联合应用氨力农和多巴胺治疗感染性休克患者的临床体会

目的评价联合应用氨力农和多巴胺治疗感染性休克患者右心室功能不全的临床疗效.方法40例感染性休克患者,随机分为两组,A组18例患者给予多巴胺2～5μg@kg-1@min-1持续静脉滴注,B组22例患者行氨力农10μg@kg-1@min-1联合多巴胺2～5μg@kg-1@min-1持续静脉滴注,运用REF-1TM右心功能监测仪,观测治疗前及72h后患者右心室射血分数(RVEF)、肺血管阻力指数(PVRI)、中心静脉压(CVP)、右心室舒张末容积指数(RVED-VI)、心排指数(CI)、肺动脉嵌压(PAWP)和右心室作功指数(RCWI)的变化;运用Seldinger技术,结合HP监护仪,观测治疗前后收缩期动脉血压(SBP)的变化.结果与治疗前相比,B组患者RVEF和RCWI显著增加,PVRI和RVEDVI明显下降,CI下降,SBP升高,CVP和PAWP无显著性改变;A组患者除收缩压明显升高外,其余指标均无显著性变化.两组患者死亡率分别为33.33%(6/18)对13.64%(3/22),P＜0.05.结论联合应用氨力农和多巴胺可迅速纠正患者的休克状态,改善右心室功能不全,降低患者死亡率.     

高原地区体外循环应用超滤对儿童术后右心室功能的影响

目的　探讨高原地区体外循环 (CPB)中应用血液超滤技术对心内直视手术后右心室功能的保护作用。方法　选择在海拔 370 0m开展的CPB心脏手术患者 12例 ,根据CPB过程中有无应用血液超滤技术 ,将患者分成血液超滤组和对照组 ,分别于CPB前、CPB结束时以及CPB后 1h、3h、6h、12h、2 4h ,测定肺动脉平均压 (MPAP)、右心房压 (RAP)、右心室舒张末容积指数 (RVEDVI)、右心室射血分数 (RVEF)、心脏指数 (CI)、右心室每搏容量指数 (RVSI)和肺血管阻力指数 (PVRI)。结果　CPB结束和CPB后 6h内 ,对照组MPAP、RVEDVI以及RAP均较CPB前明显升高 (P <0 0 5 ) ,而RVEF、CI和RVSI较CPB前降低 (P <0 0 5 ) ;CPB后 12h对照组MPAP、RVEDVI以及RAP均逐渐减低 ,但RVEF、CI和RVSI仍未高于CPB前 ;血液超滤组RVEF、CI和RVSI在CPB后各时间点均显著高于对照组 (P <0 0 5 )。结论　高原地区在CPB下施行心内直视手术后早期 ,右心室心肌收缩力显著降低 ,右心室的泵血功能受损 ;CPB中应用血液超滤技术有利于CPB后心脏泵血功能的恢复。     

不同剂量多巴酚丁胺对短期冬眠心肌室壁运动的影响及其与血流动力学关系

目的:观察不同剂量多巴酚丁胺对短期冬眠心肌室壁运动及心肌氧耗量的影响。方法:选择10条犬为研究对象,通过缩窄冠状动脉左前降支建立短期冬眠心肌模型。在缺血90分种后分别以不同剂量的多巴酚丁胺(2.5、5、10、15μg·kg~(-1)·min~(-1))持续静脉输入,用二维超声和彩色室壁运动分析(CK)观察室壁运动的变化,同时经左心导管监测心肌耗氧量的变化。结果:9条犬成功建立短期冬眠心肌模型。多巴酚丁胺剂量达5μg·kg~(-1)·min~(-1)时,心肌耗氧量的增加,剂量增大到10～15μg·kg~(-1)·min~(-1)时,心肌耗氧量进一步增加。多巴酚丁胺剂量为2.5μg·kg~(-1)·min~(-1)、5μg·kg~(-1)·min~(-1)时,前壁增厚率逐渐恢复、CK色带增宽(P<0.01)。而当剂量增大到10μg·kg~(-1)·min~(-1)、15μg·kg~(-1)·min~(-1)时,可见原已恢复的室壁运动减弱(P<0.01)。收缩期CK色带宽度和室壁增厚率呈高度相关性(r=0.957,P<0.01)。结论:短期冬眠心肌对多巴酚丁胺负荷呈双向反应。剂量为2.5～5μg·kg~(-1)·min~(-1)时,室壁运动明显增强,而10～15μg·kg~(-1)·min~(-1)时,室壁运动恶化,结果可能与心肌耗氧量增加有关。收缩末期CK色带宽度与二维超声测量的室壁增厚率有很高的相关性,可准确反映收缩期室壁运动。     

