突变型p53与Nampt在胃癌组织中的表达及其与预后的关系

目的：探讨突变型p53（mutp53）和尼克酰胺磷酸核糖转移酶（Nampt）在胃癌组织中的表达及其对患者预后的影响。方法：用免疫组化法检测68例胃癌患者胃癌组织及癌旁正常胃黏膜组织中p53（免疫组化检测到的p53主要为mutp53）与Nampt的表达,分析mutp53与Nampt表达与患者临床病理因素及预后的关系。 结果：胃癌组织中mutp53与Nampt的阳性表达率均明显高于癌旁正常胃黏膜组织（均P<0.05）;mutp53的高表达与肿瘤大小、浸润深度、淋巴结转移及TNM分期有关,而Nampt的高表达与肿瘤浸润深度、淋巴结转移及TNM分期有关（均P<0.05）。胃癌组织中,p53表达与Nampt表达呈明显正相关（r=0.982,P<0.05）。p53阳性表达患者的中位生存期明显短于阴性表达患者,且在p53阳性表达患者中,Nampt同时阳性患者的中位生存期明显短于Nampt阴性患者（均P<0.05）。结论：mutp53与Nampt的表达均与胃癌的恶性生物学行为相关,且两者存在一定的关联性,同时高表达患者预后差。

     

p53对胃癌细胞BGC823中Survivin基因表达的影响

目的 探讨p53基因对胃癌细胞株BGC823中Survivin基因表达的影响及其作用机制。方法 应用逆转录-聚合酶链反应（RT-PCR）和Western blot技术检测胃癌细胞株BGC823中Survivin和p53基因表达情况；利用质粒pcDNA3．0-rpS3转染该细胞株。应用实时聚合酶链反应（PCR）和Western blot检测细胞在培养后不同时间点Survivin mRNA和蛋白表达水平。结果 确认了胃癌细胞株BGC823中Survivin和突变型p53基因的表达。受野生型p53质粒转染的胃癌细胞在培养16和24h后，Survivin mRNA和蛋白质水平呈明显下降趋势。结论 野生型p53在转染胃癌细胞株BGC823后可显著抑制后者Survivin基因的转录和表达。     

miR-137与胃癌侵袭能力的关系研究

目的:探讨胃癌组织mi R-137的表达及其与胃癌细胞侵袭能力间的关系。方法:用q RT-PCR检测胃癌组织与癌旁组织mi R-137的表达,分析mi R-13表达与胃癌临床病理特征的关系;分别用q RT-PCR与Transwell侵袭实验检测3种胃癌细胞(AGS、SGC7901、BGC823)及正常胃黏膜细胞(GES1)mi R-137的表达与穿膜。结果:胃癌组织中mi R-137表达量明显低于癌旁组织(P<0.05),mi R-137表达与胃癌患者T分期有关,T分期越高mi R-137表达量越低(P<0.05);各胃癌细胞mi R-137表达量均低于正常胃黏膜细胞,且胃癌细胞侵袭力越强胃癌细胞mi R-137表达量越低(P<0.05);穿膜细胞数与mi R-137表达量之间呈明显负相关(r=-0.8881,P<0.05)。结论:胃癌组织mi R-137表达降低,且mi R-137表达量越低提示胃癌细胞侵袭能力越强。     

胃癌中硒结合蛋白-1的表达及其临床病理学意义

目的 检测硒结合蛋白1(SBP1)在胃癌细胞系SGC7901、BGC823、正常胃黏膜上皮细胞系GES-1、胃癌组织以及正常胃黏膜组织中的表达水平,分析其表达变化与胃癌临床病理因素之间的联系,探讨其作为胃癌标记物的可能性.方法 回顾性分析2006年至2007年武汉大学中南医院收治的135例胃癌患者的临床资料,利用免疫组织化学染色法对胃癌组织及16例正常胃黏膜组织中SBP1蛋白表达部位及水平进行测定,并进行半定量评分.Western blot和RT-PCR检测细胞系SGC7901、BGC823、GES-1中SBP1蛋白和mRNA的表达水平.组间比较采用单因素方差分析,SBP1表达强度与临床病理因素的关系采用x2检验.结果 SBP1 mRNA在胃癌细胞系BGC823、SGC7901中的表达分别为0.120±0.020、0.133±0.015,显著低于其在正常胃黏膜上皮细胞系GES-1中的表达(0.907±0.015)(F=2106.462,P＜0.05).胃癌细胞系BGC823、SGC7901中的SBP1蛋白表达分别为0.253±0.015、0.273±0.015,显著低于其在正常胃黏膜上皮细胞系GES-1中的表达水平(0.877±0.025)(F=1026.758,P＜0.05).3例胃癌组织中SBP1呈强免疫反应,而16例正常胃黏膜中SBP1呈强免疫反应.SBP1蛋白表达减少与胃癌患者临床分期相关(x2=12.629,P＜0.05),而与患者的性别、年龄、肿瘤组织学分型、分化程度、浸润深度以及淋巴结转移无关(x2=2.142,0.860,1.838,5.001,4.858,1.994,P＞0.05).结论 SBP1表达减少可以作为一种胃癌诊断的新指标.SBP1下调在胃癌发生及进展中可能发挥着重要作用.     

