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1.
J. pediatr. (Rio J.) ; 98(1): 15-25, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1360558

ABSTRACT

Abstract Objectives: Dexmedetomidine (DEX) is a highly selective alpha-2 adrenergic receptor agonist, which is the main sedative in the intensive care unit. This study aims to investigate the effectiveness and adverse events of DEX in maintaining hemodynamic stability in pediatric cardiac surgery. Sources: Databases such as PubMed, Cochrane, Web of Science, WANFANG STATA and China National Knowledge Infrastructure were searched for articles about the application of DEX in maintaining hemodynamic stability during and after pediatric cardiac surgery up to 18th Feb. 2021. Only randomized controlled trials were included and random-effects model meta-analysis was applied to calculate the standardized mean deviation (SMD), odds ratio (OR) and 95% confidence interval (CI). Summary of the findings: Fifteen articles were included for this meta-analysis, and 9 articles for qualitative analysis. The results showed that preoperative prophylaxis and postoperative recovery of DEX in pediatric patients undergoing cardiac surgery were effective in maintaining systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP) and reducing heart rate (HR) (SBP: SMD = -0.35,95% CI: -0.72, 0.01; MAP: SMD = -0.83, 95% CI: -1.87,0.21; DBP: SMD = -0.79,95% CI: -1.66,0.08; HR: SMD = -1.71,95% CI: -2.29, -1.13). In addition, the frequency of Junctional Ectopic Tachycardia in the DEX treatment group was lower than that in the placebo group. Conclusions: The application of DEX for preoperative prophylaxis and postoperative recovery in pediatric cardiac surgery patients are effective in maintaining hemodynamic stability, and the clinical dose of DEX is not significantly related to the occurrence of pediatric adverse events which may be related to individual differences.


Subject(s)
Humans , Child , Dexmedetomidine/adverse effects , Cardiac Surgical Procedures/adverse effects , Blood Pressure , Hemodynamics , Hypnotics and Sedatives/adverse effects
2.
International Eye Science ; (12): 616-622, 2022.
Article in Chinese | WPRIM | ID: wpr-922863

ABSTRACT

@#AIM: To systematically evaluate the changes of hemodynamics, astigmatism and cytokines between travoprost and timolol in the treatment of primary open angle glaucoma(POAG)in Chinese adults.METHODS:Randomized controlled trials(RCTs)and cohort studies comparing the related efficacy of travoprost and timolol for POAG were retrieved from PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure(CNKI), Chinese Biomedical Literature Database(CBM), VIP database and Wanfang database. The search time was from January 1, 2015 to December 31, 2020. The literatures were screened according to the inclusion and exclusion criteria. After quality evaluation by Cochrane tools for RCTs and NOS scores for cohort studies, Review Manager 5.4 software was used for Meta-analyses to generate weighed-mean-difference(<i>WMD</i>)as effect size contrasting the efficacy of travoprost and timolol for the peak systolic velocity(PSV), the end diastolic velocity(EDV)and the resistance index(RI)of the central retinal artery(CRA)and the posterior ciliary artery(PCA), astigmatism, the plasma endothelin-1(ET-1), the serum matrix metalloproteinase(MMP), the tissue inhibitor of metalloproteinase-2(TIMP-2)of the aqueous humor and the serum TIMP-2. RESULTS:Totally 8 RCTs and 4 retrospective cohort studies were included with 1 192 patients.Meta-analysis showed that:compared with timolol group, the travoprost group had greater effect on increasing the PSV(<i>WMD</i>=2.40, 95%<i>CI</i>: 2.12-2.68, <i>P</i><0.00001; <i>WMD</i>=3.76, 95%<i>CI</i>: 3.30-4.22, <i>P</i><0.00001)and the EDV(<i>WMD</i>=0.81, 95%<i>CI</i>: 0.70-0.91, <i>P</i><0.00001; <i>WMD</i>=0.90, 95%<i>CI</i>: 0.72-1.09, <i>P</i><0.00001)of the CRA and the PCA as well as on decreasing the RI(<i>WMD</i>=-0.07, 95%<i>CI</i>: -0.10 to -0.04, <i>P</i><0.00001; <i>WMD</i>=-0.07, 95%<i>CI</i>: -0.08 to -0.05, <i>P</i><0.00001)of the CRA and the PCA; Travoprost was more effective in decreasing astigmatism(<i>WMD</i>=-1.34, 95%<i>CI</i>: -1.62 to -1.06, <i>P</i><0.00001); Compared with timolol, travoprost could significantly decrease the plasma ET-1(<i>WMD</i>=-5.14, 95%<i>CI</i>: -7.08 to -3.20, <i>P</i><0.00001)and the serum MMP(<i>WMD</i>=-12.48, 95%<i>CI</i>: -24.27 to -0.69, <i>P</i>=0.04), while no statistically significant differences were found in the TIMP-2 of the aqueous humor(<i>WMD</i>=-1.40, 95%<i>CI</i>: -5.51-2.71, <i>P</i>=0.51)and the serum TIMP-2(<i>WMD</i>=1.69, 95%<i>CI</i>: -30.03-33.41, <i>P</i>=0.92).CONCLUSION:Compared with timolol, travoprost was more effective in improving hemodynamic indexes and decreasing astigmatism in the treatment of POAG.

3.
Journal of Medical Biomechanics ; (6): E124-E130, 2022.
Article in Chinese | WPRIM | ID: wpr-920679

ABSTRACT

Objective To study the effect of morphological characteristics of modular inner branched stent graft (MIBSG) on hemodynamic performance of postoperative aortic arch based on parameterized MIBSG model. Methods The fluid-structure interaction model of blood-MIBSG coupling performance was solved, and the effects of stent branch angles, stent diameters on hemodynamic characteristics were analyzed. Results With the increase of angles between branch stent and aortic arch stent, blood flow within the branch decreased, but the stress and displacement increased. With the decrease of stent diameters, blood flow perfusion decreased significantly, but the stress and displacement increased first, and then decreased. Conclusions The morphological changes of MIBSG not only have an impact on blood perfusion rate of branch stent, but also affect the stress exerted on stent and the corresponding displacement. Before application in clinic treatment of aortic arch diseases, the movement and torsion of MIBSG should been taken into full account in operation plan according to the actual situation.

