Objective To observe the midterm haemodynamic manifestation of the home made C-L pugestrut tilting disc mechanical valve in aortic valve replacement, and to evaluate its function. Methods Twenty patients underwent aortic valve replacement over 5 years were collected and divided into two groups, the C-L pugestrut group （n=10）：aortic valve was replaced by home-made C-L pugestrut tilting disc mechanical valve（21mm）; Medtronic-Hall group （n=10）：aortic valve was replaced by Medtronic-Hall mechanical valve （21mm）. The peak transprosthetic gradients （△P）, mean transprosthetic gradients （△Pm）and effective orifice area（EOA） at rest were compared between two groups. Results At rest, △P of the C-L pugestrut group and Medtronic-Hall group were 11.63±3.23mmHg vs. 9. 78±3. 35mmHg; △Pm of the C-L pugestrut group and Medtronic-Hall group were 6. 25±2. 32 mmHg vs. 5.85±2.32mmHg： EOA of the C-L pugestrut group and Medtronic-Hall group were 1.07±0.17 cm2 vs. 1.25±0.27 cm2. There was no statistically significance in △P, △Pm and EOA between two groups（P〉0.05）. Conclusions The midterm haemodynamic results of the home-made C-L pugestrut tilting disc mechanical valve show that it has comparable haemodynamic results to those of Medtronic-Hall mechanical valve ,and it has well-done function. The home-made C-L pugestrut valve is one of the reliable mechanical heart valves.
目的 观察体外静脉静脉转流对患者血流动力学的影响。方法原位异体肝移植患者14例，术中使用离心泵，部分肝素化方法行体外静脉转流。结果 体外静脉转流时间（98.9±23.6）min，转流量（1 168±260）ml/min，转流期及新肝5分钟心排血量（CO）明显下降，但仍维持在正常水平，体循环阻力（SVR）、肺循环阻力（PVR）转流30分钟后明显增加，心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、平均肺动脉压（MPAP）、肺毛细血管楔压（PCWP）等在转流期均无明显变化，新肝早期MAP明显下降，SVR明显增加。结论 无肝期采用离心泵行体外静脉转流，有助于稳定血流动力学，但新肝早期仍有明显血压下降，主要通过适量快速泵灌注全血来纠正。
Objective To observe the effect of lowering intraocular pressure(IOP) treatment on ocular hemodynamics in patients with nonarteritic anterior ischemic optic neuropathy (NAION). Methods A total of 68 patients with NAION (68 eyes) were enrolled in this study. The patients were randomly divided into treatment group (38 eyes of 38 patients) and control group (30 eyes of 30 patients). All the patients were received methylprednisolone pulse therapy (200 mg, three days), vasodilator therapy with intravenous infusion of Xueshuantong solution (300 mg), optic nerve nutritional therapy with mouse nerve growth factor (30 mu;g) and acupoint injection in temporal with compound anisodine (2 ml). The total course was 10 days. The patients of treatment group received IOP lowering treatment to reduce the IOP to ge;8 mm Hg (1 mm Hg=0.133 kPa) or in a 30% reduction. The patients of control group received no IOP lowering treatment. The peak systolic velocity (PSV), pulsatility index (PI) and resistance index (RI) of ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (PCA) before and after treatment were comparatively analyzed by color doppler flow imaging. Results The differences of PSV (t=1.023, 1.145, 0.569), PI (t=0.679, 0.956, 1.634) and RI (t=0.816, 1.657, 0.998) of OA, CRA and PCA before treatment in treatment group and control group were not statistically significant (P＞0.05). Compared with before treatment, PSV (t=3.150, 7.650, 3.520) and PI (t=2.420, 5.430, 7.650) of OA, CRA and PCA increased obviously (P＜0.05), RI of OA, CRA and PCA decreased obviously (t=5.320, 9.640, 18.360;P＜0.05) after treatment in treatment group. In control group, the differences of PSV (t=2.090, -2.550, -2.100) and PI (t=-2.310, -2.230, -4.490) of OA, CRA and PCA between before and after treatment were not statistically significant (P＞0.05); but the differences of RI of OA, CRA and PCA between before and after treatment was statistically significant (t=2.970, 2.160, 2.690;P＜0.05). Compared with control group, PSV (t=2.632, 2.135, 5.364) and PI (t=3.251, 2.432, 4.243) of OA, CRA and PCA increased obviously (P＜0.05), RI of OA, CRA and PCA decreased obviously (t=3.664, 2.938, 4.324;P＜0.05) after treatment in treatment group. Conclusion Lowering intraocular pressure treatment can improve the ocular hemodynamics in NAION patients.
