The current survival sepsis guideline proposes the use of vasopressors and fluid resuscitation to maintain the mean arterial pressure (MAP) ≥ 65 mmHg. Titrating catecholamine infusion to achieve higher MAP has been d...The current survival sepsis guideline proposes the use of vasopressors and fluid resuscitation to maintain the mean arterial pressure (MAP) ≥ 65 mmHg. Titrating catecholamine infusion to achieve higher MAP has been demonstrated to improve tissue oxygenation, microcirculation, renal function and overall outcome of the patient in some studies and literature on actual hemodynamic goals is scarce. AIM: To study the influence of two MAP on tissue oxygenation and perfusion parameters in patients of septic shock on norepinephrine infusion. SUBJECT AND MATERIALS: Forty adult patients with the diagnosis of septic shock were enrolled. In all patients norepinephrine was titrated to first stabilize the MAP at 65 ± 5 mmHg (Set I), followed by MAP of 85 ± 5 mmHg (Set II). Heart rate (HR), Central venous oxygen saturation (SCVO2), Transcutaneous partial pressure of oxygen (PtcO2) by TCM 400/TINA (using miniature Clark electrode), Arterial partial pressure of oxygen(PaO2), PtO2/PaO2 ratio, Urine output and Serum Base deficit were recorded in each Set after 2 hrs of stabilization. RESULTS: There was a significant increase in transcutaneous partial pressure of oxygen PtcO2 (p tO2/PaO2 (p < 0.0001), ScvO2 (p < 0.0001), urine output (p < 0.006) on increasing the MAP from 65mmHg to 85mmHg. Serum base deficit also improved (p < 0.0001). CONCLUSION: Higher MAP with norepinephrine is associated with better perfusion, oxygenation parameters in patients with established septic shock. These findings suggest that there is improvement in tissue oxygenation parameters using escalating doses of norepinephrine to achieve higher MAP without inherent adverse展开更多
Preeclampsia is a pregnancy complication;early identification with increased risk is one of the key goals in obstetrics. In a nested case control study, serum uric acid and calcium measured in first and second trimest...Preeclampsia is a pregnancy complication;early identification with increased risk is one of the key goals in obstetrics. In a nested case control study, serum uric acid and calcium measured in first and second trimesters of pregnancy were correlated with Xanthine oxidase (XO) activity, mean arterial pressure (MAP) and fetal birth weight. The mean ± SD of uric acid (2.01 ± 0.85, 4.8 ± 1.93), calcium (10.88 ± 1.97, 9.72 ± 2.04), MAP (84.32 ± 6.71, 78.40 ± 8.53) and XO activity (11.96 ± 1.91, 14.05 ± 3.09) of the study group (n=86) were observed in the first and second trimesters respectively. First trimester normotensive group (n=79) and preeclampsia cases (n = 7), showed a mean ± SD of uric acid (1.93 ± 0.80, 2.9 ± 0.88), Calcium (10.92 ± 1.9, 10.6 ± 1.72), MAP (84.19 ± 6.75, 85.71 ± 6.58) XO activity (11.82 ± 1.83, 13.57 ± 2.21). In the second trimester, normotensive group and preeclampsia cases showed a mean ± SD uric acid (4.6 ± 1.75, 7.3 ± 2.19), Calcium (9.4 ± 1.85, 12.9 ± 1.04), MAP (76.41 ± 5.41, 100.95 ± 2.52) and XO activity (13.37 ± 1.93, 21.70 ± 3.50). Statistical analysis revealed a non-significant positive correlation in first trimester between uric acid and MAP (r = +0.116, p = 0.288), negative correlations between uric acid and fetal birth weight (r = -0.118, 0.279) and between calcium and MAP (r =?-0.288, p = 0.007). In the second trimester, significant positive correlations were observed between uric acid (r = +0.246, p = 0.022), calcium (r = +0.326, p = 0.007) with MAP along with a significant negative correlation between uric acid (r = -0.641, p = 0.000), calcium (r = -0.316, p = 0.003), Proteinuria (r = -0.514, p = 0.000) with fetal birth weight. The screening of first and second trimesters XO activity, uric acid, calcium and MAP during pregnancy is beneficial in identifying women likely to develop preeclampsia with poor fetal outcome.展开更多
目的观察右美托咪定与瑞马唑仑对老年股骨转子间骨折患者防旋股骨近端髓内钉(PFNA)内固定术的镇静效果、平均动脉压(MAP)及术后认知功能的影响。方法选取100例老年股骨转子间骨折PFNA内固定术患者,按照随机数字法分为右美托咪定组(A组)...目的观察右美托咪定与瑞马唑仑对老年股骨转子间骨折患者防旋股骨近端髓内钉(PFNA)内固定术的镇静效果、平均动脉压(MAP)及术后认知功能的影响。方法选取100例老年股骨转子间骨折PFNA内固定术患者,按照随机数字法分为右美托咪定组(A组)和瑞马唑伦组(B组),每组50例,两组麻醉方式均采用股神经阻滞+腰硬联合麻醉,腰麻平面固定后在A组使用右美托咪定进行麻醉镇静,B组患者采用瑞马唑仑进行麻醉镇静。评估两组术中MAP、心率(HR)、血氧饱和度(SpO_(2))、警觉/镇静评分(MOAA/S)、麻醉深度评分(Narcotrend)、不良反应发生率以及术后认知功能。结果术前、平面固定后、术后两组患者MAP、HR、SpO_(2)差异无统计学意义(P>0.05);阻滞前、平面固定后两组Narcotrend、MOAA/S评分差异无统计学意义,镇静后60 min MOAA/S评分差异无统计学意义(P>0.05);镇静后5、15、30 min B组患者的Narcotrend、MOAA/S评分低于A组,镇静后60 min B组患者的Narcotrend低于A组(P<0.05)。术前1 d、手术结束时和术后1、7 d两组MMSE评分差异无统计学意义(P>0.05)。结论右美托咪定与瑞马唑仑应用于老年股骨转子间骨折PFNA内固定术对MAP、HR、SpO_(2)、术后认知功能影响无明显差异,但瑞马唑仑对患者镇静效果相对更好一些,可在临床选用。展开更多
目的探讨术中平均动脉压(MAP)水平对老年高血压患者胃肠大手术后急性肾损伤(AKI)的影响。方法选取择期行全身麻醉下胃肠大手术老年高血压患者480例。采用随机数字表法将患者分为两组,各240例。Ⅰ组患者术中MAP控制为65~85 mm Hg,Ⅱ组患...目的探讨术中平均动脉压(MAP)水平对老年高血压患者胃肠大手术后急性肾损伤(AKI)的影响。方法选取择期行全身麻醉下胃肠大手术老年高血压患者480例。采用随机数字表法将患者分为两组,各240例。Ⅰ组患者术中MAP控制为65~85 mm Hg,Ⅱ组患者术中MAP控制为86~100 mm Hg。观察并比较两组患者术中各指标、术后AKI发生率和住院情况。结果两组患者麻醉时间、手术时间和平衡液、胶体液、血浆、红细胞输注量及术中失血量比较均无统计学差异(均P>0.05)。与Ⅰ组比较,Ⅱ组患者术中去甲肾上腺素、去氧肾上腺素和硝酸甘油等血管活性药物用量较大(均P<0.05),术中心动过缓和房性早搏发生率亦较高(均P<0.05),术后AKI发生率、术后收治住ICU率均较低(均P<0.05),收治住ICU时间和住院时间均较短(均P<0.05)。结论老年高血压患者胃肠大手术中维持较高MAP水平可降低术后AKI发生率,有利于患者肾功能保护。展开更多
文摘The current survival sepsis guideline proposes the use of vasopressors and fluid resuscitation to maintain the mean arterial pressure (MAP) ≥ 65 mmHg. Titrating catecholamine infusion to achieve higher MAP has been demonstrated to improve tissue oxygenation, microcirculation, renal function and overall outcome of the patient in some studies and literature on actual hemodynamic goals is scarce. AIM: To study the influence of two MAP on tissue oxygenation and perfusion parameters in patients of septic shock on norepinephrine infusion. SUBJECT AND MATERIALS: Forty adult patients with the diagnosis of septic shock were enrolled. In all patients norepinephrine was titrated to first stabilize the MAP at 65 ± 5 mmHg (Set I), followed by MAP of 85 ± 5 mmHg (Set II). Heart rate (HR), Central venous oxygen saturation (SCVO2), Transcutaneous partial pressure of oxygen (PtcO2) by TCM 400/TINA (using miniature Clark electrode), Arterial partial pressure of oxygen(PaO2), PtO2/PaO2 ratio, Urine output and Serum Base deficit were recorded in each Set after 2 hrs of stabilization. RESULTS: There was a significant increase in transcutaneous partial pressure of oxygen PtcO2 (p tO2/PaO2 (p < 0.0001), ScvO2 (p < 0.0001), urine output (p < 0.006) on increasing the MAP from 65mmHg to 85mmHg. Serum base deficit also improved (p < 0.0001). CONCLUSION: Higher MAP with norepinephrine is associated with better perfusion, oxygenation parameters in patients with established septic shock. These findings suggest that there is improvement in tissue oxygenation parameters using escalating doses of norepinephrine to achieve higher MAP without inherent adverse
