Background: Surveys of pediatric endotracheal tube (ETT) management previously reported that specialists in pediatric anesthesia and intensive care medicine preferred to use uncuffed ETTs for children younger than 8 t...Background: Surveys of pediatric endotracheal tube (ETT) management previously reported that specialists in pediatric anesthesia and intensive care medicine preferred to use uncuffed ETTs for children younger than 8 to 10 years of age. The aim of this study was to reveal the most recent attitudes and clinical practices of pediatric ETT management in Japan. Methods: The attitudes and clinical practices of pediatric ETT management were investigated using the data sheets of each institution and each patient. The data sheets contained information on patient characteristics and type of hospital, surgical procedures, devices used for intubation, and ETT information including types, size, depth, intracuff pressure (ICP), interval of ICP measurement, laryngeal packing, ETT exchange, airway complications, and reintubations. Results: The response rate of this survey was 66.7%. More than half of children older than 2 years of age were intubated with cuffed ETTs;83.5% of cuffed ETTs were used with the cuffs inflated, and ICP was measured in 80.7% of cuffed ETTs. More than half of ICP measurements were only taken at the time of intubation. Post-extubation stridor was rarely observed in cuffed (0.4%) or uncuffed ETTs (1.2%). The pediatric ETT management questionnaire revealed age-based size selection, differences in pressure of air leakage between cuffed (15 - 20 cmH2O) and uncuffed ETTs (20 - 30 cmH2O) of different sizes, the depthmarking method of insertion length. Continuous measurement of ICP was not common. Conclusion: This study revealed widespread use of cuffed ETTs in children older than 2 years of age, rarely occurrence of post-extubation stridor, inflation of cuffs, and practice of ICP measurement.展开更多
AIM:To assess the safety and utility of capsule endoscopy(CE)for children who are unable to swallow the capsule endoscope.METHODS:The medical records of all of the children who underwent CE between 2010 and 2012 were ...AIM:To assess the safety and utility of capsule endoscopy(CE)for children who are unable to swallow the capsule endoscope.METHODS:The medical records of all of the children who underwent CE between 2010 and 2012 were retrospectively reviewed.The patients were divided into 2groups:group A included patients who were unable to swallow the capsule endoscope,and group B included patients who were able to swallow it.For the patients who were unable to swallow the capsule endoscope,it was placed in the duodenum endoscopically.The small bowel transit time,endoscopic diagnosis and complications of the 2 groups were compared.RESULTS:During the study period,28 CE procedures were performed in 26 patients.Group A included 11patients with a median age of 2 years(range 10 mo-9years),and group B included 15 patients with a median age of 12 years(range 8 years-16 years).The lightest child in the study weighed 7.9 kg.The detection rates did not differ between the 2 groups.The median small bowel transit time was 401 min(range 264-734 min)in group A and 227 min(range 56-512 min)in group B(P=0.0078).No serious complications,including capsule retention,occurred.No significant mucosal trauma occurred in the pharynx,esophagus,stomach or duodenum when the capsule was introduced using an endoscope.CONCLUSION:CE is a safe and useful procedure for infants and young children who are unable to swallow the capsule endoscope.展开更多
目的探讨极低出生体重儿(very low birth weight,VLBW)中适于胎龄儿(appropriate for gestational age,AGA)和小于胎龄儿(small for gestational age,SGA)身长增长对经外周中心静脉置管(peripherally inserted central catheter,PICC)...目的探讨极低出生体重儿(very low birth weight,VLBW)中适于胎龄儿(appropriate for gestational age,AGA)和小于胎龄儿(small for gestational age,SGA)身长增长对经外周中心静脉置管(peripherally inserted central catheter,PICC)尖端移位的影响,并横向比较影响程度,帮助医护人员更好地把握导管尖端位置监测的时机。方法回顾性分析2021年1月—2022年6月在医院NICU住院并使用PICC的VLBW,按出生体质量和胎龄关系分为AGA组45例和SGA组19例,记录首次置管当日身长(Ht_(1))以及PICC尖端位置、置管期间胸片检查当日身长(Ht_(n))以及PICC尖端位置,并计算相应的身长增长率。身长增长率与PICC尖端移位的相关性用Spearman秩相关分析。将AGA和SGA的身长增长率分别与PICC尖端移位进行简单线性回归分析,构建回归模型,用协方差分析比较两组回归直线。结果VLBW中AGA组97.8%患儿出现移位,SGA组所有的患儿都出现移位,占比最多的均为移位3个椎体。Spearman秩相关分析结果显示,两组患儿身长增长率与PICC尖端移位均具有相关性(AGA组rs=-0.719,P<0.001;SGA组rs=-0.769,P<0.001),随着VLBW身长增长,PICC尖端逐渐移位远离心脏。简单线性回归分析结果显示,AGA组回归模型(R^(2)=0.517,调整后R^(2)=0.513,F=129.487,P<0.001),SGA组回归模型(R^(2)=0.591,调整后R^(2)=0.585,F=95.385,P<0.001)。协方差分析结果显示,由于回归系数检验没有统计学意义,两条直线平行,说明身长增长率对两组患儿位移的影响一致。截距比较有统计学意义(F=9.265,P=0.003),说明两组患儿位移的起点不同(即增长率为零时的位移位置),说明位移与是否为AGA、SGA有关。结论随着VLBW中AGA和SGA身长增长,PICC尖端逐渐移位远离心脏,但相同的身长增长率,SGA引起的导管尖端移位幅度更大。建议AGA身长增长率12.4%、SGA身长增长率9.5%可作为监测导管尖端位置的重要时机,以免导管尖端进一步移位至非中心静脉,导致相关并发症发生。展开更多
目的分析近年来全球小于胎龄儿(small for gestational age infant,SGA)的研究现状、热点及前沿,梳理该领域发展脉络并预测未来发展趋势,为SGA研究及临床指导提供参考。方法基于Web of Science(WOS)核心合集数据库,选择科学引文索引扩展...目的分析近年来全球小于胎龄儿(small for gestational age infant,SGA)的研究现状、热点及前沿,梳理该领域发展脉络并预测未来发展趋势,为SGA研究及临床指导提供参考。方法基于Web of Science(WOS)核心合集数据库,选择科学引文索引扩展(Science Citation Index Expanded,SCI-EXPANDED)及社会科学引文索引(Social Sciences Citation Index,SSCI),检索式为:(TS=(“small for gestational age children”or“small for gestational age infant”or“small for gestational age”)AND LA=(English)AND DT=(Article OR Review Article)),时间跨度为2012年1月1日至2022年8月16日。运用CiteSpace,v.6.1.R3.64-bit绘制国家、机构、作者及关键词共现图,关键词聚类图及突现图,探究全球SGA研究领域主题演化及热点。结果共纳入6524篇文献,近年来,全球SGA研究文献年度发文量呈波动性上升趋势;综合中介中心性(0.15)和发文量(1859篇)分析,美国在该研究领域占主导优势;高产机构为卡罗林斯学院(Karolinska Institute,瑞典),以226篇文献稳居榜首;高产作者为NICOLAIDES K团队,主要研究方向为探索SGA的危险因素、SGA的早期有效筛查方法及如何降低SGA的患病率。关键词突现图发现,近3年的研究热点主要集中于流行病学研究和基因表达对妊娠结局影响的研究。结论进一步开展临床多中心的SGA分子流行病学和基础研究,揭示SGA患病危险因素,以提高SGA三级预防及治疗效果,仍是产科和儿科医务人员共同努力的研究方向。展开更多
目的探讨小于胎龄(small for gestational age infant,SGA)早产儿胆汁淤积症临床特征及其发生的高危因素。方法选取胎龄<37周且在出生24 h内收住苏州大学附属儿童医院新生儿科的SGA早产儿为研究对象,将其分为胆汁淤积症和非胆汁淤积...目的探讨小于胎龄(small for gestational age infant,SGA)早产儿胆汁淤积症临床特征及其发生的高危因素。方法选取胎龄<37周且在出生24 h内收住苏州大学附属儿童医院新生儿科的SGA早产儿为研究对象,将其分为胆汁淤积症和非胆汁淤积症两组,收集并回顾性分析2017年7月—2022年6月的临床数据。结果纳入的553例SGA早产儿中,100例(18.1%)发生胆汁淤积症。不同胎龄和出生体重组别的发生率分别为:超早产儿50.0%,极早产儿46.6%,中期早产儿32.7%,晚期早产儿9.8%;出生体重(birth weight,BW)<1000 g 60.9%,1000 g≤BW<1500 g 33.9%,1500 g≤BW<2500 g 10.7%。多因素回归分析显示,低出生体重、颅内出血、有创通气时间、第2周氨基酸累积量、第1周脂肪乳累积量、第2周脂肪乳累积量是SGA早产儿发生胆汁淤积症的独立危险因素(P<0.05)。结论SGA早产儿胆汁淤积症的发生率随胎龄和出生体重的降低而升高;SGA早产儿胆汁淤积症的发生受低出生体重、颅内出血、有创通气及氨基酸、脂肪乳累积量等多种危险因素综合影响,需采取综合治疗措施减少其发生。展开更多
