大隐静脉曲张合并小腿溃疡32例临床治疗分析

目的：探讨大隐静脉曲张合并小腿溃疡的治疗方法及效果。方法：对32例下肢大隐静脉曲张合并溃疡的患者施行大隐静脉高位结扎及抽剥术,并从腹股沟切口处取中厚皮瓣移植于溃疡面。结果：全部病例均治愈,拆除缝线后曲张静脉均消失。32例移植皮瓣全部成活,28例植皮皮瓣I期愈合,4例植皮皮瓣Ⅱ期愈合。28例获得3个月～1年随访,下肢静脉曲张和溃疡未再复发。结论：大隐静脉高位结扎及抽剥术,并从腹股沟切口取中厚皮片移植于溃疡面治疗大隐静脉曲张合并溃疡,手术方法简单、有效。     

下肢静脉性溃疡术前彩色多普勒定位交通静脉的应用价值

目的探讨彩色多普勒在治疗下肢静脉性溃疡中术前定位功能不全交通静脉的应用价值。方法选择近2年余收治的下肢静脉性溃疡36例,由术者应用彩色多普勒超声仪对患肢进行CEAP分类诊断,将溃疡周围功能不全的交通静脉准确标记定位然后进行手术治疗。结果溃疡面积10cm2的32例术后1个月内愈合,4条肢体溃疡面积较大的2.5个月内全部愈合。随访1～3年,全部溃疡均无复发。彩色多普勒复查溃疡周围功能不全的交通静脉全部消失,周围皮肤颜色及弹性明显改善。结论彩色多普勒可以精确定位下肢静脉性溃疡周围功能不全的交通静脉,对术后溃疡的愈合起到决定性作用。     

静脉剥脱联合硬化疗法治疗下肢静脉性溃疡

目的探讨大隐静脉高位结扎剥脱联合泡沫硬化剂注射对下肢静脉性溃疡的治疗效果。方法回顾性分析2013年7月~2015年8月收治的28例下肢静脉性溃疡患者临床资料,均行大隐静脉高位结扎剥脱联合泡沫硬化剂注射治疗。结果 28例患者成功接受大隐静脉高位结扎剥脱联合泡沫硬化剂注射术,平均手术时间为72(45~98)min,平均手术出血量为40(20~86)ml,平均每条肢体注射16(8~26)ml泡沫硬化剂,所有患者手术切口均一期愈合。术后活动性溃疡愈合27例(96.4%),平均愈合时间为15.8(10~28)d。1例溃疡面积较大者术后溃疡面积缩小后行植皮手术后愈合。3例患者术后小腿部曲张静脉附近呈现明显的炎症反应,予33%硫酸镁溶液湿敷后症状缓解,未出现下肢深静脉血栓形成等严重并发症。术后随访26例,平均11.6(3~26)个月,随访期间均未出现溃疡复发。结论大隐静脉高位结扎剥脱联合泡沫硬化剂注射治疗下肢静脉性溃疡安全、微创,临床效果满意。     

腔内射频联合溃疡周围透光直视旋切术治疗下肢静脉性溃疡

目的评价腔内射频联合透光直视旋切术(TriVex)治疗下肢静脉性溃疡的疗效。方法回顾性分析了173例(208条患肢)下肢静脉性溃疡患者行大隐静脉腔内射频闭合术和溃疡周围TriVex刨吸术的临床资料。结果所有患肢术后溃疡面渗出明显减少,溃疡周围皮肤色素沉着明显减轻,其中共203条患肢经术后伤口换药能达到一期愈合,愈合时间为10～65天;其余5条肢体术后溃疡面积明显缩小,创面逐渐长出新鲜肉芽,术后3个月经植皮术后溃疡愈合。结论腔内射频联合溃疡周围TriVex刨吸术治疗下肢静脉性溃疡安全有效。     

外科手术后联用超声清创机治疗下肢慢性静脉性溃疡的经验

目的总结外科手术后联用超声清创机治疗下肢慢性静脉性溃疡的经验。方法 97例(116条患肢)下肢静脉性溃疡患者,在针对不同病因采取相应的外科治疗手段后,再联用超声清创机对静脉溃疡作进一步处理,溃疡创面坏死组织多者,冲洗1次/天,溃疡创面坏死组织少者,冲洗1次/2～3天。结果 116条患肢溃疡均愈合,愈合率为100%,111条患肢在术后10～65天愈合,其余5条患肢(深静脉功能不全2条,深静脉血栓形成后遗症3条)术后3个月经植皮后溃疡愈合。门诊随访6～30个月,均未发现局部溃疡复发。结论外科手术后联用超声清创机治疗下肢慢性静脉性溃疡,疗效可靠,值得临床广泛推广和应用。     

