Kev Koom Tes Ntawm Preoperative Retrograde Hepatic Vein Flow Thiab Mob raum Kev Mob Tom Qab Kev Kho Mob
Jul 06, 2023
Abstract
Cov lus nug tseem ceeb: Puas muaj qhov kwv yees tus nqi ntawm cov kab mob siab venous flow rau postoperative mob raum raug mob (AKI) tom qab phais plawv? Cov kev tshawb pom tseem ceeb: Hauv cov neeg mob uas tau txais kev phais mob plawv, retrograde hepatic venous waves (A, V) thiab lawv qhov sib piv rau anterograde nthwv dej tau pom tias muaj kev sib raug zoo nrog kev ua haujlwm tom qab AKI, txhais tau tias yog qhov feem pua ntawm kev hloov pauv ntawm qhov siab tshaj plaws tom qab kev ua haujlwm creatinine los ntawm lub hauv paus preoperative concentration. (% ∆Cr). Lub sijhawm nrawm nrawm (VTI) ntawm retrograde A nthwv dej thiab qhov sib piv ntawm retrograde thiab anterograde nthwv dej 'VTI yog nws tus kheej cuam tshuam nrog AKI tom qab hloov kho qhov mob hnyav. Cov lus coj mus tsev: Ib qho piv txwv ntau dua ntawm retrograde / antegrade nthwv dej nyob rau hauv hepatic venous retrograde nthwv dej, uas muaj feem xyuam rau lub siab stasis, yuav kwv yees AKI tom qab kev phais plawv. Taw qhia: Hepatic venous flow qauv qhia txog kev hloov pauv hauv txoj cai ventricle thiab tseem yog cov cim ntawm cov kab mob venous congestion. Pulsatility ntawm inferior cava vein tau siv los kwv yees qhov kev pheej hmoo ntawm mob raum raug mob (AKI) tom qab kev phais plawv. Lub Hom Phiaj: Peb lub hom phiaj yog txhawm rau ntsuas kev sib koom ua ke ntawm cov qauv ua ntej ntawm lub siab venous ntws thiab kev pheej hmoo ntawm AKI hauv cov neeg mob tom qab kev phais plawv. Cov hau kev: Qhov kev cia siab no, kev soj ntsuam kev tshawb fawb suav nrog 98 tus neeg mob yam tsis muaj kab mob siab ua ntej uas tau txais kev phais mob plawv ntawm 1 Lub Ib Hlis 2018, thiab 31 Lub Peb Hlis 2020, ntawm lub plawv plawv tertiary . Ntxiv nrog rau kev soj ntsuam echocardiographic niaj hnub, peb tau sau qhov siab tshaj plaws tshaj tawm thiab tshaj tawm lub sijhawm sib koom ua ke (VTI) ntawm tus qauv plaub nthwv dej hauv cov kab mob hepatic nrog Doppler ultrasound. Peb qhov kev ntsuas tseem ceeb yog tom qab kev ua haujlwm AKI, txhais tau tias yog qhov feem pua ntawm kev hloov pauv ntawm qhov siab tshaj plaws tom qab kev ua haujlwm creatinine los ntawm lub hauv paus kev ua haujlwm ua ntej concentration (feem pua ∆Cr). Cov txiaj ntsig thib ob yog AKI, txhais los ntawm KDIGO (Kidney Disease Improving Global Outcomes) cov qauv. Cov txiaj ntsig: Lub hnub nyoog nruab nrab ntawm cov neeg mob yog 69.8 xyoo (interquartile range [IQR 25–75] 13 xyoo). Kaum xya tus neeg mob (17.3 feem pua) tau tsim kho tom qab AKI raws li KDIGO. VTI ntawm retrograde A nthwv dej hauv cov hlab ntsha hauv siab pom muaj kev sib raug zoo (B: 0.714; p=0.0001) nrog kev nce qib creatinine tom qab phais plawv. Lub sijhawm nrawm nrawm (VTI) ntawm A nthwv dej (B=0}.038, 95 feem pua CI=0.025–0.051, p < 0.001) thiab qhov piv ntawm VTI ntawm retrograde thiab anterograde tsis ( B=0.233, 95% CI=0.112–0.356, p < 0.001) nws tus kheej cuam tshuam nrog kev nce qib ntawm creatinine. Cov ntsiab lus: Qhov hnyav ntawm lub siab venous regurgitation tuaj yeem yog ib qho kev qhia ntawm venous congestion thiab zoo li muaj feem xyuam rau txoj kev loj hlob ntawm AKI.
