Influence of blood hemodynamics on the treatment outcomes of limited fluid resuscitation in emergency patients with traumatic hemorrhagic shock

Abstract Objectives Traumatic hemorrhagic shock is a major death-related factor contributing to mortality in emergencies and can be effectively handled by the Limited Fluid Resuscitation (LFR) method. In the current investigation, the authors analyzed the influence of different administrating blood pressure on the treatment outcomes of LFR. Methods 276 participants were enrolled in the current study retrospectively from January 2016 to December 2021 and were divided into three groups based on the administrating blood pressure of LFR. The difference among the three groups regarding serum levels of cytokines as well as blood hemodynamics parameters was analyzed. Results The results showed after the T2 stage treatment, cytokine levels in the three groups were all significantly influenced by different LFR strategies with medium MAP showing the strongest effects on the expression of all cytokine genes. Moreover, the MAP value was in positive correlation with IL-6, IL-10, and TNF-α levels, but showed no clear relation with IL-4 level in all three groups. Regarding the effects on hemodynamics parameters, the levels of CVP, CO, and CI were slightly increased by the different LFR administrating strategies, and the effect of medium and high MAP was statistically stronger than that of low MAP. Conclusion The present results showed that LFR would influence serum inflammatory levels by improving blood hemodynamics parameters. Medium MAP showed the strongest improving effects with the least side effects, which can be employed as the optimal administrating strategy for LFR in the future.

Subarachnoid anesthesia with ropivacaine combined with sufentanil in cesarean delivery / 中国基层医药

Objective:To investigate the efficacy of subarachnoid anesthesia with low-dose ropivacaine combined with sufentanil in cesarean delivery.Methods:A total of 120 women who were subjected to cesarean delivery in Tongxiang Second People's Hospital from May 2017 to April 2018 were included in this study. They were randomly assigned to undergo subarachnoid anesthesia either with low-dose ropivacaine plus sufentanil (observation group, n = 60) or low-dose ropivacaine alone (control group, n = 60) in cesarean delivery. The anesthesia effects, heart rate, mean arterial pressure, sensory block, 1-minute Apgar score, and the incidence of adverse reactions were compared between the two groups. Results:Time to anesthesia onset and time to pain recovery in the observation group were (2.07 ± 1.24) minutes and (51.29 ± 6.24) minutes, respectively, which were significantly shorter than those in the control group [(4.58 ± 1.69) minutes, (56.70 ± 7.91) minutes, t = 9.28, 4.16, both P < 0.05]. There was no significant difference in the duration of anesthesia between the two groups ( t = 0.76, P > 0.05). The heart rate, mean arterial pressure, and 1-minute Apgar score were (77.64 ± 6.20) beats/minute, (92.23 ± 1.38) mmHg, and (9.68 ± 0.70) points respectively in the observation group, which were significantly lower than those in the control group [(83.40 ± 5.93) beats/minute, (96.54 ± 4.06) mmHg, (7.59 ± 0.64) points, t = 5.20, 7.79, 17.07, all P < 0.05]. Time to onset of sensory block was significantly shorter in the observation group than in the control group [(52.07 ± 8.68) seconds vs. (64.30 ± 9.62) seconds, t = 7.31, P < 0.05]. Duration of sensory and motor block in the observation group were (161.75 ± 28.63) minutes and (86.26 ± 20.03) minutes, respectively, which were significantly longer than those in the control group [(130.29 ± 31.84) minutes, (78.60 ± 16.95) minutes, t = 5.69, 2.26, both P < 0.05]. The incidence of adverse reactions was significantly lower in the observation group than in the control group (5.00% vs. 16.67%, χ2 = 4.23, P < 0.05). Conclusion:Subarachnoid anesthesia with low-dose ropivacaine combined with sufentanil has satisfactory anesthetic effects in cesarean delivery. The combined therapy can stabilize hemodynamics, has little impact on newborns, and is highly safe.

Analysis of the influencing factors for post-dialysis hypertension in maintenance hemodialysis patients / 中华肾脏病杂志

Objective:To investigate the influencing factors of post-dialysis hypertension in maintenance hemodialysis (MHD) patients.Methods:This study was a cross-sectional and retrospective study. The patients receiving hemodialysis from January 9, 2017 to January 14, 2017 in 5 hemodialysis centers of Beijing area were selected. Post-dialysis hypertension was defined as an event characterized by an average increase of more than 15 mmHg in post-dialysis mean artery pressure (MAP) compared to intradialytic 3 h MAP during 3 consecutive hemodialysis sessions. Post-dialysis stable blood pressure was defined as an event characterized by an increase of less than 15 mmHg or a decrease of less than 10 mmHg in post-dialysis MAP compared to intradialytic 3 h MAP, with the exception of patients with post-dialysis hypertension and post-dialysis hypotension. The patients were divided into hypertension group and stable blood pressure group based on whether they had post-dialysis hypertension, and the differences of clinical data between the two groups were compared. The influencing factors of post-dialysis hypertension were analyzed by multivariate unconditional logistic regression.Results:A total of 491 MHD patients were enrolled in this study, including 65 patients (13.2%) in the hypertension group, 406 patients (82.7%) in the stable blood pressure group and 20 patients (4.1%) in the hypotension group. The age, blood calcium before dialysis and the proportion of patients using 1.75 mmol/L Ca 2+ dialysate in the hypertension group were higher than those of the stable blood pressure group, and pre-dialysis serum intact parathyroid hormone and pre-dialysis serum uric acid in the post hypertension group were lower than those of the stable blood pressure group (all P<0.05). The age, pre-dialysis serum intact parathyroid hormone, pre-dialysis serum calcium, pre-dialysis serum uric acid, dialysate Ca 2+ concentration of statistical differences between hypertension group and stable blood pressure group ( P<0.05), and post-dialysis serum calcium, pre-dialysis total serum cholesterol, application of β receptor blocker, gender of univariate analysis ( P<0.1) were included into the logistic regression equation as covariates. Multivariate logistic regression analysis showed that using 1.75 mmol/L Ca 2+ dialysate was the independent influencing factor of post-dialysis hypertension (with using 1.50 mmol/L Ca 2+ dialysate as reference, OR=2.930, 95% CI 1.282-6.694, P=0.011). The age and pre-dialysis serum calcium of statistical differences between hypertension group and stable blood pressure group ( P<0.05), and pre-dialysis serum sodium and pre-dialysis serum uric acid of univariate analysis ( P<0.1) were included into the logistic regression equation as covariates. The older age ( OR=1.046, 95% CI 1.000-1.093, P=0.049) and higher pre-dialysis serum calcium ( OR=21.847, 95% CI 2.111-226.075, P=0.010) were the independent influencing factors of post-dialysis hypertension when the 1.50 mmol/L Ca 2+ dialysate was used. Conclusions:The independent influencing factor of post-dialysis hypertension is using 1.75 mmol/L Ca 2+ dialysate, while the independent influencing factors of post-dialysis hypertension are the older age and the higher pre-dialysis serum calcium level when the dialysate Ca 2+ concentration was 1.50 mmol/L.

