40例合并心脏损害的儿童过敏性紫癜临床分析

目的:探讨过敏性紫癜患儿合并心脏损害的病理机制、临床特点以及诊断和治疗.方法:选择过敏性紫癜合并心脏损害患儿40例,检查、观察其心电图及心肌酶学改变,并对其不同分型作对比分析.结果:心电图异常25例,其中混合型19例,单纯型6例.心肌酶谱异常的27例中,混合型18例,单纯型9例,混合型病例心肌酶谱高于单纯型.恢复期心肌酶及心电图均可恢复正常.结论:过敏性紫癜合并心肌损害,混合型病例更为多见.对过敏性紫癜患儿应及早行心电图、心肌酶谱的检查,以及时预防和治疗心脏损害.     

磷化铝中毒致P-R间期延长的探讨

熏蒸杀虫剂磷化铝具有挥发性,其遇水分产生毒气磷化氢,经呼吸道吸收,引起恶心,呕吐及心血管、神经系统表现.中毒无特效解毒药,主要是对症处理.该患者由于磷化铝中毒后未能及时系统的解毒治疗,因而侵及心血管系统,出现心律加快使心脏负荷加重,导致心肌损害,结果心电图上出现窦性心动过速,P-R间期延长.     

急性心肌梗死患者溶栓治疗的护理体会

急性心肌梗死是指在冠状动脉病变的基础上发生冠状动脉供血急剧减少或中断,导致心肌严重而持久的急性缺血性坏死,是内科常见症状,其早期死亡率最高.因此,一旦确诊,应紧急处理.而早期进行溶栓治疗,使闭塞的冠状动脉再通,可挽救部分濒死的心肌、缩小梗死面积,改善预后.现将我院心内科2010年1～12月收治的53例急性心肌梗死患者治疗溶栓的护理体会介绍如下.     

扩张性心肌病的护理观察与体会分析

所谓扩张性心肌病是指一种以心脏扩大和心律失常以及心肌收缩期泵功能障碍为主要临床表现的充血型心肌病,此类患者往往存在着左室或双心室扩张和收缩功能损害.据流行病调查学显示随着社会发展以及人们生活习惯的改变,扩张性心肌病的临床患病率正在逐年升高,而研究表明该病发病原因及其机制尚不明朗,对其治疗往往采取ACEI类、B受体阻滞剂和利尿剂以及地高辛为主要治疗手段,但是临床治疗效果不甚理想,所以我们在治疗基础上对其实施了系统性护理措施,现总结报道如下.     

儿童和成人恙虫病临床特点的比较分析

目的 探讨恙虫病的临床特点,为临床诊断和治疗提供依据.方法 回顾性分析我院10收治的420例恙虫病,分析比较儿童和成人恙虫病的特点,并分析误诊和死亡原因.结果 (1)420例恙虫病患者,儿童105例,占25.0%;成人315例,占75.0%.(2)儿童患者肝功能异常、脑损害、间质性肺炎、肾损害及血液系统损害的发生率均高于成人组(均P＜0.01或0.05).心肌损害发生率在儿童及成人患者之间差异无统计学意义.(3)儿童并发多器官损害32例,占30.5%,成人组并发多器官损害60例,占19.0%,两者比较差异有统计学意义(P＜0.05).(4)420例入院时明确诊断370例,均有发热和焦痂,最后误诊11例,误诊率2.6%.(5)死亡7例(1.7%),均为多器官功能衰竭所致,儿童与成人病死率差异无统计学意义(1.9%vs1.6%,P＞0.05).结论 恙虫病临床表现多样,易致多器官损害,儿童比成人更容易出现多器官功能损害,早期诊治是降低病死率的关键.     

黄芪注射液对脓毒症患者心肌损伤干预作用的观察

目的:观察黄芪注射液治疗脓毒症患者心肌损伤的临床疗效.方法:将63例心肌损伤的脓毒血症患者随机分为2组,对照组30例,给予常规治疗,治疗组在33例在常规治疗的基础上家用黄芪注射液静脉滴注,观察2组临床疗效.结果:治疗组的总有率为81.82%,对照组为66.67%,治疗组的临床总有效率优于对照组(P＜0.05).结论:黄芪注射液用于脓毒症患者心肌损伤疗效显著.     

