Objective:To explore the effect of continuous non-invasive blood pressure monitoring on intraoperative hemodynamics and postoperative myocardial injury in craniotomy.Methods:120 cases of elective craniotomy were divid...Objective:To explore the effect of continuous non-invasive blood pressure monitoring on intraoperative hemodynamics and postoperative myocardial injury in craniotomy.Methods:120 cases of elective craniotomy were divided into the self-control group(continuous non-invasive blood pressure monitoring and intermittent cuff non-invasive blood pressure monitoring,CNAP group)and propensity score matching group(only intermittent cuff non-invasive blood pressure measurement in previous craniotomy,PSM group);Goal-directed hemodynamic management in CNAP group included heart rate(HR),blood pressure(BP),stroke volume(SV),stroke variability(SVV),and systemic vascular resistance index(SVRI).The main index is to compare the troponin level within 72 hours after operation between the CNAP group and the PSM group;The secondary indicators are the comparison of the hemodynamic conditions between the CNAP group and the PSM at 10 specific time points.Results:The incidence of postoperative myocardial injury in the CNAP group was significantly lower than that in the PSM group(12%vs.30%,P=0.01);in the CNAP group hypotensive episodes(6 vs.3,P=0.01),positive balance of fluid therapy(700 vs.500 mL,P<0.001),more use of vasoactive drugs(29 vs.18,P=0.04),more stable hemodynamics medical status(P=0.03)were recorded.Conclusion:The hemodynamic management strategy based on continuous non-invasive blood pressure monitoring can reduce the incidence of myocardial injury after elective craniotomy and maintain a more stable hemodynamic state.展开更多
BACKGROUND: This study was undertaken to observe the characteristics of blood pressure variability(BPV) and sepsis and to investigate changes in blood pressure and its value on the severity of illness in patients with...BACKGROUND: This study was undertaken to observe the characteristics of blood pressure variability(BPV) and sepsis and to investigate changes in blood pressure and its value on the severity of illness in patients with sepsis.METHODS: Blood parameters, APACHE II score, and 24-hour ambulatory BP were analyzed in 89 patients with sepsis.RESULTS: In patients with APACHE II score>19, the values of systolic blood pressure(SBPV), diasystolic blood pressure(DBPV), non-dipper percentage, cortisol(COR), lactate(LAC), platelet count(PLT) and glucose(GLU) were significantly higher than in those with APACHE II score ≤19(P<0.05), whereas the values of procalcitonin(PCT), white blood cell(WBC), creatinine(Cr), PaO2, C-reactive protein(CRP), adrenocorticotropic hormone(ACTH) and tumor necrosis factor α(TNF-α) were not statistically significant(P>0.05). Correlation analysis showed that APACHE II scores correlated significantly with SBPV and DBPV(P<0.01, r=0.732 and P<0.01, r=0.762). SBPV and DBPV were correlated with COR(P=0.018 and r=0.318; P=0.008 and r=0.353 respectively). However, SBPV and DBPV were not correlated with TNF-α, IL-10, and PCT(P>0.05). Logistic regression analysis of SBPV, DBPV, APACHE II score, and LAC was used to predict prognosis in terms of survival and non-survival rates. Receiver operating characteristics curve(ROC) showed that DBPV was a better predictor of survival rate with an AUC value of 0.890. However, AUC of SBPV, APACHE II score, and LAC was 0.746, 0.831 and 0.915, respectively.CONCLUSIONS: The values of SBPV, DBPV and non-dipper percentage are higher in patients with sepsis. DBPV and SBPV can be used to predict the survival rate of patients with sepsis.