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1.
目的 比较高渗氯化钠羟乙基淀粉40(HSH40)和20%甘露醇对颅内肿瘤切除术颅内压(ICP)的影响.方法 择期颅内肿瘤切除术患者60例,随机均分为HSH40组(H组)和甘露醇组(M组).麻醉前行L3~4蛛网膜下腔穿刺置管术.接压力传感器监测ICP,麻醉后按4 ml/kg量输入HSH40(H组)或20%甘露醇(M组),30 min输完.记录开始输入即刻(T0)、输完即刻(T1)、输完后15 min(T2)、30 min(T3)、60 min(T4)和120 min(T5)时的MAP、CVP、ICP、尿量和动脉血气分析结果.结果 两组T2~T5时ICP显著低于T0时(P<0.05).H组CVP在T2~T4时显著高于T0时和M组(P<0.05).H组Na+在T2、T3时显著高于T0时和M组.H组K+在T2和T3时显著低于T0时,且T2时H组低于M组.H组T3和T4时PaO2显著高于T0时.且T3时PaO2显著高于M组(P<0.05).M组T2~T5时尿量显著多于H组(P<0.05).结论 HSH40和甘露醇均能有效降低ICP,但HSH40更能维持围术期血流动力学稳定.  相似文献   

2.
One hundred ten episodes of renal salt retention (urinary sodium and/or chloride less than 10 mEq/L) were studied retrospectively to determine the significance of discordance of urinary sodium from chloride. In 16 episodes the urinary sodium exceeded chloride by at least 15 mEq/L. This disparity was associated with the necessity for urinary excretion of substantial quantities of poorly reabsorbed anions (penicillin, ketones, or diatrizoate), a rapidly falling serum bicarbonate level (due to resolving metabolic or developing respiratory alkalosis), or substantial renal insufficiency (serum creatinine greater than 3 mg/dL). In 14 of 110 episodes, urinary chloride exceeded urinary sodium by at least 15 mEq/L. These patients were more often oliguric and had a higher mean serum chloride than patients without this dissociation. In patients with oliguria, hyponatremia, or metabolic alkalosis, measurement of urinary sodium or chloride alone will, in a substantial number of cases, fail to detect renal salt retention. When evidence is sought for renal salt retention, both urinary sodium and chloride should be determined.  相似文献   

3.
Potassium (K) loading is followed by a rapid increase in sodium(Na) and K excretion. To evaluate the influence of Na intakeon this effect, we studied the acute natriuretic and kaliureticresponse to a single oral K load (100 mmol) in six healthy volunteersequilibrated on a 10-, 100-, and 400-mmol Na intake. Comparedto the 100-mmol Na intake, the 400-mmol Na intake greatly enhancedthe natriuretic effect of the K load; during the 10-mmol Naintake no natriuresis but even some Na retention occurred. Thekaliuretic effect was not significantly changed and occurredat similar values of plasma K. Plasma aldosterone was suppressedduring the 400-mmol Na diet and stimulated during the 10-mmolNa diet, but the relative increments after the KCI load didnot differ among the three diets. In conclusion, whereas theeffect of a K load on kaliuresis is relatively independent ofNa intake, its effect on Na excretion varies from marked natriuresisto slight Na retention. The Na retention is probably due toacute K-induced aldosterone stimulation, and the natriuresisto K-induced increase in distal Na delivery not utilized topromote K excretion. Apparently, the integration of renal Naand K handling after a K load is such that K balance is maintainedat the cost of Na balance.  相似文献   

