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Imparting concepts in ?ow dynamics of cardiovascular and respiratory physiology can be intimidating to the beginners in medical schools. We have tried to simplify the approach in effective transfer of these concepts using biophysical concepts and principles pertaining to functioning of these systems which help in easy understanding of the two vital systems in human body. Beginners in medical education ?nd it easy to relate to these concepts.
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Objective:To evaluate the effect of goal-directed hemodynamic management of muscle oxygen saturation (SmO 2) on the postoperative renal function in hypertensive patients undergoing laparoscopic radical gastrectomy for gastrointestinal tumors. Methods:Eighty-six essential hypertension patients, aged 18-64 yr, with body mass index ≤ 30 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, undergoing elective laparoscopic radical gastrectomy for gastrointestinal tumors under general anesthesia, were divided into 2 groups ( n=43 each) using a random number table method: routine group (group C) and SmO 2 goal-directed group (group S). The fluctuation of mean arterial pressure (MAP) and heart rate (HR) were maintained < 20% of the preoperative baseline value by adjusting infusion speed and vasoactive drugs in group C. SmO 2 was maintained not less than 70% or not less than the baseline value by evaluating cardiac output (CO), HR, stroke volume, stroke volume variation, systemic vascular resistance index and MAP and by adjusting infusion rate and vasoactive drugs in group S. SmO 2, HR, MAP, CO, cardiac index (CI), stroke volume variation and systemic vascular resistance index were recorded before anesthesia induction (T 0, baseline value), at the beginning of surgery (T 1), at 40 min after the start of pneumoperitoneum (T 2), at 5 min after the end of pneumoperitoneum (T 3), and at the end of surgery (T 4). The glomerular filtration rate was measured before surgery and at 24 h after surgery, and the occurrence of decline in postoperative acute renal function was recorded.Intraoperative hypotension, fluid input and output, postoperative tracheal extubation time, length of hospital stay, occurrence of acute kidney injury and transfer to ICU, and the Quality of Recovery-15 scale score at 24 h after operation were recorded. Results:Compared with group C, SmO 2 at T 1-3 and CO and CI at T 3 were significantly increased, SVRI at T 2-4 was decreased, the intraoperative infusion volume and urine volume were increased, the glomerular filtration rate and Quality of Recovery-15 scale score were increased at 24 h after surgery, the incidence of decline in acute renal function was decreased ( P<0.05), and no significant change was found in the incidence of intraoperative hypotension, blood loss, postoperative extubation time, length of hospital stay, incidence of acute kidney injury and rate of transfer to ICU in group S ( P>0.05). Conclusions:SmO 2 goal-directed hemodynamic management can reduce the development of decline in postoperative acute renal function and improve the quality of postoperative recovery of hypertensive patients undergoing laparoscopic radical gastrectomy for gastrointestinal tumors.
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Resumen La arteritis de Takayasu es una enfermedad de etilogía un poco incierta por la diversidad de factores que pueden afectarla. Sus manifestaciones radican en la afección vascular que produce, en cuyo caso la aorta y sus grandes vasos son los más afectados. Esta vasculitis parece más prevalente en el suroeste asiático, y a pesar de llevar varios años de su descripción, en Europa y América solo se encuentran series de casos de la misma, lo que podría indicar un posible subdiagnóstico. Es importante conocer esta vasculitis ya que su manejo oportuno puede evitar el avance de la enfermedad y la presentación de complicaciones vasculares. El tratamiento de un paciente con arteritis de Takayasu seguirá siendo un desafío para los clínicos ya que no se cuenta con un estándar de manejo; por consiguiente, las decisiones generalmente se basan en recomendación de expertos, por lo cual cada caso deberá individualizarse con el objetivo de ofrecer el manejo más adecuado a los pacientes y disminuir la aparición de complicaciones.
