不同年龄胃癌患者空肠黏膜结构变化与术后早期肠内营养耐受性的关系

目的 探讨不同年龄的胃癌患者李肠黏膜结构变化与肠内营养（EN）耐受性的关系。方法 选择行根治性全胃切除的胃瘵患者30例．65岁以上的16例为高龄组．14例40岁以下者为低龄组。术中取全层空肠黏膜标本行光镜、电镜检查，测量空肠黏膜的厚度、绒毛的高度、宽度，观察空肠上皮细胞的超微结构：术后行早期EN治疗，观察患者EN相关并发症如腹痛、腹胀、腹泻、恶心呕吐、倾倒综合征等情况，结果高龄组患苦术后早期EN时腹胀、腹泻发生比例明显高于低龄组（P〈O．01），且空肠绒毛短而宽．空肠黏膜薄（P〈0．05）：电镜结果显示，低龄组患者空肠上皮细胞微绒毛排列整齐、致密．长短一致；而高龄组微绒毛排列不整齐、稀疏，长短不一．、低龄组空肠上皮细胞线粒体结构正常，高龄组线粒体肿胀、嵴断裂、溶解甚至出现空泡化的结构改变。高龄组EN治疗发生腹胀腹泻患者与低龄组比较，其空肠黏膜薄，空肠绒毛短而粗（P〈0．05）。结论高龄患者空肠黏膜呈萎缩性改变可导致术后EN胃肠道并发症发生比例增加．致EN耐受性差；EN腹胀腹泻的发生可能与空肠黏膜萎缩及细胞线粒体肿胀、嵴断裂、溶解等改变有关．     

食管贲门癌患者术后早期肠内营养中输液增温器的应用

目的观察输液增温器加温营养液对食管贲门癌患者术后早期肠内营养后胃肠功能的影响。方法将104例食管贲门癌根治术后早期应用肠内营养支持的患者分为对照组（53例）和观察组（51例），对照组进行肠内营养时按常规经营养管输注营养液，观察组进行肠内营养时采用输液增温器对营养液予持续恒定加温，观察术后胃肠功能恢复情况和相关胃肠道并发症发生情况。结果观察组术后首次肛门排气时间、首次排便时间较对照组显著提前（均P〈0．01），术后腹胀发生率减少（P〈0．05）。结论输注营养液时应用输液增温器予持续恒定加温．增温效果确切稳定．减少了因营养液温度不适造成的胃肠道反应,有利于促进胃肠功能。     

食管贲门癌术后早期肠内与肠外营养的对比观察

目的探讨食管、贲门癌术后早期应用肠内营养（EN）的可行性、安全性和临床效果，并与肠外营养（PN）进行比较。方法将行食管、贲门癌切除的86例患者随机分为EN组与PN组各43例，分别于术后24h开始进行EN与PN，比较两组术后肠蠕动恢复时间、术后10d体重与术前1d体重下降差值及营养支持费用。结果两组在观察期间均无死亡及严重并发症发生，EN组肠蠕动恢复时间较PN组显著缩短，术后体重较PN组有明显改善，且营养支持费用显著低于PN组（P〈0．05．P〈0．01）。结论食管、贲门癌术后早期应用EN支持安全、可行，不仅有助于肠道功能恢复，善机体营养状态，降低并发症，而且能减少医疗费用。     

外科护士对围术期常规检查认知情况的调查

目的 探讨自制肠内营养液在食管癌术后患者早期应用的临床疗效。方法 将100例食管癌患者随机分为观察组和对照组各50例。对照组采用常规全胃肠外营养治疗方法，即术后静脉输入营养混合液，停止胃肠减压后过渡至肠内营养；观察组采用术中置入鼻肠管，术后24～48h经鼻肠管滴注自制肠内营养液。结果 观察组肛门排气时间、住院时间显著短于对照组（均P〈0．01）；并发症发生率显著低于对照组（P〈0．05）。结论 食管癌术后早期应用自制肠内营养液，对维持机体的正常代谢功能，减少并发症的发生有重要作用。     

老年胃癌病人术后促进肠功能恢复措施的探讨

目的：探讨老年胃癌病人术后肠功能恢复的措施。方法：将79例病人分为观察Ⅰ组、观察Ⅱ组和对照组，对照组采用常规护理；观察Ⅰ组在常规护基础上注意早期活动；观察Ⅱ组在观察Ⅰ组基础上，施行早期肠内营养。结果：观察Ⅰ、Ⅱ组病人排便时间及观察Ⅱ组排气时间与对照组比较，差异有极显著性意义（P＜0．01），观察Ⅰ组排气时间与对照组比较，差异有显著性意义（P＜0．05）；观察Ⅱ组排气，排便时间均较观察Ⅰ组明显缩短（P＜0．01）。结论：术后早期活动并施行早期肠内营养能有效促进老年胃癌病人肠功能恢复。     