Effects of treatment based on different target mean arterial pressure on gastrointestinal function in septic shock patients with hypertension / 中华危重病急救医学

Objective:To investigate the effect of fluid resuscitation and circulatory support, directed by different target mean arterial pressure (MAP), on abdominal blood flow, gastrointestinal function and inflammatory response in septic shock patients with hypertension.Methods:A prospective randomized controlled study was conducted. Hypertensive patients with septic shock admitted to the department of intensive care unit (ICU) of Liuzhou People's Hospital from January 1, 2019 to May 31, 2020 were enrolled. Patients were randomly divided into the low MAP groups (low standard group, LS group) or high MAP group (high standard group, HS group). According to the Surviving Sepsis Campaign Guidelines in 2016 and the updated guideline in 2018, all patients were given treatment of primary disease, fluid resuscitation, supportive management. The target MAP was 65-70 mmHg (1 mmHg = 0.133 kPa) in LS group, and was 75-80 mmHg in HS group. Acute gastrointestinal function injury (AGI) classification was performed on the 1st, 3rd and 7th day. The mean flow rate (Vm) and resistance index (RI) of superior mesenteric artery were evaluated using ultrasound, and the gastrointestinal function was dynamically evaluated using the modified single section ultrasonic gastric antrum method. The gastric antrum movement index (MI) and gastric empaging time (GET) were recorded. The levels of inflammatory markers in serum were detected by enzyme linked immunosorbent assay (ELISA), such as tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), procalcitonin (PCT) and vascular endothelial growth factor (VEGF). The target MAP, the days of use of vasopressors and the amount of fluid resuscitation were recorded.Results:A total of 208 hypertensive patients with septic shock were enrolled, including 109 in the LS group and 99 in the HS group. There were no significant differences in gender, age, acute physiology and chronic health evaluationⅡ (APACHEⅡ) score and sequential organ failure assessment (SOFA) score between the two groups when diagnosed. After treatment, there was no significant difference in AGI classification between the LS group and HS group on the 1st day. On the 3rd and 7th day, there were statistical differences between the two groups (3rd day: proportion of Ⅰ, Ⅱ, Ⅲ, Ⅳ grades were 25.69%, 56.88%, 11.93%, 5.50% in LS group, 15.15%, 54.55%, 25.25%, 5.05% in HS group, respectively, χ 2 = 7.900, P = 0.048; 7rd day: proportion of Ⅰ, Ⅱ, Ⅲ, Ⅳ grades were 44.96%, 49.54%, 3.67%, 1.83% in LS group, 31.31%, 52.53%, 11.11%, 5.05% in HS group, respectively, χ 2 = 8.178, P = 0.042). The Vm of superior mesenteric artery was higher and the RI was lower in the LS group than those in the HS group on day 1, 3 and 7 [Vm (cm/s): 21.72±3.02 vs. 19.50±2.83, 20.42±2.62 vs. 17.02±1.99, 26.52±2.70 vs. 22.47±4.03; RI: 0.86±0.05 vs. 0.92±0.04, 0.87±0.05 vs. 0.95±0.05, 0.81±0.03 vs. 0.85±0.03, all P < 0.01]. The MI was higher and the GET was shorter in the LS group than those in the HS group on day 3 and day 7 [MI: 3.00±0.33 vs. 2.60±0.29, 4.50±0.51 vs. 3.90±0.33; GET (minutes): 86.01±19.78 vs. 100.99±25.01, 71.00±16.37 vs. 84.98±20.18, all P < 0.01]. In addition, the levels of serum TNF-α, IL-6, PCT, VEGF were lower in the LS group than those in the HS group after 3 days of treatment [TNF-α (ng/L): 147.05±28.32 vs. 256.99±27.04, IL-6 (ng/L): 762.99±57.83 vs. 1 112.30±118.32, PCT (μg/L): 37.00±5.58 vs. 56.00±12.36, VEGF (ng/L): 123.00±19.78 vs. 167.01±21.55, all P < 0.05]. The target MAP was maintained at (68.02±4.71) mmHg in LS group, and (79.04±3.04) mmHg in HS group. The difference between the two groups was statistically significant ( P < 0.01). Compared with the HS group, the days of using vasopressors was shorter in LS group (days: 3.50±1.27 vs. 4.55±1.47), and the amountof fluid was reduced significantly (mL: 1 602.29±275.49 vs. 2 000.30±272.59, both P < 0.01). Conclusion:Maintaining a low target mean arterial pressure (65-70 mmHg) in hypertensive patients with septic shock can improve blood supply of superior mesenteric artery, protect the gastrointestinal function, reduce the level of inflammatory factors, and diminish the duration of using vasopressors and the amount of fluid.

