甲状腺切除手术中应用钳式超声刀和传统电刀的效果比较

目的比较甲状腺切除手术中应用钳式超声刀和传统电刀的效果。方法前瞻性收集笔者所在医院于2016年2月至2017年1月期间收治的160例接受开放性甲状腺手术患者的临床资料,随机分为钳式电刀组和传统电刀组,各80例。比较2组患者的手术效果指标、术后并发症发生情况和术后切口数字疼痛分级法(NRS)评分。结果在手术效果指标方面,钳式超声刀组患者的手术时间、术中出血量、术后引流量、术后引流时间、手术切口长度和住院时间均短于或低于传统电刀组,差异均有统计学意义(P0.05);在术后并发症方面,钳式超声刀组患者的声音嘶哑、伤口出血和甲状旁腺功能减退发生率,以及总并发症发生率均低于传统电刀组(P0.05),但2组患者的低钙血症、伤口感染和暂时性喉返神经麻痹发生率比较差异均无统计学意义(P0.05);在术后切口NRS评分方面,重复测量资料的方差分析结果表明,各时点钳式超声刀组患者的NRS评分均低于传统电刀组(P0.05)。结论开放性甲状腺手术中使用钳式超声刀可有效提高手术效果,减轻术后的疼痛,降低并发症的发生率。     

超声刀无缝扎技术在开放性甲状腺手术中的应用

目的：探讨超声刀无缝扎技术在开放性甲状腺手术中的应用价值。 方法：回顾性分析2012年10月—2013年6月148例接受甲状腺手术临床资料,其中78例术中采用超声刀无缝扎技术（超声刀组）,70例术中采用高频电刀结合传统缝扎止血等技术（传统组）。分别比较两组手术时间、术中出血量及并发症的发生率。 结果：两组患者在手术方式、疾病构成方面差异无统计学意义（P>0.05）;与传统组相同手术方式比较,超声刀组中手术时间、术中出血量明显减少（均P<0.05）。两组患者均无术后出血、术后喉返神经麻痹、永久性甲状旁腺功能低下发生;术后暂时性甲状旁腺功能低下超声刀组1例（1.3%）,传统组2例（2.9%）,两组术后总并发症发生率差异无统计学意义（P>0.05）。 结论：开放性甲状腺手术中应用超声刀无缝扎技术能缩短手术时间和减少术中出血量,且不增加术后并发症的发生,具有较好的临床应用价值。     

超声刀用于开放性甲状腺手术的临床研究

目的探讨超声刀在开放性甲状腺手术中应用的安全性和有效性。方法收集我院普外科2005年8月至2006年7月用超声刀行开放性甲状腺切除术326例,选取同期传统手术312例作为对照。比较两组手术时间、切口长度、术后引流量和并发症等指标。结果超声刀组单侧甲状腺叶切除和次全切/全切手术时间分别为(41±13.0)min和(55±16.6)min,传统组为(65±21.7)min和(84±19.4)min,超声刀组平均缩短约27min(P<0.01)。切口长度超声刀组平均4.2cm,比传统组减少2.7cm(P<0.01)。术后引流量差异无统计学意义(P>0.05)。超声刀组有2例发生暂时性喉返神经麻痹,1例低钙性抽搐,传统组有1例喉返神经麻痹,两组差异无统计学意义。未出现其他术中和术后并发症。结论应用超声刀行开放性甲状腺切除术安全可行,可以明显缩短手术时间,减小切口。     

超声刀行开放性甲状腺手术与传统手术的对比分析

回顾性分析2009年10月-2011年10月用超声刀行开放性甲状腺手术96例（超声刀组）与同期传统手术87例（传统组）患者的临床资料,比较2组切口长度、手术时间、术中出血量、术后引流量及术后并发症情况.超声刀组的手术时间、术中出血量、切口长度、术后引流量均显著少于传统组（P＜0.01）,2组术后并发症差异无统计学意义（P＞0.05）.超声刀在开放性甲状腺手术中能显著缩短切口长度及手术时间、减少术中出血量及术后引流量,且不增加并发症,值得推广.     

双极电凝镊在开放性甲状腺手术中的临床应用

目的探讨双极电凝镊在开放甲状腺手术中应用的安全性和可行性,并总结相应的手术技巧。方法对南京大学医学院附属鼓楼医院2011年10月至2014年10月期间347例分别应用双极电凝镊和超声刀开展的开放性甲状腺手术患者的临床资料进行回顾性分析。结果 2组病例在手术时间、术中出血量、术后引流量和术后住院时间上的差异均无统计学意义(P0.05);并发症方面,超声刀组的暂时性喉返神经麻痹及暂时性的甲状旁腺功能不足的发生率明显高于双极电凝镊组(P0.05),而在气道压迫、永久性喉返神经和甲状旁腺损伤及喉上神经麻痹发生率方面2组间的差异无统计学意义(P0.05)。结论用双极电凝镊行开放甲状腺手术是安全可行的,紧贴甲状腺被膜边凝边切并配合清楚直视下的精细分离是减少并发症的关键。     

超声刀在开放性甲状腺手术中应用的前瞻性研究

目的：探讨超声刀在开放性甲状腺手术中应用的有效性及安全性。 方法：采用前瞻性随机对照方法,将2010年2月—2012年5月210例患者分为超声刀组与电刀组,各105例,分别采用超声刀与传统电刀手术方法行开放性甲状腺切除术,手术均由普外科甲状腺手术经验丰富同一手术团队完成。比较两组在不同手术方式中手术时间、术中出血量、术后引流量、术后并发症等指标。 结果：两组患者年龄、性别、肿块大小及疾病构成比差异无统计学意义（均P>0.05）。在相同的手术方式中,超声刀组手术时间手术、术中出血量及术后引流量（减少10~40 mL）均较传统结扎结合电刀组明显减少,组间差异均有统计学意义（P<0.05）;两组间术后并发症的差异无统计学意义（P>0.05）。 结论：超声刀集切割、止血于一体,简化手术操作过程;在开放性甲状腺手术中应用超声刀,可缩短手术时间,减少出血。     

