中孚降压胶囊治疗高血压病阴虚阳亢证临床观察

目的 观察中孚降压胶囊治疗高血压病（阴虚阳亢证）的临床疗效及安全性.方法 采用分层区组随机、双盲双模拟、阳性药平行对照、多中心临床试验的方法.试验组口服中孚降压胶囊（0.5 g/粒,每次3粒,每天2次）及洛丁新片模拟剂（10 mg/片,每次1片,每天1次）;对照组口服洛丁新片（10 mg/片,每次1片,每天1次）及中孚降压胶囊模拟剂（0.5 g/粒,每次3粒,每天2次）,4周为1个疗程,观察两组的降压效果及中医证候疗效.结果 试验组降压显效率58.65%,总有效率79.81%;对照组分别为60.51%,78.34%;试验组中医证候显效率21.15%,总有效率78.85%;对照组为分别25.48%、86.62%,两组降压效果及中医证候比较,总有效率、显效率差异均无显著性（P＞0.05）.结论 中孚降压胶囊治疗高血压病疗效明显而且安全性良好.     

Hemodynamic changes in patients with SARS-CoV-2 infection presenting for cesarean delivery under spinal anesthesia: a retrospective case-control study

BackgroundCoronavirus disease 2019 (COVID-19) is associated with adverse maternal and neonatal outcomes. Early studies suggested that COVID-19 was associated with a higher incidence of hypotension following neuraxial anesthesia in parturients. We explored the hemodynamic response to spinal anesthesia for cesarean delivery in pregnant severe respiratory distress syndrome-coronavirus-2 (SARS-CoV-2) positive patients, using a retrospective case-control design.MethodsWe searched our electronic medical records for patients who received spinal anesthesia for cesarean delivery, and were SARS-CoV-2 positive or recovered at delivery, and used historical and SARS-CoV-2 negative controls from two tertiary care hospitals. We compared the demographic, clinical, and hemodynamic variables between patients who were SARS-CoV-2 positive at delivery, those who were positive during pregnancy and recovered before delivery, and controls. Analyses were stratified by normotensive versus hypertensive status of the patients at delivery.ResultsWe identified 22 SARS-CoV-2 positive, 73 SARS-CoV-2 recovered, and 1517 controls. The SARS-CoV-2 positive, and recovered pregnant patients, had on average 5.6 and 2.2 mmHg, respectively, higher post-spinal mean arterial pressures (MAPs) than control patients, adjusting for covariates. Additionally, the lowest post-spinal MAP was negatively correlated with the number of days between the onset of COVID-19 symptoms and delivery in patients with hypertension (correlation −0.55, 95% CI −0.81 to −0.09).ConclusionsPatients with SARS-CoV-2 infection during pregnancy exhibit less spinal hypotension than non-infected patients. While the clinical significance of this finding is unknown, it points to important cardiovascular effects of the virus.     

去氧肾上腺素和去甲肾上腺素预防剖宫产腰麻后低血压的研究进展

腰麻后低血压是剖宫产术中的常见并发症,低血压严重时可能对产妇和胎儿产生不良后果。血管活性药的使用在低血压的防治策略中具有重要意义。诸多研究者认为,去甲肾上腺素在腰麻剖宫产手术中预防和治疗给药维持血压的效果可能优于去氧肾上腺素。本文综述了近年来去氧肾上腺素和去甲肾上腺素预防剖宫产腰麻后低血压的研究进展,并总结和分析了预防给药方法和药效的比较结果,以期临床更加安全有效和规范地应用这两种药物,有效降低剖宫产后低血压的发生率,从而提高剖宫产术中产妇和胎儿的安全性。     

腰麻联合硬膜外麻醉剖宫产患者仰卧位低血压综合征体位干预的护理效果观察

目的 探讨护理干预对剖腹产仰卧位低血压综合征的预防机制.方法 将120例剖宫产患者随机分为对照组(60例)和实验组(60例).对照组除麻醉前静脉滴注复方平衡盐水500 ml和胶体(羟乙基淀粉130/0.4氯化钠注射液)500 ml外不作任何干预措施.实验组麻醉前30 min内快速输入与对照组相同的液体,同时给予体位干预...     

Prostaglandin synthesis inhibitor affects humoral conditions and oxygen metabolism during normothermic cardiopulmonary bypass

We have reported that infusion of prostaglandin synthesis inhibitor (PGSI) reduced the severity of hypotension during normothermic cardiopulmonary bypass (CPB). In the present study, we investigated the effects of PGSI on humoral conditions and whole body oxygen metabolism during normothermic CPB conducted for 60 min in 8 adult goats. The PGSI group (n = 4) was administered 100 to 150 mg of flurbiprofen, a potent PGSI, before and during CPB, and the control group (n = 4) was administered noradrenaline (NA) to restore hypotension. The prostaglandin E2 (PGE2) and NA concentrations in the PGSI group were significantly lower than those of the control group (PGE2 8.8 +/- 1.0 versus 30.3 +/- 11.5 pg/ml, NA 431 +/- 197 versus 3847 +/- 2,153 pg/ml). The adrenaline concentration was not significantly different between the groups. The oxygen consumption and the oxygen extraction rate were not significantly different between the groups, but the blood lactate level in the PGSI group was lower than that of the control group (34.3 +/- 7.6 versus 43.7 +/- 3.8 mg/dl). In conclusion, PGSI improves humoral disorder and thus prevents inadequate tissue oxygen delivery.     

Repeated ventricular bigeminy by trigeminocardiac reflex despite atropine administration during superficial upper lip surgery: A case report

BACKGROUNDThe trigeminocardiac reflex (TCR) is usually caused by an increased parasympathetic tone when pressure or traction is applied to the surrounding tissue of the trigeminal nerve. However, the inexperienced anesthesiologists may have challenges on the management of TCR patients.CASE SUMMARYThis is the case of an 18-year-old woman diagnosed with hemangioma of the upper lip. During the operation, about 1 h after surgery started, a constant 1:1 premature ventricular complex was detected, and blood pressure was decreased when approaching the deeper part with more strong traction for exposure of the part. Although the management of arrhythmias, such as lidocaine and atropine, was injected, arrhythmia induced by surgical stimulation could not be eliminated completely. As the traction repeated, bradycardia was also repeated, despite injecting additional atropine. Therefore, the anesthesiologist and the surgeon decided to perform the operation only to the extent that the vascular tissue was selectively removed only at the site without the reflex.CONCLUSIONWith TCR, anesthesiologists should perform appropriate monitoring. In addition to proper drug administration, surgeons should be consulted to cope with stopping the surgery and setting the scope of the surgery even if the site is superficial.     

Hemodynamic support of the micropreemie: Should hydrocortisone never be left out?

Hemodynamic support for a micropreemie is critically important for preventing mortality and morbidity. An essential consideration in hemodynamic support is insufficient transition from fetal to neonatal circulation and inadequate cortisol production. The first 72 h of life are the most critical, especially when myocardial function is immature and impaired. Therefore, there is a need to determine and adjust preload, myocardial contractility, and afterload appropriately using repeated functional echocardiography. In addition, if myocardial function is not responsive to these attempts at hemodynamic management, hydrocortisone must be used to minimize the suboptimal perfusion burden. Fetal cortisol production is supported by a supply of progesterone from the placenta, and postnatally, adrenal cortisol production in the extremely preterm infant may be inadequate if the infant is placed under excessive stress. This leads to relative adrenal insufficiency which may last for up to several weeks after birth and lead to late-onset circulatory collapse, necessitating treatment with physiological doses of hydrocortisone.