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World Journal of Clinical Cases 2024年第1期12卷 217-223页

作者： Tian-Xiang Zhang Hong-Yan Xu Wei Ma Jian-Bao Zheng Department of Tuberculosis The Tuberculosis Hospital of Shaanxi ProvinceXi’an 710100Shaanxi ProvinceChina Department of General Surgery First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061Shaanxi ProvinceChina

BACKGROUND Addison’s disease(AD)is a rare but potentially fatal disease in Western countries,which can easily be misdiagnosed at an early stage.Severe adrenal tuberculosis(TB)may lead to depression in patients.CASE SUMMARY We report a case of primary adrenal insufficiency secondary to adrenal TB with TB in the lungs and skin in a 48-year-old woman.The patient was misdiagnosed with depression because of her depressed mood.She had hyperpigmentation of the skin,nails,mouth,and lips.The final diagnosis was adrenal TB that resulted in the insufficient secretion of adrenocortical hormone.Adrenocortical hormone test,skin biopsy,T cell spot test of TB,and adrenal computed tomography scan were used to confirm the diagnosis.The patient’s condition improved after hormone replacement therapy and TB treatment.CONCLUSION Given the current status of TB in high-burden countries,outpatient doctors should be aware of and pay attention to TB and understand the early symptoms of AD.

关键词： Primary adrenal insufficiency Adrenal tuberculosis Fatigue hypotension Hyperkalemia Hyponatremia Depression Case report

Effect of remimazolam vs. propofol on hemodynamics during general anesthesia induction in elderly patients: Single-center, randomized controlled trial

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The Journal of Biomedical Research 2024年第1期38卷 66-75页

作者： Mingfeng He Chanjuan Gong Yinan Chen Rongting Chen Yanning Qian Department of Anesthesiology and Perioperative Medicine the First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsu 210029China

The current study aimed to compare the effects between remimazolam and propofol on hemodynamic stability during the induction of general anesthesia in elderly patients.We used propofol at a rate of 60 mg/(kg·h)in the propofol group(group P)or remimazolam at a rate of 6 mg/(kg·h)in the remimazolam group(group R)for the induction.A processed electroencephalogram was used to determine whether the induction was successful and when to stop the infusion of the study drug.We measured when patients entered the operating room(T_(0)),when the induction was successful(T_(1)),and when before(T_(2))and 5 min after successful endotracheal intubation(T_(3)).We found that mean arterial pressure(MAP)was lower at T_(1–3),compared with T_(0) in both groups,but higher at T_(2) in the group R,whileΔMAP_(T0–T2) andΔMAP_(max) were smaller in the group R(ΔMAP_(T0–T2):the difference between MAP at time point T_(0) and T_(2),ΔMAP_(max):the difference between MAP at time point T_(0) and the lowest value from T_(0) to T_(3)).Cardiac index and stroke volume index did not differ between groups,whereas systemic vascular resistance index was higher at T_(1–3) in the group R.These findings show that remimazolam,compared with propofol,better maintains hemodynamic stability during the induction,which may be attributed to its ability to better maintain systemic vascular resistance levels.

关键词： remimazolam propofol elderly patients hypotension left ventricular systolic function systematic vascular resistance

Effect Study of the Recombinant Human Brain Natriuretic Peptide in Patients with Heart Failure Combined with hypotension

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Journal of Biosciences and Medicines 2024年第6期12卷 1-6页

作者： Yuhui Ding Keping Yang Department of Cardiovascular Medicine Jingzhou Hospital Affiliated to Yangtze University Jingzhou China

Objective: This paper aims to investigate the effect of applying recombinant human brain natriuretic peptide in patients with heart failure combined with hypotension. Recombinant human brain natriuretic peptide is a synthetic polypeptide drug that is primarily used to treat acute heart failure. Its mechanism of action closely mimics that of human endogenous brain natriuretic peptide. By binding to receptors on cardiomyocytes, it exerts its pharmacological effects. Methods: For the study, 76 heart failure patients with hypotension were selected from our hospital between May 2022 and June 2023. These patients were divided into two groups: a control group and an observation group, each comprising 38 patients. The control group received dopamine treatment, while the observation group was treated with recombinant brain natriuretic peptide. The objective was to compare the effects of the treatments in both groups by analyzing cardiac function indices and levels of vasoactive substances to identify any significant differences in outcomes. Results: The overall response rate of the patients in the observation group and the control group was 94.74% and 73.68%, significantly higher as compared with the observation group (P 0.05). After the following treatment, BNP, ANNP and urine output in the observation group were significantly different compared with the control group, of the statistical significance (P Conclusion: For the treatment of heart failure patients with hypotension, the clinical application of recombinant human brain natriuretic peptide is the most ideal, and significantly improves the cardiac function of patients, which is worth popularizing.

