ABSTRACT
Objective: To investigate the prognostic factors of children with congenital heart disease (CHD) who had undergone cardiopulmonary resuscitation (CPR) in pediatric intensive care unit (PICU) in China. Methods: From November 2017 to October 2018, this retrospective multi-center study was conducted in 11 hospitals in China. It contained data from 281 cases who had undergone CPR and all of the subjects were divided into CHD group and non-CHD group. The general condition, duration of CPR, epinephrine doses during resuscitation, recovery of spontaneous circulation (ROSC), discharge survival rate and pediatric cerebral performance category in viable children at discharge were compared. According to whether malignant arrhythmia is the direct cause of cardiopulmonary arrest or not, children in CHD and non-CHD groups were divided into 2 subgroups: arrhythmia and non-arrhythmia, and the ROSC and survival rate to discharge were compared. Data in both groups were analyzed by t-test, chi-square analysis or ANOVA, and logistic regression were used to analyze the prognostic factors for ROSC and survival to discharge after cardiac arrest (CA). Results: The incidence of CA in PICU was 3.2% (372/11 588), and the implementation rate of CPR was 75.5% (281/372). There were 144 males and 137 females with median age of 32.8 (5.6, 42.7) months in all 281 CPA cases who received CPR. CHD group had 56 cases while non-CHD had 225 cases, with the percentage of 19.9% (56/281) and 80.1% (225/281) respectively. The proportion of female in CHD group was 60.7% (34/56) which was higher than that in non-CHD group (45.8%, 103/225) (χ2=4.00, P=0.045). There were no differences in ROSC and rate of survival to discharge between the two groups (P>0.05). The ROSC rate of children with arthythmid in CHD group was 70.0% (28/40), higher than 6/16 for non-arrhythmic children (χ2=5.06, P=0.024). At discharge, the pediatric cerebral performance category scores (1-3 scores) of CHD and non-CHD child were 50.9% (26/51) and 44.9% (92/205) respectively. Logistic regression analysis indicated that the independent prognostic factors of ROSC and survival to discharge in children with CHD were CPR duration (odds ratio (OR)=0.95, 0.97; 95%CI: 0.92~0.97, 0.95~0.99; both P<0.05) and epinephrine dosage (OR=0.87 and 0.79, 95%CI: 0.76-1.00 and 0.69-0.89, respectively; both P<0.05). Conclusions: There is no difference between CHD and non-CHD children in ROSC and survival rate of survival to discharge was low. The epinephrine dosage and the duration of CPR are related to the ROSC and survival to discharge of children with CHD.
Subject(s)
Child , Child, Preschool , Female , Humans , Male , Cardiopulmonary Resuscitation , Heart Arrest/therapy , Heart Defects, Congenital/therapy , Intensive Care Units, Pediatric , Retrospective StudiesABSTRACT
Objective To study the expression of nicotinic acetylcholine receptor α7 in CD4 + CD25 + T lymphocytes of peripheral blood in children with sepsis,and to analyze the role of α7nAChR in the development of sepsis.Methods Forty-nine hospitalized patients with sepsis from Nov.2011 to Dec.2012 in PICU of Nanjing Children's Hospital Affiliated to Nanjing Medical University were enrolled,and they were divided into the survival group (n =33)and the dead group (n =16) in accordance with the outcome.At the same time,the total of 40 cases including the children receiving inguinal hernia repair and the children receiving health examination were enrolled as control group.Peripheral venous blood was collected to detect the expression of CD4 +/CD25 +/α7nAChR by indirect flow cytometry.Simultaneously,the CD3 +,CD4 +,CD8 +,CD4 +/CD8 + ratio were detected,and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores were calculated.Results The expressions of CD4 +/CD25 +/α7nAChR in sepsis group were much lower than those in the control group [(25.8 ± 3.1) ％ vs (34.9 ± 2.9) ％,P ＜ 0.05] ; and the expression of CD4 + CD25 +/α7nAChR in the dead group was also significantly lower than that in the survival group [(22.4 ± 2.5) ％ vs (28.1 ± 2.9) ％,P ＜ 0.05].The expressions of α7nAChR on CD4 +/CD25 + T lymphocytes of peripheral blood in children with sepsis was negatively correlated with the APACHE Ⅱ score (r =-0.512,P ＜ 0.05).The CD3 +,CD4 +,CD4 +/CD8 + ratios in the dead group were significantly lower than those in the control group (all P ＜ 0.05) ; in the survival group and the control group,the values of CD3 +,CD4 +,CD8 + were not significantly different,while the ratios of CD4 +/CD8 + between these 2 groups had a significant difference(P ＜ 0.05).Conclusions The expressions of α7nAChR on the CD4 + CD25 +T lymphocytes in the children with sepsis were reduced,and the expressions were lower,the outcome were worse;the children with sepsis have cell immune dysfunction.
ABSTRACT
The aim of this study was to explore the effects of the stromal cell-derived factor (SDF-1) and chemokine receptors (CXCR4) on chemotaxis of cord blood AC133(+) cells. The optimal SDF-1 concentration was determined in Transwell System. The cell migration was calculated from the number of cells passing through polycarbonate membrane with 8 microm pore. The expressions of CXCR4 in fresh and cultured cord blood AC133(+) cells were analyzed by flow cytometry with two-color direct immunofluorescence. The results showed that the chemotactic rate of fresh cord blood AC133(+) cells increased along with increasing concentrations of SDF-1, however, it tended to be stable when the concentration of SDF-1 reached 150 ng/ml. There was no difference in the chemotactic rate of cord blood AC133(+) cells between the group with SDF-1 adding CXCR4-blocking antibody and the group without SDF-1. When AC133(+) cells were cultured in vitro with hemopoietic growth factors, the expression of CXCR4 increased at the early stage, but decreased gradually along with time extending. In conclusion, there was correlation between the chemotactic rate of AC133(+) cells and the expression of chemokine receptor CXCR4.