重组牛碱性成纤维细胞生长因子凝胶联合紫草油纱条促进肛瘘术后创面修复的临床观察

目的探讨重组牛碱性成纤维细胞生长因子凝胶联合紫草油纱条在肛瘘术后换药的疗效。方法将100例患者随机分为观察组和对照组各50例,观察组采用重组牛碱性成纤维细胞生长因子凝胶联合紫草油纱条换药,对照组单纯采用紫草油纱条换药。比较两组脓腐脱尽时间及创面愈合时间,术后第2、7、15天的创面分泌物、创面肉芽生长及创面疼痛积分。结果观察组的脓腐脱尽时间及创面愈合时间均短于对照组(P0.05),两组术后第2d的创面分泌物、创面肉芽生长及创面疼痛情况比较差异无统计学意义(P0.05),观察组术后第7、15d的各项积分均低于对照组(P0.05)。结论重组牛碱性成纤维细胞生长因子凝胶联合紫草油纱能有效地促进肛瘘术后创面的愈合。     

复方生肌玉红膏换药促进肛瘘术后创面愈合的疗效观察

目的:观察复方生肌玉红膏油纱条换药促进肛瘘术后创面愈合的疗效。方法:选取2021年11月至2022年11月,本院80例肛瘘术后患者,随机分成治疗组和对照组,每组各40例。治疗组术后创面外敷生肌玉红膏油纱条,对照组创面外敷凡士林油纱条。观察2组临床疗效,创面愈合时间,肉芽组织及上皮组织出现时间,创面疼痛评分及肉芽组织生长评分。结果:治疗组总有效率高于对照组(P<0.05),术后肉芽组织出现时间早于对照组(P<0.05),创面愈合速度明显快于对照组(P<0.05),创面疼痛、水肿及肉芽组织生长评分明显低于对照组(P<0.05)。结论:肛瘘术后采用复方生肌玉红膏纱条换药,临床效果优于传统凡士林纱条换药。可加速创面愈合,减轻术后水肿及疼痛。     

紫草生肌膏纱条在肛肠手术后的应用

目的：观察紫草生肌膏在肛肠病术后预防创口感染、减轻疼痛、促进愈合的效果。方法：观察198例肛肠病手术患者,配对分为治疗组102例,采用术后紫草生肌膏创口换药,对照组96例采用凡士林油纱条换药,进行临床疗效对比。结果：治疗组疗效明显优于对照组,创面疼痛轻,愈合时间较对照组明显缩短。结论：紫草生肌膏具有良好的抗菌消炎效果,能明显减轻创面疼痛,改善创面肉芽组织生长速度,促进创面愈合。     

紫草油联合美洲大蠊粉在低位肛周脓肿术后的应用

目的:观察紫草油纱条联合美洲大蠊粉对低位肛周脓肿术后切口愈合的作用。方法:将116例低位肛周脓肿患者随机分为观察组和对照组各58例,均采用相同的术后抗感染及支持治疗。观察组采用美洲大蠊粉联合紫草油纱条换药,对照组单纯采用紫草油纱条换药。分别观察记录两组术后第1、6、11、16 d创面疼痛VAS评分、分泌物评分、肉芽生长评分、并发肛周湿疹例数、创面愈合时间及创面愈合率等指标。结果:观察组术后1、6、11、16 d疼痛VAS评分分别为6.49±0.55、4.98±0.26、2.59±0.34、1.06±0.23,对照组为6.53±0.36、5.96±0.42、4.66±0.40、3.19±0.31,观察组治疗后6、11、16 d疼痛VAS评分均明显低于对照组(P0.05);观察组术后1、6、11、16 d创面分泌物评分分别为2.43±0.36、1.89±0.41、1.64±0.26、1.45±0.23,对照组为2.13±0.53、1.66±0.29、1.52±0.49、1.36±0.19,观察组患者治疗后6、11、16 d创面分泌物评分均明显低于对照组(P0.05);观察组术后1、6、11、16 d肉芽生长积分分别为2.51±0.53、1.59±0.49、1.01±0.39、0.71±0.28,对照组为1.61±0.64、1.03±0.36、0.86±0.26、0.42±0.21,观察组术后第11、16 d肉芽生长积分明显高于对照组(P0.05);观察组术后6、11、16 d创面愈合率分别为29.35±2.12、46.53±3.18、93.62±4.96,对照组为21.51±1.83、33.19±2.24、76.25±4.03,观察组术后6、11、16 d创面愈合率均高于对照组(P0.05);观察组并发肛周湿疹例数明显少于对照组(P0.05);观察组创面愈合时间明显少于对照组(P0.05)。结论:紫草油纱条联合美洲大蠊粉换药,可显著减轻低位肛周脓肿术后创面疼痛,减少分泌物渗出,促进肉芽生长,缩短创面愈合时间。     