不同径路应用PGE_1和PE治疗体外循环术后急性肺高压危象

目的:探讨经肺循环和体循环分别应用前列腺素E_1(PGE_1)和去氧肾上腺素(PE)治疗体外循环(CPB)术后肺高压危象的疗效。方法:11例CPB术后肺高压危象患者,经中心静脉右心房应用中等剂量PGE_1(63.7ng·kg~(-1)·min~(-1)±23ng·kg~(-1)·min~(-1))的同时,经左心房测压管应用小剂量PE(0.47ng·kg~(-1)·min~(-1)±0.09ng·kg~(-1)·min~(-1))对抗PGE_1对体循环血管的扩张作用。检测用药前后的不同时点的血流动力学参数。结果:不同径路应用PGE_1和PE 10min内,所有病例平均肺动脉压(mPAP)、肺血管阻力指数(PVRI)和中心静脉压显著降低(P<0.01);而平均动脉压(mAP)体循环血管阻力指数(SVRI)显著升高(P<0.01)。全部病例迅速恢复,无近期并发症。结论:不同径路应用PGE_1和PE是治疗的有效手段。     

多巴酚丁胺负荷超声心动图试验在心肌梗死冠脉重建术前后判定存活心肌的对比研究

目的:采用多巴酚丁胺负荷超声心动图(DSE)试验评价心肌梗死(MI)病人冠脉重建术(CRV)后心室运动功能恢复的临床意义。方法:选择30例急性心肌梗死病人,在冠脉重建术前、术后6个月,以不同剂量多巴酚丁胺(5、10、15、20、25、30μg·kg~(-1)·min~(-1))连续静注5min后,用二维超声心动图观察患者室壁运动异常(WMA)节段的变化。结果:在不同剂量多巴酚丁胺下,CRV前后患者的心率、收缩压均呈升高反应(P<0.05),WMA均有不同程度上的改变(P<0.05)。结论:DSE试验是识别MI区域存活心肌有价值的方法之一。多巴酚丁胺从5μg·kg~(-1)·min~(-1)开始有效,10～15μg·kg~(-1)·min~(-1)达高峰,≥20μg·kg~(-1)·min~(-1)则在术前对部分病人有诱发心肌缺血,使收缩功能恶化及频发室早出现。     

PGE_1对ARDS肺动脉高压症的疗效和肺气体交换的作用

最近输注前列腺素E_1(PGE_1)0.03mg·kg~(-1)·min~(-1) 7天,可改善ARDS 患者的存活,但此肺血管扩张作用很少证明对气体交换有作用,故作者对6例继发于ARDS 肺动脉高压症患者给PGE_I,测定血气、血液动力学和通气/灌注比((?)A/(?)),以评价其血管扩张作用。患者6例(男4,女2)年龄31～79岁,临床和放射学符合ARDS 诊断标准,全部患者平均肺动脉压>20mmHg,皆以呼气末正压(PEEP)通气.用自动血气分析器测量动脉和混合的静脉血气,多惰性气体排除法测定(?)A/(?)分布,5例患者用PGE_1 0.04μg·kg~(-1)·min~(-1)输注,1例用0.02μg·kg~(-1)·min~(-1).     