4.
高渗氯化钠羟乙基淀粉40注射液在创伤病人手术的应用   总被引:2,自引:0,他引:2  
目的研究高渗氯化钠羟乙基淀粉40注射液(以下简称:高渗晶胶液)用于创伤病人手术的有效性和安全性。方法创伤评分(ISS)13~15分病人50例,随机分为高渗晶胶液组(H组)和复方氯化钠组(R组),每组25例。两组病人均采用静吸复合麻醉,诱导时依次静注芬太尼1~2μg/kg、阿曲库铵0.25~0.5mg/kg、丙泊酚2mg/kg、气管插管后行机械控制呼吸,麻醉维持吸入0.5%~1%异氟醚,微量泵持续灌注阿曲库铵0.25~0.5mg·kg-1·h-1、丙泊酚2.5~5mg·kg-1·h-1。H组:术前输入高渗晶胶液250ml,输注速度10ml·kg-1·h-1;R组:常规输入复方氯化钠。于给药前和停药后30min检测血气,观察并记录Na 、Hct,观察并记录给药前、给药后5、10、15、20、25min和停药后30min的SBP、DBP、MAP、HR。术前放空尿袋,观察并记录停药后30min两组尿量。结果给药后5、10、15、20、25min和停药后30min,H组SBP、DBP、MAP均明显高于给药前和R组(P<0.05),HR慢于给药前和R组(P<0.05)。停药后30min,H组Hct明显高于给药前(P<0.05)。H组尿量明显高于R组(P<0.05)。H组未发现恶心、呕吐、皮肤潮红等不良反应。结论高渗晶胶液可以有效安全地用于创伤病人  相似文献   

5.
目的:研究前列腺肥大的患者在腰硬联合麻醉下行前列腺电切术时输注高渗氯化钠-羟乙基淀粉(hypertonic sodium chloride hetastarch,HSH)预防经尿道电切综合征的作用.方法:随机将60例前列腺肥大患者分为A组(观察组)和B组(对照组)各30例.观察组术前先输注复方氯化钠,手术开始后输注HS...  相似文献   

6.
7.
BACKGROUND: Dialysate [Na+] is often overlooked as a contributor to hypertension in patients on haemodialysis (HD). We report observational experience with a facility level decrease in dialysate [Na+] from 141 mmol/l to 138 mmol/l, in the absence of concurrent change with respect to dietary sodium regulation. METHODS: The sample comprised all patients (n=52) dialysing at a single HD facility over an 8-month period flanking the change in dialysate [Na+]. Outcomes included repeated observations of blood pressure (BP), interdialytic weight gain (IDWG), pre-dialysis plasma [Na+] and adverse events. Predictors other than dialysate [Na+] included patient demographics, clinical characteristics and number of antihypertensive medications. The study used a longitudinal unbalanced panel design, and hierarchical linear and Poisson mixed models. RESULTS: In multivariate analyses, the change in dialysate [Na+] was associated with a statistically significant small to medium-sized decrease in pre- and post-dialysis systolic and diastolic BP, pre-dialysis plasma [Na+], but not IDWG. Change was greatest in the patient tertile with the highest initial BP. There was no change in the frequency of adverse events. Modelling dialysate [Na+] exposure as the diffusion gradient from dialysate to blood water did not improve the strength of associations. CONCLUSIONS: A facility level decrease in dialysate [Na+] from 141 mmol/l to 138 mmol/l appears to be safe and well tolerated, and a useful means of improving BP control. The lack of change in IDWG probably reflects lack of dietary salt restriction, and but does raise the issue of volume-independent effects of sodium exposure on BP.  相似文献   

8.
目的 探讨高渗氯化钠羟乙基淀粉40注射液(HH40)对外伤性颅内血肿伴失血性休克患者术中颅内压(ICP)的影响.方法 外伤性颅内血肿伴失血性休克患者40例,急诊行颅内血肿清除术,随机均分为HH40组(H组)和4.2%高渗盐水组(C组).麻醉诱导后,分别在15 min内快速静脉输入HH40 5ml/kg或4.2%高渗盐水5 ml/kg.在输注HH40或4.2%高渗盐水前即刻(T0)、输注后15 min(T1)、30 min(T2)、60 min(T3)、90 min(T4)、120 min(T5)记录MAP、HR、CVP、尿量,采集桡动脉血测定血浆Na+、K+浓度进行血气分析,并计算各时点脑灌注压(CPP):CPP=MAP-ICP.结果 与T0时比较,T1~T5时两组MAP、CVP、CPP升高,HR减慢,T2~T5时ICP降低(P<0.05).与C组比较,T4、T5时H组HR减慢和T5时MAP升高(P<0.05);H组降低ICP幅度与其相似,而降ICP作用维持时间较长(P<0.05).结论 HH40可安全地用于外伤性颅内血肿伴失血性休克手术患者,能有效地纠正其休克,降低其ICP.  相似文献   

