米力农对小儿先天性心脏病并心力衰竭术前血液动力学干预的研究

目的探讨米力农对小儿先天性心脏病(CHD)并心力衰竭(CHF)术前血液动力学干预的效应。方法将80例患儿随机分为A、B、C、D四组,A、B、C组为米力农组,米力农剂量分别为0.25、0.5和0.75μg/(kg.min),D组为多巴胺组,剂量为5μg/(kg.min),各组持续给药3 d,观察不同维持量的米力农其血液动力学和心功能指标的变化并与多巴胺组进行比较。结果米力农各剂量组于用药后均可使肺动脉压力下降(P<0.01~0.05),以中剂量和大剂量组效果最满意(P<0.01),心率、血压无显著变化(P>0.05),心脏收缩和舒张功能指标LVEF、LVSF、LVSTI、RVSTI及房室瓣E/A值均有显著改善(P<0.01~0.05),有2例出现室性早搏(3.3%);多巴胺组用药前后上述指标均无显著性差异(P>0.05)。结论米力农对CHD并CHF患儿具有正性肌力和扩血管作用,能明显改善心功能和降低肺动脉压力,不影响血压和心率。     

特发性肾病综合征患儿血清游离甲状腺激素检测的临床意义

探索特发性肾病综合症（ＩＮＳ）患儿血清游离甲状腺激素（ＴＨ）、甲状腺激素结合球蛋白（ＴＢＧ）的变化情况及其变化的机理和临床意义。对１６例ＩＮＳ患儿及１５例正常儿童对照,用放免法测Ｔ３、Ｔ４、ＦＴ３、ＦＴ４,化学发光酶免疫分析法测ＴＳＨ、ＴＢＧ,放射配基单点饱和饱和结合分析法测糖皮质激素受体（ＧＣＲ）。结果：①ＩＮＳ患儿Ｔ３、Ｔ４、ＦＴ３、ＦＴ４均低于对照组,ＴＳＨ升高,差异非常显著。②ＴＢＧ降低,ＴＢＧ与ＴＨ呈正相关。③ＩＮＳ患儿ＧＣＲ升高,ＴＨ与ＧＣＲ未见相关性。提示对糖皮质激素（ＧＣ）治疗敏感的ＩＮＳ患儿,虽然其ＴＨ是降低的,但其ＧＣＲ是升高的。     

充血性心力衰竭与重症肺炎患儿血清脑钠素浓度变化的研究

目的：B型利钠肽即脑钠素(B-typeorbrainnatriureticpeptide,BNP)在成人充血性心力衰竭(con-gestiveheartfailure,CHF)时血浆浓度显著升高,对成人CHF有重要诊断价值,对成人急性呼吸困难有重要的鉴别诊断价值。在小儿有关BNP的研究不多,该实验旨在研究小儿CHF及肺炎时血清BNP浓度变化,探讨BNP对小儿急性呼吸困难的鉴别诊断价值;进一步探讨小儿重症肺炎是否会合并心衰,为肺炎合并心衰的诊断寻找客观指标。方法：将65例有呼吸困难症状的患儿分为3组CHF组(即心源性呼吸困难组)24例;肺炎组(即肺源性呼吸困难组)23例;临床诊断肺炎心衰组18例。对10例肺炎合并心衰患儿在病情平稳2~3d后再次收集血清。正常对照组15例。用ELISA法测血清BNP浓度。结果：CHF组血清BNP浓度显著高于临床诊断肺炎心衰组、肺炎组及正常组(P<0.01);临床诊断肺炎心衰组显著高于肺炎组(P<0.01)及正常组(P<0.01),肺炎组与正常组比较差异无显著性。BNP对心源性呼吸困难鉴别诊断的受试者作业特征曲线(receiveoperatorcharacteristic,ROCcurve)下面积是0.978(P<0.01);BNP以49pg/mL为诊断界值,对呼吸困难由CHF引起的诊断敏感度是87.5%,特异度是95.8%;临床诊断肺炎心衰的18例患儿中,BNP浓度>49pg/mL的11例,其BNP浓度为172.08±56.47pg/mL,显著高于肺炎组(P<0.01),与CHF组相比无差异;这11例中有10例治疗后复查血清BNP,其浓度为26.12±15.71pg/mL,低于治疗前(P<0.01)。另7例血清BNP浓度为20.46±11.78pg/mL,与肺炎组及正常组相比差异无显著性(均P>0.05)。结论：BNP浓度检测对小儿呼吸困难是否由CHF引起有鉴别诊断价值;小儿重症肺炎时可以合并心力衰竭;BNP检测可鉴别小儿重症肺炎是否合并心力衰竭。     

