Injection pain of propofol remains a common clinical problem. Previous studies demonstrated that propofol injection pain was alleviated by applying nitroglycerin ointment to the skin of injection site, which inspires ...Injection pain of propofol remains a common clinical problem. Previous studies demonstrated that propofol injection pain was alleviated by applying nitroglycerin ointment to the skin of injection site, which inspires us to test whether venous vasodilation induced by fluid preload could alleviate the pain. Different types or volumes of fluid preload were compared. 200 ASA Ⅰ-Ⅱ adult patients were randomly assigned to five groups of 40 each. A 20 G cannula was established on the dorsum or wrist of the hand. When fluid preload given with Plasma-Lyte A 100 m L（P100 group）, 250 m L（P250 group）, 500 m L（P500 group）, 0.9% saline 500 m L（N500 group） or Gelofusine 500 m L（G500 group） was completed within 30 min, respectively, Propofol（0.5 mg/kg, 1%） was injected at a rate of 0.5 m L/s. A blind investigator assessed the pain using a four-point scale. Incidence of pain in P100, P250, and P500 groups was 87.5%, 57.5% and 35%, respectively（P〈0.05）. The median pain intensity score was significantly lower in P500 group than that in P250 and P100 groups（P〈0.05 and P〈0.01, respectively）. Comparison of the effect of different types of solution preload indicated that the highest incidence of pain was in N500 group（62.5%）（N500 vs. P500, P=0.014; N500 vs. G500, P=0.007）. The median pain intensity score in N500 group was higher than that in P500 group（P〈0.05） and G500 group（P〈0.05）. There was no significant difference between P500 and G500 groups. It is suggested that Plasma-Lyte A or Gelofusine preload with 500 m L before propofol injection is effective in alleviating propofol-induced pain.展开更多
The Initial Imperfection Amplified Criterion is applied toinvestigate the geometric nonlinear dynamic buckling of staticallypreloaded ring-stiffened cylindrical shells under axial fluid-solidimpact. Tak- ing account o...The Initial Imperfection Amplified Criterion is applied toinvestigate the geometric nonlinear dynamic buckling of staticallypreloaded ring-stiffened cylindrical shells under axial fluid-solidimpact. Tak- ing account of the effects of large deformation andinitial geometric imperfection, the governing equations are obtainedby the Galerkin method and solved by the Runge-Kutta method. Theeffects of static preloading (uniform external radial pressure) onthe buckling features and the load-carrying ability of ring-stiffenedcy- lindrical shells against axial impact are discussed.展开更多
Acute pancreatitis(AP)is a frequent disease with degrees of increasing severity responsible for high morbidity.Despite continuous improvement in care,mortality remains significant.Because hypovolemia,together with mic...Acute pancreatitis(AP)is a frequent disease with degrees of increasing severity responsible for high morbidity.Despite continuous improvement in care,mortality remains significant.Because hypovolemia,together with microcirculatory dysfunction lead to poor outcome,fluid therapy remains a cornerstone of the supportive treatment.However,poor clinical evidence actually support the aggressive fluid therapy recommended in recent guidelines since available data are controversial.Fluid management remains unclear and leads to current heterogeneous