目的 运用控制性低中心静脉压(CLCVP)技术的腹腔镜肝切除术,会增加患者神经系统并发症的风险,该研究拟评估该类患者术中脑去氧饱和度事件(CDE)的发生率。方法 选择拟行择期腹腔镜肝切除术的患者94例,随机分为CLCVP组(A组)及非CLCVP组(B...目的 运用控制性低中心静脉压(CLCVP)技术的腹腔镜肝切除术,会增加患者神经系统并发症的风险,该研究拟评估该类患者术中脑去氧饱和度事件(CDE)的发生率。方法 选择拟行择期腹腔镜肝切除术的患者94例,随机分为CLCVP组(A组)及非CLCVP组(B组),各47例。两组患者均采用全凭静脉麻醉。分别观察术前(T_(0))、麻醉诱导气管插管后5 min (T_(1))、患者置于30°头高脚低位后5 min (T_(2))、手术切皮后5 min (T_(3))、切肝前5 min (T_(4))[A组实施CLCVP,中心静脉压(CVP)控制在5 cm H_(2)O以内;B组维持CVP在正常范围]、切肝结束后5 min (T_(5))和术毕(T_(6))的血流动力学变化、脑氧饱和度(rSO_(2))和升压药使用情况。记录CDE的发生情况、麻醉后监测治疗室(PACU)复苏时间、术后复苏室视觉模拟评分(VAS)≥4分、术后躁动、恶心和呕吐等发生情况。结果 两组患者平均动脉压(MAP)在T_(4)、T_(5)和T_(6)时点较T_(0)时点更低,且在T_(4)时点A组MAP下降更明显,两组患者比较,差异有统计学意义(P<0.05)。两组患者rSO_(2)在T_(4)、T_(5)和T_(6)时点较T_(1)时点降低,且A组降低更明显,差异有统计学意义(P<0.05)。A组CDE发生率较B组高(35.6%和4.3%,P=0.001),升压药物使用率较B组高(48.9%和19.6%,P=0.003)。A组恶心及呕吐发生率较B组高,差异有统计学意义(26.7%和8.7%,P=0.024)。结论 运用CLCVP技术的腹腔镜肝切除术,较常规腹腔镜肝切除术可明显降低患者术中rSO_(2),增加术中CDE发生率。展开更多
The patient was a 1-year-and-4-mo-old boy. He had drunk about 1 L of an isotonic drink for infants daily since about 10 mo after birth. He was examined by a local doctor due to anorexia and vomiting, found to have car...The patient was a 1-year-and-4-mo-old boy. He had drunk about 1 L of an isotonic drink for infants daily since about 10 mo after birth. He was examined by a local doctor due to anorexia and vomiting, found to have cardiomegaly, and transported to our hospital with suspected myocarditis. After admission, the patient showed polypnea, a decreased level of consciousness, and marked metabolic acidosis and lapsed into circulatory insufficiency, requiring catecholamine administration, endotracheal intubation, and extracorporeal membrane oxygenation. Initially, low-output heart failure due to acute myocarditis was suspected, but the central venous oxygen saturation was high, at 82%. Considering high-output heart failure to be more likely, we evaluated its cause and noted, by urinary organic acid analysis, increases in lactate, pyruvate, 3-OH-butyrate, acetoacetate, metabolic products of branched-chain amino acids, 2-ketoglutarate, 2-OHglutarate, 2-keto-adipate, and 2-OH-adipate. Since the vitamin B1 level was reduced to 12 ng/m L(normally 20-50 ng/m L), a diagnosis of cardiac beriberi due to vitamin B1 deficiency was made. When unexplained heart failure is observed in children, cardiac beriberi must be excluded as a differential diagnosis of myocarditis and cardiomyopathy. The measurement of the central venous oxygen saturation may be useful for the diagnosis.展开更多
