鸟巢式护理模式对早产儿生长发育及肠胃功能的影响

目的 探讨鸟巢式护理模式在早产儿护理中的应用价值。方法 选取2016年6月—2020年5月本院收治的早产儿94例,采用随机数表法将其分为两组,每组各47例。对照组给予早产儿采取常规护理,观察组在早产儿常规护理上实施鸟巢式护理模式。比较两组临床效果、护理前后生长发育情况、肠胃功能及家属护理满意度。结果 观察组体温波动幅度低于对照组,睡眠时间长于对照组,血氧饱和度高于对照组,出暖箱时间短于对照组,差异有统计学意义(P<0.05)。护理前,两组头围、身高、体质量比较,差异无统计学意义(t=0.381,P=0.704、t=0.211,P=0.833、t=1.472,P=0.144);护理后2周,观察组头围(28.44±1.35)cm、身高(44.86±2.05)cm、体质量(2 336.93±12.47)g,高于对照组的(27.76±1.87)cm、(42.46±2.43)cm、(2 310.14±13.56)g,差异有统计学意义(t=2.021,P=0.046、t=5.175,P<0.001、t=9.970,P<0.001);观察组首次胎便时间、胎便转黄时间分别为(21.74±7.35)h、(58.91±12.44)h,短于对照组的(25.02±8.13)h、(63.87±13.74)h,排便次数及进奶量的增加分别为(5.67±1.32)次/d、(3.38±1.43)mL/d,高于对照组的(4.21±1.84)次/d、(2.13±0.27)mL/d,差异有统计学意义(t=2.052,P=0.043、t=4.420,P<0.001、t=2.205,P=0.030、t=5.889,P<0.001);观察组护理总满意度高于对照组,差异有统计学意义(P<0.05)。结论 鸟巢式护理模式可减少早产儿体温波动幅度,提供适宜的恒温环境,促进早产儿生长发育,效果确切,值得广泛应用。     

层流洁净新生儿重症监护病房早产儿实施床旁手术的可行性分析

 目的 探讨层流洁净新生儿重症监护病房(NICU)早产儿实施床旁手术的效果与可行性。方法 回顾性分析某军队三甲综合医院2017年9月—2020年10月NICU住院并进行床旁动脉导管扎闭术(PDA)及腹部探查术的危重新生儿的临床资料,在NICU行床旁手术者列为NICU组,转入手术室进行手术者列为手术室(OR)组,比较两组新生儿术后体温、切口感染率及病死率的差异。结果 共计纳入258例新生儿,其中NICU组166例,OR组92例。NICU组新生儿出生胎龄、出生体质量、手术时体质量、新生儿危重病例评分均低于OR组;NICU组新生儿术前应用呼吸机通气比例高于OR组,差异均有统计学意义(均P＜0.05)。NICU组与OR组新生儿术中抽检空气培养微生物菌落数、术前体温、PDA与剖腹探查术的构成比例、术后切口感染发病率及病死率比较,差异均无统计学意义(均P＞0.05),但手术后OR组新生儿平均体温低于NICU组,差异有统计学意义(P＜0.05)。结论 层流洁净NICU早产儿行床旁PDA和腹部手术临床可行,且床旁手术更有利于减少术后低体温的发生。对层流洁净病房进行日常规范化维护,可以有效保障危重早产儿床旁手术的安全。     

Left ventricular noncompaction associated with a pathogenic mutation in the MYH7 gene: Known mutation,different phenotype

Left ventricular noncompaction (LVNC) is a genetically heterogeneous cardiomyopathy, with familial and sporadic forms, but genetic testing only identifies a pathogenic mutation in a minority of cases. The main complications are heart failure, embolism and dysrhythmias. Herein we report a familial case of LVNC associated with a mutation in the MYH7 gene and review the literature regarding controversies in LVNC. A 50-year-old woman was referred to the cardiology clinic for palpitations. She underwent echocardiography and cardiac magnetic resonance imaging that revealed mild left ventricular systolic dysfunction and LVNC criteria. She had several episodes of non-sustained ventricular tachycardia and received an implantable cardioverter-defibrillator (ICD). Genetic testing revealed the c.1003G>C (p.Ala335Pro) mutation in the MYH7 gene. Familial screening showed clear genotype-phenotype cosegregation, which provided strong evidence for the pathogenic role of this mutation. To the best of our knowledge, this is the first report of LVNC associated with the p.Ala335Pro mutation in the MYH7 gene. This mutation has been described in hypertrophic cardiomyopathy, suggesting that the same pathogenic sarcomere mutation may be associated with different cardiomyopathies. This case also highlights the current difficulties regarding decisions on ICD implantation for primary prevention of sudden cardiac death in LVNC.     

Mechanical Hemolysis Complicating Transcatheter Interventions for Valvular Heart Disease: JACC State-of-the-Art Review

Mechanical intravascular hemolysis is frequently observed following procedures on heart valves and uncommonly observed in native valvular disease. In most cases, its severity is mild. Nevertheless, it can be clinically significant and even life threatening, requiring multiple blood transfusions and renal replacement therapy. This paper reviews the current knowledge on mechanical intravascular hemolysis in valvular disease, before and after correction, focusing on pathophysiology, approach to diagnosis, and impact of other hematological conditions on the resultant anemia. The importance of a multidisciplinary management is underscored. Laboratory data are provided about subclinical hemolysis that is commonly observed following the implantation of surgical and transcatheter valve prostheses and devices. Finally, clinical scenarios are reviewed and current medical and surgical treatments are discussed, including alternative options for inoperable patients.