复杂先天性心脏病伴肺动脉高压患儿围手术期的呼吸道护理

目的 总结复杂危重先天性心脏病伴肺动脉高压患儿行体外循环术围手术期呼吸道管理的护理经验.方法 回顾分析2012年7月至2013年2月1 10例复杂危重先天性心脏病伴肺动脉高压行体外循环手术患儿的临床资料,总结围手术期呼吸道管理的护理经验.室间隔缺损、房间隔缺损93例,完全性房室通道6例,主动脉缩窄3例,完全性肺静脉异位引流4例,右室双出口3例,永存左上腔静脉1例,均伴肺动脉高压,肺动脉收缩压≥55 mm Hg;年龄1～12个月,平均(5.6±6.2)个月;体质量3.6～12.5 kg.术后均使用呼吸机辅助呼吸,呼吸机使用时间(36.5±10.6)h.术后均使用一氧化氮气体吸入.术前详细评估,术后重点观察预防呼吸机相关性肺炎的发生,控制肺动脉压力.结果 110例患儿监护室停留时间为(3.2±24)d,均未发生呼吸机相关性肺炎及肺动脉高压危象.平均住院时间19.4 d,均顺利出院.结论 复杂先天性心脏病伴肺动脉高压的患儿做好围手术期呼吸道的管理能有效改善患儿的呼吸功能,减少ICU停留时间.危重患儿特别是伴有肺动脉高压患儿围手术期降低肺动脉压力,术后积极预防呼吸机相关性肺炎是患儿快速恢复呼吸功能的关键.     

小于6kg的先天性心脏病并肺动脉高压患儿的围手术期处理

目的:分析我院59例体质量小于6kg的先天性心脏病并肺动脉高压患儿的临床资料,总结低体质量的先天性心脏病并肺动脉高压患儿的围手术期处理经验。方法:把握好手术时机;术前降低肺动脉压力,增加心肌能量储备功能;术中注意保护肺脏和心肌,体外循环后采用改良超滤法;术后予血管活性药物,前列腺素E1、一氧化氮吸入,予Siemens300A呼吸机、Babylog8000呼吸机、Maquet Servo呼吸机辅助呼吸。结果:57例患儿痊愈出院,在住院期期间平均肺动脉压有不同程度下降,12例出现并发症,为肺不张、肺炎、胸腔积液、急性肾功能衰竭、低心排出量、心律失常。死亡2例,1例患儿为术后出现肺水肿、肺出血,死于呼吸衰竭、循环衰竭;1例患儿死于低心排出量。结论:合理的围手术期处理是低体质量的先天性心脏病并肺动脉高压患儿手术成功的关键。     

术前机械通气对婴幼儿先天性心脏病合并重度肺动脉高压围术期治疗效果的影响

目的:探讨术前机械通气对婴幼儿先天性心脏病合并重度肺动脉高压患儿围术期治疗效果的影响。方法:将82例先天性心脏病合并重度肺动脉高压患儿随机分为观察组和对照组各41例,对照组术前行常规治疗,观察组在对照组基础上术前1 d行气管插管机械通气治疗。两组均行常规开胸矫治术,分别监测观察组呼吸机辅助呼吸治疗后及两组术后心率、血压、中心静脉压(CVP),肺动脉压、经皮血氧饱和度(Sa O2)、血气等指标变化。结果:观察组经呼吸机治疗后肺动脉压力明显下降,动脉氧分压、动脉血氧饱和度明显升高,且与对照组相比术后呼吸机辅助呼吸时间明显缩短(P<0.05),围术期并发症发生率明显降低(P<0.05)。结论:先天性心脏病合并重度肺动脉高压患者行术前呼吸机辅助通气治疗可以有效降低围术期并发症发生率,有效缩短术后呼吸机辅助呼吸时间及住监护室时间,降低住院费用。     

先天性心脏病合并重度肺动脉高压围术期的护理

总结30例先天性心脏病合并重度肺动脉高压患者加强围手术期护理，术前护理的要点是心理护理、积极控制呼吸道感染、降低肺动脉压力；术后护理的要点是：呼吸管理、胸部体疗、肺动脉高压危象的观察、循环系统监测和防治感染。认为做好精心的围术期护理是促进先天性心脏病合并重度肺动脉高血病人早日康复的重要保证。     

