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Objective:To analyze the clinical characteristics, diagnosis and treatment of 3 children with severe COVID-19 encephalopathy, aiming to improve the clinicians′ understanding of the disease.Methods:The clinical features, laboratory examinations, imaging data and diagnosis as well as treatment process of 3 cases of severe COVID-19 encephalopathy admitted to the Pediatric Intensive Care Unit of Shengjing Hospital of China Medical University from December 1, 2022 to December 31, 2022 were retrospectively analyzed.Results:Among the 3 patients, 2 were female, age was 2-11 years old, all of them had 2-3 days of medical history.All of them had clinical manifestations of high fever(≥40 ℃), convulsions and consciousness disorders, nucleic acid and antigen tests of SARS-CoV-2 were positive, and mycoplasma pneumonia IgM antibody was positive in 1 case.Within 24 hours after admission, the levels of white blood cells were basically normal, neutrophil fraction was dominant, and procalcitonin was significantly increased.Total T cells and NK cells in the blood of the three patients were significantly decreased, and the levels of blood ammonia, blood glucose and bilirubin were basically normal.During the early stage of the disease, the cell counts of the cerebrospinal fluid was normal in all three patients, the protein level was significantly increased, and there were new symmetrical lesions on head magnetic resonance imaging in 3 patients.After symptomatic treatment and immunotherapy including early use of hormone, human gamma globulin and plasma exchange, all patients were survived, but had different degrees of new dysfunction of the nervous system.Conclusion:Severe COVID-19 encephalopathy can occur in the acute phase of SARS-CoV-2 infection, mostly manifested as high fever, convulsions and severe disturbance of consciousness, combining with multiple organ dysfunction and irreversible nervous system damage.Early supportive treatment, brain protective treatment and immunotherapy are helpful to improve the prognosis of the patients.
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Objective:To analyze the clinical characteristics, diagnosis and treatment of 3 children with severe COVID-19 encephalopathy, targeted to improve the clinicians′ understanding of the disease.Methods:The clinical features, laboratory examinations, imaging data and diagnosis and treatment process of 3 cases of severe COVID-19 encephalopathy admitted to the Pediatric Intensive Care Unit of Shengjing Hospital of China Medical University from December 1, 2022 to December 31, 2022 were retrospectively analyzed.Results:Among the 3 patients, 2 were female, age was 2-11 years old, all of them had 2-3 days of medical history, all of them had clinical manifestations of high fever(≥40 ℃), convulsions and consciousness disorders, nucleic acid and antigen tests of SARS-CoV-2 were positive, and mycoplasma pneumonia IgM antibody was positive in 1 case.Within 24 hours after admission, the levels of white blood cells were basically normal, neutrophil fraction was dominant, and procalcitonin was significantly increased.Total T cells and NK cells in the blood of the three patients were significantly decreased, and the levels of blood ammonia, blood glucose and bilirubin were basically normal.In the early stage of the disease, the cell counts of the cerebrospinal fluid was normal in all the three patients, the protein level was significantly increased, there were new symmetrical lesions on head magnetic resonance imaging in 3 patients.After symptomatic treatment and immunotherapy including early use of hormone, human gamma globulin and plasma exchange, all the patients were survived, but had different degrees of new dysfunction of the nervous system.Conclusion:Severe COVID-19 encephalopathy can occur in the acute phase of SARS-CoV-2 infection, mostly manifested as high fever, convulsions and severe disturbance of consciousness, combined with multiple organ dysfunction and irreversible nervous system damage.Early supportive treatment, brain protective treatment and immunotherapy are helpful to improve the prognosis of patients.
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Objective:To analyze the causes and characteristics of children′s accidental injuries, and provide reference for preventing accidental injury in children.Methods:The case data of 350 children who were hospitalized due to accidental injury in the PICU at Shengjing Hospital of China Medical University from June 2017 to May 2020 were collected, and their age characteristics, family factors, accident time, location, cause of injury and prognosis were analyzed.Results:A total of 350 children with accidental injury were treated during three years, accounting for 12.2% of the total number of children admitted to the PICU during the same period, and the fatality rate was 10.6%.There were 200 males and 150 females; infants and young children were still the high-risk group of accidental injuries, accounting for 42.9%, while adolescent children accounted for 27.4%.The top three causes of accidental injury were poisoning in 149 cases (42.6%), traffic injury in 75 cases (21.4%), and fall injury in 65 cases (18.6%). The accident occurred most frequently in summer, mainly from 12∶00 to 18∶00, the average hospitalization days were 8.04 days, and the average hospitalization cost was 28 686.74 yuan.Conclusion:At present, accidental injuries of children are still an important factor endangering children′s health.The fatality rate is high and the characteristics of the disease are closely related to age, season, location, etc.Targeted prevention and intervention measures should be carried out according to different characteristics.
