高频振荡通气治疗新生儿呼吸窘迫综合征的临床观察

目的：研究高频振荡通气治疗新生儿呼吸窘迫的临床疗效。方法选取符合新生儿呼吸窘迫诊断的患儿40例，随机分为A组HFOV组和B组CMV组，观察治疗前后A组和B组患儿治疗前、治疗48 h后的动态血气分析以及氧合指数（OI）及吸入氧分数（FiO2）变化，并评价患儿合并症以及病情转归的变化。结果治疗后两组患儿PaO2高于治疗前，治疗后两组患儿PaCO2、FiO2和OI低于治疗前，差异显著P=0.00。A组患儿治疗后PaO2高于B组，A组患儿PaCO2、FiO2、OI低于B组；A组并发症低于B组，P=0.00。结论HFOV治疗新生儿呼吸窘迫综合征，通气效果优于CMV，有效减少并发症的发生，是一种安全、有效的通气模式。     

Review of non‐invasive ventilation in the emergency department: clinical considerations and management priorities

Aims and objectives. We aimed to synthesise evidence from published literature on non‐invasive ventilation to inform nurses involved in the clinical management of non‐invasive ventilation in the emergency department. Background. Non‐invasive ventilation is a form of ventilatory support that does not require endotracheal intubation and is used in the early management of acute respiratory failure in emergency departments. Safe delivery of this intervention requires a skilled team, educated and experienced in appropriate patient selection, available devices and monitoring priorities. Design. Systematic review. Method. A multi‐database search was performed to identify works published in the English language between 1998–2008. Search terms included: non‐invasive ventilation, continuous positive airway pressure and emergency department. Inclusion and exclusion criteria for the review were identified and systematically applied. Results. Terminology used to describe aspects of non‐invasive ventilation is ambiguous. Two international guidelines inform the delivery of this intervention, however, much research has been undertaken since these publications. Strong evidence exists for non‐invasive ventilation for patients with acute exacerbation of congestive heart failure and chronic obstructive pulmonary disease. Non‐invasive ventilation may be delivered with various interfaces and modes; little evidence is available for the superiority of individual interfaces or modes. Conclusions. Early use of non‐invasive ventilation for the management of acute respiratory failure may reduce mortality and morbidity. Though international guidelines exist, specific recommendations to guide the selection of modes, settings or interfaces for various aetiologies are lacking due to the absence of empirical evidence. Relevance to clinical practice. Monitoring of non‐invasive ventilation should focus on assessment of response to treatment, respiratory and haemodynamic stability, patient comfort and presence of air leaks. Complications are related to mask‐fit and high air flows; serious complications are few and occur infrequently. The use of non‐invasive ventilation has resource implications that must be considered to provide effective and safe management in the emergency department.     

Effektivität pulmonaler Rekrutierungsmanöver in der Therapie des akuten Lungenversagens

Zusammenfassung Insgesamt 15 pulmonale Rekrutierungsman?ver nach dem „Open Lung Concept” von B. Lachmann wurden bei 10 Patienten mit akutem Lungenversagen hinsichtlich ihrer Effektivit?t und Nebenwirkungen untersucht. Dabei wurden der Anstieg des arteriellen Sauerstoffpartialdruckes (paO₂), die H?he der zur Rekrutierung erforderlichen Beatmungsdrucke, die H?he der anschlie?end zur weiteren Beatmungstherapie erforderlichen Beatmungsdrucke und die Nebenwirkungen erfasst. In einem druckkontrollierten Beatmungsmodus wurden alle 2–3 Minuten der positive endexspiratorische Druck (PEEP) und der Beatmungsspitzendruck (PIP) um 3–5 mbar erh?ht. Nach jeder Drucksteigerung wurde eine arterielle Blutgasanalyse (BGA) durchgeführt. Erreichte der Anstieg des paO₂ ein Plateau, wurde das Rekrutierungsman?ver beendet. Ergebnisse Durch eine schrittweise Erh?hung des PEEP von 8 (4–15) mbar auf 31 (23–35) mbar bei einem ann?hernd konstanten ΔP von 19 (13–25) mbar konnte der Oxygenierungsindex (paO₂/FiO₂) von 157 (54–269) mmHg auf nahezu die doppelte H?he von 297 (63–515) mmHg angehoben werden. Für die anschlie?ende Beatmungstherapie waren deutlich h?here PEEP-Werte erforderlich als vor der Rekrutierung (13 mbar (9–15 mbar)). Kurzfristige atemmechanische St?rungen (wie Cuffundichtigkeit und Abfall des Atemzugvolumens (AZV)) waren h?ufig; in einigen F?llen kam es zu katecholaminpflichtigen Kreislaufreaktionen. Schlussfolgerung Rekrutierungsman?ver mit einer anschlie?enden l?ngerfristigen Anwendung h?herer PEEP-Werte sind effektive Ma?nahmen zur Oxygenierungssteigerung in der Therapie des akuten Lungenversagens. Nebenwirkungen sind h?ufig, wegen der begrenzten Zeit eines Rekrutierungsman?vers aber beherrschbar und reversibel. Eingegangen: 13. M?rz 2001 Akzeptiert: 17. April 2001     

