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 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
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
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
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 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
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
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 evaluat...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(P<0.05).At the four time points of measurement(T1 through T4),MAP and HR values were higher in the observation than control group(MAP,90.20±9.15 mmHg,85.50±7.22 mmHg,88.59±8.15 mmHg,and 90.02±10.02 mmHg,respectively;and HR,72.39±8.22 beats/min,69.03±9.03 beats/min,70.12±8.11 beats/min,and 71.24±9.01 beats/min,respectively;P<0.05).There was no difference in SpO;between the two groups(P>0.05).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;P<0.05).Similarly,the postoperative tumor necrosis factor-αand interleukin-6 levels were lower in the observation(2.43±0.44 pg/mL and 170.03±35.54 pg/mL,respectively)than control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).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.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
AIM: To compare the effect of propofol versus urapidil on hemodynamics and intraocular pressure during anesthesia and extubation for ophthalmic patients. METHODS: Eighty-two surgical patients (Class: ASA I-II) were ra...AIM: To compare the effect of propofol versus urapidil on hemodynamics and intraocular pressure during anesthesia and extubation for ophthalmic patients. METHODS: Eighty-two surgical patients (Class: ASA I-II) were randomly assigned to propofol (n = 41) and urapidil groups (n = 41). Their gender, age, body mass, operation time and dosage of anesthetics had no significant difference between the two groups (P > 0.05). The patients of propofol and urapidil groups were given propofol (1.5mg/kg) and urapidil (2.5mg/kg) respectively; and two drugs were all diluted with normal saline to 8mL. Then the drugs were given to patients by slow intravenous injection. After treatment, the patients were conducted immediate suction, tracheal extubation, and then patients wore oxygen masks for 10 minutes. By double-blind methods, before the induction medication, at the suction, and 5, 10 minutes after the extubation, we recorded the systolic and diastolic blood pressure (BP), heart rate (HR), pH, PaO2, PaCO2, SaO(2) and intraocular pressure (TOP) respectively. The complete recovery time of the patients with restlessness (on the command they could open eyes and shaking hands) was also recorded during the extubation. The data were analyzed by using a professional SPSS 15.0 statistical software. RESULTS: The incidence of cough, restlessness and glossocoma was significantly lower in the propofol group than that in the urapidil group after extubation (P < 0.05). There were no episodes of hypotension, laryngospasm, or severe respiratory depression. There was no statistical difference in recovery time between two groups (P > 0.05). In propofol group, the BP and HR during extubation and thereafter had no significant difference compared with those before induction, while they were significantly lower than those before giving propofol (P < 0.05), and had significant difference compared with those in urapidil group (P < 0.05). Compared to preinduction, the BP of urapidil group showed no obvious increase during aspiration and extubation. The HR of urapidil group had little changes after being given urapidil, and it was obviously increased compared with that before induction. The stimulation of aspiration and extubation caused less cough and agitation in propofol group than that in urapidil group (P < 0.05). The IOP of propofol group showed no obvious increase during extubation compared with that in preinduction, while in the urpidil group, extubation caused IOP significantly increased (P < 0.05). The changes in these indicators between the two groups had no significant difference (P > 0.05). CONCLUSION: Compared to urapidil, propofol is superior for preventing the cardiovascular and stress responses and IOP increases during emergence and extubation for the ophthalmic patients. Moreover, it has no effects on patient's recovery.展开更多
