慢性前列腺炎细菌及免疫学研究

目的　了解慢性前列腺炎细菌感染情况 ,提高治疗水平。　方法　对 132例慢性前列腺炎患者行尿及前列腺液细菌五步培养法、药物敏感试验及前列腺液免疫球蛋白IgA和lgG测定 ,并根据药敏试验结果对部分患者进行治疗。　结果　前列腺液细菌培养阳性者 74例 ,其中金黄色葡萄球菌 32例 (耐药金黄色葡萄球菌 5例 ) ,表皮葡萄球菌 17例 ,大肠杆菌 10例 ,其它细菌 15例 ;细菌培养阴性者 5 8例。细菌培养阳性者前列腺液中IgG和IgA分别平均为 1.12 g/L和 0 .32 g/L(n =34 ) ,显著高于细菌培养阴性者 (0 .2 3g/L和 0 .0 2 g/L ,n =37;P =0 .0 31和P =0 .0 36 )。　结论　慢性前列腺炎患者前列腺液细菌培养阳性率较高 (5 6 .1% ) ,以革兰阳性菌多见 (6 6 .2 % ) ,细菌可能来源于女性生殖道。下尿路细菌定位诊断可简化为“两杯法”。前列腺液细菌培养阳性者的前列腺液中免疫球蛋白IgG和IgA水平较高     

慢性前列腺炎患者前列腺液IL-6和IL-8表达变化及意义

目的　探讨慢性前列腺炎患者前列腺液中IL 6和IL 8的变化与慢性前列腺炎类型、症状和前列腺液白细胞计数的相关关系。　方法　以两杯法尿液细菌培养、前列腺液常规检查和NIH CPSI评分 ,将 10 2例前列腺炎患者分型。放免分析法测定患者和 2 8例正常对照者前列腺液中IL 6和IL 8含量 ,比较结果并进行相关分析。　结果　 90例前列腺炎患者 (Ⅱ、ⅢA、Ⅳ型 )前列腺液IL 6和IL 8水平分别为 ( 0 .5 1± 0 .5 7)ng ml和 ( 10 .75± 7.96 )ng ml,高于正常对照组的 ( 0 .32± 0 .5 1)ng ml和( 4.5 6± 5 .6 8)ng ml(P <0 .0 5和P <0 .0 1)。Ⅱ型前列腺炎患者前列腺液IL 6和IL 8水平与ⅢA型和Ⅳ型者比较差别无显著性意义 (P >0 .0 5 )。前列腺炎患者前列腺液白细胞计数与IL 8水平呈正相关(r=0 .5 2 9,P <0 .0 1)。前列腺液IL 6和IL 8水平与NIH CPSI评分无相关性 (P >0 .0 5 )。　结论　慢性前列腺炎患者前列腺液IL 6和IL 8表达增高 ,并参与前列腺的炎症反应。前列腺液IL 6和IL 8水平可作为慢性前列腺炎的诊断依据之一。     

前列安栓治疗慢性前列腺炎的安全性和有效性:随机双盲安慰剂对照试验

目的　评价前列安栓治疗各型慢性前列腺炎的安全性、有效性和依从性。　方法　多中心随机双盲安慰剂对照研究。 12 5例慢性前列腺炎患者根据美国国立卫生院 (NIH)前列腺炎分型标准分型后随机分为治疗组和对照组 ,治疗组 (6 5例 )前列安栓 1粒 ,对照组 (6 0例 )安慰剂 1粒 ,肛内用药每晚 1次 ,疗程 1个月。以NIH慢性前列腺炎症状评分 (NIH CPSI)和前列腺按摩液 (EPS)白细胞计数为疗效评价指标。　结果　试验结束时 ,12 4例可评价病例中Ⅱ型 4 8例 (38.7% ) ,Ⅲa型 4 5例 (36 .3% ) ,Ⅲb型 31例 (2 5 .0 % )。治疗组NIH CPSI总分用药前后分别为 (2 5 .4 5± 5 .82 )和 (15 .0 8± 7.84 )分 ,平均降低 10 .37分 ,症状程度评分用药前后分别为 (16 .76± 4 .0 7)和 (9.4 2± 5 .38)分 ,平均降低 7.34分 ;对照组NIH CPSI总分用药前后分别为 (2 2 .87± 5 .79)和 (16 .2 2± 6 .2 3)分 ,平均降低 6 .6 5分 ,症状程度评分用药前后分别为 (15 .2 7± 3.86 )和 (10 .5 5± 4 .2 9)分 ,平均降低 4 .72分 ;治疗组NIH CPSI总分与症状程度评分的下降幅度均较对照组更明显 (P <0 .0 1)。治疗组总显效率2 8.1% (18/ 6 4 ) ,总有效率 71.9% (4 6 / 6 4 ) ,对照组总显效率 13.3% (8/ 6 0 ) ,总有效率 4 1.7% (2 5 / 6 0 )     