Abstract Takayasu's arteritis is a disease of uncertain origin due to the diversity of factors that can be involved. Its manifestions stem from the vascular involvement that occurs, with the aorta and its large vessels being the most affected. This vasculitis seems more prevalent in south-west Asia, and due to the fact that it has been described for years, and only one series of cases of this disease are found in Europe and America, this could indicate a possible under-diagnosis. It is important to know this vasculitis since its timely management may avoid advancement of the disease, and the presentation of vascular complications. The treatment of a patient with Takayasu's arteritis will follow, being a challenge for clinicians since there is no standard management. For this reason, decisions are generally based on the recommendations by experts, therefore each case will be individualised with the aim of providing the patients with the most suitable management and reducing the appearance of complications.
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Humans , Adult , Vasculitis , Takayasu Arteritis , Cardiology , Hemodynamics , HypertensionABSTRACT
Spinal anaesthesia related hypotension and bradycardia is not rare. One of the causes for post spinal hypotension is thought to be bezold-jarisch reflex (BJR) which is mediated by serotonergic 5-HT3 receptors. Ondansetron, one of the reliable drugs for nausea and vomiting, is 5-HT3 antagonist. Effect of ondansetron to attenuate hypotension has been studied in caesarean section but there is paucity of literature for general population. Aim and Objectives: In this study we aimed at evaluating the efficacy of ondansetron on haemodynamics of patients undergoing spinal anaesthesia. Methods: This prospective study enrolled 200 ASA I and II patients assigned into 2 groups: Group O (Ondansetron group, n=100) received injection ondansetron 0.1mg/kg intravenous, diluting the drug to make volume 10 ml 5 minutes prior to spinal anaesthesia(SA). Group P (Placebo group, n=100) received injection normal saline 10 ml intravenous 5 minutes prior to spinal anaesthesia. Results: Demographic data were comparable in both the groups. There was no significant difference in MAP (mean arterial pressure), HR(heart rate) & SpO2 (oxygen saturation) values in group O whereas in group P statistically significant variations in MAP, HR & SpO2 values were observed. Fewer interventions using intravenous atropine & ephedrine were required in group O as compared to group P. Conclusion: In conclusion, intravenous administration of ondansetron 5 minutes before spinal anaesthesia attenuates the decrease in mean arterial pressure.
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Background: Various anaesthetic agents have been tried to attenuate pressor response to laryngoscopy and intubation. Among the recommended groups intravenous nalbuphine satisfies without much undesired effects. The objective was to study efficacy of two different doses of nalbuphine to attenuate pressor response to laryngoscopy and intubation.Methods: This was hospital based comparative study was carried out at Karnataka institute of Medical Sciences Hospital, Hubli, India. Patients were divided into two groups of 50 each randomly. First group was named as N1 and the second group was named as N2. Patients in N1 were given 0.1mg/kg Nalbuphine in 10ml of normal saline and patients in N2 were given 0.2-0.1mg/kg Nalbuphine in 10ml of normal saline. Appropriated statistical tests were applied like t test, ANOVA. P value if found less than 0.05 was recorded as statistically significant.Results: There was marked increase in HR, SBP, DBP and MAP immediately following laryngoscopy and intubation in the both the groups. Intravenous Nalbuphine given 5 minutes before intubation in the dose of 0.2mgkg-1 body weight effectively attenuated the hemodynamic response after laryngoscopy and intubation. However, there was a rise in HR, SBP, DBP and MAP immediately following intubation in group N2 which was clinically not significant though statistically significant. Side effects like nausea, vomiting, respiratory depression and sedation was not observed in both study groups.Conclusions: Authors concluded that 0.2mg/kg body weight dose of Nalbuphine was found to be more effective than 0.1mg/kg body weight dose of nalbuphine in maintaining the haemodynamics of the patients.
