不同护理方式对下肢静脉血液回流的影响

[目的]探讨不同护理方式对下肢静脉血流动力学的影响，为下肢深静脉血栓高危人群选择有效的活动方式提供理论依据。[方法]用彩色多普勒超声检测10名健康自愿受试者股静脉在平卧静息状态、下肢抬高30度、踝关节主动伸屈运动、踝关节被动屈伸运动4种状态下的股静脉血流峰速度、平均速度和单位时间血流量。[结果]在这4种常用护理方式中，以平卧静息状态股静脉血液回流速度最慢，其他3种方式在静息状态基础上都有增加。其中，足踝主动活动组增加最快，其次是足踝被动活动组，而下肢抬高组增加较少。[结论]下肢抬高及踝关节运动可有效促进下肢静脉血液回流，以踝关节主动运动效果最为理想。     

不同护理方式对下肢静脉血液回流的影响

[目的]探讨不同护理方式对下肢静脉血流动力学的影响,为下肢深静脉血栓高危人群选择有效的活动方式提供理论依据.[方法]用彩色多普勒超声检测10名健康自愿受试者股静脉在平卧静息状态、下肢抬高30度、踝关节主动伸屈运动、踝关节被动屈伸运动4种状态下的股静脉血流峰速度、平均速度和单位时间血流量.[结果]在这4种常用护理方式中,以平卧静息状态股静脉血液回流速度最慢,其他3种方式在静息状态基础上都有增加.其中,足踝主动活动组增加最快,其次是足踝被动活动组,而下肢抬高组增加较少.[结论]下肢抬高及踝关节运动可有效促进下肢静脉血液回流,以踝关节主动运动效果最为理想.     

早期系统护理干预防止ICU患者下肢深静脉血栓的效果

目的探讨早期系统护理干预对防止ICU患者下肢深静脉血栓（deepvenousthrombosis,DVT）的临床意义。方法将120例ICU患者按入组顺序随机分为两组,单数为试验组（n=60）,双数为对照组（n=60）。试验组给予早期系统护理干预措施,对照组给予ICU常规护理。两组患者每日1次测量下肢周径,并于入住ICU第1,7,14天行彩色多普勒检查测定股静脉血流速度,比较两组股静脉血流速度及DVT发生率。结果干预前两组患者股静脉血流速度差异无统计学意义（P〉0．05）。干预后第7,14天实验组患者股静脉血流峰速度分别为（52．8±9．6）,（52．6±8．8）分;股静脉血流平均速度分别为（34．2±6．9）,（35．3±7．2）分,均高于对照组患者股静脉血流峰速度（41．3±7．8）,（42．5±7．6）分,股静脉血流平均速度（22．5±7．1）,（23．7±6．6）分,两组比较差异均有统计学意义（t=2．724,3．125,2．722,3．114;P〈0．05）;DVT发生率试验组低于对照组,差异具有统计学差异（X^2=4．904,P〈0．05）。结论采取早期系统护理干预措施能提高下肢静脉血流速度,有效预防和减少了ICU患者DVT的发生率。     

不同频率踝关节运动对下肢静脉回流的影响

[目的]探讨不同频率踝关节运动对下肢静脉血液回流的情况,为临床护理工作提供实验依据。[方法]选17名健康受试者取平卧位于右侧下肢踝关节进行“环转”方式主动活动,借助彩色多普勒超声仪检测不同频率活动下的股静脉血流峰速度。[结果]不同频率组的踝关节运动均使下肢静脉血流速度走向趋势呈“峰”状波动,踝关节运动每分钟10次、20次、30次、40次分别为实验1组、实验2组、实验3组、实验4组,实验1组与实验3组股静脉血流速度增加量分别与其他组股静脉血流速度增加量比较,差异有统计学意义（P〈O．05）,实验2组与实验4组股静脉血流速度增加量差异无统计学意义（P〉O．05）。[结论]不同频率组的踝关节运动对下肢静脉血流速度有影响。     

