Portal hypertension and cirrhosis are associated with severe hemodynamic changes in hepatic and systemic circulation in the adult population.During cirrhosis progression,circulation becomes hyperdynamic,with cardiac,p...Portal hypertension and cirrhosis are associated with severe hemodynamic changes in hepatic and systemic circulation in the adult population.During cirrhosis progression,circulation becomes hyperdynamic,with cardiac,pulmonary and renal consequences.Cirrhotic adults also present with cirrhotic cardiomyopathy,with systolic and diastolic dysfunction and electrophysiological abnormalities.This article provides an update on normal liver hemodynamics,a brief reminder of the liver and systemic hemodynamics in cirrhotic adults,and a description of liver and systemic hemodynamics in cirrhotic children.This review attempts to clarify whether liver and systemic hemodynamics are altered in cirrhotic children like they are in adults.The characterization of these hemodynamic disturbances could contribute to a better understanding of hepatic and systemic physiopathology in pediatric cirrhosis.展开更多
Background:Congenital heart disease(CHD)occurs in 9out of 100 births and is the leadingcatuse of birth defects,with acyanotic CHD being more common.The incidence of adult CHD is risingfaster than pediatric CHD.Pulmona...Background:Congenital heart disease(CHD)occurs in 9out of 100 births and is the leadingcatuse of birth defects,with acyanotic CHD being more common.The incidence of adult CHD is risingfaster than pediatric CHD.Pulmonary hypertension is the most common complication in untreated CHDpatients.Methods:This study is retrospective descriptive research based on medical record data andthe results of right heart catheterization exanninations in adult acyanotic CHD aged>18 years and freefrom other organ disorders.Results:A total of 103 patients met the inclusion criteria,the majority wereyoung adults and predominantly fernale.The median height of 155.0 cm(IQR:150.0-160.0),the meanweight was 49.6 kg±10.7 kg,and BSA of 1.4 m2±0.1 m^(2).Most patients had a normal BMI status andwere classified as WHO-FC II.Herodynamic findings included a median PARI of 13.5 WU/m^(2)(IQR4.5-29.6),RAP 7.0 mmHg(IQR:5.0-11.0),mPAP 56.0 mmHg±23.5 mmHg,LVEDP 9.5 mmHg±3.9 mmHg,PVR 12.6 WU±11.0 WU,PVR/SVR 0.5 WU±0.4 WU,pulmonary artery saturation 74.0%±12.1%,aorticsaturation 88.1%±7.8%,mixed venous saturation 59.0%±10.1%.Conclusions:This study providescomprehensive data on the demographic characteristics and henodynamic parameters of patients withCHD and pulmonary hypertension.As a hospital-based registry,this study offers valuable insights into theclinical profile of adult CHDpatients at Dr.Hasan Sadikin GeneralHospital,Bandung,.展开更多
BACKGROUND Few studies have quantified invasive hemodynamic parameters in post heart transplant recipients.AIM To report the incidence of abnormal hemodynamics in heart transplant recipients at 1-year and 3-year post-...BACKGROUND Few studies have quantified invasive hemodynamic parameters in post heart transplant recipients.AIM To report the incidence of abnormal hemodynamics in heart transplant recipients at 1-year and 3-year post-transplant and determine if there was any correlation with recipient and donor characteristics.METHODS Data from 279 consecutive heart transplant recipients from 2007 through 2020 were analyzed.Clinical variables regarding both recipients and donors as well as hemodynamic variables obtained via right heart catheterization during 1-year and 3-year annual testing were recorded.Simple and multiple linear regression tests were used to determine how recipient and donor variables influenced hemodynamic parameters at 1-year and 3-year.RESULTS Data were available for 260 patients and 224 patients at 1-year and 3-year posttransplant respectively.At 1-year,abnormal hemodynamic parameters were common with 24%patients having right atrial pressure(RAP)>10 mmHg,52%with mean pulmonary artery pressure>20 mmHg,and 12%with pulmonary capillary wedge pressure(PCWP)>18 mmHg.Similar abnormalities were noted at 3-year post-transplant.Recipient body mass index(BMI)demonstrated the strongest correlation with all 3 variables at both 1-year and 3-year by multivariate linear regression analysis(P<0.001 for both).Both donor age and predicted heart mass difference between recipient and donor were significantly linked to RAP and PCWP at 1-year but did not predict any variables at 3-year post-transplant.CONCLUSION Abnormal hemodynamics are common at 1-year and 3-year post-transplant and are associated with recipients with high BMI.展开更多
BACKGROUND Septic shock represents one of the most severe critical illness types,characterized by significant hemodynamic disorders and neuropsychiatric symptoms.This study aimed to investigate the association mechani...BACKGROUND Septic shock represents one of the most severe critical illness types,characterized by significant hemodynamic disorders and neuropsychiatric symptoms.This study aimed to investigate the association mechanism between hemodynamic indicators and neuropsychiatric symptoms in patients with septic shock,revealing potential pathophysiological connections.AIM To investigate the link between hemodynamic parameters and neuropsychiatric symptoms in septic shock.METHODS A retrospective case-control study involving 132 patients with septic shock.Multiple assessment tools were employed,including the Confusion Assessment Method,Hospital Anxiety and Depression Scale,Posttraumatic Stress Disorder Scale,and Mini-Mental State Examination,systematically evaluating patients’neuropsychiatric symptoms and hemodynamic indicators.RESULTS Patient mean age was 52.4±12.3 years,with 68.5%males.Multivariate analysis revealed significant correlations between neuropsychiatric symptom severity and mean arterial pressure<65 mmHg[odds ratio(OR)=2.7],lactate levels>4 mmol/L(OR=3.1),and elevated interleukin-6 inflammatory factors(OR=2.4).Neuropsychiatric symptom incidence rates were:Delirium 37.1%;anxiety 28.8%;depression 24.2%;and posttraumatic stress disorder 19.7%.CONCLUSION Hemodynamic disorders in patients with septic shock are closely associated with neuropsychiatric symptoms,influencing central nervous system function through complex inflammatory and neurotransmitter pathways.展开更多
Objective:This study primarily analyzes the effectiveness of thermal insulation nursing(empowered by temperature intervention)in urological stone patients during the general anesthesia recovery period.Methods:A total ...Objective:This study primarily analyzes the effectiveness of thermal insulation nursing(empowered by temperature intervention)in urological stone patients during the general anesthesia recovery period.Methods:A total of 76 urological stone patients who underwent surgical treatment as the preferred option were selected as the research subjects.The earliest consultation time was May 2024,and the latest was May 2025.The patients were randomly divided into two groups using the random number table method,namely the observation group and the control group,with 38 patients in each group.The intervention indicators of the patients were compared.Results:The overall satisfaction rate in the observation group was higher than that in the control group,and the incidence of adverse reactions was lower,with p<0.05.At 0.5 hours,1 hour after surgery,and at the end of surgery,the body temperature in the observation group was significantly different from that in the control group,with p<0.05.Postoperatively,various hemodynamic indicators in the observation group were significantly different from those in the control group,with p<0.05.The time to clench the first upon verbal command,the time to open the eyes upon verbal command,the extubating time,and the recovery retention time in the observation group were all shorter than those in the control group,with p<0.05.Postoperative stress indicators and agitation scores at different time points in the observation group were significantly different from those in the control group,with p<0.05.Conclusion:For urological stone patients during the general anesthesia recovery period,actively implementing thermal insulation nursing combined with temperature intervention not only enhances hemodynamic stability but also effectively reduces the risk of adverse reactions such as hypothermia and shivering.It optimizes the recovery condition,significantly improves the stress state,and increases nursing satisfaction.展开更多
