目的:探究吸入用N-乙酰半胱氨酸(N-acetylcysteine,NAC)联合布地奈德治疗小儿肺炎的疗效及其对炎症和免疫功能的影响.方法:选取2019年7月至2022年4月安徽医科大学附属宿州医院收治的108例肺炎患儿为研究对象,按照随机数表法分为对照组(n=54)与观察组(n=54).对照组吸入治疗用布地奈德,观察组吸入治疗用NAC+布地奈德.比较2组临床疗效、症状消失时间、治疗前后炎症反应[超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)、降钙素原(procalcitonin,PCT)、中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)]以及免疫功能[免疫球蛋白(immunoglobulin,Ig)A、IgG、IgM]指标水平.结果:与对照组相比,观察组临床总有效率显著提高(92.59％vs 77.78％,P<0.05);观察组咳嗽、啰音、喘息症状消失时间均显著变短(均P<0.05);观察组治疗后血清hs-CRP、PCT、NLR及IgA、IgG、IgM水平均显著降低(均P<0.05).2组不良反应总发生率比较差异无统计学意义(11.11％vs 7.41％,P>0.05).结论:NAC联合布地奈德雾化吸入治疗对小儿肺炎有显著疗效,可改善患儿临床症状,减轻炎症反应,调节免疫功能.

目的:观察加温湿化高流量鼻导管氧疗(HFNC)对1～3月龄肺炎伴低氧血症患儿的临床疗效.方法:分析2016年10月至2017年9月我院PICU收治、未达到机械通气指征的1～3月龄伴有低氧血症的肺炎患儿,采用随机数表法分为HFNC治疗组、经鼻持续气道正压通气(nCPAP)治疗组和普通鼻导管吸氧治疗组(对照组),给予相应治疗.比较三组临床疗效,治疗前和治疗后1h、12h、24h的PaO2、P/F、呼吸频率等指标,患儿主要症状体征消失时间和住院时间,气漏发生情况.结果:与对照组比较,HFNC组和nCPAP组有效率明显增加(46.7％vs90.0％、86.7％,P＜0.05),但HFNC组与nCPAP组比较差异无统计学意义(P＞0.05);HFNC组和nCPAP组患儿治疗过程中出现气漏例数明显减少(P＜0.05).HFNC组和nCPAP组治疗后患儿的三凹征、呼吸急促、肺部啰音消失时间及平均住院时间与对照组比较明显缩短(P＜0.05),但HFNC组和nCPAP组比较差异无统计学意义(P＞0.05);与对照组比较,HFNC组与nCPAP组在治疗后1h、12 h、24 h PaO2、P/F升高,呼吸频率减慢(P＜0.05),但HFNC组和nCPAP组比较差异无统计学意义(P＞0.05).结论:HFNC治疗1～3月龄伴有低氧血症的肺炎患儿疗效显著,损伤小,是一种适宜1～3月龄婴儿的无创呼吸支持技术.

患者:女性,1岁1个月.患儿系因“活动后青紫3个月,反复抽搐、发热伴左侧肢体无力1周”于2017年12月入住我院.3个月前家人发现患儿活动后口唇青紫,休息后症状较快缓解,开始未予重视,上述症状反复发作,半个月前于我院门诊心脏彩色超声检查示法洛四联症.遂至中国医学科学院阜外医院就诊,血氧饱和度(puls oxygen saturation,SPO2)75％,期间出现咳嗽、发热,予以头孢类抗菌药物治疗后症状好转,于就诊前1周突然出现四肢抽搐,两眼上翻,予以地西泮镇静治疗后好转,继而出现发热,最高体温39.5℃,第2天出现左侧肢体活动障碍,肌力减弱,急诊行头颅CT示未见异常;经抗感染治疗后症状无明显好转,第2天急诊转入首都医科大学附属北京市儿童医院(北京市儿童医院),行头颅CT及磁共振成像(MRI)检查示大面积脑梗死.腰椎穿刺(腰穿)示未见异常.血培养示革兰阴性菌.经抗感染、降颅压对症治疗后症状好转,应家人要求,转入我院进一步治疗.病程中进食奶量可,未有呕吐,大小便尚可.

Objective To explore the distribution of the microorganism that caused community acquired pneumonia(CAP) of the new borns and direct the clinic prevention and therapy.Methods 137 phlegm samples of the new borns that diagnosed CAP in the hospital for microorganism from January 2009 to December 2010 were detected.Results 112 positive samples were found from 137 cases.The detectable rate was 81.8 percent.Virus positive samples were found in 68 cases(60.7 percent of all the detected samples),and the most popular virus was RSV in 30 cases(44.1 percent of all the detected samples).Bacteria positive samples were found in 40 cases(35.7 percent of all the detected samples).The most popular bacteria detected in this research were colon bacillus and staphylococcus aureus rosenbach(22.5 percent and 15 percent each in all the bacteria positive samples).MP was detected positive in 11 cases(9.8 percent of all the detected samples) and CT was detected positive in only 1 cases(0.9 percent of all the detected samples).Conclusion Virus may be the main reason that caused CAP and RSV was the most popular among the virus caused CAP.hMPV became more and more popular now and G-bacillus was a little more popular than G+ coccus in CAP.

Objective To explore the efficacy of baby touch on feeding intolerance of premature infant.Methods 72 premature infants were divided randomly into a control group and a baby touch group.The control group performed routine therapy and the baby touch group employed touch therapy on the basis of routine therapy.Results The duration of abdominal distension,gastric retention and the time back to normal body weight at birth were significantly different between the two groups(P0.05).Conclusion Baby touch is beneficial for premature infants' feeding intolerance.It can ensure adequate nutrition and better growth of premature infants.

甲氧氯普胺是儿科门诊常用止吐药物,由于儿童药物代谢能力不足,导致甲氧氯普胺中毒病例时有发生.我院对门诊收治的甲氧氯普胺中毒致锥体外系反应患儿加用东莨菪碱治疗,取得满意疗效,现报告如下.

我院门急诊2003～2005年收治39例胃复安引起锥体外系反应患儿,集中表现为扭转痉挛,其中20例采用东莨菪碱静滴治疗,疗效显著,现报告如下.