Accuracy of Mean Value of Central Venous Pressure from Monitor Digital Display: Influence of Amplitude of Central Venous Pressure during Respiration

Background A simple measurement of central venous pressure(CVP)-mean by the digital monitor display has become increasingly popular.However,the agreement between CVP-mean and CVP-end(a standard method of CVP measurement by analyzing the waveform at end-expiration)is not well determined.This study was designed to identify the relationship between CVP-mean and CVP-end in critically ill patients and to introduce a new parameter of CVP amplitude(ΔCVP=CVPmax-CVPmin)during the respiratory period to identify the agreement/disagreement between CVP-mean and CVP-end.Methods In total,291 patients were included in the study.CVP-mean and CVP-end were obtained simultaneously from each patient.CVP measurement difference(|CVP-mean-CVP-end|)was defined as the difference between CVP-mean and CVP-end.TheΔCVP was calculated as the difference between the peak(CVPmax)and the nadir value(CVPmin)during the respiratory cycle,which was automatically recorded on the monitor screen.Subjects with|CVP-mean-CVP-end|≥2 mm Hg were divided into the inconsistent group,while subjects with|CVP-mean-CVP-end|2 mm Hg were divided into the consistent group.ResultsΔCVP was significantly higher in the inconsistent group[7.17(2.77)vs.5.24(2.18),P0.001]than that in the consistent group.There was a significantly positive relationship betweenΔCVP and|CVP-mean-CVP-end|(r=0.283,P 0.0001).Bland-Altman plot showed the bias was-0.61 mm Hg with a wide 95%limit of agreement(-3.34,2.10)of CVP-end and CVP-mean.The area under the receiver operating characteristic curves(AUC)ofΔCVP for predicting|CVP-mean-CVP-end|≥2 mm Hg was 0.709.With a high diagnostic specificity,usingΔCVP3 to detect|CVP-mean-CVP-end|lower than 2mm Hg(consistent measurement)resulted in a sensitivity of 22.37%and a specificity of 93.06%.UsingΔCVP8 to detect|CVP-mean-CVPend|8 mm Hg(inconsistent measurement)resulted in a sensitivity of 31.94%and a specificity of 91.32%.Conclusions CVP-end and CVP-mean have statistical discrepancies in specific clinical scenarios.ΔCVP during the respiratory period is related to the variation of the two CVP methods.A highΔCVP indicates a poor agreement between these two methods,whereas a lowΔCVP indicates a good agreement between these two methods.

糖尿病患者白内障术后后囊膜混浊的临床研究

目的:研究糖尿病患者白内障术后后囊膜混浊(PCO)的发生情况及其危险因素。方法:收集2016-04/08于我院行白内障超声乳化联合人工晶状体植入术的白内障患者182例203眼,根据术前是否合并糖尿病分为糖尿病组(DM组,98眼)和非糖尿病组(非DM组,105眼),DM组患者按照白内障术后30mo是否发生PCO分为PCO组(26眼)和非PCO组(72眼)。比较DM组和非DM组术后PCO的发生及分级情况,分析术前糖尿病病程、糖化血红蛋白(HbA1c)水平、是否存在糖尿病视网膜病变(DR)等因素对DM组患者白内障术后PCO发生影响。结果:术后12、18、24、30mo,DM组患者PCO发生率分别为10.2%、14.3%、22.4%、26.5%,非DM组患者分别为2.8%、4.8%、10.5%、14.3%,两组患者PCO程度均逐渐加重,且DM组患者各时间点PCO程度均重于非DM组,(均P<0.05)。PCO组和非PCO组患者术前糖尿病病程、存在DR情况均有差异(P<0.05),术前HbA1c水平无差异(P>0.05)。结论:糖尿病患者白内障术后PCO的发生率高于非糖尿病患者,且混浊程度较重,糖尿病患者术前糖尿病病程、存在DR是影响PCO发生的危险因素。

Efficacy observation on long snake moxibustion for lumbar disc herniation with cold-dampness syndrome

Objectives:To observe and compare the clinical efficacy difference among long snake moxibustion,acupuncture and western medication for treating lumbar disc herniation with cold-dampness syndrome,and to provide a preferred treatment for cold-dampness lumbar disc herniation.Methods:A total of 90 patients with cold-dampness lumbar disc herniation were randomized into three groups according to the random number table,including the long snake moxibustion group(31 cases),the acupuncture group(28 cases)and the western medication group(31 cases).Treated with long snake moxibustion,patients in the long snake moxibustion group.The acupuncture group was treated with conventional acupuncture therapy,by adopting acupoints of Shènshū(肾俞 BL23),Dàchángshū(大肠俞BL25),Yāoyángguān(腰阳关GV3),Wěizhōng(委中 BL40)and local Ashi points.Patients in the western medication group were given oral diclofenac sodium.Visual analogous scale(VAS),Oswestry Dysfunction Index(ODI)score,yang deficiency scale score and clinical efficacy were observed before and after treatment.Results:(1)The VAS scores of the patients after treatment in each group decreased compared with those before the treatment.The long snake moxibustion group decreased from 7.22±1.14 to 1.10±0.75(P<0.05);the acupuncture group,from 6.75±1.18 to 1.46±0.88(P<0.05);and the western medication group,from 7.38±1.02 to 1.51 ±0.81(P<0.05).After treatment,the VAS score of the long snake moxibustion group was lower than that of the acupuncture and western medication groups,the differences were statistically significant(both P<0.05).(2)ODI scores of all the groups were lower than those before the treatment.The long snake moxibustion group decreased from 33.35±10.85 to 7.84±3.59(P<0.05);the acupuncture group,from 31.65±8.23 to 9.00±6.10(P<0.05);and the western medication group from 27.77±7.30 to 23.87±10.81(P<0.05).The score of ODI in the long snake moxibustion group was lower than those in the acupuncture and western medication groups,the differences were statistically significant(both P<0.05).(3)The scores of yang deficiency scale score in each group were lower than those before treatment.The long snake moxibustion group decreased from 61.81±15.49 to 32.26±6.08(P<0.05);the acupuncture group,from 67.64±12.47 to 62.00±17.77(P<0.05);and the western medication group from 64.68 ± 12.73 to 59.77±14.02(P<0.05).The score of yang deficiency scale of the long snake moxibustion group was lower than those of the acupuncture and western medication groups after treatment,the differences were statistically significant(both P<0.05).(4)The effective rates of the long snake moxibustion group,acupuncture group and western medication group were 93.55%,85.71% and74.19% respectively,and the differences among three groups were statistically significant(all P<0.05).Conclusion:The long snake moxibustion therapy has a significant clinical effect for lumbar disc herniation with cold-damp syndrome,which is better than those of acupuncture and western medication groups,the therapy can effectively improve the patients’ physical constitution as a preferred solution for cold-damp lumbar disc herniation by acupuncture therapy.