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Objective:To investigate the clinical characteristics, diagnosis and treatment of mycoplasma pneumoniae(MP) pneumonia in children with pseudo-macrocytic erythrocytes.Methods:The clinical data of 50 children with mycoplasma pneumoniae pneumonia with pseudo-macrocytic erythrocytes in the Department of Pediatrics at Shengjing Hospital of China Medical University from January 2019 to August 2020 were analyzed retrospectively.Results:Among the 50 cases, there were 32 boys and 18 girls.The blood routine examination showed that pseudo-macrocytic erythrocytes, red blood cells decreased significantly, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration increased significantly, as well as MP-IgM was positive.Sixteen cases were complicated with herpes simplex virus infection, one with Epstein Barr virus infection, and six with both herpes simplex virus and Epstein Barr virus infection at the same time.All 50 cases were MP pneumonia, pulmonary imaging showed lobar pneumonia, and 25 cases were complicated with pleural effusion, including 32 cases of refractory MP pneumonia.The clinical symptoms of three cases were extrapulmonary manifestations, hemolytic anemia and diagnosed with cold agglutinin syndrome.In 36 children with D-dimer more than 252 μg/L, one case had femoral vein thrombosis and one case had pulmonary embolism.Conclusion:Pseudo-macrocytic phenomenon may play important roles in clinical etiological diagnosis, severity of disease and refractory MP pneumonia.The children with hemolytic anemia suggest cold agglutinin syndrome, and the hypercoagulable state of MP infection may be related to the aggregation of red blood cells caused by cold agglutinin in MP infection.
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Objective:To evaluate the diagnostic and therapeutic value of bedside severe ultrasound in children with shock.Methods:Children who were diagnosed shock in the PICU of Shengjing Hospital of China Medical University from May 1, 2019 to April 31, 2020 were included in this study.Rapid ultrasound in shock (RUSH) exam was used to evaluate the morphology and function of heart, lung and abdomen of children with shock, so as to assist the diagnosis and treatment of shock.Results:Twenty-six children with shock were evaluated immediately according to the RUSH exam when they were admitted to hospital.Eight cases were diagnosed as septic shock, six cases as cardiogenic shock, six cases as hypovolemic shock and six cases as mixed shock.The left ventricular ejection fraction (LVEF) of children with cardiogenic shock was (26.5±8.24)%, and the width of inferior vena cava was greater than 10 mm.After the shock was corrected, LVEF increased to (32.17±26.11)%.However, the LVEF of children with septic shock was (73.25±1.28)% at admission and (50.12±31.41)% at shock correction.Nine cases (34.6%) found more B-lines in the lungs after fluid resuscitation for one hour in 26 children with shock.Among them, about 50% of the children with cardiogenic shock found more B-lines in their lungs one hour after fluid resuscitation, and 11 cases(57.9%) of the surviving children showed more B-lines after shock correction, but only six children could hear blisters after physical examination.Conclusion:According to RUSH exam, we can evaluate the volume status, cardiac function, volume responsiveness and focus on infection in children with shock, distinguish the type of shock earlier and more accurately, assist in guiding fluid resuscitation, and facilitate accurate and individualized fluid management and treatment of patients.
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Objective To assess the effect of silent mating type information regulation 2 homolog 6 (SIRT6) on migratory and proliferative activity of skin fibroblasts in the elderly,and to explore their mechanisms.Methods Circumcised foreskins were obtained from patients of different ages in Department of Urologic Surgery,Second Hospital of Shanxi Medical University,including 8 elderly patients and 8 young patients.Human skin fibroblasts were isolated from the foreskin tissues by using a collagenase digestion method.Western blot analysis was performed to determine the expression of SIRT6 and phosphorylated p65 (p-p65) in human skin fibroblasts in different age groups,scratch assay to evaluate cell migratory activity,and cell counting kit-8 (CCK8) assay to assess cellular proliferative activity.Skin fibroblasts in the elderly group were divided into 2 groups:SIRT6 group transfected with a lentiviral vector overexpressing SIRT6,and control group transfected with an empty lentiviral vector.Then,the cell migratory and proliferative activity as well as p-p65 expression were measured by the above methods,and the mRNA expression of type Ⅰ and Ⅲ collagens,and integrin subunits α3,α5 and β1 was determined by real-time PCR in the SIRT6 group and control group.Statistical analysis was carried out with GraphPad Prism 5 software by using t test for comparison between 2 groups.Results Compared with the young group,the elderly group showed significantly decreased SIRT6 expression in skin fibroblasts (0.434 ±0.179 vs.1.000 ± 0.067,t =3.040,P =0.012),migration rate (43.81％ ± 18.84％ vs.94.63％ ± 12.32％,t =5.903,P =0.003)and cellular proliferative activity at 24 and 48 hours (both P ＜ 0.05),but significantly increased p-p65 expression (1.694 ± 0.148 vs.1.000 ± 0.093,t =2.949,P =0.015).Compared with the control group,the SIRT6 group showed significantly decreased p-p65 expression (P ＜ 0.05),but significantly increased migratory and proliferative activity (both P ＜ 0.05),and elevated mRNA expression of type Ⅲ collagen and integrin subunits oα3,α5 and β1 (all P ＜ 0.05).Conclusion SIRT6 can improve the migratory and proliferative activity of human fibroblasts in the elderly,possibly by inhibiting the nuclear factor-κB pathway.
