血液透析和腹膜透析患者生存质量的多中心调查

目的评估我国广东省南部血液透析(血透)和腹膜透析(腹透)患者生存质量的状况;比较血透和腹透患者生存质量差异;探讨影响血透和腹透患者生存质量的基本因素.方法采取多中心研究方法.病例选自广东省南部,而主要是广州市的9家大医院的维持性血透、腹透3个月以上的患者,其中血透180例,腹透122例.使用KDQOL-SFTM表进行问卷调查,根据Hays RD提供的方法进行评分.结果 (1)血透患者肾脏病和透析相关生存质量(KDTA)总分为51.2±10.6,SF-36总分为48.2±19.9;腹透患者KDTA总分为56.3±12.3,SF-36总分为47.8±16.8.血透多数领域评分较欧美日同类报道为低;腹透仅部分领域低于香港特别行政区,但总体评分与香港特别行政区同类报道无显著差异.(2)比较研究提示腹透总体评分高于血透,但进一步的分层研究提示血透与腹透的生存质量差异主要是在透析的前2年.(3)血透男性患者在KDTA和SF-36及其它5个领域优于血透女性患者;而腹透男女患者之间KDTA和SF-36总分无显著差异.无论男女,腹透患者在多个领域均优于同性别血透患者.(4)血透患者的青年组(＜45岁)与中年组(45～60岁)、老年组(＞60岁)相比,在KDTA和SF-36总体水平无显著差异,仅在体能相关领域高于中老年组.腹透患者青年组在KDTA和SF-36总分以及多个分支领域明显高于中老年组患者,同时,腹透患者在不同年龄组的多个领域优于同年龄段血透患者.(5)在生存质量的总体变化趋势方面,血透患者初始的生存质量较低,透析1～2年时的生存质量逐渐提高,2～4年处于高峰,以后开始下降;腹透患者生存质量的趋势KDTA比较平稳,但2年后SF-36呈明显下降趋势.(6)多元回归分析提示,对KDTA和SF-36总体生存质量的影响因素分别为透析方式、年龄、性别和透析时间.结论 (1)广东省南部,而主要是广州市的血透和腹透患者生存质量状况的总体水平仍低于西方国家和香港特别行政区.(2)慢性肾衰竭患者一体化治疗的前2年可首选腹透.(3)血透和腹透患者的KDTA和SF-36生存质量的趋势不同,腹透不仅适合老年患者,更适合年轻患者和女性患者.(4)透析方式、透析时间、性别和年龄影响透析患者的生存质量,但影响程度和领域各不相同.     

腹膜转运和营养状况在腹透充分性中的评价

持续不卧床腹膜透析(CAPD)患者普遍存在营养不良状态,本研究探讨腹膜转运特性对CAPD患者营养状况的影响,并分析两者在透析充分性判定中的地位。     

维持性血液透析与腹膜透析患者生活质量调查

目的 评估维持性血液透析(MHD)与持续非卧床腹膜透析(CAPD)患者生活质量情况,探讨MHD和CAPD患者生活质量的影响因素.方法 选取2016年7月～9月在郑州大学第一附属医院肾脏内科和血液净化中心随访的118例MHD患者和76例CAPD患者的临床和问卷调查资料.采用KDQOL-SFTM 1.3进行问卷分析,评估MHD与CAPD患者的生活质量.结果 MHD患者KDTA评分为(62.4±11.3)分,SF-36评分为(58.3±17.9)分,明显低于一般人群(P＜0.05).在各分维度评分中11个分维度评分略高于美国,6个分维度评分略高于西班牙;与国内广州调查数据相比,各维度评分均有明显改善,且与沈阳和合肥调查数据持平.CAPD患者KDTA评分为(71.4±8.9)分,SF-36评分为(61.6±16.3)分,明显低于一般人群(P＜0.05).在各分维度评分中7个分维度显著高于中国香港,其余均较中国香港偏低;与国内广州调查数据相比各维度评分均有明显改善,且与沈阳和合肥调查数据持平.MHD患者KDTA和SF-36整体评分显著低于CAPD患者(P＜0.05).在KDTA各分维度评分中,CAPD患者均高于MHD患者,且在肾脏疾病对日常生活的影响(EKD)、肾脏疾病导致的生活负担(BKD)、工作情况(WS)、认知功能(CF)、社交质量(QSI)、性功能(SexF)、社会支持(SoS)、患者满意度(PS)方面差异明显(P＜0.05);在SF-36评分中在生理职能(RP)、躯体疼痛(BP)、总体健康(GH)、情感状况(EWB)、情感职能(RE)各维度中,CAPD组患者均高于MHD患者且差异明显(P＜0.05).对于MHD患者,生活质量在性别、文化程度、家庭年收入、医保情况、原发病因、透析龄方面存在差异(P＜ 0.05),且在SGA评分、血白蛋白(ALB)、血红蛋白(HB)、尿素清除指数(Kt/V)、甲状旁腺激素(iPTH)、钙磷乘积(Ca×P)方面均存在相关性(P＜0.05).透析龄、性别(女)、原发病(糖尿病肾病)、iPTH、Kt/V、SGA评分是影响MHD患者生活质量的独立危险因素;对于CAPD患者,职业状况、医保情况、原发病因、透析龄方面存在差异(P＜0.05),且在SGA评分、ALB、HB、Kt/V方面存在相关性(P＜0.05),原发病(糖尿病肾病)、Kt/V、ALB、SGA评分是影响CAPD患者生活质量的独立危险因素.结论 MHD患者和CAPD患者整体生活质量较低,与发达国家和地区存在差距;CAPD和MHD患者生活质量均受不同因素影响,其中原发病(糖尿病肾病)、Kt/V、SGA评分是共同独立影响因素.     

