冠心灵对犬心脏血流动力学和耗氧量的影响

冠心灵对健康麻醉开胸犬可减慢心律,降低血压,降低左室收缩压,减少dp/dtmax,减少左室作功指数,降低总外周血管阻力和冠脉阻力。冠心灵降低心肌耗氧量,降低心肌耗氧指数,而对心肌氧利用率影响不大。冠心灵保护缺血心肌的原理,可能在于降低心肌耗氧、耗能量。     

舒芬太尼和芬太尼用于体外循环下冠状动脉旁路移植术患者的效果分析

目的 研究比较舒芬太尼和芬太尼在体外循环（CPB）冠状动脉旁路移植术（on-pump CABG）中对血流动力学及血清心肌肌钙蛋白（cTn Ⅰ）浓度的影响.方法 选择2013年2～6月邢台市第三医院择期行冠状动脉旁路移植术患者60例,随机分成两组,每组30例.舒芬太尼组（S组）分别于麻醉诱导、切皮前、劈胸骨前、体外循环转流前、停机后各静注舒芬太尼1 μg/kg;芬太尼组（F组）分别于麻醉诱导、切皮前、劈胸骨前、体外循环转流前、停机后各静注芬太尼10 μg/kg.比较两组术中血流动力学参数及血清心肌cTn Ⅰ浓度.结果 血流动力学比较：气管插管即刻（T1）及切皮（T2）两组心率（HR）、平均动脉压（MAP）比麻醉诱导前（T0）升高（P＜0.05）,F组比S组升高明显（P＜0.05）,停机后即刻（T4）HR[（68.5±12.2）、（66.8±]1.2）次/min]和停机后30 min（T5）HR[（72.5±8.5）、（67.8±9.6）次/min]高于T0（56.6±7.2）、（554±8.0）次/min] （P＜0.05）,两组间其他差异无统计学意义（P＞0.05）.心肌cTn Ⅰ浓度比较：术前S组[（0.67±0.22）μg/L]与F组[（0.71±0.20）μg/L]比较差异无统计学意义（P＞0.05）,所有血管桥开放后4、8、24、48 h,两组均高于术前（P＜0.05）,S组[（2.37±0.55）、（1.82±0.62）、（1.42±0.33）、（0.84 ±0.28） μg/L]低于F组[（3.08±1.12）、（3.62±0.98）、（1.89±0.57）、（1.32±0.47）μg/L]（P＜0.05）.结论 体外循环冠状动脉旁路移植术使用舒芬太尼麻醉,血流动力学更平稳,术后血清心肌cTn Ⅰ较低,心肌保护作用较好.     

PGE1及特利加压素对抗利尿性腹腔积液的影响

目的 探究前列腺素E₁联合特利加压素对肝硬化难治性腹腔积液患者肾功能、血流动力学、心率等相关指标的影响。方法 将50例肝硬化难治性腹腔积液分为两组,联合治疗组25例,应用前列腺素E₁联合特利加压素;对照组25例,只用前列腺素E₁。特利加压素1mg,每8h 1次,静脉注射。前列腺素E₁ 10μg,每天1次,静脉注射。比较两组患者尿量、腹围、血肌酐等指标变化。结果 治疗前两组患者体重、性别、白蛋白等基本信息比较,差异无统计学意义（P>0.05）。两组患者治疗后较治疗前BUN与SCr均明显下降,差异有统计学意义（P<0.05）,且治疗后,联合治疗组SCr明显低于对照组,差异有统计学意义（t=-2.199;P=0.033）。两组患者治疗后较治疗前腹腔积液减少、尿量增多,差异有统计学意义（P<0.05）;治疗后与对照组相比,联合治疗组治疗后腹围与腹腔积液深度均明显减小,差异有统计学意义（t=-2.220,-2.155;P=0.031,0.036）,而尿量则明显增加,差异有统计学意义（t=3.404,P=0.001）。与治疗前相比,联合治疗组治疗后脾静脉与门静脉内径都明显减小,差异有统计学意义（t=7.817,5.583;P=0.000,0.000）。两组患者治疗前后平均动脉压与心率均无明显变化。结论 前列腺素E₁联合特利加压素在治疗肝硬化抗利尿性腹腔积液时疗效好于单用前列腺素E₁,且对血压、心率影响较小。     