practice.Different strategies may help to improve fluid resuscitation in AP.On one hand,integration of fluid therapy in a global hemodynamic resuscitation has been demonstrated to improve outcomein surgical or septic patients.Tailored fluid administration after early identification of patients with high-risk of poor outcome presenting inadequate tissue oxygenation is a major part of this strategy.On the other hand,new decision parameters have been developed recently to improve safety and efficiency of fluid therapy in critically ill patients.In this review,we propose a personalized strategy integrating these new concepts in the early fluid management of AP.This new approach paves the way to a wide range of clinical studies in the field of AP.展开更多
目的探讨去甲肾上腺素对脓毒性休克患者被动抬腿试验(PLR)预测液体反应性的影响。方法采用前瞻性观察研究的方法,收集2012年9月至2012年11月南京大学医学院附属鼓楼医院重症医学科收治的46例脓毒性休克患者的临床资料,其中36例PLR阳性...目的探讨去甲肾上腺素对脓毒性休克患者被动抬腿试验(PLR)预测液体反应性的影响。方法采用前瞻性观察研究的方法,收集2012年9月至2012年11月南京大学医学院附属鼓楼医院重症医学科收治的46例脓毒性休克患者的临床资料,其中36例PLR阳性患者纳入研究,以PLR实施1 min后每博输出量指数(SVI)增加(ΔSVI=SVI变化值/基础SVI)≥10%,定义为PLR阳性,提示有液体反应性。纳入研究后患者均先行第1次PLR(PLR1),然后体位改为平卧并稳定}后,给予去甲肾上腺素静脉泵入或增加去甲肾上腺素治疗剂量维持MAP≥65 mm Hg,稳定20 min后,行第2次PLR(PLR2)。采用脉搏轮廓连续心排出量监测(PiCCO)法监测患者心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心排指数(CI)、每搏输出量指数(SVI)、外周血管阻力指数(SVRI)、全心舒张末期容积指数(GEDVI)、心功能指数(CFI)等血流动力学指标。观察患者去甲肾上腺素治疗后PLR及其他血流动力学监测指标的变化。结果实施PLR1时SVI增加,ΔSVI为(20.54±9.63)%,CI增加(20.57±9.89)%,MAP升高(7.64±5.77)%,CVP亦升高(25.83±23.39)%。给予去甲肾上腺素静脉泵入或增加去甲肾上腺素治疗剂量后SVI增加,ΔSVI(16.97±9.06)%,CI增加(16.78±8.39)%,GEDVI增加(9.08±4.47)%MAP升高(28.07±12.48)%,CVP增加(7.86±8.52)%。实施PLR2时SVI增加,ΔSVI(13.74±8.79)%,CI增加(13.79±9.08)%,MAP升高(2.93±5.06)%,CVP升高(13.36±4.74)%,与PLR1比较,去甲肾上腺素治疗后及PLR2时ΔSVI均显著降低(P均<0.05)。实施PLR2时6例患者SVI增加<10%,即无液体反应性。结论去甲肾上腺素增加PLR阳性脓毒性休克患者的心脏前负荷,增加心排出量,影响液体反应性。展开更多
文摘Injection pain of propofol remains a common clinical problem. Previous studies demonstrated that propofol injection pain was alleviated by applying nitroglycerin ointment to the skin of injection site, which inspires us to test whether venous vasodilation induced by fluid preload could alleviate the pain. Different types or volumes of fluid preload were compared. 200 ASA Ⅰ-Ⅱ adult patients were randomly assigned to five groups of 40 each. A 20 G cannula was established on the dorsum or wrist of the hand. When fluid preload given with Plasma-Lyte A 100 m L（P100 group）, 250 m L（P250 group）, 500 m L（P500 group）, 0.9% saline 500 m L（N500 group） or Gelofusine 500 m L（G500 group） was completed within 30 min, respectively, Propofol（0.5 mg/kg, 1%） was injected at a rate of 0.5 m L/s. A blind investigator assessed the pain using a four-point scale. Incidence of pain in P100, P250, and P500 groups was 87.5%, 57.5% and 35%, respectively（P〈0.05）. The median pain intensity score was significantly lower in P500 group than that in P250 and P100 groups（P〈0.05 and P〈0.01, respectively）. Comparison of the effect of different types of solution preload indicated that the highest incidence of pain was in N500 group（62.5%）（N500 vs. P500, P=0.014; N500 vs. G500, P=0.007）. The median pain intensity score in N500 group was higher than that in P500 group（P〈0.05） and G500 group（P〈0.05）. There was no significant difference between P500 and G500 groups. It is suggested that Plasma-Lyte A or Gelofusine preload with 500 m L before propofol injection is effective in alleviating propofol-induced pain.