药物联合治疗慢性前列腺炎临床疗效观察(附153例报告)

目的　探讨慢性前列腺炎联合药物治疗的临床疗效。　方法　选择中重度慢性前列腺炎 15 3例 ,其中细菌性前列腺炎 2 0例 ,非细菌性前列腺炎 133例 ,按照美国国立卫生研究所 (NIH)制定的前列腺炎症状评分标准 (CPSI)和前列腺按摩液 (EPS)指标变化及细菌学检查结果评估疗效。应用敏感抗生素、α1受体阻滞剂、选择性COX 2抑制剂、中成药等联合治疗 1.5～ 5个月 ,对比分析疗效。　结果　 15 3例平均随访 11.8个月 ,行两次CPSI,平均 13.4分 ,与治疗前平均 32 .6分比较差异有显著性意义 (P <0 .0 0 0 0 1)。依据CPSI进行疗效判定 ,治愈 15 .7% ,显效 4 9.1% ,有效 18.8% ,无效 16 .7% ,总有效率 83.6 % ;治疗后平均WBC 11.6个 /HP ,与治疗前 (32 .4个 /HP)比较差异有显著性意义 (P <0 .0 0 0 0 1)。 2 0例慢性细菌性前列腺炎患者治疗后两杯判定试验 (PPMT)法行细菌培养 ,14例转为阴性 ,转阴率 70 .0 %。　结论　两杯判定试验对慢性前列腺炎分类简单易行 ,CPSI是一种较好的疗效评价方法 ,合适的抗生素、α1受体阻滞剂、选择性COX 2抑制剂和中药等联合应用对慢性前列腺炎有较好疗效。     

前列腺液中性粒细胞弹性蛋白酶测定在慢性前列腺炎诊断中的意义

目的 探讨中性粒细胞弹性蛋白酶(neutrophil elastase,NE)在慢性前列腺炎诊断中的意义.方法 试验组35例慢性前列腺炎患者及对照组35例,进行NE浓度测定、前列腺液常规检查、细菌培养及NIH前列腺炎症状评分(CPSI);进行NE浓度与白细胞(WBC)计数和CPSI评分相关性分析、CPSI评分和WBC计数以及其它指标进行相关性分析.对两组的NE浓度、CPSI评分、卵磷脂小体(SPL)等结果进行统计学分析.结果 (1)试验组35例,NE浓度与EPS中WBC数量呈较强的正相关关系,NE浓度与CPSI评分呈较强的正相关关系,CPSI评分与WBC呈正相关关系.(2)两组之间NE浓度、NIH的CPSI评分、WBC计数、前列腺培养阳性率均有显著性差异.结论 测定前列腺液中NE浓度,对于慢性前列腺炎的诊断有一定的意义.     

柏诺特胶囊治疗慢性前列腺炎临床观察

目的 :采用NIH CPSI评分评价柏诺特胶囊对慢性前列腺炎 (CP)的治疗作用。　方法 :12 5例CP患者包括 Ⅱ型CP 31例 ,ⅢA型CP 75例 ,ⅢB型CP 19例。采用柏诺特胶囊治疗 ,治疗前和治疗 2个月后行NIH CPSI评分、前列腺液常规检查和细菌培养 ,观察治疗效果。　结果 :Ⅱ型治愈率为 2 5 .8% (8/31) ,ⅢA型为 16 .0 % (12 /75 ) ,ⅢB型为2 1.1% (4 /19) ,总体治愈率为 19.2 % ;总体好转率为 6 3.5 % ,总有效率为 82 .7% ;未发现有不良反应。　结论 :柏诺特胶囊治疗CP效果良好。     