目的探讨中心静脉-动脉二氧化碳分压差(Pcv-aCO_2)指导脓毒症患者容量管理的临床意义,观察中心静脉血氧饱和度(ScvO_2)联合Pcv-aCO_2能否更好地指导脓毒症患者容量管理。方法选取2012年1月—2013年1月河北医科大学第四医院ICU收治的重...目的探讨中心静脉-动脉二氧化碳分压差(Pcv-aCO_2)指导脓毒症患者容量管理的临床意义,观察中心静脉血氧饱和度(ScvO_2)联合Pcv-aCO_2能否更好地指导脓毒症患者容量管理。方法选取2012年1月—2013年1月河北医科大学第四医院ICU收治的重症脓毒症和脓毒症休克患者36例。患者入住ICU后置入双腔抗感染中心导管,尽早开始液体复苏治疗。记录液体复苏0 h(T0)、6 h(T6)、24 h(T24)时患者的心率(HR)、呼吸(RR)、平均动脉压(MAP)、中心静脉压(CVP)、血乳酸(Lac)、血肌酐(Scr)、血红蛋白(Hb)、凝血酶原时间(PT)、白细胞计数(WBC),采集T0、T6、T24桡动脉血气分析指标〔pH、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(Pa CO2),并计算氧合指数(PaO_2/FiO_2)、碱剩余(BE)〕,上腔静脉血气分析指标〔pH、ScvO_2、上腔静脉血二氧化碳分压(Pcv CO2),计算Pcv-aCO_2〕。根据液体复苏后24 h ScvO_2和Pcv-aCO_2分为4组:组1:ScvO_2>70%,Pcv-aCO_2<6 mm Hg(1 mm Hg=0.133 k Pa);组2:ScvO_2>70%,Pcv-aCO_2≥6 mm Hg;组3:ScvO_2≤70%,Pcv-aCO_2<6 mm Hg;组4:ScvO_2≤70%,Pcv-aCO_2≥6 mm Hg。比较4组患者生理指标、生化指标及血气分析,并计算患者24 h液体入量及Lac清除率、机械通气时间、入住ICU时间、住院时间、ICU病死率、28 d病死率。结果液体复苏不同时刻,患者MAP、Scr、Hb比较,差异均无统计学意义(P>0.05);患者HR、CVP、Pcv-aCO_2、ScvO_2、pH、BE、Lac、PaO_2/FiO_2比较,差异均有统计学意义(P<0.05);其中T6、T24的HR、Pcv-aCO_2、Lac低于T0,CVP、ScvO_2、pH、BE、PaO_2/FiO_2高于T0;T24的HR、Pcv-aCO_2、Lac低于T6,CVP、ScvO_2、BE、PaO_2/FiO_2高于T6,差异均有统计学意义(P<0.05)。T0、T6、T24时,Pcv-aCO_2与Lac、BE、pH均无直线相关关系(P>0.05)。T0、T6、T24时,Pcv-aCO_2与ScvO_2呈负相关(r=-0.755、-0.920、-0.858,P<0.05)。Pcv-aCO_2与6 hLac清除率、24 hLac清除率呈负相关(r=-0.365、-0.864,P<0.05)。4组患者T24时MAP、HR、Hb、Scr�展开更多
文摘目的 运用控制性低中心静脉压(CLCVP)技术的腹腔镜肝切除术,会增加患者神经系统并发症的风险,该研究拟评估该类患者术中脑去氧饱和度事件(CDE)的发生率。方法 选择拟行择期腹腔镜肝切除术的患者94例,随机分为CLCVP组(A组)及非CLCVP组(B组),各47例。两组患者均采用全凭静脉麻醉。分别观察术前(T_(0))、麻醉诱导气管插管后5 min (T_(1))、患者置于30°头高脚低位后5 min (T_(2))、手术切皮后5 min (T_(3))、切肝前5 min (T_(4))[A组实施CLCVP,中心静脉压(CVP)控制在5 cm H_(2)O以内;B组维持CVP在正常范围]、切肝结束后5 min (T_(5))和术毕(T_(6))的血流动力学变化、脑氧饱和度(rSO_(2))和升压药使用情况。记录CDE的发生情况、麻醉后监测治疗室(PACU)复苏时间、术后复苏室视觉模拟评分(VAS)≥4分、术后躁动、恶心和呕吐等发生情况。结果 两组患者平均动脉压(MAP)在T_(4)、T_(5)和T_(6)时点较T_(0)时点更低,且在T_(4)时点A组MAP下降更明显,两组患者比较,差异有统计学意义(P<0.05)。两组患者rSO_(2)在T_(4)、T_(5)和T_(6)时点较T_(1)时点降低,且A组降低更明显,差异有统计学意义(P<0.05)。A组CDE发生率较B组高(35.6%和4.3%,P=0.001),升压药物使用率较B组高(48.9%和19.6%,P=0.003)。A组恶心及呕吐发生率较B组高,差异有统计学意义(26.7%和8.7%,P=0.024)。结论 运用CLCVP技术的腹腔镜肝切除术,较常规腹腔镜肝切除术可明显降低患者术中rSO_(2),增加术中CDE发生率。
