肺表面活性物质联合机械通气治疗新生儿肺出血疗效观察

目的观察肺表面活性物质联合机械通气治疗新生儿肺出血的临床疗效。方法 2012年1月至2015年10月深圳市龙华新区人民医院新生儿科收治新生儿肺出血患儿102例,随机分为对照组和观察组各51例。两组患儿均给予气管插管,呼吸机辅助呼吸。对照组气管内注入血凝酶、肾上腺素;观察组气管内注入血凝酶、猪肺磷脂注射液。观察两组患儿治疗后6、12、24、48h肺出血面积、肺出血持续时间、机械通气时间、不良反应及临床疗效。结果两组治疗后12、24、48h与治疗前肺出血面积相比较,差异有统计学意义(P0.05)。观察组治疗后12、24、48h肺出血面积显著低于对照组,差异有统计学意义(P0.05)。观察组患儿肺出血持续时间、机械通气时间比对照组明显缩短,差异有统计学意义(P0.05)。观察组治愈率为84.31%(43/51),显著高于对照组66.67%(34/51),差异有统计学意义(P0.05)。两组患儿均未发生明显不良反应。结论机械通气联合肺表面活性物质可以显著减少肺出血面积,缩短肺出血持续时间和机械通气时间,提高治愈率,值得在临床大力推广应用。     

早产儿人类免疫缺陷病毒感染合并多重感染一例

患儿,女,1 d,出生体重1070 g.母5年前确诊患有艾滋病,但未进行治疗.分娩前出现发热、神志欠清等神经系统症状,遂入住加拿大某二级医院治疗;同日发生胎膜早破、胎盘早剥,妊娠27周经阴道急产下该女婴.患儿生后反应差、自主呼吸弱、心率慢、四肢松软,经面罩加压给氧后心率、呼吸加快,面色转红,Apgar评分为1 min 1分、5 min 4分、10 min 7分,之后情况稳定.生后30 min新生儿转运人员到达,进行气管插管机械通气,转运至某三级医院新生儿重症监护病房(neonatal intensive care unit,NICU)进一步治疗.其母分娩后神志丧失,头颅MRI发现异常病灶,怀疑艾滋病合并弓形体感染,于12 d后抢救无效死亡.     

INSURE技术在极低和超低出生体重儿呼吸支持中的应用价值——83例临床分析

目的 探讨INSURE技术在极低及超低出生体重早产儿呼吸支持中的临床应用价值.方法 本研究为回顾性分析.清华大学第一附属医院2010年6月至2012年8月收治的有呼吸困难且需要呼吸支持的极低及超低出生体重儿83例,依据呼吸支持方法的不同分为INSURE组41例与机械通气组42例.INSURE组患儿生后尽快予以气管插管、气管内滴入肺表面活性物质、拔管后经鼻持续气道正压通气.机械通气组患儿生后予气管插管、气管内用或不用肺表面活性物质、不拔除气管导管直接连接呼吸机辅助通气.卡方检验、两独立样本t检验及秩和检验比较2组患儿治疗后1h、12h动脉血气改善情况,呼吸窘迫综合征、呼吸机相关性肺炎、气漏、慢性肺疾病、颅内出血、视网膜病变、脑白质软化等疾病的发生情况,以及呼吸机使用时间、用氧时间、住院时间、住院费用等.结果 (1)组内治疗前后氧合情况比较:INSURE组患儿治疗后1h动脉血氧分压为(78.7±11.5) mm Hg(1 mm Hg=0.133 kPa),高于治疗前[(50.1±10.8) mm Hg],而二氧化碳分压低于治疗前[(48.3±8.9) mm Hg与(54.9±11.5) mm Hg],差异均有统计学意义(t分别为9.737、-3.428,P均＜0.05).机械通气组患儿治疗后1h动脉血氧分压为(80.2±10.0) mm Hg,高于治疗前[(51.3±9.8) mm Hg],而二氧化碳分压低于治疗前[(45.6±9.5) mm Hg与(57.1±12.8) mmHg],差异均有统计学意义(t分别为10.093、-4.526,P均＜0.05).(2)组间氧合情况比较:INSURE组与机械通气组治疗后1h动脉血氧分压、二氧化碳分压相比差异无统计学意义(P均＞0.05);INSURE组治疗后12 h动脉血氧分压、二氧化碳分压分别为(89.4±11.5) mm H g、(44.2±5.9) mm Hg,与机械通气组[分别为(90.2±10.8) mm Hg、(39.1±7.3) mm Hg]相比差异也无统计学意义(t分别为0.093、0.126,P均＞0.05).(3)组间疾病发生情况比较:INSURE组患儿呼吸机相关性肺炎、气漏、颅内出血和慢性肺疾病的发生率分别为7.3％(3/41)、4.9％(2/41)、4.9％(2/41)和4.9％(2/41),均低于机械通气组[分别为34.1％(14/42)、16.7％(7/42)、19.0％(8/42)和11.9％(5/42)],差异均有统计学意义(x2分别为27.470、8.651、8.814和4.275,P均＜0.05).INSURE组患儿呼吸机使用时间、用氧时间、住NICU时间分别为5 d(3～7 d)、8 d(5～11 d)和16d(11～25 d),短于机械通气组[分别为8 d(4～12 d)、12 d(8～22 d)和21 d(12～35 d)],差异均有统计学意义(Z分别为-1.947、-2.013和-1.782,P均＜0.05). 结论 极低及超低出生体重儿应用INSURE技术进行呼吸支持,创伤小、并发症少、用氧时间短、费用低、安全性高.     