4.
Journal of Medical Biomechanics ; (6): E118-E123, 2022.
Article in Chinese | WPRIM | ID: wpr-920678

ABSTRACT

Objective To explore the hemodynamic characteristics in functional side-to-end (STE) anastomosis arteriovenous fistula (AVF) by computational fluid dynamics (CFD), so as to provide theoretical basis for clinical application of the AVF. Methods AVF models of functional STE anastomosis (STE group) and conventional STE anastomosis (cSTE group) were established. The hemodynamic parameters of models in two groups under retrograde and antegrade flow states were analyzed, including blood flow velocity, pressure drop, low wall shear stress area (LWSSA). Results Under retrograde flow, the total LWSSA in STE group was 5.70% lower than that in cSTE group, and the LWSSA on venous wall in STE group was 49.71% lower than that in cSTE group. Under antegrade flow, the total LWSSA in STE group was 6.97% greater than that in cSTE group, and the LWSSA on venous wall in STE group was 10.62% lower than that in cSTE group. Conclusions Under retrograde flow state, functional STE anastomosis can significantly decrease the LWSSA of AVF, while under antegrade flwo state, functional STE anastomosis has no significant impact on improving the LWSSA of AVF.

5.
Arq. bras. cardiol ; 118(2): 448-460, 2022. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1364325

ABSTRACT

Resumo Fundamentos Uma metodologia para identificação de pacientes portadores de aneurisma de aorta ascendente (AAAs) sob alto risco de remodelamento aórtico não está completamente definida. Objetivo Esta pesquisa objetiva caracterizar numericamente o fluxo sanguíneo aórtico, relacionando a distribuição do estresse mecânico resultante com o crescimento de AAAs. Métodos Estudo analítico, observacional, unicêntrico, em que um protocolo de fluidodinâmica computacional (CFD - Computacional Fluid Dynamics) foi aplicado a imagens de angiotomografia computadorizada (ATC) de aorta de pacientes portadores de AAAs. Duas ATC de aorta com pelo menos um ano de intervalo foram obtidas. Dados clínicos dos pacientes foram registrados e, a partir das imagens de ATC, foram gerados modelos tridimensionais. Foram realizados estudos do campo de velocidade e estruturas coerentes (vórtices) com o objetivo de relacioná-los ao crescimento ou não do aneurisma e, posteriormente, compará-los com os dados clínicos dos pacientes. O teste de Kolmogorov-Smirnov foi utilizado para avaliar a normalidade da amostra e o teste não-paramétrico Wilcoxon signed-rank foi aplicado para comparações de dados pareados entre os ângulos aórticos. A significância estatística foi fixada em 5%. Resultados Para o grupo que apresentou crescimento do aneurisma, a incidência do jato na parede aórtica gerou áreas de recirculação posterior ao jato, induzindo à formação de vórtices complexos, ocasionando um incremento na pressão média no endotélio aórtico. O grupo sem crescimento do aneurisma apresentou diminuição na pressão média. Conclusão Este estudo piloto mostrou que a CFD baseada em ATC pode, em um futuro próximo, ser uma ferramenta auxiliar na identificação dos padrões de fluxo associados ao processo de remodelamento de AAAs.


Abstract Background A methodology to identify patients with ascending aortic aneurysm (AsAA) under high risk for aortic growth is not completely defined Objetive This research seeks to numerically characterize the aortic blood flow by relating the resulting mechanical stress distribution with AsAA growth. Methods Analytical, observational, single-center study in which a computational fluid dynamics (CFD) protocol was applied to aortic computed tomography angiogram (CTA) images of patients with AsAA. Two CTA exams taken at a minimum interval of one year were obtained. From the CTA-gathered images, three-dimensional models were built, and clinical data were registered. Study of velocity field and coherent structures (vortices) was performed aiming to relate them to the presence or absence of aneurysm growth, as well as comparing them to the patients' clinical data. The Kolmogorov-Smirnov test was used to evaluate the normality of the distribution, and the non-parametric Wilcoxon signed-rank test, for non-normal distribution, was used to compare the paired data of the aortic angles. Statistical significance was set at 5%. Results The incident jet in the aortic wall generated recirculation areas in the posterior region of the jet, inducing complex vortices formation in the group with aneurysm growth, leading to an average pressure increase in the ascending aortic wall between exams. In the group without aneurysm growth, the average pressure decreased. Conclusion This pilot study showed that CFD based on CTA may in the near future be a tool to help identify flow patterns associated with AsAA remodeling process.


Subject(s)
Humans , Aortic Aneurysm/diagnostic imaging , Hydrodynamics , Aorta/diagnostic imaging , Pilot Projects , Hemodynamics/physiology
6.
J. pediatr. (Rio J.) ; 97(5): 564-570, Sept.-Oct. 2021. tab, graf
Article in English | LILACS | ID: biblio-1340152

ABSTRACT

Abstract Objective: To evaluate the influence of intra-abdominal pressure on the cardiac index (CI) at different intra-abdominal hypertension grades achieved when performing an abdominal compression maneuver (ACM). Evaluating the effectiveness of the ACM in distending the left internal jugular vein (LIJV). Methods: Prospective observational study conducted in the PICU of a quaternary care teaching hospital. Participants underwent the ACM and the IAP was measured with an indwelling urinary catheter. At each IAH grade reached during the ACM, the CI was measured by transthoracic echocardiography and the LIJV cross-sectional area (CSA) was determined by ultrasonography. Results: Twenty-four children were included (median age and weight of 3.5 months and 6.37 kg, respectively). The median CI observed at baseline and during IAH grades I, II, III, and IV were 3.65 L/min/m2 (IQR 3.12−4.03), 3.38 L/min/m2 (IQR 3.04−3.73), 3.16 L/min/m2 (IQR 2.70−3.53), 2.89 L/min/m2 (IQR 2.38−3.22), and 2.42 L/min/m2 (IQR 1.91−2.79), respectively. A 25% increase in the LIJV CSA area was achieved in 14 participants (58%) during the ACM. Conclusion: The ACM significantly increases IAP, causing severe reversible impairment in the cardiovascular system and is effective in distending the LIJV in just over half of the subjects. Even low levels of HIA can result in significant cardiac dysfunction in children. Therefore, health professionals should be aware of the negative hemodynamic repercussions caused by the increased IAP.


