外周动脉血气分析联合Apgar评分在新生儿窒息病情评价的研究进展

随着高危孕产妇的数量激增,新生儿窒息发生率上升。此类患儿会给家庭、社会造成较大的经济负担,因此低Apgar评分患儿神经系统预后仍是临床工作的关注及预防重点。国内外学者高度关注,如何早期干预及改善患儿神经系统预后,当前血气分析和Apgar评分常在临床被用于评估新生儿窒息病情,且效果显著。本文主要研究内容为外周动脉血气分析联合Apgar评分对新生儿窒息病情的评价。

肺癌患者外周动脉血和静脉血循环肿瘤细胞含量的差异及其临床意义

目的探索提高肺癌循环肿瘤细胞(circulating tumor cells,CTC)阳性率的策略。方法对病理确诊肺癌患者46例分别采取外周动脉血(A组)和外周静脉血(V组)各5 mL,采用免疫磁珠阴性富集联合免疫荧光原位杂交法对CTC进行富集计数和鉴定,计算其阳性率。结果A组CTC含量(1.98±1.73[个/3.2 mL])明显高于V组(1.39±1.86[个/3.2 mL])(t=2.533,P=0.015)。A组的CTC检出率(71.7%)明显高于V组(52.2%)(χ^(2)=8.873,P=0.032)。在早期(1期)肺癌,A组的CTC阳性率(50.0%)明显高于V组(14.3%)(χ^(2)=8.857,P=0.013)。结论肺癌患者外周动脉血CTC含量明显高于外周静脉血;检测外周动脉血CTC相比外周静脉血,可获更高阳性率,更有利于肺癌的早期诊疗及随访。

甲状腺功能亢进患者的外周动脉血流动力学研究

甲状腺功能亢进是一种常见病，目前，国内对于甲亢患者脑血流动力学的研究较多，脑血流量的增多可以初步反映甲亢的严重程度，而对外周动脉血流动力学鲜有报道。本文应用彩色多普勒对50例甲亢病人进行检测，现报道如下：

外周静脉-动脉血二氧化碳分压差可预测感染性休克患者预后:62例前瞻例研究

目的探讨早期复苏后外周静脉-动脉血二氧化碳分压差对感染性休克患者预后的预测价值。方法采用前瞻性研究方法,选择2017年5月~2018年5月南京中医药大学附属中西医结合医院重症医学科收治的感染性休克患者,测定患者早期复苏6 h后中心静脉、动脉及外周静脉血血气分析,记录患者中心静脉、动脉及外周静脉血二氧化碳分压(PCO_2),计算患者外周静脉-动脉血二氧化碳分压差(Ppv-aCO_2)及中心静脉-动脉血二氧化碳分压差(Pcv-aCO_2),根据患者28 d预后将患者分为存活组及死亡组,采用Pearson相关性分析法分析Ppv-aCO_2与Pcv-aCO_2相关性,采用多因素Logistic分析筛选患者死亡的危险因素,并通过受试者工作特征曲线(ROC)评价各项指标预测患者预后的价值。结果共入选62例感染性休克患者,28 d存活35例,死亡27例。与存活组比较,死亡组患者急性生理与慢性健康评分Ⅱ(APACHEⅡ)(24.2±6.0 vs 20.5±4.9,P=0.011)及序贯器官衰竭的评分(SOFA)(14.9±4.7 vs 12.2±4.5,P=0.027)明显升高。6 h复苏后死亡组患者Pcv-aCO_2(5.5±1.6 vs 7.1±1.7,P<0.001),Ppv-aCO_2(7.1±1.8 vs 10.0±2.7,P<0.001),及动脉乳酸(Lac)(3.3±1.2 vs 4.2±1.3,P=0.003)明显高于存活组。Pearson相关性分析显示PpvaCO_2与Pcv-aCO_2明显相关,r=0.897,R^2=0.805,P<0.001。多因素Logistic回归分析显示Ppv-aCO_2和Lac是感染性休克患者28 d生存率的独立预后因素[(Ppv-aCO_2:β=0.625,P=0.001,相对危险度(OR)=1.869,95%CI:1.311~2.664;Lac:β=0.584,P=0.041,OR=1.794,95%CI:1.024~3.415)]。ROC曲线分析显示,Ppv-aCO_2、Pcv-aCO_2和Lac对感染性休克患者预后均有预测价值,其中Ppv-aCO_2的ROC曲线下面积(AUC)最大,为0.814(95%CI:0.696~0.931,P<0.001),最佳临界值为9.05 mmHg时,预测患者28 d死亡的敏感度为70.4%,特异度为88.6%;Lac的AUC=0.732(95%CI:0.607~0.858,P=0.002),最佳临界值为3.45 mmol/L时,敏感度为70.4%,特异度为74.3%;Pcv-aCO_2的AUC=0.766(95%CI:0.642~0.891,P<0.001),最佳临界值为7.05 mmHg时,敏感度为66.7%,特异度为80.0%。结论Ppv-aCO_2与Pcv-aCO_2相关,与感染性休克患者预后相关,可作为评估感染性休克患者28 d生存率的独立预后指标。

