ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb05063.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Trauma often includes considerable losses of blood and plasma that may lead to hypovolemia and shock. The initial response of the body to trauma and hemorrhage is characterized by a neuroendocrine‐mediated general defence reaction for the maintenance of circulatory homeostasis and substrate availability for vital organ function. Endogenous fluid is mobilized from intracellular and interstitial sources into the vascular compartment. This transcapillary refill is achieved by activation of glucoseosmotic and neurogenic adaptive vascular mechanisms. The metabolic consequences of insufficient tissue perfusion are anaerobic glycolysis with increased production of lactate and hydrogen ions, acidosis, impaired mitochondrial energy production, disturbed ionic homeostatis across cell membranes, and reduced functional capacity of tissue cells. The shock‐and trauma‐induced alterations in tissue perfusion and metabolism vary, depending on the autoregulatory capacity of an organ, its basal metabolic requirements, its high energy phosphagen reserves, and its ongoing functional activity. Metabolic alterations impairing organ function occur early in the kidney and the liver and late in the heart and the brain. The ischemic tolerance of the skeletal muscle cell is considerable but vast amounts of lactic acid are produced, which at reperfusion will reach central blood and disturb vital organ function. Tissue factors released from mechanically traumatized or hypoxic cells will activate cascade systems and may induce alterations in remote organs, i.e. result in the development of multiorgan fa

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb05064.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The reported incidence of perioperative hypertension associated with coronary artery bypass–graft (CABG) surgery ranges from 30–80%, which may reflect the various definitions of the condition as well as differences in the patients' preoperative states. Systolic, diastolic and mean arterial blood pressures are variously used to define perioperative hypertension, but absolute values range from a target systolic blood pressure of below 170 mmHg in some studies to below 110 mmHg in others. Patients' preoperative states have been extensively studied to determine potential risk factors. The majority of these studies indicate that perioperative hypertension is predictive of perioperative cardiac morbidity, but others do not confirm this finding, rendering the issue unresolved. The consequences of perioperative hypertensive episodes include bleeding from vascular suture lines, cerebrovascular haemorrhage or subendocardial ischaemia, and are associated with a mortality rate that may approach 50%. Increases in peripheral vascular resistance (PVR), caused by elevated levels of circulating catecholamines, appear to be the primary aetiology. Antihypertensive agents which correct or prevent the increase in PVR would appear to be the most appropriate therapy. However, no single agent appears to be ideal for all hypertensive episodes, suggesting multiple potential aetiolog

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03816.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03615.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Trauma and sepsis activate different cascade systems. Activation of the coagulation and clotting systems, of the kinin‐kallekrein system and of the complement system are important etiological mechanisms behind development of the adult respiratory distress syndrome (ARDS) and multisystem organ failure (MOF) after extensive trauma or severe septic situations. Activation of complement with the release of anaphylatoxins and terminal complement complexes is associated with increased mortality and development of ARDS and MOF after major surgery and in situations of septic shock. The anaphylatoxins have potent vascular properties and they activate leukocytes. Their effects on the leukocytes lead to the release of free oxygen radicals, different lysosomal enzymes and cytokines, leukotrienes and histamine. All these inflammatory mediators may, if released in extensive amounts, induce microvascular injury and interstitial edema. If this process takes place in the lung, ARDS may develop and if other organs, i.e the liver and the kidneys, are involved, MOF may be the resul

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb05065.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03616.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Hypertension causes a number of alterations of the coronary circulation which may influence the outcome of anaesthesia and surgery. These include changes in the architecture of the coronary vasculature, and impairments in coronary reserve and autoregulatory ability of the coronary microvasculature during decreases in perfusion pressure. Chronic hypertension may also alter endothelial regulation of vascular control. Many of the vasodilators used to treat hypertension may have unique effects on the coronary circulation which may become modified by chronic hypertension and cardiac hypertrophy. In this review, each of these areas are considered together with some unique aspects of endothelial/vascular smooth muscle interactions as they relate to acute and chronic hypertension, and to the pharmacological agents used in the treatment of hypertension.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03817.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb05066.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03617.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb05067.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY