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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。

Clinical Analysis to Secretory Otitis Media in Children

摘要:目的:探讨儿童分泌性中耳炎的临床特点及不同治疗方案的效果.方法:回顾性分析84例分泌性中耳炎患儿的临床资料及其相关因素,并收集资料完整的22例做治疗前后的对比。结果:84例患儿中有73.8%存在鼻咽或口咽部病变,另有继发于感冒占8.33%,伴有先天性听力障碍占3.65%,例原因不明占总14.29%,鼓膜穿刺并置管同时切除增殖体病变后,听力显著提高(Plt;0.05)。结论:对反复发作的SOM患儿应行鼓膜置管,保留6个月以上,同时鼻咽和口咽部伴发病变应引起临床医生的重视,积极处理相关疾病。

盐酸氨溴索佐治小儿支气管肺炎疗效比较

目的 探讨盐酸氨溴索注射液佐治小儿支气管肺炎的临床疗效。 方法 将2008 年1月-2009年1月收治的小儿支气管肺炎60例，随机分为治疗组和对照组各30例，在抗炎治疗的基础上，治疗组加用盐酸氨溴索注射液治疗。 结果 治疗组治愈率为100%，对照组治愈率为86.7%。治疗组的肺部啰音吸收时间、胸部X线片恢复正常时间均较对照组短。 结论 盐酸氨溴索佐冶小儿支气管肺炎疗效确定，值得临床应用。

Clinical study on the treatment of refractory epilepsy in children by adding Chinese medicine

ObjectiveTo observe the clinical efficacy of Xiao’er kang xian capsule added to anti-seizure medications (ASMs) in the treatment of children with refractory epilepsy and its influence on serum neuron-specific enolase (NSE) and cludter of differentiation 19+ (CD19+) levels. Methods A total of 60 children with refractory epilepsy were selected from the pediatric outpatient department and ward of Guangdong Provincial People's Hospital from February 2021 to June 2023. The study subjects were divided into two groups by numerical random method,with 30 cases in each group. The children with Xiao’er kang xian capsule added to the original treatment were the treatment group and the children without Xiao’er kang xian capsule added to the original treatment were the control group. The frequency, duration, EEG characteristics, adverse reactions and changes in serum NSE and CD19+ levels of the two groups were compared after treatment. Results Self-control before and after treatment in the treatment group: the frequency and duration of seizures were significantly reduced, with statistical difference (P<0.05). EEG discharge index in awake period and sleep period were significantly decreased, with statistical difference (P<0.05). After 6 months of treatment, comparison between the two groups of children: the seizure frequency of children in the treatment group was significantly decreased compared with the control group (P=0.03). There was a statistical difference (P<0.05), and the seizure duration in the treatment group was less than that in the control group (P=0.863), the clinical effective rate of treatment group 83.33% was higher than that of control group 63.33% (P=0.08), the effective rate of EEG in treatment group 80% was higher than that of control group 60% (P=0.091), serum NSE and CD19+ in treatment group were lower than that of control group, with no statistical difference (P>0.05). After 12 months of treatment, the frequency and duration of seizures in the treatment group were significantly decreased (P<0.05). The clinical efficacy and effectiveness of treatment group were significantly higher than that of control group (P=0.038). The incidence of adverse reactions in both groups was 16.67% (P>0.05). The effective rate of EEG in treatment group was significantly higher than that in control group (P=0.053). Serum NSE and CD19+ in treatment group were significantly lower than those in control group (P<0.05). ConclusionFor children with refractory epilepsy, the addition of Xiao’er kang xian capsule on the basis of the original treatment has obvious effect low adverse reaction and high safety. NSE and CD19+ can be used as monitoring indicators for the influence of the disease and prognosis evaluation during the treatment of children with epilepsy.