The predictive value of estimated renal perfusion pressure in acute kidney injury of severe multiple trauma patients / 中华急诊医学杂志

Objective:To investigate the predictive value of estimated renal perfusion pressure (eRPP) for acute kidney injury (AKI) in severe multiple trauma patients.Methods:Severe multiple trauma patients were collected based on the inclusion criteria and exclusion criteria from the Trauma Center, the Third Xiangya Hospital, Central South University. Subsequently, patients were divided into the AKI group and non-AKI group according to the occurrence of AKI during 72 h admission to hospital. Further clinical information, ISS score, SOFA score, APACHE Ⅱ score, mean arterial pressure (MAP), central venous pressure (CVP) and intra-abdominal pressure (IAP) were collected, and eRPP were calculated. Additionally, the differences of parameters in the AKI group and non-AKI group were analyzed and logistic regression analysis was performed to identify the independent predicted risk factors for AKI. Finally, ROC curve was conducted to identify specificity, sensibility and best cut-off point.Results:A total of 173 severe multiple trauma patients were finally analyzed. Compared with the non-AKI group, the serum albumin [(32.21±5.20)g/L vs. (34.83±4.20)g/L, P =0.001] and 24 h urine output [(711.90±241.38)mL vs. (1 101.21±509.86)mL, P =0.001] were significantly lower and serum lactate [(2.80±0.96)mmol/L vs. (1.89±0.63)mmol/L, P<0.001], ISS score [(29.05±5.91) vs. (22.17±4.02), P <0.001], APACHEⅡ score [(38.84±21.47) vs. (31.45±18.24), P <0.001] and SOFA score [(5.26±2.08) vs. (3.14±1.34), P <0.001], in-hospital mortality (9.52% vs. 2.29%, P=0.038), and ICU stay [(8.43±6.46)d vs. (6.42±3.78) d, P =0.01) were significantly higher in the AKI group. Moreover, 6, 12 and 24 h of CVP and eRPP after admission were associated with the incidence of AKI. Logistic regression analysis showed that 24 h urine output, CVP and eRPP were the independent predictive factors (P <0.05) and 24 h of eRPP after admission applied a better predictive value of the incidence in AKI. Conclusions:24 h of eRPP might be the most suitable independent predictive factor for AKI in severe multiple trauma patients.

Analysis of risk factors and clinical prognosis of acute kidney injury early after lung transplantation / 器官移植

Objective To analyze the risk factors and clinical prognosis of acute kidney injury (AKI) early after lung transplantation. Methods Clinical data of 155 recipients undergoing lung transplantation or combined heart-lung transplantation were retrospectively analyzed, and they were divided into the AKI group (n=104) and non-AKI group (n=51) according to the 2012 Kidney Disease: Improving Global Outcomes Clinical Practice Guideline. The incidence of AKI early after lung transplantation was summarized. The main indexes of recipients were collected. The risk factors of the occurrence of AKI early after lung transplantation were subjected to univariate and multivariate analysis. The clinical prognosis of lung transplant recipients was evaluated and the survival curve was delineated. Results The incidence of AKI early after lung transplantation was 67.1%(104/155), including 47 recipients with stage 1 AKI, 34 recipients with stage2 AKI and 23 recipients with stage 3 AKI, respectively. Sixteen recipients required continuous renal replacement therapy (CRRT) early after lung transplantation. Preoperative complication with diabetes mellitus, preoperative complication with pulmonary hypertension, intraoperative mean arterial pressure (MAP) < 60 mmHg, intraoperative massive blood transfusion, and treatment with excessive therapeutic concentration of tacrolimus (Tac) within postoperative 1 week were the independent risk factors for the occurrence of AKI early after lung transplantation. Up to the end of follow-up, 66 recipients (42.6%) died, including 50 recipients in the AKI group and 16 recipients in the non-AKI group. The cumulative survival rate in the AKI group was significantly lower than that in the non-AKI group (40% vs. 66%, P < 0.05). With the increase of AKI severity, the cumulative survival rate of lung transplant recipients was decreased. Conclusions AKI develops early after lung transplantation with high incidence and poor clinical prognosis. Preoperative complication with diabetes mellitus and pulmonary hypertension, intraoperative MAP < 60 mmHg and massive blood transfusion, and treatment with excessive therapeutic concentration of Tac within postoperative 1 week are the independent risk factors for the occurrence of AKI early after lung transplantation.

Evaluation of surgical Apgar score in predicting post-laparotomy complications

Background: Surgical Apgar score is a simple, objective and economical ten point post-operative prognostic scoring system based on three readily recorded intra operative variables. Aim is to evaluate the applicability and accuracy of the surgical Apgar score in predicting post-operative complications and objectives are to identify patients at risk of developing post-operative complications based on intra-operative data, to study the incidence of post-operative complications and morbidity and mortality in patients undergoing elective and emergency laparotomy.Methods: This was a prospective analytical study carried out at SSG Hospital from November 2018 to October 2019 and achieved sample size was 160 patients. Surgical Apgar score was calculated at the end of the operation from these three parameters: heart rate, mean arterial pressure and expected blood loss.Results: Out of 160 patients, 77 patients were in group 0-5 and complications occurred in 45 patients (58.4%), 54 patients in group 6-7 in which 18 patients (33.3%) suffered a complication and 29 patients in 8-10 surgical Apgar score, rate of complications was 17.3% in category 8-10 Apgar score.Conclusions: Complications are more in low Apgar score patients compared to high Apgar score and in emergency cases compared to elective surgeries, would require more intensive monitoring in the postoperative period.

