An Application of Norepinephrine in Renal Transplantation Guided by Hemodynamic Monitoring / 昆明医科大学学报

Objective To investigate the use of noradrenaline under different monitoring methods in renal transplantation and its clinical significance in prognosis. Methods 40 patients under the surgery of renal allograft were randomly divided into two groups (20 patients each): Flotrac-vigileo group (E) and the standard monitoring group (N), then we recorded MAP (mean arterial pressure), CVP (central venous pressure) and HR (heart rate) value divided by 5 periods: after induction of general anesthesia (T1), before operation (T2), external iliac vein occlusion (T3), external iliac vein opening (T4) and the end of operation (T5).Meanwhile, intraoperative norepinephrine dosage, intake and output volumnand renal function indicators during postoperative and after three days were also studies. Length of hospital stay were also compared in this essay.Results The amount of norepinephrine in group E during operation was significantly lower than that in group N (P＜0.05). The urine volume in group E during operation was significantly higher than that in group N (P＜0.05). There was no significant difference between the two groups in the amount of transfusion, blood loss and the indexes of kidney function. Conclusions Hemodynamics monitored by peripheral cardiac output significantly reduced the amount of norepinephrine used in renal transplantation, also in the risk of renal damage. Yet it increased the amount of intraoperative urine output, which provided more accurate and personalized management of intraoperative vasoactive drugs.

Effects of A Single Bout of Aerobic Exercise on Oxidative Stress and Total Peripheral Vascular Resistance / 中国康复理论与实践

Objective To explore the effects of a single bout of aerobic exercise on oxidative stress and total peripheral vascular resis-tance. Methods 36 prehypertensive patients were divided into aerobic exercise group (n=18) and control group (n=18). The aerobic exercise group performed cycle ergometry at 70%maximal oxygen consumption for 30 min. Total peripheral vascular resistance (TPVR), malondial-dehyde (MDA), mean arterial pressure (MAP), vitamin C (VC) and vitamin E (VE) were measured before, immediately, 1 hour and 2 hours after the aerobic exercise. Results There was no significant difference in TPVR, MDA, MAP, VC and VE between two groups before exer-cise (P>0.05). TPVR was all significantly lower in the aerobic exercise group than in the control group immediately, 1 hour and 2 hours af-ter exercise (P0.05). MAP was significantly lower immediately after exercise in the aerobic exercise group than in the control group (P0.05). There was no significant difference in VC and VE between two groups immediately, 1 hour and 2 hours after exercise (P>0.05). Conclusion The level of oxidative stress increases after a single bout of aerobic exercise, and the TPVR decreases.

Time for spontaneous closure of ductus arteriosus and dynamic changes with cardiac index,peripheral vascular resistance,blood pressure of different gestational age neonates / 中华实用儿科临床杂志

Objective To investigate the time for spontaneous closure of the ductus arteriosus and the trends of cardiac index(CI),peripheral vascular resistance index(SVRI)and blood pressure of neonates with different gesta-tional ages(GA). Methods A prospective observational study about 95 newborns,including 20 full - term and 75 pre-term infants were divided into 4 groups according to their GA as GA ﹤ 32 weeks(n = 27),32 weeks≤GA ﹤ 34 weeks (n = 25),34 weeks≤GA ﹤ 37 weeks(n = 23),GA≥37 weeks(n = 20). Patent ductus arteriosus was diagnosed by echocardiography(ECHO)at the time of 24 h,48 h,72 h,7 d and 14 d. CI,SVRI and blood pressure were measured with ultrasonic cardiac output monitor(USCOM). Results The cumulative spontaneous closure rate of arterious ductus of 32 weeks≤GA ﹤34 weeks,34 weeks≤GA ﹤37 weeks group and GA≥37 weeks group at 24 h after birth was 44. 0% , 61. 0% and 90. 0% respectively. However the rate was only 59. 1% at 72 h with the GA less than 32 weeks,of which 9 cases needed ibuprofen and 1 patient was conducted ductus arteriosus ligation. The differences in cumulative closure rate among 4 groups based on GA at 5 time points were statistically significant(χ2 =6. 756,4. 735,18. 890,11. 366,28. 159,all P ﹤0. 05). There was significant increase of systolic blood pressure,diastolic blood pressure and SVRI with ductus arte-riosus closure(t = -32. 561,-19. 913,-31. 791,4. 760,all P ﹤0. 000 1;t = - 25. 091,- 23. 400,- 21. 147,2. 240,all P ﹤0. 05;t = -10. 931,-9. 975,-9. 629,2. 350,all P ﹤ 0. 05). Whereas CI significantly decreased in groups of GA ﹤32 weeks,32 weeks ≤GA ﹤34 weeks,34 weeks ≤GA ﹤37 weeks(t =9. 224,6. 515,5. 996,all P ﹤ 0. 001)and no sig-nificant changes in GA≥37 weeks(t =0. 940,P ﹥0. 05). Conclusions With the increase of gestational age,the rate of naturally early arterial catheter closure is higher. Whereas there still are nearly one - third infants requiring medical or surgical intervention in the group of GA ﹤32 weeks. Ductus arteriosus has great influence on hemodynamics. For preterm, especially very low birth weight preterm,the use of ECHO and USCOM can early detect and treat patent ductus arteriosus.