小儿烧伤惊厥的原因分析及干预措施

目的　探讨小儿烧伤并发惊厥的原因及护理措施。 方法　回顾性分析2010年3月－2012年2月收治的35例患儿烧伤并发惊厥的临床病历资料。 结果　小儿烧伤惊厥的原因有休克、高热、电解质紊乱、烧伤毒血症、脑缺氧脑水肿，各种原因之间相互影响。本组35例患儿中，惊厥持续时间30 s～5 min不等，34例治愈，1例因多器官功能衰竭死亡，所有患儿随病情而好转。 结论　小儿烧伤后并发惊厥的原因较多，在治疗和护理过程中应随时把握病情变化，正确处理患儿高热、电解质紊乱等，一旦发生惊厥应采取及时有效的救护措施，防止意外发生。

单孔腹腔镜下注射针头协助弧形弯钩的小儿腹股沟疝结扎术 180 例临床分析

目的探讨经脐单孔腹腔镜下注射针头协助弧形弯钩带线治疗小儿腹股沟疝的临床应用价值。方法对 2014 年 2 月至 2018 年 12 月期间自贡市第四人民医院普外一科经脐单孔腹腔镜手术的 180 例腹股沟疝患儿的临床资料进行回顾性分析。结果所有患儿均顺利完成采用经脐单孔腹腔镜下注射针头协助弧形弯钩带线手术治疗。术中发现对侧隐匿性疝 62 例，给予一并处理。手术时间（不包括麻醉时间和建立气腹置入 Trocar 时间）单侧 5～10 min、（5.7 ± 0.5）min，双侧 8～15 min、（11.0 ± 0.5）min。术后未见皮下积血、无阴囊积气和积液、无戳孔疝、无线结异物反应等并发症出现。术后出现上呼吸道感染有 2 例经对症治疗后 6 h 进食和下床活动。术后 24～72 h、（24±0.7）h 出院，全组病例均按临床路径流程进行。术后 2 周术区皮肤瘢痕不明显。术后最少随访 6 个月以上，复发 1 例，经再次手术术中发现 7 号丝线断裂线头松开导致；其余患者未见复发也无其他并发症。结论经脐单孔腹腔镜下注射针头协助弧形弯钩带线治疗是一种治疗小儿腹股沟疝安全有效的微创手术方法，操作简便，手术时间短，创伤小，术后瘢痕小，病情恢复快，并发症少，减轻了患儿痛苦，缩短了住院时间。

小儿手指掌侧瘢痕屈曲畸形矫正术后早期挛缩原因分析

【摘 要】 目的 回顾性分析小儿手指掌侧瘢痕屈曲畸形矫正术后早期挛缩的原因。 方法 2002 年1 月－2006 年1 月，收治98 例347 指掌侧瘢痕屈曲畸形，行掌侧瘢痕切除松解中厚皮片植皮术。男52 例185 指，女46 例162 指。年龄9 个月～ 6 岁。病程3 个月～ 2 年，平均7 个月。烫伤80 例，火焰烧伤18 例。每例为1 ～ 7 个伤指不等。瘢痕切除后，采用1.2 cm × 0.7 cm ～ 6.0 cm × 2.2 cm 中厚皮片修复。 结果 术后5 例12 指伤口Ⅱ期愈合，余均Ⅰ期愈合。患儿获8 ～ 12 个月随访，术后早期挛缩9 例20 指，发生率占患儿9.2%，占术指5.8%。发现早期挛缩后，积极加强防瘢痕处理及功能锻炼。余患儿皮片成活良好，手指活动正常。 结论 小儿手指掌侧瘢痕屈曲畸形一旦影响功能，应尽早手术。术前仔细准备，掌握手术要领和技巧, 术后坚持长期有效的防瘢痕治疗及功能锻炼，有助于减少术后早期皮片挛缩的发生。

小儿麻痹后遗症患者人工全髋关节置换术后脱位翻修一例

Application of Two Kinds of Self-made Suture Needle in Laparoscopic Herniorrhaphy in Children

