550例维持性血液透析患者血红蛋白达标情况及影响因素分析

目的:回顾性分析单中心550例维持性血液透析(maintentance hemodialysis, MHD)患者的临床资料,探讨MHD患者合并肾性贫血的临床特点,分析影响血红蛋白(hemoglobin, Hb)不达标独立影响因素。方法:分析2021年06月01日—2021年09月30日在武汉市第一医院血液净化中心MHD的550例患者,根据MHD患者Hb水平将其分为Hb达标组(Hb≥110 g/L)及Hb未达标组(Hb<110 g/L),统计MHD患者Hb达标率及达标组与未达标组临床特征比较,采用Logistic回归模型分析MHD患者Hb不达标(Hb<110 g/L)的独立影响因素。结果:(1)共纳入550例患者,其中男325例(59%),平均年龄(60.46±12.94)岁,中位透析龄58(28,98)月,10年以上透析龄的患者有101例,占18.36%,所有患者Hb(103.94±17.76)g/L,Hb>110 g/L患者有218例,达标率为39.64%。(2)与Hb达标组相比,未达标组患者女性患者比例高,白蛋白水平低,铁蛋白水平低,EPO使用量少,铁剂使用率低,...     

山西省维持性血液透析患者贫血发生情况的流行病学调查及相关因素分析

目的了解山西省维持性血液透析(maintenance hemodialysis,MHD)患者贫血的患病率及治疗情况,并研究其影响因素。 方法通过全国血液净化病例登记系统采集2017年山西省网上直报的MHD患者的临床资料,包括基本资料、透析情况、药物治疗情况及实验室指标,以血红蛋白(hemoglobin, Hb)≥110 g/L作为治疗靶目标,整理并分析数据。 结果2017年山西省MHD患者平均Hb水平为(107.2±19.2) g/L,Hb总体达标率为45.7%。红细胞生成刺激剂使用率为97.6%,铁剂使用率为35.5%,其中68.0%的患者使用静脉铁剂。性别分层显示男性Hb达标率好于女性,年龄分层显示随着年龄的增长,Hb达标率呈增高趋势。与Hb未达标组相比,Hb达标组患者男性比例、平均年龄、透析龄、使用进口透析器的人数比例、尿素下降率及尿素清除分数、静脉铁剂使用率、左旋肉碱使用率、碳酸氢根、血白蛋白、甘油三脂较高;原发病为高血压病患者比例、每周红细胞生成刺激剂剂量、转铁蛋白饱和度≤30%患者比例、甲状旁腺素及C反应蛋白较低(均P<0.05)。多因素Logistic回归分析显示,男性、静脉补铁、高血白蛋白为Hb达标的保护因素,而高甲状旁腺素、高C反应蛋白为Hb达标的危险因素。 结论山西省MHD患者Hb总体达标率(Hb≥110 g/L)为45.7%。男性、静脉补铁、高白蛋白可能为Hb达标的保护因素,高甲状旁腺素、高C反应蛋白可能为其危险因素。合理使用静脉铁剂、改善营养状态,纠正炎症反应可提高Hb达标率。     

罗沙司他对血液透析合并肾性贫血患者的治疗效果及影响因素分析

目的探讨影响罗沙司他对维持性血液透析(MHD)合并肾性贫血患者治疗效果的相关因素。方法回顾性分析2020年1月至2021年3月在本院收治的201例MHD合并肾性贫血患者的临床资料, 根据不同治疗药物分为罗沙司他组(94例)和重组人促红细胞生成素(rhEPO)组(107例)。对比两组治疗12周前后的血红蛋白(Hb)、血细胞分布宽度(RDW)、高敏C-反应蛋白(hs-CRP)、铁代谢、血脂、血清促红细胞生成素(EPO)、甲状旁腺激素(PTH)等实验室指标, 根据Hb是否达标对罗沙司他组分为未达标组(39例)和达标组(55例), 采用logistic回归分析影响罗沙司他组Hb达标率的因素。结果治疗12周后, 两组患者的Hb较治疗前均升高, 但罗沙司他组的Hb达标率高于rhEPO组(58.5% vs.40.2%, P<0.05), 且罗沙司他组治疗后的血清EPO低于rhEPO组(5.57 mU/mL vs.16.76 mU/mL, P<0.05)。罗沙司他组治疗后的总铁结合力较治疗前升高, 而铁蛋白减低, RDW、hs-CRP水平下降, 总胆固醇降低, 高密度脂蛋白胆固醇/低密度脂...     

