目的分析严重脓毒症患者脉搏指示连续心排血量（PiCCO）监测下液体复苏中的全心舒张期末容积指数（GEDI）与中心静脉压（CVP）的相关性。方法对64例严重脓毒症患者严格按照2008年脓毒症救治指南进行液体复苏，测定记录GEDI与其对应的CV...目的分析严重脓毒症患者脉搏指示连续心排血量（PiCCO）监测下液体复苏中的全心舒张期末容积指数（GEDI）与中心静脉压（CVP）的相关性。方法对64例严重脓毒症患者严格按照2008年脓毒症救治指南进行液体复苏，测定记录GEDI与其对应的CVP值，观察不同CVP范围的容量反应准确性，分析CVP与GEDI的相关性。结果对于严重脓毒症患者，CVP与GEDI无相关性（r＝-0.012，P＞0.05）；进一步分层比较发现，当CVP在0～8 mm Hg（1 mm Hg＝0.133 kPa）或＞12 mm Hg时与GEDI无相关性（r值分别为-0.009、-0.020，均P＞0.05）；在脓毒症指南所要求的6 h复苏目标CVP 8～12 mm Hg时，CVP与GEDI呈明显正相关（r＝0.653，P＜0.01）。结论 CVP不适合单独作为液体复苏容量的目标指标。展开更多
Obese patients frequently complain of dyspnea. Deconditioning and altered left ventricular(LV) systolic or diastolic function with elevated filling pressures may contribute to dyspnea. This study analyzed 4,281 patien...Obese patients frequently complain of dyspnea. Deconditioning and altered left ventricular(LV) systolic or diastolic function with elevated filling pressures may contribute to dyspnea. This study analyzed 4,281 patients who underwent diagnostic coronary angiography from January 1, 1995, to December 31, 2000. No patients had coronary artery stenoses >50%of the luminal diameter, and all underwent echocardiography within the same 6-year period. The association between body mass index(BMI) and LV structure and systolic and diastolic function was examined. All analyses controlled for age and gender, with the effect size for BMI expressed using a standardized coefficient(SC). A higher BMI was associated with greater LV mass(SC 0.18, p< 0.001), wall thickness(SC 0.17, p< 0.001), and end-diastolic diameter(SC 0.07, p< 0.001). Stroke volume increased with a higher BMI(SC 0.12, p=0.001), but there was no association between BMI and the ejection fraction(SC 0.003, p=0.81). Hemodynamic data from invasive studies showed an association between a higher BMI and increased LV end-diastolic pressure(mean 17 mm Hg for BMI< 25 kg/m2 vs 24 mm Hg for BMI ≥40 kg/m2; SC 0.18, p< 0.001), which persisted after controlling for end-diastolic volume(SC 0.22, p< 0.001). Obesity was associated with ventricular remodeling, which may normalize wall stress while increasing stroke volume to match metabolic demand. Obesity was not associated with decreased systolic function. However, obesity was associated with increased LV end-diastolic pressure, which suggests an association between obesity and diastolic dysfunction. In conclusion, ventricular remodeling, LV diastolic dysfunction, and elevated filling pressures may contribute to the prevalence of heart failure in obese patients.展开更多
文摘目的分析严重脓毒症患者脉搏指示连续心排血量（PiCCO）监测下液体复苏中的全心舒张期末容积指数（GEDI）与中心静脉压（CVP）的相关性。方法对64例严重脓毒症患者严格按照2008年脓毒症救治指南进行液体复苏，测定记录GEDI与其对应的CVP值，观察不同CVP范围的容量反应准确性，分析CVP与GEDI的相关性。结果对于严重脓毒症患者，CVP与GEDI无相关性（r＝-0.012，P＞0.05）；进一步分层比较发现，当CVP在0～8 mm Hg（1 mm Hg＝0.133 kPa）或＞12 mm Hg时与GEDI无相关性（r值分别为-0.009、-0.020，均P＞0.05）；在脓毒症指南所要求的6 h复苏目标CVP 8～12 mm Hg时，CVP与GEDI呈明显正相关（r＝0.653，P＜0.01）。结论 CVP不适合单独作为液体复苏容量的目标指标。
文摘Obese patients frequently complain of dyspnea. Deconditioning and altered left ventricular(LV) systolic or diastolic function with elevated filling pressures may contribute to dyspnea. This study analyzed 4,281 patients who underwent diagnostic coronary angiography from January 1, 1995, to December 31, 2000. No patients had coronary artery stenoses >50%of the luminal diameter, and all underwent echocardiography within the same 6-year period. The association between body mass index(BMI) and LV structure and systolic and diastolic function was examined. All analyses controlled for age and gender, with the effect size for BMI expressed using a standardized coefficient(SC). A higher BMI was associated with greater LV mass(SC 0.18, p< 0.001), wall thickness(SC 0.17, p< 0.001), and end-diastolic diameter(SC 0.07, p< 0.001). Stroke volume increased with a higher BMI(SC 0.12, p=0.001), but there was no association between BMI and the ejection fraction(SC 0.003, p=0.81). Hemodynamic data from invasive studies showed an association between a higher BMI and increased LV end-diastolic pressure(mean 17 mm Hg for BMI< 25 kg/m2 vs 24 mm Hg for BMI ≥40 kg/m2; SC 0.18, p< 0.001), which persisted after controlling for end-diastolic volume(SC 0.22, p< 0.001). Obesity was associated with ventricular remodeling, which may normalize wall stress while increasing stroke volume to match metabolic demand. Obesity was not associated with decreased systolic function. However, obesity was associated with increased LV end-diastolic pressure, which suggests an association between obesity and diastolic dysfunction. In conclusion, ventricular remodeling, LV diastolic dysfunction, and elevated filling pressures may contribute to the prevalence of heart failure in obese patients.
