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1.
[目的]探讨丹参凝胶预防椎板切除术后硬膜外黏连的效果和机制。[方法]取卡波姆(Carbom er)与丹参(salvia m iltiorrh iza,SMR),分别制成卡波姆凝胶、丹参卡波姆凝胶。36只大白兔随机分为4组;切除L3、6椎板后造成10 mm×5 mm椎板缺损区。A组:空白对照组;B组:凝胶对照组;C组:透明质酸钠(sod ium hyaluronate,HA)组;D组:丹参凝胶组。术后4、6、8周完整取出L3、62节段标本,光镜下观察各组硬膜外瘢痕黏连及炎症反应的情况,8周标本进行肉眼瘢痕黏连度评级。[结果]A组硬膜外形成致密黏连,B、C组部分黏连,D组无明显黏连;8周时4个组标本的肉眼瘢痕黏连评级秩和检验x2=16.794。[结论]丹参凝胶具有物理和生物学双重预防椎板切除术后硬膜外黏连的作用。  相似文献   

2.
《中国矫形外科杂志》2016,(21):1981-1984
[目的]通过动物实验观察高分子透明质酸钠和几丁糖对预防椎板切除术后硬膜外瘢痕粘连的作用。[方法]45只纯种日本大耳白兔,随机分成A、B、C、三组,制作L3、4椎板损伤模型,A组硬膜外涂布生理盐水,B组硬膜外涂布几丁糖,C组硬膜外涂布高分子透明质酸钠。于术后12周分别对椎板切除部位进行大体形态、组织学观察及生化检查,比较各组间瘢痕形成和粘连情况。[结果]C组改良Rydell-Balazs、胶原含量及改良Nussvaum组织学评分均优于A组和B组(P0.05),A组与B组比较差异无统计学意义(P0.05)。[结论]高分子透明质酸钠可以减轻或者预防椎板切除术后硬膜外瘢痕粘连的形成。  相似文献   

3.
[目的]比较局部应用不同浓度丝裂霉素C(MMC)预防椎板切除术后硬膜外黏连的效果。[方法]40只SD大鼠随机分为4组,分别切除L1椎板。术中各组分别以棉片浸透生理盐水(C组)、0.01 mg/m l(L组)、0.05mg/m l(M组)、0.1 mg/m l(H组)MMC,置于裸露的硬脊膜后5 m in。术后第4周处死动物取材,分别作肉眼观察、羟脯氨酸(HOP)含量测定、胶原组织面积测定及成纤维细胞记数。[结果]C组标本硬膜外瘢痕组织致密,与硬脊膜形成紧密黏连。H组无明显硬膜外黏连,HOP含量、胶原组织面积及成纤维细胞记数显著减少。M、L组HOP含量、胶原组织面积及成纤维细胞记数不同程度的减少,但不能避免硬膜外黏连的形成。[结论]局部应用浓度为0.1mg/m l的MMC能够有效减少硬膜外瘢痕组织增生,避免椎板切除术后硬膜外瘢痕黏连。  相似文献   

4.
《中国矫形外科杂志》2016,(15):1419-1423
[目的]探讨白藜芦醇对椎板切除术后硬膜外粘连的预防作用。[方法]60只Wistar大鼠行L_2椎板切除术,形成3 mm×3 mm硬膜裸露区,随机平均分为3组。A组:术后给予白藜芦醇药物溶液干预;B组:术后给予生理盐水干预;C组:单纯椎板切除术组。术后6周处死动物并取材,行羟脯氨酸(hydroxyproline hyp)含量分析;肉眼观察硬膜外粘连情况,并行Rydell分级;样品行石蜡包埋并切片后,行免疫组织化学、HE染色。[结果]术后6周A组较B组、C组粘连程度轻,Rydell分级具有统计学意义(P0.05),B组、C组间差异无统计学意义(P0.05);A、B、C三组硬膜外瘢痕组织中羟脯氨酸的含量分别为(27.95±4.88)μg/mg、(42.85±4.57)μg/mg、(43.95±5.73)μg/mg,A组较B组、C组少,差异有统计学意义(P0.05),B组、C组间差异无统计学意义(P0.05);单位成纤维细胞及波形蛋白计数,A组较B组和C组少,差异有统计学意义(P0.05),B组、C组间差异无统计学意义(P0.05)。[结论]白藜芦醇能够良好的预防大鼠椎板切除术后出现的硬膜外粘连,并可抗炎及抑制成纤维细胞增殖。  相似文献   

5.
目的:观察椎板切除术后用几丁糖(CHT)的同时在椎板缺损处植入磷酸三钙人工骨(TCP)预防硬膜外瘢痕粘连的效果。方法:40只纯种日本大耳白兔随机分成A、B、C、D四组,制作L4椎板损伤模型。A组硬膜外涂布生理盐水,B组硬膜外涂布几丁糖,C组硬膜外覆盖人工骨,D组硬膜外涂布几丁糖的同时加人工骨覆盖。术后12周对椎板切除部位进行大体观察、组织学观察及生化检查,比较各组间瘢痕形成和粘连情况。结果:B、C、D组的改良Rydell-Balazs粘连韧度评分、胶原含量及改良Nussvaum组织学评分均优于A组(P<0.01),D组优于B组与C组(P<0.05),B组与C组无显著性差异(P>0.05)。结论:联合应用几丁糖和人工骨能有效预防硬膜外瘢痕粘连的形成,比单独应用几丁糖和人工骨预防效果好。  相似文献   

