不同海拔高度对健康成年男性心脏血流动力学和心电图的影响

目的:监测中国南极冰盖考察预选队员心血管系统随海拔增高的变化,探讨筛查低氧易感队员和急性高原病的防治。方法:用无创血流动力学监护仪和十二导联心电图机,在北京(40 m)、拉萨(3 650 m)、羊八井(4 300 m)对第25次和26次南极冰盖考察预选队员心血管功能进行连续动态性监测。结果:随着海拔的增高,心率、收缩压、舒张压、平均动脉压、外周血管阻力、外周血管阻力指数显著升高(P0.05),心输出量、心指数、搏出量、搏出指数、加速度指数、速度指数、左心射血时间显著降低(P0.05),预射血期呈降低趋势(P0.05)。结论:随着海拔的增高,预选队员的外周血管阻力显著升高,左心泵血和收缩功能减弱且与Q-TC间期呈负相关。     

家庭心电图监护网络系统

家庭健康监护(Home Health Care),简称HHC。因为所监护的首先是心电,所以亦称经电话传送心电图监测(Transtelephonic Electrocardographic Monitoring),简称TEM。早在1906年,Einboven就描述了通过一根电话线传送心电图(ECG)信号。直到70年代国外才开始将TEM应用于临床。TEM可谓“心电电话系统”,其基本原理是应用心电记录仪将心电信号记录并转换成声频,随时随地能通过电话将其传送至监测中心,再经调制解调器转换成心电信号。     

连续性血液净化在肾衰危重病人抢救中的应用及效果评价

目的:探讨连续性血液净化在危重病人抢救中的应用及效果评价.方法:选取2010年1月～2012年11月我院收治的危重病人共26例,均采用连续性静脉-静脉血液滤过方法治疗,比较治疗前后的心脏血流动力学参数、肾功能与电解质的变化,观察全部患者治疗前后的临床症状改善情况及临床转归.结果:治疗前后的心率、中心静脉压、平均动脉压、心指数及心排出量差异均存在统计学意义(P＜0.05);治疗后患者的血尿素氮、肌酐及钾水平均明显低于治疗前(P＜0.05);治疗后患者的低血压、低血氧、昏迷改善率分别为66.67％、71.43％及62.50％;26例患者中死亡14例(53.85％),存活12例(46.15％).结论:连续性血液净化可以积极有效地治疗危重病患者,选择治疗的时候需要针对患者的情况进行综合判断和全面评估.     

PICCO在老年髋关节手术麻醉及血流动力学优化中的应用

目的:探讨脉搏指示持续心输出量(pulse induced contour crdic output,PICCO)技术在老年髋关节手术麻醉及血流动力学优化中的临床应用。方法:将106例老年髋关节手术患者随机分成2组,每组各53例。常规组放置中心静脉导管和动脉导管,PICCO组放置PICCO,检测平均动脉压(mean arterial pressure,MAP)、中心静脉压(central venous pressure,CVP)、心率(heart rate,HR)、心指数(cardiac index,CI)、血管外肺水指数(extravascular lung water index,ELWI)、胸腔内血容量指数(intrathoracic blood volume index,ITBI)及肺血管通透性指数(pulmonary vascular permeability index,PVPI)等血流动力学参数。记录PICCO组术中各指标的变化,比较分析两组术后前3天液体输入量,术后并发症发生情况。结果:与T0时点比较,PICCO组T1时点的MAP、CVP、CI、ITBI明显降低,HR明显升高(P0.05);T2时点MAP、CVP、CI较T1明显升高,HR明显下降(P0.05);PICCO组T2时刻各血流动力学指标均明显优于常规组(P0.05)。PICCO组术后前3天的液体入量明显少于常规组(P0.05);ELWI与PVPI、ITBI、液体入量均呈高度正相关(P0.05)。且PICCO组术后肺部感染及心血管并发症的发生率也较常规组明显降低(P0.05)。结论:PICCO监测可准确反映血流动力学状态参数,指导临床麻醉和围术期液体管理,减少术中术后不良并发症,改善患者预后。     