外周静脉-动脉血乳酸差值对感染性休克患者预后的预测价值

目的:探讨外周静脉-动脉血乳酸差值对感染性休克患者预后的预测价值。方法:采用前瞻性研究方法,选择2017年5月—2018年5月南京中医药大学附属中西医结合医院重症医学科收治的感染性休克患者,测定患者入院时及早期复苏6 h后动脉及外周静脉血血气分析,记录患者动脉血乳酸(A-lac)及外周静脉血乳酸(V-Lac),计算患者外周静脉-动脉血乳酸差值(ΔLac),根据患者28 d预后将患者分为存活组及死亡组,采用多因素Logistic回归分析患者死亡的危险因素,并通过受试者工作特征曲线(ROC)评价各项指标变化,预测患者预后。结果:共入选59例感染性休克复苏达标患者,28 d存活34例,死亡25例。与存活组比较,死亡组患者急性生理与慢性健康(acute physiology and chronic health evaluation,APCHE)Ⅱ评分及序贯器官衰竭评分(sequential organ failure assessment,SOFA)明显升高(P<0.05),患者入院时A-Lac和V-Lac明显升高(P<0.05),早期复苏6 h后V-Lac和ΔLac明显升高(P<0.05)。多因素Logistic回归分析显示,复苏后ΔLac是患者28 d生存率的独立预后因素(P=0.005)。ROC曲线分析显示,早期复苏6 h后ΔLac的ROC曲线下面积(AUC)最大,为0.838(OR=74.107,P<0.001),最佳临界值为0.65 mmol/L时,预测患者28 d死亡的敏感度为76.0%,特异度为85.3%。结论:外周静脉-动脉血乳酸差值与感染性休克患者预后相关,可作为评估感染性休克患者28 d生存率的独立预后指标。

品管圈活动在降低危重患者外周动脉测压导管重置率中的实践与成效

目的:探讨品管圈(QCC)活动在降低危重患者外周动脉测压导管重置率中的应用实践与成效。方法:选取2017年1月1日~12月31日ICU行外周动脉有创血压监测患者586例为对照组,实施常规护理;选取2018年1月1日~12月31日ICU行外周动脉有创血压监测患者632例为观察组,开展QCC活动;比较两组穿刺并发症发生率及外周动脉测压导管重置率。结果:对照组重置导管205例、重置率为34.98%,观察组重置导管114例、重置率为18.04%,观察组低于对照组(P<0.01)。对照组发生动脉穿刺并发症208例、发生率为35.49%,观察组发生动脉穿刺并发症117例、发生率为18.51%,观察组低于对照组(P<0.05)。结论:通过开展QCC活动可以有效降低ICU危重患者外周动脉测压导管重置率,降低穿刺并发症发生率,值得推广应用。

