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【Objective】 To investigate the incidence of clinical massive blood transfusion in hospitals, the proportion of departments conducted massive blood transfusion and the current situation of component transfusion, so as to provide a theoretical basis for medical decision-making and further research on massive blood transfusion. 【Methods】 The basic clinical data and transfusion of blood components were retrospectively collected from 489 patients (514 occasions) who received massive blood transfusion at Sun Yat-sen Memorial Hospital of Sun Yat-sen University from Jan. 1 2014 to Dec. 31 2018. 【Results】 The incidence of massive blood transfusion during the 5-year period was 1.2/1 000 inpatients (95%CI: 1.1-1.3), and the 30-day all-cause mortality was 21.88%; in the departments where massive blood transfusion occurred, the mortality rate was the highest in the trauma emergency department (60%), followed by intensive care unit (56.25%) and other surgery department (46.67%), while there was no death in the obstetric department. All patients received red blood cells [median 14 U (11.5-19.13)] and plasma [median 1 600 mL (1 200-2 200)], of which 47% received platelet [median 0 U (0-10)] and 32.68% received cryoprecipitate [0 U (0-10)]. The results of logistics regression analysis of all-cause mortality risk showed that compared with the youth group, the risk of all-cause death at 30 days of elderly patients over 65 years old (65 80 years old: OR=7.563, 95%CI=[1.587, 36.049], P<0.05) and 24-hour RBC infusion volume greater than 18 U (18≤RBC<27: OR=2.948 95%CI=[1.592, 5.462], P<0.05; RBC≥28: OR=3.992, 95%CI=[1.178, 13.536], P<0.05) was higher. 【Conclusion】 A dynamic definition should be included in massive transfusion studies. If only a 24-hour RBC infusion volume ≥18 U was used as the mass transfusion definition, about 68% of cases would be lost. The mortality rate of patients with massive blood transfusion was higher, and the incidence of massive blood transfusion was higher in the departments of cardiac surgery, general surgery and orthopedics surgery. More attention should be paid to the increasing number of female patients with massive blood transfusion. In addition, the risk of 30-day all-cause death was highest in elderly patients over 65 years of age and those with a 24-hour erythrocyte transfusion level of ≥18 U.
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Objective:To investigate the relationship between the level of Apelin-13 and coronary artery lesion (CAL) in patients with Kawasaki disease (KD), and assess the predictive value of Apelin-13 for CAL in acute phase of KD.Methods:A total of 240 children with KD treated in Chengdu Women and Children′s Central Hospital from September 2017 to October 2019 were recruited, and were divided into KD with CAL (KD-CAL) group and KD without CAL (KD-NCAL) group.Thirty children with acute upper respiratory infection and 30 healthy children were recruited into the febrile control group and the healthy control group, respectively.Blood routine and serum levels of albumin, C-reactive protein (CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP) and Apelin-13 were mea-sured in KD children prior to intravenous gamma globulin injection and after the diagnosis of children in the febrile control group and physical examination of children in the healthy control group.The clinical data of children in each group were compared, and the risk factors of KD complicated with CAL and the predictive value of Apelin-13 were determined by using receiver operating characteristic (ROC) curve and multiple Logistic regression analysis. Results:Apelin-13 and hemoglobin in children with KD were significantly decreased compared with those in the healthy control group and fever control group (all P<0.001). However, white blood cell(WBC) count, platelet count, CRP and NT-proBNP in KD group were significantly increased compared with those in the healthy control group and fever control group (all P<0.001). Serum albumin in KD children was significantly lower than that in the healthy control group ( P=0.004), and there was no difference when compared with the fever control group ( P=0.485). Apelin-13 and hemoglobin were significantly decreased in KD-CAL group compared with KD-NCAL group ( t=10.102, P<0.001; t=2.034, P=0.043), while NT-proBNP and CRP were significantly increased ( t=5.982, 3.728, all P<0.001). Multiple logistic regression analysis showed that Apelin-13 and NT-proBNP were independent predictors of CAL in KD.The ROC curve analysis showed that the cut-off value of Apelin-13 for predicting CAL was 2.99 μg/L, with an area under the curve (AUC) of 0.869 (95% CI: 0.820-0.909), sensitivity of 77.78% and specificity of 88.67%.While NT-proBNP cutoff value of 822 ng/L yielded sensitivity of 57.78% and specificity of 84.62% for predicting CAL with an AUC of 0.718(95% CI: 0.656-0.774). Conclusions:Apelin-13 plays a protective role in KD complicated with CAL, and could be used to predict CAL in the acute phase of KD.
