经腹小切口改良全子宫切除术184例分析

目的介绍一种微创、手术范围介于传统筋膜外和筋膜内之间的经腹小切口改良全子宫切除术式,并探讨其临床应用价值。方法病例对照研究：184例（观察组）子宫良性病变患者行经腹小切口改良全子宫切除术,另124例（对照组）行传统经腹全子宫切除术,比较两组手术疗效。结果观察组在手术时间、术中出血量、排气时间、置尿管时间、术后病率及住院时间方面均显著优于对照组（P〈0.05或P〈0.01）。观察组随访170例,对照组随访116例。观察组在阴道残端出血、阴道顶端肉芽发生率、术后阴道长度及性生活满意度方面均优于对照组（P〈0.05）。结论经腹小切口改良全子宫切除术操作简单、并发症少,优于传统全子宫切除术,是一种较好的微创子宫切除术式。     

腹腔镜和经腹子宫全切除术效果分析

目的比较腹腔镜和开腹子宫全切除术的临床效果。方法选取2014-09—2016-02间在永城市人民医院接受子宫全切手术的96例患者。随机分为2组,每组48例。观察组实施腹腔镜下子宫全切术,对照组给予经腹子宫全切术。比较2组治疗效果。结果 2组手术时间差异无统计学意义(P0.05)。观察组术中出血量及术后肛门排气时间、住院时间和并发症发生率均少于或短于对照组,差异均有统计学意义(P0.05)。结论与经腹子宫全切术比较,腹腔镜子宫全切术创伤小、术后并发症发生率低,患者恢复快,可在严格掌握手术适应证的前提下选择应用。     

腹腔镜下子宫全切术与经腹子宫切除术治疗子宫良性疾病患者的临床比较

目的对子宫良性疾病患者进行腹腔镜下子宫全切术与经腹子宫切除术治疗,比较其临床效果。方法选取2017年1月至2017年12月医院收治的子宫良性疾病患者166例,根据治疗方式不同将其分为研究组(n=286)与对照组(n=280)。对照组采用经腹子宫切除手术治疗,研究组采用腹腔镜下子宫全切术治疗,对两组患者手术治疗效果及术后并发症发生情况进行观察比较。结果在手术各项指标(术中出血量、肛门排气时间、住院时间等)方面,与对照组比较,研究组上述指标均显著降低(P0.05);术后,研究组总并发症发生率为3.5%,与对照组总并发症发生率15.0%比较显著降低,差异具有统计学意义(P0.05)。结论对子宫良性疾病患者实施腹腔镜下子宫全切术治疗的临床效果更好。该方式创伤更小,术后并发症发生率更低,有助于患者预后,可作为临床治疗子宫良性疾病的首选术式。     

思维导图在老年患者行斜侧方椎间融合术围术期健康教育中的应用

目的观察思维导图在老年患者行斜侧方椎间融合术围术期健康教育中的应用效果，以期为临床护理工作提供依据。 方法前瞻性选取我院2017年11月至2018年11月收治的75例老年腰椎退行性疾病患者作为研究对象，按照随机数字表法分为两组，对照组37例和试验组38例，所有患者行斜侧方椎间融合术，围术期对照组给予常规健康教育，试验组患者采取思维导图式健康教育，对比两组患者对护理工作的满意度及并发症发生情况，对比出院时及出院1个月后两组患者日常生活能力，术后1个月内跌倒发生情况。 结果对照组患者对护理工作满意率为83.78%，试验组患者对护理工作满意率为97.37%，差异有统计学意义（Z=-2.008，P<0.05）；试验组术后并发症发生率为7.89%，对照组为18.91%，差异无统计学意义（χ²=1.972，P>0.05）；出院1个月随访时，两组患者日常生活能力较出院时比较均有所提升（对照组：t=-8.817，P=0.000；试验组：t=-10.829，P=0.000），试验组高于对照组（t=-2.974，P<0.05）；术后1个月内观察组跌倒发生率为8.11%，试验组跌倒发生率为0，组间比较差异有统计学意义（P<0.05）。 结论思维导图式健康教育有助于促进护患双方合作，提高护理满意度，降低术后患者跌倒事件发生率，提升腰椎退行性疾病患者术后生活能力，可进一步推广应用。     

改良阴式全子宫切除术治疗妇科疾病效果观察

目的探讨改良阴式全子宫切除术治疗妇科疾病的效果。方法将160例妇科疾病患者随机分为2组,各80例。对照组行传统开腹子宫全切术,观察组行改良阴式全子宫切除术。观察比较2组手术时间、术中出血量、术后下床活动时间、住院时间和术后并发症。结果 2组患者均顺利完成手术。观察组手术时间、术中出血量、术后下床活动时间、住院时间和术后并发症均明显低于对照组,2组比较,差异均有统计学意义(P0.05)。结论与传开腹全子宫切除术相比,改良阴式全子宫切除术具有手术时间短、术中出血量小,术后患者恢复快,并发症发生率低等优势。     

