Cardiovascular reflex responses to temporal reduction in arterial pressure during dexmedetomidine

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心血管反射

(2) 传入神经和中枢联系：颈动脉窦传入冲动↑ 主动脉弓核
主动脉神经
迷走神经延髓孤束核
抑制心血管运动神经元 (3) 反射效应：
孤束核抑制下丘脑VP的释放
交感缩血管紧张↓
心交感紧张↓
心迷走紧张↑
交感缩血管神经
心交感神经
心迷走神经
外周阻力↓
心脏活动↓（搏出量↓，心率↓）
心输出量↓
血压恢复
位于主动脉弓
离体肠管穿线
用缝针没箭头方向穿线，打结
（1）
（2）
（3）
（4）
心血管反射
Cardiovascular reflex
1.颈动脉窦－主动脉弓压力感受性反射(又称减压反射)
Carotid sinus －aortic arch baroreceptor reflex: (1) 概念： ------由于A血压突然变化(↑或↓),刺激颈动脉窦－主动脉弓压力感受器所引起的血压调节(↓或↑) 反射.

response的名词解释

response的名词解释Introduction:Response is a versatile term that holds significance in various fields and contexts. It represents reactions, replies, or outcomes in response to a stimulus or situation. In this article, we will delve into the multifaceted meaning and applications of the term "response."1. Biological Response:In the realm of biology, response refers to the reaction of an organism to external stimuli. Living beings, from single-celled organisms to complex organisms like humans, have evolved intricate mechanisms to respond to their environments. These responses can be immediate, such as a reflex action, or delayed, such as a change in behavior or physiological processes. Understanding biological responses is crucial for comprehending how organisms adapt and survive.2. Psychological Response:In psychology, response refers to the reactions, both conscious and subconscious, of an individual to various stimuli or events. These responses can be emotional, cognitive,or behavioral in nature. Psychological responses can be influenced by factors such as past experiences, cultural background, and individual differences. Studying human responses helps psychologists gain insights into mental processes and behavior patterns.3. Emotional Response:Emotional response relates to the feelings or emotions elicited in individuals due to specific stimuli or situations. It encompasses a wide range of emotions, including joy, fear, anger, sadness, and surprise. Emotional responses are subjective and highly personal, varying from person to person. Understanding emotional responses plays a crucial role in fields like marketing, where emotional appeals are used to influence consumer behavior.4. Physiological Response:Physiological response pertains to the changes that occur within the body in reaction to different stimuli. These responses involve various bodily systems, such as the nervous system, endocrine system, and cardiovascular system. For example, when faced with a stressful situation, the body releases stress hormones, increases heart rate, and prepares for a fight-or-flight response. Studying physiological responses helps in comprehending the body's adaptation and functioning.5. Environmental Response:Environmental response refers to the reactions or adaptations of ecosystems or ecosystems' components to changes in their surroundings. Ecosystems exhibit response mechanisms to factors like climate change, natural disturbances, and human activities. These responses can include shifts in species composition, migration patterns, or changes in ecological processes. Understanding environmental responses is crucial for sustainable management and conservation of ecosystems.6. Communication Response:Communication response refers to the reply or feedback given in reply to a message or a stimulus. Effective communication involves not just conveying a message but also analyzing and interpreting the responses received. Communication responses can be verbal, non-verbal, or written, and they play a vital role in maintaining effective interpersonal relationships and facilitating understanding between individuals and groups.7. Emergency Response:Emergency response relates to the actions taken in response to crises or emergencies. It involves coordinated efforts by various stakeholders, including emergency services, organizations, and communities, to mitigate the impact of an adverse event. Emergency response plans encompass preparedness, response, and recovery phases, aiming to save lives, alleviate suffering, and restore normalcy after a disaster.Conclusion:The term "response" encompasses a wide range of meanings and applications across various fields. Whether it is the biological reactions of organisms, psychological reactions of individuals, or environmental adaptations of ecosystems, responses are fundamental to understanding how the world functions. By studying and analyzing responses, we can unravel the complexities of human behavior, biological processes, and ecosystem dynamics.。

6.药理学课件肾上腺素能药物

Endogenous catecholamines--
epinephrine
【pharmacological effects】 Blood pressure: rise in BP Cardiac effects: powerful cardiac stimulant. Effects on smooth muscle Metabolic effects
Endogenous catecholamines--
epinephrine
Adrenalin 【properties】 a. Unstable in alkaline solution b. Not effective after oral administration. c. Absorption from subcutaneous tissue occurs
Distribution of adrenoceptor subtypes
type tissue Most vascular smooth muscle pupillary dilator muscle α1 Pilomotor smooth muscle Prostate heart Postsynaptic CNS adrenoceptors platelet α2 Adrenergic and cholinergic nerve terminal Some vascular smooth muscle Fat cells β1 heart Respiratory, uterine and vascular smooth muscle β2 Skeletal muscle Human liver β3 D1 D2 Fat cells Smooth muscle Nerve endings action Contraction Contraction (dilates pupil) Erects hair contraction Increase force of contraction Probably multiple aggregation Inhibition of transmitter release contraction Inhibition of lipolysis Increase force and rate of contraction Promote smooth muscle relaxation Promote potassium uptake Activates glycogenolysis Activates lipolysis Dilates renal blood vessels Modulates transmitter release

抑郁症患者皮肤电反应与焦虑抑郁严重程度的分析

抑郁症患者皮肤电反应与焦虑抑郁严重程度的分析张建;岳莹莹;袁勇贵【摘要】目的探讨抑郁症患者交感神经皮肤反应(SSR)的特点及其与焦虑抑郁严重程度的相关性.方法对32例首发抑郁症、19例复发抑郁症和27例正常对照组分别检测SSR潜伏期和波幅.结果首发抑郁症和复发性抑郁症患者的双侧上下肢SSR波潜伏期和波幅与正常组相比,差异均无统计学意义(P＞0.05),但复发性抑郁症的左上肢SSR波潜伏期显著长于首发稀有症(P=0.034)；抑郁症的双侧上下肢SSR 波潜伏期和波幅与HAMD、HAMA的评分,其差异均无统计学意义(P＞0.05).结论SSR可能并不能敏感地反映抑郁症的自主神经功能损害症状,因而其临床应用价值也尚不能肯定.【期刊名称】《四川精神卫生》【年(卷),期】2013(026)001【总页数】4页(P6-9)【关键词】抑郁症;交感神经皮肤反应;自主神经【作者】张建;岳莹莹;袁勇贵【作者单位】东南大学附属中大医院心理精神科【正文语种】中文【中图分类】R749.4抑郁症患者有较多自主神经功能紊乱的临床表现，目前对此尚缺乏客观检查手段。

交感神经皮肤反应(sympathetic skin reflex，SSR)是一种与汗腺活动有关，并反映交感神经节后纤维的表皮电位，临床上用于检测植物神经功能，是一种较为客观的神经电生理指标［1］。

为此，本文对首发和复发抑郁症患者的SSR 进行研究，试图寻找抑郁症患者自主神经病变的电生理学检查方法。

现报道于后。

1 对象和方法1.1 对象为东南大学附属中大医院2010 年8月～2012 年7 月心理精神科住院51 例抑郁症患者。

入组标准:①符合CCMD-3 中国精神障碍分类与诊断标准(第三版)抑郁症诊断标准［2］;②年龄18～65 岁，性别不限;③汉密尔顿抑郁量表(HAMD)评分≥18 分，汉密尔顿焦虑量表(HAMA)评分≥14 分;④入院前2 周未服用过抗抑郁药及其它抗精神病药物;⑤患者均知情同意。

CARDIOCARECirculation

C A RD I O C AREirculationExecutive CommitteePeter B. Raven, PhD Director James L. Caffrey, PhD Associate DirectorDan Dimitrijevich, PhD Division of Cell & Tissue Engineering H. Fred Downey, PhD Division of Cardiac Hemodynamics A. H. O-Yurvati, DO Clinical Research &EducationMichael L. Smith, PhDCenter for Sleep ResearchAdvisory BoardJim EagleTrammell Crow Fort Worth, T exas Joan HenryGlaxo Wellcome Fort Worth, T exas Bob Lanier, MD Fort Worth, T exas Jere Mitchell, MD UT Southwestern Medical Center Dallas, Texas John MorrisJASAO Corporation Abilene, Texas A.H. O-Yurvati, DO Cardiovascular &Thoracic Surgery Fort Worth, T exasEditorial StaffSondra England EditorCARDIO CARE is a publi-cation of the Cardiovas-cular Research Institute at the University of North Texas Health Science Center at Fort rmation contained in this publication is educa-tional only and is not intended to replace proper medical evalua-tion. If you have specific medical questions con-cerning your personal health, please contact your family physician.CARDIOVASCULAR RESEARCH INSTITUTE • UNT HEALTH SCIENCE CENTER AT FORT WORTH • VOLUME 1, NUMBER 3 • SEPTEMBER 2000irculation CCThe Heart...the beginning of circulationdelivered and the waste collected, the blood continues through the capillaries, which come together to form venules, which increase in size to form veins, which carry the deoxygen-ated blood back to the heart. Arriving back at the heart, blood cells pass through the lungs in much the same way as they travel through the body, except that in the lungs, carbon dioxide is exchanged for oxygen and the cycle begins again.As adults, we have about 100,000miles of blood vessels in our bodies! This 100,000 miles of vessels are generally made up of arteries, arterioles, capillaries, venules and veins.Arteries, Capillaries, and VeinsArteries, pressure vessels, are strong enough to withstand the force of the contrac-tion and expansion of the left ventricle. To accomplish this, arteries have a middle layer that is muscular æexpanding and contractingto accommodate the flow of blood circulation.Capillaries are very thin. So thin that red blood cells flow through single file. Blood needs the thin walls to allow the exchange ofoxygen and carbon dioxide. Once this ex-change is made, the blood continues through the capillaries into the veins.Veins are quite similar to arteries, except that theyq transport blood at a lower pressure, and qrather than transporting oxygen richblood, veins transport blood filled with waste (carbon dioxide)irculation of blood through the body begins when the left ventricle of theheart contracts, pumping blood into the aorta through the aortic valve. The aorta, the main artery of the body, leaves the heart as one artery and quickly branches into smaller arteries which continue to branch into even smaller arteries as the blood travels. The smallest of the arteries are called arterioles.Arterioles connect to capillaries. It is within the capillaries where oxygen is ex-changed for waste (normally in the form of carbon dioxide). Once the oxygen has been2 C ARDIO C AREArteriolesCapillariesStructure of the Circulatory SystemHow Blood MovesJust as there are two sides of the heart,there are two “parts” to the circulatory system: arterial, which carries blood rich with oxygen away from the heart and venous,which carries blood with carbon dioxide (waste) back to the heart. To deliver the oxygenated (arterial) blood to our tissues,pressure from the left ventricle keeps it moving through the arteries. However, on the venous side æthe “return” side, circulation depends on the contraction of skeletal muscles to squeeze the veins, thereby pushing the deoxygenated blood forward to complete the cycle. Just as there are one-way valves in the heart to control the flow of blood, there are venous valves in veins that keep blood constantly moving toward the heart.How does blockage occur?Arteries and veins become restricted due to cholesterol deposits. Low-density lipoprotein (LDL), referred to as “bad” cholesterol, binds with oxygen molecules and deposits as soft layers of oxidized cholesterol on the walls of arteries and veins. As the cholesterol collects,it eventually hardens into plaque. The im-mune system sees plaque as an injury and releases macrophages, a form of white blood cells. Macrophages try to remove the plaque,but in the process also become attached causing a further inflammation. In response to this increased threat, the immune system sends out additional white blood cells and causes the liver to produce blood clotting factors. Eventually, the vein or artery becomes calcified and loses elasticity (known as arthrosclerosis) and the flow of blood becomes restricted.C ARDIO C ARE 3Circulation continued from page 1cornea. Currently, Dr. Dimitrijevich is working on construction of a human vascular tissue equivalent – an artery.A human vascular tissue equivalent is composed of a matrix containing collagen that is densely populated with vascular smooth muscle cells. This tissue will be lined with human artery cells on one side and a collagen gel containing a sparse population of human dermal fibroblasts on the other side. In some cases, it would be possible for the human artery to be constructed using the patient’s own cells.The application for this technology would include every one of the bypass surgeries performed every year, plus many other uses invessel replacement therapy.How Blood MovesC ARDIOVASCULAR R ESEARCH I NSTITUTE3500 Camp Bowie Boulevard Fort Worth, Texas 76107-2699An EEO/Affirmative Action InstitutionGlossary of Terms used in this issue:in vitro: in an artificial environment, such as a laboratory setting.matrix: a scaffolding substance used to support a growing biological structure.collagen: the major structural protein of connective tissues in mammals.vascular smooth muscle cells: cells capable of contraction and expansion that make up blood vessel walls.dermal fibroblasts: those cells which can develop into skin.cholesterol: the most abundant steroid in human tissue and also found in fat rich foods.CRI FacultyJames L. Caffrey , Ph.D.Associate Director of the CRI Division of Cardiac Endocrinology S. Dan Dimitrijevich, Ph.D.Division of Cell & Tissue Engineering H. Fred Downey , Ph.D.Division of Cardiac Hemodynamics Stephen Grant, Ph.D.Division of Molecular and Vascular GeneticsRobert T. Mallet, Ph.D.Division of Cardiac Metabolism Michael L. Smith, Ph.D.Center for Sleep ResearchAssociate FacultyNeeraj Agarwal, Ph.D.Mark Baker, D.O.,Barbara A. Barron, Ph.D.Joan F . Carroll, Ph.D.Glenn Dillion, Ph.D.Richard Easom, Ph.D.Michael J. Forster, Ph.D.Robert W. Gracy , Ph.D.Patricia A. Gwirtz, Ph.D.Robert L. Kaman, Ph.D.Andras Lacko, Ph.D.Robert R. Luedtke, Ph.D.Muriel Marshall, D.O., Ph.D.Michael Martin, Ph.D.Walter McConathy , Ph.D.William McIntosh, D.O.,A. H. O-Yurvati, D.O.Frederick A. Schaller, D.O.Xiangrong Shi, Ph.D.Craig W . Spellman, D.O., Ph.D.Scott Stoll, D.O., Ph.D.Donald E. Watenpaugh, Ph.D.Martin Weiss, D.O.Thomas Yorio, Ph.D.U NIVERSITY of N ORTH T EXAS H EALTH S CIENCE C ENTER at Fort Worth5Education, Research, Patient Care andServiceC A RD I O C ARE。