Correlation between Hypothyroidism and Systemic Arterial Blood Pressure: A Case–Control Study

Background: Hypothyroidism has been known to be associated with changes in systemic arterial blood pressure. Diastolicblood pressure (DBP) is known to be elevated causing proportionate reduction in pulse pressure.Aim: The aim of the study is to find out the correlation between systolic blood pressure (SBP), DBP, pulse pressure (PP), andmean arterial pressure of hypothyroid patients and normal individuals.Materials and Methods: This case–control study was conducted in Government Rajaji Hospital attached to Madurai MedicalCollege, Madurai. Twenty-five hypothyroid subjects were enrolled for the study (study group) from the department of endocrinologyand metabolism. Twenty-five normal subjects who were age and sex matched with the study group were enrolled for the study(control group). Serum thyroid-stimulating hormone (TSH) levels were estimated in all the subjects. Arterial blood pressure wasrecorded in all the subjects in the sitting posture and the results obtained. The results are tabulated and analyzed by applyingunpaired “t” test.Results and Conclusion: Among the blood pressure parameters, only PP showed a positive correlation between the studygroup and control group. SBP, DBP, and mean arterial blood pressure showed no significance.

Benefits of Video Laryngoscopy in Patients Undergoing Elective Cholecystectomies: A Comparative Study

Background: Several methods have been used to blunt the cardiovascular response associated with laryngoscopyand tracheal intubation in susceptible patients to prevent myocardial ischemia and cerebrovascular events. For almost75 years measures are taken to prevent such responses with more focus on pharmacological methods as compared tonon-pharmacological methods. Our study has focused on non-pharmacological methods in the form of using different kindof laryngoscopes in the American Society of Anesthesiologists (ASA) Group I and II patients to compare hemodynamicresponses and electrocardiographic changes in three groups, namely, Macintosh, McCoy, and Video laryngoscope (primaryaim) and also to assess the intubation time, number of attempts and complications (bleeding, laceration, dental injury, andsore throat) if any (secondary aim).Materials and Methods: This study was conducted on 90 patients of the ASA Grade I and II posted for elective opencholecystectomy surgeries under general anesthesia. Patients were allotted into three groups: Group A (Macintosh), GroupB (McCoy), and Group C (Video) and they were intubated with their respective laryngoscopes and hemodynamic parametersat 0, 1, 3, 5, 7, and 10 min after laryngoscopy were recorded along with time of intubation and any complications associatedwith the procedure.Results: The time of intubation was shortest with Group C (Video) when compared with Group A (Macintosh) and Group B(McCoy). Hemodynamic changes of patients were lowest in Group C (Video) than Group B (McCoy) and highest with Group A(Macintosh). Furthermore, number of attempts at intubation was higher with Macintosh and McCoy as compared to with Videolaryngoscope group. Likewise, more complications such as dental injury and injury to oral mucosa were seen with Macintoshlaryngoscope than McCoy and least with Video laryngoscope. The results were compiled and analyzed using software IBMSPSS 26 to draw relevant conclusions.Conclusion: Thus, we can see that with the use of Video laryngoscope, lesser alterations in hemodynamics are produced whichcan reduce the incidences of myocardial ischemia and cerebrovascular accidents in susceptible patients. Furthermore, lessertime taken by Video laryngoscope in intubation again reduces the stress response to laryngoscopy in susceptible patients.Laryngoscopy by Video laryngoscope is comparatively easy when compared with Macintosh and McCoy laryngoscopes asnumber of attempts and complication rate was lesser with Video laryngoscope.

To Assess the Correlation between Anthropometric Parameters and Cardiovascular Reactivity in Normotensive Students

Background: High blood pressure is one of the most importantrisk factor for cardiovascular disease. CVD are the number onecause of death globally. The present study was conducted toassess the correlation between Anthropometric parametersand Cardiovascular reactivity in normotensive students.Materials and Methods: This cross-sectional study wasconducted among 100 MBBS students in the age group of 19to 22 years at KD Medical College, Hospital and ResearchCentre, Mathura subjects over the period of 2 months wereselected for the study. The subject will be asked to had a lightbreakfast then in the sitting position we will take theCardiovascular parameters and Anthropometric data of thesubject. This study will be significant if the calculated ‘p’ valueis < 0.5. Data was analyzed using SPSS version 20.Correlation between Cardiovascular Reactivity andAnthropometric parameters will be accessed by Pearson’sCorrelation method.Results: In the present study the mean age of the subjectswas 21 years, mean height was 1.65, mean weight was 67.24kg and mean BMI was 23.37. P value found to be statisticallynon-significant for BMI and heart rate, BMI and DBP, BMI andTransit time, BMI and Velocity. And P value found to bestatistically significant for BMI and SBP, BMI and MAP.Conclusion: Our findings in the study showed the existingpositive correlation between the BMI and the various reactivitymeasures of the heart such as heart rate, systolic bloodpressure, diastolic blood pressure, mean arterial pressure,pulse transit time and pulse velocity.

