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Objective:To investigate the efficacy and safety of hydromorphone for postoperative analgesia in children with congenital heart disease, and provide a suitable reference dose for postoperative analgesia in children.Methods:Using a prospective study, 157 patients with congenital heart disease(ASA Ⅱ- Ⅳ) admitted to pediatric intensive care unit at Children′s Hospital of Chongqing Medical University from November 2019 to November 2021 were randomly divided into five groups.Low-dose hydromorphone group (H1 group, 30 cases): hydromorphone dose ≥2 and <3 μg/(kg·h), hydromorphone medium-dose group (H2 group, 30 cases): hydromorphone dose ≥3 and <4 μg/(kg·h), high-dose hydromorphone group (H3 group, 31 cases): hydromorphone dose ≥4 and ≤5 μg/(kg·h), sufentanil group (S group, 36 cases): the dose of sufentanil was 0.08 μg/(kg·h), morphine group (M group, 30 cases): the dose of morphine was 20 μg/(kg·h). The five groups of children received midazolam 2 μg/(kg·min) intravenously at the same time as sedative therapy.Pain score and sedation score were scored at 1 h, 4 h, 8 h, 12 h, and 24 h after operation.Heart rate, mean arterial pressure, blood glucose, lactate, and serum cortisol levels were also monitored and detected, and the occurrence of adverse reactions, the number of cases requiring additional analgesic and sedative drugs, as well as the duration of mechanical ventilation were compared.Results:(1) There were no significant differences regarding the age, body weight, cardiopulmonary bypass time, pediatric critical illness score and ASA score among five groups (all P>0.05). (2) There was no significant difference in the levels of respiration, heart rate, blood sugar, lactate and serum cortisol among five groups after operation.There was no significant difference in preoperative mean arterial pressure among the groups, but there was significant difference in the postoperative mean arterial pressure among the groups at 4 h and 8 h( P<0.05). (3) The analgesic satisfaction of H1 group, H2 group and H3 group at 1 h, 4 h, 12 h and 24 h after operation was significantly higher than that in M group ( P<0.05). There was no significant difference in analgesic satisfaction among H1 group, H2 group and H3 group at each time point.(4) The sedation satisfaction of H1 group, H2 group and H3 group at 4 h and 24 h after operation was significantly higher than that in M group ( P<0.05). There was no significant difference in sedation satisfaction among H1 group, H2 group and H3 group at each time point.(5) There was no significant difference in postoperative analgesia satisfaction and sedation satisfaction between H1 group, H2 group, H3 group and S group.(6) Children in H1 group[1(0, 2)], H2 group[1(0, 2)], H3 group[1(0, 2)] had fewer additional doses within 24 hours than that in M group[2(2, 3)]( P<0.05), and fewer children in H1 group, H2 group and H3 group had been given analgesic sedatives than that in M group ( P<0.05); The extubation time was shortest in H2 group and S group[H2 group(88.3±2.9) h, S group(85.9±3.0) h]. (7) There were no adverse reactions in H1 group, H2 group, H3 group and S group, and there were two cases of apnea in M group. Conclusion:The analgesic effect of hydromorphone in children with congenital heart disease after surgery is better than that of morphine, and the effect of hydromorphone is comparable to that of sufentanil.Hydromorphone 3-4 μg/(kg·h)+ midazolam 2 μg/(kg·min) can achieve satisfactory analgesic and sedative effects in children after congenital heart surgery, with few adverse reactions, safe and reliable, which is an excellent choice for postoperative analgesia and sedation in children.
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Prone position ventilation(PPV) is an effective treatment for moderate to severe pediatric acute respiratory distress syndrome(PARDS) and should be used in the early stage. PPV can improve oxygenation and reduce mortality.However, at present, the rate of application of PPV in moderate to severe PARDS is still low, which may be related to the insufficient understanding of its therapeutic effect and the lack of trained and skilled staff.Prone operation requires the coordinated efforts of doctors and nurses.Three to five medical personnel are required to participate in this routine operation, and the endotracheal tube and various invasive tubes must be carefully fixed.The safety of children during the prone operation should be guaranteed, and the extubation, migration or kinking of invasive pipelines must be avoided.Children receiving extracorporeal membrane oxygenation can be ventilated in prone position, but additional operators are required during prone operation.Medical staff should receive training related to the prone operation, master the contraindications of PPV, and avoid related complications.After the outbreak of COVID-19, the application of PPV has gradually increased.The key research progress of PPV in acute respiratory distress syndrome mostly comes from the adult field.More clinical studies should be carried out on the use of PPV in pediatrics in the future, so as to better treat PARDS.
