垂体后叶素对心肺转流后严重低血压患者血流动力学的影响

目的 观察垂体后叶素对心肺转流(CPB)停机后严重低血压患者血流动力学的影响.方法 110例行心内直视手术患者,CPB停机后发生严重低血压时,静脉给予垂体后叶素负荷量0.6U及维持量1～4 U/h.记录切皮前(T1)、CPB停机后注射垂体后叶素前(T2)、注射垂体后叶素后5min(T3)及术毕时(T4)MAP、HR、CVP、平均肺动脉压(MPAP)、体循环阻力(SVR)、心脏指数(CI)及每搏指数(SVI).结果 20例患者CPB停机后发生严重低血压.与T1时比较,T2时MAP及SVR显著降低(P＜0.01),HR增快(P＜0.01);与T2时比较,T3时MAP、SVR、CI及SVI显著升高(P＜0.05或P＜0.01),T4时MAP与SVR均显著升高(P＜0.01).结论 垂体后叶素可改善CPB停机后严重低血压患者血流动力学,对肺动脉压无明显影响.     

垂体后叶素对心肺转流后低血压患者冠状动脉血流量的影响

目的 评估垂体后叶素对心肺转流(cardiopulmonary bypass,CPB)术后低血压患者冠状动脉血流量的影响.方法 行心脏瓣膜置换术CPB后发生低血压患者24例,静脉注射小剂量垂体后叶素负荷量0.6 U,随后以1 U/h～4 U/h泵入维持.连续监测并记录麻醉诱导后CPB前(T1)、CPB停机后给予垂体后叶...     

系膜内注射垂体后叶素在腹腔镜输卵管妊娠保守手术中的应用

目的：对比腹腔镜保守性手术与系膜内注射垂体后叶素联合腹腔镜保守手术治疗输卵管妊娠的临床效果。方法：回顾分析246例异位妊娠患者行腹腔镜保守手术的临床资料,根据手术方式分为两组,160例直接行腹腔镜保守性手术（对照组）,86例于系膜内注射垂体后叶素后行腹腔镜保守手术（实验组）。对比分析两组患者手术时间、输卵管切口出血量、术后β-hCG下降至正常时间、术后持续输卵管妊娠的发生率。结果：实验组手术时间、输卵管切口出血量明显优于对照组．两组相比差异有统计学意义（p〈0．01）,其中实验组40例（46．5％）输卵管切开后无需双极电凝止血,对照组32例（20％）因双极电凝无法止血改为缝扎止血。两组患者术后13-hCG降至正常时间、持续性输卵管妊娠率差异无统计学意义（P〉0．05）。结论：系膜内注射垂体后叶素联合腹腔镜保守手术可显著缩短手术时间、减少输卵管切口出血量,部分可达到无血切口,且不影响术后β-hCG,不增加持续性输卵管妊娠发生率,疗效确切。     

垂体后叶素在腹腔镜输卵管妊娠切开取胚术中的应用价值

目的:探讨腹腔镜输卵管妊娠切开取胚术中垂体后叶素的应用价值。方法:随机将2007年6月至2009年6月拟行腹腔镜输卵管妊娠切开取胚术的266例患者分为两组,术中注射垂体后叶素的160例为观察组,未注射的106例为对照组。比较两组手术时间、术中出血量、术后最高体温、保留输卵管成功率和持续性宫外孕发生率等。结果:观察组手术时间、术中出血量、持续性宫外孕发生率均明显少于对照组(P0.01);保留输卵管成功率明显高于对照组(P0.01)。两组术后最高体温差异无统计学意义(P0.05)。结论:腹腔镜输卵管切开取胚术中应用垂体后叶素能明显缩短手术时间,减少术中出血,降低持续性异位妊娠率,提高保留输卵管成功率,并且安全可靠,操作简单,适合基层医院和初学者应用。     