肺表面活性物质治疗足月新生儿急性呼吸窘迫综合征疗效观察

目的观察肺表面活性物质(PS)治疗足月新生儿急性呼吸窘迫综合征(ARDS)的临床疗效。方法 2011年1月至2016年1月娄底市中心医院新生儿科收治住院的足月ARDS新生儿86例,随机分为观察组和对照组各43例。对照组给予机械通气和常规药物治疗,观察组在对照组治疗基础上同时经气管插管给予患儿肺泡表面活性物质猪肺磷脂注射液治疗,疗程1~7d。观察两组患儿机械通气时间、用氧时间、呼吸指数、氧合指数及临床疗效。结果观察组总有效率为90.69%(39/43),显著高于对照组69.76%(30/43),差异有统计学意义(P0.05);观察组患儿的机械通气时间、用氧时间、高浓度氧持续时间、氧合指数、呼吸指数均较对照组有明显改善,差异有统计学意义(P0.05);经PS治疗后观察组并发症发生率为16.28%(7/43),显著低于对照组44.19%(19/43),差异有统计学意义(P0.05)。结论在ARDS治疗早期应用PS可有效改善肺氧合功能,很大程度地缩短了机械通气时间和用氧时间,降低ARDS的并发症发生率,是一种比较安全有效的治疗方法,对临床上大范围推广具有一定意义。     

新技术应用对机械通气极低出生体重儿预后的影响

目的　探讨新的治疗技术如肺表面活性物质 (PS) ,鼻塞CPAP(NCPAP) ,以及开展新生儿转运对需机械通气的极低出生体重儿 (VLBWI)预后的影响。　方法　 73例因呼吸衰竭、反复呼吸暂停、心肺复苏需机械通气的VLBWI按用新技术前后分为A组 3 2例 (1995～ 1998年 )和B组 41例(1999～ 2 0 0 2年 )。B组有 10例用PS(占 2 4% ) ,拔管后改用NCPAP 12例 (占 2 9% ) ,转运的患儿有11例 (占 2 7% )。　结果　两组比较 ,B组存活率明显提高 (3 9%与 71% ,P <0 .0 5) ;机械通气时间缩短 [(8.15± 11.57)d与 (4.59± 3 .50 )d(P <0 .0 5) ] ;院内感染发生率降低 (47%与 2 4% ,P <0 .0 5) ;低体温、代谢性酸中毒B组亦明显减少 ,而慢性肺疾病、颅内出血两组差异无显著性。　结论　VLB WI生后即予PS预防和治疗呼吸窘迫综合征 ;尽早撤离呼吸机 ,改用NCPAP ;开展新生儿转运 ,可能提高VLBWI机械通气的存活率 ,降低病死率     