Veno-arterial extracorporeal membrane oxygenation(VA-ECMO)is a life support intervention for patients with refractory cardiogenic shock or severe cardiopulmonary failure.However,the choice of cannulation strategy rema...Veno-arterial extracorporeal membrane oxygenation(VA-ECMO)is a life support intervention for patients with refractory cardiogenic shock or severe cardiopulmonary failure.However,the choice of cannulation strategy remains contentious,partly due to insufficient understanding of hemodynamic characteristics associated with the site of arterial cannulation.In this study,a geometrical multiscale model was built to offer a mathematical tool for addressing the issue.The outflow cannula of ECMO was inserted into the ascending aorta in the case of central cannulation,whereas it was inserted into the right subclavian artery(RSA)or the left iliac artery(LIA)in the case of peripheral cannulation.Numerical simulations conducted on three patient-specific aortas demonstrated that the central cannulation outperformed the two types of peripheral cannulation in evenly delivering ECMO flow to branch arteries.Both the central and RSA cannulations could maintain an approximately normal hemodynamic state in the aortas,although the area of aortic walls exposed to abnormal wall shear stress(WSS)was considerably enlarged in comparison with the normal physiological condition.In contrast,the LIA cannulation not only led to insufficient delivery of ECMO flow to the right upper body(with ECMO flow fractions<0.5),but also induced marked flow disturbance in the aorta,causing about 40%of the abdominal aortic wall and over 65%of the resting aortic wall to suffer from high time-averaged WSS(>5 Pa)and low time-averaged WSS(<0.4 Pa),respectively.The LIA cannulation also resulted in significantly prolonged blood residence time(>40 s)in the ascending aorta,which,along with abnormal WSS,may considerably increase the risk of thrombosis.In summary,our numerical study elucidated the impact of arterial cannulation site in VA-ECMO intervention on aortic hemodynamics and ECMO flow distribution.The findings provide compensatory biomechanical information for traditional clinical studies and may serve as a theoretical reference for guiding the evaluation and selection of cannulation strategies in clinical practice.展开更多
Portal vein stenosis is one of the common complications after liver transplantation in children.Accurate hemodynamic assessment is crucial for predicting the risk of complications after liver transplantation.In order ...Portal vein stenosis is one of the common complications after liver transplantation in children.Accurate hemodynamic assessment is crucial for predicting the risk of complications after liver transplantation.In order to predict the location of portal vein thrombosis after liver transplantation surgery,single-outlet and three-outlet vascular models were reconstructed from computed tomography images by commercial software MIMICS.The velocity field was measured using a 9.4 T magnetic resonance imaging scanner.Based on the experiment data of magnetic resonance velocimetry,computational fluid dynamics was verified,validated and then used to study the pressure and shear stresses on the wall of the two portal vein models.The simulation results can serve for the clinical prediction of early thrombosis after liver transplantation in portal vein.展开更多
The present study investigates the infiuences of aorta geometry on hemodynamics and material transport.Based on the observation of the human aorta.two geometric paramelers are examined for a model aorta,savine the ane...The present study investigates the infiuences of aorta geometry on hemodynamics and material transport.Based on the observation of the human aorta.two geometric paramelers are examined for a model aorta,savine the anele spanned by the main aorticarc and the diameter of the descending aorta.irect numerical simulations are conducted for nine model aortas with difierencombinations of aorta arc and outlet diameter.Results reveal that the outlet diameter has a sienificant impact on aorta hemodynamics.A smaller outlet diameter compared to the inlet leads to accelerated blood fow in the descending segment,affecting fiowmorphology including the vortex structures,and increasing peak pressure gradient and wall shear stress.However,it reducesthe oscillatory shear index,indicating a more organized fow.Analyses show faster particle transport and reduced accumulativeresidence time for smaller outlet diameters,The arc anele has less sieniicant efiects on these properties.except for delaying thetime to reach the maximum pressure gradient during cjection.The research results may suggest that the diameter of the aorticoutlet has a greater impact on the fiow structures,while the arc angle has a relatively less efiect.These findings provide insightsinto the relation between hemodynamics and aorta geometry,with potential clinical implications.展开更多
Bicuspid aortic valve(BAV)is a common congenital malformation of the aortic valve with various structural characteristics.Different types of BAV can cause secondary aortic diseases,including calcific aortic valve sten...Bicuspid aortic valve(BAV)is a common congenital malformation of the aortic valve with various structural characteristics.Different types of BAV can cause secondary aortic diseases,including calcific aortic valve stenosis and aortic dilation,although their pathogenesis remains unclear.In this study,we first established patient-specific BAV simulation models and silicone models(Type 0 A-P,Type 1 R-N,and Type 1 L-R)based on clinical computed tomography angiography(CTA)and pressure data.Next,we applied a research method combining fluid-structure interaction(FSI)simulation and digital particle image velocimetry(DPIV)experiment to quantitatively analyze the hemodynamic,structural mechanical,and flow field characteristics of patients with different BAV types.Simulation-based hemodynamic parameters and experimental results were consistent with clinical data,affirming the accuracy of the model.The location of the maximum principal strain in the patientspecific model was associated with the calcification site,which characterized the mechanism of secondary aortic valve stenosis.The maximum wall shear stress(WSS)of the patient-specific model(>67.1 Pa)exceeded 37.9 Pa and could cause endothelial surface injury as well as remodeling under long-term exposure,thus increasing the risk of aortic dilation.The distribution of WSS was mainly caused by BAV type,resulting in different degrees of dilation in different parts guided by the type.The patient-specific model revealed a maximum viscous shear stress(VSS)value of 5.23 Pa,which was smaller than the threshold for shear-induced hemolysis of red blood cells(150 Pa)and platelet activation(10 Pa),but close to the threshold for platelet sensitization(6 Pa).The results of flow field characteristics revealed a low risk of hemolysis but a relative high risk of thrombus formation in the patient-specific model.This study not only provides a basis for future comprehensive research on BAV diseases,but also generates relevant insights for theoretical guidance for calcific aortic valve stenosis and aortic dilation caused by different types of BAV,as well as biomechanical evidence for the potential risk of hemolysis and thrombus formation in BAV,which is of great value for clinical diagnosis and treatment of BAV.展开更多
Objective To observe value of 0D-1D coupling model and 3D fluid-structure interaction(FSI)model based on coronary CT angiography(CCTA)for displaying hemodynamic characteristics of coronary artery stenosis.Methods Base...Objective To observe value of 0D-1D coupling model and 3D fluid-structure interaction(FSI)model based on coronary CT angiography(CCTA)for displaying hemodynamic characteristics of coronary artery stenosis.Methods Based on CCTA data of the stenosed left anterior descending branch(LAD)in a patient with coronary heart disease,an 0D-1D coupling model and 3D FSI model were built,respectively.Then hemodynamic characteristic indexes,including the pressure,flow velocity and wall shear stress(WSS)were obtained in every 0.01 s during 1 s at 5 sampling points(i.e.sampling point 1—5)using these 2 models,respectively,and the consistencies of the results between models were evaluated with Spearman correlation coefficient r s.Results The time consuming for construction of 0D-1D coupling model and 3D FSI model was 0.033 min and 704 min,respectively.Both models showed basically distribution of the pressure,flow velocity and WSS of the stenosed LAD.For more details,the pressure at the stenosed segment of LAD and the proximal segment of stenosis were both higher,which gradually decreased at the distal segment of stenosis,and the flow velocity at the proximal segment of stenosis was in a relatively slow and uniform condition,with significantly increased flow velocity and WSS at the stenosed segment.Compared with 3D FSI model,0D-1D vascular coupling model was relatively unrefined and lack of distal flow lines when displaying blood flow velocity.For sampling point 2 at the stenosed segment of LAD,no significant consistency for pressure between 2 models was found(P=0.118),but strong consistency for the flow velocity and WSS(r s=0.730,0.807,both P<0.05).The consistencies of pressure,flow velocity and WSS between 2 models at the proximal and distal segment of stenosis,i.e.1,3—5 sampling points were week to moderate(r s=0.237—0.669,all P<0.05).Conclusion 0D-1D coupling model exhibited outstanding computational efficiency and might provide relatively reasonable results,while 3D FSI model showed higher accuracy for details and streamline when simulating LAD stenosis.展开更多
Despite the development of noninvasive tools as echocardiography,right-sided heart catheterization remains an integral part of the cardiovascular evaluation.In the last decade,better understanding of the hemodynamic p...Despite the development of noninvasive tools as echocardiography,right-sided heart catheterization remains an integral part of the cardiovascular evaluation.In the last decade,better understanding of the hemodynamic process before heart failure decompensation led to improvement of outpatient strategies to prevent it.Advances in implantable wireless technology now allow frequent and direct measurement of intracardiac fi lling pressures,which can be monitored by health care providers to help tailor therapy to reduce fi lling pressures and hospital readmission rates.展开更多
