卵巢储备功能低下患者补充脱氢表雄酮后诱导排卵的临床研究

目的本研究的目的是评估脱氢表雄酮(DHEA)对卵巢储备功能低下不孕症患者的卵巢储备相关指标和妊娠率的作用。方法这是一项在三级医院门诊进行的随机临床试验。我们招募了卵巢储备功能低下的不孕症患者96人。研究人群被随机分为试验组和对照组各48人,试验组给予补充DHEA 25 mg 1次/8 h,对照组口服安慰剂治疗,连续2个月经周期。而后,两组患者均进行了连续3个周期的诱导排卵。比较两组患者治疗前后卵巢储备功能相关指标及后续诱导排卵结局。结果(1)两组患者基线数据[年龄、体质量指数(BMI)、抗苗勒管激素(AMH)水平、基础激素水平、窦卵泡计数(AFC)和不孕类型]比较均无统计学差异(P>0.05)。(2)试验组在DHEA治疗后血清FSH、E₂水平及FSH/LH比值均显著低于治疗前(P<0.05),而血清AMH水平及AFC显著高于治疗前(P<0.05);对照组相关观察指标在治疗前后均无统计学差异(P>0.05);相应治疗后,试验组血清FSH、E₂水平及FSH/LH比值显著低于对照(P<0.05),而AFC显著高于对照组(P<0.05)。(3)后续诱导排卵周期中,试验组较对照组平均成熟卵泡数增高而卵巢刺激时间缩短(P<0.05),且3个周期的总妊娠率显著高于对照组(20.83%vs.6.25%,P<0.05)。结论DHEA可以改善卵巢储备功能低下患者的卵巢功能,并可以提高妊娠率。     

血清及精浆中乙型肝炎病毒的存在情况对精子质量的影响

目的 探讨血清及精浆中乙型肝炎病毒存在的情况与精子参数、形态学及精子DNA完整性等精子质量的相关性。方法 收集2016年1月至2021年12月在温州医科大学附属第一医院生殖医学中心就诊男性的精液标本,采用微粒子酶免疫分析法检测血清乙肝标志物滴度、荧光定量PCR技术检测血清和精浆中HBV-DNA拷贝水平,同时所有精液标本进行精液参数、精子形态学及精子DNA碎片指数(DFI)分析。根据HBV病毒检测情况将患者分为4组：A组(HBsAg阴性,n=1 122)、B组(血清HBsAg阳性,而HBeAg、HBV-DNA和精浆HBV-DNA拷贝数均阴性,n=460)、C组(血清HBsAg、HBeAg和HBV-DNA拷贝均阳性,而精浆HBV-DNA拷贝阴性,n=81)和D组(血清HBsAg、HBeAg和HBV-DNA拷贝均阳性,且精浆HBV-DNA拷贝阳性,n=112),比较各组之间的基本资料、肝功能及精子质量的差异。结果 根据纳排标准纳入2 063例患者,HBV感染者(HBsAg阳性检出者)占45.6%(941/2 063),最终纳入分组分析的患者共1 775例。与未感染者(A组)相比,HBV感染者...     

高灵敏度HBV DNA检测指导慢性乙型肝炎患者抗病毒治疗的临床意义

目的探讨高灵敏度HBV DNA检测对于指导HBV DNA低载量慢性乙型肝炎（CHB）患者抗病毒治疗的临床意义。 方法收集应用国产试剂检测结果低于检测下限（< 10³ IU/ml）的拟停药组112例患者和拟用药组48例患者共160份血清标本采用COBAS Amplicor系统再次进行检测,并与HBsAg定量结果进行对照分析。 结果经国产试剂检测结果低于检测下限（<10³ IU/ml）的160份血清经COBAS Amplicor系统再次检测有52例（32.50%）标本HBV DNA > 10³ IU/ml,高于高灵敏度HBV DNA检测下限（20 IU/ml）的标本共115份（占71.88%）。拟停药组患者HBV DNA≥ 20 IU/ml者有72例（占64.29%）;拟用药组患者中有19例HBV DNA> 10³ IU/ml,43例≥ 20 IU/ml（占89.58%）。应用COBAS试剂检测HBV DNA不同载量组别与HBsAg浓度对数值均呈显著正相关（P < 0.01）。 结论对国产试剂检测HBV DNA低载量患者应进一步做高灵敏的定量PCR试剂检测,可更好地指导患者初始应用或停用核苷（酸）类药物。     

