Objective To explore the pediatric emergency medical mode in critical ill children by pediatrics specialty and nurses,using equipments of ICU for adults in second class general hospital. Methods We retrospectively analyzed the effect of establishing the pediatric observation unit in the adult observationdistrict and the prognosis and disease spectrum of pediatric critical patients in our emergency ICU in the past five years. Results 5 076 pediatric patients had been admitted to the emergency observation unit accounting for 3.40% of outpatient yearly. There were 464 critically ill children,accounting for 9. 14% of children into the observation unit,251 cases (54. 09%) were transported to other hospitals,35 cases (7.54%) were admitted to emergency ICU due to transport high-risk, 14 cases required ventilator support. The disease spectrum based mainly on childhood accident,including trauma,poisoning and drowning,etc. The other major diseases were severe infection and fulminant myocarditis. After the treatment such as stopping bleeding, respiratory supporting ,correcting shock, and maintaining the function of important organs,77. 14 % were improved or recovered. The survival rate of children with mechanical ventilation was > 85%. Conclusion In our country,the pediatric emergency medical service system is inadequate. The critical illness treatment model of using the advantages of equipments and nurse' s team of adult ICU in second class general hospital ,combining with pediatrician trained in PICU is feasible and consistents with our national conditions.

Objective To study the etiology, clinical features, risk factors of septic shock and multiple organ dysfunction syndrome /multiple organ failure (MODS/MOF) caused by gastroenteritis infection in the pediatric intensive care unit (PICU). Methods Case records of patients with gastroenteritis complicated by septic shock and MODS/MOF admitted to PICU in Children's hospital affiliated to Shanghai Jiaotong University from January 2000 to December 2004 were reviewed for etiology, case fatality rate, prognosis and relationship with MODS/MOF. Univariate analyses were performed to analyse the risk factors associated with septic shock and MODS/MOF. Results During the 5 years, 1 536 patients with critical illness were admitted and MODS/MOF associated with gastroenteriitis infection developed in 28 patients. The overall mortality of patients with MODS/MOF associated with gastroenteriitis was 75%. The mean age was (1.9?3.4)years and 19 cases(67.8%)were under 1 year. The patients with MODS/MOF involved (3.7?0.9)organs or systems on average. The numbers of involved organs systems were circulatory in 28 patients(100%), gastrointestinal system in 21(75%), lung in 20(71.4%), kidney in 14(50%),brain in 9(32.4%),blood in 9(32.4%) and liver in 5(17.9%). The first dysfunctional system was gastrointestinal tract in 13(46.4%),circulatory in 11(39.3%),and lung in 4(14.3%). The average volume of fluid resuscitation was (46.2?12.6)ml/kg and range from 30 ml/kg to 75 ml/kg in the first hour. The average fluid was (92.7?33.9)ml/kg and range from 70 ml/kg to 120 ml/kg in 6 hours. The cases fatality of patients with or without successful volume resuscitation were 66.7% (12 in 18 cases) and 90%(9 in 10 cases) in 6 hours respectively.Univariate analyses indicated the following risk factors: numbers of failed organ and lower pediatric critical illness score(P

Objective To investigate the clinicalmanifestation,monitoring and therapeutic measure of severe enterovirus 71 ( EV71 ) infection in children.MethodsForty-five cases of severe EV71 infectionwere admitted in our PICU from May 2010 to Sep 2011.The vital sign and arterial blood pressure,central venous pressure,mixed venous oxygen saturation,dynamic non-invasive heart function and urine volume were monitored.Forty-five cases were divided into 3 stages according to clinical manifestation:( 1 ) nervous system involvement stage; (2) respiratory system involvement stage; ( 3 ) circulatory system involvement stage ( compensation and decompensation).We adopted individualized remedy measure according to different stages.ResultsIn 45 cases,38 cases discharged from hospital,the cure rate was 84.4％.Among all the 38 cases,nervous system involvement was found in 19 cases,respiratory system involvement was found in 12 cases,circulatory system involvement was found in 7 cases.Seven cases died,who had circulation failure.ConclusionWe should identify severe EV71 infection early.Positive control of high fever,appropriate liquid treatment,control of high blood pressure,early respiratory support,preventment of circulation failure are the key measures for treatment.Individualized monitoring and treatment are effective in children with severe EV71 infection.