The randomized single-blind study was designed to compare the effects of captopril Cap),and nadolol(And)on renal hemodynamics in 60 patients with essential hyperttnsion.They were divided into two groups at random.Cap ...The randomized single-blind study was designed to compare the effects of captopril Cap),and nadolol(And)on renal hemodynamics in 60 patients with essential hyperttnsion.They were divided into two groups at random.Cap was given in dosage of 37.5-75 mg/d per os and And 40-80 mg/d.The results show that both drugs increase the blood volume distributed to the kidneys from cardiac output(renal blood flow/cardiac output),Cap increasing 10% (P<0. 05) and And 8%(F<0.05) Renal vascular resistance(RVR)is lowered by the two drugs,13%(P<0. 05) by Cap and 11%(P<0.05) by And.These suggest that both drugs facilitate the maintenance of renal blood circulation in patients with essential hypeitension.being beneficial for long-term treatment of hypertension.展开更多
Objective: To investigate the effects of exogenous recombinant human brain natriuretic peptide(rh BNP) after primary percutaneous coronary intervention(PCI) on non-invasive hemodynamic in acute myocardial infarction p...Objective: To investigate the effects of exogenous recombinant human brain natriuretic peptide(rh BNP) after primary percutaneous coronary intervention(PCI) on non-invasive hemodynamic in acute myocardial infarction patients with left ventricular failure. Methods: A number of 96 acute myocardial infarction patients accompanied with heart failure after PCI hospitalized in the People's Hospital of Sanya during February 2012 to October 2015 were selected. They were randomly divided into the therapy group(n = 50) and control group(n = 46). On the basis of routine treatment, patients in the therapy group were treated with intravenous rh BNP(1.5 μg/kg was intravenous injection with uniform speed of 3 min, followed by continuous infusion 0.007 5 μg/kg·min for 72 h), while the control group received conventional treatment. Bio Z-2011 non-invasive hemodynamic real-time monitoring system was used to monitor the hemodynamic parameters changes and the leves of plasma pro-BNP, serum creatinine, serum potassium, serum sodium and urine volume of each group before and after treating for 30 min, 1 h, 3 h, 6 h, 12 h, 24 h, 48 h, 72 h. Results: Patients in the therapy group showed no effect on heart rate, while after 30 min of intravenous injection of rh BNP, CO, CI, SV, and SI increased significantly and LVET and TFC reduced at the same time, which had certain effect on blood pressure(SBP/DBP). Compared with the control group, the therapy group showed a faster and more effective improvement on haemodynamics. Conclusions: Acute myocardial infarction patients complicated with left heart failure after primary PCI can significantly improve hemodynamics by treating with rh BNP.展开更多
AIM： To study the portal hemodynamics and their relationship with the size of esophageal varices seen at endoscopy and to evaluate whether these Doppler ultrasound parameters might predict variceal bleeding in patien...AIM： To study the portal hemodynamics and their relationship with the size of esophageal varices seen at endoscopy and to evaluate whether these Doppler ultrasound parameters might predict variceal bleeding in patients with liver cirrhosis and portal hypertension. METHODS： One hundred and twenty cirrhotic patients with esophageal varices but without any previous bleeding were enrolled in the prospective study. During a 2-year observation period, 52 patients who had at least one episode of acute esophageal variceal hemorrhage constituted the bleeding group, and the remaining 68 patients without any previous hemorrhage constituted the non-bleeding group. All patients underwent endoscopy before or after color Doppler-ultrasonic examination, and images were interpreted independently by two endoscopists. The control group consisted of 30 healthy subjects, matched to the patient group in age and gender. Measurements of diameter, flow direction and flow velocity in the left gastric vein （LGV） and the portal vein （PV） were done in all patients and controls using color Doppler unit. After baseline measurements, 30 min after oral administration of 75 g glucose in 225 mL, changes of the diameter, flow velocity and direction in the PV and LGV were examined in 60 patients with esophageal varices and 15 healthy controls. RESULTS： The PV and LGV were detected successfully in 115 （96%） and 105 （88%） of 120 cirrhotic patients, respectively, and in 27 （90%） and 21 （70%） of 30 healthy controls, respectively. Among the 120 cirrhotic patients, 37 had F1, 59 had F2, and 24 had F3 grade varices. Compared with the healthy controls, cirrhotic group had a significantly lower velocity in the PV, a significantly greater diameter of the PV and LGV, and a higher velocity in the LGV. In the cirrhotic group, no difference in portal flow velocity and diameter were observed between patients with or without esophageal variceal bleeding （EVB）. However, the diameter and blood flow velocity of the LGV were significantly higher for EVB （＋） group compared with EVB （-） group （P〈0.01）. Diameter of the LGV increased with enlarged size of varices. There were differences between F1 and F2, F1 and F3 varices, but no differences between F2 and F3 varices （P = 0.125）. However, variceal bleeding was more frequent in patients with a diameter of LGV 〉6 mm. The flow velocity in the LGV of healthy controls was 8.70＋1.91 cm/s （n = 21）. In patients with liver cirrhosis, it was 10.3＋2.1 cm/s （n = 12） when the flow was hepatopetal and 13.5＋2.3 cm/s （n = 87） when it was hepatofugal. As the size of varices enlarged, hepatofugal flow velocity increased （P〈0.01） and was significantly different between patients with F1 and F2 varices and between patients with F2 and F3 varices. Variceal bleeding was more frequent in patients with a hepatofugal flow velocity 〉15 cm/s （32 of 52 patients, 61.5%）. Within the bleeding group, the mean LGV blood flow velocity was 16.6＋2.62 cm/s. No correlation was observed between the portal blood flow velocity and EVB. In all healthy controls, the flow direction in the LGV was hepatopetal, toward the PV. In patients with F1 varices, flow direction was hepatopetal in 10 patients, to-and-fro state in 3 patients, and hepatofugal in the remaining 18. The flow was hepatofugal in 91% patients with F2 and all F3 varices. Changes in diameter of the PV and LGV were not significant before and after ingestion of glucose （PV： 1.41＋1.5 cm before and 1.46＋1.6 cm after; LGV： 0.57＋1.7 cm before and 0.60＋1.5 cm after）. Flow direction in the LGV was hepatopetal and to-and-fro in 16 patients and hepatofugal in 44 patients before ingestion of glucose. Flow direction changed to hepatofugal in 9 of 16 patients with hepatopetal and to-and-fro blood flow after ingestion of glucose. In 44 patients with hepatofugal blood flow in the LGV, a significant increase in hepatofugal flow velocity was observed in 38 of 44 patients （86%） with esophageal varices. There was a relationship between the percentage changes in flow velocity and the size of varices. Patients who responded excessively to food ingestion might have a high risk for bleeding. The changes of blood flow velocity in the LGV were greater than those in the PV （LGV： 28.3＋26.1%, PV： 7.2＋13.2%, P〈0.01）, whereas no significant changes in the LGV occurred before and after ingestion of glucose in the control subjects. CONCLUSION： Hemodynamics of the PV is unrelated to the degree of endoscopic abnormalities in patients with liver cirrhosis. The most important combinations are endoscopic findings followed by the LGV hemodynamics. Duplex-Doppler ultrasonography has no value in the identification of patients with cirrhosis at risk of variceal bleeding. Hemodynamics of the LGV appears to be superior to those of the PV in predicting bleeding.展开更多
AIM: To investigate the potential role of continuous venovenous hemofiltration (CVVH) in hemodynamics and oxygen metabolism in pigs with severe acute pancreatitis (SAP). METHODS: SAP model was produced by intraductal ...AIM: To investigate the potential role of continuous venovenous hemofiltration (CVVH) in hemodynamics and oxygen metabolism in pigs with severe acute pancreatitis (SAP). METHODS: SAP model was produced by intraductal injection of sodium taurocholate [4%, 1 mL/kg body weight (BW)] and trypsin (2 U/kg BW). Animals were allocated either to untreated controls as group 1 or to one of two treatment groups as group 2 receiving a low-volume CVVH [20 mL/(kg·h)], and group 3 receiving a high-volume CVVH [100 (mL/kg·h)]. Swan-Ganz catheter was inserted during the operation. Heart rate, arterial blood pressure, cardiac output, mean pulmonary arterial pressure, pulmonary arterial wedge pressure, central venous pressure, systemic vascular resistance, oxygen delivery, oxygen consumption, oxygen extraction ratio, as well as survival of pigs were evaluated in the study. RESULTS: Survival time was significantly prolonged by low-volume and high-volume CVVHs, which was more pronounced in the latter. High-volume CVVH was significantly superior compared with less intensive treatment modalities (low-volume CVVH) in systemic inflammatory reaction protection. The major hemodynamic finding was that pancreatitis-induced hypotension was significantly attenuated by intensive CVVH (87.4±12.5 kPa vs116.3±7.8 kPa,P＜0.01). The development of hyperdynamic circulatory failure was simultaneously attenuated, as reflected by a limited increase in cardiac output, an attenuated decrease in systemic vascular resistance and an elevation in oxygen extraction ratio. CONCLUSION: CVVH blunts the pancreatitis-induced cardiovascular response and increases tissue oxygen extraction. The high-volume CVVH is distinctly superior in preventing sepsis-related hemodynamic impairment.展开更多
