ObjectiveTo explore the pathogenesis, diagnosis and treatment of superior mesenteric artery syndrome (SMAS) complicated with Wernicke encephalopathy (WE). MethodsThe clinical data of 11 cases of SMAS patients complicated with WE were retrospectively analyzed. ResultsOf 9 SMAS patients complicated with WE, 8 patients were gradually awake and the time of consciousness recovery was from 7 d to 9 weeks (mean 5.2 weeks). Another 1 patient died of multiple organ failure attributed to severe condition. The symptoms of ophthalmopegia and ataxia in the rest 2 patients improved. All of symptoms such as ataxia, nystagmus, tinnitus, nausea, and sweating gradually disappeared. The nystagmus disappeared from 3 h to 4 d (mean 2.3 d) in five patients and the ataxia disappeared from 3 d to 12 weeks (mean 7.0 weeks) in 4 patients. The tinnitus, nausea, and sweating in 6 patients disappeared within 1 week. ConclusionImproving the understanding of SMAS complicated with WE is important during clinical practice and early diagnosis and intervention is the key point for a good prognosis.
Ｉｎ ｔｈｅ ａｃｕｔｅ ｈｅｍｏｒｒｈａｇｉｃ ｎｅｃｒｏｔｉｚｉｎｇ ｐａｎｃｒｅａｔｉｔｉｓ（ＡＨＮＰ）ｍｏｄｅｌ ｏｆ ｒａｔｓ ｉｎｄｕｃｅｄ ｂｙ ５％ ｓｏｄｉｕｍ ｔａｕｒｏｃｈｏｌａｔｅ，ａｆｔｅｒ ｔｒｅａｔｅｄ ｗｉｔｈ ｌｏｗ ｄｏｓｅ ｄｏｐａｍｉｎｅ〔５μｇ／（ｋｇ·ｍｉｎ）〕，ｔｈｅ ａｌｔｅｒｎａｔｉｏｎｓ ｏｆ ｍｅａｎ ａｒｔｅｒｉａｌ ｐｒｅｓｓｕｒｅ，ｐａｎｃｒｅａｔｉｃ ｍｉｃｒｏｆｌｏｗ，ｓｅｒｕｍ ａｍｙｌａｓｅ ａｎｄ ｌｉｐａｓｅ，ａｎｄ ｐａｎｃｒｅａｔｉｃ ｐａｔｈｏｈｉｓｔｏｌｏｇｙ ｗｅｒｅ ｓｔｕｄｉｅｄ．Ｔｈｅ ｒｅｓｕｌｔｓ ｓｈｏｗｅｄ ｔｈａｔ ｌｏｗ ｄｏｓｅ ｄｏｐａｍｉｎｅ ｃｏｕｌｄ ｉｎｃｒｅａｓｅ ｐａｎｃｒｅａｔｉｃ ｍｉｃｒｏｆｌｏｗ ｓｉｇｎｉｆｉｃａｎｔｌｙ ｗｈｉｌｅ ｍｅａｎ ａｒｔｅｒｉａｌ ｐｒｅｓｓｕｒｅ ｒｅｍａｉｎｅｄ ｓｔａｂｌｅ ｉｎ ｔｈｅ ｅａｒｌｙ ｓｔａｇｅ ｏｆ ＡＨＮＰ，ｉｔ ｃｏｕｌｄ ａｌｓｏ ｒｅｄｕｃｅ ｔｈｅ ｌｅｖｅｌｓ ｏｆ ｓｅｒｕｍ ａｍｙｌａｓｅ ａｎｄ ｌｉｐａｓｅ，ａｎｄ ａｍｅｌｉｏｒａｔｅ ｔｈｅ ｐａｔｈｏｌｏｇｉｃ ｓｅｖｅｒｉｔｙ ｏｆ ｐａｎｃｒｅａｔｉｔｉｓ．Ｔｈｅｓｅ ｓｕｇｇｅｓｔ ｔｈａｔ ｌｏｗ ｄｏｓｅ ｄｏｐａｍｉｎｅ ｃｏｕｌｄ ｂｅ ｕｓｅｄ ｔｏ ｔｒｅａｔ ｐａｎｃｒｅａｔｉｔｉｓ ｂｙ ｉｍｐｒｏｖｉｎｇ ｐａｎｃｒｅａｔｉｃ ｍｉｃｒｏｆｌｏｗ．
Objective To investigate whether pulse pressure variation( ΔPP) reflect the effects of PEEP and fluid resuscitation ( FR) on hemodynamic effects. Methods Twenty critical patients with acute lung injury was ventilated with volume control ( VT =8 mL/kg, Ti/Te = 1∶2) , and PaCO2 was kept at 35 to 45 mm Hg. PEEP was setted as 5 cm H2O and 15 cmH2O in randomized order. Hemodynamic parameters including cardiac index, pulse pressure, central venous pressure, etc. were monitered by PiCCO system.Measurements were performed after the application of 5 cmH2O PEEP ( PEEP5 group) and 15 cm H2OPEEP ( PEEP15 group) respectively. When the PEEP-induced decrease in cardiac index ( CI) was gt; 10% ,measurements were also performed after fluid resuscitation. Results Compared with PEEP5 group, CI was decreased significantly in PEEP15 group( P lt;0. 05) , and ΔPP was increased significantly( P lt; 0. 05) . In 14 patients whose PEEP-induced decrease in CI was gt; 10% , fluid resuscitation increased CI from ( 3. 01 ±0. 57) L·min - 1·m- 2 to ( 3. 62 ±0. 68) L·min- 1 ·m- 2 ( P lt;0. 01) , and decreased ΔPP from ( 17 ±3) % to ( 10 ±2) % ( P lt;0. 01) . PEEP15 -induced decrease in CI was correlated negatively with ΔPP on PEEP5 ( r= - 0.91, P lt;0. 01) and with the PEEP15 -induced increase in ΔPP ( r = - 0. 79, P lt;0. 01) . FR-induced changes in CI correlated with ΔPP before FR ( r =0. 96, P lt; 0. 01) and with the FR-induced decrease in ΔPP ( r= - 0. 95, P lt; 0. 01) . Conclusions In ventilated patients with ALI, ΔPP may be a simple anduseful parameter in predicting and assessing the hemodynamic effects of PEEP and FR.
