Background Few studies have reported the effect of different volume responsiveness evaluation methods on volume therapy results and prognosis.This study was carried out to investigate the effect of two volume responsi...Background Few studies have reported the effect of different volume responsiveness evaluation methods on volume therapy results and prognosis.This study was carried out to investigate the effect of two volume responsiveness evaluation methods,stroke volume variation （SW） and stroke volume changes before and after passive leg raising （PLR-ASV）,on fluid resuscitation and prognosis in septic shock patients.Methods Septic shock patients admitted to the Department of Critical Care Medicine of Zhejiang Hospital,China,from March 2011 to March 2013,who were under controlled ventilation and without arrhythmia,were studied.Patients were randomly assigned to the SVV group or the PLR-ASV group.The SVV group used the Pulse Indication Continuous Cardiac Output monitoring of SW,and responsiveness was defined as SW-＞12％.The PLR-ASV group used ASV before and after PLR as the indicator,and responsiveness was defined as ASV ＞15％.Six hours after fluid resuscitation,changes in tissue perfusion indicators （lactate,lactate clearance rate,central venous oxygen saturation （SCVO2）,base excess （BE））,organ function indicators （white blood cell count,neutrophil percentage,platelet count,total protein,albumin,alanine aminotransferase,total and direct bilirubin,blood urea nitrogen,serum creatinine,serum creatine kinase,oxygenation index）,fluid balance （6-and 24-hour fluid input） and the use of cardiotonic drugs （dobutamine）,prognostic indicators （the time and rate of achieving early goal-directed therapy （EGDT） standards,duration of mechanical ventilation and intensive care unit stay,and 28-day mortality） were observed.Results Six hours after fluid resuscitation,there were no significant differences in temperature,heart rate,blood pressure,SpO2,organ function indicators,or tissue perfusion indicators between the two groups （P ＞0.06）.The 6-and 24-hour fluid input was slightly less in the SW group than in the PLR-ASV group,but the difference was not statistically significant （P ＞0.05）.T展开更多
In the management of critically ill patients, the assessment of volume responsiveness and the decision to administer a fluid bolus constitute a common dilemma for physicians. Static indices of cardiac preload are poor...In the management of critically ill patients, the assessment of volume responsiveness and the decision to administer a fluid bolus constitute a common dilemma for physicians. Static indices of cardiac preload are poor predictors of volume responsiveness. Passive leg raising （PLR） mimics an endogenous volume expansion （VE） that can be used to predict fluid responsiveness. This study was to assess the changes in stroke volume index （SVI） induced by PLR as an indicator of fluid responsiveness in mechanically ventilated patients with severe sepsis. This was a prospective study. Thirty-two mechanically ventilated patients with severe sepsis were admitted for VE in ICU of the First Affiliated Hospital, Zhejiang University School of Medicine and Ningbo Medical Treatment Center Lihuili Hospital from May 2010 to December 2011. Patients with non-sinus rhythm or arrhythmia, parturients, and amputation of the lower limbs were excluded. Measurements of SVI were obtained in a semi-recumbent position （baseline） and during PLR by the technique of pulse indicator continuous cardiac output （PiCCO） system prior to VE. Measurements were repeated after VE （500 mL 6% hydroxyethyl starch infusion within 30 minutes） to classify patients as either volume responders or non-responders based on their changes in stroke volume index （ASVI） over 15%. Heart rate （HR）, systolic artery blood pressure （ABPs）, diastolic artery blood pressure （ABPd）, mean arterial blood pressure （ABPm）, mean central venous pressure （CVPm） and cardiac index （CI） were compared between the two groups. The changes ofABPs, ABPm, CVPm, and SVI after PLR and VE were compared with the indices at the baseline. The ROC curve was drawn to evaluate the value of ASVI and the change of CVPm （ACVPm） in predicting volume responsiveness. SPSS 17.0 software was used for statistical analysis. Among the 32 patients, 22 were responders and 10 were non-responders. After PLR among the responders, some hemodynamic variables （inclu展开更多
China＇s hog production is undergoing a great transformation due to the soaring demand and changing raising system. Regarding the essential role of pork in Chinese diet, a systematic analysis on the productivity and e...China＇s hog production is undergoing a great transformation due to the soaring demand and changing raising system. Regarding the essential role of pork in Chinese diet, a systematic analysis on the productivity and efficiency of hog production can provide significant implications for policy makers. This paper investigates the productivity and efficiency of hog production and the determinants of technical efficiency in China using a household level panel data（2004–2010）. A stochastic frontier translog production function with scaling property in inefficiency term is adopted for hog production analysis, and the determinants of technical efficiency are incorporated in a one-step estimation using maximum likelihood estimation. Our results show that the average technical efficiency of hog production in China is 0.5914. More importantly, we find that specialized farmers have higher technical efficiency than others, and technical efficiency in the eastern region is higher than that in Central and West China.展开更多