新生儿重症监护病房院内感染回顾性分析

目的调查新生儿重症监护病房(NICU)院内感染的发生情况,分析其危险因素,为院内感染的防控提供依据。方法对213例新生儿进行院内感染监控,观察感染发生率、感染部位,并做感染病原学统计。结果213例新生儿中25例发生29次院内感染,发生率为11.7%。新生儿发生院内感染的危险因素包括胎龄≤32周、出生体质量≤1500g、胃肠外营养及机械通气治疗(P0.05)。感染部位中以肺炎占首位(37.9%);院内感染病死率为8.0%。入院后有细菌定植者较无细菌定植者院内感染率高。结论低出生体质量、胎龄以及机械通气是院内感染重要外部因素,明确NICU患儿个体细菌的定植情况将有助于控制院内感染并对临床合理用药提供参考。     

经鼻塞持续气道正压通气治疗新生儿呼吸衰竭的疗效观察

目的：观察和分析应用经鼻塞持续气道正压通气治疗新生儿呼吸衰竭的临床疗效及价值。方法：选取2011年4月至2013年9月在我院接受治疗的呼吸衰竭患儿40例,随机分为观察组（20例）和对照组（20例）,观察组患儿采取经鼻塞持续气道正压通气治疗,对照组患儿采用气管插管后机械通气治疗,比较两组患儿在治疗前后血气分析结果的变化情况,并发症发生率以及呼吸机的使用时间等指标。结果：两组患儿在治疗前PO2、PCO2及pH值等血气分析指标无显著差异（P〈0.05）;治疗后观察组PO2、PCO2、pH值均小于对照组（P〈0.05）,差异具有统计学意义。结论：采用鼻塞持续气道正压通气对患有呼吸衰竭症状的新生儿进行治疗,有助于改善患儿呼吸状态,降低血氧及二氧化碳分压,同时降低了并发症的发生率,值得临床推广和应用。     

干预性呼吸治疗在婴幼儿先天性心脏病围手术期的应用

目的探讨干预性呼吸治疗改善先天性心脏病患儿术后呼吸功能的效果。方法选择2017年11月至2018年4月湖南省儿童医院收治的先心病患儿40例为研究对象,随机分为观察组与对照组各20例。分别给予常规呼吸治疗方法和干预性呼吸治疗方法,分别检测和比较两组患儿呼吸机辅助时间和心脏重症监护室停留时间、二次气管插管率、动脉血气分析指标,通气/血流比以及胸片结果。结果观察组患儿呼吸机辅助时间和心脏重症监护室滞留时间均显著短于对照组,差异有统计学意义(P0.05)。观察组二次气管插管率为10.0%(2/20),显著低于对照组65.0%(13/20),差异有统计学意义(P0.05)。观察组治疗后血PCO_2和PO_2均显著优于对照组,差异有统计学意义(P0.05);两组血氧饱和度比较差异无统计学意义(P0.05)。两组患儿治疗后通气/血流比值由治疗前的失调均得到明显平衡和改善。观察组并发症发生率为5.0%(1/20),显著低于对照组55.0%(11/20),差异有统计学意义(P0.05)。结论干预性呼吸治疗能改善先天性心脏病患儿术后呼吸功能和肺通气,提高手术成功率。     

