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急性坏死性脑病的临床特征及预后 被引量:5
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作者 甘颖妍 麦坚凝 +1 位作者 曾意茹 吴汶霖 《中国实用医药》 2018年第20期19-22,共4页
目的探讨急性坏死性脑病(ANE)临床及影像学特点,以便提高对该疾病的认识,早期进行诊断及治疗。方法回顾性分析9例ANE患儿的临床资料。结果本研究共纳入9例ANE患儿,3~5岁年龄段患儿较多,9例患儿均无急性脑病的家族史及类似病史,发病月份... 目的探讨急性坏死性脑病(ANE)临床及影像学特点,以便提高对该疾病的认识,早期进行诊断及治疗。方法回顾性分析9例ANE患儿的临床资料。结果本研究共纳入9例ANE患儿,3~5岁年龄段患儿较多,9例患儿均无急性脑病的家族史及类似病史,发病月份多集中发生在3~5月。9例(100.0%)患儿均有发热现象,持续时间1~10 d,中位持续时间3 d,热峰(39±1)℃。8例(88.9%)伴有反复惊厥,且惊厥为脑病的首发表现。9例(100.0%)均在病程早期出现昏迷,多数在发病第3天,最快在发病24 h出现昏迷。脑脊液检查发现8例(88.9%)出现蛋白升高(微量蛋白>0.45 g/L),2例(22.2%)出现脑脊液压力>200 mm H2O(1 mm H2O=0.0098 k Pa)。9例(100.0%)脑电图均呈现慢波背景。6例死亡患儿中4例出现基底节豆状核受累,而3例存活患儿中1例出现豆状核受累。另外死亡患儿头颅磁共振成像(MRI)受累区域数目较存活患儿多。病变性质9例(100.0%)均可见水肿病变,包括血管性、间质及细胞内水肿,还可见2例(22.2%)出血性病灶。在病原学检查中,所有患儿均进行了病原咽拭子脱氧核糖核酸(DNA)检测(包括流感A+B型、肠道病毒、单纯疱疹、肺炎支原体、衣原体、腺病毒、合胞病毒)。入院行血生化检查,6例(66.7%)出现肝酶升高,有4例(44.4%)低白蛋白(<40 g/L),有1例(11.1%)乳酸升高。9例(100.0%)血浆氨基酸、血酰基肉碱、尿气相色谱-质谱分析(GC/MS)检查未见异常。血炎症指标检查,8例(88.9%)血降钙素原明显升高。5例(55.6%)完善外周血淋巴细胞计数检查,其中4例(80.0%)出现自然杀伤性T细胞(NKT细胞)计数下降,而其他类别淋巴细胞计数正常。治疗上,所有患儿均予以甘露醇及3%氯化钠交替降颅压,流感病毒B感染患儿予磷酸奥司他韦抗病毒,单纯疱疹病毒感染患儿予阿昔洛韦,支原体感染患儿予阿奇霉素,但人免疫球蛋白和糖皮质激素治疗上差别很大,8例(88.9%)患儿予人免疫球蛋白或甲强龙治疗,而1例(11.1%)患儿未予免疫球蛋白或甲强龙治疗。人免疫球蛋白治疗量分别为0.5~2.0 g/(kg·d),使用1~2 d;5例患儿予甲强龙10 mg/(kg·d)冲击治疗,启动时间在入院第2~20天,另有3例患儿分别在入院的第2、5、20天分别予2 mg/(kg·d)、5 mg/(kg·d)、20 mg/(kg·d)甲强龙治疗。本研究中有6例(66.7%)死亡,死亡时间在入院的5~15 d(在病程的1~3周)。3例(33.3%)存活患儿均有严重的后遗症,改良RANKIN量表(m RS)评分4~5分。结论 ANE虽为罕见疾病,但病情进展快,且致死致残率高,故早期诊断,积极治疗,改善患儿预后尤为关键。 展开更多
关键词 急性坏死性脑病 儿童 头颅磁共振成像
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Prospective, naturalistic study of open-label OROS methylphenidate treatment in Chinese school-aged children with attention-deficit/hyperactivity disorder 被引量:2
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作者 ZHENG Yi WANG Yu-feng +20 位作者 QIN Jiong WANG Li-wen ZOU Li-ping J IN Xing-ming XU Tong WANG Yi OI Yuan-li GONG Mei-en YIN Qing-yun mai jian-ning JING Jin LUO Xiang-yang MA Hong-wei LI Hai-bo XIE Ling LIYan Kuang Gui-fang YI Ming-ji WANG Feng ZHU Xiao-hua YAO Yan-bin 《Chinese Medical Journal》 SCIE CAS CSCD 2011年第20期3269-3274,共6页
Background Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders during childhood, characterized by the core symptoms of hyperactivity, impulsivity and inattention and puts great... Background Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders during childhood, characterized by the core symptoms of hyperactivity, impulsivity and inattention and puts great burden on children themselves, their families and the society. Osmotic release oral system methylphenidate (OROS-MPH) is a once-daily controlled-release formulation developed to overcome some of the limitations associated with immediate-release methylphenidate (IR-MPH). It has been marketed in China since 2005 but still lacks data from large-sample clinical trials on efficacy and safety profiles. The aim of this study was to evaluate the effectiveness and safety of OROS-MPH in children aged 6 to 16 years with ADHD under naturalistic clinical setting. Methods This 6-week, multi-center, prospective, open-label study enrolled 1447 ADHD children to once-daily OROS-MPH (18 mg, 36 mg or 54 mg) treatment. The effectiveness measures were parent-rated Inattention and Overactivity With Aggression (IOWA) Conners I/O and O/D subscales, physician-rated CGI-I and parent-rated global efficacy assessment scale. Blood pressure, pulse rate measurement, adverse events (AEs) and concomitant medications and treatment review were conducted by the investigator and were served as safety measures. Results A total of 1447 children with ADHD (mean age (9.52+_2.36) years) were enrolled in this trial. Totally 96.8% children received an OROS-MPH modal dose of 18 mg, 3.1% with 36 mg and 0.1% with 54 mg at the endpoint of study. The parent IOWA Conners I/O score at the end of week 2 showed statistically significant (P 〈0.001) improvement with OROS-MPH (mean: 6.95±2..71) versus the score at baseline (10.45±2.72). The change in the parent IOWA Conners O/D subscale, CGI-I and parent-rated global efficacy assessment scale also supported the superior efficacy for OROS-MPH treatment. Fewer than half of 1447 patients (511 (35.3%)) reported AEs, and the majority of the events reported were mild (68.2%). No serious adverse events were reported during the study. Conclusion This open-label, naturalistic study provides further evidence of effectiveness and safety of OROS-MPH in school-aged children under routine practice. 展开更多
关键词 attention deficit hyperactivity disorder METHYLPHENIDATE PHARMACOTHERAPY
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