阻塞性睡眠呼吸暂停低通气综合征患者中心动脉压变化及临床意义

目的探讨阻塞性睡眠呼吸暂停综合征患者中心动脉压变化及临床意义。方法选择行睡眠呼吸暂停检测者48例的临床资料进行分析。所有患者未服用降压药物,根据呼吸暂停低通气指数分为OSAHS组(31例)和对照组(17例)。测量患者外周动脉血压、中心动脉压。结果 OSAHS患者中心动脉压、外周收缩压、外周舒张压、AHI、ODI、ba-PWV水平均显著高于对照组(P<0.05)。OSAHS患者外周收缩压、外周舒张压、ba-PWV、AHI与ODI与中心动脉压呈显著正相关的关系(P<0.05)。结论阻塞性睡眠呼吸暂停综合征患者中心动脉压显著升高,并且与病情的严重程度有线性关系。

原发性高血压患者中心动脉血压与外周肱动脉血压的相关性

目的探讨原发性高血压患者中心动脉血压与外周肱动脉血压的相关性。方法从东莞寮步社区入选单纯原发性高血压患者,所有入选者进行标准的外周肱动脉和无创中心动脉压测量,并进行肾功能、血脂和血尿酸等检测,采用Spearman相关进行相关性分析。结果共入选491例高血压患者,平均年龄(56.2±10.1)岁,其中女性230例(46.8%),平均中心动脉收缩压和舒张压分别为(136.88±22.65)和(82.32±9.30)mm Hg,平均肱动脉收缩压和舒张压分别为(123.74±19.91)和(82.41±13.62)mm Hg,肱动脉收缩压与中心动脉收缩压呈相关(r=0.972,P<0.01),肱动脉舒张压与中心动脉舒张压也呈正相关(r=0.993,P<0.01)。结论原发性高血压患者中心动脉血压与外周肱动脉血压呈显著正相关性。无创中心动脉血压测量操作方便,适用于大规模临床检查。

彩色多普勒超声诊断胎儿心律失常及对胎儿的影响

目的:分析彩色多普勒超声诊断胎儿心律失常及对胎儿的影响。方法:收集2016年3月-2022年3月在本院接受彩色多普勒超声产前检查的500名孕妇的相关资料,均采取彩色多普勒超声进行胎儿心律失常的鉴别诊断。观察彩色多普勒超声检出心律失常情况,并对比心律失常及非心律失常患者的超声诊断特征差异。分析彩色多普勒超声在胎儿心律失常治疗及预后中的指导价值。结果:500名孕妇产前检查中,检出胎儿心律失常30例,其中快速型20例,慢速型10例;30例心律失常胎儿中,检出12例颈部透明层增厚病例,合并胎儿心脏畸形9例,肢体-体壁综合征3例;其中3例孕妇在孕25周时出现胎儿重度水肿情况,另3例检出胎儿腹壁缺陷。心律失常胎儿的外周动脉血流搏动指数指标:UA水平高于非心律失常胎儿,MCA、PDA以及DAO指标低于非心律失常胎儿(P<0.05);30例心律失常胎儿中,有15例终止妊娠,剩余15例胎儿出生后再次进行彩色多普勒超复查,未检出心脏异常情况。结论:彩色多普勒超声可通过外周动脉血流搏动指数等指标的分析,有效检出心律失常胎儿,并为其临床治疗及预后提供可靠的依据。临床医师可根据彩色多普勒超声诊断及复查结果,确定治疗方案,确定是否终止妊娠,并评估新生儿预后。