9.
目的研究高渗氯化钠羟乙基淀粉40注射液(hypertomic sodiam chloride hydroxyethyl starch 40 injection,HSH)对小鼠局灶性脑缺血/再灌注损伤(ischemia/reperfusion injury,I/RI)的影响。方法30只昆明种小鼠,应用随机排列表进行随机分...  相似文献   

10.
SUMMARY:   Nephrotic syndrome is associated with avid sodium retention, leading to the development of oedema and ascites. Studies in experimental animals suggest that sodium retention in nephotic syndrome is due to increased sodium re-absorption in the collecting duct, which is also the action site of vasoregulatory hormones. However, the mechanisms underlying sodium retention in nephrotic syndrome are incompletely understood and the molecular basis remains undefined. This review summarizes recent insight into the role of epithelial sodium channels (ENaC) in animal models of nephrotic syndrome induced by puromycin aminonucleoside – or HgCl2 treatment. The sodium retention associated with nephrotic syndrome is caused by increased sodium re-absorption in the aldosterone-sensitive distal nephron segments including the connecting tubule and collecting duct, in which an increased apical targeting of ENaC subunits also plays an important role in the development of sodium retention in nephrotic syndrome.  相似文献   

11.
目的:对比观察7.5%高渗氯化钠溶液(HTS)对人类前列腺素E2(PGE2),IL-2和IL-6的影响,探讨其对人体免疫功能的调节作用及可能机制。方法:随机将40例ASA Ⅰ-Ⅱ级择期手术病人分为两组(每组20例):A组在麻醉前输入7.5%HTS4ml/kg;B组在麻醉前输入等量的复方氯化钠溶液,随后均以复方氯化钠溶液维持循环稳定,分别于输液前(T1),输液后1.5小时(T2)和输液后24小时(T3)取血测PGE2,IL-2,和IL-6。结果:A组病在T3时PGE2明显降低(P<0.01),与B组比较,A线IL-2,IL-6有上升趋势,但无统计学意义。结论:高渗氯化钠溶液可以降低血PGE2水平。  相似文献   

12.
目的探讨高渗氯化钠羟乙基淀粉40注射液(复方高渗液)应用于原位肝移植术中容量治疗的效果。方法选择2011年3月至2012年1月在广州军区广州总医院收治的15例行经典非转流原位肝移植的患者。肝移植术中当血红蛋白值与术前相差大于20g/L时,即经静脉输注复方高渗液,速度20~30ml/min,给药总剂量不超过500ml。在给药前(T0),给完药后即刻(T1)、10min(T2)、20min(T3)、30min(T4)、60min(T5)共6个时间点,分别测量平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、全心舒张末期容积指数(global end-diastolic volume index,GEDVI)、胸腔内血容积指数(intra thoracic bloodvolume index,ITBI)、血管外肺水指数(extra vascular lungwater index,EVLI)、每搏输出量(stroke volume,SV)、每搏输出量变异度(strokevolumevariation,SVV)。结果与T0比较,T1、T2、T3、T4和T5时间点的MAP明显升高(P<0.05或P<0.01);与T1比较,T3、T4时间点的MAP亦显著升高(P<0.05或P<0.01)。与T0比较,T1、T2、T3时间点的GEDVI、ITBI显著升高(均为P<0.05)。与T0比较,T1时间点的EVLI明显升高(P<0.05)。与T0比较,T1、T2时间点的SV显著升高,而T1~T4时间点的SVV则明显降低(P<0.05或P<0.01)。结果显示,患者用药后血流动力学方面达到了临床容量复苏的效果。结论复方高渗液能迅速使肝移植术中低血容量患者的血压恢复正常,为后续治疗赢得了时间,提高了容量复苏的成功率。  相似文献   

