氨溴索在预防早产儿肺透明膜病中的作用

目的探讨氨溴索预防早产儿肺透明膜病的临床效果。方法本次共选择80例早产儿作研究对象,均为我院新生儿科2011年1月至2012年6月收治的早产儿,采用数字表抽取法随机分组,就常规治疗(对照组,n=40)与加用氨溴索治疗(观察组,n=40)效果进行比较。结果观察组统计示早产儿肺透明膜病1例,占2.5%,对照组经统计示为8例,占20%,差异有显著统计学意义(P<0.05)。观察组肺出血、肺部感染、呼吸衰竭、颅内出血、动脉导管未闭并发症发生率均低于对照组,其中呼吸衰竭具统计差异(P<0.05)。结论采用氨溴索防治早产儿肺透明膜病,可显著降低其发生率,且具较高安全性,并可减少其他并发症的发生,具有非常积极的临床应用价值。     

固尔苏联合机械通气治疗早产儿肺透明膜病22例疗效观察

2000年2月～2004年2月,我院采用肺表面活性物质（PS）加机械通气治疗早产儿肺透明膜病（HMD）22例,疗效较好。现报告如下。     

固尔苏治疗新生儿肺透明膜病

目的探讨不同剂量固尔苏治疗新生儿肺透明膜病临床疗效。方法研究组患儿在进行常规治疗基础上加用剂量为每千克200mg固尔苏联合治疗;对照组患儿在进行常规治疗基础上加用剂量为每千克100mg固尔苏联合治疗,观察并记录两组患儿治疗效果,进行统计学分析,得出结论。结果研究组与对照组患儿治疗前体内PaO2、PaCO2．pH对比结果无统计学意义,两组患儿体内pH经治疗后有所上升,但上升幅度较治疗前以及两组比较结果并不明显（P〉0．05）,两组患儿经治疗后体内PaO2显著上升,而PaCO2则显著下降,且研究组患儿变化效果更为明显（P〈0．05）,研究组患儿NCPAP持续时间、吸氧持续时间、再次使用固尔苏患儿所占比例均显著低于对照组;研究组患儿经治疗后,需再次进行固尔苏给药治疗患儿所占比例为28．57％,显著低于对照组66．67％,且P〈0．05,两组患儿对比结果具有统计学意义。结论使用大剂量固尔苏对新生儿肺透明膜病患儿进行治疗,较小剂量治疗患儿更能有效改善其体内血气情况,减少辅助通气及吸氧时间,快速控制病情,达到更为有效的治疗目的,值得临床推广应用。     

固尔苏联合辅助通气治疗新生儿肺透明膜病疗效观察

目的探讨固尔苏联合辅助通气治疗新生儿肺透明膜病的临床疗效。方法对我院新生儿科确诊为新生儿肺透明膜病的71例患儿随机分为观察组(37例)和对照组(34例),对照组采用常规治疗加辅助通气,观察组在对照组的治疗基础上联合气管内滴入肺表面活性物质(固尔苏)治疗,观察患儿治疗前后的临床表现、血气、X线胸片及存活率。结果固尔苏治疗组患儿使用固尔苏后30 min和12 h,PaO2显著升高,PaCO2明显下降,与对照组比较有差异,具有统计学意义(P0.05)。观察组痊愈出院为67.6%,放弃治疗为10.8%,死亡21.6%;对照组痊愈出院44.1%,放弃治疗14.7%,死亡41.2%。结论固尔苏联合辅助通气治疗新生儿肺透明膜病能明显减轻患儿临床症状,改善患儿氧合功能,提高新生儿、特别是早产儿存活率,减少病死率。     

早产儿预防使用肺表面活性物质的疗效观察

目的观察预防使用肺表面活性物质对预防早产儿肺透明膜病(HMD)发生的效果。方法将胎龄≤34周,体质量≤2000g的同条件早产儿58例分为预防组30例和对照组28例。预防组在出生后4h内经气管内滴入肺表面活性物质,对照组不使用。结果预防组并发HMD、肺炎、需要机械通气、死亡及放弃治疗的发生率均少于对照组,差异有统计学意义(P0.05)。结论早产儿预防性应用肺表面活性物质可降低严重并发症的发病率,减轻病情,改善早产儿预后。     

