肾内血流动力学变化在输尿管结石梗阻中的应用价值

目的利用。肾内血流动力学变化,应用彩色多普勒超声观察输尿管结石,检测肾内动脉阻力指数（RI）、患侧-肾与健侧肾的RI差值（Rid）,探讨以肾内血流动力学变化为依据,RI的增高在输尿管结石梗阻中的作用。方法回顾分析41例临床疑诊为输尿管结石的病人的临床资料,检测。肾内动脉阻力指数,确定结石的存在。结果41例病人确诊,并经其他方法证实。结论因尿路梗阻早期。肾间质水肿,血管紧张素分泌量增加致肾内血管阻力增加使RI增高。彩色多普勒超声一般可以观察到RI的变化,在分析输尿管结石梗阻中有一定的诊断价值。     

彩色多普勒血流显像对Ⅱ型糖尿病患者眼球后血流动力学的研究

目的　探讨Ⅱ型糖尿病患者眼球后血流动力学变化与视网膜病变的发生、发展之间的关系。方法　应用彩色多普勒血流显像检测 80例Ⅱ型糖尿病患者的眼球后血流动力学改变 ,包括眼动脉 (OA)、视网膜中央动脉 (CRA)的各项参数。结果　在糖尿病视网膜病变 (DRP)发生过程的极早期阶段 ,眼底荧光造影尚未发现明显病变时 ,CRA血流速度较对照组增高 (P <0 .0 5 ) ,DRP早期阶段接近对照组 (P >0 .0 5 ) ,增殖前期、增殖期低于对照组 (P <0 .0 5 )并伴有OA舒张末期血流速度下降及阻力指数增高 ;Ⅱ型糖尿病不伴DRP或DRP早期者CRA血流速度与空腹血糖水平呈正相关 ,视网膜病变越重 ,血糖对CRA血流速度的影响越小。结论　Ⅱ型糖尿病患者的眼部血流动力学变化与DRP发生、发展之间的关系复杂 ,它反映了视网膜微循环对高血糖等全身与局部代谢异常的代偿与失代偿变化。视网膜血流供应不足在DRP的发生发展中起着重要作用     

彩色多普勒超声对肝硬化血流动力学改变检测的价值

目的 应用彩色多普勒超声(CDFI)探讨肝硬化患者的血流动力学改变的意义。方法 本文观察了100例肝硬化患者的门静脉(PV)宽度、血流速度、肝静脉频谱形态、肝动脉(HA)和肠系膜上动脉(SMA)的血流速度，阻力指数(RI)等项参数，并与80例健康成人进行对照。结果 显示肝硬化患者PV增宽，血流速度明显低于对照组；肝静脉频谱的负向波减低或消失；肝动脉显示率提高达98％(98／100)，明显高于对照组。SMA的RI减低。结论 本文观察的结果认为CDFI检查对肝艘化的诊断及病情变化的监测有一定的临床意义。     

抑郁症患者血流动力学变化临床分析

血流动力学是研究循环血液的流动和变形的特征,对于精神疾病患者的血流动力学特征已有一些研究报道,但对于抑郁症患者的血流动力学研究较少,本研究测定60例抑郁症患者的血流动力学指标,以了解抑郁症患者的全血黏度、血浆黏度、红细胞电泳、血细胞比容及血沉的变化,现报告如下.     

骨盆骨折后血流动力学的变化

目的：探讨骨盆骨折后血流动力学的变化特点。方法：对进入急救部的18例严重骨盆骨折的患者经颈内静脉置入Swan-Ganz导管进行了动态的血流动力学监测，对死亡者和存活者血流动力学的变化特点进行了分析。结果：死亡者和存活者的血流动力学变化有明显的不同，死亡者7例均于入院后24h内死亡，经液体复苏后4～8h，职显著降低，MAP、CI显著升高，但10h之后MAP、CI又降低非常显著，MPAP、PCWP显著升高，CVP升高非常显著。存活者11例，经液体复苏后血流动力学逐渐平稳，复苏4～6h后职降低非常显著，MAP、CVP、MPAP、PCWP、CI均升高非常显著，16～24h之后血流动力学参数趋于稳定并逐渐回到正常范围。结论：经液体复苏后血流动力学难以稳定者死亡率高。     

彩色多普勒对浆膜下肌瘤血流动力学的研究

目的：探讨浆膜下肌瘤动脉血流的应用价值。方法：采用彩色多普勒血流显像观察103例浆膜下肌瘤瘤体内动脉血流情况。结果：动脉血流阻力指数（RI）与瘤体大小呈负相关（r＝0．50）。结论：浆膜下肌瘤瘤体内动脉血流RI值与肿瘤大小有关，其RI值随瘤体增大有降低趋势。     

