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1.
目的 探讨平山病、肌萎缩性侧索硬化及远侧型肌萎缩型颈椎病的上肢神经电生理特点.方法 回顾性分析87例平山病患者、83例肌萎缩性侧索硬化患者和28例远侧型肌萎缩型颈椎病患者的上肢神经电生理检测资料.其中87例平山病患者中,72例单侧上肢、15例双侧上肢出现肌肉萎缩;83例肌萎缩性侧索硬化患者中,30例单侧上肢、53例双侧上肢出现肌肉萎缩;28例远侧型肌萎缩型颈椎病患者中,20例单侧上肢、8例双侧上肢出现肌肉萎缩.结果 平山病患者患肢尺神经刺激的复合肌肉动作电位(compound muscle action potential,CMAP)波幅明显低于正中神经刺激的CMAP波幅,肌萎缩性侧索硬化患者患肢正中神经CMAP波幅明显低于尺神经CMAP波幅,远侧型肌萎缩型颈椎病患者正中神经和尺神经CMAP波幅降低程度相同.平山病患者的平均尺神经/正中神经(U/M)CMAP比为0.58±0.40,肌萎缩性侧索硬化为2.28±1.25,远侧型肌萎缩型颈椎病为1.31 ±0.63,三者比较差异有统计学意义.在U/M CMAP比值<0.6的患肢中,平山病有62例,肌萎缩性侧索硬化和远侧型肌萎缩型颈椎病分别只有3例和1例;在U/M CMAP比值>1.7的患肢中,肌萎缩性侧索硬化有57例,平山病有12例,远侧型肌萎缩型颈椎病有4例.所有患者双侧的运动神经和感觉神经传导速度、感觉神经动作电位波幅均正常,健肢的CMAP波幅均正常.结论 平山病患者小鱼际肌肉萎缩程度重于大鱼际肌,肌萎缩性侧索硬化患者与之相反,而远侧型肌萎缩型颈椎病患者大、小鱼际肌肉萎缩程度相似.  相似文献   

2.
【摘要】 目的:通过电生理技术对接受颈椎前路植骨融合内固定手术治疗的平山病患者手术前后神经功能进行评估,探究手术干预对于神经功能恢复的作用。方法:回顾性分析2016年1月~2017年7月于我院骨科接受颈椎前路植骨融合内固定手术的平山病患者43例,其中男性41例,女性2例;手术时年龄14~26岁,平均18.2±2.8岁,病程6~84个月,平均22.3±20.1个月;随访时间3~18个月,平均7.2±4.4个月。所有患者均在术前及末次随访时接受上肢神经传导检查、针肌电图检查和上肢功能障碍评定(disability of arm shoulder hand,DASH)量表评估。通过比较复合肌肉动作电位(compound muscle action potential,CMAP)波幅、肌肉自发电位、运动单位电位形态及肌肉募集情况评估患者术后神经功能改变,并通过DASH量表评分变化评估患者术后上肢功能变化。分别比较术前症状严重侧和轻侧及手术前后电生理检查结果,通过配对样本t检验比较CMAP波幅,Pearson卡方检验比较肌肉自发电位、运动单位电位形态及肌肉募集情况;通过配对样本t检验比较手术前后DASH量表评分变化。结果:患者手术前神经电生理检查结果显示,症状严重侧正中神经及尺神经波幅较轻侧明显降低(P<0.05),超过半数患者针肌电图检查可见双侧神经源性损害。术前及术后随访结果对比显示,术前症状严重侧正中神经CMAP波幅平均为9.79±4.63mV,术后平均为11.04±4.43mV,差异有统计学意义(P<0.05);术前症状严重侧尺神经CMAP波幅平均为4.04±3.25mV,术后平均为6.19±4.30mV,差异有统计学意义(P<0.001)。轻侧正中神经及尺神经CMAP波幅恢复情况无统计学意义(P>0.05);针肌电图检查结果显示,患者严重侧上肢被检肌肉自发电位出现比例、MUAP形态宽大比例下降无统计学意义(P>0.05);部分被检肌肉募集情况有较为显著改善,其中术前42例患者症状严重侧桡侧腕屈肌存在募集减弱(42/43,97.7%),末次随访时32例患者同一肌肉存在募集减弱(32/38,84.2%),差异有统计学意义(P<0.05)。患者术前DASH量表评分为7.04±7.63分,末次随访时6.89±7.47分,差异无统计学意义(P>0.05)。结论:平山病患者接受颈椎前路植骨融合内固定手术后,上肢CMAP波幅提高,肌肉募集情况改善,该手术对控制病情进展、改善神经功能有积极作用。  相似文献   

