Objective To investigate the risk factors of infantile urolithiasis resulted from taking milk powder with melamine. Methods The clinical data of infant and young children who took free-screening for melamine associated urolithiasis in the Lanzhou University Second Hospital from September 14th, 2008 to January 6th, 2009 were collected, while the infants without urolithiasis in the same number as those with urolithiasis were also randomly collected into the control group. Then both univariate and multivariate analyses were performed with a logistic regression model to assess the independent risk factors for urolithiasis. Results Of the screened children, 647 children were included in the urolithiasis group and 647 were in the control group. There were 678 boys and 616 girls with an average age of 19.27 months. The results of logistic regression analysis showed that, the children fed with Sanlu powdered infant milk formula which contained a high level of melamine were more likely to suffer from urolithiasis than those took other melamine-contaminated formula (OR=6.09, Plt;0.01); boys were more than girls (OR=1.39, Plt;0.01), and children fed with formula alone were more than those fed with both formula and breast milk (OR=1.61, Plt;0.01). The risk of urolithiasis decreased gradually with age, and the OR value of children in age of smaller than 6 months, 6 to 12 months, 12 to 24 months were 5.23 (Plt;0.01), 2.73 (Plt;0.01), and 1.60 (Plt;0.01), respectively. The risk of urolithiasis increased gradually with the time lengthening of taking melamine-contaminated formula, and the OR value of children who had took melamine-contaminated formula for 3 to 6 months, 6 to 12 months and more than or equal to 12 months were 2.10 (Plt;0.01), 2.81 (Plt;0.01), and 4.75 (Plt;0.01), respectively. Conclusion It shows that feeding with high melamine infant formula (Sanlu powdered infant milk formula), artificial feeding and male children are the risk factors of infantile urolithiasis. Additionally, the risk of urolithiasis decreases with age and increases with time of formula feeding
Objective To discuss the prevalence of melamine-induced urolithiasis in infants and its development and to formulate more effective diagnosis and treatment. Methods A total of 402 cases of melamine-induced infantile urolithiasis were retrospectively analyzed with basic information, blood, urine, urinary B-mode ultrasonic diagnosis, treatment options and prognosis for infant urolithiasis. Results A total of 402 cases of infants had an excessive melamine milk feeding history, in which there were 9 self-discharged cases. The largest calculus diameter was 4 mm × 5 mm × 6 mm. The smallest calculus diameter was 0.5 mm × 0.5 mm × 1 mm. The average calculus diameter was 1 mm × 2 mm × 2 mm. There were 30 cases of abnormal serum creatinine, 27 of abnormal urea, 2 of abnormal uric acid, and urine occult blood positive for 167 cases. There were 395 cases which were administrated medical treatment; 7 cases were administrated surgical treatment; 6 cases had obstructive renal failure. Conclusion Infants whose age is more than six months but less than 12 months with a history of exposure to melamine have the larger risk of urolithiasis. B-mode ultrasonic diagnosis is practically significant on early screening urolithiasis. It is effective to perform surgical treatment for obstructive renal failure caused by calculus.
Objective To investigate the incidence of urolithiasis in infants aged 0-3 years old fed by milk powder tainted with melamine in the middle area of the Anhui province, as well as its relationship to gender, age, milk powder consumption and drinking water. Methods Questionnaires were distributed to 1079 infants who were screened for urolithiasis by ultrasound examination from September 25, 2008 to October 17, 2008. Data was collected by Epidata and analyzed by SPSS 13.0 software. Results A total of 646 (59.87%) male infants and 433 (40.13%) female infants underwent ultrasound examination in Anhui Provincial Hospital. Of these, 86 infants were diagnosed with urolithiasis with an incidence of 7.97%, including 62 males (72.09%) and 24 females (27.91%). The mean age of those infants with urolithiasis was 1.85±0.77, and all of calculus was located in kidney. The relationship between the incidence of urolithiasis and gender, age, drinking water, feeding bottle sanitation, birth status, as well as the amount of milk powder intake was assessed by using the Pearson Chi-square test. Results showed that significant differences were noted in the incidence of urolithiasis among infants of different genders or with different drinking water sources (Plt;0.05). The result of multiple logistic regression analyses indicated that gender was related to the incidence of urolithiasis (Plt;0.05). The incidence of urolithiasis in female infants was only 58.7% of that in male infants (OR 0.587, 95%CI 0.359 to 0.959). Conclusion The incidence of urolithiasis in infants aged 0-3 years of old in the middle area of Anhui province is relatively high and has anatomical specificity. Further data during the follow-up of these cases should be collected.