中药艾灸改善腹膜透析患者营养不良的临床研究

目的：观察中药艾灸对高腹膜转运CAPD患者腹膜营养不良的影响.方法：高腹膜转运CAPD患者26例随机分为两组,治疗组（中药艾灸）与对照组各13例,观察治疗前后透析超滤量（UF）、C反应蛋白（hs-CRP）、白细胞介素6（IL-6）、血清白蛋白（Alb）、前白蛋白（Pre-A）及中医症状计分和改良定量主观整体评估法（MQSGA）评分的变化.结果：治疗组治疗后24 h总超滤量明显增加,hs-CRP、IL-6明显下降,Alb及Pre-A明显增加,中医症状计分和MQSGA评分增加,优于对照组（P〈0.05）.结论：中药艾灸可以有效提高透析超滤量,减轻高腹膜转运CAPD患者的微炎症状态,改善营养不良.     

69例腹膜透析患者生活质量分析

目的探讨本中心腹膜透析（PeritonealDialysis,PD）对慢性肾衰竭患者生活质量的影响,并初步分析影响PD患者生活质量的因素。方法肾内科腹膜透析患者69例,运用KDQOL-SFTMl．3（包括健康调查简表MedicalOutcomesStudyHealthStatusShortForm,SF-36和Kidneydiseasetargetarea,KDTA）生活质量量表调查,根据Hays方法进行评分。结果（1）男性PD患者与女性PD患者在KDTA和SF-36总分方面有显著性差异。（2）每天透析剂量6000ml以上PD患者与每天透析剂量在6000ml以下的PD患者在KDTA和SF-36总分方面有显著性差异。（3）PD患者的生活质量与透析时间的长短明显相关。（4）40岁以下患者在KDTA和SF-36的总分方面与4（J岁以上患者无明显差异（P〉0．05）。（5）透析费用支付方式对PD患者的生活质量影响明显,医疗保险的PD患者的生活质量评分在KDTA及SF-36总分方面明显高于新农合的PD患者。结论影响PD患者生活质量的因素除医学因素外,非医学因素亦占重要地位。     

透析充分性、微炎症和残存肾功能对血液透析患者营养状态的影响

目的探讨透析充分性、微炎症和残存肾功能对血液透析患者营养状态的影响。方法本院维持性血液透析患者114例入选。检测指标包括（1）整体营养状况：使用MQSGA评估表并测定血清胰岛素样生长因子（IGF）1、胰岛素样生长因子结合蛋白3（IGFBP-3）、Hb、Alb。（2）人体指数学测定。（3）血液透析充分性：测定血清iPTH、β2-MG、BUN并计算Kt／V、nPCR。（4）残存肾功能：测量患者24h尿量。（5）微炎症：测定血清CRP、IL-6、TNF-α。结果（1）Kt／V、iPTH、β2-MG分别与测量握力（HGS）、上臂中部肌肉周径（MAMC）、无骨上臂肌肉面积（AMA）、Alb、Hb、nPCR、IGF-1相结合，MQSGA呈不同程度的相关和回归关系。（2）残存尿量在血透第1年内，与HGS、肱三头肌皮褶（TSF）、MAMC、Alb、nPCR、IGF-1呈显著相关和回归关系。（3）IL-6、TNF-α、CRP分别与HGS、MAMC、AMA、Alb、TSF、Hb、nPCR、IGF-1呈不同程度的相关和回归关系。（4）影响血透患者营养状况的因素分别是Kt／V、iPTH、IL-6、TNF—α、β2-MG、残存尿量，其中Kt／V、iFFH、IL-6、TNF—α是独立影响因素。结论血液透析中小分子毒素的透析不充分，微炎症可能是患者营养不良的关键因素之一。残存肾功能可能在透析第1年内对营养状况有显著影响。在上述诸因素中。Kt／V、iPTH、IL-6、TNF-α是影响营养状态的独立因素。     

