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Objective:To investigate the epidemiological characteristics of septic cardiomyopathy and explore the relationship between the relevant indexes measured by echocardiography and the prognosis of patients with sepsis.Methods:A case-control study was conducted. The data of patients with sepsis admitted to the department of critical care medicine of Jiangsu Subei People's Hospital Affiliated to Yangzhou University and the department of critical care medicine of Beijing Electric Power Hospital of State Grid Corporation of China from June 2018 to June 2021 were enrolled. The general information and 28-day prognosis were recorded. At the same time, ultrasonic parameters obtained by transthoracic echocardiography within 24 hours after intensive care unit (ICU) admission were recorded. The differences in ultrasound indexes between the death group and the survival group on 28 days were compared. Parameters with significant statistical differences between the death group and the survival group were included in the Logistic regression analysis to find the independent risk factors for the prognosis of patients with sepsis, the predictive value of each index for the prognosis of patients with sepsis was evaluated by receiver operator characteristic curve (ROC curve).Results:A total of 145 patients with sepsis were enrolled, including 106 patients with septic shock. Among the 145 patients, septic cardiomyopathy was found in 73 patients, with the incidence of 50.3%. The incidence of left ventricular diastolic dysfunction cardiomyopathy was 41.4% ( n = 60), the incidence of left ventricular systolic dysfunction cardiomyopathy was 24.8% ( n = 36), and the incidence of right ventricular systolic dysfunction cardiomyopathy was 12.4% ( n = 18). At 28 days, 98 patients survived and 47 died, with the mortality of 32.4%. The peak e' velocity by tissue Doppler imaging (e') and right ventricular myocardial systolic tricuspid annulus velocity (RV-Sm) of the death group were significantly lower than those of the survival group [e' (cm/s): 7.81±1.12 vs. 8.61±1.02, RV-Sm (cm/s): 12.12±2.04 vs. 13.73±1.74, both P < 0.05], left ventricular ejection fraction (LVEF) and left ventricular systolic mitral annulus velocity (LV-Sm) in the death group were slightly higher than those in the survival group [LVEF: 0.550±0.042 vs. 0.548±0.060, LV-Sm (cm/s): 8.92±2.11 vs. 8.23±1.71], without significant differences (both P > 0.05). Parameters with significant statistical differences between the two groups were included in the Logistic regression analysis and showed that e' and RV-Sm were independent risk factors for the 28-day prognosis of patients with sepsis [e': odds ratio ( OR) = 0.623, 95% confidence interval (95% CI) was 0.410-0.947, P = 0.027; RV-Sm: OR = 0.693, 95% CI was 0.525-0.914, P = 0.010]. ROC curve analysis showed that the area under the ROC curve (AUC) of e' for predicting the 28-day prognosis of patients with sepsis was 0.657, 95% CI was 0.532-0.781, P = 0.016, the best cut-off value was 8.65 cm/s, the sensitivity was 62.1%, and the specificity was 73.4%. The AUC of RV-Sm for predicting the 28-day prognosis of patients with sepsis was 0.641, 95% CI was 0.522-0.759, P = 0.030, the best cut-off value was 14.80 cm/s, the sensitivity was 96.6%, and the specificity was 26.6%. Conclusions:The incidence of septic cardiomyopathy is high. The LVEF measured by early echocardiography has no predictive value for 28-day prognosis in septic patients, while RV-Sm and e' are important predictors for 28-day prognosis.
