不同血液净化治疗方法对终末期肾病难治性高血压患者的临床观察

目的 不同血液净化方法治疗维持性血液透析患者难治性高血压的疗效观察.方法 60例终未期肾病难治性高血压患者按随机数字表法分为血液透析组,血液透析联合血液透析滤过组,血液透析联合血液灌流组,每组15例患者.血液透析联合血液透析滤过再联合血液灌流组,观察治疗前及治疗16周后所有患者血压变化及肾素、血管紧张素Ⅱ、全段甲状旁腺激素的水平变化.结果 各组患者治疗后血压及肾素、血管紧张素Ⅱ、全段甲状旁腺激素水平与治疗前比较差异有统计学意义(P＜0.05),而治疗组中血液透析联合血液透析滤过再联合血液灌流组与血液透析联合血液灌流组、血液透析联合血液透析滤过组治疗后比较,血压变化及肾素、血管紧张素Ⅱ、全段甲状旁腺激素水平与治疗前比较差异有统计学意义(P＜0.05).结论 在维持血液透析的治疗基础上联合应用血液透析滤过及血液灌流能有效的控制终未期肾病难治性高血压.     

连续性血液净化治疗尿毒症难治性高血压疗效观察

目的：观察连续性血液净化（CBP）治疗尿毒症并发难治性高血压（RH）患者的临床疗效。方法：回顾性分析32例尿毒症合并RH患者经CBP治疗后血压控制情况及治疗前后血肾素、血管紧张素Ⅱ、甲状旁腺素水平以及尿量、体重改变。结果：32例患者经过CBP治疗后收缩压、舒张压、平均动脉压、血肾素、血管紧张素Ⅱ、甲状旁腺素水平均较治疗前明显降低,体重较前亦有所下降,差异均有统计学意义（P〈0.05）,尿量变化差异无统计学意义（P〉0.05）,血压均控制在正常范围。结论：尿毒症患者RH的发生与容量负荷过重,肾素-血管紧张素系统过度活跃以及继发性甲旁亢等有关,CBP为一有效的控制尿毒症患者高血压的方法。     

组合型人工肾对尿毒症透析患者血管活性物质的影响

目的 探讨组合型人工肾(血液灌流联合血液透析)对尿毒症患者血管活性物质的影响.方法 将符合入选标准的48例尿毒症合并难治性高血压的患者按随机数字表法分为组合型人工肾组和血液透析组,检测患者治疗前、后肾素活性、内皮素1、血管紧张素Ⅱ水平,观察血压的变化情况.结果 治疗3个月后,组合型人工肾组肾素活性、内皮素1、血管紧张素...     

连续性血液净化治疗终末期肾病难治性高血压临床观察

目的探讨连续性血液净化（CBP）治疗终末期肾病（ESRD）合并难治性高血压（RH）的临床疗效。方法回顾性分析27例ESRD合并RH患者经CBP治疗后血压控制情况及治疗前后血肾素、血管紧张素Ⅱ、甲状旁腺素水平。结果患者治疗后收缩压、舒张压、平均动脉压、血。肾素、血管紧张素Ⅱ、甲状旁腺素水平均较治疗前明显降低，差异有统计学意义（P〈0．05），血压均控制在正常范围。结论CBP为一较好的控制ESRD患者难治性高血压的方法。     

血液灌流、血液透析滤过联合血透治疗尿毒症难治性高血压疗效观察

目的:比较血液灌流(HP)和血液透析滤过(HDF)联合血液透析治疗尿毒症并发难治性高血压(RH)患者的临床疗效.方法:回顾性分析26例尿毒症合并RH患者经HP及HDF治疗后血压控制情况及治疗前后血红蛋白、甲状旁腺素水平改变.结果:26例患者经过HP及HDF治疗后收缩压、舒张压、平均动脉压、甲状旁腺素水平均较治疗前明显降低,差异均有统计学意义(P<0.05),HB、ALB、干体重变化差异无统计学意义(P>0.05),血压均有改善.结论:尿毒症患者RH的发生与中大分子毒素以及继发性甲旁亢等有关,HP及HDF为有效的控制尿毒症患者高血压的方法.HP优于HDF.     