子宫动脉阻断及垂体后叶素在腹腔镜子宫肌瘤切除术中的应用体会

目的:探讨子宫动脉阻断术及垂体后叶素应用于腹腔镜子宫肌瘤切除术中的临床价值。方法:将2010年6月至2013年6月126例子宫肌瘤患者随机分为两组,实验组行腹腔镜子宫肌瘤切除术联合子宫动脉阻断术,术中应用垂体后叶素;对照组按传统手术方式行腹腔镜子宫肌瘤切除术。对比分析两组患者手术时间、术中出血量、术后恢复情况及复发率等指标。结果:实验组术中出血量、术后肛门排气时间、术后下床活动时间明显优于对照组,差异有统计学意义(P<0.05)。两组手术时间、术后切口脂肪液化或感染发生率差异无统计学意义(P>0.05)。术后随访1年,实验组复发率明显低于对照组,差异有统计学意义(P<0.05)。结论:腹腔镜子宫肌瘤切除术中应用子宫动脉阻断术、垂体后叶素可减少子宫肌瘤切除术的术中出血量,术后患者康复快,复发率低,是安全、有效的术式。术前应严格选择病例,根据肌瘤大小、数量、位置等因素综合考虑。     

维持性血液透析患者低血压的临床研究

目的:探讨血液透析中低血压的发生机制,提出防治措施.方法:收集长期接受透析的66例患者的临床资料,按有无透析低血压分为低血压组(29例)及对照组(37例),比较两组病因、年龄、透析间期体重增长率;透析中超滤量(UFV)、超滤率(UFR);血钠(Na )、白蛋白(Alb)、血红蛋白(Hb)、尿素氮(BUN)、血肌酐(Scr).结果:与对照组相比,合并糖尿病、左室肥厚及动脉硬化的老年人易发生透析低血压(P＜0.01);透析间期体重增长率(%),透析中UFV、UFR有统计学差异(P＜0.01);Na 、Alb、Hb有统计学差异(P＜0.05);BUN、Scr无差异(P＞0 05).结论:控制透析间期体重增长、减慢超滤速度,改变血液净化方法,采用序贯钠透析、低温透析,适当用药,改善心功能,纠正贫血、低蛋白血症及营养不良等可防治透析中低血压.     

血液透析患者低血压的发生机制

本文综述了维持性血液透析患者在透析中发生低血压的诱因及发病机制。     

老年糖尿病肾病患者血液透析中的低血压原因分析

目的:探讨老年糖尿病肾病(diabeticnephropathy,DN)患者血液透析发生相关性低血压的原因.方法:选择维持性血液透析的老年糖尿病肾病患者30例,根据低血压发生情况分为低血压组和无低血压组(对照组),观察两组透析间期空腹血糖(Glu)、血红蛋白(Hb)、血肌酐(Scr)、血尿素氮(BUN)、血钠(Na )、血浆白蛋白(Alb)、总胆固醇(TC)、甘油三酯(TG),计算干体重、透析间期体重增长率、超滤量、超滤率的变化.结果:低血压组首次血透时Scr、BUN高于对照组,Ccr明显低于对照组(P＜0.05);透析间期体重增长率(透析间期体重/干体重)、超滤量、超滤率均高于对照组(P＜0.05);透析期间空腹血糖Glu高于对照组(P＜0.05);Hb、Na 低于对照组(P＜0.05),而长期透析患者Scr、BUN、TG、TC之间无统计学差异(P＞0.05).结论:老年糖尿病肾病透析性低血压与首次血透时肾功能、透析间期体重增长率、超滤量、超滤率、高血糖、营养不良、贫血、血钠浓度等有关,应综合防治.     

血液透析中低血压的研究进展

血液透析中低血压是最为常见的透析相关并发症之一,是增加血液透析病人病死率的独立危险因素,加强对本病的认识并采取积极有效的措施降低透析中低血压的发生,可以提高透析的安全性和充分性,改善透析患者的生活质量和预后.本文对透析中低血压的发病机制和治疗进展进行,以进一步提高对本病的认识.     

