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Computed tomography perfusion in differentiating portal hypertension: A correlation study with hepatic venous pressure gradient
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作者 Jian Dong Yu Zhang +5 位作者 Yi-Fan Wu Zhen-Dong Yue Zhen-Hua Fan Chun-Yan Zhang Fu-Quan Liu Lei Wang 《World Journal of Gastrointestinal Surgery》 SCIE 2023年第4期664-673,共10页
BACKGROUND Hepatic venous pressure gradient(HVPG)is the gold standard for diagnosis of portal hypertension(PH),invasiveness and potential risks in the process of measurement limited its widespread use.AIM To investiga... BACKGROUND Hepatic venous pressure gradient(HVPG)is the gold standard for diagnosis of portal hypertension(PH),invasiveness and potential risks in the process of measurement limited its widespread use.AIM To investigate the correlation of computed tomography(CT)perfusion parameters with HVPG in PH,and quantitatively assess the blood supply changes in liver and spleen parenchyma before and after transjugular intrahepatic portosystemic shunt(TIPS).METHODS Twenty-four PH related gastrointestinal bleeding patients were recruited in this study,and all patients were performed perfusion CT before and after TIPS surgery within 2 wk.Quantitative parameters of CT perfusion,including liver blood volume(LBV),liver blood flow(LBF),hepatic arterial fraction(HAF),spleen blood volume(SBV)and spleen blood flow(SBF),were measured and compared before and after TIPS,and the quantitative parameters between clinically significant PH(CSPH)and non-CSPH(NCSPH)group were also compared.Then the correlation of CT perfusion parameters with HVPG were analyzed,with statistical significance as P<0.05.RESULTS For all 24 PH patients after TIPS,CT perfusion parameters demonstrated decreased LBV, increased HAF, SBV and SBF, with no statistical difference in LBF. Compared withNCSPH, CSPH showed higher HAF, with no difference in other CT perfusion parameters. HAFbefore TIPS showed positive correlation with HVPG (r = 0.530, P = 0.008), while no correlation wasfound in other CT perfusion parameters with HVPG and Child-Pugh scores.CONCLUSIONHAF, an index of CT perfusion, was positive correlation with HVPG, and higher in CSPH thanNCSPH before TIPS. While increased HAF, SBF and SBV, and decreased LBV, were found afterTIPS, which accommodates a potential non-invasive imaging tool for evaluation of PH. 展开更多
关键词 Portal hypertension Transjugular intrahepatic portosystemic shunt Hepatic vein pressure gradient perfusion Computed tomography
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Revisiting normal perfusion pressure breakthrough in light of hemorrhage-induced vasospasm 被引量:4
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作者 Matthew D Alexander E Sander Connolly Philip M Meyers 《World Journal of Radiology》 CAS 2010年第6期230-232,共3页
Cerebral arteriovenous malformations(AVMs) have abnormally enlarged arteries and veins prone to spontaneous hemorrhage.Immediately following surgical excision of a cerebral AVM,even normal brain tissue surrounding the... Cerebral arteriovenous malformations(AVMs) have abnormally enlarged arteries and veins prone to spontaneous hemorrhage.Immediately following surgical excision of a cerebral AVM,even normal brain tissue surrounding the lesion is subject to hemorrhage,a phenomenon termed normal perfusion pressure breakthrough(NPPB) syndrome.According to this theory,arteries supplying cerebral AVMs become dilated and lose their capacity to dilate or constrict to autoregulate pressure.Acutely after removal of a cerebral AVM,excessive blood pressure in these arterial feeders can cause normal brain tissue to bleed.However,this theory remains controversial.We present a patient with a cerebral AVM that demonstrated cerebrovascular reactivity and argues against an assumption underlying the theory of NPPB syndrome. 展开更多
关键词 ARTERIOVENOUS MALFORMATION AUTOREGULATION Normal perfusion pressure breakthrough SUBARACHNOID HEMORRHAGE VASOSPASM
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Retinal vessel diameter changes induced by transient high perfusion pressure 被引量:2
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作者 Yin-Ying Zhao Ping-Jun Chang +1 位作者 Fang Yu Yun-E Zhao 《International Journal of Ophthalmology(English edition)》 SCIE CAS 2014年第4期602-607,共6页
