术后早期炎性肠梗阻的临床分析

目的总结我院收治的术后早期炎性肠梗阻病例的特点,探讨其诊断和治疗措施。方法回顾性分析我院1995年1月至2008年4月收治的64例术后早期炎性肠梗阻患者的临床资料进行临床分析。结果58例患者经保守治疗痊愈,平均住院时间11.5 d。6例保守治疗无效而手术治疗。结论术后早期炎性肠梗阻应以保守治疗为主,有效的治疗包括禁食、胃肠减压、灌肠、胃肠外营养支持、糖皮质激素和生长抑素的应用。手术治疗并发症多,疗效差。     

术后早期炎性肠梗阻46例诊疗体会

目的总结术后早期炎性肠梗阻的临床特点及诊治经验。方法回顾性分析2000年5月-2007年3月收治．的46例术后早期炎性肠梗阻患者的临床资料。结果本组46例患者均在腹部手术后2周内发生术后早期炎性肠梗阻，其中144例经系统保守治疗后痊愈，2例因并发形成腹腔脓肿待手术治疗后痊愈。结论准确掌握术后早期炎性肠梗阻临床特点，系统化保守治疗不但可以治愈，而且可避免再次手术的发生。     

32例术后早期炎性肠梗阻患者的临床分析

目的探讨术后早期炎性肠梗阻的临床特点及防治措施。方法对32例术后早期炎性肠梗阻患者的临床资料进行回顾性分析。结果所有患者的临床症状、体征及影像学特点均符合术后早期炎性肠梗阻的诊断标准。29例患者经保守治疗后痊愈,住院时间6～28 d,平均(10.6±5.5)d。3例患者保守治疗时出现绞窄性肠梗阻而中转手术治疗而痊愈。结论术后早期炎性肠梗阻大多发生于术后7～14 d,其临床表现与其他类型肠梗阻相似,主要表现为腹胀,停止排气、排便,腹痛,呕吐,肠鸣音减弱甚至消失等,通过影像学检查结合临床可以确诊该疾病,保守治疗是该病的首选方法。     

奥曲肽与地塞米松联合治疗术后早期炎性肠梗阻

目的 探讨奥曲肽与地塞米松联合应用在术后早期炎性肠梗阻中的治疗作用.方法 回顾性分析34例术后早期炎性肠梗阻患者的临床资料.结果 34例患者均经保守治疗痊愈,平均治愈时间12 d.结论 术后早期炎性肠梗阻应以保守治疗为主,应重视生长抑素和糖皮质激素的联合应用.     

术后早期炎性肠梗阻36例诊疗体会

目的探讨术后早期炎性肠梗阻的诊断及治疗方法。方法回顾性分析36例术后早期炎性肠梗阻患者的临床资料。结果 36例患者均经保守治疗梗阻缓解,平均住院18d。结论术后早期炎性肠梗阻应以保守治疗为主,尽量避免手术治疗。     

术后早期炎性肠梗阻15例疗效观察

目的探讨术后早期炎性肠梗阻的临床特点。方法回顾性分析2005年4月至2008年6月我们采用76%泛影葡胺及生长抑素等保守治疗术后早期炎性肠梗阻患者15例临床资料。结果15例均经保守治疗痊愈。11例使用76%泛影葡胺溶液等治疗后5～8d内肠梗阻完全解除,有效率73.3%;4例无明显缓解者继续保守治疗11～16d梗阻症状完全缓解,平均住院16.5d;随访3～6个月恢复良好。结论术后早期炎性肠梗阻应采取积极有效措施保守治疗,早期应用76%泛影葡胺及生长抑素等治疗效果较好,多可避免再次手术,预后良好。     

腹部术后早期炎性肠梗阻48例诊治体会

目的探讨腹部术后早期炎性肠梗阻采用保守治疗的临床效果。方法回顾48例术后早期炎性肠梗阻的治疗方法 ,包括禁食、胃肠减压、中药、糖皮激素加生长抑素应用的临床资料。结果 47例经保守治疗后治愈,平均时间7～10d,1例再手术后18d痊愈。结论采用非手术方法治疗术后早期炎性肠梗阻并发症少、安全、效果满意。少数病例需手术治疗,但应严格掌握手术指征。     

术后早期炎性肠梗阻的诊断（附68例临床分析）

目的：探讨术后早期炎性肠梗阻的临床特点和治疗方法。方法：分析68例术后早期炎性肠梗阻的临床特点及治疗。结果：60例术后早期炎性肠梗阻发生于术后1周内，保守治疗64例，肠梗阻缓解时间1－6周，平均12.2d，手术治疗4例。结论：对术后早期炎性肠梗阻应先行4－6周保守治疗，过期无缓解再行手术，这样可避免不必要的手术并减少后并发症。     

急腹症手术后早期炎性肠梗阻56例诊治体会

目的总结分析急腹症手术后早期炎性肠梗阻的临床诊治措施。方法对56例急腹症手术后早期炎性肠梗阻患者的临床资料进行回顾性分析。结果本组53例(94.64%)经保守治疗痊愈。3例因肠壁充血、水肿、肠管严重粘连而中转手术治疗,术后梗阻症状解除。结论急腹症术后炎性肠梗阻多在术后2周内出现,多数保守治疗可获得良好效果,对保守治疗无效者应及时手术治疗。     

生长抑素加小剂量皮质激素治疗腹部术后早期炎性肠梗阻

目的探讨术后早期炎性肠梗阻的临床特点、诊断与治疗。方法回顾分析了2006年1月至2009年10月本院收治的25例术后炎性肠梗阻的病例。结果25例腹部手术术后发生早期炎性肠梗阻的患者经保守治疗,平均10天治愈。结论术后早期炎性肠梗阻采取非手术治疗效果较好。     

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.