BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)has been widely used in pediatric patients with cholangiopancreatic diseases.AIM To evaluate the efficacy,safety,and long-term follow-up results of ERCP i...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)has been widely used in pediatric patients with cholangiopancreatic diseases.AIM To evaluate the efficacy,safety,and long-term follow-up results of ERCP in symptomatic pancreaticobiliary maljunction(PBM).METHODS A multicenter,retrospective study was conducted on 75 pediatric patients who were diagnosed with PBM and underwent therapeutic ERCP at three endoscopy centers between January 2008 and March 2019.They were divided into four PBM groups based on the fluoroscopy in ERCP.Their clinical characteristics,specific ERCP procedures,adverse events,and long-term follow-up results were retrospectively reviewed.RESULTS Totally,112 ERCPs were performed on the 75 children with symptomatic PBM.Clinical manifestations included abdominal pain(62/75,82.7%),vomiting(35/75,46.7%),acholic stool(4/75,5.3%),fever(3/75,4.0%),acute pancreatitis(47/75,62.7%),hyperbilirubinemia(13/75,17.3%),and elevated liver enzymes(22/75,29.3%).ERCP interventions included endoscopic sphincterotomy,endoscopic retrograde biliary or pancreatic drainage,stone extraction,etc.Procedure-related complications were observed in 12 patients and included post-ERCP pancreatitis(9/75,12.0%),gastrointestinal bleeding(1/75,1.3%),and infection(2/75,2.7%).During a mean follow-up period of 46 mo(range:2 to 134 mo),ERCP therapy alleviated the biliary obstruction and reduced the incidence of pancreatitis.The overall effective rate of ERCP therapy was 82.4%;seven patients(9.3%)were lost to follow-up,eight(11.8%)re-experienced pancreatitis,and eleven(16.2%)underwent radical surgery,known as prophylactic excision of the extrahepatic bile duct and hepaticojejunostomy.CONCLUSION ERCP is a safe and effective treatment option to relieve biliary or pancreatic obstruction in symptomatic PBM,with the characteristics of minor trauma,fewer complications,and repeatability.展开更多
目的:观察右美托咪啶治疗不同年龄小儿七氟烷全麻后苏醒期躁动的效果及安全性。方法:选择七氟烷全麻术后患儿80例,根据年龄分为Ⅰ组(3～6岁)和Ⅱ组(7～12岁),每个年龄段组再随机分为2组:右美托咪啶组(MⅠ组、MⅡ组,n=20)和对照组(CⅠ组...目的:观察右美托咪啶治疗不同年龄小儿七氟烷全麻后苏醒期躁动的效果及安全性。方法:选择七氟烷全麻术后患儿80例,根据年龄分为Ⅰ组(3～6岁)和Ⅱ组(7～12岁),每个年龄段组再随机分为2组:右美托咪啶组(MⅠ组、MⅡ组,n=20)和对照组(CⅠ组、CⅡ组,n=20)。气管插管后M组静脉泵注右美托咪啶1μg.kg-1,C组静脉泵注等容积生理盐水。观察给药前5 min(T0)、给药5 min(T1)、给药后5(T2),15(T3),30(T4),60 min(T5)及拔管前停七氟烷时(T6)血流动力学、最低肺泡有效浓度(MAC)和呼出七氟烷浓度变化,记录麻醉恢复室(PACU)躁动发生率和躁动程度、苏醒时间、PACU停留时间、术后4 h及8 h Ramsay镇静评分,记录术后呼吸抑制、嗜睡、恶心呕吐、寒颤、皮肤瘙痒等不良反应发生情况。结果:与C组相比,M组T1时点SBP变化有统计学差异(P<0.05),术后躁动发生率显著下降(P<0.05);各时点MAC和呼出七氟烷浓度差异有统计学意义(P<0.05);术后4 h Ramsay镇静评分增加(P<0.01);术后发生嗜睡明显较多(P<0.05)。与C组相比,M组苏醒时间延长(P<0.05),PACU停留时间显著延长(P<0.01)。结论:右美托咪啶(1μg.kg-1)能安全、有效地治疗小儿全麻苏醒期躁动,同时能减少术中麻醉药用量。展开更多
