BACKGROUND:This study aimed to observe the effect of early goal directed therapy(EGDT)on tissue perfusion,microcirculation and tissue oxygenation in patients with septic shock.METHODS:Patients with early septic shock(...BACKGROUND:This study aimed to observe the effect of early goal directed therapy(EGDT)on tissue perfusion,microcirculation and tissue oxygenation in patients with septic shock.METHODS:Patients with early septic shock(<24 hours) who had been admitted to the ICU of Zhongda Hospital Affiliated to Southeast University from September 2009 through May 2011 were enrolled(research time:12 months),and they didn't meet the criteria of EGDT.Patients who had one of the following were excluded:stroke,brain injury,other types of shock,severe heart failure,acute myocardial infarction,age below 18 years,pregnancy,end-stage disease,cardiac arrest,extensive burns,oral bleeding,difficulty in opening the mouth,and the onset of septic shock beyond 24 hours.Patients treated with the standard protocol of EGDT were included.Transcutaneous pressure of oxygen and carbon dioxide(PtcO_2,PtcCO_2) were monitored and hemodynamic measurements were obtained.Side-stream dark field(SDF) imaging device was applied to obtain sublingual microcirculation.Hemodynamics,tissue oxygen,and sublingual microcirculation were compared before and after EGDT.If the variable meets the normal distribution,Student's t test was applied.Otherwise,Wilcoxon's rank-sum test was used.Correlation between variables was analyzed with Pearson's product-moment correlation coefficient method.RESULTS:Twenty patients were involved,but one patient wasn't analyzed because he didn't meet the EGDT criteria.PtcO_2 and PtcCO_2 were monitored in 19 patients,of whom sublingual microcirculation was obtained.After EGDT,PtcO_2 increased from 62.7+24.0 mmHg to 78.0±30.9mmHg(P<0.05) and tissue oxygenation index(PtcO_2/FiO_2) was 110.7+60.4 mmHg before EGDT and 141.6±78.2 mmHg after EGDT(P<0.05).The difference between PtcCO_2 and PCO_2 decreased significantly after EGDT(P<0.05).The density of perfused small vessels(PPV) and microcirculatory flow index of small vessels(MFI) tended to increase,but there were no significant differences between them(P>0.05).PtcO_2,PtcO_2/FiO_2,and PtcCO_2 were 展开更多
BACKGROUND: Although low central venous pressure (CVP) has been used to minimize blood loss during hepatectomy the impact of variations of CVP on the rate of blood loss and on the perfusion of end-organs has not been ...BACKGROUND: Although low central venous pressure (CVP) has been used to minimize blood loss during hepatectomy the impact of variations of CVP on the rate of blood loss and on the perfusion of end-organs has not been evaluated This animal study aimed to evaluate the hemodynamics and oxygen transport changes during hepatic resection at different CVP levels. METHODS: Forty-eight anesthetized Bama miniature pigs were divided into 8 groups with CVP during hepatic resection controlled at 0 to <1, 1 to <2, 2 to <3, 3 to <4, 4 to <5, 5 to <6, 6 to <7, and 7 