Objective To explore the application of propofol combined with midazolam intrave-nous anesthesia in pediatric upper gastrointestinal endoscopy, Methods A total of 497 ASA Ⅰ～Ⅱ patients who received sedative upper gastrointestinal endoscopy were assigned to a children group (2～14 years) and an adults group (18～65 years). The 2 groups were treated with midazolam (0.02～0.03 mg/kg, iv) and propofol (0.6～0.7 mg/s, iv) with an interval of 3～5 minutes. Enterseopy was inserted at light sleep, relaxing muscles, and disappearance of eyelash relaxation. Combining of pro-endoscopy, reaction to intravenous administration, dose of propofol, reaction to en-doscopy, time of returning to consciousness, changes of SpO2, R, HR, and BP, and sedative quali-ty were evaluated. Results Good sedation of the 2 groups after intravenous administration was ob-served. Rate of combining of pro-endoscopy in children was lower (42%) than that in adults (100%). The incidence of restlessness, hyperphasia, temporary decreasing of SpO2, dose of propofol of per kilogram weight, time of returning to consciousness in the children were 82.7%, 17%, 2.4 mg/kg, and (17.5±3.2)min, respectively, which were all higher in the adults [9%,4%,1.4 mg/kg, and (9.5±1.3)min, P<0.01]. HR and BP decreased in the 2 groups, and recovered rapidly after the endoscopy. There was no significant difference between the 2 groups (P>0.05). Conclusion It is safe and effective to use propofol combined with midazolam intravenous sedation anesthesia in pediatric upper gastrointestinal endoscopy.

Objective:The study was attempted to improve the manipulation and eliminate patient's fear for gastroscopy combined with intravenous injection.Methods:A total of 1350 patients wasrandomized into test group (n=1100 given intraveous protofol and midazolam)and the control (n=250,without anesthetics).Patient's feeling,heart rate,blood oxygen saturation,blood pressure,operative duration and operator' satisfaction were recored and analysed.Results:Data in test group showed less complaints,easier manipulation,high satisfaction and no difference in operative duration and blood oxygen saturation as compared with the control.After intravenous administration of protofol and midazolam,patient's heart rate and blood pressure (systolic and diastolic pressure) significantly decreased.Conclusions:With intravenous use of protofol and midazolam,gastroscopy can be achieved effectively,painlessly and safely.

Objective To explore the safety and the efficacy of the two-stage sedation administration method for the elderly in gastroscopic examination. Methods 128 elderly patients were divided into two groups according to age and body mass index (BMI), and were given sedation treatment before gastroscopic examination by two-stage administration method(group TSAM, n= 64)and continual administration method (group CAM, n= 64) of analgesics respectively. The following major data were recorded : ( 1 ) mean artery pressure (MAP) ;( 2 ) Blood oxygen saturation ( SpO2 ) ;(3)sedation level;(4) recovery time;(5) the amount of propofol used for sedation;(6) electrocardiogram (ECG) ;(7)the degree of pharyngeal malaise;(8) the oblivion degree of malaise. Results There was no significant difference in MAP alteration between two methods(P>0. 05). Compared with group CAM, the decreased degree of SpO2 was slighter and no patient's SpO2 was lower than 90% in group TSAM (P<0. 05). Fifty-seven patients in group TSAM fell into sedative state for gastroscopy with OAA/S score 2, while sixty patients in group CAM with OAA/S score 2, which represented a deeper sedation level in group CAM (P<0. 01). The recovery time was shorter and the amount of propofol used was significantly less in group TSAM than in group CAM (P<0. 01). During the process of gastroscopic exmaination, ST-T change and arrhythmia in ECG were not seen in either of these two groups. The pharyngeal malaise of patients in group TSAM was more severe than in group CAM (P<0. 01). However, there was no difference in the oblivion degree of malaise between two methods(P>0.05). Conclusions The two-stage sedative administration method is safer and more effective for gastroscopic examination for the elderly.

Objective To describe the characteristics of and emergency treatment for and outcomes of critical ill children with 2009 influenza A caused by H1N1 virus strain. Method A prospective observational study of 3 pediatric patients with severe influenza A of H1N1 virus strain complicated with acute respiratory distress syndrome (ARDS) from November to December 2009. Results The H1N1 virus strain was confirmed by using realtime reverse transcription polymerase chain reaction (Real-time RT-PCR). Two patients survived and one died. Fever and cough were the onset symptoms. The systemic responses to influenza A at first were relatively mild. The tragic deterioration occurred all of a sudden with cyanosis all over the lips and dyspnea. The roentgenography showed bilateral multiple tabular pulmonary effusion and diffuse opaque shadows. The length of time required to confirm the diagnosis of ARDS from the symptom onset was 4 to 6 days. All patients were severely hypoxic with the ratio of PaO2 to 0.7-0.9 fraction of inspired oxygen (FiO2) to be 70- 100 mmHg at admission to PICU. In order to avoid injury to the lung, the protective ventilation strategy was carried out with low tidal volume (6 mL/kg) and adequate pressure,and conservative fluid management. Conclusions The H1N1 strain influenza virus A is characterized by pyrexia, cough and other respiratory symptoms in the early stage of critically ill children. In a few days, cough increased along with a sudden burst of cyanotic lips and shortness of breath, highly suggesting ARDS. Timely oxygen therapy and respiratory support, conservative fluid management, and the prophylaxis of secondary infection may be the essential measures. More clinical data are needed to clarify the critical features and to evaluate the emergency therapy for H1N1 influenza A in critically ill children.

