Comparison between Emergency Severity Index and Heart Failure Triage Scale in heart failure patients: A randomized clinical trial

BACKGROUND:It is not clear whether Emergency Severity Index(ESI)is valid to triage heart failure(HF)patients and if HF patients benefi t more from a customized triage scale or not.The aim of study is to compare the effect of Heart Failure Triage Scale(HFTS)and ESI on mistriage among patients with HF who present to the emergency department(ED).METHODS:A randomized clinical trial was conducted from April to June 2017.HF patients with dyspnea were randomly assigned to HFTS or ESI groups.Triage level,used resources and time to electrocardiogram(ECG)were compared between both groups among HF patients who were admitted to coronary care unit(CCU),cardiac unit(CU)and discharged patients from the ED.Content validity was examined using Kappa designating agreement on relevance(K*).Reliability of both scale was evaluated using inter-observer agreement(Kappa).RESULTS:Seventy-three and 74 HF patients were assigned to HFTS and ESI groups respectively.Time to ECG in HFTS group was signifi cantly shorter than that of ESI group(2.05 vs.16.82 minutes).Triage level between HFTS and ESI groups was signifi cantly different among patients admitted to CCU(1.0 vs.2.8),cardiac unit(2.26 vs.3.06)and discharged patients from the ED(3.53 vs.2.86).Used resources in HFTS group was significantly different among triage levels(H=25.89;df=3;P<0.001).CONCLUSION:HFTS is associated with less mistriage than ESI for triaging HF patients.It is recommended to make use of HFTS to triage HF patients in the ED.

Real-time Three-dimensional Echocardiographic Assessment of Left Ventricular Remodeling Index in Patients with Hypertensive Heart Disease and Coronary Artery Disease

Left ventricular remodeling index （LVRI） was assessed in patients with hypertensive heart disease （HHD） and coronary artery disease （CAD） by real-time three-dimensional echocardiography （RT3DE）. RT3DE data of 18 patients with HHD, 20 patients with CAD and 22 normal controis （NC） were acquired. Left ventricular end-diastolic volume （EDV） and left ventricular end-diastolic epicardial volume （EDVepi） were detected by RT3DE and two-dimensional echocardiography Simpson biplane method （2DE）. LVRI （left ventricular mass/EDV） was calculated and compared. The results showed that LVRI measurements detected by RT3DE and 2DE showed significant differences inter-groups （P〈0.01）. There was no significant difference in NC group （P〉0.05）, but significant difference in HHD and CAD intra-group （P〈0.05）. There was good positive correlations between LVRI detected by RT3DE and 2DE in NC and HHD groups （t=0.69, P〈0.01; r=0.68, P〈0.01）, but no significant correlation in CAD group （r=0.30, P〉0.05）. It was concluded that LVRI derived from RT3DE as a new index for evaluating left ventricular remodeling can provide more superiority to LVRI derived from 2DE.

Relationship Between Serum Leptin Concentration and Lipids & Body Mass Index in Patients With Chronic Congestive Heart Failure

Objectives To investigate the relationship of serum leptin concentration with the lipids and body mass index （BMI） in patients with chronic congestive heart failure（CHF）. Methods The serum concentration of leptin in 39 patients with CHF （14 in cardiac function class Ⅱ , 21 in class Ⅲ, 4 in classⅣ , NYHA） and in 46 patients with cardiac function class Ⅰ （NYHA） were assessed by radioimmunoassay. Results The serum concentration of leptin were 9.018±4.519 μg/l in CHF group （cardiac function class Ⅱ 11.492±5.649 μg/l, class Ⅲ 7.763±3.321 μg/l, class Ⅳ 6.100±2.657 μg/l）; 11.674± 6.911 μg/l in class Ⅰ group. The serum concentrations of leptin were significantly lower in CHF group, as compared with class Ⅰ group （P〈 0.05）. Moreover, the decrease of serum leptin concentration was significantly correlated with the decreased serum concentrations of total cholesterol, triglyceride, body mass index and left ventricular ejection fraction in CHF group, respectively （P 〈 0.05）. Conclusions The significance of the decrease in serum leptin in CHF patients needs further study.