目的探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)患者妊娠早期甘油三酯葡萄糖指数(the triglyceride-gluscose index,TyG指数)与分娩小于胎龄儿(small for gestational age infant,SGA)之间的关系。方法选取2018年1月至2023年...目的探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)患者妊娠早期甘油三酯葡萄糖指数(the triglyceride-gluscose index,TyG指数)与分娩小于胎龄儿(small for gestational age infant,SGA)之间的关系。方法选取2018年1月至2023年6月复旦大学附属上海市第五人民医院和新疆喀什地区第二人民医院产科孕早期建档并符合纳入标准的孕妇1532例为研究对象,根据孕妇24~28周行口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)结果,将其分为GDM组(754例)及非GDM组(778例)。GDM组患者根据新生儿体重,将其分为SGA组、大于胎龄儿(large for gestational age infant,LGA)组和适于胎龄儿(appropriate for gestational age infant,AGA)组。分析GDM患者分娩SGA的独立影响因素,采用Logistic回归模型分析TyG指数与发生SGA的相关性。绘制ROC曲线以分析妊娠早期TyG指数对GDM患者分娩SGA的预测价值。结果GDM患者SGA组TyG指数显著低于LGA组、AGA组及非GDM组(P<0.05);多因素Logistic回归分析结果显示,TyG指数与GDM患者分娩SGA的发生独立相关(P<0.05);ROC曲线结果显示,妊娠早期TyG指数对GDM患者分娩SGA具有较好的预测价值(AUC=0.821,95%CI:0.763~0.879,P<0.001)。结论GDM患者妊娠早期TyG指数与分娩SGA之间存在独立相关,对于GDM患者分娩SGA具有较好的预测价值。展开更多
目的探讨早产小于胎龄儿（small for gestational age,SGA）在生后1年内的体格生长变化趋势是否与足月SGA存在差异,为早产SGA生后体格生长随访监测提供参考依据。方法采用前瞻性队列研究,收集2013年9月至2015年6月在重庆医科大学附属儿...目的探讨早产小于胎龄儿（small for gestational age,SGA）在生后1年内的体格生长变化趋势是否与足月SGA存在差异,为早产SGA生后体格生长随访监测提供参考依据。方法采用前瞻性队列研究,收集2013年9月至2015年6月在重庆医科大学附属儿童医院儿童保健科随访的早产SGA 54人,足月SGA 181人。分别在1、3、6、12月龄（早产SGA在纠正胎龄的1、3、6、12月龄）测量体质量、身长、头围,采用Z积分计算体格水平和生长速度。结果 ①早产SGA生后快速追赶生长发生在纠正年龄1月龄后,而足月SGA在生后即开始;早产和足月SGA在前6个月追赶生长率均达63.0%。②早产SGA未纠正胎龄的体质量Z值在6、12月龄（t=-1.189、-0.911,P=0.236、0.363）,身长、头围Z值在12月龄（t=-0.855、-1.078,P=0.394、0.282）与足月SGA比较差异无统计学意义。③早产SGA的体质量增长速度在1-3、〉3-6月龄（t=4.685、3.787,P〈0.01）,身长、头围在1-3、〉3-6、〉6-12月龄追赶速度明显快于足月SGA（t=3.487、3.626、4.179,t=5.158、3.001、4.641,P〈0.01）。但在1月龄内体质量、身长追赶速度均慢于足月SGA（t=-6.384、-4.821,P〈0.01）,甚至低于出生时Z值水平（ΔZ〈0）。结论早产SGA追赶生长的发生晚于足月SGA,体格生长水平可在1岁时追赶上足月SGA,在1岁内生长潜力大于足月SGA,在纠正年龄1月龄内易发生宫外生长迟缓。展开更多
文摘Background: Surveys of pediatric endotracheal tube (ETT) management previously reported that specialists in pediatric anesthesia and intensive care medicine preferred to use uncuffed ETTs for children younger than 8 to 10 years of age. The aim of this study was to reveal the most recent attitudes and clinical practices of pediatric ETT management in Japan. Methods: The attitudes and clinical practices of pediatric ETT management were investigated using the data sheets of each institution and each patient. The data sheets contained information on patient characteristics and type of hospital, surgical procedures, devices used for intubation, and ETT information including types, size, depth, intracuff pressure (ICP), interval of ICP measurement, laryngeal packing, ETT exchange, airway complications, and reintubations. Results: The response rate of this survey was 66.7%. More than half of children older than 2 years of age were intubated with cuffed ETTs;83.5% of cuffed ETTs were used with the cuffs inflated, and ICP was measured in 80.7% of cuffed ETTs. More than half of ICP measurements were only taken at the time of intubation. Post-extubation stridor was rarely observed in cuffed (0.4%) or uncuffed ETTs (1.2%). The pediatric ETT management questionnaire revealed age-based size selection, differences in pressure of air leakage between cuffed (15 - 20 cmH2O) and uncuffed ETTs (20 - 30 cmH2O) of different sizes, the depthmarking method of insertion length. Continuous measurement of ICP was not common. Conclusion: This study revealed widespread use of cuffed ETTs in children older than 2 years of age, rarely occurrence of post-extubation stridor, inflation of cuffs, and practice of ICP measurement.
