大剂量丙种球蛋白联合强的松治疗儿童扩张型心肌病的护理

扩张型心肌病传统治疗效果欠佳，病死率高，预后差，是致死性心力衰竭的常见原因。对32例扩张型心肌病初发患儿，在传统治疗方法的基础上采用大剂量丙种球蛋白联合强的松治疗，取得明显疗效。而在护理上，应落实各项护理措施、加强心理护理、观察病情变化，加强消毒隔离预防感染，认真执行药物治疗过程中的操作规程，密切观察药物疗效及副作用，及时发现问题并予相应处理。     

大剂量丙种球蛋白联合强的松治疗儿童扩张型心肌病的护理

扩张型心肌病传统治疗效果欠佳,病死率高,预后差,是致死性心力衰竭的常见原因.对32例扩张型心肌病初发患儿,在传统治疗方法的基础上采用大剂量丙种球蛋白联合强的松治疗,取得明显疗效.而在护理上,应落实各项护理措施、加强心理护理、观察病情变化,加强消毒隔离预防感染,认真执行药物治疗过程中的操作规程,密切观察药物疗效及副作用,及时发现问题并予相应处理.     

大剂量丙种球蛋白联合强的松治疗儿童扩张型心肌病的护理

扩张型心肌病传统治疗效果欠佳,病死率高,预后差,是致死性心力衰竭的常见原因。对32例扩张型心肌病初发患儿,在传统治疗方法的基础上采用大剂量丙种球蛋白联合强的松治疗,取得明显疗效。而在护理上,应落实各项护理措施,加强心理护理、观察病情变化,加强消毒隔离预防感染,认真执行药物治疗过程中的操作规程,密切观察药物疗效及副作用,及时发现问题并予相应处理。     

卡维地洛与美托洛尔治疗儿童扩张型心肌病临床对比研究

目的:探讨卡维地洛与美托洛尔治疗儿童扩张型心肌病临床对比研究.方法:选取我院2013年1月到2015年1月收治的扩张型心肌病患儿共80例,分为观察组和对照组各40人,分别采用卡维地洛、美托洛尔治疗,通过观察两组患者治疗前后的左心室舒张末端的内径,以及左心室的射血分数、心胸率比、N端、B端的脑钠肽变化的情况.结果:研究发现:治疗后观察组患者的左心室舒张末端的内径、N端、B端的脑钠肽改善效果明显的好于对照组,左心室的射血分数以及心胸率比的改善程度没有统计学意义.结论:卡维地洛相对于美托洛尔治疗儿童扩张型心肌病效果更明显,尤其是在治疗左心室舒张末端的内径、、N端、B端的脑钠肽变化方面,效果更佳的明显,值得在以后的应用中推广.     

原发性扩张型心肌病56例分析

目的:探讨原发性扩张型心肌病的临床治疗方法.方法:选取56例原发性扩张型心肌病患者,应用常规抗心衰药物与小剂量美托洛尔进行治疗.结果:总有效率89.2%,治疗后心率明显减慢,心脏射血分数明显提高.结论:在常规用药的基础上,联合β受体阻滞剂治疗原发性扩张型心肌病具有良好疗效.     

扩张型心肌病心力衰竭猝死的预防对策

目的探索预防扩张型心肌病(DCM)、充血性心力衰竭(CHF)猝死的对策.方法将DCMCHF108例按改进治疗措施前后分组进行对比分析,甲组为改进治疗措施后的67例,乙组为改进前的41例.结果甲组猝死率明显降低.结论DCMCHF猝死的预防措施是综合性的,关键在于对逆转心肌功能、改善心肌缺血,纠治合并症等是否及时、得力和连续.     

