Effect of dobutamine combined with meropenem on serum BNP, IGF-1, IGFBP-3, TNF-a, IL-6 and hs-CRP in children with congenital heart disease and pneumonia

Objective:To study the effect of dobutamine combined with meropenem on serum BNP, IGF-1, IGFBP-3, TNF-a, IL-6 and hs-CRP in children with congenital heart disease and pneumonia.Methods:A total of 70 children with congenital heart disease and pneumonia in our hospital from June 2014 to Octomber 2016 were enrolled in this study. The subjects were divided into the control group (n=35) and the treatment group (n=35) randomly. The control group was treated with dobutamine, the treatment group were treated with dobutamine combined with meropenem. The two groups were treated for 10 days. The serum BNP, IGF-1, IGFBP-3, TNF-a, IL-6 and hs-CRP levels of the two groups before and after treatment were compared.Results: There were no significantly differences of the serum BNP, IGF-1, IGFBP-3, TNF-a, IL-6 and hs-CRP levels of the two groups before treatment. The serum BNP, TNF-a, IL-6 and hs-CRP levels of the two groups after treatment were significantly lower than before treatment, the serum IGF-1 and IGFBP-3 levels of the two groups after treatment were significantly higher than before treatment, and that of the treatment group were significantly better than the control group.Conclusion:Dobutamine combined with meropenem can significantly reduce the serum BNP, TNF-a, IL-6 and hs-CRP levels, improve serum IGF-1 and IGFBP-3 levels of children with congenital heart disease and pneumonia, and it was worthy clinical application.

Clinical Study on the Retention Enema with Modified Dahuang Mudan Decoction in Treating Lower-Jiao Obstruction Syndrome Caused by Severe Pneumonia Complicated with Heart Failure

[Objectives]To treat patients with Lower-Jiao Obstruction Syndrome caused by severe pneumonia complicated with heart failure using the retention enema with Modified Dahuang Mudan Decoction,and to observe the effect and safety of this treatment on inflammatory indicators,cardiac function,gastrointestinal function and multiple organ failure in patients with Lower-Jiao(lower energizer)Obstruction Syndrome caused by severe pneumonia complicated with heart failure.[Methods]54 patients with Lower-Jiao Obstruction Syndrome caused by severe pneumonia complicated with heart failure diagnosed in Nanchong Chinese Medicine Hospital from January 2020 to December 2021 were randomly divided into experimental group(n=27)and control group(n=27).The control group was given conventional treatment combined with 0.9%sodium chloride injection(100 mL)+glycerine enema(40 mL).The treatment group was treated with Modified Dahuang Mudan Decoction on the basis of conventional treatment for 7 d.The efficacy indicators and adverse events such as white blood count(WBC),C-reactive protein(CRP),procalcitonin(PCT),N-terminal pro-brain natriuretic peptide(NT-proBNP),Lausanne Intestinal Failure Estimation(LIFE)and multiple organ dysfunction score(MODS)were observed.[Results](i)There was no significant difference in WBC,PCT,CRP and NT-proBNP between the two groups before treatment.All indicators after treatment were significantly lower than those before treatment in both groups(P<0.05).The levels of WBC,PCT and CRP in the treatment group were lower than those in the control group after treatment(P<0.05),and there was no significant difference in NT-proBNP between the two groups after treatment(P>0.05),but the difference in NT-proBNP before and after treatment in the treatment group was higher than that in the control group.(ii)The LIFE of the two groups decreased significantly after treatment,and the improvement of LIFE of the treatment group was better than that of the control group(P<0.05).(iii)The MODS of the two groups decreased significantly after treatment(P<0.05),and the degree of decrease after treatment in the treatment group was higher than that in the control group(P<0.05).(iv)There was no significant difference in all-cause mortality between the two groups(P>0.05).(v)No serious adverse events were found in both groups during the treatment period.[Conclusions]The conventional treatment,combined with the retention enema with Modified Dahuang Mudan Decoction could further reduce the inflammatory indicators,improve cardiac function,improve intestinal function and organ function,and the safety was good.