肺表面活性物质联合新型鼻塞持续气道正压呼吸治疗新生儿肺透明膜病疗效分析

目的探讨肺表面活性物质Curosurf联合新型鼻塞持续气道正压呼吸(NCPAP)治疗新生儿肺透明膜病(HMD)的临床效果。方法将87例HMD患儿随机分为两组,观察组43例患儿经气管内注入Curosurf100mg·kg-1·次-1,然后拔管予NCPAP治疗;对照组44例患儿不用Curosurf治疗,比较两组患儿的临床治疗效果、并发症、住院时间、住院费用等。结果治疗后1h、12h、24h两组患儿的血气结果较治疗前显著改善,差异有统计学意义(P<0.05);两组治疗后比较差异亦有统计学意义(P<0.05)。观察组患儿的高压力、高FiO2及用NCPAP等各项所需时间较对照组明显缩短,差异均有统计学意义(P<0.05)。观察组治愈率为88.4%,对照组为63.6%,两组比较差异有统计学意义(P<0.05)。观察组肺炎的发生率明显低于对照组,差异有统计学意义(P<0.05)。观察组住院费用(18875±639)元,对照组总住院费用(18060±607)元,差异无统计学意义(P>0.05)。观察组住院(16±10)d,对照组(20±11)d,差异有统计学意义(P<0.05)。结论Curosurf联合NCPAP治疗HMD疗效确切,能快速有效地改善HMD的肺换气和通气功能,缩短住院天数及减少机械通气率和肺炎并发症的发生,住院费用没有增加。     

固尔苏辅助治疗早产儿肺透明膜病184例护理体会

肺表面活性物质缺乏是新生儿（尤其是早产儿）死于肺透明膜病（NRDS）的主要原因。固尔苏为猪肺表面活性物质提取物，可降低肺泡表面张力、维持肺泡在低肺容量下的稳定性并具有抗萎陷或润滑作用，从而保持肺泡张力。2000年1月～2007年5月，我们应用固尔苏辅助治疗早产儿NRDS184例，效果满意。现将护理体会报告如下。     

新生儿肺透明膜病30例临床及X线诊断分析

目的探讨新生儿肺透明膜病（HMD）的X线表现特征和病理,以提高对新生儿肺透明膜病的X线影像学诊断的认识。方法选取我院收治的X线表现典型的30例HMD患儿进行分析,30例均具有完整胸片资料并经临床确诊。结果本组30例患儿中表现为肺纹理增强1例,细小颗粒状影及网点状影14例,粗颗粒状影6例,磨玻璃样改变5例,呈“白肺”改变4例,其中可见支气管充气征22例。结论本病的主要X线征象为网状、颗粒状影、两肺野透亮度降低和支气管充气征。X线检查对本病的诊断、预后及发现并发症具有重要的价值。     

不同用药时间应用固尔苏治疗新生儿肺透明膜病疗效观察

新生儿肺透明膜病(HMD)是围产期常见的危重急症,也是围产期致死的主要原因之一。临床上关于肺表面活性物质治疗新生儿HMD最佳应用时间的研究不多。我院2002年1月至2003年12月应用肺表面活性物质制剂固尔苏治疗早产儿HMD24例,按用药时间分3组进行观察。现报告如下。     

经鼻持续正压通气治疗新生儿肺透明膜病的临床效果观察

目的观察经鼻持续正压通气(NCPAP)治疗新生儿肺透明膜病(HMD)的临床疗效。方法将76例HMD患儿随机分为两组,研究组39例给予NCPAP治疗,对照组37例给予常规机械通气治疗,比较两组治疗前后血氧分压(Pa O2)、二氧化碳分压(Pa CO2)的变化情况及呼吸机相关性肺炎、鼻黏膜损伤、氧疗时间、住院天数、治疗费用、治疗总有效率等。结果与治疗前相比较,两组患儿经治疗后Pa O2、Pa CO2均获得了显著改善(P0.05)。两组治疗后各个时点的Pa O2、Pa CO2比较差异无统计学意义(P0.05)。研究组呼吸机相关性肺炎、鼻黏膜损伤发生率和氧疗时间、住院天数、治疗费用明显低于或短于对照组(P0.05)。研究组显效16例,有效21例,无效2例;对照组显效14例,有效20例,无效3例,两组比较差异无统计学意义(P0.05)。结论 NCPAP与常规机械通气均能有效改善HMD患儿血气指标,但NCPAP能降低不良反应发生率,缩短氧疗时间和住院时间,减少治疗费用,是HMD较为安全、有效的治疗手段。     

