微创手术治疗基底节区高血压脑出血

目的探讨小骨窗开颅显微镜下治疗基底节区高血压脑出血的临床疗效。方法对38例基底节区高血压脑出血患者采用小骨窗开颅,显微镜下清除血肿。结果术后24小时内复查CT显示,26例血肿清除90％以上,8例血肿清除70％～80％以上。死亡4例。其中2例死于术后再出血所致的脑疝,1例死于肺部感染,1例死于多器官衰竭。术后生存34例,随访3~6个月。日常生活能力（ADL）分级：I级7例,Ⅱ级13例,Ⅲ级9例,Ⅳ级4例,V级1例。结论小骨窗开颅显微镜下手术,视野清晰、操作精细,止血确切,手术创伤较小,术后恢复良好,是治疗基底节区高血压脑出血的有效手术方式之一。     

小骨窗开颅显微手术治疗基底节高血压脑出血

目的探讨小骨窗开颅微创治疗基底节高血压脑出血的临床疗效。方法对138例基底节区高血压脑出血患者采用小骨窗开颅,显微镜下清除血肿。结果术后24h内复查CT显示,117例血肿清除90%以上,21例血肿清除80%以上。死亡13例,其中5例死于术后再出血所致的脑疝,3例死于肺部感染,2例死于多器官衰竭,死于颅内感染、气道梗阻及消化道大出血各1例。术后生存125例,平均随访8(3～12)个月,日常生活能力(ADL)分级:Ⅰ级25例,Ⅱ级49例,Ⅲ级34例,Ⅳ级15例,Ⅴ级2例。结论小骨窗开颅显微手术创伤小,术野显露充分,血肿清除彻底,止血可靠,是治疗基底节高血压脑出血的有效手术方式之一。     

小骨窗开颅治疗基底节区高血压脑出血的体会

目的探讨显微镜下小骨窗开颅血肿清除治疗基底节区高血压脑出血的效果。方法对60例基底节区高血压脑出血患者采用小骨窗开颅血肿清除治疗,回顾性分析患者的临床资料。结果 60例中存活53例(88.33%),死亡7例(11.67%)。结论显微镜下行小骨窗开颅血肿清除治疗基底节区高血压脑出血,定位准确,手术时间短,创伤小,能在直视下止血,且颅骨缺损小,不需手术修补。早期手术对防止血肿压迫脑组织的不可逆性损害、降低病死率、提高生存质量有积极意义,是治疗高血压基底节区脑出血的一种较为理想的方法。     

高血压脑出血两种术式的比较

目的 比较两种手术方式治疗高血压脑出血的预后.方法 小骨窗血肿清除引流组治疗高血压脑出血68例;微创穿刺碎吸组治疗高血压脑出血59例.根据术后3个月的日常生活能力(ADL)分级评定两组病例的预后情况,分别计算恢复率、重残率、死亡率,并进行统计分析.结果 在对未发展到脑疝晚期的高血压脑出血患者进行手术治疗时,小骨窗开颅血肿清除引流和微创穿刺碎吸两种手术方式的死亡率差异无统计学意义(P＞0.05);但微创穿刺碎吸组的恢复情况要好于小骨窗开颅血肿清除引流组,存活下来的患者的重残率低于小骨窗开颅血肿清除引流组(P＜0.05).结论 微创穿刺碎吸术与小骨窗术二者术后死亡率差异无统计学意义,但微创术术后恢复情况优于开颅术,重残率低于开颅术.因此,微创术适合基层医院治疗未发展到脑疝的高血压脑出血患者以及为合并脑疝或脑疝前期患者赢得开颅手术时间.     

