吸入一氧化氮对急性肺损伤动物氧合的影响

目的　 利用不同动物模型比较吸入NO对动物急性肺损伤氧合的影响。 方法 　应用健康雄性Wistar大鼠和新西兰兔各 14只 ,经右心导管注入油酸制成急性肺损伤模型。 结果 　油酸注入大鼠右心后 ,对照组、NO组氧分压由 ( 3 2 2 3± 3 0 2 )mmHg和 ( 3 2 2 3± 2 2 9)mmHg( 1mmHg =0 13 3kPa)降为 ( 10 1 6± 12 9)mmHg和 ( 110 9± 6 1)mmHg ,吸入 40ppmNO 1h后氧分压未有上升趋势。兔急性肺损伤时 ,对照组和NO组氧分压分别由 ( 14 7 2± 11 8)mmHg和 ( 14 3 4± 7 3 )mmHg降为 ( 84 6± 4 8)mmHg和 ( 85 1± 8 6)mmHg ,吸入 2 0 ppm、40 ppmNO上升为 ( 115 1± 10 7)mmHg和 ( 117 7± 11 9)mmHg。 结论 　轻度肺损伤时吸入NO可使氧合得到适当改善 ,提高血氧分压。     

高频振荡通气结合一氧化氮吸入治疗大鼠急性肺损伤的实验研究

目的　观察高频振荡通气 (HFO)联合一氧化氮 (NO)吸入疗法对急性肺损伤 (ALI)大鼠气体交换、血流动力学参数及血中高铁血红蛋白 (MetHb)含量的影响 ,并与常规机械通气 (CMV)、CMV +NO、HFO等通气方式作比较。同时观察此疗法是否可取得较为稳定的NO输送浓度。　方法选择健康雄性Wistar大鼠 32只 ,应用油酸制作ALI模型 ,稳定 30min后 ,随机分为四组 :CMV组、CMV+NO组、HFO组、HFO +NO组。所有大鼠在基础状态、治疗 0 5h、治疗 1h记录气体交换、血流动力学参数。每组各有 4只在NO吸入前后测量血中MetHb含量。实验中用化学发光法持续监测NO的输送浓度。结果　各组大鼠基础状态时各指标差异无显著性 (P >0 0 5 )。治疗 1h后 ,HFO +NO组氧分压 [(2 13± 7)mmHg]较CMV、CMV +NO、HFO组 [分别为 (10 8± 5 )mmHg、(140± 9)mmHg、(15 8± 8)mmHg]明显提高 ,分流比例 [(4 0 4± 0 15 ) %]明显降低 [(14 0 6± 0 5 9) %、(9 4 8± 0 35 ) %、(7 0 3±0 36 ) %](P均 <0 0 5 )。与各自对照组的平均肺动脉压 [(2 2 3± 2 8)mmHg、(2 2 4± 2 9)mmHg]相比 ,HFO +NO组 [(16 8± 2 9)mmHg]及CMV +NO组 [(16 9± 2 7)mmHg]均有明显降低 (P <0 0 5 ) ,但两组间的平均肺动脉压各时点差异无显著性 (P >0 0     

一氧化氮吸入治疗新生儿肺动脉高压疗效的初步评价

利用彩色多普勒超声心动图技术 ,评价一氧化氮 (NO)吸入治疗新生儿肺动脉高压的疗效。对 8例新生儿因肺炎、肺透明膜病、持续胎儿循环和先天性支气管肺发育不良并发呼吸衰竭而采用机械通气和NO吸入治疗。NO吸入浓度为 3～2 0ppm ,吸入时间为 1小时～ 35天。多普勒超声心动图利用三尖瓣返流或动脉导管未闭定量估测NO吸入前后肺动脉收缩压 (SPAP) ,同时测量上肢收缩压 (SBP) ,计算肺 /体压力 (Pp/Ps)比值。结果显示 :NO吸入 30～ 1 2 0分钟和 1 8～ 2 4小时后 ,SPAP分别由NO吸入前的 5 7± 1 1 .6mmHg降至 41± 1 0 8mmHg和 43± 1 8 2mmHg ;Pp/Ps分别由 0 87± 0 1 5降至 0 6 1± 0 1 5和 0 6 3± 0 2 1。NO吸入前后SBP无明显变化。NO吸入后卵圆孔、动脉导管和室间隔缺损水平右向左或双向分流较吸入前明显减少。结论　NO吸入治疗新生儿肺动脉高压安全有效。彩色多普勒超声心动图技术对于指导NO的临床应用具有重要价值     

