中西医结合治疗血栓闭塞性脉管炎中红细胞免疫状态的？…

作者利用致敏酵母菌法对２８例ＴＡＯ患者进行ＲＢＣ免疫系列检查，结果表明２８例患者均存在ＲＢＣ·Ｃ３ｂ花环率及红细胞免疫促进因子（ＲＦＥＲ）降低，而ＲＢＣ·ＣＩＣ花环率及红细胞免疫抑制因子（ＲＦＩＲ）升高，本病患者存在继发性红细胞免疫缺陷，且红细胞免疫抑制状态随病情好转逐渐恢复。结果同时表明红细胞免疫抑制状态同疾病活动情况密切相关，而与病变范围无关。     

中西医结合治疗血栓闭塞性脉管炎中红细胞免疫状态的动态观察

作者利用致敏酵母菌法对２８例ＴＡＯ患者进行ＲＢＣ免疫系列检查，结果表明２８例患者均存在ＲＢＣ·Ｃ３ｂ花环率及红细胞免疫促进因子（ＲＦＥＲ）降低，而ＲＢＣ·ＣＩＣ花环率及红细胞免疫抑制因子（ＲＦＩＲ）升高，本病患者存在继发性红细胞免疫缺陷，且红细胞免疫抑制状态随病情好转逐渐恢复。结果同时表明红细胞免疫抑制状态同疾病活动情况密切相关，而与病变范围无关。     

重组人促红细胞生成素对尿毒症患者细胞免疫功能和sIL-2R表达的影响

目的观察基因重组人促红细胞生成素（r-HuEPO）对慢性肾衰竭（CRF）患者外周血T-淋巴细胞免疫功能和红细胞免疫功能的影响。方法应用流式细胞仪、双抗体夹心ELISA法和红细胞酵母菌花环实验及红细胞免疫调节因子一步法分别检测观察90例CRF患者经r—HuEPO治疗后,外周血T-淋巴细胞亚群（CD3、CD4和CD4／CD8）、可溶性白介素-2受体（sIL-2R）、红细胞Gb受体花环试验（RNC-C3bRR）、红细胞免疫复合物花环试验（RN2-ICR）、红细胞免疫粘附促进因子（RFAR）和红细胞免疫粘附抑制因子（RFIR）的变化。结果①90例CRF患者外周血清中sIL-2R水平、RBC-ICR和RFIR明显高于正常对照组（P〈0．01）,CD3、CD4、CD4／CD8、RBC-C3bRR和RFAR明显低于正常对照组（P〈0．01）;②r-HuEPO治疗后,RBC—C3bRR、RBC—ICR、RFAR和RFIR均有好转（P〈0．05）,同时sIL-2R、CD3、CD4和CD4／CD8亦有所改善,但无统计学差异（P〉0．05）。结论CRF患者存在明显的细胞免疫功能和红细胞免疫功能低下,rHuEPO治疗对红细胞免疫功能有较好的提升和调节作用,对细胞免疫功能改善不明显。     

术后镇痛对红细胞免疫功能的影响

目的 探讨术后镇痛对红细胞免疫功能的影响。方法 择期胆囊切除术患者,ＡＳＡⅠ～Ⅱ级,随机分为镇痛组（以ＶＡＳ≤３分者为试验对象,ｎ＝１５）,与对照组,分别在术前、术后３ｄ、术后７ｄ采静脉血样检测红细胞Ｃ３ｂ受体花环率（ＲＣＲ）、红细胞免疫复合花环率（ＣＩＣＲ）、自然肿瘤红细胞花环率（ＮＴＥＲＴ）、红细胞免疫粘附促进因子（ＲＦＥＲ）及红细胞免疫粘附抑制因子（ＲＦＩＲ）。结果 与对照组相比,镇痛组术前     

肝癌患者集束电极射频消融治疗前后T淋巴细胞及红细胞免疫功能的研究

目的　研究肝癌患者接受射频消融治疗前后机体T淋巴细胞及红细胞免疫功能的变化。方法　分析 12 0例肝细胞肝癌患者射频消融治疗前和治疗后 3d ,7d和 14d外周血淋巴细胞亚群(T 3 ,T 4,T 8,T4/T 8)和红细胞C 3b受体花环 (RBC C3bR )及免疫复合物花环 (RBC ICR )形成率。结果　所有肝癌患者在射频消融治疗后 7d和 14d ,T 3细胞 ,T 4细胞 ,T 4/T 8及RBC C 3bR ,RBC ICR形成率均明显高于治疗前 (P <0 .0 5 )。结论　采用射频消融治疗肝癌 ,可以改善患者的细胞免疫状态。     