青光眼后血流动力学变化

了解青光眼球后动脉血流动力学变化表现。方法用彩多普勒超声诊断仪对３４名青光眼患者的６１眼进行视网膜中央动脉,睫状后动脉和眼动脉血流频谱测量。３４例健康自愿者的６８眼作为对照。结论青光眼球后动脉血流呈低速率高阻力状态。     

超声心排血量与PICCO监测重症患者血流动力学的对比研究

目的 探讨超声心排血量与连续心排血量(PICCO)监测重症患者血流动力学的差异。方法 选取佛山市高明区人民医院2018年3月至2020年1月收治的重症患者88例,先予以PICCO监测,后予以超声心排血量监测。比较2种不同监测方法得出的血流动力学参数[每搏量(SV)、每搏量指数(SI)、心排血量(CO)、心排血指数(CI)],并分析2种监测方法得出的各血流动力学参数的相关性。结果 在监测0～24 h时间段,2种不同监测方法测得的SV、SI、CO、CI均呈显著升高趋势,且与PICCO相比,超声心排血量监测24 h的上述各项血流动力学参数升高更为明显,差异有统计学意义(均P<0.05);2种监测方法测得的SV、SI、CO、CI之间为正相关关系(r=0.813、0.856、0.792、0.901,均P<0.05);2种监测方法在2 h时CO值的一致性较差[1.96 SD=1.44,95%CIJP(0.15～1.27)],在6 h[1.96 SD=0.24,95%CI(-0.14～0.30)]、12 h[1.96 SD=0.28,95%CI(-0.21～0.33)]、24 h[1.9...     

重症急性胰腺炎大鼠腹腔脏器血流动力学的变化

目的 :研究重症急性胰腺炎大鼠腹腔主要器官的血流动力学变化。方法 :将大鼠随机分成 :重症急性胰腺炎组 (SAP)和对照组 ,术后 12h和 2 4h处死。运用多普勒超声测定胰腺局部动脉血流 (胰头、体交界处 )、门静脉血流、脾动脉血流和肠系膜上动脉血流。结果 :SAP时 ,大鼠胰腺局部动脉血流明显下降 ,术后 12h已有明显下降 (vs对照组P <0 .0 1)。随胰腺炎病程进展 ,胰腺局部血流的下降更严重 (2 4hvs12hP <0 .0 5 )。与此同时 ,门静脉、脾动脉和肠系膜上动脉的血流量也下降 (vs对照组P <0 .0 1)。结论 :重症急性胰腺炎时内脏主要器官血流明显下降     

经颅多普勒对短暂性脑缺血发作的血流动力学监测

目的：研究经颅多普勒(TCD)对临床诊断短暂性脑缺血发作(TIA)的价值。方法：对100例TIA患行TCD常规检查,检测其颅内血流动力学改变。结果：颅内血流动力学改变,不仅表现在血流速度的减慢、加快、不对称,而且伴有血流杂音及血流频谱异常等。结论：此种无创性检查对TIA的诊断及指导治疗提供了客观依据,值得推广应用。     

RETRACTED ARTICLE: Noninvasive assessment of cardiac output using thoracic electrical bioimpedance in hemodynamically stable and unstable patients after cardiac surgery: a comparison with pulmonary artery thermodilution

Objective To compare noninvasive cardiac output (CO)measurement obtained with a new thoracic electrical bioimpedance (TEB) device, using a proprietary modification of the impedance equation, with invasive measurement obtained via pulmonary artery thermodilution.Design Prospective, observational study.Setting Surgical intensive care unit (ICU) of a university-affiliated community hospital.Patients and participants Seventy-four adult patients undergoing elective cardiac surgery with routine pulmonary artery catheter placement.Interventions None.Measurements and results Simultaneous paired CO and cardiac index (CI) measurements by TEB and thermodilution were obtained in mechanically ventilated patients upon admission to the ICU. For analysis of CI data the patients were subdivided into a hemodynamically stable group and a hemodynamically unstable group. The groups were analyzed using linear regression and tests of bias and precision. We found a significant correlation between thermodilution and TEB (r = 0.83; n< 0.001), accompanied by a bias of –0.01 l/min/m² and a precision of ±0.57 l/min/m² for all CI data pairs. Correlation, bias, and precision were not influenced by stratification of the data. The correlation coefficient, bias, and precision for CI were 0.86 (n< 0.001), 0.03 l/min/m², and ±0.47 l/min/m² in hemodynamically stable patients and 0.79 (n< 0.001), 0.06 l/min/m², and ±0.68 l/min/m² in hemodynamically unstable patients.Conclusions Our results demonstrate a close correlation and clinically acceptable agreement and precision between CO measurements obtained with impedance cardiography using a new algorithm to calculate CO from variations in TEB, and those obtained with the clinical standard of care, pulmonary artery thermodilution, in hemodynamically stable and unstable patients after cardiac surgery.     

