Anticoagulation with Bivalirudin during Deep Hypothermic Circulatory Arrest in a Patient with Heparin-Induced Thrombocytopenia

Heparin-induced thrombocytopenia is a well-recognized complication of anticoagulation with heparin. We present the case of a patient with recent heparin-induced thrombocytopenia who subsequently needed surgery on an emergency basis for acute type A aortic dissection. This article reports the successful use of bivalirudin, a direct thrombin inhibitor, as an alternative to heparin throughout cardiopulmonary bypass and deep hypothermic circulatory arrest. We contend that bivalirudin is a safe alternative to heparin when performing surgery for aortic dissection and should be considered as an option for use in patients who present with heparin-induced thrombocytopenia.     

亚低温对大鼠脑微血管内皮细胞中P-糖蛋白表达的影响

目的探讨亚低温对大鼠脑微血管内皮细胞中P-糖蛋白表达的影响。方法将原代分离的大鼠脑微血管内皮细胞按培养温度分三组：37℃组、35℃组、32℃组,并在相应温度的培养箱下培养5d。运用免疫细胞方法检测大鼠脑微血管内皮细胞中P-糖蛋白,采用Westernblot方法测定各组细胞中P-蛋白的含量变化。结果37℃组细胞P-糖蛋白表达明显高于亚低温的另外两组（P均〈0．01）,35℃组细胞P-糖蛋白表达高于32℃组（P〈0．05）。结论亚低温情况下对大鼠脑微血管内皮细胞中P-糖蛋白表达量有明显影响,从而对药物药动学和药效学产生影响。     

Catecholaminergic Polymorphic Ventricular Tachycardia: Challenges During Resuscitation and Post–Cardiac Arrest Care

BackgroundCatecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare channelopathy involving cardiac calcium metabolism that often shows up at an early age with misleading clinical symptoms, such as emotion- or exercise-related syncope with a normal resting electrocardiogram. In addition, it might be the underlying cause of sudden cardiac arrest in children or young adults. The particular pathophysiology of CPVT makes it particularly challenging for both resuscitation and the subsequent intensive care management after return of spontaneous circulation (ROSC).Case ReportWe describe a case of sudden cardiac arrest in an 11-year-old girl affected by CPVT, with a particular focus on the most challenging aspects of resuscitation and intensive care management in light of other experiences found in the literature. A warning about the prodysrythmicity of mild hypothermia induced in the context of post-ROSC targeted temperature management in this particular population of patients and its possible physiopathological basis are discussed.Why Should an Emergency Physician Be Aware of This?CPVT is a rare but potentially lethal cause of stress-related syncope and sudden cardiac arrest in children and young adults. The diagnosis of CPVT requires a high level of suspicion and an interdisciplinary approach, including some adjustments during resuscitation and post–cardiac arrest care.     

亚低温联合鼠神经生长因子对缺氧缺血性脑病患儿凝血功能及神经功能的影响

目的观察亚低温联合鼠神经生长因子(mNGF)对缺氧缺血性脑病(HIE)患儿凝血功能及神经功能的影响。方法按随机数字表法将84例HIE患儿分为观察组(42例,亚低温+m NGF疗法)和对照组(42例,亚低温疗法)。比较两组的治疗效果。结果治疗后,两组PT、NBNA评分均改善,且观察组优于对照组(P<0.05)。两组ESR、FIB、S100B、NSE、MBP水平均降低,且观察组低于对照组(P<0.05)。结论亚低温和mNGF联合治疗能改善HIE患儿的凝血功能及神经功能,促进患儿预后恢复。     

复合保温管理对肝癌患者术中低体温的预防效果分析

目的 探讨复合保温管理对肝癌患者术中低体温的预防效果.方法 根据干预方法的不同将108例接受手术治疗的肝癌患者分为观察组(n=60)和对照组(n=48),观察组患者行复合保温管理,对照组患者行常规保温干预.比较两组患者进入手术室时、停用麻醉药物时、麻醉后每隔30 min时及手术结束时的体温,比较两组患者的低体温发生情况...     

对胸外科手术患者浅低温综合护理干预的效果评价

目的降低胸外科手术患者浅低温的发生率,提高围术期的护理质量。方法将普通胸外科手术患者各155例分为两组,比较手术患者浅低温综合护理干预的临床效果。对照组为常规护理;实验组采取如下干预方法：恒定室温、冲洗体腔盐水加温、铺垫38℃水循环变温毯、手术裸露部位用不同形状棉毯保护、热空气暖风装置保护体温,并制定手术患者浅低温预防的护理常规、流程、制度。评价指标为：患者年龄、手术时间、切口感染、肺部感染和浅低温发生率。结果两组浅低温发生率分别为57．41％、18．06％;切口感染率分别为8．38％、0．64％;肺部感染率分别为29．67％、5．8％。3项评价指标均有显著性差异（P〈0．01）。结论胸外科围术期患者的体温保护应成为手术室的护理常规,体温保护是提高围术期患者的护理质量、降低术后并发症的重要影响因素,应成为胸外科手术护理不可忽视的重要护理内容。     

亚低温治疗重型颅脑损伤中脑组织氧分压的临床意义

目的观察亚低温治疗重型颅脑损伤过程中患者颅内压及脑组织氧分压的变化及临床意义。方法将80例急性重型颅脑损伤患者,随机分为亚低温治疗组(40例)和对照组(40例)。亚低温组入院后或术后立即给予亚低温治疗,保持肛温在32~34℃,持续24h~5d;对照组给予常规治疗。两组均观察颅内压(ICP)和脑组织氧分压(PbtO2)变化。结果亚低温组治疗后,ICP明显下降,PbtO2逐渐升高,与对照组相比有显著性差异。结论亚低温治疗能降低脑外伤后增高的ICP,提高PbtO2;伤后24h内持续PbtO2<5mmHg预示患者预后不良。     

亚低温3 h可抑制新生大鼠缺氧缺血性脑细胞凋亡的影响

实验建立缺氧缺血性脑损伤新生大鼠模型,于缺血缺氧后立即采用31 ℃亚低温分别持续3,6,15 h进行全身干预,原位末端标记技术标记显示大鼠大脑皮质、海马、室周白质的凋亡细胞数减少,免疫组织化学法检测的细胞凋亡相关蛋白bcl-2和细胞周期调节相关蛋白p16表达降低,综合比较全部结果数据显示,且以亚低温干预3 h细胞凋亡抑制效果最佳,其次是亚低温干预6 h,而亚低温干预15 h可出现大脑皮质神经元细胞数降低的不良反应。结果证实,31 ℃亚低温干预可通过抑制细胞凋亡的方式对缺氧缺血性脑损伤组织起保护作用,3 h为最佳干预时间。