Systemic inflammatory response following acute myocardial infarction

Acute cardiomyocyte necrosis in the infarcted heart generates damage-associated molecular patterns, activating complement and toll-like receptor/interleukin-1 signaling, and triggering an intense inflammatory response. Iuflammasomes also recognize danger signals and mediate sterile inflammatory response following acute myocardial infarction （AMI）, Inflammatory response serves to repair the heart, but excessive inflammation leads to adverse left ventricular remodeling and heart failure. In addition to local inflammation, profound systemic inflammation response has been documented in patients with AMI, which includes elevation of circulating inflammatory cytokines, chemokines and cell adhesion molecules, and activation of peripheral leukocytes and platelets. The excessive inflammatory response could be caused by a deregulated immune system. AMI is also associated with bone marrow activation and spleen monocytopoiesis, which sustains a continuous supply of monocytes at the site of inflammation. Accumulating evidence has shown that systemic inflammation aggravates atherosclerosis and markers for systemic inflammation are predictors of adverse clinical outcomes （such as death, recurrent myocardial in- farction, and heart failure） in patients with AMI.

外周动静脉血血气分析差异对复苏后感染性休克患者预后的预测价值

目的 探讨外周动静脉血血气分析指标及其相应差值对感染性休克患者预后的预测价值.方法 选择2016年5月至2017年12月南京中医药大学附属中西医结合医院重症医学科（ICU）收治的年龄18～80岁的感染性休克患者,按照集束化治疗方案进行治疗,使用血气生化仪测定患者早期复苏后6 h的外周动脉血及外周静脉血血气分析指标,记录pH值、氧分压（PO2）、二氧化碳分压（PCO2）、剩余碱（BE）、碳酸氢盐（HCO3-）及乳酸（Lac）水平,并计算动脉血与静脉血各指标的差值.根据28 d预后将患者分为存活组与死亡组,采用多因素Logistic回归分析筛选患者死亡的危险因素,并通过受试者工作特征曲线（ROC）评估各指标差值对患者预后的预测价值.结果 共入选65例感染性休克复苏达标患者,28 d存活35例,死亡30例.① 两组患者性别、年龄以及初始复苏6 h后的平均动脉压（MAP）、中心静脉压（CVP）、中心静脉血氧饱和度（ScvO2）和去甲肾上腺素用量比较差异均无统计学意义.② 与存活组比较,死亡组患者动静脉血Lac水平及其Lac差值（ΔLac）,以及动静脉血PCO2差值（ΔPCO2）均明显升高〔动脉血Lac（mmol/L）：7.40±3.10比4.82±2.91,静脉血Lac（mmol/L）：9.17±3.27比5.81±3.29,ΔLac（mmol/L）：1.77±0.54比0.99±0.60,ΔPCO2（mmHg,1 mmHg=0.133 kPa）：9.64±5.08比6.70±3.71,均P〈0.01],其他动静脉血血气分析指标及其相应差值差异均无统计学意义.③ 多因素Logistic回归分析显示,ΔPCO2和ΔLac是感染性休克患者28 d死亡的独立危险因素〔ΔPCO2：β=0.247,优势比（OR）=1.280,95％可信区间（95％CI）=1.057～1.550,P=0.011;ΔLac：β=2.696,OR=14.820,95％CI=2.916～75.324,P=0.001].④ROC曲线分析显示,动脉血Lac、ΔLac和ΔPCO2对感染性休克患者预后均有预测价值,ROC曲线下面积（AUC）分别为0.792、0.857和0.680（均P〈0.05）.动脉血Lac最佳临界值为4.00 mmol/L时,预测患者28 d死亡的敏感度为100％,特异度为62.86％;ΔLac最佳临界值为1.25 mmol/L时,预测患者28 d死亡的敏感度为93.33％,特异度为68.57％;ΔPCO2最佳临界值为4.35 mmHg时,预测患者28 d死亡的敏感度为83.33％,特异度为37.14％.结论 在外周动静脉血血气分析指标及其相应差值中,ΔPCO2和ΔLac与感染性休克患者预后相关,可作为评估感染性休克患者28 d死亡的独立预测指标.

