胃大部切除术后残胃胃瘫综合征临床分析

目的探讨胃大部切除术后残胃胃瘫综合征(PGS)的病因、诊断及治疗。方法对20例胃大部切除术后发生胃瘫综合征的发病因素、临床表现、诊断方法及治疗手段进行分析。结果术前流出道梗阻和胃肠吻合方式是术后PGS的高危因素。胃镜、X线口服造影对PGS的诊断有价值。经非手术治疗,术后PGS在术后6周内一般可以恢复。结论胃大部切除术后残胃胃瘫综合征在术前流出道梗阻、胃肠毕Ⅱ式吻合的病人中发病率较高,患者经过6周的非手术治疗后,多数可以缓解恢复,从而避免了二次手术的痛苦。     

根治性胃大部切除术后胃瘫15例临床分析

目的 为探讨根治性远端胃大部切除术后胃瘫发生的病因,寻找诊断及治疗方法。方法 以根治性胃大部切除术后发生胃瘫的１５例,对其发生率,发生时间、临床表现及诱发因素进行分析,结果 除糖尿病外,术前流出道梗阻、胃肠比Ⅱ式吻合病人的发病率较高。胃镜、Ｘ线检查,核素标记胃排空测定对胃瘫诊断有价值。经非手术治疗,在术后６周内一般都能恢复。结论 胃镜检查时对残胃适度刺激对胃瘫治疗有价值,应用避免再手术。     

胃癌根治性胃大部切除术后胃瘫的危险因素分析

目的：探讨根治性胃大部切除术后发生胃瘫的危险因素及防治措施。 方法：回顾性分析2006年6月—2013年6月568例行胃癌根治性胃大部切除术患者的临床资料,其中31例发生术后胃瘫综合征（PGS）;以是否发生胃瘫为因变量,以选取的17项相关指标为自变量,进行非条件Logistic回归分析。 结果：多因素Logistic回归分析结果显示：术前合并幽门梗阻、精神紧张、术中Billroth II式吻合、术中淋巴结清扫范围（D3）、术后使用镇痛泵、术后血糖水平、术后肠内营养开始时间、术后腹腔感染、术后吻合口瘘是PGS发生的危险因素(OR>1,P<0.05),围手术期血红蛋白水平和总蛋白水平是PGS发生的保护因素（OR<1,P<0.05）。 结论：胃癌根治性胃大部切除术PGS的发生与多种因素有关,积极做好相关危险因素的处理工作,对防治PGS的发生意义重大。

     

胃切除术后残胃胃瘫综合征的临床总结

目的探讨胃大部切除术后残胃胃瘫综合征(PGS)的发生原因、机制、诊断及治疗。方法对1972年1月至2002年6月4955例胃大部切除术后出现PGS的46例患者的临床资料进行回顾性总结。结果本组PGS发生率0.92%,均发生于术后5～8d。44例非手术治愈,15d内治愈12例,16d10例,18d15例,21d2例,22d2例,25d2例,27d1例。2例于胃大部切除术后14d和15d再次手术加行胃肠或肠肠吻合仍未缓解,继续内科治疗,分别于术后20d和30d治愈。结论PGS的发生是由多种因素诱发。诊断时必须排除机械性、器质性病变。上消化道造影及胃镜检查是诊断PGS的可靠方法。采用非手术疗法均可治愈,手术治疗应列为禁忌证。     

胃癌术后胃瘫综合征的危险因素分析及其对预后的影响

目的 探讨胃癌根治性胃大部切除术后胃瘫综合征(PGS)的临床危险因素及PGS发生对患者预后的影响.方法 回顾性总结浙江省湖州市中心医院2004年1月至2010年5月间收治的422例行根治性胃大部切除术胃癌患者的临床资料,分析术后PGS的危险因素,并比较出现PGS与未出现PGS患者的术后无复发生存情况.结果 422例患者术后PGS发生率为9.5％(42/442).单因素分析显示,年龄大于65岁、术前合并焦虑症和低蛋白血症、术前存在幽门梗阻、术后血糖升高、毕Ⅱ式吻合、手术时间超过4h、术后使用自控型镇痛泵以及术后日补液量超过3500 ml者PGS发生率较高(均P＜0.05),这9项因素可作为PGS发生的潜在临床危险因素.相关分析显示,合并临床危险因素的个数与PGS发生率呈线性正相关(r=0.967,P＜0.05).术后215例(50.9％)患者获得了3～60个月的随访,其中30例发生PGS患者和185例未发生PGS患者的术后平均无复发生存时间分别为26.1和33.4个月,差异有统计学意义(P=0.029).结论 具有临床危险因素的胃癌患者行胃大部切除术后PGS发生概率增加,且PGS的发生会影响患者预后.     

