PPV指导术中液体治疗对行肝部分切除术治疗的肝内胆管结石患者术后并发症发生的影响*

目的 探讨脉压变化（PPV）指导术中液体治疗对肝内胆管结石行肝部分切除患者术后并发症的影响。方法 2008年3月~2017年3月我院收治的肝内胆管结石患者260例,在行腹腔镜肝部分切除术过程中,134例采用PPV指导的液体治疗,126例对照组常规处理。采用Logistic回归分析影响患者术后并发症发生的因素。结果 对照组术中潮气量为（7.5±1.3） mL/kg,明显低于干预组【（8.2±1.4） mL/kg,P<0.05】;手术开始时,对照组平均动脉压（MAP）和红细胞压积分别为（97.3±15.4） mmHg和（28.6±5.8）%,与干预组比,差异显著【分别为（87.4±17.2） mmHg和（34.2±7.4） %,P<0.05】;对照组手术时间和中心静脉压（CVP）分别为（414.7±164.8） min和[9.4（5.4,10.2） mmHg,与干预组比,差异显著【分别为（321.5±124.7） min和10.3（6.3,12.8）mmHg,P<0.05】;术后24 h,干预组MAP和CVP分别为（81.8±13.5）mmHg和8.3（6.2,10.1） mmHg,显著低于对照组【分别为（85.6±14.8）mmHg和11.4（8.1,14.7） mmHg,P<0.05】;干预组胶体和RBC输注单位分别为（503.5±120.4） mL和0.9（0.6,1.7）单位,显著低于对照组【分别为（743.4±243.7） mL和1.7（0.7,1.9）单位,P<0.05】;73例患者出现术后并发症,多因素分析显示红细胞压积和PPV指导为术后并发症发生的危险因素（P<0.05）。结论 运用PPV指导术中液体管理能改善肝内胆管结石行肝部分切除术患者的呼吸功能,减少输液量,缩短手术时间,减少术后并发症。     

The relationship between pulse pressure,insulin resistance,and beta cell function in non-diabetic Korean adults

AimsThe present study was conducted to assess the association of pulse pressure (PP) with insulin resistance and beta cell function in Korean non-diabetic populations.MethodsThis study used the data from the 2015 Korean National Health and Nutrition Examination Survey including 4380 adults, aged 20 or older.ResultsA multivariate analysis revealed that systolic blood pressure (SBP) (β = 0.089, 95% confidence interval [CI], 0.004–0.011; p < 0.001), diastolic blood pressure (DBP) (β = ?0.057, 95% CI ?0.014 to ?0.003; p = 0.002), and PP (β = 0.069, 95% CI 0.004–0.011; p < 0.001) were significant factors determining the homeostasis model assessment of insulin resistance (HOMA-IR). SBP (β = 0.070, 95% CI, 0.113–0.420; p = 0.001), DBP (β = ?0.068, 95% CI ?0.676 to ?0.203; p < 0.001), and PP (β = 0.050, 95% CI 0.115–0.422; p = 0.001) were significant factors determining the homeostasis model assessment of beta cell function (HOMA-B). In the analysis of covariance test, after adjusting for related variables (except age), the quartiles of PP were not associated with HOMA-IR (p = 0.191) and were inversely associated with HOMA-B (p < 0.001). However, when further adjusting for age, the quartiles of PP were positively associated with both HOMA-IR (p < 0.001) and HOMA-B (p = 0.027).ConclusionPP was positively associated with insulin resistance and beta cell function in non-diabetic Korean adults.     

Reliability of the pulse contour analysis for cardiac output measurement for assessing the fluid responsiveness

Background

The cardiac output (CO) is classically measured in intensive care unit patients. pulse contour (PC) method allows monitoring of CO.

Objective

The aim of the present study was to assess the ability of PC to assess the fluid responsiveness defined as an increase in CO more than or equal to 15% after 500 mL hydroxyethyl starch over 20 minutes.

Patients and methods

In this observational prospective study, patients in shock in whom a PC method was inserted were included. CO was measure using the PC and thermodilution methods before and after a fluid challenge indicated by the physician. The correlation coefficient was measured, the diagram of Bland and Altman was built and the percentage of error (Critchley and Critchley method) was calculated. The ability of PC to diagnose fluid responsiveness was assessed using a receiver operating characteristics (ROC) curve.

