老年尿毒症患者血液透析滤过临床疗效观察

目的探讨血液透析滤过(hemodiafiltration,HDF)对老年尿毒症患者不同分子量物质的清除率、患者耐受性及临床疗效。方法选择38例行维持性血液透析(maintenance hemodialysis,MHD)的老年尿毒症患者,依经济状况随机分为HDF组和血液透析(hemodialysis,HD)组。HDF组行前稀释HDF 1次/周,HD 2次/周;HD组患者行HD 3次/周。2组HD方案一样,且观察时间均为3个月;观察2组尿素清除指数(Kt/V)、血清肌酐(SCr)、尿素氮(BUN)、血尿酸(uric acid,UA)、β2-微球蛋白(β2-microglobulin,β2-MG)、全段甲状旁腺素(immunoreactive parathyroid hormone,iPTH)、血钾、血钙、血磷、二氧化碳结合力(carbon dioxide combining power,CO_2-CP)下降率及治疗中的并发症和不良反应发生率。结果老年尿毒症患者对HDF治疗效果和耐受性显著优于HD,HDF组的HD并发症和不适症状发生率显著低于HD组(P0.01),HDF治疗后血清β2-MG、iPTH水平显著降低,Kt/V明显增高。治疗前后2组血清BUN、SCr、UA均明显下降,但下降幅度差异无统计学意义。治疗前后2组血钾、血钙、CO_2-CP及酸碱平衡失调均明显改善或纠正(P0.01),但2组间比较其变化幅度差异无统计学意义。结论前稀释HDF、结合HD的方案与单纯HD治疗相比,能有效清除尿毒症患者血中大、中、小分子物质,透析效果显著提高。患者对该法治疗的耐受性明显提高,适用于易出现HD并发症及不适症状的老年尿毒症患者。     

碳酸镧联合不同血液净化方式对慢性肾脏病-矿物质和骨代谢异常患者钙磷代谢的影响

目的探讨碳酸镧联合不同血液净化方式对慢性肾脏病-矿物质和骨代谢异常(chronic kidney disease mineral and bone disorder,CKD-MBD)患者钙磷代谢的影响,为CKD-MBD患者选择最佳治疗方案,改善患者的生存质量。方法选择陕西省人民医院2014年1月至2015年5月行维持性血液透析的CKD-MBD患者76例,给予口服碳酸镧并按透析方式分为3组,血液透析(hemodialysis,HD)组24例、血液透析联合血液透析滤过(HD and hemodialysis filtration,HD+HDF)组27例,血液透析联合血液灌流(HD and blood perfusion,HD+HP)组25例,比较各组治疗前和治疗3个月后血钙、血磷、钙磷乘积及甲状旁腺素(parathyroid hormone,PTH)的变化。观察3组治疗中不良反应的发生率并进行比较。结果治疗3个月后,3组血钙较治疗前均升高,3组间血钙变化无统计学差异(P0.05);3组血磷及钙磷乘积较治疗前明显下降(P0.05),但HD+HDF组、HD+HP组较HD组下降更为明显(P0.05)。HD组门H在治疗前、后变化不大(P0.05),HD+HDF组和HD+HP组治疗3个月后PTH较前明显下降(P0.05)。HD组、HD+HDF组及HD+HP组患者并发症发生率分别为75.0%、18.5%、32.0%,HD组并发症明显高于HD+HDF组和HD+HP组,差异有统计学意义(P0.05),HD+HDF组并发症发生率最低。结论碳酸镧联合不同血液净化方式对血钙、血磷及PTH的清除效果不同,联合HDF和HP方式能明显清除血磷、PTH,改善钙磷代谢紊乱,不良反应小,适合临床应用治疗CKD-MBD。     

血液透析滤过对维持性血液透析患者睡眠及生活质量影响的观察

目的观察血液透析滤过(hemodiafiltration,HDF)对维持性血液透析(maintenance hemodialysis,MHD)患者睡眠质量及生活质量的影响。方法选择MHD患者70例,分为常规血液透析治疗组(HD组)和On-line HDF治疗组(HDF组),每组各35例。HD组患者均调整为每周行3次血液透析治疗,HDF组患者每周行2次常规血液透析治疗,1次HDF,时间均为4 h。比较两组治疗前后匹兹堡睡眠质量指数量表(PSQI)、健康状况调查表(SF-36)改善情况。结果两组患者治疗后睡眠质量总评分、健康状况调查表分值较治疗前均有明显改善,其中HDF组患者入睡时间、睡眠时间、睡眠效率及PSQI总分值改善优于HD组治疗后(P0.05);肢体疼痛(BP)、总体健康(GH)、精力(VT)、情感职能(RE)及心理健康(MH)分值显著低于HD组治疗后(P0.05)。结论 HDF可更好的改善MHD患者的睡眠质量及生活质量。     

