Objective To observe the effect of ophthalmotonus intervention on ocular hemodynamics in patients with ischemic ophthalmopathy (IOP). Methods 106 IOP patients (106 eyes) were enrolled in this study, including 74 eyes with nonarteritic anterior ischemic optic neuropathy (NAION), 20 eyes with retinal artery occlusion (RAO) and 12 eyes with ocular ischemia syndrome (IOS). The patients were randomly divided into ophthalmotonus intervention group and control group. There were 37 NAION eyes, 10 RAO eyes and six IOS eyes in each group. The patients of ophthalmotonus intervention group received lowering intraocular pressure treatment in addition to the basic therapy to reduce the intraocular pressure to le;12 mm Hg (1 mm Hg=0.133 kPa) or decreased by 7-8 mm Hg, or in a 20%-30% reduction. The patients of control group avoided lowering intraocular pressure treatment. The arm-retinal circulation time (A-RCT) and the peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index (RI) of ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (PCA) before and one week after treatment were comparatively analyzed by fluorescence fundus angiography (FFA) and color Doppler flow imaging. Results The differences of A-RCT before treatment in ophthalmotonus intervention group and control group in NAION, RAO and IOS patients were not statistically significant (t=0.869, 0.119, 0.000; P＞0.05). The differences of PSV (OA:t=0.586, 0.040, 0.067; CRA:t=0.285, 0.057, 0.775; PCA:t=0.658, 0.653, 1.253), EDV (OA:t=0.274, 0.080, 0.093; CRA:t=0.781, 0.077, 0.277; PCA:t=0.200, 0.209, 0.299) and RI (OA:t=0.121, 0.153, 0.138; CRA:t=0.172, 0.242, 0.642; PCA:t=1.053, 1.066, 0.266) of OA, CRA and PCA before treatment in ophthalmotonus intervention group and control group were not statistically significant (P＞0.05). Compared with control group, A-RCT shortened obviously (t=2.573, 2.236, 2.607; P＜0.05) in ophthalmotonus intervention group one week after treatment. Compared with control group, PSV (OA:t=2.367, 2.368, 2.267; CRA:t=0.775, 1.927, 2.775; PCA:t=2.253, 2.353, 2.353) and EDV (OA:t=2.303, 2.236, 2.503; CRA: t=2.277, 2.377, 2.577; PCA:t=2.299, 2.399, 2.299) of OA, CRA and PCA increased obviously (P＜0.05), RI of OA, CRA and PCA decreased obviously (OA:t=2.238, 2.387, 2.228; CRA:t=2.342, 2.442, 2.542; PCA:t=2.266, 2.366, 2.266; P＜0.05) one week after treatment in treatment group. Conclusion Ophthalmotonus intervention can improve the ocular hemodynamics in IOP patients.
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.
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 evaluate the occurrence of nocturnal hypotension (NHP) in nonarteritic anterior ischemic optic neuropathy (NAION). MethodsA evidence-based medicine study. Chinese and English as search terms for NAION and NHP was used to search literature in PubMed of National Library of Medicine, Embase, Web of science, Cochrane Library, Clinical Trials, Wanfang, and China National Knowledge Infrastructure and China Biology Medicine disc. Incomplete or irrelevant literature and review literature were excluded. The literature was meta-analyzed using Review Manager 5.4 and STATA 15.0. The 95% confidence interval (CI) were selected as the estimated value of effect size, the occurrence of NHP in NAION was calculated, and sensitivity analysis and publication bias analysis were also performed to assess the robustness of pooled outcomes. ResultsAccording to the search strategy, 159 articles were initially retrieved, and 8 articles were finally included for meta-analysis, three prospective studies and five retrospective studies. The occurrence of NHP in NAION was 43% (95%CI, 0.36-0.50). Sensitivity analyses confirmed that the evidence was robust. Subgroup analyses showed that the occurrence of NHP in NAION nearly the same in White patients (47%, 95%CI 0.39-0.55) and Chinese patients (41%, 95%CI 0.32-0.51). The occurrence of NHP in NAION was higher in using night mean artery pressure (45%, 95%CI 0.31-0.60) as the diagnostic criteria than using night systolic blood pressure & night diastolic blood pressure (40%, 95%CI 0.32-0.50). ConclusionsThe occurrence of NHP in NAION was 43%; the occurrence was similar in patients of different ethnicities. The diagnosis rate could be improved by using nMAP ＜ 70 mm Hg (1 mm Hg=0.133 kPa) as a diagnostic criterion for NHP. Careful intervention should be taken for the blood pressure of patients with NAION and NHP.