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Objective@#To investigate the epidemiology and clinical features of pulmonary hemorrhage in children at pediatric intensive care unit(PICU).@*Methods@#A retrospective cohort case analysis was performed in order to investigate the incidence, primary disease, clinical manifestations and clinical characteristics of pulmonary hemorrhage in children at PICU of Shengjing Hospital of China Medical University from January 2008 to September 2017.@*Results@#Among the 73 cases, 39 cases were male (53.4%) and 34 cases were female(46.6%), and the average age was 31(5, 72)months.The conditions of 14 cases(19.2%) were improved and discharged, 17(23.3%) cases died during the hospitalization period, and 42 cases gave up treatment halfway.The primary causes of pulmonary hemorrhage included severe heart failure in 17 patients (23.3%), acute respiratory distress syndrome (ARDS) in 12 patients (16.4%), severe sepsis in 10 patients (13.7%), hematological diseases in 10 patients (13.7%), intracranial hemorrhage occurred in 5 patients (6.8%), cardiac arrest in 5 patients (6.8%), coagulation dysfunction in 5 patients(6.8%), renal disease in 3 patients(4.2%) and other diseases in 6 patients(8.3%). The symptoms of all cases (73 cases) of pulmonary hemorrhage included dyspnea, moist rales and decreased blood oxygen saturation.Nasal bleeding or coffee ground like material drawn out from nasal stomach tube could be found in 32 cases(43.8%, 32/73 cases), 36 cases(49.3%, 36/73 cases)were complicated by shock and 9 cases (12.3%, 9/73 cases) were combined with convulsions, and 47 cases (64.4%, 47/73 cases) were given cardiopulmonary resuscitation.The positive end expiratory pressure in ARDS group was(10.2±2.4) cmH2O(1 cmH2O=0.098 kPa), which was higher than that in other groups (F=4.59, P<0.01). The oxygen concentration in acute respiratory distress syndrome group was(0.9±0.1)% , which was higher than that in other groups (F=3.16, P<0.01). International normalization ratio was 1.9±0.7 in severe sepsis group, which was higher than that in other groups (F=2.96, P<0.01). Blood platelets in hematological disease group was (52.0±46.8)×109/L, which was lower than that in other groups (F=8.23, P<0.01) and hemoglobin in hematological disease group was (81.6±15.6) g/L, which was lower than that in other groups (F=5.48, P<0.01). Chest X-ray examinations showed decreased lung permeability, multiple exudative lesions in 61 cases and increased bronchovascular shadows in 5 cases.@*Conclusions@#Pulmonary hemorrhage may be a complication of many diseases. Severe heart failure, ARDS, severe sepsis and hematological diseases are the first four primary causes of pulmonary hemorrhage at PICU. Different causes of pulmonary hemorrhage manifest different characteristics.If the symptom of a patient shows heart rate increase, dyspnea, moist rales and blood oxygen saturation decreased with bleeding tendency and pulmonary infiltration by chest X-ray, he can be suspected of pulmonary hemorrhage.
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Acute liver failure(ALF)is a life-threatening clinical syndrome in children,which has a high mortality. Extracorporeal liver support systems include bioartificial liver,nonbioartificial liver and hybrid artificial liver,with the aim of supporting children with ALF,as a bridge to recovery or liver transplantation. The theoretical basis of non-bioartificial liver support system is blood purification. Although biochemical efficacy has been demonstrated by these devices,the effect on the final prognosis has been unclear. Compared with adults,there are less data on the treatment for children with ALF,and some new blood purification modes and combined blood purification modes have shown potential in the treatment of ALF in recent years. The aim of this review is to introduce the practice of blood purification and to provide references for the treatment of children with ALF.
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Acute respiratory distress syndrome ( ARDS) is a devastating clinical syndrome with the condition of dyspnea,characterized by rapidly progressive hypoxemia with noncardiogenic pulmonary edema. Current therapeutic strategies are based on improving oxygenation and pulmonary compliance while minimizing ventilator-induced lung injury. However,many previous studies had found that the leading risk of ARDS patient′s death is circulatory collapse rather than pulmonary injury or hypoxemia. Additionally,acute cardiac dysfunc-tion caused by increased pulmonary vascular resistance is an important cause of circulatory failure. Besides,with the deepening of the studies,the dysfunction of lung and heart in ARDS patients,also known as severe acute cor pulmonale (ACP),has been shown to be associated with the pathophysiological process of the ARDS and could lead to the increase of right ventricular pressure load,which eventually might result in right ventricular failure. Furthermore,the inappropriate mechanical ventilation could also lead to right ventricular failure,and therefore it′s necessary to closely monitor the function of right ventricular in ARDS patients. To conclude,we will intro-duce the protective ventilation strategy of right ventricular preliminarily in this review.