血液灌流联合血液透析治疗尿毒症神经系统损害的疗效观察

目的 观察血液灌流(HP)联合血液透析(HD)治疗尿毒症神经系统损害的临床疗效.方法 将30例有尿毒症神经系统损害的患者随机分为联合血液灌流(HP+HD)组和单纯血液透析(HD)组,各15例.观察2组治疗前后临床体征及尿毒症中分子毒素清除效果(比较治疗前后中分子物质、血尿素氮、肌酐含量).结果 血液灌流联合血液透析治疗尿毒症神经系统损害的效果优于单纯血液透析(p<0.05).结论 尿毒症神经系统损害患者在单纯血液透析同时接受血液灌流联合治疗能有效地改善其神经系统损害症状.     

8月龄内婴儿麻疹28例临床分析

目的:探讨8月龄内婴儿麻疹的临床特点及预防措施.方法:对收治的28例麻疹患儿的临床资料进行回顾性分析.结果:28例(男19例,女9例,男女之比为2.11:1,占同期麻疹患儿的19.3%)患儿发病集中在4～5月(60.7%),出疹时间、出疹顺序、Koplik's斑典型、心肌酶、ALT变化较大,并发支气管炎、肺炎常见,预后良好.结论:与婴儿体内麻疹抗体水平下降有关,临床特征以病毒血症较重,可有心肌、肝脏损害.     

抗结核治疗导致患者肝损伤相关性分析及对策

目的:探讨抗结核药物致肝损害出现的时间、程度及与疗程的关系.方法:对154例临床应用抗结核药物致肝损害病人的临床资料分析.结果:抗结核药物的肝损害多出现在用药4周内,表现在胃肠道症状及ALT升高,经保肝及对症治疗2周内肝功多能恢复正常.结论:抗结核药物肝损害只要早发现早治疗,肝功均可恢复正常,不会影响结核病的治疗效果.     

破伤风护理体会

目的:探讨降低破伤风并发症及其病死率的护理方法.方法:对2008～2010年间集中收治的20例破伤风病人的护理过程及效果进行回顾性分析.结果:20例病人中痊愈18例,死亡2例,病死率10%.结论:在破伤风护理过程中,有效控制痉挛;注意肺内感染及心肌损害等并发症的护理,是降低病死率的关键.     

Therapy with blood and blood products]

Rare musculoskeletal tumors can be difficult to diagnose by light microscopy or immunohistochemistry. Electron microscopy can be of diagnostic assistance especially if histotype specific ultrastructural features exist. In particular, electron microscopy for uncommon sarcomas such as alveolar soft part sarcoma, parachordoma, atypical Ewing's sarcoma and epithelioid sarcoma may be the diagnostic modality of choice.     

Avoidance of homologous blood transfusion despite extreme blood loss

We report the case of a 22-year-old woman who underwent two-step scoliosis surgery without allogeneic transfusion, although the intraoperative blood loss (3500 ml) during the first procedure was higher than the calculated blood volume (3250 ml). Preoperatively the patient had donated four units of autologous blood. Intraoperatively blood-saving methods were combined. During the first operation acute normovolemic hemodilution (target hemoglobin 9.0 g/dl) was applied and during the second operation controlled hypotension (systolic blood pressure 80 mmHg). Intraoperative auto-transfusion was used in both procedures. During the first operation severe normovolemic anemia (minimal hemoglobin 3.5 g/dl) was accepted while the patient was ventilated with FiO2 1.0. The hemoglobin concentration was 8.6 g/dl after the first procedure and had increased to 11.6 g/dl 4 weeks after the second procedure. No severe complications occurred during the postoperative phase. This case report shows that also in surgical procedures with extreme blood loss any allogenic transfusion can be avoided by the combination of blood-saving methods, acceptance of low intraoperative transfusion trigger and ventilation with 100% oxygen.     

Regional blood redistribution following blood loss in unanesthetized rats

The authors describe relative changes in the blood filling of 46 vascular areas of the body in rats after a moderate and severe blood loss. Moderate blood loss caused redistribution of the blood from the skin of the chest and from the skin of the posterior limbs, the majority of the abdominal and pelvis minor organs, muscular and bone tissues of the abdomen, pelvis minor and extremities into the brain, heart, lungs, kidneys, stomach and into the muscles of the head and neck. In severe blood loss the changes were analogous, but the blood content in the kidneys and the stomach decreased, and there was also a relative elevation of the blood in the muscles and bones of the chest. The intensity of the redistributive reaction in severe blood loss was less than in moderate blood loss.     

