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1.
目的分析颈动脉支架植入(CAS)术中低血流动力学紊乱(HD)的危险因素。方法回顾性分析121例接受CAS患者,根据CAS术中血压和心率变化评估有无HD;以单因素及多因素logistic回归分析筛选CAS中发生HD的危险因素。结果共42例发生HD(HD组),其中27例见于球囊扩张时,14例见于植入支架时,1例见于以封堵器封堵血管时;79例未见HD(非HD组)。单因素分析显示,组间患者年龄、颈动脉狭窄程度和部位(有无累及球部或分叉部)、血管斑块性质及球囊后扩张差异均有统计学意义(P均<0.05);多元logistic回归结果显示,年龄、狭窄部位、血管斑块性质及球囊后扩张均为HD的独立危险因素(P均<0.05)。结论CAS术中发生HD与患者年龄、颈动脉狭窄部位、血管斑块性质及有无球囊后扩张有关。  相似文献   
2.
目的探讨注射用丹参多酚酸盐联合长春西汀注射液治疗腔隙性脑梗死的临床疗效。方法选取2018年1月-2019年9月天津市环湖医院收治的92例腔隙性脑梗死患者作为研究对象,按照随机数字表法将全部患者分为对照组和治疗组,每组各46例。对照组静脉滴注长春西汀注射液,30 mg/次,1次/d。治疗组在对照组治疗的基础上静脉滴注注射用丹参多酚酸盐,200 mg/次,1次/d。两组患者均连续治疗2周。比较两组患者治疗后的总有效率,并比较两组的神经功能缺损程度、血流动力学指标、细胞因子水平。结果在治疗后,治疗组患者的总有效率比对照组高,两组比较差异有统计学意义(P<0.05)。治疗后,两组患者的NIHSS评分明显低于治疗前(P<0.05);治疗后治疗组的NIHSS评分比对照组低,差异有统计学意义(P<0.05)。治疗后,两组的搏动指数、阻力指数均明显降低,平均血流速度明显升高(P<0.05);治疗后治疗组的搏动指数、阻力指数比对照组低,平均血流速度比对照组高,差异有统计学意义(P<0.05)。治疗后,两组的C反应蛋白(CRP)、同型半胱氨酸(Hcy)、内皮素-1(ET-1)水平均明显低于治疗前,一氧化氮(NO)明显高于治疗前(P<0.05);治疗后治疗组的CRP、Hcy、ET-1水平均比对照组低,NO水平比对照组高,差异有统计学意义(P<0.05)。结论注射用丹参多酚酸盐联合长春西汀注射液可提高腔隙性脑梗死的疗效,减轻神经功能损伤,改善血流动力学水平和细胞因子水平,具有一定的临床研究价值。  相似文献   
3.
目的分析肺动脉高压(pulmonary hypertension, PH)患者经靶向药物治疗前后右心导管及二维超声心动图参数的变化,并探讨超声参数变化与肺血管阻力、氨基末端脑利钠肽前体(NT-pro BNP)变化的相关性。方法回顾性分析2015年10月至2019年3月住院PH患者31例,比较患者经靶向药物治疗前后血流动力学参数、NT-pro BNP、6min步行距离及二维超声心动图参数的变化,并分析超声参数变化和肺血管阻力及NT-pro BNP变化的相关性。结果PH患者在靶向药物治疗后,6min步行距离延长,NT-pro BNP降低(P<0.05)。血流动力学参数中,肺动脉平均圧、肺血管阻力、平均右心房压降低,心排血指数升高(P<0.05);超声心动图参数中,右心室基底横径和右心室游离壁厚度缩小,超声估测的肺动脉收缩压降低。三尖瓣环收缩期位移、三尖瓣环收缩期峰值运动速度延长(P<0.05)。治疗前后的三尖瓣环收缩期位移、三尖瓣环收缩期峰值运动速度的差值和肺血管阻力的差值呈负相关(r=-0.5,P=0.007;r=-0.462,P=0.018),超声估测的肺动脉收缩压的差值和肺血管阻力的差值呈正相关(r=0.430,P=0.022)。治疗前后的右心房左右径、右心室基底横径的差值和NT-pro BNP的差值呈正相关(r=0.548,P=0.002;r=0.684,P<0.001),三尖瓣环收缩期位移的差值和NT-pro BNP的差值呈负相关(r=-0.449,P=0.013)。结论二维超声心动图参数可反映PH患者靶向药治疗后右心结构的逆转和右心收缩功能的增强,且其变化与血流动力学参数及心力衰竭程度相关性好,是评价PH患者靶向药物疗效的可靠且无创工具。  相似文献   
4.