新版216个护理诊断NANDA护理诊断

新版216个护理诊断NANDA护理诊断2012~2014（共216项）领域1：健康促进（Health Promotion）类别1：健康意识（Health Awareness）1.娱乐活动缺乏（Deficient Diversional Activity）（00097）2.静态的生活方式（Sedentary Lifestyle）（00168）类别2：健康管理（Health Management）1.缺乏公共卫生（Deficient Community Health）（00215）2.有危险倾向的健康行为（Risk-Prone Health Behavior）（00188）3.健康维持无效（Ineffective Health Maintenance）（00099）4.有增强免疫状态的愿望（Readiness for EnhancedImmunization Status）（00186）5.防护无效（Ineffective Protection）（00043）6.自我健康维持无效（Ineffective Self-Health Management）（00078）7.有增强自我健康管理的愿望（Readiness for EnhancedSelf-Health Management）（00162）家庭执行治疗方案无效（Ineffective Family Therapeutic Regimen Management）（00080）领域2：营养（Nutrition）类别1：摄入（Ingestion）1.母乳不足（Insufficient Breast Milk）（00216）2.婴儿喂养无效（Ineffective Infant Feeding Pattern）（00107）3.营养失调：低于机体需要量（Imbalanced Nutrition：Less ThanBody Requirement（00002）营养失调：高于机体需要量(Imbalanced Nutrition：More Than Body Requirements（00001）有增强营养的愿望（Readiness for Enhanced Nutrition）（00163）4.有营养失调的危险：高于机体需要量（Risk for ImbalancedNutrition：More Than Body Requirements）（00003）5.吞咽能力受损（Impaired Swallowing）（00103）类别2：消化（Digestion）类别3：吸收（Absorption）类别4：代谢（Metabolism）1.有血糖不稳定的危险（Risk for Unstable Blood Glucose Level）（00179）2.新生儿黄疸（Neonatal Jaundice）（00194）3.有新生儿黄疸的危险（Risk for Neonatal Jaundice）（00230）4.有肝功能受损的危险（Risk for Impaired Liver Function）（00178）类别5：水化1.有电解质失衡的危险（Risk for Electrolyte Imbalance）（00195）2.有维持体液平衡的愿望（Readiness for Enhanced FluidBalance）（00160）3.体液不足（Deficient Fluid Volume）（00027）4.体液过多（Excess Fluid Volume）（00026）5.有体液不足的危险（Risk for Deficient Fluid Volume）（00028）6.有体液失衡的危险（Risk for Imbalanced Fluid Volume）（00025）领域3：排泄（Elimination and Exchange）类别1：排尿功能（Urinary Function）1.功能性尿失禁（Functional Urinary Incontinence）（00020）2.充溢性尿失禁（Overflow Urinary Incontinence）（00176）3.反射性尿失禁（Reflex Urinary Incontinence）（00018）4.压力性尿失禁（Stress Urinary Incontinence）（00017）5.急迫性尿失禁（Urge Urinary Incontinence）（00019）6.有急迫性尿失禁的危险（Risk for Urge Urinary Incontinence）（00022）7.排尿形态改变（Impaired Urinary Elimination）（00016）8.有排尿形态恢复正常的愿望（Readiness for Enhanced UrinaryElimination）（00166）9.尿潴留（Urinary Retention）（00023）类别2：胃肠功能（Gastrointestinal Function）1.便秘（Constipation）（00011）2.感知性便秘（Perceived Constipation）（00012）3.有便秘的危险（Risk for Constipation）（00015）4.腹泻（Diarrhea）（00013）5.胃肠动力紊乱（Dysfunctional Gastrointestinal Motility）（00196）6.有胃肠动力紊乱的危险（Risk for DysfunctionalGastrointestinal Motility）（00197）7.排便失禁（Bowel Incontinence）（00014）类别3：皮肤功能（Integumentary Function）类别4：呼吸功能（Respiratory Function）1.气体交换受损（Impaired Gas Exchange）（00030）领域4：活动∕休息（Activit y∕Rest）类别1：睡眠/休息（Sleep/Rest）1.失眠（Insomnia）（00095）2.睡眠剥夺（Sleep Deprivation）（00096）3.有睡眠形态增进的愿望（Readiness for Enhanced Sleep）（00165）4.睡眠形态紊乱（Disturbed Sleep Pattern）（00198）类别2：活动/运动（Activity/Exercise）1.有废用综合征的危险（Risk for Disuse Syndrome）（00040）2.床上活动障碍（Impaired Bed Mobility）（00091）3.躯体移动障碍（Impaired Physical Mobility）（00085）4.借助轮椅活动障碍（Impaired Wheelchair Mobility）（00089）5.移位能力障碍（Impaired Transfer Ability）（00090）6.行走障碍（Impaired Walking）（00088）类别3：能量平衡（Energy Balance）1.能量场紊乱（Disturbed Energy Field）（00050）2.疲乏（Fatigue）（00093）3.漫游（Wandering）（00154）类别4：心血管/肺部反应（Cardiovascular/Pulmonary Responses）1.活动无耐力（Activity Intolerance）（00092）2.有活动无耐力的危险（Risk for Activity Intolerance）（00094）3.低效性呼吸形态（Ineffective Breathing Pattern）（00032）4.心输出量减少（Decreased Cardiac Output）（00029）5.有胃肠灌注不足的危险（Risk for Ineffective GastrointestinalPerfusion）（00202）6.有肾脏灌注不足的危险（Risk for Ineffective Renal Perfusion）（00203）7.不能维持自主呼吸（Impaired Spontaneous Ventilation）（00033）8.周围组织灌注不足（Ineffective Peripheral Tissue Perfusion）（00204）9.有心脏组织灌注不足的危险（Risk for Decreased CardiacTissue Perfusion）（00200）有脑组织灌注不足的危险（Risk for Ineffective Cerebral Tissue Perfusion）（00201）有周围组织灌注不足的危险（Risk for IneffectivePeripheral Tissue Perfusion）（00228）呼吸机依赖（Dysfunctional Ventilatory Weaning Response）（00034）类别5：自我照顾（Self-Care）1.持家能力障碍（Impaired Home Maintenance）（00098）2.有增强自理的愿望（Readiness for Enhanced Self-Care）（00182）3.沐浴自理缺陷（Bathing Self-Care Deficit）（00108）4.穿衣自理缺陷（Dressing Self-Care Deficit）（00109）5.进食自理缺陷（Feeding Self-Care Deficit）（00102）6.如厕自理缺陷（Toileting Self-Care Deficit）（00110）7.忽视自我健康管理（Self-Neglect）（00193）领域5：知觉∕认知（Perception∕Cognition）类别1：注意力（Attention）1.忽视单侧身体（Unilateral Neglect）（00123）类别2：定向力（Orientation）1.环境解析障碍综合征（Impaired Environmental InterpretationSyndrome）（00127）类别3：感觉/知觉（Sensation/Perception）类别4：认知（Cognition）1.急性意识障碍（Acute Confusion）（00128）2.慢性意识障碍（Chronic Confusion）（00129）3.有急性意识障碍的危险（Risk for Acute Confusion）（00173）4.自我控制无效（Ineffective Impulse Control）（00222）5.知识缺乏（Deficient Knowledge）（00126）6.有增加知识的愿望（Readiness for Enhanced Knowledge）（00161）7.记忆受损（Impaired Memory）（00131）类别5：沟通（Communication）1.有加强沟通的愿望（Readiness for Enhanced Communication）（00157）2.语言沟通障碍（Impaired Verbal Communication）（00051）领域6：自我知觉（Self-Perception）类别1：自我概念（Self-Concept）1.绝望（Hopelessness）（00124）2.有危及个人尊严的危险（Risk for Compromised HumanDignity）（00174）3.有孤独的危险（Risk for Loneliness）（00054）4.自我认同紊乱（Disturbed Personal Identity）（00121）5.有自我认同紊乱的危险（Risk for Disturbed Personal Identity）（00225）6.有增强自我概念的愿望（Readiness for EnhancedSelf-Concept）（00167）类别2：自尊Self-Esteem1.慢性低自尊（Chronic Low Self-Esteem）（00119）2.情境性低自尊（Situational Low Self-Esteem）（00120）3.有慢性低自尊的危险（Risk for Chronic Low Self-Esteem）（00224）4.有情境性低自尊的危险（Risk for Situational Low Self-Esteem）（00153）类别3：自我形象（Body Image）1.自我形象紊乱（Disturbed Body Image）（00118）领域7：角色关系（Role Relationships）类别1：照顾者角色（Caregiving Roles）1.母乳喂养无效（Ineffective Breastfeeding）（00104）2.母乳喂养中断（Interrupted Breastfeeding）（00105）3.有增强母乳喂养的愿望（Readiness for EnhancedBreastfeeding）（00106）4.照顾者角色紧张（Caregiver Role Strain）（00061）5.有照顾者角色紧张的危险（Risk for Caregiver Role Strain）（00062）6.抚养障碍（Impaired Parenting）（00056）7.有增进抚养能力的愿望（Readiness for Enhanced Parenting）（00164）8.有抚养障碍的危险（Risk for Impaired Parenting）（00057）类别2：家庭关系（Family Relationships）1.有依附关系障碍的危险（Risk for Impaired Attachment）（00058）2.家庭运作紊乱（Dysfunctional Family Processes）（00063）3.家庭运作中断（Interrupted Family Processes）（00060）4.有家庭运作稳定的愿望（Readiness for Enhanced FamilyProcesses）（00159）类别3：角色表现（Role Performance）1.无效的关系（Ineffective Relationship）（00223）2.有增进关系的愿望（Readiness for Enhanced Relationship）（00207）3.有关系无效的危险（Risk for Ineffective Relationship）（00229）4.父母角色冲突（Parental Role Conflict）（00064）5.角色紊乱（Ineffective Role Performance）（00055）6.社交障碍（Impaired Social Interaction）（00052）领域8：性学（Sexuality）类别1：性别认同（Sexual Identity）类别2：性功能（Sexual Function）1.性功能障碍（Sexual Dysfunction）（00059）2.性生活形态改变（Ineffective Sexuality Pattern）（00065）类别3：生殖（Reproduction）1.分娩过程无效（Ineffective Childbearing Process）（00221）2.有增进分娩过程的愿望（Readiness for Enhanced ChildbearingProcess）（00208）有分娩过程无效的危险（Risk for Ineffective Childbearing Process）（00227）有母体-胎儿受干扰的危险（Risk for Disturbed Maternal-Fetal Dyad）（00209）领域9：调适∕压力耐受（Coping∕Stress Tolerance）类别1：创伤后反应（Post-Trauma Responses）1.创伤后综合征（Post-Trauma Syndrome）（00141）2.有创伤后综合征的危险（Risk for Post-Trauma Syndrome）（00145）3.强暴创伤综合征（Rape-Trauma Syndrome）（00142）4.迁移应激综合征（Relocation Stress Syndrome）（00114）5.有迁移应激综合征的危险（Risk for Relocation StressSyndrome）（00149）类别2：应对反应（Coping Responses）1.活动计划无效（Ineffective Activity Planning）（00199）2.有活动计划无效的危险（Risk for Ineffective Activity Planning）（00226）3.焦虑（Anxiety）（00146）4.防御性应对（Defensive Coping）（00071）5.应对无效（Ineffective Coping）（00069）6.有增强应对的愿望（Readiness for Enhanced Coping）（00158）7.社区应对无效（Ineffective Community Coping）（00077）8.社区有增强应对的愿望（Readiness for Enhanced CommunityCoping）（00076）9.家庭妥协性应对（Compromised Family Coping）（00074）10.家庭应对缺陷（Disabled Family Coping）（00073）11.家庭有增强应对的愿望（Readiness for Enhanced FamilyCoping）（00075）12.死亡焦虑（Death Anxiety）（00147）13.无效性否认（Ineffective Denial）（00072）14.人生存功能衰退（Adult Failure to Thrive）（00101）15.恐惧（Fear）（00148）16.悲痛（Grieving）（00136）17.复杂性哀伤（Complicated Grieving）（00135）18.有复杂性哀伤的危险（Risk for Complicated Grieving）（00172）19.有增强能力的愿望（Readiness for Enhanced Power）（00187）20.无能为力（Powerlessness）（00125）21.有无能为力的危险（Risk for Powerlessness）（00152）22.个人复原能力受损（Impaired Individual Resilience）（00210）23.有增强复原能力的愿望（Readiness for Enhanced Resilience）（00212）24.有危及复原的危险（Risk for Compromised Resilience）（00211）25.长期悲伤（Chronic Sorrow）（00137）26.超负荷压力（Stress Overload）（00177）类别3：神经行为压力（Neurobehavioral Stress）1.自主性反射障碍（Autonomic Dysreflexia）（00009）2.有自主反射障碍的危险（Risk for Autonomic Dysreflexia）（00010）3.婴儿行为紊乱（Disorganized Infant Behavior）（00116）4.婴儿有行为能力增强的潜力（Readiness for EnhancedOrganized Infant Behavior）（00117）5.有婴儿行为紊乱的危险（Risk for Disorganized InfantBehavior）（00115）6.颅内调试能力下降（Decreased Intracranial AdaptiveCapacity）（00049）领域10：生命原则（Life Principles）类别1：价值观（Values）1.有增进希望的愿望（Readiness for Enhanced Hope）（00185）类别2：信念（Beliefs）1.有促进精神健康增强的愿望（Readiness for Enhanced SpiritualWell-Being）（00068）类别3：价值/信念/行动一致（Value/Belief/Action Congruence）1.有增强决策的愿望（Readiness for EnhancedDecision-Making）（00184）2.决策冲突（Decisional Conflict）（00083）3.道德困扰（Moral Distress）（00175）4.不合作（Noncompliance）（00079）5.虔信受损（Impaired Religiosity）（00169）6.有增进虔信的愿望（Readiness for Enhanced Religiosity）（00171）7.有虔信受损的危险（Risk for Impaired Religiosity）（00170）8.精神困扰（Spiritual Distress）（00066）9.有精神困扰的危险（Risk for Spiritual Distress）（00067）领域11：安全∕保护（Safety∕Protection）类别1：感染（Infection）1.有感染的危险（Risk for Infection）（00004）类别2：身体伤害（Physical Injury）1.清理呼吸道无效（Ineffective Airway Clearance）（00031）2.有误吸的危险（Risk for Aspiration）（00039）3.有出血的危险（Risk for Bleeding）（00206）4.牙齿受损（Impaired Dentition）（00048）5.有干眼症的危险（Risk for Dry Eye）（00219）6.有跌倒的危险（Risk for Falls）（00155）7.有受伤的危险（Risk for Injury）（00035）8.口腔黏膜受损（Impaired Oral Mucous Membrane）（00045）9.有围手术期体位性损伤的危险（Risk for PerioperativePositioning Injury）（00087）10.有周围神经血管功能障碍的危险（Risk for PeripheralNeurovascular Dysfunction）（00086）有休克的危险（Risk for Shock）（00205）11.皮肤完整性受损（Impaired Skin Integrity）（00046）12.有皮肤完整性受损的危险（Risk for Impaired Skin Integrity）（00047）13.有婴儿猝死综合征的危险（Risk for Sudden Infant DeathSyndrome）（00156）14.有窒息的危险（Risk for Suffocation）（00036）15.术后恢复延迟（Delayed Surgical Recovery）（00100）16.有烫伤的危险（Risk for Thermal Injury）（00220）17.组织完整性受损（Impaired Tissue Integrity）（00044）18.有外伤的危险（Risk for Trauma）（00038）19.有血管受损的危险（Risk for Vascular Trauma）（00213）类别3：暴力（Violence）1.有虐待他人的危险（Risk for Other-Directed Violence）（00138）2.有自虐的危险（Risk for Self-Directed Violence）（00140）3.自残（Self-Mutilation）（00151）4.有自残的危险（Risk for Self-Mutilation）（00139）5.有自杀的危险（Risk for Suicide）（00150）类别4：环境危害（Environmental Hazards）1.污染（Contamination）（00181）2.有污染的危险（Risk for Contamination）（00180）3.有中毒的危险（Risk for Poisoning）（00037）类别5：防御过程（Defensive Processes）1.有碘造影剂不良反应的危险（Risk for Adverse Reaction toIodinated Contrast Media）（000218）2.乳胶过敏反应（Latex Allergy Response）（00041）3.有过敏反应的危险（Risk for Allergy Response）（00217）4.有乳胶过敏反应的危险（Risk for Latex Allergy Response）（00042）类别6：体温调节（Thermoregulation）1.有体温平衡失调的危险（Risk for Imbalanced BodyTemperature）（00005）2.体温过高（Hyperthermia）（00007）3.体温过低（Hypothermia）（00006）4.体温调节无效（Ineffective Thermoregulation）（00008）领域12：舒适（Comfort）类别1：身体舒适（Physical Comfort）类别2：环境舒适（Environmental Comfort）类别3：社交舒适（Social Comfort）1.舒适的改变（Impaired Comfort）（00214）2.有增加舒适的愿望（Readiness for Enhanced Comfort）（00183）3.恶心（Nausea）（00134）4.急性疼痛（Acute Pain）（00132）5.慢性疼痛（Chronic Pain）（00133）6. 社交隔离（Social Isolation）（00053）领域13：生长∕发育（Growth∕Development）类别1：生长（Growth）1.有生长不成比例的危险（Risk for Disproportionate Growth）（00113）类别2：发育（Development）1.生长发育迟缓（Delayed Growth and Development）（00111）2. 有发育迟缓的危险（Risk for Delayed Development）（00112）一、新增诊断（16项）：领域1：健康促进（Health Promotion）类别2：健康管理（Health Management）缺乏公共卫生（Deficient Community Health）（00215）领域2：营养（Nutrition）类别1：摄入（Ingestion）母乳不足（Insufficient Breast Milk）（00216）类别4：代谢（Metabolism）有新生儿黄疸的危险（Risk for Neonatal Jaundice）（00230）领域4：活动∕休息（Activit y∕Rest）类别4：心血管/肺部反应（Cardiovascular/Pulmonary Responses）有周围组织灌注不足的危险（Risk for Ineffective Peripheral Tissue Perfusion）（00228）领域5：知觉∕认知（Perception∕Cognition）类别3：感觉/知觉（Sensation/Perception）类别4：认知（Cognition）自我控制无效（Ineffective Impulse Control）（00222）领域6：自我知觉（Self-Perception）类别1：自我概念（Self-Concept）有自我认同紊乱的危险（Risk for Disturbed Personal Identity）（00225）类别2：自尊Self-Esteem有慢性低自尊的危险（Risk for Chronic Low Self-Esteem）（00224）领域7：角色关系（Role Relationships）类别3：角色表现（Role Performance）无效的关系（Ineffective Relationship）（00223）有关系无效的危险（Risk for Ineffective Relationship）（00229）领域8：性学（Sexuality）类别3：生殖（Reproduction）分娩过程无效（Ineffective Childbearing Process）（00221）有分娩过程无效的危险（Risk for Ineffective Childbearing Process）（00227）领域9：调适∕压力耐受（Coping∕Stress Tolerance）类别2：应对反应（Coping Responses）有活动计划无效的危险（Risk for Ineffective Activity Planning）（00226）领域11：安全∕保护（Safety∕Protection）类别2：身体伤害（Physical Injury）有干眼症的危险（Risk for Dry Eye）（00219）有烫伤的危险（Risk for Thermal Injury）（00220）类别5：防御过程（Defensive Processes）有碘造影剂不良反应的危险（Risk for Adverse Reaction to Iodinated Contrast Media）（000218）有过敏反应的危险（Risk for Allergy Response）（00217）二、修改诊断（11项）：1.有增强母乳喂养的愿望（Readiness for EnhancedBreastfeeding）（00106）2.低效性呼吸形态（Ineffective Breathing Pattern）（00032）3.舒适的改变（Impaired Comfort）（00214）4.有感染的危险（Risk for Infection）（00004）5.新生儿黄疸（Neonatal Jaundice）（00194）6.恶心（Nausea）（00134）7.无能为力（Powerlessness）（00125）8.有无能为力的危险（Risk for Powerlessness）（00152）9.有增强自我健康管理的愿望（Readiness for EnhancedSelf-Health Management）（00162）有皮肤完整性受损的危险（Risk for Impaired Skin Integrity）（00047）10.周围组织灌注不足（Ineffective Peripheral Tissue Perfusion）（00204）三、退出诊断（1项）：领域5：知觉∕认知（Perception∕Cognition）类别5：沟通（Communication）感觉知觉紊乱（特定的：视觉、听觉、方位感、味觉、触觉、嗅觉）（Disturbed Sensory Perception）（00122）。