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OBJECTIVE@#To study the features of new-onset organ dysfunction in children with sepsis in the pediatric intensive care unit (PICU).@*METHODS@#A retrospective analysis was performed for the clinical data of children with sepsis who were admitted to the PICU from 2015 to 2016. There were 34 children with severe sepsis and 69 with non-severe sepsis, and the two groups were compared in terms of the incidence rate of new-onset organ dysfunction and the functional status on admission and at discharge.@*RESULTS@#The severe sepsis group had a significantly higher incidence rate of new-onset organ dysfunction than the non-severe sepsis group (38% vs 6%; P<0.05). The children in the non-severe sepsis group had a relatively good functional status on admission, with marked improvement in the overall functional status at discharge. The children in the severe sepsis group had a poor functional status on admission, with mild/moderate abnormalities in consciousness, sensation, communication and respiratory function at discharge.@*CONCLUSIONS@#Children with non-severe sepsis have a low incidence rate of new-onset organ dysfunction and a good prognosis, and those with severe sepsis often have a high incidence rate of new-onset organ dysfunction and a poor prognosis.
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Child , Humans , Intensive Care Units, Pediatric , Multiple Organ Failure , Patient Discharge , Prognosis , Retrospective Studies , SepsisABSTRACT
Pulmonary vessels thrombosis in the pediatric population is relatively rare when compared to adults,but potentially lethal disease.Most children with pulmonary vessels thrombosis are commonly asymptomatic or have nonspecific symptoms.Pulmonary vessels thrombosis often goes unrecognized among children leading to misdiagnosis and potentially increased morbidity and mortality,accurate and timely diagnosis is critical.Evidence-based guidelines for the diagnosis,management,and follow-up of children with pulmonary vessels thrombosis are lacking and current practices are extrapolated from adult data.Long-term sequelae of pulmonary vessels thrombosis are vastly unknown among children.More attention should be paid to pulmonary vessels thrombosis to provide more reasonable diagnosis and treatment for children with pulmonary vessels thrombosis.
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Objective To summary the clinical characteristics of acute necrotizing encephalopathy in childhood so as to estimate the prognosis and guide the therapy. Methods We collected and analyzed retro-spectively the data of 10 acute necrotizing encephalopathy cases hospitalized in the pediatric department of our hospital from January 2014 to April 2018. The clinical manifestations,laboratory examinations and imaging features were retrospectively analyzed. Results A total of 10 cases all had fever and convulsions (100％). There was no specific clinical manifestation in the early stage,always showing the symptoms of acute respira-tory infection or acute gastroenteritis. Mental malaise,lethargy,restlessness and frequent convulsions occured when the conditions aggravated. Nine patients had different degrees of consciousness disorder. It could be complicated by multiple organ dysfunction syndrome,hemophagocytic syndrome and so on. Eight patients un-derwent MRI. In acute phase, homogeneously prolonged T1 and T2 relaxation time of the brain lesions on MRI were found in most patients,and diffusion-weighted imaging ( DWI) and FLAIR showed high signal in-tensity. Six cases underwent head CT examination, hypodensities were seen on 4 cases. Cerebrospinal fluid (CSF) was detected in all patients,and the protein levels in CSF increased to varying degrees,while white blood cells did not increase. Of the 10 patients,3 died,1 was discharged normally,1 had hemophagocytic syn-drome,transferred to pediatric hematology department,and 5 patients were transferred to rehabilitation depart-ment. Conclusion Acute necrotizing encephalopathy in children always make progress rapidly, has high mortality,many survivors have severe neurological sequelae,which is worthy of being attention.