BACKGROUND: Although low central venous pressure (CVP) has been used to minimize blood loss during hepatectomy the impact of variations of CVP on the rate of blood loss and on the perfusion of end-organs has not been ...BACKGROUND: Although low central venous pressure (CVP) has been used to minimize blood loss during hepatectomy the impact of variations of CVP on the rate of blood loss and on the perfusion of end-organs has not been evaluated This animal study aimed to evaluate the hemodynamics and oxygen transport changes during hepatic resection at different CVP levels. METHODS: Forty-eight anesthetized Bama miniature pigs were divided into 8 groups with CVP during hepatic resection controlled at 0 to <1, 1 to <2, 2 to <3, 3 to <4, 4 to <5, 5 to <6, 6 to <7, and 7 to <8 cmH 2 O. Intergroup comparisons were made for hemodynamic parameters, oxygen transport dynamics, and the rate of blood loss. RESULTS: The rate of blood loss and the hepatic venous pressure during hepatic resection were almost linearly related to the CVP. A significant drop in the mean arterial pressure cardiac output, and cardiac index occurred between CVP ≥2 and <2 cmH 2 O. Oxygen delivery (DO 2 ), oxygen consumption (VO 2 ) and oxygen extraction ratio (ERO 2 ) remained relatively constant between CVPs of 2 to <8 cmH 2 O. There was a significant drop in DO 2 when the CVP was <2 cmH 2 O. There was also a significant drop in VO 2 and ExO 2 when the CVP was <1 cmH 2 O.CONCLUSION: The optimal CVP for hepatic resection is 2to 3 cmH2O.展开更多
Objective:To probe into the intervening action of polysaccharides of Zhu Zi Shen(Rhizoma Panacis Majoris)(PZZS) on oxidative stress and hemodynamics in rats with adriamycin-induced chronic congestive heart failure(CHF...Objective:To probe into the intervening action of polysaccharides of Zhu Zi Shen(Rhizoma Panacis Majoris)(PZZS) on oxidative stress and hemodynamics in rats with adriamycin-induced chronic congestive heart failure(CHF).Methods:After SD rats were successfully modeled with adriamycin,they were randomly divided into a normal control group,a model group,a PZZS group,and a captopril group,and were administrated respectively.At the end of experiment,the hemodynamic function,whole heart weight index,and the blood CK,SOD,MDA,NO,NOS were detected;and the myocardial morphological examinations were carried out.Results:Compared with the normal control group,the arterial systolic pressure(SBP),diastolic pressure(DBP),mean arterial pressure(MAP),heart rate(HR),left ventricular systolic peak(LVSP),and left ventricular pressure change rate(dp/dtmax) significantly decreased,and left ventricular end diastolic pressure(LVEDP),whole heart weight index,the blood CK,MDA,NO,NOS significantly increased in the model group.PZZS significantly improved the hemodynamic function,lowered the MDA and NO levels,and decreased the CK and NOS activities in the CHF rats.Conclusion:PZZS can improve the hemodynamic function,and alleviate the oxidative stress reaction in the CHF rat.展开更多
AIM： To evaluate treatment safety and hemodynamic changes during a single 6-h treatment with the PrometheusTM liver assist system in a randomized, controlled study. METHODS： Twenty-four patients were randomized to e...AIM： To evaluate treatment safety and hemodynamic changes during a single 6-h treatment with the PrometheusTM liver assist system in a randomized, controlled study. METHODS： Twenty-four patients were randomized to either the study group or to one of two control groups： Fractionated Plasma Separation Adsorption and Dialysis, PrometheusTM system （Study group; n = 8）; Molecular Adsorbent Recirculation System （MARS）TM （Control group 1, n = 8）; or hemodialysis （Control group 2; n = 8）. All patients included in the study had decompensated cirrhosis at the time of the inclusion into the study. Circulatory changes were monitored with a Swan-Ganz catheter and bilirubin and creatinine were monitored as measures of protein-bound and water-soluble toxins. RESULTS： Systemic hemodynamics did not differ between treatment and control groups apart from an increase in arterial pressure in the MARS group （P = 0.008）. No adverse effects were observed in any of the groups. Creatinine levels significantly decreased in the MARS group （P = 0.03） and hemodialysis group （P = 0.04）. Platelet count deceased in the Prometheus group （P = 0.04）.CONCLUSION： Extra-corporal liver support with Prometheus is proven to be safe in patients with endstage liver disease but does not exert the beneficial effects on arterial pressure as seen in the MARS group,展开更多