维持性血液透析患者贫血治疗达标情况及其影响因素分析

目的:观察维持性血液透析患者贫血治疗的有效性,并分析贫血治疗的影响因素。方法:选取维持性血液透析≥3个月,持续红细胞生成素(EPO)治疗≥3个月患者200例,EPO剂量100～150 Iu.kg-1.W-1,每月监测患者血常规,每3个月监测患者血甲状旁腺素(PTH)、透前透后生化、铁指标,根据检验结果及时调整透析方案、EPO剂量、补铁方案及营养指导。记录患者最近一次血红蛋白、PTH、白蛋白、二氧化碳结合力、铁蛋白、转铁蛋白饱和度指标,统计血透患者贫血达标情况,分析贫血与PTH、白蛋白、二氧化碳结合力、铁蛋白、转铁蛋白饱和度的关系。结果:患者贫血达标率(Hb≥110 g/L)49%(98/200),100 g/L≤Hb<110 g/L之间21%(42/200),Hb<100 g/L有30%(60/200)。将患者分为治疗达标组(Hb≥110 g/L组)和治疗未达标组(Hb<110 g/L组)。未达标组PTH、铁蛋白较达标组高,但差异无统计学意义(P>0.05),二氧化碳结合力两组差异无统计学意义(P>0.05),血白蛋白、转铁蛋白饱和度则达标组高于未达标组,差异存在统计学意义(P<0.05)。结论:血液透析患者贫血达标率49%,与患者原发病、基础疾病、营养状况、血白蛋白、缺铁状态等因素密切相关,与PTH、酸中毒、铁蛋白水平无关。     

维持性血液透析患者钙磷代谢紊乱的影响因素及其与肾性贫血的相关性

目的调查我院血液透析中心患者钙磷代谢标志物血钙、血磷、全段甲状旁腺素(intact parathyroid hormone,iPTH)等指标的达标情况,探讨维持性血液透析患者钙磷代谢紊乱的影响因素及其与肾性贫血的关系,以便更好的控制钙磷代谢紊乱并管理贫血。方法研究纳入2010年1月至2015年1月在我院血液透析中心规律行血液透析(透析时间≥3个月)的终末期肾病患者作为研究对象,收集患者年龄、性别、透析时间、透析频率、残余尿量等相关资料及患者血钙、血磷、iPTH、血红蛋白(hemoglobin,Hb)等实验室检查指标,统计我院血液透析中心患者钙磷代谢标志物血钙、血磷、iPTH等各项指标的达标情况。然后分别根据年龄、透析龄、透析频率、残余尿量进行分组,比较各组间钙磷代谢指标的差异性,再分别根据血钙、血磷和iPTH进行分组,采用趋势卡方检验及方差分析比较各组间Hb达标情况。结果①本血液透析中心263例患者中,血钙达标率45.0%,血磷达标率40.1%,iPTH达标率23.7%,与透析预后与实践模式研究第4阶段(Dialysis Outcomes and Practice Pattern Study,DOPPS4)国家达标数据(56.0%、54.5%、32.1%)比较,达标率存在一定差距。②根据透析龄进行分组,透析龄≥3年组平均血钙水平显著高于透析龄3年组平均血钙水平;根据透析频率进行分组,每周2次透析组平均血钙水平显著高于每周≤2次透析组平均血钙水平,血磷水平显著低于每周≤2次透析组。根据残余尿量进行分组,有尿组(尿量≥100 rnl/24 h)钙磷乘积显著低于无尿组。根据年龄分组,年龄45岁组平均血磷水平、iPTH水平、钙磷乘积水平显著低于年龄≤45岁组。③将血钙浓度分为2.1 mmol/L、2.1~2.5 mmol/L、2.5 mmol/L三组。随着血钙增高,Hb达标(≥110 g/L)人数占比越来越大,由38.8%上升至64%,差异有统计学意义(P0.05)。将血磷浓度分为1.13 mmol/L、1.13~1.78 mmol/L、1.78 mmol/L三组,随着血磷增高,Hb达标(110 g/L)人数占比越来越大,由31%上升至53.4%,差异有统计学意义(P0.05)。将血iPTH浓度分为150 ng/L、150~300 ng/L、300 ng/L三组。随着iPTH增高,Hb达标(≥110 g/L)人数占比越来越小,由52.8%下降至36.8%,差异有统计学意义(P0.05)。结论①适当增加透析频率及有效保护残余尿量有助于控制及改善钙磷代谢紊乱。②血钙、血磷浓度上升,有利于维持性血液透析患者Hb的达标。血iPTH浓度上升,不利于维持性血液透析患者Hb的达标。     