小儿先心病合并肺动脉高压围术期护理

目的探讨先天性心脏病合并肺动脉高压患儿的围术期护理措施和要点。方法总结29例先天性心脏病合并肺动脉高压患儿加强围手术期护理,给予有效的镇静、肌松药、加强呼吸道护理及血流动力学观察和护理。结果3例患儿术后出现肺动脉高压危象,29例患儿均顺利撤离呼吸机,痊愈出院,无护理并发症发生。结论先天性心脏病合并肺动脉高压患者围术期护理,特别是呼吸道及循环系统护理对于手术的成败和减少并发症的发生尤其重要。     

先天性心脏病合并肺动脉高压外科治疗

目的:探讨先天性心脏病合并肺动脉高压的外科治疗和手术效果.方法:先天性心脏病合并肺动脉高压患者126例,围术期给予综合降肺动脉压治疗,保护心肺功能,术后合理使用呼吸机及综合降肺动脉压治疗.结果:早期死亡8例(病死率6.35%),出现肺动脉高压危象12例.痊愈出院118例,术后随访3～24个月,所有肺动脉压力均下降至中度以下.结论:先天性心脏病合并肺动脉高压经围术期综合治疗后再行手术根治可获良好临床效果.     

先天性心脏病合并重度肺动脉高压的外科治疗

目的探讨先天性心脏病合并重度肺动脉高压外科治疗经验。方法2002年9月至2007年9月共手术治疗先天性心脏病合并重度肺动脉高压患者79例，围术期采用综合性降肺动脉压措施，注意保护心肺功能，术后合理使用呼吸机及前列腺素E1，保持呼吸道通畅。结果早期死亡6例（7．59％），术后出现肺动脉高压危象8例（10.12％）。随访62例，所有肺动脉高压均降至中度以下。结论术前准确判断肺动脉高压性质并行降肺动脉压治疗、围术期注意维护心肺功能，合理应用肺血管扩张药物，有利于降低死亡率，减少并发症。     

成人先天性心脏病合并肺动脉高压35例围术期护理

目的:探讨成人先天性心脏病合并肺动脉高压患者围术期护理方法。方法:回顾性分析35例先天性心脏病合并肺动脉高压手术患者的临床资料及术前心理护理和控制肺动脉高压,术后预防患者肺动脉高压、加强呼吸道管理等护理措施。结果:经过调查发现35例患者在围术期经过相应的临床护理,患者的症状有所缓解,均痊愈出院。结论:加强围术期临床护理是先天性心脏病合并肺动脉高压手术患者术后顺利康复的保证。     

先天性心脏病合并肺动脉高压病人的围术期呼吸道护理

[目的]总结先天性心脏病合并肺动脉高压病人的围术期呼吸道护理措施。[方法]回顾性分析71例先天性心脏病合并肺动脉高压行心脏手术病人的临床资料。[结果]本组病人术后并发肺部感染13例,死亡1例。[结论]加强围术期的护理是先天性心脏病合并肺动脉高压行心脏手术病人术后顺利康复的保证。     

先天性心脏病合并肺动脉高压病人的围术期呼吸道护理

[目的]总结先天性心脏病合并肺动脉高压病人的围术期呼吸道护理措施。[方法]回顾性分析71例先天性心脏病合并肺动脉高压行心脏手术病人的临床资料。[结果]本组病人术后并发肺部感染13例,死亡1例。[结论]加强围术期的护理是先天性心脏病合并肺动脉高压行心脏手术病人术后顺利康复的保证。     

动脉瘤性蛛网膜下腔出血病人血清FSH LH PRL GH的浓度变化

目的　研究动脉瘤性蛛网膜下腔出血 (SAH)病人血清卵泡刺激素 (FSH)、黄体生成素 (LH)、泌乳素 (PRL)、生长激素 (GH)的浓度变化规律。方法　对 35例动脉瘤性SAH病人发病后 1～ 3、7～ 9、13～ 15d血清FSH、LH、PRL、GH的浓度进行动态观察 ,用TCD检测大脑中动脉血流速度 (VMCA)。结果　动脉瘤性SAH病人血清FSH、LH、PRL、GH浓度在发病后 1～3、7～ 9d各均值明显高于对照组 ,尤以发病后 7～ 9d变化最明显 ;术前、术后有脑血管痉挛 (CVS)组和非CVS组也有明显差异。结论　动脉瘤性SAH病人血清FSH、LH、GH、PRL含量与SAH的病情演变、CVS程度有关 ,并可判断预后。     