AIM: To study the effects of endotoxin on portal hemodynamic of normal and noncirrhotic portal hypertensive rats. METHODS: Normal rats were intraperitoneally injected with 0.1, 0.25, 0.5, 1.0, 2.0, 4.0mg.kg(-1) of lip...AIM: To study the effects of endotoxin on portal hemodynamic of normal and noncirrhotic portal hypertensive rats. METHODS: Normal rats were intraperitoneally injected with 0.1, 0.25, 0.5, 1.0, 2.0, 4.0mg.kg(-1) of lipopolysaccharide(LPS) respectively, portal vein ligation(PVL) and intrahepatic portal occlusion (IPO) rats as well as sham-operated rats were treated with an intraperitoneal injection of 1.0mg.kg(-1) of LPS, the portal vein pressure(PVP), portal venous flow(PVF), inferior vena cava pressure(IVCP) and portal vein resistance(PVR) were detected 4 hours after injection. RESULTS: PVF of the 5 groups of rats accepting intraperitoneal injection of LPS were increased from 14.0 to 18.0, 22.2, 26.2, 34.8, 39.6, 38.8 mL.min(-1) 4 hours after injection of LPS(P【0.01). PVP of the 4 groups of rats accepting more than 0.1mg/kg.b.w of LPS was increased from 1.04 to 1.25, 1.50, 1.80, 1.95, 2.05 kPa(P【0.01). The increments of PVF and PVP were in a dose-dependent manner of LPS. PVR of the 5 groups of rats was decreased from 51 to 42,44,48,45,44,47 kPa.min.L(-1) (P【0.05) and no dose-dependent manner was observed. PVF of PVL, IPO and sham-operated rats increased from 22.6 to 32.8, 22.0 to 28.0, 14.0 to 34.8 mL.min(-1) (P【0.01), and PVP increased from 1.86 to 2.24, 1.74 to 1.95, 1.04 to 1.80 kPa(P【0.01), PVR decreased from 71 to 61, 67 to 61, 52 to 44 kPa.min.L(-1) after intraperitoneal injection of 1mg.kg(-1) of LPS. The increments of PVF and PVP of PVL and IPO rats were significantly less than the sham-operated rats(P【0.01), There was no significant difference between the amounts of PVR decreased in the two groups of PHT model rats and sham-operated rats(P】0.05) after intraperitoneal injection 1mg.kg(-1) of LPS. CONCLUSION: Endotoxin could prompt portal hypertension of the normal and noncirrhotic portal hypertensive rats by increasing portal blood flow mainly.展开更多
Shunt and devascularization have totally different effects on hemodynamics of the portal venous system , and the actual results of combined shunt and devascularization should be determined by more clinical observation...Shunt and devascularization have totally different effects on hemodynamics of the portal venous system , and the actual results of combined shunt and devascularization should be determined by more clinical observations. This study aimed to evaluate effects on hemodynamics of the portal venous system after conventional spleno-renal shunt combined with pericardial devascularization and pericardial devascularization only. METHODS: In 20 patients who had received conventional splenorenal shunt combined with pericardial devascularization(CP) and 18 who had received pericardial devascularization and splenectomy (PCDV), hemodynamic parameters of the portal venous system were studied by magnetic resonance angiography 1 week before and 2 weeks after operation. Free portal pressure was detected continuously by a transducer during the operation. RESULTS: Compared to the preoperative data, a decreased flow of the portal vein (PVF) (563.12±206.42 ml/min vs 1080.63±352.85 ml/min, P<0.05), a decreased diameter of the portal vein (PVD) (1.20±0.11 cm vs 1.30±0.16 cm, P<0.01 ), a decreased free portal preasure ( FPP ) (21.50±2.67 mmHg vs 29.88±2.30 mmHg, P<0.01) and an increased flow of the superior mesenteric vein (SMVF) (1105.45±309.03 ml/min vs 569.13±178.46 ml/min, P < 0.05) were found in the CP group after operation; a decreased PVD (1.27±0.16 cm vs 1.40±0.23 cm, P<0.05), a decreased PVF (684.60±165.73 ml/min vs 1175.64±415.09 ml/min, P<0.05), a decreased FPP (24.40±3.78 mmHg vs 28.80±3.56 mmHg, P<0.05) and an increased SMVF (697.91+121.83 ml/min vs 521.30±115.82 ml/min, P<0.05) were found in the PCDV group. After operation, the PVF of CP group (563.12±206.42 ml/min vs 684.60±165.73 ml/min, P>0.05) was not decreased significantly while FPP (21.50±2.67 mmHg vs 24.40±3.78 mmHg, P< 0.01) was decreased significantly as compared with that of the PCDV group. PVF and FPP could be decreased by both surgical procedures, but the effect of decreasing FPP is much better in the combined procedures than in PCDV. Since there is no significant difference in PVF between the two groups, the combined procedures could integrate advantages of shunt with those of the devascularization, maintaining the normal anatomy structure of the hepatic portal vein, and should be one of the best choices for patients with PHT when surgical interventions are considered.展开更多
AIM To study the effects of Radix Salviae Militiorrhiza (RSM), other blood-activating and stasis-eliminating Chinese herbs on hemodynamics of portal hypertension.METHODS Portal pressure of cirrhotic dogs after chronic...AIM To study the effects of Radix Salviae Militiorrhiza (RSM), other blood-activating and stasis-eliminating Chinese herbs on hemodynamics of portal hypertension.METHODS Portal pressure of cirrhotic dogs after chronic common bile duct ligation was measured directly; portal blood flow in patients with liver cirrhosis were detected by ultrasound Doppler.RESULTS After administration of RSM and Radix Angelicae Sinensis (RAS) by intravenous infusion in cirrhosis dogs, the portal venous pressure (Ppv), wedge hepatic venous pressure (WHVP), hepatic venous pressure gradient (HVPG), were significantly decreased (P＜0.05-0.01), but the mean arterial pressure (MAP), and the heart rate (HR) remained unchanged. When nifedipine was used, Ppv, WHVP, MAP and HR were significantly decreased (P＜0.05), and the MVPG unchanged (P＞0.05). After administration of RSM, RSM+nifedipine and RSM+Hirudin+Nifedpin for 10-12 weeks, the diameter of portal vein (Dpv), spleen vein (Dsv), the portal venous flow (Qpv) and splenic venous flow (Qsv) in patients with hepatic cirrhosis were significantly lowered (P＜0.05-0.01), and the effect of RAS was weaker.CONCLUSIONS The efficacy of decreasing Ppv by Chinese herbs-RSM, RAS, etc. as compared with nifedipine, demonstrated that the Chinese herbs were slower in action than that of nifedipine, but more long-lasting and without side effects. Hence, long-term administration of Chinese herbs, would be more beneficial.展开更多
INTRODUCTIONEsophageal variceal bleeding (EVB) is one of themost common complications of cirrhosis with portalhypertension.In recent years,great progress hasbeen made in medicinal treatment.Somatostatin hasbeen widely...INTRODUCTIONEsophageal variceal bleeding (EVB) is one of themost common complications of cirrhosis with portalhypertension.In recent years,great progress hasbeen made in medicinal treatment.Somatostatin hasbeen widely used in clinics,for it can effectivelylower the portal venous pressure (PVP) with展开更多
Spinal cord stimulation （SCS） is a promising technique for treating disorders of consciousness （DOCs）. However, differences in the spatio-temporal responsiveness of the brain under varied SCS parameters remain unc...Spinal cord stimulation （SCS） is a promising technique for treating disorders of consciousness （DOCs）. However, differences in the spatio-temporal responsiveness of the brain under varied SCS parameters remain unclear. In this pilot study, functional near-infrared spectroscopy was used to measure the hemodynamic responses of 10 DOC patients to different SCS frequencies （5 Hz, 10 Hz, 50 Hz, 70 Hz, and 100 Hz）. In the prefrontal cortex, a key area in consciousness circuits, we found significantly increased hemodynamic responses at 70 Hz and 100 Hz, and significantly different hemodynamic responses between 50 Hz and 70 Hz/100 Hz. In addition, the functional connectivity between prefrontal and occipital areas was significantly improved with SCS at 70 Hz. These results demonstrated that SCS modulates the hemodynamic responses and long-range connectivity in a frequency-specific manner （with 70 Hz apparently better）, perhaps by improving the cerebral blood volume and information transmission through the reticular formation-thalamus-cortex pathway.展开更多
文摘Portal hypertension and cirrhosis are associated with severe hemodynamic changes in hepatic and systemic circulation in the adult population.During cirrhosis progression,circulation becomes hyperdynamic,with cardiac,pulmonary and renal consequences.Cirrhotic adults also present with cirrhotic cardiomyopathy,with systolic and diastolic dysfunction and electrophysiological abnormalities.This article provides an update on normal liver hemodynamics,a brief reminder of the liver and systemic hemodynamics in cirrhotic adults,and a description of liver and systemic hemodynamics in cirrhotic children.This review attempts to clarify whether liver and systemic hemodynamics are altered in cirrhotic children like they are in adults.The characterization of these hemodynamic disturbances could contribute to a better understanding of hepatic and systemic physiopathology in pediatric cirrhosis.