Objective To compare the perfusion pressure between cardiopulmonary bypass (CPB) through improved intubations of femoral artery-vein and routine identical flow on organic perfusion such as brain, lung, liver, kidney, intestines, etc.. Methods Twenty dogs with body weight from 10-15kg were randomly divided into two groups: thoracoscope group(n=10): CPB was set up by the right femoral artery-vein for completely video assisted cardiac operations; routine thoracotomy group(n=10): CPB was set up by the aorta-caval vein. The perfusion pressure of innominate artery, left common carotid artery, superior mesenteric artery, renal artery, homonymic and opposite side popliteal artery and the pressure of concomitant vein were measured at the following time points: instantly after induction of anesthesia (T1) , before aortic clamping (T2) , fifteen minutes after aortic clamping (T3) , fifteen minutes after aortic opening (T4) , twenty minutes after stop (T5) . The venous blood samples were collected at the preceding time points and venous oxygen saturation (SvO2) were measured. Results There were no significant difference between both groups in arterial perfusion pressure, besides perfusion pressure of homonymic popliteal artery in thoracoscope group was lower than that in routine thoracotomy group (Plt;0. 01) . Before aortic clamping, fifteen minutes after aortic clamping and fifteen minutes after aortic opening, venous pressure of renal vein, superior mesenteric vein, homonymic and opposite side popliteal vein in thoracoscope group were higher than those in routine thoracotomy group (Plt;0. 05) . SvO2 of renal vein, superior mesenteric vein, homonymic and opposite side popliteal vein in thoracoscope group were lower than those in routine thoracotomy group (Plt;0. 05) . Conclusion The improved femoral CPB has a similar perfusion pressure with routine CPB and a higher vein pressure than routine CPB below inferior vena cava after aortic intubations. So this experiment provides theoretical evidence for the organic protection of infants’ thoracoscopic extracorporeal circulation.
Objective\ To investigate the clinical significance of measuring central venous pressure in patients after cardiac surgery.\ Methods\ Twenty four patients in postoperative cardiac surgery were randomly chosen, and investigated under three fettles:(1) The patients were sent into intensive care unit on mechanical ventilation; (2) They were all conscious and on mechanical ventilation 8 hours after operation; (3) 24 hours after operation, the patients were conscious with normal breathing.
