Significance of right ventricular filling for left ventricular enddiastolic pressure-volume relationship under acute hypoxia in the dog

Summary In 14 closed-chest dogs, the significance of right ventricular filling for left ventricular enddiastolic pressure-volume relationship was investigated under acute hypoxia by means of single plane cineventriculography and simultaneous intraventricular pressure recording.Both after 5 min asphyxia (respirator switched off) (n=5) and after 3 min hypoxia (ventilation with pure N₂) (n=9), there was a significant leftward shift (p<0.005) of the left ventricular enddiastolic pressure-volume curve as compared to the control curves under normoxia. To simulate the elevated filling of the right ventricle under acute hypoxia, rapid intraventricular infusion was applier under normoxic conditions to raise right ventricular enddiastolic pressure to the same values as that measured under hypoxia. The extent of the ensuing leftward shift of the left ventricular enddiastolic pressurevolume curve was on average 60% of the shift under hypoxia in both sets of experiments. Neither the slope of the relationship between volume stiffness and enddiastolic pressure, nor the relationship between tangent elastic modulus and left ventricular wall stress, was affected by hypoxia or asphyxia.Thus, the shift of the left ventricular enddiastolic pressure-volume curve in the early stage of hypoxia is predominantly due to the influence of increased right ventricular filling. Since the increased volume of the atria under acute hypoxia limits left ventricular distensibility additionally, the changes in left ventricular enddiastolic pressure-volume relationships, observed in the early stage of hypoxia are mainly, or even entircly, the result of interaction of the various heart compartments, and not a reflection of alterations in myocardial tissue elasticity.Preliminary results were presented at the symposium on Cardiac adaptation to hemodynamic overload, training and stress in Tübingen (1983)Supported by the Deutsche Forschungsgemeinschaft     

Venodilator effects of adenosine triphosphate and sodium nitroprusside; Comparisons during controlled hypotension

Adenosine triphosphate as well as sodium nitroprusside has been used for hypotensive anesthesia. The purpose of this study was to examine the possibility that two hypotensive drugs may exert different effects on venous capacitance during controlled hypotension. In rats anesthetized with ketamine, mean arterial pressure was lowered to 50mmHg by intravenous infusion of adenosine triphosphate or sodium nitroprusside. Venous capacitance was assessed before and during induced hypotension by measuring the mean circulatory filling pressure (MCFP). MCFP was measured after briefly arresting the circulation by inflating an indwelling balloon in the right atrium. MCFP was lower during adenosine triphosphate-induced as well as sodium nitroprusside-induced hypotension as compared with the respective value at control (P < 0.01 for adenosine triphosphate and sodium nitroprusside). However, the decrease in MCFP by adenosine triphosphate (0.8 ± 0.1mmHg) was less (P < 0.01) than that by sodium nitroprusside (2.3 ± 0.3mmHg). These results suggest that at a comparable level of arterial hypotension venodilator effect of adenosine triphosphate was less than that of sodium nitroprusside. Less venodilatation during adenosine triphosphate-induced hypotension may contribute to the maintenance of cardiac output during hypotensive anesthesia.(Hoka S, Takeshita A, Aishima K et al.: Venodilator effects of adenosine triphosphate and sodium nitroprusside; comparisons during controlled hypotension. J Anesth 1: 144–147, 1987)     

星形胶质细胞-神经元偶联失衡在AD发生进展中的作用及益肾填髓中药的干预机制

星形胶质细胞是中枢神经系统(CNS)重要的神经细胞类型,主要发挥营养与支持作用。星形胶质细胞与神经元之间存在密切的能量与物质偶联关系,能量偶联与物质偶联两者紧密关联、交互为用。近年来大量研究显示,星形胶质细胞-神经元偶联失衡在阿尔茨海默病(AD)的发生与进展中发挥核心作用,星形胶质细胞-神经元偶联网络失衡已成为AD干预的重要靶标并受到日益关注。中医学认为,AD的主要病机是肾虚髓亏,临床常用益肾填髓中药方剂治疗AD取得较好效果。研究发现大量益肾填髓方剂对星形胶质细胞-神经元偶联失衡具有调节和保护作用,中药方剂治疗AD的益肾填髓功效可能与其调节星形胶质细胞-神经元偶联失衡有一定的内在联系。该文就星形胶质细胞-神经元偶联失衡与AD肾虚髓亏病机之间可能内在联系及益肾填精中药干预机制的研究进展做一综述。     

初次妊娠孕妇妊娠期缺铁性贫血及贫血程度的影响因素分析

目的探讨初次妊娠孕妇妊娠期缺铁性贫血及贫血程度的影响因素。方法回顾性分析2016年1月至2019年12月我院收治的980例初次妊娠孕妇的临床资料,依据是否出现缺铁性贫血分为对照组(未出现缺铁性贫血,800例)和观察组(出现缺铁性贫血,180例)。根据病情严重程度将观察组分为轻度组(血红蛋白100~109 g/L, 100例)、中度组(血红蛋白70~99g/L, 60例)和重度组(血红蛋白40~69 g/L, 20例),分析四组孕妇的临床特点,以及初次妊娠孕妇妊娠期缺铁性贫血与贫血程度的影响因素。结果两组的孕次、文化程度、家庭人均月收入水平比较差异无统计学意义(P>0.05)。轻度组、中度组、重度组年龄≥35岁、膳食铁摄入差、孕前保健<3次占比均高于对照组(P <0.05)。经Logistic多因素分析显示,年龄≥35岁、膳食铁摄入差、孕前保健<3次均为妊娠期缺铁性贫血发生的危险因素(OR>1, P <0.05)。结论高龄、膳食铁摄入差、孕前保健次数少是引发妊娠期缺铁性贫血的危险因素。     

