可调钠透析技术在预防血透急性并发症中的应用

目的:探讨可调钠透析(Variablesodium Dialysis,VSD)技术在预防血液透析急性并发症中的作用。方法:选择规律性维持性血液透析患者50例,随机分成两组,每组25人,分别给予可调钠透析与标准钠透析(Standardsodium Dialysis,SSD)3个月,观察透析后低血压与失衡综合征的发生率。结果:透析后可调钠组低血压与失衡综和征的发生率明显低于标准组(P<0.01),但血钠浓度、肌酐、尿素氮等指标无明显差异(P>0.05)。结论:可调钠血液透析对维持性血液透析血容量起到稳定作用,有效防止低血压的发生,显著改善失衡综合征症状,提高患者的生活质量。     

血液稀释联合控制性降压对脊柱手术患者中心静脉血氧饱和度的影响

目的观察血液稀释联合控制性降压对脊柱手术患者中心静脉血氧饱和度（ScvO2）的影响。方法40例脊柱手术患者（ASAⅠ-Ⅱ级）随机数字表法分为血液稀释联合控制性降压组（20例）和对照组（20例）,比较术中ScvO2、术后1、6、24h血乳酸水平。以及两组患者术中出血和输异体血的情况。结果两组患者术中ScvO2以及术后1、6、24h血乳酸水平的比较差异无统计学意义（P〉0．05）;术中实施血液稀释联合控制性降压后出血明显减少,输注异体血的量也相应减少。结论血液稀释联合控制性降压不会破坏全身组织的氧供需平衡状态。可安全地应用于脊柱手术患者。     

急性高容量血液稀释对血液保护作用的研究进展

近年来,为了节约用血,减少输异体血引起的风险,人们对血液的保护越发重视。急性高容量血液稀释作为一种有效的血液保护措施,具有操作简单、费用低廉、减少污染机会、稳定血流动力学及血液保护功能等优点,但在临床应用中的安全性和有效性尚需进一步探讨。现就近年来急性高容血液稀释对机体生理功能和重要器官的影响进行综述。     

Orthostatic headache and bilateral abducens palsy secondary to spontaneous intracranial hypotension

Spontaneous intracranial hypotension (SIH) is a well-documented syndrome characterized typically by a benign, self-limited course. Patients typically present with postural or exertional headaches that can be temporarily relieved by lying in a supine or recumbent position. A 35-year-old Caucasian male suffered orthostatic headache that developed to a bilateral abducens palsy. We ordered relative rest and the patient improved and completely recovered after 3 months. Although SIH is considered as a benign and self limited process it could also be associated with disabling complications. We should be aware of the possible complications and inform our patients. SIH can present with headache and bilateral abducens palsy even when the headache is improving.     

Clinical presentation and management strategies of cardiovascular autonomic dysfunction following a COVID-19 infection – A systematic review

Background

Cardiovascular autonomic dysfunction may reportedly occur after a coronavirus-disease-2019 (COVID-19) infection, but the available evidence is scattered. Here we sought to understand the acute and mid-term effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on cardiovascular autonomic function.

Methods

We performed a systematic PubMed, Embase, Web of Science, medRxiv, and bioRxiv search for cases of cardiovascular autonomic dysfunction during an acute SARS-CoV-2 infection or post-COVID-19 condition. The clinical-demographic characteristics of individuals in the acute versus post-COVID-19 phase were compared.

Results

We screened 6470 titles and abstracts. Fifty-four full-length articles were included in the data synthesis. One-hundred and thirty-four cases were identified: 81 during the acute SARS-CoV-2 infection (24 thereof diagnosed by history) and 53 in the post-COVID-19 phase. Post-COVID-19 cases were younger than those with cardiovascular autonomic disturbances in the acute SARS-CoV-2 phase (42 vs. 51 years old, p = 0.002) and were more frequently women (68% vs. 49%, p = 0.034). Reflex syncope was the most common cardiovascular autonomic disorder in the acute phase (p = 0.008) and postural orthostatic tachycardia syndrome (POTS) the most frequent diagnosis in individuals with post-COVID-19 orthostatic complaints (p < 0.001). Full recovery was more frequent in individuals with acute versus post-COVID-19 onset of cardiovascular autonomic disturbances (43% vs. 15%, p = 0.002).

Conclusions

There is evidence from the scientific literature about different types of cardiovascular autonomic dysfunction developing during and after COVID-19. More data about the prevalence of autonomic disorders associated with a SARS-CoV-2 infection are needed to quantify its impact on human health.     

不同经穴TEAS对低血压大鼠痛阈及血压调节效应的实验研究

目的:观察不同经穴经皮穴位电刺激(transcutaneous electrical acupoint stimulation,TEAS)对低血压大鼠痛阈及血压的调节效应。方法:将50只低血压模型大鼠随机分成足三里、三阴交、太冲、曲池和合谷穴5个组,每组10只,采用经皮穴位电刺激法介入治疗,刺激参数为疏密波(频率2/100Hz)、强度(4±1)mA,时间为40 min,每天治疗1次,连续治疗3 d。采用辐射热甩尾法测量造模后、治疗中及治疗后不同时段痛阈。采用无创动物血压观察系统BP-5测量TEAS治疗前、治疗疗程结束后即时、治疗后不同时段的大鼠尾动脉收缩压。结果:5个经穴组经皮电刺激后均能不同程度提高大鼠痛阈,治疗后与自身痛阈相比具有统计学差异(P<0.05),除合谷穴外,4个经穴组经皮电刺激后均能不同程度提高低血压大鼠血压,治疗后与治疗前血压相比具有统计学差异(P<0.05)。结论:足三里、三阴交、太冲、曲池、合谷穴均能提高低血压大鼠痛阈,以足三里穴提高幅度最明显,具有较好的镇痛效应,同时,足三里、三阴交、太冲、曲池穴均能提高低血压大鼠血压,且以足三里穴升压效应最为明显。     