Effects of Danqu Capsules on Arterial Blood Pressure,Heart Rate and Myocardial Tension Time Index in Rats

[Objectives] To explore the effects of Danqu capsules(the prescription of Lei Zhongyi, the master of traditional Chinese medicine for the syndrome of intermingling of phlegm and static blood of coronary heart disease) on arterial blood pressure, heart rate and myocardial tension time index in rats. [Methods] A total of 50 SD rats, weighing(300±20) g, were randomly and evenly divided into Danqu capsule observation groups(low, middle and high-dose groups) and control groups(saline group and captopril group). Under anesthesia, the rats in each group were administered with 0.6, 1.2 and 2.4 g/kg of Danqu capsule suspension, 1 mL/100 g of saline and 10 mg/kg of captopril, respectively through duodena, and their systolic blood pressure, diastolic blood pressure, mean arterial pressure, pulse pressure difference and heart rate were measured and recorded by RM6240 multi-channel physiological signal acquisition and processing system before administration, 10, 20, 30, 40, 50, 60, 90 and 120 min after the administration, respectively, and the myocardial tension time index was calculated. [Results] Compared with the saline group, the systolic, diastolic and mean pressure reduced 10, 20, 30, 40, 50, 60, 90 and 120 min after the administration, and the pulse pressure difference did not change significantly in the Danqu capsule groups(low, middle and high-dose groups), and the heart rate slowed down and the myocardial tension time index reduced in the high-dose Danqu capsule group. Compared with the captopril group, the Danqu capsule groups showed similar blood pressure-reducing effect. [Conclusions]Danqu capsules have obvious effect of lowering blood pressure and myocardial tension time index. High-dose Danqu capsules has the effect of slowing down the heart rate. The blood pressure-lowering effect of Danqu capsules shows a dose-dependent manner. Clinically, they can be used in patients with coronary heart diseases and hypertension, suggesting that they should be used with caution in patients with hypotension.

Cardiovagal Tone: A Predictor of Heart Rate Adjusted Augmentation Index in Men but Not in Women

Purpose: Aortic augmentation index (AIx) and cardiovagal tone (CVT) are indicators of cardiovascular health. Associations between these variables provide information about their roles in cardiovascular disease. However, evaluating these associations from a gender perspective and gaining an understanding of the relationship between cardiorespiratory fitness and AIx based on gender can provide additional information. Therefore, we examined the relationships between CVT, measured as the log transformed high-frequency power of R-R intervals from electrocardiogram measurements (lnHFR-R);cardiorespiratory fitness, measured as maximum oxygen consumption (VO2max);and AIx at a heart rate of 75 beats·min-1(AIx@75). We hypothesized that the relationships between CVT, cardiorespiratory fitness, and AIx@75 would differ based on gender. Methods: We examined the associations between lnHFR-R, VO2max, and AIx@75 in 41 women and 39 men. Power spectral density analysis of heart rate variability determined lnHFR-R, radial tonometry determined AIx@75 and the Bruce Treadmill Protocol determined VO2max. Results: In men, lnHFR-R positively correlated with and significantly predicted AIx@75 (P = 0.005) but not in women (P = 0.49). For every unit increase in lnHFR-R, there was a 4.6 unit increase in AIx@75 in men versus a 1.0 unit increase in women. There was a significant inverse relationship between VO2max and AIx@75, with VO2max being a significant predictor of AIx@75 in men (P = 0.01). For every unit increase in VO2max, there was a 0.60 unit decrease in AIx@75 in men versus a 0.2 unit decrease in women. Conclusions: The associations between CVT and AIx@75 and between cardiorespiratory fitness and AIx@75 differ by gender. CVT and cardiorespiratory fitness are significant predictors of AIx@75 in men but not in women.