Ntsiab lus
Doppler ultrasound; plawv tsis ua hauj lwm; mob raum mob; hepatic venous flow.
Nyem qhov no kom paub tias Cistanche yog dab tsi
Taw qhia
Perioperative mob raum raug mob (AKI) yog ib txwm muaj thiab cuam tshuam nrog kev mob hnyav thiab kev tuag tom qab phais plawv. Ntau qhov kev pheej hmoo tau raug txheeb xyuas nyob rau hauv txoj kev loj hlob ntawm AKI, xws li cov zis tsis tshua muaj zog, cardiopulmonary bypass, thiab mob raum mob [1]. AKI [2] tau cuam tshuam nrog kev pheej hmoo ntawm sepsis, anemia, coagulopathy, thiab lub tshuab ua pa ntev ntev [3].
Tsis ntev los no, hepatic venous congestion thiab qhov tshwm sim ntawm hepatic parenchymal dysfunction yog txuam nrog muaj kev pheej hmoo rau kev tuag thiab kev tuag ntawm cov neeg mob uas muaj lub plawv tsis ua hauj lwm kawg [2,4,5]. Hauv kev phais mob plawv cov neeg mob uas muaj lub plawv tsis ua haujlwm, venous ntshav siab tuaj yeem ua rau lub raum ua haujlwm tsis zoo los ntawm kev txo cov txiaj ntsig transcranial gradient, txo qis glomerular filtration rate, thiab ua rau cov kua dej ntau dhau hauv lub sijhawm postoperative. Hauv cov kab mob pathophysiological, lub siab puas tsuaj yog tshwm sim los ntawm stasis lossis tsis muaj lub plawv tawm [6]. Lub plawv tsis tshua muaj tshwm sim ua rau ischemic kab mob siab nrog rau qhov tshwm sim centrilobular necrosis, ua rau kom nce qib transaminase thiab bilirubin hauv cov ntshav. Kev mob ntev ntev yog tus cwj pwm los ntawm qib siab alkaline phosphatase (ALP) thiab GGT. Muaj ntau qhov kev tshawb fawb uas tau tshuaj xyuas lub luag haujlwm ntawm lub siab tsis ua haujlwm cardiogenic thiab lub raum raug mob thiab lawv lub luag haujlwm tseem ceeb hauv kev muaj sia nyob mus ntev [7–9], txawm li cas los xij, cov kev tshawb fawb no ua tsis tau zoo los tshuaj xyuas qhov degree thiab qhov loj ntawm lub siab venous congestion thiab qhov tshwm sim. hepatic parenchymal dysfunction ntawm txoj kev pheej hmoo rau postoperative AKI tom qab phais plawv.
Peb xav tias qhov kev ntsuam xyuas ntawm cov hlab ntsha ntawm cov hlab ntsha thiab kev suav ntawm cov anterograde thiab retrograde ntws ua ntej kev phais plawv tuaj yeem yog cov cim tseem ceeb hauv kev kwv yees tom qab AKI. Tsis tas li ntawd, peb muab piv rau qhov sib piv ntawm cov dej ntws rov qab nrog rau lub raum ua ntej thiab lub raum tsis ua haujlwm thiab nrog cov teeb meem tom qab phais.
