目的研究孕妇短时间内高浓度吸氧对肺动脉狭窄胎儿的肺动脉及大脑中动脉(middle cerebral artery,MCA)血流的影响。方法对2016年10月至2017年3月间在广东省心血管病研究所确诊的14例单纯肺动脉狭窄或肺动脉狭窄合并其他右心畸形的单胎...目的研究孕妇短时间内高浓度吸氧对肺动脉狭窄胎儿的肺动脉及大脑中动脉(middle cerebral artery,MCA)血流的影响。方法对2016年10月至2017年3月间在广东省心血管病研究所确诊的14例单纯肺动脉狭窄或肺动脉狭窄合并其他右心畸形的单胎先天性心脏病(先心病)胎儿进行吸氧试验,胎儿超声心动图观察孕妇吸氧前、面罩高浓度吸氧10 min后胎儿MCA起始部搏动指数(pulsatility index,PI)、阻力指数(resis-tance index,RI)、收缩期峰值流速(peak systolic velocity,PSV)变化,脐动脉(umbilical artery,UA)-RI的变化,以及右肺动脉(right pulmonary arterial,RPA)起始部PI、RPA起始部内径(diameter,D)及PSV的变化。结果吸氧前后胎儿RPA-D比较,差异有统计学意义[(2.64±0.60)mm vs.(3.27±0.69)mm,P=0.001];吸氧前后胎儿MCA-PI(1.79±0.43 vs. 1.92±0.44,P=0.517)、MCA-RI[0.83(0.78～0.86)vs. 0.85(0.78～0.90),P=0.517]、MCA-PSV[0.32(0.27～0.47)m/s vs. 0.31(0.26～0.32)m/s,P=0.812]、PRA-PI(2.21±0.53 vs. 2.10±0.48,P=0.253)、RPA-PSV[0.81(0.65～0.91)m/s vs. 0.75(0.52～0.95)m/s,P=0.875]、UA-PI(1.17±0.15 vs. 1.2±0.12,P=0.567)比较,差异无统计学意义。结论孕妇在妊娠中晚期短暂吸氧对胎儿大脑血流无影响,但可促进胎儿肺动脉狭窄远端的肺血管扩张,可能有利于肺血管的发育,减少胎儿肺动脉瓣狭窄的继发性血管病变。展开更多
Objective Research on the clinical features of and risk factors for extracorporeal membrane oxygenation(ECMO)in pediatric fulminant myocarditis(FM)are currently limited.We aimed to investigate the clinical features an...Objective Research on the clinical features of and risk factors for extracorporeal membrane oxygenation(ECMO)in pediatric fulminant myocarditis(FM)are currently limited.We aimed to investigate the clinical features and outcomes of patients with pediatric FM,and to analyze the actors associated with the need for ECMO.Methods We analyzed a retrospective cohort of patients with FM admitted to the Pediatric Department of Guangdong Provincial People's Hospital,China,between 1 January 2009 and 31 December 2021.The demographic and physiological variables were summarized and compared between patients treated with and without ECMO.Results Thirty-four patients met the criteria for FM(14 male,20 female);mean age 8.0±3.7 years,range 4 months to 15.6 years.Three patients abandoned therapy,twenty-nine patients(85.3%)survived to hospital discharge.Nine patients(26.5%)received ECMO,and eight(88.9%)of these survived.At admission,patients requiring ECMO had significantly higher levels of creatine kinase MB(CK-MB;112.1 vs 77.7 U/L,p=0.045),lower left ventricular ejection fraction(LVEF;37.0%vs 49.5%,p=0.033),and fractional shortening(16.2%vs 25.9%,p=0.012).During disease progression,the ECMO group also had significantly higher peak CK-MB(109.3 vs 60.5 U/L,p=0.041),serum B-type natriuretic peptide(35,000 vs 19,433 pg/mL,p=0.001),and troponin I(12.6 vs 6.5 ng/mL,p=0.012),and significantly lower minimum LVEF(25.0%vs 45.8%,p<0.001).Mechanical ventilation and days of mechanical ventilation were significantly associated with the need for ECMO.Patients in the ECMO group had significantly longer intensive care unit stays than patients without ECMO(15.0 vs 5.0 days,p<0.001).Conclusion Initial levels of CK-MB,LVEF,and fractional shortening are possible risk factors for ECMO in children with FM.展开更多