13.
Objective: To study the reproductive toxicity of cadmium chloride in male mice. Methods: Male mice of 4 weeks old were administered cadium chloride at doses of 0.5, 2 or 8 mg·kg-1·day-1 i.p. for 10 days. At day 50, the males were mated with virgin females at 1: 2. The pregnancy rate, the litter size and the body weight of the offspring were recorded; at the same time the development of the testis, the testicular index, the germ cell miosis and the epididymal sperm count, motility and malformed sperm were observed in the intoxicated males. Results: The testicular index was lower in the 2 and 8 mg/kg groups than in the controls and 0.5 mg/kg groups (P< 0.05). In the 2 and 8 mg/kg groups, there were testicular maldeve-lopment, epididymal azoospermia and infertility. The pregnancy rate was lower in the 2 mg/kg group than in the control and 0.5 mg/ kg group (P<0.05). The ectopic pregnancy rate of the cadmium chloride group was not significantly different from that of the controls. The sperm count, motility  相似文献   

14.
高氧复方氯化钠溶液用于大鼠烧伤后休克的观察   总被引:4,自引:1,他引:4  
目的观察并探讨高氧复方氯化钠溶液对烧伤休克的防治作用. 方法 (1)将Wistar大鼠分为6组,A组正常对照组;B组制作30%TBSAⅢ度烧伤模型,伤后1 h补充复方氯化钠溶液;C组致伤后6 h补充复方氯化钠溶液;D组伤后1 h补充高氧复方氯化钠溶液;E组伤后6 h补充高氧复方氯化钠溶液;F组致伤后不治疗.动态观察各组大鼠内毒素(LPS)、白细胞介素6(IL-6)、二胺氧化酶(DAO)活性、D-乳酸、丙二醛(MDA)的变化.(2)选择烧伤面积为50%~69%TBSA、伤后3 h内入院的患者,随机分为治疗组补充高氧复方氯化钠溶液;对照组补充复方氯化钠溶液.观察患者休克期变化、经皮氧分压、血红蛋白、血细胞比容及有无并发症等. 结果大鼠伤后各组监测指标水平均较A组显著升高,呈逐步上升趋势,F组更加明显,其顺序为F组>C组>B组>E组>D组(P<0.05).烧伤患者治疗组较对照组休克期度过平稳,补液量减少,氧分压明显升高,并发症少,但血氧饱和度差异无显著性意义. 结论早期应用高氧复方氯化钠溶液,对防治烧伤休克有较好的疗效.  相似文献   

15.
目的 探讨术中及术后输注高渗氯化钠羟乙基淀粉溶液(hypertonic sodium chloride hydroxyethyl starch solution,HSH)对脑动脉瘤破裂出血介入术后脑血管痉挛(cerebral vasospasm,CVS)的影响及其机制. 方法 发病后3d内拟行颅内动脉瘤介入栓塞术的动脉瘤破裂蛛网膜下腔出血(aneurysm subarachnoid hemorrhage,aSAH)患者30例.ASA分级Ⅱ、Ⅲ级,Hunt和Hess(原发性蛛网膜下腔出血的临床状态)分级Ⅱ、Ⅲ级,改良Fisher分级1、2级,格拉斯哥昏迷评分(Glasgow ComaScale,GCS) 13~15分,年龄18~80岁.按随机数字表法分为两组(每组15例):实验组(H组),输注4.2% HSH 4 ml/kg;对照组(N组),输注等量生理盐水.两组均于术前(T0),输注HSH或生理盐水结束时(T1),手术结束时(T9及术后第1天(T3)、第2天(T4)、第3天(T5)、第4天(T6)、第5天(T7)的上午8点,分别记录MAP、CVP、血浆渗透压(plasma osmotic pressure,POP)、HR、Na+、K+、C1-等数值;采用经颅多普勒超声(transcranial doppler,TCD)监测T0及T3~T7时右侧大脑中动脉血流速度,ELISA检测上述时间点血浆中IL-6、TNF-α、内皮素-1(endothelin-1,ET-1)及一氧化氮(nitric oxide,NO)等因子浓度,同时记录患者GCS得分、神经功能缺损评分(china stroke scale,CSS)及24 h出入量. 结果 H组CVP在T1~T7时分别高于N组(P<0.05);POP在T2~T7时高于N组(P<0.05).两组患者大脑中动脉血流速度术后呈上升趋势,H组患者在T5~T7时低于N组(P<0.05);H组患者在T7时血浆IL-6、TNF-α浓度低于N组(P<0.05);T5~T7时,H组ET-1浓度低于N组(P<0.05);T4~T7时,H组NO浓度高于N组(P<0.05);上述指标其他时间点及两组间GCS得分、CSS评分、24h出入量比较,差异无统计学意义(P>0.05). 结论 脑动脉瘤破裂出血患者围手术期小量输注HSH能有效减轻脑血管介入手术后CVS发生程度,其机制可能与抑制炎症介质及血管舒缩因子平衡紊乱有关.  相似文献   

