Septic shock is a common critical condition, for which effective early fluid resuscitation is the therapeutic focus. According to the 2008 international guidelines for management of severe sepsis and septic shock, res...Septic shock is a common critical condition, for which effective early fluid resuscitation is the therapeutic focus. According to the 2008 international guidelines for management of severe sepsis and septic shock, resuscitation should achieve a central venous pressure （CVP） of 8-12 mmHg within the first 6 h. However, it is still uncertain about the sensitivity and specificity of CVP in reflecting the cardiac preload. Ultrasonography is a simple, rapid, non-invasive, and repeatable method for the measurement of sensitivity and specificity of CVP and has thus gradually attracted the increasing attention of physicians. It was reported that ultrasonography can show the inferior vena cava diameter, respiratory variability index, and blood volume in patients with sepsis or heart failure.展开更多
Persistent left superior vena cava, usually an incidental finding, is the most common thoracic vein anatomical variation draining into the coronary sinus. Central venous catheter procedures may be complicated secondar...Persistent left superior vena cava, usually an incidental finding, is the most common thoracic vein anatomical variation draining into the coronary sinus. Central venous catheter procedures may be complicated secondary to the presence of a persistent left superior vena cava, leading to life-threatening complications such as arrhythmias, cardiogenic shock, and cardiac arrest. We present a case of persistent superior vena cava diagnosed on transthoracic echocardiogram(TTE) in a patient with congestive heart failure. A dilated coronary sinus was identified on TTE, followed by injection of agitated saline into the left antecubital vein resulting in filling of the coronary sinus prior to the right atrium-an indication of persistent left superior vena-cava. This also was confirmed on cardiac computed tomography. Such a diagnosis is critical in patients who may undergo central venous catheter procedures such as our patient's potential requirement for an implantable cardiovertor defibrillator due to severe global left ventricular systolic dysfunction. The presence of a persistent left superior vena cava should always be suspected when the guidewire takes a left-sided downward course towards the rightatrium at the level of the coronary sinus. Therefore, special attention should be paid to the imaging work-up prior to central venous catheter procedures.展开更多
目的:探讨严重脓毒症患者液体复苏中中心静脉血氧饱和度(ScvO_(2))、乳酸清除率与超声测算下腔静脉呼吸变异度(IVC-RVI)的相关性,以期为临床早期制定干预方案提供参考。方法:选取2020年12月至2022年12月四川省自贡市第一人民医院60例严...目的:探讨严重脓毒症患者液体复苏中中心静脉血氧饱和度(ScvO_(2))、乳酸清除率与超声测算下腔静脉呼吸变异度(IVC-RVI)的相关性,以期为临床早期制定干预方案提供参考。方法:选取2020年12月至2022年12月四川省自贡市第一人民医院60例严重脓毒症患者,对所有患者根据早期目标导向治疗(EGDT)方案按6 h脓毒症集束化治疗行液体复苏,监测ScvO_(2)、乳酸清除率,并经超声检查测算IVC-RVI,分析ScvO_(2)、乳酸清除率及IVC-RVI与EGDT治疗达标的关系,比较不同预后患者复苏后6 h、12 h及24 h ScvO_(2)、乳酸清除率及IVC-RVI,分析其对预后评估价值。结果:EGDT治疗未达标组复苏后6 h ScvO_(2)、乳酸清除率均低于达标组,IVC-RVI高于达标组(P<0.05);复苏后6 h ScvO_(2)、乳酸清除率低水平组患者EGDT治疗不达标风险分别是高水平组的7.500倍、4.667倍;IVC-RVI高水平组患者EGDT治疗不达标风险是低水平组的3.250倍;死亡组患者复苏后6 h、12 h及24 h ScvO_(2)、乳酸清除率均低于生存组患者,IVC-RVI高于生存组患者(P<0.05);复苏后6 h、12 h及24 h ScvO_(2)、乳酸清除率、IVC-RVI联合预测AUC分别为0.856、0.892、0.933,明显较各时间点单个指标大,且复苏后24 h联合预测AUC>复苏后12 h>复苏后6 h(P<0.05);严重脓毒症患者复苏后6 h、12 h及24 h ScvO_(2)、乳酸清除率均与IVC-RVI呈负相关关系(P<0.05)。结论:严重脓毒症患者液体复苏中ScvO_(2)、乳酸清除率及IVC-RVI对于液体复苏疗效具有较高评估价值,可为临床早期预测预后提供依据,以针对性展开后续治疗,提高患者生存率。展开更多
外周静脉置人中心静脉导管（peripherally insert2ed central catheter，PICC）因其留置时间长、能够安全地输注刺激性药物、保护患者血管、减轻患者痛苦、可由护士操作等优点，已被临床广泛应用。然而导管异位是PICC常见并发症之一。...外周静脉置人中心静脉导管（peripherally insert2ed central catheter，PICC）因其留置时间长、能够安全地输注刺激性药物、保护患者血管、减轻患者痛苦、可由护士操作等优点，已被临床广泛应用。然而导管异位是PICC常见并发症之一。传统的处理方法是将导管外撤，保留在锁骨下静脉或在B超引导下将导管调整到位。但由于B超显影的局限性，给导管的正确调整造成一定困难。展开更多
文摘Septic shock is a common critical condition, for which effective early fluid resuscitation is the therapeutic focus. According to the 2008 international guidelines for management of severe sepsis and septic shock, resuscitation should achieve a central venous pressure （CVP） of 8-12 mmHg within the first 6 h. However, it is still uncertain about the sensitivity and specificity of CVP in reflecting the cardiac preload. Ultrasonography is a simple, rapid, non-invasive, and repeatable method for the measurement of sensitivity and specificity of CVP and has thus gradually attracted the increasing attention of physicians. It was reported that ultrasonography can show the inferior vena cava diameter, respiratory variability index, and blood volume in patients with sepsis or heart failure.
