目的:探讨早产儿呼吸暂停相关高危因素,指导临床防治工作。方法:对90例早产儿呼吸暂停进行回顾性分析。结果:胎龄越小,体重越低的早产儿,原发性呼吸暂停发生率越高,随着胎龄增加继发性呼吸暂停发生率亦增加,继发性呼吸暂停与缺氧、低体温、酸中毒、脑损伤、感染等因素有关,生后2~5d为发病高峰期。结论:呼吸暂停与胎龄、体重、缺氧、低体温、低血糖、酸中毒、感染、颅脑损伤等多因素有关。对有相关高危因素早产儿应足够重视,减少呼吸暂停发生。
Abstract: Objective To analyze clinical outcomes of intra-aortic balloon pump (IABP) application for high-risk patients before undergoing off-pump coronary artery bypass grafting (OPCAB), and summarize our experience and weaning indications of IABP. Methods We retrospectively analyzed clinical data of 102 high-risk patients with coronary artery disease who underwent IABP implantation before OPCAB from January 2008 to July 2011 in Zhongshan Hospital of Fudan University. There were 71 male patients and 31 female patients with their average age of 63.0±8.2 years in this IABP group. We also chose another 100 patients without IABP implantation before undergoing OPCAB as the control group, including 55 male patients and 45 female patients with their average age of 64.1±9.5 years. Postoperative systolic arterial blood pressure (SABP), mean arterial blood pressure (MABP), mechanical ventilation time, length of intensive care unit(ICU) stay, morbidity, duration of IABP treatment and in-hospital mortality of two groups were compared. Left ventricular ejection fraction (LVEF) was evaluated with echocardiography 3 months after surgery. Results Postoperative SABP (95.3±12.2 mm Hg vs. 80.1±11.7 mm Hg;t=8.440, P=0.000) and MABP (78.9±13.5 mm Hg vs. 52.3±15.1 mm Hg; t=12.410, P=0.000) of the IABP group were significantly higher than those of the control group. Mechanical ventilation time, length of ICU stay and duration of inotropic support of the IABP group were significantly shorter than those of the control group. The incidence of ventricular arrhythmia, low cardiac output syndrome, perioperative myocardial infarction and dialysis-requiring acute kidney failure of the IABP group were significantly lower than those of the control group. In-hospital mortality of the IABP group was significantly lower than that of the control group [5.9% (6/102) vs. 17.0% (17/100), χ 2 =6.180, P=0.020]. Ninety-six patients in the IABP group and 83 patients in the control group were followed up for 3 months. Three months after surgery, echocardiography showed that LVEF of the IABP group was significantly higher than that of the control group(45.3%±12.0% vs. 39.1%±8.2%, t=3.950, P=0.000). Conclusion Preoperative prophylactic IABP implantation and optimal timing of weaning from IABP support can not only significantly reduce surgical risk and improve surgical outcomes and postoperative recovery of high-risk patients undergoing OPCAB, but also considerably ameliorate patient heart function and reduce perioperative morbidity and mortality.
ObjectiveTo analyze the relation between ABO blood type and postoperative pathological features of patients with colorectal cancer served by West China Hospital of Sichuan University as a regional center in the current version of Database from Colorectal Cancer (DACCA). MethodsThe data of DACCA was updated on January 5, 2022. According to the screening conditions, the enrolled patients with colorectal cancer were divided into blood type A, B, AB, and O. The differences in the postoperative pathological characteristics of patients with different blood types, such as pathological TNM, T, N, M (pTNM, pT, pN, pM) staging, peripheral nerve involvement, high risk factors, tumor regression grade (TRG), and cancer nodules, were analyzed. ResultsAfter screening, 6 089 data rows were analyzed. The patients involved 2 058 blood type A, 1 469 blood type B, 494 blood type AB, and 2 068 blood type O. The results of statistical analysis showed that: ① There were statistical differences in the overall distribution of pTNM and pM stages among the patients with different blood types (H=11.564, P=0.009; H=7.947, P=0.047), which was reflected in: from the overall distribution trend, the proportion of patients with the four blood types in the same stage was similar, but it could still be seen that patients with blood type AB accounted for the highest proportion in the patients with stage Ⅲ, Ⅳ, M1a, M1b as compared with other blood types. ② There were no statistical differences in the overall distribution of peripheral nerve involvement and TRG in the patients with different blood types (H=3.414, P=0.332; H=1.143, P=0.767). ③ There was statistical difference in the proportion of different grades of high risk factors in the patients with different blood types (H=14.540, P=0.002). Specifically, the proportions of patients with grade 3–5 of high risk factors in the patients with AB blood type were the highest. ④ There was no statistical difference in the proportion of the grade of cancer nodules number in patients with different blood types (H=4.460, P=0.216). ConclusionsFrom results of this study, it is found that there are some differences in pTNM stage, pM stage, and high risk factors of colorectal cancer patients with different blood types, but no differences in pT stage, pN stage, peripheral nerve involvement, TRG, and cancer nodules among different blood types of patients. The influence of blood type on postoperative pathological characteristics of colorectal cancer patients needs to be further explored.