心脏瓣膜替换术对红细胞免疫系统的影响

对20例风湿性心脏病患者心脏瓣膜替换前后红细胞免疫系统功能的变化进行动态观察。结果发现,术后早期红细胞C_(3b)受体花环率,红细胞免疫复合物花环率,红细胞C_(3b)受体花环形成促进率和红细胞增强吞噬率均明显低于术前水平,而红细胞C_(3b)受体花环形成抑制率则明显高于术前水平。术后2周上述各项指标均恢复至术前水平。说明心脏瓣膜替换术后早期,红细胞免疫系统功能受损,表现为红细胞免疫粘附功能失代偿性降低,红细胞免疫促进因子活性降低,而其抑制因子活性升高。红细胞促吞噬功能降低。上述种种变化是可逆的,随着自身红细胞的增生而恢复。     

胆囊结石患者手术前后红细胞免疫功能研究

目的 探讨胆囊结石患者红细胞免疫功能的状况，借以评估其病情转化和预后。方法 对３０例胆囊结石患者手术前后外周血红细胞免疫功能采用酵母花环法进行了动态检测。结果 胆囊结石患者与健康人相比，红细胞Ｃ３ｂ受体花环率（ＲＢＣ－Ｃ３ｂＲＲ）下降（Ｐ〈０．０５）；红细胞免疫复合物花环率（ＲＩＣＲ）升高（Ｐ〈０．０５）；红细胞免疫粘附促进因子百分率（ＲＦＥＲ）下降（Ｐ〈０．０１）；抑制因子百分率（ＲＦＩＲ）升高     

骨肉瘤患者红细胞免疫功能与T淋巴细胞亚群的变化

目的 探讨骨肉瘤患者红细胞免疫功能状态与Ｔ淋巴细胞亚群改变的关系。方法 测定３５例骨肉瘤患者红细胞补体受体花环率（Ｃ３ｂＲＲ）、红细胞免疫复合物花环率（ＲＩＣＲ）、红细胞免疫促进因子（ＲＦＥＲ）、红细胞免疫抑制因子（ＲＥＩＲ）和Ｔ淋巴细胞亚群（ＣＤ３、ＣＤ４、ＣＤ８）的功能状态。结果 骨肉瘤患者Ｃ３ｂＲＲ、ＲＦＥＲ、ＣＤ３、ＣＤ４较正常对照组降低（Ｐ〈０．０５）,而ＩＲＣＲ、ＲＦＩＲ、ＣＤ８则正常     

骨肉瘤患者红细胞免疫功能与T淋巴细胞亚群的变化

目的：探讨骨肉瘤患者红细胞免疫功能与Ｔ淋巴细胞亚群的变化。方法：测定３５例骨肉瘤患者红细胞补体受体花环率（Ｃ３ｂＲＲ）、红细胞免疫复合物花环率（ＲＩＣＲ）、红细胞免疫促进因子（ＲＦＥＲ）、红细胞免疫抑制因子（ＲＦＩＲ）和Ｔ淋巴细胞亚群（ＣＤ３、ＣＤ４、ＣＤ８）的功能。同时测定３０例健康献血员免疫指标作对照。结果：骨肉瘤患者Ｃ３ｂＲＲ、ＲＦＥＲ、ＣＤ３、ＣＤ４较对照组用明显降低（Ｐ〈０．０５）,而Ｒ     

泌尿系肿瘤患者红细胞免疫功能的观察

目的：探讨红细胞免疫功能在泌尿系肿瘤中的改变。方法：测定５６例泌尿系肿瘤患者红细胞免疫功能，与正常组及泌尿系非肿瘤患者组相比。结果：红细胞Ｃ３ｂ受体花环率（ＲＢＣ·Ｃ３ｂＲ）降低而红细胞免疫复合物花环率（ＲＢＣ·ＩＣＲ）升高（Ｐ＜０．０５）；自然肿瘤红细胞花环率（ＮＴＥＲ）、直向肿瘤红细胞花环率（ＤＴＥＲ）、促肿瘤红细胞花环率（ＥＴＥＲ）及协同肿瘤红细胞花环率（ＡＴＥＲ）显著降低（Ｐ＜０．０１）。结论：泌尿系肿瘤患者红细胞免疫功能低下或紊乱。     

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 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.     

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.     

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.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

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.     

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.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.     

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.