Objective To investigate and compare the effects of succinylated gelatin injection and saline priming on the first hour blood pressure in critically ill patients receiving continuous renal replacement therapy (CRRT). Methods Inpatients who received continuous venous-venous dialysis filtration therapy in the intensive care unit of West China Hospital of Sichuan University between January and May 2024 were selected. The patients were randomly divided into an experimental group (colloidal solution group) and a control group (crystalloid solution group) in a 1∶1 ratio. The colloidal solution group used succinylated gelatin injection as the priming solution, and used the dual connection method to draw blood to the machine. The patient’s systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate at 10 minutes before and 0, 1, 3, 5, 10, 30 and 60 minute after CRRT initiation, the name and dosage of vascular compression drugs pumped intravenously at 0, 30 and 60 minutes, and the liquid inlet and outlet in the first hour were monitored and recorded. The crystalloid solution group used normal saline as the priming solution, and the rest of the methods were the same as those of the colloidal solution group. Two groups of patients were compared for changes in blood pressure and heart rate during the first hour of CRRT, as well as the incidence of hypotension. Results A total of 208 patients were included, with 104 cases in each group. There was no significant difference in baseline data between the two groups (P>0.05). At 3 minutes after CRRT, the systolic blood pressure of the crystalloid solution group was lower than that of the colloidal solution group [(122.56±23.82) vs. (129.43±25.46) mm Hg (1 mm Hg=0.133 kPa); t=−2.005, P=0.046]. There was no statistically significant difference in diastolic blood pressure, mean arterial pressure, or heart rate between the two groups at different time points (P>0.05). The intra group comparison results showed that the systolic blood pressure of the crystalloid solution group decreased compared to before at 1, 3, 5, and 10 minutes after CRRT (P<0.05), while the diastolic blood pressure and mean arterial pressure decreased compared to before at 3, 5, and 10 minutes after the start of CRRT (P<0.05); there was no statistically significant difference in blood pressure of the colloidal solution group among different time points after the start of CRRT (P>0.05). The heart rate of the crystalloid solution group was higher at 10 minutes after the start of CRRT than at 3 minutes after CRRT (P=0.045); 60 minutes after the start of CRRT, the heart rate in the colloidal solution group was lower than that 0 minutes after CRRT (P=0.032); there was no statistically significant difference between the two groups at other time points within each group (P>0.05). On the first hour of CRRT, there was a statistically significant difference in the incidence of hypotension between the two groups [33 cases (31.7%) vs. 18 cases (17.3%); χ2=5.845, P=0.016]. Conclusions The use of colloidal solution pre-flushing is more advantageous to improving the decrease in blood pressure in the first hour of CRRT in severe patients than crystalloid solution group pre-flushing. And it can reduce the incidence of hypotension in the first hour of CRRT in severe patients.
【摘要】 目的 探讨高血压危象评估和处理原则及对高血压危象急诊处理的指导意义。 方法 依据高血压危象评估和处理原则对2008年1月-2009年12月期间收治的160例高血压危象患者进行诊断和治疗。结果 160例高血压危象患者中,高血压急症134例,高血压亚急症26例。高血压急症中,以心脑血管病变为主,包括脑卒中、急性冠脉综合征和急性左侧心力衰竭。依据高血压危象评估和处理原则进行急诊处理,能够对高血压危象进行准确评估和有效处理,减少诊治失误,降低死亡率并改善预后。结论 有关高血压危象的评估和处理原则能够指导高血压危象的急诊处理,取得良好的预后。【Abstract】 Objective To investigate the principles of evaluation and management of hypertensive crises in order to guide emergency clinical practice for better managements and prognosis. Methods One hundred and sixty patients with hypertensive crises admitted to our department from January 2008 to December 2009 had been diagnosed and treated. Results There were 134 patients with hypertensive emergencies (HE) and 26 patients with hypertensive urgencies(HU)in accordance with those principle. Cardiocerebralvascular diseases were the main symptom of HE including stroke, acute coronary syndrome and acute left ventricular failure. According to those principles,the emergency management was carried out, accuracy evaluation and effective management of hypertensive crises could reduce wrong diagnosis and treatment,decrease mortality and improve prognosis. Conclusion The principle of evaluation and management of hypertensive crises could guide the emergency management of hypertensive crises and obtain better prognosis．
ObjectiveTo identify the incidence of postintubation hypotension (PIH) in critically ill patients and evaluate the responsive risk factors and prognosis. MethodsThe data of intubation patients with normal blood pressure before intubation were collected and analyzed in Intensive Care Unit (ICU) in the latest two years and divided into two groups. One contained PIH patients and the other one contained patients with no change in blood pressure after intubation. The primary outcome measure was 28-day mortality and secondary outcome measure was length of stay (LOS) in ICU and hospital. ResultsThere were 25(31.65%) PIH patients in included 79 patients. The patients in PIH group had significantly higher 28-day mortality (40.00% vs 14.81%, P=0.01) and there were no difference in LOS in ICU and hospital. Risk factors were age (OR:1.1, 95% CI:1.00-1.12), chronic respiratory diseases (OR:3.0, 95% CI:1.13-8.07) and complication with over two chronic diseases (OR:3.6, 95% CI:1.18-11.03). ConclusionPIH is more common in old patients complicated with chronic diseases and results in higher 28-day mortality.
