己酮可可碱和2—脱氧腺苷提高冷冻复温后精液质量的研究

在光学显微镜下观察和测定了己酮可可碱（ＰＦ）和２－脱氧腺苷（２－ＤＡ）在体外对冷冻复温后精液精子的活率、活力及其毛细管穿透值的影响。结果显示ＰＦ和２－ＤＡ均能提高冷冻复温后精子的活率、活力及其毛细管穿透值，其最适浓度分别为４．０ｍｍｏｌ／Ｌ和２．０ｍｍｏｌ／Ｌ，与对照组比较均有显著性差异（Ｐ〈０．０１）。两组间比较，２－ＤＡ优于ＰＦ（Ｐ〈０．０１）。提示ＰＦ与２－ＤＡ合用不具有协同作用，反而有相互     

围术期红细胞丙酮酸激酶活性的变化

目的：观察围术期红细胞内丙酮酸激酶（ＰＫ）活性的变化。方法：将３０例上腹部手术病人分成硬膜外阻滞（ＥＢ）和静脉普鲁卡因复合麻醉（ＩＰＢＡ）两组。结果：两组病人血糖于手术６０分时均开始明显升高，术后第一天值与基础值比较，ＥＢ组：８．２９±５０，４．８０±０．１８ｍｍｏｌ／Ｌ（Ｐ＜０．０１）；ＩＰＢＡ组：６．３６±０．３３，４．５５±０．１８ｍｍｏｌ／Ｌ（Ｐ＜０．０１）。红细胞内２，３－ＤＰＧ浓度无明显改变。但两组ＰＫ活性于术毕６０分时明显下降。其术后第一天值与基础值分别相比较，ＥＢ组：７．５９±１．０１，１１．６２±１．０６ＩＵ／ｇＨｂ（Ｐ＜０．０５）；ＩＰＢＡ组：７．７５±０．９４，１１．８４±１．１２ＩＵ／ｇＨｂ（Ｐ＜０．０５）。结论：在手术创伤后的高血糖反应下，红细胞内ＰＫ活性明显下降，２，３－ＤＰＧ浓度无变化。这可能与红细胞内糖酵解通路受抑制有关。     

氧化亚氮对血乳酸的影响

２１冽非经胸手术患者，随机分为实验组１１例，Ｎ２Ｏ－普鲁卡因复合全麻）和对照组（１０例，普鲁卡因复合全麻），观察除外缺氧。低血压休克等因素后 Ｎ２Ｏ对血乳酸的影响。结果提示，吸入 ５０％～６０％Ｎ２Ｏ １小时后动脉血乳酸值（２．４７±０．６１ｍｍｏｌ／Ｌ）较麻醉诱导前（１．４９±０．４０ｍｍｏｌ／Ｌ）明显增加（Ｐ＜０．０１）；而对照组血乳酸无明显变化（从１．０３±０．３２ｍｍｏｌ／Ｌ．增至１．５９±０．５７ｍｍｏｌ／Ｌ，Ｐ＞０．０５）。此结果说明，５０％～６０％Ｎ２Ｏ可导致血浆乳酸浓度增加，虽所增加数值较微，未见明显临床意义，但对于危重．应激叵应强烈以及代谢功能紊乱等患者的影响，有待进一步探讨。     

血栓素合酶反义核酸抗内毒素血症大鼠血栓形成的研究

目的研究反义寡核苷酸（ＯＤＮ）对大鼠血栓形成的影响。方法鼠静脉注射反义寡核苷酸Ⅰ（ＯＤＮⅠ）,２０Ｏ．Ｄ．／２００ｇ体重,检测其对血浆ＴＸＡ２浓度及血栓形成的影响。结果经ＯＤＮⅠ注射以后,内毒素血症大鼠血浆ＴＸＡ２水平从（２９５１．８±５８８．３）ｎｇ／Ｌ,降至（４３３．９±２５．７）ｎｇ／Ｌ,（Ｐ＜０．００１）;相应的血栓湿重分别为（１７．８±４．０）ｍｇ和（１１．２±３．１）ｍｇ（Ｐ＜０．０１）。结论ＯＤＮⅠ能减轻由内毒素所引起的ＴＸＡ２生成增加及血栓形成加强。     