AIM: To determine the correlation between portal hemodynamics and spleen function among different grades of cirrhosis and verify its significance in cirrhosis staging.METHODS: The portal and splenic vein hemodynamics ...AIM: To determine the correlation between portal hemodynamics and spleen function among different grades of cirrhosis and verify its significance in cirrhosis staging.METHODS: The portal and splenic vein hemodynamics and spleen size were investigated by ultrasonography in consecutive 38 cirrhotic patients with cirrhosis (Child's grades A to C) and 20 normal controls. The differences were compared in portal vein diameter and flow velocity between patients with and without ascites and between patients with mild and severe esophageal varices. The correlation between peripheral blood cell counts and Child's grades was also determined.RESULTS: The portal flow velocity and volume were significantly lower in patients with Child's C (12.25±1.67 cm/s vs 788.59±234 mm/min, respectively) cirrhosis compared to controls (19.55±3.28 cm/s vs 1254.03±410 mm/min,respectively) and those with Child's A (18.5±3.02 cm/s vs1358.48±384 mm/min, respectively) and Child's B (16.0±3.89cm/s vs 1142.23±390 mm/min, respectively)cirrhosis.Patients with ascites had much lower portal flow velocity and volume (13.0±1.72 cm/s vs 1078±533 mm/min) than those without ascites (18.6±2.60 cm/s vs 1394±354 mm/min).There was no statistical difference between patients with mild and severe esophageal varices. The portal vein diameter was not significantly different among the above groups.There were significant differences in splenic vein diameter,flow velocity and white blood cell count, but not in spleen size, red blood cell and platelet counts among the various grades of cirrhosis. The spleen size was negatively correlated with red blood cell and platelet counts (r= -0.620and r = -0.8.34, respectively).CONCLUSION: An optimal system that includes parameters representing the portal hemodynamics and spleen function should be proposed for cirrhosis staging.展开更多
Hepatic pseudolesion may occur in contrast-enhanced computed tomography and magnetic resonance imaging due to the unique haemodynamic characteristics of the liver.The concept of hepatic arterial buffer response(HABR)h...Hepatic pseudolesion may occur in contrast-enhanced computed tomography and magnetic resonance imaging due to the unique haemodynamic characteristics of the liver.The concept of hepatic arterial buffer response(HABR)has become mainstream for the understanding of the mechanism of the reciprocal effect between hepatic arterial and portal venous flow.And HABR is thought to be significantly related to the occurrence of the abnormal imaging findings on arterial phase of contrast enhanced images,such as hepatic arterial-portal vein shunt and transient hepatic attenuation difference,which mimic hypervascular tumor and may cause clinical problems.Third inflow to the liver also cause hepatic pseudolesion,and some of the cases may show histopathologic change such as focal hyperplasia,focal fatty liver,and focal sparing of fatty liver,and called pseudotumor.To understand these phenomena might be valuable for interpreting the liver imaging findings.展开更多
BACKGROUND: Many diseases can cause obstructive jaundice and then lead to a series of pathologic disorders. Thus preoperative assessment of liver function is of utmost importance. Traditional assessment is to monitor ...BACKGROUND: Many diseases can cause obstructive jaundice and then lead to a series of pathologic disorders. Thus preoperative assessment of liver function is of utmost importance. Traditional assessment is to monitor related indicators of liver function, but it is invasive and needs to be performed repeatedly. Color Doppler flow imaging (CDFI) was used to monitor blood flow of the hepatic artery and portal vein, a non-invasive method which can be used repeatedly. METHODS: Twenty cases of obstructive jaundice were detected by CDFI and changes of liver function were measured after operation. The variables of hemodynamic monitoring included peak flow rate and mean blood flow in the hepatic artery proper at the peak of the contraction period; the inner diameter of blood vessels, the peak flow rate, and the congestion index, the blood flow in the main portal vein. RESULTS: The average peak flow rate in the hepatic artery of patients with obstructive jaundice was significantly higher than that of normal people; both the inner diameter and congestive index of the portal vein were significantly larger than those of normal people. But the mean blood flow and peak flow rate in the portal vein were lower than those of normal people. CONCLUSIONS: CDFI is an ideal and non-invasive method for evaluating liver hemodynamics in obstructive jaundice. If the increase of hepatic arterial flow is more significant than the decrease of the blood flow in the portal vein, hepatic functional recovery after operation is smoother, suggesting a better prognosis. If the increase of the hepatic arterial flow is less significant than the decrease of the blood flow in the portal vein, hepatic functional recovery after operation may not be smooth, suggesting a worse prognosis.展开更多
