To the Editor: Pulmonary embolism (PE) is the third most common cause of cardiovascular-related death worldwide after stroke and heart attack. As a consequence of hemodynamic differences, patients with PE present a wide spectrum of clinical manifestations, ranging from asymptomatic to life-threatening conditions. There are high rates of recurrence in PE patients, and although most patients survive after the initial phase of the disease, the risk of recurrence remains throughout life. Similar to patients experiencing their first PE episodes, patients with recurrent PE may be asymptomatic. To date, much of our knowledge about recurrent PE has come from clinical trials or registry studies in which symptomatic recurrence was a major endpoint, while asymptomatic recurrence is rarely reported. Moreover, current guidelines suggest treating patients with asymptomatic PE similarly to those with symptomatic PE,[1,2] but do not recommend routine follow-up of asymptomatic patients by imaging methods after PE diagnosis.[3] Ventilation/perfusion (V/Q) lung scans are not only equally accurate and cost-effective compared to computed tomography pulmonary angiography (CTPA) but also require a much lower dose of radiation. Moreover, V/Q scans can be applied to almost all patients without any contraindications.[2] Therefore, V/Q scans may serve as a suitable choice for evaluating PE recurrence. In the present study, we investigated the asymptomatic recurrence of PE in patients who had been objectively diagnosed with PE and underwent V/Q lung scans during follow-up. This information will provide decision support for the optimal management of PE patients. The flowchart of the study design is shown in Supplementary Figure 1, https://links.lww.com/CM9/B937. From 2013 to 2020, all patients who were suspected of having PE in Fuwai Hospital underwent a standard diagnostic workup to confirm the diagnosis of PE, and the diagnostic criteria were in accordance with international guidelines.[2] CTPA was the main imaging test performed during the initial diagnostic workup for PE patients. Hospitalized patients who were diagnosed with PE and underwent V/Q scans at baseline and at least one V/Q scan during follow-up were enrolled in this study. The baseline V/Q scan was performed within a week after diagnosing PE, and the follow-up V/Q scan was performed after at least 3 months of anticoagulant treatment. The end time of observation was the date of the first asymptomatic recurrence of PE determined by V/Q scan or the date of the last V/Q scan performed. The cut-off date for collecting the results of the V/Q lung scan was September 1, 2020. Data about the patients' baseline demographics, clinical characteristics, and lab tests were collected. The Institutional Ethics Review Board of Fuwai Hospital approved the study protocol (No. 2023-2015), and each patient provided written informed consent. PE that was unprovoked or provoked[4] and major bleeding[5] were defined by the definition proposed by the International Society on Thrombosis and Hemostasis. PE recurrence was defined as a new occurrence of V/Q mismatch in a previously uninvolved pulmonary segment or the deterioration of perfusion in an initially involved pulmonary segment. Defects in ventilation or perfusion shown on V/Q scans were excluded by the influence of other conditions, such as inflammation, tumors, or chronic obstructive pulmonary disease. If PE recurrence was proven by a V/Q scan without any worsening of previous symptoms or newly developed symptoms, including shortness of breath, dyspnea, or chest pain, asymptomatic PE recurrence was considered. All V/Q scan images were adjudicated independently by two nuclear medicine physicians using the criteria of European Association of Nuclear Medicine guidelines,[6] and any disagreements were reviewed by a third nuclear medicine specialist for final determination. None of the nuclear medicine physicians were aware of the treatments the patients received. Continuous variables are expressed as the mean ± standard deviation or medians [Q1, Q3]. Normally distributed continuous variables were compared by t-test; otherwise, they were compared by non-parametric (Wilcoxon) tests. Categorical variables are expressed as number (percentage) and were compared by χ2 tests. The Kaplan–Meier method was used to estimate the cumulative rate of recurrent PE. All P values were two-tailed, and the statistical significance was set as P < 0.05. Statistical analyses were performed by SAS (version 9.4, SAS Institute, Cary, NC, USA). From 2013 to 2020, 284 patients underwent two V/Q lung scans, and 119 patients were excluded due to the following reasons: perfusion defects caused by other reasons (n = 5); primary diagnosis was chronic thromboembolic pulmonary hypertension (CTEPH) (n = 72); baseline data were not available (n = 7); and a positive VQ scan correlated with symptomatic recurrent PE (n = 35) [Supplementary Figure 1, https://links.lww.com/CM9/B937]. In total, 165 patients were included in the final analysis. The average age of all PE patients was 60.1 ± 14.8 years, and 59 (35.8%) patients were male [Supplementary Table 1, https://links.lww.com/CM9/B937]. There were 73 (42.2%) patients with deep vein thrombosis (DVT), 20 (12.1%) with a history of venous thromboembolism, and 136 (82.4%) without an identifiable risk factor. On the first admission to the hospital, 15 (9.1%) patients received systemic thrombolysis, 87 (52.7%) patients received novel oral anticoagulants (NOACs) for anticoagulant treatment, and other patients received warfarin. Pulmonary perfusion defects were observed in a total of 1142 pulmonary segments: 502 (44.0%) segments in the left lung, 640 (56.0%) segments in the right lung; 386 (33.8%) segments in the superior lobe (except the left lingual lobe), 533 (46.7%) segments in the inferior lobe, and 223 (19.5%) segments in the middle lobe (including the left lingual lobe and right middle lobe). More pulmonary perfusion defects were observed in the inferior lobe than in the superior lobe (P <0.001), and the right lung also showed more pulmonary perfusion defects than the left lung (P <0.001). The median observation period was 8.6 months [4.2, 21.9]. Only two patients experienced major bleeding but they did not have recurrent PE. Asymptomatic recurrent PE occurred in 16 patients among the 165 patients: 4 patients received warfarin and international normalized ratio was maintained between 2 and 3; for 12 patients who received NOACs, the stable dosage was kept in 8 patients, but 2 patients discontinued anticoagulant therapy, and 2 patients had decreased dosage before the last V/Q scan. The estimated recurrence rates of asymptomatic recurrence at 1-year, 2-year, and 3-year were 10.0% (95% confidence interval [CI]: 4.0–16.1%), 15.0% (95% CI: 7.1–22.8%), and 17.4% (95% CI: 8.4–26.5%), respectively [Supplementary Figure 2, https://links.lww.com/CM9/B937]. When comparing patients without any recurrent events and patients with asymptomatic PE recurrence, more unprovoked PE was observed in patients without recurrence (84.6% [126/149] vs. 62.5% [10/16], P = 0.04) [Supplementary Table 1, https://links.lww.com/CM9/B937]. By comparing images of V/Q lung scans at baseline and follow-up, a total of 55 pulmonary segments showed deterioration of pulmonary perfusion (PE recurrence). In patients with asymptomatic recurrence, no statistically significant difference in the distribution of deteriorated pulmonary segments was found between the superior (except left lingual lobe, n = 20, 36.4%) and inferior lung (n = 27, 49.1%) (P = 0.307), or the left (n = 26, 47.3%) and right (n = 29, 52.7%) lung (P = 0.686). Generally, diagnostic tests for recurrent PE are mainly performed for patients suspected of having recurrent PE, in other words, patients with symptoms or signs of PE.[2] Except for patients with risk factors for developing CTEPH, regular follow-up by imaging tests is not recommended in asymptomatic patients.[2,3] Although symptomatic recurrence is considered more common in clinical practice, we observed that there were still some patients (~9.7%) who experienced asymptomatic recurrence and the stable anticoagulant therapy was maintained in most patients. Repeatedly and insidiously recurrent PE may increase the risk for developing chronic thromboembolic disease or even CTEPH. Therefore, regular follow-up by imaging tests may be considered in PE patients. In addition, a significant difference in the distribution of pulmonary perfusion defects was observed at baseline. Because of the difference in anatomical structure between the left and right pulmonary arteries, a translocated thrombus from a deep vein is more likely to involve the right lung than the left lung. Moreover, due to the effect of gravity, a thrombus is also more likely to involve the inferior lobe than the superior lobe of the lung. Possibly due to the sample size limitation, although statistically significant differences (P = 0.05) were not always shown in patients with asymptomatic recurrence, the distribution of deteriorated pulmonary perfusion corresponded with the distribution pattern of perfusion defects at baseline. Some limitations of this study should be acknowledged. The first limitation is related to the sample size, and the asymptomatic recurrence rate we reported may not represent the exact incidence in PE patients. Thus, a large and prospective investigation is needed. Second, this study was an observational study from a single center, and the results should be interpreted carefully for other centers. Finally, we did not collect follow-up data for outcomes in the longer term, including death and the development of pulmonary hypertension, because this was not a study objective. In conclusion, the present study indicated that some PE patients may experience asymptomatic recurrence, and these patients are easily ignored. Regular follow-up by imaging tests may be considered for PE patients. Further studies are required to validate these findings, and to explore optimal management strategies for PE patients. Funding This work was supported by grants from CAMS Innovation Fund for Medical Sciences (CIFMS) (No. 2022-I2M-C&T-B-040) and the National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen (No. NCRCSZ-2023-015). Conflicts of interest None.