关键词： Recombinant Human Brain Natriuretic Peptide Heart Failure hypotension

Efficacy and safety of sacubitril/valsartan after six months in patients with heart failure with reduced ejection fraction and asymptomatic hypotension

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Journal of Geriatric Cardiology 2023年第12期20卷 855-866页

作者： An-Hu WU Zong-Wei LIN Zhuo-Hao YANG Hui ZHANG Jia-Yi HU Yi WANG Rui TANG Xin-Yu ZHANG Xiao-Ping JI Hui-Xia LU National Key Laboratory for Innovation and Transformation of Luobing Theory The Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesDepartment of CardiologyQilu Hospital of Shandong UniversityJinanChina

BACKGROUND It is not clear whether sacubitril/valsartan is beneficial for patients with heart failure(HF)with reduced ejec-tion fraction(HFrEF)and low systolic blood pressure(SBP).This study aimed to investigate the efficacy and tolerability of sacu-bitril/valsartan in HFrEF patients with SBPhypotension,and 59.8%of whom had SBP≥100 mmHg in an optimized HF follow-up management system.At the 6-month follow-up,52.4%of patients with SBPhypotension,deteriorating re-nal function,hyperkalemia,angioedema,or stroke.CONCLUSIONS Within an optimized HF follow-up management system,sacubitril/valsartan exhibited excellent tolerability and prompted left ventricular reverse remodeling in patients with HFrEF who presented asymptomatic hypotension.

关键词： patients hypotension dosage

Tamsulosin-induced life-threatening hypotension in a patient with spinal cord injury:A case report

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World Journal of Clinical Cases 2022年第25期10卷 9142-9147页

作者： Jae Young Lee Ho Seok Lee Si-Bog Park Kyu Hoon Lee Rehabilitation Medicine Hanyang University HospitalSeoul 04763South Korea

BACKGROUND Tamsulosin,a selectiveα1-adrenergic receptor antagonist,is commonly used for treating neurogenic bladder in patients with spinal cord injury(SCI).No severe adverse events have been described with such tamsulosin use.To our knowledge,we report the first case of severe life-threatening hypotension as an adverse effect of tamsulosin in a person with SCI.Therefore,we report this case to inform that this severe adverse effect of tamsulosin can occur when treating patients with SCI.CASE SUMMARY A 59-year-old woman was diagnosed with cervical spinal cord myelopathy and was classified as American Spinal Injury Association Impairment Scale D,neurological level of injury C3.Because she suffered from voiding difficulty due to neurogenic bladder,we prescribed tamsulosin.Her vital signs remained stable,but occasional hypotensive symptoms followed defecation.We reduced the dose of tamsulosin,but after administering tamsulosin for 9 d,she experienced lifethreatening hypotension with no evidence of hypovolemic shock,neurogenic shock,cardiogenic shock,or septic shock.A hypotensive condition induced by tamsulosin was the suspected cause,and her symptoms could be associated with adverse effects of tamsulosin.As symptoms resolved after stopping tamsulosin,and no other reason was found,we concluded that tamsulosin was the cause of her symptoms.CONCLUSION Caution for severe hypotension is needed when administering tamsulosin for neurogenic bladder in a patient with SCI.

关键词： Tamsulosin Neurogenic bladder Spinal cord injury hypotension Vasovagal symptoms Case report

Incidence,characteristics and risk factors for alveolar recruitment maneuver-related hypotension in patients undergoing laparoscopic colorectal cancer resection

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World Journal of Gastrointestinal Surgery 2023年第7期15卷 1454-1464页

作者： Nan-Rong Zhang Zhi-Nan Zheng Kai Wang Hong Li Department of Anesthesia The Sixth Affiliated HospitalSun Yat-sen UniversityGuangzhou 510655Guangdong ProvinceChina Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases The Sixth Affiliated HospitalSun Yat-sen UniversityGuangzhou 510655Guangdong ProvinceChina