文摘Background:Congenital heart disease(CHD)occurs in 9out of 100 births and is the leadingcatuse of birth defects,with acyanotic CHD being more common.The incidence of adult CHD is risingfaster than pediatric CHD.Pulmonary hypertension is the most common complication in untreated CHDpatients.Methods:This study is retrospective descriptive research based on medical record data andthe results of right heart catheterization exanninations in adult acyanotic CHD aged>18 years and freefrom other organ disorders.Results:A total of 103 patients met the inclusion criteria,the majority wereyoung adults and predominantly fernale.The median height of 155.0 cm(IQR:150.0-160.0),the meanweight was 49.6 kg±10.7 kg,and BSA of 1.4 m2±0.1 m^(2).Most patients had a normal BMI status andwere classified as WHO-FC II.Herodynamic findings included a median PARI of 13.5 WU/m^(2)(IQR4.5-29.6),RAP 7.0 mmHg(IQR:5.0-11.0),mPAP 56.0 mmHg±23.5 mmHg,LVEDP 9.5 mmHg±3.9 mmHg,PVR 12.6 WU±11.0 WU,PVR/SVR 0.5 WU±0.4 WU,pulmonary artery saturation 74.0%±12.1%,aorticsaturation 88.1%±7.8%,mixed venous saturation 59.0%±10.1%.Conclusions:This study providescomprehensive data on the demographic characteristics and henodynamic parameters of patients withCHD and pulmonary hypertension.As a hospital-based registry,this study offers valuable insights into theclinical profile of adult CHDpatients at Dr.Hasan Sadikin GeneralHospital,Bandung,.
文摘BACKGROUND Few studies have quantified invasive hemodynamic parameters in post heart transplant recipients.AIM To report the incidence of abnormal hemodynamics in heart transplant recipients at 1-year and 3-year post-transplant and determine if there was any correlation with recipient and donor characteristics.METHODS Data from 279 consecutive heart transplant recipients from 2007 through 2020 were analyzed.Clinical variables regarding both recipients and donors as well as hemodynamic variables obtained via right heart catheterization during 1-year and 3-year annual testing were recorded.Simple and multiple linear regression tests were used to determine how recipient and donor variables influenced hemodynamic parameters at 1-year and 3-year.RESULTS Data were available for 260 patients and 224 patients at 1-year and 3-year posttransplant respectively.At 1-year,abnormal hemodynamic parameters were common with 24%patients having right atrial pressure(RAP)>10 mmHg,52%with mean pulmonary artery pressure>20 mmHg,and 12%with pulmonary capillary wedge pressure(PCWP)>18 mmHg.Similar abnormalities were noted at 3-year post-transplant.Recipient body mass index(BMI)demonstrated the strongest correlation with all 3 variables at both 1-year and 3-year by multivariate linear regression analysis(P<0.001 for both).Both donor age and predicted heart mass difference between recipient and donor were significantly linked to RAP and PCWP at 1-year but did not predict any variables at 3-year post-transplant.CONCLUSION Abnormal hemodynamics are common at 1-year and 3-year post-transplant and are associated with recipients with high BMI.
文摘BACKGROUND Septic shock represents one of the most severe critical illness types,characterized by significant hemodynamic disorders and neuropsychiatric symptoms.This study aimed to investigate the association mechanism between hemodynamic indicators and neuropsychiatric symptoms in patients with septic shock,revealing potential pathophysiological connections.AIM To investigate the link between hemodynamic parameters and neuropsychiatric symptoms in septic shock.METHODS A retrospective case-control study involving 132 patients with septic shock.Multiple assessment tools were employed,including the Confusion Assessment Method,Hospital Anxiety and Depression Scale,Posttraumatic Stress Disorder Scale,and Mini-Mental State Examination,systematically evaluating patients’neuropsychiatric symptoms and hemodynamic indicators.RESULTS Patient mean age was 52.4±12.3 years,with 68.5%males.Multivariate analysis revealed significant correlations between neuropsychiatric symptom severity and mean arterial pressure<65 mmHg[odds ratio(OR)=2.7],lactate levels>4 mmol/L(OR=3.1),and elevated interleukin-6 inflammatory factors(OR=2.4).Neuropsychiatric symptom incidence rates were:Delirium 37.1%;anxiety 28.8%;depression 24.2%;and posttraumatic stress disorder 19.7%.CONCLUSION Hemodynamic disorders in patients with septic shock are closely associated with neuropsychiatric symptoms,influencing central nervous system function through complex inflammatory and neurotransmitter pathways.
文摘Objective:This study primarily analyzes the effectiveness of thermal insulation nursing(empowered by temperature intervention)in urological stone patients during the general anesthesia recovery period.Methods:A total of 76 urological stone patients who underwent surgical treatment as the preferred option were selected as the research subjects.The earliest consultation time was May 2024,and the latest was May 2025.The patients were randomly divided into two groups using the random number table method,namely the observation group and the control group,with 38 patients in each group.The intervention indicators of the patients were compared.Results:The overall satisfaction rate in the observation group was higher than that in the control group,and the incidence of adverse reactions was lower,with p<0.05.At 0.5 hours,1 hour after surgery,and at the end of surgery,the body temperature in the observation group was significantly different from that in the control group,with p<0.05.Postoperatively,various hemodynamic indicators in the observation group were significantly different from those in the control group,with p<0.05.The time to clench the first upon verbal command,the time to open the eyes upon verbal command,the extubating time,and the recovery retention time in the observation group were all shorter than those in the control group,with p<0.05.Postoperative stress indicators and agitation scores at different time points in the observation group were significantly different from those in the control group,with p<0.05.Conclusion:For urological stone patients during the general anesthesia recovery period,actively implementing thermal insulation nursing combined with temperature intervention not only enhances hemodynamic stability but also effectively reduces the risk of adverse reactions such as hypothermia and shivering.It optimizes the recovery condition,significantly improves the stress state,and increases nursing satisfaction.
基金supported by the National Natural Science Foundation of China(Grant Nos.12372309,12061131015).
