纳洛酮在小儿重症肺炎急救中的应用效果观察的临床研究

目的：探索纳洛酮在小儿重症肺炎急救中的效果。方法120例小儿重症肺炎患儿随机分为实验组和对照组，每组60例。所有患儿均给予基础治疗及对症治疗，实验组患儿另给予纳洛酮静脉滴注治疗。观察对比两组患儿的症状及体征消失时间、治愈情况。结果实验组患儿经治疗后，其发热、肝大、气促和心跳过速等症状及体征消失时间较对照组短，差异均具有统计学意义(P<0.05)。实验组有效率95.0%高于对照组81.7%，差异具有统计学意义(P<0.05)。结论纳洛酮治疗小儿重症肺炎可以有效缩短患儿的病程，对最终治愈患儿疾病有显著作用，值得临床应用。     

序贯性建立人工气道在重症脑损伤患者救治中的应用

目的探讨序贯性建立人工气道对重症脑损伤患者救治中的安全性的影响。方法选取2010-04-2014-03入住重症医学科(ICU)时APACHE-Ⅱ评分≥15分、4分≤GCS≤8分、ICU住院时间≥3d、估计气管插管超过3~7d者的重症脑损伤患者44例,随机分为2组,分别按不同方法实施气道开放,试验组采用序贯气道开放法,即在气管切开导管置入气管内之前仍保留气管插管,待气切导管完全正确放置,再拔除气管插管,全过程始终使用呼吸机辅助通气,常规组在气管切开造口过程中不使用呼吸机辅助通气,仅吸氧4~8L/min;观察2组患者的操作时间、APACHE-Ⅱ评分、生命体征、术后24h NSE水平、血气分析以及随访3个月的GOS评分。结果 (1)2组患者入科时、气管切开术前APACHE-Ⅱ、HR、RR、Bp、SpO2比较差异无统计学意义(P0.05);气管切开造口术后与入科时APACHE-Ⅱ、SpO2相比差异均有统计学意义(P0.05);同时气管切开术后APACHE-Ⅱ、HR、RR、Bp、SpO2在2组患者间的差异均有统计学意义(P0.05)。(2)2组患者入科时以及气管切开前血气分析中的pH、PaO2、PaCO2和术后NSE水平差异均无统计学意义(P0.05);气管切开造口术后与入科时相比升高,差异有统计学意义(P0.05);对比2组患者的气管切开术后pH、PaO2、PaCO2和术后NSE水平差异具有统计学意义(P0.05)。(3)2组患者3个月后生存质量相比差异有统计学意义(P0.05)。结论重症脑损伤患者因长期呼吸机辅助通气,采取序贯性人工气道开放法能确保其安全性,改善预后,提高抢救成功率。     

Anticipated and unanticipated complications of severe dengue in a primigravida

As the incidence of dengue is rising among adults more cases of dengue fever are being reported during pregnancy. Physiological changes of pregnancy mask the pathognomonic features of severe dengue such as increased hematocrit, thrombocytopenia, and leukopenia and a high index of suspicion are required in endemic areas. Massive hemorrhage may complicate operative deliveries in unsuspected patients. World Health Organization recommends that all patients with severe dengue should be admitted to a hospital with access to intensive care facilities and blood transfusion. We present the successful management of hemorrhage and unanticipated complications of severe dengue in a young primigravida admitted to the Intensive Care Unit after an emergency cesarean section.     

重症急性胰腺炎的持续肾脏替代治疗

重症急性胰腺炎发病急骤,机体可产生大量炎症介质,进而导致多脏器功能障碍综合征,病情变化快,病死率极高。持续肾脏替代治疗(CRRT)应用于重症急性胰腺炎患者,可以有效清除炎症介质,维持机体内环境,有利于胰腺、肺、肾等重要脏器功能的改善以及恢复,避免病情进一步恶化。CRRT是辅助治疗重症急性胰腺炎患者的有效方法之一,可能对重症急性胰腺炎患者的预后有改善作用。     

Consensus summary report for CEPI/BC March 12–13, 2020 meeting: Assessment of risk of disease enhancement with COVID-19 vaccines

A novel coronavirus (CoV), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in late 2019 in Wuhan, China and has since spread as a global pandemic. Safe and effective vaccines are thus urgently needed to reduce the significant morbidity and mortality of Coronavirus Disease 2019 (COVID-19) disease and ease the major economic impact. There has been an unprecedented rapid response by vaccine developers with now over one hundred vaccine candidates in development and at least six having reached clinical trials. However, a major challenge during rapid development is to avoid safety issues both by thoughtful vaccine design and by thorough evaluation in a timely manner. A syndrome of “disease enhancement” has been reported in the past for a few viral vaccines where those immunized suffered increased severity or death when they later encountered the virus or were found to have an increased frequency of infection. Animal models allowed scientists to determine the underlying mechanism for the former in the case of Respiratory syncytial virus (RSV) vaccine and have been utilized to design and screen new RSV vaccine candidates. Because some Middle East respiratory syndrome (MERS) and SARS-CoV-1 vaccines have shown evidence of disease enhancement in some animal models, this is a particular concern for SARS-CoV-2 vaccines. To address this challenge, the Coalition for Epidemic Preparedness Innovations (CEPI) and the Brighton Collaboration (BC) Safety Platform for Emergency vACcines (SPEAC) convened a scientific working meeting on March 12 and 13, 2020 of experts in the field of vaccine immunology and coronaviruses to consider what vaccine designs could reduce safety concerns and how animal models and immunological assessments in early clinical trials can help to assess the risk. This report summarizes the evidence presented and provides considerations for safety assessment of COVID-19 vaccine candidates in accelerated vaccine development.     

