Objective To study the neural mechanism of hypotension or shock state in acute cholangitis in severe type (ACST) and its value of clinical application. Methods A technique of blocking abdominal splanchnic nervi via right adipose capsule of kidney was carried out on 28 patients by injecting 1% lidocaine before urgent operation. Results After blocking the relevant nervi, hypotension or shock state in 23 patients were improved significantly (Ｐ＜0.05). The death rate was lower (14.3%) after having performed biliary decompressions with laparotomy. Conclusion Patients′ hypotension or shock state at the early phase of ACST is the result of neural reflex in which the splanchnic nervi is its afferent pathway. Blocking the relevant nervi before urgent operation, the valuable opportunity of emergency treatment can be obtainded and the complication and death rate are reduced significantly.
Objective To investigate the risk factors for hypotension in liver failure patients during double plasma molecular adsorption system (DPMAS) treatment, providing a theoretical basis for targeted clinical prevention and intervention. Methods Liver failure patients undergoing DPMAS at West China Hospital of Sichuan University between March 2021 and March 2023 were retrospectively enrolled. General data and clinical indicators were compared between the hypotension group and non-hypotension group. Multivariate logistic regression analysis was used to identify risk factors for hypotension. Results Of the 403 included patients, 60 (14.89%) developed hypotension, while 343 (85.11%) did not. Univariate analyses showed statistically significant differences between groups in age, sex, body mass index (BMI), albumin, serum sodium, pre-treatment systolic blood pressure, pre-treatment diastolic blood pressure, pre-treatment mean arterial pressure, and intraoperative vasoactive drug use (P<0.05). Multivariate logistic regression revealed that low BMI [odds ratio (OR)=0.712, 95% confidence interval (CI) (0.587, 0.863)], low serum sodium [OR=0.715, 95%CI (0.646, 0.792)], and intraoperative vasoactive drug use [OR=11.382, 95%CI (4.438, 29.194)] were independent risk factors for hypotension (P<0.05). Receiver operating characteristic curve analysis combining these three factors yielded an area under the curve of 0.922 [95%CI (0.886, 0.957)] for predicting hypotension incidence. Conclusions Low serum sodium, intraoperative vasoactive drug use, and low BMI are significant risk factors for hypotension during DPMAS therapy. Clinical emphasis should be placed on anticipating and mitigating hypotension to ensure uninterrupted treatment, reduce economic burdens, and improve patient prognosis.
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.
ObjectiveTo systematically review the relationship between frailty and risk of orthostatic hypotension.MethodsPubMed, EMbase, Web of Science, CNKI, CBM, VIP and WanFang Data databases were electronically searched to collect studies on the association between frailty and orthostatic hypotension from inception to July 7th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed by RevMan 5.3 software.ResultsFive cross-sectional studies involving 8 671 patients were included. The results of meta-analysis showed that prefrailty (OR=1.04, 95%CI 0.99 to 1.09, P=0.11) and frailty (OR=1.02, 95%CI=0.92 to 1.13, P=0.70) were not associated with orthostatic hypotension. The results of subgroup analysis showed that differences of sample size (<500 or ≥500), using different frailty assessment tools (Fried scale, clinical frailty scale, and frailty index), different regions (Europe, Asia, and America) and different sources of studied subjects (hospitals and communities), the risk of orthostatic hypotension were not increased with frailty.ConclusionsCurrent evidence shows that frailty does not increase the risk of orthostatic hypotension. Due to limited quality and quantity of included studies, the above conclusions are needed to be validated by more high-quality studies.
ObjectiveTo observe the incidence of hypotension in general anesthesia patients in post anesthesia care unit (PACU), compare the blood pressure before and after treatment, and analyze hypotension causes. MethodBetween September 2012 and July 2013, data of 18 931 patients in PACU after general anesthesia were retrospectively analyzed for the incidence of hypotension. At the same time, the change of blood pressure was also detected before and after treatment. ResultsSixty-two patients had hypotension during the anesthesia recovery period after general anesthesia. The incidence was 0.33%. The proportion was the highest among patients who underwent abdominal surgery, reaching 41.9%. Systolic pressure and diastolic pressure improved significantly after treatment (P<0.05). ConclusionsIt is important to perform comprehensive evaluation of vital signs, closely observe disease conditions and vital sign changes, find out and manage low blood pressure for patients in PACU, which secure their safety.
ObjectiveTo evaluate the effect of different rehydration strategies on the incidence of spinal anesthesia-induced hypotension and neonatal outcomes during elective cesarean section.MethodsWe searched PubMed, Embase, the Cochran Library, China National Knowledge Internet, VIP database, Wanfang database, and China Biology Medicine database from inception to January 2018, to collect randomized controlled trials (RCTs) about the incidence of spinal anesthesia-induced hypotension during elective cesarean section and neonatal outcomes of preloading or coloading. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias in the study. Meta-analysis was conducted using RevMan 5.3 software.ResultsA total of 11 RCTs were included, including 894 parturients, of whom 448 cases in the preload group and 446 cases in the coload group. Comparing with the preload group, the incidence of spinal anesthesia-induced hypotension during cesarean section in the coload group significantly decreased [risk ratio (RR)=1.27, 95% confidence interval (CI) (1.13, 1.43), P<0.000 1]. Subgroup analysis showed that in the crystalloid fluid group, the difference in the incidence of hypotension between the preload group and the coload group was statistically significant [RR=1.48, 95%CI (1.26, 1.73), P<0.000 01]; while in the colloidal fluid group, the difference in the the incidence of hypotension between the preload group and the coload group was not significant [RR=1.00, 95%CI (0.85, 1.17), P=0.96]. The lowest systolic blood pressure, the incidence of nausea and vomiting, and neonatal outcomes had no significant difference between the two groups.ConclusionsComparing with preloading crystalloid fluid, rapid infusion of crystalloid fluid at the same time implementation of spinal anesthesia could significantly reduce the incidence of hypotension during cesarean section while there was no superiority in infusion of colloid fluid. There was no significant effect on the severity of hypotension, nausea and vomiting, and neonatal outcomes. Due to the limitation of the quantity and quality of the included studies, the above conclusions need to be verified by more high-quality studies.