2例,周期性放电1例;间歇期有癫痫样放电39例.结论 VEEG监测对儿童重症病毒性脑炎合并SE患儿的脑功能评价具有重要意义.

目的 探讨胃肠激素水平变化在胃肠功能障碍危重患儿预后判断中的价值.方法 选取合并胃肠功能障碍的重症患儿696例作为研究对象,患儿入院后均接受常规治疗(包括抗感染、机械通气、维持内环境、保护胃肠道黏膜、营养支持等治疗),入院后采集静脉血检测胃肠激素[胃泌素(GAS)、胃动素(MOT)、生长抑素(SS)]、炎症指标[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]水平,采用胃肠功能评分(SNGF)评价胃肠功能障碍程度,并将患儿分为轻度组(SNGF＜2分)、中度组(SNGF2～4分)和重度组(SNGF＞4分).结果 轻度组各胃肠激素水平与中度组比较,差异无统计学意义(P＞0.05);重度组GAS、MOT水平低于轻度组和中度组,SS水平高于轻度组和中度组,差异有统计学意义(P＜0.05).轻度组IL-6、TNF-α水平与中度组比较,差异无统计学意义(P＞0.05);重度组IL-6、TNF-α水平高于轻度组和中度组,差异有统计学意义(P＜0.05);中度组CRP水平高于轻度组,重度组CRP水平高于中度组,差异有统计学意义(P＜0.05).IL-6、TNF-α、CRP与SS呈显著正相关(P＜0.05),与GAS、MOT呈显著负相关(P＜0.05).存活患儿GAS、MOT水平高于死亡患儿,SS水平低于死亡患儿,差异有统计学意义(P＜0.05).结论 胃肠激素水平能一定程度反映胃肠功能障碍的严重程度,尤其对重症胃肠功能障碍患儿的预后具有判断价值.

目的 探讨视频脑电图在儿童重症昏迷并发非惊厥性癫痫持续状态的应用价值.方法 回顾性分析郑州大学附属郑州儿童医院重症监护病房2017年3月-2020年7月收治的29例重症昏迷合并非惊厥性癫痫持续状态的患儿的临床资料,行长程VEEG监测并分析结果.结果 在29例患儿中,治疗后好转17例,死亡9例,遗留有抽搐3例;其中:0 ～3岁18例,死亡7例;3～6岁8例,死亡1例,遗留抽搐2例;大于6岁3例,死亡1例,遗留抽搐1例.VEEG结果:背景活动为弥漫性慢波和或局限性慢波的27例,周期性放电1例,低电压1例;间歇期有癫痫样放电的15例.29例均记录到NCSE,发作频率从数次到百余十次不等.结论 对持续昏迷或昏迷原因不明的患儿进行视频脑电图监测,对及早诊治NCSE具有重要意义.

目的 分析连续性肾脏替代治疗对严重脓毒症患儿维生素B1的影响.方法 选择2017年3月至2020年3月我院PICU住院的40例严重脓毒症患儿,实施连续性肾脏替代治疗,根据患儿维生素B1皮试结果分为A组(10例,维生素B1肌肉注射)、B组(15例,连续3 d维生素B1肌肉注射)、C组(15例,无维生素B1治疗).对比三组患儿治疗前后的维生素B1含量及治疗效果.结果 B组治疗后第3 d、第7 d的维生素B1含量高于A组与C组(P<0.05).B组的总有效率高于A组与C组(P<0.05).结论 严重脓毒症患儿在连续性肾脏替代治疗后立即接受连续3 d维生素B1补充治疗,能够有效提高维生素B1含量,提升治疗效果.

目的 探讨血栓弹力图(TEG)在儿童重症支原体肺炎(SMPP)凝血监测中的价值.方法 选取2016年1月至2019年12月入住河南省儿童医院儿科重症监护室(PICU)的37例SMPP患儿为研究对象,根据是否合并栓塞分为合并血栓组和未合并血栓组,其中合并栓塞组13例,未合并栓塞组24例.患儿入院后按照病情接受常规治疗,阿奇霉素抗感染(如合并细菌感染时加用β内酰胺类抗生素或碳氢酶烯类抗生素)、机械通气、维持内环境、营养支持、血液净化、抗凝等综合治疗.所有纳入研究的患儿均在入住PICU第1天、第3天、第5天、第7天、第9天、第11天、第13天常规监测凝血四项、D-二聚体和TEG,根据病情进行其他监测.结果 入院后第1天、第3天、第5天、第7天、第9天、第11天、第13天合并血栓组D-二聚体高于未合并血栓组(P<0.05).合并血栓组的凝血反应时间(R值)低于未合并血栓组(P<0.05);合并血栓组的血凝块形成时间(K值)低于未合并血栓组(P<0.05);合并血栓组凝固角(α角)高于未合并血栓组(P<0.05);合并血栓组最大振幅(MA)高于未合并血栓组(P<0.05);合并血栓组凝血综合指数(CI值)高于未合并血栓组(P<0.05).合并血栓患儿D-二聚体与R值、K值呈负相关(r=-0.791、-0.816,P<0.05),与α角、MA值、CI值呈正相关(r=0.893、0.725、0.691,P<0.05).TEG中各指标与D-二聚体对合并血栓的患儿诊断的敏感性差异无统计学意义(P>0.05);TEG中各指标较D-二聚体对合并血栓的患儿诊断的特异性高(P<0.05);TEG中各指标较D-二聚体对SMPP合并血栓的患儿诊断指数高(P<0.05).结论 TEG在儿童SMPP凝血监测中具有较好的价值,尤其是在合并血栓的患儿中具有较好的特异性和敏感性,可为临床干预提供指导.