PCR-ELISA法检测HBV感染者精液HBV-DNA的评价

目的 评价PCR-ELISA法检测HBV感染者精液中HBV-DNA检出情况及其临床意义. 方法 选取男性HBV感染者56例,采集患者精液、静脉血,用PCR-ELISA法来检测患者精液及血清中HBV-DNA.标本先行PCR扩增,之后行杂交固定,酶联反应后行显色、最后450nm下读光密度值(O.D),再用HBV-PCR定量的计算公式用计算样本中HBV病毒含量(单位:拷贝/ml). 结果 56例精液标本HBVDNA阳性10例,阳性率17.85%,拷贝数为1.317×103～6.351×105/ml,平均拷贝数为4.617×104/ml.56例血清标本阳性49例,阳性率为87.50%,拷贝数1.432×103～5.215×107/ml,平均拷贝数为2.462×106/ml. 结论 PCR-ELISA法定量检测精液中HBV-DNA具有较强的特异性和灵敏度,为临床了解乙型肝炎患者精液中肝炎病毒的感染状态提供了帮助,具有重要的临床意义.     

血清抗苗勒管激素水平检测在预测卵巢低反应中的应用价值

目的 探讨血清抗苗勒管激素(AMH)水平对于卵巢储备功能低下患者在控制性超排卵(COH)中卵巢反应的应用价值. 方法 回顾性分析2010年1月至6月在本中心接受体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)治疗的308周期.患者分为卵巢低反应组(65例)和卵巢正常反应组(243例).清晨空腹静脉血测定AMH(无月经周期限制)和卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)水平(月经第2～5天),同时行阴道B超检查测定窦卵泡数(AFC),以获卵数为评价标准. 结果 与获卵数的相关性由强到弱是AMH水平、AFC、年龄、FSH/LH比值、基础FSH水平、基础LH水平;预测卵巢低反应ROC曲线下面积由大到小为AMH水平、AFC、基础FSH水平、FSH/LH比值、年龄、基础LH水平、基础E2水平;预测卵巢低反应的AMH水平界值≤2.21 μg/L(灵敏度77％,特异度80％). 结论 血清AMH水平是反映卵巢储备能力的理想指标,可预测COH中卵巢的反应性,指导临床选择合适的治疗方案.     

评估卵巢储备功能的常用指标对预测卵巢反应性的价值比较

目的比较评估卵巢储备功能的常用指标在各年龄段对预测卵巢反应性的价值。方法回顾性分析1 478例行IVF/ICSI-ET助孕、符合入选标准的不孕女性的临床资料。根据年龄分为A组(≤30岁)、B组(30～38岁)、C组(>38岁);组内根据获卵数分为卵巢低反应组(<6个)、卵巢正常反应组(6～18个)及卵巢高反应组(>18个)。比较基础FSH(bFSH)、抗苗勒管激素(AMH)、基础雌二醇水平(bE₂)及窦卵泡数(AFC)单独及联合应用在各年龄段对卵巢反应性的预测价值。结果 bFSH、AMH、AFC在各年龄组间及卵巢反应亚组间均有显著差异(P<0.01);bE₂在各年龄组间及卵巢反应亚组间均无显著差异(P>0.05)。ROC曲线分析显示,单一指标预测卵巢反应性时,AMH的曲线下面积最大;联合指标对于预测30～38岁组卵巢低反应(联合bFSH、AMH、AFC)、>38岁组卵巢低反应(联合bFSH、AMH及年龄)和卵巢高反应(联合bFSH、AMH),可提高其ROC曲线下面积、预测敏感度和特异度。结论血清AMH作为单...     

