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1.
术前区域动态灌注化疗治疗乳癌   总被引:2,自引:0,他引:2  
目的 评价术前动脉灌注化疗药物在乳癌治疗中的作用。方法 采用Seldinger江经皮股动脉穿刺,将导管置于锁肌下动脉与胸廓内动脉开口交界处的近侧,用充气止血带高于患者收缩压阻断患侧肱动脉血流后,注入化疗药物。根据病人情况3-4周重复灌注化疗1次。化疗方案:吡喃阿霉素,或阿霉素,或表阿霉素50-70mg/m^3,卡铂300-400mg/m^2,5氟-脲嘧啶(5-Fu)750-1000mg/m^2,甲  相似文献   

2.
作者报告37例大肝癌采用肝动脉栓塞(TAE)加手术切除的疗效及临床病理研究结果。37例肝癌直径5~24cm(平均11.2Cm)。TAE与动脉灌注化疗同时进行。化疗药物括氟尿嘧啶(5-FU)、阿霉素(ADM)或表阿霉素(E-ADM)、丝裂霉素(MMC)和顺铂(CDDP)。多采用三种药物联合方案。肝动脉末梢栓塞剂采用国产或进口碘化油,用明胶海绵颗粒作近端栓塞。手术切除前进行1~4次TAE,每次相隔4~6周。17例AFP值增高者TAE后10例降至正常水平。肿瘤直径由平均11.2cm降至8.5cm(缩小26%)。栓塞后手术切除病理标本显示92%有肿瘤组织坏死,范围达40%~100%。1、2、3年生存率分别为80%、66.7%和53.3%。作者认为TAE加手术切除是大肝癌的有效治疗方法。  相似文献   

3.
目的 减少中晚期消化系统恶性肿瘤术后腹腔内复发和肝转移率。方法 术后将患者随机分成腹腔化疗组(观察组)和静脉化疗组(对照组),观察组52例,将丝裂霉素6!10mg/m^2和5氟脲嘧啶1 ̄1.5g/m^2加入按20ml/kg的生理盐水中,经左右下腹穿刺置管灌注腹腔。对照组53例,用MMC4 ̄6mg/m^2+NS20-30ml静脉注及5-Fu0.75 ̄1g/m^2+5%葡萄糖注射液500ml静脉点滴治  相似文献   

4.
对激素抗拒的前列腺癌的联合化疗   总被引:4,自引:0,他引:4  
目的 探讨阿霉素、丝裂霉素、5氟尿嘧啶联合化疗对激素抗拒的前列腺癌的疗效。 方法 1995 年4 月至1998 年7 月治疗15 例对激素抗拒的前列腺癌病人。随访5 ~24 个月,平均10个月。 结果 CR1 例,PR2 例,SD9 例。CR 和PR 持续6 ~18 个月,平均11 个月,CR、PR 及SD持续5 ~24 个月,平均9 个月。脱发、恶心呕吐、骨髓抑制是主要副反应。 结论 阿霉素、丝裂霉素、5氟尿嘧啶联合化疗方案可以延缓部分对激素抗拒的前列腺癌的进展。  相似文献   

5.
目的 观察介入导管动脉化学药物治疗对直肠癌根治术后患者生存率的影响。方法 采用介入导管动脉化学药物治疗(下称化疗)代替全身化疗治疗直肠癌根治术后患者56例。化疗药物为每次顺铂30 ̄40mg/m^2、5-氟尿嘧啶500 ̄750mg/m^2、丝裂霉素4 ̄5mg/,^2。结果 治疗后无大出血、肠坏死、肝肾功能障碍等严重并发症。经阴访,治疗组1、2、3、4、5年的生存率分别为94.6%(53/56)、82  相似文献   

6.
为了探讨生长因子Wnt5A在泌尿系肿瘤发生中的作用,采用半定量RTPCR(逆转录多聚酶链反应)方法对6种泌尿肿瘤细胞系、一种原代培养肾纤维母细胞(PRF)及1例正常人肾组织(NRT)进行Wnt5A检测。材料与方法 6种泌尿恶性肿瘤细胞系:膀胱癌(T24、EJ、BIU87)、肾细胞癌(GRC1、RCC949)和前列腺癌(PC3M)取自本所免疫室。所有的细胞系均用RPMI1640含有16%FCS,10mmol/LHepes和2mmol/L谷氨酰胺的培养液培养于37℃的CO2孵箱内。取…  相似文献   

