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1.
目的 探讨先天性心脏病合并重度肺动脉高压的外科治疗.方法 选择先天性心脏病合并重度肺动脉高压患者32例.动脉血氧饱和度0.84一0.94,左向右分流20例,双向分流10例,无分流2例.测肺动脉压65~120(82±14) mm Hg(1 mm Hg=0.133 kPa).所有病例均在体外循环下行心内畸形矫治手术,术前给予吸氧、西地那非等治疗,术中应用乌司他丁及低温肺保护液肺动脉灌注等手段,术后常规应用血管活性药物.结果 32例手术顺利,术后肺动脉压下降20~40 mm Hg.30例治愈出院,2例术后早期死于严重低心排血量综合征及致命性心律失常,病死率为6.25%(2/32).结论 先天性心脏病合并肺动脉高压经围手术期综合治疗后再行手术根治可获得良好的临床效果.  相似文献   

2.
米果  熊淑杰 《中国妇幼保健》2014,(32):5243-5245
目的:观察静脉间歇应用硝酸甘油对体循环的影响和改善不同程度肺动脉高压(PH)的疗效,探讨静脉间歇应用硝酸甘油治疗先天性心脏病合并PH的应用价值。方法:选取32例左向右分流型先天性心脏病(CHD)合并PH患儿,静脉间歇应用硝酸甘油0.5~10μg·kg-1·min-1,每日递增。观察不同剂量硝酸甘油对体循环压及肺动脉压的作用、疗效及不良影响。结果:研究观察持续用药耐药性强,对体循环影响大,可见血压下降。采用间歇用药,逐日递增对体循环影响小。对轻、中、重度PH患者均疗效明显;对已发生艾森曼格氏综合征的患者疗效不佳。结论:静脉间歇应用硝酸甘油对体循环影响不大,可有效地降低左向右分流心排出量,减缓PH的形成,便于临床应用。  相似文献   

3.
先天性心脏病合并重度肺动脉高压的外科治疗   总被引:1,自引:0,他引:1  
目的探讨先天性心脏病(CHD)合并重度肺动脉高压(PH)的外科治疗及效果。方法65例CHD合并PH者,房间隔缺损(ASD)27例,室间隔缺损(VSD)34例,动脉导管未闭(PDA)5例(3例为合并病例),部分心内膜垫缺损(PASD)2例。术前心脏超声检查在缺损处呈双向分流病理改变。手术治疗的指征是心脏超声检查左向右分流时相≥70%心动周期,股动脉血氧饱和度(SaO2)≥0.94。ASD,VSD均采用涤纶片修补,1例VSD在补片上缝成0.4cm右向左单向活瓣;PDA在并行循环下切开肺动脉补片缝合。术后继续吸氧,扩血管,强心,利尿治疗。结果术后早期因肺动脉高压危象,右心衰死亡2例。余随访12~60(32.30±15.24)个月,心功能Ⅰ-Ⅱ级,心彩超估测肺动脉平均压25—38mmHg,胸片示肺动脉段凸出明显减小,恢复良好。结论经吸氧、扩血管治疗、抗肺部感染、在心功能及肺动脉高压有所改善后,结合超声对分流定性及血气分析判断手术适应证,可使部分CHD合并重度PH患者获得较满意的手术效果。  相似文献   

4.
目的探讨基层医院室缺合并重度肺动脉高压(PH)的外科治疗方法。方法 41例室缺合并肺动脉高压患者采用单向活瓣补片修补室间隔缺损,同时肺动脉内留置导管泵入前列腺素E1(PGE1);术后超声心动图动态监测分流情况,并比较术前术后肺动脉压(PAP)及血气分析指标变化。结果 41例患者无1例死亡,术后2个月内单向活瓣关闭、分流消失;术后PAP明显下降,血气分析指标明显改善。结论单向活瓣补片及肺动脉置管泵入前列腺素E1(PGE1)能有效提高基层医院室缺合并肺动脉高压的治疗效果,增加围手术期安全性。  相似文献   