Heart Failure in Children: Epidemiological, Etiological and Diagnostic Aspects in Diamniadio Children’s Hospital (Senegal)

Introduction: Heart failure is a major cause of morbidity and mortality in children. The authors aimed to report the epidemiological and etiological characteristics of heart failure (HF) in children in Senegal. Patients and Methods: This was a retrospective study conducted at the Children’s Hospital of Diamniadio (CHD) from 01-01-2016 to 31-12-2017. Children aged 0 to 15 years with heart failure confirmed by echocardiography were included. Results: Sixty-six children were admitted for heart failure. The prevalence of HF was 5.3‰. The mean age of the children was 41.59 months ± 53.35 months (range: 0 to 168 months). The 0 - 5 age group was the most represented (n = 48;72.72%). The HF concerned 38 boys and 28 girls, a sex ratio (M/F) of 1.36. The majority of our patients came from the semi-urban area (42.4%). The etiology of HF was represented in order of frequency by congenital heart disease, rheumatic heart disease and cardiomyopathy with 59.09% of cases, 22.73% of cases and 7.58% of cases respectively. It was unknown in 4.54% of the cases. At echocardiography, the left ventricular ejection fraction (LVEF) was impaired (less than 50%) in 19 patients, in 29.2% of cases with an average of 64% +/- 15.16% (extremes: 24% and 86%). Anemia was the comorbidity most commonly associated with their condition (n = 33%;50%). Conclusion: Heart failure in children is uncommon. The main etiology is represented by congenital heart disease.

Heart Failure in Children in a Context of Sars-Cov 2 Infection: About Two Cases at the University Hospital Center of Libreville, Gabon

This study reports two observations of heart failure diagnosed in the context of SARS-CoV 2 infection in children at the University Hospital Center of Libreville, Gabon. Long considered exempted from serious forms of Covid-19 infection, the fatal evolution of one of the two cases proves that there is an interest for a more rigorous approach in their management in a pandemic context. The multisystem inflammatory syndrome associated with this virus in children can be responsible for cardiac manifestations that can be life-threatening. Early diagnosis and treatment are necessary to reduce mortality. However, this approach is made difficult in our regions by the limited biomedical equipment and the absence of essential therapies as noted in these two observations.

重症肺炎脓毒症患者血清Sestrin2,TLR7水平表达及对心力衰竭的预测价值分析

目的探究重症肺炎脓毒症患者血清Sestrin2,Toll样受体7(toll-like receptors 7,TLR7)水平表达及对并发心力衰竭的预测价值。方法以2022年2月~2023年5月在山西省人民医院进行诊治的86例重症肺炎脓毒症并发心力衰竭患者(并发心力衰竭组)、86例重症肺炎脓毒症患者(未并发心力衰竭组)为研究对象,另收集同期行健康检查者86例纳为对照组。酶联免疫吸附法(ELISA)测定血清Sestrin2和TLR7水平。彩色多普勒超声心动图仪测定所有受试者心功能相关指标:左室射血分数(left ventricular ejection fraction,LVEF)、左室舒张末期内径(leftventricular end diastolic diameter,LVEDD)及左室收缩末期内径(left ventricular end-systolic diameter,LESD),分析三组血清Sestrin2,TLR7水平表达及心功能。Pearson相关性分析并发心力衰竭患者血清Sestrin2,TLR7水平与心功能相关指标间的关系;受试者工作特征(receiver operating characteristic,ROC)曲线分析血清Sestrin2和TLR7水平对重症肺炎脓毒症患者并发心力衰竭的预测价值。结果未并发心力衰竭组与并发心力衰竭组血清Sestrin2(11.59±3.31ng/ml,16.13±3.62 ng/ml),TLR7(48.93±9.52 ng/ml,61.74±10.11 ng/ml)及心功能相关指标LVEDD(53.28±5.76mm,62.54±6.11mm),LESD(38.16±4.38mm,48.15±5.02mm)均显著高于对照组(7.11±2.34ng/ml,40.12±10.16ng/ml,44.86±5.02mm,29.02±4.07mm),差异具有统计学意义(qSestrin2=13.241,26.659,qTLR7=8.224,20.182,qLVEDD=13.824,29.028,qLESD=18.805,39.359,均P<0.05),且并发心力衰竭组患者显著高于未并发心力衰竭组,差异具有统计学意义(q=13.418,11.985,15.203,20.554,均P<0.05);而未并发心力衰竭组和并发心力衰竭组心功能指标LVEF(55.43%±6.62%,41.67%±5.84%)显著低于对照组(62.75%±7.16%),差异具有统计学意义(q=10.344,29.789,均P<0.05),且并发心力衰竭组患者显著低于未并发心力衰竭组,差异具有统计学意义(q=19.455,P<0.05)。Pearson相关性分析结果显示,并发心力衰竭组患者血清Sestrin2,TLR7水平与LVEF呈显著负相关(r=-0.419,-0.467,均P<0.05),与LVEDD和LESD呈显著正相关(r=0.456,0.419;0.402,0.437,均P<0.05),Sestrin2与TLR7呈显著正相关(r=0.641,P<0.05)。ROC曲线结果显示,血清Sestrin2,TLR7联合预测重症肺炎脓毒症患者并发心力衰竭的曲线下面积(area under the curve,AUC)为0.940,敏感度和特异度分别为74.9%,73.3%。结论重症肺炎脓毒症患者血清Sestrin2,TLR7水平均显著升高,且对患者并发心力衰竭具有良好的预测价值。