展开更多
目的分析不同剂量右美托咪定(Dex)复合腰硬联合麻醉对产科手术中麻醉效果、血压及视觉模拟评分法(VAS)评分的影响。方法200例产妇作为观察对象,根据Dex剂量不同分为对照组(C组)、低剂量组(D1组)、中剂量组(D2组)、中-高剂量组(D3组)和...目的分析不同剂量右美托咪定(Dex)复合腰硬联合麻醉对产科手术中麻醉效果、血压及视觉模拟评分法(VAS)评分的影响。方法200例产妇作为观察对象,根据Dex剂量不同分为对照组(C组)、低剂量组(D1组)、中剂量组(D2组)、中-高剂量组(D3组)和高剂量组(D4组),每组40例。对比五组不同时段Ramsay评分、视觉模拟评分法(VAS)评分、血压水平、不良反应发生率、新生儿1 min及5 min Apgar评分。结果入室麻醉后平卧位即刻(T0),五组产妇Ramsay、VAS评分对比差异无统计学意义(P>0.05);胎儿娩出时(T1),D2组、D3组及D4组产妇Ramsay评分分别为(4.92±0.11)、(4.95±0.13)、(4.88±0.11)分,明显高于C组的(2.84±0.24)分与D1组的(3.12±0.14)分,VAS评分分别为(2.06±0.22)、(2.03±0.19)、(2.02±0.19)分,明显低于C组的(4.13±0.24)分与D1组的(3.13±0.27)分,且D1组产妇Ramsay评分明显高于C组,VAS评分明显低于C组(P<0.05);术后12 h(T2),D2组、D3组及D4组产妇VAS评分分别为(2.46±0.37)、(2.49±0.36)、(2.42±0.34)分,明显低于C组的(5.13±0.24)分与D1组的(4.05±0.71)分,且D1组产妇VAS评分明显低于C组(P<0.05);D2组、D3组及D4组产妇T1时的Ramsay、VAS评分及T2时的VAS评分对比差异无统计学意义(P>0.05)。五组新生儿1 min及5 min Apgar评分对比差异无统计学意义(P>0.05)。T0时,五组产妇收缩压及舒张压水平对比差异无统计学意义(P>0.05);T1、T2时,D2组、D3组及D4组产妇收缩压及舒张压水平明显低于C组与D1组,且D1组产妇收缩压及舒张压水平明显低于C组(P<0.05);D2组、D3组及D4组产妇T1、T2时的收缩压及舒张压水平对比差异无统计学意义(P>0.05)。D2组产妇不良反应发生率2.5%(1/40)低于C组的15.0%(6/40)、D1组的15.0%(6/40)、D3组的15.0%(6/40)、D4组的17.5%(7/40)(P<0.05)。结论0.5μg/kg Dex有助于稳定血压水平,提高麻醉效果,减轻术中疼痛,降低麻醉后不良反应发生率,且不会对新生儿出生造成不利影响,可作为最佳调控剂量。展开更多
文摘Objective:To explore the effect of continuous non-invasive blood pressure monitoring on intraoperative hemodynamics and postoperative myocardial injury in craniotomy.Methods:120 cases of elective craniotomy were divided into the self-control group(continuous non-invasive blood pressure monitoring and intermittent cuff non-invasive blood pressure monitoring,CNAP group)and propensity score matching group(only intermittent cuff non-invasive blood pressure measurement in previous craniotomy,PSM group);Goal-directed hemodynamic management in CNAP group included heart rate(HR),blood pressure(BP),stroke volume(SV),stroke variability(SVV),and systemic vascular resistance index(SVRI).The main index is to compare the troponin level within 72 hours after operation between the CNAP group and the PSM group;The secondary indicators are the comparison of the hemodynamic conditions between the CNAP group and the PSM at 10 specific time points.Results:The incidence of postoperative myocardial injury in the CNAP group was significantly lower than that in the PSM group(12%vs.30%,P=0.01);in the CNAP group hypotensive episodes(6 vs.3,P=0.01),positive balance of fluid therapy(700 vs.500 mL,P<0.001),more use of vasoactive drugs(29 vs.18,P=0.04),more stable hemodynamics medical status(P=0.03)were recorded.Conclusion:The hemodynamic management strategy based on continuous non-invasive blood pressure monitoring can reduce the incidence of myocardial injury after elective craniotomy and maintain a more stable hemodynamic state.
