腰椎间盘突出症的手术治疗及其并发症原因分析

目的 探讨腰椎间盘突出症手术治疗的方式,术后并发症发生的原因及其处理措施.方法 对137例分别行单纯椎板间开窗髓核切除术、神经根管扩大减压加髓核摘除术的椎间盘突出症患者的手术优良率和并发症发生原因进行了回顾分析.结果 137例腰椎间盘突出症手术治疗优良率为90.5%,13例出现并发症.结论 根据患者的体征及影像学检查结果,制定出合适的手术方案,是提高手术成功率,减少手术并发症的关键.     

腰椎间盘摘除术并发神经损伤

腰椎间盘摘除术中并发神经损伤为一极其严重的并发症,是造成腰椎间盘突出症患者病废的主要原因,必须严加预防。作者报道７例,结合文献对神经损伤的病理解剖基础以及手术操作做一分析。１临床资料自１９８８年至１９９７年本院共行腰椎间盘摘除术４０２例,发生神经损伤...     

腰椎间盘术后椎间隙感染原因分析

腰椎间盘突出症手术摘除后继发椎间隙感染,临床上比较少见。为提高手术疗效,减少并发症,本文对我院自1981年1月至1990年12月间共手术治疗资料完整的腰椎间盘突出症378例,其中有5例发生椎间隙感     

腰椎间盘突出症术后并发症原因分析及治疗体会

1996年 2月～ 2 0 0 1年 2月间因腰椎间盘突出症行手术治疗的患者 392例 ,出现各种术后并发症患者 5 8例 ,经过进一步治疗 ,疗效满意 ,报告如下。1　临床资料1 1　一般资料　本组 5 8例 ,男 39例 ,女 19例 ,年龄平均38 1岁 ,首次手术开窗术 9例 ,半椎板切除术 33例 ,全椎板切除 16例。再次手术 2 6例 (9例首次手术在外院施行 ,17例在我院施行 )。1 2　腰椎间盘突出症术后并发症原因及年龄关系　见表 1。2　讨　论2 1　腰椎间盘突出症的术前准备及术中治疗问题　腰椎间盘突出合并椎管狭窄 ,腰椎间盘突出合并侧隐窝狭窄 ,多发腰椎间盘突出 ,…     

经皮内镜下腰椎间盘切除术围手术期并发症的临床研究

[目的]研究分析经皮内镜下腰椎间盘切除术治疗腰椎间盘疾病的围手术期并发症发生情况及预防措施。[方法]对2013年3月~2016年3月接受经皮内镜下腰椎间盘切除术的478例腰椎间盘疾病患者的临床资料进行回顾性分析。将术中及术后1个月内发生的与手术直接相关的不良事件纳入围手术期并发症范畴,手术导致患者新的损害于术后30 d内改善者定义为短暂并发症,超过30 d无改善者定义为持久并发症。统计分析并发症发生情况,并总结原因及对策。[结果]478例患者中共有78例患者发生围手术期并发症82项,围手术期并发症发生率为16.32%(78/478);82项并发症中4例发生4项持久并发症,74例发生短暂性并发症78项;不同腰椎间盘病变并发症发生率分别为:旁中央或中央型突出13.47%(26/193),椎间盘突出并椎管狭窄15.19%(12/79),腰椎术后复发33.96%(18/53),腰椎双节段突出者15.22%(7/46),脱出游离型13.95%(6/43),极外侧型突出14.29%(5/35),椎间盘源性腰痛者13.79%(4/29)。[结论]经皮内镜下腰椎间盘切除术围手术期并发症主要有下肢感觉异常、下肢肌力减退、术后局部血肿形成、椎体终板炎、硬膜破裂、导丝断裂、术中休克等,其中下肢感觉异常是最常见并发症,腰椎术后复发者围手术期并发症发生率较高。     