Similarities and Differences of CT Features between COVID-19 Pneumonia and Heart Failure

Aims:During the COVID-19 epidemic,chest computed tomography(CT)has been highly recommended for screen-ing of patients with suspected COVID-19 because of an unclear contact history,overlapping clinical features,and an overwhelmed health system.However,there has not been a full comparison of CT for diagnosis of heart failure or COVID-19 pneumonia.Methods:Patients with heart failure(n=23)or COVID-19 pneumonia(n=23)and one patient with both diseases were retrospectively enrolled.Clinical information and chest CT images were obtained and analyzed.Results:There was no difference in ground-glass opacity,consolidation,crazy paving pattern,the lobes affected,and septal thickening between heart failure and COVID-19 pneumonia.However,a less rounded morphology(4%vs.70%,P=0.00092),more peribronchovascular thickening(70%vs.35%,P=0.018)and fi ssural thickening(43%vs.4%,P=0.002),and less peripheral distribution(30%vs.87%,P=0.00085)were found in the heart failure group than in the COVID-19 group.Importantly,there were also more patients with upper pulmonary vein enlargement(61%vs.4%,P=0.00087),subpleural effusion(50%vs.0%,P=0.00058),and cardiac enlargement(61%vs.4%,P=0.00075)in the heart failure group than in the COVID-19 group.Besides,more fi brous lesions were found in the COVID-19 group,although there was no statistical difference(22%vs.4%,P=0.080).Conclusions:Although there is some overlap of CT features between heart failure and COVID-19,CT is still a useful tool for differentiating COVID-19 pneumonia.

Influenza vaccination in acute coronary syndromes patients in Thailand： the cost-effectiveness analysis of the prevention for cardiovascular events and pneumonia

Background Influenza vaccination has been clinically shown to reduce adverse cardiovascular outcomes in acute coronary syndrome （ACS） patients, but the economic perspectives can provide important data to make informed decisions. This study aimed to perform the economic evaluation of lifelong annual influenza vaccination for cardiovascular events and well-established pneumonia prevention. Methods Lifetime costs, life-expectancy, and quality-adjusted live years （QALYs） were estimated beyond one-year cycle length of a six-health states Markov model condition on whether a hospitalization for ACS, stroke, heart failure, pneumonia, no hospitalizations occurred, or death. The comparison of three age-groups of 40-49, 50-65, and 〉 65 years scenario was performed. Incremental cost-effectiveness ratio （ICER） and net monetary benefit （NMB） were presented as a societal perspective in 2016. The model robustness was determined by one-way and prob- abilistic sensitivity analyses. Results The influenza vaccination was cost-effective in all age-groups, by dominant ICERs （lower cost with higher effectiveness） which was completely lower than acceptable willingness-to-pay threshold of Thailand [160,000 THB （4,466.8 USD） per QALYs], with a great incremental value of NMB. Especially, the 50-year-old-and- above scenario was shown as the most benefit at 129,092 THB （3,603.9 USD） for each patient. Conclusions The annually additional influenza vaccination to standard treatment in ACS was cost-effective in all age-groups, which should be considered in clinical practice and health-policy making process.