踝关节运动对健康成年人股静脉血流动力学及下肢疲劳程度的影响

目的探讨不同方式踝关节运动对健康成年人股静脉血流动力学及下肢疲劳程度的影响。方法采用便利抽样法选取2021年1—6月南京医科大学第一附属医院符合入组条件的30名健康成年人为研究对象。采用前瞻性自身前后对照方法, 先使用多普勒超声探讨静息状态、踝关节背屈和跖屈动作对下肢股静脉血流的影响。再让受试者接受两种踝关节运动, 传统方式为背屈10 s放松5 s、跖屈10 s放松5 s;改良方式为背屈1 s放松1 s、跖屈1 s放松1 s。分别在运动5 min后即刻、运动结束休息5 min、运动结束休息10 min时对受试者股静脉血流动力学进行测定, 并评估运动持续1、3、5 min时受试者的主观感觉疲劳程度。结果与静息状态相比, 踝关节背屈和跖屈的股静脉血流峰速、平均流速、血流量均增加(P<0.01);与跖屈相比, 踝关节背屈时的股静脉血流峰速、平均流速、血流量提高(P<0.05)。不同时间点两种踝关节运动方式的股静脉血流峰速和平均流速比较, 差异无统计学意义(P>0.05)。两种运动持续1、3 min时受试者的主观感觉疲劳程度得分比较, 差异无统计学意义(P>0.05),...     

不同频率踝关节运动对下肢静脉回流的影响

[目的]探讨不同频率踝关节运动对下肢静脉血液回流的情况,为临床护理工作提供实验依据.[方法]选17名健康受试者取平卧位于右侧下肢踝关节进行"环转"方式主动活动,借助彩色多普勒超声仪检测不同频率活动下的股静脉血流峰速度.[结果]不同频率组的踝关节运动均使下肢静脉血流速度走向趋势呈"峰"状波动,踝关节运动每分钟10次、20次、30次、40次分别为实验1组、实验2组、实验3组、实验4组,实验1组与实验3组股静脉血流速度增加量分别与其他组股静脉血流速度增加量比较,差异有统计学意义(P＜0.05),实验2组与实验4组股静脉血流速度增加量差异无统计学意义(P＞0.05).[结论]不同频率组的踝关节运动对下肢静脉血流速度有影响.     

中晚孕期胎儿静脉导管和脐静脉血流量参考范围

目的 建立中晚孕期正常胎儿静脉导管和脐静脉血流量参考范围，计算脐血流人静脉导管的百分比。方法 应用彩色多普勒超声检查138例16-41孕周正常单胎胎儿，记录静脉导管和脐静脉血流波形，测定最大血流速度计算血流量。结果 静脉导管血流量随着孕龄增加而增加（P〈0．01），对应于体质量则随着孕龄增加而减低（P〈0．01）。脐静脉血流速、血管管径、血流量随孕龄增加而增加（P〈0．05，P〈0．01，P〈0．01），对应于体质量脐静脉血流量随着孕龄增加而减低（P〈0．01）。静脉导管与脐静脉血流量（Qdv／Quv）之比随着妊娠进展而减低（P〈0．01）。平均43％脐血流人静脉导管。结论 中晚孕期胎儿脐血流人静脉导管随着妊娠进展而减低，静脉导管在分流含氧高的血到脑和心肌起着次要作用。     

人力挤压腓肠肌对下肢静脉回流的影响

目的探讨人力挤压腓肠肌对下肢静脉回流的影响。方法用彩色超声多普勒检测20例40侧健康成人股静脉分别在静息状态、足踝主动运动及人力挤压腓肠肌状态下的静脉血流峰速度。结果足踝主动运动、人力挤压腓肠肌时的股静脉回流峰速度明显高于静息状态下股静脉回流峰速度，经ANDVA方差分析，F=23．596，P〈0．005，差异有统计学意义。结论人力挤压腓肠肌能促进下肢静脉回流。     

