目的 研究氯胺酮能否降低咪达唑仑诱导急诊危重患者气管插管对血压的影响。 方法 将2010年6月－2011年12月收治的56例急诊危重呼吸衰竭成年患者，随机分成咪达唑仑+芬太尼（MF）组和咪达唑仑+氯胺酮（MK）组，气管插管前咪达唑仑0.05 mg/kg静脉注入，然后MF组芬太尼2 μg/kg静脉注入，MK组氯胺酮0.5 mg/kg静脉注入，待患者达镇静状态后实施气管插管。记录用药前和插管后10 min的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）的变化，观察低血压的发生情况。 结果 实施药物诱导气管插管后血压下降以MF组更明显（P＜0.01）。低血压发生率MF组为51.7%，MK组为18.5%，两组比较差异有统计学意义（χ2=6.715，P=0.01）。 结论 急诊危重患者气管插管应用氯胺酮可减少咪达唑仑所致低血压的发生率。
Objective To study the neural mechanism of hypotension or shock state in acute cholangitis in severe type (ACST) and its value of clinical application. Methods A technique of blocking abdominal splanchnic nervi via right adipose capsule of kidney was carried out on 28 patients by injecting 1% lidocaine before urgent operation. Results After blocking the relevant nervi, hypotension or shock state in 23 patients were improved significantly (Ｐ＜0.05). The death rate was lower (14.3%) after having performed biliary decompressions with laparotomy. Conclusion Patients′ hypotension or shock state at the early phase of ACST is the result of neural reflex in which the splanchnic nervi is its afferent pathway. Blocking the relevant nervi before urgent operation, the valuable opportunity of emergency treatment can be obtainded and the complication and death rate are reduced significantly.
ObjectiveTo observe the incidence of hypotension in general anesthesia patients in post anesthesia care unit (PACU), compare the blood pressure before and after treatment, and analyze hypotension causes. MethodBetween September 2012 and July 2013, data of 18 931 patients in PACU after general anesthesia were retrospectively analyzed for the incidence of hypotension. At the same time, the change of blood pressure was also detected before and after treatment. ResultsSixty-two patients had hypotension during the anesthesia recovery period after general anesthesia. The incidence was 0.33%. The proportion was the highest among patients who underwent abdominal surgery, reaching 41.9%. Systolic pressure and diastolic pressure improved significantly after treatment (P<0.05). ConclusionsIt is important to perform comprehensive evaluation of vital signs, closely observe disease conditions and vital sign changes, find out and manage low blood pressure for patients in PACU, which secure their safety.
In intensive care units (ICU), the occurrence of acute hypotensive episodes (AHE) is the key problem for the clinical research and it is meaningful for clinical care if we can use appropriate computational technologies to predict the AHE. In this study, based on the records of patients in ICU from the MIMICⅡclinical data, the chaos signal analysis method was applied to the time series of mean artery pressure, and then the patient's Lyapunov exponent curve was drawn ultimately. The research showed that a curve mutation appeared before AHE symptoms took place. This is powerful and clear basis for AHE determination. It is also expected that this study may offer a reference to research of AHE theory and clinical application.
ObjectiveTo identify the incidence of postintubation hypotension (PIH) in critically ill patients and evaluate the responsive risk factors and prognosis. MethodsThe data of intubation patients with normal blood pressure before intubation were collected and analyzed in Intensive Care Unit (ICU) in the latest two years and divided into two groups. One contained PIH patients and the other one contained patients with no change in blood pressure after intubation. The primary outcome measure was 28-day mortality and secondary outcome measure was length of stay (LOS) in ICU and hospital. ResultsThere were 25(31.65%) PIH patients in included 79 patients. The patients in PIH group had significantly higher 28-day mortality (40.00% vs 14.81%, P=0.01) and there were no difference in LOS in ICU and hospital. Risk factors were age (OR:1.1, 95% CI:1.00-1.12), chronic respiratory diseases (OR:3.0, 95% CI:1.13-8.07) and complication with over two chronic diseases (OR:3.6, 95% CI:1.18-11.03). ConclusionPIH is more common in old patients complicated with chronic diseases and results in higher 28-day mortality.
ObjectiveTo evaluate the effect of different rehydration strategies on the incidence of spinal anesthesia-induced hypotension and neonatal outcomes during elective cesarean section.MethodsWe searched PubMed, Embase, the Cochran Library, China National Knowledge Internet, VIP database, Wanfang database, and China Biology Medicine database from inception to January 2018, to collect randomized controlled trials (RCTs) about the incidence of spinal anesthesia-induced hypotension during elective cesarean section and neonatal outcomes of preloading or coloading. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias in the study. Meta-analysis was conducted using RevMan 5.3 software.ResultsA total of 11 RCTs were included, including 894 parturients, of whom 448 cases in the preload group and 446 cases in the coload group. Comparing with the preload group, the incidence of spinal anesthesia-induced hypotension during cesarean section in the coload group significantly decreased [risk ratio (RR)=1.27, 95% confidence interval (CI) (1.13, 1.43), P<0.000 1]. Subgroup analysis showed that in the crystalloid fluid group, the difference in the incidence of hypotension between the preload group and the coload group was statistically significant [RR=1.48, 95%CI (1.26, 1.73), P<0.000 01]; while in the colloidal fluid group, the difference in the the incidence of hypotension between the preload group and the coload group was not significant [RR=1.00, 95%CI (0.85, 1.17), P=0.96]. The lowest systolic blood pressure, the incidence of nausea and vomiting, and neonatal outcomes had no significant difference between the two groups.ConclusionsComparing with preloading crystalloid fluid, rapid infusion of crystalloid fluid at the same time implementation of spinal anesthesia could significantly reduce the incidence of hypotension during cesarean section while there was no superiority in infusion of colloid fluid. There was no significant effect on the severity of hypotension, nausea and vomiting, and neonatal outcomes. Due to the limitation of the quantity and quality of the included studies, the above conclusions need to be verified by more high-quality studies.
ObjectiveTo systematically review the relationship between frailty and risk of orthostatic hypotension.MethodsPubMed, EMbase, Web of Science, CNKI, CBM, VIP and WanFang Data databases were electronically searched to collect studies on the association between frailty and orthostatic hypotension from inception to July 7th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed by RevMan 5.3 software.ResultsFive cross-sectional studies involving 8 671 patients were included. The results of meta-analysis showed that prefrailty (OR=1.04, 95%CI 0.99 to 1.09, P=0.11) and frailty (OR=1.02, 95%CI=0.92 to 1.13, P=0.70) were not associated with orthostatic hypotension. The results of subgroup analysis showed that differences of sample size (<500 or ≥500), using different frailty assessment tools (Fried scale, clinical frailty scale, and frailty index), different regions (Europe, Asia, and America) and different sources of studied subjects (hospitals and communities), the risk of orthostatic hypotension were not increased with frailty.ConclusionsCurrent evidence shows that frailty does not increase the risk of orthostatic hypotension. Due to limited quality and quantity of included studies, the above conclusions are needed to be validated by more high-quality studies.