脂肪干细胞/Ⅰ型胶原凝胶复合体的构建及其体内外成骨分化研究

目的探讨利用脂肪干细胞与Ⅰ型胶原凝胶复合构建新型骨组织工程复合体的可行性并对其体内外成骨分化情况进行分析。方法取3月龄日本大耳白兔肩胛部皮下脂肪，Ⅰ型胶原酶消化获得细胞，于体外依次进行骨、软骨、脂肪多向诱导分化鉴定；取第3代细胞与Ⅰ型胶原凝胶复合，于成骨诱导条件下体外培养，相差显微镜、扫描电镜观察复合情况并对其碱性磷酸酶、细胞外基质矿化程度进行检测，同时设立单层贴壁培养细胞作为对照（n=4）；两周后移植于裸鼠皮下，12周后处死动物，依次行放射学、组织学检测观察成骨情况（n=3）。结果（1）所获细胞具备骨、软骨、脂肪多向分化潜能，为多能干细胞。（2）形态学观察显示脂肪干细胞呈三维立体生长状态，均匀、高密度悬浮于Ⅰ型胶原凝胶中。在体外成骨诱导条件下，其碱性磷酸酶活性以及外基质矿化程度均显著高于单层贴壁培养细胞（P〈0．01，n=4）。（3）于裸鼠皮下移植12周后，放射学、组织学检测显示脂肪干细胞．Ⅰ型胶原凝胶复合体成骨明显（n=3）。结论（1）IⅠ型胶原凝胶可显著促进脂肪干细胞的成骨分化。（2）作为一种新型的骨组织工程复合物，脂肪干细胞-Ⅰ型胶原凝胶复合体可应用于骨组织工程，特别是腔隙性骨缺损的修复过程。     

脂肪源性干细胞体外成骨特性的研究

目的探讨兔脂肪源性干细胞体外成骨分化能力。方法取3个月龄新西兰白兔颈背部皮下脂肪组织,型胶原酶消化获得细胞。绘制细胞生长曲线,采用免疫细胞荧光法检测细胞表面抗原CD44、CD45;分别加入条件培养液对所获得细胞进行成骨成脂诱导,并分别进行形态学、碱性磷酸酶、钙盐沉积和油红O染色相关检测;将脂肪源性干细胞分为成骨诱导组和非成骨诱导组,分别于诱导后1、2、3、4周检测两组的碱性磷酸酶和钙离子浓度并作统计分析。结果 a）所获细胞CD44阳性表达,CD45阴性表达;所绘制的生长曲线成典型的＂S＂型。b）在诱导条件下,碱性磷酸酶及钙盐沉积均呈阳性表达,油红O染色为阳性。c）碱性磷酸酶浓度在诱导组与非诱导组之间存在组间差别,在各个时间点诱导组碱性磷酸酶浓度均高于非诱导组（P〈0.05,n=5）;诱导组碱性磷酸酶浓度在不同诱导时相其浓度变化趋势不同（P〈0.05,n=5）;钙离子浓度在诱导组与非诱导组之间存在组间差别,在各个时间点诱导组钙离子浓度高于非诱导组（P〈0.05,n=5）。诱导组钙离子浓度在不同诱导时相其浓度变化的趋势不同（P〈0.05,n=5）。结论脂肪干细胞的易分离培养、增殖快和良好的成骨诱导活性完全符合对种子细胞的要求,是一种理想的骨组织工程种子细胞。     

兔脂肪干细胞体外成骨诱导培养及成骨活性鉴定的实验研究

目的体外分离培养兔脂肪干细胞（adipose-derived stem cells,ADSCs）,在成骨诱导条件下鉴定其成骨活性。方法取4月龄新西兰大白兔腹股沟区脂肪,Ⅰ型胶原酶消化,分离、培养及传代原细胞,将第3代ADSCs消化后,加入成骨培养液中诱导分化,分别行碱性磷酸酶染色、茜素红染色、VonKoss（a钙结节）染色,以鉴定分化结果。结果体外分离培养的细胞增殖活跃,成骨诱导后碱性磷酸酶染色、茜素红染色及Von Kossa染色均呈阳性表达。结论脂肪干细胞具有成骨分化能力,是一种理想的骨组织工程种子细胞。     