高原移居者高原适应与脱适应后心血管改变

健康人从平原进入高原后的短期内,心功能会降低。Vogel曾报道高原世居者(4350m)到海平面后,心脏每搏指数明显增加,心率明显减慢,而心指数不变。探索长期习服高原的移居者(高移者)的心功能状况及其返回平原后的变化规律,对高移者劳动力保护具有实际意义。为此,我们用无创连续心排量监测仪(NCCOM-3仪)对青海高原铁路工人中36名已习服的高移者从高原返回平原前后的心功能进     

地锦粗提物对脾虚小鼠脏器指数和抗氧化能力的影响

目的探讨地锦粗提物对脾虚小鼠脏器指数和抗氧化能力的影响,为防治脾虚提供参考。方法 30只昆明小鼠随机分成3组,每组10只,即对照组、脾虚组和地锦组。脾虚组和地锦组采用泻下加劳倦方法,灌服大承气汤30 g/(kg.d),并负重游泳,对照组灌服生理盐水30 g/(kg.d),不游泳,持续60 d,然后灌胃60 d,地锦组灌胃地锦水醇浸出液30 g/(kg.d),脾虚组和对照组给予相当剂量的生理盐水。实验结束后取心、肝、脾、肺、肾,称重并计算脏器指数,测血浆过氧化氢酶(CAT)和谷胱甘肽过氧化物酶(GSH-Px)活力,测心、肝、脾、肺、肾中超氧化物歧化酶(SOD)活性和丙二醛(MDA)含量。结果脾虚组心指数和肺指数极显著增加,左肾指数显著增加,地锦组心指数显著增加。地锦组的血浆CAT和GSH-Px活力显著高于脾虚组,地锦组肝和脾中的SOD活力显著高于脾虚组,地锦组脾、肺MDA含量显著低于脾虚组。结论地锦粗提物可降低脾虚小鼠的脏器指数,并可提高脾虚小鼠抗氧化能力。     

肝脏的功能

肝脏结构概况肝脏是体内最大的消化器官(分泌胆汁),也是极重要的代谢器官(分解代谢和合成代谢),其中进行多种化学反应,所以常称肝脏是体内的化工厂。肝脏由肝细胞组成,分左右两叶。其中有四种树枝状管道系统:(甲) 供血血管系统(肝脏的血液供应丰富,调节灵敏;又分为(1)由心供血的肝动脉系统;(2)由消化道回流入肝的门脉系统)。(乙) 导血出肝的静脉系统。(丙) 淋巴管系统。(丁) 输送胆汁的胆管系统。     

农业旱情遥感监测的一种改进方法及其应用

从地表蒸散的角度出发,利用基于Priestley-Taylor公式与地表温度 植被指数(LST-VI)三角形特征空间的半经验蒸散模型,对农业干旱遥感监测方法进行改进,推导得到简化型蒸散胁迫指数(SESI).利用2008、2009年3-11月的MODIS陆地标准产品数据,构造了3种特征空间建模计算了SESI,对京津冀平原地区开展了农业旱情监测试验,并与温度植被干旱指数(TVDI)进行比较.结果表明: SESI有效地简化了基于地表蒸散估算的遥感干旱监测方法,对土壤表层水分(10、20 cm)有着良好的指示作用.该方法春、秋季监测效果优于夏季,且不同时相SESI的可比性优于TVDI.将SESI指数应用于大面积农业旱情连续监测具有一定可行性.     

