四肢主要血管损伤的治疗分析

本文报告１２年治疗的３７例四肢主要血管损伤的理体会。３６例按损伤情况分别采用端－端吻合，大隐静脉移植等方法重建血循，成功率９７．２％，总截肢率５．４％。挽潮流航运 体的预后主要取决于肢体缺血时间，神经、软组织，骨骼损伤程度及其它脏器损伤情况等因素。作者强调早期诊断和及时处理的重要性，并就诊断中的经验和教训作了总结。     

血管移植在四肢血管损伤中的应用

目的:探讨血管移植在四肢血管损伤中的作用。方法:44例（52条）四肢血管损伤患者,男35例,女9例,年龄14⁵8岁,平均27·3岁,分别采用自体血管（42条）和人造血管（10条）移植。结果:截肢3例,人工血管移植物感染行股浅-静脉原位置换2例,肢体缺血挛缩6例,神经功能恢复不完全7例。其余移植血管均通畅,远端肢体血循环良好。结论:血管移植治疗血管损伤保肢成功率高;治疗中须注意早诊断、早修复、严格显微外科原则、积极行骨筋膜室切开减压。     

血管移植在四肢血管损伤中的应用

目的:探讨血管移植在四肢血管损伤中的作用。方法:44例(52条)四肢血管损伤患者,男35例,女9例,年龄14~58岁,平均27·3岁,分别采用自体血管(42条)和人造血管(10条)移植。结果:截肢3例,人工血管移植物感染行股浅-静脉原位置换2例,肢体缺血挛缩6例,神经功能恢复不完全7例。其余移植血管均通畅,远端肢体血循环良好。结论:血管移植治疗血管损伤保肢成功率高;治疗中须注意早诊断、早修复、严格显微外科原则、积极行骨筋膜室切开减压。     

四肢血管损伤的治疗

目的评价四肢血管损伤的治疗效果。方法回顾性分析52例血管损伤伴肢体骨折、骨折脱位或软组织损伤的治疗方法与疗效。结果一期截肢8例，二期截肢2例；功能评定：优2l例(54％)，可14例(36％)，差4例(10％)。结论及时诊断，尽早手术，积极重建血液循环是保证肢体功能恢复的前提。     

显微外科治疗四肢血管损伤40例报告

四肢血管损伤日渐增多。ＤｅＢａｋｅｙ［１］报告在二战期间的２４７１例血管损伤患者中，四肢动脉损伤就占９０％。Ｈｅｒｍｒｅｃｋ［２］等报道四肢血管损伤占总创伤的３％。对四肢血管损伤的早期诊断，应用显微外科技术进行修复是提高成功率、保全肢体的关键。我科从１９９１年～１９９７年间收治四肢血管损伤４０例，报告如下：临床资料一、一般资料　本组男３１例，女９例。年龄２０岁～５６岁，平均３３．５岁。损伤因素：刀伤２０例，机器绞断撕裂伤４例，车祸挤压伤８例，骨折后刺伤２例，玻璃切割伤６例。损伤部位：股动脉１０条…     

四肢主干血管损伤的修复治疗

四肢动脉干损伤危及肢体血供,如处理不当或延误治疗,造成肢体坏死,截肢,甚至危及伤员生命。我院于1987．7～2001．7共收治四肢主干血管损伤患108例,现报告如下。     

四肢血管损伤31例治疗分析

四肢血管损伤３１例治疗分析刘建寅，程绪西，高雁卿，王洪业四肢血管损伤比较常见。ＤｅＢａｋｅｙ［１］报道美军在第二次世界大战中的２４７１例血管损伤患者，四肢动脉损伤占９０％。Ｈｅｒｍｒｅｃｋ等［２］报道四肢血管损伤占总创伤的３％。对这类损伤的早期诊断及...     

四肢血管损伤的治疗

四肢血管损伤多见于车祸、骨折损伤、挤压伤等及某些锐器直接损伤。伤口可以是开放性或闭合性。除血管损伤外,一般都伴有受损肢体血运障碍。能否及时正确处理,不仅关系到患者的生命安危,而且涉及到受损肢体的存活和功能的恢复问题。因此,必须争分夺秒进行治疗。我院自1993～1998年共收治21例,修复受损血管30条,疗效满意,现报道如下。临床资料本组21例,其中男性20例,女性1例。年龄19～70岁。血管损伤原因:车祸骨折损伤8例,机器挤压伤5例,刀伤及其它锐器伤5例,枪弹伤2例,跨栏伤1例。血管损伤部位:股动脉4例,股静脉5例,动脉2例,动静脉复合…     

