普鲁卡因和利多卡因在心脏停搏液中的作用(心功能、心肌酶和超微结构评价)

用离体做功鼠心模型观察并比较了普鲁卡因和利多卡因对钾停搏液作用的影响。实验分为四组：基础停搏液组、含１ｍｍｏｌ／Ｌ普鲁卡因停搏液组、含１ｍｍｏｌ／Ｌ利多卡因停搏液组和含０．２５ｍｍｏｌ／Ｌ利多卡因停搏液组。观察各组心脏缺血后复灌期的功能恢复百分率、心肌酶漏出量、心肌水含量和心肌超微结构变化。结果表明，１ｍｍｏｌ／Ｌ普鲁卡因对停搏液的心肌保护作用无明显影响，而０．２５ｍｍｏｌ／Ｌ和１ｍｍｏｌ／Ｌ利多卡因均表现为心肌损害作用，心功能恢复抑制与心肌损害的加重有关。０．２５ｍｍｏｌ／Ｌ利多卡因的损害作用较轻，但恢复灌后的心肌水肿程度明显加重。     

驻极体对金黄色葡萄球菌感染创面影响的实验研究

采用兔背创面模型，观察驻极体对金黄色葡萄球菌感染创面的影响。于兔背上接种金黄色葡萄球菌液（１０６／ｍｌ），将４０个创面分成两组，对照组贴上凡士林油纱布，治疗组贴上－１５００ｖ驻极体薄膜。于术后第１、２、３、５、７、１０天进行肉眼观察、痂下组织细菌定量计算及组织学检查。结果发现：从术后第３天开始，治疗组含菌量日益减少，创面开始有上皮细胞生长，至第７天，上皮细胞生长旺盛。对照组含菌量日趋增多，且无上皮细胞生长。     

利多卡因对细菌培养影响的实验研究

[目的]探讨利多卡因对细菌培养结果的影响,为临床关节假体周围感染(periprosthetic joint infection,PJI)提高细菌培养阳性率提供理论依据。[方法]制备8种标准菌株,包括金黄色葡萄球菌、表皮葡萄球菌、人葡萄球菌、大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌、化脓链球菌和白色念珠菌的菌悬液(3×10~6CFU/ml),模拟临床PJI的关节滑液。各标准菌株的菌悬液分为两组,利多卡因组为2%利多卡因100μl+菌悬液600μl,盐水组为0.45%无菌生理盐水100μl+菌悬液600μl,混匀1 min后,分别接种于5个琼脂平板培养基上进行24 h定量培养,通过菌落计数比较两组培养基上的细菌生长情况。[结果] 24 h定量细菌培养结果表明,利多卡因组金黄色葡萄球菌、表皮葡萄球菌、人葡萄球菌、大肠杆菌、肺炎克雷伯杆菌、鲍曼不动杆菌、白色念珠菌菌株的菌落计数显著低于盐水组,差异均有统计学意义(P0.05),而两组间化脓链球菌菌株的菌落计数差异无统计学意义(P0.05)。[结论] 2%利多卡因注射液对临床中常见的PJI病原菌具有很强的抗菌作用。因此,在关节液取样前使用2%利多卡因注射液进行局部浸润麻醉可能影响细菌培养结果。     

普鲁卡因和利多卡因在心脏搏液中的作用（心功能,心肌酶和超…

用离体做功鼠心模型观察并比较了普鲁卡因和利多卡因对钾停搏液作用的影响。实验分为四组：基础停搏液组，含ｌｍｍｏｌ．Ｌ普鲁卡因停搏液组，含ｌｍｍｏｌ／Ｌ利多卡因停搏液组和含０．２５ｍｍｏｌ／Ｌ利多卡因停搏液组。观察各组心脏缺血后复灌期的功能恢复百分率，心肌酶漏出量，心肌水含量和心肌超微结构变化。结果表明，１ｍｍｏｌ／Ｌ普鲁卡因对停搏液的心肌保护作用无明显的影响。而０．２５ｍｍｏｌ／Ｌ利多卡因均表现为心     

红细胞回收仪对细菌污染血液的清洗效果观察

目的：观察红细胞回收仪对细菌污染血液的清洗效果。方法：选择15例出血量大的无菌手术病人，通过红细胞回收仪采集术野积血，经清洗处理后将大部分血液回输给病人。留取处理血液200～300ml，从中取血样5ml(血样I)造行细菌培养，在余血中加入金黄色葡萄球菌、绿脓杆菌和大肠杆菌。然后再进行洗涤，并按清洗液容量分成两组，I组清洗液量为1000ml(共10例)；Ⅱ组清洗液量为1500ml(共5例)。采集洗涤后的红细胞悬液5ml(血样Ⅱ)进行细菌培养。结果：所有病人血样I的细菌培养结果均为阴性；两组病人血样Ⅱ中金黄色葡萄球菌、绿脓杆菌培养均为阴性，但大肠杆菌培养全部为阳性。结论：红细胞回收仪不能将所有的微生物从被污染的血液中清洗掉，增加清洗液容量并不能改善洗涤效果。     

