Purpose: Non-invasive blood pressure measurement is widely used as a pre-hospital triage tool for blunt trauma patients. However, scant data exits for using the mean arterial pressure (MAP), compared to the systolic blood pressure, as a guiding index. The aim of this study was to determine the association between adverse outcomes and mean arterial pressure (MAP) and to exhibit the therapeutic range of the MAP in adult blunt trauma patients. Methods: The electronic medical records for all trauma patients in a single hospital from January 2010 to September 2012 were retrospectively reviewed. Patients below 17 years of age, patients with penetrating injuries, and patients with serious head trauma (injuries containing any skull fractures or any intracranial hemorrhages) were excluded. Adverse outcomes were defined as one of the following: death in the Emergency Department (ED), admission via operating theater, admission to the intensive care unit, transfer to another hospital for emergency surgery, or discharge as hopeless. Results: There were 14,537 patients who met entry criteria. Adverse outcomes occurred for MAPs in range from 90 to 120 mmHg. Adverse outcomes were found, after adjusting for confounding variables, to occur increasingly as the MAP declined below 90 mmHg or rose above 120 mmHg. Conclusion: Not only lower but also higher mean arterial pressure is associated with increased adverse outcomes in adult blunt trauma patients. Thus, patients with a MAP above 120 mmHg should be considered as a special group requiring higher medical attention, just as those with a MAP below 90 mmHg are.
There are many things in common between hemodynamics in arterial systems and multibody dynamics in mechanical systems. Hemodynamics is concerned with the forces generated by the heart and the resulting motion of blood through the multi-branched vascular system. The conventional hemodynamics model has been intended to show the general behavior of the body arterial system with the frequency domain based linear model. The need for detailed models to analyze the local part like coronary arterial tree and cerebral arterial tree has been required recently. Non-linear analysis techniques are well-developed in multibody dynamics. In this paper, the studies of hemodynamics are summarized from the view of multibody dynamics. Computational algorithms of arterial tree analysis is derived, and proved by experiments on animals. The flow and pressure of each branch are calculated from the measured flow data at the ascending aorta. The simulated results of the carotid artery and the iliac artery show in good accordance with the measured results.
Objective: Increased aortic and carotid arterial augmentation index (AI) is associated with the risk of cardiovascular disease. The most widely used approach for determining central arterial AI is by calculating the aortic pressure waveform from radial arterial waveforms using a transfer function. But how the change of waveform by applied pressure and the pattern of the change rely on subject's characteristics has not been recognized. In this study, we use a new method for measuring radial waveform and observe the change of waveform and the deviation of radial AI in the same position by applied pressure. Method: Forty-six non-patient volunteers (31 men and 15 women, age range 21-58 years) were enrolled for this study. Informed consent in a form approved by the institutional review board was obtained in all subjects. Blood pressure was measured on the left upper arm using an oscillometric method, radial pressure waves were recorded with the use of an improved automated tonometry device. DMP-3000(DAEYOMEDI Co., Ltd. Ansan, Korea) has robotics mechanism to scan and trace automatically. For each subject, we performed the procedure 5 times for each applied pressure level. We could thus obtain 5 different radial pulse waveforms for the same person's same position at different applied pressures. All these processes were repeated twice for test reproducibility. Result: Aortic AI, peripheral AI and radial AI were higher in women than in men (P<0.01), radial AI strongly correlated with aortic AI, and radial AI was consistently approximately 39% higher than aortic AI. Relationship between representative radial AI of DMP-3000 and peripheral AI of SphygmoCor had strongly correlation. And there were three patterns in change of pulse waveform. Conclusion: In this study, it is revealed the new device was sufficient to measure how radial AI and radial waveform from the same person at the same time change under applied pressure and it had inverse-proportion to applied pressure.
It is well known that intracranial pressure (ICP) and mean arterial pressure (MAP) are increased by laryngoscopy and endotracheal intubation during induction of general anesthesia, and It may be very dangerous in neurosurgical patients who had increased ICP. Therefore, this study was performed to know the range of ICP increase during induction of the conventional general anesthesia with intubation following thiopental and succinylcholine injections. Intracranial pressure and MAP were measured in 13patients who underwent cramotomy. All the patients were monitored cerebral epidural ICP and intra-arterial pressure pre-operatively. The results were as follow: 1. Intracranial pressure was increased of $7.1{\pm}7.23mmHg$. 2. Arterial pressure was increased of $43.5{\pm}25.46mmHg$. 3. Cerebral perfusion pressure was increased of $33.3{\pm}27.53mmHg$. It is stressed that certain procedures are necessary to prevent from further increase of ICP due to induction of general anesthesia in patients with increased ICP.