不同血液净化方式联合骨化三醇冲击治疗对维持性血液透析患者肾性骨病的治疗效果

目的 观察不同血液净化方式联合骨化三醇冲击治疗对维持性血液透析患者肾性骨病的疗效,探讨治疗肾性骨病的最佳方案.方法 将45例符合标准的患者按数字表法随机分为3组,每组15例.普通透析组接受血液透析治疗;血液透析滤过组接受血液透析滤过治疗,每2周1次;血液透析灌流组接受血液透析联合血液灌流治疗,每2周1次.所有患者均使用骨化三醇冲击治疗.检测治疗0、1、3个月血清钙、磷、甲状旁腺素水平.结果 治疗前3组患者血清钙、磷、甲状旁腺素水平差异无统计学意义(P＞0.05).治疗1个月及3个月后,血液透析组患者血钙、血磷下降水平,三组间两两比较差异无统计学意义(P＞0.05).血液透析组甲状旁腺素水平治疗1个月及3个月与治疗前比较差异无统计学意义(P＞0.05);治疗3个月与治疗前及治疗1个月比较差异有统计学意义(P＜0.05).血液透析滤过组和血液透析灌流组甲状旁腺素水平治疗1个月、3个月与治疗前比较明显下降,差异有统计学意义(P＜0.05),治疗3个月与治疗1个月比较,差异有统计学意义(P＜0.05).血液透析灌流组甲状旁腺素水平治疗3个月和治疗1个月比较,差异无统计学意义(P＞0.05).治疗3个月时,甲状旁腺素水平血液透析滤过组与血液透析灌流组比较差异有统计学意义(P＜0.05).结论 对维持性血液透析肾性骨病的患者而言,血液透析滤过及血液透析灌流联合骨化三醇冲击治疗可以有效控制肾性骨病.     

血液灌流在维持性血液透析并发难治性高血压治疗中的临床疗效观察

目的观察血液灌流（hemoperfusion,HP）对维持性血液透析（hemodiaIysis,HD）患者并发难治性高血压的治疗作用并探讨其可能的致病机制。方法将58例符合难治性高血压的维持性HD患者随机分为治疗组30例及对照组28例,治疗组在HD基础上进行HP治疗,每2周1次,每次2．5h,持续12周,对照组仅行HD治疗。观察两组治疗前、后血压变化,降压药使用种类以及血浆肾素活性（plasmareninactivity,PRA）、血管紧张素（angiotensin,Ang）Ⅱ、醛固酮（aldosterone,Ald）、内皮素（endothelin,ET）、全段甲状旁腺素（intactparathyroidhormone,i-PTH）等物质的水平。结果维持性HD并发难治性高血压患者体内存在较高水平的PRA、AngⅡ、Ald、ET、i-PTH,12周后治疗组PRA、AngⅡ、Aid、ET、i-PTH较治疗前以及对照组明显下降,差异有统计学意义（P〈0．05）,而对照组治疗前、后各项指标无明显变化（P〉0．05）,治疗组血压下降,使用降压药种类减少,与治疗前及对照组比较,差异有统计学意义（P〈0．05）,而对照组治疗前、后血压无明显变化（P〉0．05）。结论HP对维持性HD伴难治性高血压患者有显著的治疗作用。这与HP有效的清除尿毒症患者体内PRA、AngⅡ、Ald、ET、i-PTH等中、大分子物质有关。     