硝酸甘油介入小剂量多巴酚丁胺心电图试验识别冬眠心肌的临床研究

目的 观察小剂量多巴酚丁胺(Dobu)合用硝酸甘油心电图负荷试验识别冬眠心肌的准确性和安全性。方法 陈旧性心肌梗死患者30例,行小剂量Dobu(5～10μg·kg~(-1)·min~(-1))及其合用硝酸甘油心电图负荷试验。在试验前、低剂量期(5μg·kg~(-1)·min~(-1))和峰值剂量期(10μg·kg~(-1)·min~(-1))行超声心动图及心电图检查,计算心电图识别冬眠心肌的准确性。结果 30例中检出冬眠心肌19例。ST段偏移识别冬眠心肌的敏感性、特异性和准确性分别为47.4％、90.9％和63.3％,若与T波假正常化相结合则可达84.2％、81.8％和83.3％,且无诱发心绞痛。结论硝酸甘油介入小剂量Dobu心电图负荷试验是识别冬眠心肌简便、安全、特异、中度敏感的指标。     

艾司洛尔治疗新生儿阵发性室上性心动过速的疗效观察

目的:观察艾司洛尔治疗新生儿阵发性室上性心动过速的临床疗效。方法:选择12例阵发性室上性心动过速的新生儿,用艾司洛尔500μg.kg~(-1)·min~(-1)静脉推注1min,观察15～30min,无效再以50μg.kg~(-1)·min~(-1)～250μg·kg~(-1)·min~(-1)微泵维持。结果:11例患儿恢复窦性心律,1例无效。除2例患儿出汗较多外,未见其他不良反应。结论:艾司洛尔能快速有效地控制新生儿阵发性室上性心动过速,改善心肌供血供氧,不良反应小,值得临床推广应用。     

体外循环与非体外循环下冠脉搭桥术患者术中血液动力学的变化

目的探讨体外循环（CPB）与非CPB下冠脉搭桥术患者术中血液动力学指标的差异。方法择期行冠脉搭桥手术患者50例,其中CPB组18例,非CPB组32例,分别记录麻醉诱导后即刻（术前）和术毕心率（HR）、平均动脉压（MAP）、肺动脉平均压（PAMP）、肺毛细血管嵌压（PAWP）、中心静脉压（CVP）、心输出量（CO）、心脏指数（CI）、心搏指数（SVI）、体循环阻力指数（SVRI）、肺循环阻力指数（PVRI）、左室作功指数（LVSWI）。结果与术前比较,两组患者术后CO、CI升高（P〈0.05）;HR、MAP、PAMP、PAWP、CVP无明显变化;LVSWI提高,且两组间比较存在明显差异。非CPB组术后SVI升高,SVRI、PVRI降低（P〈0.05）。CPB组术后SVI、SVRI、PVRI等与术前比较均无明显差异;与CPB组比较,非CPB组术后SVRI、PVRI水平下降（P〈0.05）。结论行CPB与非CPB下冠脉搭桥术的患者术后心功能均得到明显改善,但与CPB组相比,非CPB组在改善心功能及降低体、肺循环阻力方面更具优势。     

PGE_1对ARDS患者释氧量和耗氧量的影响—PGE_1多中心研究结果

为了观察PGE_1连续输注对氧运输的远期效果,作者回顾性分析了美国13个医学中心的PGE_1双盲随机对照实验的临床资料。实验组受试者50例,均为创伤、手术或败血症所致的ARDS 患者.用PGE_12.5mg 溶于5ml 无水乙醇中,以0.9%生理盐水或5%葡萄糖水稀释至1000ml;安慰剂组亦50例,采用5ml 无水乙醇加以稀释,其稀释度相同.经中心静脉导管或肺动脉插管输入,初始浓度为5ng·kg~(-1)·min~(-1),每隔半小时增加5ng·kg~(-1)·min~(-1),最终浓度30ng·kg~(-1)·min~(-1),连续7天,欲结束输注时,需     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.