氨基末端脑钠肽前体预测血液透析患者透析中低血压的发生

目的 研究维持性血液透析(MHD)患者透析中低血压(IDH)发生的危险因素,分析血氨基末端脑钠肽前体( NT-proBNP)水平与IDH发病的关系,为防治提供依据.方法 收集2009年3月至5月我院肾内科血液净化中心202例MHD患者资料,根据3个月内每次血透中血压下降情况,分为无透析中低血压组( no-IDH)、透析中低血压偶发组(o-IDH)和透析中低血压频发组(f-IDH).IDH指透析中收缩压下降≥20 mm Hg,或平均动脉压降低≥10 mm Hg并有低血压症状或需要干预措施.3个月透析过程中发生IDH频率＜1/10为no-IDH,≥1/10但≤1/3为o-IDH,＞1/3为f-IDH.应用多因素Logistic回归分析各指标与IDH发生相关性.血NT-proBNP诊断效能用受试者工作特征(ROC)曲线下面积(AUC)评价.结果 202例MHD患者中男108例(53.5％),女94例(46.5％),年龄20～80( 55.85±14.48)岁.原发病分别为肾小球肾炎133例(65.8％)、糖尿病肾病20例(9.9％)、高血压肾病17例(8.4％).IDH发病率42.1％,其中o-IDH 27.2％,f-IDH 14.9％.多因素Logistic回归分析显示年龄、性别、超滤率、血NT-proBNP、血浆白蛋白、主动脉根部内径等与IDH发生密切相关(均P＜ 0.05).血NT-proBNP水平与透析初始血压及透析中血压下降值均呈正相关(P＜0.05).以血NT-proBNP水平判断MHD患者发生IDH的AUC为0.76(95％ CI 0.69～0.83,P＜0.01);以NT-proBNP 1746.5 ng/L作为界值的灵敏度为88.61％,特异度为51.10％.判断MHD患者频发IDH的AUC为0.65(95％ CI 0.53～0.76,P＜0.05),以NT-proBNP 8208.0 ng/L作为界值的灵敏度为33.33％,特异度为91.30％.结论 高龄、女性、高超滤率、高血NT-proBNP水平、低血浆白蛋白、主动脉根部内径短是MHD患者发生IDH的主要危险因素.血NT-proBNP可作为IDH发病的预测因子.     

Dry weight evaluation in hemodialysis patients

Objective To estimate dry weight (DW) and prevent dialysis-related hypotension and hypertension with the on-line monitoring of relative blood volume（RBV） and other judgments. Methods One hundred and eight maintenance hemodialysis patients were assigned to three groups according to their blood pressure: normal blood pressure group (A group, n=43）, hypotension group (B group, n=35) and hypertension group (C group, n=35). The level of hemoglobin, serum albumin, dialysis adequacy were determined. Systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, ultrafiltration volume, relative blood volume changes and the corresponding clinical symptoms were monitored during hemodialysis in all patients. Each of the patients was continuously monitored of the indicators above for 10-12 times. At the observing period, the inferior vena cava diameter (IVCD), brain natriuretic peptide (BNP) and cardiothoracic ratio(CTR) were measured. Then according to the monitoring results, appropriate clinical interventions were given under on-line blood volume monitoring guidance. Results (1)The shape of RBV curve in group A showed double-exponential curve early, then down to the final linear decling ended during hemodialysis. (2)The RBV curve in group B was stable in the former two hours, then rapidly linear declined. RBV changes were significantly higher in group B than group A (P＜0.05), but when changes in RBV were plotted against ultrafiltration volume, there was no significant difference in the two groups. The level of RBV reduction at which symptomatic hypotension occurred showed considerable inter-individual variability (P＜0.05, coefficient of variation=0.28). (3)The RBV curve in group C slowly linear declined. At the end of dialysis, RBV changes were significantly lower in group C than group A (P＜0.05). (4)The IVCD values in three groups of patients before dialysis were greater than normal, significantly decreased after the dialysis (P＜0.05), but that in group B and group C were still greater than that in group A (P＜0.05). The BNP values were significantly greater in three groups before and after dialysis (P＜0.05), but after dialysis, the values decreased significantly than that before dialysis (P＜0.05). (5)After appropriate clinical intervention were given under on-line blood volume monitoring in hemodialysis, the patients of group B controlled weight gain, and even cut dry weight, the RBV change significantly decreased at the end of dialysis and significantly reduced the incidence of hypotension events (P＜0.05); When the patients of group C cut dry weight, increased ultrafiltration, the RBV change increased, the mean arterial pressure decreased significantly than before (P＜0.05). Conclusions (1)Hemodialysis patients with symptomatic hypotension show larger RBV decline rate in the forth hour and lager total RBV changes, which provides important information for forecasting the symptomatic hypotension in hemodialysis. (2)IVCD and CTR have certain significance to the adjustment of dry weight, but the BNP has guiding significance to volume change. (3)On-line monitoring of RBV can effectively guide the adjustment of dry weight, reduction of symptomatic hypotension occruence, and controlling of refractory hypertension in hemodialysis.     