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Objective To investigate the clinical features,pathogenic distribution of children with in-fective endocarditis(IE)during the past 10 years.Methods Medical records of 30 children with IE admitted to Shengjing Hospital of China Medical University from October 2006 to October 2016 were retrospectively analyzed,including the clinical data and pathogenic characteristics.Results Among the 30 cases of IE,there were 18 males and 12 females,age ranged from 2 months to 13 years old.Fever was found as initial symp-toms in 21 cases(70.0%),respiratory symptoms in 4 cases(13.3%),neurological symptoms in 4 cases (13.3%),edema in 2 cases(6.7%),murmur in 1 case,precordial discomfort in 1 case,and peripheral blood cell reduction in 1 case. The most common underlying factor was congenital heart disease(17 cases, 56.7%).Surgery was performed in 6 children due to congenital heart disease before endocarditis.Vegetations were detected on echocardiography in all cases(100%).Blood cultures were positive in 50.0%,Staphylococ-cus aureus was the most common organism,accounting for 6 cases (40.0%).Other notable pathogens in-cluded Streptococcus pneumoniae(4 cases,26.7%),Enterococcus faecalis(2 cases,13.3%),Streptococcus suis(1 case),Streptococcus anginosus(1 case) and Staphylococcus epidermidis(1 case).C-reactive protein was raised in 25 cases(83.3%)at the time of admission.C-reactive protein was higher than 100 mg/L in 8 cases.Conclusion Early clinical manifestations of IE are atypical.Fever is the most common symptom. Congenital heart disease is the major risk factor of IE,Gram-positive cocci is the most common organism. Antibiotic treatment is not effective,then surgical treatment may be considered.
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Objective To investigate the high risk factors of new dysfunction in Pediatric Intensive Care Unit.Methods A retrospective cohort case control analysis was performed in order to investigate the 906 patients admitted to the Pediatric Intensive Care Unit of Shengjing Hospital of China Medical University from January 2015 to January 2016.Assessment of Functional Status Scale(FSS) was performed at both admission and discharge.According to the new dysfunction diagnostic criteria,all cases were divided into new dysfunction group and control group.The 2 groups were compared in gender,glucocorticoids application time,mechanical ventilation application time,sedation application time,neuromuscular blockers application time,albumin,alanine aminotransferase,aspartate aminotransferase,creatine kinase,creatine kinase isoenzyme,leukocyte,hemoglobin and C-reactive protein.Multivariate Logistic regression was used to screen the risk factors leading to new dysfunction.All cases were divided into high risk factors group and control group according to the risk factors.The 2 groups were compared in initial FSS,FSS of discharge,ΔFSS and the discharge FSS of mental status domain,FSS of sensory domain,FSS of communication domain,FSS of motor domain,FSS of feeding domain,and FSS of respiratory domain.Results Among the 906 cases,547 cases were male and 359 cases were female,and average age was (28.1-± 1.9) months.There were 81 cases in new dysfunction group and 825 cases in control group.Factors such as mechanical ventilation application time [(3.7 ±-0.5) d vs.(1.1 ±-0.1) d],glucocorticoid application time [(3.2-±0.6) d vs.(1.7-±0.1) d],sedation application time[(4.7 ±0.7) d vs.(1.7 ±0.1)d],neuromuscular blockers application time [(0.7 ± 0.3) d vs.(0.1 ± 0.03) d],albumin [(35.6 ± 0.8) g/L vs.(40.5 ± 0.2) g/L],creatine kinase isoenzyme [(75.8 ± 12.4) U/L vs.(49.7 ± 2.6) U/L] had significant differences between the new dysfunction group and the control group(all P ＜ 0.05).Multivariate Logistic regression analysis revealed that more than 7 days of mechanical ventilation,more than 7 days of glucocorticoids application,more than 7 days of sedation application,hypoalbuminemia were risk factors to develop new dysfunction [OR =0.69 (95％ CI:0.62-0.78),OR=0.62 (95％ CI:0.75-0.94),0R=0.75 (95％ CI:0.68-0.84),0R=0.68 (95％ CI:1.06-1.16),all P ＜0.05].In the more than 7 days of mechanical ventilation group,FSS at discharge,FSS of mental status,FSS of sensory,FSS of communication,FSS of motor,FSS of feeding,FSS of respiratory were significantly different from those of the mechanical ventilation application time ≤ 7 d group (all P ＜ 0.05).In the more than 7 days of glucocorticoids application group,FSS of mental status,FSS of sensory,FSS of communication were significantly different from those of the glucocorticoids application time ≤7 d group (all P ＜ 0.05).In the more than 7 days of sedation application group,FSS at discharge,FSS of mental status,FSS of sensory,FSS of communication,FSS of motor were significantly different from those of the sedation application time ≤7 d group(all P ＜ 0.05).Concltsion More than 7 days of mechanical ventilation,glucocorticoids application and sedation application not only increase the incidence of new dysfunction,but also affect mental,sensory,communication,motor function,the muscle and cognitive function at discharge and prognosis.