Effects of A Single Bout of Aerobic Exercise on Oxidative Stress and Total Peripheral Vascular Resistance / 中国康复理论与实践

@# Objective To explore the effects of a single bout of aerobic exercise on oxidative stress and total peripheral vascular resistance. Methods 36 prehypertensive patients were divided into aerobic exercise group (n=18) and control group (n=18). The aerobic exercise group performed cycle ergometry at 70% maximal oxygen consumption for 30 min. Total peripheral vascular resistance (TPVR), malondialdehyde (MDA), mean arterial pressure (MAP), vitamin C (VC) and vitamin E (VE) were measured before, immediately, 1 hour and 2 hours after the aerobic exercise. Results There was no significant difference in TPVR, MDA, MAP, VC and VE between two groups before exercise (P>0.05). TPVR was all significantly lower in the aerobic exercise group than in the control group immediately, 1 hour and 2 hours after exercise (P<0.001), and showed a rising trend of recovery. MDA was significantly higher in the aerobic exercise group than in the control group 1 hour and 2 hours after exercise (P<0.05), however there was no significant difference in MDA between two groups immediately after exercise (P>0.05). MAP was significantly lower immediately after exercise in the aerobic exercise group than in the control group (P< 0.001), but there was no significant 1 hour and 2 hours after exercise (P>0.05). There was no significant difference in VC and VE between two groups immediately, 1 hour and 2 hours after exercise (P>0.05). Conclusion The level of oxidative stress increases after a single bout of aerobic exercise, and the TPVR decreases.

Influence of population and exercise protocol characteristics on hemodynamic determinants of post-aerobic exercise hypotension

Due to differences in study populations and protocols, the hemodynamic determinants of post-aerobic exercise hypotension (PAEH) are controversial. This review analyzed the factors that might influence PAEH hemodynamic determinants, through a search on PubMed using the following key words: “postexercise” or “post-exercise” combined with “hypotension”, “blood pressure”, “cardiac output”, and “peripheral vascular resistance”, and “aerobic exercise” combined only with “blood pressure”. Forty-seven studies were selected, and the following characteristics were analyzed: age, gender, training status, body mass index status, blood pressure status, exercise intensity, duration and mode (continuous or interval), time of day, and recovery position. Data analysis showed that 1) most postexercise hypotension cases are due to a reduction in systemic vascular resistance; 2) age, body mass index, and blood pressure status influence postexercise hemodynamics, favoring cardiac output decrease in elderly, overweight, and hypertensive subjects; 3) gender and training status do not have an isolated influence; 4) exercise duration, intensity, and mode also do not affect postexercise hemodynamics; 5) time of day might have an influence, but more data are needed; and 6) recovery in the supine position facilitates systemic vascular resistance decrease. In conclusion, many factors may influence postexercise hypotension hemodynamics, and future studies should directly address these specific influences because different combinations may explain the observed variability in postexercise hemodynamic studies.

