Hemodynamics

摘要： BACKGROUND Thoracic surgery for radical resection of lung tumor requires deep anesthesia which can lead to an adverse inflammatory response,loss of hemodynamic stability,and decreased immune function.Herein,we evaluated the feasibility and benefits of ultrasound-guided paravertebral nerve block anesthesia,in combination with general anesthesia,for thoracic surgery for lung cancer.The block was performed by diffusion of anesthetic drugs along the paravertebral space to achieve unilateral multi-segment intercostal nerve and dorsal branch nerve block.AIM To evaluate the application of ultrasound-guided paravertebral nerve block anesthesia for lung cancer surgery to inform practice.METHODS The analysis was based on 140 patients who underwent thoracic surgery for lung cancer at our hospital between January 2018 and May 2020.Patients were randomly allocated to the peripheral+general anesthesia(observation)group(n=74)or to the general anesthesia(control)group(n=66).Patients in the observation group received ultrasound-guided paravertebral nerve block anesthesia combined with general anesthesia,with those in the control group receiving an epidural block combined with general anesthesia.Measured outcomes included the operative and anesthesia times,as well as the mean arterial pressure(MAP),heart rate(HR),and blood oxygen saturation(SpO;)measured before surgery,15 min after anesthesia(T1),after intubation,5 min after skin incision,and before extubation(T4).RESULTS The dose of intra-operative use of remifentanil and propofol and the postoperative use of sufentanil was lower in the observation group(1.48±0.43 mg,760.50±92.28 mg,and 72.50±16.62 mg,respectively)than control group(P0.05).Postoperative levels of epinephrine,norepinephrine,and dopamine used were significantly lower in the observation than control group(210.20±40.41 pg/mL,230.30±65.58 pg/mL,and 54.49±13.32 pg/mL,respectively;P0.05).CONCLUSION Ultrasound-guided paravertebral nerve block anesthesia improved the stress and hemodynamic response in patients undergoing thoracic surgery for lung cancer,with no increase in the rate of adverse events.

摘要： Capillary leak syndrome(CLS)is a rare clinical syndrome associated with significant morbidity and mortality.Intensive care and supportive therapy constitute the mainstay of the treatment,along with judicious use of crystalloids and colloids such as dextran and starch during the leak phase.The advantages of proning,steroids,and intravenous immunoglobins are worth contemplating in patients with such a presentation.Extracorporeal membrane oxygenation appears to be an excellent strategy to surmount the impediments of the leak and post leak phase of CLS,especially in patients with severe or refractory hypoxemia.

摘要： BACKGROUND Acute respiratory distress syndrome(ARDS)is an acute,diffuse,inflammatory lung injury.Previous studies have shown prone position ventilation(PPV)to be associated with improvement in oxygenation.However,its role in patients with ARDS caused by sepsis remains unknown.AIM To analyze the clinical effects of PPV in patients with ARDS caused by sepsis.METHODS One hundred and two patients with ARDS were identified and divided into a control group(n=55)and a PPV treatment group(n=47).Outcomes included oxygenation index,lung compliance(Cst)and platform pressure(Pplat),which were compared between the two groups after ventilation.Other outcomes included heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),left ventricular ejection fraction(LVEF),the length of mechanical ventilation time and intensive care unit(ICU)stay,and levels of C-reactive protein(CRP),procalcitonin(PCT),and interleukin-6(IL-6)after ventilation.Finally,mortality rate was also compared between the two groups.RESULTS On the first day after ventilation,the oxygenation index and Cst were higher and Pplat level was lower in the PPV group than in the conventional treatment group(P0.05).There were no significant differences in HR,MAP,CVP,LVEF,duration of mechanical ventilation and ICU stay,and the levels of CRP,PCT,and IL-6 between the two groups on the first day after ventilation(all P>0.05).The mortality rates on days 28 and 90 in the PPV and control groups were 12.77% and 29.09%,and 25.53% and 45.45%,respectively(P<0.05).CONCLUSION PPV may improve respiratory mechanics indices and may also have mortality benefit in patients with ARDS caused by sepsis.Finally,PPV was not shown to cause any adverse effects on hemodynamics and inflammation indices.