·AIM: To investigate the effects of transient high perfusion pressure on the retinal vessel diameter and retinal ganglion cells.·METHODS: The animals were divided into four groups according to different infu... ·AIM: To investigate the effects of transient high perfusion pressure on the retinal vessel diameter and retinal ganglion cells.·METHODS: The animals were divided into four groups according to different infusion pressure and infusion time(60 mm Hg-3min, 60 mm Hg-5min, 100 mm Hg-3min, 100 mm Hg-5min). Each group consisted of six rabbits. The left eye was used as the experimental eye and the right as a control. Retinal vascular diameters were evaluated before, during infusion, immediately after infusion, 5min, 10 min and 30 min after infusion based on the fundus photographs. Blood pressure was monitored during infusion. The eyes were removed after 24 h.Damage to retinal ganglion cell(RGC) was analyzed by histology.·RESULTS: Retina became whiten and papilla optic was pale during perfusion. Measurements showed significant decrease in retinal artery and vein diameter during perfusion in all of the four groups at the proximal of the edge of the optic disc. The changes were significant in the 100 mm Hg-3min group and 100 mm Hg-5min group compared with 60 mm Hg-3min group(P 1=0.025, P 2=0.000).The diameters in all the groups recovered completely after 30 min of reperfusion. The number of RGC)showed no significant changes at the IOP in 100 mm Hg with5 min compared with contralateral untreated eye(P 】0.05).·CONCLUSION: Transient fluctuations during infusion lead to temporal changes of retinal vessels, which could affect the retinal blood circulation. The RGCs were not affected by this transient fluctuation. Further studies are necessary to evaluate the effect of pressure during realtime phacoemusification on retinal blood circulation. 展开更多
关键词 ocular perfusion pressure retinal ischemia retinal ganglion cells ANIMALS
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Computed tomography perfusion in liver and spleen for hepatitis B virus-related portal hypertension:A correlation study with hepatic venous pressure gradient 被引量:4
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作者 Lei Wang Yu Zhang +5 位作者 Yi-Fan Wu Zhen-Dong Yue Zhen-Hua Fan Chun-Yan Zhang Fu-Quan Liu Jian Dong 《World Journal of Gastroenterology》 SCIE CAS 2022年第42期6068-6077,共10页
BACKGROUND Hepatic venous pressure gradient(HVPG)is the gold standard for diagnosis of portal hypertension(PH).However,its use can be limited because it is an invasive procedure.Therefore,it is necessary to explore a ... BACKGROUND Hepatic venous pressure gradient(HVPG)is the gold standard for diagnosis of portal hypertension(PH).However,its use can be limited because it is an invasive procedure.Therefore,it is necessary to explore a non-invasive method to assess PH.AIM To investigate the correlation of computed tomography(CT)perfusion of the liver with HVPG and Child-Pugh score in hepatitis B virus(HBV)-related PH.METHODS Twenty-eight patients(4 female,24 male)with gastroesophageal variceal bleeding induced by HBV-related PH were recruited in our study.All patients received CT perfusion of the liver before transjugular intrahepatic portosystemic stent-shunt(TIPS)therapy.Quantitative parameters of CT perfusion of the liver,including liver blood flow(LBF),liver blood volume(LBV),hepatic artery fraction,splenic blood flow and splenic blood volume were measured.HVPG was recorded during TIPS therapy.Correlation of liver perfusion with Child-Pugh score and HVPG were analyzed,and the receiver operating characteristic curve was analyzed.Based on HVPG(>12 mmHg vs≤12 mmHg),patients were divided into moderate and severe groups,and all parameters were compared.RESULTS Based on HVPG,18 patients were classified into the moderate group and 10 patients were classified into the severe group.The Child-Pugh score,HVPG,LBF and LBV were significantly higher in the moderate group compared to the severe group(all P<0.05).LBF and LBV were negatively associated with HVPG(r=-0.473,P<0.05 and r=-0.503,P<0.01,respectively),whereas splenic blood flow was positively associated with hepatic artery fraction(r=0.434,P<0.05).LBV was negatively correlated with Child-Pugh score.Child-Pugh score was not related to HVPG.Using a cutoff value of 17.85 mL/min/100 g for LBV,the sensitivity and specificity of HVPG≥12 mmHg for diagnosis were 80%and 89%,respectively.CONCLUSION LBV and LBF were negatively correlated with HVPG and Child-Pugh scores.CT perfusion imaging is a potential non-invasive quantitative predictor for PH in HBV-related liver cirrhosis. 展开更多