【摘要】 目的 比较瑞芬太尼、丙泊酚、艾司洛尔用于支撑喉镜手术气管插管时患者的心血管反应。 方法 选取2009年1-3月就诊的60例拟于全身麻醉下行择期支撑喉镜下声带息肉切除术的患者，随机分为丙泊酚组、艾司洛尔组和瑞芬太尼组，每组20例。麻醉诱导采用咪达唑仑、芬太尼和丙泊酚，患者意识消失后给予琥珀胆碱。1 min后各组分别给予丙泊酚2 mg/kg、艾司洛尔1 mg/kg和瑞芬太尼1 μg/kg。30 s后进行气管插管。记录患者诱导前及插管前、插管后1、3、5 min的心率和血压水平。 结果 各组插管前的收缩压和心率较诱导前明显降低，插管后1、3 min的收缩压和心率较插管前升高（Plt;0.05)。丙泊酚组和艾司洛尔组插管后的收缩压较瑞芬太尼组升高（Plt;0.05)。丙泊酚组插管后心率较瑞芬太尼组增加（Plt;0.05)。 结论 对行支撑喉镜手术的患者，气管插管前30 s给予1 μg/kg瑞芬太尼较2 mg/kg丙泊酚和1 mg/kg艾司洛尔能更有效地减轻气管插管时的血流动力学反应。【Abstract】 Objective To assess the different effects of remifentanil, propofol, and esmolol on hemodynamic responses during intubation in CO2 laser endolaryngeal microsurgery (CO2-LELM). Methods A total of 60 patients aged from 18 to 65 years, admitted from January to March 2009 and scheduled to undergo elective CO2-LELM under general anesthesia for treatment of vocal cord polyp were randomly assigned to a propofol group, an esmolol group, and a remifentanil group. Anesthesia was induced with midazolam (0.015-0.02 mg/kg), fentanyl (1 μg/kg), and propofol (1 mg/kg). After the patients became unconscious, succinylcholine (1 mg/kg) was given one minute later. Then the patients in the three groups received propofol (2 mg/kg), esmolol (1 mg/kg), and remifentanil (1 μg/kg), respectively. Intubation was performed 30 secconds later. Heart rate (HR) and systolic blood pressure (SBP) were measured noninvasively before general anesthesia induction (baseline, Tb), just before intubation(Ti), and one, three, and five minutes after intubation (T1, T3, T5). Results The demographic data including age, sex and body weight were comparable in the three groups. Tracheal intubation caused significant increases in SBP and HR in all groups compared with Ti (Plt;0.05). After intubation, SBP in the propofol group and the esmolol group were significantly higher than that in remifentanil group (Plt;0.05), and HR in the propofol group was significantly higher than that in the remifentanil group (Plt;0.05). Conclusion In patients with CO2-LELM, remifentanil (1 μg/kg) administrated 30 seconds before intubation is maximal effective compared with propofol (2 mg/kg) or esmolol (1 mg/kg) in attenuating the hemodynamic responses to oraltracheal intubation.
Hemodynamic situation is an important factor of recurrence of postoperative carotid artery aneurysm. In order to investigate the hemodynamic factors of postoperative carotid artery aneurysm affect carotid artery aneurysm recurrence, we established a 3D finite element carotid artery aneurysm for the preoperative and postoperative periods using the three-dimensional reconstruction techniques. And then we measured the hemodynamic factors of carotid artery aneurysm of preoperative and postoperative by the finite element method. The carotid artery aneurysm model has an accurate and realistic shape; the pressure of the recurrence of aneurysm was reduced significantly after surgery,wall shear stress increased significantly at residual neck, and blood flow velocity increased significantly, which will increase the risk of recurrence. The hemodynamic analysis provides a reference for development of aneurysm clinical treatment programs and prevention of recurrence.