腔镜深筋膜下交通支结扎+溃疡周围环缝术治疗慢性下肢静脉性溃疡23例

目的 探讨腔镜深筋膜下交通支结扎（SEPS）＋溃疡周围环缝术联合治疗慢性下肢静脉性溃疡的临床疗效。方法 2004年3月至2006年9月对23例慢性下肢静脉性溃疡患者实施SEPS＋溃疡周围环缝术（联合治疗组）。另有SEPS组（19例）和溃疡周围环缝组（30例）作对照。所有病例均行常规大隐静脉高位结扎＋剥脱术。结果 联合治疗组溃疡于术后12～60d愈合,平均25．7d;SEPS组于术后18～90d愈合,平均35．1d;溃疡周围环缝组于术后21～90d愈合,平均47．3d,各组间差异均有统计学意义（P〈0．05）。3组间复发率比较,差异无统计学意义（P〉0．05）。结论 SEPS＋溃疡周围环缝术能够有效地治疗慢性下肢静脉性溃疡,2个术式联合应用其溃疡愈合时间较单独应用缩短。     

Trivex微创旋切术治疗下肢静脉性溃疡

目的：评价Trivex透光旋切术治疗下肢静脉性溃疡的安全性、有效性。方法：在大隐静脉高位结扎和主干剥脱基础上,对67例73条患肢静脉性溃疡的溃疡区域进行Trivex透光旋切治疗,同时配合溃疡局部清创、加压包扎治疗。定期随访观察疗效。结果：73条患肢溃疡面全部愈合,平均愈合时间60d。结论：在大隐静脉主干剥脱基础上,溃疡区域透光旋切可以治愈下肢静脉曲张并发的小腿溃疡,并且具有方法简单、创伤小、恢复快的优点。     

介入联合微创手术治疗下肢混合型血管性溃疡

目的:探索下肢混合型血管性溃疡的有效治疗方法。方法:对2008年10月—2011年10月收治的22例下肢混合型血管性溃疡患者采用介入联合微创手术治疗。分别采用球囊扩张成形术和支架植入术开通患者下肢动脉闭塞段,小切口大隐静脉高位结扎剥脱及溃疡周围交通静脉缝扎术等治疗患者下肢静脉功能不全。结果:全部患者溃疡迅速彻底愈合,平均愈合时间28 d。随访6~28个月,无复发病例。结论:介入联合微创手术治疗下肢混合型血管性溃疡疗效确切显著,值得推荐。     

下肢静脉曲张伴溃疡的病因分析及治疗

目的探讨下肢静脉曲张伴溃疡的病因及治疗策略。方法对2016年1月至2019年5月深圳大学第一附属医院收治的82例下肢静脉曲张合并溃疡(C5~C6级)患者(93条患肢)接受彩超及静脉顺行造影检查分析病因,并根据不同病因制定个体化治疗策略,包括主干剥脱、穿通支结扎、髂静脉支架置入、溃疡面的综合处理等。结果患者均成功完成大隐静脉曲张手术,术后溃疡面均愈合,无切口感染、深静脉血栓形成发生。患者术后随访(11.0±4.5)个月,溃疡均无复发。结论对于下肢静脉曲张伴溃疡的患者均应行下肢静脉彩超及静脉顺行造影检查找准病因,制定个体化综合治疗策略。     

中西医综合疗法治疗下肢慢性静脉性溃疡64例临床观察

目的:探讨中西医结合的综合疗法治疗下肢慢性静脉性溃疡的疗效。方法:64例下肢慢性静脉性溃疡患者,采取综合全身性治疗和局部处理相结合的中西医结合疗法,对照治疗前后创面面积、愈合率、愈合时间、愈合速度。结果:治疗8周后,64例中痊愈41例,显效8例,有效9例,无效6例;愈合率64.1%,显效率76.6%,总有效率90.6%。结论:综合疗法治疗下肢慢性静脉性溃疡具有良好的疗效。     

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.     

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.     

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.