Enhanced nonenzymatic glycosylation of blood proteins in stored blood

Significantly enhanced nonenzymatic glycosylation of hemoglobin, plasma, and erythrocyte membrane proteins was demonstrated following storage of whole blood in the liquid state under conventional blood bank conditions. Among the blood components studied, the proteins of the erythrocyte membrane were mainly involved, although the levels of glycosylated hemoglobin and plasma proteins were also significantly increased. In contrast to the nonenzymatic glycosylation observed in vivo in patients with diabetes, the in vitro process is less intensive and most probably results in less functional alteration.     

A portable blood gas analyzer for equine venous blood

Evaluation of a portable blood gas analyzer, (StatPal II, Unifet, Inc, La Jolla, CA) was performed using tonometered solutions and equine blood. Samples were analyzed by the StatPal II and either an Instrument Laboratory IL1306 (Lexington, MA) or a Radiometer ABL50 blood gas analyzer (Radiometer America Inc., Westlake, OH). Comparison of the StatPal II and the IL1306 was done by analysis of 3 tonometered solutions (acidic, normal, and alkalotic) and 27 equine venous blood samples. Blood pH, PCO2, PO2, and [HCO3] values were altered by IV infusion of 5% sodium bicarbonate or exercising the horses on a treadmill. Comparison of the StatPal II and the Radiometer was performed by analysis of 78 blood samples collected from Standardbred horses before a race. Data were analyzed for the venous blood samples using a paired two-tailed Student's t test and Bland-Altman plots, with significance set at P < .05. The coefficients of variation for pH, Pco2, Po2, and [HCO3-] values of the tonometered solutions analyzed by the StatPal II ranged from 0.067% to 0.087%, 2% to 3.21%, 1.21% to 2.67%, and 0.267% to 0.828%, respectively. Comparison of the equine blood samples analyzed by the StatPal II and the IL1306 demonstrated statistically significant, but clinically irrelevant differences in pH, Pco2, and Po2, but not [HCO3-]. There were statistically significant, but clinically irrelevant differences between the StatPal II and the Radiometer for pH, Pco2, and [HCO3-], but not for Po2. It is concluded that the StatPal II provides reproducible and acceptable analysis of equine venous blood gas samples.     

The role of blood rheology in regulating blood pressure

We hypothesize: (a) peripheral innervation densities determine map scales in dorsal horn, (b) dorsal horn cell (DHC) receptive field (RF) geometries are determined by map scales, and (c) morphologies of primary afferents (PAs) and DHCs reflect their developmental history. We suggest the following sequence: (A) PAs project in a somatotopic mediolateral sequence. (B) DHCs assemble prototype RFs by sampling presynaptic neuropil with their dendrites. (C) PAs then project to all levels where their RFs are contained within prototype RFs of DHCs. (D) A competitive mechanism produces the adult form of DHC RFs. (E) Adult distributions of PA terminals and DHC dendrites reflect this developmental history. (F) Mediolateral somatotopic gradients are determined by RF densities of axons entering at the same levels. (G) Map scales at different rostrocaudal levels are determined by somatotopic gradients. (H) Geometries of DHC RFs are determined by constant convergence and divergence of monosynaptic connections. (I) Secondary processes further modify geometries of DHC RFs. (J) Residual self-organizing capacity supports maintenance and plastic mechanisms. We adduce the following evidence: (1) agreement between monosynaptically coupled inputs and cells' excitatory low threshold mechanoreceptive fields; (2) the temporal sequence of events during penetration of the gray matter by PAs; (3)variation of PA terminal and DHC dendritic domains as a function of map scale; (4) somatotopic gradients and geometries of DHC RFs in adult dorsal horn; (5) calculations of peripheral innervation densities and dorsal horn map scales; and (6) constant divergence and convergence between PAs and DHCs.     

Corneal blood staining following autologous blood injection for hypotony maculopathy

We experienced the case of left atrial myxoma originating from posterior leaflet mitral valve. Mitral valve repair was performed in that case, because of the presence mitral leaflet defect due to removal of the myxoma. Transesophageal echocardiography was a useful tool for perioperative evaluation of the mitral valve and precise localization of the origin of the myxoma.     

Drugs acting on blood and/or blood forming organs

Pharmacologic therapy for anemia is oriented toward (1) providing components needed for red blood cell production (vitamin B12 and folic acid), including hemoglobin synthesis (iron and other minerals), and (2) stimulating bone marrow formation of red blood cells. Drugs used to stimulate bone marrow activity will be the focus of this article.