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Patent ductus arteriosus (PDA) is a common disease in prcterm infants,and haemodynamically significant patent ductus arteriosus (hsPDA) has a serious impact on mortality and disability of the premature infants.hsPDA is a complex pathophysiological process involving multiple factors.Clinical symptoms and signs are not specific,and there is no uniform standard for identifying hsPDA.Clinical manifestations combined with echocardiography and biomarkers are important means to diagnose the hsPDA.The treatment of hsPDA for premature infants includes supportive treatment,drug therapy,surgical ligation and transcatheter interventional therapy.This article reviews the research progress of hsPDA in premature infants.
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Resumen La seguridad en radiación es un tema de actualidad. A diario se evidencian las consecuencias deletéreas de esta herramienta diagnóstica y terapéutica. En su mayoría, las patologías asociadas secundarias a la exposición por radiación podrían prevenirse con una adecuada intervención preventiva y protectora. Se presenta un artículo de revisión con el fin de explicar de forma detallada los aspectos más relevantes acerca de la formación de los rayos X, su definición y clasificación dosimétrica, los efectos biológicos de la radiación, los límites recomendados y las medidas de protección para la exposición de radiación.
Abstract Radiation safety is a current topic. The harmful effects of this diagnostic and therapeutic tool are observed daily. The majority of associated secondary to radiation exposure could be prevented with suitable safety and protective measures. A review article is presented with the aim of explaining the most relevant aspects of radiation in detail, including the formation of x-rays, their dosimetry definition and classification, the biological effects of radiation, the recommended limits, as well as the protection measures for the exposure to radiation.
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Microvascular Angina , Hemodynamics , Review , Percutaneous Coronary InterventionABSTRACT
OBJECTIVE@#To compare the efficacy difference among acupuncture at "seven acupoints on neck", acupuncture at regular acupoints and betahistine mesilate tablet for cervical spondylosis of vertebral artery type, and to explore the effective treatment for cervical spondylosis of vertebral artery type.@*METHODS@#Ninety patients were randomly divided into a regular acupuncture group, a medication group and a neck-seven-acupoint group, 30 cases in each group. According to the acupoints prescription for vertigo in "11th Five-Year" Nation Textbook , the patients in the regular acupuncture group were treated with acupuncture at Fengchi (GB 20) and Baihui (GV 20), etc.; the patients in the neck-seven-acupoint group were treated with Fengfu (GV 16), Fengchi (GB 20), Tianzhu (BL 10) and Wangu (GB 12); the two groups were treated once a day, 6 treatments were taken as one course; there was an interval of 1 day between course and totally two course were given. The patients in the medication group were treated with betahistine mesilate tablets, 1 tablet each time, 3 times a day, for 2 weeks. The vertigo symptom and function score, mean blood flow velocity of left vertebral artery (LVA), right vertebral artery (RVA), basilar artery (BA) as well as pulsatile index (PI) and resistance index (RI) were observed, and the clinical efficacy of the three groups was compared.@*RESULTS@#The total effective rate was 93.3% (28/30) in the neck-seven-acupoint group, which was superior to 76.7% (23/30) in the regular acupuncture group and 70.0% (21/30) in the medication group (both 0.05). The improvement of mean blood flow velocity in the neck-seven-acupoint group was superior to those in the medication group and regular acupuncture group (all <0.05); the improvement in the regular acupuncture group was superior to that in the medication group (all <0.05). PI and RI were all reduced after treatment in the three groups (all <0.05); the reduction in the neck-seven-acupoint group was more significant those those in the medication group and regular acupuncture group (all <0.05), and the reduction in the regular acupuncture group was superior to that in the medication group (all <0.05).@*CONCLUSION@#Acupuncture at "seven acupoints on neck" has better clinical efficacy than regular acupuncture and betahistine mesilate tablets, which could obviously improve vertigo and brain blood supply.