Comparação dos valores de débito cardíaco obtidos por termodiluição e dopplerfluxometria transesofágica / Comparison between two methods for hemodynamic measurement: thermodilution and oesophageal doppler

OBJETIVO: A termodiluição (TD) é padrão de monitorização hemodinâmica. Alguns parâmetros hemodinâmicos podem ser medidos através do Doppler Transesofágico (DTE). Método simples, menos invasivo. Com o objetivo de avaliar a acurácia do DTE foram comparados TD e DTE na determinação de medidas de débito cardíaco (DC). MÉTODOS: Foram determinadas 192 medidas simultâneas, em diferentes situações clínicas em dez pacientes com idade entre 21 85 anos (cinco do gênero masculino e cinco do feminino), oito internados sépticos em uso de drogas vasoativas e dois monitorizados para laringectomia e transplante hepático; todas avaliadas ao longo de quatro horas, em intervalos de 30 minutos. Foram utilizados dois tipos de doppler: o DeltexR, e o ArrowR, introduzidos entre 35 e 45 cm da fossa nasal e localizados no ponto de maior diâmetro da aorta descendente. Na TD, foi utilizado cateter de artéria pulmonar (Swan Ganz BaxterR) e monitor DX-2001R, confirmado o posicionamento radiologicamente e através das curvas pressóricas geradas. As medidas do DC realizadas através da TD foram obtidas com soro fisiológico gelado, sendo considerada a média de quatro medidas não diferentes de 5 por cento. Foi aplicado o método estatístico de Bland e Altman, com utilização de gráfico de regressão linear. RESULTADOS: Não houve diferença estatisticamente significante entre esses dois métodos de medida hemodinâmica, com coeficiente de correlação de 0,88 para o DC (Doppler DeltexR X Swan Ganz BaxterR) e coeficiente de correlação de 0,99 DC (Doppler Arrow rR X Swan Ganz BaxterR) respectivamente, observando-se correlação. CONCLUSÃO: A medida das variáveis hemodinâmicas ao DTE foi obtida com facilidade nos dez pacientes estudados e revelou ter este dispositivo acurácia compatível à TD.

OBJECTIVES: Thermodilution (TD) is the "gold standard method" for hemodynamic monitoring. Some parameters can be measured by Oesophageal Doppler (OD), which is simpler and less invasive. To evaluate the accuracy of OD, we compared this method with TD in measurement of cardiac output (CO). METHODS: One hundred and ninety two simultaneous measurements were made in 10 patients (5 male and 5 female) with different clinical situations, 8 with sepsis using vasoactive drugs and 2 monitored for laryngectomy and liver transplantation. Measurements were taken during 4 hours at 30 minute intervals. The two oesophageal dopplers used DeltexR and ArrowR, were introduced between 35 and 45 cm from the nose and located at the point of largest diameter of the descending aorta. In TD, we used the pulmonary artery catheter (Swan Ganz BaxterR) and the DX- 2001 monitorR positioning was confirmed with support of radiology and of pressures curves. Measurements of CO carried out by means of TD were achieved using an iced saline solution considering the mean of four measurements with less than a 5 percent difference. The statistical method used was the Bland-Altman scatter plot and dispersion graphic. RESULTS: No statistically significant difference was found between the two methods for hemodyamic measurement with a correlation coefficient of 0.8 for CO (Deltex DopplerR and Baxter Swan GanzR) and a correlation coefficient of 0.99 for CO (Arrow DopplerR and Baxter Swan GanzR). CONCLUSION: Homodynamic measurements with OD have the same accuracy as those with TD and were easily obtained in the 10 patients.