Determinants of the diuretic response to furosemide in infants with congestive heart failure

Summary A wide interindividual variation in the degree of diuresis produced following treatment with furosemide has been observed in infants with congestive heart failure. A method of pharmacokinetic analysis that separates drug disposition from renal response to furosemide was used to compare the effect of this agent in infants with congestive heart failure with the effect seen in infants with fluid retention secondary to noncardiac factors. No differences in the drug elimination rate, urinary drug excretion, or renal diuretic response between the 2 groups were seen. Infants in both groups exhibited a wide range in all variables examined. The marked interindividual variation in response originates from decreased delivery of furosemide to its site of action in some patients and a decreased responsiveness to the drug in others.Supported in part by grants from the Pharmaceutical Manufacturer's Association Foundation, USPHS (GM 07566), the University of Minnesota Graduate School and the Minnesota Medical Foundation. This paper was part of the Ray C. Anderson Symposium.     

Intraaortic balloon pump management of refractory congestive heart failure in children

Summary From December 1975 to September 1989, nine children, ages 0.6–15.8 years (mean=8.1 years) and weighing 5–44 kg (mean=24 kg), were identified as requiring intraaortic balloon pump support. Indications included ventricular failure refractory to maximal conventional therapy, inability to wean from cardiopulmonary bypass, and myocardial ischemia. Prior to insertion of the balloon catheter, mean systolic blood pressure was 64 mmHg, one to four cardiotonic medications were being administered, mechanical ventilation was being performed in eight patients, and mean urine output was 0.4 ml/kg/min in eight. Following balloon catheter insertion, mean urine output increased to 0.9 ml/kg/min. Four patients survived following discontinuation of the balloon catheter 12–96 h (mean=59 h) after initiation. Though complications such as loss of distal lower extremity pulses, sepsis, thrombocytopenia, and abdominal distention were observed, most could be attributed to other causes. Thus, the intraaortic balloon pump is a valuable addition to conventional medical therapy in the treatment of refractory cardiogenic shock in children.Presented in part at the American Academy of Pediatrics Annual Meeting, Boston, Massachusetts, October 6, 1990.     

Arteriovenous malformations as a cause of congestive heart failure in the newborn and infant

Three cases of congestive heart failure are presented caused by a cerebral arteriovenous aneurysm, a pulmonary arteriovenous aneurysm and a placental angioma respectively. Such conditions should be borne in mind in otherwise unexplained heart failure in the neonatal period and in infants. The haemodynamic influence of the malformation depends on its anatomy, giving rise to various clinical pictures.     

Large placental chorioangioma as a cause of congestive heart failure in newborn infants

Summary Two rare cases of infants born from pregnancies complicated by large placental chorioangiomas are reported. Congestive heart failure occurred early in the neonatal period as the main complication. Chorioangiomas may be diagnosed early in pregnancy by ultrasound examination. Since both maternal and neonatal complications may indicate premature termination of the pregnancy or be conducive to premature birth, repeated ultrasound examinations, including fetal echocardiography and flow measurements, are suggested to determine the optimal time of delivery. Possible pathophysiological mechanisms causing neonatal complications are discussed.A preliminary report on these cases was presented as a poster at the International Congress of Pediatric Cardiology, Vienna, February 21–25, 1987.     

超声心动图评价心力衰竭患儿左、右心舒张功能

目的　探讨充血性心力衰竭（ＣＨＦ）患儿左、右心舒张功能及其相互关系。方法　对５１ 例ＣＨＦ患儿和６０ 例正常对照儿童用多普勒超声心动图测量左、右室充盈参数。结果　与正常对照组比较,ＣＨＦ组患儿左、右室充盈参数均显示舒张受损,且左、右室充盈参数呈良好相关。结论　ＣＨＦ组患儿均存在左、右心舒张功能障碍,且程度类型相似