Objective To observe the survival rate of reversed-flow free flap after anastomosing one venous reverse flow and to explore the change of intravenous pressure and mechanism of venous reverse flow. Methods Thefree vascularized posterior tibial flap with reversed flow was successfully established in NewZealand white rabbits.Fifteen rabbits were randomly allocated into 3 groups of 30 flaps. In group A,two vena comitans were anastomosed.In groups B and C,only onevenae comitans was anastomosed. In groups A and B,intravenous pressure was measured immediately and 30,60 and 120 minutes after anastomosing the vascular pedicle.Flap survival rate of group B was measured after two weeks. In group C, radiography of one venae comitans was observed.The diameters of posterior tibial vessels was measured on all the rabbits before anastomosing the vascular pedicle. Results The diameters of posterior tibial artery was 8.0±0.3mm and of vena comitans was 11.0±0.5 mm。The intravenous pressure of group B increased rapidly and reached its top value after about 30 minutes (P＜0.05).It then decreased and approached normal level after about 60 minutes (Pgt;0.05).The intravenous pressure was not significantly different between groups A and B in each time interval (Pgt;0.05).Two flapsresulted in avulsion,infection and necrosis.The remaining 8 flaps survived completely.Most of the radiopaque in group C flew back to the proximal tibia one hourlater. Conclusion Venous retrograde return is abundant in reverseflow free flap of anatomosing one vena comitans.The main way of venous reflux in reverseflow free flap can be through “direct incompetent valve route”.
【摘要】 目的 分析成都地区中老年居民脉压（pulse pressure， PP）及脉压指数（pulse presure index，PPI）与高尿酸血症（hyperuricemia，HUA）的关系。 方法 利用2007年5月代谢综合征研究调查资料（共1 061人），依据PP[≤60 mm Hg（1 mm Hg=0.133 kPa）、gt;60 mm Hg]和PPI（≤0.450、gt;0.450）将人群分为正常组及增高组，分析两组人群尿酸水平及HUA患病率，采用单因素回归及logistic回归分析PP及PPI与HUA关系。 结果 ①PP/PPI增高组血浆尿酸水平明显高于PP/PPI正常组，差异有统计学意义（P=0.000）。②PP/PPI增高组HUA患病率明显高于PP/PPI正常组，差异有统计学意义（P=0.026、0.027）。③单因素回归和logistic回归分析皆提示PP及PPI与HUA呈正相关。 结论 成都地区PP及PPI与血浆尿酸水平关系密切，PP/PPI增高可能是HUA的危险因素。【Abstract】 Objective To evaluate the relationship between pulse pressure (PP), pulse pressure index (PPI) and hyperuricemia (HUA) among middle-aged and aged residents in Chengdu. Methods Based on the level of PP [≤60 mm Hg (1 mm Hg=0.133 kPa),gt;60 mm Hg] and PPI (≤0.450,gt;0.450), We divided the 1 061 middle-aged or aged people into normal PP/PPI group and augmented PP/PPI group. All patients came from the survey for metabolic syndrome study in May 2007. We analyzed the distribution of serum uric acid (UA) and HUA, and analyzed the relationship between PP, PPI and HUA by using single-factor and logistic regression analysis. Results The index of UA in the augmented PP/PPI groups was higher than that in the normal groups with a significant difference (P=0.000). The prevalence of HUA in the augmented PP/PPI groups was statistically higher than that in the normal groups (P=0.026, 0.027). Single-factor and logistic regression analysis showed that PP and PPI were both positively correlated to HUA. Conclusion The abnormalities of PP and PPI are closely related to metabolism disorder in Chengdu, and high level of PP or PPI is probably risk factors for HUA.
目的:探讨24 h平均脉压(PP)对高血压病患者左心室肥厚(LVH)的影响。方法:入选原发性高血压病患者136 例,进行24 h 动态血压监测和超声心动图检查。根据24 h 平均脉压水平各分为3组进行比较。结果:24 h平均脉压与年龄、左心室重量指数、动脉僵硬度指数有显著的相关性。结论:脉压升高是老年高血压病患者左心室肥厚的重要危险因素。