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To investigate cerebral autoregulation(CA)in patients with severe unilateral carotid artery stenosis by near infrared spectroscopy. Thirty patients who underwent general anesthesia in our hospital from January 2015 to February 2017 were enrolled in this study.The stenosis group included 15 patients with severe unilateral internal carotid artery stenosis,and the control group included 15 patients without carotid artery stenosis.Both groups were matched in sex and age.Cerebral tissue oxygenation index(TOI)and mean arterial pressure were recorded continuously under stable general anesthesia.The Pearson correlation coefficient()was calculated to judge the CA status. TOI was not significantly different between the stenosis side and the non-stenosis side in the stenosis group(66.52±6.50 65.23±4.50;=0.93, =0.368)or between the stenosis side in the stenosis group and the stenosis side in the control group(66.52±6.50 64.22±3.87;=1.18, =0.248).The values of stenosis side and non-stenosis side in the stenosis group were 0.36±0.12 and 0.17±0.11,respectively,and the values of the stenosis side in the stenosis group and the stenosis side of the control group were 0.36±0.12 and 0.13±0.08,respectively.In the stenosis group,5 patients had transient ischemic attack and 2 patients had a history of stroke within 3 months before operation.When an value of 0.342 was used as the judgment point of CA abnormality,the sensitivity and specificity were 0.625 and 0.909,respectively. Within the range of normal blood pressure fluctuation,cerebral blood flow is linked to blood pressure at the stenosis side in patients with severe unilateral carotid artery stenosis.
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Humans , Blood Pressure , Carotid Stenosis , Cerebrovascular Circulation , Homeostasis , Ischemic Attack, TransientABSTRACT
Objective To explore the accuracy of fluid responsiveness assessment by variability of peripheral arterial peak velocity and variability of inferior vena cava diameter (ΔIVC) in patients with septic shock. Methods A prospective study was conducted. The patients with septic shock undergoing mechanical ventilation (MV) admitted to intensive care unit (ICU) of Beijing Electric Power Hospital from January 2016 to December 2017 were enrolled. According to sepsis bundles of septic shock, volume expansion (VE) was conducted. The increase in cardiac index (ΔCI) after VE ≥ 10% was defined as liquid reaction positive (responsive group), ΔCI < 10% was defined as the liquid reaction negative (non-responsive group). The hemodynamic parameters [central venous pressure (CVP), intrathoracic blood volume index (ITBVI), stroke volume variation (SVV), ΔIVC, variability of carotid Doppler peak velocity (ΔCDPV), and variability of brachial artery peak velocity (ΔVpeak-BA)] before and after VE were monitored. The correlations between the hemodynamic parameters and ΔCI were explored by Pearson correlation analysis. Receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of all hemodynamic parameters on fluid responsiveness. Results During the study, 74 patients with septic shock were included, of whom 9 were excluded because of peripheral artery stenosis, recurrent arrhythmia or abdominal distension influencing the ultrasound examination, and 65 patients were finally enrolled in the analysis. There were 31 patients in the responsive group and 34 in the non-responsive group. SVV, ΔIVC, ΔCDPV and ΔVpeak-BA before VE in responsive group were significantly higher than those of the non-responsive group [SVV: (12.3±2.4)% vs. (9.2±2.1)%, ΔIVC: (22.3±5.3)% vs. (15.5±3.7)%, ΔCDPV: (15.3±3.3)% vs. (10.3±2.4)%, ΔVpeak-BA: (14.5±3.3)% vs. (9.6±2.3)%, all P < 0.05]. There was no significant difference in CVP [mmHg (1 mmHg = 0.133 kPa): 7.5±2.5 vs. 8.2±2.6] or ITBVI (mL/m2: 875.2±173.2 vs. 853.2±192.0) between the responsive group and non-responsive group (both P > 0.05). There was no significant difference in hemodynamic parameter after VE between the two groups. Correlation analysis showed that SVV, ΔIVC, ΔCDPV, and ΔVpeak-BA before VE showed significant linearity correlation with ΔCI (r value was 0.832, 0.813, 0.854, and 0.814, respectively, all P < 0.05), but no correlation was found between CVP and ΔCI (r = -0.342, P > 0.05) as well as ITBVI and ΔCI (r = -0.338, P > 0.05). ROC curve analysis showed that the area under ROC curve (AUC) of SVV, ΔIVC, ΔCDPV, and ΔVpeak-BA before VE for predicting fluid responsiveness was 0.857, 0.826, 0.906, and 0.866, respectively, which was significantly higher than that of CVP (AUC = 0.611) and ITBVI (AUC = 0.679). When the optimal cut-off value of SVV for predicting fluid responsiveness was 11.5%, the sensitivity was 70.4%, and the specificity was 94.7%. When the optimal cut-off value of ΔIVC was 20.5%, the sensitivity was 60.3%, and the specificity was 89.7%. When the optimal cut-off value of ΔCDPV was 13.0%, the sensitivity was 75.2%, and the specificity was 94.9%. When the optimal cut-off value of ΔVpeak-BA was 12.7%, the sensitivity was 64.8%, and the specificity was 89.7%. Conclusions Ultrasound assessment of ΔIVC, ΔCDPV, and ΔVpeak-BA could predict fluid responsiveness in patients with septic shock receiving mechanical ventilation. ΔCDPV had the highest predictive value among these parameters.
