艾瑞昔布超前镇痛用于脊柱手术对患者术后镇痛效果的影响

目的观察艾瑞昔布超前镇痛用于脊柱手术对患者术后镇痛效果的影响。方法选取本院2017年3月～2018年3月收治的110例脊柱手术患者,按随机数表法分为观察组与对照组,各55例。观察组术前30 min口服100 mg的艾瑞昔布,对照组口服相同剂量的安慰剂。术毕予负荷剂量的芬太尼0.001 mg/kg。比较两组术后6 h与12 h的疼痛程度[采用视觉模拟评分法(VAS)评估]、镇静效果(采用Ramesay评分法评估)、芬太尼消耗量、自控按压总次数、不良反应总发生率。结果观察组术后6 h与术后12 h的术后疼痛VAS评分分别为(2.80±0.82)分与(1.85±0.45)分,低于对照组的(3.15±0.91)分与(2.32±0.64)分;观察组的镇静Ramesay评分分别为(2.28±0.59)分与(2.06±0.58)分,低于对照组的(2.63±0.71)分与(2.33±0.70)分,差异有统计学意义(P0.05)。观察组术后0～6 h、6～12 h、12～24 h的芬太尼消耗量及自控按压总次数均低于对照组(P0.05)。观察组的不良反应总发生率为7.27%,低于对照组的21.82%(P0.05)。结论脊柱手术患者采用艾瑞昔布进行超前镇痛可获得良好的术后镇痛效果与镇静效果,芬太尼用量与不良反应均明显减少,具有较高的有效性与安全性,值得推广。     

铅对作业工人甲状腺功能的影响

目的　了解铅对作业工人甲状腺功能的影响。方法　选择暴露于铅作业环境下的人群 ,了解工人作业工龄 ,采用火焰原子吸收光谱法测定其作业环境中铅浓度 ,用原子吸收光谱法测定作业工人血铅 (PbB)浓度 ,用血液锌原卟啉测定仪测定血锌原卟啉 (ZPP)浓度 ,用放射免疫分析法检测血清中促甲状腺素 (TSH)、三碘甲状腺原氨酸 (T3)、甲状腺素 (T4 )、游离T3(FT3)、游离T4 (FT4 ) 5项甲状腺功能指标。结果　血铅 >2 .88μmol/L时 ,T3[(1 .54± 0 .39)nmol/L]、FT3[(5 .50± 1 .2 6)pmol/L]含量明显低于血铅 (1 .92～ 2 .88) μmol/L组 [T3(1 .71± 0 .45)nmol/L、FT3(6 .1 2± 1 .64)pmol/L] ,差异有显著性(P <0 .0 5)。铅作业工龄长短对甲状腺激素 (TH)含量未见明显影响。结论　高浓度血铅可能抑制了T4 的脱碘 ;铅作业工龄对甲状腺功能未见明显影响     

Chronic biopsy proven post‐COVID myoendocarditis with SARS‐Cov‐2 persistence and high level of antiheart antibodies

PurposeTo study the clinical signs and mechanisms (viral and autoimmune) of myoendocarditis in the long‐term period after COronaVIrus Disease 2019 (COVID‐19).MethodsFourteen patients (nine male, 50.1 ± 10.2 y.o.) with biopsy proven post‐COVID myocarditis were observed. The diagnosis of COVID‐19 was confirmed by IgG seroconversion. The average time of admission after COVID‐19 was 5.5 [2; 10] months. An endomyocardial biopsy (EMB) of the right ventricle was obtained. The biopsy analysis included polymerase chain reaction diagnosis of viral infection, morphological, immunohistochemical (IHC) examination with antibodies to CD3, CD45, CD68, CD20, SARS‐Cov‐2 spike, and nucleocapsid antigens. Coronary atherosclerosis was ruled out in all patients over 40 years.ResultsThe new cardiac symptoms (congestive heart failure 3–4 New York Heart Association class with severe right ventricular involvement, various rhythm, and conduction disturbances) appeared 1–5 months following COVID‐19. Magnetic resonance imaging showed disseminated or focal subepicardial and intramyocardial late gadolinium enhancement, hyperemia, edema, and increased myocardial native T1 relaxation time. Antiheart antibodies levels were increased 3–4 times in 92.9% of patients. The mean left ventricular (LV) ejection fraction (EF) was 28% (24.5; 37.8). Active lymphocytic myocarditis was diagnosed in 12 patients, eosinophilic myocarditis in two patients. SARS‐Cov‐2 RNA was detected in 12 cases (85.7%), in association with parvovirus B19 DNA—in one. Three patients had also endocarditis (infective and nonbacterial, with parietal thrombosis). As a result of steroid and chronic heart failure therapy, the EF increased to 47% (37.5; 52.5).ConclusionsCOVID‐19 can lead to long‐term severe post‐COVID myoendocarditis, that is characterized by prolonged persistence of coronavirus in cardiomyocytes, endothelium, and macrophages (up to 18 months) in combination with high immune activity. Corticosteroids and anticoagulants should be considered as a treatment option of post‐COVID myoendocarditis.     

Core-peripheral temperature gradient in children: does it reflect clinically important changes in circulatory haemodynamics?

Following open heart surgery, changes in core and peripheral skin temperature and changes in the core-peripheral temperature gradient were measured in 10 children. These were correlated with changes in cardiac index, systemic vascular resistance index, mean arterial pressure and urinary output. During the study intervals, which lasted 1 h each, no changes in medical management were made. Using Spearman's rank correlation, only a change in central venous pressure was found to correlate with a change in the core-peripheral temperature gradient. We conclude that a change in the core-peripheral temperature will give valuable information about the patient's intravascular volume.