血清白蛋白水平对血液透析低血压发生的影响

目的了解血浆白蛋白水平对血液透析时低血压发生率的影响。方法按血清白蛋白水平分为三组:血清白蛋白>35g/L组、25-35g/L组和<25g/L组,观察三组在血透期间低血压的发生率。结果随着血清白蛋白水平的下降,低血压的发生率呈升高趋势,三组的发生率分别为4.8%,6.4%,25.7%,三组间有显著性差异(P<0.01)。结论血浆白蛋白在维持血透期间的血压起着重要的作用,低白蛋白血症,尤其白蛋白<25g/L时,易发生低血压,在拟定超滤方案时应充分考虑这一因素。     

Hypotension and thirst in rats after isoproterenol treatment

Drinking induced in rats by systemic isoproterenol treatment is markedly attenuated after bilateral nephrectomy. The present experiments demonstrate that the hypotension produced by iso-proterenol treatment was more profound, and lasted much longer, in nephrectomized rats than in intact animals. When arterial blood pressure was partially elevated by central administration of angiotensin II or carbachol (Experiment 1) or by intraarterial infusion of epinephrine (Experiment 2), drinking behavior was restored in the nephrectomized animals and their water intakes approximated the amounts consumed by intact rats given isoproterenol. In general, an inverted U-shaped curve was found to define the relation between blood pressure and water intake in rats after isoproterenol treatment. Drinking was most probable when mean arterial blood pressures were in the range of 70–85 mm Hg, whereas rats were unlikely to drink when blood pressures were much below or above this range. These findings indicate that isoproterenol-induced thirst is not dependent on a renal dipsogen, and suggest instead that the hypersecretion of renin that occurs in intact rats is simply permissive of drinking behavior by modulating the hypotensive effects of the drug treatment.     

Interaction between the septal area and the subfornical organ in the control of water intake induced by thirst-eliciting procedures

Rats bearing lesions in the septal area followed by lesions in the subfornical organ were submitted to various thirst-eliciting procedures. The rats with hyperdipsia induced by lesions of the septal area drank more water than either during the control period or after lesion of the subfornical organ under the same thirst-eliciting or angiotensin-liberating stimuli (polyethyleneglycol, isoproterenol, water deprivation and ligation of the inferior vena cava). The overdrinking elicited by lesions in the septal area was blocked after lesion of the subfornical organ. Neither hypovolemia, nor hypotension or water deprivation could elicit increased water intake in animals whose subfornical organ had been destroyed. Animals with lesions in the subfornical organ showed decreased water intake after cellular dehydration. The results obtained suggest that the subfornical organ acts as a more important structure than the septal area in the regulation of water intake elicited by angiotensin, with two opposite effects: a direct one facilitating water intake, and an indirect one inhibiting the septal area. The septal area has an inhibitory effect on the subfornical organ and on water intake.     

Gastrointestinal Contributions to the Postprandial Experience

Food ingestion induces homeostatic sensations (satiety, fullness) with a hedonic dimension (satisfaction, changes in mood) that characterize the postprandial experience. Both types of sensation are secondary to intraluminal stimuli produced by the food itself, as well as to the activity of the digestive tract. Postprandial sensations also depend on the nutrient composition of the meal and on colonic fermentation of non-absorbed residues. Gastrointestinal function and the sensitivity of the digestive tract, i.e., perception of gut stimuli, are determined by inherent individual factors, e.g., sex, and can be modulated by different conditioning mechanisms. This narrative review examines the factors that determine perception of digestive stimuli and the postprandial experience.     

The Effects of Gold Kiwifruit Intake Timing with or without Pericarp on Postprandial Blood Glucose Level

The purpose of this study was to examine how gold kiwifruit pericarp (pericarp is defined as the skin of the fruit) consumption and the timing thereof affect the postprandial blood glucose profile. The study was conducted on twelve healthy volunteers (six men and six women). According to our results, the simultaneous intake of gold kiwifruit with bread and the prior intake of gold kiwifruit evidently suppressed the postprandial blood glucose elevation compared with exclusive bread intake. There was no significant difference in postprandial blood glucose changes between the ingestion of gold kiwifruit pericarp and pulp and that of gold kiwifruit pulp only. The highest postprandial blood glucose elevation was suppressed by 27.6% and the area under the blood glucose elevation curve by 29.3%, even with the exclusive ingestion of gold kiwifruit pulp. We predicted that the ingestion of both the pericarp and pulp of gold kiwifruit would reduce the postprandial blood glucose elevation to a greater extent than that of gold kiwifruit pulp only; however, there was no significant difference between the two. These results indicate that gold kiwifruit consumption significantly suppresses the postprandial blood glucose elevation regardless of pericarp presence or absence and the timing of ingestion.     