关键词 Hepatic venous pressure gradient Portal hypertension Computed tomography perfusion Hepatitis B Liver cirrhosis
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Normal Perfusion Pressure Breakthrough Following AVM Resection: A Case Report and Review of the Literature 被引量:2
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作者 T. E. O’Connor K. M. Fargen J. Mocco 《Open Journal of Modern Neurosurgery》 2013年第4期66-71,共6页
Objective: To report a patient’s clinical course illustrative of the NPPB mechanism for hyperperfusion-induced injury. Methods: A 65-year-old female presented with a severe headache and was found to have a 6-cm right... Objective: To report a patient’s clinical course illustrative of the NPPB mechanism for hyperperfusion-induced injury. Methods: A 65-year-old female presented with a severe headache and was found to have a 6-cm right parietal AVM on imaging. The patient underwent staged, pre-operative embolization and the AVM was surgically resected without intra-operative complication. After the patient emerged from anesthesia she exhibited left hemiplegia and hemispatial neglect. Her systolic blood pressure (SBP) at that time was between 110-120 mmHg. SBP was reduced to 90-100 mmHg and the patient’s symptoms resolved shortly thereafter. The patient’s strict blood pressure goal was relaxed the next morning. However, with her SBP 110-120 mmHg in the ensuing hours, the patient’s left-sided neglect and hemiparesis returned. Her SBP was reduced again to 90-100 mmHg, leading to resolution of her symptoms. Results: This patient’s clinical course supports the NPPB theory of hyperperfusion-induced injury. Despite CT imaging demonstrating no residual AVM following resection, the patient developed neurological deficits in the immediate postoperative period. Aggressive systemic hypotension improved clinical symptoms repeatedly, whereas a brief period of normotension triggered a return of neurological deficits. As a result, there was a direct correlation between fluctuations of neurological status and SBP. This case suggests that the intrinsic autoregulatory capacity was altered in our patient, and that aggressive hypotension was necessary to compensate for diminished autonomic reactivity. Conclusions: This case provides further evidence that NPPB plays a role in hyperperfusion-induced injury following AVM excision and that blood pressure control is vital in managing hyperemic complications following complete resection of cerebral AVMs. 展开更多
关键词 Blood pressure HEMORRHAGE INTRACRANIAL ARTERIOVENOUS MALFORMATIONS Normal perfusion pressure Breakthrough
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Paracentesis following intravitreal drug injections in maintaining physiologic ocular perfusion pressure
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作者 Austin Bach Artur Filipowic +2 位作者 Aaron S. Gold Azeema Latiff Timothy G. Murray 《International Journal of Ophthalmology(English edition)》 SCIE CAS 2017年第12期1925-1927,共3页
A retrospective analysis was performed of patients who received a paracentesis immediately following an intravitreal injection of bevacizumab or triamcinolone acetonide.These patients were previously diagnosed as havi... A retrospective analysis was performed of patients who received a paracentesis immediately following an intravitreal injection of bevacizumab or triamcinolone acetonide.These patients were previously diagnosed as having glaucoma,ocular hypertension,or had responded previously with sustained elevated intraocular pressure.Of 1661 procedures were performed.Totally 219(13%) of the injections were on phakic patients.A median(SD) of 210 μL(40 μL) of aqueous was removed during each paracentesis.There were no reported incidences of any complications.We propose performing a paracentesis immediately following intravitreal injections for patients at risk for ocular hypertension,glaucoma,and retinal vein or artery occlusion. 展开更多
关键词 anterior chamber paracentesis intravitreal injection intraocular pressure ocular perfusion pressure
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Association between Mean Ocular Perfusion Pressure and Diabetic Retinopathy in a Northeastern Chinese Population
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作者 ZHAI Gang LIN Zhong +8 位作者 WANG Feng Hua WANG Yu LI Dong WEN Liang DING Xiao Xia JIANG Jing FENG Ke Mi LIANG Yuan Bo XIE Cong 《Biomedical and Environmental Sciences》 SCIE CAS CSCD 2020年第9期701-707,共7页
