POSSUM和P-POSSUM评分评价肠内营养对胃癌根治术后并发症率和死亡率的影响

目的　采用POSSUM和P POSSUM评分系统评估肠内营养对于胃癌根治术病人的手术并发症率和死亡率的影响。方法　回顾性分析 1 0 6例胃癌根治术病人的并发症率和死亡率 ,与POSSUM和P POSSUM评分预测的发生率进行比较。结果　肠内营养组实际并发症率为 2 .2 2 % ,无死亡病例 ;对照组实际并发症率为 1 6 .39% ,死亡率为 1 .6 4 %。肠内营养组病人的并发症率显著低于对照组 (P <0 .0 5 )。肠内营养组的实际并发症率和死亡率均显著低于预测发生率 ,P <0 .0 1。对照组实际并发症率和死亡率较POSSUM评分预测的发生率为低 ,P <0 .0 1 ,与P POSSUM评分预测校正后的死亡率无显著差异 (P >0 .0 5 )。结论　术后早期使用肠内营养可以降低胃癌根治术病人的并发症率和死亡率     

POSSUM评分系统在肝移植中作用及临床意义

目的 探讨POSSUM评分系统在肝移植术后并发症和死亡率评估中作用.方法 应用POSSUM评分系统对126例肝移植病人进行评估,观察术后实际并发症发生率和死亡率,并与预测值比较.结果 预测并发症发生52人,实际发生数38人(P<0.05).符合率73.1%.预测死亡数35人,实际死亡数10人(P<0.05),符合率为28.6%.高危组预测准确性高,符合率50.0%～100%,而低危组高估死亡率,符合率12.5%.结论 POSSUM评分系统高估术后并发症,但能较好的预测高危病人术后死亡率.     

运用改良POSSUM评分系统预测颈椎手术并发症发生率

目的探讨改良生理学和手术严重度评分系统（POSSUM）对预测颈椎手术患者术后并发症发生率的意义。方法根据颈椎手术特点修改POSSUM评分系统中的部分指标（将手术严重度指标中的手术范围和手术次数替换为手术方式和手术持续时间．在生理学指标中增加颈椎核磁共振检查）．并对183例颈椎手术患者术后并发症实际发生率和理论预测率进行比较。结果按Copland公式理论预测有59例（32．2％）发生并发症．实际发生为52例（28．4％）．二者比较，差异无显著性意义（P〉0．05）。结论改良POSSUM评分系统能较准确地预测颈椎手术并发症发生率，对临床医疗护理工作有重要的指导意义。     

POSSUM、(P、Cr)-POSSUM、APGBI评分系统预测结直肠癌术后死亡率的研究

目的：评价POSSUM、（P、Cr）-POSSUM、APGBI评分系统对预测结直肠癌术后死亡率的效果。方法：采用POSSUM、（P、Cr）-POSSUM、APGBI评分系统预测120例结直肠癌患者（分为中年组、老年组、总体）术后死亡率，并比较实际发生率与理论预测率的差异。结果：120例结直肠癌患者中，实际死亡率为1．67％（2例），中年组实际死亡率0％，老年组实际死亡率2．67％。POSSUM、P—POSSUM预测各组死亡率均高于实际水平；Cr—POSSUM、APGBI评分系统在预测总体水平及老年组时，理论预测率与实际死亡率比较无明显差异（x^2=0．839，P〉0．05），而预测中年患者预测值稍高于实际水平。结论：APGBI及Cr-POSSUM评分系统能较准确地评估结直肠癌患者手术风险性。     

POSSUM评分预测胃肠道肿瘤患者术后并发症发生率和死亡率的价值

目的探讨POSSUM评分系统评估胃肠道肿瘤患者手术后并发症发生率和死亡率的临床价值。方法对171例胃肠道肿瘤患者分别在术后立即进行生理学和手术侵袭度评分,预测术后发生并发症和死亡的危险性,同时观察术后并发症发生率和死亡率的实际值,并与预测值进行比较。结果POSSUM评分预测并发症发生例数为75例,与实际并发症发生的96例比较,差异无显著性意义(P=0.3529)。POSSUM评分预测死亡例数为22例,与实际死亡的17例比较,差异也无显著性意义(P=0.3326)。结论POSSUM评分能较好地评估胃肠道肿瘤手术的预后。     

