氯胺酮—异丙酚静脉复合麻醉

选择２８例ＡＳＡⅠ￣Ⅱ级、非心脏手术病人，随机分为氯胺酮－异丙酚静脉复合麻醉（Ｋ组，ｎ＝１４）和芬太尼－异丙酚静脉复合麻醉（Ｆ组，ｎ＝１４）。无术前用药。静注氯铵酮（Ｋ组）或芬太尼（Ｆ组）、维库溴铵和异丙酚诱导，气管插管。持续静脉泵入氯胺酮（Ｋ组）或芬太尼（Ｆ组）复合静滴异丙酚维持麻醉。结果诱导后Ｋ组血压（ＢＰ）和心率（ＨＲ）下降明显小于Ｆ组，但气管插管反应明显大于Ｆ组。Ｋ组麻醉后完全清醒时间较Ｆ     

异丙酚在心脏瓣膜置换术中对氧供、氧耗、氧摄取率及氧合状态的影响

目的：观察异丙酚在心脏瓣膜置换术中对氧供（ＤＯ２）,氧耗（ＶＯ２）,氧摄取率（ＥＲＯ２）及氧合状态的影响。方法：２０例心脏瓣膜置换术病人随机分为两组。组麻醉诱导与维持用异丙酚,对照组用咪唑安定。观察体外循环（ＣＰＢ）期间ＤＯ２,ＶＯ２,ＥＲＯ２,混合静脉血氧饱和度（ＳＶＯ２）及动脉血乳酸（ＡＢＬ０的变化。结果：（１）组内各时点ＤＯ２无明显变化,复温后观察组ＥＲＯ２增加非常显著;降温开始及复温后观察     

上腹部手术病人围术期红细胞内HK、PFK和G-6PD酶活性的变化

目的 探讨磷酸戊糖途径在上腹部术后糖酵解酶活性下降中的作用及其机制。方法 ２６例择期上腹部手术病人随机分成三组：硬膜外阻滞（ＥＢ）组（１０例）。异丙酚静脉麻醉（ＰＲＯ）组（１０例）和静脉普鲁卜因复合麻醉（ＩＰＢＡ）组（６例）。于麻醉前、手术６０ｍｉｎ、术后６０ｍｉｎ、术后第１ｄ和第２ｄ５个时点取静脉血,同步测定血糖和红细胞内己糖激酶（ＨＫ）、磷酸果激酶（ＰＦＫ）及６－磷酸葡萄糖脱氢酶（Ｇ－６ＰＤ）     

静脉普鲁卡因氯胺酮复合保留自主呼吸麻醉中的SpO2监测与氧治疗

静脉普鲁卡因氯胺酮复合保留自主呼吸麻醉中的ＳｐＯ２监测与氧治疗陈颖１应诗达１刘洪民２杜红玫１对口、颌面、喉及颈等不需要肌肉松弛的较大手术中，我科多采用静脉普鲁卡因氯胺酮复合保留自主呼吸全麻，术中全程采用脉搏血氧饱和度仪监测ＳｐＯ２，发现都存在不同程度...     

浅低温体外循环冠脉搭桥患者术中氧供和氧耗变化

观察浅低温体外循环冠脉搭手术期间患者氧供和氧耗的变化特点。方法：冠脉搭桥术患者３０例,小剂量芬太尼辅以异氟醚和异丙酚维持麻醉,于麻醉后切皮瓣、开胸后体外循环前,体外循环３０分钟、６０分钟停机后２０仲,手术结束六个时点,观测氧供（ＤＯ２）、氧耗（ＶＯ２）氧摄取率（Ｏ２ＥＲ）、混合静脉血氧饱和度（ＳｖＯ２）、动脉血乳酸（ＢＬ）及血流动力学等变化。结果：和体外循环前相比,体外循环中和体外循环后除ＳｐＯ２     

异丙酚复合芬太尼静脉全麻时能量代谢的变化

目的：探讨异丙酚复合芬太尼静脉全麻对能量代谢的影响。方法：选择３１例成年ＡＳＡⅠ－Ⅱ级择期手术的神经外科患者，行异丙酚复合芬太尼静脉全麻，测定麻醉期的一（ＶＯ２），二氧化碳产量（ＶＣＯ２）、呼吸商（ＲＱ）和能量代谢率（ＭＲ）。结果：体位变动和强手术刺激时ＶＯ２和ＭＲ升高。无手术刺激时的ＶＯ２和ＭＲ分别为麻醉前的９１．０９％、９１．２９％，为手术时的９３．５８％、９４．９３％。ＲＱ随时间延长逐渐从麻     

神经外科使用氯胺酮安全性的探讨

为了探讨氯胺酮对神经外科患者颅内压影响的安全性，１１例颅内手术患者术前腰穿置管联接ＤＥＴＡＸ多参数监测仪，观察静注氯胺酮１ｍｇ／ｋｇ后１５分钟内ＩＣＰ、ＥＫＧ、ＨＲ、ＲＲ、ＰＥＴＣＯ２（鼻咽部）、ＳｐＯ２和ＮＩＢＰ的变化。结果显示：注药后１～２分钟，患者的ＩＣＰ、ＰＥＴＣＯ２、ＮＩＢＰ增高（Ｐ＜０．０５）；ＨＲ、ＲＲ、ＳｐＯ２的变化不定（Ｐ＞０．０５）；ＩＣＰ升高与颅内占位病灶的体积有关（Ｐ＜０．０５）。把占位病灶最大直径小于或大于４ｃｍ为界分为Ａ、Ｂ组。Ａ组ＣＴ显示的病灶直径＜４ｃｍ，基础ＩＣ…     