拉贝洛尔治疗妊娠高血压危象疗效观察

目的：观察静脉使用拉贝洛尔治疗妊娠高血压危象的疗效。方法：妊娠高血压危象55例患者分为两组,A组（30例）使用拉贝洛尔注射液,以（0．5-1）mg／min速度静脉微泵输入,2h左右血压达安全范围,再予（70-208）ug／min静脉维持;B组（25例）采用硝苯地平10mg口服,q8h,两组同时使用硫酸镁预防子痫发生。在此期间监控血压,心电变化。结果：A组用药2h后显效23例,有效6例,显效率76．7％,总有效率96．7％。36h平均血压为（106±13）mmHg（1mmHg=0．133kPa）。B组用药2h后显效8例,有效l0例,显效率32％,总有效率72％。36h平均血压为（118．9±10．2）mmHg,出现心动过速8例。结论：拉贝洛尔治疗妊娠高血压急症疗效确切,降压平稳,未见有严重不良反应。     

不同麻醉方法对妇科腹腔镜手术患者股静脉血流动力学影响

目的:观察气管插管全身麻醉与气管插管全身麻醉复合硬膜外麻醉时妇科腹腔镜手术患者股静脉血流的影响.方法:56例行妇科腹腔镜手术患者,随机分为气管插管全身麻醉组28例(GA组)和气管插管全身麻醉复合硬膜外麻醉组28例(CGEA组).分别于麻醉后气腹前(T0)、气腹形成后(T1)、术毕排气后麻醉恢复前(T2)采用彩色多普勒超声检测股静脉血流动力学的改变,同时监测生命体征变化.结果:2组T1,T2时股静脉直径均较T0增加(P<0.05);T1时CGEA组股静脉直径小于GA组(P<0.05).T1时2组股静脉平均血流速度、平均血流量均较T0时下降(P<0.05),GA组较CGEA组下降更明显(P<0.05).结论:气管插管全身麻醉复合硬膜外麻醉下行妇科腹腔镜手术对股静脉血流动力学影响更小.     

彩色多普勒超声观察不同体位下的脑静脉颅外回流

目的 通过彩色多普勒超声对照观察不同体位下的颈内静脉和椎静脉,探讨体位对脑静脉颅外回流的影响。方法 选取40名中青年健康志愿者,于静息状态下采用彩色多普勒超声观测颈内静脉和椎静脉在仰卧位和坐位下的血流动力学参数变化情况。结果 仰卧位时,颈内静脉横截面积为(0.67±0.26)cm²,血流速度为(18.73±7.37)cm/s,血流量为(758.51±437.23)ml/min;椎静脉横截面积为(0.04±0.02)cm²,血流速度为(19.25±8.88)cm/s,血流量为(47.23±25.40)ml/min;颈内静脉血流量占脑静脉颅外回流总量(颈内静脉和椎静脉血流量之和)的94.13%。坐位时,颈内静脉横截面积为(0.16±0.09)cm²,血流速度为(18.08±10.71)cm/s,血流量为(177.43±157.42)ml/min;椎静脉横截面积为(0.06±0.03)cm²,血流速度为(36.06±16.88)cm/s,血流量为(144.61±94.97)ml/min;颈内静脉血流量占脑静脉颅外回流总量的22.02%。与仰卧位相比,坐位时颈内静脉的横截面积和血流量明显减少,椎静脉的横截面积、血流速度和血流量明显增加(P均<0.01)。结论 健康志愿者静息状态下,颈内静脉和椎静脉丛分别是仰卧位和坐位时脑静脉颅外回流的主要途径。     

Low-prime perfusion circuit and autologous priming in CABG surgery on a Jehovah's Witness: a case report