摘要： Background : In many animal experiments, it is vital to detect sudden changes in cardiac output(CO). This porcine study compared CO that was measured with a SwanGanz pulmonary catheter with the gold standard(which was a transit-time flow probe around the pulmonary artery) during interventions that caused hemodynamic instability.Methods : In one series, 7 pigs were exposed to sudden changes in CO. In another series, 9 pigs experienced more prolonged changes in CO. All the pigs had a Swan-Ganz catheter placed into the pulmonary artery and a flow probe around the pulmonary artery. Adrenaline infusion and controlled hemorrhage were used to increase and decrease CO, respectively. The measurements of CO before and after each intervention were compared for correlation, agreement, and the time delay that it took each method to detect at least a 30% change in CO. A Bland– Altman test was used to identify correlations and agreements between the methods.Results : In the first series, there was a delay of 5– 7 min for the Swan Ganz catheter to register a 30% change in cardiac output, compared with the flow probe. However,during prolonged changes in CO in the second series, there was a good correlation between the 2 methods. Mixed venous oxygen saturation reacted faster to changes than did CO;both were measured via the Swan-Ganz catheter.Conclusions : In many animal studies, the use of Swan-Ganz catheters is suitable;however, in experiments with sudden hemodynamic instability, the flow probe is the most advantageous method for measuring CO.

摘要： Endothelial cells(ECs)that reside on the surface of blood vessels are constantly exposed to mechanical stimulation,including shear stress.Fluid shear stress(FSS)controls multiple physiological processes in ECs,regulating various pathways that maintain vascular tone and homeostasis function.The complexity of in vivo biological systems raises a demand for better in vitro techniques,which can generate FSS to closely mimic the cellular microenvironment.Through the rational design and use of flow chamber devices,in vitro fluidic systems are critical for a deeper understanding of endothelial responses to various shear conditions.The paper describes principal types of FSS systems,including functional attributes,development process and recent experiments on ECs.Finally,we prospect their possible contribution in the field of endothelial diseases.

摘要： BACKGROUND Heart failure is generally regarded as a progressive and irreversible medical condition.The EVAHEART is an implantable left ventricular assist system.CASE SUMMARY We report the anesthesia management of a 56-year-old male patient with dilated cardiomyopathy undergoing an EVAHEART implantation.Transesophageal echocardiography is crucial to ensure the correct positioning of the device and the proper aortic valve outflow.Because the continuous blood flow device functions best under low systemic and pulmonary vascular resistance,milrinone is the preferred drug.Our patient was accompanied by pulmonary hypertension,so during the operation,nitric oxide was used to reduce pulmonary artery pressure.CONCLUSION The cardiac output achieved by the patient with the assistance of EVAHEART can reach 4 L/min,which of course depends on the front load,rear load,and pump speed.

摘要： Cardiovascular diseases have become a serious threat to human health now.With the rapid development of computer technology and medical imaging technology,the method of numerical simulation has become the main tool to explore the mechanism of cardiovascular diseases and to optimize the treatment planning.The cardiovascular system is a complex vascular network with multiscale characteristics,and the local hemodynamic phenomena in blood vessels is closely related to the overall blood flow distribution of the system.The hemodynamic characteristics in the local vessel and circulation system influences each other.Therefore,the traditional single-scale modeling method cannot accurately describe the real blood flow in blood vessels.While the numerical simulation of multiscale coupling model can effectively solve this problem.In this paper,the main methods of hemodynamic modeling in recent years are summarized,including lumped parameter model(0D model),distributed parameter model(1D model)and finite element model of(3D model),and their applications in cardiovascular studies.On this basis,the principles of several commonly used multiscale coupling models and their applications in cardiovascular disease researches and clinical practice are introduced,including 1D-0D,3D-0D,and 3D-1D coupling model.

摘要： Stent deployments with residual stenosis(RS)were linked to increased risk of in-stent restenosis and thrombosis.The objective of the present work was to explore the underlying biomechanical mechanism(s)for adverse events with RS.The patient-specific carotid models with RS were constructed to investigate wall shear stress(WSS),velocity,relative residence time(RRT),and oscillating shear index(OSI)after stenting in the host artery.The results showed that stented artery accompanied by RS would result in evident vortex,stagnation and recirculation zone at the stenosis throat,where relatively more areas were at abnormal low level of TAWSS,high level of RRT and OSI.Moreover,effects of stenting with RS on velocity,WSS,RRT and OSI in host artery would be significantly enhanced by severe RS,long stent and common carotid artery(CCA)stenting.These results indicated that stenting with RS might aggravate adverse flow around the stent and the other region without stent,leading to increased adverse events in clinic.Therefore,to obtain better poststenting outcomes,stenting with RS requires caution and careful consideration,especially for the host artery with a severe RS,long stent and some locations of stenting.