AIM: To explore hemodynamics and vasoactive substance levels during renal vein congestion that occurs in the anhepatic phase of liver transplantation.METHODS: New Zealand rabbits received ligation of the hepatic pedic...AIM: To explore hemodynamics and vasoactive substance levels during renal vein congestion that occurs in the anhepatic phase of liver transplantation.METHODS: New Zealand rabbits received ligation of the hepatic pedicle, supra-hepatic vena cava and infrahepatic vena cava [anhepatic phase group(APH); n = 8], the renal veins(RVL; n = 8), renal veins and hepatic pedicle [with the inferior vena cava left open)(RVHP; n = 8)], or a sham operation(SOP; n = 8). Hemodynamic parameters(systolic, diastolic, and mean arterial blood pressures) and the levels of serum bradykinin(BK) and angiotensin Ⅱ(ANGII) were measured at baseline(0 min), and 10 min, 20 min, 30 min, and 45 min after the surgery. Correlation analyses were performed to evaluate the associations between hemodynamic parameters and levels of vasoactive substances.RESULTS:All experimental groups(APH,RVL,and RVHP)showed significant decreases in hemodynamic parameters(systolic,diastolic,and mean arterial blood pressures)compared to baseline levels,as well as compared to the SOP controls(P<0.05 for all).In contrast,BK levels were significantly increased compared to baseline in the APH,RVL,and RVHP groups at all time points measured(P<0.05 for all),whereas no change was observed in the SOP controls.There were no significant differences among the experimental groups for any measure at any time point.Further analyses revealed that systolic,diastolic,and mean arterial blood pressures were all negatively correlated with BK levels,and positively correlated with ANGII levels in the APH,RVL,and RVHP groups(P<0.05 for all).CONCLUSION:In the anhepatic phase of orthotopic liver transplantation,renal vein congestion significantly impacts hemodynamic parameters,which correlate with serum BK and ANGII levels.展开更多
IM To investigate the effects of somatostatin analog on splanchnic hemodynamics and plasma glucagon level in portal hypertensive rats.METHODS Twentyeight male SpragueDawley rats were divided into two groups: intrahe...IM To investigate the effects of somatostatin analog on splanchnic hemodynamics and plasma glucagon level in portal hypertensive rats.METHODS Twentyeight male SpragueDawley rats were divided into two groups: intrahepatic portal hypertension (IHPH, n=14) by injection of CCl4 and prehepatic portal hypertension (PHPH, n=14) by stenosis of the portal vein. Animals of each group were divided into two subgroups: injection of octreotide and injection of normal saline. Seven agematched normal rats served as controls. The mean systemic arterial pressure (MSAP) and free portal venous pressure (FPP) were measured. The splanchnic blood flow was detected by injection of toad blood red cell labelled with 51Cr and 125I·T3. The concentration of plasma glucagon was determined by radioimmunoassay.RESULTS Octreotide significantly decreased both the splanchnic blood flow and FPP in portal hypertensive rats, and markedly increased splanchnic vascular and portal venous resistance. Octreotide did not significantly lower the plasma glucagon levels in both the peripheral and the portal veins.CONCLUSION The decreased splanchnic blood flow induced by octreotide in portal hypertensive rats results mainly from direct vasoconstriction but less from decreased plasma glucagon level.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 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.
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 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 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.
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(P<0.05).At the four time points of measurement(T1 through T4),MAP and HR values were higher in the observation than control group(MAP,90.20±9.15 mmHg,85.50±7.22 mmHg,88.59±8.15 mmHg,and 90.02±10.02 mmHg,respectively;and HR,72.39±8.22 beats/min,69.03±9.03 beats/min,70.12±8.11 beats/min,and 71.24±9.01 beats/min,respectively;P<0.05).There was no difference in SpO;between the two groups(P>0.05).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;P<0.05).Similarly,the postoperative tumor necrosis factor-αand interleukin-6 levels were lower in the observation(2.43±0.44 pg/mL and 170.03±35.54 pg/mL,respectively)than control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).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.
