固尔苏治疗NRDS前后血管内皮分泌功能的改变

目的 :研究肺表面活性物质 (PS)治疗新生儿呼吸窘迫综合征 (NRDS)前后血管内皮分泌功能变化及可能的治疗机理。方法 :用PS制剂固尔苏治疗 18例NRDS患儿 ,于治疗前 3 0min ,治疗后 1、 6、 12、 2 4h ,用硝酸还原酶法测定NO (一氧化氮 )、放射免疫法测定ET (内皮素 )、 6 K PGF1α (6 酮前列环素 )。结果 :固尔苏治疗后患儿NO、 6 K PGF1α明显升高 ,ET明显下降 ,与治疗前比较有显著性差异 (P <0 0 1)。治疗后 1、 6、 12、 2 4hNO、6 k PGF1α、ET各组间两两比较无明显差异 (P >0 0 5 )。结论 :PS治疗NRDS的机理可能是通过改善血管内皮功能发挥作用 ,为用外源性NO吸入和静注前列环素辅助治疗NRDS提供可能的实验依据。     

Psychological and clinical effects of renal biopsy performed using sedation

.A sedation regimen using sequential oral trinepazine, intravenous Pethco (pethidine, chlorpromazine and promethazine) and diazemuls was evaluated in children having native kidney (n = 17) and transplant kidney (n = 17) biopsies. Biopsy was successful in all cases, with no serious side effects. A self-reported scale of memory recall and pain perception showed the optimal time for biopsy to be between 30 and 90 min after the intravenous Pethco. The child’s level of distress was measured by a self-reported scale, a parent-reported scale and an observational scale for doctors and nurses; 45% of children rated themselves highly distressed prior to the procedure, their parents being the best assessors of this distress. Younger children and those undergoing native kidney biopsy had less understanding of the procedure. Children’s worries could be clearly categorised into procedural and outcome issues: those undergoing transplant biopsy were more worried about outcome, whereas those undergoing native kidney biopsy were more worried about the procedure. Received April 3, 1995; received in revised form and accepted April 17, 1996     

Aversive properties of theκ opioid agonist U50,488 in the week-old rat pup

Opioids have been shown to produce analgesia and to be reinforcing during the first week of life in the rat. Opioids also have analgesic actions in both the infant and adult, but can be aversive in the mature animal. We examined the aversive effects of the opioid agonist U50,488 during the first postnatal week in the rat pup in three ways. In the first experiment, U50,488, injected peripherally (1.0–30.0 mg/kg), was paired with an odor and pups were tested 8 h later for positional preference for avoidance of that odor. This task is similar to conditioned preference/aversion tests used with adult animals. Both 3- and 7-day-old pups learned to avoid the odor adulterated side at the two higher doses. When exposed to odors previously associated with U50,488, pups at both ages decreased locomotor activity. In a second experiment, acute treatment with U50,488 increased ultrasonic distress vocalizations (USV) equally at 3 and 7 days of age, increased locomotor activity, and decreased rectal temperature. Neither of the latter two effects was correlated with the increase in USV production. The third experiment showed that conditioned odor cues increased USV 8 h later in 3- and 7-day-old pups at 1.0–10.0 mg/kg without changes in activity or rectal temperature. The results from these studies suggest that U50,488 can produce aversions in the neonatal rat pup as it does in the adult.Supported by U.S.P.H.S. grant DA-06600     

Behavioral and autonomic responses to intermittent social stress: differential protection by clonidine and metoprolol