Subject(s)
Humans , Child , Critical Illness , Intra-Abdominal Hypertension , Prospective Studies , Ultrasonography , Hemodynamics
7.
Arq. neuropsiquiatr ; 79(8): 660-665, Aug. 2021. tab, graf
Article in English | LILACS | ID: biblio-1339227

ABSTRACT

ABSTRACT Background: The optimal blood pressure (BP) during mechanical thrombectomy for acute ischemic stroke is currently unclear. Objective: To investigate BP behavior during mechanical thrombectomy in patients with acute ischemic stroke and its relationship with drugs used for sedation or general anesthesia. Additionally, we investigated the association between BP oscillation during mechanical thrombectomy and recanalization status, and with functional outcome at discharge. Methods: Consecutive patients treated with mechanical thrombectomy for acute ischemic stroke were evaluated in a tertiary hospital from December/2009 to December/2015. Maximum, minimum, and mean systolic and diastolic BP, and mean arterial pressures were collected during the procedure. Sedative drugs were also reviewed. Results: Fifty-three patients with a mean age of 71.9 years (60.4% men) were treated with mechanical thrombectomy. The mean reduction in systolic BP and mean arterial pressure from hospital admission to mechanical thrombectomy were respectively 42 and 36 mmHg. During the procedure, oscillations were 50.4 mmHg for systolic, and 33.2 mmHg for diastolic BP. Patients treated with neuromuscular blocking drugs had more oscillation in systolic BP from hospital admission to procedure (51.1 versus 26.2 mmHg, P=0.06). The use of cisatracurium (43.9 versus 29.6 mmHg, P=0.02) and succinylcholine (44.7 versus 29.3 mmHg, P=0.01) were associated with a significant drop in BP during the procedure. Conclusions: Significant BP oscillation occurs during mechanical thrombectomy. Drugs used for conscious sedation or general anesthesia, specifically neuromuscular blocking agents, might have an influence upon BP levels.


RESUMO Antecedentes: Atualmente, a pressão arterial ideal durante a trombectomia mecânica em pacientes com acidente vascular cerebral isquêmico agudo não é clara. Objetivo: Investigar o comportamento da pressão arterial durante a trombectomia mecânica em pacientes com acidente vascular cerebral isquêmico agudo e sua relação com os medicamentos utilizados para sedação ou anestesia geral. Adicionalmente, investigar a associação entre a oscilação da pressão arterial durante a trombectomia mecânica e a capacidade de recanalização, além do status funcional no momento da alta hospitalar. Métodos: Avaliação de pacientes tratados com trombectomia mecânica por acidente vascular cerebral isquêmico agudo em um hospital terciário de dezembro/2009 a dezembro/2015. Valores máximos, mínimos e médios da pressão arterial sistólica, pressão diastólica e pressão arterial média foram coletados durante o procedimento. Drogas sedativas utilizadas também foram revisadas. Resultados: Um total de 53 pacientes com idade média de 71,9 anos (60,4% homens) foram tratados com trombectomia mecânica. A redução média da pressão arterial sistólica e da pressão arterial média desde a internação até a trombectomia mecânica foi respectivamente de 42 mmHg e 36 mmHg. Durante o procedimento, as oscilações da pressão arterial foram de 50,4 mmHg para pressão sistólica e 33,2 mmHg para pressão diastólica. Os pacientes tratados com bloqueadores neuromusculares apresentaram uma tendência a maior oscilação da pressão arterial sistólica desde a internação até o procedimento (51,1 mmHg versus 26,2 mmHg, P = 0,06). O uso de cisatracúrio (43,9 mmHg versus 29,6 mmHg, P = 0,02) e succinilcolina (44,7 mmHg versus 29,3 mmHg, P = 0,01) foram associados a uma queda significativa da pressão arterial durante o procedimento. Conclusões: Durante a trombectomia mecânica ocorre oscilação significativa da pressão arterial. Os medicamentos usados para sedação consciente ou anestesia geral, especificamente bloqueadores neuromusculares, podem ter influência nos níveis de pressão arterial.


Subject(s)
Humans , Male , Female , Aged , Pharmaceutical Preparations , Brain Ischemia , Stroke/drug therapy , Blood Pressure , Conscious Sedation , Treatment Outcome , Thrombectomy , Anesthesia, General
8.
Revista Pesquisa em Fisioterapia ; 11(4): 730-737, 20210802. tab
Article in English, Portuguese | LILACS-Express | LILACS | ID: biblio-1349049

ABSTRACT

| INTRODUÇÃO: As repercussões cardiorrespiratórias da cirurgia cardíaca podem ser avaliadas por teste submáximo. OBJETIVO: comparar as respostas cardiorrespiratórias do teste de sentar e levantar em um minuto (TSL1) nos indivíduos, entre o momento pré e pós de cirurgia cardíaca. MÉTODOS: Estudo de caráter transversal e analítico, incluiu 45 indivíduos de ambos os sexos, estáveis hemodinamicamente, com fração de ejeção maior que 45%, que foram submetidos à cirurgia de revascularização do miocárdio no Instituto do Coração de um Hospital do interior do estado do Rio Grande do Sul, entre 2018 e 2019. As variáveis de desfechos foram coletadas no repouso e ao final do teste, um dia antes da cirurgia e no pós-operatório: pressão arterial sistólica e diastólica (PAS e PAD em mmHg), frequência cardíaca (FC bpm), frequência respiratória (FR rpm), saturação periférica de oxigênio (SpO2 %), fadiga de membros inferiores (Fmm 0-10) e dispneia (Di 0-10), número de repetições e interrupções do teste. Foi utilizado o programa R para o tratamento dos dados, para avaliar a normalidade foi aplicado o teste de Shapiro Wilk, a comparação dos grupos pelo teste não paramétrico de Wilcoxon. RESULTADOS: A maioria do sexo masculino (71%) e média de idade foi de 61± 9 anos. No pré-operatório, ocorreu aumento entre o repouso e o final do teste, PAS, FC, FR, Fmm e Di (p<0,05). No pós-operatório, houve aumento entre o repouso e o final do teste, para FC, FR, Fmm e Di (P<0,05), contudo, sem elevação da PAS. Ao comparar as variáveis entre os momentos pré e pós, observamos maiores valores da FC, FR e número de interrupções na condição pós (p<0,05), bem como menores valores para a PAS, SpO2 e número de repetições (p<0,05) para essa condição. CONCLUSÃO: Os dados desta pesquisa comprovam que o TSL1 realizado no pré-operatório de cirurgia cardíaca, assim como entre o 4° ou 5° dia de pós-cirurgia cardíaca, é seguro e eficaz, representado pela ausência das repercussões cardiorrespiratórias que comprometessem ou agravassem o quadro clínico do paciente. O TSL1 foi capaz de induzir respostas cardiorrespiratórias fisiológicas no pré-operatório; contudo, na condição pós acarretou respostas cardiorrespiratórias mais elevadas no repouso e atenuada resposta em exercício em comparação ao pré-operatório.


