PICU脓毒血症患者血乳酸水平与小儿危重病例评分及预后相关性

目的探讨PICU脓毒血症患者血乳酸水平与小儿危重病例评分及预后相关性。方法选取2014年1月至2015年1月我院PICU脓毒血症患儿72例为研究对象,抽取动脉血检测血乳酸水平,并行小儿危重病例评分,根据评分分为非危重组(18例)、危重组(36例)和极危重组(18例),分析血乳酸与小儿危重病例评分及预后的相关性。结果极危重组LAC水平显著高于危重组和非危重组(P0.05),其病死率显著高于危重组(P0.05)。死亡组患儿LAC水平显著高于存活组(P0.05),PCIS评分显著低于存活组(P0.05)。PICU脓血症患儿LAC水平与PCIS评分呈负相关关系(r=-0.365,P0.01)。结论 LAC水平检测是脓毒症患儿病情严重程度和预后评估的重要指标,具有显著的临床价值。     

败血症患儿血小板计数、D-二聚体水平与危重病例评分及预后相关性研究

目的分析败血症患儿血小板计数、D-二聚体水平与小儿危重病例评分(PCIS)及预后的相关性。方法收集2016年1月至2019年8月安徽省儿童医院儿科重症监护病房收治的91例败血症患儿资料进行回顾性研究。根据患儿的PCIS分值将其分为非危重组(n=48)、危重组(n=27)和极危重组(n=16),比较三组患儿的血小板水平、D-二聚体水平以及死亡的例数。根据患儿预后将患儿分为存活组(n=82)和死亡组(n=9),比较两组患儿的PCIS评分、血小板计数、D-二聚体水平。分析血小板计数以及D-二聚体水平与预后的相关性。结果极危重组患儿D-二聚体水平高于非危重组和危重组[(10. 86±2. 75) mg/L比(1. 53±0. 33) mg/L比(3. 42±0. 74) mg/L](P <0. 05),而危重组高于非危重组(P <0. 05)。三组患儿血小板计数比较差异无统计学意义(P> 0. 05)。极危重组中有9例死亡,非危重组和危重组无死亡病例。死亡组患儿的D-二聚体水平高于存活组[(11. 01±3. 25) mg/L比(2. 82±0. 54) mg/L](P <0. 01),PCIS评分低于存活组[(67. 89±0. 63)分比(83. 06±1. 07)分](P <0. 01)。相关性分析显示,死亡组患儿D-二聚体水平与PCIS评分呈正相关(r=0. 518,P <0. 001),血小板计数与PCIS评分无相关性(r=-0. 120,P=0. 258)。结论败血症患儿血清D-二聚体的水平随着病情严重程度增加而升高,并与败血症患儿的预后相关,有望成为判断败血症患儿病情以及预测预后的指标。     

血清D二聚体和小儿危重评分在儿童重症感染性疾病中的运用价值

目的 研究血清D二聚体和小儿危重评分(PCIS)在儿童重症感染性疾病中的运用价值.方法 选取2019年1月至2019年12月本院收治的感染性疾病患儿80例,按小儿危重评分情况分为非危重组(PCIS>90分,n=23)、危重组(PCIS 70～90分,n=43)、极危重组(PCIS<70分,n=14).比较3组患儿PCIS评分、血清D二聚体水平以及治疗转归情况.结果 非危重组和危重组患儿PCIS评分均高于极危重组,非危重组PCIS评分高于危重组,差异有统计学意义(P<0.05);非危重组和危重组血清D二聚体水平均低于极危重组,非危重组血清D二聚体水平低于危重组,差异有统计学意义(P<0.05);非危重组和危重组好转率均高于极危重组,差异有统计学意义(P<0.05),非危重组和危重组好转率比较差异无统计学意义.结论 儿童重症感染性疾病实施血清D二聚体水平检测及小儿危重评分有利于判断患儿病情发展情况,评估预后效果,从而制定具针对性的治疗护理措施,提高临床治疗效果,进而加速患儿病情康复,值得临床推广运用.     

