Objective To explore the impact of early blood pressure reduction on the prognosis of acute ischemic stroke. Methods We searched PubMed, Embase, Cochrane Library, Wanfang, China National Knowledge Infrastructure, and Chongqing VIP, with the search period from databases establishment to December 31, 2024. Randomized controlled studies on early blood pressure reduction within 7 days after the onset of acute ischemic stroke were included, and meta-analysis was conducted using RevMan 5.4 software. Results Finally, 15 randomized controlled studies were included. The meta-analysis results showed that there was no statistically significant difference in the primary outcome (90 days disability or death) and the secondary outcomes (90 days all-cause death) between the early blood pressure reduction group and the control group (P>0.05). Compared with the control group, the early blood pressure reduction group had a higher National Institute of Health Stroke Scale score at 2 weeks [standardized mean difference=0.25, 95% confidence interval (0.07, 0.44), P=0.008]. Conclusion Early blood pressure reduction cannot reduce the risk of 90 days disability or death and 90 days all-cause death in patients with acute ischemic stroke, and may be detrimental to 2 weeks neurological function recovery.
摘要:目的:研究老年患者動脈彈性功能與圍術期血壓變化的關系。方法:隨機選擇68例ASA分級Ⅰ－Ⅱ級行全麻手術的老年患者,根據檢查所得動脈彈性的結果分為四組,分別是A組(C1、C2均正常),B組(C1異常,C2正常),C組(C1正常,C2異常),D組(C1、C2均異常)。測量其術前血壓及全麻誘導8分鐘后的血壓水平。結果:〓動脈彈性功能不良的患者其術前MAP較高,且全麻誘導以后血壓波動的比例較大。結論:高血壓病的老年患者動脈彈性功能普遍降低;動脈彈性下降的老年病人全麻誘導后血壓波動較大。Abstract: Objective:To investigate the relationship between the function of arterial elasticity and BP changes during perioperation in senile patients.Methods: 68 senile patients ASA class Ⅰor Ⅱ undergoing elective surgery under general anesthestia, were divided into four groups by evaluation of arterial elasticity (C1 was for large arterial elastic index and C2 for small. C1 and C2 were normal in group A, only C2 normal in group B, only C1 normal in group C, neither was normal in group D). Arterial blood pressure (BP) before operation and 8 min after induction were monitored and recorded. Results: Patients with dysfunction of arterial elasticity presented higher MAP during preoperation and significant BP changes after induction. Conclusion: Hypertension plays a key role in arterial elasticity.Arterial Blood Pressure of the senile patients with decreased arterial elasticity changes significantly after general anesthesia induction.
The continuous left ventricle blood pressure prediction based on selected heart sound features was realized in this study. The experiments were carried out on three beagle dogs and the variations of cardiac hemodynamics were induced by various dose of epinephrine. The phonocardiogram, electrocardiogram and blood pressures in left ventricle were synchronously acquired. We obtained 28 valid recordings in this study. An artificial neural network was trained with the selected feature to predict left ventricular blood pressure and this trained network made a good performance. The results showed that the absolute average error was 7.3 mm Hg even though the blood pressures had a large range of fluctuation. The average correlation coefficient between the predicted and the measured blood pressure was 0.92. These results showed that the method in this paper was helpful to monitor left ventricular hemodynamics non-invasively and continuously.
Clinical studies had demonstrated that slow breathing could lower blood pressure significantly. Based on this knowledge, a portable blood pressure depressor was designed in this study. The device used a miniature variable distance capacitive sensor to collect respiratory signal, an STM32 as the main control chip, a WT588D voice chip to generate voice and music and guide slow breathing, and a 3.5-inch color screen to display breathing state and provide guidance. For patients with difficulty in adapting themselves to the slow breathing training, an intelligent guiding breathing algorithm based on feedback regulation mechanism was proposed to train patients to breathe slowly. Ten volunteers with hypertension were recruited and then trained to breathe slowly, accumulating up to 100 times using this device. The results showed that breath rate of the volunteers decreased from 15.16±0.92 times per minute to 9.40±0.29 times per minute, and meanwhile, time length of breath rate less than 8 times per minute in the proportion of total treatment time increased from 0.079±0.017 to 0.392±0.019 as the training times increased. In a conclusion, the proposed blood pressure depressor worked effectively in guiding slow breathing training.
Objective To recognize the different phases of Korotkoff sounds through deep learning technology, so as to improve the accuracy of blood pressure measurement in different populations. Methods A classification model of the Korotkoff sounds phases was designed, which fused attention mechanism (Attention), residual network (ResNet) and bidirectional long short-term memory (BiLSTM). First, a single Korotkoff sound signal was extracted from the whole Korotkoff sounds signals beat by beat, and each Korotkoff sound signal was converted into a Mel spectrogram. Then, the local feature extraction of Mel spectrogram was processed by using the Attention mechanism and ResNet network, and BiLSTM network was used to deal with the temporal relations between features, and full-connection layer network was applied in reducing the dimension of features. Finally, the classification was completed by SoftMax function. The dataset used in this study was collected from 44 volunteers (24 females, 20 males with an average age of 36 years), and the model performance was verified using 10-fold cross-validation. Results The classification accuracy of the established model for the 5 types of Korotkoff sounds phases was 93.4%, which was higher than that of other models. Conclusion This study proves that the deep learning method can accurately classify Korotkoff sounds phases, which lays a strong technical foundation for the subsequent design of automatic blood pressure measurement methods based on the classification of the Korotkoff sounds phases.