Vasomotor reactivity as a predictor for syncope in patients with orthostatism

Gur AY, Auriel E, Korczyn AD, Gadoth A, Shopin L, Giladi N, Bornstein NM, Gurevich T. Vasomotor reactivity as a predictor for syncope in patients with orthostatism.
Acta Neurol Scand: 2012: 126: 32–36.
© 2011 John Wiley & Sons A/S. Objectives – Syncope in patients with orthostatic hypotension (OH) may be the result of impaired cerebral autoregulation. Cerebral autoregulation status can be determined by assessing cerebral vasomotor reactivity (VMR). We assessed and compared VMR in patients with OH with and without syncope. Material and methods – Twenty‐nine patients with OH underwent transcranial Doppler (TCD) and the Diamox test (1 g acetazolamide IV) for assessing VMR during elaboration of their OH syndrome. The percent difference between cerebral blood flow velocities (BFV) in the middle cerebral (MCA) and vertebral (VA) arteries before and after acetazolamide was defined as VMR%. We considered increases of BFV of ≥40% as being indicative of good VMR and classified our study patients as having good or impaired VMRs accordingly. Results – Mean VMR% values of the MCA and VA in patients with OH with syncope (n = 12) were significantly lower as compared with patients with OH without syncope (n = 17): 25.2 ± 20.5% and 42.5 ± 18.6%; 20.9 ± 15.5% and 40.8 ± 28.5%, respectively (P < 0.05). Conclusions – Among patients with OH, we found an association between the presence of syncope and impaired VMR. Assessment of VMR among patients with OH may predict those who are at higher risk to faint and fall and to support more aggressive intervention.     

不同静脉麻醉深度对罗库溴铵药效学的影响

目的研究不同静脉麻醉深度对罗库溴铵肌松作用时效的影响。方法择期耳鼻喉科手术患者40例,ASAⅠ～Ⅱ级,随机分为控制性降压组(H组)和对照组(C组),每组20例。麻醉诱导采用咪唑安定、丙泊酚、瑞芬太尼静脉注射,意识消失后启动神经刺激器,静脉注射罗库溴铵后行气管内插管。术中丙泊酚及瑞芬太尼维持麻醉。诱导后10min,H组患者加深麻醉将血压(平均动脉压)降至55～70mmHg。采用4个成串刺激(TOF)模式,记录临床维持时间、75%恢复时间和恢复指数。结果两组临床维持时间差异无统计学意义[(32.50±5.94)minvs.(30.70±5.96)min,P=0.345],而H组的75%恢复时间和恢复指数[(48.70±8.47)minvs.(42.25±6.32)min,(16.20±5.54vs.11.45±4.77),P﹤0.05]均显著长于C组。结论加深静脉麻醉深度实施控制性降压可以强化罗库溴铵的肌肉松驰作用。     

尼卡地平与硝酸甘油控制性降压对颅内动脉瘤夹闭术患者脑氧代谢的影响

目的对比尼卡地平与硝酸甘油控制性降压对颅内动脉瘤夹闭术患者脑氧代谢的影响。方法采取随机、对照、双盲的方法将40例行颅内动脉瘤夹闭术的患者分成尼卡地平(Ⅰ)组和硝酸甘油(Ⅱ)组,每组20人。打开硬脑膜行控制性降压,并于打开硬脑膜即刻(T0)、瘤体分离结束(T1)、夹闭完毕(T2)、停止控制性降压20min(T3)四个时点行桡动脉及颈内静脉球血气分析,记录PaO2、PjvO2、SaO2、SjvO2、Hab、Hjvb值,并计算Da-jvO2、COER值。结果两组患者在控制性降压效果上无明显统计学差异(P>0.05),降压期间心率均增快(P<0.01);Ⅰ组患者在T1、T2时点SjvO2值较T0、T3时点明显升高(P<0.05或P<0.01),而Da-jvO2、COER值明显降低(P<0.01);Ⅱ组患者T1、T2时点SjvO2、Da-jvO2、COER值与T0、T3时点比较无明显统计学差异(P>0.05);Ⅰ组患者在T1、T2时点SjvO2值对应Ⅱ组明显升高(P<0.05),而Da-jvO2、COER值明显降低(P<0.05)。结论硝酸甘油与尼卡地平均可安全用于颅内动脉瘤夹闭术的控制性降压,但后者能有效降低脑氧代谢,改善脑氧合,脑保护作用更优越。     

原发性低颅压综合征的临床表现与MRI诊断

目的：探讨原发性低颅压综合征的临床与MRI表现。方法：分析15例原发性低颅压综合征患者的临床资料、脑脊液生化及MRI表现。结果：15例患者均有体位性头痛,伴有或不伴有其他神经系统症状。脑脊液检查,脑脊液压力均低于70mmH20（1mmHzO=0．0098kPa）,生化检查9例正常。MRI检查硬脑膜均匀性增厚强化。经临床积极治疗,预后良好。结论：体位性头痛是低颅压综合征特征性临床表现,腰椎侧卧位穿刺脑脊液压力测量及头颅MRI检查具有诊断价值,临床积极治疗预后良好。