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Objective: To observe the application value of right heart contrast echocardiography in the cannulation of veno-venous extracorporeal membrane oxygenation (V-V ECMO). Methods: A total of 18 patients with acute respiratory failure caused by severe pneumonia who underwent V-V ECMO treatment were enrolled. The patients were intubated through right femoral vein and right internal jugular vein cannulation, and then were divided into contrast group (n=8) and control group (n=10) according to whether underwent right heart contrast echocardiography during intubation or not. Central venous pressure (CVP) and cardiac output (CO) of all patients were measured and recorded. After the operation of ECMO, patients in contrast group received cardiovascular routine ultrasound examination and right heart contrast echocardiography simultaneously to observe and adjust the position of the cannula tip in the inferior vena cava (IVC), while patients in control group received only cardiovascular routine ultrasound to observe the direction of blood flow at the valve of IVC and the position of cannula tip in IVC. The distance between cannula tip and diaphragm (DCTD) and the left femoral artery partial pressure were measured and recorded. The differences of DCTD, left femoral artery oxygen partial pressure, CVP and CO of 2 groups were compared between 2 groups. Results: DCTD (5.14[4.68,5.81]mm) and left femoral artery oxygen partial pressure in contrast group(90.05[85.06, 95.33]mmHg) were both higher than those in control group (3.31[2.96,3.69]mm, 78.61[71.82,81.04]mmHg, Z=-1.93, -2.20, both P0.05). Conclusion: Right heart contrast echocardiography can help to optimize the position of cannula tip in IVC during intubation of V-V ECMO and improve clinical therapeutic effect by reducing recirculation.
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Objective To analyze the effects of 24-hour diurnal blood pressure rhythm ( BPCR) changes on diastolic function in elderly hypertensive patients. Methods From February 2016 to February 2018,one hundred and twenty elderly patients with hypertension were divided into two groups according to their 24-hour ambulatory blood pressure status: dipper group with 65 cases ( nocturnal blood pressure drop rate (＞10%) and non-dipper group with 55 cases ( nocturnal blood pressure drop rate＜10%); ambulatory blood pressure and echocardiographic relaxation were detected. Posterior wall (PW),interventricular septum (IVS),left ventricular diameter (LVEDD),left ventricular mass index (LVM) and left ventricular mass index (LVMI) were examined. Fractional shortening ( FS),stroke volume ( SV),cardiac output ( CO) and cardiac index (CI) were calculated,and peak flow time (A peak flow time total integration,ATVI) and peak flow velocity (A Pea) were measured. K flow rate ventricular (APFV); E peak flow time ventricular integral (ETVI ), early Peak flow Velocity ( EPFV ) and left ventricular ejection fraction ( LVEF ) were detected. Results The 24 h DBP, 24 hSBP, nocturnal DBP, and nocturnal SBP in dipper group were (80. 27±7. 29) mmHg,(125. 29±10. 38) mmHg,(69. 98±6. 36) mmHg,(110. 39±10. 52) mmHg,which were lower than those of the noninvasive group ((83. 82±7. 51) mmHg,(130. 89±10. 71) mmHg,(79. 81 ±6. 84) mmHg,( 126. 83 ± 10. 92) mmHg), the differences were statistically significant ( t ＝ 12. 809, 13.954,11.053,13.289,P＝0.042,0.021,0.014,0.006).The EPFV in the dipper group was (65.02 ±11. 83) cm/s,which was higher than that in the non-dipper group ((60. 84±11. 29) cm/s). The A/E, ATVI,and APFV in the dipper group were (1.03±0.58),(5.59±1.72) cm,(63.74±11.06) cm/s, respectively,lower than those in non-dipper group( (1. 14±0. 54),(6. 11±1. 68) cm,(68. 82±11. 17) cm/s),the differences were statistically significant (t＝10. 895,11. 643,12. 339,10. 854,P＝0. 032,0. 027, 0. 013,0. 006). Left ventricular diastolic function was negatively correlated with daytime DBP (r＝－ 0. 195,－0. 217,－0. 174,－0. 173,P＜0. 05) and positively correlated with nighttime SBP( r＝0. 194,0. 171,0. 220, 0. 206,P＜0. 05). Conclusion In elderly hypertensive patients,the left ventricular diastolic function and left ventricular hypertrophy are more serious in non-dipper patients, and it is necessary to strengthen the control of nocturnal blood pressure in elderly hypertensive patients.
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Objective To investigate the utilization of ultrasound monitoring the renal blood flow during extracorporeal membrane oxygenation (ECMO).Methods Twentry one cases,who received veinartery ECMO for heart failure,were examinated by bed-side ultrasound before the ECMO initiated,right after the ECMO initiated,each day after the ECMO initiated,and right after the ECMO weaned.The renal interlobar artery peak velocity (Vmax) was measured,and the renal interlobar artery resistant index (RI) was calculated,as well as the values of the serum creatinine (SCr) and blood urea nitrogen (BUN) were recorded.All the data were compared.Results Compared to the variables right after the ECMO initiated,thc Vmax incrcascd (P ＜ 0.05) two days after ECMO initiated and right after the ECMO weaned,while RI (P ＜ 0.05),SCr (P ＜ 0.05) and BUN (P ＜ 0.05) decreased,there being significant differences (P ＜ 0.05).Conclusions While treating patients with extracorporeal membrane oxygenation,the ultrasound can monitoring the renal blood flow effectively,and provide important parameters for the clinical doctors as the basis of the diagnosis and treatment.
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Objective To investigate the early application value of echocardiography (UCG)after orthotopic heart transplantation (OHT). Methods A total of 29 patients were monitored by UCG early after OHT. On the 1st,7th,14th,30th day after operation,the left ventricular end-diastolic diameter (LVDd)and right ventricular end-diastolic diameter (RVDd),interventricular septal thickness (IVST),left ventricular posterior wall thickness (LVPWT)and the tricuspid regurgitation area (TRA)were measured,and the left ventricular ejection fraction (LVEF ) and left ventricle Tei index (LV-Tei ) were calculated. The blood pressures (BP),central venous pressure (CVP)of the patients were recorded simultaneously. Results The LVDd were larger on the 7th,14th and 30th day after operation,while the RVDd were smaller,compared with those on the 1st day after operation (all in P<0.05). The IVST,LVPWT were lower on the 1th,14th and 30th day after operation,compared with those on the 7th day after operation (all in P<0.05). The BP,CVP,LV-Tei were all significantly lower on the 1st,14th and 30th day after operation,compared with those on the 7th day after operation (P<0.05 ). There was no significant difference in LVEF between each time points(P>0.05 ).The tricuspid regurgitation was detected in 3-4 d after operation by UCG,and the TRA reached the peak value [(9.2 ±2.5)cm2]in 5-8 d after operation,then gradually decreased to (4.7 ±2.4)cm2 at 1 month after operation. Conclusions Early phase after OHT,the structure and function of transplanted heart can be monitored effectively by echocardiography,and it can timely provide multiple parameters as the basis of diagnosis and treatment for clinical doctors.