INTRODUCTION: The cardiorespiratory repercussions of heart surgery can be assessed through submaximal testing. OBJECTIVE: Compare cardiorespiratory responses to the one-minute sit-and-stand test in individuals pre- and post-heart surgery. METHODS: An analytical, cross-sectional study was conducted involving 45 hemodynamically stable male and female patients with an ejection fraction greater than 45% submitted to coronary artery bypass surgery at a cardiology service of a hospital in the interior of the state of REDACTED between 2018 and 2019. The following variables were collected at rest and the end of the test one day before surgery and postoperatively: systolic and diastolic blood pressure (SBP and DBP, mmHg), heart rate (HR, bpm), respiratory rate (RR, rpm), peripheral saturation oxygen (SpO2, %), lower limb fatigue (LLF, 0-10), dyspnea (0-10), number of test repetitions and number of interruptions. The R program was used to process the data. The Shapiro-Wilk test was used for the determination of normality. The groups were compared using the non-parametric Wilcoxon test. RESULTS: Most participants were male (71%), and the mean age was 61±9 years. In the preoperative period, statistically significant increases (p≤0.05) were found for SBP, HR, RR, LLF, and dyspnea between resting values and the end of the test. Significant increases (p≤0.05) were found in the postoperative period for HR, RR, LLF, and dyspnea between rest and the end of the test, with no increase in SBP. Comparing the preoperative and postoperative evaluations variables, higher HR, RR, the number of interruptions and lower SBP, SpO2, and the number of repetitions were found after surgery (p≤0.05). CONCLUSION: The one-minute sit-to-stand test induced physiological cardiorespiratory responses in the preoperative evaluation. However, higher cardiorespiratory responses at rest and an attenuated response to exercise were found in the postoperative evaluation compared to the preoperative evaluation.

9.
Arq. bras. med. vet. zootec. (Online) ; 73(2): 383-394, Mar.-Apr. 2021. graf, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1248923

ABSTRACT

This study used B-mode and Doppler ultrasonography to characterize the abdominal structures of healthy peccaries raised in captivity. Fifteen peccaries were used for this study. The urinary vesicle appeared as an ovoid structure, located in the abdominal and pelvic transition, with a hyperechogenic, thin, smooth, and regular wall. The kidneys presented retroperitoneal topography and had similar sizes. The kidney/aorta ratio had an average value of 10.53±15cm (right) and 10.23±0.12 (left). The right adrenal gland had a length of 1.93±0.34cm and diameter of 0.56±0.16cm. The left adrenal gland had a length of 1.85±0.42cm and diameter of 0.52±0.11cm. The spleen had a diameter of 1.13±0.18cm. The hepatic vein demonstrated polyphasic flow in pulsed Doppler, with two retrograde peaks and an anterograde peak with a flow velocity of 25.7±0.83cm/s. The abdominal aorta had a diameter of 0.58±0.05cm and a flow velocity of 115.17±5.32cm/s. The morphological and hemodynamic study of the abdominal structures of the peccary, observed through B-mode and Doppler ultrasonography, aided in identifying the size, shape, position, echogenicity, and echotexture of the abdominal organs and in making inferences about the normal parameters for these structures in this species.(AU)


Este estudo teve como objetivo utilizar as ultrassonografias de modo-B e Doppler para caracterizar as estruturas abdominais de um cateto sadio criado em cativeiro. Quinze catetos foram utilizados para este estudo. A vesícula urinária apareceu como uma estrutura ovoide, localizada na transição entre as partes abdominal e pélvica, com uma parede hiperecogênica, fina, lisa e regular. Os rins apresentaram topografia retroperitoneal e tamanhos semelhantes. A relação rim/aorta teve um valor médio de 10,53 ± 15cm (direita) e 10,23 ± 0,12cm (esquerda). A glândula adrenal direita tinha um comprimento de 1,93 ± 0,34cm e um diâmetro de 0,56 ± 0,16cm. A glândula suprarrenal esquerda tinha um comprimento de 1,85 ± 0,42cm e um diâmetro de 0,52 ± 0,11cm. O baço tinha um diâmetro de 1,13 ± 0,18cm. A veia hepática demonstrou fluxo polifásico no Doppler pulsátil, com dois picos retrógrados e um pico anterógrado com velocidade de fluxo de 25,7±0,83cm/s. A aorta abdominal tinha um diâmetro de 0,58 ± 0,05cm e uma velocidade de fluxo de 115,17±5,32cm/s. Os estudos morfológico e hemodinâmico das estruturas abdominais do queixada, observadas por meio das ultrassonografias modo-B e Doppler, auxiliaram na identificação do tamanho, da forma, da posição, da ecogenicidade e da ecotextura dos órgãos abdominais e na realização de inferências sobre os parâmetros de normalidade para as estruturas nas espécies.(AU)


Subject(s)
Animals , Artiodactyla/anatomy & histology , Abdomen/diagnostic imaging , Hemodynamics , Echocardiography, Doppler/veterinary , Ultrasonography, Doppler/veterinary
10.
Medicentro (Villa Clara) ; 25(1): 38-49, ene.-mar. 2021. tab
Article in Spanish | LILACS | ID: biblio-1287181