16.
Study Type – Prognosis (case series)
Level of Evidence 4

OBJECTIVE

To report the effect of systemic arterial pressure on erectile dysfunction (ED) in patients in the initial stages of peripheral arterial disease.

PATIENTS AND METHODS

All patients with a diagnosis of ED in the urology outpatient clinic of the Medicine School in São José do Rio Preto, Brazil were evaluated in a cross‐sectional, quantitative study. The patients were assessed using the International Index of Erectile Function, the ankle‐brachial index, and measurement of arterial blood pressure. Binary logistic regression, log‐likelihood, Pearson chi‐square and likelihood ratio chi‐square and Kruskal–Wallis Test were used for statistical analysis with P < 0.05 being considered acceptable. Fifty‐two patients (mean age 56.63 years) were enrolled in the study.

RESULTS

Differences were detected between the median grades of ED of patients with differing degrees of chronic arterial insufficiency. Hypertensive patients in the initial stages of peripheral arterial disease had less severe grades of ED than normotensive patients.

CONCLUSIONS

The progression of ED parallels the development of chronic arterial insufficiency. Systemic arterial hypertension in the initial stages of peripheral arterial disease might protect against ED, but peripheral arterial disease constitutes an aggravating factor for ED, and thus hypertension might exert a paradoxical effect in this stage of the disease.  相似文献   

17.
Whether the use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker inhibitor (ACEI/ARB) is beneficial in renal transplant recipients remains controversial. In this retrospective study on 505 renal transplant recipients, we analyzed blood pressure and graft survival according to antihypertensive treatment with ACE-I/ARB and/or calcium channel blockers (CCB) over a period of 10 years. Patients were stratified according to their blood pressure 1 year after transplantation [controlled (≤130/80 mmHg; CTR, 181 patients) and noncontrolled (>130/80 mmHg; non-CTR, 324 patients)] and according to antihypertensive treatment (ACE-I/ARB and/or CCB taken for at least 2 years). One year after transplantation, 88.4% of CTR and 96.6% of non-CTR received antihypertensive treatment ( P  < 0.05). Graft survival was longer in CTR than in non-CTR ( P  < 0.05). Importantly, graft survival was longer in patients who received long-term treatment with ACEI/ARB, CCB, or a combination of ACEI/ARB and CCB ( P  < 0.001). The beneficial effect of ACEI/ARB therapy was more pronounced in non-CTR compared with that of CTR. We conclude that blood pressure control is a key target for long-term graft survival in renal transplant patients. Long-term ACEI/ARB and CCB therapy is beneficial for graft survival, especially in patients with diabetes and/or albuminuria.  相似文献   

18.
Primary pulmonary hypertension in pregnancy; a role for novel vasodilators   总被引:2,自引:1,他引:1  
We describe the case of a 28-week pregnant woman presentingwith severe primary pulmonary hypertension (PPH). She had anelective Caesarean section under general anaesthesia at 32 weeksgestation. Pulmonary artery pressures (PAP) measured from apulmonary artery catheter before anaesthesia were in excessof 100 mm Hg. Intraoperative nitric oxide was used to reducePAP. After the delivery of a healthy infant PAP was controlledwith nebulized iloprost and a prostacyclin infusion. Seven dayslater she was discharged from intensive care taking an oralcalcium antagonist and warfarin. She developed intractable rightheart failure and died 14 days after delivery. Despite increasingexperience in the use of drugs to reduce PAP, the clinical courseof pregnancy complicated by severe PPH is usually fatal. Br J Anaesth 2001; 87: 295–8  相似文献   