基于星载通道光谱指数与小麦冠层叶片氮素营养指标的定量关系

利用空间遥感信息大面积监测小麦冠层氮素营养状况和生产力指标具有重要意义和应用前景.本研究基于不同施氮水平下小麦冠层反射光谱信息,利用响应函数模拟基于不同卫星通道构建的光谱指数(包括单波段、比值光谱指数和归一化光谱指数),分析基于星载通道的光谱指数与小麦冠层叶片氮素营养指标的定量关系,确定监测小麦冠层叶片氮素营养的较好卫星传感器和光谱波段,建立小麦冠层氮素营养指标监测方程.结果表明:利用NDVI(MSS7,MSS5)、NDVI(RBV3,RBV2)、TM4 、CH2、MODIS1和MODIS2遥感数据可以预估小麦叶片氮含量(LNC),其决定系数(R2)在0.60以上;应用NDVI(PB4,PB2)、NDVI(CH2,CH1)、NDVI(MSS7,MSS5)、RVI(MSS7,MSS5)、MODIS1和MODIS2可以预测小麦叶片氮积累量(LNA),其R2大于0.86.比较而言,NDVI(MSS7,MSS5)和NDVI(PB4,PB2)分别为预测小麦LNC和LNA的适宜星载通道光谱参数.     

基于像元三分模型的锡林郭勒草原光合植被和非光合植被覆盖度估算

定量的估算草原光合植被覆盖度(f_(PV))和非光合植被覆盖度(f_(NPV))对草原畜牧业和土地荒漠化具有重要的意义。以锡林郭勒盟西乌珠穆沁旗为研究区,以MODIS 500 m分辨率地表反射率产品MOD09GHK为数据源,采用干枯燃料指数(DFI)指数构建NDVI-DFI像元三分模型估算了锡林郭勒草原的fPV和f_(NPV),并分析了锡林郭勒草原fPV和f_(NPV)的动态变化。研究结果表明:锡林郭勒草原NDVI-DFI特征空间表现为三角形,与理论上的概念模型基本一致,符合像元三分模型的基本假设;NDVI-DFI像元三分模型适用于对草原黄枯期_(NPV)的监测,对草原生长期_(NPV)监测并不十分敏感;利用NDVI-DFI像元三分模型估算的fPV和f_(NPV)动态变化与牧草物候发育特征相吻合,可以有效的估算典型草原地区fPV和f_(NPV)值,进一步将其应用于长时间序列的典型草原fPV和f_(NPV)动态变化分析。     

Unreliable Tracking Ability of the Third-Generation FloTrac/Vigileo? System for Changes in Stroke Volume after Fluid Administration in Patients with High Systemic Vascular Resistance during Laparoscopic Surgery

Background

The FloTrac/Vigileo^™ system does not thoroughly reflect variable arterial tones, due to a lack of external calibration. The ability of this system to measure stroke volume and track its changes after fluid administration has not been fully evaluated in patients with the high systemic vascular resistance that can develop during laparoscopic surgery.

Methods

In 42 patients undergoing laparoscopic prostatectomy, the stroke volume derived by the third-generation FloTrac/Vigileo^™ system (SV-Vigileo), the stroke volume measured using transesophageal echocardiography (SV-TEE) as a reference method, and total systemic vascular resistance were evaluated before and after 500 ml fluid administration during pneumoperitoneum combined with the Trendelenburg position.

Results

Total systemic vascular resistance was 2159.4 ± 523.5 dyn·s/cm⁵ before fluid administration. The SV-Vigileo was significantly higher than the SV-TEE both before (68.8 ± 15.9 vs. 57.0 ± 11.0 ml, P < 0.001) and after (73.0 ± 14.8 vs. 64.9 ± 12.2 ml, P = 0.003) fluid administration. During pneumoperitoneum combined with the Trendelenburg position, Bland-Altman analysis for repeated measures showed a 53.8% of percentage error between the SV-Vigileo and the SV-TEE. Four-quadrant plot (69.2% of a concordance rate) and polar plot analysis (20.6° of a mean polar angle, 16.4° of the SD of a polar angle, and ±51.5° of a radial sector containing 95% of the data points) did not indicate a good trending ability of the FloTrac/Vigileo^™ system.

Conclusions

The third-generation FloTrac/Vigileo^™ system may not be useful in patients undergoing laparoscopic surgery, based on unreliable performance in measuring the stroke volume and in tracking changes in the stroke volume after fluid administration during pneumoperitoneum combined with the Trendelenburg position.     