5.
先天性心脏病肺动脉高压患者血中雌激素含量变化与机制   总被引:1,自引:0,他引:1  
目的 探讨先天性心脏病(CHD)患者出现肺动脉高压(PAH)后雌激素变化及其与肺动脉压力的相关性,为PAH激素治疗提供理论依据,同时探讨雌激素发生变化的机制.方法 以右心导管测量的肺动脉压力为标准,选取36例肺动脉压力正常和108例合并PAH的左向右分流型CHD患者,分别设为对照组和PAH组,采用化学发光免疫分析法测定两组患者血清雌二醇、孕酮、泌乳素和卵泡刺激素(FSH)含量.结果 PAH组雌二醇、孕酮、泌乳素、FSH含量均明显高于对照组(P<0.05).多元回归分析显示,三种性激素的含量变化与左向右分流水平无相关性,而与性别、年龄、月经周期等生理因素以及肺动脉压力明显相关,相关系数分别为0.607、0.531和0.518.FSH与泌乳素和雌二醇呈正相关,相关系数分别为0.917(P=0.012)和0.759(P=0.000).结论 在CHD患者中,雌二醇含量随患者肺动脉压力升高而升高,表明雌激素对肺动脉压力具有重要的调节作用,但引起雌激素升高的调节靶点位于垂体或下丘脑而非性腺.  相似文献   

6.
目的 探讨先天性心脏病(CHD)患者出现肺动脉高压(PAH)后雌激素变化及其与肺动脉压力的相关性,为PAH激素治疗提供理论依据,同时探讨雌激素发生变化的机制.方法 以右心导管测量的肺动脉压力为标准,选取36例肺动脉压力正常和108例合并PAH的左向右分流型CHD患者,分别设为对照组和PAH组,采用化学发光免疫分析法测定两组患者血清雌二醇、孕酮、泌乳素和卵泡刺激素(FSH)含量.结果 PAH组雌二醇、孕酮、泌乳素、FSH含量均明显高于对照组(P<0.05).多元回归分析显示,三种性激素的含量变化与左向右分流水平无相关性,而与性别、年龄、月经周期等生理因素以及肺动脉压力明显相关,相关系数分别为0.607、0.531和0.518.FSH与泌乳素和雌二醇呈正相关,相关系数分别为0.917(P=0.012)和0.759(P=0.000).结论 在CHD患者中,雌二醇含量随患者肺动脉压力升高而升高,表明雌激素对肺动脉压力具有重要的调节作用,但引起雌激素升高的调节靶点位于垂体或下丘脑而非性腺.  相似文献   

7.
仇烨  黄晓玲  吴杰  郑虹  吴伟森  林震 《中国妇幼保健》2007,22(16):2209-2211
目的:探讨血浆脑钠肽(BNP)及Tei指数在左向右分流型先天性心脏病(CHD)患儿中的变化及其对心功能评价的价值。方法:44例左向右分流型CHD患儿按心室容量负荷分为左心型组及右心型组,对照组20例。应用ELISA方法测定血浆BNP浓度;超声心动图测量左室舒张末期内径(LVEDD)、右室舒张末期内径(RVEDD)、肺循环血流量/体循环血流量(Qp/Qs)、左室射血分数(LVEF)及左室Tei指数,进行比较;22例CHD患儿接受手术治疗,手术前后进行比较。结果:①与对照组比较,左心型和右心型CHD组血浆BNP浓度均显著增高(P<0.001),左室Tei指数亦增大(P<0.05);②左心型和右心型CHD组血浆BNP浓度分别与LVEDD和RVEDD、Qp/Qs、左室Tei指数呈正相关;③手术后CHD患儿血浆BNP浓度和左室Tei指数均低于术前(P<0.01)。结论:血浆BNP水平及Tei指数是评价左向右分流型CHD患儿心功能的有效、敏感指标,可为临床诊治工作和疗效判断提供参考。  相似文献   

8.
目的:总结37例室间隔缺损并重度肺动脉高压手术治疗经验。方法:37例经手术治疗的室间隔缺损合并重度肺动脉高压的患者应用包括休息、吸氧、口服卡托普利及静滴前列腺素E1等在内的降肺动脉压综合治疗,治疗后若杂音增强,血氧饱和度升高,心脏彩超示左向右分流增加则手术,若变化不明显,重复用药。全组病例均在中度低温体外循环下手术修补缺损。分别观察术前术后全组病例的血氧饱和度、肺动脉压以及心功能情况,随访心功能的改善情况及。新技术:术后2例死于心排,1例死于呼吸衰竭,其他病例恢复顺利。经随访,1例患者于术后8月死亡,其他患者心功能均有明显改善。结论:合理的围手术期治疗及严格掌握手术适应症是降低室间隔缺损合并重度肺动脉高压死亡率的关键因素,血氧饱和度可作为判断是否手术的简单易行的指标。  相似文献   

