不同冲洗液对关节置换术后感染的预防作用

目的　探讨不同冲洗液冲洗对人工关节置换术后感染的预防作用。方法　将 5 4只家兔分成 5组 ,各组动物于右侧膝关节股骨远端置入钴 铬 钼合金假体 ,关节腔内加入 1× 10 8cfu/ml浓度的金黄色葡萄球菌菌液 10 0 μl。对照组伤口不予冲洗。生理盐水冲洗组、洗必泰冲洗组、活力碘冲洗组和庆大霉素生理盐水冲洗组则于加入菌液 3min后分别用生理盐水、0 .0 5 %洗必泰、0 .10 %活力碘和庆大霉素生理盐水 (2 4万U/ 5 0 0ml)各 15 0ml冲洗创面 2min。术后 14d通过观察局部炎症表现、脓液性状和细菌培养来判断是否发生感染。结果　对照组、生理盐水冲洗组和活力碘冲洗组感染率均为 10 0 %。洗必泰冲洗组感染率为 90 %。庆大霉素生理盐水冲洗组感染率为9.1% ,明显低于对照和其他各组 (P <0 .0 1)。结论　庆大霉素生理盐水冲洗创面能明显降低含有置入假体的金黄色葡萄球菌污染关节的感染率 ,可有效预防人工关节置换术后感染。     

聚维酮碘溶液联合生理盐水冲洗在脊柱手术中的应用

目的评估术中聚维酮碘溶液联合生理盐水冲洗在预防脊柱手术后切口感染的有效性。方法 426例脊柱手术患者纳入研究对象,分为聚维酮碘溶液联合生理盐水冲洗组(n=209)及单纯生理盐水冲洗组(n=217),术中分别行聚维酮碘溶液联合生理盐水冲洗及单纯生理盐水冲洗,分别计算术后感染率并进行统计学分析。结果聚维酮碘溶液联合生理盐水冲洗组209例中无感染发生;单纯生理盐水冲洗组217例中发生浅部感染1例(感染率0.46%)、深部感染4例(感染率1.84%)、全层感染5例(感染率2.3%),总感染率为4.6%。两组浅部感染率比较差异无统计学意义(P=0.378),两组深部感染率及全层感染率比较差异有统计学意义(P=0.016,P=0.007)。结论在脊柱外科手术中应用聚维酮碘溶液联合生理盐水进行冲洗,能有效地降低术后切口浅部及深部感染的发生率。     

腰椎术后感染的原因分析与治疗策略

目的探讨腰椎内固定术后感染的原因、诊断与处理对策。方法对810例脊柱后路内固定术后17例感染患者的年龄、基础疾病、手术时间、术中出血量、抗生素使用、临床表现、实验室检查、细菌学检查及治疗方案、预后进行回顾性分析。结果年龄：〈40岁、40～55岁、〉55岁的感染率分别为0、1．58％、3．59％（P〈0．05）;手术时间：〈90min、90—180min、〉180min的感染率分别为0．73％、2．03％、4．62％（P〈0．05）;出血量：〈300ml、300～600ml、〉600ml的感染率分别为1．08％、2．63％、3．80％（P〈0．05）;基础疾病：无、合并1～2种、〉2种的感染率分别为1．03％、1．87％、4．09％（P〈0．05）;术后抗生素使用时间：〈24h、24～72h、〉72h的感染率分别为2．39％、2．04％、2．07％（P〉0．05）。结论年龄〉55岁、合并2种以上基础疾病、手术时〉180min、出血量〉600ml是腰椎内固定术后感染的危险因素。病灶扩创引流结合足量长程敏感的抗生素静脉输入,辅以全身营养支持治疗腰椎后路内固定术后感染行之有效。     

局部应用万古霉素预防脊柱后路内固定术深部切口感染的疗效

目的探讨局部应用万古霉素预防脊柱后路内固定术深部切口感染的疗效。方法将675例行脊柱后路内固定术患者按时间段分为两组:对照组(320例)术前30 min静脉应用头孢呋辛钠2.0 g,术中每隔3 h追加1次;观察组(355例)常规预防感染方案同对照组,在关闭切口前于术野局部应用万古霉素1.0 g。采用病原学诊断标准,比较两组患者术后深部切口感染情况。结果术后共计17例(2.52%)发生深部切口感染,其中对照组13例(4.06%),观察组4例(1.13%),两组深部切口感染率比较差异有统计学意义(P=0.015),但颈、胸、腰椎区域组间比较差异无统计学意义(P0.05)。结论局部预防性应用万古霉素可降低脊柱后路内固定术深部切口感染率。     