胸腔镜肺癌切除术后患者静脉血栓栓塞症的预防性护理

目的探讨胸腔镜下肺癌切除术后静脉血栓栓塞症的预防性护理干预措施。方法将2017年收治的685例胸腔镜下肺癌切除术患者设为对照组,给予常规护理。将2018年收治的762例患者设为观察组,通过Caprini风险评估、分级,给予预防性护理措施。比较两组术后血液指标、胸管引流量及留置时间、血栓栓塞事件、住院时间等。结果观察组术后7d的血小板计数、D-二聚体显著低于对照组(均P0.01)。观察组术后胸管引流量、胸管留置时间、下肢静脉血栓及肺血栓栓塞发生率、住院时间、日常生活能力评分与对照组比较,差异有统计学意义(均P0.01)。结论预防性护理干预能够降低胸腔镜肺癌切除术患者的血小板计数、D-二聚体,减少血栓栓塞事件的发生。     

腹腔镜经腹膜外子宫悬吊术治疗子宫脱垂效果观察

目的观察腹腔镜腹膜外子宫悬吊术治疗子宫脱垂的效果。方法随机将2017-03—2018-01间唐河县人民医院收治的72例子宫脱垂患者分为2组,各36例。对照组行经阴道全子宫切除术,观察组行腹膜外子宫悬吊术。结果观察组治疗总有效率、住院指标、术后PISQ-12评分及并发症发生率均优于对照组,差异有统计学意义(P0.05)。结论腹腔镜经腹膜外子宫悬吊术治疗子宫脱垂,可有效降低术中出血量,缩短手术时间,降低并发症发生率,促进患者术后康复。     

腹腔镜下子宫全切术治疗子宫肌瘤的疗效观察

目的观察腹腔镜下子宫全切术治疗子宫肌瘤患的效果。方法将2012-03―2013-03间收治的80子宫肌瘤例患者随机分为对照组和观察组,各40例。对照组实施开腹手术,观察组实施腹腔镜下子宫全切除术。对比2组手术时间、住院天数、术中出血量、术后排气时间及手术并发症。结果观察组手术时间、住院天数、术后排气时间短于对照组,术中出血量少于对照组,并发症的发生率低于对照组,2组比较,差异有统计学意义(P<0.05)。结论腹腔镜下子宫全切术治疗子宫肌瘤,手术创伤小,出血少,并发症低,患者恢复时间短,值得临床应用。     

腹腔镜全子宫切除术治疗宫颈原位癌临床分析

目的:探讨腹腔镜全子宫切除术治疗宫颈原位癌的临床效果。方法:2003年2月至2008年5月收治187例经宫颈锥形切除诊断为宫颈原位癌的患者,治疗组(62例)行腹腔镜全子宫切除术,对照组分别行腹式全子宫切除术(67例)、阴式全子宫切除术(58例),回顾分析3组患者的临床资料。结果:3组手术时间、术中出血量、肛门排气时间、术后病率、术后住院时间差异均无统计学意义(P0.05),术后随访15~72个月,腹式组1例发现阴道残端轻度上皮内瘤变,余均未见肿瘤残留或复发。结论:与腹式或阴式全子宫切除术相比,腹腔镜全子宫切除术治疗宫颈原位癌效果满意,具有微创和探查全腹腔的优点。     

腹腔镜及经腹全子宫切除术应用于子宫良性病变疾病中效果

目的通过比较腹腔镜下全子宫切除术与经腹全子宫切除术应用于子宫良性病变疾病中的效果来探讨两种治疗方法的优劣势。方法回顾性分析80例子宫良性病变疾病患者临床治疗情况,其中经腹全子宫切除术者40例为对照组,另40例采用腹腔镜下全子宫切除术为治疗组。记录两组手术期间各项情况(平均手术时间、术中出血量、术后肛门排气时间、下床活动时间、住院时间)及术后并发症情况。结果观察组平均手术时间为(104.74±13.77)分钟与对照组(106.11±14.19)分钟比较,t=0.438,P=0.662;术中出血量(79.55±8.47)ml、肛门排气时间(34.76±2.76)小时、下床活动时间(7.41±2.85)小时、术后住院时间(5.98±1.36)天与对照组术中出血量(121.26±10.96)ml、肛门排气时间(47.44±4.38)小时、下床活动时间(12.39±3.19)小时、术后住院时间(10.22±1.69)天比较,P0.05。观察组术后并发症发生率2.5%(1/40)明显低于对照组15.0%(6/40),χ2=3.914,P=0.048。结论腹腔镜下全子宫切除术应用于子宫良性病变疾病中可减轻对患者的创伤,促进患者术后康复,且并发症少,具有微创、安全等优点,值得推广。     

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.