川芎嗪湿化高压氧治疗新生儿缺氧缺血性脑病疗效观察

为探讨川芎嗪湿化高压氧治疗新生儿缺氧缺血性脑病(HIE)的疗效,将126例HIE患儿随机分为观察组与对照组,观察组(66例)采用川芎嗪湿化高压氧治疗,对照组(60例)采用传统湿化高压氧治疗。两组治疗前病情、血清磷酸肌酸激酶脑型同功酶(CPK-BB)、前囟B超、脑电图、脑CT检查无统计学差异(P>0.05)。治疗后两组以上检测项目均有显著性差异(P <0.05,P <0.01)。认为川芎嗪湿化高压氧治疗HIE能迅速缓解临床症状,减少后遗症发生;其效果优于传统高压氧治疗。     

纳洛酮联合高压氧治疗HIE58例观察

近年来，我们应用纳洛酮联合高压氧治疗新生儿缺氧缺血性脑病（HIE）58例，效果显著。现报告如下。     

高压氧治疗新生儿缺氧缺血性脑病30例疗效观察和护理

目的探讨早期应用高压氧治疗新生儿缺氧缺血性脑病(HIE)的疗效和护理方法。方法将62例中重度HIE患儿随机分为治疗组30例和对照组32例,两组均给予综合治疗及常规护理,治疗组在此基础上加高压氧治疗。结果治疗组的疗效优于对照组(P0.01)。结论 HIE患儿如能尽早进行高压氧治疗,可提高治愈率,预防后遗症。     

高压氧对中、重度新生儿缺氧缺血性脑病神经元特异性烯醇酶的影响

研究表明,新生儿缺氧缺血性脑病(HIE)患儿血清神经元特异性烯醇酶(NSE)水平升高,血清NSE水平可判定HIE的严重程度.高压氧治疗对HIE患儿的临床疗效和预后有显著影响,但高压氧对HIE血清NSE的影响至今未见报道.     

缺氧缺血性脑病患儿心、肾功能损害检测及意义

检测24例正常新生儿（对照组）、87例缺氧缺血性脑病（HIE）患儿治疗前后的肌酸激酶脑型同工酶（CK—BB）、肌钙蛋白I（cTnI）及胱抑素C（CysC）水平。结果与对照组比较,HIE组轻、中、重度患儿CK—BB升高,中、重度患儿cTnI、CysC升高（P〈0．05,〈0．01）,中、重度患儿心肌、肾脏损害发生率分别为52．9％、50．6％;CysC、cTnI与CK—BB显著相关。提示动态检测上述生化指标有助于早期发现HIE患儿的心、肾功能损害,及早治疗,提高疗效。     

HIE患儿肌肌钙蛋白检测的临床意义

检测并比较新生儿缺氧缺血性脑病（HIE）患儿及足月正常新生儿的心肌肌钙蛋白（cTn-Ⅰ）水平。结果显示,HIE患儿cTn-Ⅰ水平明显高于正常,且HIE轻、中、重度之间均有明显差异（P均〈0.05）。提示cTn-Ⅰ可作为临床判断HIE病情严重程度的指标。     

高压氧对新生儿缺氧缺血性脑病的疗效分析

目的探讨高压氧(HBO)对新生儿缺氧缺血性脑病(HIE)的治疗效果。方法将108例中重度HIE患儿随机分为非高压氧治疗组和高压氧治疗组。非高压氧治疗组给予常规支持和对症治疗;高压氧治疗组在常规治疗和对症治疗的基础上加用高压氧治疗1～2个疗程,并对治疗疗效及预后进行评定。结果经高压氧治疗后,两组临床疗效比较,总有效率分别为92.29%、77.77%,有显著性差异(P0.01)。两组患儿中、重度NBNA评分治疗前无显著差异(P0.05),治疗后有显著差异(P0.01)。两组预后比较,HBO组发生后遗症的比例为22.2%,对照组38.9%,有显著差异(P0.01)。结论高压氧治疗新生儿HIE有很好的疗效,并可减少神经系统后遗症的发生。     

高压氧治疗新生儿缺氧缺血性脑病78例疗效观察

对７８例新生儿缺氧缺血性脑病（ＨＩＥ）给予高压氧加综合治疗,存活病例随访至１～４岁。采用国内ＣＤＣＣ量表测定智商及神经系统检查,复查头颅ＣＴ。对照组６２例,仅给综合治疗。结果发现：高压氧组中、重度ＨＩＥ患儿神经症状消失平均时间短于对照组（Ｐ〈０．０１）;两组总有效率比较,有显著性差异（Ｐ〈０．０１）。早期高压氧治疗发生脑损害较对照组明显减少（Ｐ〈０．０１）,预后不良率低于对照组（Ｐ〈０．０１）;晚     

高压氧辅助治疗新生儿缺氧缺血性脑病72例

2000年1月～2002年1月,我们对72例新生儿缺氧缺血性脑病（HIE）采用高压氧辅助治疗。现报告如下。     

HIE患儿血小板参数变化及临床意义

检测并比较缺氧缺血性脑病（HIE）患儿（HIE组）及足月正常新生儿（对照组）的PLT计数、血小板平均体积（MPV）和血小板体积分布宽度（PDW）。结果显示HIE组PLT随病情加重而下降（P〈0．05,〈0．01）,MPV、PDW随病情加重而升高（P〈0．05）。与对照组比较,HIE组急性期PLT明显降低（P〈0．01）,MPV和PDW明显升高（P〈0．05）;HIE恢复期PLT、MPV和PDW无明显差异（P〉0．05）。提示检测HIE患儿血小板参数,可作为临床判断其病情严重程度的指标。     

