目的 研究布拉酵母菌与锌制剂联合应用对小儿迁延性腹泻患儿治疗的效果。方法 选取我院2017年1月—2017年12月收治的136例小儿迁延性腹泻患儿,将其随机分为联合组和对照组,每组各68例患儿,在基础补液、治疗的基础上,联合组采用布拉酵母菌药物联合锌制剂治疗,对照组单纯利用锌制剂治疗,比较两组治疗效果。结果 联合组总有效率97.06%,不良反应发生率4.41%,对照组总有效率88.24%,不良反应发生率14.71%,差异有统计学意义（P<0.05）。联合组患儿血检指标、锌含量、住院时间等指标与对照组比较有差异,（P<0.05）。结论 小儿迁延性腹泻是指患儿的腹泻症状迁延不愈造成严重的肠道炎症,患儿利用基础治疗效果不明显,加用布拉酵母菌与锌制剂对患儿治疗效果的改善作用明显。

目的 分析社区综合干预对小儿反复呼吸道感染的影响,为社区临床治疗小儿反复呼吸道感染性疾病提供理论依据。方法 采用随机抽签方式,从我社区2012年10月—2014年10月期间收治的小儿反复呼吸道感染患儿中,随机抽取60例纳入本项研究,依据就诊单双顺序,分为研究组30例(社区综合干预方式)和对照组30例(常规性治疗和常规措施进行干预),对两组患儿干预结果进行对比分析。结果 研究组治疗总疗效高于对照组(93.33% vs 76.67%),差异有统计学意义(P<0.05)。对比治疗干预过程中疾病发作次数、就诊次数状况,研究组优于对照组,差异有统计学意义(P<0.05)。干预后研究组小儿呼吸道感染致病因素改善情况(除滥用抗生素外)优于对照组,差异有统计学意义(P<0.05)。结论 针对小儿反复呼吸道感染疾病可采用社区综合干预方式,可显著提升治疗有效率,缓解病情,降低反复感染发生率,效果突出,具有广阔应用前景。

目的 了解龙川地区肺炎支原体耐药情况,以便临床合理运用抗生素。方法 收集2014年—2015年间疑似肺炎支原体感染住院小儿患者的咽分泌物标本2 666例,同时作Mp培养及IgM检查,同为阳性者共149例进行耐药性统计分析。结果 在2 666例疑似感染患者中,培养肺炎支原体阳性149例,阳性率为5.59%,学龄前儿童(≤3岁)患者阳性率2.06%,学龄儿童(4～15岁)阳性率9.79% ,学龄儿童感染肺炎支原体与学龄前儿童比较有显著差异(P<0.05)。其中红霉素、阿奇霉素、罗红霉素、克林霉素、依托红霉素、克拉霉素、乙酰螺旋霉、交沙霉素、加替沙星、莫西沙星、环丙沙星、左氧氟沙星、多西环素、米诺环素耐药率分别为2%、12.4%、4%、22% 、2%、1%、80%、44%、2%、15%、10%、1%、61%、44%。冬季感染与在其他季节比较有差异(P<0.05)。结论 阿奇霉素,红霉素为代表大环内脂类抗生素仍可以作为临床一线经验用药,乙酰螺旋霉、交沙霉素耐药率大于40%,不建议作为经验药物使用。喹诺酮类抗生素耐药率一般小于15%,可作为肺炎支原体治疗的第二选择。四环素类抗生素在本地区耐药性高,不建议作为经验药物使用。要加强预防冬季肺炎支原体感染。

