监测舌下微循环、经皮氧代谢对脓毒症患者疾病严重程度及近期预后判断的价值分析

目的 分析监测舌下微循环、经皮氧代谢对脓毒症患者疾病严重程度及近期预后判断的价值。方法 回顾性选取2022年7月至12月徐州市第一人民医院收治的70例脓毒症患者作为研究对象,根据疾病严重程度,分为脓毒症组(n=36)和脓毒性休克组(n=34)。所有患者均监测舌下微循环、经皮氧代谢;采用Pearson相关性分析舌下微循环指标小血管总密度(TVDs)、灌注小血管密度(PVDs)、小血管灌注比例(PPVs)、微血管流动指数(MFIs)及经皮氧分压(TcPO₂)和经皮二氧化碳分压(TcPCO₂)与急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ评分)、脓毒症相关性器官功能衰竭评价(SOFA)评分的关系;观察脓毒症患者随访28 d预后情况,采用受试者工作特征(ROC)曲线分析舌下微循环指标联合经皮氧代谢指标预测脓毒症患者死亡的效能。结果 脓毒症组TVDs、PVDs、PPVs、MFIs、TcPO₂分别为(16.85±3.78) mm/mm²、(10.98±2.46) mm/mm²、(68....     

经皮氧监测在ARDS病人氧复苏治疗中的作用

目的　观察急性呼吸窘迫综合征 (ARDS)病人的氧动力学变化特点 ,探讨无创氧动力学监测在ARDS病人氧复苏治疗中的作用。方法　应用美国Novametric公司的经皮氧监测仪对ARDS病人进行连续动态皮肤氧 (PtcO2 )、CO2 张力(PtcCO2 )检测 ,并在 0、8、16、2 4、4 8、72h同时抽取动脉血观测PtcO2 、PtcO2 /FiO2 、PtcCO2 、SaO2 、PaO2 、PaO2 /FiO2 的变化趋势。结果　 93例病人中 ,存活 6 6例 ,死亡 2 7例 ,死亡率为 2 9 0 3%。存活组与死亡组的PtcO2 /FiO2 ,PaO2 /FiO2 的变化为 2 98 7± 70 76和97 6± 19 97;2 87 15± 6 3 7和 10 2 3± 4 0 85 (P <0 0 5 )。结论　无创氧动力学监测在ARDS病人氧复苏治疗中安全有效 ,临床动态监测对ARDS病人的氧复苏治疗有明显的指导作用 ,并且为迅速改善氧代谢提供科学依据。早期应用和合理指导能明显降低ARDS病人的死亡率     

早期目标导向治疗在脓毒性休克中的应用评价

目的 探讨早期目标导向治疗(EGDT)对脓毒性休克的治疗效果及影响因素.方法 将126例脓毒性休克患者分为治疗组(n=62)和对照组(n=64),治疗组给予EGDT治疗,对照组按传统方法进行循环与容量支持,比较两组治疗前与治疗24 h后序贯性器官衰竭评分(SOFA),急性生理和慢性健康状况(APACHEⅡ)评分及28 d病死率.在治疗组中按复苏6 h后是否达到复苏目标分为达标组(n=40)和未达标组(n=22),比较两组复苏前年龄、性别、相关血流动力学指标、SOFA评分、APACHE Ⅱ评分、血乳酸水平、28 d病死率.结果 治疗组和对照组治疗前两项评分SOFA:(12.26±4.37)vs.(12.54±5.21);KPACHE Ⅱ:(21.26±6.03)vs.(21.64±6.80);差异无统计学意义(P＞0.05),而治疗组治疗24 h后两项评分SOFA:(9.18±3.63)vs.(10.62±4.27);APACHEⅡ:(14.92±3.81)vs.(18.21±4.25);P＜0.05及28 d病死率48.39%vs.76.56%,P＜0.05)明显低于对照组.治疗达标组在年龄、平均动脉压(MAP)和APACHEⅡ评分七与未达标组差异有统计学意义,达标组28d病死率明显低于未达标组.结论 EGDT可明显改善脓毒性休克患者的预后,而年龄、复苏前MAP和APACHEⅡ评分是影响EGDT治疗效果的因素.     