Cardiovascular Complications

Types of Cardiovascular Complication
• Myocarditis 心肌炎 1. Manifestation: arrhythmia心律失常 2. Sequelae of myocarditis心肌炎后遗症: more common
Effects on fetus
Types of Cardiovascular Complication
3. Non-shunting 1) Pulmonary stenosis Not usually progressive 2) Aortic stenosis rare; its outcome is bad 3) Marfan’s syndrome (genetic disorder) Myxomatous degeneration of the heart valves; mitral and cystic medial necrosis（囊性中层坏死） of the aorta (aneurysms动脉瘤) death rate: 4%-50%
Types of Cardiovascular Complication
3) Patent ductus arteriosus (PDA)动脉导管未闭 rare (early surgical repair); hemodynamic consequence are similar to VSD 2. Right to left shunting右向左分流型 1) Tetralogy of Fallot法洛氏四联征 Pulmonary stenosis, right ventricular hypertrophy, large ventricular septal defect and overriding aorta the most common cyanotic lesion complicating pregnancy

新版216个护理诊断NANDA护理诊断

新版216个护理诊断NANDA护理诊断NANDA-I护理诊断2012~2014（共216页）1. 领域1：健康促进（Health Promotion）2. 类别1：健康意识（Health Awareness）3. 娱乐活动缺乏（Deficient Diversional Activity）（00097）4. 静态的生活方式（Sedentary Lifestyle）（00168）5. 类别2：健康管理（Health Management）6. 缺乏公共卫生（Deficient Community Health）（00215）7. 有危险倾向的健康行为（Risk-Prone Health Behavior）（00188）8. 健康维持无效（Ineffective Health Maintenance）（00099）9. 有增强免疫状态的愿望（Readiness for Enhanced Immunization Status）（00186）10. 防护无效（Ineffective Protection）（00043）11. 自我健康维持无效（Ineffective Self-Health Management）（00078）12. 有增强自我健康管理的愿望（Readiness for Enhanced Self-HealthManagement）（00162）家庭执行治疗方案无效（Ineffective FamilyTherapeutic Regimen Management）（00080）13. 领域2：营养（Nutrition）14. 类别1：摄入（Ingestion）15. 母乳不足（Insufficient Breast Milk）（00216）16. 婴儿喂养无效（Ineffective Infant Feeding Pattern）（00107）17. 营养失调：低于机体需要量（Imbalanced Nutrition：Less Than BodyRequirements）（00002）营养失调：高于机体需要量(Imbalanced Nutrition：More Than Body Requirements）（00001）有增强营养的愿望（Readiness for Enhanced Nutrition）（00163）18. 有营养失调的危险：高于机体需要量（Risk for Imbalanced Nutrition：MoreThan Body Requirements）（00003）19. 吞咽能力受损（Impaired Swallowing）（00103）20. 类别2：消化（Digestion）21. 类别3：吸收（Absorption）22. 类别4：代谢（Metabolism）23. 有血糖不稳定的危险（Risk for Unstable Blood Glucose Level）（00179）24. 新生儿黄疸（Neonatal Jaundice）（00194）25. 有新生儿黄疸的危险（Risk for Neonatal Jaundice）（00230）26. 有肝功能受损的危险（Risk for Impaired Liver Function）（00178）27. 类别5：水化28. 有电解质失衡的危险（Risk for Electrolyte Imbalance）（00195）29. 有维持体液平衡的愿望（Readiness for Enhanced Fluid Balance）（00160）30. 体液不足（Deficient Fluid Volume）（00027）31. 体液过多（Excess Fluid Volume）（00026）32. 有体液不足的危险（Risk for Deficient Fluid Volume）（00028）33. 有体液失衡的危险（Risk for Imbalanced Fluid Volume）（00025）34. 领域3：排泄（Elimination and Exchange）35. 类别1：排尿功能（Urinary Function）36. 功能性尿失禁（Functional Urinary Incontinence）（00020）37. 充溢性尿失禁（Overflow Urinary Incontinence）（00176）38. 反射性尿失禁（Reflex Urinary Incontinence）（00018）39. 压力性尿失禁（Stress Urinary Incontinence）（00017）40. 急迫性尿失禁（Urge Urinary Incontinence）（00019）41. 有急迫性尿失禁的危险（Risk for Urge Urinary Incontinence）（00022）42. 排尿形态改变（Impaired Urinary Elimination）（00016）43. 有排尿形态恢复正常的愿望（Readiness for Enhanced Urinary Elimination）（00166）尿潴留（Urinary Retention）（00023）44. 类别2：胃肠功能（Gastrointestinal Function）45. 便秘（Constipation）（00011）46. 感知性便秘（Perceived Constipation）（00012）47. 有便秘的危险（Risk for Constipation）（00015）48. 腹泻（Diarrhea）（00013）49. 胃肠动力紊乱（Dysfunctional Gastrointestinal Motility）（00196）50. 有胃肠动力紊乱的危险（Risk for Dysfunctional Gastrointestinal Motility）（00197）排便失禁（Bowel Incontinence）（00014）51. 类别3：皮肤功能（Integumentary Function）52. 类别4：呼吸功能（Respiratory Function）53. 气体交换受损（Impaired Gas Exchange）（00030）54. 领域4：活动∕休息（Activit y∕Rest）55. 类别1：睡眠/休息（Sleep/Rest）56. 失眠（Insomnia）（00095）57. 睡眠剥夺（Sleep Deprivation）（00096）58. 有睡眠形态增进的愿望（Readiness for Enhanced Sleep）（00165）59. 睡眠形态紊乱（Disturbed Sleep Pattern）（00198）60. 类别2：活动/运动（Activity/Exercise）61. 有废用综合征的危险（Risk for Disuse Syndrome）（00040）62. 床上活动障碍（Impaired Bed Mobility）（00091）63. 躯体移动障碍（Impaired Physical Mobility）（00085）64. 借助轮椅活动障碍（Impaired Wheelchair Mobility）（00089）65. 移位能力障碍（Impaired Transfer Ability）（00090）66. 行走障碍（Impaired Walking）（00088）67. 类别3：能量平衡（Energy Balance）68. 能量场紊乱（Disturbed Energy Field）（00050）69. 疲乏（Fatigue）（00093）70. 漫游（Wandering）（00154）71. 类别4：心血管/肺部反应（Cardiovascular/Pulmonary Responses）72. 活动无耐力（Activity Intolerance）（00092）73. 有活动无耐力的危险（Risk for Activity Intolerance）（00094）74. 低效性呼吸形态（Ineffective Breathing Pattern）（00032）75. 心输出量减少（Decreased Cardiac Output）（00029）76. 有胃肠灌注不足的危险（Risk for Ineffective Gastrointestinal Perfusion）（00202）77. 有肾脏灌注不足的危险（Risk for Ineffective Renal Perfusion）（00203）78. 不能维持自主呼吸（Impaired Spontaneous Ventilation）（00033）79. 周围组织灌注不足（Ineffective Peripheral Tissue Perfusion）（00204）80. 有心脏组织灌注不足的危险（Risk for Decreased Cardiac Tissue Perfusion）（00200）有脑组织灌注不足的危险（Risk for Ineffective Cerebral Tissue Perfusion）（00201）有周围组织灌注不足的危险（Risk for IneffectivePeripheral Tissue Perfusion）（00228）呼吸机依赖（Dysfunctional Ventilatory Weaning Response）（00034）类别5：自我照顾（Self-Care）81. 持家能力障碍（Impaired Home Maintenance）（00098）82. 有增强自理的愿望（Readiness for Enhanced Self-Care）（00182）83. 沐浴自理缺陷（Bathing Self-Care Deficit）（00108）84. 穿衣自理缺陷（Dressing Self-Care Deficit）（00109）85. 进食自理缺陷（Feeding Self-Care Deficit）（00102）86. 如厕自理缺陷（Toileting Self-Care Deficit）（00110）87. 忽视自我健康管理（Self-Neglect）（00193）88. 领域5：知觉∕认知（Perception∕Cognition）89. 类别1：注意力（Attention）90. 忽视单侧身体（Unilateral Neglect）（00123）91. 类别2：定向力（Orientation）92. 环境解析障碍综合征（Impaired Environmental Interpretation Syndrome）（00127）类别3：感觉/知觉（Sensation/Perception）93. 类别4：认知（Cognition）94. 急性意识障碍（Acute Confusion）（00128）95. 慢性意识障碍（Chronic Confusion）（00129）96. 有急性意识障碍的危险（Risk for Acute Confusion）（00173）97. 自我控制无效（Ineffective Impulse Control）（00222）98. 知识缺乏（Deficient Knowledge）（00126）99. 有增加知识的愿望（Readiness for Enhanced Knowledge）（00161）100. 记忆受损（Impaired Memory）（00131）101. 类别5：沟通（Communication）102. 有加强沟通的愿望（Readiness for Enhanced Communication）（00157）103. 语言沟通障碍（Impaired Verbal Communication）（00051）104. 领域6：自我知觉（Self-Perception）105. 类别1：自我概念（Self-Concept）106. 绝望（Hopelessness）（00124）107. 有危及个人尊严的危险（Risk for Compromised Human Dignity）（00174）108. 有孤独的危险（Risk for Loneliness）（00054）109. 自我认同紊乱（Disturbed Personal Identity）（00121）110. 有自我认同紊乱的危险（Risk for Disturbed Personal Identity）（00225）111. 有增强自我概念的愿望（Readiness for Enhanced Self-Concept）（00167）类别2：自尊Self-Esteem112. 慢性低自尊（Chronic Low Self-Esteem）（00119）113. 情境性低自尊（Situational Low Self-Esteem）（00120）114. 有慢性低自尊的危险（Risk for Chronic Low Self-Esteem）（00224）115. 有情境性低自尊的危险（Risk for Situational Low Self-Esteem）（00153）类别3：自我形象（Body Image）116. 自我形象紊乱（Disturbed Body Image）（00118）117. 领域7：角色关系（Role Relationships）118. 类别1：照顾者角色（Caregiving Roles）119. 母乳喂养无效（Ineffective Breastfeeding）（00104）120. 母乳喂养中断（Interrupted Breastfeeding）（00105）121. 有增强母乳喂养的愿望（Readiness for Enhanced Breastfeeding）（00106）122. 照顾者角色紧张（Caregiver Role Strain）（00061）123. 有照顾者角色紧张的危险（Risk for Caregiver Role Strain）（00062）124. 抚养障碍（Impaired Parenting）（00056）125. 有增进抚养能力的愿望（Readiness for Enhanced Parenting）（00164）126. 有抚养障碍的危险（Risk for Impaired Parenting）（00057）127. 类别2：家庭关系（Family Relationships）128. 有依附关系障碍的危险（Risk for Impaired Attachment）（00058）129. 家庭运作紊乱（Dysfunctional Family Processes）（00063）130. 家庭运作中断（Interrupted Family Processes）（00060）131. 有家庭运作稳定的愿望（Readiness for Enhanced Family Processes）（00159）类别3：角色表现（Role Performance）132. 无效的关系（Ineffective Relationship）（00223）133. 有增进关系的愿望（Readiness for Enhanced Relationship）（00207）134. 有关系无效的危险（Risk for Ineffective Relationship）（00229）135. 父母角色冲突（Parental Role Conflict）（00064）136. 角色紊乱（Ineffective Role Performance）（00055）137. 社交障碍（Impaired Social Interaction）（00052）138. 领域8：性学（Sexuality）139. 类别1：性别认同（Sexual Identity）140. 类别2：性功能（Sexual Function）141. 性功能障碍（Sexual Dysfunction）（00059）142. 性生活形态改变（Ineffective Sexuality Pattern）（00065）143. 类别3：生殖（Reproduction）144. 分娩过程无效（Ineffective Childbearing Process）（00221）145. 有增进分娩过程的愿望（Readiness for Enhanced Childbearing Process）（00208）有分娩过程无效的危险（Risk for Ineffective Childbearing Process）（00227）有母体-胎儿受干扰的危险（Risk for Disturbed Maternal-FetalDyad）（00209）146. 领域9：调适∕压力耐受（Coping∕Stress Tolerance）147. 类别1：创伤后反应（Post-Trauma Responses）148. 创伤后综合征（Post-Trauma Syndrome）（00141）149. 有创伤后综合征的危险（Risk for Post-Trauma Syndrome）（00145）150. 强暴创伤综合征（Rape-Trauma Syndrome）（00142）151. 迁移应激综合征（Relocation Stress Syndrome）（00114）152. 有迁移应激综合征的危险（Risk for Relocation Stress Syndrome）（00149）类别2：应对反应（Coping Responses）153. 活动计划无效（Ineffective Activity Planning）（00199）154. 有活动计划无效的危险（Risk for Ineffective Activity Planning）（00226）155. 焦虑（Anxiety）（00146）156. 防御性应对（Defensive Coping）（00071）157. 应对无效（Ineffective Coping）（00069）158. 有增强应对的愿望（Readiness for Enhanced Coping）（00158）159. 社区应对无效（Ineffective Community Coping）（00077）160. 社区有增强应对的愿望（Readiness for Enhanced Community Coping）（00076）161. 家庭妥协性应对（Compromised Family Coping）（00074）162. 家庭应对缺陷（Disabled Family Coping）（00073）163. 家庭有增强应对的愿望（Readiness for Enhanced Family Coping）（00075）164. 死亡焦虑（Death Anxiety）（00147）165. 无效性否认（Ineffective Denial）（00072）166. 成人生存功能衰退（Adult Failure to Thrive）（00101）167. 恐惧（Fear）（00148）168. 悲痛（Grieving）（00136）169. 复杂性哀伤（Complicated Grieving）（00135）170. 有复杂性哀伤的危险（Risk for Complicated Grieving）（00172）171. 有增强能力的愿望（Readiness for Enhanced Power）（00187）172. 无能为力（Powerlessness）（00125）173. 有无能为力的危险（Risk for Powerlessness）（00152）174. 个人复原能力受损（Impaired Individual Resilience）（00210）175. 有增强复原能力的愿望（Readiness for Enhanced Resilience）（00212）176. 有危及复原的危险（Risk for Compromised Resilience）（00211）177. 长期悲伤（Chronic Sorrow）（00137）178. 超负荷压力（Stress Overload）（00177）179. 类别3：神经行为压力（Neurobehavioral Stress）180. 自主性反射障碍（Autonomic Dysreflexia）（00009）181. 有自主反射障碍的危险（Risk for Autonomic Dysreflexia）（00010）182. 婴儿行为紊乱（Disorganized Infant Behavior）（00116）183. 婴儿有行为能力增强的潜力（Readiness for Enhanced Organized Infant Behavior）（00117）有婴儿行为紊乱的危险（Risk for Disorganized Infant Behavior）（00115）184. 颅内调试能力下降（Decreased Intracranial Adaptive Capacity）（00049）185. 领域10：生命原则（Life Principles）186. 类别1：价值观（Values）187. 有增进希望的愿望（Readiness for Enhanced Hope）（00185）188. 类别2：信念（Beliefs）189. 有促进精神健康增强的愿望（Readiness for Enhanced Spiritual Well-Being）（00068）190. 类别3：价值/信念/行动一致（Value/Belief/Action Congruence）191. 有增强决策的愿望（Readiness for Enhanced Decision-Making）（00184）192. 决策冲突（Decisional Conflict）（00083）193. 道德困扰（Moral Distress）（00175）194. 不合作（Noncompliance）（00079）195. 虔信受损（Impaired Religiosity）（00169）196. 有增进虔信的愿望（Readiness for Enhanced Religiosity）（00171）197. 有虔信受损的危险（Risk for Impaired Religiosity）（00170）198. 精神困扰（Spiritual Distress）（00066）199. 有精神困扰的危险（Risk for Spiritual Distress）（00067）200. 领域11：安全∕保护（Safety∕Protection）201. 类别1：感染（Infection）202. 有感染的危险（Risk for Infection）（00004）203. 类别2：身体伤害（Physical Injury）204. 清理呼吸道无效（Ineffective Airway Clearance）（00031）205. 有误吸的危险（Risk for Aspiration）（00039）206. 有出血的危险（Risk for Bleeding）（00206）207. 牙齿受损（Impaired Dentition）（00048）208. 有干眼症的危险（Risk for Dry Eye）（00219）209. 有跌倒的危险（Risk for Falls）（00155）210. 有受伤的危险（Risk for Injury）（00035）211. 口腔黏膜受损（Impaired Oral Mucous Membrane）（00045）212. 有围手术期体位性损伤的危险（Risk for Perioperative Positioning Injury）（00087）213. 有周围神经血管功能障碍的危险（Risk for Peripheral Neurovascular Dysfunction）（00086）有休克的危险（Risk for Shock）（00205）214. 皮肤完整性受损（Impaired Skin Integrity）（00046）215. 有皮肤完整性受损的危险（Risk for Impaired Skin Integrity）（00047）216. 有婴儿猝死综合征的危险（Risk for Sudden Infant Death Syndrome）（00156）217. 有窒息的危险（Risk for Suffocation）（00036）218. 术后恢复延迟（Delayed Surgical Recovery）（00100）219. 有烫伤的危险（Risk for Thermal Injury）（00220）220. 组织完整性受损（Impaired Tissue Integrity）（00044）221. 有外伤的危险（Risk for Trauma）（00038）222. 有血管受损的危险（Risk for Vascular Trauma）（00213）223. 类别3：暴力（Violence）224. 有虐待他人的危险（Risk for Other-Directed Violence）（00138）225. 有自虐的危险（Risk for Self-Directed Violence）（00140）226. 自残（Self-Mutilation）（00151）227. 有自残的危险（Risk for Self-Mutilation）（00139）228. 有自杀的危险（Risk for Suicide）（00150）229. 类别4：环境危害（Environmental Hazards）230. 污染（Contamination）（00181）231. 有污染的危险（Risk for Contamination）（00180）232. 有中毒的危险（Risk for Poisoning）（00037）233. 类别5：防御过程（Defensive Processes）234. 有碘造影剂不良反应的危险（Risk for Adverse Reaction to Iodinated Contrast Media）（000218）乳胶过敏反应（Latex Allergy Response）（00041）235. 有过敏反应的危险（Risk for Allergy Response）（00217）236. 有乳胶过敏反应的危险（Risk for Latex Allergy Response）（00042）237. 类别6：体温调节（Thermoregulation）238. 有体温平衡失调的危险（Risk for Imbalanced Body Temperature）（00005）239. 体温过高（Hyperthermia）（00007）240. 体温过低（Hypothermia）（00006）241. 体温调节无效（Ineffective Thermoregulation）（00008）242. 领域12：舒适（Comfort）243. 类别1：身体舒适（Physical Comfort）244. 类别2：环境舒适（Environmental Comfort）245. 类别3：社交舒适（Social Comfort）246. 舒适的改变（Impaired Comfort）（00214）247. 有增加舒适的愿望（Readiness for Enhanced Comfort）（00183）248. 恶心（Nausea）（00134）249. 急性疼痛（Acute Pain）（00132）250. 慢性疼痛（Chronic Pain）（00133）251. 社交隔离（Social Isolation）（00053）252. 领域13：生长∕发育（Growth∕Development）253. 类别1：生长（Growth）254. 有生长不成比例的危险（Risk for Disproportionate Growth）（00113）255. 类别2：发育（Development）256. 生长发育迟缓（Delayed Growth and Development）（00111）257. 有发育迟缓的危险（Risk for Delayed Development）（00112）258. 一、新增诊断（16项）：259. 领域1：健康促进（Health Promotion）260. 类别2：健康管理（Health Management）261. 缺乏公共卫生（Deficient Community Health）（00215）262. 领域2：营养（Nutrition）263. 类别1：摄入（Ingestion）264. 母乳不足（Insufficient Breast Milk）（00216）265. 类别4：代谢（Metabolism）266. 有新生儿黄疸的危险（Risk for Neonatal Jaundice）（00230）267. 领域4：活动∕休息（Activit y∕Rest）268. 类别4：心血管/肺部反应（Cardiovascular/Pulmonary Responses）269. 有周围组织灌注不足的危险（Risk for Ineffective Peripheral Tissue Perfusion）（00228）领域5：知觉∕认知（Perception∕Cognition）270. 类别3：感觉/知觉（Sensation/Perception）271. 类别4：认知（Cognition）272. 自我控制无效（Ineffective Impulse Control）（00222）273. 领域6：自我知觉（Self-Perception）274. 类别1：自我概念（Self-Concept）275. 有自我认同紊乱的危险（Risk for Disturbed Personal Identity）（00225）类别2：自尊Self-Esteem276. 有慢性低自尊的危险（Risk for Chronic Low Self-Esteem）（00224）277. 领域7：角色关系（Role Relationships）278. 类别3：角色表现（Role Performance）279. 无效的关系（Ineffective Relationship）（00223）280. 有关系无效的危险（Risk for Ineffective Relationship）（00229）281. 领域8：性学（Sexuality）282. 类别3：生殖（Reproduction）283. 分娩过程无效（Ineffective Childbearing Process）（00221）284. 有分娩过程无效的危险（Risk for Ineffective Childbearing Process）（00227）285. 领域9：调适∕压力耐受（Coping∕Stress Tolerance）286. 类别2：应对反应（Coping Responses）287. 有活动计划无效的危险（Risk for Ineffective Activity Planning）（00226）288. 领域11：安全∕保护（Safety∕Protection）289. 类别2：身体伤害（Physical Injury）290. 有干眼症的危险（Risk for Dry Eye）（00219）291. 有烫伤的危险（Risk for Thermal Injury）（00220）292. 类别5：防御过程（Defensive Processes）293. 有碘造影剂不良反应的危险（Risk for Adverse Reaction to Iodinated Contrast Media）（000218）有过敏反应的危险（Risk for Allergy Response）（00217）294. 二、修改诊断（11项）：295. 有增强母乳喂养的愿望（Readiness for Enhanced Breastfeeding）（00106）296. 低效性呼吸形态（Ineffective Breathing Pattern）（00032）297. 舒适的改变（Impaired Comfort）（00214）298. 有感染的危险（Risk for Infection）（00004）299. 新生儿黄疸（Neonatal Jaundice）（00194）300. 恶心（Nausea）（00134）301. 无能为力（Powerlessness）（00125）302. 有无能为力的危险（Risk for Powerlessness）（00152）303. 有增强自我健康管理的愿望（Readiness for Enhanced Self-Health Management）（00162）有皮肤完整性受损的危险（Risk for Impaired Skin Integrity）（00047）304. 周围组织灌注不足（Ineffective Peripheral Tissue Perfusion）（00204）305. 三、退出诊断（1项）：306. 领域5：知觉∕认知（Perception∕Cognition）307. 类别5：沟通（Communication）308.感觉知觉紊乱（特定的：视觉、听觉、方位感、味觉、触觉、嗅觉）（Disturbed Sensory Perception）（00122）。