ObjectiveTo explore the hemodynamic effects of inhaled nitric oxide (iNO) on postoperative hemodynamic in patients with cyanotic congenital heart disease (CHD) combined with decreased pulmonary blood flow.MethodsFrom 2014 to 2018, there were 1 764 patients who received corrective repair of cyanotic CHD with decreased pulmonary blood flow in the Department of Pediatric Cardiac Surgery of Fuwai Hospital. We included 61 patients with the ratio of right ventricular systolic pressure to systolic blood pressure (SBP) ≥75% after weaning from cardiopulmonary bypass. There were 41 males and 20 females, with the age of 20.5 (9.0, 39.0) months and weight of 12.5±7.8 kg. The patients were divided into two groups: a conventional group (33 patients, conventional therapy only) and a combined therapy group (28 patients, iNO combined with conventional therapy). The hemodynamics during the first 24 hours after iNO therapy and the in-hospital outcomes of the two groups were investigated and compared.ResultsThere was no statistical difference between the two groups in demographic characteristics and surgical parameters (P>0.05). The hemodynamic effects of iNO within 24 hours included the decrease in the vasoactive inotropic score (VIS, 21.6±6.6 vs. 17.3±7.2, P=0.020) along with the increase in blood pressure (SBP: 73.7±9.7 mm Hg vs. 90.8±9.1 mm Hg, P<0.001) , the decrease in central venous pressure (10.0±3.1 mm Hg vs. 7.9±2.1 mm Hg, P=0.020), the decrease in lactate (2.2±1.7 mmol/L vs. 1.2±0.5 mmol/L, P<0.001) and increase in urine output [2.8±1.7 mL/(kg·h) vs. 4.9±2.2 mL/(kg·h), P<0.001]. The decrease of VIS at 24 h after the surgery in the conventional therapy group was not statistically significant (22.1±7.9 vs. 20.0±8.5, P=0.232). Besides, we discovered that the need for renal replacement therapy (RRT) was less in the combined therapy group than that in the conventional therapy group, especially in the moderate complicated surgery [risk adjustment in congenital heart surgery (RACHS-1) ≤3] subgroup (9.5% vs. 40.7%, P=0.016).ConclusionIn pediatric patients after corrective repair of cyanotic and pulmonary blood follow decreased CHD with increased pulmonary vascular resistance, iNO combined with conventional therapy can improve the hemodynamics effectively. Compared with the conventional therapy, the combined therapy with iNO can decrease the VIS and the need for RRT, which is beneficial to the postoperative recovery of patients.
This study was performed on canine femoral veins which were interpositionally implanted into the femoral arteries and the investigation was in terms of zero-stress state, compliance and hemodynamic assessment. The results revealed that the vein grafts had the similar characteristics of compliance with the normal veins. Using Doppler ultrasonography to monitor the blood flow velocity through the vein grafts, the hemodynamic parameters such as pulsatility index (PI) and blood flow volume were evaluated consecutively within one month after the operations .No significant differences were found between these parameters at different time points. It was suggested that autogenous vein graft had an adaptive course when operating in an arterial hemodynamic circumstances and It’s mechanical changes did not bear upon the hemodynamics through the vein graft.
Objective To study the influence of the pedicle length on the perforator flaps in hemodynamics. Methods Four mature swine (2 males, 2 females; weight, 23.0±2.0 kg) were applied to the experiment.Two transverse abdominal skin flaps, based on the superior epigastric pedicle orits rectus abdominal muscle perforators, were designed; each swine was used as its own control. At 2 hours and 1, 2, 3 weeks postoperatively, the skin paddle perfusion and the blood stream velocity in the superior epigastric artery were measured by the Laser Doppler Flowmeter and the Color Doppler Ultrasound, respectively. Flap survival percentages were calculated by the grid method at 1 week postoperatively. The swine were euthanatized, and they underwent angiography at 3 weeks postoperatively. Results At 2 hours and 1 week after operation, edema of the perforator flaps with the superior epigastric pedicle was more severe than that of the skin flaps with the rectus abdominal muscle perforator, and the skin perfusion had a statistical difference between the two kindsof flaps (Plt;0.05). The skin paddle viability and the skin perfusion had nostatistical difference after the first week postoperatively (Pgt;0.05). At 2hours and 1 week after operation, the blood stream velocity in the superior epigastric artery in the perforator flap with the superior abdominal artery pediclewas reduced, and there was a statistical difference between the two kinds of flaps (Plt;0.05); however, the velocity was almost the same after the first week postoperatively. Conclusion The excessively long pedicle of the perforator skin flap may have an unfavorable influence on the flap perfusion,especially during the first week after operation, because of the vascular compromise during the dissection of the long pedicle. The blood vessel anastomosis atthis level of the blood vessels may have no relationship with the perforator flap in hemodynamics. This study can also indicate that the ligation of the branches in the recipient vessels cannot make the perforator flaps overperfused.