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Traumatic brain injury (TBI) is a common and critical illness in pediatrics,and it is also an important cause of death and disability in children. TBI may cause hyperglycemia,which may be related to stress,inflammation,pituitary function and iatrogenic factors. Hyperglycemia is closely related to the mortality and outcome of children with TBI. However strict glycemic control did not achieve good effects in patients with TBI.
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In addition to pneumonia,Mycoplasma pneumoniae (MP)infection can also cause Stevens-John-son syndrome,hemophagocytic lymphohistiocytosis,hepatitis,nervous system disease,and other serious diseases,which seriously threat to the health of children. The pathogenesis of multisystematic damage caused by MP infection is not fully understood,but it may be related to the abnormality of immune reaction after MP infection. Pediatricians should be fa-miliar with clinical manifestation of MP infection,as far as possible to the early diagnosis and treatment to improve the prognosis. This article mainly introduces the multiple system damage caused by MP infection in children.
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Objective@#To investigate the effect of fiberoptic bronchoscope-guided one-lung ventilation (OLV) on treatment of intractable atelectasis in children.@*Method@#This retrospective cohort study was conducted in Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University from December 2014 to May 2017. Six patients with intractable atelectasis of left lung were included. Three cases were male and three female with the age from 1.5 to 11.0 years. The endotracheal tube was intubated to the left main bronchus for OLV by the guidance of fiberoptic bronchoscopy. The effect of treatment by monitoring the chest imaging after treatment was evaluated.@*Result@#Six pediatric patients were successfully cured by OLV. The duration of OLV ranged from 1.5 to 30.0 hours, and the intervals of OLV were usually 3 to 5 days. Each patient received 6 to 20 OLV treatments. Chest images showed the left lung reexpanded obviously after OLV treatments. Five patients successfully weaned from invasive ventilation and were discharged. Another patient turned better, discharged from hospital with noninvasive ventilation and weaned from noninvasive ventilation one month later after discharge. During the procedure of OLV, the vital signs of all patients were stable and no complication occurred.@*Conclusion@#OLV with selective bronchial intubation guided by fiber bronchoscope is a safe and effective treatment for intractable atelectasis in children.
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Objective@#To investigate the application of regional citrate anticoagulation with calcium hemofiltration basic solution in continuous hemofiltration in children.@*Method@#The clinical data of 18 patients with citrate anticoagulation in continuous hemofiltration in children, excluding the hepatic failure and septic shock cases, were analyzed retrospectively, from September 2015 to August 2016 in Intensive Care Unit of the Children′s Hospital of Chongqing Medical University.The commercial calcium hemofiltration basic solution was used as displacement liquid . The blood gas analysis, electrolyte, four coagulation tests during the treatment and the corresponding relations of quantity of blood flow(QB), quantity of citrate flow(QCi), quantity of sodium bicarbonate flow(QSB), quantity of calcium flow(QCa), quantity of filtered solution flow (Qf) were monitored. Meanwhile, the blood gas analysis, electrolyte, four coagulation tests, useful life of filter, bleeding and clotting events internal and external before, during and after the treatments were monitored, too. And the common complications of citrate anticoagulation, such as hypocalcaemia, metabolic alkalosis, citrate accumulation and hypernatremia were observed.@*Result@#Continuous hemofiltration was applied in 18 patients for 734.5 hours, and the average useful life of filter was (25±11)h.There was no obvious clotting event. There were 168 groups of datum of the blood gas analysis, electrolyte, four coagulation tests during the treatment and the relationships of QB, QCi, QSB, QCa, Qf had been collected. The relationships of the initial parameter settings of QB, QCi, QSB, QCa and Qf were concluded as QCi=1.8×QB, QCa=0.12×QB, QSB=0.01×Qf . There were 150 times(89.3%)of extracorporeal ionized calcium(iCaE2+) and 162 times(96.4%) of intracorporal ionized calcium(iCaI2+) reached the anticoagulation target. Although all the comparisons of Na+ ((136.2±4.1)vs.(138.2±2.4)vs.(138.5±3.9)mmol/L), iCa2+ ((1.07±0.11)vs.(1.21±0.12)vs.(1.17±0.09)mmol/L), HCO3- ((22±4)vs.(28±5)vs. (26±4)mmol/L) among before, during and after treatment had significant difference(F=6.414, 18.950, 19.151; P=0.002, 0.000, 0.000). Each mean parameter was within the nearly normal range, except that the HCO3- increased slightly. High HCO3- was the most common complications, which happened 87 times (51.8%) during the treatment and 11 cases(37.9%) after the treatment. There was none with refractory hypocalcemia and total ionized calcium(TCa2+ )/iCa2+ above 2.5, which hints the accumulation of citrate.@*Conclusion@#The commercialized displacement liquid containing calcium can be used in RCA-CHF in children safely and simply.