品管圈活动在降低血液透析相关性低血压发生率中的作用

目的探讨应用品管圈（quality control circle,QCC）方法降低血液透析相关性低血压发生率的效果。方法选择2011年10月在航空总医院血液透析中心发生透析相关性低血压患者21例为研究对象,成立品管圈活动小组、确立活动课题,进行现状调查、分析发生血液透析相关性低血压的原因、设定目标值、制订对策并实施,比较实施品管圈活动前后低血压的发生率。结果开展品管圈活动后血液透析相关性低血压发生率从15．00％下降到5．38％,活动前后比较,差异具有统计学意义（P〈0．05）。结论品管圈活动可降低血液透析相关性低血压发生率。     

N-末端脑钠肽前体对预测血液透析患者透析中低血压发生的意义

目的探讨血浆N-末端脑钠肽前体（NT-proBNP）在血液透析患者透析中低血压（IDH）发生的预测价值。方法将行血液透析的患者144例,根据透析过程中是否发生血压下降,分为IDH组和非IDH组。测定透析前后的血压、NT-proBNP,并记录心胸比、超滤量、超滤量占体质量百分比、低血容量发生次数,并分析NT-proBNP与IDH的相关性。结果透析期间,IDH的发生率为28．5％。与非IDH组比较,IDH组的年龄、NT-proBNP显著降低,超滤量、超滤量占体质量百分比、心胸比、低血容量发生次数明显升高（P〈0．05）。透析后,非IDH组SBP、DBP与透析前比较,无统计学差异（P〉0．05）,而IDH组则较透析前显著下降（P〈0．05）。采用多因素Logistic回归分析结果显示,在控制年龄、超滤量、超滤量占体质量百分比、心胸比、低血容量发生次数后,NT-proBNP对透析中发生IDH仍有预测价值,OR=0．412（95％CI 0．212-0．801）。结论NT-proBNP与血液透析患者容量负荷密切相关,NT-proBNP水平检测有助于评估患者透析中血容量的变化,预测IDH的发生。     

Pylorus-preserving pancreaticoduodenectomy in patients undergoing chronic hemodialysis

This report describes three patients who underwent a pylorus-preserving pancreaticoduodenectomy (PpPD) and received maintenance hemodialysis due to chronic renal failure. The three cases were diagnosed to have bile duct cancer, intraductal papillary mucinous neoplasm, and carcinoma of the ampulla of Vater, respectively. They underwent chronic hemodialysis for 7.7 years. They all underwent a PpPD with lymph node dissection. The mean operation time was 373 min and mean blood loss was 647 ml. During the postoperative courses, hemodialysis was restarted on postoperative day 1 in all three cases. In the three patients, only minor complications were experienced and these were treated conservatively. The mean postoperative hospital stay was 48 days. Two patients are still alive 135 and 21 months after the operation, respectively, but the other patient died of another disease 21 months after the PpPD. A PpPD may therefore be safe and feasible even in patients receiving chronic hemodialysis.     