Occult hepatitis C virus infection among haemodialysis patients

Background and study aims

Hepatitis C virus (HCV) infection is a severe problem among patients on maintenance haemodialysis who are at particular risk for blood-borne infections because of prolonged vascular access and potential for exposure to contaminated equipment. Occult hepatitis C virus infection (OCI) is defined as the presence of HCV RNA in liver or peripheral blood mononuclear cells (PBMCs) in the absence of detectable HCV antibody or HCV RNA in the serum. In this study, we aimed to investigate the existence of occult hepatitis C virus infection in PBMCs of haemodialysis (HD) patients in one center. Moreover, we tried to link the condition to risk factors associated with HCV infection in those patients.

Excision and V–Y plasty reconstruction for giant condyloma acuminatum

Abstract. Background Condyloma acuminata is the most common anorectal lesion in patients infected with human immunodeficiency virus (HIV). Surgical treatment can be challenging in cases where the size and extension into the anal canal make individual excision impossible. These patients require large resections and reconstruction using grafts or local flaps.Methods Six patients were treated for giant perianal condylomas between 1999 and 2001. Four patients were HIV–positive, and were selected for surgical intervention after achieving a T4 count >350 and low viral replication. In 5 cases, the lesions were circularly resected up to the pectinate line and the defect was reconstructed using a bilateral V–Y plasty. In the remaining case, fulguration was possible on one side and a unilateral V–Y plasty was performed.Results There were no infections or healing delays in this series, and the functional and aesthetic results are satisfactory.Conclusion V–Y plasties are a valid method for perianal reconstruction after resection of giant anal condyloma, with good results in selected patients with HIV infection.     

Combination alpha-interferon and lamivudine therapy for alpha-interferon-resistant chronic hepatitis B infection: results of a pilot study

Background/Aims: Alpha-interferon achieves seroconversion in about one third of naive patients. Attempts to achieve seroconversion in patients who have previously failed alpha-interferon have proved disappointing. Combination chemotherapy (alpha-interferon with a nucleoside analogue) might provide a treatment alternative for these patients. We have undertaken a phase 2 study in 20 patients who had previously failed at least one course of alpha-interferon. The study was designed to assess the safety, tolerability and efficacy of the combination.Methods: All patients were treated for 16 weeks with alpha-interferon in combination with 12 or 16 weeks of Lamivudine (3′TC). Patients were followed for 16 weeks post-treatment. Pharmacokinetic studies were performed to identify/exclude significant pharmacokinetic drug interaction.Results: The combination was well tolerated, and side-effects of the combination were indistinguishable from the recognised side-effects of alpha-interferon. Pharmacokinetic studies performed on days 1 and 29 did not show any significant interaction. All patients achieved HBV DNA clearance during treatment, but 19 relapsed at the end of treatment. HBeAg/anti-HBe seroconversion was observed for four patients, but was sustained for a single patient (who also had sustained DNA clearance).Conclusions: Combination therapy with alpha-interferon and lamivudine given for 16 weeks appears safe and is well tolerated. However, for this group of patients who had previously failed interferon monotheraphy appears disappointing, and other treatment strategies should be investigated.     

病毒感染导致的体温升高与血常规的变化关系

目的：分析研究病毒感染导致的体温升高与血常规的变化之间的关系,为临床诊断以及治疗提供重要依据。方法选取2013年5月—2014年5月在妇幼保健院接收的由病毒感染引发的发热病例100例,其中上呼吸道感染者58例（58%）;水痘病毒感染者42例（42%）,分析研究低（37.5～38℃）、中（38.1～39℃）、高热（39.1～40℃）患者的临床血液常规检查特点,根据检查结果对比呼吸道感染毒和水痘病毒血项的不同。结果100例患者平均体温在37.8±0.7℃。其中低温58例（58%）;中温23例（23%）;高温19例（19%）。该研究一共有100例病人,临床血液常规检查正常的一共有17例,占总体的17%,当中白细胞计数平均值在（8.2±2.7）×109/L,淋巴细胞计数百分比平均值在（16±5）%,中性粒细胞百分比平均值在（77.2±8.7）%;低热组病人的临床血液常规异常为79.3%;中度发热组临床血液常规异常为100%,高热组临床血液常规异常为100%,当中以NC升高为主,其次为LC降低,高热组、中热组血常规异常率均高于低热组、高热组、中热组LC降低幅度,NC升高幅度大于低热组,差异有统计学意义（P<0.05）;上呼吸道感染毒组WBC、NC高于水痘病毒感染组,LC低于水痘病毒感染组,差异有统计学意义（P<0.05）。结论病毒感染者体温升高的同时会伴随血常规异常的发生,上呼吸道感染和水痘病毒感染的血常规异常情况有所不同,应酌情结合患者临床症状采取治疗方案。