藻酸钙敷料联合紫草油纱条用于低位单纯性肛瘘术后换药的临床效果

为探讨藻酸钙敷料联合紫草油纱条用于低位单纯性肛瘘术后换药的临床疗效,将120例行手术治疗的低位单纯性肛瘘（括约肌间瘘）患者随机分为对照组和观察组,各60例,对照组术后以传统紫草油纱条做为敷料进行常规换药,观察组采用藻酸钙敷料敷盖创面,再加紫草油纱条外敷的方式换药。结果显示,120例患者全部痊愈出院。观察组创面愈合时间、创面渗液明显减少时间、换药时创面疼痛程度、创面换药后过敏反应情况均明显优于对照组,P〈0．05。随访半年,无复发。结果表明,与单纯应用紫草油纱条换药相比,将藻酸钙敷料和紫草油纱条敷料结合用于肛瘘术后换药创面愈合时间更短,换药时患者痛苦更小,且无创面过敏反应发生,具有更高的临床应用价值。     

复方紫草膏对肛周脓肿术后创面愈合的影响

为观察复方紫草膏纱条用于肛周脓肿术后创面换药的临床疗效,将151例肛周脓肿患者随机分为观察组75例采用复方紫草膏纱条换药;对照组76例采用凡士林纱条换药,观察两组创缘红肿消失时间、脓性分泌物消失时间、肉芽组织生长情况、创口愈合时间、平均住院时间。结果显示,观察组以上指标均明显优于对照组。结果表明,复方紫草膏纱条用于肛周脓肿术后创面换药,疗效明显,可缩短疗程,无毒副作用。     

中药熏洗在痔切除术后的临床运用

为探讨中药熏洗对环状混合痔外剥内扎术后创面愈合的影响,将180例环状混合痔外剥内扎术后的患者随机分为治疗组和对照组各90例,紫草油纱条换药前,两组分别采用中药和PP液熏洗坐浴,治疗组在术后疼痛指数、肛缘水肿、创面愈合时间方面均优于对照组。结果表明,中药熏洗可加速痔术后创面愈合,减轻患者痛苦和减少并发症。     

湿润生肌油纱对肛瘘术后创面促愈作用的临床研究

目的:探讨湿润生肌油纱促进肛瘘术后创面愈合的效果。方法:将2021年1月到2022年1月于我科接受手术治疗的70例肛瘘患者随机分为观察组和对照组,每组35例,观察组术后应用湿润生肌油纱覆盖手术创口换药,对照组应用肛泰软膏纱条覆盖手术创口换药。比较2组术后疼痛程度,术后第7、14、21天创面肉芽生长情况评分和创面愈合率,以及创面愈合时间。结果:观察组术后第7、14、21天创面肉芽生长情况评分均低于对照组,创面愈合率均高于对照组,P<0.05;观察组术后疼痛程度评分低于对照组,创面愈合时间短于对照组,P<0.05。结论:湿润生肌油纱可有效促进肛瘘术后创面愈合,提高创面愈合质量,减轻患者痛苦。     

中药液冲洗换药对肛周脓肿术后患者创面的影响

为探讨中药液冲洗换药对肛周脓肿术后患者创面的影响,将90例肛周脓肿术后患者分为治疗组和对照组各45例。治疗组患者用中药液冲洗换药,对照组患者用2％双氧水、抗生素冲洗换药。每天观察效果并记录,5d后评估创面疼痛、水肿、肉芽生长情况以及愈俞时间。结果显示,在创面疼痛、水肿、肉芽生长方面治疗组优于对照组,治疗组创面愈合时问较短。结果表明,肛周脓肿患者术后采用中药液冲洗换药能促进创面愈合。     

参柏洗剂治疗肛瘘术后切口愈合缓慢的疗效观察

目的:研究参柏洗剂用于低位单纯性肛瘘术后切口愈合缓慢的临床效果。方法:选取2021年6月至2022年12月,本院40例肛瘘术后切口愈合缓慢患者,随机分为治疗组和对照组,每组20例,治疗组采用参柏洗剂纱条创口处引流换药,对照组使用0.9%的生理盐水纱条常规换药。观察2组创面分泌物情况、创面疼痛程度、创面肉芽生长情况、切口愈合时间及疗效。结果:治疗组在肛瘘术后创面分泌物评分、创面疼痛评分、创面肉芽生长评分均优于对照组(P<0.05),创口愈合时间短于对照组(P<0.05),临床总有效率高于对照组(P<0.05)。结论:肛瘘术后采用参柏洗剂治疗切口愈合延迟的患者疗效确切,能减少创面分泌物,缓解疼痛,促进肉芽生长,缩短创面愈合时间,值得临床推广应用。     

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.     

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.