Cilostazol inhibits plasmacytoid dendritic cell activation and antigen presentation

Background Cilostazol, an anti-platelet drug for treating coronary heart disease, has been reported to modulate immune cell functions Plasmacytoid dendritic cells （pDCs） have been found to participate in the progression of atherosclerosis mainly through interferon ct （IFN-ct） production. Whether cilostazol influences pDCs activation is still not clear. In this study, we aimed to investigate the effects of cilostazol on cell activation and antigen presentation ofpDCs in vitro in this study. Methods Peripheral blood mononuclear cells isolated by Ficoll cen- trifugation and pDCs sorted by flow cytometry were used in this study. After pretreated with cilostazol for 2 h, cells were stimulated with CpG-A, R848 or virus for 6 h or 20 h, or stimulated with CpG-B for 48 h and then co-cultured with naive T cell for five days. Cytokines in supernatant and intracellular cytokines were analyzed by ELISA or flow cytometry respectively. Results Our data indicated that cilostazol could inhibit IFN-α and tumor necrosis factor α （TNF-α） production from pDCs in a dose-dependent manner. In addition, the ability of priming na ve T cells of pDCs was also impaired by cilostazol. The inhibitory effect was not due to cell killing since the viability of pDCs did not change upon cilostazol treatment. Conclusion Cilostazol inhibits pDCs cell activation and antigen presentation in vitro, which may explain how cilostazol protects against atherosclerosis.

保护性肺通气策略在急性呼吸窘迫综合征患者中的实施效果分析

分析急性呼吸窘迫综合征患者临床医疗中采用保护性肺通气策略的作用效果。方法 于2020年5月1日~2023年1月1日研究期间进行研究,从广西省灵山县人民医院抽选40例急性呼吸窘迫综合征患者,随机编号抽签方式分为常规化通气组(20例,常规肺通气策略)与保护性通气组(20例,保护性肺通气策略),观察其临床效果。结果 治疗后保护性通气组症状评分、动脉血氧分压、不良反应发生率均同常规化通气组存在差异(P<0.05,有统计学意义)。结论 急性呼吸窘迫综合征患者治疗中采用保护性肺通气策略,可以缓解其临床症状,优化外周动脉血指标,并保障机械通气治疗安全性。

Effect of Liandouqingmai recipe on quality of life and inflammatory reactions of patients with coronary heart disease

OBJECTIVE: To observe the effect of Liandouqingmai recipe(Chinese herbal medicine compound preparation) on the quality of life(QOL) and inflammatory reaction of patients with coronary heart disease(CHD).METHODS: A total of 101 CHD patients were randomized into two groups: treatment group(n=45)receiving standard treatment for CHD plus Liandouqingmai recipe, and control group(n=56) receiving standard treatment only. The control group contained 16 normal healthy subjects. Changes in hs-C-reactive protein(CRP), peripheral blood leucocytes(PBL), and interleukin(IL)-6 and IL-10 levels were measured. The Seattle Angina Questionnaire(SAQ) was used to determine patient QOL before and after treatment for 2 weeks.RESULTS: Before treatment, SAQ scores [physical limitation(PL), angina stability(AS), angina frequen-cy(AF), treatment satisfaction(TS), and disease perception(DP)] were not statistically different between groups. After treatment, AS and DP levels of controls were significantly increased compared with the other groups, while PL, AS, AF, TS, and DP levels of the treatment group were significantly increased compared with controls. Treatment group SAQ scores(PL, AS, AF, TS, and DP) were significantly higher than for controls. CHD patient IL-6 and IL-10 levels were significantly higher than controls.Before treatment, mean levels of IL-6, hs-CRP and PBL of the two groups were not statistically different. After treatment, mean levels of IL-6, IL-10,hs-CRP and PBL of the two groups were significantly decreased compared with their before treatment values, and levels of IL-6, hs-CRP, and PBL of the treatment group were lower than controls. Although mean IL-10 levels of both groups decreased, there was no significant difference in between-group and in-group comparisons before and after treatment. Mean levels of IL-6 and IL-10 in the normal group were lower than in CHD patients.SAQ scores of QOL were negatively associated with the inflammatory index(IL-6/IL-10), and there was a significant negative association of IL-10 with AS(r=﹣0.15, P<0.05).CONCLUSION: Inflammatory reactions in CHD patients are related to angina status. Coadministration of CHD standard treatment and Liandouqingmai recipe increased patient SAQ scores by decreasing IL-6, IL-10, hs-CRP, and PBL levels in CHD patients, which might inhibit endothelial inflammation to improve patient QOL.