维持性血液透析患者血红蛋白波动的临床研究

目的了解维持性血液透析患者血红蛋白(Hb)波动情况,初步探讨Hb波动的影响因素。 方法选取复旦大学附属中山医院血液透析中心透析龄超过12个月的患者。以Hb110～120 g/L为靶目标值,根据前后两个月的Hb变化值是否达到10 g/L分为波动组和非波动组。应用多因素Logistic回归分析Hb波动的影响因素。 结果共163例患者,基线Hb值为(107.52±15.47)g/L,随访期平均Hb值为(106.57±15.22)g/L。基线及随访期Hb达标情况大致相似,46.6%～56.4%患者Hb未达标(Hb<110 g/L)。随访期中仅有1.2%患者Hb始终达标。患者平均Hb波动值为8.15±5.01 g/L,Hb波动率为27.0%,短期波动在大多数血液透析患者中较常见,少数患者Hb长期处于不稳定状态。非波动组患者的透析龄和基础Hb值显著高于波动组(t＝－5.602, P＝0.048; t＝－1.731, P＝0.010),促红细胞生成素(EPO)剂量显著低于波动组(t＝6.218, P<0.001)。多因素Logistic回归分析显示,经过透析龄<24个月、基础Hb<100 g/L等因素校正后,EPO剂量≥200 U/(kg·w)与Hb波动显著独立相关(OR＝4.7,95%CI 3.2～9.3,P＝0.030)。 结论Hb波动在维持性血液透析患者中普遍存在,少数患者Hb长期处于不稳定状态。Hb波动较大的维持性血液透析患者EPO剂量应用也较大。     

新乡地区维持性血液透析患者贫血现况调查及相关因素分析

目的 探讨维持性血液透析患者的贫血现况及相关影响因素.方法 收集2012年1月至3月新乡地区4家综合医院364例维持性血液透析3个月以上患者的临床资料.分析维持性血液透析患者贫血现况及其与促红细胞生成素、铁剂、营养不良、透析充分性、微炎症、甲状旁腺激素等因素的关系.结果 364例患者中促红细胞生成素治疗率为97％,铁剂治疗率为87％,贫血治疗达标率仅为30％,贫血治疗达标组患者的血白蛋白、转铁蛋白饱和度、透析龄、尿素清除指数、铁蛋白和转铁蛋白饱和度两者均达标率患者非达标组比较差异有统计学意义(P均＜0.05).而贫血治疗达标组患者的血红蛋白、透析频率、铁蛋白值、前白蛋白、铁蛋白和转铁蛋白饱和度达标率与非达标组比较差异有统计学意义(P均＜0.01),C反应蛋白值与非达标组比较差异有统计学意义(P＜0.01).贫血治疗达标组促红细胞生成素治疗量在与未达标组比较差异无统计学意义(P＞0.05),但其用量远低于肾脏病预后质量指南中推荐的量.多因素Logistic回归分析结果显示白蛋白、前白蛋白、尿素清除指数、透析频率是维持性透析贫血的独立影响因素.结论 新乡地区大部分维持性血液透析贫血患者均接受促红细胞生成素和铁剂治疗,但治疗仍不充分,达标率较低.营养不良、微炎症、透析不充分、性别也是贫血治疗达标率低的原因,但白蛋白、前白蛋白、尿素清除指数、透析频率是维持性血液透析贫血的独立影响因素.提示我们在采用充足的促红细胞生成素和铁剂治疗维持性血液透析贫血患者的同时,应加强其营养治疗和充分透析的宣传教育.     

维持性血液透析患者氧化应激水平多因素分析

目的 探究维持性血液透析(MHD)患者的氧化应激水平,并分析其影响因素,为干预提供依据.方法 选取MHD患者152例(HD组),选取健康人群30例(对照组),分别检测各组的血浆丙二醛(MDA)、总抗氧化能力(TAC)、C反应蛋白(CRP)、血浆白蛋白(ALB)、肌酐(Scr)、尿酸(UA),并统计MHD患者的透析龄、是否应用静脉铁剂、促红细胞生成素(EPO)用量等信息,运用多重线性回归法分析微炎症状态、透析龄、血浆白蛋白、肌酐等因素对MHD患者氧化应激状态的影响.结果 HD组的MDA水平高于对照组(P＜0.05),而TAC水平低于对照组(P＜0.05),微炎症状态、静脉补铁、透析龄、Scr与MDA呈正相关,其中微炎症状态的标准化偏回归系数最大.ALB、UA、EPO与MDA呈负相关、与TAC呈正相关.结论 MHD患者的氧化应激水平高于正常人群,且微炎症状态对氧化应激的影响高于其他因素.     

