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Objective:To investigate the clinical features of pregnant associated Takotsubo cardiomyopathy (PTCM).Methods:We reviewed reported PTCM cases published from January 2007 to June 2022 using the keywords "Tako-tsubo cardiomyopathy""Takotsubo cardiomyopathy" "stress cardiomyopathy" AND "parturition" "pregnancy" "cesarean delivery" "postpartum" "peripartum" "eclampsia" "abortion" in Pubmed and Web of Science databases and the corresponding Chinese words in Wanfang and Chinese Medical Journal Network. Age, obstetric history, mode of delivery, mode of anesthesia, etiological factors, clinical manifestations, treatment, and prognosis of PTCM were recorded. Descriptive statistical analysis was adopted.Results:A total of 55 articles were included, covering 60 patients with PTCM. (1) Age and time of onset: The age of onset was (32.4±6.0) years old. PTCM occurred most frequently during labor [42% (25/60)] and within one day postpartum [32% (19/60)] and during the gestational period [13%(8/60), 33.0 weeks (24.5-37.7 weeks)]. (2) Delivery-related factors: There were 38% (16/42) primiparas and 60% (25/42) multiparas. Among them, 67% (38/57) and 18% (10/57) were delivered by cesarean section and vaginal delivery, respectively. PCTM often lacks obvious triggers [40% (24/60)], with the most common inducing factor being pregnancy-related diseases [27% (16/60)]. (3) Clinical features: The initial symptoms of PTCM were dyspnea [44% (26/59)], followed by chest pain accompanied by dyspnea [17% (10/59)]. The most common subtype of PTCM was the apical type [45% (26/58)], followed by the basal type [24% (14/58)], while the biventricular type was the least common [3% (2/58)] in the PTCM classification. The left ventricular ejection fraction was (31.6±12.1) % at the onset of PTCM, which recovered to (58.2±7.6) % at discharge. PCTM was often complicated by pulmonary edema [67% (40/60)] and cardiogenic shock [55% (33/60)]. (4) Treatment and prognosis: Patients with PCTM usually require noninvasive or invasive ventilator-assisted ventilation [40% (23/58)]. One pregnant woman and five neonates died, while the remaining patients recovered well.Conclusions:PTCM should be considered in differential diagnosis of patients experiencing dyspnea and chest pain during labor and pregnancy. PTCM patients are younger and have more pulmonary edema and cardiogenic shock. Mechanical ventilation is often required, but the prognosis is favorable.
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Objective To investigate the dynamic changes of dead space fraction (VD/VT) and its effect on the prognosis in the patients with acute respiratory distress syndrome (ARDS).Methods Thirtytwo patients with ARDS in EICU of the First Affiliated Hospital of Kunming Medical University from January 2015 to August 2016 were selected and divided into the survival group and the death group according to the 28 d mortality rate.VD/VT on 1-6 d in the two groups was calculated according to the formula.The parameters of basic condition,PaO2/FiO2,APACHE Ⅱ score,LIPS score,PEEP of the two groups were compared.Results LIPS and APACHE Ⅱ scores had statistical difference between the death group and survival group (P＜0.05);VD/VT on 1-3 d had no statistical difference between the two groups (P＞0.05),and VD/VT on 4-6 d in the death group was significantly higher than that in the survival group (P＜0.01).△PCO2,pH and PaO2/FiO2 had statistical difference between the death group and the survival group (P＜0.05).The binary classification Logistic regression analysis found that APACHE Ⅱ,LIPS,△PCO2,VD/VT were the risk factors.VD/VT on the 4th day was selected,its' cut off value was 0.62,and the sensitivity of the prognostic evaluation was 90.0 ％,the specificity was 95.5 ％.Conclusion The dead space fraction is an independent risk factor for the prognosis of ARDS patients,and VD/VT on 4th day could effectively identify the high-risk patients.
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Objective To study the effect of combination mode of blood purification on insulin resistance in MODS patients and discuss the best mode of blood purification to improve insulin resistance in MODS patients.Methods A total of 60 MODS pa-tients were selected and randomly divided into control group(single mode of blood purification)and treatment group(combination mode of blood purification),each group of 30 cases.Blood glucose (BG),glucose standard deviation (BGSD),coefficient of variation of blood glucose (BGCV),regular insulin dosage (Ins),fasting insulin (FINS),insulin resistance index (HOMA-IR),HbA1c,C-re-active protein (CRP)was observed before and after treatment.Results BG,HbA1c,FINS,CRP,HOMA-IR,Ins of experimental group was lower than that of control group (P 0.05 ).Conclusion Combination mode blood purification may be more effective to insulin resistance in MODS patients.