Diaphragmatic Thickness and Excursion in Preterm Infants With Bronchopulmonary Dysplasia Compared With Term or Near Term Infants: A Prospective Observational Study

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Outcome of Preterm Infants With Postnatal Cytomegalovirus Infection via Breast Milk: A Two-Year Prospective Follow-Up Study

Approximately 15% of preterm infants may develop postnatal cytomegalovirus (CMV) infection from seropositive mothers via breast milk and are at risk for neurological sequelae in childhood. The aims of this study were to assess the effects and outcomes on growth, neurodevelopmental status, and hearing in very low birth weight (VLBW) premature infants with postnatal CMV infection via breast milk at the corrected age of 12 and 24 months.The prospective follow-up study population comprised all living preterm children (n = 55) with a birth weight ≤1500 g and gestational age of ≤35 weeks, who had been participated in our “postnatal CMV infection via breast milk” studies in 2000 and 2009, respectively. The cohort of children was assessed at 12 and 24 months. Clinical outcomes were documented during hospitalization and after discharge. Long-term outcomes included anthropometry, audiologic tests, gross motor quotient, Infant International Battery, and neurodevelopmental outcomes; all were assessed at postcorrected age in 12 and 24 months during follow-up visits.Of the 55 infants enrolled in the study (4 noninfected infants were excluded because their parents did not join this follow-up program later), 14 infants postnatally acquired CMV infection through breast-feeding (infected group) and were compared with 41 infants without CMV infection (control group). No significant differences were observed between the groups with regard to baseline characteristics, clinical outcomes, anthropometry, or psychomotor and mental development on the Bayley scale of infant development. None of the infants had CMV-related death or permanent sensorineural hearing loss.Transmission of CMV from seropositive mother via breast milk to preterm infants does not appear at this time to have major adverse effects on clinical outcomes, growth, neurodevelopmental status, and hearing function at 12 and 24 months corrected age.     

进一步加强对慢性肾脏病患者心血管疾病的防治

慢性肾脏疾病（chronic kidney disease,CKD）和心血管疾病（cardiovascular disease,CVD）,均为威胁人类健康的重大疾病,现已成为全球性的公共卫生问题。2007年初,国际肾脏病学会的公告指出,目前世界上有超过5亿的人口罹患不同形式的肾脏疾病;粗略估计,我国的慢性肾脏疾病累及人口有1亿左右,发生尿毒症者约100万,更为严重的是尿毒症患者以每年8％～11％的速度在递增。     

Determinants and Prevention of Coronary Disease in Patients With Chronic Kidney Disease

Chronic kidney disease (CKD) is associated with premature cardiovascular morbidity and mortality. Traditional Framingham risk factors contribute partially to the malignant form of cardiovascular disease in CKD. Uremic-specific risk factors including chronic inflammation, retention of uremic toxins, and abnormal bone mineral metabolism have independently been linked to the pathogenesis of premature vascular aging, atherosclerosis, and cardiovascular disease. In this review we explore the mechanisms by which premature aging occurs in CKD through its pathologic effects on cardiovascular health, and the determinants of cardiac disease in patients with CKD. We outline strategies for prevention and therapeutic interventions in this vulnerable population.     

Long-Term Nitroglycerin Treatment Is Associated With Supersensitivity to Vasoconstrictors in Men With Stable Coronary Artery Disease: Prevention by Concomitant Treatment With Captopril

Objectives. We examined whether long-term nitroglycerin (NTG) treatment leads to an increase in sensitivity to vasoconstrictors. To assess a potential role of the renin-angiotensin system in mediating this phenomenon, we treated patients concomitantly with the angiotensin-converting enzyme (ACE) inhibitor captopril.Background. The anti-ischemic efficacy of organic nitrates is rapidly blunted by the development of nitrate tolerance. The underlying mechanisms are most likely multifactorial and may involve increased vasoconstrictor responsiveness.Methods. Forearm blood flow and vascular resistance were determined by using strain gauge plethysmography. The short-term responses to intraarterial angiotensin II (1, 3, 9 and 27 ng/min) and phenylephrine (an alpha-adrenergic agonist drug, 0.03, 0.1, 0.3 and 1 μg/min) were studied in 40 male patients with stable coronary artery disease. These patients were randomized into four groups receiving 48 h of treatment with NTG (0.5 μg/kg body weight per min) or placebo with or without the ACE inhibitor captopril (25 mg three times daily).Results. In patients treated with NTG alone, the maximal reductions in forearm blood flow in response to angiotensin II and phenylephrine were markedly greater (−64 ± 3% and −53 ± 4%, respectively) than those in patients receiving placebo (−41 ± 2% and −42 ± 2%, respectively). Captopril treatment completely prevented the NTG-induced hypersensitivity to angiotensin II and phenylephrine (−33 ± 3% and −35 ± 3%, respectively) but had no significant effect on blood flow responses in patients without NTG treatment (−34 ± 2% and −37 ± 3%, respectively).Conclusions. We conclude that continuous administration of NTG is associated with an increased sensitivity to phenylephrine and angiotensin II that is prevented by concomitant treatment with captopril. The prevention of NTG-induced hypersensitivity to vasoconstrictors by ACE inhibition indicates an involvement of the renin-angiotensin system in mediating this phenomenon.     