吸入一氧化氮治疗新生儿持续肺动脉高压的临床探讨

目的　 临床探讨吸入一氧化氮 (NO)治疗新生儿持续肺动脉高压 (PPHN)的疗效。 方法 　在吸入NO治疗前后动态观测患儿氧合情况、肺动脉压力、血压、心率及高铁血红蛋白 (MHb)变化。 结果 　吸入NO 3 0min后肺动脉压力显著下降 (t =14 2 ,P <0 0 0 1) ;OI下降 (t=12 2 ,P <0 0 0 1) ;2 4例 (75 % )患儿有效 ,持续 6ppmNO治疗患儿氧合情况持续改善 ,停用后未复发。 结论 　低浓度、短期吸入NO既安全又能显著改善PPHN患儿的氧合情况 ;但需重视其毒副作用     

一氧化氮吸入疗法治疗新生儿持续肺动脉高压临床观察

使用一氧化氮(NO)吸入疗法治疗新生儿持续肺动脉高压(PPHN)。22例PPHN患儿吸入NO治疗,20ppm开始,最高40ppm,6小时后逐渐降为6ppm,持续36小时～72小时,治疗前后动态观测患儿氧合情况、肺动脉压力、血压、心率、出凝血时间、凝血酶原时间及高铁血红蛋白(MHb)变化。结果:吸入NO30分钟后肺动脉压力显著下降(t=14.2,P<0.001);OI下降(t=12.2,P<0.001);18例(81.8％)患儿有效,对全身血压、心率并无明显影响;以6ppmNO维持36小时～72小时,患儿氧合情况持续改善,停用后没有复发。低浓度、短期吸入NO既安全又能显著改善PPHN患儿的氧合情况。     

一氧化氮吸入治疗新生儿肺动脉高压疗效的初步评价

利用彩色多普勒超声心动图技术,评价一氧化氮(NO)吸入治疗新生儿肺动脉高压的疗效.对8例新生儿因肺炎、肺透明膜病、持续胎儿循环和先天性支气管肺发育不良并发呼吸衰竭而采用机械通气和NO吸入治疗.NO吸入浓度为3～20ppm,吸入时间为1小时～35天.多普勒超声心动图利用三尖瓣返流或动脉导管未闭定量估测NO吸入前后肺动脉收缩压(SPAP),同时测量上肢收缩压(SBP),计算肺/体压力(Pp/Ps)比值.结果显示NO吸入30～120分钟和18～24小时后,SPAP分别由NO吸入前的57±11.6mmHg降至41±10.8mmHg和43±18.2mmHg;Pp/Ps分别由0.87±0.15降至0.61±0.15和0.63±0.21.NO吸入前后SBP无明显变化.NO吸入后卵圆孔、动脉导管和室间隔缺损水平右向左或双向分流较吸入前明显减少.结论NO吸入治疗新生儿肺动脉高压安全有效.彩色多普勒超声心动图技术对于指导NO的临床应用具有重要价值.     

一氧化氮治疗新生儿持续肺动脉高压42例疗效观察

目的　探讨一氧化氮 (NO)吸入疗法治疗新生儿持续肺动脉高压 (PPHN)的疗效。方法　对 4 2例新生儿PPHN和呼吸衰竭患儿按解剖性血管梗阻和肺血管痉挛分为Ⅰ组和Ⅱ组 ,分别在呼吸机机械通气情况下 ,将NO气源加入呼吸机环路中 ,NO质量浓度从 2 0× 10 -6mg/L(2 0 ppm)开始 ,每经 15～ 30min无效者增加 (5～10 )× 10 -6mg/L(5～ 10 ppm) ,达到 4 0× 10 -6mg/L仍无效者停用。有效者经予吸入较高浓度NO 6h后 ,每 30min降低NO质量浓度 (5～ 10 )× 10 -6mg/L ,如患儿的PaO2 下降不超过 15 % ,可降至 6× 10 -6mg/L后维持 36～ 72h ,治疗时观察全身氧合情况的变化 ,监测心率、血压、吸入前后血高铁血红蛋白 (MHb)定量及凝血功能。结果　Ⅱ组 33例患儿中 2 7例 (81 82 % )治疗后氧合情况显著改善 ;Ⅰ组治疗后氧合情况无改善。两组心率、血压、凝血功能无明显改变 ,MHb定量的改变无临床意义。结论　低浓度短期NO吸入疗法治疗肺血管痉挛所致持续肺动脉高压有显著疗效 ,且未见明显副作用 ,但对解剖性血管梗阻所致持续肺动脉高压疗效欠佳。     

