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Objective:To evaluate the accuracy of mini-fluid challenge test in predicting fluid responsiveness in elderly patients undergoing surgery in prone position.Methods:Forty-eight elderly patients, aged ≥ 65 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective spinal surgery, were enrolled.Patients were mechanically ventilated using a volume-controlled mode with a tidal volume of 6 ml/kg of ideal body weight during operation.A radial arterial catheter was inserted and connected to FloTrac/Vigileo system to monitor hemodynamic parameters.At 5 min after prone position, volume expansion was started when the hemodynamics was stable: lactated Ringer′s solution 1 ml/kg was intravenously infused over 1 min, 1 min later lactated Ringer′s solution 1 ml/kg was intravenously infused over 1 min, 1 min later lactated Ringer′s solution 1 ml/kg was intravenously infused over 1 min, and 1 min later operation was started.After tracheal intubation and before prone position (T 1), 5 min of prone position (T 2), 1 min after 1st infusion of 1 ml/kg liquid (T 3), and 1 min after 2nd infusion of 1 ml/kg liquid (T 4) and 1 min after infusion of 3 ml/kg fluid (T 5), heart rate, mean arterial pressure, cardiac output, cardiac index, stroke volume, stroke volume index (SVI), stroke volume variability (SVV), pulse pressure variability (PPV), and changes in SVI induced by rapid infusion of 1, 2 and 5 ml/kg crystalloid (ΔSVI 1 ml/kg, ΔSVI 2 ml/kg, ΔSVI 5 ml/kg) were calculated.Positive fluid challenges were defined as an increase in SVI of 10% or more from baseline, and the patients were divided into responder group (R) and non-responder group (NR). Receiver operating characteristic curves predicting fluid responsiveness were generated for ΔSVI 1 ml/kg, ΔSVI 2 ml/kg, SVV and PPV, and areas under the receiver operating characteristic curves (AUC) were calculated. Results:Thirty patients were enrolled in group R and 18 cases in group NR.The AUC of ΔSVI 1 ml/kg in predicting fluid volume responsiveness was 0.87 with a diagnostic threshold of 7%, a sensitivity of 80%, and a specificity of 83%.The AUC of ΔSVI 2 ml/kg in predicting fluid responsiveness was 0.928 with a diagnostic threshold of 8%, a sensitivity of 78%, and a specificity of 89%.The AUC of SVV and PPV in predicting fluid responsiveness was 0.65 and 0.53, respectively. Conclusion:Mini-fluid challenge test guided by ΔSVI can predict fluid responsiveness in elderly patients undergoing surgery in prone position, and rapid infusion of 2 ml/kg crystalloid provides better accuracy than 1 ml/kg.
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Objective To study the effects and mechanism of p-hydroxyacetophenone (PHA ) on bile secretion ,choles-terol metabolism and blood lipids .Methods Cystic duct cannula was cannulated and bile were collected in SD rats .PHA was administrated in the high cholesterol rats .The activity of HMG-CoA reductase was determined by spectrophotometry in reac-tion system .Samples of liver were obtained in experiment hypercholesterolemia rats and Real-time PCR test was conducted for AQP8 ,CYP7A1 ,OATP and NTCP .Results Secretion of bile were increased ,cholesterol in bile were reduced and secretion of total bile acid were increased in rats by PHA .The level of serum cholesterol in hyperglycemia rat model was reduced signifi-cantly and inhibitory ability had been limited in the activity of HMG-CoA reeducates by PHA ,but the gene transcription inclu-ding AQP8 ,CYP7A1 ,OATP ,and NTCP were promoted ,which are related to function of excretion of biliary acid and trans-formation of cholesterol .Conclusion These results suggest that PHA ,as a lead compound ,might be of significance for fur-ther development for a bile secretory and lipid lowering agent .
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Objective:To explore the relationship between thyroid function and cardiovascular diseases .Methods:A total of 980 patients undergoing thyroid function examination during hospitalization were selected . According to their thyroid function ,they were divided into normal thyroid function group (normal group ,n= 930) , hyperthy-roidism group (n=18) ,and hypothyroidism group (n=32) .Clinical data were analyzed ,blood lipids and coagula-tion function indexes were examined and compared among three groups . Results:Compared with normal group ,the incidence rate of atrial fibrillation significantly rose ,incidence rate of hypertension ,cardiac insufficiency signifi-cantly reduced;levels of TC、TG、 LDL-C、 HDL-C significantly reduced ,activated partial thromboplastin time significantly extended in hyperthyroidism group , P<0.01 all;incidence rate of coronary heart disease significantly rose ,levels of TG、HDL-C significantly rose ,levels of TC 、LDL-C significantly reduced in hypothyroidism group , P<0.01 all;Compared with hyperthyroidism group ,the incidence rate of hypertension ,coronary heart disease sig-nificantly rose ,atrial fibrillation significantly reduced ,P<0.05 or <0.01 ;levels of TG、LDL-C、HDL-C signifi-cantly rose ,TC level significantly reduced in hypothyroidism group , P<0. 01 all .Conclusion:Thyroid function is closely related to cardiovascular diseases .so it′s suggested that thyroid function detection should be regarded as a routine examination in patients with cardiovascular diseases and a follow-up index for those with thyroid dysfunc-tion .