莫匹罗星对烧伤创面金黄色葡萄球菌感染的治疗

应用２％莫匹罗星软膏（实验组）及磺胺嘧啶银（对照组）治疗４１例平均面积２．１％±１．１２％的金黄色葡萄球菌感染创面，结果表明：试验组总有效率为８８．９％，创面细菌清除率为９６．３％，金葡菌清除率高达８８．８％；而ＳＤ－Ａｇ对照组依次分别为４５％，７０％及４０％。从烧伤创面分离的金葡菌对多种抗生药物的敏感试验表明，对莫匹罗星感率为９２．６８％，仅低于万古霉素而主头孢噻吩，亚胺硫霉素，环内氟哌酸等，差     

莫匹罗星对烧伤创面金黄色葡萄球菌感染的治疗

应用2%莫匹罗星软膏(实验组)及磺胺嘧啶银(对照组)治疗41例平均面积2.1%±1.12%的金黄色葡萄球菌感染创面,结果表明:试验组总有效率为88.9%,创面细菌清除率为96.3%,金葡菌清除率高达88.8%;而 SD-Ag 对照组依次分别为45%、70%及40%。从烧伤创面分离的金葡菌对多种抗生药物的敏感试验表明,对莫匹罗星敏感率为92.68%,仅低于万古霉素而高于头孢噻吩、亚胺硫霉素、环丙氟哌酸等,差异有显著意义。莫匹罗星对金葡菌的 MIC_(50)≤0.25 mg/L、MIC_(90)≤4 mg/L,(MIC范围0.25～256mg/L)。提示莫匹罗星软膏可作为烧伤创面金葡菌感染的首选药物。     

硫酸镁与氯胺酮相互作用的实验研究

序贯法测得小鼠静注（ｉｖ）、腹腔注射（ｉｐ）硫酸镁（Ｍａｇｎｅｓｉｕｍ　ｓｕｌｆａｔｅ，ＭＳ）的ＬＤ５０分别为１９５（１５９～２３８）和８３６（７１６～９７７）ｍｇ／ｋｇ。小鼠ｉｖ氯胺酮（Ｋｅ－ｔａｍｉｎｅ，Ｋｅｔ）的ＬＤ５０为８０．０（７３．１～８８．２）ｍｇ／ｋｇ；预先ｉｖＭＳ２０、４０ｍｇ／ｋｇ后再ｉｖＫｅｔ之ＬＤ５０分别为７５．０（７０．２～８０．１）和６９．６（６５．６～７３．８）ｍｇ／ｋｇ，仅后者比单独ｉｖ　Ｋｅｔ组之ＬＤ５０小（Ｐ＜０．０５）。对照组免（ｎ＝１０）ｉｖ　Ｋｅｔ１０ｍ…     

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

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。     

胃肠道癌术后腹腔,静脉化疗所致毒性反应临床分析

对胃肠道癌术后２３例腹腔内化疗（腹腔组）与３２例静脉化疗（静脉组）所致的毒性反应比较分析２腹腔组给予ＤＤＰ３０￣６０ｍｇ／Ｍ＾２，５－ＦＵ１￣２ｇ／Ｍ＾２，加入１Ｌ生理盐水，通过药泵滴入腹腔。静脉组给予ＤＤＰ２０￣２５ｍｇ／Ｍ＾２，５－ＦＵ０．５￣０．７５ｇ／Ｍ＾２，部分病例加用ＭＭＣ２￣４ｍｇ／Ｍ＾２静注。结果显示，腹腔组出现腹胀较静脉组多，而恶心、呕吐，周围静脉炎，肝、肾功能异常，骨髓抑制等较     

2%莫匹罗星软膏（百多邦）治疗原发和继发性皮肤感染的疗效和安全性——一...

一项多中心开放试验研究了２％莫匹罗星软膏对１３９１例皮肤感染患者的疗效和安全性。从可伯１３０４例中治愈９６１例，显著改善２９３例，总有效率９６．２％，部分患者的菌检表明，其主要感染菌株为葡萄球菌和链球菌。     

2％莫匹罗星软膏（百多邦）治疗原发和继发性皮肤感染的疗效和安全性──一项多中心开放试验

一项多中心开放试验研究了２％莫匹罗星软膏（百多邦）对１３９１例皮肤感染患者的疗效和安全性。从可评价的１３０４例中治愈９６１例（７３．７％），显著改善２９３例（２２．５％），总有效率９６．２％。部分患者的菌检表明，其主要感染菌株为葡萄球菌和链球菌。有３９例（２．９％）出现烧灼感、瘙痒和潮红等副作用，未见全身毒副作用和化验异常。本研究认为，百多邦治疗原发性和继发性皮肤感染是有效和安全的。     