【英文精品课兽医临床诊疗课件】心血管系统检查

Frequency 频率: clinical value is same to pulse. Intensity 强度: Nature 性质: Rhythm 节律: Splitting and doubling 分裂与重复: Heart murmurs 杂音：
I--ii: Auscultation of the Heart(心脏听诊)
Veterinary Clinical Diagnostics and Therapeutics
Cardiovascular System Examination Chapter 4
Cardiovascular System Examination
For diagnosis of cardiovascular system disease, knowing of whole functional status and prognosis judgment, it is very important to examine cardiovascular system.
I--ii: Auscultation of the Heart(心脏听诊)
➢ Method of auscultation ：by stethoscope ➢ Precaution of auscultation: heart is too weak to hear ➢ Optimum point of auscultation: cardiac valve area P32 ➢ Characteristic of physiological heart sound：P31 ➢ Content of auscultation
First Sound第一心音: basically originate systaltic when the vibration that mitral valve and tricuspid shut generation.（主要来源于心脏收缩时二尖瓣和三尖瓣关闭产生的振动）

重酒石酸去甲肾上腺素Norepinephrine Bitartrate 英文药品说明书

Levophed™Norepinephrine BitartrateInjection, USP R x only DESCRIPTIONNorepinephrine (sometimes referred to as l-arterenol/Levarterenol or l-norepinephrine) is a sympathomimetic amine which differs from epinephrine by the absence of a methyl group on the nitrogen atom.Norepinephrine Bitartrate is (-)-α-(aminomethyl)-3,4-dihydroxybenzyl alcohol tartrate (1:1) (salt) monohydrate and has the following structural formula:LEVOPHED is supplied in sterile aqueous solution in the form of the bitartrate salt to be administered by intravenous infusion following dilution. Norepinephrine is sparingly soluble in water, very slightly soluble in alcohol and ether, and readily soluble in acids. Each mL contains the equivalent of 1 mg base of norepinephrine, sodium chloride for isotonicity, and not more than 2 mg of sodium metabisulfite as an antioxidant. It has a pH of 3 to 4.5. The air in the ampuls has been displaced by nitrogen gas.CLINICAL PHARMACOLOGYLEVOPHED functions as a peripheral vasoconstrictor (alpha-adrenergic action) and as an inotropic stimulator of the heart and dilator of coronary arteries (beta-adrenergic action).INDICATIONS AND USAGEFor blood pressure control in certain acute hypotensive states (e.g., pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, myocardial infarction, septicemia, blood transfusion, and drug reactions).As an adjunct in the treatment of cardiac arrest and profound hypotension. CONTRAINDICATIONSLEVOPHED should not be given to patients who are hypotensive from blood volume deficits except as an emergency measure to maintain coronary and cerebral artery perfusion until blood volume replacement therapy can be completed. If LEVOPHED is continuously administered to maintain blood pressure in the absence of blood volume replacement, the following may occur: severe peripheral and visceral vasoconstriction, decreased renal perfusion and urine output, poor systemic blood flow despite “normal” blood pressure, tissue hypoxia, and lactate acidosis.LEVOPHED should also not be given to patients with mesenteric or peripheral vascular thrombosis (because of the risk of increasing ischemia and extending the area of infarction) unless, in the opinion of the attending physician, the administration of LEVOPHED is necessary as a life-saving procedure.Cyclopropane and halothane anesthetics increase cardiac autonomic irritability and therefore seem to sensitize the myocardium to the action of intravenously administered epinephrine or norepinephrine.Hence, the use of LEVOPHED during cyclopropane and halothane anesthesia is generally considered contraindicated because of the risk of producing ventricular tachycardia or fibrillation.The same type of cardiac arrhythmias may result from the use of LEVOPHED in patients with profound hypoxia or hypercarbia.WARNINGSLEVOPHED should be used with extreme caution in patients receiving monoamine oxidase inhibitors (MAOI) or antidepressants of the triptyline or imipramine types, because severe, prolonged hypertension may result.LEVOPHED Bitartrate Injection contains sodium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. The overall prevalence of sulfite sensitivity in the general population is unknown. Sulfite sensitivity is seen more frequently in asthmatic than in nonasthmatic people. PRECAUTIONSGeneralAvoid Hypertension: Because of the potency of LEVOPHED and because of varying response to pressor substances, the possibility always exists that dangerously high blood pressure may be produced with overdoses of this pressor agent. It is desirable, therefore, to record the blood pressure every two minutes from the time administration is started until the desired blood pressure is obtained, then every five minutes if administration is to be continued.The rate of flow must be watched constantly, and the patient should never be left unattended while receiving LEVOPHED. Headache may be a symptom of hypertension due to overdosage.Site of Infusion: Whenever possible, infusions of LEVOPHED should be given into a large vein, particularly an antecubital vein because, when administered into this vein, the risk of necrosis of the overlying skin from prolonged vasoconstriction is apparently very slight. Some authors have indicated that the femoral vein is also an acceptable route of administration. A catheter tie-in technique should be avoided, if possible, since the obstruction to blood flow around the tubing may cause stasis and increased local concentration of the drug. Occlusive vascular diseases (for example, atherosclerosis, arteriosclerosis, diabetic endarteritis, Buerger’s disease) are more likely to occur in the lower than in the upper extremity. Therefore, one should avoid the veins of the leg in elderly patients or in those suffering from such disorders. Gangrene has been reported in a lower extremity when infusions of LEVOPHED were given in an ankle vein.Extravasation: The infusion site should be checked frequently for free flow. Care should be taken to avoid extravasation of LEVOPHED into the tissues, as local necrosis might ensue due to the vasoconstrictive action of the drug. Blanching along the course of the infused vein, sometimes without obvious extravasation, has been attributed to vasa vasorum constriction with increased permeability of the vein wall, permitting some leakage.This also may progress on rare occasions to superficial slough, particularly during infusion into leg veins in elderly patients or in those suffering from obliterative vascular disease. Hence, if blanching occurs, consideration should be given to the advisability of changing the infusion site at intervals to allow the effects of local vasoconstriction to subside.therefore seem to sensitize the myocardium to the action of intravenously administered epinephrine or norepinephrine. Hence, the use of LEVOPHED during cyclopropane and halothane anesthesia is generally considered contraindicated because of the risk of producing ventricular tachycardia or fibrillation. The same type of cardiac arrhythmias may result from the use of LEVOPHED in patients with profound hypoxia or hypercarbia.LEVOPHED should be used with extreme caution in patients receiving monoamine oxidase inhibitors (MAOI) or antidepressants of the triptyline or imipramine types, because severe, prolonged hypertension may result.Carcinogenesis, Mutagenesis, Impairment of Fertility: Studies have not been performed.Pregnancy Category C: Animal reproduction studies have not been conducted with LEVOPHED. It is also not known whether LEVOPHED can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. LEVOPHED should be given to a pregnant woman only if clearly needed.Nursing Mothers: It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when LEVOPHED is administered to a nursing woman.Pediatric Use: Safety and effectiveness in pediatric patients has not been established.Geriatric Use: Clinical studies of LEVOPHED did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.LEVOPHED infusions should not be administered into the veins in the leg in elderly patients (see PRECAUTIONS, General).ADVERSE REACTIONSThe following reactions can occur:Body As A Whole: Ischemic injury due to potent vasoconstrictor action and tissue hypoxia. Cardiovascular System: Bradycardia, probably as a reflex result of a rise in blood pressure, arrhythmias. Nervous System: Anxiety, transient headache.Respiratory System: Respiratory difficulty.Skin and Appendages: Extravasation necrosis at injection site.Prolonged administration of any potent vasopressor may result in plasma volume depletion which should be continuously corrected by appropriate fluid and electrolyte replacement therapy. If plasma volumes are not corrected, hypotension may recur when LEVOPHED is discontinued, or blood pressure may be maintained at the risk of severe peripheral and visceral vasoconstriction (e.g., decreased renal perfusion) with diminution in blood flow and tissue perfusion with subsequent tissue hypoxia and lactic acidosis and possible ischemic injury. Gangrene of extremities has been rarely reported.Overdoses or conventional doses in hypersensitive persons (e.g., hyperthyroid patients) cause severe hypertension with violent headache, photophobia, stabbing retrosternal pain, pallor, intense sweating, and vomiting.OVERDOSAGEOverdosage with LEVOPHED may result in headache, severe hypertension, reflex bradycardia, marked increase in peripheral resistance, and decreased cardiac output. In case of accidental overdosage, as evidenced by excessive blood pressure elevation, discontinue LEVOPHED until the condition of the patient stabilizes.DOSAGE AND ADMINISTRATIONNorepinephrine Bitartrate Injection is a concentrated, potent drug which must be diluted in dextrose containing solutions prior to infusion. An infusion of LEVOPHED should be given into a large vein (see PRECAUTIONS).Restoration of Blood Pressure in Acute Hypotensive StatesBlood volume depletion should always be corrected as fully as possible before any vasopressor is administered. When, as an emergency measure, intraaortic pressures must be maintained to prevent cerebral or coronary artery ischemia, LEVOPHED can be administered before and concurrently with blood volume replacement.Diluent: LEVOPHED should be diluted in 5 percent dextrose injection or 5 percent dextrose and sodium chloride injections. These dextrose containing fluids are protection against significant loss of potency due to oxidation. Administration in saline solution alone is not recommended. Whole blood or plasma, if indicated to increase blood volume, should be administered separately (for example, by use of a Y-tube and individual containers if given simultaneously).Average Dosage: Add a 4 mL ampul (4 mg) of LEVOPHED to 1,000 mL of a 5 percent dextrose containing solution. Each mL of this dilution contains 4 mcg of the base of LEVOPHED. Give this solution by intravenous infusion. Insert a plastic intravenous catheter through a suitable bore needle well advanced centrally into the vein and securely fixed with adhesive tape, avoiding, if possible, a catheter tie-in technique as this promotes stasis. An IV drip chamber or other suitable metering device is essential to permit an accurate estimation of the rate of flow in drops per minute. After observing the response to an initial dose of 2 mL to 3 mL (from 8 mcg to 12 mcg of base) per minute, adjust the rate of flow to establish and maintain a low normal blood pressure (usually 80 mm Hg to 100 mm Hg systolic) sufficient to maintain the circulation to vital organs. In previously hypertensive patients, it is recommended that the blood pressure should be raised no higher than 40 mm Hg below the preexisting systolic pressure. The average maintenance dose ranges from 0.5 mL to 1 mL per minute (from 2 mcg to 4 mcg of base).High Dosage: Great individual variation occurs in the dose required to attain and maintain an adequate blood pressure. In all cases, dosage of LEVOPHED should be titrated according to the response of the patient. Occasionally much larger or even enormous daily doses (as high as 68 mg base or 17 ampuls) may be necessary if the patient remains hypotensive, but occult blood volume depletion should always be suspected and corrected when present. Central venous pressure monitoring is usually helpful in detecting and treating this situation.Fluid Intake: The degree of dilution depends on clinical fluid volume requirements. If large volumes of fluid (dextrose) are needed at a flow rate that would involve an excessive dose of the pressor agent per unit of time, a solution more dilute than 4 mcg per mL should be used. On the other hand, when large volumes of fluid are clinically undesirable, a concentration greater than 4 mcg per mL may be necessary.Duration of Therapy: The infusion should be continued until adequate blood pressure and tissue perfusion are maintained without therapy. Infusions of LEVOPHED should be reduced gradually, avoiding abrupt withdrawal. In some of the reported cases of vascular collapse due to acute myocardial infarction, treatment was required for up to six days.Adjunctive Treatment in Cardiac ArrestInfusions of LEVOPHED are usually administered intravenously during cardiac resuscitation to restore and maintain an adequate blood pressure after an effective heartbeat and ventilation have been established by other means. [LEVOPHED’s powerful beta-adrenergic stimulating action is also thought to increase the strength and effectiveness of systolic contractions once they occur.]Average Dosage: To maintain systemic blood pressure during the management of cardiac arrest, LEVOPHED is used in the same manner as described under Restoration of Blood Pressure in Acute Hypotensive States.Parenteral drug products should be inspected visually for particulate matter and discoloration prior to use, whenever solution and container permit.Do not use the solution if its color is pinkish or darker than slightly yellow or if it contains a precipitate.Avoid contact with iron salts, alkalis, or oxidizing agents.HOW SUPPLIEDLEVOPHED, norepinephrine bitartrate injection, USP, contains the equivalent of 4 mg base of LEVOPHED per each 4 mL ampul (1 mg/mL).Supplied as:Ampuls of 4 mL in boxes of 10, NDC 0409-1443-04Store at 20 to 25°C (68 to 77°F). [See USP Controlled Room Temperature.] Protect from light. Regitine, trademark, CIBA Pharmaceuticals Company.Revised: November, 2009Printed in USA EN-2297Hospira, Inc., Lake Forest, IL 60045, USA。