Plasmapheresis-related hypotension

Hypotension is an uncommon complication of procedures involving extracorporeal circulation, including plasmapheresis. From November 1993 to March 1999, we treated 139 patients who underwent a total of 1,137 sessions of double filtration plasmapheresis (DFP). Hypotension was defined as a systolic blood pressure (BP) < 80 mm Hg or any decrease of systolic BP with systemic reactions. A total of 17 (1.5%) episodes of hypotension were documented in 15 patients during the study period. Hypotensive episodes occurred in 2.3% of patients with inflammatory neuropathy, 1.2% of patients with myasthenia gravis, and 1.2% of patients with all other medical diseases. Involvement of the autonomic nerve system (ANS) and a low baseline BP were associated with the occurrence of hypotension. Eight (47%) of 17 episodes were symptomatic and 2 were complicated with seizure. Patients with symptomatic hypotension had a higher level of systolic BP prior to DFP and a larger drop of systolic BP and pulse rate during hypotensive attacks compared to asymptomatic patients. Most hypotensive episodes were resolved briefly after intravenous infusion of saline within 30 min. Eight (47%) of the hypotensive episodes occurred during the first session of DFP treatment. Twelve (71%) of 17 episodes occurred during the last half period of treatment; 6 of them were noted during the terminating stage of DFP. In conclusion, in this series plasmapheresis-related hypotension occurred in 1.5% of DFP sessions and had a higher prevalence in patients with ANS instability and low BP. Extra caution in monitoring BP during DFP therapy is warranted in these vulnerable patients, especially during the termination phase of the first DFP session.     

尼卡地平控制性降压结合急性高容量血液稀释对腰椎手术患者输血量的影响

目的探讨尼卡地平控制性降压结合急性高容量血液稀释以减少腰椎手术患者输血量的可行性。方法择期椎板减压椎弓根内固定术患者64例，随机分为两组：对照组(Ⅰ组，n=32)和降压稀释组(Ⅱ组，n=32)。两组皆采用气管插管静吸复合麻醉，Ⅱ组麻醉诱导后，应用尼卡地平行控制性降压结合进行急性高容量血液稀释，比较两组患者所输异体血量和术后血红蛋白变化。结果Ⅱ组术中平均出血量比Ⅰ组减少50％，Ⅱ组术中平均输液量比Ⅰ组增加150％，而输血量为零。两组患者术后虽有轻度贫血，但仍在正常范围内。结论应用尼卡地平控制性降压结合急性高容量血液稀释可使行椎板减压椎弓根内固定术患者大量减少异体血的输入。     

低温透析对血液透析过程中低血压的干预研究

目的探讨透析液温度与盐浓度对血液透析过程中低血压的干预策略及临床疗效。方法选择常规接受血液透析时间超过6个月,有超过3/4透析次数中发生症状性低血压,同时收缩压下降至少25%和(或)收缩压低于100 mm Hg,需要药物干预的门诊患者4例。每个患者分别接受低温透析、常温标准透析各3次,监测患者的平均动脉压(MAP),数据用Microsoft Excel登记汇总,用SSPS 13.0软件进行单样本t检验分析,以P<0.05为差异有统计学意义。结果两组病例透析中、透析后的MAP进行方差分析,各组在P<0.05水平上差异有统计学意义。结论低温透析改善患者对超滤的耐受性,有益于避免透析过程中低血压(IDH),显著减少了护理措施和医疗成本,患者对低温高盐透析感知正面积极,是一种简单、有益和经济的措施。     

不同剂量甲氧明治疗老年腰硬联合麻醉下低血压的临床观察

目的：探讨使用不同剂量的甲氧明治疗老年腰硬联合麻醉下低血压的临床疗效。方法：选择我院2014年2月～2015年2月收治的86例老年择期在腰硬联合麻醉下进行股骨头置换术的老年病患作为本次实验的对象。将其随机分成A1组、A2组,每组43例,分别于麻醉前5min静脉滴注5mg、3mg甲氧明,腰硬联合麻醉后分别观察各组在15、30min时点上的收缩压、舒张压、心率指标以及不良反应情况。结果：麻醉前各组收缩压、舒张压以及心率等体征指标组间没有明显差异（P＞0.05）,不具有统计学意义。麻醉后15、30min A1组的收缩压和舒张压均高于A2组,心率均低于A2组,且各指标在组间比较后结果差异有统计学意义（P＜0.05）;A1组不良反应发生8例（18.01%）和A2组10例（23.26%）比较无显著差异（P＞0.05）。结论：麻醉前采用5mg甲氧明并配合适量的补液可有效治疗腰硬联合麻醉下的低血压,改善患者生命体征,安全性能够保障的同时有效率更高,值得在老年患者中推广应用。