Objective To identify the relationship between preoperative left ventricular dysfunction and perioperative risk factors in coronary artery bypass grafting (CABG). Methods The clinical data of 192 patients who underwent CABG from November 2015 to October 2016 were analyzed retrospectively. The patients were divided into three groups by preoperative left ventricular ejection fraction (LVEF) in echocardiography: a serious left ventricular dysfunction group (LVEF≤35%, 23 patients, 15 males and 8 females at age of 63.91±5.36 years), a moderate left ventricular dysfunction group (35%<LVEF<50%, 24 patients, 20 males and 4 females at age of 66.29±6.03 years) and a normal left ventricular function group (LVEF≥50%, 145 patients, 86 males and 59 females at age of 66.60±6.41 years). Results The overall mortality was 4.16% (8/192), 17.39% (4/23) in patients with LVEF≤35% and 2.76% (4/145) in those with LVEF≥50%. Preoperative LVEF≤35%, hypoxia, assisted circulation, acute kidney injury (AKI) and postoperative continuous renal replacement therapy (CRRT) were risk factors of perioperative mortality in coronary artery surgery. LVEF≤35% and CRRT were independent preditors of mortality. There were significant differences in mortality and postoperative complications between the serious left ventricular dysfunction group and other two groups. Conclusion Postoperative mortality and complications are obviously serious in the patients with LVEF≤35%. We should pay more attention to preoperative risk factors. Postoperative individual manipulation, intra-aortic balloon pump and CRRT can enhance survival of those patients.
目的:觀察新鮮羊膜移植聯合絲裂霉素C治療復發性翼狀胬肉的臨床療效。方法:對32例(38眼)復發性翼狀胬肉行翼狀胬肉切除聯合新鮮羊膜移植加絲裂霉素C治療,觀察術后角膜上皮愈合、胬肉復發情況。結果:術后隨訪3～24個月,有2眼復發,復發率為5.26%。結論:新鮮羊膜移植聯合絲裂霉素Ｃ治療復發性翼狀胬肉降低了復發率,無嚴重手術并發癥,是一種安全有效的手術方法。
目的:研究地震對非傷員的其他內外科危重患者急診醫療的影響。方法:采用病例對照研究方法,研究和分析汶川地震發生前后一周急診科內外科危重患者情況。結果:地震后內外科危重患者數量明顯減少,轉診患者和救護車來診比例降低,但搶救患者比例增加,優化處理流程后急診診療時間明顯縮短。結論:雖然地震期間急診科內外科危重患者總量減少,但存在搶救患者比例增加和院前急救資源減少的問題。應該重視這部分患者的急救醫療需求以及優化處理流程。
Objective According to health technology assessment (HTA) methodology, to assess the efficacy and safety of different doses of metoprolol in the treatment of atrial fibrillation (AF). Methods Based on the principles of HTA, we searched some important medical databases including MEDLINE, EMBASE, The Cochrane Library and CMCC, as well as several national special heart disease databases and side effect centers. We selected eligible studies based on the inclusion and exclusion criteria and critically assessed their quality. Results Intravenous metoprolol 10 mg - 15 mg could control rapid ventricular rate in patients with chronic AF. On either rest or exercise, oral metoprolol 150 mg/d had a better control of rapid ventricular rate than 50 mg/d in patients with chronic AF. For preventing postoperative AF (POAF), the intravenous metoprolol 20 mg group and the 30 mg group could decrease the incidence of POAF compared to the 10 mg group. Oral metoprolol 150 mg/d was more effective than 100 mg/d in preventing POAF. In addition, intravenous metoprolol therapy was well-tolerated and more effective than oral metoprolol therapy in preventing atrial fibrillation after cardiac surgery. Results from several national side effect centers demonstrated that the incidence of adverse reactions associated with metoprolol was low. Conclusion Present evidence showed that high dose of metoprolol was superior to low dose in treating AF, however, the evidence available is insufficient. It is suggested that adequate evidence through further studies are needed. The safety profile of different doses of metoprolol is similar.
Severe trauma is a challenging medical problem. Uncontrolled post-traumatic hemorrhage and traumatic coagulation dysfunction are closely related to the prognosis of these patients. In May 2019, the pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma published the fifth edition of the European guideline on management of major bleeding and coagulopathy following trauma. To assist Chinese in better understanding of the latest developments, this paper translated the main treatment recommendations in the guideline and interpreted the updated content from the fourth edition.