Objective To analyze the relationship between the estimated glomerular filtration rate (eGFR) and 10-year car‐diovascular disease risk (10y CVDR) in Chongqing college staff .Methods The physical examination data of the staff in two univer‐sities including 2630 persons were collected in April 2013 .The eGFR and 10y CVDR of each staff were calculated according to the standardized formula .The differences of 10y CVDR among different eGFR level groups were analyzed .Results The average age of all the staff were (51 .76 ± 14 .53) years old ,which in males was significant higher than that in females (P<0 .01) .The smokers , hypertension patients and diabetes patients accounted for 16 .00% ,15 .20% and 4 .10% respectively .The smokers ,hypertension and diabetes patients in males were significantly more than than those in females (P<0 .05) .The height ,weight ,BMI ,systolic pressure , diastolic pressure ,serum creatinine ,triglyceride ,LDL and blood glucose in males were significantly higher than those in females (P=0 .000) ,while HDL in males was significantly lower than that in females (P=0 .000) .The median of 10y CVDR was 1 .25% , males were significantly higher than females (2 .85% vs .0 .40% ,P<0 .01) .The median of 10y CVDR for the following groups were 0 .74% ,2 .25% ,5 .58% and 14 .39% respectively :eGFR≥90 mL · min-1 · 1 .73 m2 ,75 mL · min-1 · 1 .73 m2 ≤eGFR<90 mL · min-1 · 1 .73 m2 ,60 mL · min-1 · 1 .73 m2 ≤eGFR<75 mL · min-1 · 1 .73 m2 ,and eGFR<60 mL · min-1 · 1 .73 m2 .The results of the one‐way analysis of variance showed that compared to the 10y CVDR of the group with eGFR≥90 mL · min-1 · 1 .73 m2 ,which of the other three groups were all significantly increased .Conclusion eGFR is a significant factor impacting 10y CVDR . The lower the eGFR level ,the higher the risk of the 10y CVDR .

OBJECTIVE: To investigate the efficacy and security of different administrations of propofol on the sedation in upper gastrointestinal endoscopic procedures in snoring patients. METHODS: A total of 1,117 patients with snoring in ASA I-II level, who underwent gastroscopy and received propofol as sedation, were assigned to Group A, Group B, and Group C.These groups had different administration methods of propofol. The dose of propofol, response to endoscopic procedures, changes of oxygen saturation of arterial blood (SPO₂), incidence of severe respiratory depression and sedation quality assessed by operators were observed. RESULTS: The incidence of transient decline in SPO₂ in Group A, B, and C were 50.4%, 3.1%, and 18.5%, respectively. The doses of propofol of Group A, B, and C were (108.50±18.02) mg, (57.50±7.50) mg, and (79.80±10.02) mg, respectively, with significant difference (P<0.05). The incidence of severe respiratory depression in Group A was 1.2%, but Group B and C were 0%. Compared with Group A(100%) and C(100%), the satisfaction rate of sedation quality in Group B was 74%, with significant difference (P<0.05). CONCLUSION During the upper gastrointestinal endoscopic procedures, snoring patients are premedicated with propofol in various uses by steps or one slow administration. Both methods are safe and effective to reduce the incidence of severe respiratory depression, and patients have no memory of the procedure.
Adult ; Endoscopy, Gastrointestinal ; methods ; Female ; Gastrointestinal Diseases ; complications ; diagnosis ; Humans ; Hypnotics and Sedatives ; administration & dosage ; adverse effects ; Male ; Middle Aged ; Propofol ; administration & dosage ; adverse effects ; Snoring ; complications

OBJECTIVE: To determine the efficiency and safety of capsule endoscopy for patients with intestinal diseases. METHODS: Given M2A capsule endoscopy (CE) was performed on 81 patients with obscure gastrointestinal bleeding and obscure abdominal pain, and the clinical data were analyzed. RESULTS: In the 81 patients, 9 showed negative finding, CE didn't reach the small intestine in 1 patient. In the other 71 patients, 132 intestinal lesions were detected, and the total positive rate of CE for intestinal diseases was 88.75%. The findings consisted of 36 intestinal inflammation, 24 angiopathy, 16 protuberant lesions, 15 mutipolypi in the intestine, 12 blood in the intestine, 11 single or multiple ulcers, 6 ascarid in the intestine, 5 diverticula, 1 ankylostomiasis, 1 intestinal dysplasia with internal fistula, and the 5 intestinal Crohn's disease. Ten patients with protuberant lesion were verified by surgical operation and pathology, and the 5 stromal tumors diagnosed by CE were confirmed by pathological examination, while no one of Crohn's disease, lymphoma and angioma was diagnosed correctly by CE. All images of CE were good. All the patients had no complications. CONCLUSION Capsule endoscopy is a safe and effective procedure, with a high positive rate, but the diagnostic yield is limited, which can be used for intestinal diseases.
Abdominal Pain ; diagnosis ; Adult ; Aged ; Aged, 80 and over ; Capsule Endoscopy ; Female ; Gastrointestinal Hemorrhage ; diagnosis ; Humans ; Inflammatory Bowel Diseases ; diagnosis ; Intestinal Diseases ; diagnosis ; Intestine, Small ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Sensitivity and Specificity ; Young Adult