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Objective To investigate the high risk factors of new dysfunction in Pediatric Intensive Care Unit.Methods A retrospective cohort case control analysis was performed in order to investigate the 906 patients admitted to the Pediatric Intensive Care Unit of Shengjing Hospital of China Medical University from January 2015 to January 2016.Assessment of Functional Status Scale(FSS) was performed at both admission and discharge.According to the new dysfunction diagnostic criteria,all cases were divided into new dysfunction group and control group.The 2 groups were compared in gender,glucocorticoids application time,mechanical ventilation application time,sedation application time,neuromuscular blockers application time,albumin,alanine aminotransferase,aspartate aminotransferase,creatine kinase,creatine kinase isoenzyme,leukocyte,hemoglobin and C-reactive protein.Multivariate Logistic regression was used to screen the risk factors leading to new dysfunction.All cases were divided into high risk factors group and control group according to the risk factors.The 2 groups were compared in initial FSS,FSS of discharge,ΔFSS and the discharge FSS of mental status domain,FSS of sensory domain,FSS of communication domain,FSS of motor domain,FSS of feeding domain,and FSS of respiratory domain.Results Among the 906 cases,547 cases were male and 359 cases were female,and average age was (28.1-± 1.9) months.There were 81 cases in new dysfunction group and 825 cases in control group.Factors such as mechanical ventilation application time [(3.7 ±-0.5) d vs.(1.1 ±-0.1) d],glucocorticoid application time [(3.2-±0.6) d vs.(1.7-±0.1) d],sedation application time[(4.7 ±0.7) d vs.(1.7 ±0.1)d],neuromuscular blockers application time [(0.7 ± 0.3) d vs.(0.1 ± 0.03) d],albumin [(35.6 ± 0.8) g/L vs.(40.5 ± 0.2) g/L],creatine kinase isoenzyme [(75.8 ± 12.4) U/L vs.(49.7 ± 2.6) U/L] had significant differences between the new dysfunction group and the control group(all P ＜ 0.05).Multivariate Logistic regression analysis revealed that more than 7 days of mechanical ventilation,more than 7 days of glucocorticoids application,more than 7 days of sedation application,hypoalbuminemia were risk factors to develop new dysfunction [OR =0.69 (95％ CI:0.62-0.78),OR=0.62 (95％ CI:0.75-0.94),0R=0.75 (95％ CI:0.68-0.84),0R=0.68 (95％ CI:1.06-1.16),all P ＜0.05].In the more than 7 days of mechanical ventilation group,FSS at discharge,FSS of mental status,FSS of sensory,FSS of communication,FSS of motor,FSS of feeding,FSS of respiratory were significantly different from those of the mechanical ventilation application time ≤ 7 d group (all P ＜ 0.05).In the more than 7 days of glucocorticoids application group,FSS of mental status,FSS of sensory,FSS of communication were significantly different from those of the glucocorticoids application time ≤7 d group (all P ＜ 0.05).In the more than 7 days of sedation application group,FSS at discharge,FSS of mental status,FSS of sensory,FSS of communication,FSS of motor were significantly different from those of the sedation application time ≤7 d group(all P ＜ 0.05).Concltsion More than 7 days of mechanical ventilation,glucocorticoids application and sedation application not only increase the incidence of new dysfunction,but also affect mental,sensory,communication,motor function,the muscle and cognitive function at discharge and prognosis.
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Objective To investigate the diagnostic value of plasma B-type natriuretic peptide(BNP) in left to right shunt congenital heart disease accompanied by heart failure in PICU.Methods We retrospectively reviewed the clinical data of 52 cases diagnosed left to right shunt congenital heart disease in the PICU of Shengjing Hospital of China Medical University from January 2012 to June 2014.The cases were divided into negative control group(n=18) and heart failure group(n=34) according to the criteria for the diagnosis of pediatric heart failure.We respectively compared plasma BNP,size of heart defects,left ventricular end-diastolic volume index(LVEDVI),ratio of left ventricular early diastolic filling blood flow velocity and left ventricular late diastolic filling blood flow velocity(E/A),left ventricular ejection fraction(LVEF),pulmonary artery systolic pressure(PASP),and cardiothoracic ratio between the two groups.We analyzed the correlation between plasma BNP and the size of heart defects,LVEDVI,E/A,cardiothoracic ratio,LVEF,PASP.The receiver operating characteristic curve was used to determine the optimal cut-off value of plasma BNP to diagnose heart failure.Results Plasma BNP were 87.7(22.7,165.7)pg/ml in negative control group and 716.5(326.8,1813.0)pg/ml in heart failure group.The plasma BNP level of heart failure group was significantly higher than that of negative control group(Z=5.3,P<0.01).Size of heart defects were 5.0(3.0,6.8) mm in negative control group and 7.4(5.5,9.0)mm in heart failure group.Size of heart defects of heart failure group was significantly higher than that of negative control group(Z=3.5,P<0.01).LVEDVI were (44.6±18.3)ml/m3 in negative control group and (70.8±38.4)ml/m3 in heart failure group.LVEDVI of heart failure group was significantly higher than that of negative control group(t=2.7,P=0.01).E/A were 1.3±0.3 in negative control group and 1.1±0.3 in heart failure group.E/A of negative control group was significantly higher than that of heart failure group(t=2.2,P=0.04).Plasma BNP had a positive relation with cardiothoracic ratio(r=0.49,P=0.01) and a negative correlation with E/A(r=-0.28,P=0.04).The optimal cut-off value of plasma BNP was 181.8 pg/ml.The sensitivity of diagnosis of heart failure was 94% and the specificity was 88%.The area under the receiver operating characteristic curve was 0.951.Conclusion Plasma BNP may comprise a sensitive marker for heart failure of left to right shunt congenital heart disease.It is recommended that 181.8 pg/ml is the optimal cut-off value to diagnose heart failure of left to right shunt congenital heart disease.