Non-invasive Cardiac Output by Transthoracic Electrical Bioimpedence in Post-cardiac Surgery Patients: Comparison with Thermodilution Method

OBJECTIVE: Thoracic electrical bioimpedance (TEB) cardiac output (CO) is being explored increasingly as a non-invasive alternative to the pulmonary artery catheter (PAC). This study compared TEB-CO measured using a new instrument - NICOMON (Larsen & Toubro Ltd. India) with thermodilution (Td) CO in post-cardiac surgery patients. METHODS: Postoperative cardiac surgical patients requiring a PAC for their management were studied. TEB-CO was measured by passing a 4 mA RMS alternating current across the chest and measuring the analog bioimpedence across the thorax. Kubicek equation was used to estimate TEB-CO. Td-CO was measured using a PAC. Bland-Altman analysis was used to compare paired data. RESULTS: One hundred and ninety-seven pairs of CO measurements were made by the two methods among 35 patients. Mean TEB-CO was 5.15 +/- 1.27 l/min and mean Td-CO was 5.22 +/- 1.28 l/min. Pearson correlation coefficient (r) for these measurements was 0.856 (P < 0.01), with bias -0.0651 l and precision: +/-1.37 l/min. The percentage error of measurement of this precision was 26.44%. Cardiac index also correlated among the two methods (r = 0.789; P = 0.01). CONCLUSIONS: Thoracic electrical bioimpedance cardiac output compares favorably with thermodilution method among post-cardiac surgery patients. Further studies are indi- cated with this instrument to validate its efficacy in various clinical situations and utility in monitoring hemodynamic interventions.     

Prognostic value of hemodynamic indices in patients with sepsis after fluid resuscitation

BACKGROUNDSepsis usually causes hemodynamic abnormalities. Hemodynamic index is one of the factors to identify the severity of sepsis and an important parameter to guide the procedure of fluid resuscitation. The present study investigated whether the assessment of hemodynamic indices can predict the outcomes of septic patients undergoing resuscitation therapy.AIMTo evaluate the prognostic value of hemodynamic indices in patients with sepsis after fluid resuscitation.METHODSA retrospective study was conducted in 120 patients with sepsis at Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University between October 2016 and October 2019. All patients were treated with sodium chloride combined with dextran glucose injection for fluid resuscitation. Patients’ hemodynamic parameters were monitored, including heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI), mean arterial pressure (MAP), central venous pressure (CVP), and central venous oxygen saturation. The prognostic value of hemodynamic indices was determined based on the prognosis status.RESULTSDuring fluid resuscitation, 86 patients developed septic shock and 34 did not. Ninety-nine patients survived and 21 patients died at 28 d after the treatment. Heart rate, CI, mean arterial pressure, SVRI, and CVP were higher in patients with septic shock and patients who died from septic shock than in non-shock patients and patients who survived, and central venous oxygen saturation was lower in patients with shock and patients who died than in non-shock patients and the survivors (P < 0.05). When prognosis was considered as a dependent variable and hemodynamic parameters was considered as independent variables, the results of a logistic regression analysis showed that CI, SVRI, and CVP were independent risk factors for septic shock, and CI was an independent risk factor for 28-d mortality (P < 0.05).CONCLUSIONHemodynamic indices can be used to evaluate the prognosis of septic patients after fluid resuscitation.     