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Humans , Acupuncture Points , Moxibustion , Spondylosis , Vertebral ArteryABSTRACT
Objective The objective of this study was to investigate effects of stellate ganglion blocking on the hemodynamics and cardiac function in patients with coronary heart disease(CHD). Methods A total of 54 colon cancer patients with CHD undergo-ing laparoscopic surgery underwent elective general anesthesia in our hospital from June 2014 to March 2017 were randomly divided into three groups(18 cases per group). They were the control,left stellate ganglion block(L-SGB),and right stellate ganglion block ( R-SGB)groups. The patients′mean arterial pressure(MAP),heart rate(HR),cardiac output(CO),cardiac index(CI),stroke out-put(SV),stroke,quantitative change thin(SVV)and heart rate and systolic blood pressure product(RPP),and other changes in he-modynamic parameters were compared in each group,after home invasion(T0),induction of general anesthesia(T1),the endotracheal tube into the glottis immediately(T2),and 5 min after intubation(T3). The changes of patients in superoxide dismutase(SOD),ma-londialdehyde(MDA),nitric oxide(NO)and cardiac troponin I(cTnI),creatine kinase isoenzyme(CK-MB)were also compared to T0,6 h(T4)and 24 h after anesthesia(T5)in each group. Results Compared with T0,the MAP,HR,CO,CI,SV and RPP of patients in each group were all decreased at T1,but no statistical significance was found in these groups(P>0. 05). Compared with T0,the MAP,HR,CO,CI,SV and RPP of patients in each group were significantly increased at T2;there showed a statistical significance( P<0. 05). Compared with T0,the MAP,HR,CO,CI,SV and RPP of patients in each group were decreased at T3,but the decreased changes in the R-SGB group were more great than those in the L-SGB group(P<0. 05). Compared with L-SGB and R-SGB groups,the MAP,HR,CO,CI,SV,SVV and RPP were significantly increased at T2of patients in the control group(P<0. 05). Com-pared with T0,the MDA,NO,cTnI and CK-MB in each group were significantly increased and significantly decreased in the SOD at T4of patients(P< 0. 05). Compared with the control group,there had small changes in each index of patients in R-SGB and L-SGB groups at T4,but there was a significant difference(P< 0. 05). Compared with T4,the levels of MDA,NO,cTnI and CK-MB were significantly decreased and the level of SOD were significantly increased at T5of patients in each group(P<0. 05),but all inde-xes in the control group compared with T0had statistical significance(P<0. 05). Although there had changes of R-SGB and L-SGB groups,they did not statistical significance(P>0. 05). Conclusion In patients with CHD during general anesthesia with color-ectal cancer surgery,stellate ganglion blocking can increase hemodynamic stability,improve cardiac function,and reduce myocardial oxygen consumption,thereby reducing surgical stress damage to the cardiomyocytes. The right side of the stellate ganglion blocking has better effect than that in the left side block.
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Objective To observe the role of abatacept in the treatment of diabetic nephropathy in rats. Methods Type 2 diabetic nephropathy rat model was established, and was randomly divided into abatacept group and non-intervention group, 15 each. 15 normal rats were served as control group ( NC) . The abatacept group was given abatacept for 8 weeks. The control group was set at the same time period. Then the blood biochemical indexes, blood flow parameters of renal main artery, elasticity of renal parenchymal, HE staining of renal parenchymal and ultrastructure of podocytes were all evaluated. The expression of CD31, CD34, podocin, nephrin, and B7-1 in renal parenchyma were detected. Results Compared to the NC group, the fasting blood glucose, creatinine clearance rate, urine albumin excretion rate, and kidney hypertrophy index in the non-intervention and abatacept groups were significantly increased (P<0. 05);creatinine clearance rate, urine albumin excretion rate, and kidney hypertrophy index in the abatacept group were significantly lower compared to the non-intervention group (P<0. 05). There were significant differences in peak systolic velocity, end diastolic velocity, and mean velocity among these 3 groups, and these differences were ranked as non-intervention group<abatacept group<control group ( P<0. 05 ); there were significant differences in systolic acceleration, pulsatility index, and resistance index among these three groups, with the differences ranked as non-intervention>abatacept>control groups (P<0. 05). There were significant differences in the stiffness of kidneys among these three groups, with the differences ranked as non-intervention>abatacept>control groups (P<0. 05). HE staining and transmission electron microscope observation showed that there were obvious changes in the renal parenchyma of rats in the non-intervention group and the abatacept group, and the changes of kidney in the non-intervention group were worse than those in the abatacept group. CD31 and CD34 expression in kidney parenchyma of rats in the abatacept group and non-intervention group were higher than those in the control group, the abatacept group and non-intervention group>the control group (P<0. 05), while no significant differences between the abatacept group and non-intervention group in CD31 and CD34 expression (P>0. 05). There were significant differences in podocin and nephrin expression in kidney parenchyma of rats among these three groups, and these differences were ranked as the control>abatacept>non-intervention groups (P<0. 05). There were significant differences in B7-1 expression in kidney parenchyma of rats among these three groups, and these differences were ranked as the control<abatacept<non-intervention groups (P<0. 05). Conclusion Abatacept may significantly alleviate the renal injury in type 2 diabetic nephropathy rats.