文摘Persistent left superior vena cava, usually an incidental finding, is the most common thoracic vein anatomical variation draining into the coronary sinus. Central venous catheter procedures may be complicated secondary to the presence of a persistent left superior vena cava, leading to life-threatening complications such as arrhythmias, cardiogenic shock, and cardiac arrest. We present a case of persistent superior vena cava diagnosed on transthoracic echocardiogram(TTE) in a patient with congestive heart failure. A dilated coronary sinus was identified on TTE, followed by injection of agitated saline into the left antecubital vein resulting in filling of the coronary sinus prior to the right atrium-an indication of persistent left superior vena-cava. This also was confirmed on cardiac computed tomography. Such a diagnosis is critical in patients who may undergo central venous catheter procedures such as our patient's potential requirement for an implantable cardiovertor defibrillator due to severe global left ventricular systolic dysfunction. The presence of a persistent left superior vena cava should always be suspected when the guidewire takes a left-sided downward course towards the rightatrium at the level of the coronary sinus. Therefore, special attention should be paid to the imaging work-up prior to central venous catheter procedures.
文摘目的:探讨严重脓毒症患者液体复苏中中心静脉血氧饱和度(ScvO_(2))、乳酸清除率与超声测算下腔静脉呼吸变异度(IVC-RVI)的相关性,以期为临床早期制定干预方案提供参考。方法:选取2020年12月至2022年12月四川省自贡市第一人民医院60例严重脓毒症患者,对所有患者根据早期目标导向治疗(EGDT)方案按6 h脓毒症集束化治疗行液体复苏,监测ScvO_(2)、乳酸清除率,并经超声检查测算IVC-RVI,分析ScvO_(2)、乳酸清除率及IVC-RVI与EGDT治疗达标的关系,比较不同预后患者复苏后6 h、12 h及24 h ScvO_(2)、乳酸清除率及IVC-RVI,分析其对预后评估价值。结果:EGDT治疗未达标组复苏后6 h ScvO_(2)、乳酸清除率均低于达标组,IVC-RVI高于达标组(P<0.05);复苏后6 h ScvO_(2)、乳酸清除率低水平组患者EGDT治疗不达标风险分别是高水平组的7.500倍、4.667倍;IVC-RVI高水平组患者EGDT治疗不达标风险是低水平组的3.250倍;死亡组患者复苏后6 h、12 h及24 h ScvO_(2)、乳酸清除率均低于生存组患者,IVC-RVI高于生存组患者(P<0.05);复苏后6 h、12 h及24 h ScvO_(2)、乳酸清除率、IVC-RVI联合预测AUC分别为0.856、0.892、0.933,明显较各时间点单个指标大,且复苏后24 h联合预测AUC>复苏后12 h>复苏后6 h(P<0.05);严重脓毒症患者复苏后6 h、12 h及24 h ScvO_(2)、乳酸清除率均与IVC-RVI呈负相关关系(P<0.05)。结论:严重脓毒症患者液体复苏中ScvO_(2)、乳酸清除率及IVC-RVI对于液体复苏疗效具有较高评估价值,可为临床早期预测预后提供依据,以针对性展开后续治疗,提高患者生存率。
文摘外周静脉置人中心静脉导管（peripherally insert2ed central catheter，PICC）因其留置时间长、能够安全地输注刺激性药物、保护患者血管、减轻患者痛苦、可由护士操作等优点，已被临床广泛应用。然而导管异位是PICC常见并发症之一。传统的处理方法是将导管外撤，保留在锁骨下静脉或在B超引导下将导管调整到位。但由于B超显影的局限性，给导管的正确调整造成一定困难。