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The application indications of imaging examination and cardiac catheterization in the diagnosis, treatment and follow-up of Kawasaki disease, especially cardiovascular sequelae, are further improved by the Japanese Circulation Society/Japanese Society for Cardiovascular Surgery 2020 Guideline on Diagnosis and Management of Cardiovascular Sequelae in Kawasaki Disease that also standardizes the long-term management program of Kawasaki disease in three different stages, namely, school, the adolescent/young adult and adulthood stage.In order to enhance the understanding of domestic medical staff with the latest knowledge, this paper focuses on the application progress of diagnostic imaging and cardiac catheterization in the diagnosis, treatment and long-term management of cardiovascular sequelae of Kawasaki disease in the guide.
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Objective:To investigate the relationship of heart rate variability (HRV), heart rate deceleration capacity (DC) and intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD) in children with the acute stage of KD.Methods:A total of 679 patients with KD in Chengdu Women and Children′s Central Hospital from August 2015 to May 2019 were selected.In healthy control group, 150 children obtained physical examination at the same time.Prospective cohort study was applied to analyze the data.According to the effect of initial IVIG treatment within 14 days, patients were divided into IVIG-sensitive group and IVIG-resistant group.General clinic information, HRV, DC, blood routine, liver function, cardiac troponin I (cTnI), N-terminal pro-B-type natriuretic peptide (NT-proBNP), high sensitivity C-reactive protein(hs-CRP) and erythrocytesedimentation rate (ESR) before initial IVIG treatment of the 2 groups were compared.Multivariate Logistic regression was applied to analyze the risk factors of IVIG-resistant KD. Results:Among 679 KD patients, 3 cases were lost, among the rest 676 cases, 586 cases were in IVIG-sensitive group, and 90 cases were in IVIG-resistant group.The HRV and DC indexes of IVIG-sensitive group and IVIG-resistant group were lower than those of the healthy control group, and the differences among the 3 groups were statistically significant (all P<0.05). Meanwhile, standard deviation of N-N intervals (SDNN) [(65.84±38.22) ms vs.(82.56±21.41) ms, P=0.004], and low frequency (LF)[ (192.59±114.10) ms 2vs. (258.18±162.75) ms 2, P=0.048] of IVIG-resistant group were lower than those of IVIG-sensitive group.White blood cell (WBC), platelets(PLT), hs-CRP, ESR, alanine aminotransferase(ALT), cTnI and NT proBNP in IVIG sensitive group and IVIG-resistant group were all higher than those in the healthy control group (all P<0.05). Further more, ESR[(90.32±37.91) mm/1 h vs. (65.81±25.34) mm/1 h, P=0.019], cTnI [(0.83±0.35) μg/L vs. (0.52±0.18) μg/L, P=0.037] and NT-proBNP [(854.64±293.02) ng/L vs. (584.95±177.11) ng/L, P=0.011] in IVIG-resistant group were higher than those of IVIG-sensitive group.Multivariate Logistic regression analysis demonstrated that SDNN ( OR=0.783, 95% CI: 0.0341-0.979, P=0.021), and NT-proBNP ( OR=1.195, 95% CI: 1.061-1.428, P=0.34) were independent risk factors for predicting IVIG-resistant KD. Conclusions:SDNN and NT-proBNP may be independent predictors of IVIG-resistant KD.
