目的 评价超声造影能否用于评价腹腔高压（IAH）状态下肾脏灌注的改变.方法 采用气腹法建立IAH模型,连续膀胱内压测定腹腔内压（IAP）,获得基线平均动脉压（MAP）、腹腔内压和腹腔灌注压.将12只健康的小香猪腹腔内压自基线梯度性升高至1...目的 评价超声造影能否用于评价腹腔高压（IAH）状态下肾脏灌注的改变.方法 采用气腹法建立IAH模型,连续膀胱内压测定腹腔内压（IAP）,获得基线平均动脉压（MAP）、腹腔内压和腹腔灌注压.将12只健康的小香猪腹腔内压自基线梯度性升高至10 mm Hg、15mm Hg、20 mm Hg和25 mm Hg,于每个压力梯度监测肾脏表面灌注采用激光多普勒血流灌注成像（laser Doppler perfusion imaging,LDPI）和超声造影.结果 IAP逐渐升高至25 mm Hg,相对于基线,超声造影冲入时间（WIT）和达峰值时间（TTP）明显增加（P＜0.05）,但峰值强度（PI）、上升斜率（WIS）和AUC（曲线下面积）明显下降（P＜0.05）.肾脏表面灌注单位（PU）值随腹压增高明显下降（P＜0.05）与腹腔灌注压（APP）呈中度相关（r=0.74,P＜0.05）.分析不同腹腔压力下肾脏表面灌注PU值和超声造影TIC曲线的PI和AUC之间相关性,PI和PU呈正相关（r=0.83,P＜0.05）,而AUC和PU呈负相关（r=0.92,P＜0.05）.结论 超声造影是一种实时、非侵入性和简单的技术能评估在IAH状态下肾微血管灌注.PI和AUC可用于小香猪模型中的IAP微血管肾损伤的诊断性肾损害.肾脏表面激光多普勒成像能有效地评估肾脏表面灌注,反映肾皮质血流情况.展开更多
Indocyanine green(ICG) kinetics(PDR/R15) used to quantitatively assess hepatic function in the perioperative period of major resective surgery and liver transplantation have been the object of an extensive, updated an...Indocyanine green(ICG) kinetics(PDR/R15) used to quantitatively assess hepatic function in the perioperative period of major resective surgery and liver transplantation have been the object of an extensive, updated and critical review. New, non invasive bedside monitors(pulse dye densitometry technology) make this opportunity widely available in clinical practice. After having reviewed basic concepts of hepatic clearance, we analysed the most common indications ICG kinetic parameters have nowadays in clinical practice, focusing in particular on the diagnostic and prognostic role of PDR and R15 in the perioperative period of major liver surgery and liver transplantation. As recently pointed out, even if of extreme interest, ICG clearance parameters have still some limitations, to be considered when using these tests.展开更多
Abdominal compartment syndrome(ACS)develops when organ failure arises secondary to an increase in intraabdominal pressure.The abdominal pressure is determined by multiple factors such as blood pressure,abdominal compl...Abdominal compartment syndrome(ACS)develops when organ failure arises secondary to an increase in intraabdominal pressure.The abdominal pressure is determined by multiple factors such as blood pressure,abdominal compliance,and other factors that exert a constant pressure within the abdominal cavity.Several conditions in the critically ill may increase abdominal pressure compromising organ perfusion that may lead to renal and respiratory dysfunction.Among surgical and trauma patients,aggressive fluid resuscitation is the most commonly reported risk factor to develop ACS.Other conditions that have also been identified as risk factors are ascites,hemoperitoneum,bowel distention,and large tumors.All patients with abdominal trauma possess a higher risk of developing intra-abdominal hypertension(IAH).Certain surgical interventions are reported to have a higher risk to develop IAH such as damage control surgery,abdominal aortic aneurysm repair,and liver transplantation among others.Close monitoring of organ function and intra-abdominal pressure(IAP)allows clinicians to diagnose ACS rapidly and intervene with target-specific management to reduce IAP.Surgical decompression followed by temporary abdominal closure should be considered in all patients with signs of organ dysfunction.There is still a great need for more studies to determine the adequate timing for interventions to improve patient outcomes.展开更多
文摘目的 评价超声造影能否用于评价腹腔高压（IAH）状态下肾脏灌注的改变.方法 采用气腹法建立IAH模型,连续膀胱内压测定腹腔内压（IAP）,获得基线平均动脉压（MAP）、腹腔内压和腹腔灌注压.将12只健康的小香猪腹腔内压自基线梯度性升高至10 mm Hg、15mm Hg、20 mm Hg和25 mm Hg,于每个压力梯度监测肾脏表面灌注采用激光多普勒血流灌注成像（laser Doppler perfusion imaging,LDPI）和超声造影.结果 IAP逐渐升高至25 mm Hg,相对于基线,超声造影冲入时间（WIT）和达峰值时间（TTP）明显增加（P＜0.05）,但峰值强度（PI）、上升斜率（WIS）和AUC（曲线下面积）明显下降（P＜0.05）.肾脏表面灌注单位（PU）值随腹压增高明显下降（P＜0.05）与腹腔灌注压（APP）呈中度相关（r=0.74,P＜0.05）.分析不同腹腔压力下肾脏表面灌注PU值和超声造影TIC曲线的PI和AUC之间相关性,PI和PU呈正相关（r=0.83,P＜0.05）,而AUC和PU呈负相关（r=0.92,P＜0.05）.结论 超声造影是一种实时、非侵入性和简单的技术能评估在IAH状态下肾微血管灌注.PI和AUC可用于小香猪模型中的IAP微血管肾损伤的诊断性肾损害.肾脏表面激光多普勒成像能有效地评估肾脏表面灌注,反映肾皮质血流情况.
文摘Indocyanine green(ICG) kinetics(PDR/R15) used to quantitatively assess hepatic function in the perioperative period of major resective surgery and liver transplantation have been the object of an extensive, updated and critical review. New, non invasive bedside monitors(pulse dye densitometry technology) make this opportunity widely available in clinical practice. After having reviewed basic concepts of hepatic clearance, we analysed the most common indications ICG kinetic parameters have nowadays in clinical practice, focusing in particular on the diagnostic and prognostic role of PDR and R15 in the perioperative period of major liver surgery and liver transplantation. As recently pointed out, even if of extreme interest, ICG clearance parameters have still some limitations, to be considered when using these tests.
文摘Abdominal compartment syndrome(ACS)develops when organ failure arises secondary to an increase in intraabdominal pressure.The abdominal pressure is determined by multiple factors such as blood pressure,abdominal compliance,and other factors that exert a constant pressure within the abdominal cavity.Several conditions in the critically ill may increase abdominal pressure compromising organ perfusion that may lead to renal and respiratory dysfunction.Among surgical and trauma patients,aggressive fluid resuscitation is the most commonly reported risk factor to develop ACS.Other conditions that have also been identified as risk factors are ascites,hemoperitoneum,bowel distention,and large tumors.All patients with abdominal trauma possess a higher risk of developing intra-abdominal hypertension(IAH).Certain surgical interventions are reported to have a higher risk to develop IAH such as damage control surgery,abdominal aortic aneurysm repair,and liver transplantation among others.Close monitoring of organ function and intra-abdominal pressure(IAP)allows clinicians to diagnose ACS rapidly and intervene with target-specific management to reduce IAP.Surgical decompression followed by temporary abdominal closure should be considered in all patients with signs of organ dysfunction.There is still a great need for more studies to determine the adequate timing for interventions to improve patient outcomes.