ABSTRACT

RESUMEN Introducción: la ecocardiografía ha significado una de las más espectaculares revoluciones en el campo de las ciencias médicas de los últimos cien años. Objetivo: describir algunas indicaciones del ecocardiograma transtorácico en enfermos críticos así como de los cambios terapéuticos inducidos por su resultado. Métodos: se realizó un estudio descriptivo y transversal, entre el 1 de noviembre de 2018 hasta el 31 de enero de 2020 en los servicios de emergencia del Hospital Docente Clínico-Quirúrgico Joaquín Albarrán, en la provincia de La Habana, Cuba. El universo de estudio estuvo constituido por los pacientes (89 en total) que arribaron al servicio de emergencia con inestabilidad hemodinámica en el período señalado; a todos se les realizó un ecocardiograma transtorácico. Resultados: se realizaron 106 ecocardiogramas transtorácicos, y la mayor parte de los pacientes presentaron enfermedades clínicas. En el 100 % de los pacientes fue posible adquirir imágenes útiles para el diagnóstico. En promedio, fueron utilizadas 1,9±1 ventanas acústicas por pacientes; después de la realización del ecocardiograma se realizaron 44 modificaciones terapéuticas (41,5 %). Los cambios más importantes estuvieron relacionados con el aporte de fluidos y el uso de dobutamina. Conclusiones: el ecocardiograma transtorácico, en el contexto de la emergencia, puede ofrecer información clave que conlleve a cambios importantes en la terapéutica.


ABSTRACT Introduction: echocardiography has meant one of the most spectacular revolutions in the field of medical sciences in the last hundred years. Objective: to describe some indications of the transthoracic echocardiography in critically ill patients as well as the therapeutic changes induced by its result. Methods: a descriptive and cross-sectional study was carried out between November 1, 2018 and January 31, 2020 in the emergency services at "Joaquín Albarrán" Clinical and Surgical Teaching Hospital, Havana province, Cuba. The study universe consisted of patients (89 in total) who arrived at the emergency service with hemodynamic instability in the indicated period; all underwent a transthoracic echocardiography. Results: 106 transthoracic echocardiograms were performed, and most of the patients had clinical diseases. It was possible to acquire useful images for the diagnosis in 100% of the patients. On average, 1.9 ± 1 acoustic windows were used per patient; 44 therapeutic modifications were made (41.5%) after performing the echocardiogram. The most important changes were related to fluid intake and the use of dobutamine. Conclusions: the transthoracic echocardiography, in the emergency context, can offer key information that leads to important changes in therapy.


Subject(s)
Echocardiography , Hemodynamics
11.
Int. j. cardiovasc. sci. (Impr.) ; 34(1): 74-80, Jan.-Feb. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1154526

ABSTRACT

Abstract Background Aromatherapy consists in the use of volatile aromatic compounds of plant essential oils. Application methods include massage, baths, and mainly inhalation. Lavender essential oil is considered the most effective treatment for emotional disorders, such as stress and anxiety, due to its anxiolytic and sedative agents, which are known to interfere with physiological cardiovascular reactions. Objectives To investigate the effects of aromatherapy using lavender essential oil on hemodynamic responses and emotional aspects of patients with cardiovascular diseases. Methods A systematic review was conducted using Embase, Bireme, MEDLINE, PEDro, and Scopus electronic databases. Randomized clinical trials that evaluated hemodynamic and emotional outcomes using interventions with lavender essential oil in patients with cardiovascular diseases were selected. Of 539 studies initially identified, 51 were read in full and only 5 were eligible for inclusion. Results Reductions were demonstrated in hemodynamic responses, such as systolic and diastolic blood pressure, mean arterial pressure, and heart rate, as well as a decrease in anxiety, depression, stress, and fatigue compared with the control group. Statistical significance was set at p<0.05. Conclusion: Aromatherapy with the use of lavender essential oil provided benefits to hemodynamic parameters, such as anxiety, stress, depression, and fatigue levels, in patients with cardiovascular diseases. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

12.
Article in Chinese | WPRIM | ID: wpr-910119

ABSTRACT

Objective:To explore the changes of biparietal diameter, head circumference and cerebrovascular hemodynamics in fetuses with hypoplastic left heart syndrome (HLHS) during middle pregnancy.Methods:The biparietal diameter, head circumference, middle cerebral artery pulsatility index (MCA-PI), umbilical artery pulsatility index (UA-PI) and MCA-PI/UA-PI (CPR) of 41 fetuses with HLHS(HLHS group) were retrospectively analyzed from January 2015 to December 2019 in Beijing Anzhen Hospital, and were compared with those of 82 normal fetuses matched for gestational age at the same period (control group).Results:The Z-scores of head circumference, MCA-PI and CPR in with HLHS group were lower than in control group(all P<0.05); Head circumference in HLHS group were weakly and positively correlated with the MCA-PI and CPR ( r=0.385, 0.416; all P<0.05). Conclusions:There are some changes in the head circumference and cerebral hemodynamics in fetuses with HLHS during mid-gestational age, and the head circumference is weakly and positively correlated with MCA-PI and CPR, which has clinical significance.