文摘Preeclampsia is a pregnancy complication;early identification with increased risk is one of the key goals in obstetrics. In a nested case control study, serum uric acid and calcium measured in first and second trimesters of pregnancy were correlated with Xanthine oxidase (XO) activity, mean arterial pressure (MAP) and fetal birth weight. The mean ± SD of uric acid (2.01 ± 0.85, 4.8 ± 1.93), calcium (10.88 ± 1.97, 9.72 ± 2.04), MAP (84.32 ± 6.71, 78.40 ± 8.53) and XO activity (11.96 ± 1.91, 14.05 ± 3.09) of the study group (n=86) were observed in the first and second trimesters respectively. First trimester normotensive group (n=79) and preeclampsia cases (n = 7), showed a mean ± SD of uric acid (1.93 ± 0.80, 2.9 ± 0.88), Calcium (10.92 ± 1.9, 10.6 ± 1.72), MAP (84.19 ± 6.75, 85.71 ± 6.58) XO activity (11.82 ± 1.83, 13.57 ± 2.21). In the second trimester, normotensive group and preeclampsia cases showed a mean ± SD uric acid (4.6 ± 1.75, 7.3 ± 2.19), Calcium (9.4 ± 1.85, 12.9 ± 1.04), MAP (76.41 ± 5.41, 100.95 ± 2.52) and XO activity (13.37 ± 1.93, 21.70 ± 3.50). Statistical analysis revealed a non-significant positive correlation in first trimester between uric acid and MAP (r = +0.116, p = 0.288), negative correlations between uric acid and fetal birth weight (r = -0.118, 0.279) and between calcium and MAP (r =?-0.288, p = 0.007). In the second trimester, significant positive correlations were observed between uric acid (r = +0.246, p = 0.022), calcium (r = +0.326, p = 0.007) with MAP along with a significant negative correlation between uric acid (r = -0.641, p = 0.000), calcium (r = -0.316, p = 0.003), Proteinuria (r = -0.514, p = 0.000) with fetal birth weight. The screening of first and second trimesters XO activity, uric acid, calcium and MAP during pregnancy is beneficial in identifying women likely to develop preeclampsia with poor fetal outcome.
文摘目的观察右美托咪定与瑞马唑仑对老年股骨转子间骨折患者防旋股骨近端髓内钉(PFNA)内固定术的镇静效果、平均动脉压(MAP)及术后认知功能的影响。方法选取100例老年股骨转子间骨折PFNA内固定术患者,按照随机数字法分为右美托咪定组(A组)和瑞马唑伦组(B组),每组50例,两组麻醉方式均采用股神经阻滞+腰硬联合麻醉,腰麻平面固定后在A组使用右美托咪定进行麻醉镇静,B组患者采用瑞马唑仑进行麻醉镇静。评估两组术中MAP、心率(HR)、血氧饱和度(SpO_(2))、警觉/镇静评分(MOAA/S)、麻醉深度评分(Narcotrend)、不良反应发生率以及术后认知功能。结果术前、平面固定后、术后两组患者MAP、HR、SpO_(2)差异无统计学意义(P>0.05);阻滞前、平面固定后两组Narcotrend、MOAA/S评分差异无统计学意义,镇静后60 min MOAA/S评分差异无统计学意义(P>0.05);镇静后5、15、30 min B组患者的Narcotrend、MOAA/S评分低于A组,镇静后60 min B组患者的Narcotrend低于A组(P<0.05)。术前1 d、手术结束时和术后1、7 d两组MMSE评分差异无统计学意义(P>0.05)。结论右美托咪定与瑞马唑仑应用于老年股骨转子间骨折PFNA内固定术对MAP、HR、SpO_(2)、术后认知功能影响无明显差异,但瑞马唑仑对患者镇静效果相对更好一些,可在临床选用。
文摘目的探讨术中平均动脉压(MAP)水平对老年高血压患者胃肠大手术后急性肾损伤(AKI)的影响。方法选取择期行全身麻醉下胃肠大手术老年高血压患者480例。采用随机数字表法将患者分为两组,各240例。Ⅰ组患者术中MAP控制为65~85 mm Hg,Ⅱ组患者术中MAP控制为86~100 mm Hg。观察并比较两组患者术中各指标、术后AKI发生率和住院情况。结果两组患者麻醉时间、手术时间和平衡液、胶体液、血浆、红细胞输注量及术中失血量比较均无统计学差异(均P>0.05)。与Ⅰ组比较,Ⅱ组患者术中去甲肾上腺素、去氧肾上腺素和硝酸甘油等血管活性药物用量较大(均P<0.05),术中心动过缓和房性早搏发生率亦较高(均P<0.05),术后AKI发生率、术后收治住ICU率均较低(均P<0.05),收治住ICU时间和住院时间均较短(均P<0.05)。结论老年高血压患者胃肠大手术中维持较高MAP水平可降低术后AKI发生率,有利于患者肾功能保护。