结直肠癌患者住院期间病死率新评分系统的建立和评价

目的建立预测术后病死率的改良P-POSSUM和改良Cr-POSSUM评分系统并与POSSUM比较，评价其对结直肠癌患者住院期间病死率的预测能力。方法调查北京大学第三医院1992-2005年间结直肠癌经手术切除的903例患者资料，按70：30把本组病例分成建立模型样本和预测模型样本，用Logistic回归分析建立改良P-POSSUM和改良Cr-POSSUM，用ROC曲线分析判断改良P-POSSUM和改良Cr-POSSUM评分的判别能力，用Hosmer-Lemeshow检验判断评分的拟合优度，用不同危险因素群的O：E值判断评分的预测能力。结果本组患者住院期间的病死率为1．0％（9／903）。POSSUM、P-POSSUM和Cr-POSSUM评分预测的病死率明显高于实际病死率，O：E值分别为0．18、0．35和0．20。改良P-POSSUM除在急诊手术和姑息手术中判别能力较差外，在其他手术中都具有较好的判别能力，在所有手术中预测的死亡率与实际死亡率接近（O：E值为0．91）；改良Cr-POSSUM除在姑息手术中有很好的判别能力外，在评价模型样本和急诊手术预测的死亡率高于实际死亡率，但仍在实际死亡率95％的可信区间内（0：E值为0．78）。两者的预测能力都好于POSSUM。结论POSSUM、P-POSSUM和Cr-POSSUM在中国结直肠癌手术中预测的病死率高于实际病死率。改良P-POSSUM和改良Cr-POSSUM可较准确地预测中国结直肠癌患者手术住院期间病死率。     

运用改良POSSUM评分系统预测颈椎手术并发症发生率

目的 探讨改良生理学和手术严重度评分系统(POSSUM)对预测颈椎手术患者术后并发症发生率的意义.方法 根据颈椎手术特点修改POSSUM评分系统中的部分指标(将手术严重度指标中的手术范围和手术次数替换为手术方式和手术持续时间.在生理学指标中增加颈椎核磁共振检查),并对183例颈椎手术患者术后并发症实际发生率和理论预测率进行比较.结果 按Copland公式理论预测有59例(32.2%)发生并发症,实际发生为52例(28.4%),二者比较,差异无显著性意义(P>0.05).结论 改良POSSUM评分系统能较准确地预测颈椎手术并发症发生率,对临床医疗护理工作有重要的指导意义.     

改良POSSUM评分评价前列腺电切术术后并发症的价值

目的　探讨改良POSSUM评分系统在前列腺电切术 (transurethralresectionoftheprostate ,TURP)后并发症评估中的临床价值以及TURP后并发症发生的原因及预防。 方法　回顾性分析 3 3 6例TURP术后并发症情况 ,用改良POSSUM评分系统 (在生理学指标中以Cr代替BUN ,在手术侵袭度中将“多种手术同时进行”改为“前列腺体积” ,手术侵袭性根据泌尿外科情况分 4级 )进行评分 ,并按Copeland并发症发生率计算公式 ,比较实际并发症人数与预测发病数 ,同时比较有、无并发症组POSSUM评分间的差异。结果　用改良POSSUM评分预测并发症人数 79例 ,与实际并发症人数 66例之间差异无显著性意义 (P =0 .3 5 89)。无并发症组在年龄、生理学评分和手术侵袭度评分上均低于并发症组 ,差异有显著性 (P <0 .0 5 )。结论　改良POSSUM评分系统可正确评价TURP手术预后。根据评分结果应在围手术期加强监测及器官支持治疗 ,有助于减少并发症的发生     

改良POSSUM及P-POSSUM评分在老年髋部骨折手术风险评估中的应用价值

目的 应用改良的生理学和手术严重度评分系统(POSSUM及P-POSSUM)对老年髋部骨折手术死亡率和并发症率进行评估探讨对手术风险评估的价值.方法 应用POSSUM及P-POSSUM,预测191例老年髋部骨折术后30 d内并发症率及死亡率,比较其预测价值.以并发症率50%为界,分为中低风险组(101例)及高风险组(9...     