目的 探讨鼻—空肠营养管在小儿急性胰腺炎中的疗效观察及护理。方法 采用回顾性分析法,选取2013年2月—2015年5月期间我院收治的116例急性胰腺炎患儿的临床资料,按照营养支持方法的不同将患儿分为对照组和观察组,每组58例。对照组患儿肠功能恢复后给予经口进食,观察组给予鼻—空肠营养管进行营养支持;并给予患儿针对性的护理措施。比较分析两组患儿的治疗效果。结果 观察组患儿平均住院时间、平均花费、并发症发生率、手术率及死亡率等指标均低于对照组(P＜0.05),差异有统计学意义。结论 鼻—空肠营养管应用于小儿急性胰腺炎具有较好的效果,降低患儿并发症发生率、手术发生率,缩短住院时间,减少住院消费,促进患儿康复。

Objective To observe the clinical efficiency of nasal jejunal nutrition in children with acute pancreatitis and explore the effective nursing. Methods The clinical characteristics of 116 children with acute pancreatitis from February 2013 to May 2015 in our medical center were retrospectively analyzed. Based on nutritional support, the patients were divided into two groups: the control group consisted of 58 patients receiving oral feeding after the recovery of bowel function, and the experiment group consisted of 58 patients with nasal jejunal nutrition. And all the patients were treated with special care on case-by-case. The efficiency was then compared between the two groups. Results Compared with the control group, the length of hospital stay, cost of care, the incidence of complications, the surgical proportion and the mortality were significantly decreased in the experiment group (P<0.05). Conclusion In the children with acute pancreatitis, application of nasal jejunal nutrition is more effective, leading to decrease incidences of complications and surgical proportion, shorten the length of hospital stay, reduce patients' cost, and finally help rehabilitation.

目的 对比腹腔镜疝囊高位结扎术及无张力疝修补术治疗小儿腹股沟疝的临床疗效。方法 选取2012年1月—2014年1月在本院住院手术治疗纳入研究的52例腹股沟疝患儿为研究对象,研究对象随机分为两组,A组为(腹腔镜疝囊高位结扎术),B组为(无张力疝修补术),各组均为26例,对比两组术中出血量、术后康复相关指标及术后1天与3天的VRS疼痛评分。结果 A组术中出血量明显少于B组,且术后康复相关指标优于B组,疼痛评分较B组低。结论 腹腔镜疝囊高位结扎术较无张力疝修补术治疗小儿腹股沟疝临床效果更优,值得推广。

Objective To compare the clinical effect of laparoscopic high ligation of hernial sac and non-tension herniorrhaphy in the children with inguinal hernia. Methods 56 children with inguinal hernia in our hospital from January 2012 to January 2014 were analyzed, they were randomly divided into 2 groups, 26 cases in group A were treated with laparoscopic high ligation of hernial sac, 26 cases in group B were treated with traditional non-tension herniorrhaph, and to compare the peri-operative bleeding,hospital stays, postoperative complications and postoperative VRS score between two groups. Results The peri-operative bleeding amount, hospital stays, postoperative complications and postoperative VRS score in group A were remarkable less than those of group B(P<0.01). Conclusion The advantages of laparoscopic high ligation of hernial sac is more obvious than that traditional open non-tension herniorrhaphy, and worth of being generalized.

目的 观察并分析小儿肝门静脉海绵样变性者核因子-κB(NF-κB)活性在手术前后的变化。方法 以2005年2月—2013年7月我院收治的43例小儿肝门静脉海绵变性者为研究对象,以40例正常儿童为对照组,检测对照组以及观察组儿童在手术前后血清单个核细胞(PBMC)中的NF-κB p65/Lamin B1的相对含量和NF-κB活性。结果 观察组术前、术后PBMC中NF-κB p65的相对含量分别为(1269.3±349.8)ng/mg、(884.5±154.8)ng/mg,均高于正常对照组(106.1±12.7)ng/mg(P＜0.05);与术前相比,术后相对含量降低(P＜0.05);观察组术前、术后PBMC中NF-κB的活性分别为(2194.5±471.3)ng/mg、(1376.9±203.7)ng/mg,均高于正常对照组(221.1±33.6)ng/mg(P＜0.05);与术前相比,术后相对含量降低(P＜0.05)。结论 经手术治疗后,小儿肝门静脉海绵样变性者PBMC中NF-κB p65的相对含量、NF-κB的活性均显著降低,表明手术在一定程度上有效缓解了肝门静脉高压的病症。