摘要： BACKGROUND Bacterial translocation exacerbates the hyperdynamic circulation observed in cirrhosis and contributes to a more severe disease course.Probiotics may reduce bacterial translocation and may therefore be useful to redress the circulatory imbalance.AIM To investigate the effect of probiotics on hemodynamic parameters,systemic inflammation,and complications of cirrhosis in this randomized placebocontrolled trial.METHODS This single-blind randomized placebo-controlled study included 40 patients with Child-Pugh class B and C cirrhosis;24 patients received probiotics(Saccharomyces boulardii)for 3 mo,and 16 patients received a placebo over the same period.Liver function and the systemic hemodynamic status were evaluated pre-and postintervention.Echocardiography and simultaneous blood pressure and heart rate monitoring were performed to evaluate systemic hemodynamic indicators.Cardiac output and systemic vascular resistance were calculated.RESULTS Following a 3-mo course of probiotics in comparison to the control group,we observed amelioration of hyperdynamic circulation[a decrease in cardiac output(P=0.026)and an increase in systemic vascular resistance(P=0.026)]and systemic inflammation[a decrease in serum C-reactive protein levels(P=0.044)],with improved liver function[an increase in serum albumin(P=0.001)and a decrease in the value of Child-Pugh score(P=0.001)]as well as a reduction in the severity of ascites(P=0.022),hepatic encephalopathy(P=0.048),and cholestasis[a decrease in serum alkaline phosphatase(P=0.016)and serum gamma-glutamyl transpeptidase(P=0.039)activity]and an increase in platelet counts(P<0.001)and serum sodium level(P=0.048).CONCLUSION Probiotic administration was associated with amelioration of hyperdynamic circulation and the associated complications of cirrhosis.

摘要： BACKGROUND Mechanical ventilation can lead to the severe impairment of the metabolic pathway of alveolar surfactants,inactivating alveolar surfactants and significantly reducing lung-chest compliance.The cardiopulmonary function of elderly patients usually reduced to a certain extent,and there are lung complications after surgical anesthesia,just like lung barotrauma caused by mechanical ventilation,atelectasis and postoperative hypoxemia.AIM To investigate the effects of different positive end expiratory pressures(PEEPs)and tidal volumes(VTs)on respiratory function,the degree of the inflammatory response and hemodynamic indexes in patients undergoing surgery under general anesthesia.METHODS A total of 120 patients undergoing surgery for gastric or colon cancer under general anesthesia in Xinghua People's Hospital from January 2017 to January 2021 were randomly divided into Group A and Group B,with 60 cases in each group.The ventilation mode in Group A was VT(6.0 mL/kg)+PEEP(5.0 cmH2 O),while that in Group B was VT(6.0 mL/kg)+PEEP(8.0 cmH2O).Blood gas parameters,respiratory mechanical parameters,inflammatory response indicators,hemodynamic indicators and related complications were compared between the two groups.RESULTS There were no significant differences in PaCO_(2),PaO_(2),oxygen or the examined indexes at T0 between group A and group B(P>0.05).The measured PaO_(2)value of patients in group A at T3 was higher than that in group B,and the difference was significant(P0.05).The measured Ppeak value of patients in group A at T1 was higher than that in group B,and the difference was significant(P0.05).After 4 h,the measured values of TNF-αand IL-6 in group A were lower than those in group B,and the differences were significant(P0.05).The measured values of CI and SVI at T2 in patients in group A were higher than those in group B,and the differences were significant(P<0.05).CONCLUSION For patients undergoing surgery for gastric or colon cancer under general anesthesia,the VT(6.0 mL/kg)+PEEP(5.0 cmH2O)regimen was more effective than the VT(6.0 mL/kg)+PEEP(8.0 cmH2O)regimen in protecting the lung function and ventilatory function of patients,and it had better effects on maintaining hemodynamic stability and reducing inflammatory reactions.