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Objective: The clinical manifestations and treatment of three patients with hemodynamically unstable lupus myocarditis (LM) were analyzed. Methods: The clinical data of three patients with LM with hemodynamic instability, who were admitted to the emergency ICU of the south hospital of the Renji Hospital, School of Medicine, Shanghai Jiao Tong University of Medicine from January 2018 to December 2021, were collected and analyzed, and relevant literatures were reviewed. Results: Two of the three patients had the first onset of systemic lupus erythematosus. The other patient had mixed connective tissue disease in the past, and lupus was the main manifestation of this disease. At the onset of the disease, all patients had chest tightness and shortness of breath; two patients had a fever, and the markers of myocardial injury increased. Cardiac color Doppler ultrasound indicated that left ventricular ejection fraction decreased significantly. Cardiac insufficiency with cardiogenic shock rapidly appeared as the main manifestation. Two patients immediately started veno-arterial extracorporeal membrane oxygenation (VA-ECMO), and ECMO was also started in one patient after a pacemaker placement was ineffective. For all three patients, high-dose hormones were given to control the primary disease, and then the ECMO machines were removed successfully. Conclusion: VA-ECMO treatment should be implemented in patients with hemodynamically unstable LM as soon as possible to maintain the patient's hemodynamics and help them overcome the crisis of cardiac dysfunction, allowing more time for primary disease treatment.
RESUMO
OBJECTIVE: To study the cutoff value, the appropriate time of the 50 g oral glucose challenge test (GCT) to screen the gestational diabetes mellitus (GDM) and to study the importance of the maternal age and body weight of GDM. METHODS: The clinical data of 8 665 pregnant women who underwent the GCT from January 1995 to March 2001 in the Department of Obstetrics and Gynecology of the First Hospital of Beijing University were collected, and a retrospective study was made. RESULTS: (1) The 1 h average plasma glucose level of the GCT is (6.8 +/- 1.7) mmol/L. The abnormal rate of GCT was 25.2% using 7.8 mmol/L as the cutoff, 5.3% (17/321) of GDM were misdiagnosed. When the cutoff is 7.2 mmol/L, the abnormal rate is increased to 36.5%, and 2.8% (9/321) of GDM were more diagnosed. If a value of 8.3 mmol/L as threshold, there would be 15.9% (51/321) of GDM to misdiagnose. (2) When 1 h blood glucose is >or= 11.2 mmol/L, the incidence of GDM is 55.8% (92/165). Among them, 62.0% (57/92) GDM could be diagnosed according to the fasting blood glucose. (3) There were no difference in the rate of abnormal GCT when GCT underwent between 24 and 36 weeks of gestation. (4) The rate of abnormal GCT and the incidence of the GDM are obviously different among the different age groups. The incidence of GDM among the women younger than 25 years old without high risk factors is only 0.3%, obviously lower than the other groups. (5) The average body mass index (BMI) of the women between 26 to 28 weeks of gestation is (24.9 +/- 2.9) kg/m(2). When the BMI is >or= 27.8 (x +/- s), the rate of abnormal GCT and the incidence of the GDM were obviously higher than the other women. CONCLUSIONS: (1) 7.8 mmol/L as the cutoff of the GCT for the screening of GDM is appropriate. When the 1 h blood glucose level is >or= 11.2 mmol/L, fasting blood glucose should first be done to diagnose GDM. (2) It is necessary to screen GDM as soon as possible after 24 weeks of gestation, but for the women with obviously high risk factors GCT should be done before 24 weeks of gestation. (3) Age and obesity are the important risk factors for the GDM. It is not necessary to screen GDM among the pregnant women younger than 25 years old without high risk factors.