喉罩通气在新生儿复苏中的应用和评价

目的 初步观察喉罩通气应用于新生儿复苏的可行性、有效性和安全性. 方法将分娩后需正压通气复苏的新生儿369例随机分为喉罩组(205例)及面罩组(164例),比较两种方法的复苏效果及观察喉罩操作时间、一次放置成功率及不良反应等. 结果 (1)两组新生儿生后1 minApgar评分构成差异无统计学意义,生后5 min Apgar评分构成高分者喉罩组明显多于面罩组(x2=-3.39,P=0.001).喉罩总体复苏成功率明显高于面罩组(99.02%和84.15%,x2=28.76,P＜0.01),总体复苏通气时间明显短于面罩组[(36.4±23.7)s和(66.2±35.4)s](t=-8.66,P＜0.01);其中重度窒息患儿喉罩复苏成功率为7/9,面罩组6例均未能成功复苏而需改气管插管;1 minApgar评分4～5分的新生儿喉罩复苏成功率明显高于面罩组(100.00%和42.86%,x2=23.04,P＜0.01),通气时间短于面罩组[(54.6±33.6)s和(136.4±42.0)s](t=-4.45,P＜0.01);1 minApgar评分6～7分的新生儿复苏成功率两组差异无统计学意义.(2)喉罩一次放置成功率98.54%(202/205),放置时间平均为(7.8±2.2)s,不良反应有呕吐(4例)和胃食管反流(3例). 结论喉罩通气操作相对简单,容易掌握,在较重窒息患儿中使用效果优于面罩,可在一定程度上替代气管插管,尤其适于气管插管操作不熟练者使用.     

肺表面活性物质替代治疗对支气管肺发育不良发病的影响

目的　探讨肺表面活性物质 (PS)替代治疗对支气管肺发育不良 (BPD)发生率的影响。　方法　采用单剂 Exosurf气管内治疗 2 5例新生儿呼吸窘迫综合症 (NRDS)患儿 ,并与同期未用 PS治疗的 2 5例 NRDS患儿进行前瞻性非随机对照研究 ,统计 BPD的发生情况。　结果　 PS运用组机械通气及氧疗时间较未用 PS组明显缩短 ,机械通气的天数由 (13± 9) d下降为 (6± 4) d,氧疗天数由(2 1± 9) d下降为 (9± 6 ) d,差异有显著性意义。BPD的发生率由 40 %下降至 2 0 % ,差异无显著性意义。　结论　 PS治疗 NRDS患儿能缩短机械通气的时间及氧疗天数 ,但是否减少 BPD的发生率 ,尚需进一步操讨     

Preoperative diagnosis by electron beam computed tomography and perioperative management of primary tracheal anomalies in tetralogy of Fallot.

PURPOSE: To investigate the usefulness of electron beam computed tomography (EBCT) in the preoperative detection and perioperative management of insidious concomitant primary tracheobronchial anomalies in patients with tetralogy of Fallot (TF). METHODS: From July 1995 to October 1999, 88 children (38 girls, 50 boys) with TF were enrolled in this study. EBCT examinations provided information needed to plan management. The final diagnoses of airway abnormalities were correlated with the findings of bronchoscopy in five patients and confirmed during surgery. RESULTS: Fourteen (16%) of the 88 patients had associated primary tracheobronchial anomalies. Nine patients had tracheal bronchi, which were combined with tracheobronchial stenosis in two patients and with tracheal stenosis in one patient. Two patients had tracheal diverticulum, which was combined with lower tracheal stenosis in one patient. Two patients had congenital tracheal stenosis. Tracheomalasia was found in one patient. Three patients with ventilation difficulties died postoperatively. Special attention was given to the care of the diseased airways perioperatively, and the remaining 11 patients had a smooth course of hospitalization and discharge. CONCLUSIONS: Our results show that EBCT provides good delineation of both cardiac and tracheobronchial anomalies and suggest that it should be used perioperatively to detect associated airway anomalies in TF, to facilitate the design of an appropriate ventilation care strategy.     

A comparison of a new, ultrathin-walled two-stage twin endotracheal tube and a conventional endotracheal tube in very premature infants with respiratory distress syndrome: a pilot study