THBS2表达与胃癌血管生成以及预后的关系

目的：探讨胃癌组织中血小板反应蛋白2（THBS2）的表达及其与胃癌血管生成、预后的关系。 方法：采用组织芯片和免疫组化技术检测120例胃癌和36例癌旁正常胃黏膜组织中THBS2、VEGF、MMP-2、MMP-9的表达以及CD34标记微血管密度（MVD）。同法检测总生存期≥10年的40例胃癌患者癌组织（长生存期组）和总生存期≤3年的30例胃癌患者癌组织（短生存期组）的THBS2的表达,比较两组患者的THBS2表达差异。 结果：THBS2在胃癌组织中阳性表达率明显低于正常胃黏膜组织（P<0.05）,而VEGF、MMP-2、MMP-9的阳性表达率及MVD值明显高于正常胃黏膜组织（均P<0.05）;THBS2阳性胃癌组织中MVD值明显低于THBS2阴性胃癌组织,而VEGF阳性胃癌组织中MVD值明显高于VEGF阴性胃癌组织（均P<0.05）;胃癌组织中THBS2的表达与VEGF、MMP-2、MMP-9呈明显负相关（r=-0.574、 -0.447、-0.599,均P<0.01）。长生存期组患者胃癌组织THBS2的阳性表达率明显高于短生存期组（P<0.05）。 结论：THBS2在胃癌中低表达,从而可能通过促进VEGF、MMP-2、MMP-9的表达影响胃癌的血管生成和预后。     

CDH17对胃癌细胞侵袭性的影响及其机制

目的:探讨CDH17在胃癌细胞中的表达及其对胃癌侵袭性的影响。方法:分别用Transwell侵袭实验、免疫荧光染色及Western blot法检测正常胃黏膜GES-1细胞和胃癌MGC803细胞与BGC823细胞的侵袭力与CDH17、上皮标志物E-cadherin、间质标志物N-cadherin的表达,以及两种胃癌细胞转染CDH17si RNA后以上指标的变化。结果:正常胃黏膜GES-1细胞无穿膜细胞、无CDH17与N-cadherin表达,而有明显的E-cadherin表达;与GES-1细胞比较,两种胃癌细胞均有明显的穿膜细胞及明显的CDH17与N-cadherin表达,而E-cadherin呈低表达(均P0.05),且高侵袭力的MGC803细胞上述变化较低侵袭力的BGC823细胞更为明显;两种胃癌细胞转染CDH17si RNA后,上述指标变化较转染前明显抑制(均P0.05),且在两种细胞间的差异缩小(均P0.05)。结论:CDH17高表达可能通过上皮间质转化促进胃癌细胞系侵袭性。     

miR-193b对胃癌细胞浸润和转移的影响

目的:探讨miR-193b转染对胃癌细胞浸润、转移的影响及其作用机制。 方法:应用microRNA芯片检测TGF-β1处理胃癌细胞BGC823前后miRNA的差异表达谱;应用划痕实验,transwell 迁移浸润及裸鼠成瘤等实验分别检测瞬时转染miR-193b抑制剂前后胃癌细胞株生物学行为的变化。 结果:TGF-β1处理胃癌细胞BGC823前后miRNA的表达谱存在6个差异表达,包括3个（miR-27a, miR-29b-1和 miR-194）表达上调,3个（miR-193b, miR-574-3p和miR-130b）表达下调。转染miR-193b 抑制剂后,胃癌细胞株BGC823迁移、浸润和转移的能力明显增强。 结论:TGF-β1可能通过下调miR-193b的表达负向调控胃癌细胞的迁移、浸润和转移。     