to <8 cmH 2 O. Intergroup comparisons were made for hemodynamic parameters, oxygen transport dynamics, and the rate of blood loss. RESULTS: The rate of blood loss and the hepatic venous pressure during hepatic resection were almost linearly related to the CVP. A significant drop in the mean arterial pressure cardiac output, and cardiac index occurred between CVP ≥2 and <2 cmH 2 O. Oxygen delivery (DO 2 ), oxygen consumption (VO 2 ) and oxygen extraction ratio (ERO 2 ) remained relatively constant between CVPs of 2 to <8 cmH 2 O. There was a significant drop in DO 2 when the CVP was <2 cmH 2 O. There was also a significant drop in VO 2 and ExO 2 when the CVP was <1 cmH 2 O.CONCLUSION: The optimal CVP for hepatic resection is 2to 3 cmH2O.展开更多
目的探讨术中回收式自体输血（intraoperative autotransfusion,IAT）能否改善少量出血患者的组织氧合及术后恢复。方法选择2011年12月至2012年4月在北京协和医院行腰椎后路手术、美国麻醉医师协会（American Society of Anesthesiologi...目的探讨术中回收式自体输血（intraoperative autotransfusion,IAT）能否改善少量出血患者的组织氧合及术后恢复。方法选择2011年12月至2012年4月在北京协和医院行腰椎后路手术、美国麻醉医师协会（American Society of Anesthesiologists,ASA）分级为Ⅰ~Ⅱ级且预计出血量〈20%血容量的患者,随机分为两组,回输组输注回收自体血,对照组给予等量胶体液。检测两组患者术前、术中及术后血红蛋白（hemoglobin,Hb）、乳酸及脑氧饱和度,随访并比较术后恢复指标,包括体温、不适主诉、切口愈合、下地行走时间及术后住院时间。结果共38例患者纳入本研究,回输组和对照组各19例。回输组术后0.5 h和术后1 d的Hb均高于术中水平[分别为（116.5±10.7）、（115.4±12.3）、（106.6±12.6）g/L;P=0.001,P=0.004],而对照组术后Hb与术中比较差异无统计学意义（P〉0.05）。对照组术后0.5 h乳酸高于术前[（2.5±1.0）mmol/L比（1.3±0.6）mmol/L,P=0.016],而回输组术后乳酸与术前比较差异无统计学意义（P〉0.05）。术后Hb、乳酸及脑氧饱和度两组间差异均无统计学意义（P〉0.05）。两组术后恢复指标差异亦均无统计学意义（P〉0.05）。结论在健康成人患者少量出血手术中使用IAT,对术后早期组织氧合有一定改善作用,但对术后恢复无显著影响。展开更多
目的探讨应用羟乙基淀粉(HES)溶液中添加多聚人胎盘血红蛋白(Poly Hb)对重度失血性休克大鼠模型肠缺血再灌注的影响。方法将32只SD大鼠失血至全身血容量(大鼠体重的6.5%)的60%,分别将大鼠股动静脉插管后,从股动脉端开始放血直至放血量...目的探讨应用羟乙基淀粉(HES)溶液中添加多聚人胎盘血红蛋白(Poly Hb)对重度失血性休克大鼠模型肠缺血再灌注的影响。方法将32只SD大鼠失血至全身血容量(大鼠体重的6.5%)的60%,分别将大鼠股动静脉插管后,从股动脉端开始放血直至放血量达到大鼠全身血容量的60%,然后随机均分为4组(8只/组),包括3个人工胶体液组,即HES组:6%HES130/0.4氯化钠注射液;红细胞+HES(RBC+HES)组:将大鼠自身血液反复离心洗涤3次,留取红细胞,加入到HES溶液中,使Hb浓度达到20 g/L;Poly Hb+HES组:将Poly PHb加入到HES溶液中,使Hb浓度为20 g/L;1个假手术组:只做常规手术,不放血不复苏。将大鼠行等容量液体复苏,分别在各组大鼠休克前、后,输液末、输液后1 h、2 h观测大鼠平均动脉压(MAP)、乳酸(Lac)、氧分压(Pa O2)、二氧化碳分压(Pa CO2),并在复苏2 h取各组大鼠肠组织制备成10%组织匀浆,测定丙二醛(MDA)、髓过氧化物酶(MPO)、肿瘤坏死因子(TNF-α)的含量。结果 HES、RBC+HES和Poly Hb+HES 3组大鼠输液后MAP(mm Hg)分别为88.00±9.90 vs 100.57±7.69vs 112.16±17.05(P"0.05);输液后2 h,乳酸(mmol/L)分别为3.71±0.91 vs 2.30±0.97 vs 2.50±0.65(P"0.05),Pa O2(mm Hg)分别为126.5±10.40 vs 111.16±9.64 vs 111.00±13.98(P"0.05),Pa CO2(mm Hg)分别为30.00±3.16 vs 42.66±5.31 vs 34.66±1.50(P"0.05);输液后2 h,RBC+HES、HES组MDA、MPO活性,分别为:0.47±0.34 vs 0.99±0.81,0.23±0.29 vs 0.57±0.32(P"0.05);Poly Hb+HES与HES组MPO活性、TNF-α分别为0.32±0.19 vs 0.57±0.32,89.42±21.03 vs 208.45±62.80(P"0.05)。结论 HES溶液添加多Poly Hb可以改善失血性休克大鼠组织氧供和酸中毒现象,减轻肠组织缺血再灌注损伤。展开更多