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Sepsis is defined as a host imbalance of response induced by infection leading to life-threatening organ dysfunction, and septic shock is the most severe form of sepsis resulting from systemic circulatory and metabolic abnormalities, having high mortality rate. During septic shock stage, there are myocardial injury and myocardial inhibition, and after septic shock combined with cardiac injury, the mortality will be increased significantly. Levosimendan can improve cardiac function, hemodynamics, microcirculation, tissue oxygen metabolism, organ functions, etc in patients with septic shock. Now the effects of levosimendan on internal organ functions and hemodynamics in treatment of patients with septic shock are reviewed.
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Objective:To investigate the effects of 12-week low intensity aerobic exercise on the body composition,haemodynamics and exercise endurance of the male old patients with simple obesity,and to provide evidence for conducting special exercise prescription.Methods:Forty-six male old simple obesity patients were divided into control group (n=19) and exercise group (n=27) according to subjective will.The subjects in control group maintained daily life while those in exercise group performed a 12-week low intensity aerobic exercise.Before and after experiment,the rest heart rates and blood pressures were measured,the maximal oxygen intake (VO2max),maximal power (MP) and exhaust time (ET) were detected by symptom limited graded exercise test,the heart rate curve and blood pressure curve were depicted,and the body composition was determined by body composition analyzer.Results:Compared with before experiment,the fat mass,the percentage of fat body,rest heart rate and blood pressure of the patients in exercise group were decreased (P＜0.05),the VO2 MP and ET were increased (P＜0.05),and the heart rate curve and blood pressure curve during exercise test shifted right;but the indicators in control group showed no significant changes (P＞0.05).Compared with control group,the fat mass,percentage of body fat,rest heart rate and blood pressure were decreased (P＜0.05) and the VO2 MP and ET were increased (P＜ 0.05) in exercise group after experiment.Conclusion:Low intensity aerobic exercise of 12-week may effectively improve the haemodynamic abnormality,reduce the body composition and enhance the exercise endurance.
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Objective:To investigate the effects of 12-week low intensity aerobic exercise on the body composition,haemodynamics and exercise endurance of the male old patients with simple obesity,and to provide evidence for conducting special exercise prescription.Methods:Forty-six male old simple obesity patients were divided into control group (n=19) and exercise group (n=27) according to subjective will.The subjects in control group maintained daily life while those in exercise group performed a 12-week low intensity aerobic exercise.Before and after experiment,the rest heart rates and blood pressures were measured,the maximal oxygen intake (VO2max),maximal power (MP) and exhaust time (ET) were detected by symptom limited graded exercise test,the heart rate curve and blood pressure curve were depicted,and the body composition was determined by body composition analyzer.Results:Compared with before experiment,the fat mass,the percentage of fat body,rest heart rate and blood pressure of the patients in exercise group were decreased (P＜0.05),the VO2 MP and ET were increased (P＜0.05),and the heart rate curve and blood pressure curve during exercise test shifted right;but the indicators in control group showed no significant changes (P＞0.05).Compared with control group,the fat mass,percentage of body fat,rest heart rate and blood pressure were decreased (P＜0.05) and the VO2 MP and ET were increased (P＜ 0.05) in exercise group after experiment.Conclusion:Low intensity aerobic exercise of 12-week may effectively improve the haemodynamic abnormality,reduce the body composition and enhance the exercise endurance.