心血管疾病专科护理质量监测指标的构建与实施

·护理研究·心血管疾病专科护理质量监测指标的构建与实施朱丽萍　任国琴　卢回芬　周焕芳　任玉娇南京医科大学附属无锡第二医院心内科　214002通信作者：卢回芬，Email：***************** 【摘要】　目的　探讨心血管内科疾病专科护理质量监测指标的构建和实施效果。

方法　心血管内科成立研究小组，查阅心血管内科专科疾病的诊疗及护理指南，参考已有的心血管内科专科护理质量相关指标，筛选出护理质量问题，制订出3项重点专科护理质量监测指标，即血管活性药及高危药物外渗率、低分子肝素注射致皮下出血发生率及介入穿刺伤口出血、血肿（动脉）主动发现率。

对专科护理质量指标进行监控、数据收集、分析、改进，进一步对科室内护士进行培训和实施持续质量改进。

观察2016—2018年度3项监测指标数据。

结果　心血管内科2017年3项指标相比2016年均有改进，差异均有统计学意义（均P＜0.05）。

2018年3项监测指标数据均较2017年得到改善，差异均有统计学意义（均P＜0.05）。

结论　建立心血管内科护理质量监测指标，制定有针对性的护理措施，对专科护理质量展开持续改进，能有效提升护理质量。

【关键词】　心血管内科；持续质量改进；专科护理；质量监测指标；护理管理 DOI：10.3760/cma.j.issn.1007-1245.2020.17.036Establishment and application of specific nursing quality monitoring indicators for Department of InternalMedicine-CardiovascularZhu Liping, Ren Guoqin, Lu Huifen, Zhou Huanfang, Ren YujiaoDepartment of Cardiology, Wuxi No.2 People’s Hospital, Wuxi 214002, ChinaCorrespondingauthor:LuHuifen,Email:***************** 【Abstract】Objective To explore the establishment and application of specific nursing qualitymonitoring indicators for Department of Internal Medicine-Cardiovascular. Methods Cardiovascular medicinesubject discussion group was constituted, referencing to cardiovascular medicine specific nursing quality relevantindicators and clinic guideline of diagnosis and treatment and nursing, to screen out nursing quality problems,and eventually identify three specific nursing quality indicators, namely vasoactive drugs and high-risk drugsexosmosis rate, incidence of subcutaneous hemorrhage caused by low molecular weight heparin injection, andrate of active hemorrhage discovery and hematoma in interventional puncture wound (artery). The indicators ofspecialized nursing quality were monitored, collected, analyzed, and improved, train of nurses and insisting onpersistent quality reform in our department. The three specific nursing quality indicators were observed in 2016-2018. Result The three specific nursing quality indicators were improved in 2017 compared with 2016, andmore improved in 2018, with statistically significant differences (all P<0.05). Conclusion The establishment andapplication of specific nursing quality indicators for Cardiovascular medicine help to establish targeted nursingmeasures and continuous improvement of nursing quality, and ensure the effective implementation of nursing care. 【Key words】 Cardiovascular medicine; Continuous improvement of nursing quality; Specific nursing;Nursing quality monitoring indicators; Nursing management DOI：10.3760/cma.j.issn.1007-1245.2020.17.036 护理质量管理是护理管理的核心。

兴奋性突触后电位抑制性突触后电位

2. chemical synapses:化学突触 use chemical transmitter(s)
Chemical Synapses
1. Typical Chemical Synapse 经典突触
2. Non-synaptic chemical transmission
非突触性化学传递
Typical Chemical Synapse Synapse:
AP propagate to synaptic knob Ca2+ influx
Vesicle move to presynaptic membrane Release neurotransmitters
递质
synaptic cleft: transmitter diffused to the postsynaptic membrane
(Acetylcholine
ACh
cholinesterase )
AChE
2. reuptake: be transported back into 重利用 the synaptic knob
( epinephrine and norepinephrine ) 3. Go to peripheral interstitial space 外周组织
Synapse is the anatomically specialized junction between two neurons, where information is transmitted from one neuron to another.
一个神经元的轴突末梢与其他神经元的胞体或突起相接触并进行信息传递的部位。
• Classification of synapses 分类

cardiovascular research影响因子2021

cardiovascular research影响因子2021Cardiovascular Research Impact Factor 2021Introduction:Cardiovascular disease remains a leading cause of mortality and morbidity worldwide. In an effort to advance our understanding of cardiovascular conditions and improve patient outcomes, numerous research studies are conducted annually. Among the various metrics used to evaluate and compare the impact of these studies, the Impact Factor stands out as a widely recognized measure. This article aims to explore the Impact Factor of cardiovascular research in the year 2021.Definition of Impact Factor:The Impact Factor (IF) is a metric developed by Eugene Garfield, founder of the Institute for Scientific Information, to assess the influence and reach of scientific journals. It reflects the average number of citations articles published in a journal have received over a specific period, usually two years. A higher Impact Factor signifies a greater impact and relevance of the journal within its field.Cardiovascular Research Impact Factor:In the field of cardiovascular research, the impact factor of a journal is an essential indicator of its influence among researchers and clinicians. High-impact journals attract quality submissions, disseminate pioneering research findings, and shape the direction of future studies. The Impact Factor of cardiovascular research journals helps researchers gauge thesignificance and visibility of their work and enables institutions to assess the academic performance of their faculty members.Analysis of Cardiovascular Research Impact Factor 2021:1. Prominent Journals:Among the prominent journals publishing cardiovascular research, several have consistently maintained high Impact Factors. These include the Journal of the American College of Cardiology (JACC), Circulation, European Heart Journal, and the Journal of the American Heart Association (JAHA). These journals have established a strong reputation for publishing cutting-edge research and continue to attract high-quality submissions from esteemed researchers worldwide.2. Rising Impact Factors:The field of cardiovascular research has witnessed a surge in impactful studies in recent years. As a result, several journals have experienced a significant increase in their Impact Factors. This trend signifies the growing interest in cardiovascular science and the increased recognition of its role in shaping clinical practice. It also highlights the dedication of researchers in generating novel findings that impact patient care and outcomes.3. Interdisciplinary Collaborations:Cardiovascular research often intersects with other fields, such as genetics, epidemiology, bioengineering, and imaging. Collaborations between researchers from different disciplines have played a crucial role in advancing knowledge and driving innovation in cardiovascular science. Journals publishing interdisciplinary cardiovascular research have observedan upward trend in their Impact Factors, reflecting the importance of collaborative efforts.4. Open Access and Impact Factor:Open access journals have gained popularity in recent years due to their unrestricted access to research articles. Although traditionally, Impact Factors were associated with subscription-based journals, many open access cardiovascular research journals have emerged as credible platforms with significant Impact Factors. This evolution indicates a changing landscape in scholarly publishing and the increasing acceptance of open access publishing within the cardiovascular research community.Conclusion:The Impact Factor of cardiovascular research journals serves as an essential measure for assessing the quality, influence, and visibility of scientific publications. It guides researchers in selecting appropriate platforms to disseminate their work while allowing institutions to evaluate the scholarly contributions of their faculty members. As the field of cardiovascular research continues to expand, the Impact Factor remains a crucial metric to identify high-impact journals and promote the publication of impactful research, ultimately benefiting patients worldwide.Note: The word count of the article is approximately 520 words. Please let me know if you require any further information or if you would like me to expand on any specific section.。

鼻心反射处理流程

鼻心反射处理流程In the medical field, the nasal tip reflex is an important tool for doctors to assess the functioning of the nervous system. 鼻尖反射在医学领域是医生评估神经系统功能的重要工具之一。

This reflex, also known as the noso-palpebral reflex, is elicited by gently stimulating the nasal tip, which causes a reflexive blinking of the eyelids. 这种反射，也被称为鼻眶反射，是通过轻轻刺激鼻尖来引发眼皮的反射性眨动。

The normal response to this stimulation is for both eyes to blink in response to the nasal tip being touched. 对此刺激的正常反应是当鼻尖被触摸时，两只眼睛都会眨眼以作出反应。

If the reflex is absent or asymmetrical, it could indicate potential issues with the nervous system. 如果这种反射缺失或不对称，可能表明神经系统有潜在问题。

The nasal tip reflex is an important diagnostic tool for identifying potential neurological issues. 鼻尖反射是用于确定潜在神经问题的重要诊断工具。

It is a non-invasive and quick test that can provide insight into the functioning of the nervous system. 这是一种无创和快速的检测方法，可以为神经系统的功能提供见解。

怯懦之心：描绘胆小鼠辈的内心世界

怯懦之心：描绘胆小鼠辈的内心世界Title: The Cowardly Heart: Depicting the Inner World of Timid MiceIntroduction:In the animal kingdom, mice are often associated with fear and timidity. These small creatures are known for their quick reflexes and tendency to flee at the slightest sign of danger. However, beneath their seemingly fragile exterior lies a complex and intricate inner world. This article aims to explore the inner workings of the timid mouse and shed light on their fears, insecurities, and the challenges they face.Body:1. The Nature of Fear:Fear is an innate response that is deeply ingrained in the mouse's psyche. Their survival instinct compels them to behyper-vigilant and cautious at all times. This constant state of alertness stems from their vulnerability in the face of predators. Their small size and lack of physical strength make them easy targets, creating a perpetual sense of fear within their hearts.1.1. Physiological Responses:When confronted with a threat, the timid mouse experiences a surge of adrenaline, triggering a range of physiological responses. Their heart rate increases, their senses sharpen, and their muscles tense, preparing them for fight or flight. These responses are essential for their survival, but they also contribute to their perpetual state of anxiety.1.2. The Fear Paralysis Reflex:In extreme situations, the timid mouse may enter a state of fear paralysis. This reflexive response renders them temporarily immobile, as if frozen in fear. This immobility is believed to be a defense mechanism, allowing them to blend into their surroundings and avoid detection by predators. This behavior reflects the profound impact fear has on their lives.2. Insecurities and Social Dynamics:Timid mice are not only fearful of predators but also face insecurities within their own social groups. Mice live in hierarchical societies, and the timid ones often find themselves at the bottom of the pecking order. They are subjected to bullying,exclusion, and limited access to resources, which further exacerbate their fears and insecurities.2.1. The Loneliness Factor:The timid mouse often struggles with feelings of loneliness and isolation. They may find it challenging to form close bonds with other mice due to their timid nature. This isolation can have a detrimental effect on their mental well-being, reinforcing their fears and perpetuating a cycle of social anxiety.2.2. The Quest for Safety:In their pursuit of safety, timid mice often resort to hiding and seeking refuge in secluded places. They prefer the comfort of familiar territories and avoid venturing into unknown territory. This behavior not only safeguards them from potential threats but also limits their opportunities for growth and exploration.Conclusion:The inner world of the timid mouse is a complex tapestry of fear, insecurities, and survival instincts. Understanding the nuances of their internal struggles allows us to empathize with these small creatures and appreciate the challenges they face daily. By sheddinglight on their experiences, we can develop a greater appreciation for their resilience and adaptability in the face of adversity.标题：怯懦之心：描绘胆小鼠辈的内心世界引言：在动物王国中，老鼠常常被认为是胆怯和胆小的代表。

nature cardiovascular research分区 -回复

nature cardiovascular research分区-回复Nature Cardiovascular Research (NCR) is a leading scientific journal that focuses on publishing groundbreaking research related to cardiovascular health. In this article, we will explore the various aspects of NCR, including its scope, mission, and significance within the scientific community. We will also delve into the journal's rigorous review process and its contribution towards advancing cardiovascular research.NCR primarily focuses on cardiovascular research, encompassing a wide range of topics such as cardiovascular disease, hypertension, heart failure, arrhythmias, and vascular biology. The journal aims to provide a platform for researchers to share their valuable findings, contribute to scientific knowledge, and improve cardiovascular health outcomes.As a highly esteemed scientific journal, NCR prioritizes publishing studies that demonstrate novelty, scientific rigor, and clinical relevance. An important aspect of NCR's publication process is its commitment to delivering cutting-edge research that can potentially transform clinical practice and improve patient outcomes in cardiovascular medicine.To ensure the quality and validity of research published in NCR, the journal follows a rigorous peer-review process. This process involves independent experts, who carefully evaluate the methodology, results, and implications of each submitted manuscript. The reviewers provide constructive feedback to authors and assist in improving the overall quality of the research.NCR encourages authors to adhere to stringent ethical guidelines and scientific integrity while conducting and presenting their research. The journal also promotes transparency and encourages authors to share their data and methods, allowing for reproducibility and promoting scientific collaboration.Apart from original research articles, NCR also publishes timely editorials and reviews from experts in the field. These pieces provide critical analysis, expert opinions, and insights into the latest developments in cardiovascular research. Review articles consolidate existing knowledge, highlight gaps, and propose potential research directions for scientific advancements.The significance of NCR lies in its impact on the globalcardiovascular research community. By publishing innovative studies, the journal fuels scientific progress and promotes collaboration among researchers. NCR's findings have the potential to revolutionize clinical practice, improve patient outcomes, and contribute towards the development of novel therapeutic strategies for the prevention and treatment of cardiovascular diseases.In addition to its scholarly contributions, NCR plays a crucial role in disseminating knowledge to a broader audience. The journal focuses on clear and concise communication, making complex scientific concepts accessible to clinicians, policymakers, and the general public. This ensures that the research published in NCR reaches those who can implement its findings into practice, ultimately benefiting human health.NCR also fosters interdisciplinary research by publishing studies that integrate multiple scientific disciplines, such as genetics, molecular biology, bioinformatics, and systems biology. This multidisciplinary approach promotes comprehensive understanding and paves the way for innovative solutions in cardiovascular research.In conclusion, Nature Cardiovascular Research is an essential platform for scientists and clinicians working in the field of cardiovascular health. The journal's commitment to publishing rigorous research, promoting transparency, and advancing scientific knowledge contributes significantly to the global understanding and treatment of cardiovascular diseases. NCR's influence extends beyond the scientific community and plays a pivotal role in improving cardiovascular health outcomes for individuals worldwide.。