Objective To evaluate the association between diabetic retinopathy(DR) and mean ocular perfusion pressure(MOPP) in patients with type 2 diabetes mellitus(T2 DM).Methods Patients from the Fushun Diabetic Retinopathy Co... Objective To evaluate the association between diabetic retinopathy(DR) and mean ocular perfusion pressure(MOPP) in patients with type 2 diabetes mellitus(T2 DM).Methods Patients from the Fushun Diabetic Retinopathy Cohort Study(FS-DIRECT), a communitybased prospective cohort study conducted in northeast China, were included in this study. The presence and severity of DR were determined by grading fundus photographs according to the Early Treatment Diabetic Retinopathy Study(ETDRS) retinopathy scale. Systolic and diastolic blood pressure(SBP and DBP) were recorded using an electronic sphygmomanometer. Intraocular pressure(IOP) was measured using an iCare rebound tonometer. MOPP was calculated using the formula MOPP = 2/3 [DBP + 1/3(SBP-DBP)]-IOP.Results In total, 1,857 patients who had gradable fundus photography and MOPP data were enrolled in this study. Male patients had a higher MOPP than female patients(52.25 ± 8.75 vs. 50.96 ± 8.74 mmHg, P = 0.002). Overall, both male and female patients with any type of DR, non-proliferative DR(NPDR), or non-sight-threatening DR(non-STDR) had significantly higher MOPP relative to patients without DR. Increased MOPP(per 1 mmHg) was in turn associated with the presence of any type of DR[odds ratio(OR) = 1.03, 95% confidence interval(CI) : 1.02–1.04], NPDR(OR = 1.03 95% CI: 1.02–1.04),and non-STDR(OR = 1.03, 95% CI: 1.01–1.04) after adjusting for confounders. Increased MOPP(per 1 mmHg) was also associated with an increased likelihood of macular edema(OR = 1.02, 95% CI:1.01–1.04).Conclusions The results suggest that increased MOPP was associated with DR and macular edema in northeastern Chinese patients with T2 DM. 展开更多
关键词 Diabetic retinopathy Ocular perfusion pressure Systolic blood pressure Diastolic blood pressure
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Restoring Coronary Perfusion Pressure before Defibrillation after Chest Compression Interruptions
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作者 Timothy J. Mader Ryan A. Coute +3 位作者 Adam R. Kellogg Joshua L. Harris Scot A. Millay Leonard C. Jensen 《Open Journal of Emergency Medicine》 2014年第2期29-35,共7页
Background: Sufficient coronary perfusion pressure (CPP) to provide myocardial reperfusion is required for defibrillation success after prolonged ventricular fibrillation (VF) cardiac arrest. Chest compression interru... Background: Sufficient coronary perfusion pressure (CPP) to provide myocardial reperfusion is required for defibrillation success after prolonged ventricular fibrillation (VF) cardiac arrest. Chest compression interruptions cause a precipitous drop in CPP. Objective: To quantify the ex- tent to which CPP recovers to pre-pause levels following chest compression interruptions. Me- thods: This was a secondary analysis of data from two similar IACUC approved protocols. A total of 105 Yorkshire swine were included and VF was electrically induced. After 10 minutes of untreated VF in the first study (n = 52) and 12 minutes of untreated VF in the second (n = 53), CPR began and epinephrine was administered approximately 2 minutes prior to a planned 10-second pause to record an artifact-free ECG waveform segment. Following this pause, CPR was resumed for 20- seconds prior to defibrillation. CPP data were extracted from three time points: 2 minutes after epinephrine delivery (CPP1);following the chest compression pause (CPP2);and immediately before defibrillation (CPP3). Our primary outcome was defined as the ratio of CPP recovery (CPP3- CPP2) to the drop in CPP (CPP1-CPP2). Results: Interrupting compressions resulted in a significant drop in CPP (29.8 mmHg [95%CI: 26.2, 33.4] to 6.8 mmHg [95%CI: 5.4, 8.2]). Resuming CPR for restored 83% (95%CI: 78%, 86%) of the CPP lost. Conclusion: This study demonstrates that 83% of the decline in CPP values during a planned 10-second interruption in CPR can be restored with a short period of precordial compressions prior to defibrillation. 展开更多
关键词 CARDIOPULMONARY RESUSCITATION Coronary perfusion pressure CHEST Compression INTERRUPTIONS
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Coronary Perfusion Pressure Response to High-Dose Intraosseous versus Standard-Dose Intravenous Epinephrine Administration after Prolonged Cardiac Arrest
