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1.
沈世彬  高慧珊  黄浩然  王宾  周政纲  李亮 《骨科》2023,14(5):407-412
目的 探讨3D打印导板辅助经皮椎间孔镜下腰椎间盘切除术(PELD)治疗腰椎间盘突出症(LDH)的临床效果。方法 选取2020年8月至2021年8月在我院采用PELD治疗单节段LDH的48例病人,根据是否采用3D打印导板辅助手术分为导板组和对照组。导板组24例,采用3D打印导板辅助下穿刺行PELD治疗,对照组24例,采用单纯PELD治疗。比较两组的手术时间、术中出血量、穿刺次数、穿刺时间、透视次数、住院时间,比较两组在术前及术后不同时间的疼痛视觉模拟量表(VAS)评分、日本骨科协会(JOA)评分、改良MacNab疗效评价和术后并发症发生率。结果 病人随访(9.33±1.24)个月(7~12个月)。导板组病人的手术时间、术中出血量、穿刺次数、穿刺时间、透视次数及住院时间均明显低于对照组,差异有统计学意义(P<0.05)。两组术后VAS评分均低于术前,差异有统计学意义(P<0.05);导板组在术后1天、1周时的VAS评分低于对照组,差异有统计学意义(P<0.05);但两组术后1个月、3个月的VAS评分比较,差异无统计学意义(P>0.05)。两组术后JOA评分均较术前明显升高,差异有统计学意义(P<0.05);但组间各时间段的JOA评分比较,差异无统计学意义(P>0.05)。两组末次随访改良MacNab标准的优良率、并发症发生率比较,差异均无统计学意义(P>0.05)。结论 通过3D打印导板辅助PELD治疗单节段LDH,手术效果确切,明显提高了穿刺准确性,减少了因反复穿刺而带来的手术创伤及辐射伤害,提高了手术效率、缩短了手术时间,对术后短期内疼痛的缓解作用显著,具有良好的临床使用前景。  相似文献   

2.
目的 比较计算机导航技术辅助定位穿刺和常规定位穿刺行经椎间孔入路经皮内窥镜下椎间盘切除术(PETD)治疗腰椎椎间盘突出症(LDH)的临床疗效。方法 2018年10月—2019年4月,贵港市人民医院采用PETD治疗LDH患者70例,根据穿刺方法分为计算机导航辅助定位穿刺组(导航组)和常规定位穿刺组(常规组),每组35例。记录并比较2组手术时间、透视时间、透视次数、穿刺时间、穿刺次数及并发症发生情况。采用疼痛视觉模拟量表(VAS)评分评估2组患者腰部及下肢疼痛情况,采用日本骨科学会(JOA)评分和Oswestry功能障碍指数(ODI)评估术后功能恢复情况。结果 所有手术顺利完成。导航组手术时间、透视时间、透视次数、穿刺时间、穿刺次数均少于常规组,差异有统计学意义(P < 0.05)。2组术后腰痛VAS评分、下肢痛VAS评分、JOA评分及ODI均较术前显著改善,差异有统计学意义(P < 0.05),组间比较差异无统计学意义(P > 0.05)。导航组术后出现LDH复发2例、脱出椎间盘残留2例,常规组术后出现LDH复发2例、脱出椎间盘残留4例,根据严重程度行非手术或再次手术治疗后症状均缓解。Pearson相关分析显示,透视次数、透视时间、穿刺次数、穿刺时间及手术时间之间存在高度相关性。结论 计算机导航技术辅助定位穿刺行PETD可减少透视和穿刺的次数和时间,进而减少手术时间及降低医患的辐射暴露,值得临床推广。  相似文献   