This study aims to detect early changes of kidney in patients with primary hypertension by 3.0 T functional magnetic resonance imaging (fMRI). 26 patients with primary hypertension (hypertension group) and 33 healthy volunteers (control group) underwent conventional and functional magnetic resonance scans, which included blood oxygen level-dependent (BOLD) MRI, diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI). We measured renal cortical thickness (CT), parenchymal thickness (PT), and functional values of renal cortex and medulla including R2* value, apparent diffusion coefficient (ADC) value and fractional anisotropy (FA) value in each group, and then calculated the cortical/parenchymal thickness ratio (CPR). Compared with those in the control group, CT and CPR in hypertension group were larger (P<0.01), cortical and medullar R2* values increased (P<0.01) whereas medullar FA values decreased (P<0.05). It could be well concluded that noninvasive 3.0 T functional MRI would have important clinical significance in identifying early abnormalities of kidney in hypertension patients.
ObjectiveTo systematically review the efficacy of amlodipine versus valsartan in the treatment of diabetes mellitus combined with hypertension and renal impairment. MethodsAll relevant randomized controlled trials (RCTs) were retrieved in WanFang Data, CNKI, VIP, CBM, The Cochrane Library (Issue 10, 2013), PubMed, EMbase and Ovid up to October 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. ResultsNine RCTs were finally included involving 794 cases. The results of meta-analysis showed that amlodipine was better than valsartan in improving 24-hour proteinuria (basic level < 1 000 mg:WMD=-10.24, 95%CI-18.52 to-1.95, P=0.02; basic level > 1 000 mg:WMD=-575.69, 95%CI-781.02 to-370.36, P < 0.000 01). However, there was no significant difference between two groups in lowing urine albumin excretion rates (UAER), serum creatinine (Scr), systolic blood pressure (SBP), diastolic blood pressure (DBP), and incidences of adverse events (UAER:WMD=-11.29, 95%CI-27.93 to 5.36, P=0.18; Scr:WMD=1.05, 95%CI-3.89 to 5.99, P=0.68; SBP:WMD=0.52, 95%CI-0.83 to 1.87, P=0.45; DBP:WMD=-0.40, 95%CI-1.41 to 0.62, P=0.44; ADR:WMD=1.00, 95%CI 0.3 to 3.34, P=1.00). ConclusionCurrent evidence shows that, compared with valsartan, amlodipine has the same efficacy in treatment of diabetes mellitus combined with hypertension and renal impairment, and it is even better in improving 24-hour proteinuria.
目的:观察乌拉地尔与尼卡地平联合应用治疗ICU常规治疗效果不佳的高血压患者的疗效及不良反应。方法:23例ICU高血压患者应用乌拉地尔与尼卡地平持续泵入。结果:有效率达100%,其中21例患者在用药10 min内血压明显下降。用药过程中没有严重并发症。结论:两药合用疗效佳,起效快,耐受性好。