The effects of warming intravenous fluids on intraoperative hypothermia and postoperative shivering during prolonged abdominal surgery

Background: The infusion of several liters of crystalloid solution at room temperature may significantly contribute to intraoperative hypothermia because warming fluid to core temperature requires body heat. The aim of this study was to evaluate the effect of delivering warmed intravenous (IV) fluid to the patient on preventing intraoperative hypothermia.
Methods: Intraoperative core and mean skin temperatures were measured during prolonged abdominal surgery in 18 patients randomly divided into two groups according to intraoperative IV fluid management. In 9 patients (control group) all IV fluids infused were at room temperature. In the other 9 patients (group receiving warmed fluids) all IV fluids were warmed using an active IV fluid tube-warming system. In all 18 patients a warming blanket covered the skin surface available for cutaneous warming. Intraoperative changes in total body heat content (kJ) were calculated from core and mean skin temperatures.
Results: At the end of surgery, core temperature was 36.7±0.2°C in the group receiving warmed fluids and 35.8±0.2°C in the control group ( P <0.05). The estimated reduction in heat loss provided by warming IV fluid was 217 kJ, a value very close to the theoretical value expected from thermodynamic calculation. During recovery, one patient shivered in the group receiving warmed fluids and seven in the control group ( P <0.05).
Conclusion: In conclusion, infusion of warmed fluids, combined with skin-surface warming, helps to prevent hypothermia and reduces the incidence of postoperative shivering.     

Utilization of a mass-infusion system in the management of ruptured abdominal aortic aneurysms: An alternative application for devices employed in cardiopulmonary bypass

To stabilize the hemodynamics before and during ruptured abdominal aortic aneurysmal repair, a mass-infusion system was developed and successfully employed in the treatment of two patients. The system consists of a combination of devices used in cardiopulmonary bypass, namely: suction, a reservoir, a heat exchanger, a bubble trap, and an intracaval large-sized venous femoral cannula for infusion. It proved extremely useful to tide the patients over hypovolemic shock before cross-clamping of the proximal aorta, preventing intraoperative hypothermia, which is known to cause multiple physiologic derangement associated with an adverse outcome. Moreover, the employment of a large-sized cannula allowed for a temporary switch from the preceding venous infusion support to the hypothermic circulatory assist with central aortic cannulation, using the caval cannula for drainage. This system provides an optional advantage for patients requiring an open proximal anastomosis.     

深低温停循环中不同脑灌注方式皮层超氧化物歧化酶、丙二醛及超微结构的变化

目的观察不同脑灌注方法对深低温停循环（DHCA）中脑皮质超氧化物歧化酶（SOD）、丙二醛（MDA）及超微结构的影响，比较不同灌注方式的脑保护效果。方法健康成年杂种犬15条，随机分为3组。Ⅰ组单纯行DHCA为对照，Ⅱ组DHCA＋逆行脑灌注（RCP），Ⅲ组DHCA＋选择性顺行脑灌注脑保护（SACP）。转流降温至鼻咽部温18℃时停循环90min，然后复温再灌注90min。结果停循环期皮层SOD活性下降而MDA含量上升，复温再灌注时变化更明显，各时间点差异有统计学意义（P〈0．05）。增加或下降程度以Ⅰ组最为明显，Ⅱ组次之，Ⅲ组最小。Ⅱ、Ⅲ组与Ⅰ组比较SOD、MDA变化明显减轻（P〈0．01），Ⅱ、Ⅲ组间亦差异有统计学意义（P〈0．05），与电镜观察结果一致。结论深低温停循环期间SACP有明显脑保护作用，RCP亦可减轻DHCA中脑损害。     

1例心搏骤停复苏后患者的人工亚低温循证治疗

目的为1例心搏骤停复苏后昏迷患者制定人工亚低温循证治疗方案。方法针对提出的临床问题，检索Medline（1981—2006年）和Cochrane图书馆（2006年第2期）。结果检索发现，关于心搏骤停复苏后人工亚低温治疗RCT3篇和SR1篇，通过分析检索结果、结合临床医生经验及患者实际情况，为患者制定了循证治疗方案，通过6个月随访发现证实，该方案适合患者。结论对心搏骤停复苏后昏迷者，采用人工亚低温治疗可改善患者的预后。     

亚低温治疗犬颅脑枪弹伤后局部脑组织c-jun蛋白的表达

目的 研究颅脑枪弹伤常温下及全身亚低温治疗后脑神经元c-jun蛋白表达的变化。方法 18只杂种犬,随机分为常温组(正常犬温为38.5~39.5 ℃)、亚低温组(31.5~32.5℃)。以德国小口径步枪子弹致伤犬颅脑贯通伤(PCI)模型为对象,采用免疫组化法检测两组脑组织伤后30 min、2 h、6 h弹道挫伤区、震荡区及脑干神经元中c-jun蛋白的表达。结果 全身亚低温治疗组弹道挫伤区、震荡区及脑干神经元中c-jun蛋白表达较常温组显著减少(P<0.01)。结论 颅脑枪弹伤后全身亚低温治疗能够抑制脑神经元c-jun蛋白的表达。     

Effect of delayed induction of postischemic hypothermia on spinal cord damage induced by transient ischemic insult in rabbits