Cardiac surgery on Jehovah's Witnesses is a great challenge for the cardiothoracic surgery team and especially for the perfusionist. To reduce the risk of surgery in these patients, a very small extracorporeal circuit was designed to decrease the amount of priming volume and thereby the degree of hemodilution. A small bypass system was built, consisting of a 3/8-in. arterial line and a 3/8-in. venous line, a venous collapsible reservoir, a centrifugal pump, a hollow fiber oxygenator and a cell saver reservoir. The circuit priming volume was 650 ml. By using antegrade and retrograde autologous priming, the total amount of priming was reduced to +/-50 ml. Bypass time was 63 min with an average blood flow of 5300+/-114 ml/min and postmembrane pressures of 180+/-45 mmHg. Venous line pressure was monitored and kept between -8 and -20 mmHg with a mean arterial pressure (MAP) of 55+/-12.3 mmHg. The hematocrit before extracorporeal circulation (ECC) was 36%, per-ECC 35% and post-ECC 35%. On the fifth postoperative day, the hematocrit was 40%. The patient was discharged 7 days after surgery. A low-prime circuit, in combination with autologous priming, seems to be safe and effective in avoiding the use of banked blood.     

Failure of impedance plethysmography to follow exercise-induced changes in limb blood flow

1. The blood flow in the forearm and the calf of six healthy volunteers was measured at rest and after exercise by impedance plethysmography using pulsatile (QZp) and venous occlusion (QZocc) methods, and by venous occlusion strain gauge plethysmography (Qsg). 2. At rest, the impedance QZp method gave values slightly higher than those of Qsg. In the forearm, the ratio QZp to Qsg was 1.26 in the supine position and 1.97 in the upright sitting position. For the calf muscle, the ratios were 1.08 in the supine position and 1.23 in the upright position. 3. Immediately after exercise, Qsg increased from resting values of approximately 2-4 ml min-1 100 ml-1 to mean values of 16-25 ml min-1 100 ml-1 in upright and supine arm or leg exercise. In contrast, the QZp values after exercise increased to only 3.1-4.6 ml min-1 100 ml-1. QZocc likewise failed to show increases in flow except in the supine leg exercise, where flow increased to 8.7 ml min-1 100 ml-1. 4. In an additional subject, it was shown that electrode position had no significant effect on the QZp blood flow measurement after exercise. 5. The failure of QZp to accurately follow the change in Qsg with exercise was probably due in part to pulsatile venous outflow. In addition, changes in microvessel packed cell volume and shear rate may influence the observed QZp. It is concluded that impedance plethysmography is not valid for estimation of limb blood flow during reactive hyperaemia after exercise.     

Whole body clearance of norepinephrine. The significance of arterial sampling and of surgical stress

The whole body clearance of norepinephrine (NE) was measured in seven patients pre- and postoperatively. L[³H]NE was infused intravenously for 90 min and steady-state concentrations of L[³H]NE were measured at 75 and 90 min in both arterial and peripheral venous blood. Preoperatively, in the resting supine position, the clearance values based on arterial and venous sampling averaged 1.4 and 2.5 liter/min, respectively (P < 0.02). The difference in clearance values was due to a peripheral uptake of NE averaging 45%.     

监护仪测血压不同卧位与上肢压迫时间的对比研究

目的 探讨用监护仪测右上肢肱动脉血压,不同卧位与上肢压迫时间所得血压的对比研究.方法 对90例患者,选用右上肢肱动脉测压法,分别用监护仪测量仰卧位、右侧卧位30 min、右侧卧位60 min,左侧卧位30 min、左侧卧位60min时的血压.结果 仰卧位时收缩压平均(123.34±19.56)mmHg(1 mmHg=0.133 kPa),右侧卧位30min、右侧卧位60 min时收缩压平均(124.34±l8.43)mmHg,(124.40±18.30)mmHg,与仰卧位时比较(P＞0.05),差别无统计学意义;仰卧位时舒张压平均(76.16±10.34)mmHg,右侧卧位30 min、60 min时舒张压平均(74.52±9.62)mmHg、(75.55±9.60)mmHg,与仰卧位时比较(P＞0.05),差别无统计学意义;仰卧位时收缩压平均(125.34±19.60)mmHg,左侧卧位30 min、左侧卧位60 min时收缩压平均(113.01±21.13)mmHg、(113.03±21.14)mmHg,与仰卧位时比较(P＜0.05),差别有统计学意义.左侧卧位30 min、左侧卧位60 min舒张压平均(60.56±11.08)mmHg、(60.54±11.05)mmHg,与仰卧位时比较(P＜0.05),差别有统计学意义.结论 选用右上肢肱动脉用监护仪测压时,右侧卧位30 min、右侧卧位60 min与仰卧位无创血压测量无明显变化,左侧卧位时无创血压测量的结果显著低于仰卧位时无创血压测量的结果,收缩压平均低14.47 mmHg,舒张压平均低14.17 mmHg.     

