A comparison of pulmonary and femoral artery thermodilution cardiac indices in paediatric intensive care patients

We have assessed the agreement between pulmonary artery and femoral artery (COLD) thermodilution measurements of the cardiac index (C1) in a group of paediatric intensive care patients. The COLD method gave consistently higher cardiac index values than the pulmonary artery catheter (PAC); however, the difference was small, with a mean value of 0.191/min⁻¹ m⁻² or 4.4% of the mean cardiac index. This difference is not clinically important and suggests that, under these circumstances. the COLD system provides an acceptable alternative to the pulmonary artery catheter for measurement of the cardiac index at the bedside.     

Perioperative haemodynamic effects of an intravenous infusion of calcium chloride in children following cardiac surgery

Murdoch IA, Qureshi SA, Huggon IC. Perioperative haemodynamic effects of an intravenous infusion of calcium chloride in children following cardiac surgery. Acta Pzdiatr 1994;83:658–61. Stockholm. ISSN 0803–5253
Twelve children received an infusion of 10% calcium chloride 0.1 ml/kg to a maximum dose of 5 ml, infused over 5 min, following open heart surgery. Blood ionized calcium, systemic arterial pH, cardiac index, mean systemic arterial blood pressure and systemic vascular resistance index were measured at baseline and repeated 20 and 40 min following completion of the infusion. There was considerable overlap, with no significant differences in the response to the calcium chloride infusion between children with ionized hypocalcaemia (< 1.1 mmol/l) and those with ionized normocalcaemia when its effect on percentage change in either the haemodynamic or biochemical measurements was assessed ( p>0.2 for all measurements; Mann-Whitney). For this reason they were treated as a single group. Significant changes from baseline were noted in mean systemic arterial pressure (p 10.02), cardiac index (p<0.01) and systemic vascular resistance index (p<0.01) after completion of the calcium chloride infusion when analysed using Friedman's two-way analysis of variance. A significant increase in mean systemic arterial blood pressure occurs after an infusion of 10% calcium chloride as a direct result of an increase in the systemic vascular resistance index with a concomitant decrease in cardiac index.     

Clinical factors influencing the efficacy of pooled platelet transfusions

To determine the relative importance of clinical factors on the efficacy of platelet transfusions, 941 pooled platelet transfusions from HLA-unmatched donors were studied prospectively in 133 patients with bone marrow failure. Multiple linear regression analyses identified the major factors influencing one-hour-corrected increments (CI) as prior splenectomy, bone marrow transplantation, disseminated intravascular coagulation, concurrent intravenous amphotericin B, splenomegaly, and HLA antibody grade. The relative impact of these factors on CI has been quantitated by using a formula developed from these data. A linear relationship was demonstrated between increasing percentage of HLA antibody grade and decreasing CI. A number of other factors were less important in the linear regression model than the aforementioned major factors. These included platelet-specific antibodies, concurrent antibacterial antibiotics, clinical bleeding grade, and temperature. Factors that did not influence CI included the number of prior platelet transfusions, prior granulocyte transfusions, prior red cell transfusions, infection, age, blood group, diagnosis, sex, pretransfusion platelet count, prior pregnancies, and concurrent antineoplastic drugs. This study identified major clinical factors that significantly influenced CI and were major causes of refractoriness to pooled platelet transfusions.     

小儿严重外伤性硬脑膜静脉窦损伤19例

目的探讨小儿严重硬脑膜静脉窦损伤的治疗方法。方法回顾性分析19例小儿严重硬脑膜外伤性静脉窦损伤的诊治经过。19例中,采取上矢状窦结扎4例,上矢状窦修补14例,人造血管静脉窦重建1例。在处理静脉窦损伤的同时行颅内血肿清除及颅骨凹陷骨折复位术,其中7例开放性损伤患儿均行颅骨片一期植入术。结果全组痊愈14例(73.6%),肢体瘫痪2例(10.5%),死亡3例(15.7%)。术中平均失血量500 ml(200～4000 ml),其中8例出现失血性休克。3例死亡患儿均因术中严重失血导致不可逆性休克而死亡。结论小儿严重硬脑膜静脉窦损伤伤情重,处理困难,术中死亡率高。术前应根据颅骨骨折类型、部位及程度对静脉窦损伤作出诊断,充分准备,快速控制大出血,果断采取不同的止血及修补措施,以达到止血及恢复静脉窦通畅的目的。     

丹参多酚酸盐对实验性小鼠草酸钙结晶生成的影响

目的 观察中药丹参多酚酸盐对小鼠肾脏草酸钙结晶生成的干预效果,并探讨其可能的作用机制.方法 24只8周龄雄性C56BL/6小鼠根据丹参多酚酸盐干预与否以及干预浓度（80mg/kg、160 mg/kg）进行分组,每组8只.各组小鼠均给予腹腔注射乙醛酸盐（100 mg/kg）造模,丹参多酚酸盐干预组在乙醛酸盐诱导结晶肾损伤基础上加用不同浓度的丹参多酚酸盐注射液,均为1次/d,连续给药7d后,收集肾脏组织标本.光镜下观察各组小鼠肾组织中草酸钙结晶生成情况;检测肾组织中钙含量、脂质过氧化丙二醛（malondialdehyde,MDA）、谷胱甘肽（glutathione,GSH）、过氧化氢酶（catalase,CAT）及超氧化物歧化酶（superoxide dismutase,SOD）活性.结果 与模型组相比,给予丹参多酚酸盐注射液后的小鼠肾组织SOD、GSH和CAT显著升高,而MDA和肾组织钙含量显著下降（P＜0.05）,但丹参多酚酸盐两种浓度间未见明显的量效关系.结论 丹参多酚酸盐能有效的抑制由乙醛酸盐诱导的小鼠草酸钙结晶的生成.