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Objective To evaluate the effects of goal-directed fluid therapy on the tissue perfusion of elderly patients undergoing Laparoscopic Radical Cystectomy.Methods Thirty patients aged 60-82 years with ASA physical status Ⅰ or Ⅱ who were presenting for elective laparoscopic radical cystectomy were randomly divided into routine fluid replacement group (group C,n=15) and GDFT group (group G,n=15).Patients in group C received routine fluid replacement.Patients in group G were treated under goal-directed fluid infusion strategy with a target of SVV≤13%,CI≥2.5 L·min-1·m-2 and ScvO2≥73% under the monitoring of PiCCO.The indexes of hemodynamics and tissue perfusion were collected and recorded at 7 time points: before induction of anesthesia (T1),5 minutes after intubation (T2),5 minutes after pneumoperitoneum and change positions (T3),1 hour after pneumoperitoneum (T4),5 minutes after the abdomen was opened (T5),1 hour after the abdomen was opened (T6) and the end of surgery (T7).Results Compared with group C,group G received less fluid.MAP and SVV between two groups were no statistical significance.The CI in group G in time point T4,T6 and T7 was significantly higher than that in group C (P<0.05).The HR in group G in time point T5 and T6 was significantly higher than that in group C (P<0.05).The aLac in group G in time point T4 and T5 was significantly lower than that in group C (P<0.05).Pcv-aCO2,DO2I and O2ERe between the two groups were not statistically different.Postoperative rehabilitation indexes between the two groups were not statistically significant.Conclusion The GDFT guided under SVV,CI and ScvO2 can keep the effective circulatory volume and pressure to ensure the whole body perfusion,reduce aLac and improve microcirculation without affecting the balance of oxygen supply and demand and the postoperative complication.
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Objective To observe the clinical efficacy of electroacupuncture plus rehabilitation in treating cerebral palsy.Method A total of 104 patients with cerebral palsy were randomized into a treatment group and a control group, 52 cases in each group. The two groups both received routine medications, based on which, the treatment group was given electroacupuncture plus rehabilitation training while the control group was given rehabilitation training alone. Before and after the treatment, the Gross Motor Function Measure (GMFM), muscle tension, comprehensive capability, development quotient (DQ) and cerebral haemodynamics were observed, and the clinical efficacies were compared between the two groups.Result The total effective rate was 94.2% in the treatment group versus 71.2% in the control group, and the between-group difference was statistically significant (P<0.05). After the treatment, the scores of item D and E of GMFM-88 were significantly increased (P<0.01) and the muscle tension scores were significantly decreased in both groups (P<0.01); the scores of item D and E of GMFM-88 and muscle tension in the treatment group were significantly different from those in the control group (P<0.05). The comprehensive capability score and DQ were markedly increased in both groups after the treatment (P<0.01); after the treatment, the comprehensive capability score and DQ in the treatment group were significantly different from those in the control group (P<0.01). The cerebral artery mean flow velocity (Vm) increased significantly (P<0.05), and pulsatility index (PI) and resistance index (RI) decreased significantly after the treatment in both groups (P<0.05); after the treatment, the cerebral artery Vm, PI and RI in the treatment group were significantly different from those in the control group (P<0.05).Conclusion Electroacupuncture plus rehabilitation is an effective approach in treating cerebral palsy, and it can obviously improve the limb dysfunction, DQ, and cerebral haemodynamics of the patients.
