心脏植入性电子装置感染的诊疗与预防

心脏植入性电子装置(cardiac implantable electronic device,CIED)是治疗心律失常的常用设备.自1958年首次应用以来,CIED使用量逐年增加.与此同时,CIED感染率也随之升高.虽然首次植入CIED的感染率很低,但CIED感染后果严重,往往需要取出设备治疗,感染患者病死率高,卫生...     

1例反复起搏器置入术致感染性心内膜炎的护理支持

正随着微电子技术的进步和心脏医学发展,心脏电子植入装置(Cardiovascular Implant-able Electronic Device,CIED)包括普通永久心脏起搏器、埋藏式心脏复律除颤器(ICD)、心脏再同步化治疗(CRT,CRT-P/D)(Cardiovascular Implantable Electronic device,CIED)已经广泛应用于威胁生命的心律失常和慢性心力衰竭的治疗。随着CIED数量增加,术后感染也随之增多,严重者引起心内膜炎、菌血症,危及生命。由心脏电子植入装置相关     

心脏电子装置植入囊袋感染的原因分析及护理

随着微电子技术的进步和心脏医学发展,心脏电子植入装置(Cardiovascular implantable electronic device,CIED)包括永久心脏起搏器、植入式体内电除颤器(Implantable cardiac defibrilator,ICD)和心脏再同步化(Cardiac resynchronized therapy,CRT)装置,已经广泛应用于威胁生命的心律失常和慢性心力衰竭的治疗。随着CIED数量增     

起搏器感染防护的发展现状

随着心血管疾病患病率的增加,近年来植入永久起搏器（PMs）、植入型心律转复除颤器（ICD）以及心脏再同步治疗（CRT）的数量逐年增加。据统计[1]在美国每年有超过30万例的患者接受起搏器治疗,而在全球范围内每年约有90万患者接受该项治疗。随着心脏植入性电子器械（CIED）应用的普遍化,老龄化以及患者情况的复杂化,势必会导致术后感染发生率的增加。研究提示,起搏器感染的发生率从0.13%到12.6%不等;而且2006年的一项调查发现,1996—2003年,永久起搏器感染的发生率增加了2.8倍。植入器械感染率的增加似乎已经超过了植入器械增加的比率。植入器械增加0.49倍,心血管植入性电子器械（CIED）感染增加3.1倍[2]。术后感染成为较常见且严重的并发症,需引起足够重视。笔者通过对临床经验的累积,分析了起搏器感染的发生率、起搏器感染发生率增加的原因、起搏器感染的危险因素以及起搏器感染的防护,提出了相应的防护措施,旨在减少起搏器感染的发生,延长起搏器的使用寿命,现报道如下。     

心血管电子器械植入术围术期评估和康复随访

正近年来心血管植入型电子器械(cardiovascular implantable electronic devices,CIED)的应用越来越受到重视,主要包括心脏起搏器(cardiac pacemaker)、植入型心律转复除颤器(implantable cardioverter defibrillator,ICD)和心脏再同步治疗(cardiac resynchronization therapy,CRT),其对于严重缓慢性心律失常、快速型恶性心律失常和严重心力衰竭等心血管危、急、重症等治疗,尤其是在常规药物治疗无效或禁忌的     

起搏器相关心律失常识别和处理

起搏器属于一类与心律诊断与治疗相关的心血管植入电子装置(CIED),包括单双腔(VVI、DDD)、除颤起搏器(ICD)、双心室同步装置(CRT-D)等。随着起搏器的种类和功能的不断增多,往往起搏器相应故障和参数设置不当可导致相关的心律失常,准确识别和处理此类心律失常是起搏器术后随访和管理的重要内容。本文主要讲述常见的与起搏器相关的心律失常的识别和处理。     

首例经食道超声心动图监测下采用EVOLUTION鞘拔除左室主动电极的护理配合

正三腔心脏起搏器(cardiac resynchronization therapy,CRT)适用于扩张型心肌病所致的心衰患者,特别是心电图QRS时间≥0.12 s者,单纯药物治疗常常不能取得满意的效果,通过在体内植入一个心脏再同步治疗装置,可以纠正室间及室内不同步跳动从而改善心衰患者的症状并提高生存率。随着心律植入性装置(cardiovascular implantable electronic device,CIED)的广泛应     

泌尿道感染者UU、MH和CT的检测药敏及意义

为了解泌尿道感染者解脲支原体(UU)、人型支原体(MH)、衣原体(CT)的阳性率,以及美满霉素、阿奇红霉素和司帕沙星对支原体的敏感性,本文对110例泌尿道感染者进行检测.     

注射用头孢曲松钠与注射用法莫替丁存在配伍禁忌

临床工作中,很多药物的配伍禁忌在《306种注射剂临床配伍应用检索表》中没有说明,药物的不合理配伍现象偶有出现.临床工作中我们发现:注射用罗氏芬(头孢曲松钠)与注射用高舒达(法莫替丁)之间存在配伍禁忌,现报道如下. 临床资料罗氏芬(头孢曲松钠)为白色淡黄色的结晶性粉末,为第三代头孢菌素,用于敏感致病菌所致的下呼吸道感染、尿路、胆道感染、腹腔感染、盆腔感染、皮肤软组织感染、骨和关节感染、败血症、脑膜炎等,以及手术期感染预防.     

血液透析患者并发感染的相关因素分析及护理干预

目的 分析血液透析患者并发感染的危险因素,并提出护理干预对策.方法 回顾性调查分析140例行血液透析患者的临床资料,包括年龄、住院时间、透析时间以及部分实验室检查指标,包括血肌酐( Scr)、血红蛋白(Hb)、血白蛋白(Alb)、C反应蛋白(CRP)等.分析血液透析患者并发感染的相关因素,并总结护理干预体会.结果 140例行血液透析患者中共58例患者发生感染,感染率为41.43％.其中导管相关感染所占构成比最高为32.76％,与其他比较差异显著.糖尿病肾病患者行血液透析并发感染的发生率最高为53.85％,不同原发疾病患者的感染发生率不同,但无显著差异.感染组的年龄、住院时间、透析时间、Scr、CRP明显高于非感染组,差异显著.感染组的Hb、Alb明显低于非感染组,差异显著.对患者年龄、住院时间、透析时间、Scr、Hb、Alb以及CRP等指标与感染的关系经过Logistic回归分析,结果显示,住院时间、透析时间、Scr和CRP与感染存在密切相关性；而年龄、Hb、Alb与感染无明显的相关性.结论 血液透析患者并发感染是多因素共同作用的结果,住院时间、透析时间、Scr和CRP与并发感染存在密切相关性.     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus,therapy, and the vaccination

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening.     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

动态心电图临床操作标准化方法

动态心电图,又称Holter或Holter检查,是一种评价各种心脏病患者心电图异常的简便、高效、准确、安全的无创检查,广泛用于心律失常的相关症状评价,心肌缺血的诊断,心脏病患者的预后和日常生活能力评估,药物疗效评价,起搏器等埋藏式心脏电治疗装置监测等领域。目前动态心电图已广泛用于于临床各级医疗机构,为了更好地发挥其作用,有必要对该项技术进行规范化培训。本文参考相关指南、共识及专家建议,结合作者经验,撰写动态心电图临床操作标准化方法供临床使用时参考。     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.