老年血液病患者医院侵袭性真菌感染的临床分析

目的：分析老年血液病患者医院侵袭性真菌感染的临床资料,为临床防治老年血液病患者医院真菌感染提供依据.方法：回顾性统计分析我院2006年11月1日-2009年12月31日收治的合并有医院真菌感染的120例老年血液病患者的临床资料.结果：120例老年血液病患者中,有105例合并慢性基础疾病,有108例1周前使用了广谱抗菌药物 在感染部位中,呼吸道感染占首位 在真菌培养结果中,白色念珠菌106 株,占首位 早期诊断并给予适当治疗者的病死率为6.4%（7/110例） 晚期诊断者的病死率为40.0%（4/10例）.结论：老年血液病合并医院侵袭性真菌感染患者多有慢性基础疾病和使用广谱抗菌药物的病史,病死率较高,对有相关病史的老年血液病患者应早期诊断早期治疗,减少病死率.     

终末期肾病血液透析患者感染死亡事件调查

目的 探讨终末期肾病血液透析（血透）患者感染死亡的临床特点及防治措施。 方法 回顾性调查1998年至2008年在本院血透中心登记透析并随访死亡的终末期肾病患者的资料,分析感染作为直接死因及促进因素在死亡患者中的作用。 结果 共252例死亡,其中男性162例（64.29%）,女性90例（35.71%）,死亡年龄为（63.48±14.77）岁,紧急透析者占59.52%。首位基础疾病为原发性肾小球疾病（27.23%）,其次为糖尿病肾病（16.90%）和高血压肾病（14.55%）。17.4%患者直接死因为感染,17.4%患者为感染促进死亡。首位死因为脑血管事件,占23.6%,心血管事件占13.4%。在老年患者组（≥65岁）,感染作为直接死因和促进因素者分别占18.63%和21.57%。与感染有关死亡者年龄显著高于非感染相关死亡者。因感染死亡患者及因感染促进死亡患者中存活<3个月者分别占48.15% 和38.71%,高于非感染相关死亡患者的30.34%。存活>2年者中,前两者比例分别为22.22%和32.26%,低于非感染相关死亡患者中比例（37.93%）。死亡患者最常见的感染为肺部感染（77.59%）,其次为血行感染（10.34%）,导管相关性感染（5.17%）。58.62%感染有关死亡者病原检出阳性,以革兰阴性杆菌居多（38.24%）,50%检出者合并真菌感染。 结论 感染是终末期肾病血透患者重要直接死因及死亡促进因素,且是老年患者和透析开始3个月内的主要死因。引起血透患者死亡的感染以肺部感染最常见。致病菌以革兰阴性杆菌多见,且半数患者合并真菌感染。应重视血透患者感染的防治,尤其在老年患者和透析初期。     

乙型肝炎慢加急性肝功能衰竭继发感染的临床特点及其与疾病转归的关系

目的 分析乙型肝炎慢加急性肝功能衰竭（acute-on-chronic liver failure,ACLF）患者合并感染的特点及其对疾病转归的影响,并探讨合并感染的相关因素.方法 对2007年1-12月中山大学附属第三医院收治的186例ACLF患者进行回顾性调查,分析感染常见部位、临床和病原学特点及其对预后的影响.采用非条件Logistic回归方法分析感染相关因素.结果 在186例ACLF患者中,合并感染160例（86.0%）,常见感染部位为腹腔、胆道、肺部和肠道.血清白蛋白（Alb）≤30 g/L、总胆红素（TBil）〉342 μmol/L、凝血酶原时间（PT）〉28 s以及存在其他肝功能衰竭（肝衰竭）等严重并发症者有更高的感染率（χ~2值分别为5.4、7.3、21.3和14.7,P值均〈0.05）.ACLF合并感染者的病死率为74.5%（119/160）,未合并感染者的病死率为42.3%（11/26）,差异具有统计学意（χ~2=10.9,P=0.000）;合并多部位感染者的病死率（79.8%,79/99）明显高于单部位感染者（65.6%,40/61）,差异同样具有统计学意义（χ~2=4.0,P=0.045）.结论 ACLF患者感染发生率高,且与病情的严重程度密切相关.     

