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Objective:To investigate the clinical features and etiology of 176 children with liver dysfunction, and to provide reference for the diagnosis and treatment of children with liver dysfunction.Methods:From April 2017 to February 2019, 176 children with liver function abnormalities from 2 months to 13 years old who were admitted to Hangzhou Children's Hospital were selected inthe study.The pathogens of the children's secretions were detected by fluorescence quantitative method.The blood was tested for hepatitis B virus, hepatitis C antibody and hepatitis A antibody, and blood culture method was used to detect and identify bacteria, and blood genetic metabolism and coagulation function were also screened.According to the age of the children, they were divided into infant group, toddlergroup, preschool group and school age group.Results:Among the 176 children, the infants had the most abnormal liver function, 93 cases(52.84%), followed by 43 children (24.43%) in the toddler group.Causes of the disease: 138 cases (78.41%) of the original diseases, 8 cases (4.55%) of non-infectious diseases, 30 cases (17.04%) of the undetected pathogens.Among the 138 cases with liver function abnormality due to infectious diseases, 123 cases (89.13%) were infected with virus, 8 cases (5.80%) were infected with bacteria, 6 cases (4.35%) were infected with mycoplasma, and 1 case (0.72%) was infected with Toxoplasma gondii.Among the 123 cases of liver dysfunction caused by viral infection, cytomegalovirus was detected in 62 cases (50.41%), followed by EB virus in 38 cases (30.89%), rotavirus in 10 cases (8.13%), and EV71 virus in 5 cases (4.07%), 4 cases of common enterovirus (3.25%), 2 cases of respiratory syncytial virus (1.63%), 1 case of herpes simplex virus and Coxsackie A16 virus (0.81%). Pre-school and above were mainly infected with EB virus; the age>1 year-old liver function abnormality was 37.10% (23/62) due to cytomegalovirus, and the proportion of EB virus infection was 92.11% (35/38). Compared with 62.90% and 7.89% of age 2 months to 1 year, the difference was statistically significant (χ 2=29.27, P=0.00). Eightcases of liver infection caused by bacterial infection: 3 cases of Staphylococcus aureus, 2 cases of Streptococcus pneumoniae, 2 cases of Escherichia coli, and 1 case of Pseudomonas aeruginosa.There were 3 cases of genetic metabolic diseases, including 2 cases of hepatolenticular degeneration and 1 case of glycogen accumulation.Characteristics of liver function abnormalities in children: the main clinical manifestations of children were jaundice, splenomegaly and hepatomegaly, cough, diarrhea, etc.Outcome: 98 cases (55.68%) were healed, 60 cases (34.09%) were improved, and 17 cases (9.66%) were aggravated, 1 case of death (0.57%). Conclusion:The abnormal liver function of infants was mainly caused by virus infection, especially cytomegalovirus.Infants and young children have no obvious symptoms in the early stage of the disease, severe cases can be manifested as jaundice and hepatosplenomegaly, mainly mild, with a good prognosis.
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Objective@#To explore the clinical features, the serotype distribution and drug resistance of the isolates in patient with invasive pneumococcal disease (IPD).@*Methods@#By retrieving the laboratory information system in 18 children′s hospitals from 2012 to 2017, the children with IPD were enrolled. Streptococcus pneumoniae (Spn) must be isolated from the sterile sites (blood, cerebrospinal fluid, hydrothorax and joint effusion etc.). The clinical characteristics, serotype, drug resistance, treatment and prognosis were reviewed and analyzed. According to the telephone follow up results, the patients were divided into death group and recovered group. The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis.@*Results@#There were 1 138 children with IPD, including 684 male and 454 female. The proportion of male to female was 1.5∶1. The age ranged from one day to 16 years. The median age was 1 year 3 month. The majority was under 5 years of age (89.3%, n= 1 016), especially under 2 years of age (61.9%, n=704). In all cases, 88.2% (n=1 004) were community acquired infection. The infections included meningitis (n=446, 39.2%), pneumonia with bacteremia (n=339, 29.8%), and bacteremia without focus (n=232, 20.4%). Underlying diseases were found in 242 cases (21.3%). Co-infections were determined in 62 cases (5.4%) with mycoplasma, 27 cases (2.4%) with adenovirus and 34 cases with influenza virus (3.0%). The penicillin insensitivity (PNSP) rates in meningitis and non-meningitis isolates were 69.5% (276/397) and 35.9% (221/615), respectively. There were 81 strains serotyped, in which 93.8% (76/81) were covered by 13-valent protein-polysaccharide conjugate vaccine (PCV13). In the 965 patients who were followed up by phone call, 156 cases (16.2%) were confirmed dead. The independent risk factors for the death were under 2 years of age (OR=2.143, 95%CI 1.284-3.577, P=0.004), meningitis (OR=3.066, 95%CI 1.852-5.074, P<0.01), underlying disease (OR=4.801, 95%CI 2.953-7.804, P<0.01), septic shock(OR=3.542, 95%CI 1.829-6.859, P<0.01), disseminated intravascular coagulation (DIC) (OR=4.150, 95%CI 1.468-11.733, P=0.007), multiple organ failure (OR=12.693, 95%CI 6.623-24.325, P<0.01) and complications of central nervous system (OR=1.975, 95%CI 1.144-3.410, P=0.015).@*Conclusions@#Most children with IPD were under 5 years of age, having underlying diseases and acquired the infection in community. The independent risk factors for death were under two years old, meningitis, underlying diseases and multiple organ failure. The problem of drug resistance was severe. The universal immunization of PCV13 would be effective to prevent IPD in Chinese children.