Clinical cardiac regenerative studies in children

Although the incidence of pediatric heart failure is low, the mortality is relatively high, with severe clinical symptoms requiring repeated hospitalization or intensive care treatment in the surviving patients. Cardiac biopsy specimens have revealed a higher number of resident human cardiac progenitor cells, with greater proliferation and differentiation capacity, in the neonatal period as compared with adults, demonstrating the regeneration potential of the young heart, with rising interest in cardiac regeneration therapy in critically ill pediatric patients. We review here the available literature data, searching the MEDLINE, Google Scholar and EMBASE database for completed, and www.clinicaltrials.gov homepage for ongoing studies involving pediatric cardiac regeneration reports. Because of difficulties conducting randomized blinded clinical trials in pediatric patients, mostly case reports or cohort studies with a limited number of individuals have been published in the field of pediatric regenerative cardiology. The majority of pediatric autologous cell transplantations into the cardiac tissue have been performed in critically ill children with severe or terminal heart failure. Congenital heart disease, myocarditis, and idiopathic hypertrophic or dilated cardiomyopathy leading to congestive heart failure are some possible areas of interest for pediatric cardiac regeneration therapy. Autologous bone marrow mononuclear cells, progenitor cells, or cardiospheres have been applied either intracoronary or percutaneously intramyocardially in severely ill children, leading to a reported clinical benefit of cell-based cardiac therapies. In conclusion, compassionate use of autologous stem cell administration has led to at least short-term improvement in heart function and clinical stability in the majority of the critically ill pediatric patients.

老年心力衰竭并发肺炎患者血清FOXM1和IGF2表达水平及与预后价值研究

目的探究血清叉头盒蛋白M1(forkhead box protein M1,FOXM1)和胰岛素样生长因子2(insulin-like growth factor 2,IGF2)表达对老年心力衰竭合并肺炎患者预后的预测价值。方法将邯郸市中心医院2021年3月~2022年6月收治的126例老年心力衰竭并发肺炎患者设为病例组,并根据随访情况将122例患者分为预后不良组(n=33)和预后良好组(n=89),另选取该院同期126例健康体检者为对照组。检测两组(病例组和对照组)血清FOXM1和IGF2水平,检测病例组用力肺活量(forced vital capacity,FVC)和第一秒用力呼容积(forced expiratory volume in one second,FEV1)。采用Spearman分析法分析老年心力衰竭并发肺炎患者血清FOXM1和IGF2水平与心功能分级的相关性;受试者工作特征(receiver operating characteristic,ROC)曲线分析血清FOXM1和IGF2水平对老年心力衰竭并发肺炎患者预后的预测价值。结果与对照组比较,病例组血清FOXM1(2.39±0.55 vs 1.06±0.21)和IGF2(71.33±7.96pg/ml vs 47.82±5.14pg/ml)水平明显较高,差异有统计学意义(t=25.358,27.581,均P<0.05);与预后良好组比较,预后不良组血清FOXM1(3.87±1.06 vs 1.95±0.51)和IGF2水平(85.88±9.54pg/ml vs 69.14±8.73pg/ml)明显较高,差异具有统计学意义(t=13.453,9.174,均P<0.05);预后良好组和预后不良组心功能分级比较差异有统计学意义(χ^(2)=7.120,P<0.05),且与预后不良组比较,预后良好组FEV1(1.24±0.32L vs 1.08±0.25L)和FEV1/FVC(55.46%±5.77%vs 52.30%±5.38%)明显较高,差异有统计学意义(t=2.592,2.735,均P<0.05);老年心力衰竭并发肺炎患者血清FOXM1水平和IGF2水平与心功能分级呈显著正相关(r=0.496,0.517,均P<0.05)。ROC曲线结果显示,血清FOXM1单独预测老年心力衰竭并发肺炎患者预后的曲线下面积(area under the curve,AUC)为0.854(95CI%:0.779~0.912),其敏感度、特异度分别为75.76%,86.52%,最佳截断值为2.75;IGF2单独预测老年心力衰竭并发肺炎患者预后的AUC为0.874(95CI%:0.802~0.927),其敏感度、特异度分别为72.73%,85.39%,最佳截断值为78.30 pg/ml;二者联合预测老年心力衰竭并发肺炎患者预后的AUC显著大于血清FOXM1和IGF2单独诊断的AUC(Z=2.413,2.737,P=0.006,0.016)。结论血清FOXM1和IGF2水平在老年心力衰竭并发肺炎患者中升高,且二者联合检测对患者预后具有较高的预测价值。

