老年高血压病患者大动脉扩张性的临床研究

目的 探讨老年高血压病患者大动脉扩张性的改变及其相关因素。方法 应用脉搏波传导速度(PWV)自动测量系统测定颈动脉-股动脉PWV作为反映大动脉扩张性的参数。对118例老年高血压病患者进行了PWV检测,其中男87例,女31例,年龄64-83岁,平均(67.12±10.26)岁。结果 118例老年高血压病患者的研究结果显示PWV随年龄的增大而增加(P<0 001)。多元逐步回归分析结果表明年龄、收缩压与反映大动脉扩张性的PWV关系密切(P<0.001)。结论 老年高血压病导致大动脉扩张性降低,年龄、收缩压与患者大动脉扩张性密切相关。     

不同水平脉压差变异率指导肺切除术中液体管理的随机对照研究

目的评价以不同阈值脉压差变异率(PPV)为目标导向液体治疗(GDFT)对胸腔镜肺切除患者术后早期康复的影响。方法选择2017年8月至2018年11月在安徽医科大学第二附属医院择期行胸腔镜肺实质切除患者171例,采用随机数字表法分为标准血流动力学管理组(C组) 57例、低PPV组(G_1组) 57例及高PPV组(G_2组) 57例。C组根据中心静脉压(CVP)、心率(HR)、尿量指导输液; G_1组以低PPV(3%≤PPV≤6%)为目标指导输液; G_2组以高PPV(10%≤PPV≤13%)为目标指导输液。比较3组患者各时间点血流动力学、液体出入量、术后1周肺部并发症(PPCs)、术后肺功能、住院时间等差异。结果 3组患者HR在不同时间点有随时间变化的趋势,时间效应有统计学意义(P <0. 05),分组效应及交互效应无统计学意义(P> 0. 05)。3组患者的平均动脉压(MAP)在不同时间点有随时间及分组变化的趋势,时间效应及分组效应有统计学意义(P <0. 05),交互效应无统计学意义(P> 0. 05),G_1组、G_2组术中各时间点MAP值较C组更稳定。3组患者的乳酸值(Lac)在不同时间点有随时间及分组变化的趋势,时间效应、分组效应及交互效应有统计学意义(P <0. 05),G_1组术中各时间点Lac值更稳定,优于C组、G_2组。3组患者的氧合指数(PaO_2/FiO_2)在不同时间点有随时间及分组变化的趋势,时间效应及分组效应有统计学意义(P <0. 05),交互效应无统计学意义(P> 0. 05),G_1组、G_2组术中各时间点PaO_2/FiO_2值更稳定,优于C组。3组患者的动脉血二氧化碳分压(PaCO_2)在不同时间点有随分组变化的趋势,分组效应有统计学意义(P <0. 05),时间效应及交互效应无统计学意义(P> 0. 05),G_1组、G_2组术中各时间点PaCO_2更稳定,优于C组。C组、G_1组、G_2组患者术后1周术后肺部并发症(PPCs)发生率分别为35. 09%、14. 04%和28. 07%,3组患者PPCs发生率的差异有统计学意义(χ~2=6. 855,P=0. 032)。C组、G_1组、G_2组住院时间分别为(14. 56±5. 52) d、(11. 42±3. 83) d、(12. 91±3. 77) d,G_1组患者住院时间与C组、G_2组患者相比明显缩短(P<0. 05)。结论胸腔镜下肺切除术中运用GDFT时,以低PPV为目标的液体输注方案为好,能够改善氧合,降低PPCs发生率、缩短住院时间,有利于预后。     