文摘The patient was a 1-year-and-4-mo-old boy. He had drunk about 1 L of an isotonic drink for infants daily since about 10 mo after birth. He was examined by a local doctor due to anorexia and vomiting, found to have cardiomegaly, and transported to our hospital with suspected myocarditis. After admission, the patient showed polypnea, a decreased level of consciousness, and marked metabolic acidosis and lapsed into circulatory insufficiency, requiring catecholamine administration, endotracheal intubation, and extracorporeal membrane oxygenation. Initially, low-output heart failure due to acute myocarditis was suspected, but the central venous oxygen saturation was high, at 82%. Considering high-output heart failure to be more likely, we evaluated its cause and noted, by urinary organic acid analysis, increases in lactate, pyruvate, 3-OH-butyrate, acetoacetate, metabolic products of branched-chain amino acids, 2-ketoglutarate, 2-OHglutarate, 2-keto-adipate, and 2-OH-adipate. Since the vitamin B1 level was reduced to 12 ng/m L(normally 20-50 ng/m L), a diagnosis of cardiac beriberi due to vitamin B1 deficiency was made. When unexplained heart failure is observed in children, cardiac beriberi must be excluded as a differential diagnosis of myocarditis and cardiomyopathy. The measurement of the central venous oxygen saturation may be useful for the diagnosis.
文摘目的探讨中心静脉-动脉二氧化碳分压差(Pcv-aCO_2)指导脓毒症患者容量管理的临床意义,观察中心静脉血氧饱和度(ScvO_2)联合Pcv-aCO_2能否更好地指导脓毒症患者容量管理。方法选取2012年1月—2013年1月河北医科大学第四医院ICU收治的重症脓毒症和脓毒症休克患者36例。患者入住ICU后置入双腔抗感染中心导管,尽早开始液体复苏治疗。记录液体复苏0 h(T0)、6 h(T6)、24 h(T24)时患者的心率(HR)、呼吸(RR)、平均动脉压(MAP)、中心静脉压(CVP)、血乳酸(Lac)、血肌酐(Scr)、血红蛋白(Hb)、凝血酶原时间(PT)、白细胞计数(WBC),采集T0、T6、T24桡动脉血气分析指标〔pH、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(Pa CO2),并计算氧合指数(PaO_2/FiO_2)、碱剩余(BE)〕,上腔静脉血气分析指标〔pH、ScvO_2、上腔静脉血二氧化碳分压(Pcv CO2),计算Pcv-aCO_2〕。根据液体复苏后24 h ScvO_2和Pcv-aCO_2分为4组:组1:ScvO_2>70%,Pcv-aCO_2<6 mm Hg(1 mm Hg=0.133 k Pa);组2:ScvO_2>70%,Pcv-aCO_2≥6 mm Hg;组3:ScvO_2≤70%,Pcv-aCO_2<6 mm Hg;组4:ScvO_2≤70%,Pcv-aCO_2≥6 mm Hg。比较4组患者生理指标、生化指标及血气分析,并计算患者24 h液体入量及Lac清除率、机械通气时间、入住ICU时间、住院时间、ICU病死率、28 d病死率。结果液体复苏不同时刻,患者MAP、Scr、Hb比较,差异均无统计学意义(P>0.05);患者HR、CVP、Pcv-aCO_2、ScvO_2、pH、BE、Lac、PaO_2/FiO_2比较,差异均有统计学意义(P<0.05);其中T6、T24的HR、Pcv-aCO_2、Lac低于T0,CVP、ScvO_2、pH、BE、PaO_2/FiO_2高于T0;T24的HR、Pcv-aCO_2、Lac低于T6,CVP、ScvO_2、BE、PaO_2/FiO_2高于T6,差异均有统计学意义(P<0.05)。T0、T6、T24时,Pcv-aCO_2与Lac、BE、pH均无直线相关关系(P>0.05)。T0、T6、T24时,Pcv-aCO_2与ScvO_2呈负相关(r=-0.755、-0.920、-0.858,P<0.05)。Pcv-aCO_2与6 hLac清除率、24 hLac清除率呈负相关(r=-0.365、-0.864,P<0.05)。4组患者T24时MAP、HR、Hb、Scr�
