内皮素及NO在严重烧伤早期胃肠粘膜缺血中的作用

目的　采用３０ ％ Ｔ Ｂ Ｓ Ａ 烧伤小型猪模型,系统观察内皮素及一氧化氮（ Ｅ Ｔ／ Ｎ Ｏ） 在胃肠缺血中的作用,并通过应用 Ｎ Ｏ 供体 Ｃ８７３７５４ 对胃肠缺血防治机制进行探讨。方法　小型猪１８只,随机分为对照组（ Ｃ 组） 、烧伤组（ Ｂ 组） 及 Ｎ Ｏ 供体组（ Ｎ 组） 。 Ｃ 组只手术不致伤,其余各组伤后按 Ｐａｒｋｌａｎｄ 公式进行复苏。 Ｎ 组在复苏同时给予 Ｃ８７３７５４（００１２５ ｍｇ·ｋｇ － １ ·ｍｉｎ － １） 。结果　烧伤后 Ｂ 组在肠道血流量下降的同时,门脉血及肠道组织中的 Ｅ Ｔ 含量迅速升高,于伤后１ｈ 达到峰值,伤后７２ｈ 未能恢复到伤前水平;而同时 Ｎ Ｏ 含量呈相反变化,二者呈显著负相关。 Ｎ 组能使肠道血流量在伤后２４ｈ 内恢复较快,同时发现能升高门脉血及肠道组织内 Ｎ Ｏ 含量。 Ｎ Ｏ Ｓｄ Ｎ Ａ Ｄ Ｐ Ｈ 染色也发现肠组织内密度明显较 Ｂ 组增加。结论　①胃肠道血流量下降与 Ｅ Ｔ／ Ｎ Ｏ 变化有关。② Ｎ Ｏ 供体能通过释放 Ｎ Ｏ,有效地改善胃肠组织血流灌注,对防治胃肠缺血有积极意义。     

烧伤早期营养对大鼠降钙素基因相关肽影响的实验研究

目的观察烧伤早期不同营养途径对肠道的复苏效应,及其与降钙素基因相关肽(cal-citoningene-relatedpeptide,CGRP)的关系方法30%TBSAⅢ度烧伤Wistar大鼠,随机分为灌喂组(EF组,30只)及早期静脉营养组(EPN组,30只).此外,6只大鼠不烧伤,作对照组(C组).伤后6、12、24、48、72h观察大鼠一般情况、肠黏膜血流量、血浆CGRP免疫活性物质浓度、CGRP染色阳性物质在肠道的变化.结果烧伤后大鼠肠黏膜血流量下降,EF组下降程度明显低于EPN组(P＜0.05～0.01);烧伤后血浆CGRP升高,EF组血浆CGRP在伤后72h明显低于EPN组(P＜0.01);肠道CGRP阳性染色物质在烧伤后明显减少(P＜0.05～0.01),EF组在伤后24、48h明显多于EPN组(P＜0.05);肠黏膜血流量下降和肠肌间丛CGRP下降呈正相关(r=0.72,P＜0.05).结论肠道营养在烧伤早期肠道的复苏效应方面较静脉营养优越,伤后肠道CGRP免疫活性物质减少,血浆CGRP免疫活性物质过度增高可能是烧伤后肠道血供减少的重要机制之一,早期肠道营养可能通过调节CGRP而发挥复苏作用.     

大鼠烧伤休克延迟复苏肠道微血流量的改变及其与细菌移位的关系

目的　探讨烧伤休克期延迟复苏肠道局部微循环改变及其与肠道细菌移位的关系。方法　采用大鼠烧伤休克延迟复苏模型 ,动物分为烧伤休克不复苏组、伤后 8h延迟复苏组、立即复苏组和手术对照组 ,检测肠道细菌移位发生频率、回肠末端肠壁微血流量和体循环平均动脉压变化。　结果　伤后 8h复苏组细菌移位率高达 5 4.2 % ,明显高于立即复苏组 (P <0 .0 1) ,与不复苏组相差不显著 (P >0 .0 5 ) ;延迟复苏后 4h ,肠壁微血流量虽已得到改善 ,但远未达到立即复苏组同时相的微循环血流灌注量 ,而此时外周循环的平均动脉压已恢复至正常范围。　结论　烧伤休克延迟复苏后肠道细菌移位频率居高不下 ,可能与肠壁微血流量改善滞后有关     

休克期切痂对血浆内皮素及NO水平的影响

目的观察烧伤休克期切痂和休克期后切痂对血浆内皮素及一氧化氮水平的影响。方法利用小型猪制成35％Ⅲ度烧伤动物模型,分为两组,休克期切痂组(S组)于伤后24小时切痂,对照组(C组)于伤后96小时切痂,分别检测血浆内皮素(ET)、一氧化氮(NO),并计算ET/NO。结果两组ET及NO均高于伤前,伤后96小时开始S组ET明显低于C组;而NO水平S组明显高于C组;ET/NO亦显示伤后24小时开始S组明显低于C组。结论休克期切痂可减轻内皮细胞损伤,减轻渗出与水肿,减少组织缺氧,改善微循环。     