目的 观察脓毒症患儿HDL等脂代谢及高敏肌钙蛋白T(hsTnT)水平的变化,并分析其临床意义.方法 选取2016年10月-2018年2月在我院接受治疗的脓毒症患儿40例为观察组,同时选取同期在我院接受体检的40例健康儿童作为对照组.观察两组研究对象HDL等脂代谢水平、高敏肌钙蛋白T、免疫指标和炎症因子水平的差异,并分析HDL等脂代谢水平、高敏肌钙蛋白T、免疫指标与炎症因子水平的相关性.结果 观察组患儿的HDL水平明显低于对照组,LDL-C、TC、TG和hs-TnT水平高于对照组(t=-9.974、-4.968、-6.554、-29.013,P<0.001);观察组患儿的IgG、IgA和IgM水平均低于对照组(t=9.269、12.158、5.852,P<0.001);观察组患儿的IL-10、IL-6和IL-12水平均高于对照组(t=-21.719、-27.575、-24.533,P<0.001);观察组患儿HDL-C水平与IgG、IgA和IgM水平正相关,与IL-10、IL-6和IL-12水平负相关;LDL-C、TC、TG和hs-TnT水平与IgG、IgA和IgM水平负相关,与IL-10、IL-6和IL-12水平正相关.结论 脓毒症患儿HDL和高敏肌钙蛋白T水平均较高,且与炎症因子IL-10、IL-6、IL-12和免疫功能指标IgG、IgA、IgM具有一定的相关性.

目的 探讨儿童癫痫持续状态(SE)的临床特点和预后影响因素.方法 回顾性分析河南省儿童医院2014年8月至2018年7月收治的70例SE患儿临床资料,根据其随访1个月预后情况分为预后良好组与预后不良组,分析其预后影响因素.结果 本研究纳入的70例SE患儿中60.00％为小于或等于5岁,67.14％病因为症状性,61.43％由于感染所诱发,85.71％为惊厥性癫痫持续状态;对患儿进行随访,其中预后良好51例(72.86％),预后不良19例(27.14％).两组患儿性别、诱因、既往惊厥病史、癫痫发作类型、外周血白细胞计数(WBC)比较差异无统计学意义(P>0.05),年龄、影像学检查、惊厥持续时间、用药至发作停止时间、C反应蛋白水平、血糖水平比较差异有统计学意义(P<0.05);logistic回归分析显示年龄、影像学检查、惊厥持续时间、用药至发作停止时间、C反应蛋白水平、血糖水平是影响SE患儿预后的独立危险因素.结论 年龄、影像学检查异常、惊厥时间、用药至发作停止时间、C反应蛋白水平、血糖水平可影响SE患儿的预后.

目的 探讨脓毒症患者血清中炎性因子、组织因子(TF)及组织因子途径抑制物(TFPI)水平的变化及临床意义.方法 选择2012年1月至2015年12月郑州市儿童医院收治的89例脓毒症患者为研究对象,根据患者病情分为脓毒症组(n=61)、严重脓毒症组(n=17)和脓毒性休克组(n=11).各组患者入院后立即采集静脉血2 mL,采用酶联免疫吸附试验检测血清中C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、TF及TFPI水平,采用电化学发光法检测血清中降钙素原(PCT)水平;并分析各指标与小儿危重病例评分(PCIS)的相关性.结果 严重脓毒症组和脓毒性休克组患者血清中CRP、TNF-α、PCT及TF水平高于脓毒症组,TFPI水平低于脓毒症组(P<0.05);脓毒性休克组患者血清中CRP、TNF-α、PCT和TF水平高于严重脓毒血组,TFPI水平低于严重脓毒症组(P<0.05).脓毒症患者血清中CRP、TNF-α、PCT及TF水平与PCIS呈显著负相关(r=-0.76、-0.72、-0.81、-0.70,P<0.05),TFPI水平与PCIS呈显著正相关(r=0.73,P<0.05).结论 血清中CRP、TNF-α、PCT、TF及TFPI水平在评估脓毒症患者的病情严重程度中具有一定的价值,CRP、TNF-α、PCT及TF水平越高,TFPI水平越低,患者病情越严重.