Herba Cistanche
Cov txheej txheem
1. Kawm Tsim
Cov txiaj ntsig kev tshawb fawb tau tshaj tawm raws li STROBE nqe lus. Peb txoj kev tshawb fawb tau pom zoo los ntawm Pawg Saib Xyuas Kev Tshawb Fawb ntawm Semmelweis University (IRB 141/2018), thiab nws tau sau npe ua ClinicalTrials.gov tus lej NCT02893657. Hauv qhov kev cia siab no, kev soj ntsuam kev tshawb fawb, peb tau tso npe rau 98 tus neeg mob uas tau txais kev phais mob plawv thaum lub Ib Hlis 2018 thiab Kaum Ob Hlis 2019 hauv ib lub plawv tertiary. Cov neeg mob uas muaj kab mob raum ua ntej ua ntej (txhais tias GFR qis dua 30 mL / min / 1.73 m2 hepatic cirrhosis, lossis portal vein thrombosis tsis suav nrog. Txhua tus neeg mob uas tau pom zoo koom nrog kos npe rau kev pom zoo ua ntej kev tshawb xyuas thawj zaug, uas feem ntau yog ob mus rau peb. hnub ua ntej qhov kev npaj phais.
2. Kev txhais thiab kev ntsuas (Variables and Data Sources and grouping)
Cov ntaub ntawv pej xeem, cov kev kuaj ua ntej ua ntej, qhov sib txawv ntawm qhov sib txawv (cov txheej txheem, lub sijhawm ua haujlwm ntawm lub plawv dhia, cov kua dej sib npaug, kev tswj hwm cov khoom siv ntshav, xav tau cov tshuaj vasoactive), thiab cov yam ntxwv tom qab (cov kua dej tshuav, cov tshuaj vasoactive) tau siv hauv kev tshuaj xyuas. Tshwj xeeb, peb tau sau cov ntaub ntawv ntawm qhov kev kwv yees ntawm European System rau Kev Ntsuas Kev Ua Haujlwm Txaus Siab [10,11] thiab MELD Qauv rau Kab Mob Siab Kawg (MELD) qhab nia [12,13], vasoactive-inotrope qhab nia (VIS) , thiab cov qhab nia inotropic (IS) [14]. Peb tau suav cov qhab nia AKI Thakar li al. Tom qab ntawd, cov qhab nia no tau kwv yees thiab hloov kho rau hauv peb cov kev ntsuas ntau yam sib txawv. Daim ntawv teev npe ntawm cov khoom sib txawv thiab cov pej xeem sib txawv thiab cov naj npawb ntawm qhov tseem ceeb uas ploj lawm yog qhia hauv Cov Khoom Siv Ntxiv.
3. Kev soj ntsuam ntawm cov kab mob siab
Venous ntshav ntws nyob rau hauv cov kab mob hepatic tam sim ntawd ua ntej influx mus rau inferior caval vein yog siv rau kev tsom xam. Ib qho tseem ceeb txoj cai inferior hepatic vein ntxiv rau txoj cai hepatic leeg nyob rau hauv 30-61 feem pua ntawm cov neeg mob. Sab laug thiab nruab nrab cov hlab ntsha hauv siab koom ua ib leeg leeg ua ntej nkag mus rau qhov tsis zoo vena cava (IVC) hauv 60-86 feem pua ntawm cov neeg [15,16]. Cov kab mob hepatic vein waveform, txawm hais tias feem ntau tau piav qhia tias yog triphasic, muaj plaub yam: retrograde A nthwv dej, antegrade S nthwv dej, kev hloov pauv nthwv dej (uas yuav yog antegrade, retrograde, lossis nruab nrab), thiab antegrade D yoj (17] . Peb tau sau cov qauv plaub yoj '(A, S, V, D) maximal tshaj tawm thiab tshaj tawm-lub sij hawm integralVTl) (18 19). Qhov sib piv ntawm qhov siab tshaj plaws rau retrograde piv rau anterograde tshaj tawm thiab qhov piv ntawm retrograde VTI piv rau anterograde VTls raug xam (20 21].
