加速康复外科理念在青少年特发性脊柱侧凸围术期的应用

目的 探讨加速康复外科(ERAS)在手术治疗青少年特发性脊柱侧凸(AIS)病人中的应用效果.方法 收集2016年1月至2020年12月在我院接受AIS手术治疗的138例病人的病例资料.将2016年1月至2018年6月给予常规围术期管理措施的69例病人纳入对照组,2018年7月至2020年12月进行ERAS理念管理的69...     

Lenke 5+型青少年特发性脊柱侧凸患者后路选择性融合术后胸弯的转归

目的:探讨Lenke 5+型脊柱侧凸患者不同融合策略疗效及选择性融合术后胸弯自发矫正情况.方法:回顾性分析2010年1月～2018年12月期间在我院接受手术治疗且随访2年以上Lenke 5+型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者资料,共80例,男13例,女6...     

以胸弯为主的青少年特发性脊柱侧凸对肺功能的影响研究

目的 分析以胸弯为主的青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)对肺功能的影响.方法 回顾性分析2018年10月至2019年11月在我院确诊并接受治疗的31例AIS病人的临床资料,分析用力肺活量占预测值的百分比(FVC％pred)、第1秒用力呼气容积占预测值的百分比(...     

儿童脊柱畸形的支具治疗

目的:探讨应用矫形支具治疗各种儿童脊柱畸形的临床效果及意义.方法:对本院1998年1月～2001年5月采用热塑支具治疗或辅助治疗的138例脊柱畸形患儿进行分组观察分析,包括特发性脊柱侧凸94例、先天性脊柱侧凸29例、脊柱后凸6例、脊柱结核7例、外伤性脊柱侧弯2例.结果:全部病儿均经过2～4年的随访,绝大多数有不同程度的畸形矫正,基本上达到矫治的预期目的.结论:由于儿童的病理及生理特点,支具对各种脊柱畸形均有不同程度的矫正作用,可有效地控制早期脊柱侧凸的发展,甚至可以避免手术或减轻手术患者侧凸的严重程度以及手术难度,减少并发症的发生.     

骶棘肌内软组织肿瘤致严重脊柱侧凸

脊柱侧凸是最常见的脊柱畸形之一,它是一个临床诊断而不是病因诊断,它可以由很多不同病因引起.根据病因学,脊柱侧凸可分为特发性、先天性、神经肌肉性、间充质源性、外伤性、肿瘤性及混杂性等川.脊柱的前外侧椎旁组织肿瘤所致的脊柱侧凸虽有报道[2],但极为罕见,而脊柱后方骶棘肌内肿瘤敛脊柱侧凸,国内外尚未检索到文献报道.我院1998年1月至2007年11月共手术治疗2547例脊柱侧凸畸形,其中发现有2例为骶棘肌内软组织肿瘤所致,报告如下.     

椎弓根螺钉固定三维矫治特发性脊柱侧凸的疗效观察

目的 探讨椎弓根螺钉固定在特发性脊柱侧凸矫形术中的治疗效果.方法 自2000年1月至2008年8月,对21例特发性脊柱侧凸患者行脊柱侧凸矫形术,术中采用徒手技术置入椎弓根螺钉行侧凸矫形,术后佩戴胸腰支具3～5个月.结果 随访8～36个月,平均22个月.切口均获得Ⅰ期愈合.患者术前Cobb角平均为67.1°,术后Cobb角平均为25.4°,畸形矫正率为62%,随访中角度丢失平均为3.3°,身高平均增加约6cm.所有病例术中术后均无脊髓神经根损伤表现,均获得满意的脊柱融合.结论 椎弓根螺钉固定能提供强大的三维矫正力,效果可靠、并发症少,应用椎弓根螺钉固定治疗特发性脊柱侧凸具有较好的临床效果.     

脊柱矫形术中严重神经并发症的转归及相关因素分析

目的:分析脊柱矫形术中发生严重神经并发症的自然转归及其预后不良的危险因素。方法:2000年1月至2017年12月期间7 851例脊柱畸形患者接受矫形手术治疗,回顾性分析发生单侧或双侧下肢全瘫或不全瘫等严重神经并发症59例患者的临床资料,男28例,女31例;年龄为25.0±16.3岁（范围6~71岁）。青少年特发性脊柱侧...     

儿童脊柱畸形的支具治疗

目的：探讨应用矫形支具治疗各种儿童脊柱畸形的临床效果及意义。方法：对本院1998年1月-2001年5月采用热塑支具治疗或辅助治疗的138例脊柱畸形患儿进行分组观察分析，包括特发性脊柱侧凸94例、先天性脊柱侧凸29例、脊柱后凸6例、脊柱结核7例、外伤性脊柱侧弯2例。结果：全部病儿均经过2～4年的随访，绝大多数有不同程度的畸形矫正，基本上达到矫治的预期目的。结论：由于儿童的病理及生理特点，支具对各种脊柱畸形均有不同程度的矫正作用，可有效地控制早期脊柱侧凸的发展，甚至可以避免手术或减轻手术患者侧凸的严重程度以及手术难度，减少并发症的发生。     

ISOLA与TSRH技术治疗特发性脊柱侧凸的疗效比较

目的 探讨应用ISOLA及ISRH技术治疗特发性脊柱侧凸的临床疗效,分析各自相对通应症。方法 在1997年9月至2002年3月份间分别应用ISOLA(28例)及,TSRH(62例)技术治疗共90例特发性脊柱侧凸患者,对侧凸的矫正度、脊柱的平衡以及并发症等结果进行分析。结果 Cobb角小于65度的患者,ISOLA组矫正率率为67％,TSRH组矫正率为62％;Cobb角大于65度的患者．ISOLA组矫正率为59％,TSRH组矫止率为40％。结论 ISOLA及TSRH技术是治疗特发性脊柱侧凸的行之有效的矫形内固定方法对于脊柱侧凸角度超过65度,伴有脊柱侧后凸的患者,运用ISOLA技术矫正效果较好。     

脊柱侧凸病人矫形术后首次下床活动时间影响因素的单因素分析

目的 观察脊柱侧凸病人矫形术后首次下床活动时间并分析其影响因素。方法 2016年8月至2017年7月采用便利抽样方法选择在我院行脊柱矫形术的病人58例。男18例,女40例;年龄为（15.14±3.39）岁（7~22岁）;脊柱侧凸类型：特发性脊柱侧凸36例,先天性脊柱侧凸10例,神经肌肉型脊柱侧凸12例;Cobb角为54.87°±14.26°。收集病人的一般资料、脊柱侧凸类型、术中情况、术后情况和病人术后首次下床活动时间,并分析术后首次下床活动时间的影响因素。结果 本组58例脊柱侧凸病人矫形术后首次下床活动时间为（5.34±1.19） d;术中出血量、术后疼痛情况、术后是否呕吐为影响脊柱侧凸病人术后首次下床活动时间的因素（P均＜0.001）。结论 在对脊柱侧凸病人进行术后护理时,要根据病人的身体体质、疼痛及术后并发症情况确定病人的首次下床活动时间,适时适当地指导病人下床活动,加速病人康复。     

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.     

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.     

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.