肝硬化并细菌感染预后的危险因素

目的研究肝硬化并细菌感染者预后危险因素。 方法收集2014年1月至2016年2月广东省东莞市桥头医院收治的肝硬化并细菌感染者120例。对入组患者进行为期两年的随访,根据患者生存情况将其分为死亡组（52例）和存活组（68例）。比较两组患者白细胞计数、中性粒细胞、血钠以及C-反应蛋白等实验室指标水平,以及年龄、性别、消化道出血、Child-Pugh分级、合并肺部感染、合并泌尿系感染等基本资料。应用多因素Logisitic回归分析上述各项因素与患者预后的相关性。 结果死亡组患者白细胞计数、中性粒细胞、C-反应蛋白分别为（11.70 ± 8.27）× 10⁹/L、（10.20 ± 7.50）× 10⁹/L、（61.38 ± 30.24）mg/L,均高于存活组患者[（8.92 ± 6.38）× 10⁹/L、（7.48 ± 5.66）× 10⁹/L、（48.52 ± 20.11）mg/L],差异均有统计学意义（t = 2.079、2.264、2.793,P = 0.040、0.025、0.006）。死亡组患者年龄≥ 50岁、消化道出血、Child-Pugh分级C、合并肺部感染人数分别为42例（80.77%）、25例（48.08%）、41例（78.85%）和32例（61.54%）,均高于存活组患者[33例（48.53%）、16例（23.53%）、38例（55.88%）和27例（39.71%）,差异均有统计学意义（χ² = 13.068、7.894、6.908、5.620,P = 0.000、0.005、0.009、0.018）。多因素Logisitic回归分析结果显示,白细胞计数、中性粒细胞、C-反应蛋白、年龄≥ 50岁、消化道出血、合并肺部感染、合并泌尿系感染均为肝硬化并细菌感染者死亡的独立危险因素（P均< 0.05）。 结论导致肝硬化并细菌感染者死亡风险的因素较多,临床工作中应综合分析,并制定出针对性的预防措施。     

老年患者直肠癌根治术后切口感染的相关因素分析

目的:探讨老年患者直肠癌根治术后切口感染的影响因素,为降低老年直肠癌根治术后切口感染率提供依据。方法:收集2010年1月至2015年1月行直肠癌根治术的210例老年患者的临床资料,对可能影响手术切口感染的相关因素进行单因素与多因素分析。结果:210例患者中15例出现切口感染,感染率7.14%(15/210)。单因素分析结果显示,感染组较非感染组患者年龄更大,手术时间更长,切口更长,行开腹手术者更多,合并慢性疾病者更常见(P0.05);经多因素Logistic回归分析后发现,年龄、手术时间、手术方式、切口长度及合并慢性疾病是切口感染的独立危险因素(P0.05)。结论:年龄、手术时间、手术方式、切口长度及合并慢性疾病是老年直肠癌根治术后患者切口感染的独立危险因素。腹腔镜手术可有效降低术后切口感染率,临床中更适合老年直肠癌患者。     

多发伤患者侵袭性真菌感染78例回顾性分析

目的探讨多发伤患者侵袭性真菌感染的临床特点,以提高临床医生对多发伤真菌感染的认识。方法对2007年3月至2011年12月浙江大学附属第二医院急诊ICU多发伤患者确诊的78例侵袭性真菌感染患者的临床资料进行回顾性分析。结果 78例患者均存在基础疾病及感染诱因,感染部位依次为呼吸道（39.7%）、泌尿道（28.2%）、消化道（7.69%）、眼部（6.41%）、血液（6.41%）和颅内（5.13%）,病原菌以白色念珠菌为主（48.7%）,但非白色念珠菌有上升趋势;患者病死率高（46.1%）,病程中具有某些有意义的临床表现征象。结论多发伤患者侵袭性真菌感染易患因素较多,且具有其独特性,发病呈上升趋势,且病死率高,充分了解其临床特点,对早期诊治有重要意义。     

非手术老年住院患者合并急性肾损伤相关危险因素及预后分析

目的 分析非手术老年住院患者合并急性肾损伤（acute kidney injury,AKI）的相关危险因素及预后,以提高临床工作者对老年患者发生AKI的警惕性.方法 回顾性分析2012年5月至2013年5月入住武警北京总队医院的非手术老年住院患者的临床资料,应用多因素Logistic回归分析AKI发生的相关危险因素,并对各组患者的预后进行对比分析.结果 1 206例非手术老年住院患者中,共有112例老年患者合并AKI,AKI发病率为9.3％.其中AKIⅠ级73例,Ⅱ级17例,Ⅲ级22例.多因素Logistic回归分析显示合并2种及以上慢性基础疾病、急性感染、低血容量、应用肾毒性药物、血尿酸升高是AKI发生的危险因素（P＜0.05）.AKI组住院病死率（25.0％ vs 8.5％,P＜0.01）、平均住院时间[（26.0±5.9）d vs （20.5±5.2）d,P＜0.01]均显著高于未合并AKI组;AKI分级与患者的住院病死率（r=0.603,P＜0.01）,平均住院时间（r=0.561,P＜0.01）呈显著正相关关系.结论 合并超过2种慢性基础疾病、急性感染、低血容量、应用肾毒性药物、血尿酸升高是非手术老年住院患者发生AKI的独立危险因素;合并AKI的非手术老年住院患者预后差,控制慢性基础疾病,有效防治感染,纠正低血容量,减少肾毒性药物的应用,降低血尿酸是减少AKI发生的重要措施.     