监测严重脓毒症患者舌下微循环对病情严重程度及预后判定的临床意义

目的 探讨动态监测严重脓毒症患者舌下微循环的变化对判断病情严重程度和预后的临床意义.方法 采用前瞻性研究方法,收集北京友谊医院重症医学科2010年6月至12月符合入选标准的住院患者65例,其中脓毒症30例,严重脓毒症35例;严重脓毒症患者进行早期目标导向液体复苏治疗;于治疗0(治疗前)、6、12、24、48、72 h,采用旁流暗视野技术测定各组患者舌下微循环总血管密度(TVD)、灌注血管密度(PVD)、灌注血管比例(PPV)、微血管流动指数(MFI),并记录急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、住重症监护病房(ICU)天数及28 d病死率.另以同期30例健康体检者作为健康对照组.结果 脓毒症组舌下微循环PPV、MFI较健康对照组明显降低[PPV:(73.60±16.77)％比(85.17±7.60)％;MFI:3.23±0.77比3.78±0.35,均P＜0.05];严重脓毒症组PVD、PPV、MFI较脓毒症组明显降低[PVD(mm/mm2):7.53±4.38比12.15±2.88;PPV:(49.13±33.74)％比(73.60±16.77)％;MFI:2.21±1.41比3.23±0.77,均P＜0.05].严重脓毒症患者经早期目标导向液体复苏后,舌下微循环指标均较治疗前(0 h)明显改善,以12h最为明显[TVD(mm/mm2):5.76±2.25比6.72±4.37;PVD(mm/mm2):7.57±1.77比5.48±4.39;PPV:(69.47±19.24)％比(34.55±30.82)％;MFI:3.17±0.49比1.55±1.14,均P＜0.05].与脓毒症组比较,严重脓毒症组APACHEⅡ评分(分)有所增加(24.77±7.45比19.30±10.36,但P＞0.05),住ICU天数(d)明显延长(20.60±19.87比10.33±9.53,P＜0.05),28 d病死率有所升高(45.71％比36.36％,但P＞ 0.05).在严重脓毒症患者中,与存活组(19例)比较,死亡组(16例)舌下微循环PVD、PPV、MFI降低更明显[PVD(mm/mm2):6.70±5.15比8.53±3.13;PPV:(44.23±37.71)％比(54.96±28.41)％;MFI:1.89±1.65比2.58±0.98,P＜0.05或P＜0.01];APACHEⅡ评分(分:23.19±6.46比20.31±6.03)及住ICU天数(d:16.13±10.90比19.19±9.90)差异均无统计学意义(均P＞0.05).相关性分析显示:PPV与患者预后呈显著负相关(r=-0.374,P＜0.05).结论 严重脓毒症患者舌下微循环动态监测可用于判断病情严重程度,对指导预后有一定意义.     

主动脉内球囊反搏术在感染性休克患者抢救治疗中的应用价值

目的 探讨血管活性药物联合应用主动脉内球囊反搏术(IABP)治疗感染性休克患者的临床疗效及应用价值.方法 采用单中心注册研究方法.选择北京世纪坛医院2006年7月至2010年10月入住重症监护病房(ICU)确诊为感染性休克的晚期患者78例,根据患者家属自愿的原则分为单用血管活性药物组(多巴胺+去甲肾上腺素治疗)和联合IABP组(多巴胺+去甲肾上腺素+IABP治疗)两组,每组39例.两组在治疗前后均行血流动力学及组织灌注监测,同时观察休克恢复时间、血管活性药物用量、住ICU时间、28 d死亡情况.结果 两组治疗前各监测指标比较差异无统计学意义;两组治疗后心率、血压及心脏功能等指标均较治疗前明显改善.联合IABP组平均动脉压(MAP,mm Hg,1 mm Hg=0.133 kPa)在IABP后24h和72 h,心排血指数(CI,L·min-1·m-2)在IABP后48 h、停用IABP后2h,多巴胺用量(μg· kg-1· min-1)在IABP后24、48、72 h和停用IABP后2h的改善程度均明显优于单用血管活性药物组(MAP:53.0±6.3比52.1±6.2,65.6±4.3比65.0±2.1; CI:3.40±0.20比3.30±0.50,3.60±0.30比3.60±0.30;多巴胺用量:17.5±1.2比17.6±1.3,10.2±1.3比12.8±1.6,5.8±1.5比6.8±1.7,3.0±0.7比4.1±1.3,P＜0.05或P＜0.01);且与单用血管活性药物组比较,联合IABP组患者休克恢复时间(d)明显缩短(10.4±2.2比14.1±3.4),28 d病死率明显降低(34.1％比45.6％,均P＜0.01);两组住ICU时间无明显差异.结论 IABP对感染性休克患者能显著改善血流动力学指标,增加冠状动脉及全身组织灌注,减轻心脏后负荷,提高CI,减少血管活性药物用量,对缩短住ICU时间、改善预后、减少患者病死率都有着重要的临床价值,可推荐作为感染性休克患者药物治疗不佳的备选治疗方法.     

