Managing the oncologic patient with suspected pneumonia in the intensive care unit

Introduction: Solid cancer patients are frequently admitted in intensive care units for critical events. Improving survival rates in this setting is considered an achievable goal today. Respiratory failure is the main reason for admission, representing a primary target for research.

Areas covered: This review presents a diagnostic and therapeutic algorithm for pneumonia and other severe respiratory events in the solid cancer population. It aims to increase awareness of the risk factors and the different etiologies in this changing scenario in which neutropenia no longer seems to be a decisive factor in poor outcome. Bacterial pneumonia is the leading cause, but opportunistic diseases and non-infectious etiologies, especially unexpected adverse effects of radiation, biological drugs and monoclonal antibodies, are becoming increasingly frequent. Options for respiratory support and diagnostics are discussed and indications for antibiotics in the management of pneumonia are detailed.

Expert commentary: Prompt initiation of critical care to facilitate optimal decision-making in the management of respiratory failure, early etiological assessment and appropriate antibiotic therapy are cornerstones in management of severe pneumonia in oncologic patients.     

不同手术方式对高血压脑出血患者术后并发症及疗效的影响

目的探讨不同手术方式对高血压脑出血患者术后并发症及临床疗效的影响。方法选取186例高血压脑出血患者为研究对象,随机分为大骨瓣组、小骨窗组、钻孔组各62例。大骨瓣组采用大骨瓣开颅术治疗,小骨窗组采用小骨窗开颅术治疗,钻孔组采用钻孔血肿抽吸引流术治疗。观察3组患者手术前与术后(2周)GCS评分和NIHSS评分及术后并发症和临床疗效。结果大骨瓣组术后GCS评分均低于其余2组(P0.05),大骨瓣组术后NIHSS评分均高于其余2组(P0.05);而小骨窗组与钻孔组术后GCS评分、NIHSS评分差异无统计学意义(P0.05)。3组术后再出血差异无统计学意义(P0.05),但大骨瓣组感染、应激性溃疡、肾衰竭发生率均高于其余2组(P0.05);同时,小骨窗组与钻孔组感染、肾衰竭发生率差异无统计学意义(P0.05),而小骨窗组应激性溃疡发生率高于钻孔组(P0.05)。大骨瓣组良好率为20.9%,小骨组窗48.4%,钻孔组50.0%,大骨瓣组与其余2组比较差异有统计学意义(χ~2=13.779,P=0.001);大骨瓣组病死率为25.8%,小骨窗组20.9%,钻孔组19.4%,大骨瓣组与其余2组比较差异无统计学意义(χ~2=0.687,P=0.709)。结论综合高血压脑出血患者不同手术术后并发症及临床疗效,钻孔血肿抽吸引流术优于小骨窗开颅术,小骨窗开颅术优于大骨瓣开颅术;但3种不同手术方式在病死率上无明显差异。     

320排CT冠脉成像缩窄采集时间窗的可行性研究

目的：通过分析320排CT冠脉成像图像质量与重建时相及心率的关系,探讨前瞻性心电门控缩窄采集时间窗的可行性。方法：回顾性分析了2018年5月至2018年12月心率65～95bpm的90例患者261支冠脉血管,按血管的图像质量评分结果,确定血管和患者的最佳时相；分析患者最佳时相与心率的关系,找出最佳时相转移的临界心率；根据临界心率和患者最佳时相,分别分析并确定采集时间窗能够缩窄的范围。对比分析缩窄采集时间窗前后的图像质量以及辐射剂量。结果：患者最佳时相转移的临界心率为70bpm。心率65～70bpm时采集时间窗可缩窄为R-R间期的72%～80%；心率70～95bpm时则可缩窄为40%～50%。缩窄采集时间窗后的最佳时相与预设时相的图像评分差异有统计学意义(P=0.00),图像质量明显提高。缩窄采集时间窗前后的有效辐射剂量(ED)差异有统计学意义(P=0.00),辐射剂量明显降低。结论：根据不同心率进一步缩窄采集时间窗,既可提高图像质量,又能明显降低辐射剂量,值得临床应用和推广。     

