胆囊切除术患者围手术期的护理体会

目的总结胆囊切除术围手术期的护理体会。方法对58例行胆囊切除术的患者围手术期积极给予心理疏导,管道护理、饮食指导等护理干预。结果本组患者均成功完成手术,术后排气时间(2.11±0.64)d。发生切口感染3例(开腹胆囊切除术2例,小切口胆囊切除术1例),胆漏1例(开腹胆囊切除术),皮下气肿1例(腹腔镜胆囊切除术)。并发症发生率为8.62%,均遵医嘱予以对症处理后痊愈。住院时间(6.82±3.12)d,均顺利出院。结论对行胆囊切除术的患者实施围术期精心护理,可提高手术成功率、降低术后并发症发生率。     

腹腔镜下胆囊切除术治疗胆囊结石临床分析

目的探讨腹腔镜下胆囊切除术治疗胆囊结石患者临床疗效。方法回顾性分析2013年6月至2017年6月71例胆囊结石患者临床诊治资料,所有患者均行腹腔镜下胆囊切除术治疗。记录患者手术及术后情况。结果 71例患者手术均成功,无中转开腹情况。手术时间为(32.24±4.17)分钟,术中出血量(6.88±1.62)ml,术后平均住院时间为(3.87±0.88)天。术后切口感染率2.82%(2/71),镇痛药物使用率1.41%(1/71)。结论应用腹腔镜下胆囊切除术治疗胆囊结石患者效果显著。     

小切口胆囊切除术治疗老年人胆石症

目的　探讨老年人胆囊切除手术时机及手术方式的选择。　方法　手术治疗 6 5岁以上老年人胆石症 1395例 ,其中 135 6例采用 (4～ 6 )cm小切口胆囊切除术治疗。　结果　 135 6例小切口胆囊切除术成功 ,占本组手术 97.2 %。手术并发症为 2 .6 % ,无死亡 ,平均术后 6 .2天出院。　结论　老年人胆石症应尽早手术为宜。小切口胆囊切除术创伤小、术后恢复快 ,可作为首选术式。     

小切口胆囊切除术复杂情况的处理

目的 总结小切口胆囊切除术的临床经验。探讨小切口胆囊切除术中复杂情况的处理方法及手术安全性。方法 回顾性分析我院2002年1月～2007年6月行小切口胆囊切除术患者的临床资料。结果 全组136例，131例成功行小切口胆囊切除术，5例延长切口完成手术，全部治愈出院，无并发症发生。结论 对于复杂情况的胆囊炎患者，只要方法得当，小切口胆囊切除术仍是一种安全有效的手术方法。     

老年人胆囊切除术的围手术期处理

目的探讨老年人胆囊切除术的围手术期处理策略。方法回顾性分析我院2007年1月至2013年12月经手术治疗的386例年龄大于70岁的胆囊切除患者的病例资料。结果腹腔镜胆囊切除295例,小切口开腹胆囊切除79例,11例中转开腹胆囊切除,胆囊造瘘1例,25.6%的病人(99例)存在不同类型的并存病,手术并发症发生率7.3%(28例),均治愈,死亡1例。结论老年人胆囊切除手术应加强围手术期的处理合理选择手术时机和手术方式是关键。     

腹腔镜与小切口胆囊切除治疗胆囊结石的疗效探讨

目的比较腹腔镜胆囊切除术与小切口胆囊切除术两种术式治疗胆囊结石的临床疗效。方法选取2009年5月至2012年6月我院行手术治疗胆囊结石患者120例,其中60例行腹腔镜胆囊切除术作为实验组,小切口胆囊切除术手术治疗60例作为对照组。观察并比较两组临床疗效结果。结果实验组术中出血量少于对照组,手术时间、胃肠道功能恢复时间及术后住院时间短于对照组,两组比较,差异有统计学意义(P0.05);对照组、观察组术后并发症发生率分别为21.7%、8.3%,差异有统计学意义(P0.05)。结论腹腔镜胆囊切除术具有创伤小、恢复快、住院时间短和并发症少等优点,值得临床推广。     

腹腔镜胆囊切除术治疗急性胆囊炎的临床价值

目的探讨腹腔镜胆囊切除术治疗急性胆囊炎的的临床价值。方法对2000年6月～2006年6月行腹腔镜胆囊切除术治疗的159例急性炎症期患者的临床资料进行回顾性分析。结果150例患者成功完成腹腔镜胆囊切除术,手术成功率为94.3%(150/159)。9例中转开腹,2例术后出现胆漏,无肝外胆管损伤、术后再出血等严重并发症发生。结论急性炎症期腹腔镜胆囊切除术是可行的,手术时机最好在发病72 h内。     

老年患者腹腔镜胆囊切除术围手术期处理体会

目的:探讨老年(＞60岁)患者行腹腔镜胆囊切除术围手术期的处理.方法:对行腹腔镜胆囊切除术的827例老年患者的临床资料进行回顾性分析.结果:827例患者全部治愈,术后无严重心肺并发症,无死亡病例.结论:充分做好围手术期处理,熟练手术技巧,腹腔镜胆囊切除术对老年患者是安全可靠的.     

腹腔镜与小切口胆囊切除术治疗胆囊结石临床分析

目的分析腹腔镜与小切口胆囊切除术治疗胆囊结石的疗效。方法将120例胆囊结石患者随机分为治疗组和对照组,每组60例。对照组采用小切口胆囊切除术,治疗组采用腹腔镜胆囊切除术(LC),比较2组手术效果。结果 2组患者均顺利完成手术。治疗组手术时间、术中出血量、术后排气时间、住院时间均少于对照组,而住院费用明显高于对照组,2组比较,差异均有统计学意义(P0.05)。对照组术后发生切口感染6例(10%),治疗组发生并发症5例(8.33%),2组比较,差异无统计学意义(P0.05)。结论 LC较小切口胆囊切除术,具有创伤小、身体恢复快等优点,但住院费用高、适应证局限。2种手术方式各有优缺点,应根据患者实际情况合理选择。     

老年急性胆囊炎腹腔镜胆囊切除并发症的预防

目的总结老年急性胆囊炎患者、腹腔镜胆囊切除术并发症预防的经验。方法回顾分析178例老年急性胆囊炎患者、腹腔镜胆囊切除术的临床资料。结果腹腔镜胆囊切除术成功156例(87.6%),中转开腹22例(12.3%),术后并发症13例(7.3%)。结论腹腔镜胆囊切除术治疗老年急性胆囊炎切实可行,老年患者腹腔镜胆囊切除术须加强围手术期的处理,耐心细致的手术操作,才能有效地预防并发症。     

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.