苏州大学生理复习题

第一章生理知识绪论一．名词解释：1 internal environment2 homeostasis3 excitability4 stimulus5 reaction6 threshold7 excitation8 inhibition 9 negative feedback 10 positive feedback三．单选题：1 可兴奋细胞兴奋时，共有的特征是产生（E）A.神经活动B.肌肉收缩C.腺体分泌D.反射活动E.动作电位2 机体处于应激状态时，糖皮质激素分泌增多是属于（C）A.全身性体液调节B.局部性体液调节C.神经体液调节D.神经调节E.自身调节3 维持机体稳态的重要途径是（B）A.正反馈调节B.负反馈调节C.神经调节D.体液调节E.自身调节4 下列生理过程中，不属于负反馈调节的是（E）A.血液中红细胞数量的恒定B.降压反射C.呼吸节律的维持D.体温恒定的维持E.排尿反射5 下列生理过程中，不属于正反馈调节的是（C）A.血液凝固B.排便反射C.血浆晶体渗透压升高时ADH释放增加D.排尿反射E.分娩反射6 人体生理学是研究（E）A.人体与环境关系B.人体细胞功能C.人体功能调节D.各器官的生理功能E.人体功能活动规律7 神经调节的基本方式是（A）A.反射B.反应C.适应D.正反馈E.负反馈8 衡量组织兴奋性高低的客观指标是（D）A.动作电位B.阈电位C.组织对刺激的反应能力D.强度阈值E.除极速度9 机体功能调节中，最重要的调节方式是（A）A.神经调节B.体液调节C.自身调节D.反馈调节E.前馈调节10 下列关于刺激和反应的说法，哪项是错误的（A）A.有刺激必然产生反应B.产生反应时，必然接受了刺激C.阈刺激时，必然产生反应D.有刺激时，不一定产生反应E.有时反应随刺激强度加大而增强四．回答题：1. Please describe the patterns and characteristics of Human physiological regulation.2. What are the basic characteristics of life?第二章细胞的基本功能一．名词解释：1 simple diffusion2 facilitated diffusion3 pump conveying4 resting potential5 action potential6 threshold potential7 local excitation 8 absolute refractory period 9 all or nonephenomenon10 excitation-contraction coupling 11 isotonic contraction12 isometric contraction 13 complete tetanus 14 polarize15 depolarization 16 repolarization 17 hyperpolarization18 over shoot三．单选题：1 人体内O2、C02和NH3进出细胞膜是通过（A）A.单纯扩散B.易化扩散C.主动转运D.入胞出胞E.继发性主动转运2 葡萄糖进入红细胞属于（D）A. 主动转运B.入胞C. 单纯扩散D. 易化扩散E.继发性主动转运3 肠上皮细胞由肠腔吸收葡萄糖属于（D）A.单纯扩散B. 易化扩散C.原发性主动转运D. 继发性主动转运E.入胞4 产生细胞生物电现象的离子跨膜移动属于（C）A.单纯扩散B.载体为中介的易化扩散C. 通道为中介的易化扩散D. 入胞E. 出胞5 运动神经纤维末稍释放Ach属于（D）A.单纯扩散B.易化扩散C.主动转运D.出胞E.继发性主动转运6 钠钾泵的作用是（A）A.将Na+泵出细胞外，将K+泵入细胞内B.将Na+泵入细胞内，将K+泵出细胞外C. 将Na+泵入细胞内D.将Na+和K+泵入细胞内E. 将Na+和K+泵出细胞外7 在一般生理情况下，每分解一分子ATP，钠泵运转可使（D）A.2个Na+移出膜外B. 2个K+移出膜外C. 2个Na+移出膜外，同时有2个K+移出膜内D. 3个Na+移出膜外，同时有2个K+移出膜内E. 3个Na+移出膜外，同时有3个K+移出膜内8 细胞膜内，外正常的Na+和K+浓度差的形成和维持是由（D）A.膜在安静时对K+通透性大B. 膜在兴奋时对Na+通透性增加C. Na+、K+易化扩散的结果D.膜上钠-钾泵的作用E. 膜上ATP的作用9 判断组织兴奋性高低最常用的指标（B）A.基强度B. 阈强度C. 阈时间D.利用时E. 时值10神经细胞在接受一次阈上刺激后，其兴奋性的周期变化是（D）A. 相对不应期→绝对不应期→超常期→低常期B. 绝对不应期→相对不应期→低常期→超常期C. 绝对不应期→低常期→相对不应期→超常期D. 绝对不应期→相对不应期→超常期→低常期E. 绝对不应期→超常期→低常期→相对不应期11组织兴奋后处于绝对不应期时，其兴奋性为（A）A.零B.无限大C.大于正常D.小于正常E.等于正常12神经细胞产生静息电位的主要原因是（A）A.细胞内高 K+浓度和安静时膜主要对K+有通透性B. 细胞内高 K+浓度和安静时膜主要对Na+有通透性C. 细胞内高 Na+浓度和安静时膜主要对K+有通透性D. 细胞内高 Na+浓度和安静时膜主要对Na+有通透性E. 细胞外高 K+浓度和安静时膜主要对K+有通透性13神经细胞产生静息电位的大小接近于（B）A.钠平衡电位B. 钾平衡电位C. 钠平衡电位和钾平衡电位之和D. 钠平衡电位和钾平衡电位之差E. 锋电位与超射值之差14下列关于可兴奋细胞动作电位的叙述，正确的是（C）A.动作电位是细胞受刺激时出现的快速而不可逆的电位变化B.在动作电位的去极相，膜电位由内正外负变成内负外正C.动作电位的幅度大小不随刺激强度和传导距离而改变D.动作电位由去极化波构成E. 不同细胞的动作电位幅度均相同15神经细胞动作电位的幅度接近于（C）A.钾平衡电位B.钠平衡电位C.二者之和D.二者之差E. 超射值16.人工地减少细胞浸浴液中Na+ 浓度，则单根神经纤维动作电位的超射值将（B）A.增大B.减少C.不变D.先增大后减少E.先减少后减少17.下列关于单细胞动作电位的描述，正确的是（E）A.刺激强度小于阈值时，出现低幅度的动作电位B. 刺激强度达到阈值时，再增加刺激强度能使动作电位幅度增大C.动作电位一经产生，便可沿细胞膜作紧张性扩布D. 动作电位的大小随着传导距离增加而变小E.各种可兴奋细胞动作电位的幅度和持继时间可以各不相同18.动作电位的“全或无”现象是指同一细胞的电位幅度（C）A.不受细胞外的Na+浓度影响B.不受细胞外的K+浓度影响C. 与刺激强度和传导距离无关D.与静息电位值无关E. 与Na+通道复活的量无关19.神经纤维Na+通道失活的时间在（D）A.动作电位的上升相B.动作电位的下降相C.动作电位超射时D.绝对不应期E.相对不应期20.在强直收缩中，肌肉产生的动作电位（B）A.发生叠加或总和B. 不发生叠加或总和C. 幅值变大D. 幅值变小E. 频率变低21.神经纤维的阈电位是指引起膜对下列哪种离子的通透性突然增大的临界膜电位值（B）A.K+B. Na+C.Ca2+D.Cl-E.Mg2+22.下列哪项是具有局部兴奋特征的电信号（A）A.终板电位B.神经纤维动作电位C.神经干动作电位D.锋电位E.后电位23.下列关于兴奋传导的叙述，错误的是（E）A.动作电位可沿细胞膜传导到整个细胞B.传导通过局部电流刺激未兴奋部实现C. 在有髓纤维是跳跃式传导D.有髓纤维传导动作电位的速度比无髓纤维快E.传导距离越远，动作电位的幅度越小24.骨骼肌收缩时，随之不缩短的有（B）A.肌小节B.暗带C.明带D.H带E.肌纤维25.兴奋通过神经-骨骼肌接头时，乙酰胆碱与N-型Ach门控通道结合，使终板膜（B）A.对 Na+、K+ 通透性增加，发生超极化B. 对 Na+、K+ 通透性增加，发生去极化C.仅对K+ 通透性增加，发生超极化D.仅对Ca2+通透性增加，发生去极化E. 对ACh通透性增加，发生去极化26.对骨骼肌兴奋-收缩耦联过程的叙述，正确的是（C）A.电兴奋通过纵管传向肌细胞深部B. 纵管膜产生动作电位C.纵管终末池的 Ca2+通道开放，Ca2+进入肌浆中D. 终末池中的 Ca2+逆浓度差进入肌浆E. Ca2+和肌动蛋白结合27.在骨骼肌兴奋-收缩耦联过程中起关键作用的离子是（B）A. Na+B. .Ca2+ C Cl- D. K+ E.Mg2+28骨骼肌细胞中横管的功能是（D）A. Ca2+的贮存库B. Ca2+进出肌纤维的通道C.营养物质进出肌细胞的通道D.将兴奋传向肌细胞深部E.使Ca2+和肌钙蛋白结合四．回答题：1. Please describe the feature and mechanism of the resting potential and the action potential?2. Please describe the feature and course of neuromuscular junction transferring.?3. Please describe material transmembrane transporting patterns?第三章血液生理一．名词解释：1 blood plasma2 hematocrit3 serum4 blood plasma crystal osmotic pressure5 blood plasma colloid osmotic pressure6 red blood cell suspension stability7 blood coagulate 8 blood-types 9 blood volume 10 blood coagulation factor三．单选题：1.低温库存较久的血液，血浆中哪种离子浓度升高（C）A.Cl-B.Ca2+C.K+D.Na+E.有机负离子2.红细胞比容是指红细胞（D）A.与血浆容积之比B.与血管容积之比C.与血细胞容积之比D.在血液中所占的容积百分比E. 在血液中所占的重量百分比3.有生命危险的急性失血量是指超过总血量的（E）A.5%B.10%C.15%D.20%E.30%4.构成血浆胶体渗透压的主要成分是（A）A.白蛋白B.球蛋白C.珠蛋白D.血红蛋白E.纤维蛋白原5.影响红细胞内外水分正常分布的因素主要是（B）A.血浆胶体渗透压B.血浆晶体渗透压C.组织液胶体渗透压D.组织液静水压E.毛细血管血压6.血液中除去血细胞的液体部分是（D）A.体液B.细胞内液C.细胞外液D.血浆E.血清7.维生素B12和叶酸缺乏将导致（C）A.缺铁性贫血B.再生障碍性贫血C.巨幼红细胞性贫血D.地中海贫血E.溶血性贫血8.在过敏反应时，其数量明显增加的血细胞是（D）A.淋巴细胞B. 嗜中性粒细胞C. 嗜酸性粒细胞D. 嗜碱性粒细胞E. 单核细胞9.下列哪种凝血因子为外源性凝血时需要，而内源性凝血时不需要（B）A.因子IVB.因子VIIC.因子IID.因子VIIIE.因子X10.血管外破坏红细胞的主要场所是（A）A.肝和脾B.肝和肾C.脾和淋巴结D.肾和骨髓E.胸腺和骨髓11.促红细胞生成素的作用是促进（D）A.铁的吸收B.蛋白质的吸收C.维生素B12的吸收D.骨髓造血和红细胞成熟E.雄激素的释放12.内源性凝血叙述，正确的（A）A.由因子XII的激活开始B.所需时间较外源性凝血短C.不需要因子V参加D. 不需要Ca2+参加E.不需要VIII参加13.肝硬化病人容易发生凝血障碍，主要是由于（C）A.血小板减少B.维生素A缺乏C.某些凝血因子不足D.维生素B12缺乏E.毛细血管通透性增加14.血小板减少可导致皮肤呈现出血性斑点，称为紫癜，其最主要原因是（C）A.血小板不易聚集成团B.释放血管活性物质的量不足C.不能修复和保持血管内皮细胞完整性D.血管收缩障碍E.延缓凝血过程15.在实验条件下，将正常人红细胞置于0.4%NaCl溶液中将会出现（E）A.红细胞叠连现象B. 红细胞皱缩C.红细胞凝集D.红细胞沉降速度加快E. 溶血现象16.50Kg体重的正常人的体液量和血液量分别为（B）A.40.0L和4.0LB. 30.0L和3.5L –4.0LC. 20.0L和4.0LD. 30.0L和2.5LE. 20.0L和2.5L17.血液凝固的主要步骤是（C）A. 凝血酶原形成→凝血酶形成→纤维蛋白形成B. 凝血酶原形成→凝血酶形成→纤维蛋白原形成C. 凝血酶原激活物形成→凝血酶形成→纤维蛋白形成D. 凝血酶原激活物形成→凝血酶形成→纤维蛋白原形成E. 凝血酶原形成→纤维蛋白原形成→纤维蛋白形成18.抗凝血酶III的抗凝血作用主要是（D）A. 抑制血小板的粘着和聚集B.抑制凝血酶原激活物形成C. 阻止纤维蛋白原转变为纤维蛋白 D. 使凝血酶失去活性E.激活纤维蛋白溶解系统19.具有变形性运动和吞噬能力，并参与激活淋巴特异免疫功能的是（D）A.中性粒细胞B.嗜酸性粒细胞C.嗜碱性粒细胞D.单核巨嗜细胞E.淋巴细胞20.已知供血者血型为A型，交叉配血试验中主侧凝集，次侧不凝聚，受血者的血型为（D）A.A型B.B型C.AB型D. O型E.以上都不是21.对红细胞生成的叙述，错误的是（B）A.红细胞的主要成分是血红蛋白B.制造血红蛋白的主要原料是叶酸和维生素B12C.只有Fe2+才能被肠上皮细胞吸收D.促进红细胞生成素主要在肾合成E.雄激素可使红细胞数量增多22.对交叉配血试验的叙述，错误的是（B）A.主侧指供血者红细胞与受血者血清相混合,次侧指供血者血清与受血者红细胞相混合B.对已知的同型血液输血，可不必做此试验 C.主侧和次侧无凝集反应，可以输血 D.主侧有凝集反应，不论次侧有何结果，均不能输血 E.主侧无凝集反应，次侧发生凝集，在严密观察下，可以少量、缓慢输血四．回答题：1. Please describe classify and main effect of leucocyte?2. What is the elementary process of blood coagulation and main factors which haveparticipated blood coagulation?3. Please describe the principle of classification and blood transfusion of ABO blood groupsystem?第四章血液循环生理一．名词解释：1 cardiac cycle2 stroke volume3 cardiac output4 cardiac index5 Ejection fraction6 cardiac reserve7 normal pacemaker foci 8 sinus rhythm 9 premature systole10 compensatory pause 11 blood pressure 12 contractive pressure13 diastolic pressure 14 pulse pressure 15 mean arterial pressure16 central venous pressure 17 microcirculation 18 effective filtration pressure 19 vasoconstrictor nerve 20 blood-brain barrier21 blood-cerebrospinal fluid barrier 22 depressor reflex23 renin - angiotonin- aldosterone system 24 electrocardiogram25 effective refractory period三．单选题：1.心室内压力达最高值在（C）A.心房收缩期末B.等容收缩期末C.快速射血期D.等容舒张期末E.心室充盈期末2.心室容积达最大值在（A）A.心房收缩期末B.等容收缩期末C.射血期D.等容舒张期末E.心室充盈期末3.下列哪项使心室舒张末期充盈量减少（D）A.心率一定程度减慢时B.外周静脉压与心房压之差加大C.心房压与心室压之差加大D.心肌收缩加强E.心房收缩能力加大4.正常人心率超过去180次/分时，主要影响下列哪些变化（E）A.心动周期缩短B.收缩期缩短C.舒张期缩短D.收缩期缩短明显E.舒张期缩短明显5.从动脉瓣关闭到下一次动脉瓣开放的时间相当于心动周期中的（D）A.心室舒张期B.心室射血期C.等容收缩期D.心室舒张期+等容收缩期E. 等容舒张期+等容收缩期6.房室瓣开放发生在（E）A.等容舒张期初B. 等容收缩期末C.心室收缩初期D.等容收缩期初E. 等容舒张期末7.心室容积最小在（C）A.等容收缩期末B. 快速射血期末C.减慢射血期末D.等容舒张期初E. 心室充盈期初8.在刚刚停跳的心脏，给其左心室一次阈强度的电刺激，会引起（E）A.局部的心肌收缩B. 左心室收缩C.左心室和左心房收缩D.左心室和右心室收缩E. 整个心脏收缩9.正常人心率超过去180次/min时，心输出量减少的主要原因（A）A.快速充盈期缩短B.减慢充盈期缩短C.等容收缩期缩短D.快速射血期缩短E.减慢射血期缩短10.在心率、前负荷和收缩力不变的情况下，增加心肌的后负荷，会使（C）A.等容收缩期延长，射血速度加快，每搏输出量增加B.等容收缩期延长，射血速度减慢，每搏输出量增加C.等容收缩期延长，射血速度减慢，每搏输出量减少D.等容收缩期缩短，射血速度加快，每搏输出量增加E.等容收缩期缩短，射血速度减慢，每搏输出量减少11.心室肌的前负荷是指（A）A.心室舒张末期容积或压力B. 心室收缩末期容积或压力C. 心室等容收缩期的容积或压力D. 心室等容舒张期的容积或压力E. 大动脉血压12.第一心音产生主要是由于（C）A.半月瓣关闭B. 半月瓣开放C. 房室瓣关闭D. 房室瓣开放E. 心房肌收缩13.第二心音产生主要是由于（B）A.主动脉瓣和肺动脉瓣开放B. 主动脉瓣和肺动脉瓣关闭C. 房室瓣突然开放D. 房室瓣突然关闭E. 心房肌收缩14.第二心音发生在（D）A.等容收缩期末B. 快速射血期C.减慢射血期D.等容舒张期E. 心室充盈期15.心室肌细胞动作电位0期去极是由于（B）A.Na+电导降低B. Na+电导增加C. Ca2+电导降低D. Ca2+电导增加E. K+电导增加16.当心室肌细胞膜动作电位由静息水平去极化达到阈电位水平时，Na+通道处于（C）A.静息状态B.备用状态C. 激活状态D. 失活状态E. 复活状态17.心室肌动作电位1期复极是由于下列哪种离子流动的结果（A）A. K+外流B. K+内流C.Na+内流D. Ca2+内流E. Cl- 内流18.心室肌细胞动作电位平台期是下列哪能离子跨膜流动的综合结果（C）A. Na+内流，Cl- 外流B. Na+外流，Cl- 内流C. Ca2+内流，K+外流D. K+内流 Ca2+外流E. Na+内流，K2+外流19.心室肌细胞动作电位4期恢复细胞内外离子正常浓度梯度靠（E）A.细胞膜渗漏B.单纯扩散 C通道易化扩散 D. 载体易化扩散 E. 钠-钾泵主动转运20.心室肌有效不应期的长短主要取决于（E）A.动作电位0期去极的速度B.动作电位复极末期的长短C.阈电位水平的高低D. 钠-钾泵功能E.动作电位2期的长短21.浦肯野细胞和心室肌细胞动作电位的区别主要是（A）A.4期自动除极有无B.3期复极速度不同C.平台期持续时间相差较大D. 1期形成机制不同E.0期除极速度不同22.窦房结细胞动作电位0期去极大是由于（C）A.Na+电导增加B. Na+电导降低C. Ca2+电导增加D. Ca2+电导降低E. K+电导增加23.对心室肌细胞有效不应期特征的叙述，错误的是（B）A.可产生局部兴奋B. 阈上刺激能产生动作电位C. Na+通道失活D. 此期相当于心室全收缩期舒张早期E.此期时间较长远24.心肌不会产生强直收缩的原因是（E）A.心肌有自律性B. 心肌呈“全或无”收缩C. 心肌肌浆网不发达D. 心肌对胞外Ca2+ 依赖性大 E心肌的有效不应期特别长25.房室延搁的生理意义（E）A.使P波增宽B. 使QRS波增宽C. 使心室肌有效不应期延长D.使心室肌不会产生强直收缩E.使心房、心室不会产生收缩重叠26.兴奋在心脏内传导时，速度最慢的是（C）A.心室肌B.心房肌C. 房室交界D.结希束E.浦肯野纤维27.将心肌细胞分为快反应细胞和慢反映细胞，主要是根据动作电位的（A）A.0期除极速度B. 1期复极速度C. 平台期形成速度D. 3期复极速度E.4期自动去极速度28.自律细胞区别于非自律细胞的生物电活动主要特征是（E）A.0期除极速度快B.平台期较明显C.1期复极速度慢D. 3期复极速度慢E.4期有自动除极29.下列哪项不是心肌细胞平台期的特点（E）A.膜电位处于零电位水平B.是区别神经细胞和骨骼肌细胞动作电位的主要特征C.心肌动作电位时程较长的主要原因之一D. 它与心室肌不会产生强直收缩有关E.形成的离子是Na+缓慢内流30.下列哪项对心肌兴奋传导影响不大（E）A.细胞直径B.0期除极速度和幅度C.邻近部位细胞膜静息电位与阈电位差距D. 邻近部位膜0期除极时钠或钙通道性状E.胞外Ca2+浓度31.关于心肌动作电位和心电图关系的叙述，错误的是（E）A.QRS综合波相当于心室肌细胞动作电位0期B.S-T段相当于平台期C.T波反映心室肌3期复极D. P波代表心房除极过程E.Q-T间期时程与心率成正变关系32.心交感神经兴奋使自律细胞自律性升高的主要作用机制是（E）A.使阈电位水平上移B.动作电位0期去极速度加快C.最大复极电位绝对值增大D. 降低肌浆网摄取Ca2+的速度E.加强I f内向电流，使4期自动除极速度加快33.心迷走神经使自律细胞自律性降低的主要作用机制是（C）A.动作电位0期去极速度减慢B.阈电位水平下移C.最大复极电位绝对值增大D. 4期I k衰减过程加快E.抑制4期I f内向电流34.总截面积最大的血管（A）A.毛细血管B.小动脉C.小静脉D. 大静脉E.大动脉35.血液在血管内流动时，血流阻力（D）A.与血管的半径成正比B.与血管半径的立方成反比C. 与血管半径的平方成正比D. 与血管半径的四次方成反比E. 与血管半径的平方成反比36.血流阻力主要来自（C）A.毛细血管B.微静脉C.微动脉D. 动脉E.大动脉37.外周阻力和心率不变而每搏输出量增大时，动脉血压的变化主要是（A）A.收缩压升高B.舒张压升高C. 收缩压和舒张压升高幅度相同D. 收缩压降低，舒张压升高E. 收缩压升高，舒张压降低38.收缩压为100mmHg，舒张压为70mmHg，其平均动脉压均为（C）A. 70mmHgB. 75mmHgC. 80mmHgD. 85mmHgE. 90mmHg39.下列因素中促进静脉回心血量增加的是（E）A.心输出量增加B.外周阻力增C.动脉血压升高D.体循环平均充盈压降低E.心舒期室内压降低40.影响毛细血管前括约肌舒缩活动的主要因素是（C）A.交感舒血管神经纤维末梢释放的乙酰胆碱B. 副交感神经末梢释放的乙酰胆碱C.局部代谢产物增多D.肾上腺髓质释放的肾上腺素E.交感神经末梢释放的去甲肾上腺素41.关于微循环直捷通路功能的叙述，正确的是（C）A.血流速度较慢B. 是血液和组织之间进行物质交换的主要部位C.经常处于开放状态D.在骨骼肌组织中较少见E.在体温调节中发挥作用42.生成组织液的有效滤过压等于（A）A.(毛细血管血压+组织液胶体渗透压）-（血浆胶体渗透压+组织液静水压）B.(毛细血管血压+血浆胶体渗透压）-（组织液胶体渗透压+组织液静水压）C.(毛细血管血压+组织液静水压）-（毛细血管血压+组织液胶体渗透压）D.(血浆胶体渗透压+组织液胶体渗透压）-（毛细血管血压+组织液静水压）E.(组织液静水压+组织液胶体渗透压）-（毛细血管血压+血浆胶体渗透压）43.当心迷走神经兴奋时（C）A.可使心率加快B. 心房肌收缩缩力加强C.心房肌不应期缩短D.房室传导速度加快E.左心室收缩压升高44.化学感受性反射的效应主要是（B）A.肾泌尿功能增强B. 呼吸加深加快C.血压升高D.心输出量增加E.血容量增多45.下列物质中，哪一种与器管血流量调节无直接关系（C）A.二氧化碳B. 乳酸C.肾素D.腺苷E.前列腺素46.心交感神经对心脏的兴奋作用可被下列哪种阻断剂所阻断（D）A.筒箭毒B. 异搏定C.六烃季胺D.心得安E.阿托品47.调节心血管活动的基本中枢位于（E）A.大脑皮层B.脊髓C.下丘脑D.脑干E.延髓腹外侧部48.刺激心迷走神经时，心肌的作用可被下列哪一种受体的拮抗剂所阻（D）A.α -肾上腺素能受体B. β-肾上腺素能受体C.组织胺能受体D.胆碱能M受体E.胆碱能N受体49.肾素-血管紧张素系统活动增强时，将出现（D）A.醛固酮释放减少B. 静脉回心血量减少C.交感缩血管中枢紧张性活动减弱D.肾小管对Na+重吸收增加E.外周阻力下降50.动脉压力感受性反射的生理意义（D）A.只能使升高的血压降低B.只能使降低的血压升高C.协助动脉血压进行自身调节D.维持动脉血压处于相对稳E.维持体液量处于相对平衡51.对冠脉血流量调节的叙述，错误的是（E）A.对其调节最重要的是心肌本身代谢水平B.心肌提高从单位血液中摄取氧的潜力小C.在代谢产物中腺苷作用最重要D.迷走神经兴奋使冠脉扩张E.交感神经兴奋只能使冠脉收缩52.在正常情况下，组织液的压力为负压的器管（D）A.脑组织B.肝脏C.肾脏D.肺泡E.骨骼肌四．回答题：1. please describe intraventricular pressure , volume open and close, and blood stream’s direction’ change in cardiac cycle ?2. what is the cardiac output?what are the factors to influence cardiac output ?3. please describe the transmembrane potentia , mechanism and characteristic about cardiac working cell and cardiac working cell.4. How do bearing premature and compensatory pause form?5. Please describe the arterial blood pressure’ formation and influential factor?6. What are the influential factors about venous return?7. Please describe the main cardiovascular reflex and its physiological meaning.8. What are the different and similar of the Adr and noradrenalin to regulate cardiovascular activity?9. What are the effects of angiotonin to regulate cardiovascular activity?10. What are the effects of antidiuretic hormone to regulate cardiovascular activity?第五章呼吸生理一．名词解释：1 respiration2 lung ventilation3 intrathoracic pressure(ITP)4 pulmonary compliance5 tidal volume6 breathing capacity7 time vital capacity 8 minute ventilation volume 9 alveolar volume10 pulmonary ventilation 11 organization breath 12 saturation of blood oxygen13 oxygen dissociation curve 14 pulmonary stretch reflex15 surface active substance 16 ratio of ventilation and blood flow二．单选题：1肺通气的直接动力来自（C）A.呼吸肌的舒缩B.肺舒缩运动C.肺内压与大气压之差D.胸廓的舒缩E.肺内压与胸内压之差2 胸内压形成的主要原因是（A）A.肺的回缩力B.肺弹性阻力C.大气压力D.胸膜腔的密闭性E.胸廓的扩张3 维持胸内压的必要条件是（B）A.呼吸运动B.胸膜腔的密闭性C.胸膜腔中浆液分子的内聚力D.肺的自然容积小于胸廓的自然容积E.胸廓扩张4 胸廓弹性阻力影响呼吸，主要取决于（D）A.呼吸肌舒缩程度B.胸内压大小C.肺弹性阻力大小D.胸廓所处的位置E.肺内压大小5 对肺弹性阻力的叙述，错误的是（C）A.肺弹性阻力包括肺泡表面张力所产生的回缩力B.肺组织本身的弹性阻力主要来自弹性纤维C.肺组织本身的弹性阻力约占肺总弹性阻力的2/3D.肺弹性阻力大小一般用肺顺应性来表示E.肺弹性阻力与肺顺应性成反变关系6 关于肺泡表面活性物质的叙述，错误的是（D）A.由肺泡两型上皮细胞分泌B.主要成分是脂质C.可降低肺泡表面张力D.能增加肺的回缩力E.防止液体流入肺泡7 某人潮气量为500ml，呼吸频率为14次/分，其肺泡通气量约为（C）A.3 LB.4 LC.5 LD.6 LE.7 L8 气体扩散速率与（E）A.分压差成反比B.温度成反比C.扩散面积成反比D.扩散距离成正比E.扩散系数成正比9 决定肺内气体交换方向的主要因素是（A）A.气体分压差B.气体溶解度C.气体分子量D.呼吸膜通透性E.气体与血红蛋白亲和力10 有关氧的运输的叙述，下列哪项错误（E）A.O2的运输形式有物理溶解和化学结合两种形式B.O2的结合形式是氧合血红蛋白C.血液中化学结合的O2量远大于物理溶解的O2量D. O2与Hb的结合反应快，不需要酶的催化，，且可逆的E.吸入高压氧主要是增加化学结合的O2量11 Hb氧饱和度的高低主要决定于（B）A.Hb的浓度B.氧分压C.血浆pH值D.CO2分压E.2,3-DPG含量12 氧解离曲线通常表示（C）A.Hb氧容量与PO2关系的曲线B.Hb氧含量与PO2关系的曲线C.Hb氧饱和度与PO2关系的曲线D.O2在血液中溶解的量与PO2关系的曲线E.血中CO2含量与PO2关系的曲线13 切断兔颈部的双侧迷走神经后，呼吸将（D）A.变深变快B.变浅变快C.变浅变慢D.变深变慢E.吸气时相缩短14 生理情况下，血液中调节呼吸的最重要因素是（D）A.OH-B.H+C.O2D.CO2E.NaHCO315 中枢化学感受器最敏感的刺激物是（C）A.血液中的CO2B.血液中的H+C.脑脊液中的H+D.脑脊液中的CO2E.脑脊液中的PO2降低16 动脉血PCO2升高对呼吸的兴奋作用主要是通过下列哪条途径实现的（C）A.直接刺激呼吸中枢B.刺激外周化学感受器C.刺激中枢化学感受器D.刺激颈动脉窦、主动脉弓压力感受器E.直接兴奋呼吸肌17 使氧解离曲线左移的是（E）A.PCO2升高B.pH降低C.温度升高D.2,3-DPG升高E.库存三周后的血液18 肺活量等于（A）A.深吸气量+补呼气量B.肺总容量-肺活量C.深吸气量-潮气量D.深吸气量-补呼气量E.补呼气量+残气量19 调节呼吸的基本中枢位于（B）A.脊髓B.延髓C.脑桥D.中脑E.大脑皮层20 胸内压是由下列哪个因素形成的（E）A.大气压-非弹性阻力B. 大气压+跨肺压C.肺内压+跨胸壁压D.大气压+肺回缩力E.大气压-肺回缩力三．回答题：1. Please describe characteristic , form mechanism and physiological meaning about intrathoracicpressure.2. What are the influence factors of the gas exchange？3. Please describe concept , characteristic and influence factors about oxygen dissociation curve.4. How do oxygen-poor, CO2retention and H+ density step up to influence the respiratory movement.第六章消化生理一．名词解释：1 digestion2 absorption3 basic electric rhythm4 gastrointestinal hormone5 brain- gut peptides6 stomach mucosa-hydrocarbonate barricade7 intrinsic factor8 gastric emptying(GE) 9 cholate intestines-hepatic circulation 10 receptive relaxation。