Biomechanical effect of major extremity vessels in choosing repair methods for peripheral artery injury

Objective： To investigate the biomechanical effect of major extremity vessels to choose appropriate repair methods for vascular injuries of the extremities. Methods ： The data of 385 patients （337 males and 48 females, aged 18-71 years, mean = 32.6 years ） including 403 injured vessels, who suffered from vascular injuries of the extremities and were treated in our hospital from October 1960 to August 2005, were studied retrospectively in this article. We compared the results of different repair methods for the defect of vessels and evaluated different injured vessels for repairing arterial injuries with anastomosis and venous graft, respectively. Results： A significant difference was found between the defect lengths of the arteries repaired with anastomosis and venous graft （ P 〈 0. 0001 ）. The upper limits of the confidence interval in the defect lengths of the brachial artery, the femoral artery and the popliteal artery were 3.43 cm, 2. 38 cm and 2. 42 cm, respectively, when repaired with anastomosis. The lower limits were 2.16 cm, 2.16 cm and 1. 63 cm, respectively, when repaired with venous graft. The defect length of each artery repaired with venous graft had linear correlation with the graft length. Conclusion - Because of the longitudinal biomechanical difference of different options of repair arterial injuries. human peripheral vessels, are necessary for different arterial injuries.

Impact of type 2 diabetes on the plasma levels of vascular endothelial growth factor and its soluble receptors type 1 and type 2 in patients with peripheral arterial disease

Objective： Type 2 diabetes coexistent with lower extremity artery disease （peripheral arterial disease （PAD）） can be observed in numerous patients. The mechanism compensating for ischemia and contributing to healing is angiogenesis-the process of forming new blood vessels. The purpose of this study was to assess the likely impact of type 2 diabetes on the plasma levels of proangiogenic factor （vascular endothelial growth factor A （VEGF-A）） and angiogenesis inhibitors （soluble VEGF receptors type 1 and type 2 （sVEGFR-1 and sVEGFR-2）） in patients with PAD. Methods： Among 46 patients with PAD under pharmacological therapy （non-invasive）, we identified, based on medical history, a subgroup with coexistent type 2 diabetes （PAD-DM2＋, n=15） and without diabetes （PAD-DM2-, n=31）. The control group consisted of 30 healthy subjects. Plasma levels of VEGF-A, sVEGFR-1, and sVEGFR-2 were measured using the enzyme-linked immunosorbent assay （ELISA） method. Results： The subgroups of PAD-DM2＋ and PAD-DM2- revealed significantly higher concentrations of VEGF-A （P=-0.000007 and P=0.0000001, respectively） and significantly lower sVEGFR-2 levels （P=-0.02 and P=-0.00001, respectively）, when compared with the control group. Patients with PAD and coexistent diabetes tended to have a lower level of VEGF-A and higher levels of sVEGFR-1 and sVEGFR-2 comparable with non-diabetic patients. Conclusions： The coexistence of type 2 diabetes and PAD is demonstrated by a tendency to a lower plasma level of proangiogenic factor （VEGF-A） and higher levels of anglogenesis inhibitors （sVEGFR-1 and sVEGFR-2） at the same time. Regardless of the coexistence of type 2 diabetes, hypoxia appears to be a crucial factor stimulating the processes of angiogenesis in PAD patients comparable with healthy individuals, whereas hyperglycemia may have a negative impact on angiogenesis in lower limbs.