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戊已奎醚复合阿托品对小儿围手术期管理影响

目的 观察术前应用戊已奎醚复合阿托品对患儿静脉复合全身麻醉围手术期管理的影响。 方法2008年3月-2009年2月选择60例患儿，ASAⅠ或Ⅱ级，随机分为3组，A组:静注阿托品；B组：静注戊已奎醚；C组：静注戊已奎醚复合阿托品（阿托品0.25 mg、戊已奎醚0.25 mg），3组均按0.01 mg/kg静注。记录给药前（T0）、进入术间后（T1）、手术开始时（T2）、手术开始30 min（T3）、苏醒期（T4）的HR、MAP、SpO2，记录吸痰次数、吸痰的时间。 结果A组：T1~T4时HR、MAP明显高于T0时（Plt;0.05），与B、C组同时段比较HR明显增快、MAP明显升高（P＜0.05）；B组：T1、T3、T4时HR低于T0（P＜0.05），T2比T0时增高，但比较无差异（P＞0.05），T1~T4时MAP与T0时比较无差异(P＞0.05)；C组：T1、T2时HR略高于T0时，T3、T4时低于T0时，T1~T4时MAP与T0时比较无差异（P＞0.05），各时段三组吸痰次数比较无差异（P＞0.05）。 结论 戊已奎醚复合阿托品有效地抑制了患儿腺体分泌，使得围手术期心率、血压更加平稳，提高了患儿围手术期的安全。

婴幼儿检查前水合氯醛灌肠效果影响因素分析

【摘要】　目的　总结婴幼儿检查前应用水合氯醛灌肠镇静效果的影响因素及对策。　方法　2008年11月－2010年11月对450例进行MRI、CT、多导心电图等检查前的患儿应用10％水合氯醛灌肠。　结果　308例（68.4％）在20 min内进入睡眠，85例（18.9％）患儿能在20～30 min内进入睡眠镇静，57例（12.7%）无效。　结论　水合氯醛保留灌肠的效果受时间、体位等诸多因素影响，采取必要的措施就能提高灌肠的有效率。

ANATOMICAL FEATURES OF CONGENITAL CHORDEE WITHOUT HYPOSPADIAS IN CHILDREN AND IMPLICATION FOR DIAGNOSIS AND TREATMENT

Objective To investigate the anatomical features of congenital chordee without hypospadias in children and to discuss the diagnosis and treatment.Methods From August 1984 to December 2004, 94 children with chordee withouthypospadias treated in the West China Hospital of Sichuan University were classified and analyzed for anatomical alterations. Their ages ranged from 18 months to 13 years (mean 6.9 years). Ninety-four patients were divided into four groups. With intraoperation artificial erection, the patients with penis straightened after degloving were classified as type Ⅰ patients (skin-tethering), those with peins straightened after fibrotic tissue in Buck’s fascia released as type Ⅱ patients (dysgenetic fascia), those with normal urethra and orthoplasty failed after degloving and removing fibrotic tissue as type Ⅲ patients (corporal disproportion), and those with dysgenetic urethra tethering the corpora cavernosa as type Ⅳ patients (short urethra).Results In type Ⅰ (n=31, 32.9%) patients, the ventral skin and dartos fascia were contracted while Buck’s fascia and the urethra was normal, in some (7 cases) scrotal skin extended to the ventral portion of penis (webbed penis). In type Ⅱ (n=45, 47.9%), contracture of Buck’s fascia was evident and the thickening fibrotic tissue constituted the chief obstacle to orthoplasty, though in some skin was shortened. In type Ⅲ (n=6), the dorsal and ventral sides of the corpora cavernosa were disproportionated, and the morphologically normal urethra tightly adhered to the ventral aspect of corpora cavernosa. In some cases ventral skin and fascia were contracted, but orthoplasty could notbe achieved through releasing these layers. In type Ⅳ (n=12, 12.8%), the distal urethra was paper-thin and lacking corpus spongiosum, or dense fibrotic bandswere found to be deep to the urethra. The urethra tethered the corpora cavernosaand formed a bow-to-string relation. The overlying skin and fascia were contracted in varying degrees while none had significance in straightening the penis. After operation, the length of penis increased to 6.9 cm from 5.2 cm on average and the chordee was corrected to 1.6° from 42.6° before operation on average. The patients were followed up 1 months to 15 years. The results were satisfactory.Chordee remained in 2 cases, fistula and urethral stricture occurred in 2 casesrespectively, fistula in association with urethral stricture and diverticulum in 1 case; the operation was given again and the results was satisfactory. Conclusion Patients with chordee without hypospadias may be divided into four types depending on which layer of the ventral penis constitutes thechief contribution to chordee. A systematic approach with repeated artificial erection tests is needed in determining the classification and surgical correction. 