Objective To systematically review the benefits and risks of more intensive versus less intensive blood pressure control in Asian elderly patients over 60 years old. Methods The PubMed, EMbase, Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect randomized controlled trials (RCTs) of intensive versus less blood pressure control from inception to August 2022. Two reviewers independently screened the literature, extracted data and evaluated the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 6 RCTs involving 20 701 patients were included. The results of meta-analysis showed that intensive blood pressure control could reduce the incidence of cardiovascular death, stroke, and heart failure. However, it could not reduce the incidence of all-cause death and myocardial infarction. Subgroup analysis showed that systolic blood pressure greater than 140 mmHg could not reduce the incidence of cardiovascular death. The safety evaluation found no increase in adverse events or renal injury in intensive blood pressure control group. Conclusion The current evidence shows that intensive blood pressure control can reduce the incidence of cardiovascular death, stroke and heart failure events in elderly Asian patients over 60 years old, but it has no effect on all-cause mortality and myocardial infarction events. It has good safety. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
摘要:目的: 觀察腰硬聯合麻醉在前列腺電切術患者中的臨床應用效果。 方法 : 76例經尿道前列腺電切術患者(78±7歲)隨機均分為腰硬聯合麻醉組(C組)及硬膜外組(E組)。C組以腰硬聯合穿刺針于L34穿刺至蛛網膜下腔后,注入05%布比卡因2 mL,通過硬膜外穿刺針置入硬膜外導管;E組行L34間隙硬膜外穿刺置管。記錄麻醉起效時間、麻醉效果、麻醉前及麻醉后5、15、30分鐘時血壓、心率。 結果 : 所有患者均穿刺順利,麻醉起效時間C組為36±13 min, E組68±15 min;C組麻醉效果完善率為100%,E組為95%;麻醉后兩組血壓均下降(〖WTBX〗P lt;005),但降幅均未超過基礎值的20%;兩組麻醉前及麻醉后血壓、心率均無顯著性差異。 結論 :腰硬聯合麻醉用于前列腺電切術具有起效快、麻醉效果佳的優點。Abstract: Objective: To investigate and compare the clinical efficacy and safety of combined spinalepidural(CSEA) and epidural(EA) anesthesia on elderly patients undergoing transurethral resection of the prostate(TURP). Methods : 76 patients(78±7 years) suffering TURP were divided into two group: group CSEA(38cases) and groupEA(38 cases). The dose of bupivacaine in spinal anesthesia is 10 mg. Blood pressure(BP), heart rate(HR) and anesthesia efficacy were observed before anesthesia, 5, 15 and 30min after anesthesia. Results : BP decreased after anesthesia in two groups than before anesthesia(〖WTBX〗P lt;005). The decreases of BP were less than 20% of basises. There were no significant differents of BP and HR between two groups before and after anesthesia. Conclusion :CSEA with bupivacaine 10 mg is safe and efficient in elderly undergoing TURP.
摘要:目的: 觀察急性鏈球菌感染后腎炎(APSGN)患兒血壓變化規律。 方法 :觀察15例重型APSGN(重型組)和20例普通型APSGN(普通組)患兒病程中各時期血壓及尿量變化,并進行免疫和生化指標對比。 結果 :APSGN患兒高血壓總共26例(7429%),其中重癥組高血壓14例(933%),普通組高血壓12例(60%),高血壓發生率重癥組高于普通組〖WTBX〗P lt;005。重癥APSGN患兒入院時舒張壓、少尿期收縮壓舒張壓、多尿期舒張壓與普通組比較均有顯著性差異,〖WTBX〗P lt;005;而且重癥APSGN與普通組在少尿期持續時間、尿量、多尿期持續時間、尿量的指標比較也均有顯著性差異,〖WTBX〗P lt;005。重癥APSGN患兒血IgG、BUN、Cr明顯高于普通APSGN,Plt;005。 結論 :高血壓是APSGN主要臨床表現之一,血壓增高多發生于少尿期,但重癥APSGN患兒于多尿期出現血壓增高的第二次高峰,臨床上應注意監測,及時治療。Abstract: Objective: To observe the law of the changes of children’s blood pressure after the infection of steptococcus with acute nephritis(APSGN).〖WTHZ〗Methods :Watching 15 cases of serious APSGN and 20 cases of ordinary APSGN for their changes in blood pressure and their urine amounts in various periods; contrasting their indexes in immunity and biochemistry.〖WTHZ〗Results :Among 26cases(7429%)of patients’high blood pressure with APSGN,of which 14cases (933%)are serious ones and 12cases (60%)are ordinary ones,the occurrence rate of the serious group is higher than that of the ordinary group, Plt;005At the initial stage, either the diastolic presssure or the diastolic pressure and the systolic pressure of the serious group with a small amount of unine, the diastolic pressure with a large amount of urine are evidently different from those of the ordinary group, Plt;005Furthermore,there are evident differences in the durations and amounts of urine with either a small or a large amount of urine, Plt;005The IgG,BUN and Cr of the serious group are evidently higher than those of the ordinary group,Plt;005 Conclusion :High blood pressure is one of the main clinical manifestations of APSGN.The increase of blood pressure mostly occurs during the period of a small amount of urine, but a second summit of high blood pressure with APSGN mostly appears in the period of a large amount of urine.It must be closely observed and therefore given the timely treatment.