PiCCO在ARDS合并感染性休克的老年患者早期目标导向治疗中的应用

目的:探讨脉波指示剂连续心排血量监测(PiCCO)技术在急性呼吸窘迫综合征(ARDS)合并感染性休克的老年患者早期目标导向治疗(EGDT)中的临床指导价值.方法:将88例ARDS合并感染性休克的老年患者随机分成治疗组和对照组,治疗组采用PiCCO技术指导下EGDT,对照组按规常进行EGDT.记录两组患者6、24 h各项参数,6、24 h达标率及30 d病死率等参数.结果:治疗组6、24 h复苏液体量显著多于对照组(P＜0.01),血管活性药物用量显著少于对照组(P＜0.05);复苏24 h的MAP、CVP、ScvO2、每小时尿量、氧合指数(PaO2/FiO2)、全心舒张末期容积指数(GEDI)、胸腔内血容量指数(ITBVI)、心排指数(CI)、6、24 h达标率显著高于对照组(P＜0.05);血清乳酸浓度(Lac)、血管外肺水指数(EVLWI)、全身血管阻力指数(SVRI)、肺血管通透性指数(PVPI)、30 d病死率显著低于对照组(P＜0.05).结论:PiCCO指导下液体复苏在ARDS合并感染性休克的老年患者EGDT中具有积极的临床意义.     

中心静脉-动脉二氧化碳分压差在反映感染性休克患者组织灌注及氧代谢状态的临床研究

目的:探讨中心静脉-动脉二氧化碳分压差[P(cv-a)CO_2]在反映感染性休克患者组织灌注和氧代谢状态的临床价值。方法:将82例经早期目标导向治疗(EGDT)后中心静脉血氧饱和度(ScvO_2)≥70%的感染性休克患者进行前瞻性研究。以入组时P(cv-a)CO_2=6mmHg(1mmHg=0.133kPa)为临界值,将患者分成低P(cv-a)CO_2组和高P(cv-a)CO_2组。记录患者的一般情况,急性生理和慢性健康评分(APACHEⅡ)、序贯器官衰竭评估(SOFA)评分、感染指标、6h乳酸清除率、24h△SOFA评分、ICU病死率及28d病死率等,动态监测患者血流动力学及氧代谢指标变化。结果:2组患者年龄、SOFA评分、APACHEⅡ评分、感染指标、平均动脉压(MAP)、中心静脉压力(CVP)、ScvO_2、氧消耗(VO_2)比较差异均无统计学意义;低P(cv-a)CO_2组患者心排血指数(CI)、每搏输出量指数(SVI)、氧输送(DO_2)、动脉-中心静脉氧含量差[C(a-cv)O_2]显著高于高P(cv-a)CO_2组,每搏输出量变异(SVV)、氧摄取率(ERO_2)显著低于高P(cv-a)CO_2组(P0.05,P0.01),24h△SOFA、6h乳酸清除率均显著高于高P(cv-a)CO_2组(P0.05),ICU病死率及住院28d病死率显著低于高P(cv-a)CO_2组(P0.05)。结论:P(cv-a)CO_2是感染性休克患者组织灌注不足的敏感指标,可以准确的反映组织灌注和氧代谢状态,是早期识别并纠正感染性休克的重要标准,对于评价患者液体管理及预后判断有重要的意义。     

