多药物MIMO模糊逻辑智能系统监控血压与心排量

目的本文以动物实验证实4种药物多输入多输出的模糊逻辑智能系统的监控血压及心排量的原理及方法。方法在模糊决策制定模块的基础上现用模糊心血流动力学控制模块和治疗评估模块组成系统。结果对4种药物6种症状的狗实验证实此系统实际成效。结论应用4种药物MIMO模糊逻辑系统是利用狗实验成功的方法，将会对临床应用引入创新性。     

住院老年糖尿病患者的多药性研究

目的研究住院老年糖尿病患者的多药性和多病性。方法 2008年—2011年住院的老年糖尿病患者,依据我院的电子病历记录,分为成人糖尿病组和老年糖尿病组。以2型糖尿病作为第一诊断患者为统计对象。药物计算为出院前第1天使用的药物数量,病种数以出院诊断为统计依据;同时使用5种或5种以上药物为多药性。结果成人糖尿病组平均使用药物为6.3种,老年糖尿病组使用为11.2种,老年糖尿病组使用药物数、病种数高于成人糖尿病组(P<0.05),老年糖尿病亚组间无统计学意义。结论糖尿病患者普遍存在多药性和多病性,老年患者更突出,需要进一步优化治疗。     

80岁以上老年人多病因心力衰竭诊治中的几个问题

目的 对老年人多病因心力衰竭中的出血、贫血、退行性心脏瓣膜病、慢性肾功能不全等问题的诊治做探讨。方法 本文收集1998—2004年住广州军区广州总医院80岁以上老年人多病因心衰病例145例，就其资料完整的127例的病因构成与组合进行回顾。结果老年心力衰竭患者往往因为有多种病因存在，增加了临床上诊断和处理的难度。结论 对老年人多病因心衰进行治疗时，须多学科协作，调控各系统间的相互影响，抓住主要矛盾，重点治疗其原发病及去除诱因。根据老年特点，格外注意选择药物及调控药物，做到细致和稳妥，注意个体不同耐受性，避免发生副作用。     

《中华老年多器官疾病杂志》欢迎来稿，欢迎订阅

《中华老年多器官疾病杂志》是由解放军总医院主管,解放军总医院老年心血管病研究所主办的医学学术期刊。2002年6月创刊,由王士雯院士任总编辑、国内多学科知名专家组成编委会。该刊旨在交流老年心脏病和老年多器官疾病的诊治经验与教训,探讨老年病的发病机制和有效防治措施,重点报道我国在老年心脏病尤其是涉及多器官疾病的临床、基础和预防方面的最新成果和经验,努力推广老年心脏病和老年多器官疾病的新观点、新方法、新措施和新药物。     

老年高血压患者并发症及特征分析

目的分析老年高血压患者的发病特征和并发症,为指导老年高血压的临床合理综合治疗提供依据。方法选择年龄≥70岁的老年高血压患者110例,分析其症状、体征、血压特点、常见并发症、常用药物种类及不良反应。结果老年高血压患者中,症状体征多不典型,并发症多;常用药物以钙拮抗剂或以钙拮抗剂为主的联合用药。药物不良反应以低血压、低灌注、心率加快、心力衰竭加重等最常见。最常见的前5位并发症为大动脉粥样硬化症、缺血性脑病、脑梗死、糖尿病、高血压性心脏病。结论老年高血压患者依从性差,症状体征多不典型,易合并严重并发症,健康指导、合理的药物选择对改善长期预后非常重要。     

纤支镜下病灶内滴注加替沙星治疗耐多药肺结核伴空洞涂阳的临床研究

目的探讨纤支镜下病灶内滴注加替沙星治疗耐多药肺结核伴空洞涂阳的临床疗效。方法85例耐多药肺结核伴空洞涂阳患者，随机分成两组，加替沙星介入治疗组42例，常规内科处理组43例，比较两组的治疗效果。结果加替沙星介入治疗组在控制患者症状，促进体征转归，缩短涂阳转阴时间，特别是围手术期缩短涂阳转阴的治疗疗程，创造手术时机等多方面均优于常规处理组。结论纤支镜下病灶滴注加替沙星治疗耐多药肺结核伴空洞涂阳，可有效控制患者症状，缩短涂阳转阴病程，特别是为空洞型肺结核合并大咯血病人争取手术时机具有重要意义。     

心脏移植治疗老年晚期心脏病(附4例报告)