美托洛尔联合曲美他嗪治疗儿童扩张型心肌病合并心力衰竭的临床疗效观察

目的:了解美托洛尔联合曲美他嗪治疗儿童扩张型心肌病(DCM)合并心力衰竭的临床疗效,为该病提供有效的治疗措施。方法:107例DCM心力衰竭患儿被随机分为治疗组(57例)和对照组(50例)。两组患儿均采用相同的常规治疗方法;对照组给予美托洛尔,治疗组给予美托洛尔联合曲美他嗪。观察两组患儿的心率、血压、左室射血分数(LVEF)、左室舒张末期内径(LVIDd)、左室收缩末期内径(LVIDs),评价治疗效果,观察治疗过程中的药物不良反应。结果:治疗后对照组的收缩压、舒张压、心率、LVIDs比治疗前显著降低,LVEF显著升高(P均<0.05);治疗后治疗组的收缩压、舒张压、心率、LVIDd、LVIDs比治疗前显著降低,LVEF显著升高(P均<0.05);治疗后治疗组的收缩压、舒张压、心率、LVIDd、LVIDs、LVEF和对照组比较,差异有统计学意义(P均<0.05)。治疗组治疗后的显效率为63.2%,总有效率为89.5%,均显著高于对照组(χ2=15.377、6.029,P均<0.05)。对照组的药物不良反应发生率为8.8%(5/57),治疗组的药物不良反应发生率10.0%(5/50),差异无统计学意义(χ2=0.312,P>0.05)。结论:美托洛尔联合曲美他嗪可有效治疗儿童DCM合并心力衰竭,且不良反应较少,具有较高的临床推广价值。     

不同剂量美托洛尔治疗扩张型心肌病临床观察

目的探讨不同剂量美托洛尔对扩张型心肌病（DCM）心力衰竭（心衰）患者心室重构和心功能的影响。方法26例DCM心衰患者在常规药物治疗基础上,加用美托洛尔治疗,按美托洛尔每日用量分为A组（美托洛尔≤75mg/d）,B组（美托洛尔≥100mg/d）,比较2组患者在用药前和用药后1年的心功能NYHA分级、心胸比率、心脏彩色超声心动图各项测量指标变化。结果用药1年后2组患者心功能NYHA分级、心胸比率、心室形态各项指标均有改善,且B组改善更明显,差异有统计学意义（P〈0.05）。结论提示美托洛尔治疗DCM心衰时,尽可能达到最大剂量或最大耐受量。     

大剂量强的松治疗Graves眼病31例病例分析

目的:探讨强的松治疗Graves眼病的临床疗效.方法:31例Graves眼病患者随机分为对照组及强的松组,对照组仅控制甲功及眼球局部用药,强的松组在对照组基础上加用大剂量强的松冲击,30-40mg/天,逐渐减量至5mg/天,总疗程3个月.结果:治疗3个月后,强的松组的总有效率为81.25%,对照组的总有效率仅为46.67%;治疗前后,强的松组的眼球突出度明显缩小(P＜0.05),对照组的眼球突出度无明显缩小(P＞0.05).结论:大剂量强的松冲击治疗Graves眼病疗效明确,方法简单,适于在基层医院推广.     

大剂量维生素C联合磷酸肌酸钠治疗小儿病毒性心肌炎疗效分析

目的 综合分析大剂量维生素C联合磷酸肌酸钠治疗小儿病毒性心肌炎的疗效及对血肌钙蛋白T的影响.方法 选取2015年12月至2016年12月在东营市第二人民医院住院治疗的112例病毒性心肌炎患儿,按照入院顺序随机分为实验组(56例,应用大剂量维生素C联合磷酸肌酸钠治疗)和对照组(56例,应用常规治疗方法).分析实验组和对照组患者的临床治疗总有效率、治疗前后心肌酶(肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶)以及血肌钙蛋白T等指标的变化情况.结果 ①实验组总有效率为96.42%,高于对照组总有效率的78.57%,两组总有效率差异有统计学意义(χ2=19.999,P<0.05);②治疗前两组患者的肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶水平比较差异均无统计学意义(均P>0.05),治疗后实验组患者的肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶水平均显著低于对照组(t值分别为14.154、18.788、16.162,均P<0.05);③治疗前两组患者的血肌钙蛋白T水平比较差异无统计学意义(t=2.226,P>0.05);治疗后实验组患者的血肌钙蛋白T水平显著低于对照组(t=8.858,P<0.05).结论 大剂量维生素C联合磷酸肌酸钠治疗小儿病毒性心肌炎的疗效显著,有效地改善了血肌钙蛋白T水平.     