目的:探討女性強直性脊柱炎患者的臨床特點。方法:回顧性分析華西醫院風濕免疫科2003年1月1日至2009年1月1日住院收治的女性強直性脊柱炎患者住院病歷共計46例,抽取與女性患者入院時間及病程大致相等的男性病歷40例,記錄發病年齡、病程、首發癥狀、臨床表現、實驗室檢查,并對兩組數據進行比較,調查女性患者中血小板計數與血沉、C-反應蛋白、球蛋白的相互關系。結果:發病年齡女性組為(30±11)歲,男性組為(24±7)歲(P＝0.003);首發癥狀、主要臨床表現、關節活動受限和病情活動指標在兩組無統計學差異(Pgt;0.05)。相關分析顯示,血小板計數與C-反應蛋白、血沉、球蛋白分別存在較好的正相關關系(C反應蛋白:r=0.608,P=0.000;血沉:r=0.558,P=0.000;球蛋白r=0.411,P=0.005)。女性組中HLAB27陽性患者與陰性患者的年齡差異無統計學意義(P＞0.05)。結論:女性強直性脊柱患者的發病年齡大于男性,患者的血小板計數有助于評價病情活動。
Objective To analyze the clinical pathogenic characteristics of children with co-infected pneumonia, and to provide reference for clinical diagnosis and treatment. Methods Children with co-infected pneumonia treated in the pediatrics department of the First Affiliated Hospital of Chengdu Medical College between June 2023 and May 2024 were selected. According to age, the children were divided into goups of infants, toddlers, preschoolers, school-aged children, and adolescents. The clinical pathogenic characteristics of children with pneumonia were analyzed. ResultsA total of 358 pediatric patients were included. Among them, there were 189 males (52.79%) and 169 females (47.21%); 71 (19.83%) were infants, 74 (20.67%) were toddlers, 113 (31.56%) were preschoolers, 75 (20.95%) were school-aged children, and 25 (6.98%) were adolescents. There was no statistically significant difference in the composition of males and females among different age groups or types of pneumonia (P>0.05). The bacteria detected were mainly Haemophilus influenzae, Staphylococcus aureus, Moraxella catarrhalis and Streptococcus pneumoniae. Viruses in the pathogen mainly included adenovirus, influenza A and B stream, human rhinovirus and respiratory syncytial virus. The main atypical pathogen detected was Mycoplasma pneumoniae (240 cases). Except for atypical pathogens (P>0.05), the detection rates of bacteria and viruses among different age groups showed statistically significant differences (P<0.05). The compositions of bacterial co-infections, viral co-infections, bacterial+viral infections, and co-infections involving atypical pathogens were compared among different age groups, and the difference was statistically significant (P<0.05). The proportions of different types of pathogens detected in winter were the highest. Conclusions Children with co-infected pneumonia are mainly aged 0-6 years old. The incidence of co-infected pneumonia in children is the highest in winter. Mycoplasma is the main pathogen in dual infections or co-infections. Co-infections in early childhood are mainly caused by bacterial infections, and the incidence of viral infections increases with age.
目的:觀察顯微鏡直視下經外路手術治療孔源性視網膜脫離的臨床療效。方法:孔源性視網膜脫離38例(38眼),術前在三面鏡下檢查裂孔位置、大小及脫離范圍;在手術顯微鏡直視下行裂孔及變性區定位,放出視網膜下液,在裂孔及周圍行視網膜冷凝,作硅膠墊壓及環扎帶。最后頂起硅膠墊壓塊,證實裂孔位于鞏膜脊前坡上,視裂孔位置及眼壓情況,玻璃體腔內注入C3F8。術后觀察視力、眼壓、葡萄膜反應及視網膜復位情況。結果:視網膜裂孔封閉36眼(94.74％),視網膜完全復位34眼(89.47％),視網膜下積液2眼(5.26％),于7～10d吸收。有２眼術后發現墊壓嵴偏離視網膜裂孔,經再次手術調整后視網膜復位。術后視力提高28眼(73.68％)。結論:顯微鏡直視下經外路視網膜脫離手術視野清晰,操作簡便,手術效果良好。
The hemodynamic management of adult patients with distributed shock often includes the use of catecholamines vasoconstrictor drugs. It was unclear whether adding vasopressin or vasopressin analogs to catecholamine therapy was beneficial for the treatment of patients with distributed shock. The Canadian Society of Intensive Care recently updated its clinical practice guideline to provide recommendations for the addition of vasopressin to catecholamine boosters in adults with distributed shock. This paper interprets it to assist domestic doctors for better understanding of the latest progress.
Objective To analyze the burden and trend of stroke attributable to metabolic risk factors in China from 1990 to 2021. Methods Data on deaths and disability-adjusted life years (DALYs) attributed to metabolic risk factors for stroke were analyzed based on the Global Burden of Disease (GBD) database 2021 in China, globally, and across different socio-demographic index (SDI) regions from 1990 to 2021. Joinpoint regression analysis was utilized to calculate the average annual percent change (AAPC) to evaluate temporal trends in disease burden. Results In 2021, the age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) of stroke attributable to metabolic risk factors in China were 93.57/100 000 and 1 793.16/100 000, respectively, both higher than global and all SDI regional averages. Among metabolic-related stroke subtypes, ischemic stroke accounted for the highest disease burden, whereas subarachnoid hemorrhage had the lowest. Disease burden was greater in men compared with women. Both stroke mortality and DALYs rate increased with advancing age, with DALYs rate slightly declined only after the age of 95 years. Elevated systolic blood pressure (SBP) was identified as the leading metabolic risk factors for stroke burden. Between 1990 and 2021, the ASMR (AAPC=?1.34) and ASDR (AAPC=?1.38) attributed to metabolic risk factors of stroke in China showed decreasing trends, consistent with global and regional SDI averages, with greater reductions observed in women. Declining trends were also observed across all stroke subtypes, only stroke burden associated with high body mass index (BMI) exhibited an increasing trend. By 2031, the ASMR and ASDR are projected to decrease to 77.37/100 000 and 1 478.88/100 000, respectively. Conclusion From 1990 to 2021, the burden of stroke attributable to metabolic risk factors in China showed an overall declining trend. However, the burden remained higher compared with global and regions SDI levels, particularly among men and older adults. Future efforts should focus on enhancing metabolic factors screening and management in high-risk populations, along with optimizing individualized interventions to further reduce stroke burden.