不同免疫状态下慢性HBV感染者外周血调节性B细胞及血清IL-10和IP-10的表达特点

目的观察不同免疫状态下慢性乙型肝炎病毒(HBV)感染者外周血调节性B细胞(Breg细胞)比例及血清白细胞介素-10(IL-10)和干扰素诱导蛋白-10(IP-10)水平特点。方法采集63例不同免疫状态下慢性HBV感染者和16例健康个体的外周血,采用流式细胞术检测其外周血Breg细胞(CD24hiCD38hi B细胞)比例,采用Luminex技术检测其血清IL-10和IP-10水平。结果免疫活化组外周血Breg细胞比例高于免疫耐受组和健康对照组[(7.89±3.37)%vs(4.77±2.42)%,F=9.27,P=0.010;(7.89±3.37)%vs(3.83±2.14)%,F=16.55,P0.001],免疫耐受组成熟B细胞(CD24intCD38int B细胞)比例低于健康对照组[(43.40±10.74)%vs(54.56±10.72)%,F=7.39,P=0.02]。免疫活化组血清IL-10和IP-10水平高于免疫耐受组、非活动HBV携带组及健康对照组[(22.53±24.81)pg/ml vs(0.69±1.34)pg/ml,(22.53±24.81)pg/ml vs(0.31±1.12)pg/ml,(22.53±24.81)pg/ml vs(0.003±0.009)pg/ml,P均0.001;(2 540.19±1 870.73)pg/ml vs(720.52±285.73)pg/ml,(2 540.19±1 870.73)pg/ml vs(567.38±208.72)pg/ml,(2 540.19±1 870.73)pg/ml vs(624.80±274.45)pg/ml,P均0.001]。慢性HBV感染者外周血Breg细胞比例与血清IL-10水平、ALT水平呈正相关关系(r=0.282,P=0.025;r=0.305,P=0.026),免疫活化期感染者血清IL-10、IP-10水平与ALT水平呈正相关(r=0.715,P0.001;r=0.653,P0.001)。结论免疫活化期的慢性HBV感染者Breg细胞比例升高,且其外周血IL-10、IP-10也显著升高。慢性HBV感染者外周血Breg细胞比例与血清IL-10、ALT水平正相关,免疫活化期感染者血清IL-10、IP-10水平与ALT水平正相关。     

HBsAg阳性孕妇胎盘组织HBV感染相关因素分析

目的研究HBs Ag阳性孕妇乙型肝炎病毒血清标志物(HBVM)、HBV DNA含量与胎盘乙型肝炎病毒(HBV)感染的关系,进一步研究胎盘组织在HBV宫内感染中的作用。方法以30例HBs Ag阳性足月妊娠孕妇产前外周血及胎盘组织为研究对象。采用酶联免疫吸附试验检测孕妇外周血HBV血清标志物;实时荧光定量PCR方法检测孕妇外周血HBV DNA含量。免疫组织化学染色方法检测胎盘组织HBs Ag和HBc Ag表达情况。结果 30例HBs Ag阳性孕妇中,HBe Ag阳性18例,HBe Ag阴性12例。HBV DNA104 IU/ml者17例,HBV DNA 102~104 IU/ml者13例。21例胎盘组织HBs Ag和HBc Ag免疫组织化学染色阳性,胎盘HBV感染率为75%(21/30),HBs Ag和HBc Ag阳性率分别为55.67%(17/30)和70%(21/30)。HBe Ag阳性组中胎盘组织HBV感染率为88.89%(16/18),高于HBe Ag阴性组41.67%(5/12),差异有统计学意义(P0.05);血清中HBV DNA高含量组(104 IU/ml)胎盘组织HBV感染率为94.12%(16/17),高于低含量组(102~104 IU/ml)患者的胎盘感染率38.46%(5/13),差异有统计学意义(P0.05)。结论孕妇血清HBe Ag阳性和高病毒载量是发生胎盘组织HBV感染的高危因素。胎盘组织是HBV宫内感染传播途径之一。     