儿童腺病毒肺炎并发呼吸衰竭的危险因素分析

目的探讨腺病毒感染致重症社区获得性肺炎患儿并发呼吸衰竭的临床特点和相关危险因素。方法回顾性分析2019年1月至12月江西省儿童医院收治的127例重症腺病毒肺炎(SAP)住院患儿的临床资料,根据有无并发呼吸衰竭分为呼吸衰竭组(n=51)和非呼吸衰竭组(n=76),选取同期住院的轻症腺病毒肺炎(AVP)患儿作为对照组(n=80),分析SAP患儿并发呼吸衰竭的危险因素。结果呼吸衰竭组、非呼吸衰竭组与对照组在热程、住院天数、患基础疾病情况、C反应蛋白(CRP)、天冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)、胸腔积液比例、肺实变比例、合并感染比例比较,差异均有统计学意义(P<0.05)。单因素分析结果显示,呼吸衰竭组和非呼吸衰竭组的热程、住院天数、CRP、AST、LDH、肌酐、血糖、白细胞(WBC)、中性粒细胞计数、血红蛋白(Hb)比较,差异有统计学意义(P<0.05);呼吸衰竭组与非呼吸衰竭组患基础疾病情况、胸腔积液比例、肺实变比例、合并感染比例比较,差异有统计学意义(P<0.001)。多因素logistic回归分析结果显示,热程>14.5 d(β=0.209,OR=1.233,95%CI=1.043~1.458)、住院天数>16.5 d(β=0.270,OR=1.309,95%CI=1.080~1.588)、患基础疾病(β=2.059,OR=7.839,95%CI=1.277~48.106)、CRP>14.9 mg/L(β=0.033,OR=1.033,95%CI=1.002~1.066)是SAP患儿发生呼吸衰竭的危险因素。结论SAP患儿热程、住院时间长于轻症腺病毒肺炎患儿,患胸腔积液、肺实变及合并感染比例、CRP、AST、LDH高于轻症腺病毒肺炎患儿。当SAP患儿存在发热持续时间长、住院治疗时间长、罹患基础疾病及CRP增高时,会增加发生呼吸衰竭风险,在临床上应进行早期评估病情及干预。

β受体阻滞剂应用于小儿充血性心力衰竭的系统评价与Meta分析

目的 系统评价β受体阻滞剂对小儿充血性心力衰竭患者的疗效,为临床用药提供证据。方法 从PubMed、Embase、the Cochrane Library及CNKI、万方、维普数据库中检索相关前后对照试验与随机对照试验,检索时限自建库起至2023年10月31日。结局指标有左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)、左心室舒张末期内径(LVDD)、左心室收缩末期内径(LVSD)、N端B型脑钠肽(NT-proBNP)、心率、血压及心功能改善情况。结果 共纳入20项符合标准的研究,包含1 068例患儿,包括扩张型心肌病、心内膜弹力纤维增生。Meta分析显示,在常规心力衰竭药物治疗的基础上,使用β受体阻滞剂(琥珀酸美托洛尔、比索洛尔及卡维地洛),对改善患儿LVEF[MD=13.06,95%CI(11.67,14.45),P <0.001]、LVFS [MD=6.96,95%CI(6.54,7.37),P <0.001]、LVDD [MD=-6.43,95%CI(-7.58,-5.28),P <0.001]和LVSD [MD=-8.30,95%CI(-8.83,-7.76),P <0.001]效果显著;也可改善患儿血压、心率、NT-proBNP和心功能。结论 在常规心力衰竭药物治疗的基础上使用β受体阻滞剂的联合方案可提高小儿充血性心力衰竭患者的心功能及改善心力衰竭症状,推荐将β受体阻滞剂积极应用于该类患儿的常规治疗方案中。

基于循证理论的预见性护理策略结合声门下间歇冲洗预防2型糖尿病伴心力衰竭患者呼吸机相关性肺炎的效果及对炎性介质水平的影响

目的分析基于循证理论的预见性护理策略结合声门下间歇冲洗在预防2型糖尿病(T2DM)伴心力衰竭(HF)患者呼吸机相关性肺炎(VAP)中的应用效果。方法择取2021年1月至2022年1月收治的100例T2DM伴HF患者为研究对象,随机将其分为对照组和观察组,各50例。对照组采用常规护理干预,观察组在对照组基础上加基于循证理论的预见性护理策略结合声门下间歇冲洗。比较两组的干预效果。结果观察组的VAP发生率、随机血糖水平低于对照组,机械通气时间、气管插管时间及住院时间短于对照组(P<0.05)。干预后,观察组的肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)及C反应蛋白(CRP)水平低于对照组(P<0.05)。干预后,观察组的脑钠肽(BNP)水平及糖化血红蛋白(HbA1c)低于对照组(P<0.05)。结论基于循证理论的预见性护理策略结合声门下间歇冲洗能够有效预防T2DM伴HF患者VAP的发生,降低炎性介质水平,改善血糖及心功能,值得临床推广与应用。

