Objective:To compare the differences in sleep structure between healthy children and children with cerebral palsy (CP) using polysomnography (PSG).Methods:Fifty-six children aged 1-15 hospitalized for cerebral palsy formed the experimental group, while 30 healthy children served as controls. Both groups were given 24-hour PSG, and their sleep structures were compared and analyzed.Results:The incidence of sleep disorders in the children with cerebral palsy (55.4%) was significantly higher than among the healthy children (20.0%). The average sleep latency was significantly higher than among the healthy children, while the duration and the percentage of the rapid eye movement (REM) stage were significantly lower than among the healthy children. Total sleep time [(458.47±95.62)min], sleep efficiency [(74.26±13.63)%], duration of REM [(68.90±42.70)min] and REM percentage [(13.87±7.12)%] were all significantly lower for the children with severe cerebral palsy than for those with mild or moderate disorder. Their time to wake up after falling asleep was significantly longer. Moreover, the duration of REM and the REM percentage of children with dyskinetic cerebral palsy were significantly lower than for those with spastic cerebral palsy.Conclusions:The incidence of sleep disorders among children with cerebral palsy is higher than among healthy children. They have more difficulty in falling asleep and have a shorter REM stage. Children with severe cerebral palsy and involuntary cerebral palsy have more sleep problems.

目的 介绍河南省脑瘫儿童登记及康复管理平台(HCPRRMS)建设过程,探讨区域性脑瘫登记管理及监测网络建设思路.方法 系统性地介绍HCPRRMS建设过程、登记内容及初步结果.结果 2014年开始自主开发HCPRRMS,2015年3月开始登记单中心住院脑瘫儿童相关信息,2018年底开始在河南省多家县市级医疗及康复机构推广应用,截止到2019年9月共23家儿童康复机构使用.共纳入1357例脑瘫儿童,登记内容包括性别、出生体质量、孕周、高危因素、脑瘫分型、粗大运动功能分级(GMFCS)以及并发症情况.其中,男性936例(68.98％);孕周小于37周501例(36.92％);出生体质量小于2500 g 443例(32.65％);出生时并发缺氧缺血性脑病者430例(31.69％);脑瘫类型中痉挛型最多,为1117例(86.74％);不同型别脑瘫儿童GMFCS分级有显著性差异(P<0.05);有头部MRI检查记录者1117例,其中侧脑室周围白质软化为主的白质损伤最多,为480例(42.97％);并发症方面,并发癫痫196例(14.44％),并发视觉障碍109例(8.03％),并发听觉障碍158例(11.64％),≥2岁769例中,并发语言-言语障碍424例(52.66％),≥4岁216例中,并发智力障碍82例(37.96％).结论 HCPRRMS有助于了解脑瘫儿童高危因素、临床和影像学特点及并发症情况.

目的 观察抗痉挛联合神经生理疗法(Bobath)治疗痉挛型脑瘫患儿的效果.方法 选取60例痉挛型脑瘫患儿,随机对照表法分为对照组和观察组,各30例.对照组采用Bobath治疗,观察组采用抗痉挛联合Bobath治疗.比较分析2组患儿治疗前及治疗3个疗程后四肢解痉情况(肌张力Ashworth评分)及运动功能[粗大运动功能评估量表(GMFM)]评分结果.结果 治疗3个疗程后,观察组患儿的Ashworth评分上肢(1.94±0.34)分、下肢(1.75±0.26)分,低于对照组的上肢(2.56±0.41)分、下肢(2.32±0.40)分,差异有统计学意义(P＜0.001);治疗后,观察组患儿GMFM评分为(51.25±7.86)分,对照组为(41.24±6.79)分,均高于治疗前,且观察组高于对照组,差异有统计学意义(P＜0.001).结论 抗痉挛联合Bobath可减轻患儿痉挛症状.

OBJECTIVE:To study the clinical efficiency, electroencephalogram (EEG) changes and cognitive improvements of ketogenic diet (KD) in children with refractory epilepsy. METHODS:Twenty pediatric patients (7-61 months in age) with refractory epilepsy were recruited between August 2012 and August 2013. KD therapy was performed on all participants for at least 3 months based on a fasting initiation protocol with the lipid-to-nonlipid ratio being gradually increased to 4 : 1. Seizure frequency, type and degree were recorded before and during KD therapy. A 24 hours video-electroencephalogram (V-EEG) examination and Gesell Developmental Scale assessment were performed prior to KD therapy, and 3, 6, 9 months after KD therapy. RESULTS:Six patients became seizure free after KD therapy, with a complete control rate of 30%. Seizure frequency reduction occurred in 13 (65%) patients, EEG improvement in 8 (40%) patients, and improvement in Gesell Developmental Scales (gross motor and adaptability in particular) in 6 (30%) patients. The KD therapy-related side effects were mild. CONCLUSIONS:KD therapy is safety and effective in reducing seizure frequency and improving EEG and cognitive function in children with refractory epilepsy.