13.
Article in Chinese | WPRIM | ID: wpr-909181

ABSTRACT

Objective:To investigate the effects of fluid resuscitation under pulse-indicated continuous cardiac output monitoring on endothelial function, inflammatory indexes and hemodynamics in patients with traumatic shock.Methods:The clinical data of 62 patients with traumatic shock who received treatment in the First Affiliated Hospital of Zhejiang Chinese Medical University, China between July 2019 and July 2020 were retrospectively analyzed. These patients were divided into observation and control groups ( n = 31/group) according to different fluid resuscitation methods. The control group was given conventional fluid resuscitation and the observation group was subjected to guided fluid resuscitation under pulse-indicated continuous cardiac output monitoring. General treatment and nitric oxide, endothelin-1, C-reactive protein, interleukin-6, interleukin-1β, tumor necrosis factor-α, central venous pressure, mean arterial pressure, and central venous oxygen saturation before and 24 hours after treatment as well as complications were compared between the two groups. Results:Time to early resuscitation, duration of mechanical ventilation, intensive care unit length of stay and the length of hospital stay in the observation group were (5.33 ± 0.51) hours, (37.45 ± 4.84) hours, (8.75 ± 1.20) days, (16.85 ± 2.03) days, respectively, which were significantly shorter than those in the control group [(8.14 ± 1.20) hours, (46.06 ± 4.71) hours, (11.46 ± 1.63) days, (20.01 ± 2.41) days, t = 11.999, 7.098, 7.455, 5.584, all P < 0.01). At 24 hours after treatment, serum level of nitric oxide in the observation group was significantly higher than that in the control group [(52.04 ± 3.91) μmol/L vs. (40.25 ± 4.25) μmol/L, t = 11.367, P < 0.01]. Serum level of endothelin-1 in the observation group was significantly lower than that in the control group [(66.95 ± 4.75) ng/L vs. (78.04 ± 7.92) ng/L, t = 6.686, P < 0.01)]. Serum levels of C-reactive protein, interleukin-6, interleukin-1β, tumor necrosis factor-α in the observation group were (8.32 ± 1.56) mg/L, (113.03 ± 15.74) ng/L, (69.82 ± 6.50) ng/L, (42.80 ± 4.32) ng/L, respectively, which were significantly lower than those in the control group [(11.61 ± 1.74) mg/L, (130.42 ± 20.68) ng/L, (81.33 ± 7.30) ng/L, (56.11 ± 6.36) ng/L, t = 7.838, 3.726, 6.556, 9.639, all P < 0.01)]. Mean arterial pressure, central venous pressure and central venous oxygen saturation in the observation group were (76.64 ± 5.05) mmHg, (10.79 ± 0.53) mmHg, (79.93 ± 5.04) %, respectively, which were significantly higher than those in the control group [(70.32 ± 4.31) mmHg, (9.50 ± 0.62) mmHg, (73.40 ± 4.76) %, t = 5.300, 8.806, 5.245, all P < 0.01]. The incidence of complications in the observation group was significantly lower than that in the control group [9.68% (10/31) vs. 32.26% (8/31), χ2 = 4.769, P < 0.05]. Conclusion:Fluid resuscitation under pulse-indicated continuous cardiac output monitoring has an obvious effect traumatic shock, which can improve vascular endothelial function, inflammatory index and hemodynamic index, and is worthy of popularization and application.

14.
Article in Chinese | WPRIM | ID: wpr-909179

ABSTRACT

Objective:To investigate the effects of dexmedetomidine on hemodynamics, quality of recovery from anesthesia and postoperative analgesia in children patients with hernia subjected to laparoscopic hernia repair.Methods:A total of 120 children patients who received laparoscopic hernia repair in Shangyu Maternal and Child Health Hospital from March 2019 to March 2020 were included in this study. They were randomly assigned to receive anesthesia maintenance with either inhaled sevoflurane (control group, n = 60) or intravenous dexmedetomidine hydrochloride (observation group, n = 60). The hemodynamic changes at different time points [5 minutes before skin incision (T0), 5 minutes after skin incision (T1) and 15 minutes after skin incision (T2)] were compared between the control and observation groups. Time to extubation, time to recovery from anesthesia, time to wake up, occurrence of agitation, and duration of agitation were compared between the two groups. Visual Analogue Scale score at 3, 12 and 24 hours after surgery were compared between the control and observation groups. Results:Mean arterial pressure and heart rate measured at T1 in the observation group were (72.01 ± 1.64) mmHg and (136.42 ± 3.20) beats/minute, respectively, which were significantly lower than those in the control group [(76.31 ± 1.89) mmHg and (143.21 ± 3.45) beats/minute, t = 13.311, 11.177, both P < 0.05]. Mean arterial pressure and heart rate measured at T2 in the observation group were (69.32 ± 1.36) mmHg and (130.02 ± 2.61) beats/minute, respectively, which were significantly lower than those in the control group [(72.02 ± 1.86) mmHg, (134.09 ± 3.26) beats/minute, t = 9.077, 7.549, both P < 0.05]. Time to extubation, time to recovery from anesthesia, and time to wake up in the observation group were (7.15 ± 0.89) minutes, (10.36 ± 1.74) minutes, (26.76 ± 8.32) minutes, respectively, which were significantly shorter than those in the control group [(9.20 ± 1.43) minutes, (8.23 ± 1.56) minutes, (39.42 ± 12.15) minutes, t = 9.428, 7.060, 6.659, P < 0.05]. The incidence of agitation in the observation group was significantly lower than that in the control group [10.00% (6/15) vs. 25.00% (15/60), χ2= 4.675, P < 0.05)]. Duration of agitation in the observation group was significantly shorter than that in the control group [(6.75 ± 1.32) minutes vs. (10.85 ± 2.14) minutes, t = 12.631, P < 0.05]. At 3, 12 and 24 hours after surgery, Visual Analogue Scale score in the observation group was (2.15 ± 0.34) points, (1.45 ± 0.38) points and (1.08 ± 0.26) points, respectively, which were significantly lower than that in the control group [(3.24 ± 0.53) points, (2.16 ± 0.39) points, (1.54 ± 0.32) points, t = 13.409, 10.100, 8.642, all P < 0.05]. Conclusion:Dexmedetomidine hydrochloride has little effect on hemodynamics during surgery in children patients with hernia subjected to laparoscopic hernia repair, with fast recovery from anesthesia, a low incidence of agitation, and obvious postoperative analgesia.

15.
Article in Chinese | WPRIM | ID: wpr-908820

ABSTRACT

Hemodynamics is a branch of fluid mechanics, which mainly studies the physiological process of circulatory system from the perspective of mechanics, and has a wide range of applications in medicine. The entity teaching model is made to help medical students master the knowledge of hemodynamics more easily and intuitively by showing them the phenomenon of laminar flow, turbulence and axial concentration of red blood cells. And then we check their learning effect by questionnaires. Students are interested in the entity teaching model that the teacher has used in the class. Thus, the entity teaching model can play an important role in the teaching process.