目的总结心脏移植治疗老年人晚期心脏病的经验。方法4例男性晚期心脏病患者，年龄分别为60、60、62和65岁，接受心脏移植术。围手术期以达昔单抗诱导，术后三联方案预防急性排斥反应。结果4例患者均痊愈出院，未发生并发症，生活质量良好。结论心脏移植可为老年晚期心脏病患者提供一种更佳的治疗和康复选择，合理的免疫方案及围手术期积极防治合并症是成功的关键。     

复发性多软骨炎五例分析

目的　探讨复发性多软骨炎 (RP)的临床特征、治疗方法 ,特别是RP合并严重气道狭窄的介入治疗。方法　结合文献资料回顾分析 5例临床病例。结果　RP是一种以全身多器官软骨结构及结缔组织反复发作性炎症为特征的自身免疫性疾病。目前以皮质类固醇激素、免疫抑制剂及氨苯砜为主的药物治疗常不能有效控制病变发展 ,其中气道软骨受累最危险 ,常需介入性对症治疗如气管造口、气管内插管、支架等。通过气道内可扩张的金属支架安置术成功缓解了一名RP患者因广泛气道软骨塌陷所致的严重呼吸困难。结论　对有特征性临床表现的病例应及早确诊并予药物治疗 ,当出现气道软骨受累时应及时给予压力支持及介入治疗以维持气道开放     

老年慢性肺源性心脏病合并冠心病的疗效观察

目的探讨老年慢性肺源性心脏病合并冠心病的治疗方法及疗效。方法选取我院2014年7月~2015年6月收治的老年慢性肺源性心脏病合并冠心病患者76例为研究对象,探究患者的治疗疗效。结果患者给予山莨菪碱进行治疗后,呼吸衰竭患者的呼吸功能得到显著改善;给予硝酸甘油治疗后,急性心肌梗死患者的心前区疼痛症状逐渐消失;心肌缺血患者心肌缺血症状得到明显好转;陈旧性心肌梗死及心力衰竭患者的上腹部饱满、呼吸困难及心慌等症状消失,水肿减退,心率降低,心功能恢复良好。结论对老年慢性肺源性心脏病合并冠心病患者采取扩血管药物进行治疗能取得良好的疗效,对患者的临床症状可进行有效改善,在一定程度上恢复患者的心功能。     

老年甲状腺功能亢进性心脏病临床特点及治疗

目的探讨老年甲状腺功能亢进性心脏病临床特点，总结经验，降低误诊率。方法对67例老年甲状腺功能亢进性心脏病的临床资料进行分析。结果心律失常27例(70．9％)，心衰4例(12．9％)，误诊率为35．8％。结论老年甲状腺功能亢进症(甲亢)起病隐匿，表现出较高的误诊率。对于以心脏病为首发症状的病例，采用早期、联合治疗可取得满意的治疗效果。     

Validation of a new formula for mean arterial pressure calculation: the new formula is superior to the standard formula.

Mean arterial pressure (MAP) has traditionally been derived from systolic and diastolic pressures, weighted 1/3 systolic and 2/3 diastolic. No correction is made for the increasing time dominance of systole with increasing heart rates. In a previous study, we developed a new and more accurate heart rate-corrected MAP formula from central aorta pressure determinations in a large number of patients: MAP = DP + [0.33 + (HR x 0.0012)] x [PP] where SP and DP are systolic and diastolic pressure and HR is heart rate. The current study validates the new MAP formula in the same patient at increasing paced heart rates. A central aorta catheter was used to obtain computer-determined systolic, diastolic, and MAP in 12 patients. Values were obtained at baseline and then at increasing right atrial paced heart rates. The new and standard MAP formula-derived values were compared with computer-determined values. The new formula showed a much closer correlation with the computer-derived values for MAP. Standard MAP calculations for MAP can easily be improved by inclusion of a heart rate factor.     

Calculated mean arterial pressure in the posterior tibial and radial artery pressure wave in newbown infants