偏瘫患者的肌腱振动提示肌梭Ia、Ⅱ类传入纤维在下肢肌肉痉挛反射中的作用

偏瘫患者的肌腱振动提示肌梭Ia、Ⅱ类传入纤维在下肢肌肉痉挛反射中的作用Nardone A.;Schieppati M.;郭中孟【期刊名称】《世界核心医学期刊文摘：神经病学分册》【年(卷),期】2005(000)010【摘要】Objective: Foot dorsiflexion evokes a short- (SLR) and a medium- latency EM G response (MLR) in the soleus of standing subjects. SLR is mediated by spindle group Ia, while group II fibres contribute to MLR through an oligosynaptic circu it. We studied the effects of Achilles’ tendon vibration on both responses in spastic patients to disclose any abnormal excitability of these pathways. Method s: SLR and MLR were evoked in 11 hemiparetics and 11 normals. The vibration- in duced changes in both responses were correlated to the Ashworth score of the aff ected leg. Results: There were no differences between normals and patients in th e size of control SLR or MLR. Vibration decreased SLR to 70% in normal subject s, but increased it to 110% in patients, in both affected and unaffected leg. Vibration did not affect MLR in normals, but increased it to 165% on the affec ted and 120% on the unaffected side of patients. Ashworth score was solely cor related with the degree of vibration- induced increase of MLR. Conclusions: Whi le the lack of inhibitory effect of vibration on SLR confirms a reduced inhibiti bility of the monosynaptic reflex, the increased MLR indicates a disin hibition of group II pathway inpatients, connected to the loss of descending control on group II interneurones. Spastic hypertonia depends on release of gro up II rather than group Ia reflex pathways. Significance: These findings give a neurophysiological support for the pharmacological treatment of spastic hyperton ia and suggest a method for the assessment of its effects.【总页数】2页(P12-13)【作者】Nardone A.;Schieppati M.;郭中孟【作者单位】Department of Experimental Medicine University of Pavia Centro Studi Attivit’ a Motorie (CSAM) I- 27100 Pavia Italy【正文语种】中文【中图分类】R741【相关文献】1.局部振动训练对脑梗偏瘫患者上肢痉挛和功能康复的疗效分析 [J], 吴超2.基于Bobath理念的全身振动疗法对脑卒中偏瘫患者上肢痉挛的影响 [J], 王国胜;郭钢花;李哲;梁英姿3.局部振动治疗仪对偏瘫患者下肢痉挛及三维步态参数的效果研究 [J], 师昉;李福亮;吕泽平4.选择性周围神经肌梭传入Ia类纤维切断治疗痉挛性脑性瘫痪的实验研究Ⅱ.家兔胫后神经选择性切断后肌力变化的实验研究 [J], 刘小林;朱家恺;程钢;刘均墀5.选择性周围神经肌梭传入Ia类纤维切断治疗痉挛性脑性瘫痪的实验研究——1 家兔胫神经小束乙酰胆碱酯酶组织化学与电生理学的相关实验研究 [J], 刘小林;朱家恺;程钢;刘均墀因版权原因，仅展示原文概要，查看原文内容请购买。