16.
Article in Chinese | WPRIM | ID: wpr-908703

ABSTRACT

Objective:To observe the clinical efficacy of levosimendan in the treatment of patients with acute myocardial infarction (AMI) combined with cardiogenic shock (CS) and its effects on monitoring hemodynamic parameters of pulse index continuous cardiac output (PICCO).Methods:One hundred and six patients with AMI combined with CS admitted and treated in Jiaxing Second Hospital from June 2017 to December 2019 were divided into the control group and observation group according to the random number table method , with 53 cases in each group. The control group received routine comprehensive intervention, while the observation group received levosimendan treatment based on the control group. In observation group, 12 μg/kg of levosimendan was administered intravenously within 10 min, then, 0.1 μg/(kg·min) was administered intravenously and continued for 24 h. In control group, 5% glucose injection was administered intravenously, and the intravenous infusion rate and time was same as that in observation group. Both groups were treated for 24 h. PICCO was used to monitor the hemodynamic parameters , including heart rate (HR), central venous pressure (CVP), cardiac index (CI), global end-diastolic volume index (GEDVI) and extravascular lung water index (EVLWI) before and after the treatment; the neurohumoral indexes including norepinephrine (NE), angiotensinⅡ(AngⅡ); cardiac function indexes including stroke volume (SV), left ventricular ejection fraction (LVEF), and the efficacy and complications were observed and compared between two groups.Results:After 24 h of treatment, the levels of HR, CVP, GEDVI, EVLWI in two groups were decreased, and the levels of above index in the observation group were lower than those in the control group: (90.26 ± 12.61) beats/min vs. (97.82 ± 12.58) beats/min, (9.85 ± 1.14) cmH 2O (1 cmH 2O = 0.098 kPa) vs. (11.63 ± 1.37) cmH 2O, (759.53 ± 62.47) ml/m 2 vs. (867.21 ± 63.24) ml/m 2, (7.95 ± 1.56) ml/kg vs. (9.01 ± 1.78) ml/kg; after treatment the level of CI in the observation group was higher than that in the control group: (3.58 ± 0.74) L/(min·m 2) vs. (2.37 ± 0.86) L/(min·m 2), and the differences were statistically significant ( P<0.05). After 24 h of treatment, the levels of NE and AngⅡ in two groups was decreased, and the levels of NE and AngⅡ in the observation were lower than those in the control group: (60.42 ± 5.93) ml vs. (54.42 ± 6.14) ml, (41.62 ± 4.19)% vs. (36.87 ± 4.36)%, and the differences were statistically significant ( P<0.05). After 24 h of treatment, the time of intra-aortic balloon counterpulsation (IABP) in the observation was shorter than that in the control group: (61.52 ± 15.41) h vs. (89.56 ± 17.63) h; the injury rate of renal functions in the observation was lower than that in the control group: 3.77%(2/53) vs. 18.87%(10/53), and the differences were statistically significant ( P<0.05). There was no significant difference in mortality and other complications after 30 d of follow-up between two groups ( P>0.05). Conclusions:Levosimengdan can significantly improve the PICCO hemodynamics, neurohumoral indexes and cardiac function indexes of patients with AMI and CS. It has a protective effect on the kidneys of patients, but it cannot significantly improve the 30-day mortality rate of patients.

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Article in Chinese | WPRIM | ID: wpr-908673

ABSTRACT

Objective:To study the effect of different sufentanil doses on hemodynamics and interleukin (IL)-6 in children with ventricular septal defect repair (VSDR).Methods:A total of 96 children who underwent VSDR surgery in Three Gorges Hospital Affiliated to Chongqing University from January 2016 to June 2019 were selected. Children with VSDR were enrolled and divided into A group (0.8 μg/kg), B group (1.0 μg/kg) and C group (1.1 μg/kg) according their sufentanil doses. The heart rate (HR), contraction pressure (SBP), the brain electric double frequency index (BIS) and IL-6 in different time were studied and compared. The adverse cardiovascular events and other indicators were studied and compared.Results:At t 2 to t 6, there were significant difference among the three groups in HR, A group: (104.62 ± 10.58), (128.73 ± 13.29), (127.59 ± 13.53), (125.62 ± 12.60) and (118.49 ± 11.62) times/min, B group: (100.27 ± 10.11), (119.33 ± 12.62), (116.57 ± 11.40), (113.57 ± 11.94) and (113.37 ± 11.46) times/min, C group: (87.92 ± 8.87), (98.62 ± 9.69), (94.42 ± 9.38), (88.72 ± 8.62) and (89.36 ± 9.17) times/min; SBP, A group: (79.54 ± 7.59), (102.75 ± 10.62), (90.62 ± 9.52), (85.19 ± 8.62) and (83.98 ± 8.62) mmHg (1 mmHg = 0.133 kPa), B group: (76.74 ± 7.28), (90.45 ± 9.57), (87.38 ± 8.51), (84.72 ± 8.50) and (83.77 ± 8.58) mmHg, C group: (70.62 ± 7.27), (75.62 ± 7.83), (72.69 ± 7.80), (71.28 ± 7.43) and (71.39 ±7.16) mmHg, P<0.05. At t 2 to t 4, there were significant differences among the three groups in BIS, A group: 48.64 ± 5.03, 53.58 ± 5.71 and 59.61 ± 5.87, B group: 48.79 ± 5.12, 50.23 ± 5.24 and 57.75 ± 5.66, C group: 43.59 ± 4.62, 50.31 ± 5.34, 55.26 ± 5.53, P<0.05. At T 2 to T 6, there was a significant difference among the three groups in IL-6, A group: (0.41 ± 0.06), (0.49 ± 0.11), (0.53 ± 0.13), (0.82 ± 0.17) and (0.61 ± 0.15) μg/L, B group: (0.38 ± 0.05), (0.42 ± 0.08), (0.46 ± 0.09), (0.75 ± 0.14) and (0.53 ± 0.12) μg/L, C group: (0.35 ± 0.05), (0.40 ± 0.06), (0.43 ± 0.07), (0.72 ± 0.12) and (0.51 ± 0.11) μg/L, P<0.05. Compared with that in A group and C group, HR, SBP and BIS in B group had relatively low volatility. At T 2 to T 6, IL-6 level in A group was significantly higher than that in B group and C group, and there was a statistically significant difference ( P<0.05). The incidence of cardiovascular adverse events in A group and C group was significantly higher than that in B group, and there was statistical difference ( P<0.05). Conclusions:1.0 μg/kg sufentanil can have less effect on hemodynamics and IL-6 in children with VSDR with less adverse cardiovascular events and other indicators.

