参芪扶正注射液对体外循环术后红细胞免疫功能的影响

目的探讨参芪扶正注射液（简称参芪液）对体外循环（CPB）术后患者红细胞免疫功能的影响。方法选取20例体外循环手术患者,分为参芪液组与对照组（每组10例）。参芪液组于术前5天开始及术中体外循环结束时每日静脉滴注参芪液250mL。于麻醉前、术后6h、24h、72h及7d抽取肝素抗凝的外周静脉血,动态检测两组患者红细胞C3b受体花环率（RBC-C3bRR）、红细胞免疫复合物花环率（RBC-ICR）。结果参芪液组患者RBC-C3bRR、RBC-ICR术后6h、24h、72h及7d明显高于对照组,并且于术后7d恢复到正常水平,红细胞免疫功能明显优于对照组患者（P〈0.05）。结论CPB可以导致红细胞免疫功能低下,围术期应用参芪扶正注射液能明显改善CPB患者术后红细胞的免疫功能,促进受损红细胞免疫功能的恢复。     

血脂异常中医证候规律及其客观化研究

目的 探讨血脂异常中医证候规律及其与C-反应蛋白、同型半胱氨酸、颈动脉超声、血脂、血液黏度之间的相关性。方法入选血脂异常患者152例,共筛选出32个症状、体征（包括舌象、脉象）,并对其进行了分级量化及因子分析;同时检测患者的血脂、C-反应蛋白、同型半胱氨酸、颈动脉超声、血液黏度等指标,采用典型相关分析的方法,探讨不同证候与相应理化指标之间的相关性。结果通过因子分析得出5种证候,分别是肾阴虚证、脾气虚证、痰浊内阻证、血瘀证和痰瘀互阻证。典型相关分析结果表明,肾阴虚证C-反应蛋白含量显著增高,血液黏度显著增高;脾气虚证极低密度脂蛋白胆固醇（VLDL-C）显著增高;痰浊内阻证总胆固醇显著增高,高密度脂蛋白胆固醇（HDL-C）显著降低;痰瘀互阻证同型半胱氨酸显著增高。结论痰浊内阻证、脾气虚证、肾阴虚证、血瘀证和痰瘀互阻证是血脂异常的常见中医证候,且不同证候与相应的理化指标具有相关性,从而为血脂异常证候客观化提供了新的依据。     

Serum Aspergillus galactomannan antigen values strongly correlate with outcome of invasive aspergillosis: a study of 56 patients with hematologic cancer

BACKGROUND: Determining the outcome of patients with aspergillosis can be particularly difficult because patients with aspergillosis are at risk for other conditions that mimic this infection. Galactomannan is an Aspergillus-specific antigen released during invasive aspergillosis and is detected by the quantitative serum galactomannan index (GMI) test. METHODS: Using a kappa correlation coefficient test (KCC), the strength of correlation was determined between GMI and survival outcome of aspergillosis among 56 adults with hematologic cancer (90% had myeloma) who underwent serial GMI monitoring until hospital discharge or death. RESULTS: All 56 patients received antineoplastic therapy (myeloablative followed by stem cell transplantation [autologous in 21 patients and allogeneic in 3 patients] or nonmyeloablative therapy [32 patients]). The overall correlation between survival outcome and GMI was excellent (KCC = 0.8609; 95% confidence interval [95% CI], 0.7093-1.000 [P < .0001]) and was comparable among neutropenic and nonneutropenic patients (KCC = 0.8271; 95% CI, 0.6407-1.000 [P < .0001] and KCC = 1.0; 95% CI, 1-1 [P = .0083], respectively). CONCLUSIONS: The survival outcome of patients with aspergillosis strongly correlated with serum GMI. These findings have important implications for patient care and clinical trials of mold-active antifungal agents.     

Continuous positive airway pressure and lung separation during cardiopulmonary bypass to facilitate congenital heart surgery via the right thorax in children

We describe a fast track anesthesia technique that facilitates congenital heart surgery via right axillary thoracotomy in children. Continuous positive airway pressure on the dependent lung, before and during cardiopulmonary bypass, approximates the heart towards the chest wall incision, and significantly improves the surgeon's access to the heart.     

急性脑梗死患者血糖波动与NIHSS评分、mRS评分及血清炎症因子水平的相关性研究

目的 研究急性脑梗死患者血糖波动与血清炎症因子水平、美国国立卫生院研究卒中表(NIHSS)评分和改良Rankin量表(mRS)评分的相关性.方法 将河北大学附属医院神经内科2019年2月-2021年2月间收治的97例急性脑梗死患者纳入观察组,同时将60例健康体检合格者纳入对照组,比较2组血糖波动参数及血清炎症因子,比较...     