Correlation between Three Methods of Blood Pressure Measurement (Impedance Cardiography, Sphygmomanometry, and Invasive Methods)

Aims and Objectives: The aims of the study were to find out the correlation between three methods of blood pressure (BP) measurement with impedance cardiography (ICG) device, conventional non-invasive sphygmomanometer, and cath lab-based invasive arterial pressure (AP) study. Patients Materials and Methods: Patients who had definite indications for coronary angiography (CAG) or coronary intervention due to cardiac reasons were selected for the measurement of BP by three methods, namely, by transducer-based invasive central aortic pressure study, by ICG, and by conventional sphygmomanometry. One hundred patients of acute myocardial infarction having chest pain, ST elevation in two or more contiguous leads of electrocardiogram (ECG), biomarker positivity, and echocardiographic evidence of regional wall motion abnormality were selected. Transfemoral or radial access of the ascending aorta allowed the measurement of central aortic pressure during invasive procedure. CAG was done in the cath lab having “Siemens™ Axiom Artis Zee (floor)” equipment. The subjects who were unwilling to participate, who were moribund, critically ill subjects, and patients with concomitant heart failure, arrhythmia, and valvular lesions were excluded from the study. GE™ Vivid 7 Dimension machine was used for ECG-gated echo-Doppler studies. ICG-derived BP values (systolic BP [SBP], diastolic BP [DBP], mean AP [MAP], and pulse pressure) were recorded for comparison with similar pressure data obtained from two other methods. Results and Analysis: Analysis of results show a comparison of data on SBP, DBP, and MAP measured by three methods by sphygmomanometry, invasive, and ICG methods. The analysis also shows the values of correlation coefficients – all of which are significantly positive correlations. ICG has been found to have positive correlation with both sphygmomanometric and invasive methods of BP measurement. It also shows a graphical presentation of the correlation between SBP, DBP, and MAP measured by three methods by sphygmomanometry, invasive, and ICG methods. Conclusion: There is a significant correlation between three methods of BP measurement with ICG device, conventional noninvasive sphygmomanometer-based method, and cath lab-based invasive AP study

Cerebral Autoregulation in Patients with Unilateral Carotid Artery Stenosis / 中国医学科学院学报

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.

A Comparative Study of Haemodynamic Changes on LMA Insertion with Propofol, Etomidate and Propofol+Etomidate Admixture in Laparoscopic Cholecystectomy

The objective of current study was to compare the efficacy of three different anaesthesia induction approachesi.e. Inj propofol, Inj etomidate and admixture of Inj propofol and Inj etomidate in maintaining hemodynamicstability during induction and following Proseal LMA insertion in laparoscopic cholecystectomy. Patientswere randomly divided in to 3 groups with 90 patients each and received 2.5mg/kg of propofol(P), 0.3mg/kgof etomidate(E) and 1mg/kg of propofol+0.2mg/kg of etomidate which was mixed in a 20ml syringe. We alsostudied side-effects like PONV, myoclonus, pain on Injection, allergic reactions and thrombophlebitis. Wefound that the use of P-E admixture for induction of Proseal LMA provides hemodynamic stability as itprevents hypotension caused by propofol and also hypertension caused by etomidate when used alone. Admixturewas also associated with less incidence of other side effects like PONV, pain on Injection and myoclonus. Weconcluded that combination of propofol and etomidate for induction of anaesthesia for Proseal LMA issignificantly better than either drug used alone

Variables hemodinámicas y desenlace de la función renal en pacientes de terapia intensiva / Haemodynamic variables and outcomes of renal function on intensive care patients / Variáveis hemodinâmicas e resultados da função renal em pacientes de terapia intensiva

Resumen: Introducción: Las variables hemodinámicas nos informan sobre la progresión de lesión renal aguda (AKI por sus siglas en inglés). Material y métodos: Estudio prospectivo, observacional, longitudinal, de pacientes ingresados a la Unidad de Terapia Intensiva del 2017 al 2018. Se incluyeron mayores de 18 años, con lesión renal aguda (AKI 1 o 2), monitoreo hemodinámico de tensión arterial media (TAM), tensión arterial diastólica (PAD), frecuencia cardiaca (FC) y de presión venosa central (PVC). Determinados desde las 24 horas del diagnóstico hasta el egreso. Resultados: Fueron 164 pacientes, 105 (64%) presentaron progresión de AKI cuando TAM < 75.98 mmHg. PAD < 61, PVC >8 cm H2O, FC > 90 x', TAM-PVC < 67.64 mmHg, PAD-PVC < 53.28 mmHg. Conclusiones: La TAM, PAD y la PVC tienen el mayor impacto en el riesgo de progresión de AKI cuando se calcula la presión de perfusión media con estas variables.

Abstract: Introduction: Haemodynamic variables inform us about the progression of acute kidney injury (AKI). Material and methods: Prospective, observational and longitudinal study of patients admitted to Intensive Care (ICU) from 2017-2018. patients over 18 years were included, with acute kidney injury (AKI 1, 2), and hemodynamic monitoring of mean arterial blood pressure (MAP), diastolic blood pressure (DBP), heart rate (HR) and central venous pressure (CVP). Determined from 24 hours after diagnosis and its evolution was recorded until discharge. Results: A total of 164 patients were included, progression of AKI presented when MAP < 75.98 mmHg, DBP < 61 mmHg, CVP < 8 cmH2O, FC 90 x', MAP-CVP 67.64 mmHg, DBP-CVP 53.28 mmHg, HR > 90 beats/minute. Conclusions: MAP, DBP and CVP have the greatest impact on the risk of AKI progression, especially when the mean perfusion pressure (PPM) is calculated with these two variables.

