Effect of thrombelastography in the diagnosis of disseminated intravascular coagulation in children / 中华儿科杂志

<p><b>OBJECTIVE</b>To study the effect of thrombelastography (TEM) in the diagnosis of disseminated intravascular coagulation (DIC) in children.</p><p><b>METHOD</b>The data of 117 children suffering from DIC in the pediatric intensive care unit (PICU) and Cardiologic ICU (CICU) in the authors' hospital from January 2010 to June 2012 were collected. Ninety-four children without DIC were enrolled into the control group. The platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimers and TEM were determined. The sensitivity and specificity of TEM were measured and the relevance of TEM and DIC was investigated to evaluate the effect of TEM and the conventional tests of the coagulation system in the diagnosis of DIC in children.</p><p><b>RESULT</b>The average R reaction time in the DIC group was significantly longer than that in the control group[(13.3 ± 3.3)s vs. (4.5 ± 2.6)s, P = 0.000 5], and the average α-angle in the DIC group was smaller than that in the control group significantly (37.2° ± 1.4° vs. 55.6° ± 3.8°, P = 0.001 0). There was significant decrease in the maximal amplitude (MA) and amplitude (A) in the DIC group, compared with the control group. The OR value (95%CI) of the R reaction time,α-angle and MA was 3.538 (1.298-5.389), 2.472 (1.820-2.224) and 0.256 (0.263-0.831) respectively, which suggests good correlation with the existence of DIC (all P < 0.01). The specificity of R reaction time, α-angle and MA was higher than that of PT, APTT and D-dimers (85.7%, 73.5% and 72.9% vs. 27.0%, 42.1% and 68.2%) . The average R reaction time of children suffering from hemorrhage of severe liver disease(n = 36) was significantly longer than that of 40 healthy children [(9.2 ± 2.7) vs. (2.3 ± 1.8)s, P = 0.001 0], while the α-angle (42.8° ± 7.6° vs. 59.2° ± 10.8°, P = 0.040 0) and the MA value [(33.9 ± 5.1) vs.(56.0 ± 8.1) mm, P = 0.020 0] were significantly smaller. The average R reaction time of children suffering from congenital coagulopathy was significantly longer than that of healthy children [(6.8 ± 3.1) vs. (2.3 ± 1.8)s, P = 0.003 0], too.</p><p><b>CONCLUSION</b>TEM, which has high specificity, is beneficial to the diagnosis of DIC in children.</p>

Analysis of relationship between stress hyperglycemia and variation of serum insulin in critical ill children / 中华实用儿科临床杂志

Objective To study the relationships between the level of blood glucose in critical ill children with the degree of critical illness and the variation of immunoreactive insulin (IRI) and true insulin (TI).Methods Fiftyeight children form the Neonatal Intensive Care Unit (PICU) and Department of Respiration were enrolled in this study.The children were divided into PICU group (42 cases) and control group (16 cases).The PICU group were scored pediatric critical score in 24 hours after admission.The 42 critical ill children were divided into stress hyperglycemia group (20 cases) and non-stress hyperglycemia group (22 cases) according to their blood glucose levels.The IRI,TI,C-Peptide and blood glucose were measured.Results The pediatric critical illness score of stress hyperglycemia group [(74.80 ± 8.07) scores] was significantly lower than that of non-stress hyperglycemia group [(84.36 ±9.46) scores] (t =1.964,P ＜ 0.05).The death rate of stress hyperglycemia group (45.0％,9/20 cases) was significantly higher than that of non-stress hyperglycemia group (13.6％,3/22 cases) (x2 =5.05,P ＜ 0.05).The IRI,TI and C-Peptide of stress hyperglycemia group were significantly higher than those of non-stress hyperglycemia group and control group(F =136.90,61.25,45.89,all P ＜ 0.05).The TI/IRI of stress hyperglycemia group was significantly lower than that of non-stress hyperglycemia group and control group (F =27.64,P ＜ 0.05).The TI,IRI and C-Peptide of stress hyperglycemia group were higher than after admission (t =2.241,2.087,2.014,all P ＜ 0.05).Conclusions The children with critical illness have stress hyperglycemia and the component of insulin is changed,and the absolute level as well as the rate of TI and TI/IRI are descended.