Flow-related techniques for preoperative goal-directed fluid optimization

Background. Improved postoperative outcome has been demonstratedby perioperative maximization of cardiac stroke volume (SV)with fluid challenges, so-called goal-directed therapy. OesophagealDoppler (OD) has been the most common technique for goal-directedtherapy, but other flow-related techniques and parameters areavailable and they are potentially easier to apply in clinicalpractice. The objective of this investigation was thereforeto use OD for preoperative SV maximization and compare the findingswith a Modelflow determined SV, with an OD estimated correctedflow time (FTc), with central venous oxygenation () and with muscle and brain oxygenation assessedwith near infrared spectroscopy (NIRS). Methods. Twelve patients scheduled for radical prostatectomywere anaesthetized before optimization of SV estimated by OD.A fluid challenge of 200 ml colloid was provided and repeatedif at least a 10% increment in OD SV was obtained. Values werecompared with simultaneously measured values of Modelflow SV,FTc, and muscle and cerebral oxygenation estimated by NIRS. Results. Based upon OD assessment, optimization of SV was achievedafter the administration of 400–800 ml (mean 483 ml) ofcolloid. The hypothetical volumes administered for optimizationbased upon Modelflow and differed from OD in 10 and 11 patients, respectively. Changes in FTcand NIRS were inconsistent with OD guided optimization. Conclusion. Preoperative SV optimization guided by OD for goal-directedtherapy is preferable compared with Modelflow SV, FTc, NIRSand until outcome studies for the latter are available.     

Semi-invasive monitoring of cardiac output by a new device using arterial pressure waveform analysis: a comparison with intermittent pulmonary artery thermodilution in patients undergoing cardiac surgery

BACKGROUND: Thermodilution technique using a pulmonary artery catheter (PAC)is a widely used method to determine cardiac output (CO). Itis increasingly criticized because of its invasiveness and itsunclear risk–benefit ratio. Thus, less invasive techniquesfor measuring CO are highly desirable. We compared a new, semi-invasivedevice (FloTrac/Vigileo^TM) using arterial pressure waveformanalysis for CO measurement in patients undergoing cardiac surgerywith bolus thermodilution measurements. METHODS: Forty patients undergoing coronary artery bypass grafting orvalve repair were enrolled. A PAC was inserted and routine radialarterial access was used for semi-invasive determination ofCO with the Vigileo. CO was measured simultaneously by bolusthermodilution and the Vigileo technique after induction ofanaesthesia (T1), before cardiopulmonary bypass (CPB) (T2),after CPB (T3), after sternal closure (T4), on arrival in theintensive care unit (ICU) (T5), and 4 h (T6), 8 h(T7), and 24 h after surgery (T8). CO was indexed to thebody surface area (cardiac index, CI). RESULTS: A total of 244 pairs of CI measurements were analysed. Biasand precision (1.96 SD of the bias) were 0.46 litre min^–1m^–2 and ± 1.15 litre min^–1 m^–2 (r =0.53) resulting in an overall percentage error of 46%. Subgroupanalysis revealed a percentage error of 51% for data pairs obtainedintraoperatively (T1–T4), 42% in ICU (T5–T8), and56% for values obtained during low CI (T1–T8). CONCLUSIONS: In cardiac surgery patients, CO measured by a new semi-invasivearterial pressure waveform analysis device showed only moderateagreement with intermittent pulmonary artery thermodilutionmeasurement.     

Measurement of cardiac output: a comparison between transpulmonary thermodilution and uncalibrated pulse contour analysis

Background: Recently, continuous monitoring of cardiac output (CO) basedon pulse contour analysis (Vigileo^®) has been introducedinto practice. In this clinical study, we evaluated the accuracyof this system by comparing it with the transpulmonary thermodilutiontechnique (TPID) in septic patients. Methods: We studied 24 mechanically ventilated patients with septic shock(16 male, 8 female, age 26–77 yr) receiving treatmentwith norepinephrine who for clinical indication underwent haemodynamicmonitoring by the transpulmonary thermodilution technique usinga PiCCO^®plus system (Pulsion Medical Systems, Munich, Germany).In parallel, arterial pulse contour was applied using the femoralarterial pressure curve (FloTrac^® pressure sensor, Vigileo^®monitor, Edwards Lifesciences, Irvine, USA). After baselinemeasurement, mean arterial pressure was elevated by increasingnorepinephrine dosage, and CO was measured again before meanarterial pressure was reduced back to baseline levels. Fluidstatus and ventilator settings remained unchanged throughout.At each time point, CO by transpulmonary thermodilution wascalculated from three central venous bolus injections of 15ml of saline (<8°C). Linear regression and the Bland–Altmanmethod were used for statistical analysis. Results: Overall, CO was 6.7 (SD 1.8) (3.2–10.1) litre min^–1for CO(TPID) and 6.2 (2.4) (3.0–17.6) litre min^–1for CO(Vigileo^®). Linear regression revealed: CO(Vigileo^®)= 1.54 + 0.72 x CO(TPID) litre min^–1, r² = 0.26 (P <0.0001). Mean bias between techniques [CO(TPID)–CO(Vigileo^®)]was 0.5 litre min^–1 (SD 2.3 litre min^–1). Correlationcoefficients at the three time points were not significantlydifferent from each other. Conclusions: Pulse contour analysis-derived CO (Vigileo^® system) underestimatesCO(TPID) and is not as reliable as transpulmonary thermodilutionin septic patients.     

老年慢性肺源性心脏病诊治分析

目的 探讨老年慢性肺心病的病因及防治措施.方法 对我院2004年7月-2011年1月收治的65例老年慢性肺心病的临床资料进行回顾性分析.结果 本组65例老年慢性肺心病患者治愈56例,死亡9例.结论 老年慢性肺心病是一种多发病、常见病,积极治疗原发病,给予合理的营养支持治疗,是减少患病率和病死率的关键.