高张盐溶液与中分子右旋糖酐复苏烧伤休克对犬心肌功能的影响

采用含Ｎａ~＋２５０ｍｍｏｌ／Ｌ的乳酸钠高张盐溶液与６％中分子右旋糖酐（ＨＬＤ）复苏烧伤休克，与乳酸钠林格氏液（ＬＲ）比较，综合评价其复苏效果并探讨其部分机制。结果表明ＨＬＤ组心脏指数（ＣＩ）在伤后４、８、１２、２４ｈ均明显高于ＬＲ组（Ｐ＜０．０５）。ＨＬＤ组心肌收缩功能（ｄｐ／ｄｔｍａｘ），心肌舒张功能（－ｄｐ／ｄｔｍａｘ）在伤后１２、２４ｈ也高于ＬＲ组（Ｐ＜０．０５）。ＨＬＤ组在伤后２４ｈ的心肌ＭＤＡ含量（１．７４±０．２８×１０~（－２）ｍｏｌ／ｇ组织）明显低于ＬＲ组（３．２３±０．５６×１０~（－２）ｍｏｌ／ｇ组织，Ｐ＜０．０５）。而其心肌ＳＯＤ活力（１５７．４９±３２．２３ｕ／ｍｇ组织）明显高于ＬＲ组（４６．８８±１６．２８ｕ／ｍｇ，Ｐ＜０．０１）。提示：与ＬＲ复苏相比，ＨＬＤ复苏烧伤休克能明显改善心肌功能，并可持续到伤后２４ｈ。ＨＬＤ可能通过提高心肌组织ＳＯＤ活力从而降低心肌组织脂质过氧化物含量，减轻脂质过氧化物对细胞膜的损伤，进而起到保护心肌、改善心肌功能的作用。     

骨肉瘤大剂量甲氨喋呤化疗的血清药物浓度监测

测定骨肉瘤大剂量甲氨喋呤（ｍｅｔｈｏｔｒｅｘａｔｅＭＴＸ）化疗４２例次，化疗方案分两组，第一组ＭＴＸ剂量为２００ｍｇ／ｋｇ，静脉滴注时间为２、４、６小时；第二组静脉滴注时间为６小时，ＭＴＸ剂量为２００ｍｇ／ｋｇ、３００ｍｇ／ｋｇ、４００ｍｇ／ｋｇ、５００ｍｇ／ｋｇ。结果表明，零时血清药物浓度随滴注时间的延长而下降，为６．２×１０－４ｍｏｌ／Ｌ，５．１×１０－４ｍｏｌ／Ｌ、５．０×１０－４ｍｏｌ／Ｌ，各时间组之间无显著性差异；零时血清药物浓度随ＭＴＸ剂量增加而显著增高，为５．０×１０－４ｍｏｌ／Ｌ、７．７×１０－４ｍｏｌ／Ｌ、１．１×１０－３ｍｏｌ／Ｌ、２．７×１０－３ｍｏｌ／Ｌ。零时血清药物浓度越高，血清药物浓度下降速度越快，２４小时为１×１０－６ｍｏｌ／Ｌ左右，２４小时以后，下降速度缓慢，至７２小时为１×１０－７ｍｏｌ／Ｌ左右。２４小时以后的血清药物浓度差异不大     

应用头孢噻甲羧肟后烧伤病人体内的药代动力学改变

将１０名烧伤面积３０％～６０％含Ⅲ度伤的患者分为休克期组（ｎ＝５）和休克期后组（ｎ＝５），并设正常对照组（ｎ＝６），进行药代动力学比较研究。并通过高效液相法动态分析了应用头孢噻甲羧肟后，血浆、尿液和烧伤水疱液中的浓度。结果显示：休克期组与正常对照组比较差异有非常显著意义，表观分布容积（０．４５±０．０６Ｌ／ｋｇ对０．２３±０．０５Ｌ／ｋｇ）、非肾清除率（３０．５４±２１．９７ｍｌ·ｍｉｎ（－１）对１１．０８±４．９１ｍｌ·ｍｉｎ（－１））等虽增加，但药物的消除相半衰期却延长（３．２０±１．１２ｈ对１．８９±０．１５ｈ）。提示在大面积烧伤的早期，用药剂量不需增加。烧伤病人水疱液中可测出有效的抑菌浓度，为１．００４～２１．６２ｍｇ／Ｌ。证明早期全身性用药，可穿透Ⅱ度烧伤组织。     

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.     

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.     

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.