ObjectiveTo investigate the effect of focused ultrasonography on clinical outcomes of septic shock.MethodsPatients with septic shock were randomized into an integrated cardiopulmonary ultrasonography (ICUS) group and conventional (CON) group. Within 1 hour of admission, the ICUS group underwent ICUS examination for hemodynamic decision-making, while the CON group received standard treatment. The primary endpoint was 28-day mortality after admission. The secondary endpoints were cumulative fluid administration in the first 6, 24, and 72 hours; use of vasoactive drugs; lactate clearance; duration of ventilation; and ICU stay.ResultsNinety-four qualified patients were enrolled (ICUS group, 49; CON group, 45). ICUS showed no significant effect on 28-day mortality. Within the initial 6 hours, the ICUS group tended to have a higher fluid balance and fluid intake than the CON group. The duration of vasopressor support was shorter in the ICUS group. There were no differences in the cumulative fluid infusion within 24 or 72 hours, lactate clearance, ICU stay, or duration of ventilation.ConclusionsThe initially focused ICUS did not affect the clinical outcomes of septic shock, but it tended to be associated with a higher fluid balance within the initial 6 hours and shorter duration of vasopressor support.  相似文献   
5.
Rationale:The prone position is commonly used in spinal surgery. There have been many studies on hemodynamic changes in the prone position during general anesthesia. We report a rare case of transient left bundle branch block (LBBB) in a prone position.Patient concern:Electrocardiogram (ECG) of a 64-year-old man scheduled for spinal surgery showed normal sinus rhythm change to LBBB after posture change to the prone position.Diagnosis:Twelve lead ECG revealed LBBB. His coronary angio-computed tomography results showed right coronary artery with 30% to 40% stenosis and left circumflex artery with 40% to 50% stenosis. The patient was diagnosed with stable angina and second-degree atrioventricular block of Mobitz type II.Intervention:Nitroglycerin was administered intravenously during surgery. Adequate oxygen was supplied to the patient. After surgery, the patient was prescribed clopidogrel, statins, angiotensin II receptor blocker, and a permanent pacemaker was inserted.Outcome:Surgery was completed without complications. After surgery, the transient LBBB changed to a normal sinus rhythm. The patient did not complain of chest pain or dyspnea.Lesson:The prone position causes significant hemodynamic changes. A high risk of cardiovascular disease may cause ischemic heart disease and ECG changes. Therefore, careful management is necessary.  相似文献   
6.
AimHemocompatibility-related adverse events (HRAE) are a major cause of readmissions in patients with left ventricular assist devices (LVAD). The impact of aortic insufficiency (AI) on HRAE remains uncertain. We aimed to investigate the impact of AI on HRAE.Methods and ResultsPatients who underwent LVAD implantation between August 2014 and July 2017 and had echocardiograms 3 months post-LVAD implantation were enrolled. AI severity was assessed by measuring the systolic/diastolic ratio of flow and the rate of diastolic flow acceleration using Doppler echocardiography of the outflow cannula. Regurgitation fraction was derived from these parameters. Significant AI was defined as regurgitation fraction > 30%. Among 105 patients (median age, 56 years; 76% male), 36 patients (34%) had significant AI. Baseline characteristics were statistically not significantly different between those with and without significant AI except for higher rates of ischemic etiology and atrial fibrillation in the significant AI group (P < 0.05 for both). One-year survival free from HRAE was 44% in patients with AI compared to 67% in patients without significant AI (P = 0.018). The average hemocompatibility score, which defines the net burden of HRAE, was higher in the AI group (1.72 vs 0.64; P = 0.009), due mostly to higher tier I (mild HRAE; P = 0.034) and tier IIIB scores (severe HRAE; P = 0.011).ConclusionSignificant AI, as assessed by Doppler echocardiographic parameters, was associated with HRAE during LVAD support.  相似文献   
7.
BackgroundHemodynamic instability during spinal anesthesia for cesarean delivery is associated with adverse maternal and fetal outcomes. Plain and hyperbaric bupivacaine are commonly used for cesarean delivery, however, their distinctive pharmacologic properties may affect maternal hemodynamic profiles differently. The aim of this study was to compare hemodynamic profiles using a suprasternal Doppler cardiac output (CO) monitor in healthy term parturients randomized to receive plain or hyperbaric bupivacaine for cesarean delivery.MethodsOne hundred-and-sixty-eight healthy parturients scheduled for elective cesarean delivery were randomly assigned to receive 10.9 mg of intrathecal 0.5% plain or hyperbaric bupivacaine, both with 0.2 mg morphine. The primary outcome was CO change after spinal anesthesia. Secondary outcomes were the incidence of hypotension, vasopressor use, and conversion to general anesthesia.ResultsThe mean (±SD) CO at baseline, 1 min and 5 min after spinal anesthesia, and after placental delivery was 4.6 ± 1.2, 5.4 ± 1.3, 5.1 ± 1.4, and 6.4 ± 1.7 L/min in the plain bupivacaine, and 4.5 ± 1.1, 5.2 ± 1.3, 4.9 ± 1.3, and 6.2 ± 1.9 L/min in the hyperbaric bupivacaine group. There were no significant differences in CO, mean arterial pressure, or systemic vascular resistance. Incidences of hypotension, vasopressor and supplemental analgesic use, and conversion to general anesthesia, were not different between groups.ConclusionsCardiac output changes after plain or hyperbaric bupivacaine were not different in term parturients undergoing spinal anesthesia for cesarean delivery. Further studies comparing block quality and the rate of conversion to general anesthesia are required.  相似文献   
8.