药用炭联合血液透析滤过治疗尿毒症皮肤瘙痒的临床疗效分析

目的观察药用炭联合血液透析滤过治疗尿毒症皮肤瘙痒的临床效果。方法选择2009年1月至2015年11月仙桃市中医医院肾病内科就诊的尿毒症伴皮肤瘙痒患者78例,分为对照组(每周3次单纯血液透析)、血液透析联合血液滤过组(血滤组,每周2次血液透析和1次血液透析滤过)、治疗组(在每周2次血液透析和1次血液透析滤过基础上使用药用炭口服),每组26例,连续治疗3个月,比较3组患者治疗前、后皮肤瘙痒评分、血磷、血β2微球蛋白、血甲状旁腺素、血尿素氮、血肌酐等指标的变化及治疗有效率。结果 3组患者治疗后血磷、血β2微球蛋白、血清甲状旁腺素、血尿素氮、血肌酐均降低,与治疗前比较,差异有统计学意义(P0.05);对照组、血滤组、治疗组治疗后总有效率分别为42.31%,69.24%,88.47%,治疗组在总有效率上优于对照组和血滤组(P0.05);3组治疗前皮肤瘙痒评分分别为(33.28±5.72)分、(34.12±5.88)分、(35.20±4.82)分,治疗后皮肤瘙痒评分分别为(21.28±3.56)分、(12.28±2.87)分、(5.25±2.12)分,与治疗前比较,差异具有统计学意义(P0.05);3组间治疗后皮肤瘙痒评分比较,差异具有统计学意义(P0.05)。结论血液透析联合血液透析滤过及口服药用炭能够明显缓解尿毒症性皮肤瘙痒,同时降低血磷、血β2微球蛋白、血清甲状旁腺素、血肌酐、尿素氮等,疗效显著。     

甲状旁腺切除加自体移植术对尿毒症患者近期临床症状及钙磷代谢的影响（附20例临床分析）

目的观察甲状旁腺切除加自体移植(parathyroidectomy with autotransplantation,PTX+AT)对尿毒症继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)患者近期临床症状及各项生化指标的影响。方法回顾性分析20例SHPT手术前和手术后短期内的临床症状、血清全段甲状旁腺激素(intact parathyroid hormone,i PTH)、血钙、血磷等变化以及术后近期疗效及并发症的发生情况。结果 20例尿毒症继发性甲状旁腺功能亢进症患者,术前i PTH为(1648±797)pg/m L,甲状旁腺切除后,术后1w i PTH为(125±263)pg/m L,P0.01,差异具有统计学意义。术前血钙(2.58±0.25)mmol/L、血磷(2.30±0.73)mmol/L;术后第1天血钙(1.97±0.46)mmol/L、血磷(1.92±0.81)mmol/L,术后1 w血钙(1.99±0.46)mmol/L、血磷(1.38±0.66)mmol/L。术后1w 15例患者(占总失眠人数100%)失眠症状,13例患者(占总皮肤瘙痒人数80%)皮肤瘙痒症状、3例患者(占不安腿人数100%)不安腿症状明显好转,12例患者(占骨关节痛患者80%)骨关节疼痛症状、5例患者(占肌无力患者60%)肌无力症状有所改善。术后5位患者出现抽搐,4例患者出现声音嘶哑,经相应处理后,患者症状明显改善。结论甲状旁腺切除在短期内显著改善尿毒症继发性甲状旁腺功能亢进患者的骨关节痛、皮肤瘙痒、肌无力、失眠等临床症状,同时缓解高钙,高磷血症。     

不同置换液量血液透析滤过治疗尿毒症皮肤瘙痒疗效观察

目的：观察不同置换液量血液透析滤过(HDF)对尿毒症皮肤瘙痒的治疗作用。方法：将30例并发皮肤瘙痒的维持性血液透析尿毒症患随机分为三个组，分别接受高置换液量后稀释HDF(置换液20L)、低置换液量后稀释HDF(置换液10L)和高通量血液透析治疗。均使用F60透析器，隔日1次，连续3次，其余治疗条件相同。对皮肤瘙痒症状定量计分，比较三组病人治疗前后皮肤瘙痒症状积分的改变以及血磷和甲状旁腺激素(PTH)的变化。结果：高置换液量HDF组治疗后皮肤瘙痒积分明显下降，有统计学意义。其余两组无差异。以皮肤瘙痒积分下降50％为有效计算，高置换液量HDF组7例有效，有效率70％；低置换液量HDF组3例有效。有效率30％；透析组1例有效，有效率10％。三组间比较有统计学差异。三组透析后血磷均明显下降，有统计学意义；PTH亦有下降，HDF组有统计学差异，HD组无统计学差异。结论：增加置换液量可以提高HDF治疗尿毒症皮肤瘙痒的疗效；HDF治疗尿毒症皮肤瘙痒疗效优于高通量血液透析；HDF清除PTH的效果高于HD。     

血液透析联合血液灌流治疗尿毒症患者皮肤瘙痒的疗效

目的 观察血液透析联合血液灌流治疗尿毒症皮肤瘙痒患者的临床疗效.方法 选择我院72例维持性血液透析伴皮肤瘙痒患者,采用数字表法随机分为观察组(HD+ HP组)和对照组(HD组),每组各36例.对照组采用单纯血液透析(HD)治疗,每周3次,每次4小时;观察组在常规血液透析基础上加用2～3次/月的组合型人工肾治疗[血液透析(HD)联合血液灌流(HP)治疗].检测两组患者治疗前后β2-微球蛋白(β2-MG)、甲状旁腺激素(PTH),并观察两组患者皮肤瘙痒改善情况.结果 治疗2个月后观察组患者血β2-MG、PTH比对照组明显下降,差异有统计学意义(P＜0.05),皮肤瘙痒的程度明显减轻.结论 血液透析联合血液灌流可有效的清除血液中大分子毒素;有效缓解长期血液透析患者皮肤瘙痒症状,改善预后,提高了尿毒症患者生存质量.     