慢性心力衰竭患者三酰甘油葡萄糖指数与心房颤动发生的相关性研究

背景胰岛素抵抗(IR)与心房颤动(AF)及心房重构有关,三酰甘油葡萄糖(TyG)指数作为IR新型简单且有价值的指标与慢性心力衰竭(CHF)患者发生AF相关性的研究甚少。目的探讨CHF患者TyG指数与AF发生风险的相关性。方法回顾性选取2021年1月—2022年1月在郑州大学第二附属医院心血管内科住院的CHF患者417例为研究对象,根据CHF患者是否发生AF将其分为两组:AF组(138例)和非AF组(279例)。依据四分位数将TyG指数分为4个水平:Q1(TyG指数≤8.20)、Q2(8.20<TyG指数≤8.44)、Q3(8.44<TyG指数≤8.84)、Q4(TyG指数>8.84)。通过医院电子病历系统收集患者基线资料,包括TyG指数及基本资料、实验室检查指标、超声心动图资料等。利用LASSO回归分析进行变量筛选,采用多因素Logistic回归分析探讨CHF患者TyG指数与AF发生风险的相关性,并构建回归模型。同时采用受试者工作特征曲线分析TyG指数对CHF患者发生AF的预测价值。绘制TyG指数与CHF患者AF发生风险相关性的限制性立方样条图。结果AF组患者BMI,美国纽约心脏病学会心功能分级Ⅲ~Ⅳ级、高血压比例,血尿酸(SUA)、三酰甘油、血尿素氮(BUN)、空腹血糖、N末端B型钠尿肽前体、TyG指数、左心房内径(LAD),β受体阻滞剂、钙拮抗剂、利尿剂使用比例高于非AF组,而总胆固醇(TC)、内生肌酐清除率(Ccr)、左心室射血分数,血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)类药物使用比例低于非AF组(P<0.05)。多因素Logistic回归分析结果显示,合并高血压(OR=1.749,95%CI=1.048~2.918,P=0.032)、BUN升高(OR=1.269,95%CI=1.104~1.457,P=0.001)、SUA升高(OR=1.002,95%CI=1.000~1.005,P=0.047)、TyG指数升高(OR=2.360,95%CI=1.397~3.987,P=0.001)、LAD升高(OR=1.065,95%CI=1.034~1.097,P<0.001)、使用利尿剂(OR=4.019,95%CI=2.140~7.548,P<0.001)是CHF患者发生AF的危险因素;Ccr升高(OR=0.985,95%CI=0.975~0.996,P=0.006)、TC升高(OR=0.587,95%CI=0.445~0.775,P<0.001)、使用ACEI/ARB类药物(OR=0.427,95%CI=0.253~0.718,P=0.001)是CHF患者发生AF的保护因素。充分调整混杂因素后,与Q1水平相比,TyG指数Q2、Q3、Q4水平CHF患者AF发生风险分别是Q1水平的1.902倍、2.060倍和2.841倍(P<0.05)。限制性立方样条分析显示,TyG指数与AF发生风险呈线性正相关(P_(非线性)=0.494)。TyG指数及LASSO-Logistic回归模型预测CHF患者发生AF的曲线下面积分别为0.661(95%CI=0.608~0.724,P<0.001)、0.843(95%CI=0.803~0.882,P<0.001)。TyG指数与AF的相关性在不同亚组中一致。结论在CHF患者中,TyG指数与AF发生独立相关,且在识别该类患者AF的发生中具有一定的临床价值。

Tei index值与心功能不全程度之间的关系

我们用Ｄｏｐｐｌｅｒ法测得一种指标，即从房室瓣血流及心室射血血流频谱中，求得Ｔｅｉｉｎｄｅｘ值（Ｔｅｉ值＝｛等容收缩期（ＩＣＴ）＋等容舒张期（ＩＲＴ）｝／心室射血时间（ＥＴ））、并与临床心功能对比，讨论该指标的意义。结果：该指数与心功能之间有一定关系。在人群间的重迭程度小，并且，指数与心率、二尖瓣返流程度无明显关系。

