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Objective:To analyze and clarify the causes, types, risk factors and treatment principles of early postoperative tachycardia in children with congenital heart disease.Methods:A retrospective analysis of the clinical data of 2 126 children with primary radical congenital heart surgical procedure in Shanghai Children′s Hospital from January 2014 to December 2020, including 1 322 cases of ventricular septal defect or ventricular septal defect combined with atrial septal defect, 421 cases of atrial septal defect, 194 cases of tetralogy of Fallot, D-transposition of the great artery or double outlets of right ventricle combined with pulmonary stenosis, and 189 cases of other complex congenital heart disease. The surgical method is a median sternal skin incision or a small right axillary skin incision, and cardiopulmonary bypass is established routinely. The age, body mass, disease type, cardiopulmonary bypass and aortic occlusion time, vasoactive drug use, ECG monitoring and other indexes were observed and monitored.Results:There are 425 cases of early postoperative tachycardia in 2 126 children with congenital heart disease, with an incidence of 20.0%. The incidences of sinus tachycardia, borderline ectopic tachycardia, atrial tachycardia and ventricular tachycardia were 14.8%(314/2 126), 4.5%(96/2 126), 0.8%(17/2 126) and 0.5%(10/2 126), respectively. Logistic regression analysis revealed that the low age ( OR=1.98, 95% CI: 1.25-2.65, P<0.01), low weight ( OR=2.35, 95% CI:1.86-2.75, P<0.01), large ventricular septal defect ( OR=1.56, 95% CI:1.09-2.06, P=0.02), complex congenital heart disease ( OR=2.03, 95% CI: 1.57-2.52, P<0.01), long duration of cardiopulmonary bypass ( OR=1.77, 95% CI: 1.23-2.28, P<0.01), long aortic cross-clamp time ( OR=1.89, 95% CI:1.20-2.55, P<0.01), acidosis ( OR=1.63, 95% CI:1.11-2.14, P<0.01), and the combination usage of vasoactive drugs ( OR=1.86, 95% CI:1.23-2.48, P<0.01) were significantly associated with the occurrence of early postoperative tachycardias. Conclusion:This study has important clinical guiding value for predicting early postoperative tachycardia in children with congenital heart disease, clarifying its causes and types, and timely handling, so as to improve the postoperative survival rate of children.
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Objective:To analyze the etiology of hand, foot and mouth disease (HFMD) cases collected from Wenshan prefecture from 2014 to 2018 and the molecular epidemiology of coxsackievirus A6(CV-A6).Methods:Viruses were isolated by RD cells and Hep-2 cells from stool samples collected from HFMD patients in Wenshan prefecture from 2014 to 2018. Virus RNA was extracted and virus VP4/VP2 junction region sequence was firstly amplified and sequenced by MD91 and OL68-1 primer pairs, then the virus serotype was determined. Virus entire VP1 gene sequences were determined by relative primer pairs according to the references. The reference sequences of CV-A6 virus entire VP1 gene were downloaded from the GenBank and the phylogenetic tree was constructed and the genetic characteristics and molecular epidemiology were analyzed.Results:During five years of study period, a total of 581 strains of enteroviruses (EVs) was isolated with an isolation rate of 20.40% (581/2 848). Among 581 strains, 74 strains were CV-A6, accounting for 12.74% (74/581); 124 were CV-A16, accounting for 21.34% (124/581); 374 were EV-A71, accounting for 64.37% (374/581); nine were other EVs, accounting for 1.55% (9/581). The entire VP1 sequences of 74 CV-A6 strains were filtered by constructing a phylogenetic tree and the completely same strains were excluded from analysis. We finally analyzed the phylogenetic characteristics of 22 strains isolated in this study with 52 reference strains. The results showed that all 22 Wenshan strains belonged to D3a sub-genotype, of which 21 strains belonged to cluster 1, and only one strain belonged to cluster 2.Conclusions:From 2014 to 2018, the outbreaks of HFMD in Wenshan prefecture were mainly caused by EV-A71, CV-A16 and CV-A6, accounting for 64.37%, 21.34% and 12.74% respectively. Phylogenetic analysis showed, similar to the situation in China, the sub-genotype D3a of CV-A6 was the predominant virus and the cluster 1 was the main sub-genotype in this outbreak.
