目的 探討≤10 kg體重嬰幼兒心臟直視術后呼吸機使用時間的相關因素。 方法 從2005年3月－2011年6月，選擇納入接受心臟直視手術的體重≤10 kg的先天性心臟病嬰幼兒，分析各項圍術期指標與術后呼吸機使用時間的關系，討論該類嬰幼兒術后呼吸機使用時間決策。 結果 共納入體重≤10 kg的嬰幼兒42例，呼吸機使用時間（42.74 ± 52.55） h，中位數20.88 h;發現術后2 h入量（mL/kg），術后4、8、16 h總入量（mL/kg）與術后呼吸機使用時間相關（P＜0.05），術后呼吸機使用時間與患兒ICU入住時間約成線性相關（P＜0.05）。 結論 影響低體重嬰幼兒心臟直視術后呼吸機使用時間是術后液體管理，實施“限制性液體管理”治療策略可能會促進患兒的術后快速康復。術后液體管理如何具體影響患兒呼吸機使用時間，影響患兒的預后，尚需進一步研究。Objective To evaluate the factors related to the postoperative mechanical ventilation (MV) duration in low-weight infants weighing less than 10 kg having undergone open cardiac surgery. Methods From March 2005 to June 2011, infants less than 10 kg undergoing congenital cardiac surgery were included in this research. We analyzed the relationship between various peri-operative indexes and the duration of MV, and discussed the decision for ventilation time for these infant patients. Results A total of 42 infants were included in our study. The ventilation time was (42.74 ±52.55) hours with a median of 20.88 hours. The postoperative second-hour fluid intake and the total intake of fluid at hour 4, 8, and 16 were related to the duration of mechanical ventilation (P＜0.05). And the ventilation time had a linear relationship with the ICU-stay time (P＜0.05). Conclusions The postoperative fluid management is associated with the duration of mechanical ventilation for low-weight infants having undergone open cardiac surgery. “Fluid controlling management” may facilitate quick recovery of the infant patients. However, as for how the fluid should be managed, how the fluid management influences ventilation time and the prognosis, more research is needed.
ObjectiveTo evaluate the effect of low-to-moderate doses of corticosteroids on human infections with avian influenza A (H7N9) virus, and explore when to initiate the treatment of corticosteroids and the duration of corticosteroids administration.MethodsThe study collected clinical data of 8 cases with avian influenza A (H7N9) virus infection admitted from January 25, 2017 to May 12, 2017. The final analysis included 5 severe patients who had received adjuvant corticosteroid treatment. The variation curves of WBC, CRP, PCT, CK, HBDH, LDH, temperature, ratio of SpO2/FiO2 were depicted and analyzed. The progress of clinical improvements, deterioration and prognosis were observed and discussed.ResultsThere were 1 female and 4 males in the 5 included patients with a median age of 58.0 years, among them 3 survived. The median time of illness onset to hospitalization and diagnosis confirmed were 4 days and 8 days respectively; the median duration of hospitalization to admission to infective ICU were 3 days. The first course of adjuvant corticosteroid treatment was initiated 11 days (median) after admission with a duration of 4 days (median), during which, the serum levels of HBDH and LDH decreased remarkably except the patient 3, and the oxygenation (SpO2/FiO2) improved except the patient 3. The second course of systemic administration of corticosteroid was given at a median of 26.5 days after admission with a duration of 9 days (median), during which, the patients survived with improved oxygenation (SpO2/FiO2), and weaned from mechanical ventilation.ConclusionsFor patients suffered severe human infection with avian influenza A (H7N9) virus, low-to-moderate doses of corticosteroids may decrease the level of inflammation, regulate the aberrant immune response, improve the oxygenation, make an early unassisted breathing. And corticosteroids treatment can be initiated at the time of disease deterioration, after/at the peak inflammatory response, and within 10-14 days of ARDS. Also, the adjuvant corticosteroids may be administered when oxygenation is dificult to be improved by other ways, or dificult to be liberated from mechanical ventilation, suffering severe septic shock, and refractory fever. And the duration of corticosteroids may be prolonged to 10-14 days, or until the higher level of HBDH and LDH decreased again.
Objective Since the first case of avian influenza A (H7N9) virus infection in humans identified in Suining, Sichuan province on January 25th, 2017, there were other five severely ill patients confirmed in the following 3 weeks. It is urgent to find out the common clinical characters of these patients, so that to make sure the optimal ways for early diagnosis and treatment for H7N9 virus infection in community hospitals or primary hospitals as soon as possible. Methods The early symptoms, the data of early laboratory findings, the early imaging study, the early process of diagnosis and treatment of these six patients were collected and analyzed. Results All six patients had high fever, dry cough, hypocalcemia, and hypophosphatemia, with advanced CT image lesions manifested as consolidation and ground-grass opacity in bilateral lower lung lobes. Some patients had typically leukopenia, lymphopenia, thrombocytopenia. And most of them had a history of direct exposure to live poultry before complaining of flu-like syndromes. However, the flu can not be effectively controlled by routine anti-infection. Conclusion The human infection with H7N9 virus can be early identified by combining the epidemiology of live poultry exposure, the symptoms of high fever, dry cough, dramatical leukopenia, lymphopenia, thrombocytopenia, the typical CT image, and the rapidly worsen clinical condition.