HCG日血清孕酮和孕酮与雌二醇比值对早卵泡期长效长方案活产率的影响

目的探讨HCG日血清孕酮(P)和P与雌二醇(E_2)比值(P/E_2)对早卵泡期长效长方案活产率的影响。方法回顾性队列分析2015年10月至2018年6月在郑州大学第三附属医院生殖中心行早卵泡期长效长方案促排卵且行新鲜胚胎移植周期的临床资料,共纳入3 987个周期。根据卵巢反应不同,分为卵巢正常反应组(2 350个周期)和卵巢高反应组(1 637个周期)。又根据HCG日血清P及P/E_2区分亚组,正常反应组分为P1.36ng/ml(4.31nmol/L)组,P≥1.36ng/ml组,P/E_20.48组,P/E_2≥0.48组;高反应组分为P1.48ng/ml(4.69nmol/L)组,P≥1.48ng/ml组;P/E_20.42组,P/E_2≥0.42组。通过受试者工作特征曲线(ROC)与Logistic回归分析不同卵巢反应人群HCG日血清P和P/E_2对活产率的影响。结果正常反应组和高反应组比较,高反应组的年龄、Gn总量显著低于正常反应组(P0.05);抗苗勒管激素(AMH)、基础窦卵泡数(AFC)、HCG日E_2水平、获卵数、移植取消率显著高于正常反应组(P均0.05);胚胎着床率、中重度卵巢过度刺激综合征(OHSS)发生率、多胎率及活产率亦显著高于正常反应组(P均0.05)。正常反应组中,P≥1.36ng/ml亚组的活产率显著低于P1.36ng/ml组(48.1%vs.56.2%,P0.01),P/E_2≥0.48亚组的活产率显著低于P/E_2 0.48组(49.6%vs.55.3%,P=0.02);高反应组中,P≥1.48ng/ml亚组的活产率显著低于P1.48ng/ml组(54.0%vs.60.4%,P=0.04),P/E_2≥0.42亚组的活产率显著低于P/E_20.42组(51.2%vs.56.9%,P=0.03)。通过Logistic回归分析认为,在卵巢正常反应和高反应人群中,P及P/E_2升高是活产率的独立危险因素。结论 HCG日血清P、P/E_2值升高是早卵泡期长效长方案活产率的独立危险因素。根据卵巢反应不同,其具体截点不同:对于卵巢正常反应人群,P≥1.36ng/ml或P/E_2≥0.48时,活产率明显下降;对于卵巢高反应人群,P≥1.48ng/ml或P/E_2≥0.42时,活产率明显下降。     

不同AFC分层下应用PPOS和拮抗剂方案的每周期累积活产率比较：一项倾向性评分匹配研究

目的 比较拮抗剂方案和高孕激素状态下促排卵(PPOS)方案在不同基础窦卵泡数(AFC)患者中的每取卵周期累积活产率。方法 回顾性队列研究分析2017年1月至2021年4月在上海市第一妇婴保健院生殖医学科行体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)并采用拮抗剂方案或PPOS方案的3 752名不孕症患者临床资料，根据促排卵方案不同分为两组：拮抗剂组和PPOS组，使用倾向性得分匹配(PSM)方法在不同AFC水平(AFC≤5;6≤AFC≤15;AFC≥16)下按1∶1匹配均衡两组间的变量，比较在不同卵巢储备状态(AFC水平不同)下两组患者的基本特征、临床/实验室指标及妊娠结局等；通过多因素Logistic回归分析校正混杂因素后对比两种促排卵治疗的每取卵周期累积活产率。结果 匹配后，共1 378名(PPOS方案组与拮抗剂方案组各698名)患者纳入分析，两组患者的年龄、不孕因素等基本情况均无显著差异(P>0.05)。在AFC≥16时，拮抗剂方案组的每移植周期临床妊娠率显著高于PPOS组(27.47%vs.16.28%,P<0.05);两组方案在不同AFC水平中的每...     

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.