目的探讨同型半胱氨酸(Hcy)、糖化血红蛋白(HbA1c)、脂蛋白相关磷脂酶(Lp-PLA2)水平与糖尿病周围血管病变的相关性。方法选择206例诊断为2型糖尿病(T2DM)的患者为研究对象,根据检查结果不同,将其分为正常组(颈动脉正常患者,116例)和粥...目的探讨同型半胱氨酸(Hcy)、糖化血红蛋白(HbA1c)、脂蛋白相关磷脂酶(Lp-PLA2)水平与糖尿病周围血管病变的相关性。方法选择206例诊断为2型糖尿病(T2DM)的患者为研究对象,根据检查结果不同,将其分为正常组(颈动脉正常患者,116例)和粥样斑块组(糖尿病伴颈动脉粥样斑块患者,90例)。分析T2DM患者各项指标与颈动脉内膜中层厚度(IMT)的相关性,记录血清学指标(HbA1c、Lp-PLA2、Hcy)及不良事件发生情况,探讨T2DM患者血管并发症的影响因素。探讨冠状动脉微循环阻力指数(IMR)与Lp-PLA2、Hcy的相关性,采用多因素Logistic回归分析探讨IMR升高的危险因素。结果粥样斑块组与正常组的超敏C反应蛋白(hs-CRP)和尿酸水平比较,差异有统计学意义(P<0.05);随访第6、12个月时,2组HbA1c、Lp-PLA2、Hcy指标比较,差异有统计学意义(P<0.05);粥样斑块组第6、12个月时不良事件发生率均高于正常组,差异有统计学意义(P<0.05)。T2DM患者血浆Lp-PLA2与总动脉、外动脉及双侧颈内动脉IMT呈显著正相关(P<0.01);尿酸与右颈总动脉、外动脉、内动脉IMT呈显著正相关(P<0.05);餐后2 h C肽水平与左颈外动脉、内动脉、右颈外动脉IMT呈显著正相关(P<0.05)。Lp-PLA2、hs-CRP是糖尿病血管并发症的主要影响因素。Hcy、Lp-PLA2与IMR呈显著正相关(P<0.01),冠状动脉血流储备(CFR)与IMR呈显著负相关(P<0.01)。IMR升高的危险因素为Hcy和年龄,保护因素为HDL-C、CFR(P<0.05)。结论HbA1c、Lp-PLA2、Hcy是糖尿病周围血管病变的独立影响因素。展开更多
目的研究苯扎氯铵与罂粟碱联合应用对血管吻合手术模型大耳白兔血管刺激因素的影响及意义,为血管吻合术的药物应用提供实验依据。方法选取36只新西兰大耳白兔,随机分为对照组(0.9%氯化钠溶液组,A组)、0.01%苯扎氯铵组(B组)、0.01%苯扎...目的研究苯扎氯铵与罂粟碱联合应用对血管吻合手术模型大耳白兔血管刺激因素的影响及意义,为血管吻合术的药物应用提供实验依据。方法选取36只新西兰大耳白兔,随机分为对照组(0.9%氯化钠溶液组,A组)、0.01%苯扎氯铵组(B组)、0.01%苯扎氯铵与罂粟碱联合用药组(C组)。制作血管吻合手术实验动物模型。分析3组实验动物术后动脉阻力指数、搏动指数、血液内皮素、一氧化氮浓度的变化。结果术后3组RI、PI均呈现减低、ET含量减少、NO含量增多的状态。术后6、12 h A组与B组比较差异无统计学意义(P>0.05),术后24 h A组与B组差异有统计学意义(P<0.05),术后6、12、24 h C组与A组和B组比较差异有统计学意义(P<0.05)。结论0.01%苯扎氯铵溶液与罂粟碱联合应用对血管壁刺激性较小,有利于血管断端血流恢复,有效降低血管阻力,能够更好的舒张血管,缓解血管痉挛,对防止血栓形成有一定帮助,对吻合口通畅起到保护作用,提高血管吻合手术的成功率;在血管吻合手术中联合应用0.01%苯扎氯铵溶液与罂粟碱术后疗效较好。展开更多
目的探讨血乳酸、血乳酸清除率(LCR)联合无创血流动力学监测预测慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭(RF)患者预后的临床价值。方法选择2022年1—12月收治的AECOPD合并RF 100例,入院后行常规治疗。统计28 d预后情况,分为预...目的探讨血乳酸、血乳酸清除率(LCR)联合无创血流动力学监测预测慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭(RF)患者预后的临床价值。方法选择2022年1—12月收治的AECOPD合并RF 100例,入院后行常规治疗。统计28 d预后情况,分为预后不良组(死亡)、预后良好组(存活)。比较2组临床资料、血流动力学指标[心脏指数(CI)、心排血量(CO)、血管阻力指数(SVRI)、每搏量(SV)]、血乳酸、LCR,分析预后不良影响因素,并分析血流动力学指标、血乳酸、LCR预测AECOPD合并RF患者预后的价值,进一步通过曲线下面积(AUC)、净重新分类指数(NRI)、综合判别改善指数(IDI)评价含与不含血流动力学指标、血乳酸、LCR预测方案的预测效果。结果100例AECOPD合并RF患者28 d病死率为29.00%(29/100)。预后不良组年龄、急性加重次数≥2次/年占比、治疗24 h SVRI和血乳酸、LCR<10%占比高于预后良好组,机械通气时间、住院时间长于预后良好组,治疗24 h CI、CO、SV低于预后良好组(P<0.01)。年龄、急性加重次数、机械通气时间、治疗24 h SVRI和血乳酸均为AECOPD合并RF患者预后不良的影响因素,治疗24 h CI、CO、SV及LCR为保护因素(P<0.01)。治疗24 h CI、CO、SVRI、SV、血乳酸及LCR预测预后不良的AUC为0.778、0.767、0.779、0.814、0.804、0.909。含血流动力学指标、血乳酸、LCR预测方案的AUC大于常规预测方案的AUC(P<0.05)。进一步通过NRI、IDI分析显示,与常规预测方案比较,含血流动力学指标、血乳酸、LCR预测方案的预测效果有明显改善(P<0.05)。结论血乳酸、LCR联合无创血流动力学监测在预测AECOPD合并RF患者预后方面具有良好效能。展开更多
BACKGROUND Sepsis usually causes hemodynamic abnormalities.Hemodynamic index is one of the factors to identify the severity of sepsis and an important parameter to guide the procedure of fluid resuscitation.The presen...BACKGROUND Sepsis usually causes hemodynamic abnormalities.Hemodynamic index is one of the factors to identify the severity of sepsis and an important parameter to guide the procedure of fluid resuscitation.The present