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Methicillin-resistant Staphylococcus aureus (MRSA) infection can cause pneumonia,bacteremia,infective endocarditis and other diseases,seriously threat to the health of children.Pediatricians should discover the focus of infection.And the focus of infection should be removed or debrided in time.Vancomycin is an important drug for the treatment of MRSA infection,the use of Vancomycin need to ensure that the blood concentration is effective.Now,the advances in treatment of MRSA infection in children was mainly summarized.
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Objective To investigate the application of citrate injected by dialysis pump in regional citrate anticoagulation (RCA) for child continuous hemofiltration(CHF). Methods The clinical data of 49 children patients with RCA-CHF with citrate anticoagulation in ICU of the Affiliated Children's Hospital of Chongqing Medical University from September 2015 to January 2017 were retrospectively analyzed. All cases were divided into the traditional group(20 cases) for conducting RCA-CHF treatment and improved group(29 cases,dialysis pump injection of citric acid) for conducting RCA-CHF under CHF mode. The occurence situation of common complications such as infusion pump bubble alarming, blood undesirable collection, bleeding and coagulation, and complications such as filter lifetime and citrate anticoagulation were observed. Results The bubble alarming and filter lifetime had statistical difference between the two groups(P<0.05). The biochemical indicators before and after treatment, and Na+ , iCa2+ , TCa2+/iCa2+ and HCO3- before and after treatment had statistical difference between the two groups. But Na+ , iCa2+ , TCa2+ /iCa2+and HCO3- before and after treatment had no statistical difference between the improved group and traditional group(P>0.05). Conclusion The improved technology of dialysis pumps instead of citrate pumps can more safely and more effectively use in child RCA-CHF treatment.
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Intracranial hypertension is one of the most common pediatric acute and severe diseases.Intracranial pressure(ICP) monitoring can dynamically evaluate the changes of the patients with brain injury,calculate the cerebral perfusion pressure,guide the clinical treatment.ICP monitoring can not reflect the cerebral microvascular dysfunction and cell dysfunction,so it is necessary to carry out multimodality monitoring based on ICP monitoring.The information integration of ICP monitoring and multimodality monitoring is helpful to further understand the pathophysiological mechanism of brain injury,and it is also helpful for individualized treatment of patients.
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Inhaled nitrous oxide (iNO) can alleviate pulmonary hypertension and enhance ventilation-perfusion matching to improve oxygenation in pediatric acute respiratory distress syndrome (PARDS).But duration of improvement was short.From the existing researches,iNO can't effectively improve outcome in PARDS.So iNO is not recommended for routine use in PARDS.However,iNO may be used in patients with documented pulmonary hypertension or severe right ventricular dysfunction.In addition,iNO can be a rescue intervention for severely PARDS to buy time and allow other therapies.
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New guideline for the acute medical management of severe traumatic brain injury in infants,children,and adolescents was published in Pediatric Critical Care Medicine in 2012.This guideline made relevant recommendations and suggestions on intracranial pressure monitoring,threshold for treatment of intracranial hypertension,cerebral perfusion pressure thresholds,advanced neuromonitoring,neuroimaging and therapy for intracranial hypertension in pediatric patients with severe traumatic brain injury.This guideline was simply interpretated in order to improve the treatment of severe traumatic brain injury.
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Objective:To investigate survival and apoptotic responses of alveolar epithelial typeⅡcells(ATⅡ cell)under oxidative stress and to discuss the regulation mechanism mediated by c-jun NH2-terminal kinase(JNK).Methods:Primary rat alveolar epithelial typeⅡcells were attacked by Hydrogen peroxide(H2O2)and cells were pretreated with SP600125 in some groups.Cell viability,apoptotic rate and the expression of phosphorylated JNK(p-JNK)were measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide(MTT)assay,flow cytometry and western blot analysis,respectively.Results:Compared with control group,decreased cell viability and increased apoptotic rate in ATⅡ cells occurred in time-dependent manner when treated with 500?mol/L H2O2 in different time.H2O2 induces phosphorylation of JNK.SP600125 enhanced cell viability and decreased apoptotic rate after H2O2-exposure.Conclusion:Apoptosis could be induced by H2O2 in ATⅡ cells in time-dependent manner.JNK signaling pathway may play a proapoptotic role in the regulation of apoptosis induced by H2O2.
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Objective To study the effects of dexamethasone(Dex) on expression of aquaporin-4(AQP4) in rabbit non-pigmented ciliary epithelium(NPCE).Methods To construct rabbit corticosteroid-induced glaucoma model and then compare the differences of AQP4 expression in NPCE with normal controls by immunohistochemistry and immunofluorescence methods,as well as Western blot method.Results The immunohistochemistry results indicated that the AQP4 expression in NPCE of DEX group(OD=0.119?0.072) was suppressed(0.242?0.056)(P