血浆Th1/Th2细胞、ET、PTA、PCT与脓毒症患儿病情严重程度及转归的关系分析

目的 探究血浆辅助性T细胞1(help T cell 1,Th1)/辅助性T细胞2(help T cell 2,Th2)细胞、内毒素(endotoxin, ET)、凝血酶原活动度(prothrombin activity, PTA)、降钙素原(procalcitonin, PCT)与脓毒症患儿病情严重程度及转归的关系。方法 选取我院脓毒症患儿96例,通过小儿危重症评分(pediatric critical illness score, PCIS)评估病情严重程度,分为非危重组(PCIS分值>80分,n=39)、危重组(PCIS分值71～80分,n=32)、极危重组(PCIS分值≤70分,n=25),比较3组一般资料、入院时血浆Th1/Th2细胞、ET、PTA、PCT水平,分析血浆各指标与脓毒症患儿PCIS分值的关系,并统计脓毒症患儿28 d预后情况,比较不同预后患儿入院时血浆Th1/Th2细胞、ET、PTA、PCT水平,分析血浆各指标与脓毒症患儿预后的关系及预测脓毒症患儿预后的价值。结果 极危重组血浆Th1/Th2细胞、PTA水平低于危重组、非危重组,且危重组低于非危重组;极危重...     

早期乳酸清除率判断危重患儿预后的临床意义

目的初步探讨早期血乳酸清除率在危重患儿预后判断中的作用。方法选择新乡医学院第一附属医院儿科重症监护病房(PICU)2010年5月至2012年5月收治的小儿危重病例评分(PCIS)<80分、存活时间>6 h的患儿。在患儿入住PICU 1 h内(治疗前)进行危重症评分,行动脉血气分析并测定血乳酸水平,治疗6 h再次观测上述指标,计算6 h乳酸清除率。根据预后将患儿分为存活组和死亡组,比较2组动脉血乳酸清除率与乳酸水平的差异。结果存活组和死亡组治疗前动脉血乳酸水平、PCIS比较差异无统计学意义(P>0.05);2组间治疗后血乳酸水平和血乳酸清除率比较差异有统计学意义(P<0.05)。结论早期乳酸清除率可作为危重患儿预后判断的一个良好指标。     

血清N末端B型脑钠肽原检测对危重患儿病情评估的价值

目的：探讨血清N末端B型脑钠肽原（NT-ProBNP）检测在危重儿童中检测的意义及对病情评估的价值。方法：122例重症医学科（ICU）危重患儿,入院24h内检测血清NT-ProBNP及进行PCIS评分,并统计多脏器功能障碍（MODS）和病死率情况。将患儿按PCIS分值,分为非危重组（>80分）、危重组（71~80分）、极危重组（≤70分）;分别比较各组患儿NT-ProBNP、MODS、病死率的差异以及与PCIS的相关性。结果：非危重组、危重组和极危重组的NT-ProBNP的对数值以极危重组升高最为明显,危重组次之,两两比较差异均有统计学意义（P＜0.05）。非危重组、危重组和极危重组的MODS率和病死率水平以极危重组最高,危重组次之,两两比较差异均有统计学意义（P＜0.05）。NT-ProBNP的对数值与PCIS评分呈负相关（r=-0.889,P＜0.O5）。结论：危重患儿NT-ProBNP显著升高,提示心血管功能早期即受到损害。随病情加重,NT-ProBNP呈指数型升高,且NT-ProBNP越高,患儿并发症越多、预后越差。NT-ProBNP的对数值与PCIS呈负相关,二者结合可以更加敏感地评价病情和判断预后。     

危重儿血清胆碱酯酶与病危程度及预后的相关性分析

目的:探讨血清胆碱酯酶对危重儿病危程度及预后的判断价值。方法:按小儿危重病例评分法(PCIS)进行评分,选取2011年3月-2013年11月收入本院儿科病房的225例患儿,将其分为非危重组(评分81分)80例、危重组(评分71~81分)80例、极危重组(评分71分)65例,分别于入院后24 h内检测血清胆碱酯酶活性,并用多系统器官功能衰竭(MSOF)诊断标准评价系统器官功能,分析血清胆碱酯酶、PCIS评分、MSOF之间的相关性。结果:极危重组血清胆碱酯酶活性明显低于危重组,危重组明显低于非危重组,不同PCIS评分组间的血清胆碱酯酶、MSOF发生率与死亡率比较,PCIS评分越低,血清胆碱酯酶活性越低,多器官功能衰竭发生率越高,死亡率越高,差异均有统计学意义(P0.01)。结论:危重病例评分越低者,血清胆碱酯酶活性下降越明显,多器官功能衰竭发生率越高及病死率越高,故血清胆碱酯酶活性测定可作为评判危重儿病危程度及预后的一项指标。     