study investigated whether the assessment of hemodynamic indices can predict the outcomes of septic patients undergoing resuscitation therapy.AIM To evaluate the prognostic value of hemodynamic indices in patients with sepsis after fluid resuscitation.METHODS A retrospective study was conducted in 120 patients with sepsis at Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University between October 2016 and October 2019.All patients were treated with sodium chloride combined with dextran glucose injection for fluid resuscitation.Patients’hemodynamic parameters were monitored,including heart rate(HR),cardiac index(CI),systemic vascular resistance index(SVRI),mean arterial pressure(MAP),central venous pressure(CVP),and central venous oxygen saturation.The prognostic value of hemodynamic indices was determined based on the prognosis status.RESULTS During fluid resuscitation,86 patients developed septic shock and 34 did not.Ninety-nine patients survived and 21 patients died at 28 d after the treatment.Heart rate,CI,mean arterial pressure,SVRI,and CVP were higher in patients with septic shock and patients who died from septic shock than in non-shock patients and patients who survived,and central venous oxygen saturation was lower in patients with shock and patients who died than in non-shock patients and thesurvivors (P < 0.05). When prognosis was considered as a dependent variable andhemodynamic parameters was considered as independent variables, the results ofa logistic regression analysis showed that CI, SVRI, and CVP were independentrisk factors for septic shock, and CI was an independent risk factor for 28-dmortality (P < 0.05).CONCLUSIONHemodynamic indices can be used to evaluate the prognosis of septic patientsafter fluid resuscitation.展开更多
文摘目的探讨同型半胱氨酸(Hcy)、糖化血红蛋白(HbA1c)、脂蛋白相关磷脂酶(Lp-PLA2)水平与糖尿病周围血管病变的相关性。方法选择206例诊断为2型糖尿病(T2DM)的患者为研究对象,根据检查结果不同,将其分为正常组(颈动脉正常患者,116例)和粥样斑块组(糖尿病伴颈动脉粥样斑块患者,90例)。分析T2DM患者各项指标与颈动脉内膜中层厚度(IMT)的相关性,记录血清学指标(HbA1c、Lp-PLA2、Hcy)及不良事件发生情况,探讨T2DM患者血管并发症的影响因素。探讨冠状动脉微循环阻力指数(IMR)与Lp-PLA2、Hcy的相关性,采用多因素Logistic回归分析探讨IMR升高的危险因素。结果粥样斑块组与正常组的超敏C反应蛋白(hs-CRP)和尿酸水平比较,差异有统计学意义(P<0.05);随访第6、12个月时,2组HbA1c、Lp-PLA2、Hcy指标比较,差异有统计学意义(P<0.05);粥样斑块组第6、12个月时不良事件发生率均高于正常组,差异有统计学意义(P<0.05)。T2DM患者血浆Lp-PLA2与总动脉、外动脉及双侧颈内动脉IMT呈显著正相关(P<0.01);尿酸与右颈总动脉、外动脉、内动脉IMT呈显著正相关(P<0.05);餐后2 h C肽水平与左颈外动脉、内动脉、右颈外动脉IMT呈显著正相关(P<0.05)。Lp-PLA2、hs-CRP是糖尿病血管并发症的主要影响因素。Hcy、Lp-PLA2与IMR呈显著正相关(P<0.01),冠状动脉血流储备(CFR)与IMR呈显著负相关(P<0.01)。IMR升高的危险因素为Hcy和年龄,保护因素为HDL-C、CFR(P<0.05)。结论HbA1c、Lp-PLA2、Hcy是糖尿病周围血管病变的独立影响因素。
文摘目的研究苯扎氯铵与罂粟碱联合应用对血管吻合手术模型大耳白兔血管刺激因素的影响及意义,为血管吻合术的药物应用提供实验依据。方法选取36只新西兰大耳白兔,随机分为对照组(0.9%氯化钠溶液组,A组)、0.01%苯扎氯铵组(B组)、0.01%苯扎氯铵与罂粟碱联合用药组(C组)。制作血管吻合手术实验动物模型。分析3组实验动物术后动脉阻力指数、搏动指数、血液内皮素、一氧化氮浓度的变化。结果术后3组RI、PI均呈现减低、ET含量减少、NO含量增多的状态。术后6、12 h A组与B组比较差异无统计学意义(P>0.05),术后24 h A组与B组差异有统计学意义(P<0.05),术后6、12、24 h C组与A组和B组比较差异有统计学意义(P<0.05)。结论0.01%苯扎氯铵溶液与罂粟碱联合应用对血管壁刺激性较小,有利于血管断端血流恢复,有效降低血管阻力,能够更好的舒张血管,缓解血管痉挛,对防止血栓形成有一定帮助,对吻合口通畅起到保护作用,提高血管吻合手术的成功率;在血管吻合手术中联合应用0.01%苯扎氯铵溶液与罂粟碱术后疗效较好。