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Objective To investigate the effects of thyroid hormone on extremely severe traumatic brain injury (TBI).Methods A retrospective case-control study was conducted to analyze the treatment of 105 patients with extremely severe TBI admitted from July 2010 to April 2014.There were 79 males and 26 females,with an average age of 32.9 years.The patients were divided into conventional treatment group (Group A,35 cases),conventional treatment ± thyroxine treatment group (Group B,35 cases) and thyroxine treatment group after the condition that thyroxine level was low (Group C,35 cases) according to the random number table method.The incidence of low T3 and T4,incidence of hypotension,the dosage of vasoactive drugs,function evaluation of liver and kidney damage,Glasgow outcome scale (GOS),and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) within 20 days after admission,and mortality rate within 30 days after admission were compared and analyzed.Results Within 20 days after admission,the rates of low thyroxine levels and hypotension of the Group B (22.9％,77.1％) were significantly lower than those in the other two groups (Group A:40％,100％;Group C:37％,100％) (all P ＜ 0.05).The doses of dopamine and norepinephrine in Group B was significantly lower than the other two groups and the combination rate of vasopressors in Group B was significantly lower than the other two groups (P ＜ 0.05),while there was no significant difference between Group A and Group C (P ＞ 0.05).The corresponding data in Group A and Group C had no statistically significant difference (P ＞ 0.05).The liver and renal dysfunction rates of Group B (29％,31％) were significantly lower than those of the other two groups (Group A:49％,51％;Group C:43％,51％) (all P ＜ 0.05).The corresponding data in Group A and Group C had no statistically significant difference (P ＞ 0.05).GOS in Group B [(4.8 ± 1.9) points] was significantly higher than that in Group A [(3.3 ± 0.2) points] (all P ＜ 0.05) within 30 days after admission and significantly higher than that of itself at the beginning [(3.6 ± 1.1) points] (P ＜ 0.05).The APACHE Ⅱ in Group A was significantly higher than those in other two groups as well as that in Group A at admission (P ＜ 0.05).Mortality rates in Group B (31％) and Group C (29％) were significantly lower than that in Group A (69％) within 30 days after admission (P ＜ 0.05).Conclusions Thyroxine can reduce the incidence of hypotension,liver and kidney injury rate in extremely severe TBI.Prevention is better than the supplementary treatment after severe TBI.Thyroxine can also reduce the mortality of extremely severe TBI within 30 days after admission.
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Objective To apply Plato analysis method to clinical cases which were reported from clinical nursing, finding out the key link of the risks which were related to the cases:the key age, the key period, the key spectrum of disease and the key projects, etc. To carry out the feedforward control of the quality of care, and ensure the quality and safety of nursing. Methods A database were set up including clinical special cases, high-risk cases, security hidden danger cases and emergency cases. Thetwo eightprinciple of Plato analysis method was used to find out the main factors, the principal contradiction, the key hazard and the key problems of the cases, etc. The aim was to provide guidelines of risk analysis, risk prevention and risk aversion for nurses, and improve their consciousness of security hidden danger, and reduce security hidden danger cases. Results The results of 207 cases collected from 2014 to 2015 showed that the main risks involved the age groups were 41-80 years old and 21-30 years old. The major risks involved the spectrum of disease were the nervous system, cardiovascular disease, surgical anesthesia related problems, kidney disease, cancer and respiratory system. The major risks involved the time were the midnight, morning and afternoon. The major risks involved the locations were sickroom, emergency room, auxiliary inspection departments and outpatient. The major risks involved items were disease mutation, psychological problems, medication safety and instrument safety, among the disease mutation, timely discovered, rescued 13 patients with heart and breathing pause, stop 13 patients who attempted suicide. Since the Plato analysis method was applied to identify the security risks of the clinical cases, the number of falling, all kinds of pipe shed, skin problems and suicides were decreased from 6, 6, 7, 5 in 2014 to 2, 2, 2, 1 in 2015, declining trend year by year. Conclusions Applying the Plato analysis method to identify the security risks of the clinical cases which can find out the main problems of cases and improve nursing quality and management efficiency.