四肢主要血管损伤的显微外科修复

目的 通过对四肢主要血管损伤158例的诊治分析，探讨四肢主要血管损伤的早期诊断，提高疗效，降低截肢率。方法 应用显微外科技术修复四肢主要血管损伤158例，其中直接血管吻合88例，自体静脉移植修复32例，单纯修复38例。术后按显微外科方法监测治疗。结果 治愈145例，截肢13例，死亡1例。结论 严密观察伤肢缺血现象和综合分析临床表现对血管损伤的早期诊断至关重要，应用显微外科技术早期修复损伤血管有助于降低截肢率；缺损大于3cm应作静脉移植；术后注意骨筋膜室综合征的发生并及早切开减压是提高治愈率和功能恢复的关键。     

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.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Intrathecal administration of sameridine to patients subjected to arthroscopic knee joint surgery

Background: Sameridine, a new substance with both local anesthetic and opioid effects, was administered intrathecally for the first time to humans, i. e. in patients subjected to arthroscopic knee joint surgery.
Method: A dose-escalating (10, 15, 20 and 25 mg), open study was performed in 33 patients. Only two patients were included in the 25 mg group.
Results: Sameridine provided good quality of surgical anesthesia in all patients except those receiving 10 mg. The maximum level of sensory block, Th5–Th7, was reached within 30 min with a median duration of 3.6–3.9 h. The motor block was more profound with increasing dose, but never lasted longer than the sensory block. The influence on heart rate and blood pressure was minor and atropine and ephedrine were needed in four patients. No clinically significant ECG-changes were detected and no arrhythmias were recorded. Oxygen saturation and respiratory rate did not decrease in a clinically significant way and were not affected by concomitant morphine given i. v. postoperatively. There were few side-effects, the most frequent being mild pruritus (10/33).
Conclusion: Sameridine provided clinically adequate anesthesia for the patients receiving the doses of 15, 20 and 25 mg. Further studies are needed to evaluate the substance and it is of great interest to clinically investigate the opioid component with respect to postoperative analgesia.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

Anesthésie du patient épileptique

Although surgery of brain tumors and epilepsy are restricted to few specialized centers, anaesthesia for a patient with epilepsy is commonly encountered. Surgical treatments of epilepsy are currently soaring due to the lack of significant progress about effectiveness of antiepileptic drugs (AEDs). Theoretical principles for the anaesthesiologist are quite complex, involving interactions between physiological and pharmacological anaesthesia and AEDs, such as enzyme induction with the first generation molecules mainly (phenytoin, carbamazepin, phenobarbital). The latest generation AEDs (levetiracetam, lamotrigine, gabapentin, oxcarbazepin, vigabatrin, lacosamide...) are better tolerated and induce fewer drug interactions. Practically, the risk of severe perioperative complications is low, provided that the administration of AEDs is kept as close as possible to its usual dosage, and that metabolic disturbances are prevented. The main anaesthetic drugs to avoid are alfentanil, remifentanil and sevoflurane, although their contraindication are only relative, since the clinical benefit might be clear and the doses should remain moderate.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.     

Intravenous endotoxin does not increase tissue extravasation of albumin in rats

Background : It is unclear whether activation of the inducible nitric oxide synthase (iNOS) increases or decreases the extravasation of plasma.
Methods : Chloralose anaesthetised male Wistar rats received E. coli lipopolysacharide (LPS), 3 mg kg^-1 i.v., or the corresponding volume of saline, 3 or 5 h before the end of the experiment. Mean arterial pressure (MAP) and heart rate (HR) were recorded. Tissue clearance of radio-labelled albumin, during the last 2 h of each experiment, was determined by a double-isotope method. In separate animals, the serum concentration of nitrite and nitrate was determined, 5 h after LPS or the solvent.
Main Results : LPS initially decreased MAP and lastingly increased HR. In the 3-h LPS animals (n=8), tissue plasma clearance was lower in the heart and calf muscle and increased only in diaphragm, compared to corresponding control animals (n=8). In the 5-h LPS rats, clearance was lowered (n=8) in the entire gastrointestinal tract and in testes, compared to controls (n=8). The serum nitrite/nitrate concentration was higher in animals given LPS (n=6) than in controls (n=6).
Conclusion : After LPS, tissue clearance of albumin was not increased in any major tissue, in spite of increased serum levels of NO end products. Apparently, after activation of iNOS, the augmented release of NO is not necessarily associated with increased albumin extravasation.