3.
青年上肢远端肌萎缩症的临床及电生理特点   总被引:1,自引:0,他引:1  
目的 通过回顾性分析青年上肢远端肌萎缩症的临床和电生理检测结果,探讨该病的神经电生理特点.方法 分析77例青年上肢远端肌萎缩症患者正中神经和尺神经的运动和感觉神经传导、F波潜伏期及响应率,并分析针极肌电图中上肢肌受累情况.结果 在77例青年上肢远端肌萎缩症患者中,男74例,女3例;平均发病年龄(17.7±2.6)岁,平均病程(28.2±25.7)个月;57例患者以单侧上肢受累为主诉.尺神经复合肌肉动作电位(CMAP)波幅降低最多见;正中神经和尺神经F波响应率降低;感觉神经传导速度和感觉神经动作电位(SNAP)波幅均在正常范围内.针极肌电图表现为慢性神经源性改变为主,部分呈活动性改变.其中仅10例发现单侧上肢肌异常,67例均表现为双上肢肌损害.77例患者均有颈7~胸1节段的神经源性损害,部分患者伴有不同程度的颈5、6节段损害表现.无一例见颈1~颈4及其他节段支配肌的神经源性改变.结论 青年上肢远端肌萎缩症神经传导检查突出表现为尺神经CMAP波幅降低,尺神经和正中神经F波响应率降低.针极肌电图表现为双侧颈7、8与胸1节段支配肌呈慢性神经源性损害,可伴有颈5、6节段支配肌受累.  相似文献   

4.
目的研究颈型颈椎患者颈椎中立、常规侧位X片解剖数据的差异,讨论较有诊断价值的侧位X片。方法150例颈型颈椎病人随机分为甲组(70例)与乙组(80例),甲组先拍摄中立侧位X片,后拍摄常规侧位X片,乙组则相反。测量甲乙二组病人X片的颈椎弧弦距、颈椎(2-3、3-4、4-5、5-6、6-7)间隙前后缘的距离,进行t检验。结果1.颈椎弧弦距:甲组中立、常规侧位分别为(2.2±5.5)mm、(7.9±6.3)mm。乙组中立、常规侧位分别为(2.1±4.7)mm、(7.8±5.0)mm。甲乙二组相同侧位弧弦距无统计学差异(P0.05),不同侧位弧弦距有统计学差异(P0.001)。2.颈椎4-5间隙前后缘的距离:甲组中立、常规侧位前缘分别为(3.4±1.1)mm、(4.1±1.2)mm,二者有统计学差异(P0.001)。甲组中立、常规侧位后缘分别为(2.1±0.8)mm、(1.7±0.8)mm,二者有统计学差异(P0.001)。乙组中立、常规侧位前缘分别为(3.3±1.0)mm、(3.8±1.1)mm,二者有统计学差异(P0.001)。乙组中立、常规侧位后缘分别为(1.9±1.0)mm、(1.7±0.8)mm,二者有统计学差异(P0.01)。甲乙组相同侧位相同前缘或后缘距离无统计学差异(P0.05)。3.颈椎(2-3、3-4、5-6、6-7)间隙前缘、后缘距离测量统计结果基本上同颈椎4-5。4.颈椎间隙总均值,中立与常规侧位片组分别为(2.64±0.58)mm与(2.79±0.61)mm,二者有统计学差异(P0.001)。结论对于颈型颈椎病来讲,颈椎中立侧位与常规侧位X片是有差别的,中立侧位X片较有诊断价值。  相似文献   