3.
目的 比较骨科机器人辅助经皮椎弓根螺钉内固定术治疗胸腰段骨折与传统后路椎弓根螺钉内固定术、C形臂X线机透视导航经皮椎弓根螺钉内固定术的临床疗效,探讨机器人辅助手术治疗胸腰段骨折的微创化与精准化价值。方法 2018年2月—2019年6月,收治无神经症状胸腰段骨折患者52例,18例接受机器人辅助经皮椎弓根螺钉内固定术治疗(机器人组),15例接受C形臂X线机透视导航经皮椎弓根螺钉内固定术治疗(透视组),19例接受传统后路椎弓根螺钉内固定术治疗(传统组)。记录并比较3组的手术时间、透视时间、辐射剂量、术中出血量、置钉准确率、卧床时间、住院天数,术前、术后6个月伤椎前缘相对高度及Cobb角,以及术前、术后3 d、术后6个月的疼痛视觉模拟量表(VAS)评分和日本骨科学会(JOA)评分。结果 所有手术顺利完成,未出现手术相关并发症。所有患者随访6~12个月,平均8个月。机器人组和透视组的手术时间、术中出血量、卧床时间、住院天数均少于传统组,差异有统计学意义(P<0.05);透视组透视时间最长、辐射剂量最大,机器人组透视时间最短、辐射剂量最少,差异有统计学意义(P<0.05);机器人组置钉准确率高于透视组和传统组,差异有统计学意义(P<0.05)。3组患者术后6个月伤椎前缘相对高度、Cobb角、VAS评分和JOA评分均较术前改善,差异有统计学意义(P<0.05)。3组术前、术后3 d和术后6个月伤椎前缘相对高度、Cobb角及JOA评分差异无统计学意义(P>0.05);机器人组与透视组术后3 d VAS评分优于传统组且差异有统计学意义(P<0.05),术前及术后6个月3组VAS评分差异无统计学意义(P>0.05)。结论 机器人辅助经皮内固定术是治疗无神经症状胸腰段骨折的有效方法,具有手术时间短、精度高、创伤小、辐射少、患者术后恢复快等优势,满足适应证时可作为优先选择。  相似文献   

4.
目的 探讨“天玑”骨科机器人辅助经椎间孔入路脊柱内窥镜手术治疗单节段腰椎椎间盘突出症(LDH)的临床效果。方法 2018年6月—2020年6月,北京积水潭医院收治单节段LDH患者33例,其中16例采用传统经椎间孔入路脊柱内窥镜手术治疗(A组),17例采用“天玑”骨科机器人辅助经椎间孔入路脊柱内窥镜手术治疗(B组)。记录术中医师及患者辐射暴露次数;麻醉后体位摆放完成至置入工作通道总时间(T0);穿刺针刺破皮肤至导针初次放置到满意位置的时间(T1);导针放置完成到置入工作通道时间(T2);其他时间(T3),A组包括穿刺前透视定位穿刺点等时间,B组包括示踪器放置、术中X线扫描、穿刺通道制订等时间。记录术前和术后3 d、1个月、6个月时腿痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)和日本骨科学会(JOA)评分。结果 所有手术顺利完成,无并发症发生。B组医师辐射暴露次数明显少于A组,患者辐射暴露次数明显多于A组,差异均有统计学意义(P < 0.05)。2组T0差异无统计学意义(P > 0.05);B组T1、T2比A组短,T3比A组长,差异均有统计学意义(P < 0.05)。2组术后各时间点腿痛VAS评分、ODI和JOA评分明显优于术前,差异均有统计学意义(P < 0.05),术后各时间点组间差异无统计学意义(P > 0.05)。结论 “天玑”骨科机器人辅助经椎间孔入路脊柱内窥镜手术治疗单节段LDH临床效果良好,且术中医师辐射暴露次数少,穿刺操作准确、便捷,稳定性可靠。  相似文献   

5.
目的 探讨电磁导航辅助经椎间孔脊柱内窥镜系统(TESSYS)靶向定位穿刺治疗腰椎椎间盘突出症(LDH)的临床价值。方法 回顾性分析2018年4月—2019年4月在洛阳正骨医院接受TESSYS治疗的72例LDH患者临床资料,其中36例术中采用电磁导航靶向定位穿刺(导航组),另36例采用常规定位穿刺(常规组)。记录手术时间、透视次数、透视时间、穿刺时间、减压时间及相关并发症发生情况。采用疼痛视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分、Oswestry功能障碍指数(ODI)及改良MacNab标准评价临床疗效。结果 所有手术顺利完成,患者随访7~18个月,平均12.1个月;导航组导航建立时间为(11.97±2.14)min。导航组手术时间、透视次数、透视时间、穿刺时间均少于常规组,差异有统计学意义(P<0.05);2组减压时间差异无统计学意义(P>0.05)。2组末次随访腿痛VAS评分、JOA评分、ODI较术前明显改善,差异均有统计学意义(P<0.05);组间比较差异无统计学意义(P>0.05)。改良MacNab标准评价疗效:导航组优21例,良12例,可3例,优良率为91.7%(33/36);常规组优18例,良13例,可5例,优良率为86.1%(31/36);组间差异无统计学意义(P>0.05)。所有患者均未发生严重神经根损伤、血管损伤和感染等并发症,常规组4例患者在穿刺过程中出现一过性神经根疼痛,调整穿刺方向后疼痛消失。结论 电磁导航辅助TESSYS靶向定位穿刺治疗LDH能减少手术时间、术中透视次数、穿刺时间,与常规穿刺方法疗效及安全性相当,可降低TESSYS学习曲线,提高青年医师一次性穿刺成功率。  相似文献   