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Objective To investigate the effect of anisodamine on oxygen metabolism and organ function in dogs with sepsis.Methods Twenty beagles were divided into sepsis group (n =8) and anisodamine-treated group (n =12) according to the random number table.The sepsis model was established by cecal ligation and puncture.Changes in thrombomodulin (TM),arterial oxygen partial pressure (PaO2),oxgen uptake rate (ERO2) and lactate were mearsured before and 1,3,8 and 24 h after operation.Wet/dry ratio of lung tissues and incidence of multiorgan dysfunction syndrome (MODS) were detected 24 h after operation.Results Level of TM was increased progressively after operation,which was significantly higher in sepsis group than in anisodamine-treated group at 3,8 and 24 h [(28.7±15.9) vs (19.5 ±10.6)ng/ml,(36.5±20.8) vs (21.9±12.8)ng/ml,(52.6±32.7)vs (31.3 ± 18.4)ng/ml respectively] (P ＜ 0.05).The PaO2 decreased slowly after operation,with the decrease more significant in sepsis group than in anisodamine-treated group at 24 h [(65.6 ± 14.5) vs (83.3 ± 16.3)mmHg] (P ＜0.05).The ERO2 had a rise-and-fall trend after operation,with the level lower in sepsis group than in anisodamine-treated group at 24 h [(16.7 ± 3.1) ％ vs (21.7 ± 2.9) ％] (P ＜ 0.05).Level of blood lactate increased gradually,with the level higher in sepsis group than in anisodamine-treated group at 24 h [(4.4 ± 1.2) vs (3.1 ± 0.8) mmol/L] (P ＜ 0.05).Wet/dry ratio of lung tissues in sepsis group was (510 ± 80) ％ versus (370 ± 50) ％ in anisodamine-treated group at 24 h (P ＜ 0.05).Incidence of MODS in sepsis group was 38％ versus 17％ in anisodamine-treated group at 24 h (P ＜ 0.05).Conclusion Anisodamine may ameliorate the injury to vascular endothelial cells and oxygen metabolism disorder after sepsis and hence contributes to the reduction of sepsis-induced MODS.
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Objective To evaluate the efficacy of intravenous immunoglobulin (IVIG) in the treatment of severe EV71 infection in children.Methods The clinical data of children with severe EV71 infection,who admitted in our hospital from January 2010 to November 2012 were retrospectively analyzed.According to the time of admission and treatment principles,the patients were divided into the 2010 group and the 2012 group.The patients of the 2010 group routinely received IVIG treatment,but patients in the 2012 group received IVIG treatment in serious condition.The obvious effective rate,effective rate,ineffective rate,the incidence rate of critically ill and mortality of the two groups were compared.Results There were no significant differences in the obvious effective rate (86.0％ and 85.2％),effective rate (9.6％ and 11.8％),ineffective rate (4.4％ and 3.0％),the incidence rate of critically ill (4.0％ and 2.2％) between the two groups (x2 =0.011,1.269,1.657,3.304,all P ＞ 0.05).The mortality of the 2010 group (2.8％) was higher than that of the 2012 group (0.6％)(x2 =8.213,P ＜0.05).Conclusion IVIG has no effect on patients with severe EV71 infection,and is not recommended.
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Objective To explore the effect of multiple-formed nursing teaching ward-round.Methods Trainings and practices about muhiple-formed nursing teaching ward-round were executed to clinical instruction teachers.Results 95.9%of nursing students were satisfied with the quality of nursing teaching ward-round.After training ang practices,the evaluation to the nursing teaching ward-round and the scores of theoretic and operation examination of nursing students raised significantly(P＜0.05).Conclusions The trainings and practices improve the teachers' ability of utilizing multiple-formed nursing teaching ward-round,which not only enhance the students' study initiative,but also improve the query of nursing teaching teaching ward-round.