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目的探讨胆道镜联合钬激光碎石治疗术后肝内胆管难取性结石的价值。方法2010年7月~2012年7月,采用纤维胆道镜下用钬激光碎石治疗术后肝内胆管难取性结石(嵌顿结石或结石〉1em)37例,功率0.8—1.2J/5~10Hz。结果37例行钬激光碎石1~12次,平均2.6次。1例因结石位于四级胆管,胆道镜无法进入,未完全取净,36例结石全部取净,成功率为97.3%(36/37),碎石过程中无胆管壁灼伤、胆道穿孔。36例结石取净者术后随访3~25个月,平均12.3月,B超复查未发现结石复发。结论对于术后肝内胆管难取性结石,胆道镜下钬激光碎石是一种安全、有效的方法。 相似文献
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目的探讨胆道镜下钬激光碎石技术在治疗肝内、外胆管难取性结石的可行性、安全性及应用价值。方法自2008年1月至2010年1月共收集36例肝内外难取性结石患者(术中32例,术后残余胆道结石4例),经术中胆总管切口或术后T管窦道置入胆道镜,当结石嵌顿或巨大而在取石网无法取出时,采用钬激光碎石后再以网篮取出。结果 36例经胆道镜下钬激光碎石结石全部取净(在胆道镜所及范围内),碎石时间1~5min,碎石次数1~4次。碎石过程中无胆管壁灼伤、出血及胆道穿孔。所有病例随访6~30个月,平均12个月,无结石残留或复发,无胆道狭窄发生。结论对于肝内、外胆管难取性结石,胆道镜下钬激光是一种简单、安全、有效的方法。 相似文献
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目的探讨经胆道镜联合钬激光碎石治疗肝内外胆管难取性结石的价值。方法纤维胆道镜窥视下用钬激光碎石治疗肝内外胆管难取性结石29例,观察临床效果。结果经1~3次胆道镜下钬激光碎石治疗,28例患者结石全部取尽,1例未完全取净,成功率为96.55%(28/29);近期无胆道出血、漏胆、黄疸等并发症发生。26例获得随访,随访时间6~20个月,平均13个月,未发现结石复发及胆管狭窄。结论经胆道镜钬激光碎石是一种治疗肝内外胆管难取性结石简便、安全及有效的方法。 相似文献
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肝内外胆管难取性残留结石经胆道镜钬激光碎石治疗 总被引:5,自引:0,他引:5
目的 探讨经胆道镜钬激光碎石治疗肝内、外胆管难取性残留结石的实用性及安全性。方法 观察18例胆道术后肝内、外胆管难取性残留结石患者接受胆道镜下钬激光碎石治疗的临床效果,并进行随访。结果 经1~4次胆道镜下钬激光碎石治疗,18例患者残石全部取尽,未出现近期并发症。16例获得随访,随访时间6月到1年,无结石复发和钬激光碎石相关的胆管狭窄出现。结论 经胆道镜钬激光碎石是治疗肝内、外胆管难取性残留结石的一种安全、有效的方法。 相似文献
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胆道镜联合钬激光治疗肝内外胆管难取性结石 总被引:5,自引:0,他引:5
目的探讨胆道镜联合钬激光碎石治疗肝内、外胆管难取性结石的价值及安全性。方法21例肝内外难取性结石(初次手术15例,术后残余胆道结石6例),经术中胆总管切口或术后T管窦道置入胆道镜联合钬激光(美国Coherent公司)碎石治疗,激光波长2.1μm,最大平均输出功率100W,脉冲峰值功率6kW,脉冲宽度0.25μs,光导纤维直径400μm。结果20例经胆道镜下钬激光碎石结石全部取净,碎石时间3~8min,碎石次数1~3次;1例经3次碎石,取出1枚结石,1枚结石位于肝内Ⅲ级肝管碎石未成功,结石未取出。碎石总数52枚,结石排净率95.2%(20/21)。术中无胆管壁灼伤及胆道穿孔。18例随访6~20个月,平均10个月,未发现结石复发及残留,无胆道狭窄。结论胆道镜联合钬激光是治疗肝内、外胆管难取性结石的一种简便、安全、有效的方法。 相似文献
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术中胆道镜钬激光碎石治疗难取性肝内胆管结石 总被引:14,自引:2,他引:12
目的探讨术中经胆道镜结合钬激光治疗肝内难取性结石的方法、安全性及疗效。方法38例难取性肝内胆管结石接受术中经胆道镜钬激光碎石治疗,激光机波长2.1μm,最大平均输出功率100w,脉冲峰值功率6kW,光导纤维直径400μm。结果38例均一次性完全清除。碎石时间3—5min,碎石次数3,8次,碎石总数65枚。无胆道损伤、胆漏;术后2个月行胆道造影和B超检查,未发现残留结石。随访半年,无复发。结论钬激光碎石术是目前治疗肝内胆管难取性结石的一种安全、有效的新技术。 相似文献
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目的 探讨经皮肝胆管穿刺置管胆胰镜下钬激光碎石术治疗胆管结石的可行性。方法 选取12例难以耐受手术或难以实施手术的肝内外胆管多发结石患者,经皮肝径路行胆胰镜下钬激光碎石术,术后行PTCD引流,CT提示胆总管无结石残留、无胆道梗阻后拔出PTCD管。结果 12例均顺利施行经皮肝胆胰镜下钬激光碎石术,手术时间1.0~3.5 h,平均2.5 h;5例行单次碎石术,6例行2次碎石术,1例行3次碎石术;1例术中出现发热反应,1例出现PTCD管脱落。结论 经皮肝胆管穿刺置管胆胰镜下钬激光碎石术治疗肝内外胆管多发结石是一微创、安全、有效的术式。 相似文献
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Vasopressor hormone response following mesenteric traction during major abdominal surgery 总被引:1,自引:0,他引:1
A. Brinkmann W. Seeling C. F. Wolf E. Kneitinger C. Schonberger N. Vogt K. H. Orend M. Buchler P. Radermacher M. Georgieff 《Acta anaesthesiologica Scandinavica》1998,42(8):948-956
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-PGF1α (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. 相似文献
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Don Dame 《Artificial organs》1996,20(5):613-617
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. 相似文献
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Kai von Appen Christoph Weber Udo Losert† Heinrich Schima† Hans-Jürgen Gurland Dieter Falkenhagen 《Artificial organs》1996,20(6):420-425
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. 相似文献
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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 H2 O 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. 相似文献
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 H
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. 相似文献
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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. 相似文献
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Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts 总被引:3,自引:0,他引:3
B. Heindl B. F. Becker S. Zahler P. F. Conzen 《Acta anaesthesiologica Scandinavica》1998,42(8):995-1003
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. 相似文献
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. 相似文献
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D. Ma S. M. Sapsed-Byrne M. K. Chakrabarti J. G. Whitwam 《Acta anaesthesiologica Scandinavica》1998,42(6):670-677
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. 相似文献
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Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery 总被引:1,自引:0,他引:1
J. Boldt M. Papsdorf S. Piper W. Padberg G. Hempelmann 《Acta anaesthesiologica Scandinavica》1998,42(8):941-947
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. 相似文献
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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. 相似文献