Multi-channel electrical bioimpedance: a non-invasive method to simultaneously measure cardiac output and individual arterial limb flow in patients with cardiovascular disease

Background  Cardiac output is the fundamental determinant of peripheral blood flow however; optimal regional tissue perfusion is ultimately dependant on the integrity of the arterial conduits that transport flow. A complete understanding of tissue perfusion requires knowledge of both cardiac and peripheral blood flow. Existing noninvasive devices do not simultaneously assess the cardiac and peripheral circulations. Multi-channel electrical bioimpedance (MEB) measures cardiac output and peripheral flow simultaneously. Objectives  Assessment of the accuracy of MEB to measure cardiac output in patients with clinical heart failure (group 1) and to measure regional arterial limb flow in patients with exertional leg pain clinically thought to have peripheral arterial disease (group 2). Methods  Cardiac output was measured by MEB in 44 patients with moderate to severe clinical heart failure (group 1) and was compared to a cardiac output measured by 2D-Echo Doppler. Peripheral blood flow (regional ankle and arm flow) was measured by MEB in another group of 25 patients with exertional leg pain clinically thought to be claudication (group 2). The MEB ankle/arm flow ratio (AAI index) was then compared to a conventional ankle/brachial pressure ratio (ABI index). Results  There was excellent correlation between the mean cardiac index by MEB (2.01 l/min/m²) and by 2D-Echo Doppler (2.06 l/min/m²) and bias and precision was 0.05 (2.4%) and ±0.48 l/min/m² (±23%), respectively. The correlation was maintained for each measurement over a wide range of cardiac indices. There was good correlation between AAI and ABI measurements (P < 0.05). Conclusions   MEB accurately measures cardiac output in patients with moderate to severe clinical heart failure and accurately measures regional arterial limb flow in patients with peripheral arterial disease. Stanley AWH, Herald JW, Athanasuleas CL, Jacob SC, Bartolucci AA, Tsoglin AN. Multi-channel electrical bioimpedance: a non-invasive method to simultaneously measure cardiac output and individual arterial limb flow in patients with cardiovascular disease     

Lung recruitment maneuver depresses central hemodynamics in patients following cardiac surgery

Objective To assess the impact of the lung recruitment maneuver on circulation following cardiac surgery.Design and setting Prospective randomized cross-over study at the Departments of Anesthesia and Thoracic Surgery, Copenhagen University Hospital.Patients Ten adult undergoing coronary artery bypass surgery.Interventions Patients were randomized to two durations of lung recruitment maneuvers (40 cmH₂O airway pressure for 10 s and 20 s or vice versa after 5 min) administered immediately after surgery.Measurements and results Transesophageal echocardiography (left ventricular short axis view), pulse contour cardiac output, and arterial blood pressure were monitored continuously. Systemic and pulmonary arterial blood gases were sampled before and after each lung recruitment maneuver to calculate the intrapulmonary shunt. Left ventricular end-diastolic areas decreased significantly during both the 10-s and the 20-s lung recruitment maneuvers. Cardiac output was 5.6±0.8 l/min at baseline, decreasing by 3.0±1.1 l/min and 3.6±1.2 l/min during lung recruitment maneuvers of 10 and 20 s, respectively. Shunt decreased from 20±5% to 15±6% after the first lung recruitment maneuver and from 15±6% to 12±5% after the second.Conclusions Lung recruitment maneuvers markedly reduced cardiac output and left ventricular end-diastolic areas in hemodynamically stable patients following cardiac surgery.This article is discussed by the editorial available at: Supported by the Danish Medical Research Council (no. 22-03-0299 and no. 22-04-0420) and the Danish Heart Foundation (no. 04-10-B152-A230-22194).     

Thermodilution vs pressure recording analytical method in hemodynamic stabilized patients

Purpose

Many mini-invasive devices to monitor cardiac output (CO) have been introduced and, among them, the pressure recording analytical method (PRAM). The aim of this study was to assess the agreement of PRAM with the intermittent transpulmonary thermodilution and continuous pulmonary thermodilution in measuring CO in hemodynamically stabilized patients.

Materials and Methods

This is a prospective clinical study in a mixed medical-surgical intensive care unit (ICU) and in a postcardiac surgical ICU. Forty-eight patients were enrolled: 32 patients to the medical-surgical ICU monitored with PiCCO (Pulsion Medical System AG, Munich, Germany) and 16 were cardiac patients monitored with Vigilance (Edwards Lifesciences, Irvine, CA).

Results

A total of 112 measurements were made. Ninety-six comparisons of paired CO measurements were made in patients hospitalized in medical-surgical ICU; 16, in cardiac surgical patients.The mean Vigilance-CO was 4.49 ± 0.99 L/min (range, 2.80-5.90 L/min), and the mean PRAM-CO was 4.27 ± 0.88 L/min (range, 2.85-6.19 L/min). The correlation coefficient between Vigilance-CO and PRAM-CO was 0.83 (95% confidence interval, 0.57-0.94; P < .001). The bias was 0.22 ± 0.55 L/min with limits of agreement between 0.87 and 1.30 L/min. The percentage error was 25%.Mean TP-CO was 6.78 ± 2.04 L/min (range, 4.12-11.27 L/min), and the mean PRAM-CO was 6.11 ± 2.18 L/min (range, 2.82-10.90 L/min). The correlation coefficient between PiCCO-CO and PRAM-CO was 0.91 (95% confidence interval, 0.83-0.96; P < .0001). The bias was 0.67 ± 0.89 L/min with limits of agreement − 1.07 and 2.41 L/min. The coefficient of variation for PiCCO was 4% ± 2%, and the coefficient of variation for PRAM was 10% ± 8%. The percentage error was 28%.