【摘要】　目的　探讨自制双孔导线针在腹腔镜小儿腹股沟疝手术中的应用价值。　方法　回顾性分析2006年4月-2010年6月行腹腔镜小儿腹股沟疝手术655例患儿的临床资料。单孔针手术组452例，双孔针手术组203例，将两组患儿术中、术后资料进行对比分析。　结果　单孔针组手术时间(17. 7±3. 5) min；术中出血(5. 4±1. 3) mL，住院时间(2. 5±1. 0) d发生腹壁下小血肿15例，术后复发3例；双孔针组手术时间(8. 2±2. 3) min，术中出血(1. 4±0. 3) mL，住院时间(2. 1±0. 8) d，发生腹壁下小血肿2例，术后复发1例。双孔针组的手术时间、术中出血、并发症发生率等均明显优于双孔针组(Plt;0. 05)，两组住院天数、复发率差异均无统计学意义(Pgt;0. 05)。　结论　自制双孔导线缝扎针在腹腔镜小儿腹股沟疝手术中应用能够缩短手术时间，操作安全快捷，创伤更小等优点，值得推广应用。【Abstract】　Objective　To explore the clinical value of self-made diplopore suture needle in laparoscopic herniorrhaphy in children.　Methods　The clinical data of 655 patients who underwent laparoscopic herniorrhaphy between April 2006 and June 2010 were retrospectively analyzed. The patients were divided into the single-hole needle group (452 patients) and the diplopore needle group (203 patients), and the operative and post-operative data of the two groups were analyzed and compared.　Results　The operation time in the single-hole needle group was (17.7±3.5) minutes and the bleeding volume during the operation was (5.4±1.3) mL; while 15 patients suffered from small hematoma under the abdominal wall and three recurred. The operation time in the diplopore needle group was (8.2±2.3) minutes with (1.4±0.3) mL blood loss; while two patients suffered from small hematoma under the abdominal wall and one recurred. The patients in the single-hole needle group stayed in the hospital for (2.5±1.0) days, while the patients in diplopore needle group stayed for (1.4±0.3) days. The operation time, bleeding volume, rate of complications in diplopore needle group were significantly less than those in the single-hole needle group (Plt;0.05). The hospital staying days, and the recurrence rate in the two groups didn’t differ much (Pgt;0.05).　Conclusion　The advantages of self-made diplopore needle in laparoscopic herniorrhaphy in children include short operation time, less trauma, and simple operation; it is worth generalizing and applying.

BALLOON DILATATION FOR LOWER URETHRAL OBSTRUCTION IN CHILDREN

Objective To evaluate the clinical effect of balloon dilatation in the treatment of lower urinary tract obstruction in children. Methods Twenty-six boys suffering from lower urinary tract obstruction underwent the balloon dilatation operation. These patients included 23 cases of posterior urethral valves, 2 cases of anterior urethral valves and 1 case of traumatic urinary tract stricture. Their ages ranged from 18 days to 7 years. All the patients were diagnosed by voiding cystourethrogram (VCG). Some of the boys suffered from bilateral hydronephrosis and dilated ureters. Before operation, the patients with urine retention or abnormal renal function should drain urine and correct the disorderof fluid and electrolyte. Balloon dilatation was done after their conditions were improved. During operation, ketamine anaesthesia was used, and 30% diatrizoate melglumine was used as dilatation drug. The balloon catheters which had the length of 4 cm and the diameters of 5，8，10 mm respectively were used for dilating the urethra. After operation, a Foley’s catheter was routinely indwelled. Results During procedure, compression phenomena disappeared in the course of operation. All the patients urinated normally after catheter was removed at 1 week post operatively. 6 cases received ureteral reimplantation to prevent vesioureteral reflux after 1 to 3 months. 25patients were followed up from 1 to 13 years and all patients had normal micturition and the bilateral hydronephrosis were improved. Conclusion Balloon dilatation is a safe, effective and feasible therapy for lower urinary tract obstruction in children.