A Meta-Analysis of Budesonide versus Dexamethasone for the Treatment of Acute Laryngitis in Children of China

【摘要】　目的　分析国内布地奈德、地塞米松吸入治疗小儿急性喉炎的疗效。　方法　系统检索中国生物医学文献数字库（CBM）、中国期刊全文数据库（CNKI）、维普、万方数据库，检索时间为各个数据库建库至2010年7月。纳入布地奈德对比地塞米松吸入治疗小儿急性喉炎的随机对照试验（randomized controlled trial，RCT），对纳入研究进行质量评价和Meta分析。　结果　共纳入11个RCT，分析结果提示两组声嘶、犬吠样咳嗽、呼吸困难、喉喘鸣症状消失时间差异均存在统计学意义，其MD及95%CI分为:-0.88 （-1.10，-0.65），-1.43 （-2.01，-0.84），-0.48 （-0.63，-0.32），-0.59 （-0.78，-0.41）。　结论　基于当前国内证据，布地奈德改善小儿急性喉炎梗阻症状疗效优于地塞米松吸入治疗。【Abstract】　Objective　To evaluate the effectiveness of budesonide versus dexamethasone for the treatment of acute laryngitis in children of china.　Methods　Literatures in CBM, CNKI, VIP, WanFang databases were searched from the time of establishment of these databases till July 2010. Randomized controlled trials (RCT) of budesonide versus dexamethasone for the treatment of acute laryngitis in children were gathered, and quality was evaluated and meta-analysis was carried out.　Results　Eleven RCTs were identified, and meta-analysis indicated that there were significant differences between the two groups in the disappearing time of hoarseness, barking cough, dyspnea and laryngeal stridor. The MD values and their 95% CI were respectively -0.88 (-1.10, -0.65), -1.43 (-2.01, -0.84), -0.48 (-0.63, -0.32), and -0.59 (-0.78, -0.41).　Conclusion　Based on current evidence in China, budesonide is better than dexamethasone for the improvement of acute laryngitis in children.

小儿ChiariⅠ型畸形合并脊髓空洞症研究进展

小儿Chiari Ⅰ型畸形合并脊髓空洞症临床少见，患儿临床症状较少、隐袭且与成年人有很大区别，容易发生误诊、误治。随着MRI的广泛应用，该疾病诊断数量日渐增多，但目前关于小儿Chiari Ⅰ型畸形合并脊髓空洞症的研究存在较多争议，临床工作者对其认识和诊治水平尚待提高。根据国内外文献、专著及最新临床试验研究成果，现就小儿Chiari Ⅰ型畸形合并脊髓空洞症研究进展进行综述。

小儿食指背侧岛状皮瓣修复拇指深度烧伤

腹膜透析治疗小儿心脏手术后并发急性肾功能衰竭

目的 总结腹膜透析（PD）治疗小儿心脏手术后并发急性肾功能衰竭(ARF)的临床经验。 方法 27例ARF患者，年龄3个月～12岁（4.20±3.58岁）；体重4.2～30.0 kg（12.35±7.65 kg）。因心脏手术后发生ARF进行PD。动态监测血气分析、电解质、血清肌酐(Cr)、尿素氮（BUN）、平均动脉压（MAP）和中心静脉压（CVP）的变化。 结果 PD后 5d Cr、BUN与PD前比较明显下降（Plt;0.01），血钾、血钠、碳酸氢根（HCO3-）恢复正常。术后死亡8例（29.6%），死于低心排血量3例，感染并发多器官功能衰竭3例，恶性心律失常1例，肺动脉高压危象1例。发生并发症9例（33.3%），其中管周漏液3例，腹膜炎3例，透析管堵塞3例（其中感染堵塞1例、大网膜堵塞2例）。 结论 小儿心脏手术后ARF早期行PD疗效肯定、安全，操作方便，可降低死亡率。

MEMBRANECTOMY WITH INTESTINAL PLASTY FOR THE TREATMENT OF DUODENAL AND UPPER JEJUNAL CONSTRICTIVE ABNORMALITIES

OBJECTIVE To sum up the experience of diagnosis and treatment of intrinsic upper gastro-intestinal membrane, 13 cases in children were studied retrospectively. METHODS There were 10 boys and 3 girls, the major symptoms were vomiting and epigastric distension. Eleven cases were treated by membranectomy with intestinal plasty, and 2 cases were treated by retrocolic side to end duodenojejunostomy. RESULTS All cases had good results without severe complications. CONCLUSION The children who have typical symptom of upper digestive tract should be considered duodental and upper jejunal membrane, and should be proved by contrast radiology. The membranectomy with intestinal plasty is the better operative method.

Effect of Integrative Training in Intellectual Development of Cerebral Palsy Children

【摘要】 目的 探讨感觉统合训练及神经发育疗法对脑性瘫痪患儿智能发育的影响。方法 对2006年7月—2008年6月脑性瘫痪患儿100例,随机分成治疗组和对照组,治疗组50例,男26例,女24例,年龄8个月～5.8岁,平均2.7岁。对照组50例,男27例,女23例,年龄9个月～5.8岁,平均年龄2.7岁。两组均采用神经发育疗法,治疗组加用感觉统合训练,1次/d,30 min/次,每周5次,3个月1疗程,连续治疗2个疗程；治疗前后进行Gesell量表测试,观察患儿智能发育改善情况。结果 治疗组显效24例,有效25例,无效1例；对照组显效8例,有效39例,无效3例,两组比较有统计学意义(Plt;0.05),Gesell测试5项评分,两组治疗前无差异(Pgt;0.05),治疗后差异有统计学意义(Plt;0.05)。结论 感觉统合训练可提高脑性瘫痪患儿的智能发育,是减少小儿残疾的一个重要途径。

Practice and effect of the Handbook for the Training Nurses in the standardized training for nurses in pediatric surgery

Objective To explore the application of the Handbook for the Training Nurses in the standardized training for nurses in pediatric surgery. Methods Twenty-four training nurses trained under the instruction of the Handbook for the Training Nurses in Department of Pediatric Surgery from July 2014 to December 2015 were included as the observation group. Their training effects were compared historically with those of twenty-four training nurses who were trained without the help of the handbook from January 2013 to June 2014 (the control group). Results After the completion of the half-year training, theoretical score of training nurses in the observation group was better than that in the control group, and the difference was significant (87.16±4.18 vs. 83.71±5.46; t=2.492, P=0.016). Meanwhile, the specialist practical skill examination of training nurses in the observation group, such as femoral vein blood collection, replacement of drainage bag and indwelling needle infusion in children, and emergency practical skill examination such as cardiopulmonary resuscitation and the use of simple respirator were higher than those in the control group; and the working performance scores of training nurses in the observation group, such as the ability to adapt to the environment, patient satisfaction, nursing document writing, work efficiency and morning questions were better than those in the control group; the differences were significant (P< 0.05). Conclusion The Handbook for the Training Nurses can help the training nurses to adjust their working environment, master the practical skills and nursing knowledge in pediatric surgery.