间歇充气加压装置不同使用模式对预防直肠癌腹腔镜术中患者静脉血栓的效果

目的 探讨腹腔镜直肠癌手术患者术中不同模式间歇充气加压装置(intermittent pneumatic compression,IPC)预防下肢深静脉血栓(deep vein thrombosis,DVT)的效果.方法 2020年4月—2021年4月,在温州市某三级甲等医院结直肠外科连续选择符合纳入标准的130例拟行...     

Cerebral blood flow during conventional,new and open-chest cardio-pulmonary resuscitation in dogs

The following parameters were monitored simultaneously in 15 dogs, in order to evaluate the efficacy of conventional CPR (C-CPR), new CPR (N-CPR), and open-chest CPR (O-CPR) on cerebral perfusion: arterial blood pressure (BP), central venous pressure (CVP), intrathoracic airway pressure, blood flow in carotid artery, intracranial pressure (ICP), sagittal sinus blood flow (sinus BF) and pressure (sinus P), and blood flow in cerebral cortex (cortical BF). The sinus blood flow was measured by the direct-method and with a cannulating electromagnetic flowmeter. The cortical blood flow was measured with a termocouple tissue flowmeter. Intracranial pressure was obtained by measuring subarachmoid cerebrospinal fluid pressure. Ventricular fibrillation was induced electrically. Chest compression and ventilation were always done manually in all cardiopulmonary resuscitation.The mean blood pressures during C-CPR, N-CPR and O-CPR were 52, 68 and 95 mmHg, respectively, and mean carotid blood flows per stroke were 36, 71 and 131% of the control values, respectively. The intracranial pressures were 30, 42 and 36 mmHg, respectively, giving the calculated cerebral perfusion pressures (BP-ICP) of 22, 27 and 60 mmHg, respectively. This should have been reflected in cerebral blood flow. Sinus blood flows/min were 18, 18 and 42%, and sinus blood flows per stroke were 55, 45 and 127% of control values, respectively; the differences between C-CPR and N-CPR were not significant. This was also true for cortical blood flow. From this we conclude that, firstly, N-CPR is not significantly better than C-CPR in cerebral perfusion because of its accompanying high intracranial pressure, secondly, O-CPR is far superior to the other two methods in respect of cerebral perfusion.     

Affinity pump system: a new peristaltic blood pump for cardiopulmonary bypass

An in vitro study has been carried out to assess the pump performance of a new peristaltic, extracorporeal displacement pump (Affinity) for cardiopulmonary bypass. The pump system consists of a pump rotor (0-110 rpm), a pump chamber, a venous reservoir with a 5/8" connecting tube and the Affinity console. The polyurethane chamber is connected to the venous reservoir by a 5/8" tube and fills passively due to the hydrostatic pressure exhibited by the fluid height in the venous reservoir. The implementation of an occlusive segment in the pump chamber, which collapses in low filling states, should prevent significant negative pressures. An in vitro circuit was filled with bovine blood (37 degrees C, hematocrit 35%) and the pump flow was measured by an ultrasonic transit time flow probe with respect to pre-load, diameter and length of attached tubing in the venous line, pump speed (rpm) and size of the connecting tube (3/8" and 5/8"). At 108 rpm and a preload equal to 10 mmHg, the flow was 8.6 +/- 0.42 l/min for an afterload of 80 mmHg. The reduction of the inlet connector to 3/8" diminished the pump flow significantly to 5.2 +/- 0.31 l/min (p < 0.0001). The pump flow decreased linearly with respect to the length of the attached tube in the venous line and for a 2 m long 5/8" silicon tube, the rpm-optimized flow was still 6.0 +/- 0.28 l/min at a preload of 10 mmHg. In case of low filling state or too high rpm, the occlusive segment collapsed and no cavitation bubbles could be detected. Our in vitro measurements yield a nomogram for rpm-optimized blood flow with respect to the pre-load in the venous reservoir. The delivered 5/8"connecting tube facilitates optimum filling of the pump chamber for high blood flow, but limits the use of venous reservoirs to Affinity products. The pump yields a high blood flow even when long tubing in the venous line is used. This makes the pump a candidate for a ventricular assist device. In hypovolemia or high rpm, the occlusive segment collapses and no negative pressure is generated at the inflow site of the pump chamber.     