缓慢低效透析滤过对维持性血液透析患者低血压状态的影响

目的探讨应用持续缓慢低效每日透析滤过（SLEDI）-f）对于维持性血液透析（MHD）患者合并低血压状态的临床治疗效果。方法选择我院血液净化中心合并低血压状态的MHD患者36例,应用SLEDI）-f治疗,观察每次治疗过程中患者生命体征指标（血压、脉搏、心率、体温）、血氧饱和度,记录总超滤量、尿素氮和血肌酐变化并计算尿素清除指数（Kt／V）;整个疗程治疗前、后行彩色多普勒超声检测心功能指标,同时监测C反应蛋白（CRP）。结果治疗过程中,患者生命体征稳定,并发症少,透析充分性好。治疗后,患者左心室舒张末期内径（LVDd）较治疗前降低（P〈0．05）,心脏指数（CI）及左心室射血分数（LVEF）较治疗前升高（P〈0．05）,CRP较治疗前降低（P〈0．01）。结论采用SLEDI）-f治疗可提高MHD合并低血压状态患者对治疗的适应性,显著改善心功能指标,有助于提高患者治疗效果。     

不同剂量乌拉地尔预防垂体后叶素诱发腹腔镜子宫肌瘤剥除术患者心血管反应的效果

目的 评价不同剂量乌拉地尔预防垂体后叶素诱发腹腔镜子官肌瘤剥除术患者心血管反应的效果.方法 拟在全身麻醉下行腹腔镜子官肌瘤剥除术患者60例,采用随机数字表法,将其随机分为4组(n=15),对照组(C组)静脉注射生理盐水5ml;不同剂量乌拉地尔组(U1-3组)分别静脉注射乌拉地尔0.3、0.5、0.8 mg/kg.5min后子宫肌瘤部位注射垂体后叶素6U和生理盐水20ml混合液,随后剥除子宫肌瘤.术中维持BIS值45～55.记录垂体后叶素注射后心血管反应的发生情况.结果 C组、U1组、U2组和U3组心血管反应发生率分别为100％、67％、40％和20％.与C组比较,U1组、U2组和U3组心血管反应发生率降低(P＜0.01);与U1组比较,U2组和U3组心血管反应发生率降低(P＜0.01);U2组和U组心血管反应发生率比较差异无统计学意义(P＞0.05).结论 乌拉地尔可预防垂体后叶素诱发腹腔镜子宫肌瘤剥除术患者的心血管反应,其适宜剂量为0.5 mg/kg.     

Mathematical modeling of thermal and circulatory effects during hemodialysis

Intradialytic hypotension (IDH) is one of the most common complications of hemodialysis (HD) treatment. The initiating factor of IDH is a decrease in blood volume, which is related to an imbalance between ultrafiltration (UF) and refilling rate. Impaired reactivity of resistance and capacitance vessels in reaction to hypovolemia plays possibly a major role in the occurrence of IDH. These vessels also fulfill an important function in body temperature regulation. UF‐induced cutaneous vasoconstriction would result in a reduced surface heat loss and an increase in core temperature. To release body heat, skin blood flow is increased at a later stage of the HD treatment, whereby possibly IDH can occur. The aim of the study is to develop a mathematical model that can provide insight into the impact of thermoregulatory processes on the cardiovascular (CV) system during HD treatment. The mathematical procedure has been created by coupling a thermo‐physiological model with a CV model to study regulation mechanisms in the human body during HD + UF. Model simulations for isothermal versus thermoneutral HD + UF were compared with measurement data of patients on chronic intermittent HD (n = 13). Core temperature during simulated HD + UF sessions increased within the range of measurement data (0.23°C vs. 0.32 ± 0.41°C). The model showed a decline in mean arterial pressure of ?7% for thermoneutral HD + UF versus ?4% for isothermal HD + UF after 200 min during which relative blood volume changed by ?13%. In conclusion, simulation results of the combined model show possibilities for predicting circulatory and thermal responses during HD + UF.