早期肠道喂养对烧伤大鼠肠道一氧化氮合酶的影响

目的阐明烧伤大鼠经早期肠道喂养后肠组织中一氧化氮合酶(NOS)的变化规律及其与肠粘膜血流量(IMBF)的关系。方法采用30％TBSAⅢ度烧伤大鼠模型,分为正常对照(C)组,单纯烧伤(B)组和早期喂养(EF)组,分别检测伤前及伤后0,3,6,12,24,48小时肠组织中 NOS 活性,包括原生型 NOS(cNOS)和诱导型 NOS(iNOS),并测定肠粘膜血流量。结果烧伤后各组 cNOS 和 IMBF 呈下降趋势,二者呈显著正相关(r=0.97,P<0.01),而 NOS 总活性和 iNOS 活性都呈上升趋势,IMBF 与 iN-OS 和总 NOS 相关不显著。烧伤后 EF 组 cNOS 和 IMBF 明显高于 B 组,iNOS 则低于 B 组,NOS 总活力两组无显著差异。结论①两型 NOS 中 cNOS 与 IMBF 的关系更加密切。②早期肠道喂养改善烧伤后肠道缺血状况,可能与食物对肠壁神经的刺激从而提高 cNOS 活性有关。     

高原烧伤大鼠脑损伤与丙二醛、超氧化物歧化酶含量变化

目的 观察高原严重烧伤延迟复苏后早期大鼠脑组织中丙二醛及超氧化物歧化酶含量变化及其与脑损伤的关系.方法 130只雄性Wistar大鼠设计高原(海拔3800 m)烧伤实验动物模型(TBSA 30%,Ⅲ度),并随机分4组:A组(高原烧伤即时复苏组)、B组(高原烧伤延迟复苏组)和C组(高原正常对照组),同时设D组(兰州地区正常对照组)(海拔1517 m).采用分光光度比色法检测脑组织中超氧化物歧化酶(SOD)的活性及丙二醛(MDA)的含量,采用干、湿重比重法测定脑组织含水量,运用末端脱氧核苷酸介导的X-dUTP缺口末端标记法(TUNEL)测定脑皮质细胞凋亡阳性细胞数.结果 A组大鼠脑组织中SOD活性于烧伤后24 h降至最低(90.45±14.78),B组大鼠腩组织中SOD活性除烧伤后12h外各时相点均低于A组(P<0.05).高原烧伤后大鼠脑组织中MDA含量即显著升高,于烧伤后12 h达最高峰(10.63±4.98),其后逐步降低至正常水平;B组大鼠脑组织中MDA含量变化趋势同A组,但于伤后7 d仍处于较高水平.脑组织含水量于伤后6 h开始升高,于24 h达高峰(71.70±2.32),于伤后7 d降至正常水平;B组变化趋势同A组.脑皮质TUNEL阳性细胞在伤后1 h即增多,于伤后24 h达高峰(233.33±16.22),于伤后7 d仍高于正常水平.结论 高原严重烧伤及延迟复苏后,脑组织中脂质过氧化物增加及超氧化物歧化酶耗竭,表明其可能参与了高原严重烧伤延迟复苏脑损伤的发生.     

喂饲左旋精氨酸对烫伤大鼠肠道保护作用机制的研究

目的探讨喂饲左旋精氨酸(L-Arg)对烫伤大鼠肠道缺血再灌注损伤的作用机制。方法将66只SD大鼠随机分为正常对照组(6只,不作烫伤和其他处理)、精氨酸组(30只,烫伤后2h喂饲70g/LL-Arg,1ml/次,2次/d)和普通喂养组(30只,烫伤后喂饲等量凉开水)。检测正常对照组及两组烫伤大鼠伤后6、12、24、48、72h肠组织内皮素(ET)水平、一氧化氮(NO)含量、ET/NO比值以及血浆内毒素水平的变化,并取回肠组织标本作病理学观察。结果伤后6、12、24h,精氨酸组大鼠肠组织ET水平分别为(0.80±0.26)、(0.75±0.30)、(0.63±0.22)ng/g,低于普通喂养组(1.26±0.38)、(1.34±0.37)、(0.97±0.19)ng/g(P<0.05);其NO含量显著高于普通喂养组(P<0.01);ET/NO比值和血浆内毒素水平均低于普通喂养组(P<0.05或0.01)。病理学观察显示,精氨酸组大鼠肠黏膜损伤情况明显轻于普通喂养组。结论喂饲L-Arg可减轻烫伤大鼠肠组织缺血再灌注损伤,有利于保护肠黏膜屏障功能。其机制为喂饲L-Arg后增加了肠黏膜局部NO的含量,有助于维持ET/NO比值的稳定。     