6.
目的观察持续灌洗联合透明质酸钠局部应用对兔硬膜外粘连的预防效果。方法对25只成年健康新西兰白兔行椎板切除术,每只兔的背部均为3处切口,分别切除L1、L4、L7棘突、椎板,显露硬脊膜囊。将术后存活的22只白兔施行手术的66个节段随机分成3组:对照组(直接缝合)、几丁糖组(放置几丁糖膜)和冲洗组(持续灌洗72h后在拔管前注入透明质酸钠)。术后12周取材,进行大体和光镜检查并采用Rydell评分标准和改良Nussbaum评分标准比较组间差异。结果对照组硬膜外大量瘢痕组织填充,与周围组织难以分离;几丁糖组硬膜外瘢痕增生不明显,与硬膜之间有明显间隙,可与硬膜分离;冲洗组可见硬膜与肌肉组织之间为脂肪浸润和少量瘢痕出现,与硬膜部分粘连,易于分离。对3组的Rydell评分和改良Nussbaum评分结果进行两两比较,冲洗组和几丁糖组之间差异无统计学意义(P〉0.05);分别将此两组与对照组进行比较,差异均有统计学意义(P〈0.05)。结论持续冲洗和局部应用透明质酸钠是预防硬膜外粘连的有效方法 。  相似文献   

7.
目的 观察几丁糖加聚乳酸薄膜联合运用对椎板切除术后预防硬膜外瘢痕粘连的效果.方法 80只成年家兔[体质量(2.0±0.2)kg]制作椎板切除模型,在椎板缺损处分别覆盖等渗盐水(A组)、聚乳酸薄膜(B组)、几丁糖(C组)及几丁糖加聚乳酸薄膜(D组),术后12周对椎板切除部位进行大体观察、组织学观察及透射电镜比较各组间瘢痕形成和粘连情况.结果 B、C、D组的Rydell-Balazs粘连度评分、Nussvaum组织学评分均优于A组(P<0.01),D组优于B组和C组(P<0.01),B组与C组间差异无统计学意义(P>0.05).结论 联合应用几丁糖加聚乳酸薄膜能有效预防硬膜外瘢痕粘连,比单独应用几丁糖或聚乳酸薄膜效果好.  相似文献   

8.
目的 观察几丁糖加聚乳酸薄膜联合运用对椎板切除术后预防硬膜外瘢痕粘连的效果.方法 80只成年家兔[体质量(2.0±0.2)kg]制作椎板切除模型,在椎板缺损处分别覆盖等渗盐水(A组)、聚乳酸薄膜(B组)、几丁糖(C组)及几丁糖加聚乳酸薄膜(D组),术后12周对椎板切除部位进行大体观察、组织学观察及透射电镜比较各组间瘢痕形成和粘连情况.结果 B、C、D组的Rydell-Balazs粘连度评分、Nussvaum组织学评分均优于A组(P<0.01),D组优于B组和C组(P<0.01),B组与C组间差异无统计学意义(P>0.05).结论 联合应用几丁糖加聚乳酸薄膜能有效预防硬膜外瘢痕粘连,比单独应用几丁糖或聚乳酸薄膜效果好.  相似文献   

9.
目的 观察几丁糖加聚乳酸薄膜联合运用对椎板切除术后预防硬膜外瘢痕粘连的效果.方法 80只成年家兔[体质量(2.0±0.2)kg]制作椎板切除模型,在椎板缺损处分别覆盖等渗盐水(A组)、聚乳酸薄膜(B组)、几丁糖(C组)及几丁糖加聚乳酸薄膜(D组),术后12周对椎板切除部位进行大体观察、组织学观察及透射电镜比较各组间瘢痕形成和粘连情况.结果 B、C、D组的Rydell-Balazs粘连度评分、Nussvaum组织学评分均优于A组(P<0.01),D组优于B组和C组(P<0.01),B组与C组间差异无统计学意义(P>0.05).结论 联合应用几丁糖加聚乳酸薄膜能有效预防硬膜外瘢痕粘连,比单独应用几丁糖或聚乳酸薄膜效果好.  相似文献   

10.
目的 观察几丁糖加聚乳酸薄膜联合运用对椎板切除术后预防硬膜外瘢痕粘连的效果.方法 80只成年家兔[体质量(2.0±0.2)kg]制作椎板切除模型,在椎板缺损处分别覆盖等渗盐水(A组)、聚乳酸薄膜(B组)、几丁糖(C组)及几丁糖加聚乳酸薄膜(D组),术后12周对椎板切除部位进行大体观察、组织学观察及透射电镜比较各组间瘢痕形成和粘连情况.结果 B、C、D组的Rydell-Balazs粘连度评分、Nussvaum组织学评分均优于A组(P<0.01),D组优于B组和C组(P<0.01),B组与C组间差异无统计学意义(P>0.05).结论 联合应用几丁糖加聚乳酸薄膜能有效预防硬膜外瘢痕粘连,比单独应用几丁糖或聚乳酸薄膜效果好.  相似文献   

11.
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 (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.  相似文献   

12.
Don Dame 《Artificial organs》1996,20(5):613-617
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.  相似文献   

13.
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.  相似文献   

14.
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.  相似文献   

15.
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.  相似文献   

16.
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.  相似文献   

17.
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.  相似文献   

18.
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.  相似文献   

19.
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.  相似文献   

20.
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.  相似文献   

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