9.
目的:分析该院68例年龄小于1岁先天性心脏病(CHD)病人的临床资料,总结小婴儿CHD围手术期的治疗方法。方法:回顾性分析该院自2006年3月~2009年3月68例年龄小于1岁病人的临床资料、术前准备、手术方式、术后监护处理。结果:该组病例均在体外循环下行Ⅰ期根治术,术后发生肺高压危象3例,低心排4例,肺部感染13例,肺不张3例,脑萎缩1例。死亡1例(病死率1.72%),其余均治愈出院,随访3~24月,生长发育改善,无远期并发症。结论:小婴儿CHD病情复杂、危重,选择适当的手术时机,完善围手术期处理,可取得满意疗效。  相似文献   

10.
目的 探讨先天性心脏病(CHD)伴重度肺动脉高压(PH)体外循环(CPB)术后的拔管时机.方法 对行CPB手术的40例CHD伴重度PH患者的临床资料进行回顾性分析,按术后机械通气时间是否>24h,分为早期拔管组(19例)和延迟拔管组(21例),比较两组影响拔管的围手术期因素.行多因素Logistic回归分析确定延迟拔管(机械通气时间≥72 h)的影响因素.结果 两组术前NYHA心功能分级、撤机后肺循环与体循环收缩压比值(Pp/Ps)、CPB时间、CPB温度比较差异有统计学意义(P<0.05或<0.01).术后早期缺氧发作(OR=0.022,95%CI0.001~0.580)和严重低氧血症(OR=0.031,95%CI0.002~0.568)是延迟拔管的独立危险因素.结论 CHD伴重度PH患者若术前NYHA心功能分级≥Ⅲ级、撤机后Pp/Ps>0.5、CPB时间>90 min或CPB温度<32℃,可考虑延迟拔管.对术后早期有缺氧发作或严重低氧血症者,宜延迟拔管并加强心功能和肺动脉压监测;对无上述情况且术后心肺功能稳定者可考虑早期拔管.  相似文献   

11.
Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.  相似文献   

12.
This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.  相似文献   

13.
深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.  相似文献   

14.
Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO2) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO2. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO2 at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO2 gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO2 also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO2.  相似文献   

15.
The risk of heat exhaustion at a deep underground metalliferous mine was assessed in relation to thermal conditions prevailing on the surface. For each day of a 1-year prospective case series of heat exhaustion, surface 24-h mean wet and dry bulb temperatures were recorded. From this data, 24-h mean wet bulb globe temperatures were derived using certain assumptions. The three surface temperature variables were significantly higher on those days on which heat exhaustion occurred, compared to those days on which it did not occur (P < 0.001). The relative risk of heat exhaustion on days when the 24-h mean wet bulb globe temperature was in the range 26.0-28.0 degrees C was 4.82 (95% confidence interval 2.12-10.96). Surface temperature data could be used at this mine to warn miners about the risk of heat exhaustion.  相似文献   

16.
Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L?1 to a maximum of 79?mg·L?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.  相似文献   

17.
Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).  相似文献   

18.

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.  相似文献   

19.
20.
The repeatability and validity of a questionnaire for upper limb and neck complaints were assessed in a population of 105 hospital outpatients with a range of upper limb and neck disorders (including cervical spondylosis, adhesive capsulitis, lateral epicondylitis, carpal tunnel syndrome and Raynaud's phenomenon). Subjects were asked to complete a modified Nordic-style upper limb and neck discomfort questionnaire on two occasions closely spaced in time. The repeatability of their responses was assessed by calculating a kappa coefficient (kappa), and the sensitivity and specificity of component items in the questionnaire were determined for specific diagnostic categories of upper limb and neck disorder. Symptom reports for pain in the upper limb and neck, pain interfering with physical activities, neurological symptoms and blanching were all found to be highly repeatable (kappa = 0.63-0.90). A number of regional pain reports proved to be very sensitive in relation to specific upper limb disorders, but, with the exception of reported finger blanching in patients with Raynaud's phenomenon, none proved to have a good specificity (range = 0.33-0.38). We conclude that a modified Nordic-style questionnaire is repeatable and sensitive, and is likely to have a high utility in screening and surveillance. However a complementary examination schedule of adequate specificity and repeatability is essential to establish a clinical diagnosis.  相似文献   

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