严重烧伤抗休克时胃肠粘膜内缺血的研究

目的探讨烧伤早期胃肠缺血(pHi 降低)的发生规律。方法采用模拟临床的 TBSA30％Ⅲ度烧伤小型猪模型,从血流动力学、胃肠缺血、血液流变学等方面探讨烧伤早期胃肠缺血的发生规律及相关因素。伤后1小时开始复苏,按 Parkland 公式补充平衡液。结果烧伤后平均动脉压(MAP)无明显变化,但右房压(RAP)、平均肺动脉压(MPAP)、肺动脉楔压(PAWP)及心排指数(CI)等均显著下降,于伤后48小时降至谷值,经复苏后于24小时恢复正常。胃肠 pHi 于伤后1小时就迅速下降,并且恢复缓慢,伤后72小时仍未达到正常。门脉血流量也呈类似变化,并且与肠 pHi 呈显著正相关。门脉全血粘度及血浆粘度均在伤后有明显的提高。结论①胃肠缺血发生早、恢复慢。②与血流动力学变化不一致。③常规液体复苏疗法不易纠正。④门脉血液流变学变化可能加重胃肠缺血损伤。     

氯化镧对烫伤鼠肠道细菌移位的防治研究

目的　探讨氯化镧对烫伤鼠肠道细菌移位的作用及其机制。　方法　SD大鼠分为正常对照组 (A)、烧伤对照组 (B)及烧伤治疗组 (C) ,每组 30只。采用PUC19质粒转染大肠杆菌示踪加限制性内切酶指纹图谱分析法 ,对肠道菌向肠系膜淋巴结 (MLN)及血液中的播散进行示踪及定量研究。　结果　阳性菌落经酶切图谱分析后 ,证实B、C组MLN匀浆及血液培养生长细菌与灌胃的细菌具有完全相同的酶切图谱 ;C组MLN菌量在伤后 3、5d低于B组 (P <0 .0 5 )。C组血细菌阳性率在伤后 3d低于B组 (P <0 .0 5 )。C组血ET、NO及NOS量在伤后 1、3、5d均低于B组 (P <0 0 1)。C组肠组织MDA量在伤后 1、3、5d低于B组 (P <0 .0 1) ,C组肠组织SOD量在伤后 1、3d高于B组 (P<0 .0 5 )。　结论　血和MLN培养出的细菌由肠道细菌移位而来 ;氯化镧能有效防治肠道细菌移位 ;氯化镧通过抗菌、降低血中的ET、抑制NOS的活性减少NO的生成、提高SOD的活性并使MDA的产生下降等途径减少肠道细菌移位。     

肠内输入高渗电解质葡萄糖液对犬35%总体表面积烧伤复苏效果的研究

目的 探讨肠内输入高渗电解质葡萄糖液(HEGS)对犬35%总体表面积(TBSA)烧伤复苏效果的影响.方法 Beagle犬18只,随机分为对照组(N组)、高渗液组(H组)和等渗液组(Ⅰ组),每组6只,采用凝固汽油燃烧法制作35%TBSA Ⅲ°烧伤模型.高渗液组于伤后0.5 h通过肠道给予HEGS(1.8%NaCl的5%葡萄糖液),24 h补液总量按2 ml/(kg·1%TBSA)计算;等渗液组烧伤后0.5 h通过肠道补充IEGS(即0.9%NaCl的5%葡萄糖液),24 h补液总量按4 ml/(kg·1%TBSA)计算;对照组烧伤后不予补液.测定各组犬烧伤前及烧伤后0.5、2.0、4.0、6.0、8.0、24.0 h的心排血指数、全心舒张末期容积指数、血容量、血浆渗透浓度、肠黏膜血流量、肠道对复苏液中水分和钠离子的吸收速率,数据进行双因素方差分析.结果 烧伤后各组心排血指数、全心舒张末期容积指数、血容量和肠黏膜血流量均明显下降,两补液组于伤后2 h逐渐回升,明显高于对照组(P<0.05),两补液组之间差异无统计学意义(P>0.05);高渗液组补液后血浆渗透浓度明显升高,显著高于其他两组(P<0.05);烧伤后两补液组肠道对复苏液中的水分和钠离子的吸收速率均逐渐增加,高渗液组肠道对水分吸收速率低于等渗液组(P<0.05),钠离子吸收速率则高于等渗液组(P<0.05).结论 35%TBSA烧伤后0.5 h通过肠内补充HEGS可以被肠道有效吸收,并在减少1/2补液量的前提下,基本维持有效血容量,达到肠内补充等渗液体复苏相似的血流动力学效果.     

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.