文摘Veno-arterial extracorporeal membrane oxygenation(VA-ECMO)is a life support intervention for patients with refractory cardiogenic shock or severe cardiopulmonary failure.However,the choice of cannulation strategy remains contentious,partly due to insufficient understanding of hemodynamic characteristics associated with the site of arterial cannulation.In this study,a geometrical multiscale model was built to offer a mathematical tool for addressing the issue.The outflow cannula of ECMO was inserted into the ascending aorta in the case of central cannulation,whereas it was inserted into the right subclavian artery(RSA)or the left iliac artery(LIA)in the case of peripheral cannulation.Numerical simulations conducted on three patient-specific aortas demonstrated that the central cannulation outperformed the two types of peripheral cannulation in evenly delivering ECMO flow to branch arteries.Both the central and RSA cannulations could maintain an approximately normal hemodynamic state in the aortas,although the area of aortic walls exposed to abnormal wall shear stress(WSS)was considerably enlarged in comparison with the normal physiological condition.In contrast,the LIA cannulation not only led to insufficient delivery of ECMO flow to the right upper body(with ECMO flow fractions<0.5),but also induced marked flow disturbance in the aorta,causing about 40%of the abdominal aortic wall and over 65%of the resting aortic wall to suffer from high time-averaged WSS(>5 Pa)and low time-averaged WSS(<0.4 Pa),respectively.The LIA cannulation also resulted in significantly prolonged blood residence time(>40 s)in the ascending aorta,which,along with abnormal WSS,may considerably increase the risk of thrombosis.In summary,our numerical study elucidated the impact of arterial cannulation site in VA-ECMO intervention on aortic hemodynamics and ECMO flow distribution.The findings provide compensatory biomechanical information for traditional clinical studies and may serve as a theoretical reference for guiding the evaluation and selection of cannulation strategies in clinical practice.
基金the Interdisciplinary Program of Shanghai Jiao Tong University(No.YG2021QN36)the National Natural Science Foundation of China(Nos.82000615 and 52106050)the Natural Science Foundation of Shanghai(No.21ZR1431800)。
文摘Portal vein stenosis is one of the common complications after liver transplantation in children.Accurate hemodynamic assessment is crucial for predicting the risk of complications after liver transplantation.In order to predict the location of portal vein thrombosis after liver transplantation surgery,single-outlet and three-outlet vascular models were reconstructed from computed tomography images by commercial software MIMICS.The velocity field was measured using a 9.4 T magnetic resonance imaging scanner.Based on the experiment data of magnetic resonance velocimetry,computational fluid dynamics was verified,validated and then used to study the pressure and shear stresses on the wall of the two portal vein models.The simulation results can serve for the clinical prediction of early thrombosis after liver transplantation in portal vein.
基金the support of the Clinical Medicine Plus X-Young Scholars Project at Peking University for thiswork.
文摘The present study investigates the infiuences of aorta geometry on hemodynamics and material transport.Based on the observation of the human aorta.two geometric paramelers are examined for a model aorta,savine the anele spanned by the main aorticarc and the diameter of the descending aorta.irect numerical simulations are conducted for nine model aortas with difierencombinations of aorta arc and outlet diameter.Results reveal that the outlet diameter has a sienificant impact on aorta hemodynamics.A smaller outlet diameter compared to the inlet leads to accelerated blood fow in the descending segment,affecting fiowmorphology including the vortex structures,and increasing peak pressure gradient and wall shear stress.However,it reducesthe oscillatory shear index,indicating a more organized fow.Analyses show faster particle transport and reduced accumulativeresidence time for smaller outlet diameters,The arc anele has less sieniicant efiects on these properties.except for delaying thetime to reach the maximum pressure gradient during cjection.The research results may suggest that the diameter of the aorticoutlet has a greater impact on the fiow structures,while the arc angle has a relatively less efiect.These findings provide insightsinto the relation between hemodynamics and aorta geometry,with potential clinical implications.
基金supported by Zhuhai Fudan Innovation Institute and Science and Technology Project of Shanghai Administration for Market Regulation(Grant No.2022-71).
文摘Bicuspid aortic valve(BAV)is a common congenital malformation of the aortic valve with various structural characteristics.Different types of BAV can cause secondary aortic diseases,including calcific aortic valve stenosis and aortic dilation,although their pathogenesis remains unclear.In this study,we first established patient-specific BAV simulation models and silicone models(Type 0 A-P,Type 1 R-N,and Type 1 L-R)based on clinical computed tomography angiography(CTA)and pressure data.Next,we applied a research method combining fluid-structure interaction(FSI)simulation and digital particle image velocimetry(DPIV)experiment to quantitatively analyze the hemodynamic,structural mechanical,and flow field characteristics of patients with different BAV types.Simulation-based hemodynamic parameters and experimental results were consistent with clinical data,affirming the accuracy of the model.The location of the maximum principal strain in the patientspecific model was associated with the calcification site,which characterized the mechanism of secondary aortic valve stenosis.The maximum wall shear stress(WSS)of the patient-specific model(>67.1 Pa)exceeded 37.9 Pa and could cause endothelial surface injury as well as remodeling under long-term exposure,thus increasing the risk of aortic dilation.The distribution of WSS was mainly caused by BAV type,resulting in different degrees of dilation in different parts guided by the type.The patient-specific model revealed a maximum viscous shear stress(VSS)value of 5.23 Pa,which was smaller than the threshold for shear-induced hemolysis of red blood cells(150 Pa)and platelet activation(10 Pa),but close to the threshold for platelet sensitization(6 Pa).The results of flow field characteristics revealed a low risk of hemolysis but a relative high risk of thrombus formation in the patient-specific model.This study not only provides a basis for future comprehensive research on BAV diseases,but also generates relevant insights for theoretical guidance for calcific aortic valve stenosis and aortic dilation caused by different types of BAV,as well as biomechanical evidence for the potential risk of hemolysis and thrombus formation in BAV,which is of great value for clinical diagnosis and treatment of BAV.
文摘Objective To observe value of 0D-1D coupling model and 3D fluid-structure interaction(FSI)model based on coronary CT angiography(CCTA)for displaying hemodynamic characteristics of coronary artery stenosis.Methods Based on CCTA data of the stenosed left anterior descending branch(LAD)in a patient with coronary heart disease,an 0D-1D coupling model and 3D FSI model were built,respectively.Then hemodynamic characteristic indexes,including the pressure,flow velocity and wall shear stress(WSS)were obtained in every 0.01 s during 1 s at 5 sampling points(i.e.sampling point 1—5)using these 2 models,respectively,and the consistencies of the results between models were evaluated with Spearman correlation coefficient r s.Results The time consuming for construction of 0D-1D coupling model and 3D FSI model was 0.033 min and 704 min,respectively.Both models showed basically distribution of the pressure,flow velocity and WSS of the stenosed LAD.For more details,the pressure at the stenosed segment of LAD and the proximal segment of stenosis were both higher,which gradually decreased at the distal segment of stenosis,and the flow velocity at the proximal segment of stenosis was in a relatively slow and uniform condition,with significantly increased flow velocity and WSS at the stenosed segment.Compared with 3D FSI model,0D-1D vascular coupling model was relatively unrefined and lack of distal flow lines when displaying blood flow velocity.For sampling point 2 at the stenosed segment of LAD,no significant consistency for pressure between 2 models was found(P=0.118),but strong consistency for the flow velocity and WSS(r s=0.730,0.807,both P<0.05).The consistencies of pressure,flow velocity and WSS between 2 models at the proximal and distal segment of stenosis,i.e.1,3—5 sampling points were week to moderate(r s=0.237—0.669,all P<0.05).Conclusion 0D-1D coupling model exhibited outstanding computational efficiency and might provide relatively reasonable results,while 3D FSI model showed higher accuracy for details and streamline when simulating LAD stenosis.
文摘Despite the development of noninvasive tools as echocardiography,right-sided heart catheterization remains an integral part of the cardiovascular evaluation.In the last decade,better understanding of the hemodynamic process before heart failure decompensation led to improvement of outpatient strategies to prevent it.Advances in implantable wireless technology now allow frequent and direct measurement of intracardiac fi lling pressures,which can be monitored by health care providers to help tailor therapy to reduce fi lling pressures and hospital readmission rates.
文摘The randomized single-blind study was designed to compare the effects of captopril Cap),and nadolol(And)on renal hemodynamics in 60 patients with essential hyperttnsion.They were divided into two groups at random.Cap was given in dosage of 37.5-75 mg/d per os and And 40-80 mg/d.The results show that both drugs increase the blood volume distributed to the kidneys from cardiac output(renal blood flow/cardiac output),Cap increasing 10% (P<0. 05) and And 8%(F<0.05) Renal vascular resistance(RVR)is lowered by the two drugs,13%(P<0. 05) by Cap and 11%(P<0.05) by And.These suggest that both drugs facilitate the maintenance of renal blood circulation in patients with essential hypeitension.being beneficial for long-term treatment of hypertension.