Creatine kinase and myoglobin determination in myocardial infarction

Summary In order to evaluate the diagnostic and prognostic impertance of serum myoglobin (Mb) determination during acute myocardial infarction (AMI) we determined the time of first rise of both CK and Mb, that is the time in hours between the onset of pain and the last normal myoglobin and enzyme determination (TFR for Mb=2.2±1.5 h; TFR for CK=4.0±2.5 h). We also attempted to evaluate infarct size by mathematical analysis of the serum concentrations of Mb. The average percentage difference between the infarct size calculated from the CK concentrations and Mb concentrations was 35.8±35.2%. The results show that the determination of serum myoglobin is a useful and sensitive test for the early diagnosis of AMI. On the other hand, the serum myoglobin cannot be utilized to evaluate infarct size. The main limitation in the determination of infarct size from the serum Mb concentrations lies in the extreme variability of the disappearance rate (Kd), mainly resulting from the renal elimination of the substance.     

载酯蛋白A-I与急性呼吸道感染的关系

目的 探讨急性呼吸道感染患者血清载酯蛋白A-I(ApoA-I)变化及临床意义.方法 2006年12月至2007年7月入住上海交通大学附属第一人民医院急诊ICU及急诊观察室急性呼吸道感染患者为试验组(44例),根据降钙素原(PCT)的质量浓度进行分组,分为PCT＜0.5 ng/ml组,0.5ng/ml∧≤PCT＜2 ng/ml组,PCT≥2 ng/ml组.41例健康体检者为对照组.试验组和对照组均在入院24h内测定静脉血中ApoA-I、PCT、C反应蛋白(CRP)和白蛋白水平.统计学方法计量资料用均数±标准差(x±s)表示,应用SPSS 12.0软件进行统计学分析,计量资料的比较采用t检验及方差分析,相关性分析采用直线相关分析,P＜0.05为差异具有统计学意义.结果 随着PCT质量浓度增加,ApoA-I和血清白蛋白值越低而CRP值越高(P＜0.05).结论 ApoA-I与呼吸道感染的严重程度呈正相关,在较严重的呼吸道感染ApoA-I具有一定的诊断价值,表明这类患者存在脂质代谢紊乱.     

内皮素与经皮冠状动脉介入治疗术后再狭窄研究概况

作者从内皮素的合成、分泌、作用机制及其对血管平滑肌细胞的增殖作用等方面综述内皮素与经皮冠状动脉介入治疗术后再狭窄的研究概况。     

Attenuation-Corrected vs. Nonattenuation-Corrected 2-Deoxy-2-[F-18]fluoro-<Emphasis Type="SmallCaps">d</Emphasis>-glucose-Positron Emission Tomography in Oncology,A Systematic Review

Purpose To perform a systematic review and meta-analysis to determine the diagnostic accuracy of attenuation-corrected (AC) vs. nonattenuation-corrected (NAC) 2-deoxy-2-[F-18]fluoro-d-glucose-positron emission tomography (FDG-PET) in oncological patients. Procedures Following a comprehensive search of the literature, two reviewers independently assessed the methodological quality of eligible studies. The diagnostic value of AC was studied through its sensitivity/specificity compared to histology, and by comparing the relative lesion detection rate reported with NAC-PET vs. AC, for full-ring and dual-head coincidence PET (FR- and DH-PET, respectively). Results Twelve studies were included. For FR-PET, the pooled sensitivity/specificity on a patient basis was 64/97% for AC and 62/99% for NAC, respectively. Pooled lesion detection with NAC vs. AC was 98% [95% confidence interval (95% CI): 96–99%, n = 1,012 lesions] for FR-PET, and 88% (95% CI:81–94%, n = 288 lesions) for DH-PET. Conclusions Findings suggest similar sensitivity/specificity and lesion detection for NAC vs. AC FR-PET and significantly higher lesion detection for NAC vs. AC DH-PET.     