氧代谢指标在感染性休克中的应用进展

<正>重症监护病房(ICU)中感染性休克患者需要充分的液体复苏、优化容量管理以达到机体组织器官功能的恢复[1],而改善器官灌注、纠正组织缺氧、恢复细胞功能是救治的关键。随着ICU技术的进步,氧代谢指标的监测受到越来越多的重视。2012年"严重全身性感染与感染性休克治疗指南"再次强调中心静脉血氧饱和度(Scv O2)的监测及达标,并将乳酸的监测及达标纳入了感染性休克及脓毒症的早期目标导向治疗(early goal-directed therapy,     

携氧代血浆扩容及携氧功能初步动物实验研究

目的建立大鼠重度失血性休克模型和大鼠失血性休克-肠系膜微循环模型,用以探讨携氧代血浆的扩容和携氧功能。方法将20只SD大鼠失血至全身血容量的60%,造成重度失血性休克大鼠模型后,随机均分为6%羟乙基淀粉(HES)组和携氧代血浆组做相应样品的等容量输注复苏。分别在造模前、休克、输液末以及输液后1 h观测大鼠平均动脉压(MAP)、股动脉取血测定血气,检测组织氧分压(PtO_2)。另取20只大鼠建立失血性休克-肠系膜微循环模型,观察、记录大鼠造模前基础值、休克、输液末以及输液后1 h微血管直径的变化和血流状态。结果 HES组与携氧代血浆组比较,输液末微静脉直径(μm)与微动脉直径(μm)分别为:31.23±4.96 vs 31.86±5.43、19.46±1.47 vs19.40±2.10(P0.05),输液后血流状态均得到恢复;输液后1 h的MAP(mm Hg)为:90.70±3.83 vs 98.90±9.18(P0.05);组织氧分压(mm Hg)为:输液末7.03±1.47 vs 15.32±2.34(P0.05),输液后1 h 5.53±2.39 vs 8.90±2.01(P0.05);2组大鼠血气指标在各时间点相近(P0.05)。结论携氧代血浆能够改善大鼠失血性休克所致的微循环障碍,具有与HES相似的血管扩容作用,并且在大鼠休克复苏初期恢复组织氧分压的效果优于HES。     

早期动脉血乳酸清除率在评估严重脓毒症患者预后中的价值

目的：探讨早期动脉血乳酸清除率（LCR）在评估严重脓毒症患者预后中的价值。方法回顾性分析河源市人民医院重症监护病房68例严重脓毒症患者的临床资料。计算出患者治疗前后6 h的乳酸清除率、24 h内APACHEⅡ评分,监测ScvO2、CVP、MAP和尿量。分别比较存活组和死亡组、MODS组和NMODS组、EGDT达标组和EGDT未达标组、CBP组和NCBP组的6 h乳酸清除率,以及其与ScvO2的相关性。结果存活组6 h乳酸清除率显著高于死亡组（ P＜0.05）。 NMODS组、EGDT达标组及CBP组的动脉血乳酸清除率分别高于MODS组、EGDT未达标组及NCBP组（均P＜0．05）;且前者的死亡率明显低于后者（均P＜0．05）,EGDT达标组治疗6 h后患者ScvO2、CVP、MAP、尿量明显改善,差异均有统计学意义（ P＜0．05）。动脉血乳酸清除率与ScvO2呈显著正相关（r＝0．90,P＜0．05）。结论早期动态检测严重脓毒症患者的动脉乳酸清除率可评估其严重程度及预后,而通过积极的EGDT、CBP等治疗明显提高早期动脉血乳酸清除率,从而改善严重脓毒症患者的预后。     

Effect of early goal directed therapy on tissue perfusion in patients with septic shock

BACKGROUND:

This study aimed to observe the effect of early goal directed therapy (EGDT) on tissue perfusion, microcirculation and tissue oxygenation in patients with septic shock.