腰椎间盘突出症和椎管狭窄症手术并发症的回顾性分析

目的 回顾性分析腰椎间盘突出症和椎管狭窄症手术并发症发生的原因及对策。方法 自1992年5月～2002年5月手术治疗腰椎间盘突出症和椎管狭窄症2560例，发生并发症134例，发生率为5．23％，其中腰椎间盘突出症的并发症发生率为3.75％．腰椎间盘突出症伴侧隐窝狭窄为4．70％．单纯侧隐窝狭窄为5．13％．腰椎间盘突出症伴中央椎管狭窄为8.97％．单纯中央椎管狭窄为7．93％。器械使用不当引起的并发症为67例．其中椎板咬骨钳所致53侧．占79．1%。术后椎间盘炎8例．发生率0．3％，定位错误19例．发生率为0.74%。术后发生脑血栓2例、肺栓塞1例!2例L4全椎板切除术后发生继发性腰椎滑脱。3倒硬脊膜撕裂者术后发生脑脊液囊肿。复发性腰椎间盘突出症26例。切口血肿致神经根性放射痛12例，结果 19例定位错误者．其中15例术中纠正，4例再次手术。神经根损伤者18例，其中16例完垒恢复．马尾神经损伤者4例均不完全恢复。右髂外动脉破裂者经及时探查、修补后康复。除肺栓塞者经抢救无效死亡外，其余并发症通过处理痊愈。结论 要严格把好术前诊断、术中操作和术后处理关，以减少并发症的发生。     

腰椎间盘突出症手术并发症临床分析与处理对策

1991年9月～2003年9月,我院手术治疗1226例腰椎间盘突出症患者,出现并发症57例,笔行针对并发症的原因和处理方法进行分析。     

经皮椎间孔镜下腰椎间盘摘除术并发症分析

目的:分析局麻下经皮椎间孔镜技术在治疗腰椎间盘突出症的并发症,探讨如何避免椎间孔镜手术并发症的发生。方法:对2013年10月至2015年6月采用经皮椎间孔镜下腰椎间盘摘除术治疗的132例腰椎间盘突出症患者进行回顾性分析,其中男85例,女47例;平均年龄42.9岁;L3,4突出6例,L4,5突出68例,L5S1突出58例。统计术中、术后并发症发生率,分析各类并发症发生原因。结果:132例患者中,术中发生硬膜损伤1例(硬膜与髓核粘连),术后未出现脑脊液漏,术后肌力感觉较术前无下降,创口愈合良好;术中减压不满意立即改为开放手术2例,为伴有椎间孔狭窄及髓核粘连患者,均取得满意疗效;短期(3个月)内复发2例,术后髓核残留3例,均通过翻修手术治疗,取得满意疗效;术后发生室上性心动过速1例,经询问原有心脏病史。术中发生高脑脊液压2例。结论:经皮椎间孔镜学习曲线陡峭,初学者在开始椎间孔镜手术前,必须有一定的开放手术经验,严格把握手术指征。在熟悉解剖和经皮椎间孔镜技术的前提下,经皮椎间孔镜下治疗腰椎间盘突出症是安全可靠的。     

经皮内窥镜下腰椎间盘切除术治疗腰椎间盘突出症的并发症

【摘要】 目的：回顾性分析经皮内窥镜下腰椎间盘切除术（percutaneous endoscopic lumbar discectomy,PELD）治疗腰椎间盘突出症的并发症及其相关因素。方法：自2006年3月~2010年10月共行经皮内窥镜下腰椎间盘切除术治疗162例腰椎间盘突出症患者,男82例,女80例;年龄21~71岁,平均36.5岁。统计术中、术后早期及术后长期并发症的发生情况。结果：162例患者均获得3~60个月的随访,平均随访30个月。本组患者出现手术并发症共12例,发生率为7.2%。术中发生并发症4例,其中节段定位错误1例,术中活动出血1例,硬膜囊损伤1例,钬激光器械金属头部断裂1例;术后早期发生并发症5例,其中髓核遗漏2例,椎间隙感染1例,神经感觉异常2例;术后中长期并发症3例,2例为同节段椎间盘突出复发,术后遗留活动后明显慢性腰部疼痛1例。结论：经皮内窥镜下腰椎间盘切除术治疗腰椎间盘突出症有一定的并发症,术者的手术经验及技巧、术前准备与术后处理、手术适应证的选择与手术并发症有关。     

腰椎间盘镜手术并发症的分析

目的：探讨腰椎间盘镜手术并发症的原因及治疗。方法：2000年8月-2004年5月用SOFAMOR DANEK公司METRX椎间盘镜治疗腰椎间盘突出症162例，对其临床结果进行回顾性分析。结果：出现并发症10例：硬脊膜撕裂6例，神经根断裂1例，马尾神经损伤1例，椎间隙感染1例，腰背骶脊肌抽搐1例。治疗后1例神经断裂随访23个月未见明显好转，1例马尾神经损伤随访9个月有所好转，但大小便仍不能控制。结论：椎间盘镜治疗腰椎间盘突出具有切口小、创伤小、恢复快等优点；手术操作必须规范、熟悉解剖，避免神经损伤等并发症发生。     

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.