基金the National Natural Sciences Foundation of China(No.19802017)
文摘The Initial Imperfection Amplified Criterion is applied toinvestigate the geometric nonlinear dynamic buckling of staticallypreloaded ring-stiffened cylindrical shells under axial fluid-solidimpact. Tak- ing account of the effects of large deformation andinitial geometric imperfection, the governing equations are obtainedby the Galerkin method and solved by the Runge-Kutta method. Theeffects of static preloading (uniform external radial pressure) onthe buckling features and the load-carrying ability of ring-stiffenedcy- lindrical shells against axial impact are discussed.
文摘Acute pancreatitis(AP)is a frequent disease with degrees of increasing severity responsible for high morbidity.Despite continuous improvement in care,mortality remains significant.Because hypovolemia,together with microcirculatory dysfunction lead to poor outcome,fluid therapy remains a cornerstone of the supportive treatment.However,poor clinical evidence actually support the aggressive fluid therapy recommended in recent guidelines since available data are controversial.Fluid management remains unclear and leads to current heterogeneous practice.Different strategies may help to improve fluid resuscitation in AP.On one hand,integration of fluid therapy in a global hemodynamic resuscitation has been demonstrated to improve outcomein surgical or septic patients.Tailored fluid administration after early identification of patients with high-risk of poor outcome presenting inadequate tissue oxygenation is a major part of this strategy.On the other hand,new decision parameters have been developed recently to improve safety and efficiency of fluid therapy in critically ill patients.In this review,we propose a personalized strategy integrating these new concepts in the early fluid management of AP.This new approach paves the way to a wide range of clinical studies in the field of AP.
文摘目的探讨去甲肾上腺素对脓毒性休克患者被动抬腿试验(PLR)预测液体反应性的影响。方法采用前瞻性观察研究的方法,收集2012年9月至2012年11月南京大学医学院附属鼓楼医院重症医学科收治的46例脓毒性休克患者的临床资料,其中36例PLR阳性患者纳入研究,以PLR实施1 min后每博输出量指数(SVI)增加(ΔSVI=SVI变化值/基础SVI)≥10%,定义为PLR阳性,提示有液体反应性。纳入研究后患者均先行第1次PLR(PLR1),然后体位改为平卧并稳定}后,给予去甲肾上腺素静脉泵入或增加去甲肾上腺素治疗剂量维持MAP≥65 mm Hg,稳定20 min后,行第2次PLR(PLR2)。采用脉搏轮廓连续心排出量监测(PiCCO)法监测患者心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心排指数(CI)、每搏输出量指数(SVI)、外周血管阻力指数(SVRI)、全心舒张末期容积指数(GEDVI)、心功能指数(CFI)等血流动力学指标。观察患者去甲肾上腺素治疗后PLR及其他血流动力学监测指标的变化。结果实施PLR1时SVI增加,ΔSVI为(20.54±9.63)%,CI增加(20.57±9.89)%,MAP升高(7.64±5.77)%,CVP亦升高(25.83±23.39)%。给予去甲肾上腺素静脉泵入或增加去甲肾上腺素治疗剂量后SVI增加,ΔSVI(16.97±9.06)%,CI增加(16.78±8.39)%,GEDVI增加(9.08±4.47)%MAP升高(28.07±12.48)%,CVP增加(7.86±8.52)%。实施PLR2时SVI增加,ΔSVI(13.74±8.79)%,CI增加(13.79±9.08)%,MAP升高(2.93±5.06)%,CVP升高(13.36±4.74)%,与PLR1比较,去甲肾上腺素治疗后及PLR2时ΔSVI均显著降低(P均<0.05)。实施PLR2时6例患者SVI增加<10%,即无液体反应性。结论去甲肾上腺素增加PLR阳性脓毒性休克患者的心脏前负荷,增加心排出量,影响液体反应性。