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NEUROSCIENCES AND NEUROANAESTHESIACardiovascular reﬂex responses to temporal reduction in arterial pressure during dexmedetomidine infusion:a double-blind,randomized,and placebo-controlled studyJ.Kato 1,Y.Ogawa 2*,W.Kojima 1,K.Aoki 2,S.Ogawa 1and K.Iwasaki 21Department of Anesthesiology and 2Division of Hygiene,Department of Social Medicine,Nihon UniversitySchool of Medicine,30-1Oyaguchi-Kamimachi,Itabashi-Ku,Tokyo 173-8610,Japan*Corresponding author.E-mail:yojiro@med.nihon-u.ac.jpBackground.The low and moderate doses of dexmedetomidine reduce arterial pressure and heart rate (HR),suggesting attenuation of sympathetic activity and dominance of cardiac-vagal activity.These autonomic responses under dexmedetomidine sedation may attenuate cardio-vascular reﬂex responses to temporal reduction in arterial pressure,inducing a severe hypo-tension.W e therefore investigated the effects of dexmedetomidine on cardiovascular reﬂex responses to temporal reduction in arterial pressure induced by the thigh cuff method.Methods.T welve healthy men received placebo,low-dose (loading 3m g kg 21h 21for 10min;maintenance 0.2m g kg 21h 21for 60min),and moderate-dose (loading 6m g kg 21h 21for 10min;maintenance 0.4m g kg 21h 21for 60min)dexmedetomidine infusions in a randomized,double-blind,crossover study.After 70min of drug infusion,systolic arterial pressure (SAP)and HR responses after thigh cuff deﬂation were evaluated as indices of cardiovascular reﬂex.Results.Reduction in SAP (D SAP)[placebo 8(4),low 12(4),moderate 19(5)mm Hg]after thigh cuff deﬂation was signiﬁcantly greater in dexmedetomidine than placebo infusions,in a dose-dependent manner.The change in HR (D HR),D HR/D SAP ,and the percentage restoration of SAP were lower with dexmedetomidine compared with placebo.Conclusions.The present results indicated that dexmedetomidine weakens arterial pressure preservation and HR responses after thigh cuff deﬂation,suggesting attenuated cardiovascular reﬂexes.Therefore,it must be cautioned that dexmedetomidine can lead to further and sus-tained reduction in arterial pressure during transient hypotension induced by postural changes,haemorrhage,and/or other stresses.Br J Anaesth 2009;103:561–5Keywords :anaesthetics i.v.;arterial pressure,drug effects;arterial pressure,hypotension;cardiovascular system,responses;sedation Accepted for publication:June 4,2009The a 2-receptor agonist dexmedetomidine is often used in the anaesthetic setting 1–4and the intensive care unit.56Dexmedetomidine has a biphasic dose–response relation-ship to arterial pressure.7Clinical doses of dexmedetomi-dine reduce arterial pressure,89because low and moderate doses of dexmedetomidine may be below the threshold required to produce signiﬁcant peripheral vasoconstriction or because the sympatholytic effects of dexmedetomidine may offset direct effects on the peripheral vasculature.7Moreover,dexmedetomidine reduces heart rate (HR)by a reduction of tonic levels of sympathetic outﬂow 10and a dominance of cardiac-vagal activity.11These autonomic responses under dexmedetomidine sedation may attenuate cardiovascular reﬂex responses to transient hypotension induced by postural changes or haemorrhage.However,no study has investigated the effects of dexmedetomidine on cardiovascular reﬂex responses to temporal reductions in arterial pressure.#The Author [2009].Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia.All rights reserved.British Journal of Anaesthesia 103(4):561–5(2009)doi:10.1093/bja/aep210Advance Access publication August 13,2009To test our hypothesis that dexmedetomidine attenuates cardiovascular reﬂex responses to transient hypotension, we investigated arterial pressure and HR responses after thigh cuff deﬂation.MethodsThe Institutional Review Board of Nihon University School of Medicine(Itabashi-ku,Tokyo,Japan)approved this study.All study participants provided written informed consent and also a medical history,and were screened by a physical examination including ECG and arterial pressure measurements.We investigated12 healthy,normotensive males with a mean(range)age21 (18223)yr,height173(1632182)cm,and weight66 (57279)kg.These subjects were a subset of the group of subjects previously studied by us during an investigation on cerebral autoregulation.12All participants fasted for at least2h before the exper-iments,and refrained from heavy exercise and consuming caffeinated or alcoholic beverages for at least24h before the experiments.All participants were familiarized with the measurement techniques and experimental conditions before starting the study.Participants lay supine in a comfortable bed,in an environmentally controlled experimental room,at an ambient temperature of23–258C.An ECG,pulse oxi-meter,nasal cannula(Life scope BSM-5132;Nihon Kohden,Tokyo,Japan),and bispectral index monitor(BIS XP w;Aspect Medical Systems,Inc.,Norwood,MA,USA) were applied.Continuous arterial pressure was measured in the radial artery using tonometry with a non-invasive arterial pressure monitor at the heart level on a beat-to-beat basis,and calibrated by intermittent arterial pressure measured using the oscillometric method with a sphygmomanometer cuff placed over the brachial artery (JENTOW7700;Colin,Aichi,Japan).Each waveform of ECG and continuous arterial pressure were recorded at a sampling rate of1kHz using commercial software (Notocord-hem3.3;Notocord,Paris,France)throughout the experiment.For the thigh cuff method,large cuffs were placed around both thighs of all the participants. A22G catheter was inserted into a forearm vein for drug infusion.The study was a randomized,double-blind,crossover comparison between two doses of dexmedetomidine and placebo(normal saline).At least7days were allowed between experiments.Moderate-dose dexmedetomidine was infused as an initial loading dose of6m g kg21h21 for10min,followed by0.4m g kg21h21for60min (Moderate DEX).The dose of dexmedetomidine for low-dose infusion was half that of moderate-dose dexme-detomidine(Low DEX:an initial loading dose of3m g kg21h21for10min;with a maintenance dose of0.2m g kg21h21for60min).These doses and periods of infusion were chosen to obtain dexmedetomidine plasma concen-trations of$0.6and0.3ng ml21respectively,as describedin the manufacturer’s material(Hospira Japan K.K.,Osaka,Japan).Moreover,these infusion regimens weresimilar to those used in previous studies.8913An equalvolume of normal saline per hour was infused as placebo.Infusion of drugs was continued during the measurements.All subjects received all three types of infusions.Seventy minutes after commencement of infusion ofdexmedetomidine or placebo(loading10min;mainten-ance60min),6min worth of data of ECG and continuousarterial pressure waveforms were obtained for steady-statedata.Ventilatory frequency,end-tidal carbon dioxidepressure(E0CO2),and arterial oxygen saturation(S pO2)wererecorded every minute during this period.Steady-statevalues of systolic arterial pressure(SAP),diastolic arterialpressure(DAP),HR,ventilatory frequency,E0CO2,and S pO2 were averaged over the6min time interval before thighcuff inﬂation.After measuring steady-state data of thesewaveforms,thigh cuffs were inﬂated to30mm Hg abovethe subject’s SAP by using a rapid cuff inﬂator(E20Rapid Cuff Inﬂator;Hokanson,Inc.,Bellevue,WA,USA).This instrument inﬂates a large cuff to50mm Hg in,0.3s and deﬂates it again in,0.2s.After2min of inﬂation,the cuffs were rapidly deﬂated to produce temporalreductions in arterial pressure.The cardiovascular reﬂex after release of the large cuffsapplied around both thighs was ing pre-viously validated algorithms,14–17beat-to-beat values ofSAP and HR were obtained using PC-based Notocord-hem3.3software(Notocord-hem3.3;Notocord,Paris,France).The computer then plotted curves as presented in Figure1.Baseline values of SAP and HR were obtained by calculat-ing their averages during the10s before thigh cuffrelease.Baseline values were obtained for all three typesof infusions.Reduction in SAP(D SAP)was calculated bysubtracting the lowest value of SAP after thigh cuffrelease(minimum SAP)from baseline SAP,whereaschange in HR(D HR)was calculated by subtracting base-line HR from the highest value of HR after thigh cuffrelease(maximum HR).Then,an increase in HR inresponse to reduction in SAP(D HR/D SAP),as an index ofarterial cardiac reﬂex,was calculated.In addition,percen-tage restoration of SAP was expressed as:Percentage restoration of SAP¼restorationreductionÂ100¼ðrecovery SAPÀminimum SAPÞðbaseline SAPÀminimum SAPÞÂ100ð%Þ;where recovery SAP is the average SAP measured in the10s interval between20and30s after thigh cuff release,this being the predicted time by which recovery of SAPafter thigh cuff release is complete or overshoots baselinelevels under normal conditions.17Kato et al.Inter-dose variables were compared using one-way repeated-measures analysis of variance (ANOVA )(placebo,Low DEX,and Moderate DEX).To determine where sig-niﬁcant differences occurred,the Student–Newman–Keuls post hoc test was used for all pairwise comparisons.A P -value of ,0.05was considered statistically signiﬁ-cant.The analyses were performed using PC-based soft-ware (SigmaStat;Systat Software,Inc.,San Jose,CA,USA).Data are presented as mean (SD ).ResultsThe average values of steady-state haemodynamic and res-piratory data with each infusion dose are presented in Table 1.Steady-state SAP,and DAP with Low DEX and Moderate DEX were signiﬁcantly lower than with the placebo.HR tended to decrease in association with an increase in the dexmedetomidine dose (ANOVA ,P ¼0.063).Although S p O 2with Low DEX and Moderate DEX was slightly but signiﬁcantly lower than with placebo,venti-latory frequency and E 0CO 2were not signiﬁcantly different among the three infusions.Bispectral index tended todecrease in association with an increase in the dexmedeto-midine dose (ANOV A ,P ¼0.057).The values of all these indices were not signiﬁcantly different between Low DEX and Moderate DEX.The average values of cardiovascular reﬂex indices assessed by the thigh cuff method are presented in Table 2.Averaged tracings from the entire series are presented in Figure 2.A decrease in SAP (D SAP)with Low DEX and Moderate DEX was signiﬁcantly larger than with placebo;this decrease also being signiﬁcantly larger with Moderate DEX when compared with Low DEX.The response of HR (D HR),D HR/D SAP,and the percentage restoration of SAP were signiﬁcantly lower with Low DEX and Moderate DEX than with placebo.DiscussionThe primary ﬁnding of the present study was that when temporal reduction in arterial pressure was induced by thigh cuff deﬂation,the reduction in SAP was signiﬁcantly greater during dexmedetomidine infusion than with placebo,in a dose-dependent manner.Also,change in HR,D HR/D SAP,and the percentage restoration of SAP were lower in dexmedetomidine infusions when compared with placebo,even with low-dose dexmedetomidine infusion.These results indicate that dexmedetomidine weakens arterial pressure preservation and HR responses after thigh cuff deﬂation.Table 1Steady-state haemodynamics and respiratory conditions before thigh cuff deﬂation.SAP,systolic arterial pressure;DAP,diastolic arterial pressure;HR,heart rate;S p O 2,arterial oxygen saturation;Resp-R,ventilatory frequency;E 0CO 2,end-tidal carbon dioxide pressure;BIS,bispectral index.Values are means (SD ).*P ,0.05(vs placebo)PlaceboLow DEX Moderate DEX SAP (mm Hg)117(13)98(10)*102(9)*DAP (mm Hg)62(9)51(6)*54(5)*HR (beats min 21)58(6)53(6)53(8)S p O 2(%)98(1)97(1)*97(1)*Resp-R (bpm)13(3)13(2)14(2)E 0CO 2(kPa) 5.3(0.8) 5.3(0.8) 5.5(0.7)BIS86(5)83(7)78(8)Table 2Arterial pressure and HR after thigh cuff deﬂation.D SAP,the reduction in SAP after thigh cuff release;D HR,the response in HR after thigh cuff release;D HR/D SAP,increase of HR in response to reduction of SAP after thigh cuff release;%Restoration of SAP,percentage restoration of SAP in the interval from 20to 30s after thigh cuff release.Values are mean (SD ).*P ,0.05(vs placebo);#P ,0.05(vs Low DEX)PlaceboLow DEX Moderate DEX D SAP (mm Hg)8(4)12(4)*19(5)*,#D HR (beats min 21)16(8)12(4)*11(4)*D HR/D SAP (beats min 21mm Hg 21) 3.3(4) 1.1(1)*0.6(0)*%Restoration of SAP 189(171)82(31)*50(8)*Baseline SAP 95100105S A P (m m H g )110115Time (s)Baseline HR 30406050H R (b e a t s m i n –1)7080Time (s)Fig 1Representative changes in SAP and HR induced by thigh cuff deﬂation.Thigh cuffs were released at time 0.Baseline SAP was the average SAP during the 10s before thigh cuff release.Minimum SAP was the lowest value of SAP after thigh cuff release.D SAP was the difference between baseline SAP and minimum SAP.Recovery SAP was the average SAP measured in the 10s interval between 20and 30s after thigh cuff release.Baseline HR was the average HR during the 10s before thigh cuff release.Maximum HR was the highest value of HR after thigh cuff release.D HR was the difference between baseline HR and maximum HR.Dexmedetomidine and cardiovascular reﬂexesThe present results of steady-state haemodynamics indi-cated a decrease in arterial pressure and HR similar to that observed in previous studies,8913implying diminution of sympathetic activity and dominance of cardiac-vagal activity.71011The autonomic effects of small doses of dexmedetomidine may compromise cardiovascular reﬂexes,namely increases in HR and augmentation of per-ipheral vascular resistance that occur in response to the transient hypotension by postural changes,haemorrhage,vasodilatation by heating,epidural bolus drug injection,or lifting patients for transfer from the intensive care unit beds to transporters.The present study induced transient hypotension using the thigh cuff method.This method provides a temporal reduction in arterial pressure and a transient increase in HR by rapid deﬂation of the thigh cuff after temporary ischaemia in the lower limbs with cuff inﬂation.14–17In previous studies,it has been presented that circulatory occlusion of resting skeletal muscles with thigh cuff inﬂation does not evoke either cardiovascular metabore-ﬂexes or mechanoreﬂexes,14–16suggesting that the cuff inﬂation used in the present study caused no interference with cardiovascular reﬂexes.Thus,use of the thigh cuff method during dexmedetomidine sedation would aid in evaluation of cardiovascular reﬂex responses to simulated haemodynamic changes without any autonomic effects by administration of vasoactive drugs.A representative change after thigh cuff deﬂation (Fig.1)had three phases with different characteristics,similar to that observed in a previous study.17In phase 1,after thigh cuff release,arterial pressure decreased rapidly.In response to this decrease in arterial pressure,HR increased after a slight time delay.In phase 2,in association with the restoration of arterial pressure from the nadir to the level before thigh cuff release,HR con-tinuously increased with simultaneous increases in arterial pressure.In phase 3,arterial pressure overshot pre-deﬂation levels,HR decreased from maximal responses and recovered to the level before thigh cuff release in association with a recovery of arterial pressure.Thus,phases 1,2,and 3of cardiovascular reﬂexes after thigh cuff release would be indicated by the indices used in the present study (D SAP,D HR,and percentage restoration in SAP),respectively.Also,the D HR/D SAP was estimated as an index of cardiac reﬂexes.Consequently,the present results of all these indices suggest together that dexmede-tomidine attenuated cardiovascular reﬂex.Dexmedetomidine has beneﬁcial effects in the anaes-thetic setting,including sedation,analgesia,anxiolysis,and reduction in opioid,and inhalation anaesthetic require-ment.34101819Moreover,sedation with dexmedetomidine is efﬁcacious in critically ill patients in the intensive care unit.56These previous studies have also reported that dex-medetomidine prevents incidences of detrimental haemo-dynamic changes in the operating theatre and the intensive care unit.However,the present study found that cardiovas-cular reﬂex index to temporal reductions in arterial pressure was attenuated during dexmedetomidine sedation.From the present results,it must be cautioned that when transient hypotension is induced by postural changes,haemorrhage,and/or other stresses,dexmedetomidine administration can lead to further and sustained reduction of arterial pressure.The present regimen would produce steady-state plasma concentration,but potential instability cannot be excluded.12The plasma concentration of dexmedetomidine–1090100S A P (m m H g )110120010A2030Time (s)–10010B 2030Time (s)–10010C2030Time (s)–105060H R (b e a t s m i n –1)70800102030Time (s)–100102030Time (s)–100102030Time (s)Fig 2Group-averaged SAP and HR during the thigh cuff method.Placebo (A );low-dose dexmedetomidine:low DEX (B );and moderate-dose dexmedetomidine:moderate DEX (C ).Thigh cuffs were released at time 0.Kato et al.should have been measured for more precise study.Then, the SD in percentage restoration of SAP was very large in the placebo infusion,because the index includes not only the complete recovery but also the overshoot in SAP.17Indeed,a subject who overshot extensively relative to reduction of SAP indicates673%in percentage restor-ation of SAP.We investigated the effects of dexmedetomidine on car-diovascular reﬂex responses to temporal reductions in arterial pressure induced by the thigh cuff method. Dexmedetomidine weakens arterial pressure preservation and HR responses after thigh cuff deﬂation,suggesting attenuated cardiovascular reﬂexes.Therefore,dexmedeto-midine infusion can lead to further and sustained reduction in arterial pressure when transient hypotension occurs in the perioperative period.FundingThis work was supported by institutional funding and Hospira Japan K.K.(Osaka,Japan).References1Vilo S,Rautiainen P,Kaisti K,et al.Pharmacokinetics of intrave-nous dexmedetomidine in children under11yr of age.Br J Anaesth2008;100:697–7002Kadoi Y,Saito S,Kawauchi C,Hinohara H,Kunimoto F.Comparative effects of propofol vs dexmedetomidine on cer-ebrovascular carbon dioxide reactivity in patients with septic shock.Br J Anaesth2008;100:224–93T anskanen PE,Kytta¨JV,Randell TT,Aantaa RE.Dexmedetomidine as an anaesthetic adjuvant in patients undergoing intracranial tumour surgery:a double-blind,randomized and placebo-controlled study.Br J Anaesth2006;97:658–654Scheinin B,Lindgren L,Randell T,Scheinin H,Scheinin M.Dexmedetomidine attenuates sympathoadrenal responses to tracheal intubation and reduces the need for thiopentone and peroperative fentanyl.Br J Anaesth1992;68:126–315Shehabi Y,Ruettimann U,Adamson H,Innes R,Ickeringill M.Dexmedetomidine infusion for more than24hours in critically illpatients:sedative and cardiovascular effects.Intensive Care Med 2004;30:2188–966Venn M,Newman J,Grounds M.A phase II study to evaluate the efﬁcacy of dexmedetomidine for sedation in the medical intensive care unit.Intensive Care Med2003;29:201–77Ebert TJ,Hall JE,Barney JA,Uhrich TD,Colinco MD.The effects of increasing plasma concentrations of dexmedetomidine in humans.Anesthesiology2000;93:382–948Hall JE,Uhrich TD,Barney JA,Arain SR,Ebert TJ.Sedative, amnestic,and analgesic properties of small-dose dexmedetomi-dine infusions.Anesth Analg2000;90:699–7059Arain SR,Ebert TJ.The efﬁcacy,side effects,and recovery charac-teristics of dexmedetomidine versus propofol when used for intraoperative sedation.Anesth Analg2002;95:461–610Bloor BC,Ward DS,Belleville JP,Maze M.Effects of intravenous dexmedetomidine in humans.II.Hemodynamic changes.Anesthesiology1992;77:1134–4211Hogue CW,Jr,T alke P,Stein PK,Richardson C,Domitrovich PP, Sessler DI.Autonomic nervous system responses during sedative infusions of dexmedetomidine.Anesthesiology2002;97: 592–812Ogawa Y,Iwasaki K,Aoki K,Kojima W,Kato J,Ogawa S.Dexmedetomidine weakens dynamic cerebral autoregulation as assessed by transfer function analysis and the thigh cuff method.Anesthesiology2008;109:642–5013Prielipp RC,Wall MH,T obin JR,et al.Dexmedetomidine-induced sedation in volunteers decreases regional and global cerebral bloodﬂow.Anesth Analg2002;95:1052–914Rowell LB,Hermansen L,Blackmon JR.Human cardiovascular and respiratory responses to graded muscle ischemia.J Appl Physiol1976;41:693–70115Rowell LB.Arterial baroreﬂexes,central command,and muscle chemoreﬂexes:a synthesis.In:Rowell LB,ed.Human Cardiovascular Control.New Y ork:Oxford University Press,1993;441–8316Williamson JW,Mitchell JH,Olesen HL,Raven PB,Secher NH.Reﬂex increase in blood pressure induced by leg compression in man.J Physiol1994;475:351–717Zhang R,Behbehani K,Crandall CG,Zuckerman JH,Levine BD.Dynamic regulation of heart rate during acute hypotension:new insight into baroreﬂex function.Am J Physiol2001;280:H407–19 18Belleville JP,Ward DS,Bloor BC,Maze M.Effects of intravenous dexmedetomidine in humans.I.Sedation,ventilation,and meta-bolic rate.Anesthesiology1992;77:1125–3319Lin TF,Y eh YC,Lin FS,et al.Effect of combining dexmedetomi-dine and morphine for intravenous patient-controlled analgesia.Br J Anaesth2009;102:117–22Dexmedetomidine and cardiovascular reﬂexes。