6.
目的 探讨经椎间孔入路经皮内窥镜下椎间盘切除术(PETD)中采用可视化椎间孔成形技术治疗单节段腰椎椎管狭窄症(LSS)的疗效和安全性。方法 回顾分析2018年3月—2019年3月采用PETD治疗的58例单节段LSS患者临床资料,其中36例采用“V”区解剖引导的可视化椎间孔成形技术(观察组),22例采用传统椎间孔成形技术(对照组)。记录2组手术时间、术中透视次数、术中出血量、住院时间及并发症(神经根损伤、硬膜囊损伤、血管损伤等)发生情况。术前及术后1、12个月时采用疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评估腰腿痛程度及腰椎功能。采用改良MacNab标准评估疗效。结果 所有手术顺利完成,患者随访(13.54±0.56)个月。观察组手术时间、术中透视次数显著低于对照组,差异有统计学意义(P < 0.05);2组术中出血量和住院时间差异无统计学意义(P > 0.05)。2组患者术后各时间点VAS评分、ODI均较术前显著改善,差异有统计学意义(P < 0.05),且VAS评分、ODI均随术后随访时间增加进一步改善;观察组术后1个月VAS评分、ODI显著低于对照组,差异有统计学意义(P < 0.05),2组术后12个月VAS评分、ODI相比,差异无统计学意义(P > 0.05)。2组疗效优良率差异无统计学意义(P > 0.05)。2组术后均未发生严重并发症。结论 PETD中采用可视化椎间孔成形技术治疗单节段LSS与传统椎间孔成形技术疗效相当,并可减少穿刺次数和成形扩张操作次数,减轻患者机体创伤,缩短恢复时间,并可降低医患辐射量,值得临床推广。  相似文献   

7.
巩陈  吴建明  张文志  刘向阳 《骨科》2023,14(5):401-406
目的 探讨自制辅助穿刺装置联合三维可视化技术在经皮内窥镜下经椎间孔腰椎间盘切除术(PETD)治疗腰椎间盘突出症(LDH)中的应用效果。方法 2021年1月至2022年5月,安徽医科大学附属亳州医院脊柱外科94例LDH病人接受PETD治疗,采用随机数字表法选择通道建立方法。46例采用自制辅助穿刺装置联合三维可视化技术建立通道(研究组),48例采用传统穿刺法建立通道(对照组),两组通道建立后采用经皮椎间孔镜(TESSYS)技术完成椎间盘切除和神经根减压。分析两组透视次数、穿刺次数、穿刺时间、一次穿刺成功数、住院天数、手术时间及末次随访时改良MacNab标准评价结果。结果 所有病人都顺利完成手术和随访,无严重并发症发生。研究组和对照组的随访时间分别为(8.9±2.1)个月、(8.7±1.8)个月,两组差异无统计学意义(t=0.622,P=0.109)。研究组的穿刺时间少于对照组[(14.1±4.3) min vs. (19.1±3.7) min],穿刺次数少于对照组[(3.8±2.1)次 vs. (7.9±2.6)次],透视次数少于对照组[(8.3±3.3)次 vs. (15.1±4.2)次],手术时间少于对照组[(79.0±8.5) min vs. (89.7±13.4) min],一次穿刺成功数多于对照组(12例 vs. 4例),组间比较,差异均有统计学意义(P<0.05)。两组住院天数以及末次随访时的优良率比较,差异无统计学意义(P>0.05)。结论 采用自制辅助穿刺装置联合三维可视化技术建立通道可以明显减少穿刺次数、透视次数、穿刺时间和手术时间,一次穿刺成功率较高,手术安全且疗效满意,这种新的通道建立方法是可行的。  相似文献   

8.
目的 探讨硬膜外运动-感觉分离麻醉在经椎间孔入路经皮内窥镜下椎间盘切除术中(PETD)的应用效果。方法 2017年10月—2020年1月,采用PETD治疗腰椎椎间盘突出症(LDH)患者137例,其中77例术中采用硬膜外运动-感觉分离麻醉(分离组),60例采用局部麻醉(局部组)。记录2组患者手术时间、透视次数及并发症发生情况。术前、术后3个月采用疼痛视觉模拟量表(VAS)评分评估疼痛程度,并分别记录切开皮肤时、椎间孔成形时及处理后纵韧带时的VAS评分;采用日本骨科学会(JOA)评分评估腰椎功能。术后3个月随访时统计患者再手术意愿。结果 所有手术顺利完成。分离组随访12 ~ 25(17.33±6.12)个月,局部组随访12 ~ 27(18.56±6.11)个月。分离组手术时间短于局部组,再手术意愿优于局部组,差异均有统计学意义(P < 0.05);2组透视次数差异无统计学意义(P > 0.05)。2组术后3个月VAS评分、JOA评分较术前明显改善,差异均有统计学意义(P < 0.05);组间差异无统计学意义(P > 0.05)。分离组在椎间孔成形时、处理后纵韧带时的VAS评分优于局部组,差异均有统计学意义(P < 0.05);2组切开皮肤时的VAS评分差异无统计学意义(P > 0.05)。2组并发症发生率差异无统计学意义(P > 0.05)。结论 硬膜外运动-感觉分离麻醉用于PETD具有患者接受程度高、麻醉效果好等优点,可以有效降低术中疼痛,利于手术顺利完成。  相似文献   