基于三酰甘油葡萄糖指数联合血管弹性指标的绝经后女性高血压患者冠心病发生风险模型开发研究

背景绝经后女性高血压患者是冠心病易发人群,其冠心病患病率与死亡率较绝经前显著升高。本研究在团队前期研究基础上进一步联合糖脂代谢、血管弹性等相关指标诊断绝经后女性高血压患者发生冠心病,以期为临床识别绝经后女性高血压患者的冠心病风险提供新思路。目的探讨三酰甘油葡萄糖(TyG)指数、踝肱指数(ABI)、臂踝脉搏波传导速度(baPWV)、脉压指数(PPI)、动脉硬化指数(AI)联合与绝经后女性高血压患者发生冠心病的相关性及预测价值,构建绝经后女性高血压患者冠心病发生风险的预测模型。方法本研究选取2019—2022年就诊于中日友好医院中西医结合心内科的首次行冠状动脉造影检查的绝经后女性高血压患者,根据冠状动脉造影结果分为冠心病组与非冠心病组。收集患者入院时的TyG指数、ABI、baPWV、PPI、AI等临床资料,采用多因素Logistic回归分析构建绝经后女性高血压患者冠心病发生风险预测模型,并绘制列线图实现模型可视化。采用受试者工作特征(ROC)曲线、校准曲线、临床决策曲线分析(DCA)评价诊断效能。结果本研究共纳入首次行冠状动脉造影的绝经后女性高血压患者300例,其中非冠心病组141例、冠心病组159例。多因素Logistic回归分析结果显示,ABI、baPWV、TyG指数、PPI、AI是绝经后女性高血压患者发生冠心病的影响因素(P<0.05),并根据预测方程绘制列线图。ROC曲线分析结果显示,ABI、baPWV、TyG指数、PPI、AI和联合预测模型预测绝经后女性高血压患者发生冠心病的ROC曲线下面积(AUC)分别为0.662、0.687、0.659、0.700、0.612、0.808(P<0.001),预测模型预测绝经后女性高血压患者冠心病发生风险的灵敏度为0.7806,特异度为0.7410。校准曲线显示预测结果与实际结果具有较好的一致性。DCA曲线表明列线图具有较好的临床实用价值。结论ABI、baPWV、TyG指数、PPI、AI是绝经后女性高血压患者发生冠心病的影响因素,新开发模型可对冠心病风险进行有效预警。

The Impacts of Maternal Gestational Diabetes Mellitus (GDM) on Fetal Hearts

Objective To evaluate the fetal cardiac function in gestational diabetes mellitus （GDM） pregnancies under different maternal glycemic controls. Methods Forty four GDM mothers received 78 fetal echocardiographic evaluations at three gestational periods （〈28, 28-34 and ≥34 weeks） and were divided into poorly-（DM1） and well-（DM2） controlled groups according to their glycemic control at examination. Seventy uncomplicated mothers were selected as controls. Parameters of fetal cardiac anatomy and function were measured and analyzed. Results GDM fetuses＇ cardiac ventricular walls were thicker than controls＇, and the differences between DM1 and DM2 were not significant except for end-diastolic left ventricular walls. In both GDM groups, the aortic flow velocities increased earlier than pulmonary artery and DM1 fetuses changed earlier than DM2 ones. GDM fetuses＇ left atrial shortening fraction was smaller than the controls＇ in the period of ≥34 weeks and negatively correlated with thicknesses of left ventricular walls and interventricular septum in DM1 fetuses （r=-0.438 and -0.506）. The right ventricular diastolic function in DM1 and DM2 fetuses decreased after the period of 28-34 weeks and in the period of ≥34 weeks respectively. Tel index of both left and right ventricles increased in DM1 group after the period of 〈28 weeks and in DM2 group only in the period of ≥ 34 weeks, with no significant differences between DM1 and DM2 groups in this period. Conclusion Fetuses of GDM mothers showed cardiac function impairments. Good maternal glycemic control may delay the impairments, but cannot reduce the degree. Some cardiac changes in GDM fetuses were similar to those in pregestational diabetic pregnancies except for several parameters and their changing time.

Differences in Heart Stroke Volume between Han and Korean-Chinese Nationalities and Correlative Factors

Objective To compare the differences in stroke volume （SV） and stroke volume index （Sl） between Han and Korean-Chinese and to investigate the correlated risk factors. Methods A total of 1 647 Han and 876 Korean-Chinese aged 10-80 years were investigated. SV, SI, cardiac output, cardiac output index, heart rate （HR）, systemic vascular resistance （SVR）, systemic vascular resistance index （SVRI）, and blood pressure were measured. Results SV/SI values in Korean-Chinese were lower than those in the Han of the same sex and age. Covariance analysis showed that, apart from the effect of sex, age and body mass index （BMI）, the differences in SV and SI between the two cohorts were still significant （P〈O.O01）. Multiple regression analysis revealed that the SV difference between the two ethnicities was affected （in descending order from a strong to weak correlation） by SVR, SVRI, HR, diastolic blood pressure, mean arterial pressure, BMI, and systolic blood pressure, while the SI difference was affected by SVR, SVRI, HR, mean arterial pressure, diastolic and systolic blood pressure, and BMI. Conclusion The Fact that SV and SI in Korean-Chinese are lower than those in Han is related with higher SVR, HR and blood pressure in the Korean-Chinese.