目的 探讨丙酮酸乙酯(EP)对缺氧缺血性脑损伤(HIBI)新生大鼠海马神经元凋亡及磷脂酰肌醇3-激酶(PI3-K)/蛋白激酶(Akt)信号通路的影响.方法 将7d龄Wistar大鼠随机分为假手术组(sham组)、模型组(HIBI组)、丙酮酸乙酯处理组(EP组,于缺血缺氧前30 min行3 mg/kg EP腹膜内注射).采用Rice法制备HIBI模型,透射电子显微镜下观察新生大鼠海马区神经元变化;2,3,5-三苯基四氮唑-水合物(TTC)染色法检测缺氧缺血脑组织损伤情况;TUNEL法和双重免疫荧光染色法检测海马神经元凋亡情况;免疫组织化学法和蛋白免疫印迹法检测海马组织p-Akt和Bcl-2蛋白表达情况.结果 模型制备24 h后,sham组神经元结构基本正常,HIBI组神经元呈气蚀性改变,EP组神经元气蚀性变化减少,神经元受损情况改善.模型制备48 h后,与sham组比较,HIBI组梗死面积显著增加(P＜0.05);与HIBI组比较,EP组梗死面积显著降低(P＜0.05).sham组TUNEL阳性染色细胞少,而HIBI组TUNEL阳性细胞显著高于sham组(P＜0.05);EP组TUNEL阳性细胞数显著降低(P＜0.05).HIBI组双标记阳性细胞比例显著高于sham组(P＜0.05);与HIBI组比较,EP组双标记阳性细胞比例显著降低(P＜0.05).与HIBI组比较,EP组p-Akt和Bcl-2的平均光密度值显著高于HIBI组(P＜0.05);EP组D-Akt和Bcl-2蛋白表达水平显著增加(P＜0.05).结论 EP处理通过激活PI3K/Akt信号通路,促进Bcl-2表达,缓解HIBI引起的神经元凋亡,从而发挥脑保护作用.

目的 探讨渗透性降颅压对万古霉素静脉泵入治疗颅内感染患儿血药浓度的影响.方法 回顾性分析2012年1月-2016年12月350例于医院接受降颅内压治疗的颅内感染患儿资料,根据治疗方案分为三组:甘露醇组145例、甘油果糖组86例、联合组(甘油果糖联合甘露醇)119例,比较三组患儿治疗效果、万古霉素血药浓度、肾小球滤过率(glomerular filtration rate,GFR)变化情况及不良反应发生率.结果 联合组治疗有效率优于甘油果糖组(P＜0.05);甘油果糖组起效时间长于甘露醇组和联合组(P＜0.05),联合组持续时间长于甘露醇组和甘油果糖组(P＜0.05);甘露醇组用药后GFR水平低于甘油果糖组和联合组(P＜0.05);甘油果糖组患儿血药谷浓度最佳值15～20 mg/L的占比为39.53％,高于甘露醇组和联合组(P＜0.05);甘露醇组肾功能损害和电解质紊乱发生率高于甘油果糖组和联合组(P＜0.05).结论 甘油果糖联合甘露醇降颅压治疗颅内感染患儿的效果好,且不会明显影响万古霉素血药谷浓度.

Clinical features of sepsis-associated encephalopathy in children with different prognoses were analyzed and the changes of regional cerebral oxygen saturation (rScO2) and central venous oxygen saturation (ScvO2) were measured. Eighty children with sepsis-related encephalopathy, admitted to the Pediatric Intensive Care Unit (PICU) of the Children's Hospital Affiliated to Zhengzhou University, were enrolled in this study and post-intensive care syndrome (PICS) scoring was performed within 24 h after admission. Patients were separated into groups according to the score results and treatment outcomes. Clinical features, functional tests, imaging examinations, PICS scores, and modified Glasgow Coma Scale (GCS) scores were compared among children with varying severities and prognoses. The changes of rScO2 and ScvO2 at different time-points among children with different prognoses were measured and compared. According to PICS scores, there were 8 non-critically ill children, 42 critically ill children, and 30 extremely critically ill children. Fifty-two children survived, and the survival rate was 65%. Comparison of the clinical characteristics of children with different conditions showed that deep coma, generalized seizure, severe electroencephalogram (EEG) abnormalities, and the survival of children were significantly associated with the severity of disease (P<0.05). At the same time, compared to the survivors group, the rates of generalized seizures and severe EEG abnormalities were significantly increased in the deceased children group, while the PICS and GCS scores were significantly decreased (P<0.05). rScO2 values in the deceased group were lower than those in the survival group at different time-points, but the differences were not significant (P>0.05). On the contrary, ScvO2 values were significantly higher in the deceased group than those in the survivors group (P<0.05). The lower the PICS and GCS scores in children with sepsis-related encephalopathy, the more serious the condition, and the more likely to develop disturbance of consciousness, epileptic seizures, and abnormal EEG changes. Whereas, changes of ScvO2 are closely related to prognosis.