基于心肺运动试验客观定量评估的个体化运动在高血压患者中的应用

目的探讨基于心肺运动试验(CPET)客观定量评估的个体化运动在高血压患者中的应用及对血压、血压变异性、脂代谢和脉搏波波形特征的影响。方法选取2019年1月至2019年6月济宁医学院教职工中的40例高血压患者,男23例,女17例,年龄(48.5±4.6)岁,年龄范围为40~58岁。采用随机数表法将患者随机分为常规组和CPET组,每组20例。常规组给予常规生活方式干预,CPET组在常规组的基础上给予基于CPET客观定量评估的个体化运动。观察两组患者干预前后静息血压、血清低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、总胆固醇、甘油三酯、24 h收缩压标准差(24 hSSD)、24 h舒张压标准差(24 hDSD)、日间收缩压标准差(dSSD)、日间舒张压标准差(dDSD)、夜间收缩压标准差(nSSD)、夜间舒张压标准差(nDSD)和桡动脉脉搏波切迹幅度。结果 CPET组干预后收缩压[(126.8±8.2)mmHg(1 mmHg=0.133 kPa)]和舒张压[(75.3±6.1)mmHg]水平均低于常规组[(132.1±6.2)mmHg、(79.7±6.4)mmHg],差异有统计学意义(P<0.05)。CPET组患者干预后LDL-C[(2.2±0.5)mmol/L]、总胆固醇[(4.8±0.6)mmol/L]、甘油三酯[(1.2±0.4)mmol/L]水平均显著低于常规组[(3.4±0.4)mmol/L、(5.3±0.7)mmol/L、(1.8±0.3)mmol/L],HDL-C[(1.5±0.2)mmol/L]高于常规组[(1.1±0.1)mmol/L],差异均有统计学意义(P<0.05)。CPET组干预后24 hSSD[(10.3±4.3)mmHg]、dSSD[(11.6±3.8)mmHg]、nSSD[(9.5±4.1)mmHg]、24 hDSD[(9.7±2.8)mmHg]、dDSD[(11.2±3.3)mmHg]、nDSD[(8.2±2.8)mmHg]水平低于常规组[(13.4±5.4)mmHg、(14.3±4.8)mmHg、(12.1±3.4)mmHg、(12.4±3.4)mmHg、(13.0±4.2)mmHg、(10.1±3.8)mmHg],差异有统计学意义(P<0.05)。CPET组干预后脉搏波切迹幅度高于常规组,差异有统计学意义(P<0.05)。结论基于CPET客观定量评估的个体化运动用于高血压干预可改善患者的血压控制效果,降低血压变异性,改善脂代谢,增加脉搏波切迹幅度,改善血管弹性水平,具有临床推广价值。     

Noninvasively measured radial pressure wave analysis provides insight into cardiovascular changes during pregnancy and menopause

ObjectivePregnancy and menopause are significant life events associated with major changes in female hormone levels and changes in cardiovascular health. The role of estrogen in influencing cardiovascular risk is an ongoing research topic. Many studies have provided evidence that radial pressure wave characteristics are an important indicator to consistently and independently predict cardiovascular events. The aim of this study was to investigate if radial pressure wave analysis provided statistical insights into the physiological variations due to pregnancy and menopause. Furthermore, the study investigated how these variations could serve as an indicator for cardiovascular risks. As the radial pulse measurement is non-invasive and speedy, it may be helpful in evaluating cardiovascular changes and risk during these transitions.Materials and methodA total of 702 randomly selected female subjects (90 pregnant and 97 post-menopausal), aged 20–59, enrolled in the study. The visit measured the subject's hemodynamic parameters including heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP) and radial pressure waves. SBP and DBP were evaluated by an automatic blood pressure monitor. Radial pressure wave data were continuously recorded for 12-s using a TD01C pulse measuring instrument. Spectrum analysis of the radial pressure wave was performed to evaluate the first five harmonic components (C1–C5).ResultsA comparison of pregnant women to non-pregnant women showed C3 and C5 were lower. Heart rate C2 and C4 were higher in pregnant women. A comparison of women pre-menopausal and post-menopausal showed no significant difference in SBP or DBP. Menopause significantly changed the C1 and C4 radial pressure wave harmonics. An increase in C1 and a decrease in C4 were observed.Conclusion and discussionThis study provided further clinical evidence to support the hemodynamic model that describes the cardiovascular changes and risks related to the harmonic components of the pulse spectrum. Beyond blood pressure, the effects of menopause on the radial pressure wave, especially on hemodynamic index C4, independent of age and BMI, may explain increased post-menopausal cardiovascular risk. This and past studies collectively suggest that radial pressure wave components may be an indicator of a female body's ability to supply oxygen and nutrients. Harmonic analysis of the radial pressure wave may provide additional insights into the underlying mechanism of the cardiovascular changes over the lifespan of a woman.     