Prognostic factors in heart failure patients with cardiac cachexia

Objective To clarify whether cardiac cachexia(CC)alters the prognostic impact of other general risk factors in patients with heart failure(HF).Methods This was an observational study.CC was defined as the combination of a body mass index of<20 kg/m^2 and at least one of the following biochemical abnormalities:C-reactive protein>5 mg/L;hemoglobin<12 g/dL;and/or albumin<3.2 g/d L.We divided 1608 hospitalized HF patients into a CC group(n=176,10.9%)and a non-CC group(n=1432,89.1%).The primary endpoints were cardiac event and all-cause death.Results The presence of CC showed significant interactions with other risk factors including cancer,estimated glomerular filtration rate(eGFR),and sodium in predicting these endpoints.Multiple Cox proportional analysis revealed that use of a blockers[hazard ratio(HR)=1.900,95%confidence interval(CI):1.045–3.455,P=0.035]and eGFR(HR=0.989,95%CI:0.980–0.998,P=0.018)were independent predictors of cardiac event in the CC group,while age(HR=1.020,95%CI:1.002–1.039,P=0.029)and hemoglobin(HR=0.844,95%CI:0.734–0.970,P=0.017)were independent predictors of all-cause death.The survival classification and regression tree analysis showed the optimal cut-off points for cardiac event(eGFR:59.9 m L/min per 1.73 m^2)and all-cause death(age,83 years old;hemoglobin,10.1 g/dL)in the CC group.Conclusions In predicting prognosis,CC showed interactions with several risk factors.Renal function,age,and hemoglobin were pivotal markers in HF patients with CC.

Evaluation of chronic kidney disease in chronic heart failure: From biomarkers to arterial renal resistances

Chronic kidney disease and its worsening are recurring conditions in chronic heart failure(CHF) which are independently associated with poor patient outcome.The heart and kidney share many pathophysiological mechanisms which can determine dysfunction in each organ. Cardiorenal syndrome is the condition in which these two organs negatively affect each other, therefore an accurate evaluation of renal function in the clinical setting of CHF is essential. This review aims to revise the parameters currently used to evaluate renal dysfunction in CHF with particular reference to the usefulness and the limitations of biomarkers in evaluating glomerular dysfunction and tubular damage. Moreover, it is reported the possible utility of renal arterial resistance index(a parameter associated with abnormalities in renal vascular bed) for a better assesment of kidney disfunction.

Effect of Body Mass Index on All-cause Mortality and Incidence of Cardiovascular Diseases─Report for Meta-Analysis of Prospective Studies on Optimal Cut-off Points of Body Mass Index in Chinese Adults

Objective To verify the optimal cut-off points for overweight and obesity in Chinese adults based on the relationship of baseline body mass index (BMI) to all-cause mortality, and incidence of cardiovascular diseases from pooled data of Chinese cohorts. Methods The prospective study data of existing cohort studies in China were collected, and the age-adjusted all-cause mortality stratified by BMI were estimated. The similar analysis was repeated after excluding deaths within the first three years of follow-up and after excluding smokers. The incidence of age-adjusted coronary heart disease (CHD) and stroke stratified by BMI were also analyzed. Multiple Cox regression coefficients of BMI for the incidence of CHD and stroke after controlling other risk factors were pooled utilizing the methods of weighting by inverse of variance to reveal whether BMI had independent effect and its strength on the incidence of CHD and stroke. Results The data of 4 cohorts including 76 227 persons, with 745 346 person-years of follow-up were collected and analyzed. The age-adjusted all-cause mortality stratified by BMI showed a U-shaped curve, even after excluding deaths within the first three years of follow-up and excluding smokers. Age-adjusted all-cause mortality increased when BMI was lower than 18.5 and higher than 28. The incidence of CHD and stroke, especially ishemic stroke increased with increasing BMI, this was consistent with parallel increasing of risk factors. Cox regression analysis showed that BMI was an independent risk factor for both CHD and stroke. Each amount of 2 kg/m2 increase in baseline BMI might cause 15.4%, 6.1% and 18.8 % increase in relative risk of CHD, total stroke and ischemic stroke. Reduction of BMI to under 24 might prevent the incidence of CHD by 11% and that of stroke by 15 % for men, and 22 % of both diseases for women. Conclusion BMI ≤18.5, 24-27.9 and ≥28 (kg/m2) is the appropriate cut-off points for underweight, overweight and obesity in Chinese adults.