ObjectiveTo systematically review the effectiveness and safety of intensive blood pressure lowering in intracerebral hemorrhage (ICH). MethodsRandomised controlled trials (RCTs) and quasi-RCTs about ICH patients receiving intensive blood pressure lowering were searched from PubMed, EMbase, SCIE, The Cochrane Library (Issue 2, 2013), CBM, CNKI, VIP and WanFang Data until March, 2014. Literature was screened according to the exclusion and inclusion criteria by two reviewers independently and meta-analysis was conducted using RevMan 5.2 software after data extraction and quality assessment. ResultsA total of 24 studies were included involving 6 299 patients, of which 10 were RCTs and 14 were quasi-RCTs. The results of meta-analysis showed that intensive blood pressure lowering was superior to guideline-recommended intervention in reducing 24-h hematoma expansion rates (OR=0.36, 95%CI 0.28 to 0.46, P < 0.05), 24-h hematoma expansion volume (MD=-3.71, 95%CI-4.15 to-3.28, P < 0.05) and perihematomal edema volume (MD=-1.09, 95%CI-1.92 to-0.22, P < 0.05). Meanwhile, intensive blood pressure lowering improved 21-d NIHSS score (MD=-3.44, 95%CI-5.02 to-1.87, P < 0.05). But there was no significant difference in mortality and adverse reaction between the two groups. ConclusionCurrent evidence shows that intensive blood pressure lowering could reduce hematoma expansion volume and perihematomal edema volume, which is beneficial to recovery of neurological function, but ICH patients' long-term prognosis needs to be further studied. Due to the limited quantity and quality of the included studies, high quality studies are needed to verify the above conclusion.
Objective To analyze the influencing factors of prognosis of patients with traumatic brain injury (TBI), and explore the influence of hemoglobin (Hb) level combined with blood pressure variability (BPV) on the quality of prognosis of patients with TBI. Methods The data of 186 TBI patients who received systemic treatment in the Affiliated Zhangjiagang Hospital of Soochow University between January 2020 and December 2021 were retrospectively analyzed. According to the Glasgow Outcome Scale (GOS) 3 months after treatment, they were divided into group A (GOS 4-5, 159 cases) and group B (GOS 1-3, 27 cases). The general clinical data, BPV indexes and Hb levels of the two groups were analyzed by single factor analysis and multiple logistic regression analysis, and the predictive value of the logistic regression model was evaluated by receiver operating characteristic (ROC) curve, sensitivity, specificity and area under the curve (AUC). Results There was no statistical significance in gender, age, body mass index, blood urea nitrogen, prothrombin time, fasting blood glucose level, or smoking history (P>0.05); the patients’ Glasgow Coma Scale at admission in group A was higher than that in group B (P<0.05), and the constituent ratio with a history of hypertension of group A was significantly lower than that of group B (P<0.05). The between-group differences in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and Hb at admission, and SBP, DBP, and MAP 72 h after treatment were not statistically significant (P>0.05); the SBP-standard deviation (SD), DBP-SD, SPB-coefficient of variation (CV) and DBP-CV of group B 72 h after treatment were significantly higher than those of group A (P<0.05), and the level of Hb was significantly lower than that of group A (P<0.05). Hb [odds ratio (OR)=0.787, 95% confidence interval (CI) (0.633, 0.978), P=0.031], SBP-CV [OR=1.756, 95%CI (1.073, 2.880), P=0.023] and DBP-CV [OR=1.717, 95%CI (1.107, 2.665), P=0.016] were all independent prognostic factors of TBI patients. The ROC showed that the combined index of BPV and Hb was more valuable than that of single prediction, with an AUC of 0.896 [95%CI (0.825, 0.935), P<0.05]. Conclusions Both BPV and Hb are independent factors affecting the prognosis of TBI patients, and their combined application can more effectively predict the prognosis of TBI patients. Therefore, when treating and evaluating the prognosis of TBI patients, closely monitoring the changes in blood pressure and Hb levels can timely and effectively control the development of the disease, and provide scientific reference for subsequent treatment.