文摘BACKGROUND: This study was undertaken to observe the characteristics of blood pressure variability(BPV) and sepsis and to investigate changes in blood pressure and its value on the severity of illness in patients with sepsis.METHODS: Blood parameters, APACHE II score, and 24-hour ambulatory BP were analyzed in 89 patients with sepsis.RESULTS: In patients with APACHE II score>19, the values of systolic blood pressure(SBPV), diasystolic blood pressure(DBPV), non-dipper percentage, cortisol(COR), lactate(LAC), platelet count(PLT) and glucose(GLU) were significantly higher than in those with APACHE II score ≤19(P<0.05), whereas the values of procalcitonin(PCT), white blood cell(WBC), creatinine(Cr), PaO2, C-reactive protein(CRP), adrenocorticotropic hormone(ACTH) and tumor necrosis factor α(TNF-α) were not statistically significant(P>0.05). Correlation analysis showed that APACHE II scores correlated significantly with SBPV and DBPV(P<0.01, r=0.732 and P<0.01, r=0.762). SBPV and DBPV were correlated with COR(P=0.018 and r=0.318; P=0.008 and r=0.353 respectively). However, SBPV and DBPV were not correlated with TNF-α, IL-10, and PCT(P>0.05). Logistic regression analysis of SBPV, DBPV, APACHE II score, and LAC was used to predict prognosis in terms of survival and non-survival rates. Receiver operating characteristics curve(ROC) showed that DBPV was a better predictor of survival rate with an AUC value of 0.890. However, AUC of SBPV, APACHE II score, and LAC was 0.746, 0.831 and 0.915, respectively.CONCLUSIONS: The values of SBPV, DBPV and non-dipper percentage are higher in patients with sepsis. DBPV and SBPV can be used to predict the survival rate of patients with sepsis.
文摘目的分析不同剂量右美托咪定(Dex)复合腰硬联合麻醉对产科手术中麻醉效果、血压及视觉模拟评分法(VAS)评分的影响。方法200例产妇作为观察对象,根据Dex剂量不同分为对照组(C组)、低剂量组(D1组)、中剂量组(D2组)、中-高剂量组(D3组)和高剂量组(D4组),每组40例。对比五组不同时段Ramsay评分、视觉模拟评分法(VAS)评分、血压水平、不良反应发生率、新生儿1 min及5 min Apgar评分。结果入室麻醉后平卧位即刻(T0),五组产妇Ramsay、VAS评分对比差异无统计学意义(P>0.05);胎儿娩出时(T1),D2组、D3组及D4组产妇Ramsay评分分别为(4.92±0.11)、(4.95±0.13)、(4.88±0.11)分,明显高于C组的(2.84±0.24)分与D1组的(3.12±0.14)分,VAS评分分别为(2.06±0.22)、(2.03±0.19)、(2.02±0.19)分,明显低于C组的(4.13±0.24)分与D1组的(3.13±0.27)分,且D1组产妇Ramsay评分明显高于C组,VAS评分明显低于C组(P<0.05);术后12 h(T2),D2组、D3组及D4组产妇VAS评分分别为(2.46±0.37)、(2.49±0.36)、(2.42±0.34)分,明显低于C组的(5.13±0.24)分与D1组的(4.05±0.71)分,且D1组产妇VAS评分明显低于C组(P<0.05);D2组、D3组及D4组产妇T1时的Ramsay、VAS评分及T2时的VAS评分对比差异无统计学意义(P>0.05)。五组新生儿1 min及5 min Apgar评分对比差异无统计学意义(P>0.05)。T0时,五组产妇收缩压及舒张压水平对比差异无统计学意义(P>0.05);T1、T2时,D2组、D3组及D4组产妇收缩压及舒张压水平明显低于C组与D1组,且D1组产妇收缩压及舒张压水平明显低于C组(P<0.05);D2组、D3组及D4组产妇T1、T2时的收缩压及舒张压水平对比差异无统计学意义(P>0.05)。D2组产妇不良反应发生率2.5%(1/40)低于C组的15.0%(6/40)、D1组的15.0%(6/40)、D3组的15.0%(6/40)、D4组的17.5%(7/40)(P<0.05)。结论0.5μg/kg Dex有助于稳定血压水平,提高麻醉效果,减轻术中疼痛,降低麻醉后不良反应发生率,且不会对新生儿出生造成不利影响,可作为最佳调控剂量。