文摘BACKGROUND:This study aimed to observe the effect of early goal directed therapy(EGDT)on tissue perfusion,microcirculation and tissue oxygenation in patients with septic shock.METHODS:Patients with early septic shock(<24 hours) who had been admitted to the ICU of Zhongda Hospital Affiliated to Southeast University from September 2009 through May 2011 were enrolled(research time:12 months),and they didn't meet the criteria of EGDT.Patients who had one of the following were excluded:stroke,brain injury,other types of shock,severe heart failure,acute myocardial infarction,age below 18 years,pregnancy,end-stage disease,cardiac arrest,extensive burns,oral bleeding,difficulty in opening the mouth,and the onset of septic shock beyond 24 hours.Patients treated with the standard protocol of EGDT were included.Transcutaneous pressure of oxygen and carbon dioxide(PtcO_2,PtcCO_2) were monitored and hemodynamic measurements were obtained.Side-stream dark field(SDF) imaging device was applied to obtain sublingual microcirculation.Hemodynamics,tissue oxygen,and sublingual microcirculation were compared before and after EGDT.If the variable meets the normal distribution,Student's t test was applied.Otherwise,Wilcoxon's rank-sum test was used.Correlation between variables was analyzed with Pearson's product-moment correlation coefficient method.RESULTS:Twenty patients were involved,but one patient wasn't analyzed because he didn't meet the EGDT criteria.PtcO_2 and PtcCO_2 were monitored in 19 patients,of whom sublingual microcirculation was obtained.After EGDT,PtcO_2 increased from 62.7+24.0 mmHg to 78.0±30.9mmHg(P<0.05) and tissue oxygenation index(PtcO_2/FiO_2) was 110.7+60.4 mmHg before EGDT and 141.6±78.2 mmHg after EGDT(P<0.05).The difference between PtcCO_2 and PCO_2 decreased significantly after EGDT(P<0.05).The density of perfused small vessels(PPV) and microcirculatory flow index of small vessels(MFI) tended to increase,but there were no significant differences between them(P>0.05).PtcO_2,PtcO_2/FiO_2,and PtcCO_2 were
基金supported by a grant from the GuangxiNatural Science Foundation (GKZ0447066)
文摘BACKGROUND: Although low central venous pressure (CVP) has been used to minimize blood loss during hepatectomy the impact of variations of CVP on the rate of blood loss and on the perfusion of end-organs has not been evaluated This animal study aimed to evaluate the hemodynamics and oxygen transport changes during hepatic resection at different CVP levels. METHODS: Forty-eight anesthetized Bama miniature pigs were divided into 8 groups with CVP during hepatic resection controlled at 0 to <1, 1 to <2, 2 to <3, 3 to <4, 4 to <5, 5 to <6, 6 to <7, and 7 to <8 cmH 2 O. Intergroup comparisons were made for hemodynamic parameters, oxygen transport dynamics, and the rate of blood loss. RESULTS: The rate of blood loss and the hepatic venous pressure during hepatic resection were almost linearly related to the CVP. A significant drop in the mean arterial pressure cardiac output, and cardiac index occurred between CVP ≥2 and <2 cmH 2 O. Oxygen delivery (DO 2 ), oxygen consumption (VO 2 ) and oxygen extraction ratio (ERO 2 ) remained relatively constant between CVPs of 2 to <8 cmH 2 O. There was a significant drop in DO 2 when the CVP was <2 cmH 2 O. There was also a significant drop in VO 2 and ExO 2 when the CVP was <1 cmH 2 O.CONCLUSION: The optimal CVP for hepatic resection is 2to 3 cmH2O.