Endogenous adenosine mediates coronary vasodilation during exercise after K(ATP)+ channel blockade.

The mechanism of coronary vasodilation produced by exercise is not understood completely. Recently, we reported that blockade of vascular smooth muscle K(ATP)+ channels decreased coronary blood flow at rest, but did not attenuate the increments in coronary flow produced by exercise. Adenosine is not mandatory for maintaining basal coronary flow, or the increase in flow produced by exercise during normal arterial inflow, but does contribute to coronary vasodilation in hypoperfused myocardium. Therefore, we investigated whether adenosine opposed the hypoperfusion produced by K(ATP)+ channel blockade, thereby contributing to coronary vasodilation during exercise. 11 dogs were studied at rest and during exercise under control conditions, during intracoronary infusion of the K(ATP)+ channel blocker glibenclamide (50 micrograms/kg per min), and during intracoronary glibenclamide in the presence of adenosine receptor blockade. Glibenclamide decreased resting coronary blood flow from 45 +/- 5 to 35 +/- 4 ml/min (P < 0.05), but did not prevent exercise-induced increases of coronary flow. Glibenclamide caused an increase in myocardial oxygen extraction at the highest level of exercise with a decrease in coronary venous oxygen tension from 15.5 +/- 0.7 to 13.6 +/- 0.8 mmHg (P < 0.05). The addition of the adenosine receptor antagonist 8-phenyltheophylline (5 mg/kg intravenous) to K(ATP)+ channel blockade did not further decrease resting coronary blood flow but did attenuate the increase in coronary flow produced by exercise. This was accompanied by a further decrease of coronary venous oxygen tension to 10.1 +/- 0.7 mmHg (P < 0.05), indicating aggravation of the mismatch between oxygen demand and supply. These findings are compatible with the hypothesis that K+ATP channels modulate coronary vasomotor tone both under resting conditions and during exercise. However, when K(ATP)+ channels are blocked, adenosine released from the hypoperfused myocardium provides an alternate mechanism to mediate coronary vasodilation in response to increases in oxygen demand produced by exercise.     

The efficacy and safety of telmisartan compared to enalapril in patients with severe hypertension

This 8-week, open-label study compared the efficacy and safety of once-daily telmisartan, either alone or in combination with hydrochlorothiazide (HCTZ) and amlodipine, with a similar enalapril regimen in patients with severe hypertension. Clinically relevant reductions in supine systolic blood pressure/DBP were observed with telmisartan (14.6/13.2 mmHg) and enalapril (13.0/12.9 mmHg) monotherapy. Incremental reductions were seen with up-titration of monotherapy (telmisartan 8.1/7.4 and enalapril 9.2/7.7 mmHg), and the addition of HCTZ (telmisartan 14.9/8.7 and enalapril 8.0/6.7 mmHg), and amlodipine (telmisartan 8.0/6.5 and enalapril 10.5/6.4). After 8 weeks of treatment, supine DBP control was achieved in 55% and 35% of the patients on the telmisartan and enalapril regimens, respectively. Both treatment regimens were well tolerated. Telmisartan, a new angiotensin receptor blocker, is a safe and effective drug to use in combination for the treatment of patients with severe hypertension and proved at least as effective as the enalapril combination.