先锋V尿道内加压灌注治疗慢性前列腺炎80例报告

我们自1992年以来用先锋V尿道内加压灌注保留方法治疗慢性细菌性前列腺炎80例，效果满意，有效率达85％以上。现报道如下。临床资料1．一般情况：本组病例来自我院1992年～1995年门诊和住院病人，年龄为19—42岁，平均为25．4岁，病程3月～2年，平均5．6月。未婚12例。2．本组病人均符合以下要求：（1）病程3个月以上；（2）有急性尿道炎病史和不正规的治疗史；（3）前列腺液常规；WBC＞10个／HP，或见有脓细胞；（4）前列腺液培养有细菌生长。本组病例细菌分类：大肠杆菌46例，克雷伯杆菌8例，淋球菌16例，金黄色葡萄球菌6例，链球菌4例…     

人工瓣膜材料细菌粘附与细菌生长的关系

目的通过体外实验,评价人工瓣膜材料细菌粘附与细菌生长的关系。方法采用平板菌落计数法、１２５Ⅰ标记细菌放射性测定法测定金黄色葡萄球菌、表皮葡萄球菌、大肠杆菌和绿脓杆菌的生长曲线,同时测定４种细菌对人工瓣膜材料涤纶、热解碳、聚四氟乙烯的粘附情况。结果４种细菌对３种人工瓣膜材料粘附能力与细菌生长曲线基本一致。细菌在体外生长不受人工瓣膜材料存在的影响,不同时间同一细菌对同一材料粘附不同。结论细菌对材料粘附与细菌生长曲线基本一致,细菌对人工瓣膜材料的粘附是一个动态变化过程     

外科感染病原菌耐药现状及对策

细菌耐药性是抗菌药物治疗的大敌。无论使用多么强有力的抗生素,如果细菌对其耐药,也只能是隔靴搔痒,无济于事。了解病原菌的耐药现状并据此采取相应对策,对提高抗感染治疗的临床效果十分重要。一、外科感染常见病原菌据解放军304医院资料,外科感染最常见的菌种依次是绿脓杆菌(20.7%)、大肠杆菌(19.9%)、金黄色葡萄球菌(17.2%)、沙雷菌属(7.8%)、凝固酶阴性葡萄球菌(6.6%)、变形杆菌(6.0%)、肠球菌(5.5%)和克雷伯菌属(4.4%);据湖北地区报告顺序为金黄色葡萄球菌(15.6%～26.3%)、绿脓杆菌(18.5%～20.0%)、大肠杆菌(13.0%～17.9%)、凝固酶阴性…     

痔外坐液熏洗治疗肛门疾病的研究

以痔外坐液熏洗治疗肛门疾病１７４例，显效４２例、有效１１８例、无效１４例，总有效率９４％；以ＰＰ液作对照组熏洗治疗肛门疾病８６例，显效１５例、有效５７例、无效２９例，总有效率为６５％；统计学处理二者有非常显著差异（Ｐ＜０．００１）．抑菌试验表明痔外坐液能抑制金黄色葡萄球菌、白色葡萄球菌、大肠杆菌的生长。其ＭＢＣ分别为１：３２，１：３２，１：１。皮肤渗透性急性毒性试验表明痔外坐浴对兔皮肤无刺激性。作者认为痔外坐浴具有疏风清热解毒、散瘀消肿止痛之功，适用于肛门疾病所致之肿痛、出血、脱出诸症，亦可作为肛门保健坐浴之用。     

利多卡因通过增加细胞周期素依赖的蛋白激酶抑制剂1A（p21）表达抑制NIH-3T3细胞的增殖

背景研究利多卡因抑制大鼠胚胎成纤维细胞株NIH-3T3增殖的分子机制。体外实验中，局麻药可抑制细胞增殖，但它们对伤口愈合的影响目前尚存在争议。我们观察了利多卡因对体外大鼠成纤维细胞株NIH一3T3增殖的作用及机制。方法将NIH-3T3细胞置于含利多卡因（O、0．05、0．5、1、2、5rIM）的培养液中生长。细胞计数反映细胞增殖水平，并测定溴脱氧尿苷的摄取来反映利多卡因的抑制作用，基因表达和蛋白增殖水平分别采用PcR和westem测定。结果利多卡因呈浓度依赖性地抑制NIH—313细胞增殖，其抑制程度从无（Q05和Q5mM）到轻微（1mM）到很强（2mM和5mM）（P=0．006）。第3．5天，2mM利多卡因组明显抑制溴脱氧尿苷的摄取（与对照组相比P=0．02，与lmM利多卡因组相比P=Q0495）。第1．5天，利多卡因可上调细胞周期蛋白D1和细胞周期素依赖性蛋白激酶抑制剂1A（p21）的表达。第2．5天，利多卡因增加了p21蛋白水平。结论在脊髓麻醉、硬膜外麻醉和神经阻滞时，血浆中利多卡因浓度较低，其对成纤维细胞的增殖无明显影响，而高浓度的利多卡因可升高p21蛋白水平，使细胞增殖停止在细胞周期的S期，从而抑制细胞增殖。组织渗透后可能达到的高浓度利多卡因可能通过抑制成纤维细胞增殖而阻碍伤口的愈合。     

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.