Low-Intensity Ultrasound Reduces High Glucose-Induced Nitric Oxide Generation in Retinal Pigment Epithelial Cells

Diabetic retinopathy (DR) is a severe micro-vascular complication of diabetes. High glucose (HG)-evoked nitric oxide (NO) production mediated by increased oxidative stress is a key factor in DR pathogenesis. In this study, we examined whether low-intensity ultrasound (LIUS) stimulation can reduce HG-induced NO generation. We determined that LIUS stimulation decreased the HG-induced NO generation possibly via inhibition of reactive oxygen species (ROS) and subsequently diminished the associated pro-inflammatory pathway involving the induced expression of inducible nitric oxide synthase, cyclooxygenase-2 and vascular endothelial growth factor. In addition, we determined that LIUS stimulation reduced the quantity of NO produced by N-acetylcysteine, which was not mediated by ROS. These results indicate that LIUS can inhibit both ROS-dependent and -independent NO generation processes in ARPE-19 cells. We envision LIUS as a potential therapeutic alternative to treat DR. Further studies are required to understand the underlying mechanism of the LIUS-induced reduction of NO generation for DR therapy.     

In vivo study assessed meropenem and amikacin combination therapy against carbapenem-resistant and carbapenemase-producing Enterobacteriaceae strains

BackgroundCarbapenem-resistant Enterobacteriaceae (CRE), especially for carbapenemase-producing Enterobacteriaceae (CPE), is an emerging cause that pose a significant threat to public health. However, efficient therapy has not been established. We assessed the antimicrobial efficacy of meropenem (MEPM) and amikacin (AMK) combination therapy.Material and methodsTotal eight isolates of Escherichia coli or Klebsiella pneumoniae, including CRE and/or CPE have carbapenemase genes were used. The relationship between phenotype and in vivo efficacy was assessed in neutropenic murine thigh infection model. Efficacy was determined using the change in bacterial density and survival rate.ResultsThe combination therapy showed enhanced antimicrobial activities against CRE+/CPE+ and CRE+/CPE-K. pneumoniae isolates than MEPM monotherapy (0.63 ± 0.04 vs. 2.56 ± 0.24 ⊿log₁₀ cfu/mL, p < 0.05; −1.05 ± 0.15 vs. −0.48 ± 0.30 ⊿log₁₀ cfu/mL, p < 0.05). Likewise, the combination therapy showed enhanced antimicrobial activities against CRE+/CPE+ and CRE+/CPE-E. coli isolates than MEPM monotherapy (0.90 ± 0.68 vs. 1.86 ± 0.23 ⊿log₁₀ cfu/mL, p < 0.05; −1.81 ± 0.06 vs. −0.88 ± 0.23 ⊿log₁₀ cfu/mL, p < 0.05). Also, combination therapy group showed similar to higher survival rates in CRE + E. coli infection mice, compared to MEPM monotherapy group.ConclusionOur results are the first supportive data to threat CRE infections with combination therapy of MEPM and AMK with in vivo model. The current results verify the promising utility of the combination therapy with MEPM and AMK against CRE isolates with a wide range of MEPM MICs.     

过表达APE1对糖尿病心肌病小鼠心肌损伤的保护作用及机制的研究

目的探讨APE1过表达在糖尿病心肌病小鼠中对心肌损伤的保护作用及机制。方法采用雄性APE1转基因PCR阳性小鼠与其同窝雄性阴性对照小鼠分别给予正常饮食和高糖高脂饮食8周后,按70mg·kg-1的标准腹腔注射链脲佐菌素(STZ)或相应剂量的柠檬酸钠缓冲液72h后,若空腹血糖(FBG)>11.1mmol·L-1视为造模成功。后随机分为4组:普通饲料喂养的阴性小鼠对照组(CON组)、普通饲料喂养的APE1转基因小鼠组(CON+APE1组)、高糖高脂饮食结合STZ的阴性小鼠对照组(DCM组)和高糖高脂饮食结合STZ的APE1转基因小鼠组(DCM+APE1组),每组各15只小鼠。再培养8周后,分别测定小鼠体重、血糖值;镜下观察心肌细胞及组织病理变化;酶联免疫吸附法(ELISA)检测心肌组织活性氧(ROS),丙二醛(MDA),超氧化物歧化酶(SOD)及炎性因子IL-6、IL-1β和肿瘤坏死因子-α(TNF-α)的含量。结果与DCM组相比,DCM+APE1组的糖尿病心肌病小鼠的体重有所增加,而FBG有所下降(P<0.05);抑制心肌细胞肥大、凋亡及心肌纤维化的程度;增强SOD活性,降低MDA和ROS含量(P<0.05);降低组织中炎性因子IL-1β,IL-6,TNF-a的含量(P<0.05)。结论 APE1对糖尿病心肌病小鼠的心肌细胞损伤具有保护作用,其机制可能与APE1的抗氧化应激和抗炎作用有关。