文摘目的探讨血乳酸、血乳酸清除率(LCR)联合无创血流动力学监测预测慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭(RF)患者预后的临床价值。方法选择2022年1—12月收治的AECOPD合并RF 100例,入院后行常规治疗。统计28 d预后情况,分为预后不良组(死亡)、预后良好组(存活)。比较2组临床资料、血流动力学指标[心脏指数(CI)、心排血量(CO)、血管阻力指数(SVRI)、每搏量(SV)]、血乳酸、LCR,分析预后不良影响因素,并分析血流动力学指标、血乳酸、LCR预测AECOPD合并RF患者预后的价值,进一步通过曲线下面积(AUC)、净重新分类指数(NRI)、综合判别改善指数(IDI)评价含与不含血流动力学指标、血乳酸、LCR预测方案的预测效果。结果100例AECOPD合并RF患者28 d病死率为29.00%(29/100)。预后不良组年龄、急性加重次数≥2次/年占比、治疗24 h SVRI和血乳酸、LCR<10%占比高于预后良好组,机械通气时间、住院时间长于预后良好组,治疗24 h CI、CO、SV低于预后良好组(P<0.01)。年龄、急性加重次数、机械通气时间、治疗24 h SVRI和血乳酸均为AECOPD合并RF患者预后不良的影响因素,治疗24 h CI、CO、SV及LCR为保护因素(P<0.01)。治疗24 h CI、CO、SVRI、SV、血乳酸及LCR预测预后不良的AUC为0.778、0.767、0.779、0.814、0.804、0.909。含血流动力学指标、血乳酸、LCR预测方案的AUC大于常规预测方案的AUC(P<0.05)。进一步通过NRI、IDI分析显示,与常规预测方案比较,含血流动力学指标、血乳酸、LCR预测方案的预测效果有明显改善(P<0.05)。结论血乳酸、LCR联合无创血流动力学监测在预测AECOPD合并RF患者预后方面具有良好效能。
文摘BACKGROUND Sepsis usually causes hemodynamic abnormalities.Hemodynamic index is one of the factors to identify the severity of sepsis and an important parameter to guide the procedure of fluid resuscitation.The present study investigated whether the assessment of hemodynamic indices can predict the outcomes of septic patients undergoing resuscitation therapy.AIM To evaluate the prognostic value of hemodynamic indices in patients with sepsis after fluid resuscitation.METHODS A retrospective study was conducted in 120 patients with sepsis at Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University between October 2016 and October 2019.All patients were treated with sodium chloride combined with dextran glucose injection for fluid resuscitation.Patients’hemodynamic parameters were monitored,including heart rate(HR),cardiac index(CI),systemic vascular resistance index(SVRI),mean arterial pressure(MAP),central venous pressure(CVP),and central venous oxygen saturation.The prognostic value of hemodynamic indices was determined based on the prognosis status.RESULTS During fluid resuscitation,86 patients developed septic shock and 34 did not.Ninety-nine patients survived and 21 patients died at 28 d after the treatment.Heart rate,CI,mean arterial pressure,SVRI,and CVP were higher in patients with septic shock and patients who died from septic shock than in non-shock patients and patients who survived,and central venous oxygen saturation was lower in patients with shock and patients who died than in non-shock patients and thesurvivors (P < 0.05). When prognosis was considered as a dependent variable andhemodynamic parameters was considered as independent variables, the results ofa logistic regression analysis showed that CI, SVRI, and CVP were independentrisk factors for septic shock, and CI was an independent risk factor for 28-dmortality (P < 0.05).CONCLUSIONHemodynamic indices can be used to evaluate the prognosis of septic patientsafter fluid resuscitation.