The present study investigated physiological and pharmacological characteristics of socially stressed animals. Specifically, we examined (1) to what degree autonomic and behavioral stress reactions during intermittent confrontations between an intruder male adult Long-Evans rat with an aggressive resident undergo habituation, and (2) to what extent the defeat-experienced animal can be protected against these stress reactions with clonidine or metoprolol, two adrenergic agents with clinical anxiolytic effects. We developed an acute social stress situation that consisted of initially placing an experimental rat as an intruder into the homecage of a resident while the resident was not present, thereafter permitting brief physical agonistic interactions with the reintroduced resident until the intruder was forced into a submissive supine posture and emitted ultrasonic vocalizations (USV), and eventually exposing the intruder to the resident's threats for one hour, while being shielded from potentially injurious attacks (threat encounter). Over the course of the initial 4-weekly threat encounters the acute tachycardia but not the hyperthermic stress responses decreased in magnitude. Following the first three threat encounters core temperature (T_c) was significantly elevated for at least 3 h. The T_c was already elevated when the repeatedly defeated intruder was confronted with the olfactory cues of the resident's cage. This conditioned anticipatory hyperthermia developed in the course of the first three confrontations and was paralleled by a decrease in exploratory and motor behavior and by an increase in defensive behaviors and in both types of USV emitted in the low (20–30 kHz) and the high (31–70 kHz) frequency range. Clonidine (0.01–0.1 mg/kg, IP), an ₂-adrenergic agonist and metoprolol, a -adrenergic blocker (1.0–10.0 mg/kg, IP), dose-dependently prevented the tachycardic response to stress. Only clonidine, but not metoprolol, also attenuated the rise in T₀ during the 1-h agonistic interaction. Clonidine decreased those aspects of motor behavior (e.g. rearing, walking) that are of lesser cost for the individual but maintained high levels of defensive reactions and increased the duration of low USV. The high doses of clonidine (0.06, 0.1 mg/kg) attenuated the homeostatic regulation and sedated the intruder while exposed to threats during a social confrontation. The absence of attenuation of the high level of defensive behavior and the prolonged low USV suggest a stress intensification by the higher doses of clonidine. In conclusion, after the fourth encounter, the autonomic, behavioral and vocal response pattern prior to and during repeated weekly confrontations show no evidence for habituation for the following 6 weeks. Moreover, adrenergic therapeutic agents that are applied to treat symptoms of anxiety block the tachycardic response but may actually intensify defensive behavior and certain stress vocalizations.     

Periventricular- intraventricular hemorrhage in the premature infant- A historical perspective

The objective of this chapter is to trace the evolution of intraventricular hemorrhage in the premature infant highlighting the importance of the germinal matrix, a critical role for cerebral blood flow changes in the genesis of hemorrhage, clinical factors that increase the bleeding risk, and potential preventative strategies. In 1976, neuropathological studies demonstrated capillary rupture within the germinal matrix as the precursor of hemorrhage. In 1980, introduction of cranial ultrasound facilitated diagnosis of intraventricular hemorrhage. In 1979, loss of cerebral autoregulation in sick newborn infants was demonstrated. In the 1980’s, studies demonstrated the importance of intravascular factors in provoking hemorrhage. In 1983, the association of cerebral blood flow velocity fluctuations and subsequent hemorrhage was demonstrated. In 1994, antenatal steroids use to accelerate lung development was recommended. This was associated with an unanticipated reduction in hemorrhage. In the mid 1990’s early indomethacin administration was associated with a reduction of severe hemorrhage.     

气道压力释放通气对急性呼吸窘迫综合征患者呼吸机相关性肺损伤的影响

目的 通过测定机械通气对急性呼吸窘迫综合征（Acute Respiratory Distress Syndrome,ARDS）患者支气管肺泡灌洗液（BronchoAlveolar Lavage Fluid,BALF）与血清中肺损伤标记物的变化,明确气道压力释放通气（Airway Pressure Release Ventilation,APRV）与小潮气量保护性通气（Low Tidal Volume Protective Ventilation,LTV）对ARDS患者呼吸机相关性肺损伤（Ventilator-Induced Lung Injury,VILI）的影响。方法 收集深圳大学总医院及海南省人民医院2018-01至2019-05内ARDS住院患者40例,以随机数字法分为两组：A组21例,B组19例,A组先予APRV通气24 h,随后转为LTV 24 h;B组先予LTV 24 h,再转为APRV 24 h,比较干预治疗0 h、24 h、48 h两组患者氧合指数、呼吸力学、BALF及血清中肺泡表面活性蛋白（Pulmonary Surfactant Protein D,SP-D）、重组...     

健胃消炎颗粒治疗餐后不适综合征型功能性消化不良40例

目的:观察健胃消炎颗粒治疗餐后不适综合征型功能性消化不良患者的临床疗效.方法:将70例本病患者随机分为两组,治疗组40例采用健胃消炎颗粒治疗,对照组30例,采用多潘立酮治疗,疗程均为3周.结果:治疗组总有效率为72.5％,对照组为44.3％,两组疗效比较,差异具有统计学意义(P＜0.05).结论:健胃消炎颗粒治疗餐后不适综合征功能性消化不良疗效显著.     

围急性呼吸窘迫综合征血清CC16蛋白水平的预警意义

目的：探讨围急性呼吸窘迫综合征患者血清Clara细胞分泌的特异性蛋白-CC16蛋白水平的预警意义。方法回顾性分析我院从2013年3月到2014年3月入院治疗的60例急性呼吸窘迫综合症患者(将其定义为观察组)的临床资料。另选取我院同期参加健康体检的健康成年人58例的临床资料为对照组。将观察组患者病情进展过程中不同时期血清中Clara细胞分泌的特异性蛋白-CC16蛋白水平与对照组健康人群指标进行比较,评估其临床预警意义。结果观察组患者各时期血清CC16蛋白水平均高于对照组,随着病情的进展,血清CC16蛋白水平持续增高,前三个阶段血清CC16蛋白水平呈逐级递增趋势,差异具统计学意义(P＜0.05),临终期与ARDS期血清CC16蛋白水平接近,差异无统计学意义(P＞0.05)。结论急性呼吸窘迫综合征患者血清Clara细胞分泌蛋白CC16水平在患者炎症反应初期即开始升高,且变化早于血气分析指标的变化,故可将CC16指标变化情况用于早期急性呼吸窘迫综合征的诊治及预后评估,值得临床广泛推广应用。     

Addressing the psychosocial needs of cancer patients: a retrospective analysis of a distress screening and management protocol in clinical care

Background: A growing recognition of the impact of distress on the quality of life and adherence to treatment of cancer patients has been documented. As a result, national guidelines and standards of care mandate providers to implement distress screening protocols to connect patients with psychosocial services. However, limited literature has examined whether distressed patients are referred to care and their needs addressed. This article assessed differences in rates of referral and psychosocial services by demographic factors, clinical characteristics, and distress severity. Potential predictors of these two outcomes were investigated.

Methods: A retrospective analysis of patient data abstracted from electronic medical records of a NCI-designated Academic Comprehensive Cancer Center was conducted. Of the 399 cases meeting the inclusion criteria, 302 (75.7%) were screened for distress with the Distress Thermometer. Differences were examined with chi-square, t-tests, and ANOVAs. Predictors were identified with multivariate logistic regressions.

Results: Overall, patients who were identified as distressed were referred to a psychosocial provider (71.4%) and psychosocial services were delivered in approximately 64% of the cases. Referrals and service delivery rates varied by age group, clinic, health insurance coverage, distress severity, and presence of psychosocial issues. Only the distress score predicted the likelihood of being referred, and of a provider intervention to occur.

Conclusions and implications for psychosocial providers: Although the protocol appeared to facilitate referral and service delivery to patients scoring above the cutoff for distress, our results suggest that patients were more likely to not have their distress and psychosocial needs addressed if they were older, without insurance coverage, and were seen in clinics where a social worker was not consistently available. Future studies able to monitor patient outcomes in terms of quality of life, satisfaction with care, and service utilization are recommended.     

Measuring distress in South African children during burns dressing changes: A pilot study

Objectives: To establish and trial a practical, evidence-based, sensitive, language-fair, and culture-fair test battery to measure South African children’s distress during burns dressing change. Methods: We previously identified a broad test battery for pediatric procedural distress from the literature. This comprised child and parent heart rate; three instruments for observed distress behaviors—(1) Face, Legs, Activity, Cry, Consolability (FLACC); (2) Pain Behavior Check List (PBCL); and (3) Children’s Hospital Eastern Ontario Pain Scale (CHEOPS); and dressing change time, number of nurses required, and nurses’ perspectives of child’s distress. A consecutive cohort of South African inpatient children with burns was recruited. In the first study, three observers independently piloted the broad set of measures on four children. This set was subsequently modified to increase practicality of application and measurement sensitivity. In the second study, the modified battery was tested on 16 children for sensitivity to different children’s distress levels during burns dressing change phases. Results: The modified test battery was comprised of the CHEOPS, dressing change time, number of nurses required, and nurses’ qualitative perspectives of child’s distress. In combination, these tests were practical and sensitive to children’s distress. Discussion: South African children’s distress during burn dressing changes manifests in different ways. Adequate capture of it requires a comprehensive set of objective, observational, and qualitative measures, which are independent of language and culture.