This was a pilot study to test the feasibility of use of the ultrathin-walled two-stage twin endotracheal tube (UTTS-T-ETT), with one half to one third the resistance to gas flow and one third to one seventh the dead space of a conventional tracheal tube, in very premature infants. Twenty-eight infants with gestational age 24 to 28 weeks and birthweight >/= 500 g with respiratory distress syndrome requiring intubation and mechanical ventilation were randomly assigned to be intubated with either the UTTS-T-ETT (13 infants) or with a conventional ETT (15 infants). The infants in the two groups were similar in GA, birthweight, age of entry in the study, and initial ventilator settings. Indications for intubation and extubation were standardized. To evaluate the feasibility of the UTTS-T-ETT, complications with insertion of the endotracheal tube, traumatic injury of the upper airway, number of accidental extubations, number of re-intubations after attempted extubation, number of x-ray/days of mechanical ventilation, prevalence of atelectasis, prevalence of air-leak syndrome, duration of ventilation, bronchopulmonary dysplasia, length of stay, and mortality in the two groups were compared. No significant differences in the outcomes were observed. Specifically, no complications during intubation or traumatic injury of the upper airway due to indwelling ETT were observed in either group. The proportion of failed extubation attempts was 7% in the UTTS-T-ETT V 40% in the conventional ETT group ( P = 0.08). The use of the UTTS-T-ETT is feasible in preterm infants. There was no difference in adverse events associated with its use compared with a conventional ETT. Given the proven in vitro advantages and a favorable trend toward facilitation of extubation in this pilot study, a larger randomized trial to assess clinical benefit and confirm safety is indicated.     

北京地区早产发生现状及早产儿结局的调查分析

目的 探讨北京地区早产发生现状及不同孕周、不同类型早产儿的结局.方法 选择2006年12月1日-2007年5月31日在北京大学第一医院(北大一院)、首都医科大学附属北京妇产医院(市妇产医院)、北京市海淀区妇幼保健院(海淀妇幼)、北京大学第三医院(北大三院)住院分娩的孕28周～36周~(+6)早产产妇955例及其早产儿1066例为研究对象,4家医院同期分娩数为15 197例.结果 (1)早产发生率:早产总发生率为6.3%(955/15 197).其中北大三院的早产发生率为13.1%(150/1142),北大一院的早产发生率为8.1%(125/1549),市妇产医院的早产发生率为5.5%(369/6656),海淀妇幼的早产发生率为5.3%(311/5850).其中北大三院的早产发生率明显高于其他医院(P<0.01).两家综合医院(北大一院及北大三院)的早产率10.2%(275/2691)明显高于两家专科医院(市妇产医院及海淀妇幼)的早产率5.4%(680/12 506),两者比较,差异有统计学意义(P<0.01).(2)早产发生孕周:<34周的早产发生率为28.5%(272/954),≥34周的早产发生率为71.5%(682/954),早产主要发生在孕34周以后.各家医院的早产发生孕周分布有明显不同,其中,海淀妇幼<34周的早产发生率明显低于其他3家医院(P<0.01),北大一院<34周的早产发生率最高(P<0.05),北大三院与市妇产医院相比较,差异无统计学意义(P>0.05).(3)早产发生的原因:在早产的发生原因排序中,未足月胎膜早破(PPROM)早产占首位(405例),其次为医源性早产(340例)和自发性早产(205例).各医院早产发生的原因有所不同,北大三院的医源性早产率明显高于其他各医院(P<0.01);北大一院的PPROM发生率较高而自发性早产率较低.医源性早产的发生原因排序中前4位分别是子痫前期143例(42.0%),胎儿窘迫58例(17.1%),前置胎盘43例(12.6%),胎盘早剥33例(9.7%).(4)各家医院的早产儿结局比较:4家医院由于早产原因、孕周不同,其早产儿结局也存在较大差异,市妇产医院早产儿死亡率最高,为5.4%(22/408),与海淀妇幼(1.3%,4/320)及北大三院(0.6%,1/170)比较,差异有统计学意义(P<0.01);与北大一院(2.4%,3/124)比较,差异无统计学意义(P>0.05).(5)不同孕周的早产儿结局比较:<32孕周的早产儿治愈率显著低于≥32孕周者(P<0.01),≥34孕周的早产儿治愈率为99.6%.<32孕周的早产分娩家属放弃及早产儿死亡率显著高于332孕周者,其中,<32孕周的早产儿死亡率为22.1%,≥34孕周者仅为0.3%,两者比较,差异有统计学意义(P<0.01).(6)不同原因的早产儿结局比较:医源性早产的早产儿死亡率(4.9%)高于PPROM早产(1.6%),两者比较,差异有统计学意义(P<0.05).PPROM、自发性早产及医源性早产3者的早产儿治愈率相互比较,差异无统计学意义(P>0.05).结论 早产儿死亡率较高,尤其是<32孕周的早产儿死亡率更高,这部分早产儿是早产预防的重点;同时,减少医源性早产,积极预防PPROM早产的发生也是降低早产发生率的重要因素.     