Mean arterial pressure (MAP) is the area under the pressure wave averaged over the cardiac cycle, and therefore depends on pressure wave contour. A generally used rule of thumb to estimate MAP of peripheral arteries in adults is adding one-third of the arterial pulse pressure (PP) to diastolic arterial pressure (DAP). As peripheral pressure wave forms in neonates do not resemble adult peripheral wave forms, it may be expected that this rule of thumb does not hold for neonates. Previously, we found that MAP can be calculated by adding 50% PP to DAP in radial artery waves in neonates. In the present study, we investigated in neonates how MAP in the posterior tibial artery depends on systolic and diastolic pressure and we compared these findings to those found in the radial artery. Forty infants admitted for intensive care were studied. We analyzed 5000 invasively and accurately obtained blood pressure waves in the posterior tibial artery of 20 neonates and another 5000 waves similarly obtained from the radial artery in another group of 20 neonates. We found that MAP in posterior tibial artery waves is well approximated by adding 41.5±2.0% of PP to DAP, whereas MAP in radial artery waves can be calculated by adding 46.7±1.7% of PP to DAP. These values are significantly different (p<0.0001). In conclusion, the rule of thumb as used in the adult to find MAP, where 33% PP is added to DAP, does not hold for the newborn. We recommend to calculate MAP in the tibial artery by adding 40% of PP to DAP and in the radial artery by adding 50% of PP to DAP.Abbreviations ABP Arterial Blood Pressure - SAP Systolic Arterial Pressure - DAP Diastolic Arterial Pressure - MAP Mean Arterial Pressure - PP Pulse Pressure - MAP% (MAP-DAP)/(SAP-DAP)x100% i.e. the level of the MAP in the wave, expressed in % PP - IRDS Idiopathic Respiratory Distress Syndrome - PDA Patent Ductus Arteriosus     

Factors influencing progression in patients with chronic renal failure

To identify factors influencing the progression rate of chronic renal failure (CRF) in non-diabetics, the medical records of 124 patients with established CRF were reviewed retrospectively (serum creatinine between 200-350 mumols l-1 at the start of follow-up) for the period 1980-86. Sixteen patients were excluded because they did not fulfil the inclusion criteria. The remaining 108 patients were divided, using their original diagnosis, into four groups and were also assigned into one of three groups expressing their rate of progression. The definitions of these rates of progression were chosen arbitrarily. Comparisons with respect to mean arterial pressure (MAP), urinary protein excretion (UPE) and the progression rate of CRF were then made between the groups. In the group showing no progression of CRF (n = 17) there was a significantly lower MAP and UPE than in the two groups showing progression. Over all the patients and in the various diagnosis groups there was a strong correlation between UPE and the progression rate of CRF. There was no significant correlation between MAP and the progression rate of CRF in the diagnosis groups. These results indicate that an increasing magnitude of proteinuria is an adverse prognostic factor in CRF, irrespective of aetiology, and support the view that excessive glomerular protein filtration leads to glomerulosclerosis.     

Can ambulatory blood-pressure monitoring provide reliable indices of arterial stiffness?

BACKGROUND: The use of ambulatory recordings of blood pressure (BP) was proposed to estimate arterial stiffness (AS). We compared the relative value of the ambulatory AS index (AASI), and of the slope of pulse pressure (PP) according to mean BP (MBP) obtained from 24-h ambulatory BP monitoring, to the monitoring of the arrival time of Korotkoff sounds (QKD interval) in the prediction of cardiovascular (CV) events. METHODS: Twenty-four-hour ambulatory BP and QKD monitoring were recorded at baseline, before antihypertensive treatment of hypertensive patients in our Bordeaux cohort. From these recordings, the AASI, the PP/MBP slope, and the theoretical value of the QKD for a systolic pressure of 100 mm Hg and a heart rate of 60 beats/min (QKD100-60) were calculated. The patients were then given antihypertensive treatment and followed by their family physicians, who were unaware of the QKD, AASI, and PP/MBP slope results. Regular updates on patients were obtained. The reproducibility of measurements was studied in 38 normal subjects evaluated on two occasions. RESULTS: The reproducibility of the AASI and the PP/MBP slope was less than that of BP over 24 h and of QKD100-60. The cohort comprised 469 patients. With an average follow-up of 70+/-39 months, 62 CV complications, including 13 deaths, were recorded. In the monovariate analysis, age, PP over 24 h, QKD100-60, AASI, and the PP/MBP slope were significantly related to the occurrence of complications. In the multivariate analysis, when age and PP over 24 were included in the model, only QKD100-60 remained significantly linked to CV events. CONCLUSIONS: Our data support the value of the AASI as an indirect estimate of AS and as an element in the evaluation of CV risk in hypertensive patients. However, the reproducibility of this index is less, and its predictive value for complications is poorer, than that of QKD100-60, a parameter that we believe is more closely linked to AS.     

Association between mean arterial pressure and sublingual microcirculation during major non-cardiac surgery: Post hoc analysis of a prospective cohort

Objective

To test the hypothesis that there is an association between mean arterial pressure (MAP) and sublingual perfusion during major surgery, and perhaps an identifiable harm threshold.