瑞芬太尼和氯胺酮静脉麻醉用于重睑术的效果比较

目的：比较瑞芬太尼复合异丙酚和氯胺酮复合异丙酚在重睑成形手术中的静脉镇痛、镇静效果及清醒时间、手术时间和不良反应的发生率。方法：选择200例ASAⅠ-Ⅱ级择期行重睑成形术患者,随机分为A、B两组各100例。A组：瑞芬太尼复合异丙酚;B组：氯胺酮复合异丙酚。分别以瑞芬太尼复合异丙酚或氯胺酮复合异丙酚缓慢静脉推注,观察记录两组患者在入室麻醉前（t0）、静脉麻醉后即刻（t1）、局部浸润麻醉后即刻（t2）、局部浸润麻醉后5min（t3）、局部浸润麻醉后10min（t4）、局部浸润麻醉后20min（t5）时的心率（HR）、收缩压（SBP）、舒张压（DBP）变化情况及脉搏血氧饱和度（SpO2）,并记录两组患者的静脉麻醉镇痛与镇静效果、清醒时间、手术时间以及术中与术后恶心呕吐、呼吸抑制及躁动等不良反应。结果：A组患者静脉麻醉后（t1）与麻醉前（t0）相比HR、SBP、DBP有所下降,但差异无统计学意义（P＞0.05）;B组患者静脉麻醉后（t1）HR、SBP、DBP较麻醉前（t0）有所升高,差异有统计学意义（P＜0.05）;t1、t2、t3、t4节点B组HR、SBP、DBP均明显高于A组,两组差异有统计学意义（P＜0.05）;两组患者的静脉麻醉镇痛、镇静效果均很好,差异无统计学意义（P＞0.05）;A组与B组清醒时间分别为（6.5±2.2）min、（25.1±4.5）min,差异有统计学意义（P＜0.05）;A组与B组手术时间分别为（50.1±9.7）min、（83.4±11.5）min,差异有统计学意义（P＜0.05）;A组不良反应、并发症低于B组,差异有统计学意义（P＜0.05）。结论：瑞芬太尼与异丙酚静脉复合麻醉用于重睑成形术对患者的心血管刺激小,血流动力学影响小、并发症少;患者清醒时间、手术时间均较氯胺酮复合异丙酚麻醉时间短。总之,瑞芬太尼与异丙酚静脉复合麻醉用于重睑成形术效果优于氯胺酮复合异丙酚麻醉。     

大肠癌患者粪便中C-erbB-2扩增和p53突变的检测及临床意义

目的　建立大肠癌患者粪便 Ｃｅｒｂ Ｂ２ 扩增及ｐ５３ 突变的检测方法,探讨大肠癌的基因诊断的临床意义。 方法　以差异聚合酶链反应（ Ｐ Ｃ Ｒ） 、 Ｐ Ｃ Ｒ单链构象多态性分析（ Ｓ Ｓ Ｃ Ｐ） 银染技术,分别检测大肠癌患者粪便 Ｃｅｒｂ Ｂ２ 扩增及ｐ５３ 突变。 结果　１４ 例中查出 Ｃｅｒｂ Ｂ２ 扩增７ 例（５０ ％ ） ,ｐ５３ 突变８ 例（５７ ％ ） ,二基因联合检出１１ 例（７９ ％ ） 。２ 例粪便潜血试验（ Ｆ Ｏ Ｂ Ｔ） 阴性中,１ 例 Ｃｅｒｂ Ｂ２扩增及ｐ５３ 突变均阳性,另１ 例ｐ５３ 突变阳性。 结论　联合多基因检测能对大肠癌的基因诊断提供更多的帮助,粪便 Ｄ Ｎ Ａ 标本的 Ｃｅｒｂ Ｂ２ 扩增及ｐ５３ 突变分析可为筛查尚无出血或 Ｆ Ｏ Ｂ Ｔ 假阴性的大肠癌及大肠癌高危个体的一种新的有效手段。     

七氟醚全麻复合硬膜外阻滞在肝切除术中的应用

目的：观察两组行肝切除术患者肝门阻断前后血压脉搏变化以及术后肝功能变化情况。方法：２０例择期行肝部分切除术（均阻断肝门）的肝癌患者随机分为两组，Ａ组（复合组）１０例选用七氟醚全身麻醉复合硬膜外阻滞去，Ｂ组（对照组）１０例全凭撖这内吸入七氟醚全麻。结果：两组患者血压脉搏变化基本稳定，且两组间变化无明显差异；Ａ组患者在术后１周后肝功能恢复情况明显优于Ｂ组。结论：吸入七氟醚全身麻醉复合硬膜外阻滞是应用于     

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.