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作者 Timothy J. Mader Ryan A. Coute +1 位作者 Adam R. Kellogg Joshua L. Harris 《Open Journal of Emergency Medicine》 2014年第1期1-7,共7页
Background: This study was done to compare coronary perfusion pressure (CPP) prior to the first rescue shock (RS) among a group of animals that received intraosseous (IO) epinephrine 0.1 mg/ kg (high-dose epinephrine ... Background: This study was done to compare coronary perfusion pressure (CPP) prior to the first rescue shock (RS) among a group of animals that received intraosseous (IO) epinephrine 0.1 mg/ kg (high-dose epinephrine [HDE]) with a group that received intravenous (IV) epinephrine 0.01 mg/kg (standard-dose epinephrine [SDE]) during cardiac arrest resuscitation using a swine model of prolonged out-of-hospital ventricular fibrillation (VF) cardiac arrest. Methods: This was a secondary analysis of prospectively collected data from two IACUC approved protocols. Seventy-nine Yorkshire swine (25 - 35 kg) were surgically instrumented under anesthesia and VF was electrically induced. After 10 minutes of untreated VF in the IO study (n = 26) and 12 minutes of untreated VF in the IV study (n = 53), resuscitation commenced with closed chest compressions (CCC). A single dose of epinephrine (HDE IO or SDE IV, respectively) was given and flushed with saline. The CCC and RS attempts were standardized for all animals. The CPP was defined as aortic diastolic pressure minus right atrial diastolic pressure measured 2.5 minutes after medication delivery. Descriptive statistics were used to analyze the data. Results: Baseline group characteristics were mathematically the same. Just prior to the first RS, HDE IO resulted in a mean CPP of 33.2 mmHg (95%CI: 26.6, 39.9), while SDE IV resulted in a mean CPP of 25.0 mmHg (95%CI: 20.5, 29.4). Conclusion: This observation study reaffirms the assertion that HDE IO may be required to generate CPP values similar to SDE IV during resuscitation of prolonged VF. 展开更多
关键词 Cardiac ARREST RESUSCITATION Coronary perfusion pressure INTRAOSSEOUS EPINEPHRINE
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Clinical study on the effect of abdominal cavity chemotherapy by hot perfusion and sustained low losmatic pressure on malignant ascites caused by gastrointestinal tumors
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作者 杨光 刘长安 《中国组织工程研究与临床康复》 CAS CSCD 2001年第18期152-,共2页
关键词 Clinical study on the effect of abdominal cavity chemotherapy by hot perfusion and sustained low losmatic pressure on malignant ascites caused by gastrointestinal tumors
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Effect of early goal directed therapy on tissue perfusion in patients with septic shock 被引量:19
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作者 Yuan-hua Lu Ling Liu +3 位作者 Xiao-hua Qiu Qin Yu Yi Yang Hai-bo Qiu 《World Journal of Emergency Medicine》 CAS 2013年第2期117-122,共6页
BACKGROUND:This study aimed to observe the effect of early goal directed therapy(EGDT)on tissue perfusion,microcirculation and tissue oxygenation in patients with septic shock.METHODS:Patients with early septic shock(... BACKGROUND:This study aimed to observe the effect of early goal directed therapy(EGDT)on tissue perfusion,microcirculation and tissue oxygenation in patients with septic shock.METHODS:Patients with early septic shock(<24 hours) who had been admitted to the ICU of Zhongda Hospital Affiliated to Southeast University from September 2009 through May 2011 were enrolled(research time:12 months),and they didn't meet the criteria of EGDT.Patients who had one of the following were excluded:stroke,brain injury,other types of shock,severe heart failure,acute myocardial infarction,age below 18 years,pregnancy,end-stage disease,cardiac arrest,extensive burns,oral bleeding,difficulty in opening the mouth,and the onset of septic shock beyond 24 hours.Patients treated with the standard protocol of EGDT were included.Transcutaneous pressure of oxygen and carbon dioxide(PtcO_2,PtcCO_2) were monitored and hemodynamic measurements were obtained.Side-stream dark field(SDF) imaging device was applied to obtain sublingual microcirculation.Hemodynamics,tissue oxygen,and sublingual microcirculation were compared before and after EGDT.If the variable meets the normal distribution,Student's t test was applied.Otherwise,Wilcoxon's rank-sum test was used.Correlation between variables was analyzed with Pearson's product-moment correlation coefficient