不同透析剂量对CAPD患者生存质量的影响

目的评估不同透析剂量对持续性非卧床腹膜透析（CAPD）患者生存质量的影响，以寻求更合理的符合中国人特点的腹膜透析剂量。方法将稳定的CAPD3个月的患者随机分为2组，即低剂量组（2L／次，3次／天）和常规剂量组（2L／次，4次／天）。每半年对两组患者进行生存质量、营养状态、炎症状态、残余肾功能、严重心血管事件发生率进行评估，持续2年，比较两组之间的差异，使用KDQOL-SFTM1．2生存质量表进行调查，根据Hays提供的方法进行评分，SPSS10．0软件包分析数据。结果①随着透析时间的延长，患者的生存质量评分逐渐增加；②低剂量组与常规剂量组患者的KDTA和SF-36总分无显著性差异，在KDTA的4个分支领域及SF-36的2个分支领域评分高于常规剂量组；③两组患者的营养状态、全身微炎症状态、高血压的控制、严重心血管事件的发生率无明显差别；④低剂量组残余肾功能优于常规剂量组。结论低透析剂量较常规透析剂量能更好的保护残余肾功能，值得推荐。     

持续性不卧床腹膜透析及肾移植者生活质量研究

目的 比较持续性不卧床腹膜透析与肾移植术对终末期肾病患者生存质量的影响.方法 选择2011年2月至2012年12月在昆明医科大学第一附属医院和昆明医科大学第二附属医院接受持续性不卧床腹膜透析或肾移植术3个月以上的105例终末期肾病患者,其中54例接受肾移植术[肾移植组,男35例,女19例,平均年龄(39±10)岁],51例接受持续性不卧床腹膜透析[腹膜透析组,男30例,女21例,平均年龄(41±10)岁],采用KDQOL-SFTM 1.2量表对其生存质量进行评估.采用t检验进行数据统计.结果 肾移植组SF-36总分及其分支领域得分(精力状况除外)均显著高于腹膜透析组,差异有统计学意义(P＜0.05).肾移植组KDTA总分、症状、肾病影响、肾病负担、性功能、睡眠及社会支持得分均高于腹膜透析组,差异有统计学意义(P＜0.01),两组工作状况、认知功能、社交质量得分差异无统计学意义.结论 肾移植者的生活质量优于接受维持性腹膜透析者.     

不同腹膜溶质转运特性腹膜透析患者营养状况的比较

目的 探讨腹膜转运特性对腹膜透析患者营养状态的影响。方法 按照腹膜平衡试验(PET)计算结果,将82例稳定的CAPD患者分为高转运组和低转运组。检测患者血浆和腹透透出液总蛋白、白蛋白及氨基酸量,同步计算蛋白质摄入量(DPI)和蛋白质分解率(nPCR)。比较两组营养状态及分析相关因素。结果两组的残余肾功能、腹透治疗时间、每日透析液剂量、超滤量、葡萄糖吸收量、血糖、BUN、Scr和Kt／V均无显著性差异。高转运组每日经腹透透出液丢失的总蛋白质和多种氨基酸量明显高于低转运组;各项营养指标均低于低转运组,且体重及血清白蛋白有显著性差异。血中及经腹透透出液丢失的白蛋白和氨基酸量均与转运类型相关。结论 腹膜透析高转运患者营养状态较低转运者差。单纯提高透析充分性并不能明显改善营养状态。要加强对高转运患者的营养管理和指导。     

腹膜溶质转运特性对腹膜透析患者营养指标的影响

目的探讨腹膜溶质转运特性对腹膜透析患者营养指标的影响.方法按照腹膜平衡试验(PET)计算结果,将68例稳定的连续性不卧床性腹膜透析(CAPD)患者分为高转运组(37例)和低转运组(31例).检测患者血浆和腹透透出液中的总蛋白、白蛋白及氨基酸量,同步计算蛋白质摄入量(DPI)和蛋白质分解率(nPCR).比较两组营养状态及进行相关因素分析.结果两组的残余肾功能、CAPD治疗时间、每日透析液剂量、超滤量、葡萄糖吸收量、血糖、尿素氮(BUN)、血清肌酐(Scr)和尿素清除指数(Kt/V)比较,差异无显著性意义(均P>0.05).高转运组每日经腹透透出液丢失的总蛋白质和多种氨基酸量显著高于低转运组(均P<0.05);各项营养指标均低于低转运组;两组体重及血清白蛋白比较,差异有显著性意义(均P<0.05).每日经腹透液丢失的Alb量和TAA与D/P4Scr呈正相关关系(均P<0.05).结论腹膜透析高转运患者营养指标较低转运者差,应加强对高转运患者的营养护理和指导;每日透析液量及超滤量能达到TCcr与DPI平衡即可,不宜盲目增加腹透液的剂量、浓度和存留时间,导致过度透析,引起蛋白质和氨基酸经腹透液大量丢失及吸收大量的葡萄糖,加重患者蛋白质缺乏性营养不良.     

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.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.