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Article in Chinese | WPRIM | ID: wpr-908485

ABSTRACT

Cirrhotic portal hypertension refers to a series of syndroms characterized by structural abnormality and dysfunction of hepatic sinusoid caused by chronic liver injury and obstructing portal-systemic blood flow, resulting in gradually increased portal venous system pressure as clinical manifestations. Increased intrahepatic resistance and portal venous system blood flow are main causes for cirrhotic portal hypertension. The structural abnormality and dysfunction of hepatic sinusoid cause not only increased intrahepatic resistance, but also substance exchange barriers between hepatic sinusoidal blood and hepatocytes, resulting in splanchnic artery dilation and increased blood flow and pressure of portal venous system. Dysfunction of splanchnic hemodynamic is an important factor for hyperdynamic circulation in cirrhotic portal hypertension. As the disease progresses, cirrhotic portal hypertension can continuously promote the activation of hyperdynamic circulation, which in turn can accelerate the development of cirrhotic portal hyperten-sion. This vicious circle is the main reason for the irreversible and untreatable end-stage liver disease. The authors review the pathophysiological mechanisms of cirrhotic portal hypertension, splanchnic hemodynamic dysfunction and hyperdynamic circulation.

19.
Article in Chinese | WPRIM | ID: wpr-907992

ABSTRACT

Objective:To assess the left ventricular function and hemodynamic status in infantile pneumonia by ultrasonic cardiac output monitor (USCOM).Methods:The clinical data of 74 children with infantile pneumonia hospitalized in the Department of Pediatrics of Affiliated Hospital of North Sichuan Medical College from October 2018 to January 2020 were collected in this study, and those cases were divided into the mild pneumonia group (45 cases) and the severe pneumonia group (29 cases). USCOM was employed to measure such data of patients in both groups as heart rate (HR), flow time corrected (FTc), stroke volume variability (SVV), stroke volume index (SVI), cardiac index (CI), inotropy index(INO), and systemic vascular resistance index (SVRI). The specific values of CI and SVRI in all ages were employed to determine the hemodynamic type.According to values of CI, they were grouped into normal, high and low output; according to values of SVRI, they were grouped into normal, high and low resistance.The left ventricular function and hemodynamic status of infants with pneumonia in both groups were compared.Results:(1) In the mild pneumonia group, 42.22% of infants (19/45 cases) presented with abnormal hemodynamic status, of which 94.74% were high-output and low-resistance type.In the severe pneumonia group, 79.31%(23/29 cases) of infants presented with abnormal hemodynamic status, of which 86.96%(20/23 cases) were non-high-output and non-low-resistance type.The proportion of different hemodynamic types from high to low in order is as follows: low-output and high-resistance (39.13%), high-output and normal-resistance (26.09%), low-output and low-resistance (13.04%), and normal-output and low-resistance (8.70%). (2)Before treatment, HR, SVI, CI, INO and SVRI in the severe pneumonia group and the mild pneumonia group were (153.2±19.3) times/min, (32.0±5.8) mL/m 2, (4.3±1.0) L/(min·m 2), (1.1±0.4) W/m 2, (1 139.0±280.6) d·s·cm -5·m 2 and(140.2±13.2) times/min, (39.2±4.1) mL/m 2, (5.1±0.8) L/(min·m 2), (1.4±0.2) W/m 2, and (904.7±175.8) d·s·cm -5·m 2, respectively.SVI, CI and INO in the severe pneumonia group were lower than those in the mild pneumonia group, which indicated that the difference was statically significant (all P<0.05). HR and SVRI in the severe pneumonia group were higher than those in the mild pneumonia group, which indicated that the difference was statically significant (all P<0.05). There was no significant difference in cardiac preload between both groups before treatment ( P>0.05). HR in the severe pneumonia group after treatment[(137.6±9.3) times/min] were significantly lower than before treatment, while SVI and CI[(36.2±3.4) mL/m 2, (4.7±0.3)L/(min·m 2)] were higher than before treatment, which indicated that the differences were statistically significant (all P<0.05). Conclusions:The USCOM provided a rapid approach for the dynamic measurement of left ventricular function and hemodynamic status.As per the findings with USCOM, more infants with mild pneumonia presented with hemodynamic abnormalities, and most of them were high-output and low-resistance types.The majority of infants with severe pneumonia presented with different types of hemodynamic abnormalities, and most of them were non-high-output and non-low-resistance types, which can return to normal after treatment.

20.
Article in Chinese | WPRIM | ID: wpr-907643

ABSTRACT

Objective:To study on the effects of gastrointestinal function and portal vein hemodynamics applicated with abdominal hot compressing with evodiae fructus and crude salt after hepatectomy.Methods:A total of 60 patients who underwent hepatectomy were randomly divided into 2 groups by random number table method, with 30 in each group. The control group was treated with conventional basic western medicine, while the treatment group was treated with medicinal evodiae fructus and crude salt hot compress on abdomen on the basis of the control group. The portal vein diameter (PVD), portal venous flow velocity (PVV), recovery time of main clinical indexes, clinical symptom scores and liver function indexes were dynamically monitored at different observation time points.Results:The scores of abdominal distension, nausea and vomiting in the treatment group were significantly lower than those in the control group 3 days after treatment ( t values were -3.489 and -2.740, respectively, all Ps<0.05). The recovery time of bowel sounds, first exhaust time and first defecation time in the treatment group were significantly earlier than those in the control group ( t values were -3.622, -4.297 and -4.151, respectively, all Ps<0.01). With the extension of treatment time, ALT in 2 groups showed a gradual downward trend ( P<0.05 or P<0.01), DBIL in control group was significantly higher at 3 days after treatment than before ( t=-2.157, P=0.039), and TBIL was significantly lower at 7 days after treatment than before ( t=2.175, P=0.038). The PVD ( t values were 3.528, 2.160) and PVV ( t values were 11.096, 4.264) of the treatment group were significantly higher than those of the control group 3 and 5 days after treatment ( P<0.01 or P<0.05). Conclusion:Early application of abdominal hot compressing with evodiae fructus and crude salt hot compress on abdomen after hepatectomy can improve the portal vein blood circulation and promote the rehabilitation of gastrointestinal function in patients with hepatectomy.

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