文摘目的探讨术中回收式自体输血（intraoperative autotransfusion,IAT）能否改善少量出血患者的组织氧合及术后恢复。方法选择2011年12月至2012年4月在北京协和医院行腰椎后路手术、美国麻醉医师协会（American Society of Anesthesiologists,ASA）分级为Ⅰ~Ⅱ级且预计出血量〈20%血容量的患者,随机分为两组,回输组输注回收自体血,对照组给予等量胶体液。检测两组患者术前、术中及术后血红蛋白（hemoglobin,Hb）、乳酸及脑氧饱和度,随访并比较术后恢复指标,包括体温、不适主诉、切口愈合、下地行走时间及术后住院时间。结果共38例患者纳入本研究,回输组和对照组各19例。回输组术后0.5 h和术后1 d的Hb均高于术中水平[分别为（116.5±10.7）、（115.4±12.3）、（106.6±12.6）g/L;P=0.001,P=0.004],而对照组术后Hb与术中比较差异无统计学意义（P〉0.05）。对照组术后0.5 h乳酸高于术前[（2.5±1.0）mmol/L比（1.3±0.6）mmol/L,P=0.016],而回输组术后乳酸与术前比较差异无统计学意义（P〉0.05）。术后Hb、乳酸及脑氧饱和度两组间差异均无统计学意义（P〉0.05）。两组术后恢复指标差异亦均无统计学意义（P〉0.05）。结论在健康成人患者少量出血手术中使用IAT,对术后早期组织氧合有一定改善作用,但对术后恢复无显著影响。
文摘目的探讨应用羟乙基淀粉(HES)溶液中添加多聚人胎盘血红蛋白(Poly Hb)对重度失血性休克大鼠模型肠缺血再灌注的影响。方法将32只SD大鼠失血至全身血容量(大鼠体重的6.5%)的60%,分别将大鼠股动静脉插管后,从股动脉端开始放血直至放血量达到大鼠全身血容量的60%,然后随机均分为4组(8只/组),包括3个人工胶体液组,即HES组:6%HES130/0.4氯化钠注射液;红细胞+HES(RBC+HES)组:将大鼠自身血液反复离心洗涤3次,留取红细胞,加入到HES溶液中,使Hb浓度达到20 g/L;Poly Hb+HES组:将Poly PHb加入到HES溶液中,使Hb浓度为20 g/L;1个假手术组:只做常规手术,不放血不复苏。将大鼠行等容量液体复苏,分别在各组大鼠休克前、后,输液末、输液后1 h、2 h观测大鼠平均动脉压(MAP)、乳酸(Lac)、氧分压(Pa O2)、二氧化碳分压(Pa CO2),并在复苏2 h取各组大鼠肠组织制备成10%组织匀浆,测定丙二醛(MDA)、髓过氧化物酶(MPO)、肿瘤坏死因子(TNF-α)的含量。结果 HES、RBC+HES和Poly Hb+HES 3组大鼠输液后MAP(mm Hg)分别为88.00±9.90 vs 100.57±7.69vs 112.16±17.05(P"0.05);输液后2 h,乳酸(mmol/L)分别为3.71±0.91 vs 2.30±0.97 vs 2.50±0.65(P"0.05),Pa O2(mm Hg)分别为126.5±10.40 vs 111.16±9.64 vs 111.00±13.98(P"0.05),Pa CO2(mm Hg)分别为30.00±3.16 vs 42.66±5.31 vs 34.66±1.50(P"0.05);输液后2 h,RBC+HES、HES组MDA、MPO活性,分别为:0.47±0.34 vs 0.99±0.81,0.23±0.29 vs 0.57±0.32(P"0.05);Poly Hb+HES与HES组MPO活性、TNF-α分别为0.32±0.19 vs 0.57±0.32,89.42±21.03 vs 208.45±62.80(P"0.05)。结论 HES溶液添加多Poly Hb可以改善失血性休克大鼠组织氧供和酸中毒现象,减轻肠组织缺血再灌注损伤。