This experiment was performed to estimate the changes on blood flow of the oral structures in hemorrhagic shock. Rabbits were anesthetized by intravenous injection of nembutal(30mg/kg). The Femoral artery was exposed and cannulated with polyethylene tubing filled with heparinized saline. Hypovolemic shock was induced by collecting the bloos of which amount was equaled as 2 % of body weight through arterial cannula for about 30 minutes. During hemorrhage, arterial blood pressure was recorded on recorder. In hypovolemic shock, arterial blood pressure decreased from 116.2±4.1 mmHg to 62.6±4.0 mmHg. Distribution of blood flow in oral tissues decreased to 30-50 % of control group. But blood flow of the masseter muscle was increased and the mandibular angle was not changed.
This study was performed to examine the mean arterial pressure and nociceptive jaw opening reflex after microinjection of glutamate into the amygdala in freely moving rats, and to investigate the mechanisms of antinociceptive action of amygdala. Animals were anesthetized with pentobarbital sodium (40 mg/kg, ip). A stainless steel guide cannula (26 gauge) was implanted in the amygdala and lateral ventricle. Stimulating and recording electrodes were implanted into each of the incisor pulp and anterior digastric muscle. Electrodes were led subcutaneously to the miniature cranial connector sealed on the top of the skull with acrylic resin. After 48 hours of recovery from surgery, mean arterial pressure and digastric electromyogram (dEMG) were monitored in freely moving rats. Electrical shocks (200 ${\mu}sec$ duration, $0.5{\sim}2$ mA intensity) were delivered at 0.5 Hz to the dental pulp every 2 minutes. After injection of 0.35 M glutamate into the amygdala, mean arterial pressure was increased by $8{\pm}2$ mmHg and dEMG was suppressed to $71{\pm}5%$ of the control. Injection of 0.7 M glutamate elevated mean arterial pressure by $25{\pm}5$ mmHg and suppressed dEMG to $20{\pm}7%$ of the control. The suppression of dEMG were maintained for 30 minutes. Naloxone, an opioid receptor antagonist, inhibited the suppression of dEMG elicited by amygdaloid injection of glutamate from $28{\pm}4\;to\;68{\pm}5%$ of the control. Methysergide, a serotonin receptor antagonist, also inhibited the suppression of dEMG from $33{\pm}5\;to\;79{\pm}4%$ of the control. However, phentolamine, an ${\alpha}-adrenergic$ receptor antagonist, did not affect the suppression of dEMG. These results suggest that the amygdala can modulate both cardiovascular and nociceptive responses and that the antinociception of amygdala seems to be attributed to an augmentation of descending inhibitory influences on nociceptive pathways via serotonergic and opioid pathways.
Journal of Physiology & Pathology in Korean Medicine
/
v.16
no.4
/
pp.701-706
/
2002
CheonghunHwadam-tang(CHT) have been used in oriental medicine for many centuries as a therapeutic agent of vertigo by wind, fire and phlegm. CHTS was CHT adding Schizonepetae Herba. The effects of CHTS on the cerebral blood flow and blood pressure is not known. The purpose of this Study was to investigate effects of CHTS on the regional cerebral blood flow(rCBF) and mean arterial blood pressure(BP), action-mechanism of CHTS-induced changed-rCBF and BP. The changes of rCBF and BP was determinated by Laser-Doppler Flowmetry(LDF). The results were as follows ; CHTS extract was increased significantly rCBF in a dose-dependent, but was not changed BP compared with CHTS non-treated group. Pretreatment with propranolol, indomethacin and methylene blue were inhibited CHTS induced increase of rCBF, propranolol(all CHTS-treated group) and indomethacin(CHTS 0.01 mg/kg) of them were significantly decreased. Pretreatment with propranonol and indomethacin were inhibited CHTS induced increase of BP, but pretreated with methylene blue was significantly accelerated BP in high dosage. This results suggest that CHTS increased rCBF by dilating pial arterial diameter and the action of CHTS is also mediated by adrenergic β -receptor and cyclooxygenase.