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·AIM:To analyze the clinical efficacy of Ranibizumab in the treatment of wet age-related macular degeneration ( ARMD) .·METHODS: Clinical data of patients with wet age-related macular degeneration received treatment of ranibizumab at our hospital from 2015 to 2017 were analyzed. At 1mo after treatment, the clinical efficacy, ocular hemodynamics and ocular inflammation were evaluated.·RESULTS: A total of 41 patients were analyzed. After treatment, patients got significantly increased in LogMAR (0. 651 ± 0. 067 vs 0. 321 ± 0. 049; t= 25. 460, P<0. 01 ) and decreased in central foveal thickness ( 239. 1 ± 51. 9μm vs 452. 9±69. 8μm;t=15. 740, P<0. 01). There was no serious complication during treatment period. After treatment, the levels of TNF-α (13. 1±4. 1ng/L vs 16. 1±3. 5ng/L; t=3. 563, P<0. 01) and IL-6 (12. 1±1. 9ng/L vs 13. 8±2. 5ng/L;t = 3. 467, P < 0. 01 ) in aqueous fluid decreased significantly. There was no significantly changes of blood flow volume of central retinal artery and ophthalmic artery at peak systolic velocity and end diastolic velocity before and after treatment (P>0. 05).·CONCLUSION: In the treatment of wet age- related macular degeneration, the ranibizumab shows a good therapeutic effect without serious adverse drug reactions.
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Functional echocardiography (fECHO) refers to a bedside, limited assessment of the ductus arteriosus, myocardial performance and pulmonary or systemic haemodynamics that is brief in nature and addresses a specific clinical question or management dilemma. This point-of-care ultrasonography is increasingly used internationally and locally among neonatal units to assist with management of neonatal haemodynamic conditions. This article intends to explain the modality, its indications, interpretation and implications for management, and how it impacts long-term outcomes, particularly in chronic lung disease for premature infants born before 32 weeks of gestation. This review will focus on fECHO as a clinical tool to assess the haemodynamics of sick neonates and how it assists in the logical choice for cardiovascular support. Training should be approached as a combined effort between the paediatric cardiology service and neonatology service.
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Objective To discuss the effects of the goal-directed fluid therapy on the haemody-namics,oxygen delivery and consumption and tissue perfusion in patients with continuous hyperther-mic peritoneal perfusion.Methods Eighty patients (61 males,19 females,aging from 30 to 60years old,ASA grade Ⅰ-Ⅲ)undergoing continuous hyperthermic peritoneal perfusion were selected and di-vided into 2 groups (n=40).Conventional liquid treatment group(group C)and Stroke Volume Vari-ation-directed liquid treatment group(group S).All patients were received general anesthesia and mo-nitored with FloTrac/Vigile systerm.MAP,HR,CVP,CI,PaO2 ,SaO2 ,PvO2 ,ScvO2 and Lac were all recorded in the time before anesthesia(T0 ),5 min after endotracheal intubation (T1 ),before CHPP (T2 ),CHPP for 30 min (T3 ),CHPP for 60 min (on the end,T4 ),30 min after CHPP (T5 ), and at the end of surgery (T6 ).According to the formula to calculate oxygen transport (DO2 I)and oxygen consumption index (VO2 I).Results Compared with group C,the amount of fluid, crystalloid solution,and urine volume were all much lower and colloidal solution was much higher in group S (P <0.05).Compared with T1 ,MAP decreased in the two groups at T3 and T4 ,yet HR in-creased and CVP decreased in group C at T4 (P <0.05).CVP increased in group C at T6 and in group S at T3-T5 .At the time points of T3 to T6 ,MAP and CI in group S were significantly higher than those in group C,while CVP and HR were much lower in group S (P <0.05).Compared with T1 , the DO2 I in group C were lower at T4 ,T5 (P <0.05),while VO2 I,O2 ER and Lac in group C in-creased at T3-T6 (P <0.05),also ScvO2 decreased at the same time (P <0.05).Compared with T1 , the VO2 I increased at T4-T6 ,but ScvO2 decreased at T3 ,T4 in group S (P <0.05).DO2 I in group S were higher than those in group C at T4 and T5 ,whereas,VO2 I,O2 ER and Lac level in group S were much lower than those in group C,and ScvO2 were significantly higher than those at T3-T6 in group C (P <0.05).Conclusion Stroke variation degree-oriented liquid treatment could effectively maintain hemodynamic stability,increase the body's oxygen supply,reduce oxygen consumption and improve tissue perfusion.
