We report a patient with severe pulmonary arterial hypertension (PAH) undergoing tibio-talo-calcaneal fusion due to Charcot joint. Despite the advancement in the management of PAH, the risks of anesthesia, surgery, an...We report a patient with severe pulmonary arterial hypertension (PAH) undergoing tibio-talo-calcaneal fusion due to Charcot joint. Despite the advancement in the management of PAH, the risks of anesthesia, surgery, and postoperative morbidity and mortality still remain high. A 46-year-old female was presented with severe PAH and end stage renal disease requiring hemodialysis three times a week. Ultrasound-guided sciatic, femoral, and obturator nerve blocks were performed with 0.5% levobupivacaine 15 ml, 10 ml, and 5 ml, respectively. All the blocks were successful, and the patient underwent uneventful anesthesia and surgery. In addition, the postoperative pain control lasted for 15 h and the patient was discharged on POD 5 without any complications. Therefore, ultrasound-guided sciatic, femoral, and obturator nerve blocks are valuable alternative to the general or neuraxial anesthesia in patients with severe pulmonary hypertension.展开更多
<strong>OBJECTIVE:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">To determine the types o...<strong>OBJECTIVE:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">To determine the types of major maternal-perinatal morbidity associated with prolonged, acute-onset severe systolic hypertension during pregnancy and postpartum.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">METHODS: </span></b></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">A medicolegal database retaining only medical record data was created from all cases involving women with medical/hypertensive disorders of pregnancy evaluated by the first author between 1986-2015. Case files of women that experienced severe systolic hypertension (SSH) sustained for many hours to days were identified for study. </span><b><span style="font-family:Verdana;">RESULTS: </span></b><span style="font-family:Verdana;">Sixty six pregnant/postpartum women met study criteria. Stroke secondary to intracranial hemorrhage or thrombosis (65.2) and acute pulmonary edema (33%) were the leading causes of maternal morbidity and mortality, most often antepartum as a component of early-onset preeclampsia (</span></span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">≤</span><span style="font-family:Verdana;">34 weeks). Eclampsia, abruptio placenta and injury to heart, liver and/or kidneys were other frequent co-morbidities. Seven postpartum women developed sudden new-onset postpartum SSH and suffered a stroke 4</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">13 days after delivery. Maternal mortality (54.6%) and morbidity as persistent disability (24.2%) were high in this cohort. </span><b><span style="font-family:Verdana;">CONCLUSION: </span></b><span style="font-family:Verdana;">Failure to rapidly respond, reduce and sustain at a safe level acute-onset SSH poses a significant threat to the wellbeing of mothers and babies, before and in the weeks following delivery. Systems to implement safe practices to identify and emergently treat severe maternal hypertension are needed.</span></span></span></span>展开更多
目的:采用中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)、红细胞分布宽度(red cell distribution width,RDW)联合多层螺旋CT(multislice spiral CT,MSCT)分析肺高压(pulmonary hypertention,PH)患者的临床特征,探讨与疾...目的:采用中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)、红细胞分布宽度(red cell distribution width,RDW)联合多层螺旋CT(multislice spiral CT,MSCT)分析肺高压(pulmonary hypertention,PH)患者的临床特征,探讨与疾病严重程度的相关性。方法:收集南京医科大学第一附属医院2018年8月—2022年2月由经胸超声心动图(transthoracic echocardiography,TTE)评估为PH的124例患者作为PH组,同期收集120例本院健康体检者作为对照组。纳入患者MSCT、TTE、血常规等相关结果,对病情严重程度进行综合评估。结果:(1)与正常对照组相比,PH组NLR、RDW及MSCT测量的主肺动脉直径(diameters of the main pulmonary artery,dMPA)、主肺动脉与升主动脉内径比(ratio of main pulmonary artery to ascending aorta diameter,rPA)及升主动脉内径值(ascending aortic diameter,AOD)明显升高,差异有统计学意义(P<0.05);(2)与轻度PH组相比,中重度PH组NLR、RDW及dMPA、rPA明显升高,差异有统计学意义(P<0.05);(3)NLR、RDW及dMPA、rPA与肺动脉收缩压(systolic pulmonary artery pressure,PASP)呈正相关,AOD与PASP无相关性;(4)NLR、RDW及dMPA、r PA对PH严重程度有较好的预测价值;(5)RDW、dMPA为PASP升高的危险因素。结论:对于PH的病情评估,NLR、RDW、dMPA及rPA均具有较高的预测价值,可作为评估患者病情严重程度的指标;RDW、dMPA被证实为PH患者病情加重的危险因素。展开更多
文摘We report a patient with severe pulmonary arterial hypertension (PAH) undergoing tibio-talo-calcaneal fusion due to Charcot joint. Despite the advancement in the management of PAH, the risks of anesthesia, surgery, and postoperative morbidity and mortality still remain high. A 46-year-old female was presented with severe PAH and end stage renal disease requiring hemodialysis three times a week. Ultrasound-guided sciatic, femoral, and obturator nerve blocks were performed with 0.5% levobupivacaine 15 ml, 10 ml, and 5 ml, respectively. All the blocks were successful, and the patient underwent uneventful anesthesia and surgery. In addition, the postoperative pain control lasted for 15 h and the patient was discharged on POD 5 without any complications. Therefore, ultrasound-guided sciatic, femoral, and obturator nerve blocks are valuable alternative to the general or neuraxial anesthesia in patients with severe pulmonary hypertension.