自体富血小板血浆诱导兔脂肪干细胞成软骨分化的实验研究

[目的]体外分离、培养、鉴定兔脂肪干细胞,探讨富血小板血浆体外诱导脂肪干细胞成软骨分化潜能。[方法]取Ⅰ型胶原酶消化兔脂肪后,贴壁法分离培养脂肪干细胞,取第3代细胞分别予以成脂、成骨诱导,证实其多向分化潜能;同时取第3代细胞予以富血小板血浆诱导,2周后倒置显微镜观察细胞形态,行Ⅱ型胶原免疫荧光细胞化学染色、甲苯胺蓝染色和实时荧光定量PCR检测Ⅱ型胶原和聚集蛋白聚糖的表达。[结果]可以从兔脂肪中培养出脂肪干细胞,成脂、成骨诱导证实其多向分化潜能。经自体富血小板血浆诱导的脂肪干细胞,其Ⅱ型胶原免疫荧光细胞化学染色、甲苯胺蓝染色均为阳性。实时荧光定量PCR检测发现经自体富血小板血浆诱导的兔脂肪干细胞Ⅱ型胶原α1链基因和聚集蛋白聚糖基因表达明显高于对照组未经诱导的兔脂肪干细胞(P<0.01)。[结论]自体富血小板血浆可以有效诱导兔脂肪干细胞表达II型胶原和蛋白聚糖,可以诱导兔脂肪干细胞向软骨细胞方向分化。     

富血小板血浆与地塞米松对人骨髓基质干细胞成骨分化作用的对比研究

目的 通过系统评价富血小板血浆(PRP)与地塞米松(DEX)对人骨髓基质干细胞(BMSCs)成骨分化的影响,为PRP临床骨组织修复应用提供更为可靠的实验依据.方法 将体外培养的BMSCs分为单纯血清培养组(FCS组)、PRP诱导组和DEX组,通过相差显微镜观察碱性磷酸酶(ALP)染色、钙盐沉积染色,RT-PCR法检测碱性磷酸酶(ALP)、骨钙素(OC)、Ⅰ型胶原(Coll-Ⅰ)、骨连接蛋白(ON)、中心结合因子(Cbfα1)mRNA表达系统评价PRP的成骨分化能力. 结果 PRP抑制了BMSCs向三角形、多角形细胞转变,DEX则诱导BMSCs向三角形、多角形细胞转变;PRP抑制了ALP分泌,钙盐沉积;DEX增加了ALP分泌,促进钙化结节形成.与FCS组相比,DEX促进了ALP、OCmRNA表达,PRP抑制了ALP、OC mRNA表达;PRP、DEX对Coll-Ⅰ、ON、Cbfα1 mRNA表达均无影响.结论 在本实验条件下,PRP对人BMSCs体外成骨分化的直接作用是抑制效应;在体外PRP并不能代替DEX作为人BMSCs成骨分化的诱导因子.     

低氧环境下共培养的骨膜细胞和髓核细胞骨向分化能力的研究

[目的]探讨低氧环境对体外共培养的骨膜细胞、髓核细胞骨向分化能力的影响。[方法]采用组织块法分离兔骨膜细胞,胰酶、胶原酶消化法获取髓核细胞,传至3代进行共培养实验,实验分为2组:正常氧组(20%O2)、低氧组(5%O2),共培养后用CCK-8检测细胞增殖情况,用AKP试剂盒、BCA试剂盒检测碱性磷酸酶活性,RT-PCR检测骨钙素、Ⅰ型胶原、RUNX2以及HIF-1a mRNA的表达,免疫组化试剂盒检测Ι型胶原的表达,茜素红染色检测钙盐沉积或钙结节。[结果]骨膜细胞和髓核细胞在体外成功分离和培养,共培养后保持了较高的增殖率,经过成骨诱导培养后成功诱导为成骨细胞,细胞增殖曲线为"S"型,两组在1、3、5、7、9 d的光吸收值(OD)比较差异有统计学意义(P0.05);低氧组的骨钙素、Ⅰ型胶原、RUNX2以及HIF-1a mRNA表达水平高于常氧组(P0.05),碱性磷酸酶(ALP)活性高于常氧组(P0.05),细胞成骨染色(茜素红染色、免疫组化)结果显示低氧组较常氧组表达增多。[结论]低氧条件下体外共培养的骨膜细胞和髓核细胞经成骨诱导后向成骨细胞分化的能力更强。     