Kev tshawb nrhiav echocardiographic tau ua los ntawm ob tus kws kho plawv. Standard 2D tsis yog ejection feem, tricuspidal annular dav hlau systolic excursion, lub diameters ntawm atria thiab ventricles, thiab qhov tshwm sim ntawm valve insufficiency. Cov kev kuaj mob ultrasound tau ua los ntawm cov kws kho plawv uas muaj ntawv pov thawj hauv echocardiography thiab tau sau tseg rau ntawm tib lub tshuab thiab tshuaj xyuas los ntawm tib tus neeg tom qab kawm tiav. Cov kws kho mob nyob rau lub sijhawm postoperative tau dig muag rau cov txiaj ntsig ntawm kev ntsuas siab ntawm lub siab.
Cistanche ntxiv
4. Cov txiaj ntsig
Peb qhov txiaj ntsig tseem ceeb yog tom qab kev ua haujlwm AKI, txhais tau tias yog qhov feem pua ntawm kev hloov pauv ntawm qhov siab tshaj plaws tom qab kev ua haujlwm creatinine los ntawm lub hauv paus ua ntej kev ua haujlwm siab (% ∆Cr) thawj peb hnub tom qab phais. Lub hauv paus creatinine tau txhais tau tias yog qib creatinine ua ntej ntsuas tom qab kuaj xyuas hauv tsev kho mob tab sis ua ntej kev phais. Lub ncov feem ntau hloov pauv tau siv los ua tus cim ntawm lub raum pom kev puas tsuaj [22,23]. Qhov txiaj ntsig thib ob yog AKI, txhais los ntawm KDIGO (Kidney Disease Improving Global Outcomes) cov qauv [24,25].
5. Kev suav fais fab
Peb lub zog tsom xam tau qhia tias nrog 8 tus neeg muaj peev xwm kwv yees qhov mob raum raug mob, yam tsawg kawg ntawm 90 tus neeg mob yuav tsum tau ua tus qauv kev kwv yees nrog tus qauv tsim nyog thiab tsis txhob ua ntau dhau.
6. Kev Tshawb Fawb Txog Kev Tshawb Fawb
Kev sim tau zoo nrog Kolmogorov-Smirnov xeem. Skewed distributions yog piav raws li qhov nruab nrab thiab interquartile ranges (interquartile range 25–75) thiab tau muab piv nrog kev xeem Mann–Whitney U. Kev piav qhia cov txheeb cais rau cov ntshav creatinine ntau npaum li cas kwv yees GFR raws li qhov sib npaug, nrog rau KDIGO-raws li AKI cov ntsiab lus, yog muab rau ob qho tib si hauv paus (preoperative) thiab cov kev ntsuas siab tshaj tom qab. Cov kev hloov pauv tsis tu ncua tau nthuav dav thawj zaug nrog kev txwv cubic splines (kom tso cai rau qhov muaj feem cuam tshuam tsis zoo) thiab tsuas yog siv rau hauv daim ntawv linear yog tias qhov sib txawv ntawm linearity tsis tseem ceeb raws li qhia los ntawm kev xeem F thoob ntiaj teb (p > 0.05 ). Peb cov kev txheeb xyuas tau qhia tias AVmax, A VTI, thiab Antero / reroVTI yog cov tsis sib xws, thiab yog li ntawd, cov kev hloov pauv no tau hloov pauv ua ntej nkag mus rau ntau qhov sib txawv ntawm kev txheeb xyuas. Cov txiaj ntsig ntawm cov kab mob siab rau ntawm qhov siab tshaj plaws creatinine fractional hloov (feem pua ∆Cr) tau soj ntsuam los ntawm kev tshuaj xyuas ntau qhov sib txawv ntawm cov kab rov tav thiab hloov kho rau tus neeg mob- thiab cov yam ntxwv ntawm kev phais uas suav nrog kev hloov kho rau qhov sib txawv ntawm qhov tseem ceeb [26]. Cov kev hloov pauv hauv qab no tau raug txiav txim siab, suav nrog hnub nyoog, lub raum ua haujlwm, EuroSCORE II thiab AKI qhov kev twv twv txiaj los ntawm Thakar li al. [23], lub sijhawm ua haujlwm, cov kua dej sib npaug, thiab qhov siab tshaj plaws vasopressor-inotropic qhab nia hauv thawj 72 teev tom qab phais. Cov kev xaiv sib txawv tau ua raws li cov kev tshawb fawb tau tshaj tawm yav dhau los nrog kev tsom mus rau AKI tom qab kev phais plawv. Tus qauv multivariable tau sim rau multicollinearity (los ntawm qhov ntim nce nqi) ntawm cov tshuaj kho mob sib txawv. Cov kev hloov pauv hauv R2 tau tshaj tawm tom qab txhua kauj ruam ntawm tus qauv regression los txiav txim qhov kev koom tes ntawm txhua qhov sib txawv ntxiv uas tau ntxiv rau tus qauv regression.