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Objective To compare and observe the effect of GASMAN software computer aided and traditional teaching method in the teaching of inhalation anesthesia. Methods 48 members of interns who need to enter the inhalation anesthesia department to study the theory of inhalation anesthesia were ran-domly divided into either GASMAN software group or traditional group with 24 people in each group, using the above two methods to carry on the study of inhalation anesthesia. After the end of the teaching course, the study effect and the satisfaction degree of the two groups of students were investigated by the written exam and questionnaire. SPSS 11.5 was used for statistical analysis, using±s to express measurement data. The results of the examination were compared with the independent sample t test, and the satisfaction survey feedback was compared with chi square test, The difference was statistically significant (P<0.05 ). Result The mean score of GASMAN software group (95.4 ±2.7) was significantly higher than that of tra-ditional group (85.0 ±3.5) (t=11.5,P=0.000). Satisfaction survey results showed that GASMAN computer assisted instruction software learning was easier for students to accept, and there were significant difference between two groups (P=0.001). Conclusion Teaching mode of GASMAN software is a good learning technique of inhalation anesthesia, which is worthy of promotion.
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It’s still controversial whether there is specificity of acupoints, because numerous studies showed that stimulation to acupoints and sham acupoints produced parallel clinical efficacies. For example, acupoint specificity was not detected when Visual Analogue Scale was adopted to evaluate pain, while hemodynamic and neuroimaging studies suggested the existence of acupoint specificity. This article reviewed and summarized relevant studies that supported or didn’t support acupoint specificity. Further researches are required to prove the existence of specificity of acupoints.
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A series of 6 novel 2-amino-4, 5-diarylpyrimidines were synthesized by the reaction of isoflavones with guanidine. They were identified by the spectra of IR, 1H NMR, 13C NMR and elemental analysis. The protective effects of 2-amino-4, 5-diarylpyrimidines against oxygen-glucose deprivation leading by sodium hydrosulfite in PC12 cells were studied by MTT method. It was shown that 2-amino-4, 5-diarylpyrimidines exhibited neuroprotective effects against oxygen-glucose deprivation injury in PC12 cells, which could increase the amount of survival PC12 cells and reduce their injured degree in the model.
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Objective To summarize the experience of anesthesia management of retroperitoneoscopic surgery in aged patients(aged more than 70 years old).Methods The clinical data of 81 aged patients(ranged from 70 to 86 years old,mean:74.2 years old)receiving retroperioneoscopic surgery from October 2002 to January 2007 was reviewed retrospectively in our hospital.Of whom,77 patients had concomitant diseases.81 patients were operated on under general anesthesia.Results Hypercarbia,acidosis and hypertension occurred in 35(43.2%),35(43.2%) and 41(50.6%) cases,respectively,after pneumoperitoneum.Tracheal catheters were pulled out in 66 patients in operation room,with the decannulation time being 5-50 minutes(mean,15.1 minutes).14 patients(17.3%) were transferred to ICU postoperatively.1 patient(1.2%) died from acute myocardial infarction.Sever delirious state was found in 1 patient.Conclusions On the basis of cautious perianesthesia management,aged patients can tolerate hypercapnia,acidosis and elevation of blood pressure induced by pneumoperitoneum,but the management of perianesthesia period should be prudent.