Pulse pressure waveform estimation using distension profiling with contactless optical probe

The pulse pressure waveform has, for long, been known as a fundamental biomedical signal and its analysis is recognized as a non-invasive, simple, and resourceful technique for the assessment of arterial vessels condition observed in several diseases. In the current paper, waveforms from non-invasive optical probe that measures carotid artery distension profiles are compared with the waveforms of the pulse pressure acquired by intra-arterial catheter invasive measurement in the ascending aorta. Measurements were performed in a study population of 16 patients who had undergone cardiac catheterization. The hemodynamic parameters: area under the curve (AUC), the area during systole (AS) and the area during diastole (AD), their ratio (AD/AS) and the ejection time index (ETI), from invasive and non-invasive measurements were compared. The results show that the pressure waveforms obtained by the two methods are similar, with 13% of mean value of the root mean square error (RMSE). Moreover, the correlation coefficient demonstrates the strong correlation. The comparison between the AUCs allows the assessment of the differences between the phases of the cardiac cycle. In the systolic period the waveforms are almost equal, evidencing greatest clinical relevance during this period. Slight differences are found in diastole, probably due to the structural arterial differences. The optical probe has lower variability than the invasive system (13% vs 16%). This study validates the capability of acquiring the arterial pulse waveform with a non-invasive method, using a non-contact optical probe at the carotid site with residual differences from the aortic invasive measurements.     

Is arterial stiffness in HIV-infected individuals associated with HIV-related factors?

We investigated the association between pulse wave velocity (PWV) and HIV infection, antiretroviral treatment-related characteristics, viral load, immune status, and metabolic changes in a cross-sectional study nested in a cohort of HIV/AIDS patients who have been followed for metabolic and cardiovascular changes since 2007. The study included patients recruited from the cohort (N = 261) and a comparison group (N = 82) of uninfected individuals, all enrolled from April to November 2009. Aortic stiffness was estimated using the carotid-femoral PWV (Complior-Artech, Paris, France). The groups were similar with respect to age, metabolic syndrome, diabetes mellitus, Framingham score, and use of antihypertensive and hypolipidemic medications. Hypertension was more frequent among the controls. Individuals with HIV had higher triglyceride, glucose and HDL cholesterol levels. Among individuals with HIV/AIDS, those with a nadir CD4⁺ T-cell count <200 cells/mm³ had a higher PWV (P = 0.01). There was no statistically significant difference when subjects were stratified by gender. Heart rate, age, male gender, and blood pressure were independently correlated with PWV. Nadir CD4⁺ T-cell count did not remain in the final model. There was no significance difference in PWV between HIV-infected individuals and uninfected controls. PWV was correlated with age, gender, and blood pressure across the entire population and among those infected with HIV. We recommend cohort studies to further explore the association between inflammation related to HIV infection and/or immune reconstitution and antiretroviral use and PWV.     

How to encourage management of feline obesity in practice

Feline obesity is a disease the veterinary professional encounters on a daily basis, yet we frequently hear that addressing the disease is more challenging in cats than dogs. Furthermore, obesity in companion animals is now recognised as a chronic incurable disease yet the statistics indicate an increasing trend in overweight and obese cats. The multifactorial causes leading to obesity create challenges in how and who addresses the disease with the client in practice. A whole-practice approach is recommended, involving vets, receptionists and nurses to ensure pet owners receive a consistent message. This article aims to provide guidance, practical solutions for the consult room, how to communicate the problem and follow through with support for clients and patients.