7.
经腹肝动脉门静脉双置泵栓塞灌注化疗治疗中晚期肝癌   总被引:11,自引:1,他引:11  
目的探讨提高中晚期肝癌外科治疗的有效途径。方法回顾性分析经腹肝动脉门静脉双置泵栓塞灌注化疗治疗不能手术切除的中晚期肝癌38例的临床资料。结果肿瘤直径5~18cm,平均92cm,皆为多供血型。巨块型24例,结节型8例,弥漫型6例。伴门静脉癌栓18例。肝动脉栓塞采用40℃的碘油和明胶海绵微粒;化疗药物采用阿霉素(ADM),顺铂(DDP),丝裂霉素C(MMC)和氟脲嘧啶(5Fu)。32例甲胎蛋白值升高者治疗后16例降至正常。肿瘤直径平均缩小45%。8例行二期手术切除肿瘤,其生存期均在12个月以上,最长已达3年;未行二期手术者30例,中位生存期为96个月。结论经腹肝动脉门静脉双置泵栓塞灌注化疗,附加局部注射无水酒精和热电疗法,是治疗不能手术切除中晚期肝癌首选而有效的方法。  相似文献   

8.
作者报告10例局灶节段硬化性肾小球肾炎(FSGS),用静脉注射环磷酰胺(CP)同时口服泼尼松疗法的效果。对象与方法:10例患儿男6例,女4例,平均起病年龄6-2岁。5例泼尼松初治(60mg/m2/天8周)缓解,以后频繁复发(一年中复发>三次),泼尼松再治(剂量疗程同初治)无效。5例泼尼松初治即无效。10例患儿均予以静脉注射CP500mg/m2+NS250ml3~4小时内静脉滴注,24小时内鼓励多饮水,每月一次共6个月;同时口服泼尼松,服法:60mg/m2/天,2月,60mg/m2隔日,4月,3…  相似文献   

9.
静脉注射不同剂量异丙酚对血流动力学及通气功能的影响   总被引:76,自引:0,他引:76  
应用阻抗法和分气流监测法观察静脉注射不同剂量异丙酚(Propofol,PRO)后患者血流动力学(MAP、NR、SLCI、IFI、VET、EVI、SVRI、IC、PFI、LSWI)与通气功能(VT、RR、VE、FEV1%、ETCO2、SPO2、 I-EtO2)的变化。 40例(ASAⅠ~ Ⅱ)随机分成四组,PRO剂量分别为 1.0mg/kg、1.5mg/kg、2.0mg/kg、2.5mg/kg。结果:(1)1~4组呼吸暂停发生率为0%、20%、30%、80%,苏醒时间分别为3 0±1.5、7.4±2.3、9.1±3.6、9.6±4.2分钟:(2)静脉注射不同剂量PRO启SAP、DAP、MAP、SI下降,HR、CI、SVRI无明显变化,心肌收缩性(IC、PFI、EVI)明显减弱,SVRI减少;(3)PRO对呼吸有抑制作用,以VT和VE影响最大,与剂量呈正相关;对面罩吸氧患者SpO2、RR、ETCO2无明显改变,I-EtO2减少;舌后坠者托起下颌对VT、VE的恢复颇为有效。  相似文献   

10.
直肠癌术前动脉插管化疗后手术时机的选择   总被引:16,自引:0,他引:16  
Zhang J  Wang X  Wang B  Xin S  Zhang Q  Duan Z 《中华外科杂志》1999,37(3):174-176,I007
探讨直肠癌患者术前动脉管化疗后的手术时机。方法对27例Dukes’B-C期直肠癌患者,选择肠系膜下动脉或左髂内动脉,以5-氟脲嘧啶600mg/m^2、丝裂霉素15mg/m^2、表阿霉素30mg/m^2、丝裂霉素15mg/  相似文献   

11.
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 (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.  相似文献   

12.
Don Dame 《Artificial organs》1996,20(5):613-617
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.  相似文献   

13.
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.  相似文献   

14.
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.  相似文献   

15.
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.  相似文献   

16.
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.  相似文献   

17.
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.  相似文献   

18.
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.  相似文献   

19.
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.  相似文献   

20.
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.  相似文献   

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