Heart failure may lead to subclinical circulatory disturbances and remain an unrecognized cause of ischemic liver injury. We present the case of a previously healthy 40-year-old bodybuilder, referred to our Intensive-...Heart failure may lead to subclinical circulatory disturbances and remain an unrecognized cause of ischemic liver injury. We present the case of a previously healthy 40-year-old bodybuilder, referred to our Intensive-Care Unit of Hepatology for treatment of severe acute liver failure, with the suspicion of toxic hepatitis associated with anabolic steroid abuse. Despite the absence of symptoms and signs of congestive heart failure at admission, an anabolic steroid-induced dilated cardiomyopathy with a large thrombus in both ventricles was found to be the underlying cause of the liver injury. Treatment for the initially unrecognized heart failure rapidly restored liver function to normal. To our knowledge, this is the f irst reported case of severe acute liver failure due to an unrecognized anabolic steroid-induced cardiomyopathy. Awareness of this unique presentation will allow for prompt treatment of this potentially fatal cause of liver failure.展开更多
目的评价经鼻高流量氧疗(HFNC)对急性低氧性呼吸衰竭(AHRF)患者预后的影响。方法检索Cochrane、Web of Scicence、Pumbed、ScienceDirect、OVID、Medline及谷歌学术(Google Scholar)、中国期刊全文数据库(CNKI)、中国生物医学文献数据库...目的评价经鼻高流量氧疗(HFNC)对急性低氧性呼吸衰竭(AHRF)患者预后的影响。方法检索Cochrane、Web of Scicence、Pumbed、ScienceDirect、OVID、Medline及谷歌学术(Google Scholar)、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBMdisc)、维普数据库(VIP)和万方数据库(Wanfang Data),收集HFNC对AHRF患者预后影响的随机对照试验(RCTs)。检索时间均为建库起至2019年7月31日,以Revman5.3软件对数据进行统计分析处理。结果共纳入文献10篇,共1889名患者。Meta分析结果显示,HFNC与常规氧疗(COT)相比,可有效减缓患者的呼吸频率[MD=-2.39,95%CI(-3.36,-1.42),P<0.01],但不能提高患者的舒适度[MD=-0,17,95%CI(-0.64,0.31),P=0.49]和减少无创机械通气率[RR=0.79,95%CI(0.15,4.02),P=0.77]。同时在死亡率与插管率的结局比较上,经HFNC与COT相比,差异无统计学意义[RR=0.97,95%CI(0.82,1.14),P=0.69;RR=0.87,95%CI(0.75,1.01),P=0.06]。HFNC与无创机械通气(NIPPV)比较,可有效减慢患者的呼吸频率[MD=-2.00,95%CI(-3.77,-0.23),P=0.03],但对插管率无明显影响[RR=0.81,95%CI(0.61,1.06),P=0.12]。结论HFNC可以短期内改善AHRF患者的呼吸急促症状,但尚不能证明HFNC能够确切有效地减少AHRF患者的插管率及死亡率。展开更多
文摘Heart failure may lead to subclinical circulatory disturbances and remain an unrecognized cause of ischemic liver injury. We present the case of a previously healthy 40-year-old bodybuilder, referred to our Intensive-Care Unit of Hepatology for treatment of severe acute liver failure, with the suspicion of toxic hepatitis associated with anabolic steroid abuse. Despite the absence of symptoms and signs of congestive heart failure at admission, an anabolic steroid-induced dilated cardiomyopathy with a large thrombus in both ventricles was found to be the underlying cause of the liver injury. Treatment for the initially unrecognized heart failure rapidly restored liver function to normal. To our knowledge, this is the f irst reported case of severe acute liver failure due to an unrecognized anabolic steroid-induced cardiomyopathy. Awareness of this unique presentation will allow for prompt treatment of this potentially fatal cause of liver failure.
文摘目的评价经鼻高流量氧疗(HFNC)对急性低氧性呼吸衰竭(AHRF)患者预后的影响。方法检索Cochrane、Web of Scicence、Pumbed、ScienceDirect、OVID、Medline及谷歌学术(Google Scholar)、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBMdisc)、维普数据库(VIP)和万方数据库(Wanfang Data),收集HFNC对AHRF患者预后影响的随机对照试验(RCTs)。检索时间均为建库起至2019年7月31日,以Revman5.3软件对数据进行统计分析处理。结果共纳入文献10篇,共1889名患者。Meta分析结果显示,HFNC与常规氧疗(COT)相比,可有效减缓患者的呼吸频率[MD=-2.39,95%CI(-3.36,-1.42),P<0.01],但不能提高患者的舒适度[MD=-0,17,95%CI(-0.64,0.31),P=0.49]和减少无创机械通气率[RR=0.79,95%CI(0.15,4.02),P=0.77]。同时在死亡率与插管率的结局比较上,经HFNC与COT相比,差异无统计学意义[RR=0.97,95%CI(0.82,1.14),P=0.69;RR=0.87,95%CI(0.75,1.01),P=0.06]。HFNC与无创机械通气(NIPPV)比较,可有效减慢患者的呼吸频率[MD=-2.00,95%CI(-3.77,-0.23),P=0.03],但对插管率无明显影响[RR=0.81,95%CI(0.61,1.06),P=0.12]。结论HFNC可以短期内改善AHRF患者的呼吸急促症状,但尚不能证明HFNC能够确切有效地减少AHRF患者的插管率及死亡率。