基金supported by Science and Education Project of Hainan Province Health and Family Planning administrationand Sanya Health and Technology Innovation Project(NO.2015YW19)
文摘Objective: To investigate the effects of exogenous recombinant human brain natriuretic peptide(rh BNP) after primary percutaneous coronary intervention(PCI) on non-invasive hemodynamic in acute myocardial infarction patients with left ventricular failure. Methods: A number of 96 acute myocardial infarction patients accompanied with heart failure after PCI hospitalized in the People's Hospital of Sanya during February 2012 to October 2015 were selected. They were randomly divided into the therapy group(n = 50) and control group(n = 46). On the basis of routine treatment, patients in the therapy group were treated with intravenous rh BNP(1.5 μg/kg was intravenous injection with uniform speed of 3 min, followed by continuous infusion 0.007 5 μg/kg·min for 72 h), while the control group received conventional treatment. Bio Z-2011 non-invasive hemodynamic real-time monitoring system was used to monitor the hemodynamic parameters changes and the leves of plasma pro-BNP, serum creatinine, serum potassium, serum sodium and urine volume of each group before and after treating for 30 min, 1 h, 3 h, 6 h, 12 h, 24 h, 48 h, 72 h. Results: Patients in the therapy group showed no effect on heart rate, while after 30 min of intravenous injection of rh BNP, CO, CI, SV, and SI increased significantly and LVET and TFC reduced at the same time, which had certain effect on blood pressure(SBP/DBP). Compared with the control group, the therapy group showed a faster and more effective improvement on haemodynamics. Conclusions: Acute myocardial infarction patients complicated with left heart failure after primary PCI can significantly improve hemodynamics by treating with rh BNP.
基金Supported by the Natural Science Foundation of Shanghai, No. 034119921
文摘AIM： To study the portal hemodynamics and their relationship with the size of esophageal varices seen at endoscopy and to evaluate whether these Doppler ultrasound parameters might predict variceal bleeding in patients with liver cirrhosis and portal hypertension. METHODS： One hundred and twenty cirrhotic patients with esophageal varices but without any previous bleeding were enrolled in the prospective study. During a 2-year observation period, 52 patients who had at least one episode of acute esophageal variceal hemorrhage constituted the bleeding group, and the remaining 68 patients without any previous hemorrhage constituted the non-bleeding group. All patients underwent endoscopy before or after color Doppler-ultrasonic examination, and images were interpreted independently by two endoscopists. The control group consisted of 30 healthy subjects, matched to the patient group in age and gender. Measurements of diameter, flow direction and flow velocity in the left gastric vein （LGV） and the portal vein （PV） were done in all patients and controls using color Doppler unit. After baseline measurements, 30 min after oral administration of 75 g glucose in 225 mL, changes of the diameter, flow velocity and direction in the PV and LGV were examined in 60 patients with esophageal varices and 15 healthy controls. RESULTS： The PV and LGV were detected successfully in 115 （96%） and 105 （88%） of 120 cirrhotic patients, respectively, and in 27 （90%） and 21 （70%） of 30 healthy controls, respectively. Among the 120 cirrhotic patients, 37 had F1, 59 had F2, and 24 had F3 grade varices. Compared with the healthy controls, cirrhotic group had a significantly lower velocity in the PV, a significantly greater diameter of the PV and LGV, and a higher velocity in the LGV. In the cirrhotic group, no difference in portal flow velocity and diameter were observed between patients with or without esophageal variceal bleeding （EVB）. However, the diameter and blood flow velocity of the LGV were significantly higher for EVB （＋） group compared with EVB （-） group （P〈0.01）. Diameter of the LGV increased with enlarged size of varices. There were differences between F1 and F2, F1 and F3 varices, but no differences between F2 and F3 varices （P = 0.125）. However, variceal bleeding was more frequent in patients with a diameter of LGV 〉6 mm. The flow velocity in the LGV of healthy controls was 8.70＋1.91 cm/s （n = 21）. In patients with liver cirrhosis, it was 10.3＋2.1 cm/s （n = 12） when the flow was hepatopetal and 13.5＋2.3 cm/s （n = 87） when it was hepatofugal. As the size of varices enlarged, hepatofugal flow velocity increased （P〈0.01） and was significantly different between patients with F1 and F2 varices and between patients with F2 and F3 varices. Variceal bleeding was more frequent in patients with a hepatofugal flow velocity 〉15 cm/s （32 of 52 patients, 61.5%）. Within the bleeding group, the mean LGV blood flow velocity was 16.6＋2.62 cm/s. No correlation was observed between the portal blood flow velocity and EVB. In all healthy controls, the flow direction in the LGV was hepatopetal, toward the PV. In patients with F1 varices, flow direction was hepatopetal in 10 patients, to-and-fro state in 3 patients, and hepatofugal in the remaining 18. The flow was hepatofugal in 91% patients with F2 and all F3 varices. Changes in diameter of the PV and LGV were not significant before and after ingestion of glucose （PV： 1.41＋1.5 cm before and 1.46＋1.6 cm after; LGV： 0.57＋1.7 cm before and 0.60＋1.5 cm after）. Flow direction in the LGV was hepatopetal and to-and-fro in 16 patients and hepatofugal in 44 patients before ingestion of glucose. Flow direction changed to hepatofugal in 9 of 16 patients with hepatopetal and to-and-fro blood flow after ingestion of glucose. In 44 patients with hepatofugal blood flow in the LGV, a significant increase in hepatofugal flow velocity was observed in 38 of 44 patients （86%） with esophageal varices. There was a relationship between the percentage changes in flow velocity and the size of varices. Patients who responded excessively to food ingestion might have a high risk for bleeding. The changes of blood flow velocity in the LGV were greater than those in the PV （LGV： 28.3＋26.1%, PV： 7.2＋13.2%, P〈0.01）, whereas no significant changes in the LGV occurred before and after ingestion of glucose in the control subjects. CONCLUSION： Hemodynamics of the PV is unrelated to the degree of endoscopic abnormalities in patients with liver cirrhosis. The most important combinations are endoscopic findings followed by the LGV hemodynamics. Duplex-Doppler ultrasonography has no value in the identification of patients with cirrhosis at risk of variceal bleeding. Hemodynamics of the LGV appears to be superior to those of the PV in predicting bleeding.
基金Supported by the Social Development Foundation of Jiangsu Province, No.BS2000051
文摘AIM: To investigate the potential role of continuous venovenous hemofiltration (CVVH) in hemodynamics and oxygen metabolism in pigs with severe acute pancreatitis (SAP). METHODS: SAP model was produced by intraductal injection of sodium taurocholate [4%, 1 mL/kg body weight (BW)] and trypsin (2 U/kg BW). Animals were allocated either to untreated controls as group 1 or to one of two treatment groups as group 2 receiving a low-volume CVVH [20 mL/(kg·h)], and group 3 receiving a high-volume CVVH [100 (mL/kg·h)]. Swan-Ganz catheter was inserted during the operation. Heart rate, arterial blood pressure, cardiac output, mean pulmonary arterial pressure, pulmonary arterial wedge pressure, central venous pressure, systemic vascular resistance, oxygen delivery, oxygen consumption, oxygen extraction ratio, as well as survival of pigs were evaluated in the study. RESULTS: Survival time was significantly prolonged by low-volume and high-volume CVVHs, which was more pronounced in the latter. High-volume CVVH was significantly superior compared with less intensive treatment modalities (low-volume CVVH) in systemic inflammatory reaction protection. The major hemodynamic finding was that pancreatitis-induced hypotension was significantly attenuated by intensive CVVH (87.4±12.5 kPa vs116.3±7.8 kPa,P＜0.01). The development of hyperdynamic circulatory failure was simultaneously attenuated, as reflected by a limited increase in cardiac output, an attenuated decrease in systemic vascular resistance and an elevation in oxygen extraction ratio. CONCLUSION: CVVH blunts the pancreatitis-induced cardiovascular response and increases tissue oxygen extraction. The high-volume CVVH is distinctly superior in preventing sepsis-related hemodynamic impairment.