目的 探索降钙素原(procalcitonin,PCT)在小儿体外循环(cardiopulmonary bypass,CPB)心脏术后早期的自然变化规律及其影响因素.方法 采用观察性临床研究方法,对2018年6月-2019年12月阜外医院小儿心脏外科中心重症监护病房(pediatric intensive care unit,PICU)收治的年龄3岁以下、先天性心脏病(先心病)手术风险矫正评分(risk adjustment of congenital heart surgery,RACHS)2～5级、CPB下手术、无术前感染或炎性疾病的患儿,连续测定术前至术后第7d的PCT、C-反应蛋白(c-reactive protein,CRP)、白细胞(white blood cell,WBC)计数,同时行痰培养和胸部X线片检查,对体温＞38℃的患儿行血培养,对伤口化脓的患儿行伤口分泌物培养.统计术后7 d内感染及并发症情况,根据术后7 d内有无感染和并发症将入组患儿分为4组:感染+并发症组、单纯感染组、单纯并发症组以及正常组.结果 最终选择住PICU≥4 d的患儿为研究对象,共429例患者入选,其中男268例、女161例,年龄8.0(0.7,26.0)个月.包括单纯感染组145例、单纯并发症组38例、正常组230例以及感染+并发症组16例.小儿CPB心脏术后PCT、CRP、WBC均较术前明显升高,其中CRP、WBC在术后第2 d达到高峰,一直持续到术后第7 d仍高于正常.PCT在术后第1 d达到高峰,一般在术后第5 d降至正常.年龄、体重、RACHS评分、CPB及主动脉阻断时间均与术后早期PCT浓度有一定程度相关性.单纯感染组、单纯并发症组及正常组之间两两比较,年龄、体重、RACHS评分、CPB及主动脉阻断时间等基础资料差异无统计学意义.其中单纯感染组与正常组术后第3～7 d的PCT浓度差异具有统计学意义(P＜0.01),单纯并发症组与正常组术后第1～7 d的PCT浓度差异均有统计学意义(P＜0.01),单纯感染组与单纯并发症组术后第1～5 d的PCT浓度差异有统计学意义(P＜0.05).结论 小儿CPB心脏术后WBC、CRP、PCT均明显升高,从其动态变化趋势看,三者相比,PCT更能预警术后早期感染或并发症的存在.影响小儿CPB心脏术后早期PCT浓度的因素包括年龄、体重、RACHS评分、CPB和主动脉阻断时间、感染以及并发症.

目的 通过对高危血栓风险先心病儿童在术后阿司匹林初次使用前血小板聚集率的测定,探讨此类人群血小板聚集率的基础状态及主要影响因素,为药物效果正确评价提供前期基础.方法 纳入对象为2020年4月～2020年9月在中国医学科学院北京协和医学院国家心血管病中心阜外医院小儿外科中心住院手术的所有先心病儿童,具有高危血栓风险并且签订知情同意书,在其手术后阿司匹林初次使用前进行血小板聚集率(PAG-AA)测定,了解此类人群的血小板基础聚集率状态.并通过单因素及多因素分析,探讨主要影响因素.结果 最终满足入选条件进行基础PAG-AA检测患者共196例(男,116),年龄13个月(12天～6岁),体质量(10.2±4.9)kg.基础状态的 PAG-AA 中位值为 20.7％(1.3％～86.5％),其中 67.3％PAG-AA 均处于低下状态(＜55％),47.9％PAG-AA处于严重低下状态(≤20％).体外循环手术患者术后基础PAG-AA显著低于非体外循环患者(31±27 vs.58±28,P＜0.05);体外循环术后3天内检测者显著低于3天后检测者(26±26 vs.49±26,P＜0.01);紫绀病人显著高于非紫绀病人(39±27 vs.26±26,P＜0.05).多因素回归分析显示体外循环与否以及术后检测时间是影响先心病儿童基础PAG-AA检测值的主要影响因素,紫绀并无显著影响.结论 高危血栓风险先心病儿童在术后阿司匹林初次使用前血小板聚集率的基础值波动范围较大,但大多数均位于正常值以下,严重低下者占比近50％.其主要影响因素为是否行体外循环以及术后检测时点.体外循环术后3天内PAG-AA显著减低,是否紫绀对基础状态测定值无显著影响.评价阿司匹林的药物效果应该以体外循环影响基本结束后的PAG-AA结果为参考基准,建议以手术3天后为宜.

Background Aspirin following unfractionated heparin is the most common anticoagulation strategy for pediatric patients who experienced cardiac surgery at high risk of thrombosis. The platelet aggregation test is the golden method to evaluate the aspirin effect on platelet function. However, the platelet aggregation basal status before postoperative aspirin initiation and the related clinical influencing factors hasn't been investigated systemically in this population. Methods In a prospective cohort of 247 children, arachidonic acid-induced platelet aggregation (PAG-AA) was measured by means of light transmission aggregometry (LTA) before the first dose of aspirin after cardiac surgical procedure and the perioperative variables were also collected. Distribution of this population's PAG-AA basal status was described. Univariate and multivariate logistic regression analysis were performed to identify the main influencing factors of PAG-AA. Results The median time of aspirin administration was 2 (1–27) days after surgery and the corresponding median value of basal PAG-AA was 20.70% (1.28–86.49%), with 67.6% population under 55% and 47.8% population under 20%. Patients undergoing cardiopulmonary bypass (CPB) had a significantly lower basal PAG-AA than those without (30.63 ± 27.35 vs. 57.91 ± 27.58, p = 0.013). While patients whose test done within 3 days after CPB had a significantly lower PAG-AA than those out of 3 days (25.61 ± 25.59 vs. 48.59 ± 26.45, p = 0.001). Univariate analysis implied that the influencing factors of the basal PAG-AA including CPB use, test time point, cyanosis, and platelet count. Multivariate regression analysis indicated that only CPB use, test time point, and platelet count were the main independent influencing factors for the basal PAG-AA. Conclusion The majority of children have impaired basal platelet aggregometry responses before postoperative aspirin initiation. The main influencing factors are CPB use, test time point, and platelet count. To establish the platelet aggregometry baseline prior to commencement of aspirin therapy, testing should be performed 3 days later following the procedure when effect of CPB is basically over.

Background: Children are at risk of extubation failure after congenital heart disease surgery. Such cases should be identified to avoid possible adverse consequences of failed extubation. This study aimed to identify ultrasound predictors of successful extubation in children who underwent cardiac surgery. Methods: Children aged 3 months to 6 years who underwent cardiac surgery (if they were intubated for >6 h and underwent a spontaneous breathing trial) were included in this study. Results: We included 83 children who underwent surgery for congenital heart disease. Transthoracic echocardiography and lung ultrasound were performed immediately before spontaneous breathing trials. Upon spontaneous breathing trial completion, respiratory parameters, including arterial blood gas analysis and frequency-to-tidal volume ratio, were similarly recorded. For outcome assessment, all children were followed up for >= 48 h after extubation. We successfully extubated 57 children (68.7%). These children were significantly older and weighed more but had shorter aortic cross-clamp and cardiopulmonary bypass times. Children who could not be weaned or extubated had prolonged total mechanical ventilation and pediatric intensive care unit stay. In the multivariate regression analysis, a lung ultrasound score and ejection fraction 40% immediately before spontaneous breathing trials were the only independent predictors of successful extubation. When combined, the lung ultrasound score >= 12 and an ejection fraction >= 40% showed a better diagnostic performance than every other isolated variable (lung ultrasound, N-terminal-pro-B-type natriuretic peptide, and frequency-to-tidal volume ratio). Conclusions: The combination of lung ultrasound and transthoracic echocardiography immediately before the spontaneous breathing trial effectively predicts extubation outcomes in children after cardiac surgery.

目的 探讨新生儿危重先心病手术治疗时机的选择及术前调整策略.方法 收集从阜外医院PICU入组2019年9月～2020年9月期间行小儿外科手术先心病新生儿53例,及未行手术治疗新生儿共60例.未手术的7例中,5例自动出院,2例患儿院内死亡),接受手术的新生儿中位日龄为14天,男性37例,女性16例.以14 d分组对比两组术后临床指标,比较两组临床预后情况.结果 行外科手术治疗的年龄14 d以内(含)新生儿27例,年龄14 d以上新生儿26例,对比两组新生儿术前体质量无明显差异(3.344±0.428 vs.3.631±0.622)kg,对比术前转入ICU调整例数,两组无明显差异(16vs.11),对比术前出现危重状态例数,两组无明显差异(9 vs.5).临床预后对比,年龄14 d以上组术后呼吸机使用时间明显少于年龄14 d以内组(318±330 vs.156±167)h(P＜0.05);ICU住院时间方面,14 d以上组明显少于14 d以内组新生儿(20±17 vs.11±6)d(P＜0.01);术后并发症对比:两组新生儿在术后死亡率、渗漏、二次插管、延迟关胸等方面均无明显差异.结论 新生儿年龄是否大于14天与院内死亡率、渗漏发生率、二次插管发生率、延迟关胸等方面无明显相关,危重先心病术前危重状态出现概率与年龄无相关,尽早外科手术治疗新生儿危重先天性心脏病并不能改善临床预后,推迟危重状态出现时间的ICU系统调整策略尤为重要.

目的 先天性心脏病患儿术后血淀粉酶升高在既往已有研究报道.对于血淀粉酶变化趋势的规律研究较少.本研究旨在探索先天性心脏病术后患儿血淀粉酶变化趋势及对于血淀粉酶升高峰值延迟原因的探索.方法 本研究为一项回顾性研究.连续入组阜外医院2019年1月1日至2019年12月31日先天性心脏病术后(1个月至6岁)血淀粉酶升高大于正常值3倍以上的180名患儿.按照血淀粉是否在48 h内达峰值,分为两组,正常达峰组和延迟达峰组,比较两组在人口学基本特征、体外循环时间、先天性心脏病种类、手术方式、重症监护时间及有创呼吸机时间等的差别.探索血淀粉酶高峰延迟的影响因素.对于血淀粉酶峰值延后的因素探索采用logistic回归.结果 血淀粉酶在两组患儿性别、年龄、体质量指数等人口基本学特征、阻断时间、谷丙转氨酶、甘油三酯、肌酸激酶、乳酸最高值水平、淀粉酶最高值水平、呼吸机时间上无统计学差异.淀粉酶峰值在术后48 h后出现组右心病变的比例较高(P＜0.01),有更长的转机时间(P＜ 0.01),相对更长的ICU时间(P＜0.01).右心病变为术后淀粉酶峰值延迟的独立危险因素.结论 右心病变是血淀粉酶术后48 h仍处于上升趋势的独立危险因素.

目的 探讨新生儿危重先天性心脏病术前危重状态的识别及针对危重状态的治疗策略.方法 收集2019年9月至2020年9月我院的收治新生儿手术患儿60例,其中53例接受手术治疗,5例自动出院,2例死亡.手术新生儿中位年龄14 d,男37例,女16例.以术前出现危重状态分组,比较两组术后临床指标及预后情况.结果 53例接受手术治疗的新生儿中,术前出现危重状态14例,未出现危重状态39例.两组新生儿术前体重、手术年龄无明显差异,危重组新生儿术前调整时间显著多于非危重组新生儿[(3.5±2.2)d,(1.2±2.5)d].危重组术后呼吸机使用时间明显多于非危重组[(382.6±262.8)h,(187.0±260.2)h].危重组新生儿ICU住院时间明显高于非危重组[(23.5±12.8)d,(12.8±12.9)d].两组新生儿在术后死亡率、渗漏、二次插管等方面均无明显差异,危重组新生儿术后延迟关胸发生率明显多于非危重组.结论 新生儿危重先天性心脏病术前出现危重状态将影响预后,术前危重状态出现概率与年龄不相关,做好术前危重状态评估和系统调整策略尤为重要.

目的 探讨心肺联合超声(CPUS)在法洛四联症(TOF)婴幼儿围术期监测中的临床应用价值.方法 选取2020年2月至2020年9月在中国医学科学院阜外医院进行一期根治手术治疗的TOF患儿54例.于术后2 h进行CPUS检查,记录左室射血分数(LVEF),右室面积变化分数(FAC),肺超声评分,残余室间隔缺损,瓣膜反流及胸腹腔积液情况,同时记录临床监测及实验室指标.根据术后机械通气时间是否大于48 h分为延迟恢复组(22例)及正常恢复组(32例),比较2组间参数,选择具有统计学意义的超声参数制定CPUS评分,评价其与呼吸机时间及ICU时间的相关性.结果 2组患儿在年龄、性别、经皮氧饱和度、McGoon比值、术前LVEF、右室FAC等基线资料上无统计学差异(P＞0.05).延迟恢复组患儿跨环补片者多于正常恢复组(P＜0.05).2组患儿临床监测及实验室指标差异无统计学意义(P＞0.05).超声参数中,2组间左室舒张末内径、肺动脉瓣峰值跨瓣压差及存在残余室间隔缺损者无统计学差异(均P＞0.05);延迟恢复组LVEF及右室FAC低于正常恢复组,肺超声评分高于正常恢复组,存在肺动脉瓣反流≥中量及胸腹腔积液者均多于正常恢复组(均P＜0.05).CPUS评分预测延迟恢复的ROC曲线下面积为0.893,最佳截断值为6,敏感性68％,特异性91％.Kaplan-Meier曲线示CPUS≥6分者与＜6分者比较,呼吸机时间及ICU时间均较长,差异具有统计学意义(均P＜0.05).结论 CPUS对TOF根治术后患儿围术期监测具有较高临床价值,可以评价心室功能、肺内渗出情况,从而指导围术期治疗,促进术后快速康复.

目的:探讨心肺联合超声(CPUS)在先天性心脏病(先心病)婴儿术后机械通气脱机评估中的临床应用价值.方法:选取2020年2～6月在中国医学科学院阜外医院经外科手术治疗先心病婴儿109例,平均年龄(0.70±0.25)岁,平均体重(7.48±1.49)kg.达到临床脱机标准后进行心肺联合超声检查,记录肺超声评分、左心室射血分数(LVEF)、肺动脉收缩压、畸形矫治情况与膈肌运动情况.同时记录临床监测以及血气分析指标,N末端B型利尿肽原(NT-proBNP).根据是否成功脱机分为脱机成功组(n=84)及脱机失败组(n=25),比较两组间参数,评价心肺联合超声参数对脱机失败的预测效能.结果:脱机成功组和脱机失败组性别、术前LVEF、心率、平均动脉压、中心静脉压、动脉血二氧化碳分压、合并肺动脉高压者差异无统计学意义(P均>0.05).脱机失败组术后LVEF、动脉血氧分压低于脱机成功组,肺超声评分、NT-proBNP以及合并膈肌功能障碍者高于脱机成功组(P均<0.05).以肺超声评分为标准预测脱机失败的ROC曲线下面积为0.84,最佳截断值为13分,敏感度为60％,特异度91％.Logistic回归分析示肺超声评分≥13分,LVEF<40％及膈肌功能障碍均与脱机失败显著相关(P均<0.05),联合预测脱机失败的ROC曲线下面积为0.88.结论:床旁心肺联合超声对先心病术后婴儿预测呼吸机撤离具有较高的可操作性及诊断价值.

