目的 分析脓毒症心肌病短期预后及其影响因素.方法 选取2017年8月至2020年10月于首都医科大学宣武医院收治的脓毒症心肌病患者86例,研究终点为15 d死亡,按其预后分为生存组(n=46)和死亡组(n=40),分析影响两组患者的预后因素.结果 回顾性分析显示:死亡组患者氧合指数及平均动脉压较生存组更低(P<0.05),其心率、肌酐及APACHEⅡ评分、SOFA评分均高于生存组,各部位感染率及急性肾衰发病率均远高于生存组,且合并高血压比率更高(55％vs.39.1％,P<0.05),而生存组24 h乳酸清除率明显高于死亡组(OR=0.352,95％CI:0.145～0.789,P=0.013),差异有统计学意义(P<0.05).经多因素Logistic回归分析,24 h乳酸清除率、APACHEⅡ评分、肺部感染及合并急性肾损伤(AKI)是影响脓毒症心肌病患者预后的主要因素.结论 脓毒症心肌病具有极高的死亡率,其预后转归受多种因素影响,主要因素包括:24 h乳酸清除率、APACHEⅡ评分、各种感染及急性肾损伤等,其中24 h乳酸清除率为独立保护因素.

Objective:To explore the influencing factors and guiding significance of troponin I (TnI) increased in patients with renal transplantation.Methods:The clinical data of 195 patients with renal transplantation from December 2019 to June 2021 in Xuanwu Hospital, Capital Medical University were retrospectively analyzed. TnI was routinely detected after surgery, and TnI>0.02 μg/L was abnormal. The incidence of acute coronary syndrome during hospitalization was recorded. Multivariate Logistic regression analysis was used to analyze the independent risk factors of TnI increased after renal transplantation.Results:Among 195 patients with renal transplantation, postoperative TnI increased in 55 cases (28.2%). The age, diabetes complication rate and dialysis time before first renal transplantation in patients with TnI increased were significantly higher than those in patients with TnI normal: (49.2±9.0) years old vs. (41.6±10.6) years old, 27.3% (15/55) vs. 14.3% (20/140) and 24.0 (11.0, 60.0) months vs. 11.0 (4.0, 24.0) months, and there were statistical differences ( P<0.01 or<0.05); there was no statistical difference in hospitalization length of stays ( P>0.05). During hospitalization, acute coronary syndrome occurred in 8 patients (4.1%, 8/195), and 2 patients died. Multivariate Logistic regression analysis result showed that age>50 years old was the independent risk factor of TnI increased after renal transplantation ( OR = 5.11, 95% CI 2.47 to 10.59, P<0.01). Conclusions:The incidence of TnI increased after renal transplantation is high, but the incidence of acute coronary syndrome is not high. The age increases the risk of postoperative TnI increased, but TnI increased does not prolong the hospital stay.

目的 总结不明原因卒中合并中小卵圆孔未闭患者的临床特点及经导管封堵的治疗经验.方法 分析2020年7月至2020年12月在首都医科大学宣武医院因不明原因卒中合并中小卵圆孔未闭行介入治疗(经导管封堵)的11例患者的临床资料及随访情况.结果 11例患者中,3例反复发作脑梗死.卵圆孔未闭最大直径1.8～2.5mm,其中小卵圆孔未闭3例(27.2％),中卵圆孔未闭8例(72.7％);9例(81.8％)为高危卵圆孔未闭.所有患者均成功实施经导管封堵手术,围术期及术后随访无手术相关并发症及封堵器移位、脱落等情况发生.6例术前大量右向左分流患者,术后1个月随访时,1例残余分流为中量,1例残余分流为少量,余4例未见残余分流.随访期间无患者出现新发脑梗死及短暂性脑缺血发作.结论 不明原因卒中合并中小卵圆孔未闭经导管封堵手术治疗临床效果佳,安全有效.

倾斜试验是晕厥诊断中非常重要的辅助检查之一,该检查于1986首次提出,通过变换体位模拟神经介导性反射寻找晕厥病因并指导治疗.该检查主要用于反射性晕厥、直立性低血压所致晕厥的诊断,同时对于晕厥与其他心源性晕厥、癫痫、心因性假性晕厥等疾病的鉴别诊断也有一定作用,但其敏感性和特异性有限.倾斜试验阳性的反射性晕厥患者,接受起搏治疗前要综合评估患者情况.