肝癌超声造影时间窗及影响因素分析

目的:探讨肝癌超声造影时间窗及影响因素。方法:经左肘静脉注造影剂SonoV ue 2.4 mL后,分别以肝动脉、门脉主干或二、三级分支显影作为动脉相、门脉相的开始,肝实质回声增强达峰值视为实质相的开始。结果:肝癌超声造影开始强化时间8~26 s,平均(13.57±4.21)s,开始消退时间20~80 s,平均(35.52±13.91)s,持续强化时间10~66s,平均(21.97±12.62)s。各时相出现的早晚及持续时间的长短,主要与肿瘤主供血管的性质及流入血管间或流入血管与流出血管间有无短路有关。以动脉供血为主的肝癌,动脉相快速强化,门脉相消退,该表现见于大多数肝癌。以门静脉供血为主者,动脉相、门脉相均强化,至实质相方消退,该现象见于肝癌。动-门瘘时可使动脉相缩短,门脉相提前显影。结论:以相关血管显影作为时相的起始及时段,较能全面反映肿瘤特征,有助于定性诊断。主供血管的性质将影响时相的起始及长短。     

Programming a Long Paced Atrioventricular Interval May Be Risky in DDDR Pacing

In patients with intermittent AV block and dual chamber pacemakers, a long paced AV interval of 200 msec or more can be selected to prolong pulse generator life (by avoiding the ventricular pace output) and to enable a more physiological and hemodynamically superior activation sequence. This case report describes the potential risks of programming a long paced AV interval in a patient with a DDDR pacemaker. T wave pacing, as described here, can occur if the conducted QRS complex is not sensed because it occurs during the ventricular blanking period (delivery of the atrial stimulus). This can be initiated by the mechanisms that induce apparent and actual P wave undersensing of the conducted QRS complex. In this case report apparent P wave undersensing and subsequent T wave pacing with ventricular capture (in a patient with intermittent AV block) occurred frequently during an exercise test done in the DDDR mode with a paced AV interval of 200 msec, according to the clinical evaluation protocol.     

高血压基底节区出血不同手术方法的比较

高血压脑出血是神经外科常见的危重急症,死亡率可达30%~40%,即使存活,还有相当一部分病人遗留严重后遗症,是神经内外科医生应迫切解决的问题之一。本文总结了高血压基底节区出血的50例病人,用小骨窗血肿清除术和骨瓣开颅进行外科治疗,就有关高血压脑出血的手术指征、手术方法和     

治疗窗窄药片5种分剂量准确性研究

目的了解5种治疗窗窄药片分剂量的准确性,为临床合理用药提供参考。方法应用药片切割器、剪刀、刀片对5种药片分剂量成2等份及4等份。结果 5种治疗窗窄药片中,硬度最大和最小的药片分别为氨茶碱、地高辛;直径最大和最小的药片分别为卡马西平、地高辛;厚度最大和最小的药片分别为卡马西平、地高辛。地高辛（切）、苯妥英钠（切）FW1/2和FW1/4与TW1/2和TW1/4比较差异有统计学意义（P〈0.05）;地高辛（剪）、氨茶碱（剪）、华法林钠（剪）、苯妥英钠（剪）FW1/4与TW1/4比较差异有统计学意义（P〈0.05和P〈0.01）;华法林钠（刀）FW1/2和FW1/4与TW1/2和TW1/4比较差异有统计学意义（P〈0.01）。5种药片用3种工具分剂量至少有5片超出质量差异15%,均不符合欧洲药典标准。分剂量成2等份时,应用剪刀超出平均质量15%的药片数均较其他2种方法多;分剂量成4等份时,3种方法超出平均质量15%的药片数均较分剂量成2等份时多。结论 5种治疗窗窄药片应用3种工具分剂量准确性较差,临床用药应引起足够的注意。需要调整给药剂量时,可考虑用液体制剂分剂量。     

MC-002对大鼠局灶性脑缺血/再灌注治疗时间窗的研究

目的:研究受试药3-甲氧基-4-O-(2’-亚甲基-3’5’6’-三甲基吡嗪基)肉桂酸(MC-002)对大鼠局灶性脑缺血/再灌注损伤(CIRI)的治疗时间窗。方法:线栓法制作大鼠大脑中动脉闭塞(MCAO)2 h/再灌注22 h,并于复灌后0、0.5、1、2、4 h时治疗给药。观察MC-002对CIRI大鼠脑功能、脑梗死体积、脑含水量、组织形态学的影响以及MC-002各剂量组对大鼠脑组织内生化指标的影响。结果:MC-002在复灌后0、0.5、1、2 h给药能够显著性改善MCAO后大鼠的脑神经功能(P<0.05,P<0.01),降低大鼠的脑梗死率和含水量(P<0.05、P<0.01);增加CIRI大鼠脑组织超氧化物歧化酶(SOD)活力(P<0.01),降低丙二醛(MDA)及乳酸(LD)含量(P<0.05,P<0.01)。脑组织病理切片结果显示,和模型组比较,治疗组神经细胞形态和数目均得到显著改善。结论:MC-002 2 h内治疗给药对大鼠局灶性脑缺血/再灌注损伤有很好的保护作用。