单中心腹膜透析患者血红蛋白达标率及相关因素分析

目的通过调查腹膜透析(peritoneal dialysis, PD)患者贫血状况,分析影响血红蛋白(hemoglobin, Hb)达标的因素。方法收集2019年5月1日至9月30日间在安徽医科大学第一附属医院腹膜透析中心规律随访的所有年龄≥18岁且透析龄≥3个月的随访资料完整的PD患者280例,以Hb≥110 g/L为血红蛋白达标标准,分析Hb达标率及影响Hb达标因素。结果 (1)PD患者Hb浓度为(106.08±20.42) g/L,Hb达标率为40.36%,转铁蛋白饱和度、铁蛋白达标率分别为76.78%、38.95%;(2)Hb达标组与未达标组相比,透析龄、每周重组人促红细胞生成素使用剂量、营养评估体质指数(subjective global assessment, SGA)、血磷水平显著低于未达标组(P0.05);达标组血清白蛋白、胆固醇、血钙、血清铁、转铁蛋白饱和度、总肌酐清除率(creatinine clearance rate, Ccr)、残肾Kt/V、残肾Ccr显著高于未达标组(P0.05);(3)高转运组与低平均转运组、高平均转运组相比血红蛋白水平差异具有统计学意义;(4)单因素logistic回归分析显示透析龄1年、高SGA评分、血清白蛋白35 g/L、全段甲状旁腺素(intact parathyroid hormone, iPTH)300 ng/L、血钙2.5 mmol/L、血清铁10.6μmol/L、转铁蛋白饱和度20%、无残余肾功能是PD患者Hb不达标的影响因素;(5)多因素Logistic回归分析结果显示透析龄5年、血清白蛋白35 g/L、iPTH800 ng/L、血清铁10.6μmol/L、转铁蛋白饱和度20%为PD患者贫血的独立危险因素。结论高透析龄、低白蛋白水平、甲状旁腺功能亢进、铁缺乏为PD患者贫血的独立危险因素。     

滁州市维持性血液透析患者矿物质和骨异常现状调查

目的了解滁州地区维持性血液透析(maintenance hemodialysis,MHD)患者的矿物质和骨异常(mineral and bone disorder,MBD)现状。方法调查2014年4~6月滁州地区7家医院血液透析中心的MHD患者情况。调查内容包括患者一般人口学特征、实验室检查、临床表现及用药情况等。分别以肾脏疾病患者生存质量指导(Kidney Disease Outcomes Quality Initiative,KDOQI)和改善全球肾脏病预后组织(Kidney Disease:Improving Global Outcomes,KDIGO)指南为标准,观察血校正钙、血磷、全段甲状旁腺素(immunoreactive parathyroid hormone,iPTH)达标情况,将其达标率与透析预后和实践模式研究(the dialysis outcomes and practice patterns study,DOPPS)4比较;并比较三级医院与二级医院MHD者血校正钙、血磷、iPTH达标率。结果①入选病例1 021例,平均透析时间(46.6±37.3)月。原发病前3位是慢性肾小球肾炎(512例,占50.1%)、糖尿病肾脏疾病(206例,占20.2%)、高血压肾病(144例,占14.1%)。②以KDOQI指南为标准,滁州市MHD者血校正钙、磷、iPTH达标率分别为40.5%、37.4%、21.3%,低于DOPPS4的56.7%、52.6%、29.6%(均P0.01)。③以KDIGO指南为标准,上述指标达标率分别为51.5%、19.8%、46.2%。④以KDOQI指南为标准,三级医院患者血磷、血iPTH达标率高于二级医院(P0.05),而血校正钙达标率两者差异无统计学意义。⑤MBD治疗状况:以KDIGO指南为标准,低钙、高磷和继发性甲状旁腺功能亢进的不当治疗分别占47.5%、47.6%、32.5%。结论滁州地区MHD者血钙、血磷及iPTH达标率低。三级医院MHD患者MBD控制情况较二级医院好,加强检测和管理有望提高相关指标的达标率。     

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.     

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.