小骨窗开颅术治疗高血压脑出血围术期的综合护理

目的观察对小骨窗开颅治疗高血压脑出血围术期的综合护理效果。方法对32例高血压脑出血实施小骨窗开颅治疗的患者围术期实施心理、病情观察、饮食、康复指导综合护理措施。结果 32例患者经治疗和护理后存活29例(90.63%),死亡3例(9.38%),依据术后生活能力(ADL)分级:Ⅰ级8例,Ⅱ级12例,Ⅲ级6例,Ⅳ级2例,V级1例。结论对小骨窗开颅治疗高血压脑出血的患者围术期的综合护理措施,可提高手术清除血肿效果,降低病死率,改善患者预后生活质量。     

小骨窗微创手术治疗高血压脑出血68例分析

目的:探讨高血压脑出血小骨窗微创手术治疗的适应证及疗效。方法:对68例高血压脑出血患者采取小骨窗在显微镜下行血肿清除治疗,对并发血肿破入脑室者加行侧脑室穿刺引流治疗。结果:68例患者,术后24h内复查头颅CT,血肿清除率达90%以上24例,50%以上33例,30%以上5例。6例血肿复发,其中4例行二次手术。术后存活61例,死亡7例。获随访55例,生活质量按ADL评价:Ⅰ级15例(27.3%),Ⅱ级21例(38.2%),Ⅲ级8例(14.5%),Ⅳ级9例(16.4%),Ⅴ级2例(3.6%)。结论:小骨窗开颅显微手术治疗高血压脑出血是一种安全有效的方法,合理掌握手术适应证及手术技巧,可明显提高疗效。     

小骨窗开颅显微手术治疗基底节高血压脑出血

目的探讨小骨窗开颅微创治疗基底节高血压脑出血的临床疗效。方法对138例基底节区高血压脑出血患者采用小骨窗开颅,显微镜下清除血肿。结果术后24h内复查CT显示,117例血肿清除90%以上,21例血肿清除80%以上。死亡13例,其中5例死于术后再出血所致的脑疝,3例死于肺部感染,2例死于多器官衰竭,死于颅内感染、气道梗阻及消化道大出血各1例。术后生存125例,平均随访8(3～12)个月,日常生活能力(ADL)分级:Ⅰ级25例,Ⅱ级49例,Ⅲ级34例,Ⅳ级15例,Ⅴ级2例。结论小骨窗开颅显微手术创伤小,术野显露充分,血肿清除彻底,止血可靠,是治疗基底节高血压脑出血的有效手术方式之一。     

小骨窗开颅显微手术治疗高血压性脑出血

目的评价小骨窗开颅显微手术治疗高血压性基底节区脑出血的手术疗效及安全性.方法自1992年2月～2002年7月,70例高血压性基底节区脑出血病例被同期分为小骨窗开颅组与传统大骨窗开颅组,行显微手术治疗.比较两组在显露及清除血肿方面、对出血动脉止血方面、对周围脑组织保护和手术减压方面的效果,同时对两组的术中出血、手术所用的时间、术后平均住院时间、远期疗效进行统计学分析,通过测量总结小骨窗开颅的适宜尺寸.结果小骨窗开颅组39例,开颅窗最大径(3.20±0.42)cm;传统大骨窗开颅组31例,开颅窗最大径为(7.95±0.47)cm.两组在术前一般情况、术前意识状态、血肿部位及血肿量、手术时机方面差异无显著性(P＞0.05),手术方面,两组在血肿显露、清除及对出血动脉止血方面差异无显著性(P＞0.05),小骨窗开颅组血肿清除术后减压满意.小骨窗开颅组有手术时间短、出血较少、平均住院时间短等优点((P＜0.01),在远期效果方面小骨窗组也优于传统开颅组(P＜0.05)结论对高血压性基底节区脑出血的显微手术,小骨窗开颅术可达到传统大骨窗开颅手术的疗效及安全性标准.由于小骨窗开颅设计建立在术前对病变精确的空间定位基础上,以最适宜的手术入路、最适合的开颅尺寸进行血肿清除,所以,与传统大骨窗开颅手术相比较,显微手术既能减小手术创伤,减少术中出血,又能使血肿清除术后减压满意.     

