2015年 · 第53卷第08期

Since the establishment of the first batch of pediatric intensive care units (PICUs) in the early 1980s, the specialty of pediatric intensive care medicine has experienced more than 30 years of ups and downs^[1]。 The establishment and development of PICU is increasingly important in protecting children's life and health in China, especially in responding to public health emergencies, disasters and outbreaks of acute infectious diseases in children (hand, foot and mouth disease, influenza A, etc.). After decades of clinical practice, the status of PICU has been fully affirmed by the state, the public and hospitals^[2]。

extracorporeal membrane oxygenation (ECMO) can effectively replace the respiratory function of patients, partially replace the cardiac function, maintain the oxygen supply of various organs of the body, and provide long-term cardiopulmonary support for patients with severe heart and lung failure. It is a recognized cardiopulmonary function replacement technology. 1972 Hill et al.^[1]A 24-year-old patient with multiple organ injury and acute respiratory distress syndrome was successfully treated with extracorporeal circulation equipment for the first time, which marked the launch of extracorporeal life support technology in clinical practice. 1975, Bartlett et al.^[2]The doctor improved the equipment and successfully provided bedside cardiopulmonary support to an infant, which kicked off the "ECMO". In 1989, the extra – corporeal life support organization (ELSO) was established in Michigan, USA. It provides global training, promotes new ECMO devices, and establishes a global database. ELSO statistics released in January 2015 show that^[3]By the end of 2014, a total of 65 171 patients worldwide received ECMO support, with a success rate of 71.00%, including 50 903 cases in children (including NICU and PICU), with a success rate of 74.86%, while the success rate in adults was only 58.56%, showing the application value of ECMO in pediatrics.

Acinetobacter baumannii is an opportunistic pathogen and one of the important pathogens of nosocomial infections, showing a global epidemic trend. In China, nosocomial infections caused by Acinetobacter baumannii, especially in intensive care unit (PICU), are becoming increasingly serious, which has become one of the important killers threatening the life of hospitalized patients. In the first quarter of 2014, an 8-year-old child with severe pneumonia was admitted to PICU in our hospital. On the third day of admission, he was given ventilator-assisted ventilation due to respiratory distress. On the fourth day after admission to the ventilator, pan drug resistant was detected in sputum culture for the first timeAcinetobacter baumannii, PDRAB), followed by 26 sputum cultures, drug-resistant Acinetobacter baumannii was detected in 24 times, and Klebsiella pneumoniae was detected at the same time in only one time. After difficult anti-infection and symptomatic support comprehensive treatment, they improved and were discharged after 54 days, and finally recovered. Combined with the clinical diagnosis and treatment experience of this child and our treatment experience, we will talk about the diagnosis and coping strategies of drug-resistant Acinetobacter baumannii infection in children.

Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis infection, which has been endangering human health for a long time. It was once controlled, and it became epidemic again in 1990s. The World Health Organization (WHO) declared a "global tuberculosis emergency" in 1993. China is one of the 22 countries with high burden of tuberculosis. The fourth national epidemiological sampling survey of tuberculosis in 2000 showed that the infection rate of tuberculosis was 44.5%, and the prevalence rate of active tuberculosis was 367/100,000^[1]。 Tuberculosis also endangers children's health for a long time and is an important cause of child mortality in high-endemic countries. Childhood tuberculosis plays an important role in the spread of tuberculosis^[2,3]However, it was neglected for a long time due to insufficient awareness until the first edition of the WHO National Tuberculosis Programme-Guidelines for the Management of Childhood Tuberculosis was released in 2006 and the Roadmap for Zero Deaths from Childhood Tuberculosis was released in 2013^[4]。 This article introduces the current epidemic status, diagnosis, treatment, prevention and drug-resistant bacteria of childhood tuberculosis, so as to improve the understanding and diagnosis and treatment level of pediatricians in China.

According to the requirements of the health administrative department, it is the key to protect children's health and life to grasp the characteristics of children's diseases, establish a three-level referral system for regional emergency department and critically ill children, and carry out the transfer of critically ill children according to local conditions. The transportation of severe children is divided into on-site transportation, in-hospital transportation and inter-hospital transportation. On-site transfers are transfers carried out through public emergency telephone calls; In-hospital transportation refers to transportation between different medical areas of the same hospital; Inter-hospital transport refers to transport between different medical units. This expert recommendation aims to provide hospitals at all levels with the basic principles for the inter-hospital transport of critically ill children.