9.
目的:评价经皮椎间孔镜治疗老年性腰椎管狭窄症的临床效果。方法:对2006年7月至2011年7月收治的60例老年性腰椎管狭窄症患者进行回顾性分析,其中男32例,女28例;年龄72~83岁,平均(66.7±2.5)岁。根据手术方法不同分为传统手术组和椎间孔镜组,每组30例。记录比较两组患者围手术期观察指标、手术切口VAS评分(术后12、24、48、72 h),采用Oswestry功能障碍指数(ODI评分)对两组患者术前,术后6、24个月的日常生活能力进行评定。结果:在手术时间、术中出血量、术后使用镇痛药物例数和住院时间的比较上,椎间孔镜组明显优于传统手术组(P<0.05).术后椎间孔镜组切口疼痛程度较传统手术组明显降低(P<0.05).60例患者均获得至少24个月的随访,两组患者于术后1、24个月时ODI评分均较术前明显改善,但椎间孔镜组患者ODI评分改善明显优于传统手术组患者(P<0.05).结论:腰椎经皮椎间孔镜技术在手术切口、术中出血量、住院时间等方面具有微创优越性,对脊柱稳定结构破坏小,患者术后恢复快,是治疗老年性腰椎管狭窄症的一种新的有效的微创手术方式。  相似文献   

10.
目的:比较透视与机器人辅助下微创经椎间孔椎体间融合术(minimal invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗单间隙腰椎间盘突出症的安全性与置钉准确性。方法:回顾性分析2019年3月至2020年2月采用MIS-TLIF手术方式治疗的52例单间隙腰椎间盘突出症临床资料。其中24例患者采用脊柱机器人辅助MIS-TLIF治疗(A组);28例患者采用透视下辅助MIS-TLIF治疗(B组)。记录两组患者术中出血量,手术时间,术中透视次数,手术前后视觉模拟评分(visual analogue scale,VAS)和日本骨科协会(Japanese Orthopaedic Association,JOA)评分以及手术相关并发症。术后通过CT平扫采用Gertzbein-Robbins对螺钉精准度进行评级。其中A级和B级被评估为满意置钉,C、D、E级被评估为置钉错误,采用Babu等方法评估螺钉对上关节突的侵犯情况。结果:A组手术时间、术中出血量及术中透视次数均少于B组(P<0.05)。末次随访所有患者VAS及JOA评分较术前明显改善(P<0.05),但组间比较差异无统计学意义(P>0.05)。A、B组置入螺钉分别为96枚和112枚。术后3 d根据Gertzbein-Robbins分类法评估两组置钉精准度,A组中A级90枚,B级5枚,C级1枚,无D、E级置钉;B组中A级84枚,B级16枚,C级8枚,D级4枚,无E级置钉;两组比较差异有统计学意义(Z=-3.709,P=0.000)。A组满意置钉率为98.96%(95/96);B组满意置钉率为89.29%(100/112),两组比较差异有统计学意义(χ2=8.254,P=0.004)。术后3 d根据Babu等方法评估椎弓根螺钉对上关节突关节侵犯情况,其中A组0级90枚,1级4枚,2级2枚,3级0枚;B组0级86枚,1级12枚,2级10枚,3级4枚,两组比较差异有统计学意义(Z=-3.433,P=0.001)。两组患者均未出现因置钉失误造成的严重脊髓、神经及血管损伤及其他手术相关并发症。两组患者均获随访,时间6~12(9.06±1.60)个月。术后神经症状均改善良好,随访期间未见症状复发及内固定松动、断裂的情况。结论:与透视下辅助MIS-TLIF相比,脊柱机器人辅助MIS-TLIF术式不仅更具有微创性与安全性,而且置钉精准更高,侵犯上关节突的发生率更低,明确减压靶点更精准,可用于单间隙腰椎间盘突出症的微创治疗。  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.
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   

14.
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   

15.
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   

16.
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.  相似文献   

17.
Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.  相似文献   

18.
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   

19.
Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.  相似文献   

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