Decrease with aging of the microcirculatory function of the lumbar vertebral marrow preceding the loss of bone material density and the onset of intervertebral discal degeneration: A study about the potential cause

ObjectiveUsing a dynamic computed tomographic perfusion (CTP) imaging method to explore the age-related distribution of the microcirculation perfusion function in the vertebral marrow, the bone material density (BMD), and the intervertebral discal degeneration (IDD). Further, to discuss a possible causation relationship between them.MethodsOne hundred and eighty-six people were randomly enrolled by stratified sampling and grouped by age: ≤15, 16–25, 26–35, 36–45, 46–55, 56–65, 66–75, and ≥76 years old. The average CTP and BMD of the third and fourth lumbar vertebrae marrow were measured and the IDD incidence of the third-fourth vertebrae was assessed. The temporal–spatial distribution patterns of the age-related changes of the CTP, BMD, and IDD were described, and the correlations between them were calculated.ResultsThe microcirculatory perfusion function of the vertebral marrow develops to maturity by 25 years and is maintained until age 35, then declines with aging. The BMD grew to a peak from 26 to 45 years old, then decreased yearly. The IDD showed a sudden increase after 45 years of age. The CTP [BF (r = 0.806, P = 0.000), BV (r = 0.685, P = 0.005) and PMB (r = 0.619, P = 0.001)] showed strong positive correlations and CTP [TTP (r = −0.211, P = 0.322) and MTT (r = −0.598, P = 0.002)] showed negative correlations with BMD. The CTP [BF (r = −0.815, P = 0.000), BV (r = −0.753, P = 0.000) and PMB (r = −0.690, P = 0.000)] had strong negative correlations, and CTP [TTP (r = 0.323, P = 0.126) and MTT (r = 0.628, P = 0.001)] had positive correlations with the incidence of IDD.ConclusionThe decrease with aging of the microcirculatory perfusion in the lumbar vertebral marrow preceded, and is a potential causative factor for the loss of BMD and the onset of IDD.     

超声评估急重症患者容量状态研究进展

循环不稳定是急重症患者常见急症之一,快速评估其容量状态是指导治疗的关键。检测中心静脉压（CVP）是目前临床评估容量负荷的较常用方法,但为有创操作,且存在较多近远期并发症。超声作为无创检查已广泛应用于监测血流动力学,近年来,采用急诊超声评估患者容量状态并指导液体治疗日益普及。本文对超声评估急重症患者容量状态的应用进展进行综述。     

创伤性肺栓塞应用华法林治疗前后的血流动力学变化研究

目的：探讨创伤性肺栓塞患者使用华法林治疗后,血流动力学变化特征。方法将该院2013年10月—2014年10月收纳的36例创伤性肺栓塞患者设为观察组;另选取同期于该院接受体检的36名健康体检者设为对照组。对比两组研究对象不同时期的血流动力学变化值。结果相较于对照组,观察组患者治疗前MAP、CI、SV、SI、PAWP明显更低,HR、SVR、TFC、PVR明显更高,组间对比差异有统计学意义（P＜0.05）。结论华法林治疗创伤性肺栓塞会引起血流动力学变化,临床可根据该监测指标对患者对患者病情与治疗紧张进行准确评估。     

重组人心钠肽治疗急性心力衰竭的临床研究

目的：探讨重组人心钠肽治疗急性心力衰竭疗效。方法：对自2011年5月～2013年2月我院收治的急性心力衰竭患者应用重组人心钠肽治疗,于用药前后监测患者的血流动力学参数。结果：66例患者59例症状缓解,显效27例,有效32例,无效7例,有效率89．39％。结论：重组人心钠肽是治疗急性心力衰竭疗效可靠的药物,安全性高。     