小骨窗开颅手术治疗高血压脑出血63例临床分析

目的探讨小骨窗开颅手术治疗高血压性脑出血的临床疗效和意义。方法采用小骨窗开颅治疗高血压性脑出血63例。结果63例中,52例意识完全恢复,有效率为82.5%,1例植物生存,死亡10例,死亡率15.8%(10/63)。结论小骨窗开颅治疗高血压性脑出血有良好的效果,具有视野清楚、清除血肿彻底、减压快、创伤小等优点,术后防治并发症至关重要,直接影响疗效。     

不同微创方法治疗高血压性脑出血的疗效观察

目的比较小骨窗微创开颅清除血肿手术和CT引导下的微创穿刺血肿引流手术的疗效对比。方法将189例高血压脑出血患者随机分为2组,小骨窗组94例实施小骨窗微创开颅清除血肿手术,CT引导组95例实施CT引导下的微创穿刺血肿引流手术。结果小骨窗组患者术后意识恢复所需时间少于CT引导组。术后神经功能缺损评分低于CT引导组,并发症发生明显少于CT引导组,ADL评分级明显优于CT引导组,两组比较,差异均有统计学意义(P0.05)。结论对高血压脑出血患者实施小骨窗微创开颅清除血肿手术,术后恢复快,并发症少,临床疗效肯定。     

小骨窗颅内血肿清除术治疗高血压性脑出血临床分析

目的总结小骨窗颅内血肿清除术治疗高血压性脑出血的效果。方法对38例高血压性脑出血患者行小骨窗颅内血肿清除,术后对患者随防6个月,观察治疗效果。结果术后第4、7、14天对存活的32例患者进行CT检查,血肿完全消失者分别为22例、8例、2例。术后6个月ADL评分Ⅰ级7例,Ⅱ级11例,Ⅲ级7例,Ⅳ级5例,植物生存2例,死亡6例,病死率15.8%。死亡原因:血肿破入脑室者2例、多器官功能衰竭2例、合并上消化道出血1例、肺部感染1例。结论对高血压性脑出血患者行小骨窗开颅血肿清除术,具有直视下血肿清除彻底、创伤小、止血效果确切、可迅速降低颅内压等优点,应作为治疗高血压性脑出血的首选手术方法。     

小骨窗显微镜下微创手术治疗高血压基底节区脑出血体会

目的:探讨小骨窗显微手术治疗基底节区高血压性脑出血的疗效.方法:回顾性分析应用小骨窗开颅,显微镜下清除血肿及止血治疗24例患者的临床资料.结果:临床治愈22例:按adl分级ⅰ级3例,ⅱ级10例,ⅲ级6例,ⅳ级3例,死亡2例.结论:小骨窗显微手术治疗基底节区高血压性脑出血手术时间短、组织创伤小、术中显露好、失血量少手术操作简单、快速、疗效满意,是比较好的手术方法.     

微创手术治疗基底节区高血压脑出血

目的探讨小骨窗开颅显微镜下治疗基底节区高血压脑出血的临床疗效。方法对38例基底节区高血压脑出血患者采用小骨窗开颅,显微镜下清除血肿。结果术后24小时内复查CT显示,26例血肿清除90％以上,8例血肿清除70％～80％以上。死亡4例。其中2例死于术后再出血所致的脑疝,1例死于肺部感染,1例死于多器官衰竭。术后生存34例,随访3~6个月。日常生活能力（ADL）分级：I级7例,Ⅱ级13例,Ⅲ级9例,Ⅳ级4例,V级1例。结论小骨窗开颅显微镜下手术,视野清晰、操作精细,止血确切,手术创伤较小,术后恢复良好,是治疗基底节区高血压脑出血的有效手术方式之一。     

显微镜小骨窗开颅血肿清除术治疗高血压性基底节区脑出血效果分析

目的 探讨显微镜小骨窗开颅血肿清除术治疗高血压性基底节区脑出血的临床效果.方法 回顾性分析兰考第一医院神经外科2019-05—2021-02收治的58例高血压性基底节区脑出血患者的临床资料.分为传统开颅大骨瓣血肿清除术组(大骨瓣组,28例)和显微镜小骨窗开颅血肿清除组(小骨窗组30例).比较2组患者的手术时间、住院时间...     

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.