A hospital based survey on childhood accidental injuries in five years / 中国小儿急救医学

ObjectiveTo study the causes and risk factors of childhood accidental injuries as a reference for prevention.MethodsA retrospective analysis was made on the clinical data of 4 116 cases of childhood accidents admitted to children's hospital of Fudan university from Jan 1,2005 to Aug 31,2009.ResultsThe 4 116 cases with accidental injuries were found to account for 4.35 ％ (4 116/94 579) of all inpatients during the same period.Ratio of male to female was 2.01∶ 1.The most common causes of injury were accidental falls (30.73％,1 265/4 116),traffic accidents (23.71％,976/4 116) and accidental drops (11.59％,477/4 116).Accidental falls were mainly seen in children over one year,traffic accidents mainly occurred in children aged four to seven,while the accidental drops were mainly seen in infants less than oneyear-old.The top three causes of accidental injury with highest mortality rate were airway foreign body,drowning and poisoning.Bone and joint injuries were mostly seen in accidental injury.ConclusionAccidental injury of children has been a serious threat to the lives of children and we should base on the characteristics of children to take preventive measures.

The application of bronchofibroscope in PICU / 中国小儿急救医学

Objective To explore the efficacy and safety of clinical application of bronchofibroscope (BFS) in PICU. Methods Seventy-nine critically ill children in our PICU were operated with BFS in 89 cases and the etiology of these children was analyzed. The blood-gas analysis and oxygenation index both before and after the treatment had been compared, and syndrome was observed as well. For 40 cases in which critically ill children received bronchoalveolar lavage in addition to mechanical ventilation, and the index of respiratory mechanics was analyzed. Analysis and summary had been performed on the culture results of bronchoalveolar lavage fluid in 74 cases. Results The primary disease in these cases was mainly respiratory diseases (64/79). There was no major change in oxygenation index and blood pH ( P ＞0. 05 ) before and after operation with BFS. No severe syndrome,such as sudden cardiac arrest and pneumothorax, was recorded. However,transient decrease in SpO2 was most frequently observed in minor syndromes (15/79). The children treated with mechanical ventilation were recorded with significant decrease in air way resistance ( P ＜ 0. 05 ) after bronchoalveolar lavage. However,dynamic compliance and work of breathing only changed slightly (P ＞0. 05 ). The culture positive rate of bronchoalveolar lavage fluid was 29. 1% (23/79) ,mainly gram-negative bacteria, which coincided with disease spectrum of PICU. Conclusion The application of BFS in PICU can improve salve and tracheobronchial management for critically ill children. The diagnosis and treatment is safe and reliable by strictly grasping the examination indication by BFS under the custody of PICU.

Effect of L-arginine Therapy on Serum Nitric Oxide and Endothelin in Acute Hypoxic Rat / 复旦学报（医学版）

PurposeTo study the changes of serum nitric oxide(NO)and endothelin(ET)levels by L-Arg therapy in acute hypoxic model. MethodsNADPH diaphorase histochemical staining method, Griess biochemical assay and radioimmune assay were applied to investigate the changes of nitric oxide synthase (NOS) ,NO, cGMP and ET in normal, hypoxic and L-Arg treated hypoxic rats. Resultsduring acute hypoxia, while serum ET rose up significantly, both the levels of serum NO and cGMP and the activity of NOS were significantly lower. After the application of L-Arg therapy, the activity of NOS did not change significantly, but the levels of serum NO and cGMP rose up significantly, and the level of serum ET was to the opposite direction. ConclusionsNO and ET may modulate hypoxic pulmonary hypertension, and acute hypoxia can result in acute hypoxic pulmonary hypertension. L-Arg can reverse the acute hypoxic hypertension.