Kev ntsuam xyuas txheeb cais tau {{0}}sab, thiab p < 0.05 tau suav tias yog qhov tseem ceeb. Kev txheeb xyuas txheeb cais tau ua nrog SPSS software, Version 27.0 (IBM, Armonk, NY, USA).
Cistanche tubulosa
Kev sib tham
Hauv cov neeg mob uas tau phais mob plawv, peb pom muaj kev sib raug zoo ntawm qhov sib piv ntawm retrograde nthwv dej piv rau anterograde hepatic venous waves thiab postoperative AKI. Kev sib raug zoo ntawm retrograde A nthwv dej thiab qhov retrograde rau anterograde piv nrog AKI tseem ceeb heev tom qab hloov kho rau tus neeg mob- thiab cov yam ntxwv ntawm tus txheej txheem. VTI, tab sis tsis yog qhov siab tshaj plaws ntawm qhov retrograde thiab anterograde nthwv dej, pom muaj kev sib raug zoo nrog AKI.
Echocardiography yog ib qho kev siv dav thiab lees txais cov txheej txheem hauv kev tswj xyuas perioperative ntawm cov neeg mob kev phais mob plawv [27,28]. Tsis ntev los no, ob peb lub ntsiab lus ntawm kev saib xyuas ultrasound (POCUS) [29] tau raug txheeb xyuas tias yog cov cim muaj peev xwm txhawm rau txheeb xyuas cov kab mob venous thiab kua dej ntau dhau [30]. Cov qauv ntws ntawm caval, kab mob siab, thiab lub raum cov hlab ntsha tau kawm txog qhov no, thiab lub plawv dhia lossis qhov siab tshaj plaws ntawm cov retrograde thiab anterograde nthwv dej yog txuam nrog qhov mob ntawm lub plawv tsis ua hauj lwm tom qab phais plawv [31,32]. Kev kho mob muaj txiaj ntsig zoo ntawm POCUS hauv kev kuaj pom cov kab mob venous tseem ceeb tuaj yeem ua kom muaj zog los ntawm kev ntsuas qhov ntsuas tsis nyob hauv lub raum thiab cov hlab ntsha siab thiab los ntawm kev sib piv ntawm cov kab mob siab thiab lub raum ntawm qhov ntsuas qhov tseeb [30]. Peb tau xav tias tus qauv kab mob siab kab mob siab tuaj yeem siv los kwv yees lub plab venous insufficiency, uas tuaj yeem ua rau txo qis transanal perfusion gradients thiab mob plab plab. Tsis tas li ntawd, VTI ntawm retrograde yoj tau cuam tshuam nrog cov qib bilirubin ntau dua, qhia tias muaj kev cuam tshuam ntawm lub siab excretory.