品管圈对缩短精神科急诊患者就诊等待时间的效果探讨

目的探讨品管圈对缩短精神科急诊患者就诊等待时间的效果。方法选取2019年7月至2020年6月于我院精神科急诊就诊的300例患者作为研究对象,150例予以常规就诊指导的患者纳入对照组,150例予以品管圈就诊指导的患者纳入观察组。比较两组的就诊等待时间及护理满意度。结果观察组的就诊等待时间显著短于对照组,护理满意度评分显著高于对照组(P<0.05)。结论品管圈可缩短精神科急诊患者的就诊等待时间,提高患者的护理满意度。     

心内科抗凝老年患者静脉留置针穿刺部位及留置长度探讨

目的探讨心内科抗凝老年患者静脉留置针不同穿刺部位及留置长度的临床效果。方法 196例心内科抗凝老年患者分为对照组(A1组、 A2组)和观察组(B1组、 B2组),选择不同穿刺部位及留置长度进行静脉留置针穿刺,观察各组的留置时间、不良事件发生情况。结果 B2组的留置针平均留置时间显著长于A2组,不良事件发生率显著低于A2组(P <0.05)。结论对于心内科抗凝老年患者,前臂中1/3段穿刺并保留导管2 mm在体外,能延长留置时间,降低不良事件发生率。     

整体责任制护理对乳腺癌手术患者生活质量及护理满意度的影响

目的探讨整体责任制护理对乳腺癌手术患者生活质量及护理满意度的影响。方法选取2019年6月至2020年6月期间于我院行手术治疗的71例乳腺癌患者,随机分为两组。对照组35例采用常规护理,观察组36例采用整体责任制护理。比较两组护理前后的生活质量及护理满意度。结果护理后,两组的生活质量各维度评分均显著高于护理前,且观察组的生活质量评分均显著高于对照组(P <0.05)。观察组的护理满意度为91.67%,显著高于对照组的68.57%(P <0.05)。结论整体责任制护理可有效改善乳腺癌手术患者的生活质量,提升其护理满意度。     

PDCA管理后死亡医学证明书填写质量分析

目的探讨PDCA管理对死亡医学证明书填写质量的影响。方法选择2018年10月—2019年5月我院实施PDCA管理前开具的死亡医学证明书68份作为对照组,选择2019年10月—2020年5月我院实施PDCA管理后开具的死亡医学证明书71份作为研究组,比较两组填写质量。结果研究组的死亡医学证明书患者基本信息填写完整率、准确率高于对照组(P<0.05)。研究组的死亡医学证明书死因项填写不规范率低于对照组(P<0.05)。研究组的网络直报数据不准确率低于对照组(P<0.05)。研究组的死亡医学证明书填报延时率低于对照组(P<0.05)。研究组的死亡医学证明书填写质量评分高于对照组(P<0.05)。结论PDCA管理可保证死亡医学证明书填写完整性、准确性及规范性,提高填报质量,促进了上报的时效性,从而有效提高人口死亡信息登记管理水平。     

运用品管圈提高血药浓度监测及个体化服务项目的认可度

目的提高血药浓度监测(TDM)及个体化服务项目的认可度。方法2019年1—7月,针对TDM每月监测例数较低,针对医生进行问卷调查,按品管圈的10个步骤实施各项活动,并对活动成果进行评价。结果明确了影响TDM监测例数低的因素,通过品管圈活动拟定了一系列对策,有形成果方面,每月监测例数逐步提高;无形成果方面,圈员的品管手法、解决问题能力、责任心都有不同程度的提升。结论品管圈活动显著提高了血药浓度监测及个体化服务的认可度。     

ITGβ1、IFI16、TTR血清水平与妊娠期高血压疾病进展程度关联性及临床表达意义探究

目的 探究整合素β1(integrin β1,ITGβ1)、人γ干扰素诱导蛋白16(interferon - inducible protein 16,IFI16)、转甲状腺素蛋白(transthyretin,TTR)血清水平与妊娠期高血压疾病进展程度关联性及临床表达意义。 方法 选取2018年11月—2020年1月在攀枝花市中心医院住院分娩的妊娠期高血压疾病患者91例为研究组,另随机选取同期正常妊娠孕妇91例为对照组。对比两组血清ITGβ1、IFI16、TTR水平,采用Spearson秩相关分析血清各指标与妊娠期高血压疾病进展程度的相关性,采用受试者工作(receiver operating characteristic,ROC)曲线分析探讨血清各指标对妊娠期高血压疾病患者妊娠结局的预测价值。 结果 研究组血清ITGβ1、IFI16水平高于对照组,血清TTR水平低于对照组(P＜0.05);妊娠期高血压疾病进展程度与血清ITGβ1、IFI16水平呈正相关,与血清TTR水平呈负相关(P＜0.05);血清ITGβ1＞2.38 ng/ml、IFI16＞24.39 ng/ml、TTR≤315.08 mg/L联合预测妊娠期高血压疾病患者有无不良妊娠结局的曲线下面积(area under the carve,AUC)为0.861,大于各指标单一预测的AUC(0.782、0.813、0.790),联合预测的敏感度、特异度分别为80.00%、81.82%。 结论 妊娠期高血压疾病患者血清ITGβ1、IFI16表达明显升高,血清TTR表达水平降低,与妊娠期高血压疾病的发生及病情进展程度密切相关,且能辅助临床预测患者妊娠结局。