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Objective:To explore the changes of sympathetic and parasympathetic activity in children with chest pain and/or chest distress of unknown cause based on their plasma catecholamine and heart rate variability indexes, and to analyze the predictive value of each index in diagnosing pediatric sympathetic excitation-related chest pain and/or chest distress by used receiver operating characteristics (ROC) curve analysis.Methods:Fifty-seven children who complained of unexplained chest pain and/or chest distress and had no organic diseases according to routine examinations in the Chengdu Women′s and Children′s Hospital from June 2017 to June 2019 were enrolled in the study group.There were 22 males and 35 females, aged 5-15 years old[(8.40±0.35) years old]. Meanwhile, 54 healthy children in the same period were enrolled in the healthy control group, including 21 males and 33 females, aged 5-15 years old (8.87±0.36) years old]. The disease history enquiring, physical examination, chest X-ray, 12-lead electrocardiogram, echocardiogram, blood routine test and biochemical test excluded the organic heart, lung, digestive tract and chest wall diseases in both groups.Their blood samples were collected to detect catecholamine and they were monitored by dynamic electrocardiogram.SPSS 25.0 software was used for statistical analysis and ROC curve analysis.Results:The study group exhibited higher dopamine, adrenaline and norepinephrine levels than those in the healthy control group[(0.83±0.04) nmol/L vs.(0.54±0.03) nmol/L, (0.76±0.04) nmol/L vs.(0.56±0.03) nmol/L and(3.59±0.18) nmol/L vs.(2.51±0.15) nmol/L], and the differences were statistically significant( t=4.906, 3.611, 4.596, all P<0.01). The levels of standard deviation of NN intervals, standard deviation of all mean 5-minutes NN intervals, standard deviation of all NN intervals for all 5-minute segments of 24 hours, root mean squared successive difference and proportion of NN 50 in the total number of NN intervals in the study group were lower than those in the healthy control group [(110.49±2.81) ms vs.(132.13±2.55) ms, (86.37±3.26) ms vs.(118.96±2.00) ms, (33.46±2.21) ms vs.(68.91±1.29) ms, (37.63±1.22) ms vs.(48.93±1.75) ms and(17.37±1.45)% vs.(22.22±1.61)%], and the differences were statistically significant( t=-5.710, -8.419, -13.862, -5.354, -2.245, all P<0.05). The area under the curve of plasma dopamine, adrenaline and norepinephrine in the diagnosis of pediatric sympathetic excitation-related chest pain and/or chest distress were 0.753, 0.689 and 0.746, respectively, higher than that of all heart rate variability indexes. Conclusions:Children′s unexplained chest pain and/or chest distress is highly related with autonomic nervous dysfunction (increased sympathetic activity and decreased parasympathetic activity). The level of plasma catecholamine can be used to reflect the changes of sympathetic activity in these children and diagnose sympathetic excitation-related chest pain and/or chest distress.Psychological counseling and relaxation therapy are supposed to be effective in redu-cing sympathetic activity, improving subjective symptoms and elevating their quality of life.
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Objective To discuss the nursing for the different postoperative residual urine of patient with pelvic floor dysfunction.Method To evaluate the nursing for the postoperative residual urine of patient with pelvic floor dysfunction and the time of urinary catheters inserted,We completed a retrospective review of 138 adult patients.Results ①Toally 138 participants were categorized into 3 groups:74 (53.6％) patients carried a residual volume ＜ 100ml,53 (38.4％) patient did 100～300ml,11 (8.0％)did ＞300ml.②About11 patients who were able to void but carried a residual volume ＞300ml required indwelling catheterization.In these cases,100％ carried a residual volume ＜ 100ml after indwelling urinary catheter extraction (IUCE) after 4～5 days.③About 53 patients who were able to void but carried a residual volume between 100ml to 300ml received urine nursing,phychological nursing and bladder function exercise.Two days after IUCE 41 (77.4％) patients' residual volume was ＜100ml;three days after IUCE 11 (20.7％) patients' residul volume was ＜100ml;five days 1 patiens' residul volum was ＜100ml.Conclusion When a postvoid residual＞300ml,the patient should be performed catheterization,When a postvoid residual between 100ml to 300ml,the nurse should give the patient mental easing and teach them to perform pelvic floor muscle exercise.This can reduce the suffering of patients.