Objective: This study was performed to determine the effect of delayed induction of mild hypothermia after transient spinal cord ischemia in rabbits. Methods: Abdominal aortic occlusion was performed for 15 minutes to induce spinal cord ischemia at a rectal temperature of 37.3±0.3°C. Four groups of rabbits were investigated: Group 1 (n=8) was subjected to ischemia and reperfused at the same temperature for 7 hours; Group 2 (n=8) was subjected to ischemia and reperfused at the same temperature for 1 hour, followed by 6 hours of systemic hypothermia (32.5±0.5°C); Group 3 (n=8) was subjected to ischemia, reperfusion at the same temperature for 3 hours and then 6 hours of systemic hypothermia (32.5±0.5°C); and Group 4 (n=8) comprised non-ischemic controls. Neurological status of all rabbits in Groups 1– 3 was recorded and animals were sacrificed 1 week after ischemic injury. Spinal cord sections were examined microscopically to determine the extent of ischemic neuronal damage. Results: Mean modified Tarlov’s score at 1 week after ischemic insult was 0.5±0.8 in Group 1, compared to 4.3±1.5 in Group 2 and 2.9±1.8 in Group 3. Mean total number of surviving neurons within examined sections of spinal cord was significantly greater for Groups 2 and 3 compared with Group 1 (Group 1, 81±66.1; Group 2, 293.4±110.9; Group 3,227.1± 105.5; p<0.001). Conclusions: Delayed postischemic hypothermia induced within 3 hours after reperfusion significantly reduces ischemia-induced spinal cord neuronal damage in rabbits.     

脑深部电刺激对帕金森病患者基底节环路的影响及其作用机制

目的研究双侧丘脑底核(STN)慢性电刺激术(DBS)对晚期帕金森病(PD)患者静止期脑局部糖代谢的影响,并探讨DBS的作用机制.方法对7例进行双侧STNDBS的晚期PD患者,在术前和术后1个月电刺激条件下,分别进行18F-脱氧葡萄糖(FDG)/PET检查和UPDRS评分,并通过SPM99统计学软件进行数据分析,研究双侧STNDBS对PD患者脑内代谢的影响.结果双侧STN DBS使PD患者临床症状明显改善,同时脑局部糖代谢也发生了明显变化双侧豆状核、脑干(中脑、脑桥)、双侧顶枕部、运动前区(BA6)及扣带回的脑代谢增加;前额叶底部、海马的脑代谢减少(P＜0.05).结论双侧STN DBS可能通过兴奋STN轴突的方式,使轴突投射区域的基底节上行和下行通路代谢改善,并增加相应的额叶高级运动中枢的代谢,使PD患者临床症状改善.     

经皮质感觉性失语患者的阅读障碍

分析９例经皮质感觉性失语患者的阅读障碍特点。结果（１）在患者朗读１０个合体字中，无１例有与声旁有关的语音错读，（２）在词，朗读中有很多词义代替一词义错读，表明９例的阅读障碍属深部失读。（３）在词配画作业中，形音失读占２０％，形义失读占１７．７％，未表现形义联系强于形音联系。     

脑室内低温对家兔急性脑出血模型细胞凋亡的影响

目的 本实验对家兔急性脑出血模型进行脑室内低温保护,通过对动物行为和出血灶周围脑组织凋亡细胞数的观察,探讨脑室内低温对家兔急性脑出血模型细胞凋亡的影响.方法 雄性家兔12只(4～6个月龄),随机分为2组:等温组、低温组各6只.右侧内囊点注入自体动脉血0.5mL制作脑出血模型,用双腔微导管穿刺左侧侧脑室,建立脑室内灌注装置,以等温/低温等渗盐水灌注2小时.术后24小时观察其肢体运动后取材、固定、染色,观察脑组织细胞凋亡数.结果 经脑室内低温保护的动物肢体偏瘫程度轻,血肿周围脑组织内出现的TUNEL阳性细胞数量较少(P<0.05).结论 对家兔急性脑出血模型进行脑室内低温脑保护可以减少血肿周围脑组织的细胞凋亡,对于急性脑出血的治疗,脑室内低温作为选择性脑部低温的一个新的思路值得关注.     

Transient Manic‐like Episode Following Bilateral Deep Brain Stimulation of the Nucleus Accumbens and the Internal Capsule in a Patient With Tourette Syndrome

Objective. Deep brain stimulation (DBS) increasingly attracts attention as a potential treatment of mental disorders. Beside depression and obsessive–compulsive disorders, DBS has already been shown to be beneficial for Tourette syndrome (TS). Clinical Presentation/Method. The authors report on the outcome of a patient with treatment‐resistant TS who underwent bilateral DBS of the nucleus accumbens and the internal capsule. Results. Within the 10‐month follow‐up, a substantial reduction of tics has been observed. Yet, as a side‐effect of DBS, the patient developed a transient manic‐like episode when primarily stimulated by the most proximally contact in the internal capsule. Conclusions. This case supports the hypothesis that DBS of the nucleus accumbens and the internal capsule represents an effective therapeutic alternative for otherwise treatment‐resistant TS. Yet, future controlled studies are needed to determine optimal stimulation parameters and to reduce negative side‐effects such as transient hypomanic episodes.