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National Natural Science Foundation of China (No.39580683)
文摘AIM: To compare the effect of propofol versus urapidil on hemodynamics and intraocular pressure during anesthesia and extubation for ophthalmic patients. METHODS: Eighty-two surgical patients (Class: ASA I-II) were randomly assigned to propofol (n = 41) and urapidil groups (n = 41). Their gender, age, body mass, operation time and dosage of anesthetics had no significant difference between the two groups (P > 0.05). The patients of propofol and urapidil groups were given propofol (1.5mg/kg) and urapidil (2.5mg/kg) respectively; and two drugs were all diluted with normal saline to 8mL. Then the drugs were given to patients by slow intravenous injection. After treatment, the patients were conducted immediate suction, tracheal extubation, and then patients wore oxygen masks for 10 minutes. By double-blind methods, before the induction medication, at the suction, and 5, 10 minutes after the extubation, we recorded the systolic and diastolic blood pressure (BP), heart rate (HR), pH, PaO2, PaCO2, SaO(2) and intraocular pressure (TOP) respectively. The complete recovery time of the patients with restlessness (on the command they could open eyes and shaking hands) was also recorded during the extubation. The data were analyzed by using a professional SPSS 15.0 statistical software. RESULTS: The incidence of cough, restlessness and glossocoma was significantly lower in the propofol group than that in the urapidil group after extubation (P < 0.05). There were no episodes of hypotension, laryngospasm, or severe respiratory depression. There was no statistical difference in recovery time between two groups (P > 0.05). In propofol group, the BP and HR during extubation and thereafter had no significant difference compared with those before induction, while they were significantly lower than those before giving propofol (P < 0.05), and had significant difference compared with those in urapidil group (P < 0.05). Compared to preinduction, the BP of urapidil group showed no obvious increase during aspiration and extubation. The HR of urapidil group had little changes after being given urapidil, and it was obviously increased compared with that before induction. The stimulation of aspiration and extubation caused less cough and agitation in propofol group than that in urapidil group (P < 0.05). The IOP of propofol group showed no obvious increase during extubation compared with that in preinduction, while in the urpidil group, extubation caused IOP significantly increased (P < 0.05). The changes in these indicators between the two groups had no significant difference (P > 0.05). CONCLUSION: Compared to urapidil, propofol is superior for preventing the cardiovascular and stress responses and IOP increases during emergence and extubation for the ophthalmic patients. Moreover, it has no effects on patient's recovery.
基金supported by a grant from the GuangxiNatural Science Foundation (GKZ0447066)
文摘BACKGROUND: Although low central venous pressure (CVP) has been used to minimize blood loss during hepatectomy the impact of variations of CVP on the rate of blood loss and on the perfusion of end-organs has not been evaluated This animal study aimed to evaluate the hemodynamics and oxygen transport changes during hepatic resection at different CVP levels. METHODS: Forty-eight anesthetized Bama miniature pigs were divided into 8 groups with CVP during hepatic resection controlled at 0 to <1, 1 to <2, 2 to <3, 3 to <4, 4 to <5, 5 to <6, 6 to <7, and 7 to <8 cmH 2 O. Intergroup comparisons were made for hemodynamic parameters, oxygen transport dynamics, and the rate of blood loss. RESULTS: The rate of blood loss and the hepatic venous pressure during hepatic resection were almost linearly related to the CVP. A significant drop in the mean arterial pressure cardiac output, and cardiac index occurred between CVP ≥2 and <2 cmH 2 O. Oxygen delivery (DO 2 ), oxygen consumption (VO 2 ) and oxygen extraction ratio (ERO 2 ) remained relatively constant between CVPs of 2 to <8 cmH 2 O. There was a significant drop in DO 2 when the CVP was <2 cmH 2 O. There was also a significant drop in VO 2 and ExO 2 when the CVP was <1 cmH 2 O.CONCLUSION: The optimal CVP for hepatic resection is 2to 3 cmH2O.
文摘Objective:To probe into the intervening action of polysaccharides of Zhu Zi Shen(Rhizoma Panacis Majoris)(PZZS) on oxidative stress and hemodynamics in rats with adriamycin-induced chronic congestive heart failure(CHF).Methods:After SD rats were successfully modeled with adriamycin,they were randomly divided into a normal control group,a model group,a PZZS group,and a captopril group,and were administrated respectively.At the end of experiment,the hemodynamic function,whole heart weight index,and the blood CK,SOD,MDA,NO,NOS were detected;and the myocardial morphological examinations were carried out.Results:Compared with the normal control group,the arterial systolic pressure(SBP),diastolic pressure(DBP),mean arterial pressure(MAP),heart rate(HR),left ventricular systolic peak(LVSP),and left ventricular pressure change rate(dp/dtmax) significantly decreased,and left ventricular end diastolic pressure(LVEDP),whole heart weight index,the blood CK,MDA,NO,NOS significantly increased in the model group.PZZS significantly improved the hemodynamic function,lowered the MDA and NO levels,and decreased the CK and NOS activities in the CHF rats.Conclusion:PZZS can improve the hemodynamic function,and alleviate the oxidative stress reaction in the CHF rat.