纳米磁流体-单纯疱疹病毒胸苷激酶重组质粒的构建及其对胃癌细胞增殖的影响

目的研究hTERT启动子调控下单纯疱疹病毒胸苷激酶（HSV-tk）重组质粒的构建、在人胃癌细胞BGC823中的表达及对胃癌细胞BGC823增殖的影响。方法构建重组质粒pGL3-hTERT-tk和相应的荧光报告质粒pGL3-hTERT-tk-Luc＋：经纳米磁流体PEG-PEI／Fe304转染胃癌细胞BGC823．荧光显微镜观察细胞形态变化和转染效率．免疫组织化学（免疫组化）方法检测目的基因在胃癌细胞BGC823中的表达．M1Tr法检测胃癌细胞BGC823的增殖能力．以上实验均以正常肝细胞L02为对照。结果重组质粒pGL3-hTERT-tk构建成功,其长度为1100bp。荧光素酶标记的阳性、阴性对照及治疗报告质粒pGL3-hTERT-TK-Luc＋均能有效转染高表达端粒酶活性的胃癌细胞BGC823,转染效率为（28．1±2．3）％。免疫组化结果显示,重组质粒组胃癌细胞BGC823的细胞质中可见大量HSV-tk基因编码的表达。MqT检测结果示．转染pGL3．hTERT-tk质粒4d后．BGC823细胞增殖受抑制．其A,,值为0．254±0．011,低于L02细胞的0．322±0．013;亦低于pGL3-basic-tk转染的BGC823细胞（0．357±0．014）（均P〈0．05）。结论纳米磁流体能将重组质粒pGL3-hTERT．tk转染BGC823细胞并获得表达,PEG-PEI／Fe3O4纳米磁流体-tk可显著抑制BGC823细胞增殖。有望成为胃癌基因治疗的新型生物制剂之一。     

胃癌中p16、p53蛋白表达与细胞增殖、浸润、转移及预后的关系

目的 探讨p16、p53蛋白表达与胃癌细胞增殖、浸润、转移及预后的关系。方法 应用免疫组化S－P法研究100例胃癌，20例中、重度异型增生，16例萎缩性胃炎和10例正常胃黏膜p16、p53蛋白和增殖细胞核抗原（PCNA）的表达。结果 正常胃黏膜p16阳性率为80％,p53未表达。萎缩性胃炎、异型增生和胃癌组织中p16阳性率分别为68．8％、35％和43％；p53阳性率分别为12．5％、25％和56％。p16在胃癌中的阳性率与预后明显相关（P＜0．05）；p53阳性率与肿瘤病理分级、Lanren分型有显著相关（P＜0．05），与预后关系密切（P＜0．01）。从正常胃黏膜到病变组织PCNA指数逐渐上升，以异型增生、胃癌细胞增殖显著（P＜0．01），癌细胞PCNA指数p16阴性组，p53阳性组高于对照组，与肿瘤大小、浸润浓度密切相关（P＜0．05）。p16、p53阳性表达具有协同性（P＜0．05）。结论 胃黏膜中、重度异型增生有较高的增殖活性，基因水平上已表现出癌变特性，是癌变发生过程中的一个重要阶段。p16、p53蛋白表达在胃癌的发生发展中起重要作用，可作为判断预后的可靠指标。     

大肠癌中抑制基因BCL-2、p53与Beclin-1的表达及其与肠癌生物学行为的关系

目的：探讨Beclin-1与BCL-2、p53蛋白在大肠癌中的表达意义及其与肠癌生物学行为的关系。 方法：采用免疫组化法检测20例正常大肠黏膜、38例大肠黏膜异型增生和92例结直肠癌组织中Beclin-1与BCL-2、p53蛋白的表达水平,并结合结直肠癌的生物学行为和患者的生存率进行分析。 结果：Beclin-1蛋白在病变大肠组织中的表达率显著高于正常大肠黏膜（P<0.05）,但其与结直肠癌Dukes分期、肿瘤分化程度和淋巴结转移均无明显关系（P>0.05）;BCL-2和p53蛋白在病变大肠组织中的阳性表达率较高,但在正常大肠黏膜中几乎不表达（P<0.05）;BCL-2和p53的表达还与结直肠癌Dukes分期及淋巴结转移有关（P<0.05）;相关性分析显示,Beclin-1与p53蛋白的表达呈正相关（r=0.342,P<0.05）,且p53蛋白阴性表达的患者5 年生存率较阳性表达者高（P<0.05）。 结论：在大肠组织中,Beclin-1与BCL-2、p53基因相互协作,对其异常及癌变起到重要作用,三者的表达情况可作为大肠癌病程进展及预后的参考指标。     

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.