老年冠心病并发心力衰竭患者院内肺部感染影响因素及风险预测模型构建

目的 探讨老年冠心病伴心力衰竭患者出现院内肺部感染的影响因素。方法 回顾性选取2021年3月至2023年8月苏州大学附属第二医院老年科诊治的老年冠心病伴心力衰竭患者196例,根据住院期间有无出现肺部感染分为感染组52例和非感染组144例。采用logistic回归分析影响继发院内肺部感染的危险因素,并依据危险因素构建综合指数;采用ROC曲线分析继发院内肺部感染的诊断价值。结果 感染组年龄、纽约心脏病协会(New York Heart Association, NYHA)心功能分级Ⅲ~Ⅳ级、吸烟史、糖尿病史、机械通气时间>48 h、住院时间>14 d、入院时清蛋白<30 g/L、入院时红细胞分布宽度(red blood cell distribution width, RDW)显著高于非感染组(P<0.05,P<0.01)。Logistic回归分析显示,NYHA心功能分级Ⅲ~Ⅳ级、糖尿病史、机械通气时间>48 h、住院时间>14 d、入院时清蛋白<30 g/L、入院时RDW是影响老年冠心病伴心力衰竭患者继发院内肺部感染的危险因素(OR=2.398,95%CI:1.157~4.969;OR=2.732,95%CI:1.278~5.839;OR=2.607,95%CI:1.138~5.973;OR=3.368,95%CI:1.567~7.242;OR=2.677,95%CI:1.218~5.886;OR=1.762,95%CI:1.488~61.222)。ROC曲线分析显示,NYHA心功能分级Ⅲ~Ⅳ级、糖尿病史、机械通气时间>48 h、住院时间>14 d、入院时清蛋白<30 g/L、入院时RDW预测老年冠心病伴心力衰竭患者继发院内肺部感染的曲线下面积分别为0.598、0.620、0.586、0.595、0.615、0.850,综合指数的曲线下面积为0.743,显著优于单项指标(P<0.05)。结论 年龄、心功能NYHA分级、吸烟史、糖尿病史、机械通气时间、住院时间、入院时清蛋白、RDW水平会对老年冠心病伴心力衰竭患者继发院内肺部感染产生不良影响,依据这些危险因素构建综合指数模型对预测院内肺部感染有较高的效能。

重症社区获得性肺炎患者发生心力衰竭危险因素的分析

目的:探讨重症社区获得性肺炎患者(severe community-acquired pneumonia,SCAP)发生心力衰竭(heart failure,HF)的危险因素。方法:回顾性收集2021年11月至2023年5月,河北中石油中心医院住院治疗的SCAP 113例患者,合并心力衰竭为病例组(n=53)及未出现HF对照组(n=60)。比较两组患者住院期间的临床资料、超声检查参数、实验室参数间的差异,并将P<0.05的变量纳入多因素Logistic回归模型,评估SCAP患者发生HF的危险因素。结果:纳入53例病例组和60例对照组患者,多因素Logistic回归分析显示,冠心病(OR=3.64,95%CI:1.26~10.53,P=0.02)、心律失常(OR=5.66,95%CI:1.72~18.66,P=0.01)、急性心肌梗死(OR=3.72,95%CI:1.52~9.12,P=0.004)、使用有创呼吸机(OR=3.36,95%CI:1.13~9.98,P=0.03)是SCAP患者发生HF的危险因素。结论:冠心病、心律失常、急性心肌梗死、使用有创呼吸机是SCAP患者发生HF的危险因素。

急性前壁ST段抬高型心肌梗死患者院内发生心力衰竭的危险因素

目的分析急性前壁ST段抬高型心肌梗死(STEMI)患者住院期间发生心力衰竭的危险因素。方法回顾性分析2015年1月至2022年12月于厦门大学附属东南医院收治的接受经皮冠状动脉介入治疗(PCI)的急性前壁STEMI患者临床资料。全部患者根据住院期间是否发生心力衰竭将患者分为心力衰竭组(309例)和非心力衰竭组(261例)。比较两组患者的临床资料,采用多因素Logistic回归分析影响急性前壁STEMI患者院内发生心力衰竭的独立危险因素。通过受试者工作特征曲线(ROC)和曲线下面积(AUC)分析危险因素预测诊断发生心力衰竭效能。结果共纳入570例急性前壁STEMI患者,其中心力衰竭组309例(54.21%)、非心力衰竭组261例(45.79%)。多因素Logistic回归结果显示,室性心律失常(OR=5.583,95%CI:2.240~13.917,P<0.001)、存在社区获得性肺炎(OR=4.689,95%CI:2.371~9.275,P<0.001)、年龄增加(OR=1.029,95%CI:1.011~1.047,P=0.001)和N末端脑钠肽前体(NT-pro-BNP)峰值升高(OR=1.082,95%CI:1.055~1.110,P<0.001)是前壁STEMI患者发生院内心力衰竭的独立危险因素,而左室射血分数(LVEF)增加(OR=0.958,95%CI:0.936~0.982,P<0.001)是其保护因素。NT-proBNP峰值预测前壁STEMI患者发生院内心力衰竭的AUC最大为0.753,最佳诊断切点为2031 pg/dl。结论室性心律失常、社区获得性肺炎、年龄增加、LVEF降低和峰值NT-proBNP升高均是急性前壁STEMI患者发生院内心力衰竭的危险因素。