超声刀FOCUS在开放甲状腺手术中的应用

目的比较超声刀FOCUS与传统手术方法在开放甲状腺手术中应用的特点。方法收集我科自2010年7月至2011年12月接受开放甲状腺手术的患者共计126例,随机分为两组,超声刀组66例,使用超声刀FOCUS进行手术;传统手术组60例,采用高频电刀结合缝扎止血。两组均由同一手术组医生进行手术。分别比较两组的手术时间、术中出血量、术后引流量、切口大小、住院时间和手术并发症发生率(喉返神经损伤、喉上神经损伤、甲状旁腺功能低下)。结果超声刀组在手术时间、术中出血量、术后引流量、切口大小、住院时间方面均短于或少于传统手术组,差异有统计学意义(P<0.05)。两组中均有1例甲状旁腺损伤,而喉上神经损伤、喉返神经损伤各1例仅见于传统手术组。两组间的手术并发症发生率差异无统计学意义(P>0.05)。结论使用超声刀行开放甲状腺手术要优于传统手术方法,可尽量兼顾美容的优点,符合现代微创外科理念,值得应用和推广。     

超声刀结合保留背膜解剖法在甲状腺切除术中的应用

目的:探讨超声刀结合保留背膜解剖法在甲状腺腺叶全切除手术中的操作技巧,及对喉返神经与甲状旁腺的保护效果。方法:对2009年2月至2012年3月144例甲状腺腺叶切除术均采用保留背膜解剖法,其中超声刀应用组72例与传统组72例的临床资料进行回顾性分析,通过手术时间、术中出血量、术后引流量、术后并发症等临床资料进行统计学分析。结果:应用超声刀结合保留背膜解剖法在甲状腺切除术中最大限度地原位保留了甲状旁腺,实现其功能的保留,喉返神经显露率达99%。同时超声刀的应用对术中出血量、手术时间均优于传统手术组,对术后并发症增加无统计学差异。结论:超声刀结合保留背膜解剖法在甲状腺腺叶全切除术中的应用能最大限度保留甲状旁腺功能,降低喉返神经、甲状旁腺损伤率;同时减少了出血量,缩短了手术时间。     

腔镜辅助下巨大甲状腺肿物手术中喉返神经监测的临床效果分析

目的探讨喉返神经监测在腔镜辅助下巨大甲状腺肿物手术中的应用效果。方法回顾性分析2013年1月至2015年6月期间在腔镜辅助下治疗的158例巨大甲状腺肿物患者的临床资料,其中喉返神经监测79例(喉返神经监测组),喉返神经未监测79例(喉返神经未监测组)。对比分析2组在手术时间、术中出血量、术后引流量、术后住院时间、术后暂时性及永久性喉返神经损伤发生情况之间的差异。结果 158例患者均顺利完成腔镜辅助颈部小切口甲状腺手术。与喉返神经未监测组比较,喉返神经监测组的手术时间(min)明显缩短(76.2±23.4比89.2±29.8,P0.05),术中出血量(m L)和术后引流量(m L)均明显减少(术中出血量:16.3±13.6比20.6±10.7,P0.05;术后引流量:20.7±9.6比25.5±9.1,P0.05),但2组的术后住院时间(d)比较差异无统计学意义(3.2±1.3比3.3±1.9,P0.05)。术后随访8周,喉返神经监测组暂时性神经损伤发生率明显低于喉返神经未监测组〔5.6%(5/90)比21.8%(17/78),P0.05〕,但永久性神经损伤发生率在2组间比较差异无统计学意义〔0(0/90)比1.3%(1/78),P0.05〕。结论腔镜辅助巨大甲状腺结节手术中应用喉返神经监测技术可有效减少神经损伤发生率,缩短手术时间。     

微创钨针在开放性甲状腺手术中喉返神经和甲状旁腺保护的临床应用

目的比较微创钨针和高频电刀在开放性甲状腺手术中的临床应用效果。方法选取陆军军医大学大坪医院乳腺甲状腺外科2017年1月至2017年12月接受开放性甲状腺手术的95例为研究对象,根据方法不同将其分为微创钨针组(n=50)和高频电刀组(n=45),比较两组的手术时间、术中出血量、术后引流量、术后并发症发生率和复发转移率。结果微创钨针组和高频电刀组在手术时间[(79.3±14.7 vs 73.7±13.9)min,t=1.914,P=0.059]、术中出血量[(31.8±9.7 vs 30.3±10.6)ml,t=0.702,P=0.484]、术后引流量[(67.3±13.0 vs 71.3±10.8)ml,t=-1.650,P=0.102]比较差异无统计学意义(P>0.05)。微创钨针组暂时性喉返神经损伤(2%vs 17.8%,χ^2=5.518,P=0.023)和暂时性甲状旁腺功能低下(18%vs 44%,χ^2=7.810,P=0.005)发生率低于高频电刀组,差异有统计学意义(P<0.05)。两组均无永久性喉返神经损伤和甲状旁腺功能低下,随访期内无复发转移。结论微创钨针在开放性甲状腺手术中对喉返神经和甲状旁腺功能保护效果优于高频电刀,值得临床推广应用。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.