目的 观察以“五物甘草生摩膏”为介质的膏摩法对小儿外感咳嗽的疗效及其社区应用价值。方法 90例符合纳入、诊断标准的患儿随机分观察组与对照组,观察组以“五物甘草生摩膏”为介质膏摩法干预;对照组服用玉屏风颗粒;疗程均为2个月,观察服药后1个月(治疗)以及停药后1年内(预防)的疗效。结果 不论是从近期疗效还是远期疗效观察,观察组的疗效更显著;观察组儿童外感咳嗽症状的发生率也明显低于对照组。结论 “五物甘草生摩膏”为介质的膏摩法对小儿外感咳嗽的疗效影响显著,值得在家庭和基层医疗机构中推广应用。

目的 评价阿奇霉素序贯疗法治疗小儿支原体肺炎的临床疗效及药物经济学效果。方法 将我院儿科于2011年3月—2013年8月收治的522例支原体肺炎患儿随机分为静滴组(n=265)和序贯组(n=287),两组均给予阿奇霉素进行疗程为5 d的治疗,静滴组采用静脉滴注的给药方法进行治疗,序贯组采用静脉滴注2 d后口服序贯给药3 d的方法进行治疗,运用药物经济学原理对两种给药方案进行成本－效果分析。结果 静滴组和序贯组的总有效率分别为94.0%(249/265)和92.7%(266/287),两组比较差异无统计学意义(P>0.05),但静滴组的成本高于序贯组(P<0.01);静滴组和序贯组的不良反应发生率分别为34.7%(92/265)和26.9%(76/287),两组比较差异有统计学意义(P<0.05)。结论 采用序贯疗法治疗小儿支原体肺炎符合安全、有效、经济的临床用药原则,值得临床广泛推荐。

Objective To evaluate the clinical efficacy and pharmacoeconomic effect of sequential therapy of azithroycin on treatment of community mycoplasmal pneumonia(MP)in chindren. Methods 522 cases with MP from March 2011 to August 2013 in pediatrics department of our hospital were randomly divided into intravenous-drip group(n=265)and sequential-therapy group(n=287),and both two groups were treated by azithromycin for 5 days.The intravenous-drip group was treated with intravenous drip of azithromycin,and the sequential-therapy group was treated with azithromycin in the way of intravenous drip for 2 days and oral-taken for 3 days.The two treatments were cost-effectiveness analyzed by pharmacoeconomic theory. Results The total efficiency of the sequential-therapy group and intravenous-drip group were 94.0%(249/265)and 92.7%(266/287),respectively.There was no different between the sequential-therapy group and the intravenous-drip group(P<0.05).But the cost in intravenous-drip group was higher than that in sequential-therapy group(P<0.01).The incidence of adverse reaction of the sequential-therapy group and intravenous-drip group were 94.0% 34.7%(92/265)and 26.9%(76/287),respectively.And it was significant different between the two groups(P<0.05). Conclusions The treatment of sequential therapy of azithromycin is safety,effective and economical.And it is worthy to be widely recommended in clinical.

目的 研究探讨小儿支气管肺炎应用穿心莲内酯磺化物雾化吸入治疗的临床疗效及安全性。方法 选取2012年7月—2014年6月我院收治并确诊的128例小儿支气管肺炎患儿为研究对象,将所有患儿随机分为对照组和观察组各64例。两组患儿均给予常规退热,消炎、镇咳、平喘、抗病毒感染等治疗,对照组患儿在常规治疗基础上采用红霉素、青霉素和头孢等药物治疗,观察组患儿在常规治疗基础上采用喜炎平注射液雾化吸入治疗,观察两组患儿治疗后退烧时间、肺部啰音消失时间、咳嗽消失时间、临床总有效率以及住院天数。结果 治疗后观察组患儿的各症状消失时间以及住院天数均短于对照组患儿,差异有统计学意义(P<0.05)。观察组患儿总有效率为96.88%高于对照组的85.94%,两组差异有统计学意义(P<0.05)。结论 采用喜炎平注射液雾化吸入治疗小儿支气管肺炎有效果,能效缓解患儿的临床症状,值得大力推广。