Conclusions

The PRAM system showed good agreement with pulmonary artery catheter and PiCCO in hemodynamically stabilized patients.     

一氧化氮吸入对脓毒症幼猪血流动力学和氧合功能的影响

目的：研究脓毒症幼猪吸入一氧化氮（N0）后心脏指数（CI）与氧合指数的变化。方法：静脉注入革兰氏阴性杆菌内毒素（LPS）诱导脓毒症幼猪模型。随机分为两组：NO组（n＝8）为脓毒症模型建立后,在容量控制通气基础上持续吸入80 ppmNO 30 min;对照组（n＝4）为脓毒症模型建立后单纯容量控制通气,观察30 min以确定模型的稳定性并与NO组比较。利用脉波指示剂连续心排血量监测（PICC0）技术和动脉血气分析,测定各组血流动力学参数和肺气体交换。结果：静脉注射内毒素能够诱导稳定的脓毒症幼猪模型。该模型血气分析指标pH、HCO3－、股动脉血氧分压（PaO2）、平均动脉压（MAP）及心脏指数（CI）均较基础值明显降低（P＜0．01）。NO组PaO2及CI均较吸入前和同时点对照组明显升高（P＜0．01）。NO组及对照组心率（HR）、中心静脉压（CVP）、全心舒张末容积指数（GEDI）及胸腔内血容积指数（ITBI）均无明显变化。结论：吸入NO气体可以改善脓毒症幼猪的心功能及氧合功能。     

胸电生物阻抗法用于妊高征血液动力学分析

目的：探讨无创血液动力学监测在妊娠高血压综合征患者诊断中的应用价值。方法：对由Bioz．com数字化无创血液动力学监测系统所采集的157例妊高征患者、158倒正常孕妇的资料进行回顾分析。结果：两组血液动力学指标除胸液水平（TFC）、左心做功指数（LCWI）、左心做功（LCW）3项无显著差异外（P〉0．05），其余指标均有显著差异（P〈0．01）。结论：较之正常孕妇，妊高征患者的血液动力学指标有明显改变，故它可有效预测妊高征的严重程度，指导医师及时发现异常、处理异常，提高围产医学质量，保障母婴健康。     

两种热稀释法测量血流动力学参数在犬失血性休克模型中的比较

目的 比较经肺热稀释法和肺动脉导管法测量血流动力学参数。方法 通过经肺热稀释法（COa）、右心漂浮导管热稀释法（COpa）和脉搏诱导持续心输出量测量法（COpa）在加只犬失血性休克模型制作前后以及应用不同液体容量复苏后测量心输出量和血液动力学参数，比较COa、COpa、COpc之间的关系。并且比较经肺热稀释法、右心漂浮导管热稀释法两种方法测得的血液动力学参数（包括SVRI和SVI）。结果 实验全程中COpc、COa和COpc的相关性好，准确性很稳定。体循环指数（SVRI）和每搏输出量指数（SVI）在经肺热稀释法和右心漂浮导管热稀释法比较中呈正相关。结论 在犬失血性休克模型中，我们发现与肺动脉导管法相比较，经肺热稀释法测量得到的血流动力学参数准确稳定，COpc准确、可靠，体循环指数（SVRI）和每搏输出量（SVI）在两种方法中的相关性良好。     

胸阻抗无创血流动力学监测在危重患者的应用研究

目的评价胸阻抗（TEB）无创血流动力学监测在危重患者的应用价值。方法选取2006年10月至2007年8月入住本院综合ICU住院时间超过24h的危重患者48例,所有病例在常规监护基础上进行TEB监测,并在此期间行超声心动图检查,对两种方法同时测得的心输出量（CO）、心脏指数（CI）、每搏播出量（SV）、每搏指数（SI）等结果进行相关性分析。结果TEB法与超声心动图法所测得的CO、CI、SV和SI均具有很好的相关性。结论 TEB法与超声心动图法监测结果有很好的相关性;TEB法可用于危重患者的血流动力学监测。