基金The NOVO Nordic Foundation, Savvrksejer Jeppe & Ovita Mindelegat, Fabricant Vilhelm Pedersen & Wifes Mindelegat, A.P. Moller Scientific Foundation, the Danish Medical Association Research Fund and the Laerdal Foundation for Acute Medicine, and by an unrestricted grant from the Fresenius Medical Care GmBH
文摘AIM： To evaluate treatment safety and hemodynamic changes during a single 6-h treatment with the PrometheusTM liver assist system in a randomized, controlled study. METHODS： Twenty-four patients were randomized to either the study group or to one of two control groups： Fractionated Plasma Separation Adsorption and Dialysis, PrometheusTM system （Study group; n = 8）; Molecular Adsorbent Recirculation System （MARS）TM （Control group 1, n = 8）; or hemodialysis （Control group 2; n = 8）. All patients included in the study had decompensated cirrhosis at the time of the inclusion into the study. Circulatory changes were monitored with a Swan-Ganz catheter and bilirubin and creatinine were monitored as measures of protein-bound and water-soluble toxins. RESULTS： Systemic hemodynamics did not differ between treatment and control groups apart from an increase in arterial pressure in the MARS group （P = 0.008）. No adverse effects were observed in any of the groups. Creatinine levels significantly decreased in the MARS group （P = 0.03） and hemodialysis group （P = 0.04）. Platelet count deceased in the Prometheus group （P = 0.04）.CONCLUSION： Extra-corporal liver support with Prometheus is proven to be safe in patients with endstage liver disease but does not exert the beneficial effects on arterial pressure as seen in the MARS group,
基金Supported by the National Science Fund or Foundation for Postdoctoral Fellows in China,No.2001.6the Medical Science Found of Shandong Province,No.1999CA2BJBA1.
文摘AIM: To determine the correlation between portal hemodynamics and spleen function among different grades of cirrhosis and verify its significance in cirrhosis staging.METHODS: The portal and splenic vein hemodynamics and spleen size were investigated by ultrasonography in consecutive 38 cirrhotic patients with cirrhosis (Child's grades A to C) and 20 normal controls. The differences were compared in portal vein diameter and flow velocity between patients with and without ascites and between patients with mild and severe esophageal varices. The correlation between peripheral blood cell counts and Child's grades was also determined.RESULTS: The portal flow velocity and volume were significantly lower in patients with Child's C (12.25±1.67 cm/s vs 788.59±234 mm/min, respectively) cirrhosis compared to controls (19.55±3.28 cm/s vs 1254.03±410 mm/min,respectively) and those with Child's A (18.5±3.02 cm/s vs1358.48±384 mm/min, respectively) and Child's B (16.0±3.89cm/s vs 1142.23±390 mm/min, respectively)cirrhosis.Patients with ascites had much lower portal flow velocity and volume (13.0±1.72 cm/s vs 1078±533 mm/min) than those without ascites (18.6±2.60 cm/s vs 1394±354 mm/min).There was no statistical difference between patients with mild and severe esophageal varices. The portal vein diameter was not significantly different among the above groups.There were significant differences in splenic vein diameter,flow velocity and white blood cell count, but not in spleen size, red blood cell and platelet counts among the various grades of cirrhosis. The spleen size was negatively correlated with red blood cell and platelet counts (r= -0.620and r = -0.8.34, respectively).CONCLUSION: An optimal system that includes parameters representing the portal hemodynamics and spleen function should be proposed for cirrhosis staging.
文摘Hepatic pseudolesion may occur in contrast-enhanced computed tomography and magnetic resonance imaging due to the unique haemodynamic characteristics of the liver.The concept of hepatic arterial buffer response(HABR)has become mainstream for the understanding of the mechanism of the reciprocal effect between hepatic arterial and portal venous flow.And HABR is thought to be significantly related to the occurrence of the abnormal imaging findings on arterial phase of contrast enhanced images,such as hepatic arterial-portal vein shunt and transient hepatic attenuation difference,which mimic hypervascular tumor and may cause clinical problems.Third inflow to the liver also cause hepatic pseudolesion,and some of the cases may show histopathologic change such as focal hyperplasia,focal fatty liver,and focal sparing of fatty liver,and called pseudotumor.To understand these phenomena might be valuable for interpreting the liver imaging findings.
