药物治疗小儿肺炎支原体肺炎106例临床分析

目的 探讨红霉素、阿奇霉素序贯治疗小儿肺炎支原体肺炎的临床效果。方法 106例小儿肺炎支原体肺炎患儿随机分为A组和B组。A组单独给予阿奇霉素治疗，B组采用红霉素、阿奇霉素序贯治疗，观察两组患者体温恢复正常时间、呼吸道症状消失时间、肺部罗音消失时间及平均住院时间。结果 B组患儿的体温恢复时间、呼吸道症状消失时间、肺部罗音消失时间及平均住院时间均明显低于A组，差异有统计学意义（P 〈 0.05 ）。结论 红霉素、阿奇霉素序贯治疗小儿肺炎支原体肺炎安全有效，具有治疗依从性好、方便、经济的优点，值得临床推广。     

阿奇霉素序贯治疗小儿肺炎支原体肺炎的临床效果分析

目的探讨阿奇霉素序贯治疗小儿肺炎支原体肺炎的临床效果。方法选择笔者所在医院2008年12月～2010年12月肺炎支原体肺炎患儿80例,将上述患儿随机分为观察组和对照组两组。对照组采用红霉素序贯治疗,观察组采用阿奇霉素序贯治疗。观察两组患儿治疗期间临床症状和体征的改善情况;记录两组住院时间和不良反应发生情况。结果观察组总有效率为97.5%,对照组总有效率为95.0%,两组总有效率比较差异无统计学意义（P〉0.05）;两组住院时间及不良反应发生率比较,差异有统计学意义（P〈0.05）。结论阿奇霉素序贯治疗小儿肺炎支原体肺炎临床效果显著,能够缩短住院时间,减少不良反应发生,值得借鉴。     

红霉素与阿奇霉素治疗小儿肺炎支原体性肺炎及对血清TNF-α水平的影响

目的:观察红霉素与阿奇霉素治疗肺炎支原体性肺炎患儿血清TNF-α水平的效果及其差异.方法:2007年1月至2011年1月在我院儿科住院治疗的肺炎支原体性肺炎患儿60名,随机分为阿奇霉素治疗组与红霉素治疗组,分别予以阿奇霉素、红霉素治疗;同期正常随访小儿30名为对照组.所有研究对象检测血清TNF-α的指标,观察治疗期间的临床和实验室改变.结果:(1)阿奇霉素组治疗总有效率为93.33％,明显高于红霉素组的73.33％,差异有统计学意义(P＜0.05);(2)肺炎组患儿血清TNF-α水平为63 17±10.07ng/L,明显高于正常对照组的患儿13.74±10.9ng/L,且差异有统计学意义(P＜0.05);(3)重症肺炎患儿血清TNF -α水平高于非重症肺炎患儿,给予阿奇霉素治疗后,他们的血清TNF-α水平均有明显下降.结论:阿奇霉素治疗支原体肺炎的效果好于红霉素,TNF-α可以作为反映肺炎严重程度和治疗效果的指标之一.     

阿奇霉素序贯治疗小儿支原体肺炎的临床疗效及安全性分析

目的探讨阿奇霉素治疗小儿支原体肺炎的临床疗效及安全性。方法选择经血清学检测肺炎支原体抗体阳性的支原体肺炎患儿63例,随机分为治疗组33例和对照组30例。治疗组采用阿奇霉素序贯治疗,对照组用红霉素序贯治疗,观察治疗前后患者症状、肺部体征的变化及不良反应。结果治疗组、对照组治疗总有效率分别为97.9%、75.7%,两组比较差异有统计学意义;不良反应的差异有统计学意义。治疗组疗效明显优于对照组。结论阿奇霉素治疗支原体肺炎其疗效好,副作用少,安全有效,值得临床推广使用。     

清胰汤对呼吸机相关肺炎患者免疫功能的影响

目的:探讨中药清胰汤在改善呼吸机相关肺炎患者免疫功能中的应用。方法:将106例呼吸机相关肺炎患者随机分为常规治疗组(对照组)和清胰汤治疗组(研究组),分别于治疗前,治疗后第7 d、第10 d,采用流式细胞仪检测外周血T淋巴细胞亚群及NK细胞比例,运用ELISA和放射免疫法测定细胞因子IL-8、IL-17、髓过氧化物酶(MPO)浓度;并比较两组患者的治愈率、死亡率以及ICU住院时间。结果:研究组于治疗后第7 d、第10 d,CD4+T细胞、CD4+/CD8+、NK细胞百分率明显高于对照组(P<0.05),CD8+T细胞百分率明显低于对照组(P<0.05);IL-8、IL-17、MPO浓度显著低于对照组(P<0.05)。研究组治愈率明显高于对照组(P<0.05),死亡率显著低于对照组(P<0.05)。对照组和研究组ICU住院时间分别为(19.7±3.5)d、(12.2±2.7)d(P<0.05)。结论:清胰汤治疗可以显著改善呼吸机相关肺炎患者的免疫功能,减轻炎症和应激反应,提高临床疗效。     