BACKGROUND Alveolar recruitment maneuvers(ARMs)may lead to transient hypotension,but the clinical characteristics of this induced hypotension are poorly understood.We investigated the characteristics of ARM-related hypotension in patients who underwent laparoscopic colorectal cancer resection.AIM To investigate the characteristics of ARM-related hypotension in patients who underwent laparoscopic colorectal cancer resection.METHODS This was a secondary analysis of the PROtective Ventilation using Open Lung approach Or Not trial and included 140 subjects.An ARM was repeated every 30 min during intraoperative mechanical ventilation.The primary endpoint was ARM-related hypotension,defined as a mean arterial pressure(MAP)hypotension were identified.The peri-ARM changes in blood pressure were analyzed for the first three ARMs(ARM_(1,2,3))and the last ARM(ARMl_(ast)).RESULTS Thirty-four subjects(24.3%)developed ARM-related hypotension.Of all 1027 ARMs,37(3.61%)induced hypotension.More ARMs under nonpneumoperitoneum(33/349,9.46%)than under pneumoperitoneum conditions(4/678,0.59%)induced hypotension(Phypotension was higher at ARM_(1)points than at non-ARM_(1)points(18/135,13.3%vs 19/892,2.1%;Phypotension.CONCLUSION When the ARM was repeated intraoperatively,a quarter of subjects developed ARM-related hypotension,but only 3.61%of ARMs induced hypotension.ARM-related hypotension most occurred in a hemodynamically unstable state or a hypovolemic state,and in elderly subjects.Fortunately,ARMs that were performed under pneumoperitoneum conditions had less impact on blood pressure.

关键词： Alveolar recruitment maneuvers hypotension Laparoscopic colorectal cancer resection

What is the relationship between frailty and orthostatic hypotension in older adults?

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Journal of Geriatric Cardiology 2019年第3期16卷 272-279页

作者： Suleyman Emre Kocyigit Pinar Soysal Esra Ates Bulut Ali Ekrem Aydin Ozge Dokuzlar Ahmet Turan Isik Unit for Aging Brain and Dementia Department of Geriatric MedicineFaculty of MedicineDokuz Eylul UniversityIzmirTurkey Department of Geriatric Medicine Bezmialem Vakif UniversityFaculty of MedicineIstanbulTurkey

Background Frailty and orthostatic hypotension (OH),which is common in older adults,is associated with morbidity and mortality.The relationship between them remains unclear.The aim of the study is to determine whether there is a relationship between frailty and OH.Methods A total of 496 patients who were admitted to the geriatric clinic and underwent comprehensive geriatric assessment were retrospectively reviewed.In a cross-sectional and observational study,OH was measured by the Head-up Tilt Table test at 1,3,and 5 min (respectively,OH1,OH3,and OH5) and the frailty was measured by the Fried’s frailty scale.Results The mean age of all patients was 75.4 ± 7.38.The prevalence of females was 69.8%.When the frail people were compared with the pre-frail and the robust ones,the frailty was associated with OH1.There was no relationship between the groups in terms of OH1 when the pre-frail group was compared with the robust group.OH3 were higher in the frail group than in the pre-frail group (P 0.05).Slowness and weakness were associated with OH1 (P < 0.05),whereas the other components of the Fried’s test were not.Conclusions Frailty may be a risk factor for OH1.The 1^st min measurements of OH should be routinely evaluated in frail older adults to prevent OH-related poor outcomes.

关键词： Frail Orthostatic hypotension Pre-frail Robust

Comparison of two vasopressor protocols for preventing hypotension post-spinal anesthesia during cesarean section: a randomized controlled trial

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Chinese Medical Journal 2021年第7期134卷 792-799页

作者： Qian-Qian Fan Yong-Hui Wang Jing-Wen Fu Hai-Long Dong Man-Ping Yang Duo-Duo Liu Xiao-Fan Jiang Zhi-Xin Wu Li-Ze Xiong Zhi-Hong Lu Department of Anesthesiology and Perioperative Medicine Xijing HospitalFourth Military Medical UniversityXi’anShaanxi 710032China Department of Gynecology and Obstetrics Xijing HospitalFourth Military Medical UniversityXi’anShaanxi 710032China Department of Neurosurgery Xijing HospitalFourth Military Medical UniversityXi’anShaanxi 710032China Department of Anesthesiology and Translational Research Institute of Brain and Brain-like Intelligence Shanghai Fourth People’s Hospital Affiliated to Tongji University School of MedicineShanghai 200081China.

Background:Norepinephrine infusion decreases hypotension after spinal anesthesia during cesarean section.This study aimed to compare the efficacy of norepinephrine infusion and ephedrine bolus against post-spinal hypotension in parturients.Methods:In this double-blinded,randomized controlled clinical trial,parturients scheduled for elective cesarean section were randomly allocated to receive norepinephrine infusion(0.05μg·kg^(-1)·min^(-1))just before spinal anesthesia continuing for 30 min or ephedrine bolus(0.15 mg/kg)just before spinal anesthesia.A rescue bolus(5μg norepinephrine for the norepinephrine group,and 5 mg ephedrine for the ephedrine group)was administered whenever hypotension occurred.Our primary outcome was the incidence of hypotension within 30 min of spinal anesthesia administration.Secondary outcomes included maternal and neonatal outcomes 30 min after spinal block,and neonatal cerebral oxygenation 10 min after birth.Results:In total,190 patients were enrolled;of these patients,177 were included in the final analysis.Fewer patients suffered hypotension in the norepinephrine group than in the ephedrine group(29.5%vs.44.9%,odds ratio[OR]:0.51,95%confidence interval[CI]:0.28-0.95,P=0.034).Moreover,the tachycardia frequency was lower in the norepinephrine group than in the ephedrine group(OR:0.22,95%CI:0.11-0.44,Phypotension and tachycardia,and exhibited potential neonatal benefits.