脊柱后路椎弓根螺钉系统内固定术后感染临床分析

[目的]探讨脊柱后路椎弓根螺钉内固定系统术后感染的危险因素、诊断及处理方法。[方法]对脊柱后路椎弓根螺钉系统内固定术后并发感染的16例患者的手术时间、术中失血量、围手术期抗生素的使用、临床表现、实验室检查、细菌培养等进行回顾性分析。[结果]本组541例患者，术后感染发生率为2．98％，手术时间60min以内、60～120min、大于120min术后感染发生率依次为0．00％，3．04％，5．90％；术中失血量〈400ml，400～800ml，〉800ml术后感染发生率分别为2．12％，3．15％，11．16％；术后使用抗生素，术中术后使用抗生素，术前术中术后均使用抗生素，术后感染发生率分别为1．10％，4．32％，10．25％。15例取出内固定者及1例未取出者，切口均甲级愈合。16例患者二次手术后随访11～23个月，均无复发征象。[结论]脊柱后路椎弓根螺钉系统内固定术后感染与手术时间、术中失血量有关，手术失血量越多，手术时间越长，术后越易发生感染，围手术期使用抗生素可有效减少感染的发生；确诊后病灶清除，内固定物取出，灌洗引流，静脉应用有效抗生素，可获得满意疗效。     

两种冲洗液用于术前结膜囊冲洗的效果比较

目的 探讨两种冲洗液用于术前结膜囊冲洗的临床效果。方法 选择行内眼手术100例患者（100眼），随机分为对照组与观察组各50例。对照组采用生理盐水200ml加庆大霉素9．6万U行结膜囊冲洗，观察组采用生理盐水200ml行结膜囊冲洗，冲洗90min后用棉拭子采集结膜囊标本并在30min内送栓进行细菌培养。结果两组结膜囊冲洗后细菌阳性率比较，差异无显著性意义（P〉0．05）。结论 应用生理盐水作为术前结膜囊冲洗液，既能达到抑菌、抗感染的目的，又能减少抗生素耐药性的形成。     

腹腔、腹壁肌和皮肤三个层面冲洗在预防阑尾切口感染中的应用及疗效比较

目的 评价术中冲洗在预防阑尾切口感染的作用。方法 600例穿孔性阑尾炎随机分成三组。腹腔冲洗组189例（A组）、腹腔、腹壁肌冲洗组202例（B组）、腹腔、腹壁肌和皮肤三个层面冲洗组209／N（cN），冲洗均用生理盐水及甲硝唑。术后观察三组切口感染情况。结果 切口感染率A组为18．52％（35／189），BN为7．43％（15／202），C组为3．35％（7／209），三组差异有显著性（P〈0．05）。结论 腹腔、腹壁肌和皮肤三个层面清洁能显著降低阑尾切口感染率。     

颅内肿瘤切除术中应用庆大霉素盐水冲洗的效果观察

目的探讨应用庆大霉素盐水冲洗颅腔预防颅内肿瘤切除患者术后感染的效果。方法将136例颅内肿瘤切除术患者按手术时间分成4组各34例,分别以庆大霉素16万U加入生理盐水500ml中（手术时间≤4h为观察1组．〉4h为观察2组）或只用生理盐水500ml（手术时间≤4h为对照1组,〉4h为对照2组）在颅内肿瘤切除彻底止血后,缝合硬脑膜前冲洗颅腔。比较4组冲洗前后脑脊液细菌培养情况,患者术后体温、脑膜刺激征及切口感染发生率。结果4组冲洗前后细菌菌落数比较,差异有统计学意义（P〈0．05）;患者术后体温、脑膜刺激征发生率在手术时间≤4h两组组间比较,差异无统计学意义,而手术时间〉4h两组比较,对照组显著高于观察组。结论庆大霉素盐水冲洗应用于手术时间〉4h的颅内肿瘤切除手术可以有效预防术后感染。     

鱼腥草注射液膀胱冲洗预防泌尿系感染

将103例重型脑外伤病人随机分为对照组(51例)和观察组(52例)，对照组采用庆大霉素8万U加无菌生理盐水250m1进行膀胱冲洗，观察组采用鱼腥草注射液30m1加无菌生理盐水250ml进行膀胱冲洗，均为2次／d，连续3—14d。结果，尿细菌培养阳性率观察组显著低于对照组(P＜0．05)，提示鱼腥草注射液有良好的预防泌尿系感染作用，效果优于庆大霉素。     

双向腔静脉-肺动脉吻合术的手术配合

目的 探讨0．5％甲硝唑、庆太霉素加入0．9％氯化钠溶液膀胱冲洗预防宫颈癌术后留置尿管感染的临床效果。方法 宫颈癌（Ⅰb～Ⅱa期）根治术后留置尿管患者97例，随机分为观察组（49例）和对照组（48例），观察组术后用0．5％碘伏棉球会阴擦洗。2次／d，并于第5天开始每天上午予0．5％甲硝唑0.5g、下午予庆大霉素16万U膀胱冲洗；对照组术后用0．1％苯扎溴铵棉球会阴擦洗，2次／d，并于第5天开始予0．02％呋喃西林250ml膀胱冲洗，2次／d。观察两组惠者置尿管后3、7、10d中段尿培养细菌阳性率。结果 观察组置尿管后3、7、10d尿路感染率显著低于对照组（P〈0．05。P〈0．01）。结论 甲硝唑与庆大霉素膀胱冲洗可以有效预防或减少宫颈癌根治术后留置尿管患者尿路感染的发生。     

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.     

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.     

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.     

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.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.