Reflex control of vascular capacitance during hypoxia, hypercapnia, or hypoxic hypercapnia

We tested the hypothesis that the changes in venous tone induced by changes in arterial blood oxygen or carbon dioxide require intact cardiovascular reflexes. Mongrel dogs were anesthetized with sodium pentobarbital and paralyzed with veruronium bromide. Cardiac output and central blood volume were measured by indocyanine green dilution. Mean circulatory filling pressure, an index of venous tone at constant blood volume, was estimated from the central venous pressure during transient electrical fibrillation of the heart. With intact reflexes, hypoxia (arterial PaO2 = 38 mmHg), hypercapnia (PaCO2 = 72 mmHg), or hypoxic hypercapnia (PaO2 = 41; PaCO2 = 69 mmHg) (1 mmHg = 133.32 Pa) significantly increased the mean circulatory filling pressure and cardiac output. Hypoxia, but not normoxic hypercapnia, increased the mean systemic arterial pressure and maintained the control level of total peripheral resistance. With reflexes blocked with hexamethonium and atropine, systemic arterial pressure supported with a constant infusion of norepinephrine, and the mean circulatory filling pressure restored toward control with 5 mL/kg blood, each experimental gas mixture caused a decrease in total peripheral resistance and arterial pressure, while the mean circulatory filling pressure and cardiac output were unchanged or increased slightly. We conclude that hypoxia, hypercapnia, and hypoxic hypercapnia have little direct influence on vascular capacitance, but with reflexes intact, there is a significant reflex increase in mean circulatory filling pressure.     

The ability of left ventricular end-diastolic volume variations measured by TEE to monitor fluid responsiveness in high-risk surgical patients during craniotomy: a prospective cohort study

Background

This study was aimed to evaluate the ability of left ventricular end-diastolic volume variations (LVEDVV) measured by transesophageal echocardiography (TEE) compared with stroke volume variation (SVV) obtained by the FloTrac/Vigileo monitor to predict fluid responsiveness, in patients undergoing craniotomy with goal direct therapy.

Methods

We used SVV obtained by the FloTrac/Vigileo monitor to manage intraoperative hypotension in adult patients undergoing craniotomy (ASA III – IV) after obtaining IRB approval and informed consent. The LVEDVV were measured by TEE through the changes of left ventricular short diameter of axle simultaneously. When cardiac index (CI)?≤?2.5 and SVV?≥?15%, comparisons were made between the two devices before and after volume expansion.

Results

We enrolled twenty-six patients referred for craniotomy in this study and 145 pairs of data were obtained. Mean Vigileo-SVV and TEE-LVEDVV were 17.8?±?2.78% and 22.1?±?7.25% before volume expansion respectively, and were 10.95?±?2.8% and 13.58?±?3.78% after volume expansion respectively (P <?0.001). The relationship between Vigileo-SVV and TEE-LVEDVV was significant (r2?=?0.55; p <?0.001). Agreement between Vigileo-SVV and TEE-LVEDVV was 3.3%?±?3.9% (mean bias ± SD, Bland-Altman).

Conclusions

For fluid responsiveness of patients during craniotomy in ASA III-IV, LVEDVV measured by left ventricular short diameter of axle using M type echocaidiographic measurement seems an acceptable monitoring indicator. This accessible method has promising clinical applications in situations where volume and cardiac function monitoring is of great importance during surgery.

Trial registration

Chinese Clinical Trial Registry, ChiCTR-TRC-13003583, August 20, 2013.

     