Resumo: Introdução: As variáveis hemodinâmicas informam sobre a progressão da lesão renal aguda (LRA). Materiais e métodos: Estudo prospectivo, observacional, longitudinal de pacientes admitidos em terapia intensiva (UTI) de 2017-2018. Foram incluídos pacientes maiores de 18 anos, com lesão renal aguda (LRA 1 ou 2), monitorização hemodinâmica da pressão arterial média (TAM), pressão arterial diastólica (PAD), freqüência cardíaca (FC) e pressão venosa central (PVC). Determinada a partir de 24 horas de diagnóstico até a alta. Resultados: 164 pacientes (p), 105 p (64%) apresentaram progressão da LRA quando TAM < 75.98 mmHg, PAD < 61 mmHg, PVC > 8 cmH2O, FC > 90 x´, TAM-PVC < 67.64 mmHg, PAD- PVC < 53.28 mmHg. Conclusões: TAM, PAD e PVC têm o maior impacto no risco de progressão da LRA quando a pressão média de perfusão (PMP) é calculada com essas variáveis.

A Study of Systolic, Diastolic Blood Pressure and Non-Invasive Mean Arterial Pressure with Regard to Adverse Events in Acute Hemorrhagic Stroke in A Rural Tertiary Care Hospital

Introduction: Stroke is an important and leading cause ofmorbidity and mortality worldwide. As hemorrhagic strokehas high degree of morbidity and mortality, and treatmentbeing more with supportive therapy and interventional therapybeing beyond the reach of an average Indian, it becomesimperative to identify the risk factors and prevent the event asa primary approach and it becomes important to identify theimportant prognosticating factors in assessing the morbidityand mortality in acute hemorrhagic strokes. Study aimed toidentify an added risk factor at the time of presentation in theform of blood pressure measurement by assessing the systolicblood pressure, the diastolic blood pressure and non-invasivemean arterial blood pressure at the time of presentation tothe hospital and also correlated it with the ICH score andestimated whether the blood pressure parameters could beused independently or in addition to the existing ICH scoringsystem to prognosticate the outcome of the hemorrhagicstroke event during in-hospital stay.Material and methods: 50 patients who presented to thepresent medical college with acute hemorrhagic stroke wereassessed with their systolic blood pressure, diastolic bloodpressure and non-invasive mean arterial pressure. Clinicaland imaging factors as per ICH scoring system, namelyage, hematoma volume, intra-ventricular hemorrhage, infratentorial origin of hemorrhage and Glasgow - coma scale wealso studied.Results: The systolic, diastolic blood pressure and meanarterial pressure elevation was consistently in correlation withhigh ICH score which indicated the high degree of mortality inour study. 7 patients (14%) who were below the age of 79 and11 patients (22%) above the age of 80 died. In our study, weobserved that High systolic and diastolic blood pressure wereassociated with increased ICH score and mortality.Conclusion: Hence we conclude that along with ICH scoring,the assessment of systolic, diastolic blood pressure and meanarterial pressure on admission to the hospital can be usedas an added criterion to assess the short-term mortality inintracerebral hemorrhage.

Effect of high salt diet on arterial blood pressure in urea transporter B gene depletion mice and its mechanism / 吉林大学学报(医学版)

Objective: To investigate the effect of high salt diet on the arterial blood pressure in the urea transporter B (UT-B) gene depletion (UT-B-/-) mice, and to clarify the possible mechanism of the UT-B-/- leading to the changes in the arterial blood pressure of the mice. Methods: The heterozygous (UT-B/-) mice were mated to obtain the wild-type (UT-B1/) and UT-B-/- mice with the same genetic background. The 4-week-old male UT-B1/1 and UT-B-/- mice were selected and fed on normal diet (0. 3% NaCl) or high salt diet (8. 0% NaCl) for 4 weeks. The mice were divided into UT-B/1 mice + normal diet (UT-B /1 +N) group, UT-B-/- mice + normal diet (UT-B-/- +N) group, UT-B1/1 mice+high salt diet (UT-B /1 +H) group, and UT-B-/- mice + high salt diet (UT-B-/- +H) group. The changes in water intakes and mean arterial pressures of the mice in various groups were monitored; RT-PCR, Western blotting and immunohistochemistry were used to detect the expression levels and location of UT-B mRNA and protein in choroid plexus (CP) of the brain tissue of the mice. The levels of serum angiotensin II (Ang II) and the Na levels in cerebrospinal fluid of the mice in various groups were determined by ELISA. Results: The PCR results of genomic DNA of mouse tail showed that there was a 400 bp base fragment in the UT-B mice, 250 and 400 bp base fragments in the UT-B mice, and 250 bp base fragment in the UT-B- - mice. Compared with normal salt diet group, the water intake of the mice in high salt diet was significantly increased (P<0. 01); compared with UT-B-/- +N group and UT-B1/1 + H group, the mean arterial pressure of the mice in UT-B-/- +H group was significantly increased (P<0. 01). The UT-B mRNA and protein expressed in the epithelial cells of CP in the UT-B/1 mice. Compared with UT-B-/- +N group and UTS1/ mice+H group, the Ang II level in serum of the mice in UT-B-/- mice+H group was significantly increased (P< 0.01); the Na level in cerebrospinal fluid of the mice was significantly increased (P< 0. 05). Conclusion: High salt diet can cause a significant increase in the mean arterial pressure in the UT-B-/- mice, and its mechanism is related to increasing the serum Ang II level and the Na' level in cerebrospinal fluid in the mice.