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Objective To analyze the risk factors and pathogen distribution of nosocomial infection in adult patients undergoing extracorporeal membrane oxygenation (ECMO) after cardiac surgery.Methods The clinical data of 325 patients who underwent ECMO support in the Department of Adult Cardiac Surgery of Beijing Anzhen Hospital from January 2012 to December 2017 were retrospectively analyzed.There were 132 patients with nosocomial infection (infected group) and 193 patients without nosocomial infection (noninfected group).Multivariate logistic analysis was used to analyze the risk factors of nosocomial infection,and the distribution of pathogens in infected patients was also analyzed.Results Among 132 infected patients,67 cases (50.76％) had respiratory infection,40 cases (30.30％) had blood infection,15 cases (11.36％) had surgical wound infection,and 10 cases (7.58％) had urinary tract infection.The case fatality rates of the infected group and non-infected group were 61.37％ (81/132) and 52.85％ (102/ 193),respectively (x2 =6.356,P ＜ 0.05).Univariate analysis showed that long operation time,application of extracorporeal circulation and long-term ECMO support were associated with nosocomial infection.Multivariate logistic regression analysis found that ECMO time (OR =5.565,95％ CI =2.868-10.799,P ＜0.01) was an independent risk factor for nosocomial infection after ECMO treatment in adult patients after cardiac surgery.Among the 132 infected patients,364 strains of pathogens were detected,of which 233 were Gram-negative bacteria,including 79 strains of Acinetobacter Baumann (33.9％) and 32 strains of K.pneumoniae (13.73％);101 strains were Gram-positive bacteria,including Streptococcus aureus (14.85％),Micrococcus (14.85％) and catarrhal bacteria (14.85％);30 strains were fungi and Candida albicans accounted for 70％ of fungi infections.Conclusion The long ECMO support time is an independent risk factor for ECMO-related hospital infections in adult patients undergoing cardiac surgery,and the pathogens are mainly Gram-negative bacteria.
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Objective To investigate and analyze the dwarf reasons for children in the area of Huai'an city,Jiangsu province.Methods A retrospective analysis of 92 cases of children with short stature in our hospital in recent 5 years had been made.Results The dwarf reasons for the 92 cases of undersized children were:lack of growth hormone (53.3％),physical sexual puberty delay (16.3％),hypothyroidism (9.8％),turner syndrome (7.6％),nanosoma essentialis (5.4％),familial short stature (4.3％),intrauterine growth retardation (2.2％)and glycogen storage disease type Ⅰ (1.1％).Conclusion The main dwarf reasons for children were growth hormone deficiency and physical sexual puberty delay,and medical treatment should be used as soon as possible.
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Objective To analyze the diagnostic methods and etiological factors in patients with fever of unknown origin (FUO).Methods The clinical data of 358 patients with FUO,Who were treated in hospital since February 2001 to April 2005,were retrospectively analyzed.Results Among the 358 patients,312 patients were definitely agnosed(87.2%),A- mong the 312 definitely diagnosis patients,172 cases were infectious disease(132 cases were bacterial infection,31 cases were virus infection,6 eases were fungus infection and 3 cases belonged to other disese),143 cases were bacterial were non-infections disease(66 cases were collagen vascular diseases,63 cases were malignant tumor and 14 cases belonged to other disese).46 cases remained origin-unknown until they were discharged from hospital.Conclusion In the diag- nosis of FUO,We should manage to collect oathogenic,immunologic and pathologic evidences.Infectious diseases,collagen vascular diseases and malignant tumors are the main causes of FUO.