19.
目的 观察术中高渗氯化钠羟乙摹淀粉40注射液(HSS40)对恶性肿瘤患者体内自然杀伤细胞(NK细胞)和血小板活化分子CD41影响.方法 将76例手术患者随机分两组:输血组(A组)38例、HSS40组(B组)38例.于麻醉前1 h、术后1、3、7 d抽取外周血,细胞检测仪检测CD56和CD41含量;以乳酸脱氢酶释放法检测NK细胞活性.结果 组间比较:CD56术后第3、7天B组高于A组,差异显著(25.560±11.026比15.648±6.729;29.040±10.221比15.035±6.758,P<0.01),NK细胞活性术后第7天两组比较差异有统计学意义(19.939±6.994比15.307±5.107,P<0.05);CD4,术后l d B组明显低于A组(7.740 4-4.101比10.752 4-5.493,P<0.01).组内比较:A组术后第3天NK细胞活性下降(P<0.05),术后第7天下降明显,与术前比较差异有统计学意义(P<0.01),B组术后第7天NK细胞活性与术前比较差异有统计学意义(P<0.05),CD56术后第3天有所上升(P<0.05),术后第7天上升明显,与术前比较差异有统计学意义(P<0.01).两组CD41术后1~7 d均明显高于术前水平(P<0.01).结论 手术和输血可导致术后NK细胞活性降低,血小板CD41含量明显升高,术中输注HSS40,术后NK细胞活性及数目不同程度升高,且降低血小板CD41含量.  相似文献   

20.
目的 探讨术中输注高渗氯化钠羟乙基淀粉溶液(hypertonic sodium chloride hydroxyethyl starch solution,HSH)对脑动脉瘤夹闭术后患者早发性脑血管痉挛(cerebral vasospasm,CVS)的影响.方法 选择美国麻醉医师协会(ASA)分级Ⅱ~Ⅲ级,Hunt and HessⅡ~Ⅲ级、Glasgow评分13~14分,年龄20岁~60岁拟行脑血管瘤夹闭术的动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)患者20例,按随机数字表法均等分为两组:A组:输注4.2%HSH(实验组) ;B组:常规输液(对照组).A组患者于麻醉诱导前和动脉瘤夹闭后分别静脉输注4.2%HSH40注射液各3 ml/kg,术中液体维持以平衡盐溶液和胶体液按2:1比例输注 ;B组患者麻醉和手术过程中按2:1比例匀速输注平衡盐溶液和胶体液.记录两组患者输液总量,术中及术后各时点两组患者颅内压(intracerebral pressure,ICP)、平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)、红细胞比容(HCT)及血浆渗透压(plasma osmotic pressure,POP),采用经颅多普勒超声(TCD)监测手术结束时(T5)、术后6(T6)、12(T7)、24 h(T8)两组患者的右侧大脑中动脉血流速度.结果 A组CVP在T6和T8时点分别显著高于B组(9.4±1.3 vs 7.6±1.0和9.4±1.5 vs 7.2±1.6,P<0.05),而其余血流动力学参数两组间比较差异无统计学意义 ;A组ICP在T5、T6和T7时点分别低于B组,两组数据比较差异有统计学意义(16.5±4.7 vs 21.5±3.6,20.4±3.2 vs 28.2±3.9和22.6±3.7 vs 27.4±2.7,P<0.05) ;A组大脑中动脉血流速度在T6和T7时点分别显著低于B组(121±15 vs 139±17和125±13 vs 137±15,P<0.05).结论 脑动脉瘤夹闭术中输注4.2% HSH 6 ml/kg可有效减轻术后患者早发性CVS发生程度.  相似文献   

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