文摘BACKGROUND: Many diseases can cause obstructive jaundice and then lead to a series of pathologic disorders. Thus preoperative assessment of liver function is of utmost importance. Traditional assessment is to monitor related indicators of liver function, but it is invasive and needs to be performed repeatedly. Color Doppler flow imaging (CDFI) was used to monitor blood flow of the hepatic artery and portal vein, a non-invasive method which can be used repeatedly. METHODS: Twenty cases of obstructive jaundice were detected by CDFI and changes of liver function were measured after operation. The variables of hemodynamic monitoring included peak flow rate and mean blood flow in the hepatic artery proper at the peak of the contraction period; the inner diameter of blood vessels, the peak flow rate, and the congestion index, the blood flow in the main portal vein. RESULTS: The average peak flow rate in the hepatic artery of patients with obstructive jaundice was significantly higher than that of normal people; both the inner diameter and congestive index of the portal vein were significantly larger than those of normal people. But the mean blood flow and peak flow rate in the portal vein were lower than those of normal people. CONCLUSIONS: CDFI is an ideal and non-invasive method for evaluating liver hemodynamics in obstructive jaundice. If the increase of hepatic arterial flow is more significant than the decrease of the blood flow in the portal vein, hepatic functional recovery after operation is smoother, suggesting a better prognosis. If the increase of the hepatic arterial flow is less significant than the decrease of the blood flow in the portal vein, hepatic functional recovery after operation may not be smooth, suggesting a worse prognosis.
基金Supported by Natural Science Foundation of Gansu Province,China,No.3ZS051-A25-104Clinical Medicine Research Special Funds of Chinese Medical Association,China,No.14040360573
文摘AIM: To explore hemodynamics and vasoactive substance levels during renal vein congestion that occurs in the anhepatic phase of liver transplantation.METHODS: New Zealand rabbits received ligation of the hepatic pedicle, supra-hepatic vena cava and infrahepatic vena cava [anhepatic phase group(APH); n = 8], the renal veins(RVL; n = 8), renal veins and hepatic pedicle [with the inferior vena cava left open)(RVHP; n = 8)], or a sham operation(SOP; n = 8). Hemodynamic parameters(systolic, diastolic, and mean arterial blood pressures) and the levels of serum bradykinin(BK) and angiotensin Ⅱ(ANGII) were measured at baseline(0 min), and 10 min, 20 min, 30 min, and 45 min after the surgery. Correlation analyses were performed to evaluate the associations between hemodynamic parameters and levels of vasoactive substances.RESULTS:All experimental groups(APH,RVL,and RVHP)showed significant decreases in hemodynamic parameters(systolic,diastolic,and mean arterial blood pressures)compared to baseline levels,as well as compared to the SOP controls(P<0.05 for all).In contrast,BK levels were significantly increased compared to baseline in the APH,RVL,and RVHP groups at all time points measured(P<0.05 for all),whereas no change was observed in the SOP controls.There were no significant differences among the experimental groups for any measure at any time point.Further analyses revealed that systolic,diastolic,and mean arterial blood pressures were all negatively correlated with BK levels,and positively correlated with ANGII levels in the APH,RVL,and RVHP groups(P<0.05 for all).CONCLUSION:In the anhepatic phase of orthotopic liver transplantation,renal vein congestion significantly impacts hemodynamic parameters,which correlate with serum BK and ANGII levels.
文摘IM To investigate the effects of somatostatin analog on splanchnic hemodynamics and plasma glucagon level in portal hypertensive rats.METHODS Twentyeight male SpragueDawley rats were divided into two groups: intrahepatic portal hypertension (IHPH, n=14) by injection of CCl4 and prehepatic portal hypertension (PHPH, n=14) by stenosis of the portal vein. Animals of each group were divided into two subgroups: injection of octreotide and injection of normal saline. Seven agematched normal rats served as controls. The mean systemic arterial pressure (MSAP) and free portal venous pressure (FPP) were measured. The splanchnic blood flow was detected by injection of toad blood red cell labelled with 51Cr and 125I·T3. The concentration of plasma glucagon was determined by radioimmunoassay.RESULTS Octreotide significantly decreased both the splanchnic blood flow and FPP in portal hypertensive rats, and markedly increased splanchnic vascular and portal venous resistance. Octreotide did not significantly lower the plasma glucagon levels in both the peripheral and the portal veins.CONCLUSION The decreased splanchnic blood flow induced by octreotide in portal hypertensive rats results mainly from direct vasoconstriction but less from decreased plasma glucagon level.