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Objective To investigate the relationship of heart rate variability (HRV) and procalcitonin (PCT),high sensitivity C-reactive protein (hs-CRP) and erythrocyte sedimentation rate (ESR) in children with Kawasaki disease (KD) in the acute stage,and to investigate their value in diagnosis and prognosis of KD especially incomplete KD (iKD).Methods Two hundred and twenty patients with KD in Chengdu Women and Children's Central Hospital from August 2012 to October 2015 were selected.According to the diagnostic criteria,patients with KD were divided into a typical KD group and an iKD group.According to the status of coronary artery damage,the patients with KD were divided into coronary artery lesion (CAL) group and no coronary artery lesion(NCAL) group.Another 100 healthy children were selected as healthy control group.All the children received 24 h dynamic electrocardiogram and were given tests of blood PCT,hs-CRP and ESR.The differences of HRV,PCT,hs-CRP and ESR between the CAL group and the NCAL group,between the typical KD group and iKD group were compared.The correlations of HRV and PCT,hs-CRP and ESR were analyzed.Results Of 220 KD patients,182 cases were in the typical KD group and 38 cases in the iKD group;64 cases in the CAL group and 156 cases in the NCAL group.The mean levels of HRV were lower in KD group than those in healthy control group (all P ＜ 0.05),especially those in the CAL group fell more obviously.The differences in the standard deviation of N-N intervals(SDNN),percent ages of N-N 50 in the total number N-N intervals (PNN50) and low frequency (LF) between the CAL group,the NCAL group and the healthy control group were all statistically significant(all P ＜0.05).The mean levels of HRV,PCT and hs-CRP had no statistically significant difference between typical KD and iKD groups (all P ＞ 0.05).The mean level of ESR had a statistically significant difference between 2 groups (P ＜ 0.05).SDNN was negatively correlated with PCT,hs-CRP and ESR (r =-0.443,-0.364,-0.427,all P ＜ 0.05).Conclusion In patients with KD in the acute stage,the decrease of HRV can be correlated with inflammatory reaction.HRV can be used as valuable predictors for coronary artery lesion in patients with KD,but its help in the early diagnosis of iKD has not found.
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Objective To explore the diagnostic value of N‐terminal Pro‐Brain Natriuretic Peptide (NT‐proBNP) in Kawasaki disease (KD) in children .Methods Ninety one children with KD were collected and 80 patients with acute upper respiratory infec‐tion were used as controls .Plasma NT‐pro BNP concentrations and other laboratory date were collected in the acute of KD .The re‐lationships between NT‐pro BNP values and different clinical and laboratory data in the acute phase were sought .Results The mean plasma NT‐pro BNP concentration in patients with KD in the acute phase was (1 042 .38 ± 528 .7)pg/mL ,significantly higher than those of control group(458 .6 ± 412 .3)pg/mL (P<0 .05) .The results of linear correlation analysis indicated that plasma NT‐pro BNP was positively correlated with CRP (r= 0 .442 ,P< 0 .05) ,and negatively correlated with Hematocrit ,Albumin and Na (r= -0 .216 ,r= -0 .204 ,r= -0 .315 ,respectively ;P<0 .05) .According to ROC analysis ,the AUC of NT‐pro BNP for detection of KD were 0 .881 ,sensitivity and specificity was 70 .1% and 84 .0% respectively for the cut‐off value of 530 pg/mL .Conclusion Our findings showed that NT‐proBNP would elevate in the acute stage of KD and was a reliable marker for the diagnosis of KD .A high level of NT‐pro BNP is associated with systemic inflammatory responses and increased vascular permeability .
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Objective To explore the potential role of endogenous vascular elastase (EVE) in pathogenesis of coronary ar-tery lesions (CAL) in Kawasaki diseases (KD). Methods A total of 60 children with KD admitted from Jan. 2012 to Apr. 2013 were enrolled, and at the same time 60 febrile children with respiratory infection were enrolled as controls. The left and right coro-nary artery diameter value was measured by ultrasonic cardiogram. The levels of EVE, matrix metalloproteinases (MMP)-9 and transforming growth factor (TGF)-β1were determined by enzyme-linked immunosorbent assay and their correlations with coro-nary artery diameter were analyzed. Results The levels of EVE, MMP-9 and TGF-β1 in KD children in the acute phase were significantly higher than those in control group (P<0.01). Meanwhile, the level of EVE in KD children with coronary artery le-sion (CAL) is significantly higher than that in KD children without CAL. The results of correlation analysis indicated that the levels of EVE, MMP-9 and TGF-β1 were positively correlated with coronary artery diameters (r=0.64~0.79, P<0.01). Conclu-sions EVE plays an important role in the CAL of KD may through inducing the produce of MMP-9, TGF-β1 and finally caus-ing the formation of CAL.
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@#Based on the resources of military sanatorium, we developed a mode of rehabilitation that combined the hospital-, sanatorium- and community-based rehabilitation as a whole.