老年肾病综合征临床分析

目的了解老年肾病综合征的临床表现和病理特点。方法回顾性分析安徽医科大学第二附属医院肾内科2009年3月至2013年5月收治的287例成人肾病综合征患者的临床表现和病理资料,按WHO1995年肾小球疾病分类标准进行病理学分类。结果住院成人肾病综合征患者共287例,其中(年龄≥60岁)老年肾病综合征61例,约占21.2%。61例老年肾病综合征的原发病:原发性肾病综合征53例,占86.9%;继发性肾病综合征8例,占13.1%,其中肾淀粉样变3例,狼疮肾炎2例,多发性骨髓瘤2例,血管炎1例。老年肾病综合征临床表现以浮肿、血尿为主,合并血尿者占67.2%(41/61);53例原发性肾病综合征患者中,合并贫血者占52.8%(28/53);急性肾衰竭的发生率为42.6%(26/61),慢性肾衰竭的发生率为6.6%(4/61);感染的发生率59.0%(36/61),包括肺部感染、泌尿系感染,其中16例发生于激素或激素联合免疫抑制剂治疗前,20例发生于治疗后;血栓、栓塞的发生率11.5%(7/61)。53例原发性肾病综合征,17例行肾穿刺活检术,其中膜性肾病10例,系膜增生性肾小球肾炎3例,IgA肾病2例,局灶节段性肾小球硬化1例,弥漫增生硬化性肾小球肾炎1例,以膜性肾病为主(58.8%)。结论在肾病综合征患者中,老年人所占比例并不高(21.2%),其临床表现与年轻人的肾病综合征相似,但较复杂,合并贫血、急慢性肾衰竭和感染的比例较高,最常见的病因是仍是原发性肾小球疾病(86.9%),其病理类型以膜性肾病最常见。     

住院患者肺炎克雷伯菌血流感染的临床特点与耐药分析

目的了解住院患者肺炎克雷伯菌血流感染的临床特点、预后及耐药情况,为临床经验性治疗提供依据。 方法回顾性分析本院2011年1月至2015年1月收治的肺炎克雷伯菌血流感染者的临床资料、抗菌药物使用和实验室检查结果。细菌鉴定和药敏试验采用Vitek-2 Compact系统和配套鉴定及药敏卡,应用Whonet 5.6进行耐药分析。 结果75例入组者主要分布科室为ICU、普外科、血液科和急诊内科,平均年龄63岁,合并多种基础疾病,其中以肺部感染（46.67%）、颅脑疾病（30.67%）、糖尿病（29.33%）、胆道疾病（18.67%）、低血红蛋白症（18.67%）、肾功能不全（14.67%）和实体器官肿瘤（13.33%）多见,发生脓毒血症、感染性休克患者15例（20.00%）。药敏试验结果显示,75株肺炎克雷伯菌产ESBLs占42.67%,对美罗培南、亚胺培南和厄他培南的耐药率分别为6.67%、10.67%和8.00%,对哌拉西林/他唑巴坦（16.00%）和阿米卡星（10.67%）耐药率较低（均< 20%）。入组患者病死率为25.33%,MDR组患者病死率（29.73%）高于非MDR组（21.05%）。感染性休克、入住ICU为患者死亡的独立危险因素（χ² = 18.91、P = 0.025,χ² = 6.63,P = 0.01）。 结论肺炎克雷伯菌血流感染常合并多种基础疾病,且病死率高,碳青霉烯类耐药菌的出现应引起重视。     

妇产科侵袭性真菌感染患者的诊断和治疗探讨

目的 总结侵袭性真菌感染（IFI）在北京协和医院妇产科手术及肿瘤患者中的诊断和治疗特点,主要关注其分布、病原学特点、高危因素和治疗效果.方法 对2003年1月至2009年12月间北京协和医院细菌室及病案科记录的IFI资料行回顾性分析,按诊断标准分为确诊、临床诊断和拟诊病例,按治疗性质分为手术、化疗和恶性肿瘤终末期患者.分析不同IFI患者的分布、病原学特点、高危因素和治疗效果.结果 总计220例妇科IFI病例入选,其中确诊、临床诊断和拟诊病例分别为52例、11例和157例.妇产科IFI患者泌尿生殖系感染显著高于全院水平（46.2% vs 18.7%,P＜0.001）;可能的高危因素包括低白蛋白血症（87.3%）、中性粒细胞减少（52.4%）和放化疗（50.8%）;手术、化疗和恶性肿瘤终末期患者的总体治疗有效率分别为100.0%（108/108）、91.6%（87/95）和52.9%（9/17）,存在显著差异（P＜0.001）.结论 妇产科侵袭性真菌感染重症患者多,感染部位分布特殊,易感因素多样,手术及化疗患者中的治疗效果好.     

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.