维生素C联合免疫球蛋白治疗儿童病毒性心肌炎的效果

目的探讨维生素C(Vitc)联合免疫球蛋白治疗病毒性心肌炎患儿的临床效果及心肌重塑情况。方法选取2018年1月-2019年12月海南医学院第一附属医院心内科收治的80例病毒性心肌炎患儿,按随机数字表法将其分为研究组(n=40)和对照组(n=40)。对照组给予常规治疗,研究组在此基础上采用Vitc联合免疫球蛋白进行治疗,两组均治疗2周。比较两组患儿临床疗效,血清炎症因子[白细胞介素-18(IL-18)、巨噬细胞炎症蛋白-1α(MIP-1α)、细胞间黏附分子-1(ICAM-1)],心肌酶指标[肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、羟丁酸脱氢酶(HBDH)]及心脏功能指标[心脏指数(CI)、左心室短轴缩短率(LVFS)、左心室射血分数(LVEF)]变化。结果治疗2周后,研究组治疗总有效率为92.50%(37/40),高于对照组的75.00%(30/40),两组比较差异有统计学意义(χ²=4.501,P=0.034);治疗后,两组血清IL-18、MIP-1α、ICAM-1水平较治疗前均降低(P<0.05),且研究组指标水平均低于对照组(P<0.05);治疗后,两组血清CK、CK-MB、LDH、HBDH水平较治疗前均降低(P<0.05),且研究组指标水平均低于对照组(P<0.05);治疗后,两组心脏功能指标CI、LVFS、LVEF水平较治疗前均升高,且研究组指标水平均高于对照组(P<0.05)。结论 Vitc联合免疫球蛋白治疗病毒性心肌炎,可显著降低患儿血清IL-18、MIP-1α、ICAM-1水平,减轻炎症,并能增强患儿心功能,改善心肌重塑,进而有助于提高疗效。     

环孢素A联合治疗重型再生障碍性贫血的临床研究

目的探讨环孢素A（CsA）联合大剂量免疫球蛋白和雄激素治疗重型再生障碍性贫血（SAA）的临床疗效和不良反应。方法28例重型再生障碍性贫血患者随机分为观察组和对照组,对照组用大剂量免疫球蛋白（HD—IVIG）和雄激素治疗,观察组在对照组治疗的基础上加用CsA3～5ms／（kg·d）,分两次口服,疗程不少于6～12个月。结果两组患者经治疗后观察组总有效率为75％,对照组总有效率为50％,两组比较,差异有统计学意义（P〈0．05）。结论CsA联合HD—IVIG和雄激素治疗重型再生障碍性贫血是有效的治疗方案,其不但安全可靠,且不良反应少,值得临床推广应用。     

Using the group method to study and treat parents of asthmatic children.

This paper describes the use of the group method to study and treat parents of hospitalized asthmatic children. The needs of parents as revealed by the group process are discussed, and the implications for treatment of both child and family are reviewed.     

Uterine artery embolization to treat hemorrhage following second-trimester abortion by dilatation and surgical evacuation

Background

This study was conducted to review cases of second-trimester postabortal hemorrhage (PAH) occurring at a private women's health facility that were treated with uterine artery embolization (UAE).

Methods

A retrospective review was conducted on all second-trimester terminations performed at a private women's health facility between 1999 and 2006. Cases of PAH treated with UAE were reviewed in detail, reviewing progress, operative and discharge notes along with anesthesia records.

Results

Fifteen cases of PAH were identified among 3936 second-trimester terminations that were performed. Seven cases were identified in which UAE was used to treat PAH. Etiologies leading to hemorrhage varied in the seven cases as did the presence of coexisting factors such as infection and anatomic lesions. All cases were successfully treated by UAE, requiring no additional surgical intervention.

Conclusion

Given the success of embolization, we offer this as an alternative to exploratory surgery and hysterectomy and as a first-line approach in cases of PAH after conservative management strategies have failed.     

高L-蛋氨酸饮食对血管内皮细胞损伤的研究

目的:研究高L-蛋氨酸饮食对血管内皮细胞的损伤.方法:将SD大鼠16只,随机分为两组,高蛋氨酸组(M组)和对照组(C组),每组各8只.每天给予M组大鼠3%的蛋氨酸饮食,在第16周处死,取血检测内皮素、一氧化氮,取主动脉行病理学检查.结果:M组大鼠血清内皮素含量显著高于C组,一氧化氮明显低于C组.主动脉病理检查可见有明显内膜萎缩,内膜表面有脂肪颗粒沉着,中膜增厚,弹性纤维增生、紊乱,外膜弹性纤维增生,部分移入中膜.结论:高蛋氨酸饮食对大鼠血管内皮细胞有明显的损伤作用.     

