【摘要】 目的 探讨感觉统合训练及神经发育疗法对脑性瘫痪患儿智能发育的影响。方法 对2006年7月—2008年6月脑性瘫痪患儿100例,随机分成治疗组和对照组,治疗组50例,男26例,女24例,年龄8个月～5.8岁,平均2.7岁。对照组50例,男27例,女23例,年龄9个月～5.8岁,平均年龄2.7岁。两组均采用神经发育疗法,治疗组加用感觉统合训练,1次/d,30 min/次,每周5次,3个月1疗程,连续治疗2个疗程；治疗前后进行Gesell量表测试,观察患儿智能发育改善情况。结果 治疗组显效24例,有效25例,无效1例；对照组显效8例,有效39例,无效3例,两组比较有统计学意义(Plt;0.05),Gesell测试5项评分,两组治疗前无差异(Pgt;0.05),治疗后差异有统计学意义(Plt;0.05)。结论 感觉统合训练可提高脑性瘫痪患儿的智能发育,是减少小儿残疾的一个重要途径。
【摘要】 目的 比较喉罩和气管内插管吸入七氟烷全麻用于小儿无痛苦纤支镜检查的麻醉效果、苏醒时间、苏醒质量。 方法 将2008年3月-2009年3月40例行纤支镜检查的患儿随机分为喉罩组（L组，21例）和气管内插管组（T组，19例）。两组均采用逐渐诱导法吸入七氟烷，静脉给予芬太尼1 μg/kg；L组置入喉罩，T组气管插管后控制呼吸。手术中，两组均吸入2%～5%七氟烷维持麻醉。分别记录麻醉前（T0）、麻醉后纤支镜进入前（T1）、进镜至咽部（T2）、声门部（T3）、气管内（T4）及第15 min（T5）时的血压（BP）、心率（HR）、MAP和动脉血氧饱和度（SPO2）。观察纤支镜检查期间有无呛咳、气道痉挛或体动；记录停药至拔管的时间，苏醒后是否再入睡及麻醉满意度。 结果 两组HR在T1、T3、T4时升高，与T0时比较，有统计学意义（Plt;0.05）；其中HR在T1时T组高于L组，组间比较有统计学意义（Plt;0.05）；MAP在T1、T2、T3、T4时，T组低于L组，组间比较有统计学意义（Plt;0.05）。两组患儿镜检期间均无呛咳、气道痉挛或体动；L组苏醒时间短于T组（Plt;0.05），苏醒后再入睡率低于T组（Plt;0.05），麻醉满意度高于T组（Plt;0.05）。 结论 喉罩吸入七氟烷全麻用于小儿无痛苦纤支镜检查，能保证稳定的血流动力学状态，苏醒快速，效果满意。【Abstract】 Objective To assess the feasibility and safety of Laryngeal mask combined with sevoflurane in painless fiberoptic bronchoscopy anesthesia in children. Methods Forty children from March 2008 to March 2009 were randomized divided into laryngeal mask airway group (group L) and endotracheal intubation group (group T). Anaesthesia was induced and maintenanced with 2%-5% sevoflurane and fentanyl 1 μg/kg. The blood pressure (BR), heart rate (HR) and oxygen saturation by pulse oximeter (SPO2)were recorded before anaesthesia (T0), immediately after anaesthesia induction (T1), when FOB at the level of pharynx(T2), vocal cords (T3), trachea (T4) and in 15 min of the FOB (T5). Extubation time, recovery quality and anesthesia effects were also analyzed. Results Compared with T0, there were significant increases in HR at T1、T3 and T4 (Plt;0.05), and HR was significantly higher in the group T than that in the group L at T1 (Plt;0.05). MAP was significantly lower in group T than that in group L at T1、T2、T3 and T4, respectively(Plt;0.05). Recovery time was significantly shorter in group L than that in group T. Incidence of sleep after recovery was lower in group L than that in group T. Anesthesia satisfaction was higher in the group L than that in the group T. Conclusions Laryngeal mask combined with Sevoflurane provide satisfactory anesthesia for painless fiberoptic bronchoscopy in children.
摘要: 目的: 探讨小儿先天性心脏病（CHD）部分性房室间隔缺损（PAVSD）的外科治疗方法，以期提高疗效。方法: 对1999年6月至2009年8月收治27例PAVSD临床资料进行分析，男16例，女11例，年龄1.3~14岁,平均6.08岁。术前均经彩色多普勒超声心动图（Echo）和部分心导管检查确诊。手术全部在中低温体外循环（CPB）下行根治术。结果: 无手术死亡。22例获1个月~10年随访，1例术后3个月因重度二尖瓣返流（MR）,心力衰竭死亡，1例Ⅱ°房室传导阻滞（AVB）6个月后自行恢复，2例仍有轻度二尖瓣关闭不全; 余生活、学习正常，心功能Ⅰ级。结论: 一旦确诊应尽早手术治疗。修补原发孔缺损，注意避免损伤传导束，二尖瓣裂修复完善是手术成功和减少并发症的关键。Abstract: Objective: To discuss the surgical treatment of congenital heart disease as partial atrioventricular septal defect（PAVSD）to improve the therapeutic effect. Methods: From June1999 to December2008, the clinical data of 27 children suffering from PAVSD were analyzd. Male：16,female: 11. The ages ranged from 1.3 to 14 years, the average age is 6.08±3.73 years.All the children were final diagnosised by color Doppler echocardiogram and right catheterization.All underwent the radical correction under moderate hypothermic cardiopulmonary bypass. Results: There was no operative mortality. 25 cases were followed up for 6 months to 10 years, 1 case died of heart failure secondary to severe mitral regurgitation 3 months after the operation, 1 case had Ⅱdegree atrioventricular block , recovered 6 months later. 2 cases still had mild mitral regurgitation. Other cases lived and studied normally, their heart function is first class. Conclusion: Surgical treatment should be taken as soon as the diagnosis is confirmed. Shallow suturing repairing primum atrial defect and complete repairing mitral valve cleft are the key points of success and avoiding complications.