儿茶酚胺类药物对感染性休克兔胃肠灌注的影响

Objective To assess the effects of dopamine,dobutamine and norepinephrine on the P(g-a)CO2 and superior mesenteric blood flow in septic shock.Methods Rabbit septic shock model was established by challenging with intravenous injection of lipopolysaccharides from Escherichia coil(2 mg/kg).The rabbits with septic shock were randomly assigned to 3 groups-dopamine group(n = 8),dobutamine group(n = 8) and norepinephrine group(n = 8).Apart from volume resuscitation with normal saline solution [20 ml/(kg· h)]，dopamine[5μg/(kg·min)],dobutamine[(5μg/(kg·min)]and norepinephrine [(1μg/(kg·min)]were infused in dopamine group,dobutamine group and norepinephrine group respeclively.Cardiac index(CI) and superior mesenteric blood flow index(SMBFI) were continuously monitored by doppler flowrneter.Gastric mucosal PCO2 was evaluated by gas tonometry every 10 min.Arterial and venous blood gas analyses and lactate levels were measured every 1 h.Results MAP,CI,and SMBFI significandy decreased and P(g-a) CO2 increased after lipopolysaccharides infusion in three groups.After 2-hour treatment,MAP in norepinephrine group[(70 +3) mm Hg]was higher than that of dopamine group[(66±4) mm Hg]and dobutamine group[(65±4) mm Hg](P ＜0.05).SMBFI in norepinephrine group [(18.7±2.9) ml/(kg·min)]was higher than that of dopamine group[(16.2±1.6) ml/(kg·min)]and dobutamine group[(15.8±1.9) ml/(kg·min)](P＜0.05).P(g-a) CO2 in norepinephrine group [(30±6) mm Hg]was lower than that of dobutamine group[(23±5)mm Hg](P＜0.05).Condnsion As an adjuvant therapy of volume resuscitation,norepinephrine is more effective than low dose dopamine and dobutamine in improving splanchnic perfusion.     

急诊室小儿心搏呼吸骤停流行病学调查及初步复苏效果评估

目的 调查儿科急诊室内小儿心搏呼吸骤停情况,分析影响心肺复苏效果的因素,并对复苏效果做初步评估.方法 采用标准的院内Utstein格式(the in-hospital Utstein style)前瞻性收集数据,填写调查表,内容包括:心搏呼吸骤停的原因、影响心肺复苏效果的因素及复苏效果.用自主循环恢复(return of spontaneous circulation,ROSC)评估初步复苏效果.结果 2008年7月1日至2010年2月28日,北京儿童医院急诊室全部就诊患者(29 d至18岁)182 380例,心搏呼吸骤停237例(0.13％).实施心肺复苏169例,其中ROSC 88例(52.1％).性别和年龄对ROSC的影响差异无统计学意义.原发病和初始节律对ROSC的影响有显著性意义.有无院前转运的ROSC分别为64.1％和44.8％；CPR时间≤10 min、10 ～ 30 min及＞30 min的ROSC分别为67.5％、61.4％和30.5％,差异均具有统计学意义.多元逐步Logistic回归分析显示,初始节律和CPR持续时间对ROSC有明显影响.结论 急诊室内小儿心肺复苏的ROSC为52.1％.初始节律和CPR持续时间对ROSC有明显影响.     

儿茶酚胺类药物对感染性休克兔胃肠灌注的影响

Objective To assess the effects of dopamine,dobutamine and norepinephrine on the P(g-a)CO2 and superior mesenteric blood flow in septic shock.Methods Rabbit septic shock model was established by challenging with intravenous injection of lipopolysaccharides from Escherichia coil(2 mg/kg).The rabbits with septic shock were randomly assigned to 3 groups-dopamine group(n = 8),dobutamine group(n = 8) and norepinephrine group(n = 8).Apart from volume resuscitation with normal saline solution [20 ml/(kg· h)]，dopamine[5μg/(kg·min)],dobutamine[(5μg/(kg·min)]and norepinephrine [(1μg/(kg·min)]were infused in dopamine group,dobutamine group and norepinephrine group respeclively.Cardiac index(CI) and superior mesenteric blood flow index(SMBFI) were continuously monitored by doppler flowrneter.Gastric mucosal PCO2 was evaluated by gas tonometry every 10 min.Arterial and venous blood gas analyses and lactate levels were measured every 1 h.Results MAP,CI,and SMBFI significandy decreased and P(g-a) CO2 increased after lipopolysaccharides infusion in three groups.After 2-hour treatment,MAP in norepinephrine group[(70 +3) mm Hg]was higher than that of dopamine group[(66±4) mm Hg]and dobutamine group[(65±4) mm Hg](P ＜0.05).SMBFI in norepinephrine group [(18.7±2.9) ml/(kg·min)]was higher than that of dopamine group[(16.2±1.6) ml/(kg·min)]and dobutamine group[(15.8±1.9) ml/(kg·min)](P＜0.05).P(g-a) CO2 in norepinephrine group [(30±6) mm Hg]was lower than that of dobutamine group[(23±5)mm Hg](P＜0.05).Condnsion As an adjuvant therapy of volume resuscitation,norepinephrine is more effective than low dose dopamine and dobutamine in improving splanchnic perfusion.     

儿茶酚胺类药物对感染性休克兔胃肠灌注的影响

Objective To assess the effects of dopamine,dobutamine and norepinephrine on the P(g-a)CO2 and superior mesenteric blood flow in septic shock.Methods Rabbit septic shock model was established by challenging with intravenous injection of lipopolysaccharides from Escherichia coil(2 mg/kg).The rabbits with septic shock were randomly assigned to 3 groups-dopamine group(n = 8),dobutamine group(n = 8) and norepinephrine group(n = 8).Apart from volume resuscitation with normal saline solution [20 ml/(kg· h)]，dopamine[5μg/(kg·min)],dobutamine[(5μg/(kg·min)]and norepinephrine [(1μg/(kg·min)]were infused in dopamine group,dobutamine group and norepinephrine group respeclively.Cardiac index(CI) and superior mesenteric blood flow index(SMBFI) were continuously monitored by doppler flowrneter.Gastric mucosal PCO2 was evaluated by gas tonometry every 10 min.Arterial and venous blood gas analyses and lactate levels were measured every 1 h.Results MAP,CI,and SMBFI significandy decreased and P(g-a) CO2 increased after lipopolysaccharides infusion in three groups.After 2-hour treatment,MAP in norepinephrine group[(70 +3) mm Hg]was higher than that of dopamine group[(66±4) mm Hg]and dobutamine group[(65±4) mm Hg](P ＜0.05).SMBFI in norepinephrine group [(18.7±2.9) ml/(kg·min)]was higher than that of dopamine group[(16.2±1.6) ml/(kg·min)]and dobutamine group[(15.8±1.9) ml/(kg·min)](P＜0.05).P(g-a) CO2 in norepinephrine group [(30±6) mm Hg]was lower than that of dobutamine group[(23±5)mm Hg](P＜0.05).Condnsion As an adjuvant therapy of volume resuscitation,norepinephrine is more effective than low dose dopamine and dobutamine in improving splanchnic perfusion.     

关于肺孢子菌肺炎的诊断和治疗——如何运用《儿童侵袭性肺部真菌感染诊治指南(2009版)》

近年来,儿童侵袭性肺部真菌感染的发病率呈上升趋势.因肺部真菌感染的病原学检查阳性率低,肺活检在儿童的应用又受到一定限制,易造成漏诊或误诊.<儿童侵袭性肺部真菌感染诊治指南(2009版)>的推出对临床规范该类疾病的诊治非常重要[1].     

高频振荡通气治疗新生儿胎粪吸入综合征

曾健生，李克华，崔玉涛，等．中华儿科杂志，２００１，３９４：１９５１９７．采用高频振荡通气治疗９例患胎粪吸入综合征的新生儿。通过逐渐增加平均气道压１．９６ｋＰａ至３０ｋＰａ实施肺复张策略的同时调节振荡压力幅度４．４ｋＰａ至５．９ｋＰａ即４５ｃｍＨ２Ｏ至６０ｃｍＨ２Ｏ及振荡频率７Ｈｚ至１５Ｈｚ，使动脉血二氧化碳分压ＰａＣＯ２为４．７ｋＰａ至８．０ｋＰａ。治疗过程中监测心率、血压、动脉血气及氧合指数。通过治疗，以实现吸入氧体积分数为０．４或以下时，经皮氧饱和度等于或超过０．９。结果：８例患儿在施行…     

重症手足口病的特点与诊治

手足口病(hand-food-mouth disease,HFMD) 是一种由肠道病毒引起的急性传染性疾病,传染性强, 传播途径复杂,在短期内即可造成大流行.2008年安徽省阜阳市爆发该病流行,并出现一些合并脑炎、肺水肿和肺出血的重症病例,20余例死亡,引起我国医疗卫生界及公众的重视.及早诊断并积极治疗重症病例,对降低该病病死率有重要意义.     

高频振荡通气的肺复张策略

高频振荡通气(HFOV)已成为治疗小儿缺氧性呼吸衰竭的重要通气方法,肺复张(recruitment)是高频振荡通气的基本策略,其目的是使HFOV在最佳肺容量状态下进行。肺复张有2种基本方法:持续肺充气和逐步增加平均气道压。它可以减少肺损伤的发生,改善肺部氧合,是HFOV取得成功的重要前提。     

儿童重症监护病房心肺复苏的回顾性分析

目的分析在儿童重症监护病房(PICU)心肺复苏(CPR)的有效性及影响CPR存活率的因素。方法回顾性分析PICU发生呼吸心跳骤停而行CPR的临床情况,评价其与CPR存活率的关系。不包括仅用辅助正压通气或复苏药物而未施行胸外按压的病例。结果1998年4月至2004年8月间北京儿童医院PICU共258例患儿施行CPR,131例(50.8%)初步复苏成功,36例(14.0%)治愈出院。性别和年龄对存活率的影响差异无显著性。原发病及其合并症对存活率有显著影响。入PICU24h内及24h后行CPR其存活率分别为23.1%和17.4%;CPR时间≤5min,5～15min及≥5min的存活率分别为53.7%,23.5%和2.1%,差异均有显著性。CPR次数增多存活率下降。结论PICU行CPR后患儿的存活率较低。原发病及其合并症、复苏时间、复苏次数及入住ICU至心肺复苏时间是影响存活率的重要因素。     

高频振荡通气在儿科临床的应用

高频振荡通气为一种新的机械通气方法，本文就其概念，气体交换机理，通气策略，临床应用，注意事项及发展方向作一综述。