Objective To Study and investigate the curative effect and security using nebulizer inhalation of Andrographolide Sulfonate to children's bronchopneumonia. Methods From July,2012 to June, 2014, we chose 128 children who had been diagnosed as bronchopneumonia by our hospital as our research subjects, and divided them into the contrast group and the observation group randomly with 64 children each. The both groups were all treated by using the methods of Antipyretic,anti-inflammatory,antitussive,antiasthmatic,anti-viral infection, treated by using erythromycin, penicillin and cefotaxime in the contrast group,treated the observation group by using Xiyanpin injection by nebulizer inhalation, of cause these two treatment were all on the basis of the conventional treatment. After treatment, we recorded the exact time of when the fever was gone, the disappearing time of pulmonary rales and their cough, the total effective rate and the time of being in hospital of the two groups. Results The time of all the observation group's symptom disappearing and being in hospital was obviously shorter than that of the contrast group after treatment. The difference between both groups was statistically significant(P<0.05). The total effective rate for the observation group was 96.88%, and it's higher than the contrast groups',which was 85.94%. The difference was statistically significant(P<0.05)too. Conclusion Using Xiyanpin injection by nebulizer inhalation for children's bronchopneumonia could effectively relieve the children's clinical symptom. It is worth popularizing for its good clinic medical value.

目的 探讨急性阑尾炎(acute appendicitis, AA)及急性感染性肠炎(acute infectious enteritis, AIE)患儿的阑尾高频超声影像特点及其显像敏感性。方法 回顾性分析临床确诊为急性阑尾炎患儿120例,急性感染性肠炎患儿160例,并对其行高频超声检查,另设120例正常儿童为对照组。分析高频超声阑尾显示率,阑尾外径,阑尾周围系膜炎性变化以及阑尾的位置等情况。结果 AA组、AIE组、对照组阑尾的显示率分别为96.7%、80.6%、68.3%,差异有统计学意义(P<0.05)。三组超声显示的阑尾外径分别为(8.5±2.2)mm、(4.3±0.8)mm、(3.5±0.7)mm,相互间差异亦均有统计学意义(P<0.05)。AA组所有的阑尾周围系膜炎症改变均可探及,但AIE组的阑尾周围系膜无变化。结论 小儿急性阑尾炎高频超声显像敏感性高,旨在为临床对AA早期诊断、早期治疗提供较准确全面的影像学依据。

Objective Use high-frequency ultrasound to determine the frequency of visualization and image feature of the appendix in children with acute appendicitis (acute appendicitis, AA) and with acute infectious enteritis (acute infectious enteritis, AIE). Methods The ultrasonic features of 120 children with AA, 160 children with AIE, and 120 randomly selected asymptomatic children were analyzed retrospectively. And their visualization rate, outer appendiceal diameter, presence or absence of inflamed periphery appendiceal mesenterium, and location of the appendix were recorded. Results The visualization rates of the appendix were 96.7%, 80.6%, and 68.3% for AA groups, AIE groups, and the control, respectively(P<0.05). The outer appendiceal diameters for the 3 groups were (8.5±2.2)mm, (4.3±0.8)mm, and (3.5±0.7)mm. Difference among the 3 groups was statistically significant also. Periphery appendiceal inflamed mesenterium was detected in all AA cases, but in none of the AIE cases. Conclusion High ultrasound imaging sensitivity of puerile acute appendicitis provided relatively accurate comprehensive imaging basis for clinical early diagnosis and early treatment.