Superoxide dismutase and catalase activity in tracheobronchial secretions after surfactant treatment of newborn infants with respiratory distress syndrome

Oxygen toxicity and mechanical ventilation are main factors in the development of chronic lung disease in preterm infants. We examined two antioxidant enzymes, superoxide dismutase (SOD) and catalase, in tracheal fluid of preterm infants with severe respiratory distress syndrome (RDS) treated with surfactant. SOD and catalase catalyse the transformation of oxygen radicals and hydrogen peroxide to less toxic metabolites. 31 preterm infants were randomised to either single or multiple dose treatment with surfactant (Curosurf). Tracheal aspirates were obtained during routine tracheal suctioning and the two enzymes were measured during the first week of life. 11 of 31 preterm babies (35%) did not show any SOD-activity in tracheal fluid. Four out of the eleven preterm infants developed bronchopulmonary dysplasia. Patients receiving multiple dose treatment had significantly higher SOD-activity (> 10 micrograms/mg albumin, p < 0.01) than patients with single dose treatment. Only 2 of 31 preterm babies (6%) lacked catalase activity in tracheal aspirate. 94% had catalase activity between 1 and 12 micrograms/mg albumin. We conclude that, the majority of preterm infants with severe RDS do not have protective superoxide dismutase activity in tracheal fluid. Following multiple dose surfactant replacement significantly higher SOD activity was observed as compared to single dose therapy.     

Carbon monoxide: An old poison with a new way of poisoning

We present two events of carbon monoxide (CO) poisoning, which spread out through ventilation pipes to kill or injure neighbors. This is a previously undocumented poisoning process. In?the first event, three people died and eight others suffered CO poisoning from a gas-powered water heater in an apartment building. Similar to the first event, three people expired and three others were injured by CO poisoning in the second event. We subsequently determined the cause of these tragedies were due to obstructions at the openings of ventilation pipes. CO?is one of the most common causes of poisoning worldwide and these cases often result in tragedy. Early recognition of CO poisoning resulting from obstructed ventilation pipes will facilitate proper management and prevent possible lethal disasters. Additionally, all clinicians and other paramedical personnel ought to raise the suspicion of chemical-related casualties when encountering clusters of patients from a single locale.     

A survivor following repair of laryngotracheo-esophageal cleft: lessons learned

A survivor, following successful repair of laryngotracheo-esophageal cleft extending up to cervical trachea, is being described. The cleft was repaired with anterior laryngofissure approach, using no interposition of tissue between trachea and esophagus. The patient had an uneventful recovery, short hospitalization, and satisfactory outcome on follow-up for over 1-1/2 years, as of now. Optimum ventilation was achieved intra-operatively via an endotracheal tube passed through operative field, following visualization of the cleft. Postoperatively, mechanical ventilation was given via nasotracheal tube left indwelling in trachea following completion of tracheal repair. Early nutrition through enteral route was started 72 hours postoperatively by drip feeds (using infusion pump) through a soft nasogastric tube that was left indwelling following esophageal repair. This maneuver, along with positional and medical therapy, helped us to gain control over gastro-esophageal reflux that is known to be incapacitating in these patients. The authors recommend a reexamination of existing management strategies for patients with laryngotracheo-esophageal clefts and suggest that conservative approach in dealing with associated problems can help decrease morbidity in these patients.     

Randomized, multicenter trial of conventional ventilation versus high-frequency oscillatory ventilation for the early management of respiratory failure in term or near-term infants in Colombia.

