［Abstract］Objective： To describe the left ventricular function of uremia patients with longterm peritoneal dialysis by application of myocardial layerspecific strain analysis and myocardial work techniques, and to evaluate the changes of myocardial function under longterm peritoneal dialysis. Methods： A total of 14 patients with uremia who underwent peritoneal dialysis regularly and whose left ventricular ejection fraction (LVEF) was normal by routine echocardiography were enrolled in the study. Routine two-dimensional echocardiographic parameters were measured. Left ventricular global longitudinal peak systolic strain (GLS) and the longitudinal peak systolic strain (LS) of the endocardium (LSendo), myocardium (LSmyo) and epicardium (LSepi) were measured by twodimensional speckle tracking imaging (2DSTI) and myocardial layerspecific strain analysis. Combined with blood pressure, the overall work parameters of the left ventricular myocardium were obtained to jointly evaluate the myocardial function of the left ventricle. The patients were followed up for 5 years and compared before and after 5 years of peritoneal dialysis. Results： After 5 years of regular peritoneal dialysis, there was no statistical difference in the change of LVEF in uremia patients, GLS significantly decreased in the four-chamber plane of the heart (P=0.018), and decreased from endocardium to epicardium (LSendoP=0.029, LSmyoP=0.017, LSepiP=0.004); global work parameters were mainly increased in global wasted work (GWW, P=0.048), but there were no significant differences in global constructive work (GCW), global work index (GWI) and global work efficiency (GWE). Conclusion： In uremia patients with longterm regular peritoneal dialysis for 5 years, the overall myocardial function of the left ventricle remained stable, but the local myocardial systolic function was further impaired, mainly evidenced by decrease of the myocardium of the posterior septum and lateral wall, and the myocardial work was dominated by elevated GWW.

［Abstract］Objective： To investigate the accuracy of noninvasive blood pressure measurement and the impact on clinical decisionmaking in critically ill patients. Methods： Using a prospective observational study, a total of 133 critically ill patients with established invasive blood pressure monitoring in the ICU of Nanjing Drum tower Hospital from March to December 2021 were included. Non-invasive and invasive blood pressure were measured and recorded simultaneously within 1 h after admission. The patients were divided into shock group with vasoactive drugs and non-shock group without vasoactive drugs. Spearman, Bland-Altman correlation analysis and interclass correlation coefficient (ICC) were applied to verify the consistency of the two monitoring methods, and the error grid method was used to analyze the effect of noninvasive blood pressure on guiding clinical decision-making. Results： ① Spearman correlation results showed that in nonshock patients, there were significant positive correlation between invasive and the non-invasive blood pressure (r of SBP, DBP, MAP were 0.69, 0.72, 0.70, all P<0.001). In shock patients, there was a significant positive correlation between SBPinvasive-SBPnoninvasive (r=0.34, P<0.05), while DBPinvasive-DBPnoninvasive, MAPinvasiveMAPnoninvasive without significant correlation (both P>0.05). ② Simple linear regression analysis revealed that in non-shock patients, there was a significant positive correlation between invasive and non-invasive blood pressure (R2 of SBP, DBP, MAP were 0.56, 0.58, 0.43, all P<0.05). In shock patients, invasive and noninvasive SBP and MAP were significantly positively correlated (R2 of SBP, MAP were 0.20, 0.10, P<005). DBPinvasive and DBPnoninvasive linear regression equation was not statistically significant (P>0.05). ③ The Bland-Altman analysis results showed that patients in the non-shock and shock groups, the proportion of data points between invasive and noninvasive blood pressure in the mean difference interval ±10 mmHg did not meet the non-invasive blood pressure measurement criteria of AAMI. Poor consistency (SBPinvasive-SBPnoninvasive, DBPinvasive-DBPnoninvasive, MAPinvasive-MAPnoninvasive data points in the average difference range of 10 mmHg: 63%, 73% and 76% of patients in non-shock group, and 35%, 50% and 52% in the shock group, respectively, all P<0.05). ④ The ICCs showed that in nonshock group patients, there was a significant positive correlation between SBPinvasive and SBPnoninvasive (the absolute consistency was 0.76＞0.75, P<0.001). In shock group patients, there were bad consistency coefficients between SBPinvasive and SBPnoninvasive, MAPinvasive and MAPnoninvasive (the absolute consistencies were 0.33, 0.31<0.4, both P<0.001), and the noncorrelation between DBPinvasive and DBPnoninvasive (P>0.05). ⑤ Error grid analysis results showed that in the shock group patients, the proportions of SBP measurements in the A to E hazard areas were 88.7%, 6.5%, 4.8%, 0%, and 0%. The proportions of the MAP measurements were 61.3%, 38.7%, 0%, 0%, and 0%. In the nonshock group .atients, the proportions of SBP measurements in the A to E hazard zone were 95.8%, 4.2%, 0%, 0%, and 0%. The proportions of MAP measurements were 97.2%, 1.4%, 1.4%, 0%, and 0%. ⑥ The multivariate Logistic regression showed that shock was a risk factor for the difference between non-invasive and invasive SBP, DBP and MAP greater than 10 mmHg (P<0.05), age was a risk factor for the difference between noninvasive and invasive SBP and MAP greater than 10 mmHg (P<0.05); heart rate was a risk factor for the difference between non-invasive and invasive SBP greater than 10 mmHg (P<0.05), and was a protective factor for the difference between noninvasive and invasive DBP and MAP greater than 10 mmHg (P<0.05). Conclusion： For critically ill patients with nonshock, the accuracy of non-invasive blood pressure measurement is better, and is more reliable to guide clinical decisionmaking with non-invasive MAP. It should be cautious when using non-invasive blood pressure instead of invasive blood pressure measurement in critically ill patients with shock.

脓毒症作为全球关注的公共卫生问题，是重症监护病房(intensive care unit,ICU)患者死亡的主要原因之一，进一步发展可致脓毒性休克，住院死亡率达40.4%。血管活性药物的早期、正确、合理使用，在一定程度上可以显著降低脓毒症或脓毒性休克的死亡率。脓毒症血管活性药物主要包括去甲肾上腺素、血管加压素、肾上腺素、多巴酚丁胺、多巴胺和去氧肾上腺素等。在脓毒症血管活性药物选择上，首选去甲肾上腺素，对于去甲肾上腺素及相关剂量难以有效的患者，可加用血管加压素或肾上腺素；对于心动过缓患者可考虑使用多巴胺。早期单独使用适量的去甲肾上腺素，或联用适量的血管加压素、肾上腺素、多巴酚丁胺，可有效地逆转顽固性低血压，从而恢复组织器官的有效灌注，同时需强调时机与剂量的重要性。此外，根据病情变化的不同阶段，选择适合患者病情的液体复苏，适时调整血管活性药物的类型和剂量，使受损器官及系统功能逐渐改善，患者平稳度过危险阶段。本文针对脓毒症血管活性药物的选择作一简要综述。

脓毒症是一种威胁生命的急性综合征，也是重症监护室患者死亡的主要原因。肝脏维持着人体代谢和免疫平衡，脓毒症时发生的肝损伤往往预示着不良预后和住院死亡率升高。近年来大量研究表明炎症级联反应、细胞焦亡、氧化应激、自噬、miRNA等因素在脓毒症肝损伤的发生过程中起着重要作用。本文综述了近年来脓毒症诱发肝损伤的发病机制，以期为寻找有效治疗靶点提供新思路。