METHODS:

Patients with early septic shock (<24 hours) who had been admitted to the ICU of Zhongda Hospital Affiliated to Southeast University from September 2009 through May 2011 were enrolled (research time: 12 months), and they didn’t meet the criteria of EGDT. Patients who had one of the following were excluded: stroke, brain injury, other types of shock, severe heart failure, acute myocardial infarction, age below 18 years, pregnancy, end-stage disease, cardiac arrest, extensive burns, oral bleeding, difficulty in opening the mouth, and the onset of septic shock beyond 24 hours. Patients treated with the standard protocol of EGDT were included. Transcutaneous pressure of oxygen and carbon dioxide (PtcO₂, PtcCO₂) were monitored and hemodynamic measurements were obtained. Side-stream dark field (SDF) imaging device was applied to obtain sublingual microcirculation. Hemodynamics, tissue oxygen, and sublingual microcirculation were compared before and after EGDT. If the variable meets the normal distribution, Student''s t test was applied. Otherwise, Wilcoxon''s rank-sum test was used. Correlation between variables was analyzed with Pearson''s product-moment correlation coefficient method.

RESULTS:

Twenty patients were involved, but one patient wasn’t analyzed because he didn’t meet the EGDT criteria. PtcO₂ and PtcCO₂ were monitored in 19 patients, of whom sublingual microcirculation was obtained. After EGDT, PtcO₂ increased from 62.7±24.0 mmHg to 78.0±30.9 mmHg (P<0.05) and tissue oxygenation index (PtcO₂/FiO₂) was 110.7±60.4 mmHg before EGDT and 141.6±78.2 mmHg after EGDT (P<0.05). The difference between PtcCO₂ and PCO₂ decreased significantly after EGDT (P<0.05). The density of perfused small vessels (PPV) and microcirculatory flow index of small vessels (MFI) tended to increase, but there were no significant differences between them (P>0.05). PtcO₂, PtcO₂/FiO₂, and PtcCO₂ were not linearly related to central venous saturation, lactate, oxygen delivery, and oxygen consumption (P>0.05).

CONCLUSION:

Peripheral perfusion was improved after EGDT in patients with septic shock, and it was not exactly reflected by the index of systemic perfusion.KEY WORDS: Transcutaneous pressure of oxygen, Transcutaneous pressure of carbon dioxide, Microcirculation, Septic shock, EGDT, Tissue perfusion, Tissue oxygenation, Sidestream dark field imaging     

Transcutaneous oxygen tension monitoring in critically ill patients receiving packed red blood cells

Purpose

Whether transfusions of packed red blood cells (PRBCs) affect tissue oxygenation in stable critically ill patients is still matter of discussion. The microvascular capacity for tissue oxygenation can be determined noninvasively by measuring transcutaneous oxygen tension (tcpO₂). The aim of this study was to assess tissue oxygenation by measuring tcpO₂ in stable critically ill patients receiving PRBC transfusions.

Methods

Nineteen stable critically ill patients, who received 2 units of PRBC, were prospectively included into this pilot study. Transcutaneous oxygen tension was measured continuously during PRBC transfusions using Clark's electrodes. In addition, whole blood viscosity and global hemodynamics were determined.

Results

Reliable measurement signals during continuous tcpO₂ monitoring were observed in 17 of 19 included patients. Transcutaneous oxygen tension was related to the global oxygen consumption (r = − 0.78; P = .003), the arterio-venous oxygen content difference (r = − 0.65; P = .005), and the extraction rate (r = − 0.71; P = .02). The transfusion-induced increase of the hemoglobin concentration was paralleled by an increase of the whole blood viscosity (P < .001). Microvascular tissue oxygenation by means of tcpO₂ was not affected by PRBC transfusions (P = .46). Packed red blood cell transfusions resulted in an increase of global oxygen delivery (P = .02) and central venous oxygen saturation (P = .01), whereas oxygen consumption remained unchanged (P = .72).

Conclusions

In stable critically ill patients, microvascular tissue oxygenation can be continuously monitored by Clark's tcpO₂ electrodes. According to continuous tcpO₂ measurements, the microvascular tissue oxygenation is not affected by PRBC transfusions.     

经皮氧分压监测在脓毒性休克患者中的临床应用

脓毒症和脓毒性休克是ICU患者最常见的死亡原因之一。液体治疗是治疗脓毒性休克的重要手段之一，如何进行液体治疗仍然存在很大争议，目前普遍以容量反应性来指导液体治疗。但也有学者发现，即使宏观血流动力学恢复，微循环仍可能存在障碍。休克的本质是微循环障碍，如何监测微循环状况及利用微循环监测对脓毒性休克患者进行早期诊断、病情评估，以及指导液体治疗可能是今后研究的方向。经皮氧分压（TcPO₂）监测技术是通过无创方法将皮肤表面电极加热来估测组织氧分压的技术手段。越来越多的学者研究发现TcPO₂在监测脓毒症和脓毒性休克患者局部组织灌注不足、预测患者预后、指导液体治疗等方面有重要的临床价值。因此本文对TcPO₂在脓毒性休克中的应用进行整理和总结。     

Effect of high frequency transcutaneous electrical nerve stimulation at root level menstrual pain in primary dysmenorrhea

IntroductionPrimary dysmenorrhea (PD) is a painful menstruation due to contractions in the uterus that induce ischemic pain associated with normal pelvic anatomy.ObjectiveThe purpose of the study is to evaluate the effect of High TENS application (root level) among adolescent girls of PD.Methodology140 adolescent girls were included with 14–19 years of age and randomly allocated into two groups of Experimental and Control group. The measurement of lower abdominal pain, referred low back pain, and referred bilateral thighs pain was performed by numerical pain rating scale and measurement of systolic as well as diastolic blood pressure by aneroid sphygmomanometer. The data collection was done before and after the intervention.Results & conclusionThere were highly significant difference in intragroup and intergroup comparison of all the outcome variables in group A (p value < 0.001). The study concluded that High frequency TENS application at root level show significant improvement for managing primary dysmenorrhea.     

Influence of tissue pressure on central venous pressure/peripheral venous pressure correlation: An experimental report

BACKGROUND: Peripheral venous pressure (PVP) has been shown to correlate with central venous pressure (CVP) in a number of reports. Few studies, however, have explored the relationship between tissue pressure (TP) and PVP/CVP correlation.METHODS: PVP and CVP were simultaneously recorded in a bench-top model of the venous circulation of the upper limb and in a single human volunteer after undergoing graded manipulation of tissue pressure surrounding the intervening venous conduit. Measures of correlation were determined below and above a point wherein absolute CVP exceeded TP.RESULTS: Greater correlation was observed between PVP and CVP when CVP exceeded TP in both models. Linear regression slope was 0.975 (95% CI: 0.959-0.990); r² 0.998 above tissue pressure 10 cmH₂O vs. 0.393 (95% CI: 0.360-0.426); and r² 0.972 below 10 cmH₂O at a flow rate of 2000 mL/h in the in vitro model. Linear regression slope was 0.839 (95% CI: 0.754-0.925); r² 0.933 above tissue pressure 10 mmHg vs. slope 0.238 (95% CI: -0.052-0.528); and r²0.276 in the en vivo model.CONCLUSION: PVP more accurately reflects CVP when absolute CVP values exceed tissue pressure.     

剖宫产对早期新生儿的影响

目的探讨剖宫产对早期新生儿的影响。方法新生儿按照分娩方式分成自然分娩组和剖宫产组。比较两组新生儿体质量丢失程度、奶量达到生理需要时间、大便转黄时间及经皮胆红素（TCB）情况。结果剖宫产组新生儿出生后第2天体质量丢失程度[（0.0730±0.0078）kg]大于自然分娩组[（0.0560±0.0071）kg],差异有统计学意义（P〈0.05）。第3天及第5天两组新生儿体质量丢失程度比较差异无统计学意义（P〉0.05）。生后第2天自然分娩组TCB值[（9.8±2.2）mg/dl]较剖宫产组[（8.9±1.8）mg/dl]高,差异有统计学意义（P〈0.05）。第4天及第5天两组TCB值比较差异无统计学意义（P〉0.05）;两组新生儿大便转黄时间及奶量满足生理需要时间比较差异均无统计学意义（P〉0.05）。结论剖宫产对早期新生儿有一定的影响。     

The influence of different levels of PEEP on peripheral tissue perfusion measured by subcutaneous and transcutaneous oxygen tension