POSSUM评分系统预测胰十二指肠切除术手术风险的价值

目的 探讨POSSUM评分系统在预测胰十二指肠切除术(PD)手术风险中的价值.方法 采用POSSUM评分系统(含12项生理学指标和6项手术学指标)对2005年1月至2007年12月在四川大学华西医院肝胆胰外科接受PD手术的265例患者的资料前瞻性地进行评分,根据公式计算出预期术后并发症和术后病死率的发生情况;按Clavien术后并发症诊断标准和国内参考标准分别统计分析术后实际并发症的发生情况,并与预期并发症发生情况进行比较.结果 265例患者的生理学评分为12-24分,平均15分;手术学评分为14～24分,平均17分;POSSUM评分值为0.24～0.88分,预期平均并发症发生率为43.8%.发生例数为116例;实际观察有105例术后发生不同程度的并发症,实际并发症发生率为39.6%,与预测数比较差异无统计学意义(P>0.05).进一步的分层分析发现,POSSUM评分为0.4～0.8分时预测最为准确;POSSUM评分系统在预测术后总的病死率时价值不大,但对于POSSUM评分≥0.5分患者的病死率预测仍有意义.结论 POSSUM评分系统能较好地预测PD的手术风险,对于PD手术及术后处理决策有指导意义.     

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.     

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.     

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.     

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.     

Intraoperative autotransfusion is associated with modest reduction of allogeneic transfusion in prosthetic hip surgery

Background: The efficacy of intraoperative salvage and washing of wound blood and the predictors of allogeneic red cell transfusions in prosthetic hip surgery are insufficiently known.
Methods: In 96 patients, undergoing primary or revision surgery, salvaged and washed red cells and, if necessary, allogeneic blood were used to keep haematocrit not lower than 33%. The bleeding of red cells during hospital stay was calculated from the red cell balance. The preoperative red cell reserve (millilitres of red cells in excess of a haematocrit of 33%) was estimated and the difference between this volume and the total bleeding of red cells was retrospectively used to classify patients with regard to the need for red cells. Stepwise regression analysis was used to define patient-related variables associated with allogeneic blood transfusion.
Results: Preoperative knowledge of the type of operation (primary, revision), the preoperative red cell reserve, and the body mass could predict roughly half of the need for banked blood (r²=0.45). Only one-third of the total bleeding of red cells was retransfused. For complete avoidance of allogeneic blood, autotransfusion was most effective in patients with a moderate need (0–4 u). However, 32% of such patients required allogeneic blood.
Conclusions: Autotransfusion has a limited efficacy to decrease the need for allogeneic blood, and other blood-saving methods should be added for this purpose. It is difficult to predict the need for allogeneic blood preoperatively.     

缺氧对肾小管上皮细胞分泌外泌体的影响

目的    观察缺氧对肾小管上皮细胞分泌外泌体的影响,探讨外泌体在缺氧致肾脏损伤中的作用及机制。 方法    （1）常氧（21% O₂）及缺氧（1% O₂）分别处理大鼠肾小管上皮细胞（NRK-52E）48 h,收集细胞上清液并使用高速梯度离心法分离外泌体。采用透射电镜、纳米示踪分析、Western印迹、蛋白浓度定量鉴定并比较两组外泌体的基本特性。（2）在共培养实验中,以不同浓度（1、10、50、100、300 mg/L）的常氧外泌体、缺氧外泌体分别干预脂多糖（LPS）诱导的大鼠原代腹腔巨噬细胞,使用实时荧光定量PCR与酶联免疫吸附试验（ELISA）法分别检测巨噬细胞白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、诱导型氮氧化物合酶（iNOS）水平;使用Western印迹法检测巨噬细胞磷酸化（p）STAT/STAT及细胞因子信号传导抑制蛋白1（SOCS1）的蛋白表达;最后,使用实时荧光定量PCR法检测常氧外泌体与缺氧外泌体中炎性反应相关微RNA（microRNA,miR）的表达差异。 结果    （1）离心得到的囊泡具有外泌体典型的结构,粒径小于150 nm,表达外泌体标志蛋白CD63,说明分离得到外泌体。缺氧对肾小管上皮细胞分泌的外泌体形态、粒径分布比例无明显影响,但提高了外泌体的分泌量。（2）缺氧外泌体相比于常氧外泌体促进了LPS诱导的M1型巨噬细胞IL-6、TNF-α、iNOS 的表达和分泌（均P＜0.01）,同时提高STAT的磷酸化水平并减少SOCS1的蛋白表达（均P＜0.01）;对炎性反应相关microRNA检测发现缺氧外泌体中miR-155、miR-27a表达量较常氧外泌体明显升高（P＜0.05）。 结论    缺氧可改变外泌体的生物学功能,表现为协同促进LPS诱导的M1型巨噬细胞的表型转化,这可能是慢性肾脏病微炎性反应状态持续的原因之一。     