method.RESULTS:Twenty patients were involved,but one patient wasn't analyzed because he didn't meet the EGDT criteria.PtcO_2 and PtcCO_2 were monitored in 19 patients,of whom sublingual microcirculation was obtained.After EGDT,PtcO_2 increased from 62.7+24.0 mmHg to 78.0±30.9mmHg(P<0.05) and tissue oxygenation index(PtcO_2/FiO_2) was 110.7+60.4 mmHg before EGDT and 141.6±78.2 mmHg after EGDT(P<0.05).The difference between PtcCO_2 and PCO_2 decreased significantly after EGDT(P<0.05).The density of perfused small vessels(PPV) and microcirculatory flow index of small vessels(MFI) tended to increase,but there were no significant differences between them(P>0.05).PtcO_2,PtcO_2/FiO_2,and PtcCO_2 were not linearly related to central venous saturation,lactate,oxygen delivery,and oxygen consumption(P>0.05).CONCLUSION:Peripheral perfusion was improved after EGDT in patients with septic shock,and it was not exactly reflected by the index of systemic perfusion. 展开更多
关键词 Transcutaneous pressure of oxygen Transcutaneous pressure of carbon dioxide MICROCIRCULATION Septic shock EGDT Tissue perfusion Tissue oxygenation Sidestream dark field imaging
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Effects of body mass index on intraocular pressure and ocular pulse amplitude 被引量:3
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作者 Remzi Karadag Zeynel Arslanyilmaz +1 位作者 Bahri Aydin Ibrahim F. Hepsen 《International Journal of Ophthalmology(English edition)》 SCIE CAS 2012年第5期605-608,共4页
AIM: To investigate the effects of body mass index (BMI) on intraocular pressure (IOP) and ocular pulse amplitude(OPA). METHODS: Totally 140 healthy individuals without any systemic diseases were included in the study... AIM: To investigate the effects of body mass index (BMI) on intraocular pressure (IOP) and ocular pulse amplitude(OPA). METHODS: Totally 140 healthy individuals without any systemic diseases were included in the study. BMI (kg/m2) was calculated for every individual. IOP and OPA were measured with Pascal Dynamic contour tonometer (DCT). Blood pressure was also measured along with the DCT. The patients were divided into three groups according to BMI as: Group1, BMI<25; Group2, 25≤BMI<30; Group3, BMI≥30. Mean values of IOP, OPA, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were used in statistical analysis.RESULTS: In Group1, the means of IOP, OPA, were 16.8±2.3mmHg, 2.7±0.7mmHg respectively; and SBP, DBP were 120.0±6.1mmHg, and 77.4±5.6mmHg respectively. In group2, the mean IOP, OPA, SBP, and DBP were found to be 16.6±2.1mmHg, 2.4±0.7mmHg, 121.7±5.3mmHg, and 79.5±4.9mmHg respectively. In group3, the mean IOP, OPA, SBP, and DBP were found to be 17.3±1.7mmHg, 2.1±0.7mmHg, 122.4±5.7mmHg, and 79.7±5.2mmHg respectively. There were no statistically significant difference between groups in terms of IOP, SBP and DBP, while OPA values were significantly lower in group3 (P=0.001). CONCLUSION: Decreased OPA values in individuals with higher BMI may indicate that subjects with higher BMI have lower choroidal perfusion and lower ocular blood flow. 展开更多
关键词 body mass index choroidal perfusion intraocular pressure ocular pulse amplitude OBESITY
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Elevated intra-abdominal pressure:A review of current knowledge 被引量:6
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作者 Piotr Łagosz Mateusz Sokolski +2 位作者 Jan Biegus Agnieszka Tycinska Robert Zymlinski 《World Journal of Clinical Cases》 SCIE 2022年第10期3005-3013,共9页
Elevated intra-abdominal pressure(IAP)is a known cause of increased morbidity and mortality among critically ill patients.Intra-abdominal hypertension(IAH)and abdominal compartment syndrome can lead to rapid deteriora... Elevated intra-abdominal pressure(IAP)is a known cause of increased morbidity and mortality among critically ill patients.Intra-abdominal hypertension(IAH)and abdominal compartment syndrome can lead to rapid deterioration of organ function and the development of multiple organ failure.Raised IAP affects every system and main organ in the human body.Even marginally sustained IAH results in malperfusion and may disrupt the process of recovery.Yet,despite being so common,this potentially lethal condition often goes unnoticed.In 2004,the World Society of the Abdominal Compartment Syndrome,an international multidisciplinary consensus group,was formed to provide unified definitions,improve understanding and promote research in this field.Simple,reliable and nearly costless standardized methods of non-invasive measurement and monitoring of bladder pressure allow early recognition of IAH and timely optimized management.The correct,structured approach to treatment can have a striking effect and fully restore homeostasis.In recent years,significant progress has been made in this area with the contribution of surgeons,internal medicine specialists and anesthesiologists.Our review focuses on recent advances in order to present the complex underlying pathophysiology and guidelines concerning diagnosis,monitoring and treatment of this life-threatening condition. 展开更多