一氧化氮治疗新生儿持续肺动脉高压的临床研究

目的　一氧化氮吸入疗法是 2 0世纪 90年代才逐渐发展起来的治疗肺动脉高压一种新技术 ,国内尚缺乏系统的临床研究 ,该文探讨吸入一氧化氮 (NO)治疗新生儿持续肺动脉高压 (PPHN)的疗效和不良反应。方法　对 4 0例PPHN患儿在呼吸机机械通气下行NO吸入 ,浓度从 2 0× 10 -6mg/L(2 0 ppm)开始 ,不超过 4 0× 10 -6mg/L ,治疗时观察氧合情况的变化 ,监测心率、血压、吸入前后血高铁血红蛋白 (MHb)定量及凝血功能。 结果　患儿经NO治疗后肺动脉压力显著下降 (P <0 .0 1) ;PaO2 ,TcSaO2 ,MAP等指标改善均有显著性意义 (P <0 .0 1) ;心率、血压、凝血功能无明显改变 ,MHb定量的改变无临床意义。结论　低浓度短期NO吸入疗法治疗肺血管痉挛所致持续肺动脉高压有显著疗效 ,且未见明显副作用。     

高肺血流所致肺血管结构重建时内源性一氧化氮体系的研究

目的　探讨高肺血流所致肺血管结构重建时内源性一氧化氮 (NO)体系的变化。方法对大鼠行腹主动脉 下腔静脉分流术。 11周后以右心导管法测定肺动脉平均压 (mPAP) ,检测右心室 /左心室 +室间隔 [RV/(LV +S) ]的比值。观测肺血管显微及超微结构的变化 ,并且以分光光度计测定血浆NO含量 ,分别以原位杂交和免疫组织化学的方法检测肺动脉内皮型NO合酶 (eNOS)mRNA和蛋白的表达。结果　分流组大鼠mPAP明显高于对照组 [分别为 (2 2 5± 2 6)mmHg、(15 8± 2 8)mmHg,1mmHg =0 13 3kPa ,P <0 0 1],RV/(LV +S)比值也明显增加。光镜下 ,肺小血管肌化程度明显增强 ,肺中、小型肌型动脉相对中膜厚度明显增加。电镜下 ,肺腺泡内动脉内皮细胞增生、变性 ,内弹力层粗细不均 ,平滑肌细胞肥厚、向合成表型转化。并且分流组大鼠血浆NO含量明显高于对照组 [分别 (为3 0 2± 7 9) μmol/L、(19 7± 5 7) μmol/L ,P <0 0 1],肺动脉eNOSmRNA和蛋白表达均明显增强。 结论　NO体系 eNOSmRNA表达、eNOS蛋白表达及血浆NO含量上调在高肺血流所致肺动脉高压和肺血管结构重建的形成中起重要的调节作用     

吸入一氧化氮治疗先天性心脏病术后肺动脉高压

目的评价吸入一氧化氮(NO)在左向右分流性先天性心脏病(先心病)术后严重肺动脉高压的治疗效果。方法81例先天性心脏病患儿术后予以吸入NO治疗,治疗指征:肺/体动脉收缩压之比(Pp/Ps)>0.5,氧合指数(PaO2/FiO2)<150mmHg,传统降肺动脉压治疗无效。初始吸入浓度为20×10-6vol/vol,根据血气及血流动力学情况进一步调整,不超过45×10-6vol/vol,同时监测二氧化氮(NO2)浓度及高铁血红蛋白浓度。结果81例吸入NO治疗后肺动脉压力明显下降,从(54.0±15.8)mmHg降至(45.7±12.8)mmHg(P<0.01),而体动脉压力无明显变化,同时PaO2/FiO2明显改善,从100.6±40.1升至135.8±29.7(P<0.01)。监测NO2浓度<1×10-6vol/vol,高铁血红蛋白浓度<2%。未发现明显出血及其他不良反应。结论吸入NO治疗可以安全有效地降低肺动脉压力,提高氧合指数,从而改善先心病合并肺动脉高压的预后。     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.