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ABSTRACT OBJECTIVE：To compare the effectiveness and economics of peramivir and oseltamivir in the treatment of influenza complicated with febrile seizures in children. METHODS：In retrospective study，152 children with influenza complicated with febrile seizures were collected from our hospital during Dec. 2018 to Mar. 2019.They were divided into peramivir group（81 cases） and oseltamivir group （71 cases）. Fever remission time， medication duration， hospital duration， clinical efficacy （determined by convulsion，cough，nasal obstruction，runny nose，sore throat，etc.），the incidence of rash，the number of children with combined antibiotic and TCM were compared between 2 groups. Cost-effectiveness analysis was used to evaluate cost-effectiveness ratio（CER）and incremental cost-effectiveness ratio（ICER）of medication regimen in 2 groups. The sensitivity analysis of the effect and total cost were carried out with Logistic regression and multiple linear regression respectively through CER and ICER calculated by reducing 15％ drug price. RESULTS：There was no statistical significance in fever remission time， medication duration，hospitalization duration，the incidence of rash and proportion of children with combined antibiotics between 2 groups（P＞0.05）. There was statistical significance in proportion of children with combined TCM and clinical effect，and the proportion of children with combined TCM in peramivir group was significantly lower than oseltamivir group（P＜0.001）. Clinical effect of peramivir group was significantly better than that of oseltamivir group（P＝0.021）. Total cost of peramivir group and oseltamivir group were 5 442.84 yuan/person and 5 571.71 yuan/person（P＝0.795）；CER of them were 54.47 and 56.51；ICER of peramivir group was － 89.38. The results of sensitivity analysis were consistent with those of basic analysis.CONCLUSIONS： Compared with oseltamivir，peramivir is more effective and less costly for children with influenza and febrile seizures.
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Objective To provide useful information for the diagnosis and differentiation through exploring the tumor with polyserositis as the initial symptom.Methods There was a case present with fever,poor spirit,abdominal distention and edema in Children's Hospital of Hebei Province.The characteristics and results of physical examination were summarized and discussed according to the condition evolution phases.The possible etiological factors were analyzed.The treatment was adjusted.Further physical examination was improved.The final diagnosis was tracked.Results After getting admitted to hospital,the patient received CT scan and ultrasound examination for many times.The results suggested the pericardial effusion,pleural effusion,peritoneal effusion and cardiac insufficiency.The child had made a slight improvement through treatment.However,he had hemiparesis.Cerebral infarction was demonstrated through magnetic resonance imaging(MRI),magnetic resonance angiography (MRA),magnetic resonance venography (MRV).Ultrasound showed that there was more pericardial effusion,aortic root solid low echo mass,pulmonary arterial wall stiffness,left and right pulmonary artery blood flow speed increased.Neck and chest enhanced CT showed mediastinal lesions.Pathology examination results suggested myeloid sarcoma after referral to superior hospital.Conclusions When children had an unexplained polyserositis,more comprehensive analysis were needed.The illness condition should be explained with Monism as far as possible.Repeated inspections would be necessary when the pathogenesis was not clear.Careful watch for the tumor should be kept.
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Objective To explore the effectiveness and safety of high frequency oscillatory ventilation(HFOV) in children with measles complicated with severe pneumonia and the acute respiratory distress syndrome(ARDS).Methods A total of 63 children with measles complicated with severe pneumonia and the ARDS were divided into conventional mechanical ventilation(CMV) group and HFOV group.The PaO2/ FiO2,oxygenation index (OI),HR and mean arterial pressure (MAP) before treatment and 12 h,24 h,48 h after treatment were detected.The rate of air leak and the motality in two groups were compared.The efficacy and safety of HFOV treatment were evaluated in children with measles complicated with pneumonia and severe ARDS.Results In HFOV group,the PaO2/FiO2 ratio was elevated and OI was decreased significantly after 12 h and maintained for at least 48 h.Compared with CMV group,OI of HFOV group improved more significantly,and the difference was statistically significant.The ventilation time in HFOV group was shorten than that in CMV group[(7.97 ±3.06) d vs.(11.03 ±3.60) d],but there was no statistical difference between two groups (P ＞ 0.05).The heart rate after treatment 48 h was gradually returned to normal,and there was no statistical difference between the two groups.There were no significant changes in the MAP of two groups after treatment.There were no significant differences in the incidence of air leak between the CMV group and the HFOV group(24.2％ vs.16.7％).The mortality rate of CMV group and HFOV group was respectively 45.5 ％ and 33.3 ％,and there was no statistically significant difference.Conclusion HFOV was effective in oxygenation and seems to be safe for pediatric patients with measles complicated with severe pneumonia and the ARDS.Also it didn't influence the occurrence of complications.It has no adverse influence on hemodynamic parameters.Early intervention of HFOV is safe and effective for the children with measles complicated with severe pneumonia and ARDS.
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Objective To investigate the relationship between the coagulation system status and the pulmonary hemorrhage in children with severe hand,foot and mouth disease(HFMD)and approach the clinical significance of early detection of coagulation function. Methods By prospective case design method,89 cases with HFMD admitted to Department of Critical Care Medicine of Hebei Provincial Children Hospital from July 2010 to July 2012 were enrolled. The children were divided into severe group(46 cases)and critical group(43 cases)according to the severity of disease,and the children in critical group were subdivided into survivor group(26 cases)and non-survivor group (17 cases). Forty-four healthy children with the same age and in the same period were served as healthy control group. The blood of children was collected immediately after admission for determination of blood routine, prothrombin time(PT),thrombin time(TT),activated partial thrombin time(APTT),fibrinogen(Fg),and D-dimer (DD). Results There were no significant differences in PT,TT,APTT and Fg among severe group,critical group and health control group(all P>0.05). The blood platelets count(PLT)in severe group and critical group was significantly lower than that in health control group(×109/L:245±130,237±156 vs. 389±120),while the DD was significantly higher than that in healthy control group(mg/L:0.34±0.67,0.41±0.08 vs. 0.24±0.13),and the DD in critical group was obviously higher than that in severe group(all P0.05),but the DD in non-survivor group was significantly lower than that in survivor group(mg/L:0.60±0.09 vs. 0.12±0.09,P<0.05). Conclusions In children with severe or critical HFMD, the coagulation factor and blood platelet were in a state of mobilization,mild consumption state with the existence of fibrinolytic inhibition,but without systemic bleeding tendency,therefore it is in a compensatory stage of disseminated intravascular coagulation(DIC),not the mechanism of pulmonary hemorrhage. The monitor of DD has its clinical significance in evaluations of the disease situation and its prognosis.
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Analysis main reasonsof needle stabbing are poor self-protection awareness,unsound health care management system and dangerous behavior and habits.Therefore,medical staffshould strengthen safety education,arouse consciousness of self protection,improve working environment and do proper treatment after needle stabbing to avoid needle injury and safeguard their own health.
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Nitric oxide (NO) played an important role in the pathogenesis of many diseases. It selectively dilates the pulmonary vasculare, combats pulmonary hypertension associated with hypoxemia, improves oxygen. At the same time, it could relaxe bronchial smooth muscle, kill pathogens and have anti-inflammatory effect,etc. Inhaled nitric oxide has important significance in the treatment of respiratory diseases.