关键词 Abdominal compartment syndrome Intra-abdominal hypertension Intra-abdominal pressure Multiple organ failure Abdominal perfusion pressure
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Closed cranial window rodent model for investigating hemodynamic response to elevated intracranial pressure 被引量:1
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作者 Matt T.Oberdier James F.Antaki +1 位作者 Alexander Kharlamov Stephen C.Jones 《Animal Models and Experimental Medicine》 CSCD 2021年第4期391-397,共7页
Background:Elevated intracranial pressure(ICP)occurs in several physiological and pathological conditions,yet long-term sequellae are not common,which implies that blood flow is preserved above ischemic thresholds.Met... Background:Elevated intracranial pressure(ICP)occurs in several physiological and pathological conditions,yet long-term sequellae are not common,which implies that blood flow is preserved above ischemic thresholds.Methods:This pilot study sought to confirm this hypothesis using a closed cranial window model in a rat in which ICP was elevated to 120 mmHg for 12 min,and superficial cortical perfusion was measured by laser Doppler flowmetry and laser speckle flowmetry.Results:Following a transient increase,cortical blood flow decreased to between 25%and 75%of baseline.These levels correspond to disrupted metabolism and decreased protein synthesis but did not exceed thresholds for electrical signaling or membrane integrity.This may partially explain how some episodes of elevated ICP remain benign.Conclusion:The closed cranial window model provides a platform for prospective study of physiologic responses to artificially elevated ICP during neurosurgery to promote hemostasis. 展开更多
关键词 cerebrovascular circulation CRANIOTOMY HEMODYNAMICS HYDROCEPHALUS intracranial pressure perfusion
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IMPAIRED BLOOD-BRAIN BARRIER AFTER CHRONIC CEREBRAL HYPOPERFUSION
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作者 毛青 丁美修 +3 位作者 程华怡 王秉玉 吴逸群 朱平 《Medical Bulletin of Shanghai Jiaotong University》 CAS 1999年第2期83-86,共4页
Ohjectire To examine the hypothesis of normal perjusion pressure breakthrough (NPPB). Methods A modified Spetzler carotid -jugular (CJ) fistula model was created to imitate NPPB. In 9 male adult Sprague- Dawley rats, ... Ohjectire To examine the hypothesis of normal perjusion pressure breakthrough (NPPB). Methods A modified Spetzler carotid -jugular (CJ) fistula model was created to imitate NPPB. In 9 male adult Sprague- Dawley rats, the ipsilateral vertebral artery and bilateral external carotid arteries were occluded. The period of hypoperfusion CJ fistula was extended to 14 weeks, as a modofcation of Spetzler model. The histological change were examtned under transmission electron microscope 14 weeks after creation of the listula. Results Ischemic histological changes such as increased pinocytosis, increased lucency of the basal lamina, and frank necrosis of the cerebral capillary were found in rats of CJ fistula group. Conclusion The findings in this study suggest that blood - braln barrier (BBB) was impaired by chronic hypoperfusion. The impaired BBB mny be one of the important causes of the NPPB phenomenon. 展开更多
关键词 normal perfusion pressure BREAKTHROUGH blood - brain barrier CHRONIC CEREBRAL HYPOperfusion
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Effect of Body Positioning on lntra-abdominal Pressure Measurement and Prognosis in Critically III Patients
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作者 Min Yi Yu Bai Xi Zhu 《麻醉与监护论坛》 2011年第1期37-42,共6页
关键词 高血压 腹内高压 临床分析 腹部灌注压
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消痔灵灌注联合负压抽吸治疗腋臭的效果
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作者 昌泓 黄新建 徐永飞 《西北药学杂志》 CAS 2024年第4期192-195,共4页
