Etomidate for Rapid-sequence Intubation in Young Children: Hemodynamic Effects and Adverse Events

OBJECTIVES: Physicians commonly use etomidate for adult rapid-sequence intubation (RSI), but the manufacturer does not recommend its use for children under 10 years of age due to a lack of data. The authors present their experience with etomidate for pediatric RSI in order to further develop its risk-benefit profile in this age group. METHODS: Trained abstractors reviewed the medical records for all children under 10 years old who received etomidate for RSI between July 1996 and April 2001. RESULTS: 105 children, with an average age of 3 (+/-2.9) years, received a median dose of 0.32 (+/-0.12) mg/kg of etomidate. The systolic blood pressure increased an average of 4 mm Hg (95% CI = -3.3 to 9.2); the diastolic blood pressure increased 7 mm Hg (95% CI = -3.1 to 11) within 10 minutes of receiving etomidate. The heart rate increased an average of 10 beats/min (95% CI = 4.0 to 17.4). Complications included three patients who vomited within 10 minutes of etomidate administration. There were no cases of documented myoclonus, status epilepticus, or new-onset seizures. Thirty-eight patients received corticosteroids during the hospital course, none for suspected adrenal insufficiency. Three patients died, all from severe brain injury. CONCLUSIONS: In children less than 10 years old, etomidate seems to produce minimal hemodynamic changes, and appears to have a low risk of clinically important adrenal insufficiency, myoclonus, and status epilepticus. The association between etomidate and emesis (observed in less than 3% of enrolled patients) remains unclear. For clinical situations in which minimal blood pressure changes during RSI are critical, etomidate appears to have a favorable risk-benefit profile for children under 10 years old.     

Surfactant

Surfactant, a complex substance containing specific proteins and phospholipids, is essential for gas exchange in the lungs. Research shows that surfactant not only lowers surface tension, but also plays a role in host defense. Surfactant replacement therapy is a cornerstone in the treatment of respiratory distress syndrome in premature infants. New information on endogenous surfactant composition including surfactant apoproteins has led to advances in the surfactant replacement products currently available. Because of the success of surfactant deficiency treatment in neonates, surfactant replacement therapy has been studied in both the pediatric and adult population for the treatment of other respiratory disorders. This article describes the composition, metabolism, and function of endogenous surfactant and other uses of surfactant replacement therapies in neonates.     

危重症患者的APACHEⅡ评分与中医辨证相关性研究

目的：通过比较不同中医证型的ICU危重症患者的APACHEⅡ评分，同时对比两组死亡率，评价中医辨证在预后判断中的临床意义。方法：对纳入研究的85例ICU危重症患者于入ICU及出ICU时分别进行中医辨证，分为阳类证和阴类证两型，对所有病人进行APACHEⅡ评分，比较两型病人在进入ICU及出ICU时的APACHEⅡ分值，并与死亡率比较。结果：初始为阴类证的患者在入ICU及出ICU时的APACHEⅡ评分显著高于初始为阳类证的患者（P=0．0001及F〈0．05），死亡率亦显著高于阳类证患者（P=0．0369）：治疗后由阳类证转为阴类证患者APACHEⅡ评分较维持阳类证者增高（P=0．0161），而阴类证转为阳类证的患者APACHEⅡ分值较维持阴类证者减低（P=0．0424）。结论：中医证型对危重症的病情程度及预后判断有较好的预测价值，阴类证患者的预后较阳类证患者差，证型转换可能引起预后改变。     

Treatment of premature ejaculation: New drugs and treatment strategies

This review discusses treatment options for men with premature ejaculation (PE), a common sexual dysfunction characterized by short ejaculatory latency, decreased sexual satisfaction, and distress. For a number of reasons, including embarrassment and the belief that PE is a normal part of aging, that it has no effective treatment, or that it will resolve itself, few men with PE seek treatment. Although several treatment options exist (eg, behavioral, cognitive, and sex therapy methods; desensitizing drugs; off-label use of antidepressants, phosphodiesterase type 5 inhibitors, or à-blockers), the majority of men with PE are not satisfied with their results. New pharmacologic drugs develped specifically for the treatment of PE are undergoing evaluation in clinical trials. For example, recent clinical research studies have revealed on-demand administration of one such drug, dapoxetine, which achieved significant improvements in ejaculatory latency, control over ejaculation, and satisfaction with sexual intercourse. In addition, partners of men who received dapoxetine likewise reported improved satisfaction with sexual intercourse. Future studies may reveal that integration of pharmacologic drugs with psychologic and/or behavioral therapy techniques may be the optimal approach to the management of PE. PE is a treatable condition, and new drugs in development may provide benefits over those available.     

4132名少年儿童血压状况调查分析

目的了解7～14岁少年儿童血压特点,为流行病学及预防成人高血压提供参考数据。方法用统一标准采集血压及有关数据,用概率单位法行正态性检验,确定血压95%参考值范围,对年龄与血压和体质指数进行相关性分析,行U检验、t检验。结果随年龄增大血压也逐渐上升,各年龄段男女之间血压差异无统计学意义。体质指数随年龄增大而增加。血压偏高者其体质指数高于同年龄段中值水平。结论年龄与血压和体质指数呈正相关。血压偏高者体质指数都具有较高中值水平。     

体重指数分级标准应用方法的探讨

目的探讨按照体重指数分级标准计算出的体重值应用表的实用价值。方法将身高作为选定变量,其变量值间距为1 cm,按照体重指数分级标准上、下限值,分别乘以身高2(m2),即求出相对应的体重(kg),依此制成应用表。判定时依据身高和实测的体重,对照应用表得出其体重指数分级范围。结果制成并列出以体重值查对其相对应危险值应用表。结论本查对表适用于大规模的预防性健康体检。在人体生长发育阶段能做到自身动态监测,对早期预防肥胖症具有积极作用。