术中保温对胰十二指肠切除患者体温及凝血功能的影响

目的：观察术中采取保温措施对胰十二指肠切除患者体温及凝血功能的影响。方法：将60例择期行胰十二指肠切除术患者随机分为对照组和观察组各30例。对照组按常规进行手术；观察组在常规手术的基础上，采取电子加温毯、充气温控毯加强躯体保温，采用输液加温器对输入液体进行加温。两组分别于患者麻醉前、手术开始后30、90、180、270min及术毕测量患者肛温及凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）。结果：随着手术的进行，不同时间的体温及各项凝血指标比较，差异有显著性意义（均P〈0．01）；对照组手术开始后及结束时体温下降，PT、APTT、TT延长，观察组波动较小，两组比较，差异有显著性意义（均P〈0．01）。结论：胰十二指肠切除患者术中采取电子加温毯、充气温控毯和输液加温器等保温措施可维持患者的体温及凝血功能。     

全胃切除术后不同营养支持方式对患者免疫功能的影响

目的探讨全胃切除术后不同营养支持方式对患者免疫功能的影响。方法选择行全胃切除术患者33例，随机分为肠内营养组（17例，EN组）和肠外营养组（16例，PN组），分别于手术前后检测外周血补体和免疫球蛋白水平及各种淋巴细胞百分率的变化，并观察感染性并发症发生率及胃肠功能恢复时间。结果术后第1天．两组患者补体、免疫球蛋白及淋巴细胞百分率均较术前明显下降（P〈0．05）；而术后第8天，EN组补体及免疫球蛋白水平较术后第1天有所恢复（P〈0．01），且改变量与PN组比较差异有统计学意义（P〈0．05）。术后第8天，两组患者淋巴细胞百分率及EN组的CD4^＋／CD8^＋较术后第1天有所恢复（P〈0．01）；EN组淋巴细胞百分率的改变量与PN组比较差异有统计学意义（P〈0．01）。PN组术后感染性并发症的发生率（31.3％）高于EN组（5．9％）（P〈0．05）。结论全胃切除术后患者EN支持较PN支持能更好地促进免疫功能的恢复，降低肺内感染的发生率。     

肾移植病人家庭护理干预效果分析

目的：了解家庭护理干预对社区肾移植病人生活质量的影响。方法：将200例出院后肾移植病人随机分为两组，干预组（100例）进行生理，心理，社会行为等护理干预，对照组（100例）未实施干预，运用日常生活能力量表（ADL），社会功能评定量表（SDSS），抑郁自评量表（SDS）及护理依赖性评估干预前后的效果进行分析，比较；同时比较两组并发症发生情况。结果：干预组病人的心理功能，社会功能及日常生活能力较干预前显著改善，差异有极显著性意义（均P＜0．01），两组并发症发生率比较，差异有极显著性意义（P＜0．01），结论：家庭护理干预可提高肾移植病人的生活质量，减少术后并发症的发生率。     

护理干预对体外震波碎石术疗效的影响

目的：探讨护理干预对体外震波碎石术疗效的影响。方法：将490例碎石治疗的尿石症病人随机分为对照组230例，观察组260例。对照组采取常规护理，观察组分别在碎石前、中、后进行护理干预（建立干预基础以及采取认知、情绪、行为干预）。比较两组术中疼痛情况、治疗效果及并发症发生率。结果：观察组术中疼痛发生率为6．92％，术后并发症发生率5．00％，碎石有效率达99．23％；对照组分别为28．26％、16．09％、96．09％，两组比较，差异有极显著性意义（均P＜0．01）。结论：护理干预能提高体外震波碎石术法疗效果，降低并发症的发生率。     

改良管饲法对脑卒中预后的影响

目的：提高脑卒中病人的管饲效果。方法：将80例脑卒中病人随机分为对照组和观察组各40例，对照组行常规管锔营养，观察组采用早插管引流胃液，管内注入胃粘膜保护剂，止血剂，胃肠动力药物，并在管饲的温度，速度，食物量，餐次，体位上进行观察与调整。结果：观察组病人并发消化道出血、肺炎及胃肠功能障碍明显低于对照组（均P＜0．05），吞咽功能及神经功能的恢复优于对照组（均P＜0．01）。结论：改 良管饲营养厅减少脑卒中病人并发症的发生，促进吞咽及神经功能的恢复。     

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.