目的 探究膈肌折叠术治疗先天性心脏病(先心病)术后膈肌麻痹的手术时机及疗效.方法 收集2013年1月至2019年2月于阜外医院行膈肌折叠术患儿30例,男17例、女13例,年龄19.5(3,72)个月,其中双侧膈肌麻痹(双侧组)6例,单侧膈肌麻痹(单侧组)24例,比较两组患者的临床资料.结果 双侧膈肌麻痹患者中2例行双侧膈肌折叠术,其余4例经单侧膈肌折叠后继续脱机锻炼.单侧组与双侧组比较,呼吸机使用时间较短[(266.77±338.34)h vs.(995.33±622.29)h,P=0.001],总ICU滞留时间较短[(33.21±23.97)d vs.(67.33±28.54)d,P=0.008],差异有统计学意义.双侧组死亡1例,两组差异无统计学意义(P=0.363).两组患者膈肌折叠术后ICU滞留时间差异无统计学意义[(11.68±10.28)d vs.(29.83±27.73)d,P＞0.05].结论 膈肌折叠术是先心病术后膈肌麻痹经保守治疗无效后的有效治疗手段,双侧膈肌麻痹经手术治疗其预后较单侧膈肌麻痹效果差,严格把握手术适应证有利于患儿早期康复.

奥美沙坦作为一种新型的血管紧张素Ⅱ受体拮抗剂,具有高度选择性的药代学特征.奥美沙坦不仅在24 h稳定的降压效果方面得到肯定,其安全性也使其成为青少年高血压患者降压的候选药物之一.除降压之外,该药物在其他方面的作用近年来研究颇多.现就该药物在近年来的临床试验及动物模型研究结果做一综述.

目的:对高血压药物临床试验文献的伦理问题进行调研,以了解我国杂志是否提高了报告临床试验伦理道德的情况.方法:在维普中文科技期刊数据库中检索2003年、2008年和2013年高血压患者口服降压药物临床研究文献,分析文献中是否有通过伦理委员会批准、是否患者签署知情同意书的描述,比较各阶段高血压口服降压药物临床试验文献的伦理状况.结果:共收集到相关文献2003年292篇、2008年603篇、2013年1 046篇,随机对照临床试验的各有76篇(26.03％)、364篇(60.36％)、828篇(79.15％)(p =0.000),其中描述通过伦理委员会审查的文献分别为为2(2.63％),4(1.10％),以及57 (6.88％),(P=0.000),描述患者签署知情同意书的分别为7(9.21％),29(7.67％),和144(17.39％) (P =0.000).结论:与2003、2008年相比,2013年我国降压药物临床试验文献对伦理的报告有明显改善,但与国外文献相比仍有差距,我国药物临床试验文献的伦理管理仍亟需加强.

血管靶向抗肿瘤药物的出现,标志着肿瘤治疗进入新的纪元.但是由于血管靶向抗肿瘤药物选择性作用于肿瘤血管,也带来了临床试验中重要的临床安全问题—其潜在的心血管不良反应.通过对血管靶向抗肿瘤药物可能产生的心血管不良反应及发生机制的分析,提出如何正确应对血管靶向肿瘤药物临床试验中心血管毒性作用的预防及治疗.

Objective: To explore the relationship between erythrocyte sedimentation rate (ESR) and myocardial infarction (MI) occurrence in patients with rheumatoid arthritis (RA) combining coronary artery disease (CAD). <br> Methods: A total of 106 consecutive patients with RA combining CAD were studied. There were 46 male and 60 female patients and divided into 2 groups:RA with MI group, n=46 and RA without MI group, n=60. The base line condition was compared between 2 groups, and multivariate regression analysis was conducted to explore the risk factors for MI occurrence in relevant patients. <br> Results: Compared with RA without MI group, RA with MI group had the lower level of cholesterol and higher levels of inlfammatory indexes of ESR, high sensitivity C-reactive protein (hs-CRP) and CRP, P<0.05. The base line condition was similar between 2 group, P>0.05. Multivariate regression analysis indicated that ESR was the independent risk factor of MI occurrence, OR=1.024, 95%CI 1.024 (1.007-1.043), P=0.007. <br> Conclusion: ESR was independently related to MI occurrence in patients with RA combining CAD.

目的：比较冠心病合并强直性脊柱炎（AS ）患者与不合并AS冠心病患者的人口学特征[性别、年龄、体重指数（BMI）]、传统的冠心病风险因素（高血压、血脂代谢异常、糖尿病、吸烟的比例）及冠状动脉受累情况（病变的严重程度及发生心肌梗死的比例）的差异。