东莞市1275例儿童重症肺炎的病原学及临床特点分析

目的:分析东莞市儿童重症肺炎的病原学及临床特点,为临床诊治提供参考依据。方法:回顾性分析2018年1月—2022年12月东莞市妇幼保健院收治的1275例儿童重症肺炎的病原检测、影像学资料、临床诊治及预后等资料。结果:1275例重症肺炎以≤1岁的婴儿为主(56.7%),夏季(26.35%)及秋季(31.22%)高发。主要临床表现为发热、咳嗽、气促、喘息、发绀,合并心肺基础疾病者多见。病原检测以细菌感染(21.7%)及非典型病原体感染(21.3%)为主,检出病原前五位为:肺炎支原体、呼吸道合胞病毒、流感嗜血杆菌、肺炎链球菌、腺病毒。98例儿童出现肺实变,48例胸腔积液,肺实变以细菌及混合感染为主,胸腔积液以肺炎支原体感染最常见。药物治疗包括应用抗生素(83.0%)、甲泼尼龙琥珀酸钠治疗(22.4%)、免疫球蛋白治疗(8.4%)等,机械通气211例(16.54%),机械通气以病毒及混合感染常见,非典型病原感染最少。结论:东莞地区儿童重症肺炎好发于1岁以下婴儿,夏、秋季节高发,以细菌及非典型病原感染为主,最常见感染病原为肺炎支原体、呼吸道合胞病毒、流感嗜血杆菌等,<3个月龄小婴儿以呼吸道合胞病毒感染最常见,3个月~1岁婴儿以呼吸道合胞病毒及流感嗜血杆菌感染为主,1岁以上儿童以肺炎支原体感染最常见,肺炎支原体感染易合并胸腔积液,病毒及混合感染易出现呼吸衰竭。

俯卧位通气治疗小儿肺炎合并呼吸衰竭的临床效果、安全性及对肺动态顺应性的影响分析

目的分析小儿肺炎合并呼吸衰竭使用俯卧位通气治疗的临床效果、安全性及对肺动态顺应性(Cdyn)的影响。方法将90例小儿肺炎合并呼吸衰竭患儿根据治疗方法不同分为研究组与对照组,各45例。对照组以仰卧位通气治疗,研究组以俯卧位通气治疗。比较两组患儿机械通气总时长、住儿童重症加强护理病房(PICU)时长、不良事件发生情况及治疗前后肺功能[每分钟肺通气量(MVV)、潮气量(VT)以及肺动态顺应性]、血气参数[血氧分压(PaO_(2))和血氧饱和度(SaO_(2))]。结果研究组的机械通气总时长(70.28±7.67)h和住PICU时长(5.12±0.49)d显著短于对照组的(93.35±9.32)h、(7.57±0.57)d,差异有统计学意义(P<0.05)。两组治疗后的MVV、VT、肺动态顺应性均比治疗前有明显改善,且研究组的MVV(80.22±7.14)L/min、VT(8.91±1.25)ml/kg、肺动态顺应性(13.12±2.28)ml/cm H_(2)O(1 cm H_(2)O=0.098 kPa)显著优于对照组的(71.12±6.37)L/min、(7.02±1.20)ml/kg、(9.34±2.75)ml/cm H_(2)O,差异有统计学意义(P<0.05)。两组治疗后的PaO_(2)、SaO_(2)均比治疗前有良好改善,且研究组的PaO_(2)(87.22±5.35)mm Hg(1 mm Hg=0.133 kPa)、SaO_(2)(96.78±2.31)%显著优于对照组的(53.31±5.26)mm Hg、(93.43±2.12)%,差异有统计学意义(P<0.05)。研究组不良事件总发生率2.22%与对照组的6.67%比较,差异无统计学意义(P>0.05)。结论小儿肺炎合并呼吸衰竭使用俯卧位通气治疗可在很大程度上改善患儿的肺动态顺应性和血气参数指标,促进患儿加快康复,同时具有良好安全性。