The dried roots of Danshen (Salvia miltiorrhiza) and Sanchi (Panax notoginseng) have been widely used in traditional Chinese medicine for promoting blood circulation as well as various other bodily functions. Here we investigated the effects of a mixture of aqueous extracts of Danshen and Sanchi, named PASEL, on blood pressure and vascular contractility in rats. Orally administered PASEL (62.5 mg/kg and 250 mg/kg, for 5 weeks) lowered the blood pressure of spontaneous hypertensive rats (SHR) but this was not observed in normal Wistar-Kyoto rats (WKR). We then investigated the effects of PASEL on the arterial contraction of the small branches of cerebral arteries (CAs) and large conduit femoral arteries (FAs) in rats. PASEL did not affect high-K (KCI 60 mM)- or phenyleprine (PhE)-induced contracture of FAs. The myogenic response, a reactive arterial constriction in response to increased luminal pressure, of small CA was dose-dependently suppressed by PASEL in SHR as well as control rats. Interestingly, the KCI-induced contraction of small CAs was slowly reversed by PASEL, and this effect was more prominent in SHR than control WKR. PASEL did not inhibit angiotensin-converting enzyme (ACE) activity. These results demonstrated that the antihypertensive effect of PASEL might be primarily mediated by altering the arterial MR, not by direct inhibition of L-type $Ca^{2+}$ channels or by ACE inhibition.
Certain oriental medication have been shown to be effective in decreasing pulmonary vascular resistance and increasing cardiac output in primary pulmonary artery pressure secondary to pulmonary edema. So oleic acid was administered in 14 dogs in order to induce acute lung injury. And we studied the hemodynamics and blood gas changes of Pyengpaetang(50mg, 100mg) with continuous postive pressure was ventilation in pulmonary edema. The pulmonary edema group, arterial oxygenation was improved after 5 and $10cmH_2O$ PEEP(positive end expiratory pressure), but cardiovascular system was depressed. Blood pressure and cardiac output were decreased, and CVP, MP AP, PCWP were increased. In Pyengpaetang(50mg) group, mean aortic pressure was decreased and PCWP(pulmonary capillary wedge pressure) was decreased remarkably, while there was a significant increase in cardiac output. And there was improvement in $PaO_2$ and $PaCO_2$ without hemodynamic changes after applying 5cm $H_2O$ PEEP, but arterial blood gases$(PaO_2,\;PaCO_2)$ were improved, while cardiovascular effects were depressed after cm $H_2O$ PEEP. In Pyengpaetang(100mg) treated group, there was no significant hemodynamic change. But mean pulmonary arterial pressure was significantly increased, and cardiac output was decreased significantly after applying the more degree of PEEP. And blood gases were not changed significantly after applying the more degree of PEEP. The above results suggest that the effects of Pyengpaetang(50mg) group is superior to those of Pyengpaetang(100mg) group on the effects of hemodynamics and gas exchanges in acute lung injury in dogs. So we can conclude that lower degree PEEP 5cm $H_2O$ is more beneficial in Pyengpaetang(50mg) treated group.
Objectives : This experimental study was designed to investigate the effects of Lumbricus extract (LE) on the changes in regional cerebral blood flow (rCBF) and mean arterial blood pressure (MABP) in normal rats, and further to determine the mechanism of action of LE. Methods : The changes of rCBF were observed by Laser-Doppler flowmetry (LDF) and the changes of MABP were recorded by a data acquisition system assembled with MacLab and Macintosh. Results : LE significantly increased rCBF in a high dosage(10.0 mg/kg, i.p), but MABP was somewhat increased as compared with baseline. This result suggests that LE significantly increased rCBF by dilating pial arterial diameter. Increase of LE-induced rCBF was significantly inhibited by pretreatment with indomethacin (1 mg/kg, i.p), an inhibitor of cyclooxygenase, but was not significantly inhibited by pretreatment with methylene blue ($10{\mu}g/kg$, i.p), an inhibitor of guanylate cyclase. Conclusions : LE increased rCBF by dilating pial arterial diameter, and the action of this response was mediated by cyclooxygenase.
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