冠状动脉临界病变的评价与治疗

摘要：冠脉造影是诊断冠心病的“金标准”，对冠脉的储备功能、发作的缺血程度、心肌缺血的阈值均无法评价。对冠状动脉临界病变，冠状动脉造影有明显的局限性，应该进一步进行IVUS、OCT或FFR等检查，再给予相应的药物治疗、DES或者CABG治疗，同时进行必要的临床随访，必要时进行造影随访，建立完善的冠状动脉评价与治疗体系。     

Approach to Cardiovascular Disease Prevention in Patients With Chronic Kidney Disease

OPINION STATEMENT: Chronic kidney disease (CKD) is associated with a large burden of cardiovascular risk factors ultimately leading to increased cardiovascular events and mortality. Prevention of cardiovascular disease (CVD) in CKD involves early identification of individuals at high-risk of renal disease. In fact, substantial evidence points to a complex bidirectional relationship between CKD and CVD. Therefore, most interventions directed at CKD prevention should include multiple risk factor interventions with the goal of preventing CVD events while slowing progression of CKD. Clearly, prevention of CVD in CKD is a complex task and requires a multidisciplinary team approach, with a well-defined program, rational targets for each risk factor, and implementation of the most effective intervention strategies. Although several interventions to prevent CVD have proven effective in the general population and in individuals at high risk for CVD, a true benefit in patients with CKD remains to be demonstrated for several of them. A few rational targets of intervention should be optimal blood pressure control, reduction of proteinuria, treatment of dyslipidemia, good control of diabetes, smoking cessation, dietary salt restriction, achievement of normal body mass index, partial correction of anemia, and management of mineral metabolism abnormalities. Lifestyle modification and pharmacological therapy with renin-angiotensin blockers, β-blockers, diuretics, statins, and aspirin should be encouraged in the early stages of CKD.     

Early Mobilization in People With Acute Cardiovascular Disease

BackgroundEarly mobilization (EM) is recommended in critical care units. However, there is little known about EM in people with acute cardiovascular disease.MethodsConsecutive admissions to a tertiary-care cardiovascular intensive care unit (CICU) before and after implementation of an EM program were reviewed. The Level of Function (LOF) Mobility Scale, which ranges from 0 (bed immobile) to 5 (able to walk >20 m), was used to measure and guide mobility. The primary outcome was discharge home.ResultsThere were 1489 patients included in the analysis (preintervention, N = 637; intervention, N = 852). There were no differences in age, sex, or admission for ischemic heart disease (age 68.1 ± 16.1 years; 39.3% female). In the intervention cohort, one-quarter (N = 222; 26.1%) had at least mildly impaired prehospital functional status. The LOF was 4.6 ± 0.7 prehospital, 3.2 ± 1.4 on admission, and 4.2 ± 0.9 on CICU discharge. Half of patients (51.6%) increased their LOF by ≥1 during CICU admission. Nearly all mobility opportunities had a mobility activity (97.0%). The adverse event rate was 0.3% with no life-threatening events, falls, line dislodgements, or health care personnel injuries. The intervention group, compared with the preintervention group, was more likely to be discharged home (83.9% vs 78.3%, P < 0.007) and had a lower rate of in-hospital death (4.2% vs 6.8%; P = 0.04). When adjusted for age, sex, and comorbid illness, admission LOF was a predictor of discharge to health care facility (odds ratio = 0.72; P < 0.001).ConclusionsEM is safe and feasible in the CICU and effective at increasing discharge home.