宫腔镜下子宫内膜电切联合刮宫术治疗多发性子宫内膜息肉的效果观察

目的观察宫腔镜下子宫内膜电切术联合刮宫术(dilatation and curettage,D&C)治疗多发性子宫内膜息肉(endometrial polyp,EMP)的效果。方法回顾性分析清远市人民医院2008～2010年间98例异常子宫出血(abnormal uterine bleeding,AUB)经B超联合宫腔镜检查诊断为多发性子宫内膜息肉患者的临床治疗资料,其中50例采用宫腔镜下子宫内膜息肉电切联合刮宫术(A组);48例单纯行宫腔镜下子宫内膜息肉电切术(B组)。结果手术时间A组平均(20.05±0.42)min,B组平均(18.20±0.35)min,出血量A组平均(32.05±0.61)ml,B组平均(30.10±0.52)ml,1年内息肉复发率A组为2.0%(1/50),B组为4.17%(2/48),以上各项两组比较,差异均无统计学意义(P>0.05);1年内异常子宫出血复发率A组为2.0%(1/50);B组为10.42%(5/48);两组比较差异有统计学意义(P<0.05)。结论宫腔镜下多发性子宫内膜息肉电切术联合刮宫术安全有效,更能降低术后异常子宫出血复发率。     

The dose of behavioral interventions to prevent and treat childhood obesity: a systematic review and meta-regression

Background

A better understanding of the optimal “dose” of behavioral interventions to affect change in weight-related outcomes is a critical topic for childhood obesity intervention research. The objective of this review was to quantify the relationship between dose and outcome in behavioral trials targeting childhood obesity to guide future intervention development.

Methods

A systematic review and meta-regression included randomized controlled trials published between 1990 and June 2017 that tested a behavioral intervention for obesity among children 2–18 years old. Searches were conducted among PubMed (Web-based), Cumulative Index to Nursing and Allied Health Literature (EBSCO platform), PsycINFO (Ovid platform) and EMBASE (Ovid Platform). Two coders independently reviewed and abstracted each included study. Dose was extracted as intended intervention duration, number of sessions, and length of sessions. Standardized effect sizes were calculated from change in weight-related outcome (e.g., BMI-Z score).

Results

Of the 258 studies identified, 133 had sufficient data to be included in the meta-regression. Average intended total contact (# sessions x length of sessions) was 27.7 (SD 32.2) hours and average duration was 26.0 (SD 23.4) weeks. When controlling for study covariates, a random-effects meta-regression revealed no significant association between contact hours, intended duration or their interaction and effect size.

Conclusions

This systematic review identified wide variation in the dose of behavioral interventions to prevent and treat pediatric obesity, but was unable to detect a clear relationship between dose and weight-related outcomes. There is insufficient evidence to provide quantitative guidance for future intervention development. One limitation of this review was the ability to uniformly quantify dose due to a wide range of reporting strategies. Future trials should report dose intended, delivered, and received to facilitate quantitative evaluation of optimal dose.

Trial registrations

The protocol was registered on PROSPERO (Registration #CRD42016036124).

     

Alternatives to bodyweight for estimating the dose of praziquantel needed to treat schistosomiasis

Data on age, height and mid upper-arm circumference (MUAC) from nearly 6000 schoolchildren in Ghana, Tanzania and Malawi (not MUAC) were used to examine their power to predict bodyweight and thus the dosage of praziquantel required to treat schistosomiasis. Height was found to provide a simple and reasonably accurate estimate of weight, and about 75% of children would have been given a dosage of praziquantel within the range normally given using bodyweight at a dosage of 40 mg/kg bodyweight. The upper and lower ranges in dosage did not exceed dosages of praziquantel which have been used before or are currently recommended to treat schistosomiasis. A pole marked with the number of tablets could thus be used as a simple way to determine the dose of praziquantel to treat children in school-based health programmes.