ObjectiveTo investigate the efficacy and safety of percutaneous transhepatic gallbladder drainage (PTGBD) combined with early laparoscopic cholecystectomy (LC) in the treatment of elderly patients with high-risk acute cholecystitis.MethodsThe clinical data of 128 elderly patients with high-risk acute cholecystitis admitted to Department of Hepatobiliary Surgery in Dazhou Central Hospital from January 2015 to January 2019 were retrospectively analyzed. Among them, 62 patients underwent PTGBD combined with early LC treatment (PTGBD+early LC group), 66 patients underwent PTGBD combined with delayed LC treatment (PTGBD+delayed LC group). Comparison was performed on the operative time, intraoperative blood loss, conversion to laparotomy rate, postoperative indwelling time, postoperative hospitalization time, total hospitalization time, and complication.ResultsPTGBD was successfully performed in all patients, and the symptoms were relieved within 72 hours. There was no significant difference in operative time, intraoperative blood loss, conversion to laparotomy rate, postoperative indwelling time, postoperative hospitalization time, and total complication rate between the two groups (P>0.05), but the total hospitalization time of the PTGBD+early LC group was shorter than that of the PTGBD+delayed LC group (P<0.001). There was no second operation and death in both two groups. The 128 patients were followed-up for 2–50 months with a average of 19 months. Results of follow-up after operation showed that the patients did not complain of obvious abdominal pain, abdominal distension, chills, fever, jaundice, and other discomforts.ConclusionsFor elderly patients with high-risk acute cholecystitis, early LC is a safe and effective treatment for patients with good overall condition after PTGBD. It can not only shorten the total hospitalization time, but also significantly shorten the time of tube-taking and improve the quality of life of patients. It has important clinical application value.
Objective To investigate the information of label use of high-alert drugs for children of high risk population, in the Military General Hospital of Beijing PLA. Methods We selected high-alert drugs used in this hospital as objectives. The package inserts of these drugs were investigated and medication parts for children were analyzed. Results 201 drugs regarded as high-alert drugs were included, of which only 78 drugs have accurate detailed description of medication for children, accounting for 38.8% of the total of investigated high-alert drugs. Conclusion Children, as high-risk population, needs more attention concerning the use of high-alert drugs. However, risks in the use of high-alert drugs increased due to the lack of the information of label use of high-alert drugs. To ensure the safety of drug use in children, the information of drug use for children in the package inserts should be urgently supplemented.
ObjectiveTo investigate the specific CT findings of high-risk gastrointestinal stromal tumors (GISTs). MethodsCT findings of 24 patients with high-risk GISTs from August 2009 to March 2014 proved by surgery and pathology were retrospectively reviewed. ResultsTwelve of the high-risk GISTs were from the stomach, 11 from the small intestine (5 from duodenum, 4 from jejunum, and 2 from ileum), and 1 from the rectum. The biggest transverse diameter of the tumor was between 2.5 and 15.0 cm, and 2 were less than 5 cm and 22 of them were over 5 cm. The tumors appeared as irregular in 20 cases, and with indefinite boundary in 21 cases. Twenty-four tumors showed different levels of necrosis and cystic change, 15 showed ulcer, 2 showed perforation with effusion and pneumatosis, and 3 showed calcification. The enhancement of lesion was mostly moderately to markedly inhomogeneous. High-risk small intestinal stromal tumors had more significant enhancement and vessels. Hepatic metastasis in 3 cases was detected. ConclusionCT features of HRGISTs can be found with certain characteristics, which may contribute to the diagnosis.
Objective To analyze the clinical characteristics of the Guang’an Omicron epidemic and summarize the management experiences and practices in pandemic prevention and control of major infectious diseases.Methods Retrospective analysis was performed on patients infected with coronavirus disease (COVID-19), afterwards treated and observed in the isolation ward of Guang’an People’s Hospital and the shelter of Guang’an City from May 9 to June 26, 2022. The characteristics of patients at different age stages and the related factors affecting the severity, re-positive and negative conversion was analyzed. Results Finally 1 278 patients were collected, including 508 males and 770 females, with an average age of 41.3±22.6 years. Among them, 1 054 patients were asymptomatic carriers. The overall severe rate was 0.86%, the severe rate of the high-risk group was 3.06%. The median negative conversion time was 10.0 days and re-positive rate was 7.36%. Patients aged>60 years were 2.589 times more likely to have a longer negative conversion time than those aged≤60 years (95%CI 1.921-3.489, P<0.001). Conclusion The clinical characteristics of Guang’an COVID-19 epidemic are mainly that the elderly with high risk factors are more likely to develop severe cases, have longer clearance time, and re-positve is more likely to occur.