关键词： hypotension Spinal anesthesia Norepinephrine Ephedrine Cesarean section

Changes in arterial blood pressure induced by passive leg raising predict hypotension during the induction of sedation in critically ill patients without severe cardiac dysfunction

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Chinese Medical Journal 2013年第13期126卷 2445-2450页

作者： YU Tao PAN Chun GUO Feng-mei YANG Yi QIU Hai-bo Department of Critical Care Medicine Nanjing Zhongda Hospital Southeast University School of Medicine Nanjing 210009 China

Background hypotension due to the induction of sedation with dexmedetomidine infusion may be harmful in critically ill patients. Changes in pulse pressure induced by the passive leg raising test （PLR-APP） as marker of fluid responsiveness, assessed prior to sedation, may predict hemodynamic changes. The present study was to investigate the power of the PLR test in critically ill patients in predicting hypotension induced by the induction of dexmedetomidine sedation. Methods Fluid responsiveness was estimated by a passive leg raising （PLR） test before dexmedetomidine sedation. Patients were assigned to either the ＂Nonresponders＂ or ＂Responders＂ group according to their hemodynamic responses to the PLR test （＂Nonresponders＂, PLR-APP 〈10.3%; ＂Responders＂, PLR-APP 〉10.3%）. Sedation was performed with a dexmedetomidine infusion （0.5 pg/kg over a 10-minute loading period, then 0.2-0.7 pg.kg-l.h1） and titrated to maintain the target Richmond agitation sedation scale （RASS） score in the range of -2 to -1 and the bispectral index value in the range of 60 to 75. Radial artery pulse pressure, heart rate （HR）, and central venous pressure （CVP） were measured at each phase of the study procedure. Hemodynamic fluctuations during the use of dexmedetomidine sedation were recorded and compared between the two groups. Results Fifty patients had a median （25%-75% interquartile range） of 71 （61-78） years old were studied. At baseline, 39 of the 50 patients were ＂Nonresponders＂ and 11 were ＂Responders＂. Following dexmedetomidine sedation, patients classified as ＂Responders＂ had a significantly greater systolic blood pressure decrease during the induction of dexmedetomidine sedation than the ＂Nonresponders＂（（-26.3 ＋ 6.8）% vs. （-11.8 ＋ 8.5）%, P 〈0.001）. In addition, the ＂Responders＂ group required significantly more fluid boluses （8 vs. 3; P 〈0.001） and vasopressors （2 vs. 0; P 〈0.05） than the ＂Nonresponders＂ group to restore blood pressure. Finally, PLR-APP was positively correlated with changes in systolic blood pressure （PLR-ASBP）（

关键词： passive leg raising test, dexmedetomidine hypotension intensive care unit

Repeated ventricular bigeminy by trigeminocardiac reflex despite atropine administration during superficial upper lip surgery: A case report

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World Journal of Clinical Cases 2022年第32期10卷 11967-11973页

作者： Su-Yeon Cho Bo-Hyun Jang Hye-Jin Jeon Dong-Joon Kim Department of Anesthesiology and Pain Medicine Chosun University HospitalGwangju 61453South Korea

BACKGROUND The trigeminocardiac reflex(TCR)is usually caused by an increased parasympathetic tone when pressure or traction is applied to the surrounding tissue of the trigeminal nerve.However,the inexperienced anesthesiologists may have challenges on the management of TCR patients.CASE SUMMARY This is the case of an 18-year-old woman diagnosed with hemangioma of the upper lip.During the operation,about 1 h after surgery started,a constant 1:1 premature ventricular complex was detected,and blood pressure was decreased when approaching the deeper part with more strong traction for exposure of the part.Although the management of arrhythmias,such as lidocaine and atropine,was injected,arrhythmia induced by surgical stimulation could not be eliminated completely.As the traction repeated,bradycardia was also repeated,despite injecting additional atropine.Therefore,the anesthesiologist and the surgeon decided to perform the operation only to the extent that the vascular tissue was selectively removed only at the site without the reflex.CONCLUSION With TCR,anesthesiologists should perform appropriate monitoring.In addition to proper drug administration,surgeons should be consulted to cope with stopping the surgery and setting the scope of the surgery even if the site is superficial.

关键词： Trigeminocardiac reflex Bigeminy Arrhythmia hypotension Atropine Case report