2种危重症评分在手足口病并脑炎病情评估中的应用研究

目的 探讨小儿危重病例评分(PCIS)及第三代小儿死亡危险评分(PRISM Ⅲ)在儿童手足口病并脑炎病情评估及预后判断中的应用价值。 方法 分别用PCIS及PRISM Ⅲ对2010年收住院的手足口病并脑炎患儿进行评分,分非危重组、危重组和极危重组,比较各组间的死亡率,运用ROC曲线比较两者在预判手足口病并脑炎患儿死亡风险的特异性和灵敏度。 结果 ①PCIS评分:3组死亡率比较差异有统计学意义(8/466,10/12,5/5,χ2=93.099,P＜0.001);②PRISM Ⅲ评分:3组比较死亡率,差异亦有统计学意义(4/458,4/7,15/18,χ2=114.579,P＜0.001);③2种评分的非危重组、危重组和极危重组组间死亡率比较,差异均无统计学意义(1.72% vs. 0.87%,χ2=1.282,P=0.258,88.24% vs. 76.00%,χ2=0.349,P=0.555);④Logistic回归分析显示:PCIS各评分指标中,心率、血压(收缩压)及肾功能,PRISM Ⅲ各评分指标中,神志状态及血糖对手足口病死亡风险预测作用较强(P均＜0.05)。⑤ROC曲线下面积分别为:PCIS评分0.929,PRISM Ⅲ评分0.985。 结论 PCIS和PRISM Ⅲ均可用于手足口病并脑炎患儿病情的评估,两者在预测其死亡风险方面有较高的特异性和灵敏度。      

血清胆碱酯酶和血乳酸对小儿危重症病情的评估价值

目的:寻求血清胆碱酯酶和血乳酸在小儿危重症病情评估中的应用价值。方法:选择我院儿科住院患儿225例,分为非危重组80例,危重组80例,极危重组65例,入院后即采动脉血检测血乳酸浓度,并于24h内检测血清胆碱酯酶活性,分析血清胆碱酯酶、血乳酸与PCIS评分之间的关系。结果:极危重组的血清胆碱酯酶明显低于危重组,危重组明显低于非危重组,而极危重组的血乳酸明显高于危重组,危重组明显高于非危重组,差异均有统计学意义(P<0.05),患儿PCIS评分越低,病情越重,血清胆碱酯酶越低,两者呈正相关,而PCIS评分越低,血乳酸越高,两者呈负相关。结论:危重儿的血清胆碱酯酶和血乳酸对小儿危重症的病情评估具有一定预警价值。     

血乳酸检测在小儿脓毒症预后评估中的临床价值

目的:探讨血乳酸检测在小儿脓毒症预后评估中的临床价值。方法:87例脓毒症患儿根据入院时乳酸水平分为<2.0 mmol·L-1组(n=42)、2.0~3.9 mmol·L-1组(n=28)、≥4.0 mmol·L-1组(n=17),比较各组患儿病死率和小儿危重病例评分(PCIS);根据预后情况分为存活组(n=66例)和死亡组(n=21),比较各组患儿在入院1 h内,6、12、24、48 h等时间点的乳酸水平。结果:随着乳酸水平逐渐升高,脓毒症患儿病死率明显增高(P<0.05),PCIS明显下降(P<0.05);随入院时间逐渐延长,存活组患儿乳酸水平明显降低,而死亡组患儿乳酸水平明显升高,死亡组患儿乳酸水平在各时间点均明显高于存活组(P<0.05);血清乳酸水平与PCIS呈负相关性关系(r=-0.365,P<0.01)。结论:血乳酸检测对脓毒症患儿疾病严重程度和预后评估具有十分重要的临床价值,值得临床推广应用。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.