文摘AIM: To study the effects of endotoxin on portal hemodynamic of normal and noncirrhotic portal hypertensive rats. METHODS: Normal rats were intraperitoneally injected with 0.1, 0.25, 0.5, 1.0, 2.0, 4.0mg.kg(-1) of lipopolysaccharide(LPS) respectively, portal vein ligation(PVL) and intrahepatic portal occlusion (IPO) rats as well as sham-operated rats were treated with an intraperitoneal injection of 1.0mg.kg(-1) of LPS, the portal vein pressure(PVP), portal venous flow(PVF), inferior vena cava pressure(IVCP) and portal vein resistance(PVR) were detected 4 hours after injection. RESULTS: PVF of the 5 groups of rats accepting intraperitoneal injection of LPS were increased from 14.0 to 18.0, 22.2, 26.2, 34.8, 39.6, 38.8 mL.min(-1) 4 hours after injection of LPS(P【0.01). PVP of the 4 groups of rats accepting more than 0.1mg/kg.b.w of LPS was increased from 1.04 to 1.25, 1.50, 1.80, 1.95, 2.05 kPa(P【0.01). The increments of PVF and PVP were in a dose-dependent manner of LPS. PVR of the 5 groups of rats was decreased from 51 to 42,44,48,45,44,47 kPa.min.L(-1) (P【0.05) and no dose-dependent manner was observed. PVF of PVL, IPO and sham-operated rats increased from 22.6 to 32.8, 22.0 to 28.0, 14.0 to 34.8 mL.min(-1) (P【0.01), and PVP increased from 1.86 to 2.24, 1.74 to 1.95, 1.04 to 1.80 kPa(P【0.01), PVR decreased from 71 to 61, 67 to 61, 52 to 44 kPa.min.L(-1) after intraperitoneal injection of 1mg.kg(-1) of LPS. The increments of PVF and PVP of PVL and IPO rats were significantly less than the sham-operated rats(P【0.01), There was no significant difference between the amounts of PVR decreased in the two groups of PHT model rats and sham-operated rats(P】0.05) after intraperitoneal injection 1mg.kg(-1) of LPS. CONCLUSION: Endotoxin could prompt portal hypertension of the normal and noncirrhotic portal hypertensive rats by increasing portal blood flow mainly.
文摘Shunt and devascularization have totally different effects on hemodynamics of the portal venous system , and the actual results of combined shunt and devascularization should be determined by more clinical observations. This study aimed to evaluate effects on hemodynamics of the portal venous system after conventional spleno-renal shunt combined with pericardial devascularization and pericardial devascularization only. METHODS: In 20 patients who had received conventional splenorenal shunt combined with pericardial devascularization(CP) and 18 who had received pericardial devascularization and splenectomy (PCDV), hemodynamic parameters of the portal venous system were studied by magnetic resonance angiography 1 week before and 2 weeks after operation. Free portal pressure was detected continuously by a transducer during the operation. RESULTS: Compared to the preoperative data, a decreased flow of the portal vein (PVF) (563.12±206.42 ml/min vs 1080.63±352.85 ml/min, P<0.05), a decreased diameter of the portal vein (PVD) (1.20±0.11 cm vs 1.30±0.16 cm, P<0.01 ), a decreased free portal preasure ( FPP ) (21.50±2.67 mmHg vs 29.88±2.30 mmHg, P<0.01) and an increased flow of the superior mesenteric vein (SMVF) (1105.45±309.03 ml/min vs 569.13±178.46 ml/min, P < 0.05) were found in the CP group after operation; a decreased PVD (1.27±0.16 cm vs 1.40±0.23 cm, P<0.05), a decreased PVF (684.60±165.73 ml/min vs 1175.64±415.09 ml/min, P<0.05), a decreased FPP (24.40±3.78 mmHg vs 28.80±3.56 mmHg, P<0.05) and an increased SMVF (697.91+121.83 ml/min vs 521.30±115.82 ml/min, P<0.05) were found in the PCDV group. After operation, the PVF of CP group (563.12±206.42 ml/min vs 684.60±165.73 ml/min, P>0.05) was not decreased significantly while FPP (21.50±2.67 mmHg vs 24.40±3.78 mmHg, P< 0.01) was decreased significantly as compared with that of the PCDV group. PVF and FPP could be decreased by both surgical procedures, but the effect of decreasing FPP is much better in the combined procedures than in PCDV. Since there is no significant difference in PVF between the two groups, the combined procedures could integrate advantages of shunt with those of the devascularization, maintaining the normal anatomy structure of the hepatic portal vein, and should be one of the best choices for patients with PHT when surgical interventions are considered.
文摘AIM To study the effects of Radix Salviae Militiorrhiza (RSM), other blood-activating and stasis-eliminating Chinese herbs on hemodynamics of portal hypertension.METHODS Portal pressure of cirrhotic dogs after chronic common bile duct ligation was measured directly; portal blood flow in patients with liver cirrhosis were detected by ultrasound Doppler.RESULTS After administration of RSM and Radix Angelicae Sinensis (RAS) by intravenous infusion in cirrhosis dogs, the portal venous pressure (Ppv), wedge hepatic venous pressure (WHVP), hepatic venous pressure gradient (HVPG), were significantly decreased (P＜0.05-0.01), but the mean arterial pressure (MAP), and the heart rate (HR) remained unchanged. When nifedipine was used, Ppv, WHVP, MAP and HR were significantly decreased (P＜0.05), and the MVPG unchanged (P＞0.05). After administration of RSM, RSM+nifedipine and RSM+Hirudin+Nifedpin for 10-12 weeks, the diameter of portal vein (Dpv), spleen vein (Dsv), the portal venous flow (Qpv) and splenic venous flow (Qsv) in patients with hepatic cirrhosis were significantly lowered (P＜0.05-0.01), and the effect of RAS was weaker.CONCLUSIONS The efficacy of decreasing Ppv by Chinese herbs-RSM, RAS, etc. as compared with nifedipine, demonstrated that the Chinese herbs were slower in action than that of nifedipine, but more long-lasting and without side effects. Hence, long-term administration of Chinese herbs, would be more beneficial.
基金the National Natural Science Foundation and Ministry of Public Health of China,No.39500141
文摘INTRODUCTIONEsophageal variceal bleeding (EVB) is one of themost common complications of cirrhosis with portalhypertension.In recent years,great progress hasbeen made in medicinal treatment.Somatostatin hasbeen widely used in clinics,for it can effectivelylower the portal venous pressure (PVP) with
基金supported by the National Key Research and Development Program of China (2017YFB1002502)the National Natural Science Foundation of China (81501550, 81600919, and 31771076)+5 种基金the Cross Training (Shipei) Project of High-Caliber Talents in Beijing Municipal Institutions (2017–2018)the Supplementary and Supportive Project for Teachers at Beijing Information Science and Technology University (2018–2020, 5029011103)the School Scientific Research Project at Beijing Information Science and Technology University (1825010) the Beijing Municipal Science and Technology Commission (Z161100000516165) the Shenzhen Peacock Plan (KQTD2015033016104926)the Guangdong Pearl River Talents Plan Innovative and Entrepreneurial Team grant (2016ZT06S220)
文摘Spinal cord stimulation （SCS） is a promising technique for treating disorders of consciousness （DOCs）. However, differences in the spatio-temporal responsiveness of the brain under varied SCS parameters remain unclear. In this pilot study, functional near-infrared spectroscopy was used to measure the hemodynamic responses of 10 DOC patients to different SCS frequencies （5 Hz, 10 Hz, 50 Hz, 70 Hz, and 100 Hz）. In the prefrontal cortex, a key area in consciousness circuits, we found significantly increased hemodynamic responses at 70 Hz and 100 Hz, and significantly different hemodynamic responses between 50 Hz and 70 Hz/100 Hz. In addition, the functional connectivity between prefrontal and occipital areas was significantly improved with SCS at 70 Hz. These results demonstrated that SCS modulates the hemodynamic responses and long-range connectivity in a frequency-specific manner （with 70 Hz apparently better）, perhaps by improving the cerebral blood volume and information transmission through the reticular formation-thalamus-cortex pathway.