Role of beta-adrenergic agonists in the control of vascular capacitance

The role of beta-adrenergic agonists, such as isoproterenol, on vascular capacitance is unclear. Some investigators have suggested that isoproterenol causes a net transfer of blood to the chest from the splanchnic bed. We tested this hypothesis in dogs by measuring liver thickness, cardiac output, cardiopulmonary blood volume, mean circulatory filling pressure, portal venous, central venous, pulmonary arterial, and systemic arterial pressures while infusing norepinephrine (2.6 micrograms.min-1.kg-1), or isoproterenol (2.0 micrograms.min-1.kg-1), or histamine (4 micrograms.min-1.kg-1), or a combination of histamine and isoproterenol. Norepinephrine (an alpha- and beta 1-adrenergic agonist) decreased hepatic thickness and increased mean circulatory filling pressure, cardiac output, cardiopulmonary blood volume, total peripheral resistance, and systemic arterial and portal pressures. Isoproterenol increased cardiac output and decreased total peripheral resistance, but it had little effect on liver thickness or mean circulatory filling pressure and did not increase the cardiopulmonary blood volume or central venous pressure. Histamine caused a marked increase in portal pressure and liver thickness and decreased cardiac output, but it had little effect on the estimated mean circulatory filling pressure. Isoproterenol during histamine infusions reduced histamine-induced portal hypertension, reduced liver size, and increased cardiac output. We conclude that the beta-adrenergic agonist, isoproterenol, has little influence on vascular capacitance or liver volume of dogs, unless the hepatic outflow resistance is elevated by agents such as histamine.     

Tissue oxygenation in septic respiratory failure

The relationships between tissue oxygenation and the different haemodynamic and respiratory parameters were studied in 20 patients with ARDS of septic origin. Good regressions were found between O2 delivery and cardiac index (r = 0.8507), O2 delivery and systemic vascular resistance (r = -0.7051), O2 extraction ratio and mixed venous O2 saturation (r = 0.8978), O2 consumption and cardiac index (r = 0.6593), O2 consumption and systemic vascular resistance (r = -0.6548), and O2 consumption and mixed venous O2 saturation (r = -0.7068). The correlation among the parameters of tissue oxygenation was more expressed between O2 extraction ratio and O2 consumption (r = 0.7285), than between O2 delivery and O2 consumption (r = 0.6095). A better result was achieved by multiple regression analysis, where the multiple r was 0.9748 between O2 consumption and O2 delivery + O2 extraction ratio, whereas the other variables did not increase the multiple r significantly. These regressions also proved the relationship following from the Fick equation, that is O2 consumption is the result of O2 delivery multiplied with the O2 extraction ratio.     

Comparative effects of vasodilator drugs on flow distribution and venous return

Systemic vascular effects of hydralazine, prazosin, captopril, and nifedipine were studied in 115 anesthetized dogs. Blood flow (Q) and right atrial pressure (Pra) were independently controlled by a right heart bypass. Transient changes in central blood volume after an acute reduction in Pra at a constant Q showed that blood was draining from two vascular compartments with different time constants, one fast and the other slow. At three dose levels producing comparable reductions in systemic arterial pressure (30-40% at the highest dose), these drugs had different effects on flow distribution and venous return. Hydralazine and prazosin had parallel and balanced effects on arterial resistance of the two vascular compartments, and flow distribution was unaltered. Captopril preferentially reduced arterial resistance of the compartment with a slow time constant for venous return (-26 +/- 6%, -30 +/- 6%, -50 +/- 5% at 0.02, 0.10, and 0.50 mg X kg-1 X h-1, respectively; means +/- SEM) without altering arterial resistance of the fast time-constant compartment. Blood flow to the slow time-constant compartment was increased 43 +/- 14% at the highest dose, and central blood volume was reduced 108 +/- 15 mL. In contrast, nifedipine had a balanced effect on arterial resistance with the lowest dose (0.025 mg/kg) but caused a preferential reduction in arterial resistance of the fast time-constant compartment at higher doses (-38 +/- 4% and -55 +/- 2% at 0.05 and 0.10 mg/kg, respectively). Blood flow to the slow time-constant compartment was reduced 36 +/- 5% at the highest dose of nifedipine, and central blood volume was increased 66 +/- 12 mL. Total systemic venous compliance was unaltered or slightly reduced by each of the four drugs. These results add further evidence to the hypothesis that peripheral blood flow distribution is a major determinant of venous return to the heart.     