重症瓣膜置换术患者围术期氧供,氧耗,氧摄取率和氧合状态的变化

目的：观察重症瓣膜置换术患者围术期氧供需平衡和氧合状态的变化。方法：监测２６例重症瓣膜置换术患者围术期氧供（ＤＯ２）、氧耗（ＶＯ２、氧摄取率（ＥＲＯ２）、混合静脉血氧饱和度（ＳｖＯ２）和动脉血乳酸含量（ＡＢＬ）的动态变化。结果：麻醉诱导后至ＣＰＢ前（ＤＯ２）、ＶＯ２、ＥＲＯ２均下降，ＳｖＯ２升高，与麻醉前比较差异显著或非常显著（Ｐ＜０．０５，Ｐ＜０．０１）。停ＣＰＢ后２０小时内ＤＯ２、ＶＯ２、ＥＲＯ２持续升高，停ＣＰＢ８小时内ＳｖＯ２持续下降，ＡＢＬ持续升高，与ＣＰＢ前时值差异显著或非常显著（Ｐ＜０．０５，Ｐ＜０．０１）。结论：停ＣＰＢ后氧供需平衡障碍、组织缺氧明显存在，且有在一定时间内加重的趋势。     

保留交感神经的高选择性迷走神经切断术——动物模型的建立

保留交感神经的高选择性迷走神经切断术（ＨＳＶＡＰ）手术方法是在高选择性迷走神经切断术（ＨＳＶ）基础上，保留胃小弯的血管，从而保留了支配胃的交感神经。６０只雄性ＳＤ大鼠随机分为三组：ＨＳＶＡＰ组、ＨＳＶ组和正常对照组（Ｃ组），每组２０只。ＨＳＶＡＰ术后胃部泌酸区交感神经分布密度与Ｃ组比较，下降不显著。去甲肾上腺素含量与Ｃ组无差别（７４５８±４０８９ｖｓ８９９６±２３５１，Ｐ＞００５）。而ＨＳＶ术后胃部泌酸区交感神经分布密度显著下降，去甲肾上腺素含量低于ＨＳＶＡＰ术后（２９３±２１４８ｖｓ７４５８±４０８９，Ｐ＜００１）。本试验证实采用保留胃小弯血管的ＨＳＶ，既可完全切断支配胃体的迷走神经，又可保留交感神经。     

芬太尼,阿芬太尼对低氧性肺血管收缩的影响

用家兔ＨＰＶ模型研究芬太尼和阿芬太尼对低氧性肺血管收缩（ＨＰＶ）的影响。３０只家兔随机分为三组，低氧组、芬太尼组和阿芬太尼组，每组均经三次低氧。芬太尼组和阿芬太尼组，三次低氧时药物浓度分别为２．３×１０－４ｍｍｏｌ／Ｌ、４．６×１０－４ｍｍｏｌ／Ｌ、６．９×１０－４ｍｍｏｌ／Ｌ和１．３×１０－３ｍｍｏｌ／Ｌ、２．６×１０－３ｍｍｏｌ／Ｌ、３．９×１０－３ｍｍｏｌ／Ｌ。与低氧组相比，芬太尼及低浓度阿芬太尼对ＨＰＶ无影响（Ｐ＞０．０５）。而３．９×１０－３ｍｍｏｌ／Ｌ，阿芬太尼时明显抑制ＨＰＶ（Ｐ＜０．０１）。提示阿芬太尼抑制ＨＰＶ与剂量相关。低氧前后灌流液中ＰＧＩ２和ＴＸＡ２的浓度测定，发现ＰＧＩ２／ＴＸＡ２平衡改变可能参与阿芬太尼抑制ＨＰＶ。     