5.
目的:观察平山病患者颈椎曲度、相邻节段椎体屈曲度与脊髓萎缩的相关性,为手术治疗平山病提供依据.方法:对2006年10月~2010年10月我院确诊的36例平山病患者进行回顾性分析.术前均行颈椎侧位、过伸、过屈位X线片检查与中立位MRI检查.在X线片上用Borden法测量C2~C7颈椎曲度(颈椎生理曲线的深度,即弧弦距),用椎体后缘切线法测量C3~C7相邻椎体曲度在中立位与屈曲位时的差值即为相邻椎体屈曲度:在中立位MRI上观察矢状位脊髓萎缩情况,测量C3~C7各节段椎体上缘水平脊髓横断面面积.根据颈椎曲度测量结果,将患者分为:颈椎正常前凸,7mm≤弧弦距≤17mm;颈椎变直或轻度后凸,1mm<弧弦距<7mm;颈椎中度后凸,-4mm<弧弦距≤1mm;颈椎重度后凸,弧弦距≤-4mm.对各相邻椎体屈曲度与中立位MRI上相应节段颈髓的横断面积进行相关性分析.结果:颈椎正常前凸8例;颈椎变直或轻度后凸13例;中、重度后凸15例,其中14例后凸顶椎为C5,1例为C4.在中立位MRI上,共有14例颈脊髓萎缩变细,分布集中在C4~C7节段.颈椎曲度变直及后凸的患者脊髓萎缩的发生率为13/28,明显高于颈椎正常前凸患者的1/8 (P<0.01).C3~C7各相邻椎体屈曲度之间有显著性差异(P<0.05),C5~C7椎体屈曲度较C3~C5更大(P<0.05).各相应节段脊髓面积也有显著性差异(P<0.05),C5~C7颈脊髓横截面积较C3~C5更小(P<0.05).相邻节段之间的屈曲度与相应节段脊髓横截面积之间呈负相关(r=-0.205,P<0.05),C5~C6相邻椎体屈曲度与相应脊髓横截面积之间呈负相关(r=-0.536,P<0.05).结论:颈椎曲度及相邻节段椎体屈曲度的异常改变是平山病的重要特征,可能是导致平山病患者颈脊髓萎缩的重要因素,手术治疗平山病的关键在于限制颈椎过度活动,恢复颈椎正常曲度.  相似文献   

6.
目的 为健侧颈7移位提供解剖学依据.方法 在30侧成人上肢标本上测量经皮下和椎前两种健侧C7移位时,正中神经返支起点至健侧C7神经吻合口之间的距离,并对两者进行比较:分别测量尺神经深支以及正中神经返支起点以上365 mm点距肱骨外上髁的长度.结果 经椎体前通路时测得效应器与健侧C7神经吻合点之间长度为(80.6±2.9)cm,经颈前皮下通路时长度为(86.5±3.1)cm.两者相比有统计学意义(t=6.32,P<0.05).测量正中神经返支和尺神经深支起点上365 mm分别位于肱骨外上髁上(4.6±0.7)cm和(6.7±0.8)cm处,两点均位于肘上部.结论 健侧C7移位修复正中神经不能恢复内在肌功能;经椎前通路优于经皮下通路;高位正中神经和尺神经损伤均位于肘上.  相似文献   