Qhov hnyav ntawm cov kab mob hepatic venous congestion tau pom tias yog tus kwv yees ntawm AKI hauv kev tshawb fawb yav tom ntej ntawm cov neeg mob phais plawv [30,33,34]. Ntau yam kev tshawb fawb tau ntsuas qhov siab tshaj plaws ntawm S thiab D nthwv dej thiab qhov hnyav ntawm venous congestion los ntawm S thiab D nthwv dej piv ua ntej, thaum muaj kev saib xyuas hnyav, thiab tom qab tso tawm [32,35]. Lawv kuj pom muaj kev koom tes tseem ceeb ntawm AKI thiab qhov kev ua haujlwm siab tshaj plaws ntawm S nthwv dej. Hauv qhov sib piv, peb ntsuas ob qhov siab tshaj plaws thiab VTI ntawm lub siab nthwv dej thiab pom tias VTI, thiab lawv cov derivates, tau cuam tshuam nrog kev nce siab tom qab ntawm creatinine thiab AKI thaum qhov siab tshaj plaws tsis yog. Raws li peb cov txiaj ntsig, peb pom tias qhov loj ntawm cov nthwv dej retrograde nyob rau hauv hepatic venous ncig tsis yog los ntawm qhov hnyav ntawm lub plawv tsis ua haujlwm. Ntawm cov kev txwv no (tricuspid regurgitation, TAPSE, lossis txoj cai ventricular diameters) tsuas yog thaj tsam atrial systolic txoj cai tau pom muaj kev koom tes nrog cov nthwv dej ntawm lub siab.
Qhov kev sib txuas ntawm cov kab mob plawv thiab lub siab tau hais txog [36,37]. Kev ua haujlwm ntawm lub plawv tsis ua haujlwm ua rau hypoperfusion thiab stasis hauv daim siab, thiab nws ua rau muaj kev ua haujlwm tsis zoo [15,38]. Kev suav ntawm MELD thiab lawv cov kev hloov kho [12] tau cuam tshuam nrog kev tuag thiab kev mob tshwm sim hauv lub plawv tsis ua haujlwm kawg thiab cov neeg mob tom qab hloov lub plawv [2]. Hauv peb cov neeg kawm, tsis muaj qhov sib txawv ntawm MELD cov qhab nia hauv AKI thiab cov neeg mob uas tsis yog-AKI, tab sis kev sib koom ua ke ntawm bilirubin thiab retrograde A nthwv dej ua rau muaj kev cuam tshuam rau cov kab mob siab hauv cov dej ntau dhau thiab kev tswj hwm tshuaj vasoactive [39]. Hauv cov neeg mob uas muaj univentricular physiology (Fontane circulation), thaum ntxov weaning los ntawm cov neeg kho tshuab qhov cua, thiab rov qab los ntawm kev ua tsis taus pa yog ib qho tseem ceeb heev vim hais tias tsis zoo thoracic siab yuav ua rau kom venous rov qab, nce preload, thiab tswj lub plawv tawm [40]. Qhov xwm txheej zoo sib xws: cov kev ntxhov siab tsis zoo (piv txwv li, extubation thaum ntxov) tuaj yeem pab txo qis tom qab ntawm daim siab, thaum cov kua dej ntau dhau, kev ua pa ntev ntev, thiab kev tsim cov edema yuav ua rau cov venous congestion. Kev rov zoo thaum ntxov tom qab kev phais plawv tuaj yeem txhawb nqa los ntawm kev tswj xyuas cov kua dej kom zoo, thiab kev kuaj pom ua ntej ntawm venous congestion lossis venous plab tsis txaus nrog kev kho kom txaus tuaj yeem kho tau zoo hauv feem ntau ntawm cov neeg mob.