慢性前列腺炎患者前列腺液中IL-2、IL-8及IL-10水平分析

目的: 检测慢性前列腺炎(CP)患者前列腺液中细胞因子IL 2、IL 8及IL 10的水平,探讨这些细胞因子对CP发病机制及诊断方面的价值。　方法: 采用双抗体夹心ELISA法测定 31例CP患者前列腺液中IL 2、IL 8及IL 10的水平,并以 10例健康男性为对照。对每例患者进行两杯法尿液细菌培养、前列腺常规检查和美国国立卫生院前列腺炎症状指数评分 (NIH CPSI)。按NIH分类法将 31例CP患者分为 3型:Ⅱ型 5例,ⅢA型 13例,ⅢB型 13例。　结果: CP组与对照组比较,前列腺液IL 8含量显著升高(P<0. 05),IL 2和IL 10含量显著降低 (P均<0. 05)。Ⅱ型CP组前列腺液IL 2、IL 8和IL 10水平与ⅢA型CP组比较,差异均无显著性。ⅢB型CP组与Ⅱ型和ⅢA型CP组比较,前列腺液IL 8水平显著降低(P均<0. 05)。CP患者前列腺液IL 8水平与IL 10水平呈负相关(r=-0. 503,P<0. 05),与前列腺液白细胞计数呈正相关(r=0. 663,P<0. 05)。前列腺液IL 2、IL 8和IL 10水平与NIH CPSI评分无相关性(P>0. 05)。　结论: 前列腺液中IL 2、IL 8及IL 10在CP的发病过程中起重要作用,是诊断CP有价值的指标。     

经会阴前列腺包膜下穿刺治疗慢性前列腺炎

目的 :探讨经会阴前列腺包膜下穿刺注射药物治疗慢性前列腺炎的效果。　方法 :对 4 0例难治性慢性前列腺炎患者的前列腺液进行细菌培养和药敏试验 ,选择一种敏感抗生素 ,加入地塞米松和利多卡因的混合液中行经会阴前列腺包膜下注射 ,隔 7d注射 1次 ,4次为 1个疗程 ,治疗后 1个月评价其疗效并随访 6个月。　结果 :4 0例慢性前列腺炎患者中治愈 2 1例 (5 2 .5 % ) ,有效 16例 (40 % ) ,无效 3例 (7.5 % ) ,总有效率达 92 .5 %。 2 8例获 6个月随访 ,无 1例复发。　结论 :经会阴前列腺包膜下穿刺注射药物治疗慢性前列腺炎是一种安全有效、治愈率较高的治疗方法。     

中西医结合治疗解脲支原体、沙眼衣原体性慢性前列腺炎48例报告

目的 :探讨解脲支原体 (UU)和沙眼衣原体 (CT)性慢性前列腺炎的治疗措施。　方法 :对 48例UU和CT性慢性前列腺炎病人实施米诺环素、中成药前列舒乐及α1A受体阻滞剂盐酸坦洛新等综合治疗 ,观察治疗前后病人症状、前列腺液常规、UU和CT检测结果的变化 ,辅以慢性前列腺炎症状指数CPSI评分作疗效评价。　结果 :显效41例 ( 85 .4% ) ,有效 5例 ( 10 .4% ) ,无效 2例 ( 4.2 % )。治疗前CPSI评分为 ( 2 2± 8)分 ,治疗后降至 ( 7± 3 )分 ,差异有极显著性 (P <0 .0 1)。UU转阴 2 0例 ,CT转阴 2 5例 ,转阴率分别为 83 %和 89%。　结论 :中西医结合治疗UU和CT性慢性前列腺炎疗效显著 ,值得推荐     

慢性前列腺炎综合征病人NIH-CPSI问卷分析

目的 :探讨NIH CPSI对慢性前列腺炎综合征的临床价值。　方法 :应用NIH CPSI问卷 ,随机对 2 2 7例慢性前列腺炎综合征 (CPS) /慢性盆腔疼痛综合征 (CPPS ,包括ⅢA和ⅢB)和 32例良性前列腺增生 (BPH)进行观察。结果 :①CPS病人的主要症状表现为疼痛或不适 ,明显多于BPH病人 ;② 79.30 %CPS病人有排尿不尽 ,而排尿后 2h以内又有尿意为 4 4 .93% ;③ 5 1.5 1%CPS病人因慢性前列腺炎症状影响工作 ,90 .31%的病人影响业余生活 ,6 8.72 %的病人影响生活质量 ,与BPH病人比较 ,明显影响CPS病人的生活质量。　结论 :应用NIH CPSI问卷观察CPS ,表明CPS病人的主要症状是疼痛或不适 ,且对工作与生活质量有明显的影响     

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 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.     

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.