Elevated radial arterial augmentation index in hypertensive patients with diastolic dysfunction

Objective To investigate the correlation between augmentation index (AI) of the radial artery and diastolic heart function in patients with hypertension. Methods Echocardiographs were obtained for 305 patients with hypertension. AI, pulse wave velocity (PWV) of peripheral arteries and serum pro-brain natriuretic peptide (proBNP) levels were determined. Correlations and receiver operating characteristic (ROC) curves were drawn between AI values and impaired diastolic function. Results AI levels were significantly increased in patients with impaired diastolic function diagnosed by ultrasound. Assessment of diastolic heart function based on proBNP levels revealed that AI and aortic pulse wave velocity were significantly elevated in patients with impaired diastolic function. The operating curve indicated that AI may be a more accurate and efficient index for the evaluation of impaired diastolic function compared to PWV. Correlation analysis also showed that proBNP levels had altered in parallel with changes in AI and PWV. After adjusting for various factors including age, gender, blood pressure and blood lipid, a positive correlation was observed between proBNP and AI with a correlation coefficient of 0.3697 (P=0.003). However, no correlation between proBNP and aortic PWV was seen after adjustment. Conclusions Changes in radial AI levels may reflect parallel changes in diastolic cardiac function in patients with hypertension, suggesting that AI may be utilized as a non-invasive clinical indicator of diastolic heart function.

Dynamic Simulation and Hemolysis Evaluation of the Regurgitant Flow over a Tilting-Disc Mechanical Heart Valve in Pulsatile Flow

Regurgitation in the heart diastolic phase represents a critical flow condition associated with many heart valve design considerations. The finite volume method, the Low-Reynolds-Number k-ω turbulent model and sliding mesh model are employed to solve and compare the complex flow field and the torque in each case. The end results expected from a cardiovascular CFD analysis are not limited only to the flowfield investigations. More importantly, it needs an evaluation criterion to judge if the design is acceptable as considered from a broader blood cell damage or activation perspective. In this study, blood cell damage index developed based on stress-time empirical rule and Lagrangian particle tracking is introduced to assess the viscous and turbulence-induced stresses effect to the blood cells.

基于HEART评分的门急诊急危重症胸痛患者心肺功能指标预测模型构建

目的探究门急诊急危重症胸痛患者基于HEART评分的心肺功能指标预测模型的构建。方法选取2019年5月~2021年5月首都医科大学附属北京友谊医院医院门急诊收治的206急危重症胸痛患者,以1个月内是否发生心血管不良事件(MACE)为分组标准,其中128例未发生MACE的患者作为对照组,1个月内发生过MACE的78例患者作为观察组。比较两组受试者HEART评分及心肺功能指标差异,采用多因素logistic回归模型分析急危重症胸痛发生MACE与HEART评分及心肺功能指标的相关性,并构建门急诊急危重症胸痛患者发生MACE的预测模型。结果观察组HEART评分高于对照组[(9.13±1.78)分vs.(5.66±2.43)分],差异有统计学意义(t=10.945,P<0.05)。观察组心肌坏死标志物阳性率均明显高于对照组(64.10%vs.21.88%、82.05%vs.27.34%),差异均具有统计学意义(χ^(2)=36.733、58.109,P<0.05)。结论基于HEART评分的心肺功能指标对门急诊急危重症胸痛患者发生MACE具有较高的预测价值,可在临床应用。

Study on Multi-effect Time Parameters of Ergonomic Validity Index in Low-carbon Residential Kitchen

