��֫�����Ĥ�ؽ�������Ч����

目的分析下肢深静脉瓣膜修复成形术治疗下肢深静脉瓣膜功能不全的临床疗效。方法对下肢原发性深静脉瓣膜功能不全的101例116条肢体实施股静脉瓣膜外修复成形术,并利用静脉功能不全评分、双向彩超、流速剖面图彩超技术和空气体积描记仪(APG)等方法对其疗效进行分析。结果随访率87.9%,随访病例症状消失,96.1%的肢体浅静脉曲张消失无复发。13例溃疡肢体中有11条在术后3～6个月溃疡消失,2条明显缩小。术前Ⅲ度返流肢体术后90%以上静脉瓣膜功能达Ⅱ度以下,67.6%的瓣膜功能恢复正常或接近正常;静脉功能不全评分从术前15.33±1.83改善到术后5.07±0.60(P<0.01);术前Ⅳ度返流肢体术后80%以上静脉瓣膜功能达Ⅱ度以下,40.5%的瓣膜功能恢复正常或接近正常,静脉功能不全评分从术前17.38±2.67改善到术后7.25±1.12(P<0.01)。51例58条肢体经流速剖面图彩超检查示,术后静脉返流量均值比术前明显减少(P<0.01);经APG检测术后VFI均值比术前明显减少(P<0.01)。结论下肢深静脉瓣膜外修复成形术能有效地治疗深静脉瓣膜功能不全,并可大大改善血流动力学指标,对静脉性溃疡也有一定的疗效。     

深静脉瓣膜修复成形术治疗下肢慢性静脉功能不全的随机对照临床研究

目的探讨深静脉瓣膜修复成形术在下肢慢性静脉功能不全治疗中的作用与疗效。方法30例双下肢慢性静脉功能不全的患者接受静脉系统手术治疗。每例2条肢体各采取不同手术方式并随机分组。1条患肢行股浅静脉外瓣膜复成形术加浅静脉手术(A组);另1条患肢仅行浅静脉手术(B组)。术后1个月和3年,利用彩超、流速剖面图彩超技术、空气体积描记仪(APG)和静脉功能不全评分等方法,比较各例2条肢体的疗效以及2组间疗效。结果全组30例患者60条肢体均为CEAP临床分级(Kistner分级)C2～C4级,经彩超和下肢静脉造影证实深静脉瓣膜功能不全返流均为Ⅲ度。术后1个月和3年随访比较,各例属于A组的患肢在静脉返流度、静脉返流量及各项指标均比属于B组患肢改善明显;A组的静脉返流量、静脉灌注指数均值与B组比较差异有统计学意义(P<0.001)。2组的静脉返流度比较差异有统计学意义(P<0.05)。3年随访时2组的射血分数和剩余容量分数均值比较差异有统计学意义(P<0.05);静脉功能不全评分均值比较差异有统计学意义(P<0.001)。结论深静脉瓣膜修复成形术可使下肢深静脉返流量明显减少,瓣膜功能明显恢复,与下肢浅静脉手术联合治疗下肢慢性静脉功能不全有更好的疗效。     

术中深静脉逆行造影在下肢静脉曲张手术中的应用

探讨术中经大隐静脉行深静脉逆行造影在下肢静脉曲张手术治疗中的应用价值。下肢静脉曲张手术中经大隐静脉置造影导管,阻断股总静脉行下肢深静脉逆行造影,观察深静脉瓣膜开放及返流程度,瓣膜功能及返流判定参考Kistner分级标准。本组178条肢体,返流0级35条(19.7%),Ⅰ级33条(18.5%),Ⅱ级59条(33.1%),Ⅲ级37条(20.8%),Ⅳ级14条(7.9%)。本组均行大隐静脉高位结扎+主干及曲张静脉剥脱+交通支结扎术,其中15例一期股浅静脉瓣膜环型缩窄术。术中逆行造影能更好地评价下肢深静脉瓣膜功能,有助于明确是否需要同期瓣膜修复手术。     

��֫���Ѫ˨�γɲ���ת������е�Ѫ������ѧ�仯

目的探讨下肢深静脉血栓形成病理转归过程中血流动力学的变化规律.方法自1999年12月至2002年6月期间,采用无创性血管检测技术(APG和CDFI)分别在不同时期(入院及治疗后1周、1个月、3个月、6个月、12个月、24个月)测定73条下肢深静脉血栓形成(DVT)患肢血流动力学参数变化情况并结合相应时期症状、体征的变化情况进行分析. 结果双侧小腿周径差均值入院后1个月较入院时明显减少(P<0.01),12个月后与1～6个月相比又明显增加(P<0.05).APG检测OF和VFI均值入院后1个月较入院时有明显增加(P<0.01),1～6个月间无明显变化(P>0.05),12个月后比入院和1～6个月又进一步增加(P<0.01).EF均值1个月与入院时相比差异有非常显著意义(P<0.01),而其后各时期均值间相比差异均无显著性(P>0.05).RVF均值入院后1个月较入院时明显下降(P<0.01), 6个月后逐渐回升.CDFI检测STEN均值入院后1个月比入院时明显下降(P<0.01),12个月时下降至(22.75±14.39)%,与6个月前相比差异均有非常显著意义(P<0.01).入院后1个月时出现Ⅰ度瓣膜返流占10.96%,6个月出现Ⅱ度返流占9.59%,12个月时Ⅱ度、Ⅲ度返流占36.85%,24个月时所有肢体均出现返流,Ⅱ度、Ⅲ度返流达到72.00%.结论下肢深静脉回流障碍是DVT发生后1个月内的主要病理改变,此后逐渐改善,而深静脉返流逐渐增加, 12个月后成为DVT的主要病理改变.     