Results

Sixty-two fluid challenges were performed in 37 included patients. After fluid challenge, r² was 0.05 (P < 0.01), the bias between PC and thermodilution was 0.3 ± 1.2 L/min and the percentage of error was 36%. The area of the ROC curve was 0.601 [0.468–0.723].

Conclusion

In ICU patients with shock, PC cannot replace thermodilution to diagnose fluid responsiveness.     

格列喹酮联合氨氯地平对高血压病患者动脉弹性的影响

目的探讨格列喹酮联合氨氯地平治疗对高血压合并糖尿病患者动脉弹性和血压的短期影响。方法120例患者被分成四组,高血压和高血糖控制组（双高控制组）30例,高血压控制而血糖未控制组（高血糖组）30例,高血压未控制而血糖控制组（高血压组）30例,高血压和高血糖均未控制组（双高未控制组）30例。另设正常对照组E30例。应用VP-1000动脉硬化分析仪测定受试者臂踝脉搏波传导速度（baPWV）。结果baPWV自正常对照组至双高未控制组,呈逐渐下降趋势,双高未控组明显低于其他四组（P〈0．01）,Z,L高未控组、高血压组和高血糖组分别较双高控制组及正常对照组明显下降（P〈0．01）,双高未控组也明显低于高血压组和高血糖组（P〈0．01）;双高控制组及正常对照组之间差异无统计学意义（P〉0．05）;在收缩压（SBP）、舒张压（DBP）和脉压（PP）方面,高血压组、高血糖组和双高未控组明显高于双高控制组、对照组（P〈0．01）。baPWV与血压、脉压差和血糖呈正相关,并且与SBP、血糖呈强相关。结论降压降糖联合治疗较单纯降压或降糖更能改善动脉弹性功能,延缓动脉硬化。     

高血压患者脉搏波速与动态心电图异常的关系

目的研究高血压患者脉搏波速与动态心电图异常的关系。方法对80例高血压患者行脉搏波速与动态心电图检测,根据脉搏波速（PWV）水平分为A组（〈13m/s）、B组（13～17m/s）、C组（17～21m/s）、D组（21m/s）并分析检测结果。结果随着PWV增大心律失常（房早外）,心肌缺血发生率呈增大趋势,差异均有统计学意义。结论高血压患者脉搏波速与动态心电图异常的关系密切。     

血脂异常与脉压指数的相关性研究

目的研究原发性脂蛋白异常血症患者血脂水平与脉压及脉压指数的相关性,探讨血脂不同成分对心血管疾病的影响。方法 120例原发性脂蛋白异常患者按照临床表型分组,测定肱动脉血压;空腹状态下抽取血样本,检测血脂;配对资料t检验分析不同分组脉压及脉压指数差异,多元回归分析血脂成分与脉压指数的相关性。结果高胆固醇血症、混合型脂蛋白异常血症脉压指数平均值分别为0.47及0.45,高于其它组及对照组（P〈0.05）;胆固醇、低密度脂蛋白对脉压指数的偏回归平方和F值分别为4.31、4.42,大于F0.05,（1,20）,表明胆固醇脂及低密度脂蛋白是脉压指数的独立危险因素。结论血浆胆固醇、低密度脂蛋白水平增高患者血管的动态顺应性和固有顺应性减低,冠状动脉病变严重程度可能重于高甘油三酯血症患者,心血管并发症危险性增大。     

高血压患者动态动脉硬化指数与微量白蛋白尿关系的相关性分析

目的:动态动脉硬化指数(ambulatory arterial stiffness index,AASI)是一个反映动脉硬度的新指数。本文旨在探讨动脉动态硬化指数与微量白蛋白尿(MAU)的相关性。方法:本研究从2009年1月-2010年2月在心内科因高血压就诊患者中选取120例,其中MAU阳性患者32例为试验组,88例MAU阴性患者为对照组,均行动态血压监测、颈动脉IMT、心电图、尿微量白蛋白、血糖、血脂等检查。结果:MAU阳性组患者AASI、脉压水平显著高于MAU阴性组(P<0.05)。结果显示MAU、AASI有明显相关关系,呈正相关(r=0.432,P<0.05)。结论:本研究显示动态动脉硬化指数与MAU有明显相关关系。MAU越大,动态动脉硬化指数越增大;脉压越大,动态动脉硬化指数也越增大。     