International expert consensus on concepts and definitions related to pediatric sepsis, first published in 2005^[1]It has been widely recognized by the pediatric community all over the world; In 2006, Chinese pediatric critical care experts formulated the "recommended diagnosis and treatment plan of pediatric septic shock (septic shock)"^[2]It has positive guiding significance for domestic pediatricians. In 2012, the International Guidelines for Severe Sepsis and Septic Shock in the "Battle to Save Sepsis" included quantitative indicators such as hemodynamics, tissue perfusion and organ dysfunction, so as to make the diagnosis and treatment of sepsis, severe sepsis and septic shock more objective^[3]。 Based on the international guidelines and the actual situation in China, the recommended scheme for the diagnosis and treatment of pediatric septic shock in China was partially revised, and an updated expert consensus was put forward.

In order to achieve the maximum benefit and best care of the transfer of critically ill children, and to ensure the homogeneity and safety of the transfer, regional medical centers should take the lead in establishing a referral network covering a certain range, and encourage pediatricians at all levels to transfer critically ill children who need referral to the Children's Intensive Care Unit (PICU) of the receiving hospital at the next level. In order to effectively make use of children's intensive care resources, promote cooperation among medical institutions, ensure the safety and quality of the transfer process of critically ill children, and lead the upgrading of the overall level of pediatric intensive care, the Pediatric Group of Emergency Medicine Branch of Chinese Medical Association, the Emergency Group of Pediatric Branch of Chinese Medical Association and the Children's Intensive Care Physician Branch of Chinese Medical Doctors Association have organized experts to discuss in Changsha, Beijing, Shenyang, Chongqing and other places for many times, and formulated the "Expert Suggestions for Inter-hospital Three-level Referral of Critically ill Children" (hereinafter referred to as "Suggestions").

According to the global sepsis alliance (GSA), sepsis has become the most common disease in the world. Over the past decade or so, it has been increasing at an annual rate of 8% to 13%. The epidemiological survey in the United States shows that from 1995 to 2005, the prevalence of sepsis in children increased by 60%, and the number of children hospitalized for severe sepsis every year is about 75,000. The mortality rate of sepsis in children in developed countries is 3% ~10%, septic shock can reach 15% ~30%, and the mortality rate of septic shock can reach 50% in developing countries^[1,2]。 According to the World Health Organization (WHO), 60% of deaths among children under the age of 5 are caused by severe infections, and 6 million newborns and young children die of sepsis every year. Due to the high incidence and mortality of sepsis, which is a serious risk to children's health, the European Society of Critical Care Medicine (ESICM), the American Society of Critical Care Medicine (SCCM) and the International sepsis Forum (ISF) launched the "surviving sepsis campaign" (SSC) in 2001. In 2002, several European and American organizations jointly launched and signed the "Barcelona Declaration". In 2004, the first evidence-based guidelines for the management of severe sepsis and septic shock (hereinafter referred to as "the guidelines") were published, and then revised twice in 2008 and 2012 respectively^[3]。 The formulation of the "Guidelines" plays a positive role in guiding clinicians to identify severe sepsis and septic shock early, intervene and treat in time, and reduce the mortality rate of sepsis. The GSA proposes to strive to reduce the sepsis fatality rate by 20% by 2020.

A 7-year-old male was admitted with "intermittent headache for 9 months". Nine months before admission, the child developed fever with a body temperature of 38℃, cough and runny nose. Two days later, he developed headache, which was bilateral temporal pulsatile pain, accompanied by eye pain, non-jet vomiting and lethargy. There were no other accompanying symptoms. The attack occurred more than 10 times a day, each time lasting for several minutes to several hours. The local hospital diagnosed "viral encephalitis", and the symptoms disappeared after 2 days of anti-infection and intracranial pressure lowering treatment. Five months before admission, the child had "cold" fever, headache and vomiting, and was relieved after intracranial pressure reduction and anti-infective treatment again; Three months before admission, the child reappeared with headache and vomiting attacks without fever, lasting 2-3 h; In the future, children had intermittent headache and vomiting, which occurred once every 2 to 3 weeks, mostly after a cold. The child was the mother's second birth and second birth. The mother had a history of threatened abortion during pregnancy, had pregnancy treatment, was born prematurely at 32 weeks of pregnancy, with a birth weight of 1 500 g, and was healthy in the neonatal period. Slow growth and development since childhood, height and weight are significantly lower than those of children of the same age, intelligence, language and motor development are normal, and they can walk and talk at the age of 1; Tooth eruption at about 1 year and 6 months; He is usually weak in constitution and prone to colds; Denial of family genetic history.