股浅静脉瓣膜外修复成形术后血流动力学动态变化74例分析

目的检测股浅静脉瓣膜外修复成形术后血流动力学动态变化 ,以分析其治疗下肢深静脉瓣膜功能不全的疗效。方法回顾性分析原发性下肢深静脉瓣膜功能不全 74例 ( 96条肢体 )的资料 ,利用流速剖面图彩超和空气体积描记仪分别于术前、术后 1、3个月及 1年进行血流动力学指标检测并进行统计学分析。结果全组术后静脉返流量、灌注指数、静脉功能不全评分指标于术后 1、3个月、1年均较术前显著降低 (P <0 0 1)。而射血分数、剩余容积分数均值于术后 3个月、1年较术前明显改善 (P <0 0 1)。溃疡愈合率达 78 8% ( 2 6 /33) ,术后 93 6 %的肢体各种症状体征消失和明显缓解。结论股浅静脉瓣膜外修复成形术可显著改善血流动力学状况 ,对治疗原发性下肢深静脉瓣膜功能不全及静脉性溃疡有确切疗效     

股浅静脉第一对瓣膜环缩术治疗原发性下肢深静脉瓣膜功能不全(附40例报告)

目的 评估应用股浅静脉第一对瓣膜环缩术治疗原发性下肢深静脉瓣膜功能不全的疗效。方法 对原发性下肢深静脉瓣膜功能不全的40例患者(共45条下肢)施以股浅静脉第一对瓣膜环缩术．环缩材料选用7—0或6—0无损伤缝线。结果 经上述治疗后．全组病例术后随访2～24个月．临床症状均明显缓解。彩超复查88．6％(31／35)的患肢瓣膜无返流发生。结论 股浅静脉第一对瓣膜环缩术是治疗原发性下肢深静脉瓣膜功能不全比较理想和有效的方法。     

大隐静脉全程置管下肢深静脉造影

目的：探讨大隐静脉全程置管下肢深静脉造影的新方法及其临床诊断意义。方法：选择136例下肢静脉曲张患者，经内踝处大隐静脉穿刺，由导丝交换置入4F造影导管，送至大隐静脉和股静脉交界处，注入造影剂了解深静脉情况。结果：136例高位置管造影均获得成功，根据造影返流程度，0级31例、Ⅰ级71例、Ⅱ级19例、Ⅲ级11例、Ⅳ级4例。结论：大隐静脉全程置管下肢深静脉造影是一种安全可靠的新方法，在诊断下肢深静脉瓣膜功能不全中具有较大临床意义。     

��֫�����Ĥ�������37�����ƾ���

目的研究下肢深静脉瓣膜外成形术的临床应用价值。方法自2001年1月至2002年10月，四川省人民医院选择经静脉造影或彩色多普勒检查确诊为原发性下肢静脉瓣膜功能不全的37条患肢行静脉瓣膜外成形术。结果31条患肢随访6个月至2年，疗效良好者30条，轻度肿胀1条。经彩色多普勒检查，均无返流。结论深静脉瓣膜外成形术方法简便，不需阻断、切开深静脉，只要操作正确，术后并发症少，是治疗原发性下肢深静脉瓣膜功能不全的首选术式。     

浅静脉及小腿交通静脉术后深静脉血流动力学变化分析

目的检测浅静脉及交通静脉术后血流动力学变化,以分析浅静脉及交通静脉在下肢慢性静脉功能不全中的作用。方法连续追踪原发性下肢深静脉瓣膜功能不全I°-Ⅱ°患者75例 78条肢体,利用双功能超声、流速剖面图彩超技术和空气体积描记仪分别于术前、术后1、3个月及 1年进行血流动力学指标的检测并进行统计学分析。结果患肢症状完全消失88．5％(69／78)。溃疡愈合率92．8％(13／14)。全组灌注指数指标于术后1、3个月、1年均较术前显著减少(P<0．01); SEPS组,灌注指数及剩余容积分数指标于术后1、3个月、1年较术前均明显改善(P<0．01)。而术后全组静脉返流量、射血分数均值与术前比较差异无统计学意义(P>0．01)。结论浅静脉手术可有效阻断浅静脉逆向灌注;腔镜筋膜下交通静脉手术(SEPS)可显著减轻小腿的静脉性淤血,但两者均未能明显影响深静脉血流动力学状况。     

血管腔内激光治疗下肢浅静脉曲张的初步观察

我院从2003年6～11月，应用DIOMED 810nm激光结合手术治疗下肢浅静脉曲张21例，近期疗效满意，报道如下。1临床资料 1．1一般资料21例中男8例，女13例，平均年龄55．23岁(31～73岁)，平均病程15．26年(5．5～40年)，共27条肢体。患肢均有浅静脉曲张；下肢肿胀13条；有不同程度色素沉着11条；溃疡或溃疡已经愈合4条。原发性深静脉瓣膜功能不全8例11条肢体，单纯性大隐静脉曲张13例16条肢体。经彩色多普勒超声检查，均存在浅静脉返流。16例行下肢浅、深静脉顺行造影，发现深静脉Ⅱ度以上返流8例，共11条肢体。     

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.