目的 分析轮状病毒性腹泻患儿心肌受损情况和所伴随生化检验指标改变。 方法 2008年7月－2010年7月收治腹泻患儿80例，年龄6～27个月，平均12.9个月。其中有50例为轮状病毒腹泻（A组），30例为非轮状病毒性腹泻（B组）。A组患儿均符合轮状病毒腹泻诊断标准，有心肌损伤的异常指标但达不到心肌炎诊断标准者诊断为心肌损害。B组患儿有水样腹泻，但症状较轻，病程较短，轮状病毒抗原检测阴性。用全自动生化分析仪测定血清谷草转氨酶、乳酸脱氢酶、肌酸磷酸激酶和肌酸磷酸激酶同工酶，免疫亲和层析法测定血清肌钙蛋白值，并进行心电图检查。 结果 A组50例轮状病毒性腹泻患儿中，44例（88.0%）存在心肌损害，其血清谷草转氨酶（74.32 ± 13.77）U/L、肌酸磷酸激酶（52.01 ± 10.37）U/L、肌酸磷酸激酶同工酶（273.43 ± 27.55）U/L均升高，且明显高于B组[（24.98 ± 7.03）、（17.11 ± 6.52）、（151.46 ± 16.52）U/L]，差异有统计学意义(P＜0.05)。两组患儿的乳酸脱氢酶变化差异无统计学意义(P＞0.05)。 结论 轮状病毒性腹泻患儿往往伴有心肌损害及相应的血液生化检测指标改变；以肌酸磷酸激酶同工酶作为近期心肌损害的诊断指标更为特异和敏感。
Acute diarrhea has a high incidence in children. Pediatric tuina has been widely used in children with acute diarrhea in China. However, there is no guideline on the treatment of tuina for children with acute diarrhea. This guideline was developed following evidence-based principles and the World Health Organization handbook for guideline development. The linked systematic review was conducted following the Cochrane handbook. The quality of evidence and the strength of recommendations were evaluated using the GRADE approach. The reporting followed the RIGHT statement. Seven clinical questions (2 foreground questions and 5 background questions) were identified by literature review and expert consensus. Based on the linked systematic review and through comprehensive consideration of the balance of benefit and harm, quality of evidence, patient preferences, and other resources, we formulated the recommendations using Delphi expert consensus. We suggested combination of a weak recommendation for tuina with Western medicine usual care to treat children with acute diarrhea. This guideline can be used by clinicians and nurses in the department of traditional Chinese medicine pediatrics, and department of pediatric tuina, and can also be used as a reference for relevant clinicians of Western medicine and is also applicable to all institutions that practice tuina treatment.
ObjectiveTo select and obtain the related evidence of non-drug management of diarrhea after laparoscopic cholecystectomy (LC) at home and abroad and summarize the best evidence.MethodsWe systematically searched the PubMed, Cochrane Library, British Medical Journal best clinical practice, JBI evidence-based Health Care Center database, CINAHL database, Scottish inter-college Guide Network, American Guide Network, Ontario Nursing Society of Canada website, British National Institute of Clinical Medicine, and Chinese Biomedical Literature Database. All evidences on the non-drug management of diarrhea in the LC patients, including guidelines, system evaluation, expert consensus, etc. were retrieved. The retrieval time was limited from the establishment of the databases to November 9, 2019. The quality of the literature was independently evaluated by 2 researchers, and the data were extracted from the standard literature according to the judgment of professionals.ResultsThere were 15 literatures including 9 guidelines, 4 expert consensuses, and 2 systematic reviews. After the evaluation, 28 evidences for the non-drug management of diarrhea after LC were summarized.ConclusionsThe best evidences selected in this study could be applied to the practice of non-drug management of diarrhea after LC. However, the evidences should be selected according to the patients’ actual conditions and the individuation.
Objective To review the recent studies regarding etiology and management of diarrhea after liver transplantation. Methods The current related literatures about the etiology and management of diarrhea after liver transplantation were reviewed. Results There were approximately 10.00% to 35.44% recipients developed diarrhea after liver transplantation. Other symptoms such as severe body fluid and electrolyte loss, discomfort, and increase blood level of immunosuppressive drug can be caused by diarrhea as well. Clostridium difficile, cytomegalovirus, rotavirus infection and immunosuppressant were main etiological factors. It is important to find out the inducement of diarrhea and work out the corresponding management and other supportive care on the basis of the etiology. Conclusion Diarrhea is a common complication of liver transplantation whose etiology is complex. Appropriate approaches may be helpful to decrease the risk of this complication.
Objective To investigate the infection rates of toxin-producing Clostridium difficile and Candida albicans in patients with antibiotic-associated diarrhea (AAD) in West China Hospital of Sichuan University, analyze their clinical characteristics and make a survey of the therapy. Methods Fecal specimens of AAD patients were collected in West China Hospital of Sichuan University from September 2014 to January 2015. Toxin-producing Clostridium difficile and Candida albicans were identified by polymerase chain reaction and then clinical data of cases was collected and analyzed. Results Twenty-eight patients with Clostridium difficile infection were detected from the 126 AAD patients, 20 patients (15.9%) in whom were infected with toxin-producing Clostridium difficile. Type A+B+, type A-B+, and type A+B- accounted for 35.7% (10/28), 35.7% (10/28) and 28.6% (8/28), respectively. Fifty-four patients (42.9%) with yeast infection were detected. The predominant isolate was Candida albicans, accounting for 20.6% (26/126), and the others were Candida glabrata (n=11), Candida tropical (n=10), Candida parapsilosis (n=3), Saccharomyces cerevisiae (n=2), Pichia pastoris (n=1), and Kodamaea ohmeri (n=1). Toxin-producing Clostridium difficile strains and Candida albicans strains were both isolated from 3 patients (2.4%). The main antibiotics used in AAD ppatients were penicillins, carbapenems, third generation cephalosporins, and fluoroquinolones. AAD patients were all with underlying diseases at different degrees. The main treatments were probiotics and montmorillonite powder. Conclusion The relatively high infection rates and complicated factors of AAD indicate that much more attention needs to be paid to the diagnosis and therapy of AAD by the clinical doctors.
Objective To systematically evaluate the clinical effect and safety of Bifidobacterium tetravaccine tablets in the treatment of antibiotic associated diarrhea (ADD) in infants in China. Methods Randomized controlled trials (RCTs) of treatment of AAD by Bifidobacterium tetravaccine in infants were searched by computer from China Knowledge Resource Integrated Database, VIP and Wanfang Data from their inception to November 2016. Meta-analysis of the data was carried out by RevMan 5.3 software. Results Twelve RCTs were chosen, which included 1 761 infant patients. The Meta analysis showed that the effects of treatment of ADD were significantly superior to those of the control group [OR=5.74, 95%CI (4.14, 7.96),P<0.000 01]. Among the 12 RCTs, 8 had no adverse reactions, while the rest4 articles did not mention adverse reactions. Conclusions Based on the present clinical evidences, treatment of ADD by Bifidobacterium tetravaccine in infants is effective and safe. But due to the small number and different quality of RCTs, this conclusion still needs to be confirmed by large sample, multicenter, and high-quality clinical RCTs.