强脉冲光（IPL）联合A型肉毒毒素在面部老化中的应用

目的：观察强脉冲光（IPL）联合A型肉毒毒素在预防及治疗面部皱纹中的临床应用效果。方法：首先在面部静态或动态皱纹明显处附近标记点注射A型肉毒毒素,随后用强脉冲光行全面部照射治疗,每月1次,5次1个疗程。结果：共治疗68例,术后随访半年,有效率达91.2%,满意率达89.7%,疗效满意。结论：强脉冲光（IPL）联合A型肉毒毒素在预防及治疗面部皱纹方面有着非常好的应用前景。     

Investigation of effects of different treatment modalities on structural and functional vessel wall properties in patients with ankylosing spondylitis

Aim

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease that is associated with increased cardiovascular burden. The aim of this study was to investigate vascular structural and functional changes in patients with AS, with special emphasis on the effects of different treatment modalities, through evaluation of level of vascular stiffness (pulse wave velocity [PVW]) and carotid intima media thickness (IMT-C).

Methods

A total of 67 AS patients, and age, sex, body mass index (BMI) smoking status, lipid profiles and blood pressure-matched healthy control subjects (n = 34) were studied. Of these, 34 patients were on anti-TNF alpha and 33 on non steroid anti inflammatory drugs (NSAIDs). The IMT-C and PWV values of the right common carotid artery were measured by high-resolution ultrasound.

Results

The AS patients (n = 67) had significantly higher PWV values than the controls [9.0 ± 1.49 m/sec vs. 8.27 ± 0.90 m/sec, P = 0.004; 95% confidence interval (CI), −1.22 to −0.24]. Multiple stepwise linear regression analysis revealed that PWV could only be explained by systolic blood pressure (P < 0.05) and IMT (P < 0.05) in AS. Even though IMT-C in anti-TNF alpha treated group was higher compared to the NSAID treated group, it was not statistically significant (P = 0.5).

Conclusion

PWV was found to be higher in AS patients than in the control group, and there was no significant difference between the average PWV values of AS patients treated with anti -TNF alpha or NSAIDs.     

Subdividing the digital divide: differences in internet access and use among rural residents with medical limitations

Background

Access to health care is often contingent upon an individual’s ability to travel for services. Certain groups, such as those with physical limitations and rural residents, have more travel barriers than other groups, reducing their access to services. The use of the Internet may be a way for these groups to seek care or information to support their health care needs.

Objective

The purpose of this study was to examine Internet use among those whose are, for medical reasons, limited in their ability to travel. We also examined disparities in Internet use by race/ethnicity and rural residence, particularly among persons with medical conditions.

Methods

We used data from the 2001 National Household Travel Survey (NHTS), a nationally representative sample of US households, to examine Internet use among individuals with medical conditions, rural residents, and minority populations. Internet use was defined as any use within the past 6 months; among users, frequency of use and location of use were explored. Control variables included sociodemographics, family life cycle, employment status, region, and job density in the community. All analyses were weighted to reflect the complex NHTS sampling frame.

Results

Individuals with medical conditions were far less likely to report Internet use than those without medical conditions (32.6% vs 70.3%, P < .001). Similarly, rural residents were less likely to report Internet access and use than urban residents (59.7% vs 69.4%, P < .001). Nationally, 72.8% of white respondents, versus 65.7% of persons of “other” race, 51.5% of African Americans, and 38.0% of Hispanics reported accessing the Internet (P < .001). In adjusted analyses, persons with medical conditions and minority populations were less likely to report Internet use. Rural-urban differences were no longer significant with demographic and ecological characteristics held constant.

Conclusions

This analysis confirmed previous findings of a digital divide between urban and rural residents. Internet use and frequency was also lower among those reporting a medical condition than among those without a condition. After we controlled for many factors, however, African Americans and Hispanics were still less likely to use the Internet, and to use it less often, than whites. Policy makers should look for ways to improve the access to, and use of, the Internet among these populations.