IL-6、CRP、NLR和NT-proBNP对老年心力衰竭合并肺炎的诊断价值

目的探讨白细胞介素-6(IL-6)、C-反应蛋白(CRP)、中性粒细胞与淋巴细胞比值(NLR)和N末端前脑钠肽前体(NT-proBNP)对老年心力衰竭(以下简称心衰)合并肺炎的诊断价值。方法选取2022年4月至2023年4月该院收治的165例老年心衰患者作为研究对象,根据是否合并肺炎分为心衰合并肺炎组(78例)和单纯心衰组(87例),根据美国纽约心脏病协会(NYHA)心功能分级标准分为Ⅱ级组(59例)和Ⅲ级+Ⅳ级组(106例)。比较各组IL-6、CRP、NT-proBNP水平和NLR;采用Spearman相关分析IL-6、CRP、NLR与NT-proBNP水平的相关性;采用受试者工作特征(ROC)曲线评估IL-6、CRP、NLR、NT-proBNP单独及联合检测对心衰患者合并肺炎的诊断效能。结果心衰合并肺炎组IL-6、CRP、NT-proBNP水平及NLR明显高于单纯心衰组(P<0.05),Ⅲ级+Ⅳ级组IL-6、CRP、NT-proBNP水平及NLR明显高于Ⅱ级组(P<0.05)。Spearman相关性分析结果显示,NT-proBNP水平与IL-6、CRP、NLR水平呈正相关(r=0.263、0.419、0.468,P<0.001)。IL-6、CRP、NLR和NTproBNP联合诊断心衰合并肺炎的曲线下面积(AUC)为0.726(95%CI:0.650~0.803),灵敏度为67.9%,特异度为71.3%。结论心衰合并肺炎患者IL-6、CRP、NT-proBNP水平和NLR明显高于单纯心衰患者,上述4项指标联合检测对心衰合并肺炎患者有一定的诊断效能。

小儿重症肺炎合并心衰及小儿哮喘临床治疗效果分析

目的 分析小儿重症肺炎合并心力衰竭(心衰)及小儿哮喘的临床治疗效果。方法 甄选0.5~5.5岁患有重症肺炎合并心力衰竭的患儿42例以及哮喘患儿34例作为观察对象。42例重症肺炎合并心力衰竭患儿依照就诊顺序分为参照A组(采用基础治疗, 21例)与实验A组(实施多巴胺、多巴酚丁胺治疗, 21例);34例哮喘患儿依照就诊顺序分为参照B组(进行常规治疗, 17例)和实验B组(实行特布他林联合布地奈德雾化吸入治疗, 17例)。比较两种疾病各亚组治疗效果。结果 治疗后,重症肺炎合并心力衰竭患儿中实验A组与参照A组的总有效率分别为95.23%、71.43%,两组总有效率比较,差异显著(P<0.05)。治疗后,哮喘患儿中实验B组与参照B组的总有效率分别为94.12%、64.71%,两组总有效率比较,差异显著(P<0.05)。结论 小儿重症肺炎合并心力衰竭以药物治疗为主,同时应注意小儿重症肺炎和心力衰竭的治疗,以减少各种并发症的发生;联用特布他林与布地奈德雾化吸入治疗能全面提高小儿哮喘的整体疗效,提升患儿的生命质量。

重症肺炎伴心力衰竭患者急救中的标准化护理干预效果研究

目的:分析重症肺炎伴心力衰竭患者急救中标准化护理干预的应用效果。方法:选取山东大学齐鲁医院2022年1月至2023年6月期间收治的80例重症肺炎伴心力衰竭患者,随机分为对照组和观察组,各40例,对照组采用常规护理,观察组给予标准化护理干预,对比两组急救时效性、心、肺功能。结果:观察组急诊反应时间、分诊评估时间、检查时间、心电图时间及总体急救时间均短于对照组(P<0.05)。两组入院7d左室射血分数(LVEF)、每搏输出量、心脏指数以及用力肺活量(FVC)、第一秒用力呼气容积(FEV1)及最大呼气流速(PEF)较入院时均明显提高(P<0.05),但治疗后,两组心、肺功能各项指标比较无明显差异(P>0.05)。结论:重症肺炎伴心力衰竭患者急救中标准化护理干预的应用,效果突出,值得临床应用。