Background The requisite techniques for safe fetal cardiac arrest during cardiac interventions need to be further developed. Furthermore, little is known about the pathophysiologic effect of cardiopulmonary bypass（CP...Background The requisite techniques for safe fetal cardiac arrest during cardiac interventions need to be further developed. Furthermore, little is known about the pathophysiologic effect of cardiopulmonary bypass（CPB）at different levels of temperature with cardioplegic arrest on the developing fetus. Methods Twelve pregnant goats were randomly divided into hypothermic CPB group（H group）： cardiopulmonary bypass with perfusion at 30-32℃（n=6） and normothermic CPB group（N group）： cardiopulmonary bypass with perfusion at 36℃-38℃（n=6）. Fetal cardiopulmonary bypass was maintained including 30 minutes of cardiac arrest. Fetal mean arterial blood pressure（MAP） and heart rate（HR） were monitored. Fetal arterial blood samples were analyzed. The pulse index（PI） and resistance index（RI） of the fetal umbilical artery were recorded. Results The maternal weight,fetal weight and pump flow had no significant difference between the 2 groups. After clamp removal, two fetal hearts did not auto-beat in H group. The fetal HR and MAP b were significantly different（P〈0.05） etween the 2 groups. There was remarkable decreasing in post-CPB fetal HR and MAP in H group. A stable decrease in partial pressure of oxygen with a concomitant stable increase of carbon dioxide partial pressure in H group was noted.The lactic acid in H group was significantly higher than that in the N group（P〈0.05）. The PI and RI in H group were significantly elevated 1 hour after off CPB and further markedly increased 2 hours after off bypass. Conclusions Fetal CPB could be performed under both hypothermic and normothermic conditions. However, normothermic bypass may provide better delivery of oxygen to fetal tissue.展开更多
文摘目的研究孕妇短时间内高浓度吸氧对肺动脉狭窄胎儿的肺动脉及大脑中动脉(middle cerebral artery,MCA)血流的影响。方法对2016年10月至2017年3月间在广东省心血管病研究所确诊的14例单纯肺动脉狭窄或肺动脉狭窄合并其他右心畸形的单胎先天性心脏病(先心病)胎儿进行吸氧试验,胎儿超声心动图观察孕妇吸氧前、面罩高浓度吸氧10 min后胎儿MCA起始部搏动指数(pulsatility index,PI)、阻力指数(resis-tance index,RI)、收缩期峰值流速(peak systolic velocity,PSV)变化,脐动脉(umbilical artery,UA)-RI的变化,以及右肺动脉(right pulmonary arterial,RPA)起始部PI、RPA起始部内径(diameter,D)及PSV的变化。结果吸氧前后胎儿RPA-D比较,差异有统计学意义[(2.64±0.60)mm vs.(3.27±0.69)mm,P=0.001];吸氧前后胎儿MCA-PI(1.79±0.43 vs. 1.92±0.44,P=0.517)、MCA-RI[0.83(0.78～0.86)vs. 0.85(0.78～0.90),P=0.517]、MCA-PSV[0.32(0.27～0.47)m/s vs. 0.31(0.26～0.32)m/s,P=0.812]、PRA-PI(2.21±0.53 vs. 2.10±0.48,P=0.253)、RPA-PSV[0.81(0.65～0.91)m/s vs. 0.75(0.52～0.95)m/s,P=0.875]、UA-PI(1.17±0.15 vs. 1.2±0.12,P=0.567)比较,差异无统计学意义。结论孕妇在妊娠中晚期短暂吸氧对胎儿大脑血流无影响,但可促进胎儿肺动脉狭窄远端的肺血管扩张,可能有利于肺血管的发育,减少胎儿肺动脉瓣狭窄的继发性血管病变。
文摘Objective Research on the clinical features of and risk factors for extracorporeal membrane oxygenation(ECMO)in pediatric fulminant myocarditis(FM)are currently limited.We aimed to investigate the clinical features and outcomes of patients with pediatric FM,and to analyze the actors associated with the need for ECMO.Methods We analyzed a retrospective cohort of patients with FM admitted to the Pediatric Department of Guangdong Provincial People's Hospital,China,between 1 January 2009 and 31 December 2021.The