目的 探讨≤10 kg体重婴幼儿心脏直视术后呼吸机使用时间的相关因素。 方法 从2005年3月－2011年6月，选择纳入接受心脏直视手术的体重≤10 kg的先天性心脏病婴幼儿，分析各项围术期指标与术后呼吸机使用时间的关系，讨论该类婴幼儿术后呼吸机使用时间决策。 结果 共纳入体重≤10 kg的婴幼儿42例，呼吸机使用时间（42.74 ± 52.55） h，中位数20.88 h;发现术后2 h入量（mL/kg），术后4、8、16 h总入量（mL/kg）与术后呼吸机使用时间相关（P＜0.05），术后呼吸机使用时间与患儿ICU入住时间约成线性相关（P＜0.05）。 结论 影响低体重婴幼儿心脏直视术后呼吸机使用时间是术后液体管理，实施“限制性液体管理”治疗策略可能会促进患儿的术后快速康复。术后液体管理如何具体影响患儿呼吸机使用时间，影响患儿的预后，尚需进一步研究。Objective To evaluate the factors related to the postoperative mechanical ventilation (MV) duration in low-weight infants weighing less than 10 kg having undergone open cardiac surgery. Methods From March 2005 to June 2011, infants less than 10 kg undergoing congenital cardiac surgery were included in this research. We analyzed the relationship between various peri-operative indexes and the duration of MV, and discussed the decision for ventilation time for these infant patients. Results A total of 42 infants were included in our study. The ventilation time was (42.74 ±52.55) hours with a median of 20.88 hours. The postoperative second-hour fluid intake and the total intake of fluid at hour 4, 8, and 16 were related to the duration of mechanical ventilation (P＜0.05). And the ventilation time had a linear relationship with the ICU-stay time (P＜0.05). Conclusions The postoperative fluid management is associated with the duration of mechanical ventilation for low-weight infants having undergone open cardiac surgery. “Fluid controlling management” may facilitate quick recovery of the infant patients. However, as for how the fluid should be managed, how the fluid management influences ventilation time and the prognosis, more research is needed.
【摘要】 目的 总结先天性心脏病术后无创通气的监护。 方法 2008年1-12月胸外ICU 36例先天性心脏病术后患儿，在使用无创通气前后监测血压、心率、呼吸及血气变化。 结果 与无创通气前相比，无创通气后30 min、1 h、2 h的指标均恢复到满意水平，循环稳定。 结论 通过采用无创通气，80%的患儿避免了再次插管，缩短有创通气时间，同时避免了相关的呼吸道并发症，缩短了患儿住院时间，节省了医疗费用，提升了先天性心脏病患儿术后成活率。【Abstract】 Objective To summarize the nursing experience of noninvasive ventilation for infants with congenital heart disease after the surgery. Methods A total of 36 patients who underwent noninvasive ventilation from January to December 2008 were enrolled. The blood pressure, heart rate, respiration, and blood gas were recorded and analyzed before and after noninvasive ventilation. Results Compared with the results before noninvasive ventilation, all of the indexes returned to a satisfying level and the circulation kept stable 30 minutes, one hour, and two hours after noninvasive ventilation. Conclusion Noninvasive ventilation may avoid reintubation, shorten the invasive ventilatory time, decrease the respiratory complications, shorten the time of hospitalization, save the medical expenses, and promote the survival rate of infants with congenital heart disease.
Objective To investigate the effects of exogenous pulmonary surfactant （PS） on ventilation weaning and respiratory mechanics in infants with acute lung injury（ALI） after cardiopulmonary bypass （CPB）.Methods Twelve infants underwent cardiopulmonary bypass cardiac surgery committed with ALI and difficulty in weaning from ventilation were included in this study.Exogenous PS was used in the treatment via intra-tracheal administration.The changes of blood gas，respiratory mechanics and the conditions of ventilation weaning were observed.Results After intra-tracheal PS administration，spontaneous breath remained steady；spontaneous respiratory rate significantly decreased from，tidal volume of spontaneous breath increased significantly.Three concave sign disappeared and koilosternia was alleviated.PaCO2 value decreased significantly and peak inspiratory pressure（PIP） decreased from （36.18±10.25）cm H2O to （25.11±5.14）cm H2O （Plt;0.01）.Static lung compliance （Cstat） increased from （1.49±0.65）mL·cm H2O-1·kg-1 before treatment to （1.95±0.50） mL·cm H2O-1·kg-1 6 h after treatment （Plt;0.01）；and airway resistance （Rstat）decreased from （128.17±26.34） cm H2O·L-1·s-1 before treatment to （78.56±18.22） cm H2O·L-1·s-1 6 h after treatment （Plt;0.01）.All 12 infants weaned from ventilator successfully.Conclusion Combined with PS intra-tracheal treatment，lung protective ventilation strategy can significantly improve parameters of respiratory mechanics，increase dynamic lung compliance，decrease airway resistance，which can decrease the breathing effort of the infants and make it easy to wean from ventilator.