血液灌流联合血液透析治疗尿毒症并发症的临床观察

目的 探讨血液灌流联合血液透析治疗尿毒症并发症的疗效.方法 将46例尿毒症并发症患者按随机数字表法分为治疗组和对照组,治疗组接受血液灌流联合血液透析治疗,对照组接受常规血液透析治疗,观察2组患者治疗前、后的实验室检查指标(肾功能、甲状旁腺激素、β2微球蛋白、电解质)变化与临床症状(肾性骨痛、失眠、皮肤瘙痒、食欲减退)的变化.结果 治疗后治疗组患者的肾性骨病、皮肤瘙痒、睡眠障碍、食欲减退症状得到明显改善,对照组患者的食欲症状有所改善,而皮肤瘙痒、骨痛、睡眠症状未出现明显改善,两组比较差异有统计学意义(P＜0.05);治疗组血浆甲状旁腺激素水平、β2微球蛋白、钙、磷及肌酐、尿素氮指标与治疗前比较差异有统计学意义(P＜0.05);对照组治疗前肌酐、尿素氮水平与治疗后比较差异有统计学意义(P＜0.05),而血浆甲状旁腺激素水平、β2微球蛋白、钙、磷水平比较差异无统计学意义(P＞0.05).结论 血液灌流联合血液透析能有效地清除甲状旁腺激素、β2微球蛋白等中分子毒素,纠正钙磷代谢紊乱,从而改善患者的尿毒症并发症的临床症状,提高患者生存质量与长期生存率.     

血液灌流联合血液透析治疗尿毒症并发症的临床观察

目的 探讨血液灌流联合血液透析治疗尿毒症并发症的疗效.方法 将46例尿毒症并发症患者按随机数字表法分为治疗组和对照组,治疗组接受血液灌流联合血液透析治疗,对照组接受常规血液透析治疗,观察2组患者治疗前、后的实验室检查指标(肾功能、甲状旁腺激素、β2微球蛋白、电解质)变化与临床症状(肾性骨痛、失眠、皮肤瘙痒、食欲减退)的变化.结果 治疗后治疗组患者的肾性骨病、皮肤瘙痒、睡眠障碍、食欲减退症状得到明显改善,对照组患者的食欲症状有所改善,而皮肤瘙痒、骨痛、睡眠症状未出现明显改善,两组比较差异有统计学意义(P＜0.05);治疗组血浆甲状旁腺激素水平、β2微球蛋白、钙、磷及肌酐、尿素氮指标与治疗前比较差异有统计学意义(P＜0.05);对照组治疗前肌酐、尿素氮水平与治疗后比较差异有统计学意义(P＜0.05),而血浆甲状旁腺激素水平、β2微球蛋白、钙、磷水平比较差异无统计学意义(P＞0.05).结论 血液灌流联合血液透析能有效地清除甲状旁腺激素、β2微球蛋白等中分子毒素,纠正钙磷代谢紊乱,从而改善患者的尿毒症并发症的临床症状,提高患者生存质量与长期生存率.     

血液灌流联合血液透析治疗慢性肾功能衰竭继发甲状旁腺功能亢进的临床观察

目的 观察血液灌流联合血液透析治疗慢性肾功能衰竭继发性甲状旁腺功能亢进的临床疗效.方法 选取在我院行血液透析治疗的慢性肾功能衰竭合并继发性甲状旁腺功能亢进患者60例,按随机数字表法分为血液灌流+血液透析组30例,血液透析组30例,比较透析前及连续3次治疗后两组患者血清钙、磷、甲状旁腺激素水平的变化.结果 血液灌流+血液透析组患者和血液透析组患者治疗后血磷水平与治疗前比较差异有统计学意义(P＜0.05);血液灌流+血液透析组患者治疗后血甲状旁腺激素水平与治疗前比较差异也有统计学意义(P＜0.05),血液透析组患者治疗前血甲状旁腺激素水平与治疗后比较差异无统计学差异(P＞0.05);血液灌流+血液透析组患者治疗后血磷与血液透析组患者比较差异有统计学意义(P＜0.05);两组患者经治疗后血钙与治疗前比较差异也有统计学意义(P＜0.01).结论 血液灌流联合血液透析在降低血甲状旁腺激素水平和血磷水平要优于单纯血液透析的治疗.     

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.