在運(yùn)動(dòng)醫(yī)學(xué)界,有一種運(yùn)動(dòng)作為誘發(fā)哮喘唯一因素的運(yùn)動(dòng)性疾病,稱為運(yùn)動(dòng)性哮喘(EIA),是哮喘的特殊類型,發(fā)病地點(diǎn)多在運(yùn)動(dòng)場(chǎng),起病較急,可危及運(yùn)動(dòng)員的生命,其發(fā)病機(jī)制至今尚未完全明了。速尿是一種袢利尿劑,也是15-羥前列腺素脫氫酶抑制劑,吸入速尿后對(duì)特應(yīng)性和非特應(yīng)性哮喘所致的支氣管收縮有對(duì)抗作用[1]。目前國(guó)內(nèi)尚未見應(yīng)用速尿防治EIA的臨床報(bào)道。我們通過(guò)觀察患者吸入速尿前后、運(yùn)動(dòng)前后肺功能指標(biāo)第1秒用力呼氣容積(FEV1)占預(yù)計(jì)值百分比(FEV1%pred)及峰流速(PEF)的變化,探討霧化吸入速尿?qū)IA的防治作用。
Objective To estimate the relationship of methods and drugs for management of constrictive pericarditis during pericardiectomy. Methods We reviewed the records of 45 patients (mean age, 40.24±15.34 years) with a diagnosis of constrictive pericarditis who underwent pericardiectomy in our hospital from 2012 through 2014 year. During operation, inotropic agents, vasodilators and diuretics were used. According to the diuretics, patients were divided into two groups including a furosemide group(group F) with 38 patients and a lyophilized recombinant human brain natriuretic peptide (lrhBNP) group with 7 patients(group B). Results Preoperatively, 30 patients were pulmonary congestion, which was diagnosed by chest radiographs. Pericardiectomy was finished by off pump in 43 patients. Another 2 patients required cardiopulmonary bypass (CPB) for pericardiectomy. In the group F 52.6% of the patients needed vasodilators to reduce cardiac preloading following pericardiectomy. None of other vasodilators were used in the group B. After pericardiectomy, the fluctuation of systolic and diastolic pressure decreased significantly in the group B (P=0.01, respectively). In the group F, the fluctuation of diastolic pressure decreased significantly (P<0.05). Low cardiac output was the most common postoperative problem. One patient accepted postoperative extracorporeal membrane oxygenation (ECMO) support. Postoperative poor renal function was found in 42.2% of the patients. Three of them needed hemofiltration. Postoperative poor renal function accompanied by poor hepatic function was found in 15.6% of the patients. One of them used dialysis and artificial liver. Three patients were respiratory failure with longer mechanical ventilation and tracheotomy. The overall perioperative mortality rate was 6.7% (3 patients). All patients, who died or used with hemofiltration, artificial liver and ECMO were found in the group F. Conclusion More stable haemodynamics after pericardiectomy may occur with using lrhBNP. lrhBNP may reduce postoperative major morbidity and mortality. Because of the small group using lrhBNP in our study, more patients using lrhBNP for pericardiectomy need to be studied.