胃大部切除术后胃瘫综合征的治疗

回顾性分析2000—2004年421例因胃癌行根治性胃大部切除术后发生胃瘫综合征（PGS）17例的临床资料。结果示PGS患病率为4.04%。术后补液量较多（P﹤0.001）及白蛋白（清蛋白）降低程度较严重（P﹤0.001）是PGS的高危因素。经限制性补液及充分的蛋白补充、适当的营养支持，所有病例均于5周内恢复。提示限制性补液及充分、合理的营养支持是治疗术后PGS的重要手段。     

胃大部切除术后胃瘫综合征的临床危险因素分析

目的探讨胃大部切除术后胃瘫综合征(PGS)的临床危险因素。方法回顾性研究我院近年来行胃大部切除术后PGS及无PGS病例的临床资料。结果全组年龄65岁以上,术前合并焦虑症、糖尿病、低蛋白血症,术前存在幽门梗阻,毕Ⅱ式胃肠吻合,手术时间>4h,术后使用自控型镇痛泵,日补液量>3500ml患者PGS发生率较高。结论上述因素可能是胃大部切除术后PGS发生的高危因素,在围手术期纠正或避免这些高危因素对预防PGS发生有意义。     

胃大部切除术后胃瘫综合征的相关因素分析

目的　探讨胃大部切除术后胃瘫综合征 (PGS)的诱发因素 ,从而为PGS的预防及治疗提供依据。方法　回顾性分析 167例胃大部切除术后 13例发生PGS患者的临床资料 ,并对多种因素进行Logistic回归分析 ,找出PGS的关联因素。 结果　病人自控性静脉镇痛、硬膜外麻醉联合全身麻醉、术前低钾血症与PGS的发生有显著相关性。结论　PGS是多因素诱发的     

胃癌根治术后胃瘫综合征的危险因素分析及其对预后的影响

探讨胃癌根治术后发生术后胃瘫综合征(PGS)的危险因素及其对患者预后的影响。回顾23例行根治性远端胃大部切除术治疗的胃癌患者的临床资料,按照1:2选择无PGS患者作为对照组,对可能影响PGS的病理因素行单因素分析与Logistic多元回归分析。出院后随访3年,比较两组患者1~3年生存率。单因素分析结果显示,年龄、糖尿病、低蛋白血症、幽门梗阻、手术方式、胃空肠吻合方式、淋巴结清扫范围及术后并发症8个因素可能影响PGS;Logistic多元回归分析显示,糖尿病、低蛋白血症、幽门梗阻、毕Ⅱ式胃远端大部分切除术和第3站淋巴结清扫为PGS发病的危险因素。两组患者1、2、3年生存率比较差异无统计学意义(P0.05)。PGS的发生与多种因素有关,避免危险因素对降低PGS的发生几率和改善胃癌患者的生活质量具有重要意义。     

根治性远端胃大部切除术后胃瘫危险因素的分析

目的探讨根治性远端胃大部切除术后胃瘫发生的危险因素。方法对7年间收治的508例行根治性远端胃大部切除术患者的临床资料进行回顾性分析。以手术后是否发生胃瘫为因变量,进行单因素及多因素非条件Logistic逐步回归分析。结果 25例术后发生胃瘫,单因素分析显示16个因素中有9个与术后胃瘫发生有关。非条件Logistic逐步回归分析模型共筛出10个术后胃瘫的相关因素。结论术前幽门梗阻、毕Ⅱ式胃肠吻合方式、淋巴结清扫范围、术后血糖水平、术后腹腔感染、术后吻合口瘘、术后开始行肠内营养时间、术前情绪紧张为术后胃瘫的危险因素;而术前血红蛋白水平及术后总蛋白水平为术后胃瘫的保护性因素。     

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.     

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.     

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.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.