A Comparative Study of Nonpulsatile and Pulsatile Perfusion on Hemodynamics and Renal Function Centered on the patients undergoing coronary artery bypass grafting with cardiopulmonary bypass / 대한마취과학회지

BACKGROUND: It has been widely believed that pulsatile flow was better than nonpulsatile flow. However it remains uncertain whether pulsatile perfusion has shown substantive clinical improvement compared to standard, nonpulsatile perfusion. The purpose of this study was to compare nonpulsatile perfusion with pulsatile perfusion on hemodynamic and renal function during and after cardiopulmonary bypass (CPB) in the patients undergoing coronary artery bypass grafting (CABG). METHODS: Twenty patients undergoing CABG were divided into two groups, nonpulsatile perfusion group (NP) and pulsatile perfusion group (PP). Hemodynamic data was measured at preinduction, postinduction, immediately after aorta cross clamping (ACC on), and 60 minutes after the start of CPB (CPB 60'). Hemodynamic variables included mean arterial pressure (MAP), peripheral vascular resistance (PVR), plasma catecholamine (epinephrine, norepinephrine), and dosage of the vasodilator (sodium nitroprusside). Renal parameters were urine output, and serum BUN and creatinine. They were measured at preCPB, during CPB, postCPB, and POD 1. RESULTS: MAP was significantly higher in NP at CPB 60'. At CPB 60, PVR returned to preinduction level in NP, but was still decreased in PP. The dosage of vasodilator (sodium nitroprusside) infusionwas significantly higher in NP than in PP. In both groups, plasma epinephrines were increased significantly during CPB but there was no difference between the groups. Plasma norepinephrine was significantly higher in NP than in PP during CPB. At postCPB, urine output was higher than preCPB only in PP. At POD 1, serum BUN increased to the preCPB level in NP but was still decreased in PP. After CPB, serum creatinine was decreased significantly in PP. There was no significant difference in renal parameters between both groups. Conclusion: It was suggested that pulsatile perfusion, compared with nonpulsatile perfusion, can attenuate hemodynamic changes by decreasing release of plasma norepinephrine, peripheral vascular resistance, mean arterial pressure and dosage of vasodilator during cardiopulmonary bypass. Pulsatile perfusion didn't show substantive clinical difference of renal outcome in patients without preoperative renal dysfunction.

Effects of MPD on Heart Hemodynamics in Normal Anesthetic Dogs / 中药新药与临床药理

Objective To investigate the pharmacological effects of MPD on heart hemodynamics and myocardial oxygen consumption in dogs, and to study its mechanism. Methods The changes of parameters such as blood pressure (BP), coronary blood flow, myocardial oxygen consumption and heart rates were observed in normal anesthetic dogs. Results Compared to those in the normal group, MPD can obviously lower the BP and peripheral vascular resistance, dilate the coronary and peripheral artery, increase the coronary blood flow and improve the left ventricle function and myocardium oxygen consumption rate. Conclusion MPD can improve the heart hemodynamics and regulate myocardium oxygen consumption.

The Effects of Ryo-kei-jutsu-kan-to / 日本東洋医学雑誌

There are many indications for Ryo-kei-jutsu-kan-to, such as orthostatic hypotension, cardiac neurosis, migraine, congestive heart failure, benign paroxysmal positional vertigo and eye disease. Although in oriental medicine Ryo-kei-jutsu-kan-to is used as a hydragogue agent for sui-doku (disorders of the body's fluid metabolism), its actual effect on hydragogue action remains unclear. We previously carried out hemodynamics tests before and after administration of Ryo-kei-jutsu-kan-to for a patient with orthostatic hypotension due to peripheral autonomic disorder. The pathosis of the patient before administration of Ryo-kei-jutsu-kan-to was found to be sui-doku caused by the excessive increase of circulating blood volume. We reported that after administration of Ryo-kei-jutsu-kan-to the blood pressure of the patient in the standing position was elevated by increased peripheral vascular resistance, while excessively increased circulating blood volume decreased. This time we administered Ryo-kei-jutsu-kan-to for four cases, such as orthostatic hypotension with migraine, cardiac neurosis, congestive heart failure, and hypotension in dialysis. We again realized that it also increases peripheral vascular resistance. As one of the dimensions of so-called hydragogue action, it is important to understand that Ryo-kei-jutsu-kan-to has a hydragogue effect against the retention of excess fluids (sui-doku) in the body through increasing peripheral vascular resistance by vasoconstriction.