Effect of mean arterial pressure on acute kidney injury in patients with septic shock / 中华急诊医学杂志

Objective@#To study the effect of mean arterial pressure (MAP) level on acute kidney injury (AKI) in patients with septic shock, and to determine the best resuscitation target MAP to prevent the occurrence or progression of sepsis- associated AKI.@*Methods@#The study subjects included 168 adult patients with septic shock (age≥65 years) who were admitted to the Department of Intensive Care Unit (ICU) of the First Hospital of Jilin University from January 2016 to January 2019. The clinical data of all enrolled patients were retrospectively analyzed. The baseline data were compared between the AKI group (n=111) and non-AKI group (n=57). Multivariate logistic regression analysis was used to determine the risk factors of AKI in patients with septic shock.@*Results@#① The first, second, third, and forth quartile of ΔMAP (pre-resuscitation MAP minus post-resuscitation MAP) were -24.3-3.9 mmHg, 4.0-12.3 mmHg, 12.4-19.8 mmHg, and 19.9-43.5 mmHg, respectively. The second to fourth quartile interval wasΔMAP ≥4 mmHg.② There were no significant differences in age, body mass index, sex, pre-resuscitation MAP, MAP at first hour, SOFA score, positive culture ratio, negative culture ratio, hypertension, peripheral vascular disease, cerebrovascular accident, chronic obstructive pulmonary disease, gastrointestinal ulcer, liver cirrhosis, and tumor between the two groups (P>0.05). There were significant differences in post-resuscitation MAP (P=0.01), APACHEⅡ score (P=0.02), diabetes mellitus (P=0.01), fluid balance (P=0.01), and ΔMAP from the second to fourth quartile (P=0.03) between the two groups.③ ΔMAP ≥4 mmHg (OR=0.26, 95%CI: 0.12-0.57, P=0.01), diabetes (OR=6.03, 95%CI: 1.35-44.16, P=0.04), and high APACHE Ⅱ score (OR=0.96, 95%CI: 0.84-0.97, P=0.02) were closely related to the increased incidence of AKI in patients with septic shock. Post-resuscitation MAP and fluid balance had no significant effect on the incidence of AKI in patients with septic shock.@*Conclusions@#ΔMAP ≥4 mmHg, APACHE Ⅱ score and diabetes were independent risk factors for the incidence of AKI in patients with septic shock. The incidence of AKI in septic shock patients with post-resuscitation MAP 4 mmHg or more lower than pre-resuscitation MAP is significantly increased.

Effects of different target blood pressure resuscitation on peripheral blood inflammatory factors and hemodynamics in patients with traumatic hemorrhagic shock / 中华危重病急救医学

Objective To investigate the target blood pressure level of restrictive fluid resuscitation in patients with traumatic hemorrhagic shock. Methods Sixty patients with traumatic hemorrhagic shock admitted to the First Affiliated Hospital of Bengbu Medical College from January 2016 to December 2018 were enrolled. All patients were resuscitated with sodium acetate ringer solution after admission. According to the difference of mean arterial pressure (MAP) target, the patients were divided into low MAP (60 mmHg ≤ MAP < 65 mmHg, 1 mmHg = 0.133 kPa), middle MAP (65 mmHg ≤ MAP < 70 mmHg) and high MAP (70 mmHg ≤ MAP < 75 mmHg) groups by random number table using the admission order with 20 patients in each group. Those who failed to reach the target MAP after 30-minute resuscitation were excluded and supplementary cases were deferred. The restrictive fluid resuscitation phase was divided into three phases: before fluid resuscitation, liquid resuscitation for 30 minutes and 60 minutes. The most suitable resuscitation blood pressure level was further speculated by monitoring the inflammatory markers and hemodynamics in different periods in each group of patients. Pearson correlation analysis was used to detect the correlation of variables. Results Before fluid resuscitation, there was no significant difference in hemodynamics or expressions of serum cytokines among the three groups. Three groups of patients were resuscitated for 30 minutes to achieve the target blood pressure level and maintain 30 minutes. With the prolongation of fluid resuscitation time, the central venous pressure (CVP), cardiac output (CO) and cardiac index (CI) were increased slowly in the three groups, and reached a steady state at about 30 minutes after resuscitation, especially in the high MAP group and the middle MAP group. The expressions of serum inflammatory factors in the three groups were gradually increased with the prolongation of fluid resuscitation time. Compared with the low MAP group and the high MAP group, after 30 minutes of resuscitation the middle MAP group was superior to the other two groups in inhibiting the expressions of pro-inflammatory factors tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and promoting anti-inflammatory factors IL-10 [TNF-α mRNA (2-ΔΔCt):0.21±0.13 vs. 0.69±0.34, 0.57±0.35; IL-6 mRNA (2-ΔΔCt): 0.35±0.31 vs. 0.72±0.39, 0.59±0.42; IL-10 mRNA (2-ΔΔCt): 1.25±0.81 vs. 0.61±0.46, 0.82±0.53; all P < 0.05], but there was no significant difference in promoting the expression of IL-4 mRNA among three groups. At 60 minutes of resuscitation, compared with the low MAP group and the high MAP group, the middle MAP group could significantly inhibit the expressions of TNF-α, IL-6 and promote IL-10 [TNF-α mRNA (2-ΔΔCt): 0.72±0.35 vs. 1.05±0.54, 1.03±0.49; IL-6 mRNA (2-ΔΔCt): 0.57±0.50 vs. 1.27±0.72, 1.01±0.64; IL-10 mRNA (2-ΔΔCt): 1.41±0.90 vs. 0.81±0.48, 0.94±0.61; all P < 0.05]. Compared with the high MAP group, the middle MAP group had significant differences in promoting the expression of IL-4 mRNA (2-ΔΔCt: 1.32±0.62 vs. 0.91±0.60, P < 0.05). There was no significant difference in serum cytokine expressions at different time points of resuscitation between the low MAP group and the high MAP group (all P > 0.05). Correlation analysis showed that there was a strong linear correlation between MAP and mRNA expressions of TNF-α, IL-6, IL-10 in the middle MAP group (r value was 0.766, 0.719, 0.692, respectively, all P < 0.01), but had no correlation with IL-4 (r = 0.361, P = 0.059). Fitting linear regression analysis showed an increase in 1 mmHg per MAP, the expression of TNF-α mRNA increased by 0.027 [95% confidence interval (95%CI) = 0.023-0.031, P < 0.001], IL-6 mRNA increased by 0.021 (95%CI = 0.017-0.024, P < 0.001), and IL-10 mRNA increased by 0.049 (95%CI = 0.041-0.058, P < 0.001). Conclusions When patients with traumatic hemorrhagic shock received restrict fluid resuscitation at MAP of 65-70 mmHg, the effect of reducing systemic inflammatory response and improving hemodynamics is better than the target MAP at 60-65 mmHg or 70-75 mmHg. It is suggested that 65-70 mmHg may be an ideal target MAP level for restrictive fluid resuscitation.