文摘Background Few studies have reported the effect of different volume responsiveness evaluation methods on volume therapy results and prognosis.This study was carried out to investigate the effect of two volume responsiveness evaluation methods,stroke volume variation （SW） and stroke volume changes before and after passive leg raising （PLR-ASV）,on fluid resuscitation and prognosis in septic shock patients.Methods Septic shock patients admitted to the Department of Critical Care Medicine of Zhejiang Hospital,China,from March 2011 to March 2013,who were under controlled ventilation and without arrhythmia,were studied.Patients were randomly assigned to the SVV group or the PLR-ASV group.The SVV group used the Pulse Indication Continuous Cardiac Output monitoring of SW,and responsiveness was defined as SW-＞12％.The PLR-ASV group used ASV before and after PLR as the indicator,and responsiveness was defined as ASV ＞15％.Six hours after fluid resuscitation,changes in tissue perfusion indicators （lactate,lactate clearance rate,central venous oxygen saturation （SCVO2）,base excess （BE））,organ function indicators （white blood cell count,neutrophil percentage,platelet count,total protein,albumin,alanine aminotransferase,total and direct bilirubin,blood urea nitrogen,serum creatinine,serum creatine kinase,oxygenation index）,fluid balance （6-and 24-hour fluid input） and the use of cardiotonic drugs （dobutamine）,prognostic indicators （the time and rate of achieving early goal-directed therapy （EGDT） standards,duration of mechanical ventilation and intensive care unit stay,and 28-day mortality） were observed.Results Six hours after fluid resuscitation,there were no significant differences in temperature,heart rate,blood pressure,SpO2,organ function indicators,or tissue perfusion indicators between the two groups （P ＞0.06）.The 6-and 24-hour fluid input was slightly less in the SW group than in the PLR-ASV group,but the difference was not statistically significant （P ＞0.05）.T
文摘In the management of critically ill patients, the assessment of volume responsiveness and the decision to administer a fluid bolus constitute a common dilemma for physicians. Static indices of cardiac preload are poor predictors of volume responsiveness. Passive leg raising （PLR） mimics an endogenous volume expansion （VE） that can be used to predict fluid responsiveness. This study was to assess the changes in stroke volume index （SVI） induced by PLR as an indicator of fluid responsiveness in mechanically ventilated patients with severe sepsis. This was a prospective study. Thirty-two mechanically ventilated patients with severe sepsis were admitted for VE in ICU of the First Affiliated Hospital, Zhejiang University School of Medicine and Ningbo Medical Treatment Center Lihuili Hospital from May 2010 to December 2011. Patients with non-sinus rhythm or arrhythmia, parturients, and amputation of the lower limbs were excluded. Measurements of SVI were obtained in a semi-recumbent position （baseline） and during PLR by the technique of pulse indicator continuous cardiac output （PiCCO） system prior to VE. Measurements were repeated after VE （500 mL 6% hydroxyethyl starch infusion within 30 minutes） to classify patients as either volume responders or non-responders based on their changes in stroke volume index （ASVI） over 15%. Heart rate （HR）, systolic artery blood pressure （ABPs）, diastolic artery blood pressure （ABPd）, mean arterial blood pressure （ABPm）, mean central venous pressure （CVPm） and cardiac index （CI） were compared between the two groups. The changes ofABPs, ABPm, CVPm, and SVI after PLR and VE were compared with the indices at the baseline. The ROC curve was drawn to evaluate the value of ASVI and the change of CVPm （ACVPm） in predicting volume responsiveness. SPSS 17.0 software was used for statistical analysis. Among the 32 patients, 22 were responders and 10 were non-responders. After PLR among the responders, some hemodynamic variables （inclu
基金sponsored by the National Natural Science Foundation of China(71473123,71333008)A Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions(PAPD),ChinaChina Center for Food Security Studies,Nanjing Agricultural University,China
文摘China＇s hog production is undergoing a great transformation due to the soaring demand and changing raising system. Regarding the essential role of pork in Chinese diet, a systematic analysis on the productivity and efficiency of hog production can provide significant implications for policy makers. This paper investigates the productivity and efficiency of hog production and the determinants of technical efficiency in China using a household level panel data（2004–2010）. A stochastic frontier translog production function with scaling property in inefficiency term is adopted for hog production analysis, and the determinants of technical efficiency are incorporated in a one-step estimation using maximum likelihood estimation. Our results show that the average technical efficiency of hog production in China is 0.5914. More importantly, we find that specialized farmers have higher technical efficiency than others, and technical efficiency in the eastern region is higher than that in Central and West China.