OBJECTIVE:To determine the efficacy and safety of high-frequency oscillatory ventilation (HFOV) compared to conventional ventilation (CV) for the treatment of respiratory failure in term and near-term infants in Colombia.STUDY DESIGN:Eligible infants with moderate to severe respiratory failure were randomized to early treatment with CV or HFOV. Ventilator management and general patient care were standardized. The main outcome was neonatal death or pulmonary air leak.RESULTS:A total of 119 infants were enrolled (55 in the HFOV group; 64 in the CV group) during the study period. Six infants in the HFOV group (11%) and two infants in the CV group (3%) developed the primary outcome (RR: 3.6, 95% CI: 0.8-16.9). Five infants in the HFOV group (9%) and one infant in the CV (2%) died before 28 days of life (RR: 5.9 CI: 0.7-48.2). Secondary outcomes were similar between groups.CONCLUSION:HFOV may not be superior to CV as an early treatment for respiratory failure in this age group. Standardization of ventilator management and general patient care may have a greater impact on the outcome in Colombia than mode of ventilation.     

11例妊娠合并白血病患者的临床分析

目的探讨妊娠合并白血病的诊断、处理及预后。 方法对2010年1月至2015年10月广州医科大学附属第三医院收治的11例妊娠合并白血病患者的临床资料进行回顾性分析,分析患者的临床表现、实验室检查、处理方式和随访结果。 结果11例病例中,3例无临床症状,8例表现为典型或不典型症状。11例血常规均异常,骨髓活检确诊为白血病,其中8例为急性白血病,3例慢性粒细胞白血病。6例急性白血病接受化疗,5例存活,1例产后2个月死亡;2例急性白血病患者拒绝化疗后死亡。3例慢性粒细胞白血病患者均接受了化疗,均完全缓解。随访结果：7例患者存活,1例失访;新生儿存活8例。 结论妊娠合并白血病罕见,其症状与妊娠相似,不易及时确诊,处理方式应根据白血病类型、孕龄、孕妇及胎儿状况综合考虑。     

General anesthetic management for diagnostic splenectomy in a patient with paraneoplastic pemphigus.

Paraneoplastic pemphigus (PNP) is an autoantibody-mediated mucocutaneous blistering disease that often occurs with confirmed or occult malignancy. It is often accompanied by extensive eruption of respiratory mucosa and can lead to respiratory failure. The indications for anesthetic management in patients with PNP are rare due to the high risk of generating further eruption of respiratory mucosa during intubation, with potentially disastrous consequences. We report the anesthetic management in a 43-year-old woman with PNP scheduled for diagnostic splenectomy. The surgery was postponed due to persistent hoarseness, diffuse oral-pharyngeal mucositis, and laryngeal erosion. Methylprednisolone 40 mg 3 times daily was prescribed for controlling the mucosa lesions. Two weeks later, after the improvement of mucosal lesions, direct laryngoscopic intubation and the scheduled splenectomy were performed under general anesthesia. Pathology of the spleen showed low-grade B-cell lymphoma had induced PNP. Flexible fiberoptic bronchoscopic examination revealed neither bleeding nor bullae formation in the trachea either immediately after intubation or before extubation. The tracheal mucosa is highly susceptible to mechanical stimulation with direct laryngoscopic intubation. Cuff inflation and positive pressure ventilation, awareness of the disease characteristics of PNP, a sufficient course of steroid therapy beforehand, and adequate mucosal protection are essential to the uneventful anesthetic management of the patient with PNP involving the respiratory tract mucosa.     

Airway management and transesophageal echocardiographic monitoring for pulmonary artery sling.

Pulmonary artery sling is an uncommon vascular anomaly and can be life threatening when it causes tracheal compression. We report on a 14-day-old boy who presented with respiratory distress soon after birth. A series of examinations showed tracheal stenosis due to a pulmonary artery sling. Surgery was performed with the aid of cardiopulmonary bypass. The external compression and intrisic stenosis could not be resolved by vascular surgery because of tracheal malacia and a complete tracheal ring. We recommend cutting extra holes 1 to 2 cm from the distal end of the endotracheal tube for endobronchial intubation. The airway obstruction was resolved successfully with a custom-made endobronchial tube. However, the patient died of pneumomediastinum and pneumothorax induced by barotrauma, on the fourth postoperative day.