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Objective@#To investigate the incidence and clinical characteristics of new-onset organ dysfunction of patients in pediatric intensive care unit (PICU).@*Method@#A retrospective observational study identified all patients admitted to the PICU of Shengjing Hospital Affiliated to China Medical University from January 2015 to January 2016. The functional status score (FSS) was evaluated at admission and hospital discharge respectively, and the difference defined as ΔFSS between the FSS at hospital discharge and the FSS at admission was calculated. According to the initial FSS, the patients were divided into normal group (6-7 scores), mildly abnormal group (8-9 scores), moderate abnormal group (10-15 scores), severe abnormal group (16-21 scores) and extreme severe abnormal group (22-30 scores). According to the primary disease, all cases were divided into cardiovascular disease group, urinary disease group, surgery group, digestive disease group, neurological disease group, respiratory disease group, hematological disease group, poisoning group and other group. According to the FSS domain, all cases were divided into mental status group, sensory group, communication group, motor group, feeding group, respiratory group. The incidence of new-onset organ dysfunction, the case fatality rate and the FSS of each group were calculated. Comparisons were performed using a chi-square test, t test and analysis of variance.@*Result@#The study population included 928 patients (561(60.5%) male, mean age (31.1±1.3) months). The incidence of new-onset organ dysfunction was 8.8%(82/928) and the case fatality rate was 1.3%(12/928). The FSS at hospital discharge(scores), ΔFSS (scores) and the incidence of new-onset organ dysfunction were significantly less in patients in the normal group (6.38±0.17, -0.20±0.17 and 1.3%(3/229), respectively) compared to patients in the mildly abnormal group (7.09±0.27, -1.39±0.27 and 7.2%(12/170), respectively, t=2.36, 3.93, χ2=7.39, all P<0.05), patients in the moderately abnormal group (8.86±0.28, -2.76±0.28 and 10.6%(38/359), t=6.56, 6.91, χ2=17.14, all P<0.05), patients in the severely abnormal group(13.56±0.88, -4.39±0.88 and 24.6%(19/79), t=12.29, 7.13, χ2=42.43, all P<0.05) and patients in the extreme severely abnormal group(18.68±0.99, -6.59±0.91 and 10.9%(10/91), t=18.15, 10.10, χ2=13.27, all P<0.05). Significant difference was found regarding the incidence of new-onset organ dysfunction among patients in cardiovascular disease group (27.3%, 24/88), surgery group (9.2%, 6/65), digestive disease group (8.2%, 8/97), neurological disease group (7.7%, 23/299), respiratory disease group (6.9%, 17/248), hematological disease group (3.9%, 2/51) and toxic group (0, 0/61) (χ2=37.75, all P<0.05). There were significant differences among primary disease groups regarding the FSS at admission, the FSS at hospital discharge, ΔFSS, Δmental status FSS, Δsensory FSS, Δcommunication FSS, Δmotor FSS, Δfeeding FSS, and Δrespiratory FSS (F=13.56, 8.97, 10.84, 6.30, 7.37, 7.84, 7.47, 9.97, 10.50, all P<0.05).@*Conclusion@#The incidence of new-onset organ dysfunction in PICU was high. The case fatality rate in patients with new-onset organ dysfunction was high. The functional status at hospital discharge was strongly associated with the functional status at admission. Patients in the cardiovascular disease group had the highest incidence of new-onset organ dysfunction and the most severe deterioration of functional status.More attention must be paid to motor function and respiratory function in cardiovascular disease, respiratory disease and hematological disease.