瑞舒伐他汀对脑梗塞患者脑血流动力学的影响

目的 探讨瑞舒伐他汀对脑梗塞患者脑血流动力学的影响效果.方法 选择我院2013年8月至2014年2月收治的80例脑梗塞患者为研究对象,随机分为对照组40例,观察组40例,对照组行常规抗血小板聚集、营养脑神经药物治疗,观察组在常规治疗基础上,加用瑞舒伐他汀治疗,对两组患者行多普勒超声检查,对比两组患者的脑血流动力学状况.结果 观察治疗后双侧大脑动脉Vm为(62.35±15.68) cm·s-1,双侧大脑动脉Vs为(88.62±25.31)cm·s-1,双侧大脑动脉PI为(0.63±0.31),对照组治疗后双侧大脑动脉Vm为(57.51±12.56) cm·s-1,双侧大脑动脉Vs为(80.51±21.54) cm·s-1,双侧大脑动脉PI为(0.73±0.51),差异有统计学意义(P＜0.05).结论 对脑梗塞治疗时,加用瑞舒伐他汀,可显著改善患者脑血流动力学,能帮助患者的病情恢复,值得临床进一步推广使用.     

Astragalus polysaccharide attenuates isoproterenol-induced cardiac hypertrophy by regulating TNF-α/PGC-1α signaling mediated energy biosynthesis

We previously reported that Astragalus polysaccharide (APS) extracted from Chinese medicine Astragalus membranaceus (Fisch.) Bge, attenuates hypertrophy of neonatal rat ventricular myocytes (NRVMs) induced by isoproterenol (Iso). The present study was designed to investigate the effects and the possible mechanism of APS on Iso-induced hypertrophy in rats and NRVMs with focus on tumor necrosis factor α (TNF-α)/peroxisome proliferator-activated receptor-γ coactivator 1α (PGC-1α) signaling mediated energy biosynthesis. 36-Week old rats were randomly divided into 3 groups: (1) Control, rats received vehicle; (2) Iso, rats received isoproterenol injections; (3) Iso+APS, rats received isoproterenol injections and APS. NRVMs were divided into similar groups as rats. The results showed that combination of APS with Iso significantly attenuated the pathological changes, reduced the ratios of heart weight/body weight (HW/BW) and left ventricular weight/BW (LVW/BW), improved the cardiac hemodynamics, down-regulated mRNA and protein expression of atrial natriuretic peptide (ANP), increased the ratios of ATP/ADP and ATP/AMP, and decreased the content of free fatty acid (FFA) in heart tissue of rats compared with Iso alone. In addition, pretreatment with APS significantly decreased the surface area and protein content, down-regulated mRNA and protein expression of ANP, increased the ratios of ATP/ADP and ATP/AMP, and decreased the content of FFA in NRVMs compared with Iso alone. Furthermore, APS increased the protein expressions of ATP5D, the σ subunit of ATP synthase, PGC-1α and pyruvate dehydrogenase kinase 4 (PDK4) in tissue and NRVMs respectively and inhibited the production of TNF-α in serum and culture medium compared with Iso alone. The results suggested that APS attenuates Iso-induced cardiac hypertrophy through regulating TNF-α/PGC-1α signaling mediated energy biosynthesis.     

Improvement in Hemodynamics After Methylene Blue Administration in Drug-Induced Vasodilatory Shock: A Case Report

Introduction

The purpose of this study is to describe a case where methylene blue improved hemodynamics in a poisoned patient.

Case Report

This is a single case report where a poisoned patient developed vasodilatory shock following ingestion of atenolol, amlodipine, and valsartan. Shock persisted after multiple therapies including vasopressors, high-dose insulin, hemodialysis, and 20% intravenous fat emulsion. Methylene blue (2 mg/kg IV over 30 min) was administered in the ICU with temporal improvement as measured by pulmonary artery catheter hemodynamic data pre- and post-methylene blue administration. Within 1 h of methylene blue administration, systemic vascular resistance improved (240 dyn s/cm5 increased to 1204 dyn s/cm5), and vasopressor requirements decreased with maintenance of mean arterial pressure 60 mmHg.

Discussion

Methylene blue may improve hemodynamics in drug-induced vasodilatory shock and should be considered in critically ill patients poisoned with vasodilatory medications refractory to standard therapies.