文摘<strong>OBJECTIVE:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">To determine the types of major maternal-perinatal morbidity associated with prolonged, acute-onset severe systolic hypertension during pregnancy and postpartum.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">METHODS: </span></b></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">A medicolegal database retaining only medical record data was created from all cases involving women with medical/hypertensive disorders of pregnancy evaluated by the first author between 1986-2015. Case files of women that experienced severe systolic hypertension (SSH) sustained for many hours to days were identified for study. </span><b><span style="font-family:Verdana;">RESULTS: </span></b><span style="font-family:Verdana;">Sixty six pregnant/postpartum women met study criteria. Stroke secondary to intracranial hemorrhage or thrombosis (65.2) and acute pulmonary edema (33%) were the leading causes of maternal morbidity and mortality, most often antepartum as a component of early-onset preeclampsia (</span></span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">≤</span><span style="font-family:Verdana;">34 weeks). Eclampsia, abruptio placenta and injury to heart, liver and/or kidneys were other frequent co-morbidities. Seven postpartum women developed sudden new-onset postpartum SSH and suffered a stroke 4</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">13 days after delivery. Maternal mortality (54.6%) and morbidity as persistent disability (24.2%) were high in this cohort. </span><b><span style="font-family:Verdana;">CONCLUSION: </span></b><span style="font-family:Verdana;">Failure to rapidly respond, reduce and sustain at a safe level acute-onset SSH poses a significant threat to the wellbeing of mothers and babies, before and in the weeks following delivery. Systems to implement safe practices to identify and emergently treat severe maternal hypertension are needed.</span></span></span></span>
文摘目的:采用中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)、红细胞分布宽度(red cell distribution width,RDW)联合多层螺旋CT(multislice spiral CT,MSCT)分析肺高压(pulmonary hypertention,PH)患者的临床特征,探讨与疾病严重程度的相关性。方法:收集南京医科大学第一附属医院2018年8月—2022年2月由经胸超声心动图(transthoracic echocardiography,TTE)评估为PH的124例患者作为PH组,同期收集120例本院健康体检者作为对照组。纳入患者MSCT、TTE、血常规等相关结果,对病情严重程度进行综合评估。结果:(1)与正常对照组相比,PH组NLR、RDW及MSCT测量的主肺动脉直径(diameters of the main pulmonary artery,dMPA)、主肺动脉与升主动脉内径比(ratio of main pulmonary artery to ascending aorta diameter,rPA)及升主动脉内径值(ascending aortic diameter,AOD)明显升高,差异有统计学意义(P<0.05);(2)与轻度PH组相比,中重度PH组NLR、RDW及dMPA、rPA明显升高,差异有统计学意义(P<0.05);(3)NLR、RDW及dMPA、rPA与肺动脉收缩压(systolic pulmonary artery pressure,PASP)呈正相关,AOD与PASP无相关性;(4)NLR、RDW及dMPA、r PA对PH严重程度有较好的预测价值;(5)RDW、dMPA为PASP升高的危险因素。结论:对于PH的病情评估,NLR、RDW、dMPA及rPA均具有较高的预测价值,可作为评估患者病情严重程度的指标;RDW、dMPA被证实为PH患者病情加重的危险因素。
文摘目的:探讨重症肺动脉高压患者终末期临床特点及救治策略。方法:回顾性分析2000至2004期间我院肺动脉高压死亡患者19例的临床表现及治疗经过。结果:12例患者末次住院诱因为肺部感染。19例患者肺动脉收缩压平均(100.6±20.2)mm Hg(1 mm Hg=0.133 Kpa),右心室内径与左心室内径之比(RV/LV)为1.12±0.52。死亡前诱发因素主要为大便用力(42.1%)和突然的体位改变(10.5%);死亡前呼吸频率及心率明显加快,超声心动图检查示右心室较入院时进一步扩大。分析患者直接死亡原因,10例为心源性休克(52.6%),6例为急性肺水肿(31.6%),2例为失血性休克(10.5%),1例为呼吸衰竭(5.2%)。结论:重症肺动脉高压尤其是心室内径之比RV/LV>1.0预后差,常在使心率加快、回心血量骤然减少等诱发因素下,启动急性肺水肿和心源性休克抢救,无效死亡。目前尚无明确有效的抢救措施。因此,应当积极预防和控制各项诱发因素,尝试不同给药途径合理应用血管活性药物进行救治。