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Objective@#To analyze the clinical characteristics of community-acquired pneumonia (CAP) in children under five years of age and analyze the safety and efficiency of nasal continuous positive airway pressure (NCPAP) ventilation for CAP in this population.@*Method@#This was a prospective multicenter study. Children who were admitted to these six centers with CAP and met the NCPAP ventilation indications, aged from 29 d to 5 years, were continuously included during November 2013 to October 2015. The baseline data were collected and NCPAP ventilation were then followed up by operation standards, and the vital signs and arterial blood gas change at special time points were observed and recorded. Any side effect associated with NCPAP were recorded. For categorical variables, comparisons were performed using Fisher test. Rank-sum test and t test were performed respectively for abnormal and normal distribution continuous variables. The variables pre-NCPAP and post-NCPAP were analyzed by repeated measures ANOVA analysis.@*Result@#Totally 145 children were included, and 13 children were excluded due to incomplete data. One hundred and two children(77.3%)were ≤12 months; 91 children (68.9%) were from rural area. NCPAP ventilation was effective in 123 children, with a response rate of 93.2%, were all discharged with a better condition; it was ineffective in 9 children(6.8%), and they were all intubated and went on mechanical ventilation, 5 were discharged with a better condition, and 4 died after gaving up treatment. The gender, age, body weight, residence, main symptoms, main signs, imaging diagnosis, medications, partial pressure of oxygen(PaO2), breath and heart rate before NCPAP treatment of two groups had no significant differences(allP>0.05). The rates of combining underlying diseases, trouble with feeding and cyanosis, and the partial pressure of carbon dioxide(PaCO2 ) before NCPAP ventilation were higher in NCPAP ineffective group ((59±11 )vs.( 49±11) mmHg, 1 mmHg=0.133 kPa, t=-2.597, P=0.028); while the PaO2/fraction of inspiration O2 (FiO2 ) before NCPAP was lower((150±37) vs. (207±63) mmHg, t=2.697, P=0.008). The breathing, heart rate and PaCO2 of NCPAP effective group decreased significantly, while the PaO2 and PaO2/FiO2 increased significantly after 2, 8, 24 h of NCPAP ventilation(all P=0.000). PaCO2 in children with hypercapnia before NCPAP ventilation in NCPAP effective group decreased significantly ((48±9), (47±12), (45±11)vs.(58±7)mmHg, all P=0.000). All children tolerated well to NCPAP ventilation, and there were no severe side effects or complications associated with NCPAP ventilation.@*Conclusion@#NCPAP ventilation is safe and effectively improved the oxygenation and hypercapnia in infants with CAP. But it may not work well in children with underlying diseases, manifest as difficulty in feeding/cyanosis and extremely high PaCO2 or low PaO2/FiO2, and they may need early intubation.
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Objective To explore the role of CD3 +CD8 +T cells in children with severe bacterial meningitis at early stage by studying the changes of CD3 +CD8 +T cells and its relationships with markers of inflammation and humoral immunity. Methods Thirty-nine cases aged ≤14 years old were enrolled in this retrospective study,who were admitted in our PICU from Aug 1. 2014 to Dec 31. 2015 with diagnosis of se-vere bacterial meningitis. The patients were divided into 2 groups according to the changes of CD3 +CD8 + T cells:group A:normal or elevated(≥190/mm3,n=22),group B:decreased( 80% was more than 7 cases(31. 8%) in group A,there were significant differences(P<0. 05). Fourteen cases(82. 3%) with glucose concentration lower than 2. 0 mmol/L in group B was more than 11 cases (50. 0%) in group A,the difference was significant(P<0. 05). Conclusion CD3 +CD8 +T cells might be suppressed in children with severe bacterial meningitis at early stage,and might associate to the damaging de-gree of brain,inflammation reaction and prognosis in those patients,which should be helpful in using of im-mune regulators for children with severe bacterial meningitis.
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Objective To investigate the clinical features and risk factors in children with symptomatic central venous catheter-related deep vein thrombosis,and to provide guidence for clinical therapy.Methods The clinical data of 105 children with central venous catheter were retrospectively analyzed.According to the thrombosis or not,these children were classified into two groups:thrombosis group and non-thrombosis group.The risk factors influencing symptomatic central venous catheter-related deep vein thrombosis forming were identified by Logistic regression analysis.Results Among the 105 cases with central venous catheter,the male to female ratio was 68:37;age ranged from 8.5 months to 13 years old with average age(5.5 ±4.0) years old.There were 98 cases in non-thrombosis group and 7 cases in thrombosis group.Factors such as age[(5.7 ±4.1)years old vs.(2.5 ± 1.8) years old],central venous catheter dwell time[(6.1 ±2.3)d vs.(8.9 ± 2.1) d],more than 7 days parenteral nutrition application (11/98 cases vs.5/7 cases) and more than 7 days intravenous application of mannitol(7/98 cases vs.4/7 cases)were found significantly different between the thrombosis group and non-thrombosis group(P ＜ 0.05).Multivariate Logistic regression analysis showed that more than 7 days parenteral nutrition application and intravenous mannitol were the risk factors of symptomatic central venous catheter-related deep vein thrombosis [OR =50.703 (95 ％ CI 3.258-789.056),OR =15.590 (95 ％ CI 1.196-203.146),P ＜ 0.05].Conclusion Symptomatic central venous catheter-related deep vein thrombosis is a common complication of deep venous catheterization.It cause acute pulmonary embolism and some critical diseases,and influence the prognosis and prolong hospital stay.Application of intravenous nutrition more than 7 days and intravenous mannitol more than 7 days are the risk factors of symptomatic central venous catheter-related deep vein thrombosis.