In Vitro Function and Durability Assessment of a Novel Polyurethane Heart Valve Prosthesis

Abstract While flexible-leaflet, central-flow prosthetic heart valves promise relief from anticoagulation therapy, they continue to be restricted by inadequate durability. In consequence, a novel trileaflet valve, made entirely from polyurethane, has been developed. A batch of 6 consecutively manufactured polyurethane valves was subjected to hydrodynamic function and accelerated fatigue testing. Computerized data acquisition and control systems have been introduced to improve valve testing methodologies. In terms of hydrodynamic function, the polyurethane valve demonstrates transvalvular pressure gradients similar to those for a bioprosthetic valve (Carpentier-Edwards) and levels of retrograde flow significantly less than those for either the bioprosthetic valve or a bileaflet mechanical valve (St Jude Medical). The equivalent of 10 years of cycling without failure has been exceeded by all 6 polyurethane valves in accelerated fatigue tests with 2 valves remaining intact after 674 million cycles (equivalent to approximately 17 years) in continuing tests. Highspeed photography revealed considerable differences in leaflet motion between valves cycled at accelerated and physiological rates.     

Negative pressure ventilation vs. spontaneous assisted ventilation during rigid bronchoscopy: A controlled randomised trial

Background: Ventilation during interventional rigid bronchoscopy (IRB) under general anaesthesia (jet ventilation, positive pressure ventilation and spontaneous assisted ventilation) may offer some difficulties. This study compares the effectiveness during IRB of intermittent negative pressure ventilation (INPV) and spontaneous assisted ventilation (SAV). Methods: Thirty-eight patients submitted to IRB were randomised into two groups: SAV or INPV. All patients received a total intravenous anaesthesia; INPV patients were paralysed. Pre-and intra-operative arterial blood gases and O₂ flow through a rigid bronchoscope were assessed. The endoscopist applying a subjective score evaluated the operating conditions. Results: Patients of the INPV group, as compared to the SAV group, required a lower dosage of fentanyl (2.6 ± 1.8 (μg · kg^?1· h^?1 vs. 6.6 ± 4.8 μg · kg^?1· h^?1), a lower O₂ supply (3.3 ± 2.8 1/min vs. 11.6 ± 3.4 1/min), a shorter recovery time (5.4 ± 2.9 min vs. 9.8 ± 7.1 min) and no manually assisted ventilation (0 ± 0 vs. 1 ± 1.1 nd?/procedure). Intraoperative PaCO₂ was higher in the SAV (8.1 ± 1.3 kPa) than in the INPV group (5.0 ± 1.6 kPa) and intraoperative pH differed in the two groups (7.26 ± 0.05, SAV vs. 7.47 ± 0.08, INPV). Operating conditions, as assessed by a subjective score, were considered better with INPV than with SAV (4.9 vs. 4.3). Conclusions: As compared to SAV, INPV in paralysed patients during IRB reduces administration of opioids, shortens recovery time, prevents respiratory acidosis, excludes the need for manually assisted ventilation, reduces 02 need and affords optimal surgical conditions. INPV appears a safe, non-invasive and effective ventilatory management during IRB.