目的：观察护理风险管理在神经外科长期卧床患者中的应用效果。方法随机选取108例神经外科长期卧床患者分为研究组55例和对照组53例。对照组实行常规护理模式，研究组实行护理风险管理。对比2组基础护理合格率、护理风险发生率及对护理工作的满意度。结果研究组基础护理合格率为100％，对照组为84.91％，2组比较差异有统计学意义（P＜0.01）；研究组护理风险发生率为1.82％，对照组11.32％，2组比较差异有统计学意义（P＜0.01）；研究组护理工作满意度为100％，对照组为90.57％，2组比较差异有统计学意义（P＜0.01）。结论对神经外科长期卧床患者实行护理风险管理既有助于减少护理缺陷的发生，又能有效提升护理质量。

目的 探讨适合气管切开患者的气管湿化方法.方法 选取我院2010年10月--2012年10月收治的气管切开患者178例,随机分成观察组和对照组,观察组采取微量泵持续滴入法,对照组采取传统气道内间断滴入加湿法,比较两组气管切开患者的临床情况.结果 观察组刺激性咳嗽、黏膜出血发生率和痰痂形成发生率明显低于对照组,差异具有显著性,有统计学意义(P＜0.05).结论 对气管切开患者采取微量泵持续滴入法可以有效减少刺激性咳嗽和痰痂形成的发生率,为气管切开患者的气道湿化效果更好,并发症发生率更低,安全有效,让容易患者满意.

Objective To observe the effect on Foxg1 gene expression in the subgranular zone (SGZ) of cerebral tissue from neonatal rats with hypoxic-ischemic brain damage (HIBD) after transplantation of neural stem cells (NSCs) derived from umbilical cord blood.Methods Mononuclear cells separated from umbilical cord blood by density gradient centrifugation were cultured with orientated induction to differentiate the NSCs.The neuronal phenotype was identified using immunocytochemical methods.A total of 150 Sprague-Dawley rats were randomly divided into a sham-operation group,an HIBD group and an HIBD-NSCs group.Rats in the HIBD group and the HIBD-NSCs group were subject to ligation of the left carotid artery and then kept in a box under 8％ oxygen and 92％ nitrogen for 2.5 hours to establish the HIBD animal model.The artery was separated but not ligated in the sham operation group,which was not subjected to hypoxia.Twenty-four hours after the operation,the cultivated NSCs were transplanted by caudal vein injection into the rats in the HIBD-NSCs group.Rats were then sacrificed on the 3rd,7th,14th,21st and 28th days after the operation.Foxg1 gene expression in the SGZ was examined using in-situ hybridization methods.Results The number of Nestin-positive cells peaked on the 6th day of cultivation and then decreased by the 9th day.The Foxg1 gene was expressed in the SGZs of each group.The expression increased by the 3rd day after surgery in the HIBD and HIBD-NSCs groups,and peaked on 7th day after the operation,then declined gradually.The average expression level of Foxg1 in the HIBD group was significantly lower than that in the HIBD-NSCs group on the 7th day and thereafter.Conclusions Human umbilical cord blood mesenchymal stem cells can be induced and differentiated into neural stem cells.Foxg1 genes can still be present in the SGZ after birth.HIBD can induce the expression of Foxg1 genes.Transplanting NSCs can promote the expression of Foxg1 genes and improve morphological and functional recovery after HIBD,at least in neonatal rats.

<正>Canavan病属常染色体隐性遗传病,是由于乙酰天门冬氨酸酶编码基因缺陷导致乙酰天门冬氨酸酶活性受损,乙酰天门冬氨酸转化为乙酰CoA和天门冬氨酸的过程障碍,大量乙酰天门冬氨酸在血中蓄积,引起脑白质变性为主的疾病[1]。Myrtelle Canavan[2]于1931年首先报道此病,目前尚无有效治疗方法[3]。患儿苏某,男,3月,以"四肢间断抖动2月余,对声音无

Objective To study the application of Performance evaluation in hospital infection management.Methods In daily work of hospital infection management,every aspects of hospital infection control were standardized,quality of the hospital infection was evaluated periodically and examination data was included in hospital performance management.Results Through performance appraisal,the awareness of hospital infection of medical staff increased significantly.Hospital false negative rate of infection dropped to 4.88%.Infection specimen submission rate increased by 34.20%.Conclusion The introduction of hospital infection management into performance appraisal system could effectively improve the quality of hospital infection control,reduce or eliminate the risks of nosocomial infection and protect the health safety.

目的探讨口腔门诊医院感染的原因及控制措施。方法对口腔门诊存在的医院感染因素进行分析,针对问题提出控制措施。结果通过控制措施的施行,有效地控制口腔门诊医院感染的发生。结论口腔科器械多而复杂,且易受污染,因而造成感染的机会也相对增多,感控人员应积极采取正确的控制方法,从而减少医院感染的发生。

<正>手卫生是减少医院感染最简单、最有效、最经济的方法[1]。由于口腔科各种诊疗操作的特殊性,导致医务人员手部染菌的风险增加。为了避免或减少因医务人员的双手导致的医院感染,笔者对本院口腔内科医务人员手卫生进行目标性监测,并对监测结果进行分析,制定有效的手卫生措施,减少经手传播的医院感染的发生。

OBJECTIVE To investigate the causes and protective measures of occupational exposures of medical staff in operating room.METHODS The data of the reasons,modalities,post-exposure handling and prevention strategies of the occupational exposures occurred in the operating room during 2009 were analyzed by polling the records and inquiring the staff.RESULTS A total of 14 persons were reported,among them 11 were nurses(78.57%),2 were doctors(14.29%) and one was dustman(7.14%).Among the medical worker less than 5 years carreer;the medical 12 cases(85.72%) reported occupational exposure,but of the medical workers more than 10 years and 15 years both were just one case(7.14%).Among the 14 cases.10(71.43%) of them were puncture or sharp instrument injury,4(28.57%) of them were mucous membrane contaminated,all of the cases were validly handled and no infection was found.CONCLUSION The cognitions to prevention for medical staff on the occupational exposure are lack.The training of skill and knowledge about defending against occupational exposure should be strengthened to enhance the occupational safety of the medical staff.