文摘AIM:To assess the safety and utility of capsule endoscopy(CE)for children who are unable to swallow the capsule endoscope.METHODS:The medical records of all of the children who underwent CE between 2010 and 2012 were retrospectively reviewed.The patients were divided into 2groups:group A included patients who were unable to swallow the capsule endoscope,and group B included patients who were able to swallow it.For the patients who were unable to swallow the capsule endoscope,it was placed in the duodenum endoscopically.The small bowel transit time,endoscopic diagnosis and complications of the 2 groups were compared.RESULTS:During the study period,28 CE procedures were performed in 26 patients.Group A included 11patients with a median age of 2 years(range 10 mo-9years),and group B included 15 patients with a median age of 12 years(range 8 years-16 years).The lightest child in the study weighed 7.9 kg.The detection rates did not differ between the 2 groups.The median small bowel transit time was 401 min(range 264-734 min)in group A and 227 min(range 56-512 min)in group B(P=0.0078).No serious complications,including capsule retention,occurred.No significant mucosal trauma occurred in the pharynx,esophagus,stomach or duodenum when the capsule was introduced using an endoscope.CONCLUSION:CE is a safe and useful procedure for infants and young children who are unable to swallow the capsule endoscope.
文摘目的探讨极低出生体重儿(very low birth weight,VLBW)中适于胎龄儿(appropriate for gestational age,AGA)和小于胎龄儿(small for gestational age,SGA)身长增长对经外周中心静脉置管(peripherally inserted central catheter,PICC)尖端移位的影响,并横向比较影响程度,帮助医护人员更好地把握导管尖端位置监测的时机。方法回顾性分析2021年1月—2022年6月在医院NICU住院并使用PICC的VLBW,按出生体质量和胎龄关系分为AGA组45例和SGA组19例,记录首次置管当日身长(Ht_(1))以及PICC尖端位置、置管期间胸片检查当日身长(Ht_(n))以及PICC尖端位置,并计算相应的身长增长率。身长增长率与PICC尖端移位的相关性用Spearman秩相关分析。将AGA和SGA的身长增长率分别与PICC尖端移位进行简单线性回归分析,构建回归模型,用协方差分析比较两组回归直线。结果VLBW中AGA组97.8%患儿出现移位,SGA组所有的患儿都出现移位,占比最多的均为移位3个椎体。Spearman秩相关分析结果显示,两组患儿身长增长率与PICC尖端移位均具有相关性(AGA组rs=-0.719,P<0.001;SGA组rs=-0.769,P<0.001),随着VLBW身长增长,PICC尖端逐渐移位远离心脏。简单线性回归分析结果显示,AGA组回归模型(R^(2)=0.517,调整后R^(2)=0.513,F=129.487,P<0.001),SGA组回归模型(R^(2)=0.591,调整后R^(2)=0.585,F=95.385,P<0.001)。协方差分析结果显示,由于回归系数检验没有统计学意义,两条直线平行,说明身长增长率对两组患儿位移的影响一致。截距比较有统计学意义(F=9.265,P=0.003),说明两组患儿位移的起点不同(即增长率为零时的位移位置),说明位移与是否为AGA、SGA有关。结论随着VLBW中AGA和SGA身长增长,PICC尖端逐渐移位远离心脏,但相同的身长增长率,SGA引起的导管尖端移位幅度更大。建议AGA身长增长率12.4%、SGA身长增长率9.5%可作为监测导管尖端位置的重要时机,以免导管尖端进一步移位至非中心静脉,导致相关并发症发生。