Mob raum raug mob yog txuam nrog siab morbidity thiab tuag tom qab phais plawv. Peb xaiv AKI thiab nce qib creatinine raws li cov txiaj ntsig tseem ceeb ntawm peb txoj kev kawm [1,30,41]. Nyob rau hauv cov qauv sib txawv, peb kuj tau kho cov retrograde waveforms rau EuroSCORE II, GFR, thiab operative yam tseem ceeb, thiab nws tseem tseem ceeb, tab sis qhov tshwm sim ntawm AKI kuj tsawg nyob rau hauv peb cov neeg kawm. Yog li ntawd, peb tau tsom mus rau tom qab kev ua haujlwm creatinine nce siab (txawm tias tsis ncav cuag KDIGO cov qauv), uas tau ua rau muaj txiaj ntsig zoo hauv kev sib koom ua ke ntawm creatinine nce thiab cov cim qhia ntawm venous congestion. Peb cov txiaj ntsig tau qhia tias qhov hnyav ntawm cov hlab ntshav yuav tsum tau soj ntsuam ua ntej, tab sis nws kuj tau qhia kom ua raws li lub sijhawm tom qab phais.
Peb txoj kev kawm muaj kev txwv. Ua ntej, nws yog ib qho kev kawm hauv ib qho chaw. Hauv kev npaj ntawm txoj kev tshawb no, peb tsis tau xav txog kev txuas ntxiv mus rau lub sijhawm tom qab phais. Ob peb yam tseem ceeb ntawm kev ua haujlwm, xws li cov kua dej zoo, kev siv vasopressor, lossis kev teeb tsa zoo ntawm cov tshuab ua pa, tuaj yeem cuam tshuam rau anterograde / retrograde ratios. Yog li ntawd, preoperative lub hauv paus dluab ntawm lub hepatic veins yuav tsum tau muab nyob rau hauv spontaneously ua pa cov neeg mob. Feem ntau, qhov anterograde / retrograde piv, uas tsis suav nrog kev tsis ncaj ncees los ntawm qhov sib txawv ntawm Doppler nthwv dej ntawm cov hlab ntsha hauv siab, yuav yog qhov kev pom zoo.
Cistanche capsules
Cov lus xaus
Peb tuaj yeem txiav txim siab tias congestion thiab / lossis mob plab venous insufficiency hauv daim siab tuaj yeem kwv yees lub raum ua haujlwm tsis zoo. Abdominal ultrasound yog ib qho yooj yim muaj thiab, qhov tseem ceeb tshaj plaws, cov cuab yeej tsis muaj kab mob uas yuav tsum tau siv los txheeb xyuas cov tsos mob ntawm plab venous congestion. Kev soj ntsuam cov kab mob siab tuaj yeem ua tau yooj yim, thiab ua ke nrog tus qauv ua ntej ua haujlwm echocardiography, nws tuaj yeem nthuav tawm cov ntaub ntawv ntxiv txog lub siab thiab lub raum tshaj li qhov ntsuas qhov ntsuas. Nws kuj tau qhia kom muaj nuj nqis qhia peb cov kev ntsuas thiab tsis yog nrog cov qauv ntws xwb.
Cov ntaub ntawv
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Csaba Eke 1 , András Szabó 1 , Ádám Nagy 1 , Boglár Párkányi 2 , Miklós D. Kertai 3 , Levente Fazekas 4 , Attila Kovács 4 , Bálint Lakatos 4 , Jánszálán 4 Harty ly 4 thiab Andrea Székely 5,
1 Károly Rácz Tsev Kawm Ntawv ntawm PhD Studies, Semmelweis University, 1085 Budapest, Hungary; 25csabaeke@gmail.com (CE); andraas.szaboo@gmail.com (AS); nagyadam05@gmail.com (A.N.)
2 Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary; parkanyib@gmail.com
3 Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37212, USA; miklos.kertai@vumc.org
4 Lub plawv thiab Vascular Center, Semmelweis University, 1085 Budapest, Hungary; drfalev@gmail.com (LF); kovacs.attila@med.semmelweis-univ.hu (AK); lakatos.balint@med.semmelweis-univ.hu (BL); hartyanszky.istvan@gmail.com (IH); merkely.bela@med.semmelweis-univ.hu (BM)
5 Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary; gal.janos@med.semmelweis-univ.hu