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Objective To evaluate the value of Univent tube in the airway management during one-lung ventilation. Methods A total of 40 patients with pneumothorax undergoing video-assisted thoracoscopic surgery (VATS) were randomly divided into Univent (U) and double-lumen tube (Robertshaw) (D) groups (20 in each). In U group, intubation was performed under the guidance of a fibreoptic bronchoscope; while in D group, the position of the tube was confirmed using fibreoptic bronchoscopy after intubation. The time of intubation, number of secondary dislodgements, quality of lung deflation, peak airway pressure during one-lung ventilation, and blood artery gas analysis data in the two groups were recorded 30 minutes after one-lung ventilation. Results The intubation time in U group was significantly longer than that in D group [(6.18?1.26) min vs (3.26?0.82) min, t=8.654, P=0.000]. The number of secondary dislodgements was 7 in U group, and 5 in D group(U=187.500, P=0.663). No significant difference was detected in the quality of lung deflation between the two groups, (U group: 15 excellent, 3 fair, and 2 poor; D group: 17 excellent, 2 fair, and 1 poor;U=179.500, P=0.583). The peak airway pressure during one-lung ventilation in U group was significantly lower than that in D group [(15.3?3.5) cm H2O vs (21.4?6.6) cm H2O, t=-3.649, P=0.001]; and the oxygen pressure in group U was significantly higher than that in group D [(303.8?65.7) mm Hg vs (258.4?72.9) mm Hg, t=2.066, P=0.046]. No significant difference was found in carbon dioxide pressure and oxygen saturation between the two groups. Conclusion During VATS, univent tube showed the same effectiveness and safety as DLT for one-lung ventilation.
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Objective To investigate effects and complications of medline and paramedian approaches for intravertebral anesthesia in knee arthroscopy.Methods A total of 120 ASA I or II patients scheduled for knee arthroscopy were randomly assigned into 2 groups: either receiving midline approach intravertebral block(Medline Group) or paramedian approach block(Paramedian Group).A combined spinal-epidural anesthesia was performed with the single-segment needle-through-needle technique in both groups.The anesthetic response time,successful puncture rate,incidence of paresthesia,incidence of difficult epidural catheterization,incidence of traumatic needle placement,and backache rate and duration of both groups were observed respectively.Values of SBP,DBP,HR,and SpO2 at 1,5,10,30 minutes after anesthesia respectively were recorded.Results There were no significant differences(P
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Objective To evaluate the safety and efficacy of the general anesthesia for laparoscopy-assisted surgery in aged patients (≥80years). Methods The effects of general anesthesia in 39 patients who underwent laparoscopy-assisted surgery during the period from May 2000 to February 2007 were analyzed retrospectively. All the patients were 80 years old or above, with a mean of 83.3 years old. Among the patients 38 cases had systemic diseases, and some of them had more than one concomitant disease. The systemic diseases included diabetes mellitus in 6 cases, coronary atherosclerotic heart disease in 10 cases, hypertension in 18 cases, arrhythmia in 15 cases, cerebral vascular disease in 8 cases and anemia in 1 case. The laparoscopy-assisted surgery included cholecystectomy in 14 cases, radical resection for rectal cancer in 6 cases, for colon carcinoma in 8 cases, and for kidney cancer in 6 cases, and resection for colonic benign tumor, hernioplasty, gastro-jejunal anastomosis and fenestration of hepatic or renal cysts in 1 patient each. Results During the peri-narcosis period cerebral infarction occurred in 1 patient, and 20 patients were transferred to Intensity Care Unit. After operation 33 patients (84.6%) were cured and 6 patients (15.4%) had the illness condition improved. Conclusions The general anesthesia in laparoscopy-assisted surgery is safe and feasible for the elderly patients over 80 years old. The elderly patients may safely tide over the peri-narcosis period with good prognosis with effective control of complications and concomitant diseases. So the general anesthesia should not be categorically forbidden in laparoscopy-assisted surgery for the elderly patients with complications.