不同糖皮质激素诱导鸡股骨头坏死的实验研究

目的:观察甲泼尼龙琥珀酸钠与地塞米松对鸡股骨头坏死发生的影响。方法:健康来航鸡36只,随机分成正常组(A组)、甲泼尼龙小剂量组(B组)、甲泼尼龙大剂量组(C组)、地塞米松小剂量加马血清组(D组)、地塞米松中剂量加马血清组(E组)、地塞米松大剂量组(F组),共6组,每组6只。分别于第6、12周翼下静脉采血,检测血清总胆固醇(CHO)和甘油三酯(TG)、高密度脂蛋白(HDL)和低密度脂蛋白(LDL);在实验12周取股骨头,行HE染色,光镜下计数空骨陷窝率,观察其病理学改变。结果:与正常组相比,在第6周,C、F组CHO升高(P0.05),B、C、E组TG升高(P0.05),而B、C、E组HDL降低;在第12周,B、C、E、F组动物血TG、CHO均升高(P0.05),C、D、E组动物血HDL降低(P0.05),多数实验鸡血清内LDL未能检出。在第12周,C、E组股骨头空骨陷窝明显高于正常组(P0.05),并出现较典型骨坏死病理学改变。结论:甲泼尼龙琥珀酸钠较地塞米松更易诱导鸡早期股骨头坏死的发生,而血脂代谢紊乱可能是激素引起该股骨头坏死的重要病理基础。     

阿奇霉素治疗小儿肺炎支原体感染的临床疗效观察

目的：探讨阿奇霉素治疗小儿肺炎支原体感染的临床疗效,为其临床治疗提供可参考依据。方法共纳入82例入住我院诊断为肺炎支原体感染的患儿作为研究对象,采用随机数字法平均分为观察组与对照组,观察组患儿给予阿奇霉素治疗,对照组给予罗红霉素治疗,对两组患儿的住院时间、临床疗效等进行比较。结果观察组治疗总有效率明显优于对照组,总有效率分别为97.6％及85.3％,差异有统计学意义（P ＜0.05）;且观察组住院时间明显低于对照组,差异有统计学意义（P ＜0.05）。观察组出现恶心、呕吐的例数明显低于对照组,差异有统计学意义（P ＜0.05）。结论阿奇霉素治疗小儿肺炎支原体感染有较好的临床疗效,可以更好的改善患者的症状,同时安全性较高,值得临床推广应用。     

糖皮质激素治疗胸部外伤所致心肌挫伤的临床观察

目的观察糖皮质激素治疗胸部外伤所致心肌挫伤的效果。方法随机将40例胸部外伤所致心肌挫伤患者分为对照组和治疗组,各20例。对照组给予吸氧、稳定生命体征、营养心肌等常规治疗方法,治疗组在此基础上静滴甲泼尼龙琥珀酸钠针80 mg,观察2组患者治疗前及治疗后5 d磷酸肌酸同工酶(CK-MB)、肌红蛋白(MYO)、超敏肌钙蛋白I(Trop I)。结果治疗组5 d复查磷酸肌酸同工酶(CK-MB)、肌红蛋白(MYO)、超敏肌钙蛋白I(Trop I)改善情况明显好于对照组(P0.05)。结论糖皮质激素对胸部外伤所致心肌挫伤具有临床治疗作用。     

中低剂量糖皮质激素影响新型冠状病毒清除时间的回顾性研究

目的研究中低剂量糖皮质激素治疗对新型冠状病毒肺炎(COVID-19)患者病毒清除时间的影响。方法回顾性分析2020年1月19日至2月17日浙江大学医学院附属第一医院收治的72例COVID-19患者的临床资料。全部患者均接受阿比多尔和/或联合洛匹那韦/利托那韦、达芦那韦/考比司他抗病毒以及对症支持治疗,其中51例使用甲泼尼龙(0.75~1.50 mg·kg-1·d-1)抗炎治疗作为糖皮质激素治疗组,21例未使用糖皮质激素者作为对照组。比较两组患者及普通型患者痰液病毒核酸转阴时间和肺部影像学改善时间。组间比较采用Kruskal-Wallis检验或Fisher精确检验。结果糖皮质激素治疗组与对照组中位年龄分别为52(45,62)和46(32,56)岁,两组比较差异有统计学意义(χ2=4.365,P<0.05)。两组临床分型差异有统计学意义(P<0.01),糖皮质激素治疗组中重型患者占52.0%,而对照组中普通型占71.4%。两组患者从发病至痰液病毒核酸转阴中位时间分别为15(13,20)和14(12,20)d,差异无统计学意义(P>0.05);两组患者从发病至肺部影像学好转中位时间分别为13(11,15)和13(12,17)d,差异无统计学意义(P>0.05)。在普通型患者中,糖皮质激素治疗组与对照组从发病至痰液病毒核酸转阴中位时间为13(11,18)和13(12,15)d,差异无统计学意义(P>0.05);从发病至肺影像学好转中位时间分别为12(10,15)和13(12,17)d,差异也无统计学意义(P>0.05)。结论在不同临床类型的COVID-19患者中,中低剂量糖皮质激素使用对病毒清除时间未见明显影响;普通型患者中未观察到激素可以加快肺损伤的改善,故不建议使用。     

局部和全身应用激素治疗突发性耳聋耳鸣近期效果比较

目的分析并比较局部和全身应用激素治疗突发性耳聋耳鸣的近期效果。方法随机将160例突发性耳聋耳鸣患者分为2组,各80例。观察组在常规治疗基础上鼓室内注射甲泼尼龙琥珀酸钠液,对照组静滴甲泼尼龙琥珀酸钠液,疗程均为10 d。随访3个月,比较2组疗效和不良反应。结果 2组不良反应发生率差异无统计学意义(P0.05)。观察组总有效率(70.0%)明显高于对照组(38.75%),差异有统计学意义(P0.05)。结论局部应用激素治疗突发性耳聋耳鸣,操作简便、并发症少,近期效果较好。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.