Effect of mean arterial pressure on acute kidney injury in patients with septic shock / 中华急诊医学杂志

Objective To study the effect of mean arterial pressure (MAP) level on acute kidney injury (AKI) in patients with septic shock, and to determine the best resuscitation target MAP to prevent the occurrence or progression of sepsis- associated AKI.Methods The study subjects included 168 adult patients with septic shock (age≥65 years) who were admitted to the Department of Intensive Care Unit (ICU) of the First Hospital of Jilin University from January 2016 to January 2019. The clinical data of all enrolled patients were retrospectively analyzed. The baseline data were compared between the AKI group (n=111) and non-AKI group (n=57). Multivariate logistic regression analysis was used to determine the risk factors of AKI in patients with septic shock.Results ① The first, second, third, and forth quartile ofΔMAP (pre-resuscitation MAP minus post-resuscitation MAP) were -24.3-3.9 mmHg, 4.0-12.3 mmHg, 12.4-19.8 mmHg, and 19.9-43.5 mmHg, respectively. The second to fourth quartile interval wasΔMAP≥4 mmHg.② There were no significant differences in age, body mass index, sex, pre-resuscitation MAP, MAP at first hour, SOFA score, positive culture ratio, negative culture ratio, hypertension, peripheral vascular disease, cerebrovascular accident, chronic obstructive pulmonary disease, gastrointestinal ulcer, liver cirrhosis, and tumor between the two groups (P>0.05). There were significant differences in post-resuscitation MAP (P=0.01), APACHEⅡ score (P=0.02), diabetes mellitus (P=0.01), fluid balance (P=0.01), andΔMAP from the second to fourth quartile (P=0.03) between the two groups.③ΔMAP≥4 mmHg (OR=0.26, 95％CI: 0.12-0.57,P=0.01), diabetes (OR=6.03, 95％CI: 1.35-44.16,P=0.04), and high APACHEⅡ score (OR=0.96, 95％CI: 0.84-0.97,P=0.02) were closely related to the increased incidence of AKI in patients with septic shock. Post-resuscitation MAP and fluid balance had no significant effect on the incidence of AKI in patients with septic shock.Conclusions ΔMAP≥4 mmHg, APACHEⅡ score and diabetes were independent risk factors for the incidence of AKI in patients with septic shock. The incidence of AKI in septic shock patients with post-resuscitation MAP 4 mmHg or more lower than pre-resuscitation MAP is significantly increased.

Establishment of a non-venous bypass orthotopic liver transplantation model in Bama miniature pigs / 器官移植

Objective To establish a non-venous bypass orthotopic liver transplantation model in Bama miniature pigs with high repeatability and stability. Methods Twelve Bama miniature pigs were randomly divided into the donor group (n=6) and recipient group (n=6). Pigs underwent non-venous bypass orthotopic liver transplantation. The time of anhepatic phase during operation was shortened, blood pressure during anhepatic phase was stably maintained, and management of anesthesia and body fluid during operation were strengthened. The operation time, anhepatic phase and survival status of the recipients were observed and recorded. The intraoperative heart rate, mean arterial pressure (MAP) and changes in arterial blood gas analysis were monitored. The perioperative liver function was evaluated. Results Among 6 Bama miniature pigs, 1 died from transplantation failure intraoperatively. The operation time of the remaining 5 pigs was (247±27) min and the time of anhepatic phase was (46±4) min. Three animals survived for more than 2 weeks. Compared with the preanhepatic phase, the heart rate of the animals was significantly faster, MAP was considerably reduced to (46±6) mmHg, blood pH value, base excess (BE) and HCO3- level were all significantly decreased and serum level of K+ was significantly elevated during the anhepatic phase (all P < 0.05). In the neohepatic phase, MAP of Bama miniature pigs was significantly increased, heart rate was dramatically slower.Blood pH value, BE, HCO3- level were significantly increased and serum level of K+ was significantly declined (all P < 0.05). During abdominal closure, MAP, blood gas indexes and serum level of K+ were almost recovered to those in the preanhepatic phase. Compared with preoperative levels, the levels of alanine aminotransferase(ALT), aspartate aminotransferase(AST), lactate dehydrogenase(LDH)and alkaline phosphatase(ALP)were significantly increased after operation (all P < 0.05), the change in AST was the most obvious, and it gradually decreased at postoperative 2 d. The level of γ-gutamyl transferase(GGT) did not significantly elevated. The level of total bilirubin (TB) was evidently elevated at postoperative 5 d. Compared with the preoperative levels, the levels of total protein (TP) and albumin (ALB) were significantly decreased after operation (both P < 0.05), and began to gradually increase at postoperative 1 d. Conclusions The non-venous bypass orthotopic liver transplantation model of Bama miniature pig is convenient, with highly reproducible and survival rate, which can be utilized as a standardized liver transplantation model.