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Objective To discuss the effects of pressure control (PC) and positive end-expiratory pressure (PEEP) incremental method lung recruitment maneuver (RM) on haemodynamics in piglets with acute lung injury (ALI) induced by paraquat (PQ) poisoning. Methods The ALI/acute respiratory distress syndrome (ARDS) model was reproduced by intraperitoneal injection of 20% PQ (20 mL) in 10 healthy female piglets, and they were randomly divided into PC lung RM group (RM1 group) and PEEP incremental method lung RM group (RM2 group), with 5 piglets in each group. Heart rate (HR), mean arterial pressure (MAP), and cardiac index (CI) were monitored by pulse-indicated continuous cardiac output (PiCCO) monitoring before model reproduction (baseline), on the time of successfully set up of model and at 5, 15 and 30 minutes after RM. At the same time the arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2) were recorded, and oxygenation index was calculated. Lung tissues were collected before model reproduction, on the time of successfully set up of model, and at 30 minutes after RM respectively, and pulmonary pathology changes were observed after hematoxylin and eosin (HE) staining under light microscopy. Results The HR, MAP, and PaCO2 on the time of successfully set up of model in both groups were increased obviously while CI, PaO2, and oxygenation index were decreased obviously as compared with those at baseline, all of which conformed to the expression of ALI/ARDS. With RM time extended, the HR in both groups was declined while MAP and CI were increased gradually. The HR and MAP at 5 minutes after RM of RM1 group were significantly lower than those of the RM2 group [HR (bpm): 126.8±5.2 vs. 134.0±3.8, MAP (mmHg, 1 mmHg = 0.133 kPa): 98.4±3.3 vs. 102.8±2.6, both P 0.05). The lung tissue in both groups showed a variety of pathological changes at 30 minutes after RM. The main performances were the loss of alveolar epithelial cells, the further wideness of alveolar interval and the distension of alveolar, and the part breakage of alveolar interval. The wideness of alveolar interval was more significant in RM2 group than that of RM1 group, and alveolar cleft was more common too. Conclusion Both PC and PEEP incremental method lung RM can improve the oxygenation of the piglets with ALI/ARDS induced by PQ, and the PC lung RM has less impact on haemodynamics.
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Objective To compare the safety of dopamine ( DA) and norepinephrine ( NE) in hypovolemic shock , and the impact on the stability of blood pressure and haemodynamics .Methods Eighty two patients with hypovolemic shock were given fluid resuscitation . All the patients were divided into two groups including DA group (n=41) and NE group(n=41).Recovery of blood pressure, hemody-namic parameters were observed at different time point , and the complications and mortality of two groups were recorded .Results Blood pressure of all the patients returned to normal in 15min after the medication, and became stable after 30min.There was no significant difference in the blood pressure in both groups except that of 15min.Compared with T0, There were higher in the numerous of CVP , CI, ELWI, ITBI.The ELWL at T2 in DA group was higher than that of NE group , while there was no significant difference in the other time points between the two groups(P>0.05).After treatment for 24 h, blood oxygen saturation, urine volume in two groups were significantly increased, blood lactic acid markedly reduced , but lactic acid in NE group was obviously lower than that in DA group (P0.05).Conclusion The effect of NE and DA in maintaining the stability of blood pressure and hemodynamic are equivalent , and NE did not increase the risk of acute kidney injury , but can effectively improve tissue perfusion , reduce arrhythmia and case fatality rate , improve clinical outcomes .