7.
以尺侧上副动脉为蒂尺神经移植的临床研究   总被引:6,自引:1,他引:5  
目的术中观测尺侧上副动脉对尺神经肘下段的血供及检测尺神经游离后末端的功能.方法对8例全臂丛根性撕脱伤患者,作以尺侧上副动脉为蒂的尺神经移植,在切断尺神经前后检测尺神经干(12cm长)感觉神经动作电位(SNAP)的波幅及传导速度.观察其远端的出血情况,并用脉搏血氧饱和度仪测定其末端的血氧饱和度.结果8例尺神经远端(腕部段)有持续渗血.游离后20min,尺神经的感觉传导速度、SNAP波幅较游离前分别下降了0.63%~19.02%和2.28%~37.47%.下降程度与尺神经肘下段的游离长度与肘部横径之比(长宽比)成正的直线相关,直线回归方程分别为Y=0.9283X-41.5066、Y=2.1433X-98.4498,r值分别为0.8138、0.8977,t值分别为3.4305、4.9906,P<0.01.游离后20min,尺神经肘上段血氧饱和度为97%~100%,而其末端血氧饱和度为72%~89%,与长宽比成负的直线相关,回归方程为Y=124.1266-0.8168X,r值为-0.8617,t值为4.1599,P<0.01.结论尺侧上副动脉能为于腕部切断的尺神经全长提供血供,越靠近肘部尺神经血供越佳.  相似文献   

8.
目的 为健侧颈7移位提供解剖学依据.方法 在30侧成人上肢标本上测量经皮下和椎前两种健侧C7移位时,正中神经返支起点至健侧C7神经吻合口之间的距离,并对两者进行比较:分别测量尺神经深支以及正中神经返支起点以上365 mm点距肱骨外上髁的长度.结果 经椎体前通路时测得效应器与健侧C7神经吻合点之间长度为(80.6±2.9)cm,经颈前皮下通路时长度为(86.5±3.1)cm.两者相比有统计学意义(t=6.32,P<0.05).测量正中神经返支和尺神经深支起点上365 mm分别位于肱骨外上髁上(4.6±0.7)cm和(6.7±0.8)cm处,两点均位于肘上部.结论 健侧C7移位修复正中神经不能恢复内在肌功能;经椎前通路优于经皮下通路;高位正中神经和尺神经损伤均位于肘上.  相似文献   

9.
目的 为健侧颈7移位提供解剖学依据.方法 在30侧成人上肢标本上测量经皮下和椎前两种健侧C7移位时,正中神经返支起点至健侧C7神经吻合口之间的距离,并对两者进行比较:分别测量尺神经深支以及正中神经返支起点以上365 mm点距肱骨外上髁的长度.结果 经椎体前通路时测得效应器与健侧C7神经吻合点之间长度为(80.6±2.9)cm,经颈前皮下通路时长度为(86.5±3.1)cm.两者相比有统计学意义(t=6.32,P<0.05).测量正中神经返支和尺神经深支起点上365 mm分别位于肱骨外上髁上(4.6±0.7)cm和(6.7±0.8)cm处,两点均位于肘上部.结论 健侧C7移位修复正中神经不能恢复内在肌功能;经椎前通路优于经皮下通路;高位正中神经和尺神经损伤均位于肘上.  相似文献   

10.
目的 为健侧颈7移位提供解剖学依据.方法 在30侧成人上肢标本上测量经皮下和椎前两种健侧C7移位时,正中神经返支起点至健侧C7神经吻合口之间的距离,并对两者进行比较:分别测量尺神经深支以及正中神经返支起点以上365 mm点距肱骨外上髁的长度.结果 经椎体前通路时测得效应器与健侧C7神经吻合点之间长度为(80.6±2.9)cm,经颈前皮下通路时长度为(86.5±3.1)cm.两者相比有统计学意义(t=6.32,P<0.05).测量正中神经返支和尺神经深支起点上365 mm分别位于肱骨外上髁上(4.6±0.7)cm和(6.7±0.8)cm处,两点均位于肘上部.结论 健侧C7移位修复正中神经不能恢复内在肌功能;经椎前通路优于经皮下通路;高位正中神经和尺神经损伤均位于肘上.  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: 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   

15.
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   

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.
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 : 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   

19.
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   

20.
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   

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