Antihypertensive therapy with diltiazem and comparison with hydrochlorothiazide

Fourteen hypertensive patients with a mean sitting systolic and diastolic blood pressure (BP) of 153 +/- 16/100 +/- 4 mm Hg were treated successively with hydrochlorothiazide and diltiazem for 8 weeks each. The BP response and changes in heart rate, left ventricular size and function, and plasma catecholamine concentrations and renin activity were monitored. The 2 drugs had comparable antihypertensive effects, with mean decreases of 14, 9 and 11 mm Hg for the sitting, standing and supine diastolic BP, respectively, during hydrochlorothiazide treatment and mean decreases of 16, 18 and 12 mm Hg during diltiazem treatment. Heart rate was unchanged, although plasma norepinephrine concentrations increased significantly during diltiazem treatment. Plasma renin activity increased slightly, from 0.6 to 0.9 ng/ml/hour during diltiazem treatment, but the change was not significant (p less than 0.10). Left ventricular ejection fraction and end-diastolic volume were not affected by either agent. In conclusion, diltiazem is an effective antihypertensive agent, which because of its benign side effect profile, may be useful as a step 1 agent.     

Beta blocker overdose with propranolol and with atenolol

During a one-month period, two cases of beta-adrenergic blocker overdose were treated by the emergency staff at our hospital. One case of propranolol intoxication demonstrated profound cardiovascular collapse and generalized tonic-clonic seizures. The condition failed to respond to high-dose intravenous pressor agents, but did improve significantly with IV glucagon infusion. The second overdose involved atenolol. Although the blood levels reported were very high, the patient showed no cardiovascular compromise and required only inhaled bronchodilators for an exacerbation of her asthma.     

Safer colonoscopy with patient-controlled analgesia and sedation with propofol and alfentanil.

BACKGROUND: The aim of this study was to assess the efficacy of patient-controlled analgesia and sedation with propofol/alfentanil for colonoscopy compared with continuous drug infusion and conventional nurse-administered medication. METHODS: One hundred fifty patients undergoing colonoscopy on an outpatient basis were randomly assigned to 1 of 3 medication regimens. To maintain blinding, all patients were connected to an infusion pump. Group I patients could self-administer boluses of 4.8 mg propofol and 125 microg alfentanil without restriction. Group II patients received a continuous infusion with 0.048 mg/kg propofol and 0.12 microg/kg alfentanil per minute. Group III patients received intravenous premedication with 0.035 mg/kg midazolam and 0.35 mg/kg meperidine. RESULTS: There were no differences between the groups with respect to pain (visual analogue scale) and procedure time. Patient-controlled analgesia and sedation with propofol/alfentanil (group I) resulted in less of an increase in the transcutaneous partial pressure of carbon dioxide (p = 0.0004) during colonoscopy and less of a decrease in mean arterial blood pressure (p = 0.0021) during recovery, as well as more complete recovery (p = 0.0019) after 45 minutes compared with conventional administration of midazolam/meperidine. Furthermore, patient-controlled analgesia and sedation yielded a higher degree of patient satisfaction than continuous infusion of propofol/alfentanil (p = 0.0033) or nurse-administered midazolam/meperidine (p = 0.0094). CONCLUSIONS: Patient-controlled administration of propofol and alfentanil for colonoscopy may provide a better margin of safety than conventional administration of midazolam and meperidine and results in a higher level of patient satisfaction and shorter recovery.     

Refractory anemia with ring sideroblasts and RARS with thrombocytosis

Disease Overview : Ring sideroblasts (RS) are erythroid precursors with abnormal perinuclear mitochondrial iron accumulation. Two myeloid neoplasms defined by the presence of RS, include refractory anemia with ring sideroblasts (RARS) and RARS with thrombocytosis (RARS‐T). Diagnosis : RARS is a lower risk myelodysplastic syndrome (MDS) with dysplasia limited to the erythroid lineage, <5% bone marrow (BM) blasts and ≥15% BM RS. RARS‐T is a provisional entity in the MDS/MPN (myeloproliferative neoplasm) overlap syndromes, with diagnostic features of RARS, along with a platelet count ≥450 × 10(9)/L and large atypical megakaryocytes similar to those observed in BCR‐ABL1 negative MPN. Mutations and Karyotype : Mutations in the SF3B1 gene are seen in ≥80% of patients with RARS and RARS‐T, and strongly correlate with the presence of BM RS; RARS‐T patients have additional mutations such as, JAK2V617F (～60%), MPL (<5%), and CALR (<5%). Cytogenetic abnormalities are uncommon in both RARS and RARS‐T. Risk stratification : Most patients with RARS are stratified into lower risk groups by the International Prognostic Scoring System (IPSS) for MDS and the revised IPSS. Disease outcome in RARS‐T is better than that of RARS, but worse than that of essential thrombocytosis. Both RARS and RARS‐T have a low risk of leukemic transformation. Treatment : Anemia and iron overload are complications in both diseases and are managed similar to lower risk MDS. Aspirin therapy is reasonable in RARS‐T, especially in the presence of JAK2V617F, but the value of platelet‐lowering drugs is uncertain. Case reports of RARS‐T therapy with lenalidomide warrant additional studies. Am. J. Hematol. 90:550–559, 2015. © 2015 Wiley Periodicals, Inc.