目的探讨全身麻醉联合颈丛神经阻滞(CPB)对老年甲状腺癌患者血流动力学指标、血糖和激素水平及炎性反应指标的影响。方法根据麻醉方式的不同将78例接受甲状腺癌根治术的老年甲状腺癌患者分为全麻组和联合组,每组39例。全麻组患者采用全身麻醉,联合组患者采用全身麻醉联合CPB。比较两组患者术前和术毕的血流动力学指标[收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)及心率(HR)],比较两组患者术后5 h的疼痛程度和苏醒指标(吞咽时间、睁眼时间、应答时间及应答状态),比较两组患者术前和术毕的血糖和激素[促肾上腺皮质激素(ACTH)、皮质醇、肾上腺素及去甲肾上腺素]水平,比较术前和术后24 h两组患者的血清炎性反应指标[超敏C反应蛋白(hs-CRP)和白细胞介素-6(IL-6)],比较两组患者的术中指标,分析两组患者的麻醉相关不良反应。结果术毕,联合组患者的SBP、DBP、MAP及HR均低于全麻组,血糖、ACTH、皮质醇、肾上腺素及去甲肾上腺素水平也均低于全麻组,差异均有统计学意义(P﹤0.05)。联合组患者术后5 h的视觉模拟评分法(VAS)评分低于全麻组,差异有统计学意义(P﹤0.05);术后,联合组患者的吞咽时间、睁眼时间和应答时间均短于全麻组,改良警觉与镇静评分(OAA/S)低于全麻组,差异均有统计学意义(P﹤0.05)。术后24 h,联合组患者的血清hs-CRP和IL-6水平均低于全麻组,差异均有统计学意义(P﹤0.05)。两组患者的手术时间、丙泊酚用量、芬太尼用量及补液量比较,差异均无统计学意义(P﹥0.05)。两组均未见严重的麻醉相关不良反应,仅有轻微头晕、恶心等不良反应,均自行缓解。结论全身麻醉联合CPB能够保障老年甲状腺癌患者术中血流动力学平稳,减轻术后应激反应与术后炎性反应,对患者术中血糖与激素水平的影响也较全身麻醉轻,术后痛感小且苏醒效果好。  相似文献   
9.
Aortic stenosis (AS) and coronary artery disease (CAD) frequently coexist, with up to two thirds of patients with AS having significant CAD. Given the challenges when both disease states are present, these patients require a tailored approach diagnostically and therapeutically. In this review the authors address the impact of AS and aortic valve replacement (AVR) on coronary hemodynamic status and discuss the assessment of CAD and the role of revascularization in patients with concomitant AS and CAD. Remodeling in AS increases the susceptibility of myocardial ischemia, which can be compounded by concomitant CAD. AVR can improve coronary hemodynamic status and reduce ischemia. Assessment of the significance of coexisting CAD can be done using noninvasive and invasive metrics. Revascularization in patients undergoing AVR can benefit certain patients in whom CAD is either prognostically or symptomatically important. Identifying this cohort of patients is challenging and as yet incomplete. Patients with dual pathology present a diagnostic and therapeutic challenge; both AS and CAD affect coronary hemodynamic status, they provoke similar symptoms, and their respective treatments can have an impact on both diseases. Decisions regarding coronary revascularization should be based on understanding this complex relationship, using appropriate coronary assessment and consensus within a multidisciplinary team.  相似文献   
10.
Transcatheter aortic valve (TAV) replacement has become a viable alternative to surgery for high and intermediate risk patients with severe aortic stenosis. This technology may extend to the younger and lower risk patients. In this population, long-term durability of the TAV is key. Increased leaflet mechanical stress is one of the main determinants of valve structural deterioration. This in vitro study aims at evaluating leaflet bending stress (LBS) in the self-expanding TAV for different valve sizes, stroke volumes (SV), and degrees of valve oversizing (OS). Three different sizes (23, 26, and 29 mm) of CoreValve (CV) were tested on a pulse duplicator in annulus size ranging from 17 to 26 mm. Leaflet bending stress and bending of the leaflet coaptation line in diastole pinwheeling index (PI) were measured using high-speed camera imaging (1000 images/s). For each given CV and annulus size, geometric orifice area (GOA) increased significantly with OS (P < .001) and SV (P = .001). LBS decreased with increasing prosthesis size and aortic annulus (AA) size while increasing with SV (P < .03). The largest value of peak LBS (3.79 MPa) was obtained with the CV 23 mm in AA of 17 mm (%OS = 35%), SV 90 mL and the smallest value (0.99 MPa) for the CV 29 mm in AA of 26 mm (%OS = 12%), SV 30 mL. On multivariable analysis, LBS increased independently with larger OS, smaller AA size and higher SV. The PI increased with decreasing AA size and increasing OS. Moderate valve OS, such as generally used for transcatheter aortic valve implantation, is associated with increased LBS during valve opening and closing, especially in small annuli. Hence, TAV OS may negatively impact long-term valve durability.  相似文献   
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