小骨窗开颅治疗基底节区高血压性脑出血（附66例报告）

高血压性脑出血以基底节区最为常见，当出血量较多时，需要手术开颅清除血肿，减轻高颅压及脑疝，过去常用颞部骨瓣开颅，清除血肿后去骨瓣减压，自1999年来笔者采用小骨窗直视下清除血肿方法取得较满意的效果，现报告如下。     

不同部位高血压性脑出血不同术式的探讨

目的探讨不同部位高血压性脑出血的有效术式. 方法 2001年1月～2003年8月,对85例不同部位高血压性脑出血采取不同手术方式.40例皮层下、基底节区外侧型未出现脑疝者,采用局麻加强化麻醉下小骨窗开颅血肿清除术;26例基底节区内侧型未出现脑疝者,采用局麻加强化麻醉下头皮小切口颅骨钻孔血肿穿刺抽吸术;11例术前脑疝及6例小脑半球出血者采用静脉全麻,开颅清除血肿;2例脑干出血破入第四脑室者采取侧脑室外引流术,其他部位出血破入脑室加用侧脑室外引流. 结果 85例病死率12.9%(11/85),其中皮层下、小脑、脑干、基底节区外侧型未出现脑疝的病例无死亡;基底节区内侧型病死率29.0%(9/31);11例术前脑疝的病死率45.5%(5/11). 结论皮层下、基底节区外侧型未出现脑疝的病人经局麻小骨窗开颅清除血肿效果显著,小脑出血经积极手术预后良好,基底节区内侧型出血经局麻小切口钻孔抽吸效果较差.     

显微镜小骨窗开颅血肿清除术治疗高血压性基底节区脑出血效果分析

目的 探讨显微镜小骨窗开颅血肿清除术治疗高血压性基底节区脑出血的临床效果.方法 回顾性分析兰考第一医院神经外科2019-05—2021-02收治的58例高血压性基底节区脑出血患者的临床资料.分为传统开颅大骨瓣血肿清除术组(大骨瓣组,28例)和显微镜小骨窗开颅血肿清除组(小骨窗组30例).比较2组患者的手术时间、住院时间...     

高血压基底节区脑出血小骨窗显微外科手术

目的：探讨小骨窗开颅显微镜下清除高血压基底节区脑出血的临床效果。方法总结72例高血压基底节区脑出血均经小骨窗开颅，在显微镜下解剖侧裂池，切开岛叶皮质，清除血肿，术后予综合治疗。结果随访3-6个月，按日常生活能力分级法评估预后：Ⅰ级6例，Ⅱ级9例，Ⅲ级27例，Ⅳ级21例，Ⅴ级7例，死亡2例。结论高血压基底节区脑出血小骨窗显微外科手术具有疗效确切、手术时间短、创伤小等优点。     

早期微创穿刺与小骨窗开颅血肿清除术治疗高血压脑出血的疗效分析

【摘要】〓目的〓比较早期微创穿刺引流术与小骨窗血肿清除术治疗基底节区高血压脑出血的临床疗效。方法〓回顾性分析98例高血压性基底节区脑出血患者临床资料,根据资料,按不同的手术方法分为微创穿刺引流术(微创组,n=63例)和小骨窗开颅血肿清除术(小骨窗组,n=35例),评价两组患者手术和住院时间、意识障碍恢复时间、治疗1个月时神经功能缺损程度(NID)和3个月时日常生活活动能力(ADL)。结果〓微创组手术时间和住院天数显著短于小骨窗组,意识恢复时间无显著性差异;而1个月后微创组患者的NID明显低于小骨窗组(P<0.05);治疗3个月后随访,患者ADL达自理水平的较好状态者(Barthel指数≥80),两组有显著性差异(P<0.05),微创组优于小骨窗组。结论〓与小骨窗组相比,微创穿刺术可明显缩短高血压基底节区脑出血患者的手术时间和住院时间,,改善神经功能缺失程度。     

小骨窗微创治疗高血压性基底节区脑出血的临床分析

目的分析小骨窗微创手术治疗高血压性基底节区脑出血的效果。方法回顾性分析小骨窗开颅微创手术治疗36例基底节区脑出血患者的临床资料。结果按ADL疗效评定标准,36例患者中,良好26例,不良8例,死亡2例。结论小骨窗开颅微创手术治疗高血压性基底节区脑出血,愈合率高、创伤小、术后出血等并发症低、疗效确定。     

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.     

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.     

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.