In vivo atrial peptide-venodilation: minimal potency relative to nitroglycerin in dogs

Venodilation is thought to contribute to the hemodynamic actions of atrial peptides. Therefore, we measured the effective vascular compliance (EVC) as a parameter of overall venous tone in 7 pentobarbital anesthetized dogs under autonomic blockade during i.v. infusions of rat atriopeptin II (AP II, up to 100 pmol/kg/min), rat alpha-atrial natriuretic factor, and nitroglycerin (GTN). AP II lowered mean arterial pressure by reducing peripheral vascular resistance with a threshold between 3 and 10 pmol/kg/min (but was ineffective in anesthetized or conscious dogs without autonomic blockade). Neither atrial peptide altered EVC, while GTN augmented EVC and caused a 4.6-fold larger reduction of central venous pressure than AP II at equihypotensive dosage. These findings, with infusion rates probably close to endogeneous release, reveal a vasodilator potency of atrial peptides, which is restricted to systemic arterioles without affecting venous tone.     

Reference cardiopulmonary values in normal dogs

The purpose of this project was to collate canine cardiopulmonary measurements from published and unpublished studies in our laboratory in 97 instrumented, unsedated, normovolemic dogs. Body weight; arterial and mixed-venous pH and blood gases; mean arterial, pulmonary arterial, pulmonary artery occlusion, and central venous blood pressures; cardiac output; heart rate; hemoglobin; and core temperature were measured. Body surface area; bicarbonate concentration; base deficit; cardiac index; stroke volume index, systemic and pulmonary vascular resistance indices; left and right cardiac work indices; alveolar partial pressure of oxygen (pO2) ; alveolar-arterial pO2 gradient (A-apO2); arterial, mixed-venous, and pulmonary capillary oxygen content; oxygen delivery; oxygen consumption; oxygen extraction; venous admixture; arterial and mixed-venous blood CO2 contents; and CO2 production were calculated. In the 97 normal, resting dogs, mean arterial and mixed-venous pH were 7.38 and 7.36, respectively; partial pressure of carbon dioxide (pCO2), 40.2 and 44.1 mm Hg, respectively; base-deficit, -2.1 and -1.9 mEq/liter, respectively; pO2, 99.5 and 49.3 mm Hg, respectively; oxygen content, 17.8 and 14.2 ml/dl, respectively; A-a pO2 was 6.3 mm Hg; and venous admixture was 3.6%. The mean arterial blood pressure (ABPm), mean pulmonary arterial blood pressure (PAPm), pulmonary artery occlusion pressure (PAOP) were 103, 14, and 5.5 mm Hg, respectively; heart rate was 87 beats/min; cardiac index (CI) was 4.42 liters/min/m2; systemic and pulmonary vascular resistances were 1931 and 194 dynes.sec.cm-5, respectively; oxygen delivery, consumption and extraction were 790 and 164 ml/min/m2 and 20.5%, respectively. This study represents a collation of cardiopulmonary values obtained from a large number of dogs (97) from a single laboratory using the same measurement techniques.     

Overview: the role of angiotensin-converting enzyme inhibitors in cardiovascular therapy

Angiotensin-converting enzyme (ACE) inhibitors favorably modify control mechanisms that are disturbed in hypertension and congestive heart failure, principally, but perhaps not exclusively, through reduction in angiotensin II levels. Pharmacodynamic actions are vasodilation, increased sodium excretion, and lowering of blood pressure. Investigations with captopril and enalapril in the treatment of hypertension indicate efficacies comparable to each other and to current step 1 and 2 agents. Enalapril is more potent than captopril and has a longer duration of action. The hemodynamic mechanism of action is reduction in peripheral vascular resistance. Addition of a diuretic potentiates blood pressure lowering and proportion of patients responding. When used in congestive heart failure, ACE inhibitors exert a balanced vasodilator effect on arterial and venous beds and do not induce tachycardia or fluid retention. Cardiac output is increased whereas systemic vascular resistance, central pressures, and systemic blood pressure are reduced acutely and chronically. Although captopril is associated with certain side effects, possibly resulting from the sulfhydryl group in its structure, this profile has not been encountered thus far in clinical investigations with enalapril. The effects of ACE inhibitors on the natural histories of hypertension (independent of blood pressure lowering) and congestive heart failure are yet to be determined.