腹腔镜胆囊切除术中肺功能变化的临床研究

本文观察了１２例ＡＳＡ１级胆囊结石病人腹腔镜胆囊切除术中的肺功能变化。年龄为４０．７±９．４岁，体重６１．４±９．４ｋｇ。Ｍｉｄａｚｏｌａｍ－Ｆｅｎｔａｎｙｌ－Ｉｓｏｆｌｕｒａｎｅ－Ｔｒａｃｒｉｕｍ维持麻醉，控制呼吸，间歇正压通气。连续监测吸气气道峰压（ＰＩＰ），动态肺应性（ＬＣ），ＰＥＣＯ２，ＥＫＧ，ＮＩＢＰ和ＳｐＯ２。结果：体位改变对ＰＩＰ和ＰＥＣＯ２无明显影响（Ｐ＞０．０５），却使ＬＣ下降９．７％（Ｐ＞０．０５）。腹腔充气后３０分钟ＰＩＰ上升１７％（Ｐ＜０．０５），ＬＣ与麻醉后和充气前相比分别下降２５．８％和２０．８％（Ｐ＜０．０１），ＰＥＣＯ２增加１９．１％（Ｐ＜０．０１）；腹腔充气后６０分钟，ＰＩＰ和ＰＥＣＯ２未继续增加，但ＬＣ继续下降，比麻醉后和充气前下降３４．２％和２７．１％（Ｐ＜０．０１）。本文显示腹腔镜胆囊切除术中肺顺应性显著下降，气道压明显升高，ＰＥＣＯ２明显增加。     

前列腺癌患者血清及尿液唾液酸测定的意义

为观察前列腺癌患者血唾液酸（ＳＡ）与病情、疗效及血清ＰＳＡ的关系，按血ＰＳＡ高低将病人分为３组：Ａ组（治疗前，１７例）血ＰＳＡ≥５０μｇ／Ｌ，７０７％为临床Ｃ、Ｄ１、Ｄ２期，病情进展，前列腺症状或骨痛明显。Ｂ组（治疗前，６例）血ＰＳＡ８～３７μｇ／Ｌ，临床分期为Ｃ、Ｄ期，占５０％。Ｃ组（治疗后，８例）血ＰＳＡ＜４μｇ／Ｌ，除临床Ｃ期１例，余均为临床Ｂ期术后，病愈或明显好转。血ＳＡ均值，Ａ组为３０８ｍｍｏｌ／Ｌ，大于Ｂ组２８１ｍｍｏｌ／Ｌ及Ｃ组２１４ｍｍｏｌ／Ｌ；Ａ、Ｃ间有非常显著性差异（Ｐ＜０００１），尿ＳＡ结果同血ＳＡ，Ｐ＜００５。此外，血ＰＳＡ与血ＳＡ（或尿ＳＡ）密切相关，Ｐ＜００１。同为阳性（或阴性）一致率血ＳＡＰＳＡ为８１６％，尿ＳＡＰＳＡ为７２２％。本实验所用“一步法”简便快速，血ＳＡ敏感性１０００％，特异性７８１％，不需进口试剂或设备，有助于前列腺癌的检出与病情疗效追踪观察。     

胃液与盐酸误吸导致大鼠肺损伤的对比性研究

在定压式人工呼吸下，分别经气管给大鼠肺内注入胃液（ｐＨ＝１．５）和相同ｐＨ值的盐酸３．０ｍｌ／ｋｇ，然后用纯氧持续通气３小时。结果：误吸后胃液组的ＰａＯ２由６０ｋＰａ左右下降至１４ｋＰａ以下，而盐酸组仅下降至３０ｋＰａ左右（Ｐ〈０．０１）。胃液组的ＰａＣＯ２与盐酸相组比上升速度快，幅度高（Ｐ〈０．０５）。胃液组ｐＨ的下降幅度明显大于盐酸组（Ｐ〈０．０１）。８只胃液组大鼠有５只在３小时内因乏氧、酸中     

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.     

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.     

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.     

Immunomodulation in Transplantation with Photopheresis

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.