In the study on functional low-carbon ergonomic validity in buildings,ergonomic validity is different from resource validity which is easy for quantitative analysis. To eliminate the complexity and uncertainty impacts of human factors on quantitative study,it proposes a method of building a parameter of ergonomic validity—multi-effect time by using cardiotachometer to record heart rate change,being used to evaluate the functional low-carbon ergonomic validity targeting at the ontological characteristics of kitchen. This method is used to determine the physical consumption intensity( multi-effect) through heart rate incremental relation based on the principles of physiology and ergonomics,and to confirm the ergonomic validity of environmental factors by the time to complete standard work as well as multi-effect quantitative analysis. The test results show that,under the kitchen operating conditions,the multi-effect( ME) can properly reflect the real-time status of the operator and is easily operated; the parameters obtained are not significantly related to the physiological status of the operator,and multi-effect time( MT) is sensitive to the physical consumption brought about to the operator due to kitchen environmental factors; thus,it can be taken as an objective index,which is simple and easy to operate in residential kitchen functional low-carbon evaluation.

关于体外循环专业质量控制指标遴选的一些思考

质控指标体系是医疗质量管理与控制体系的重要组成部分。构建科学、规范的医疗质控指标体系对加强科学化、精细化医疗质量管理,促进医疗质量持续改进具有重要意义[1-2]。近年来,为进一步加强医疗质量与医疗技术管理,规范临床诊疗行为,促进医疗服务的标准化、同质化,国家卫生健康委办公厅陆续发布了部分临床专业质控指标、单病种质量控制指标、国家限制类技术质控指标。截止到2023年11月国家卫健委共制定了43个专业(含限制性技术等)质量质控指标,同期国家卫生健康委医院管理研究所汇总了2015年至2023年11月间由国家卫健委发布的各专业的医疗质量控制指标,并编制发布了《医疗质量管理与控制指标汇编》5.0版本供临床参阅。

超声新技术在评估胎儿心功能中的研究进展

超声心动图检查是目前评估胎儿心功能的主要方法之一。胎儿心脏定量分析技术(fetal heart quantify,Fetal HQ)、心肌做功指数(myocardial performance index,MPI)等超声心动图新技术可以较准确、客观地评估胎儿心功能。本文就Fetal HQ、MPI评估胎儿心功能的研究进展进行综述。

超声引导下RISS平面阻滞对胸腹部手术患者血清Cor、SP、PGE2、IL-6的影响

目的 探究超声引导下菱形肌-肋间肌-低位前锯肌(RISS)平面阻滞对胸腹部手术患者血清Cor、SP、PGE2、IL-6的影响。方法 选取2021年1月至2022年7月入住秦皇岛市第一医院接受胸腹部手术的患者126例,按照随机掷硬币法分为观察组和对照组,各63例,两组进行常规麻醉诱导,气管插管后观察组行超声引导下RISS平面阻滞,对照组不行神经阻滞。比较两组术后疼痛视觉模拟(VAS)评分及镇静Ramsay评分、手术麻醉药物用量、围术期血流动力学指标(收缩压、舒张压、心率)及炎症应激指标[皮质醇(Cor)、P物质(SP)、前列腺素E2(PGE2)、白细胞介素-6(IL-6)]水平、不良反应发生情况。结果 手术结束后2 h、12 h、24 h,观察组VAS评分和Ramsay评分均显著低于对照组,差异均有统计学意义(P<0.05);术中及术后24 h,观察组舒芬太尼使用量显著低于对照组,差异有统计学意义(P<0.05);插管后两组收缩压、舒张压和心率均低于插管前,差异有统计学意义(P<0.05),插管后10 min和停药后10 min,观察组收缩压、舒张压心率显著低于对照组,差异有统计学意义(P<0.05);术后两组外周血中Cor、SP、PGE2、IL-6水平均低于术前,差异有统计学意义(P<0.05);术后12 h、24 h,观察组Cor、SP、PGE2、IL-6水平均低于对照组,差异有统计学意义(P<0.05);观察组麻醉不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。结论 超声引导下RISS平面阻滞具有良好镇痛镇静效果,能减轻胸腹部手术患者应激及炎症反应,安全性较高,值得临床应用推广。