富血小板血浆诱导脂肪干细胞成骨作用的实验研究

目的探讨在体外培养中富血小板血浆（PRP）对脂肪干细胞的增殖及诱导成骨的影响。方法从Wistar大鼠自体动脉血中提取PRP，配制成条件培养液，并作用于培养状态的脂肪干细胞，MTT法检测细胞的增殖情况，Kaplow法染色检测细胞碱性磷酸酶表达情况，碱性磷酸酶活性检测，茜素红染色鉴定钙结节形成情况。结果脂肪干细胞经诱导培养后，PRP诱导组较对照组增殖明显（P〈0．01），碱性磷酸酶活性较对照组增高明显（P〈0．01），PRP诱导组碱性磷酸酶染色阳性，茜素红染色可见钙结节形成。结论体外培养时，PRP可促进脂肪干细胞的增殖并能诱导成骨分化，从而为骨组织工程提供一种新的方法。     

骨形态发生蛋白和碱性成纤维细胞生长因子激发纤维环细胞成骨的潜能

目的研究联合使用重组人骨形态发生蛋白（recombinant human bone morphogenetic protein-2，rhBMP-2）和碱性成纤维细胞生长因子（basic fibroblast growth factor，bFGF）椎间盘纤维环细胞成骨潜能的激发作用。方法向体外培养的纤维环细胞中分别及联合加入rhBMP-2和bFGF，观察纤维环细胞的表型表达特点。结果联合使用rh-BMP-2和bFGF能够明显促进椎间盘细胞增殖，提高细胞内碱性磷酸酶活力，增加I型胶原分泌，提高钙盐沉积程度，提高骨钙素的表达水平。结论联用rhBMP-2和bFGF能够诱导纤维环细胞向成骨细胞方向分化，分泌钙盐并形成钙结节。     

七厘散含药血清对骨髓间充质干细胞增殖、成骨分化的影响

目的 分析七厘散对体外培养的骨髓间充质干细胞增殖，成骨分化的影响。方法 采用5倍等效剂量七厘散灌服大鼠，制得含药血清，以灌服等体积生理盐水制得对照血清；采用贴壁筛选法培养大鼠骨髓间充质干细胞，同时进行细胞表型鉴定，并以含药血清干预第三代rBMSCs。MTT 法检测细胞增殖情况；于干预后的第3、6、9和12d分别测定细胞碱性磷酸酶（alkaline phosphatase，ALP）活性、干预后6、11、16d分别测定骨钙素（BGP）、Ⅰ型胶原、钙盐沉积量及钙化结节数，并比较两组间差异。结果 七厘散含药血清显著促进外源性骨髓间充质干细胞增殖及促进骨髓间充质干细胞成骨性分化，表现在该组的碱性磷酸酶活性、骨钙素、Ⅰ型胶原、钙盐沉积量和钙化结节数高于对照组（P<0.01）。结论 七厘散含药血清具有显著促进rBMSCs增殖和成骨性分化活性的作用。     

补骨合剂调节大鼠骨髓间充质细胞分化机制的研究

目的：应用体外培养骨髓间充质细胞，在细胞和分子水平观察补骨合剂对细胞分化的影响，探讨补骨合剂治疗骨质疏松症的机制。方法：分离SD大鼠骨髓间充质细胞，通过形态学、碱性磷酸酶、细胞内骨钙素、转化生长因子β1基因表达等指标，对重组人骨形态发生蛋白2(rhBMP2)诱导下的骨髓间充质细胞向成骨细胞分化的程度进行探讨。结果：一定浓度的补骨合剂可促进分化中的骨髓间充质细胞分泌碱性磷酸酶和骨钙素，增强rhBMP2的活性，促进分化中的骨髓间充质细胞表达转化生长因子β1，补骨合剂的这种促进骨髓间充质细胞分化作用与密钙息基本相同。结论：补骨合剂不仅可以增强rhBMP2的活性，促进分化中的骨髓间充质细胞表达转化生长因子β1，大量分泌Ⅰ型胶原，以利于钙盐沉积；还可以促进rhBMP2诱导的骨髓间充质细胞分泌碱性磷酸酶和骨钙素，促进骨髓间充质细胞向成骨细胞表型分化．从而促进钙、磷在骨表面沉积。     

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.     

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.     

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.