文摘目的分析近年来全球小于胎龄儿(small for gestational age infant,SGA)的研究现状、热点及前沿,梳理该领域发展脉络并预测未来发展趋势,为SGA研究及临床指导提供参考。方法基于Web of Science(WOS)核心合集数据库,选择科学引文索引扩展(Science Citation Index Expanded,SCI-EXPANDED)及社会科学引文索引(Social Sciences Citation Index,SSCI),检索式为:(TS=(“small for gestational age children”or“small for gestational age infant”or“small for gestational age”)AND LA=(English)AND DT=(Article OR Review Article)),时间跨度为2012年1月1日至2022年8月16日。运用CiteSpace,v.6.1.R3.64-bit绘制国家、机构、作者及关键词共现图,关键词聚类图及突现图,探究全球SGA研究领域主题演化及热点。结果共纳入6524篇文献,近年来,全球SGA研究文献年度发文量呈波动性上升趋势;综合中介中心性(0.15)和发文量(1859篇)分析,美国在该研究领域占主导优势;高产机构为卡罗林斯学院(Karolinska Institute,瑞典),以226篇文献稳居榜首;高产作者为NICOLAIDES K团队,主要研究方向为探索SGA的危险因素、SGA的早期有效筛查方法及如何降低SGA的患病率。关键词突现图发现,近3年的研究热点主要集中于流行病学研究和基因表达对妊娠结局影响的研究。结论进一步开展临床多中心的SGA分子流行病学和基础研究,揭示SGA患病危险因素,以提高SGA三级预防及治疗效果,仍是产科和儿科医务人员共同努力的研究方向。
文摘目的探讨小于胎龄(small for gestational age infant,SGA)早产儿胆汁淤积症临床特征及其发生的高危因素。方法选取胎龄<37周且在出生24 h内收住苏州大学附属儿童医院新生儿科的SGA早产儿为研究对象,将其分为胆汁淤积症和非胆汁淤积症两组,收集并回顾性分析2017年7月—2022年6月的临床数据。结果纳入的553例SGA早产儿中,100例(18.1%)发生胆汁淤积症。不同胎龄和出生体重组别的发生率分别为:超早产儿50.0%,极早产儿46.6%,中期早产儿32.7%,晚期早产儿9.8%;出生体重(birth weight,BW)<1000 g 60.9%,1000 g≤BW<1500 g 33.9%,1500 g≤BW<2500 g 10.7%。多因素回归分析显示,低出生体重、颅内出血、有创通气时间、第2周氨基酸累积量、第1周脂肪乳累积量、第2周脂肪乳累积量是SGA早产儿发生胆汁淤积症的独立危险因素(P<0.05)。结论SGA早产儿胆汁淤积症的发生率随胎龄和出生体重的降低而升高;SGA早产儿胆汁淤积症的发生受低出生体重、颅内出血、有创通气及氨基酸、脂肪乳累积量等多种危险因素综合影响,需采取综合治疗措施减少其发生。
文摘目的探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)患者妊娠早期甘油三酯葡萄糖指数(the triglyceride-gluscose index,TyG指数)与分娩小于胎龄儿(small for gestational age infant,SGA)之间的关系。方法选取2018年1月至2023年6月复旦大学附属上海市第五人民医院和新疆喀什地区第二人民医院产科孕早期建档并符合纳入标准的孕妇1532例为研究对象,根据孕妇24~28周行口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)结果,将其分为GDM组(754例)及非GDM组(778例)。GDM组患者根据新生儿体重,将其分为SGA组、大于胎龄儿(large for gestational age infant,LGA)组和适于胎龄儿(appropriate for gestational age infant,AGA)组。分析GDM患者分娩SGA的独立影响因素,采用Logistic回归模型分析TyG指数与发生SGA的相关性。绘制ROC曲线以分析妊娠早期TyG指数对GDM患者分娩SGA的预测价值。结果GDM患者SGA组TyG指数显著低于LGA组、AGA组及非GDM组(P<0.05);多因素Logistic回归分析结果显示,TyG指数与GDM患者分娩SGA的发生独立相关(P<0.05);ROC曲线结果显示,妊娠早期TyG指数对GDM患者分娩SGA具有较好的预测价值(AUC=0.821,95%CI:0.763~0.879,P<0.001)。结论GDM患者妊娠早期TyG指数与分娩SGA之间存在独立相关,对于GDM患者分娩SGA具有较好的预测价值。