目的观察并比较单一负压抽吸术与负压抽吸联合消痔灵灌注治疗腋臭的临床疗效及并发症发生情况,探讨联合治疗对腋臭患者异味程度和生活质量的影响。方法选取收治的81例首次治疗腋臭的患者,随机分为负压抽吸组(39例)与联合治疗组(42例)。... 目的观察并比较单一负压抽吸术与负压抽吸联合消痔灵灌注治疗腋臭的临床疗效及并发症发生情况,探讨联合治疗对腋臭患者异味程度和生活质量的影响。方法选取收治的81例首次治疗腋臭的患者,随机分为负压抽吸组(39例)与联合治疗组(42例)。抽吸组给予单一负压抽吸术治疗,联合治疗组给予负压抽吸联合消痔灵灌注治疗。比较2种治疗方法的临床疗效及并发症发生情况。结果术后随访3~6个月,负压抽吸组的伤口愈合时间长于联合治疗组(P<0.05);负压抽吸组的总有效率(84.62%)低于联合治疗组(100.00%),P<0.05;负压抽吸组的并发症总发生率(26.92%)高于联合治疗组(13.10%),P<0.05;负压抽吸组患者的生活质量评分显著低于联合治疗组(P<0.05)。结论消痔灵灌注联合负压抽吸对于腋臭的治疗效果优于单一负压抽吸治疗,且能显著降低并发症的发生,减轻腋臭患者的异味程度,改善其生活质量。 展开更多
关键词 消痔灵灌注 负压抽吸 腋臭
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无灌注区、黄斑区双激光方案在视网膜静脉分枝阻塞继发黄斑水肿患者中的应用分析
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作者 汤丽燕 李俊 +1 位作者 孙巧红 陈利双 《中国医药导报》 CAS 2024年第9期116-120,共5页
目的 探讨无灌注区、黄斑区双激光方案在视网膜静脉分枝阻塞(BRVO)继发黄斑水肿(ME)患者中的应用分析。方法 根据随机数字表法将浙江省丽水市人民医院2021年5月至2022年5月收治的150例BRVO继发ME患者分为对照组(雷珠单抗玻璃体腔内注射... 目的 探讨无灌注区、黄斑区双激光方案在视网膜静脉分枝阻塞(BRVO)继发黄斑水肿(ME)患者中的应用分析。方法 根据随机数字表法将浙江省丽水市人民医院2021年5月至2022年5月收治的150例BRVO继发ME患者分为对照组(雷珠单抗玻璃体腔内注射治疗)和双激光组(雷珠单抗联合无灌注区、黄斑区双激光治疗),各75例。治疗后3个月,比较两组临床效果、恢复情况[最佳矫正视力(BCVA)、眼内压(IOP)、黄斑中心视网膜厚度(CMT)]、黄斑区血流情况及荧光素眼底血管造影检查结果。结果 双激光组疗效优于对照组(P<0.05)。治疗后3个月,两组BCVA高于治疗前,IOP、CMT低于治疗前,且双激光组BCVA高于对照组,IOR、CMT低于对照组(P<0.05)。治疗后3个月,两组浅、深层毛细血管血流密度均高于治疗前,且双激光组高于对照组(P<0.05)。双激光组囊样渗漏、弥漫渗漏、局部渗漏发生率均低于对照组(P<0.05)。结论 玻璃体腔内注射雷珠单抗联合无灌注区、黄斑区双激光治疗BRVO继发ME可提高雷珠单抗的效果,促进患者视力恢复,还可改善黄斑区血流状况,减少血管渗漏发生。 展开更多
关键词 雷珠单抗 无灌注区 黄斑区 视网膜静脉分枝阻塞 黄斑水肿 最佳矫正视力 黄斑中心视网膜厚度 眼内压
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PPV和PVI在胃肠肿瘤手术目标导向液体治疗中的疗效对比研究
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作者 王宇 张茹 刘维鹏 《新疆医科大学学报》 CAS 2024年第8期1097-1101,共5页
目的比较脉压变异率(Pulse pressure variation,PPV)与脉搏灌注变异指数(Pleth variability index,PVI)在胃肠肿瘤手术目标导向液体治疗(Goal-directedfluidtherapy,GDFT)中的疗效。方法选取2021年9月-2024年2月在延安市人民医院麻醉科... 目的比较脉压变异率(Pulse pressure variation,PPV)与脉搏灌注变异指数(Pleth variability index,PVI)在胃肠肿瘤手术目标导向液体治疗(Goal-directedfluidtherapy,GDFT)中的疗效。方法选取2021年9月-2024年2月在延安市人民医院麻醉科全麻下行腹腔镜胃肠道肿瘤手术的患者106例,采用随机数字表法分为PPV组(n=53)和PVI组(n=53)。两组患者术中背景输液情况为复方氯化钠3 mL·kg^(-1)·h^(-1)。PPV组若PPV≥11%持续1 min,则按照15 mL·kg^(-1)·h^(-1)的速度输注晶体液,若超过15 min则继续胶体液输注,直到PPV<11%持续1 min,恢复背景输液速度。PVI组若PVI≥11%持续1 min,则按照15 mL·kg^(-1)·h^(-1)的速度输注晶体液,若超过15 min则继续胶体液输注,直到PPV<11%持续1 min,恢复背景输液速度。记录患者术中低血压时间加权平均值(Time weighted average of Hypotension,TWAH)、输液情况、尿量;记录患者术毕24 h QoR-15评分、恶心呕吐发生率、肾功能以及肠道排气时间,测定术毕24、48 h患者血清肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、IL-10的水平。结果与PPV组相比,PVI组术中总输液量、晶体输注量、尿量,术毕24 h和48 h血清IL-6水平更低,差异有统计学意义(P<0.05);两组低血压时间加权平均值、胶体输注量、术毕24 h肾功能、恶心呕吐发生率、肠道排气时间差异均无统计学差异(P>0.05)。结论在腹腔镜胃肠道肿瘤手术中,基于PVI的GDFT并不劣于PPV作为目标的GDFT,该方法无创、简便,值得在临床推广应用。 展开更多
关键词 脉压变异率 脉搏灌注变异指数 目标导向液体治疗 时间加权平均值 胃肠道手术
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经颅多普勒超声在动脉瘤性蛛网膜下腔出血患者颅内压及脑灌注压评估中的应用价值
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作者 刘帅 王淑雅 +5 位作者 徐珊珊 田莹 陈晓霖 张琳琳 石广志 周建新 《中国急救医学》 CAS CSCD 2024年第9期822-828,F0003,共8页
目的探索动脉瘤性蛛网膜下腔出血(aSAH)患者经颅多普勒超声(TCD)参数及衍生参数与颅内压(ICP)及脑灌注压(CPP)的相关性和一致性。方法本研究为单中心回顾性观察性研究,纳入aSAH术后行ICP监测及TCD检查患者,收集大脑中动脉(MCA)收缩期血... 目的探索动脉瘤性蛛网膜下腔出血(aSAH)患者经颅多普勒超声(TCD)参数及衍生参数与颅内压(ICP)及脑灌注压(CPP)的相关性和一致性。方法本研究为单中心回顾性观察性研究,纳入aSAH术后行ICP监测及TCD检查患者,收集大脑中动脉(MCA)收缩期血流速度(FVs)、舒张期血流速度(FVd),计算平均血流速度(FVm)、搏动指数(PI),并记录平均动脉压(MAP)和ICP,然后采用基于FVd公式计算得到无创颅内压(nICP)、无创脑灌注压(nCPP)。采用Spearman相关系数评价TCD参数及衍生参数与ICP和CPP的相关性,根据TCD结果分为血流速度正常组、轻度TCD诊断的血管痉挛(TCD-VS)组和中重度TCD-VS组,并进行亚组分析。采用Bland-Altman法评估nICP和ICP以及nCPP和CPP的一致性,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC),以确定nICP检测ICP>22 mmHg以及nCPP检测CPP<60 mmHg的能力。结果纳入95例aSAH术后患者共201例次TCD参数、衍生参数和对应的ICP。nICP与ICP显著正相关(r=0.240,P<0.001),FVd、FVm与ICP显著负相关(r分别为-0.154、-0.142,P<0.05)。PI与CPP显著负相关(r=-0.161,P<0.05),nCPP、脑血流指数(CBFi)与CPP显著正相关(r分别为0.695、0.734,P<0.001)。亚组分析结果显示,在血流速度正常组和轻度TCD-VS组中,nICP与ICP显著正相关(r分别为0.238、0.539,P<0.05),中重度TCD-VS组nICP与ICP无相关性(P>0.05)。当出现任何程度的TCD-VS时,FVs、FVd、FVm、PI、CBFi与ICP均无相关性(P>0.05)。无论是否诊断为TCD-VS,三组nCPP与CPP均存在显著正相关性(r分别为0.659、0.828、0.781,P<0.001),CBFi与CPP存在显著正相关性(r分别为0.709、0.856、0.795,P<0.001)。在Bland-Altman图分析中,ICP和nICP在总体人群中的平均差异为(-2.35±9.22)mmHg,CPP和nCPP在总体人群中的平均差异为(2.38±9.23)mmHg。nICP的AUC为70.1%(95%CI 60.0%~80.3%,P<0.001),预测ICP>22 mmHg的截断值为21.5 mmHg,敏感度、特异度分别为80.6%、53.9%。在TCD血流速度正常组中,nICP的AUC为71.4%(95%CI 59.5%~83.2%,P<0.01),预测ICP>22 mmHg的截断值为23.5mmHg,敏感度、特异度分别为84.6%、55.0%。nCPP的AUC为92.8%(95%CI 86.1%~99.6%,P<0.001),预测CPP<60 mmHg的截断值为65.6 mmHg,敏感度和特异度分别为94.4%、83.3%。在TCD血流速度正常组中,nCPP的AUC为90.0%(95%CI 82.1%~97.9%,P<0.01),预测CPP<60 mmHg的截断值为58.5 mmHg,敏感度、特异度分别为97.2%、80.0%。结论TCD监测可用于评估aSAH患者的ICP,但在中重度TCD-VS时的价值有限。TCD联合MAP监测可用于评估aSAH患者的脑灌注。 展开更多
关键词 经颅多普勒超声 颅内动脉瘤 蛛网膜下腔出血 颅内压 无创颅内压 脑灌注压 无创脑灌注压
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