demographic and physiological variables were summarized and compared between patients treated with and without ECMO.Results Thirty-four patients met the criteria for FM(14 male,20 female);mean age 8.0±3.7 years,range 4 months to 15.6 years.Three patients abandoned therapy,twenty-nine patients(85.3%)survived to hospital discharge.Nine patients(26.5%)received ECMO,and eight(88.9%)of these survived.At admission,patients requiring ECMO had significantly higher levels of creatine kinase MB(CK-MB;112.1 vs 77.7 U/L,p=0.045),lower left ventricular ejection fraction(LVEF;37.0%vs 49.5%,p=0.033),and fractional shortening(16.2%vs 25.9%,p=0.012).During disease progression,the ECMO group also had significantly higher peak CK-MB(109.3 vs 60.5 U/L,p=0.041),serum B-type natriuretic peptide(35,000 vs 19,433 pg/mL,p=0.001),and troponin I(12.6 vs 6.5 ng/mL,p=0.012),and significantly lower minimum LVEF(25.0%vs 45.8%,p<0.001).Mechanical ventilation and days of mechanical ventilation were significantly associated with the need for ECMO.Patients in the ECMO group had significantly longer intensive care unit stays than patients without ECMO(15.0 vs 5.0 days,p<0.001).Conclusion Initial levels of CK-MB,LVEF,and fractional shortening are possible risk factors for ECMO in children with FM.
基金supported by the National Natural Science Foundation of China(No.81370274)Guangdong Provincial Natural Science Foundation(No.2016A030310313)
文摘Background The requisite techniques for safe fetal cardiac arrest during cardiac interventions need to be further developed. Furthermore, little is known about the pathophysiologic effect of cardiopulmonary bypass（CPB）at different levels of temperature with cardioplegic arrest on the developing fetus. Methods Twelve pregnant goats were randomly divided into hypothermic CPB group（H group）： cardiopulmonary bypass with perfusion at 30-32℃（n=6） and normothermic CPB group（N group）： cardiopulmonary bypass with perfusion at 36℃-38℃（n=6）. Fetal cardiopulmonary bypass was maintained including 30 minutes of cardiac arrest. Fetal mean arterial blood pressure（MAP） and heart rate（HR） were monitored. Fetal arterial blood samples were analyzed. The pulse index（PI） and resistance index（RI） of the fetal umbilical artery were recorded. Results The maternal weight,fetal weight and pump flow had no significant difference between the 2 groups. After clamp removal, two fetal hearts did not auto-beat in H group. The fetal HR and MAP b were significantly different（P〈0.05） etween the 2 groups. There was remarkable decreasing in post-CPB fetal HR and MAP in H group. A stable decrease in partial pressure of oxygen with a concomitant stable increase of carbon dioxide partial pressure in H group was noted.The lactic acid in H group was significantly higher than that in the N group（P〈0.05）. The PI and RI in H group were significantly elevated 1 hour after off CPB and further markedly increased 2 hours after off bypass. Conclusions Fetal CPB could be performed under both hypothermic and normothermic conditions. However, normothermic bypass may provide better delivery of oxygen to fetal tissue.