Objective To compare subcutaneous (PscO₂) and transcutaneous (PtcO₂) oxygen tension measurements in relation to hemodynamic variables at different levels of PEEP, and to evaluate the usefulness of these measurements as monitors of peripheral tissue perfusion.Design Prospective trial.Setting Intensive care unit in a university hospital.Patients Seven patients with gastric cancer who where undergoing total gastrectomy.Interventions Silicone catheter was placed in the upper arm and transcutaneous oxygen monitor was placed on the upper part of the chest. A pulmonary artery catheter was placed in the right pulmonary artery.Measurements and results PscO₂ and PtcO₂ together with hemodynamic variables were measured at different levels of PEEP. Progressive increase of PEEP reduced cardiac index (CI) (p<0.05) with a concomitant decrease of PscO₂ (p<0.05) and oxygen delivery (DO₂) (p<0.05). Changes in PtcO₂ parallelled changes in arterial oxygen tension (PaO₂), but no correlation was found between PtcO₂, CI and DO₂.Conclusion PscO₂ is a sensitive indicator of subcutaneous tissue perfusion, which can be used to identify the PEEP level, with optimum peripheral perfusion. PscO₂ seems to be a more reliable indicafor of tissue perfusion than PtcO₂.This study was supported by Tore Nilsons Fund for Medical Research. Lundgrens Stiftelse, Medical Faculty, University of Lund and by the Swedish Medical Research Council Projecr no. B88-17x-00640-24B     

组织压监测下治疗小腿骨筋膜室综合征30例报告

目的：探讨测定组织压与血压的差值在诊治小腿骨筋膜室综合征的临床意义。方法：应用穿刺法,通过测量30例筋膜室综合征患者组织压、血压,明确减压手术的客观指标。结果：30例中10例行保守治疗,20例行减压治疗,随访均未发生骨筋膜室后遗症。结论：组织压、收缩压、舒张压的结合测量对指导何时行减压术有重要临床意义。当差值为20mmHg时,需即刻减压。     

Impact of mitral E/A ratio on the accuracy of different echocardiographic indices to estimate left ventricular end-diastolic pressure

The objective was to determine the influence of left ventricular (LV) inflow pattern on the accuracy of different echocardiographic indices for estimation of LV end-diastolic pressure (LVEDP). Echocardiography with color tissue Doppler imaging (TDI) and LVEDP measurements using fluid-filled catheters were performed in 176 consecutive patients on the same day. Mitral peak diastolic velocities (E, A) and the difference in duration between pulmonary venous retrograde velocity and mitral A-velocity (PV(R)-A) were recorded by pulsed Doppler. Propagation velocity of the early mitral inflow (V(P)) was assessed using color M-mode. Early diastolic longitudinal (E'(lat)) and radial (E'(radial)) velocities of mitral annulus were measured by TDI. Area under ROC curve (AUC) for prediction of elevated LVEDP (> or =15 mm Hg) was computed for each parameter. For E/A > or =1 (98 patients, 46 with elevated LVEDP), the AUC values were: PV(R)-A: 0.914; E/E'(lat): 0.780; E/E'(radial): 0.729; E/V(P): 0.712 (p < 0.001). When E/A <1 (78 patients, 26 with elevated LVEDP), only PV(R)-A reached statistical significance (AUC = 0.893, p < 0.001). The conclusions were: PV(R)-A enabled the most accurate noninvasive estimation of LVEDP irrespective of LV filling profile and combined indices E/V(P), E/E'(lat) and E/E'(radial) represent more feasible alternatives for patients with mitral E/A-1.     

自体外周血干细胞移植治疗糖尿病下肢缺血效果观察

目的 探讨自体外周血干细胞(PBSC)移植治疗糖尿病性下肢缺血的疗效。方法 应用自体PBSS移植治疗18例30条糖尿病性下肢缺血。采用主观、客观评价指标对疗效进行观察评定。结果 自体PBSC移植后1个月患者疼痛、冷感、麻木症状明显改善,改善率分别为96.7％ (29/30)、100％(30/30)、95.8％ (23/24);间歇性跛行明显缓解,总有效率为76.9％ (10/13)。3个月后踝肱指数(ABI)升高,由术前的0.60±0.11增加到术后的0.71±0.12,差异有统计学意义(t=-6.882,P＜0.01)。93.3％(28/30)的患者皮氧分压不同程度地升高;同时患者的足部感染得到控制,溃疡或足趾坏疽好转或愈合。移植后所有患者均未出现并发症和明显不良反应。结论 自体PBSC移植治疗糖尿病性下肢缺血是一种相对简单、安全、有效的方法。