目的:探讨经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)在儿科患者应用中出现的常见并发症及预防处理对策对策,以期减少并发症的发生。方法:对我院儿科2 1 8例行P I C C患者进行调查,分析其相关并发症,同...目的:探讨经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)在儿科患者应用中出现的常见并发症及预防处理对策对策,以期减少并发症的发生。方法:对我院儿科2 1 8例行P I C C患者进行调查,分析其相关并发症,同时总结预防处理对策。结果:2 1 8例患儿均置管成功,置管后39例出现了置管相关并发症(12例导管出现2种以上并发症),其发生率为2 3.4%(5 1/2 1 8),其中静脉炎发生率最高,发生率为1 8(8.3%);非计划性拔管、导管堵塞、导管异位及导管相关血流感染发生率分别为12(5.5%)、7(3.2%)、6(2.8%)、5(2.3%)。结论:加强小儿PICC的围手术期护理和有效干预,对并发症进行积极有效的处理,可延长置管时间,减少并发症的出现。展开更多
基金上海市卫生和计划生育委员会青年科研项目(20134Y090)；上海申康医院发展中心临床管理优化项目(SHDC2014616)Fund programShanghai Municipal Bureau of Health Youth Project，Shanghai Shen-kang Hospital Development Center Program
基金Supported by the Shanghai Municipal Health Bureau,No.ZY(2018-2020)-FWTX-1105
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)has been widely used in pediatric patients with cholangiopancreatic diseases.AIM To evaluate the efficacy,safety,and long-term follow-up results of ERCP in symptomatic pancreaticobiliary maljunction(PBM).METHODS A multicenter,retrospective study was conducted on 75 pediatric patients who were diagnosed with PBM and underwent therapeutic ERCP at three endoscopy centers between January 2008 and March 2019.They were divided into four PBM groups based on the fluoroscopy in ERCP.Their clinical characteristics,specific ERCP procedures,adverse events,and long-term follow-up results were retrospectively reviewed.RESULTS Totally,112 ERCPs were performed on the 75 children with symptomatic PBM.Clinical manifestations included abdominal pain(62/75,82.7%),vomiting(35/75,46.7%),acholic stool(4/75,5.3%),fever(3/75,4.0%),acute pancreatitis(47/75,62.7%),hyperbilirubinemia(13/75,17.3%),and elevated liver enzymes(22/75,29.3%).ERCP interventions included endoscopic sphincterotomy,endoscopic retrograde biliary or pancreatic drainage,stone extraction,etc.Procedure-related complications were observed in 12 patients and included post-ERCP pancreatitis(9/75,12.0%),gastrointestinal bleeding(1/75,1.3%),and infection(2/75,2.7%).During a mean follow-up period of 46 mo(range:2 to 134 mo),ERCP therapy alleviated the biliary obstruction and reduced the incidence of pancreatitis.The overall effective rate of ERCP therapy was 82.4%;seven patients(9.3%)were lost to follow-up,eight(11.8%)re-experienced pancreatitis,and eleven(16.2%)underwent radical surgery,known as prophylactic excision of the extrahepatic bile duct and hepaticojejunostomy.CONCLUSION ERCP is a safe and effective treatment option to relieve biliary or pancreatic obstruction in symptomatic PBM,with the characteristics of minor trauma,fewer complications,and repeatability.
文摘目的:观察右美托咪啶治疗不同年龄小儿七氟烷全麻后苏醒期躁动的效果及安全性。方法:选择七氟烷全麻术后患儿80例,根据年龄分为Ⅰ组(3～6岁)和Ⅱ组(7～12岁),每个年龄段组再随机分为2组:右美托咪啶组(MⅠ组、MⅡ组,n=20)和对照组(CⅠ组、CⅡ组,n=20)。气管插管后M组静脉泵注右美托咪啶1μg.kg-1,C组静脉泵注等容积生理盐水。观察给药前5 min(T0)、给药5 min(T1)、给药后5(T2),15(T3),30(T4),60 min(T5)及拔管前停七氟烷时(T6)血流动力学、最低肺泡有效浓度(MAC)和呼出七氟烷浓度变化,记录麻醉恢复室(PACU)躁动发生率和躁动程度、苏醒时间、PACU停留时间、术后4 h及8 h Ramsay镇静评分,记录术后呼吸抑制、嗜睡、恶心呕吐、寒颤、皮肤瘙痒等不良反应发生情况。结果:与C组相比,M组T1时点SBP变化有统计学差异(P<0.05),术后躁动发生率显著下降(P<0.05);各时点MAC和呼出七氟烷浓度差异有统计学意义(P<0.05);术后4 h Ramsay镇静评分增加(P<0.01);术后发生嗜睡明显较多(P<0.05)。与C组相比,M组苏醒时间延长(P<0.05),PACU停留时间显著延长(P<0.01)。结论:右美托咪啶(1μg.kg-1)能安全、有效地治疗小儿全麻苏醒期躁动,同时能减少术中麻醉药用量。