Gut microbiota in burned patients with Clostridioides difficile infection

BackgroundThe survival rate of patients with severe burn is positively associated with increasing the incidence of the Clostridioides difficile (C. difficile) infection (CDI). The surviving rate of severe burn patients now has an improved but the incidence of Clostridioides difficile (C. difficile) infection (CDI) has been continues increasing during recent two decades.This study assessed the molecular typing and phenotypic characterization isolates of C. difficile in burn patients with diarrhea, as well as environmental and skin infections with C. difficile spores at a referral burn hospital in Isfahan, Iran. It mainly aimed to evaluate the dominant bacterial structure in the gut microbiome of burned subjects with and without CDI.MethodsIn general, 309 samples were collected from 189 burned patients with hospital-acquired diarrhea and 120 swabs were collected from the healthcare workers’ dominant hands, different sites of patients’ skin, and medical tools. In addition, C. difficile isolates were characterized considering the existence of antibiotic resistance and toxin genes. Clinical cultures with identification of organisms and antibiotic susceptibility were done. C. difficle isolates were then genotyped and compared to clinical outcomes. Finally, the clinical characteristics of the participants were gathered through their records, and the bacterial targets of the gut microbiome were detected using quantitative real-time polymerase chain reaction (PCR).ResultsBased on the findings, 51 C. difficile isolates were detected from 189 severe burn patients hospitalized in the hospital. Further, PCR amplification tcdB and tcdA showed 23 isolates (12.2%) as toxigenic. Overall, 18.3% (22/120) of skin and environment samples demonstrated a positive result for C. difficile colonization. A low concentration of metronidazole and vancomycin (MIC90, 0.5, and 1.2 mg/L) inhibited all toxigenic C. difficile strains. Moreover, these isolates represented the highest rates of resistance to moxifloxacin and clindamycin (MIC90, 0.5, and 1.6 mg/L). A significantly reduced abundance of Clostridium spp., Bacteroidetes, and Bifidobacterium and an increase in the quantity of Firmicutes was observed in the gastrointestinal microbiome of burn patients (P < 0.01). Burn patients with CDI showed a significant decrease in Faecalibacterium prausnitzii (F. prausnitzii) while higher Akkermansia muciniphila (A. muciniphila) loads in comparison with healthy controls (P < 0.001 and P < 0.05). Contrarily, burned cases displayed increased levels of opportunistic pathogenic bacteria including the members of Enterococcus spp. and Escherichia coli (P < 0.05).ConclusionsDespite appropriate infection control strategies in the burn intensive care unit, CDI remains prevalent in severe burn patients. Eventually, the overgrowth of A. muciniphila and the decreased abundance of F. prausnitzii in burn cases with CDI could be potential predictive microbiome biomarkers in burned patients.     

脑状态指数联合中枢神经系统感染评分表在重型脑外伤并发颅内感染患者中的应用

目的探讨脑状态指数(CSI)联合中枢神经系统(CNS)感染评分表在重型脑外伤并发颅内感染患者病情监测中的应用。方法选取2018年6月至2019年6月开封市中心医院神经外科收治的重型脑外伤患者78例,采用CSI评分及CNS评分对患者病情进行评估。结果CSI评分10~30分组、31~50分组、51~80分组、CNS评分0~13分组、14~26分组、27~39分组在性别、年龄、脑挫裂伤、颅内血肿等方面比较差异均无统计学意义(均P>0.05),而CSI评分10~30分组、31~50分组、51~80分组在颅内感染发生率、死亡率、格拉斯哥预后评分(GOS)、Barthel指数差异均有统计学意义(均P<0.05)。CNS评分0~13分组、14~26分组、27~39分组颅内感染发生率及死亡率差异均有统计学意义(均P<0.05)。经Pearson单因素分析可知,CSI评分与CNS评分呈负相关(P<0.05)。结论CSI评分联合CNS评分对重型脑外伤并发颅内感染患者病情判断及预后有重要的价值,可为患者实施预见性护理提供指导,从而降低重型脑外伤患者颅内感染率及死亡率,提高患者临床治疗效果。     

围产新生儿SARS-CoV-2感染临床观察研究方案专家建议

严重急性呼吸综合征冠状病毒2(Severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)感染流行,但因目前新生儿病例报道较少,证据资料欠完善,对新生儿SARS-CoV-2感染的途径、临床特征、治疗及预后甚至诊断标准等认识尚不清楚和统一,故围产界应积极对围产儿SARS-CoV-2感染进行系统全面研究,因为这些临床资料、统计数据和研究结果将对于此次乃至今后冠状病毒感染在这些最脆弱特殊人群防治具有十分重要的意义。为此,中国医师协会新生儿科医师分会循证学组、中华医学会围产医学分会重症学组联合组织专家组研制本建议,供围产学界同行拟定该方面具体项目计划参考。