左卡尼汀联合促红细胞生成素治疗肾性贫血的疗效分析

目的探讨血液透析(HD)患者应用左卡尼汀与促红细胞生成素(EPO)联合治疗肾性贫血的疗效。方法收集2015年1月至2016年12月入院的80例肾性贫血HD患者以随机号码表随机分为2组,每组40例,对照组患者给予EPO治疗,治疗组患者则在对照组治疗的基础上加用左卡尼汀,比较2组患者治疗前后血红蛋白、红细胞比容、血清铁蛋白与血清转铁蛋白饱和度等相关参数、总体治疗效果、左室重构与不良反应。结果治疗组患者治疗后血红蛋白、红细胞比容、血清铁蛋白、血清转铁蛋白饱和度水平分别为(106.52±9.42)g/L、(28.17±2.55)%、(268.22±40.35)μg/L、(31.59±5.60)%均显著高于对照组的(95.72±8.29)g/L、(25.35±2.13)%、(220.07±41.94)μg/L、(26.48±4.91)%,甲状旁腺素、血磷、左心房前后径、左心室收缩期内径与左心室舒张期内径水平为(59.80±11.34)mmol/L、(1.39±0.37)mmol/L、(31.32±0.87)mm、(32.17±1.20)mm、(54.85±1.41)mm均显著低于对照组的(84.60±17.56)mmol/L、(1.77±0.45)mmol/L、(33.92±1.13)mm、(33.89±1.06)mm、(58.42±1.57)mm,存在显著差异(P0.01);显效率明显高于对照组,存在明显差异(P0.05);2组患者药物不良反应率不存在明显差异(P0.05)。结论肾性贫血HD患者应用左卡尼汀与EPO联合治疗的疗效显著,可明显改善贫血指标,促进心室重构,从而提升治疗效果,同时具有极高的安全性,不易发生不良反应,值得临床上大力推广与应用,给肾性贫血HD患者带来福音,对该领域治疗研究,具有深远的借鉴意义。     

不同血液净化方式对维持性血液透析患者毒素清除效果的影响

目的观察不同血液净化方式对维持性血液透析(maintenance hemodialysis, MHD)患者毒素清除的效果。方法选取在首都医科大学附属北京朝阳医院行MHD的患者60例为研究对象, 其中20例接受血液透析(hemodialysis, HD)治疗, 20例接受血液透析滤过(hemodiafiltration, HDF)治疗, 20例接受HD+血液灌流(hemoperfusion, HP)治疗。比较三组患者透析前、后β2-微球蛋白(β2-microglobulin, β2-MG)、血磷、血肌酐、尿素氮、血钙、白蛋白的变化。结果 (1)HD、HDF、HD+HP三种血液净化方式均能有效清除MHD患者体内的血肌酐、尿素氮、血磷, 三组患者尿素清除率(urea reduction ratio, URR)分别为69.1%、69.7%、69.8%, 三组URR差异无统计学意义。三种血液净化方式均对血钙及血清白蛋白无明显影响。(2)HDF、HD+HP均能降低MHD患者β2-MG水平, 下降率分别为69.42%、37.07%, HDF组下降较HD+HP组明显, HD组β2-MG的下降率为7.1...     

血液灌流联合血液透析治疗尿毒症患者高β2-微球蛋白和高甲状旁腺激素临床观察

目的 观察血液灌流(hemoperfusion,HP)联合血液透析(hemodialysis,HD)在尿毒症患者治疗中,对血β2-微球蛋白(β2-MG)、全段甲状旁腺激素(I-PTH)清除效果及临床症状改善情况.方法 将血液灌流器与透析器串联作血液灌流-血液透析(hemoperfusion/hiemocIialysis,HP/HD)联合治疗,先行HP/HD2小时,树脂吸附达饱和后取下灌流器,继续HD 2小时,单次总治疗时间4小时,治疗前后各测1次β2-MG和I-PTH观察疗效.结果 β2-MG治疗前(37108.55±13570.59)μg/L,治疗后下降为32133.81±13785.98μg/L,iPTH治疗前(631.91±436.60)pg/mL,治疗后为(380.60±245.40)pg/mL,差异均有统计学意义.患者睡眠改善,食欲增加.结论 血液灌流对中大分子物质清除有效,长期应用可显著提高患者生活质量及生存率.     

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.