The 11-year-old 2-month-old male was admitted to the hospital on October 25, 2014 due to "cough, paroxysmal abdominal pain for 40 days and shortness of breath for 20 days". 40 days before admission, the child developed cough without obvious trigger, initially dry cough, a small amount of sputum in the later stage of the disease, sometimes accompanied by paroxysmal abdominal pain, nausea, no fever, wheezing, vomiting, hemoptysis, rash, joint pain, etc., and was given intravenous drip of cephalosporin antibiotics for 7 days and intravenous drip of dexamethasone for 3 days in the local hospital, but the symptoms did not improve significantly. Twenty days before admission, the child developed shortness of breath, which gradually worsened. Chest CT in the local hospital showed inflammatory changes in both pneumonies. Considering "interstitial pneumonia", he was treated with ceftriaxone, fluconazole, dexamethasone and gamma globulin in the local hospital for more than ten days. The child's cough and shortness of breath gradually worsened, he could not move on the ground, and paroxysmal abdominal pain was also worse than before. For further diagnosis and treatment, he went to our hospital. Since the onset of the disease, he ate poorly and lost 2 kg of weight.

autism, also known as autism, is a type of autism spectrum disease (ASD)^[1], widespread mental developmental disorders characterized by social interpersonal disorders, abnormal verbal communication, stereotyped and repetitive behaviors^[2]。 Autism is a highly heterogeneous disease with unknown etiology, which can involve multiple organ systems in the body, including the nervous system, immune system, gastrointestinal tract, and skin and mucous membranes^[1]。 More than 100 susceptibility genes have been discovered in recent 30 years of research on disease-causing genes. Advances in biomedical fields suggest that vaccines, infections, stress and trauma may affect their pathogenesis^[3]。 Immune system is an important component in maintaining the stability of the body's immune internal environment. Immune disorder plays an important role in the pathogenesis of autism^[4]。 For different types of the autism spectrum, the presentation of their immune abnormalities may vary. This paper reviews the immune abnormalities in autism from the aspects of cellular immunity, humoral immunity, inflammation, cytokine and autoimmunity.

Professor Zhu Qirong has worked in Fudan University Pediatric Hospital for 51 years. When he entered the happy year, he dedicated most of his life to Fudan University Pediatric Hospital and his pediatric career that he never gave up. Professor Zhu Qirong was assigned to Fudan University Pediatric Hospital after graduating from the Department of Pediatrics of Nanjing Medical College in 1964. In 1983, he was sent to study abroad at Newcastle University, Australia, and obtained a master's degree in medicine. He was the director of the Department of Infectious Diseases, vice president (in charge of scientific research, teaching and postgraduate work), dean and director of the Institute of Pediatrics of Fudan University Pediatric Hospital, and is one of the famous professors and doctoral supervisors of Fudan University Pediatric Hospital.

He is one of the leading pediatrics figures in China, the first deputy chairman of the Pediatrics Branch of Chinese Medical Association outside Beijing, the winner of the first Pediatrics Lifetime Achievement Award, and the first leader of the National Pediatric Emergency Group; He is the first president of Hunan Children's Hospital, and single-handedly built the life home of 20 million children in Hunan; He is Professor Zhao Xiangwen, who has been a doctor for 65 years and saved countless children. At the age of 90, he is still in the front line of clinical practice. He wrote the legend of a pediatric expert with sincerity.

We often refer to the use of "blinding" in clinical studies. Blinding can be roughly understood as a method in which the investigator, trial participants, subjects, evaluators, etc. are unaware of the subject's group (or intervention) in a study. By applying the blinding method, the effect of intentional or unintentional subjective bias on the research results can be avoided. According to different objects, blinding can be divided into single-blind, double-blind and triple-blind.