Methods

This post hoc analysis of a prospective cohort included patients who had elective major non-cardiac surgery with a duration of ≥2 h under general anesthesia. We assessed sublingual microcirculation every 30 min using SDF+ imaging and determined the De Backer score, Consensus Proportion of Perfused Vessels (Consensus PPV), and the Consensus PPV (small). Our primary outcome was the relationship between MAP and sublingual perfusion which was evaluated with linear mixed effects modeling.

Results

A total of 100 patients were included, with MAP ranging between 65 mmHg and 120 mmHg during anesthesia and surgery. Over a range of intraoperative MAPs between 65 and 120 mmHg, there were no meaningful associations between blood pressure and various measures of sublingual perfusion. There were also no meaningful changes in microcirculatory flow over 4.5 h of surgery.

Conclusions

In patients having elective major non-cardiac surgery with general anesthesia, sublingual microcirculation is well maintained when MAP ranges between 65 and 120 mmHg. It remains possible that sublingual perfusion will be a useful marker of tissue perfusion when MAP is lower than 65 mmHg.     

Ejection fraction and blood pressure are important and interactive predictors of 4-week mortality in severe acute heart failure

BACKGROUND: In acute heart failure syndromes (AHFS), the prognostic value of left ventricular ejection fraction (LVEF), although widely accepted, has been recently challenged. In contrast, blood pressure is increasingly gaining ground over LVEF as predictor of mortality. Therefore, it is not clear whether both LVEF and mean arterial pressure (MAP) are independent risk factors in patients with AHFS. METHODS AND RESULTS: The EFICA study enrolled 581 AHFS patients admitted to 60 CCU/ICUs. Survival at 4 weeks was analyzed for all cases with echocardiographic LVEF available on admission (n=355). Four-week mortality was 23%. Multivariable analysis identified lower LVEF, lower MAP and serum creatinine >1.5 mg/dl as independent correlates of mortality (respectively, OR: 1.27 per 10% decrease, CI: 1.05-1.53, p=0.012; OR: 1.30 per 10 mmHg decrease, CI: 1.15-1.48, p<0.0001; OR: 2.84, CI: 1.64-4.93, p=0.0002). LVEF interacted significantly with MAP (p<0.0001) and the subgroup analysis showed that reduced LVEF was a strong risk factor in patients with MAP 90 mmHg. CONCLUSIONS: Both LVEF and MAP are important predictors of death in severe AHFS. LVEF can provide additional prognostic information on top of MAP but mainly in patients with low MAP (相似文献   

米库氯铵在老年患者气管插管中的应用及其对心率和平均动脉压的影响

目的探讨米库氯铵在老年患者气管插管中的应用及其对心率(HR)和平均动脉压(MAP)的影响。方法选取2016年8月至2018年8月西安交通大学第二附属医院收治的老年患者60例为研究对象。随机数表法分为2组:米库氯铵组和阿曲库铵组,每组30例。比较2组患者的肌松药起效时间和静脉注射肌松药到4个成串刺激(TOF)恢复25%时间。比较麻醉前(T0)、静脉注射肌松药后1 min(T1)、静脉注射肌松药后2 min(T2)、插管前即刻(T3)、插管后即刻(T4)时2组患者的HR、MAP、脑电双频谱指数(BIS)、血清去甲肾上腺素(NE)和组胺(HIS)。采用SPSS 21.0软件进行数据处理。结果米库氯铵组患者的肌松药起效时间[(211.3±32.5)vs(383.5±34.5)s]、静脉注射肌松药到TOF恢复25%时间[(23.5±4.5)vs(40.4±6.4)min]均显著短于阿曲库铵组(P0.05)。T4时米库氯铵组患者的HR[(84.3±13.8)vs(94.5±15.4)次/min]、MAP[(94.3±13.8)vs(104.7±9.2)mmHg(1 mmHg=0.133 kPa)]、BIS[(55.7±6.8)vs(60.2±7.0)]和NE浓度[(654.7±165.3)vs(766.0±100.0)ng/ml]均显著低于阿曲库铵组(P0.05)。T1[(1.31±0.17)vs(0.56±0.05)ng/ml]、T2[(1.04±0.15)vs(0.55±0.03)ng/ml]、T3[(0.79±0.09)vs(0.54±0.03)ng/ml]、T4[(0.67±0.08)vs(0.56±0.04)ng/ml]时米库氯铵组患者的血清HIS浓度均显著高于阿曲库铵组(P0.05)。结论与顺苯磺酸阿曲库铵相比,米库氯铵在老年患者气管插管中的应用效果更好,更能有效保持患者HR和MAP稳定。