骨化三醇治疗对血液透析患者矿物质、骨代谢紊乱及FGF23的影响

目的:评价骨化三醇不同给药方案对血液透析患者矿物质及骨代谢紊乱(CKD-MBD)及FGF23的影响。方法:选取血甲状旁腺素(PTH)水平在300~621 pg/ml(正常的4~9倍)之间的血液透析患者,随机分成骨化三醇常规治疗组(常规组,22例)和间歇给药组(间歇组,26例),疗程16周,检测治疗前后血清FGF-23水平、钙磷代谢等指标变化。结果:(1)两组患者治疗终点与治疗前比较,血PTH均明显下降、血维生素D及FGF23均明显升高(P0.05)。间歇组在治疗终点,血钙明显升高、碱性磷酸酶明显下降(P0.05),而持续组,治疗前后血钙、碱性磷酸酶无明显变化。(2)在不同治疗时间点,持续组PTH明显下降(P0.05);间歇组PTH、碱性磷酸酶明显下降,血钙明显升高(P0.05)。治疗第4周、第8周,间歇组PTH下降较持续组明显(P0.05)。(3)治疗期间,持续组有6例患者血磷升高,间歇组无血磷升高患者。治疗期间无高钙血症发生。结论:骨化三醇不同给药方案能不同程度下降患者血PTH、升高FGF23,间歇组较持续组明显;间歇给药组血钙明显升高、碱性磷酸酶明显下降。两组治疗方案均能改善继发性甲状旁腺功能亢进,间歇给药组降PTH效果更佳。骨化三醇治疗轻中度继发性甲状旁腺功能亢进安全有效。     

帕立骨化醇治疗维持性血液透析患者继发性甲状旁腺功能亢进症的前瞻性研究

目的 观察帕立骨化醇治疗维持性血液透析患者继发性甲状旁腺功能亢进症（secondary hyperparathyroidism,SHPT）的疗效及安全性.方法 选择我科血液净化中心进行维持性血液透析治疗的13例患者,血全段甲状旁腺素（intact parathyroid hormone,iPTH）≥33 pmol/L,血钙水平＜2.55 mmol/L,钙磷乘积＜65,根据iPTH水平使用帕立骨化醇1～18 μg治疗,于每次透析治疗后给药,共观察12周.分别于治疗前及治疗后第2、4、6、8、10、12周测定患者的iPTH、血钙、血磷水平.结果 13例患者的血清iPTH水平在治疗后第2、4周已开始下降,但与治疗前相比差异无统计学意义.从治疗后第6周开始,iPTH水平与治疗前相比存在统计学差异（P＜0.05）,治疗后第12周时下降至（46.68±38.06） pmol/L,与治疗前（78.30±52.13） pmol/L比较,有统计学差异（P＜0.01）.治疗后第2、4周血钙水平升高,与治疗前比较有统计学差异（P＜0.05）,其中治疗后第4周时血钙水平升高尤为显著（P＜0.01）.经调整帕立骨化醇剂量后,治疗后第6周患者的血钙水平逐渐恢复正常并保持稳定,血磷、钙磷乘积水平在治疗前、后均无明显统计学差异.治疗过程中,患者耐受性良好,无相关不良反应的发生.结论 使用帕立骨化醇治疗维持性血液透析患者SHPT是有效、安全的.     

中西医结合治疗血液透析患者继发性甲状旁腺功能亢进的临床观察

目的：观察中西医结合治疗血液透析患者继发性甲状旁腺功能亢进临床疗效。方法：将80例入选者随机分为对照组和治疗组,对照组采用骨化三醇治疗,治疗组在对照组治疗的基础上加服中药自拟健骨方,比较两组治疗前后血钙、磷、钙磷乘积、碱性磷酸酶、血清全段甲状旁腺素（iPTH）等指标。结果：两组治疗20周后血钙明显上升、碱性磷酸酶、iPTH明显下降,两组内治疗前后比较差异有统计学意义（P〈0.05）,两组间治疗后比较差异有统计学意义（P〈0.05）。但两组治疗后血磷及钙磷乘积和治疗前比较,差异无统计学意义（P〉0.05）.结论：中药自拟健骨方同时与骨化三醇联合应用,中西医结合,可有效控制血液透析患者继发性甲状旁腺功能亢进,安全性良好。     

醋酸钙片治疗腹膜透析患者高磷血症的疗效观察

目的：观察醋酸钙片治疗腹膜透析患者高磷血症的临床疗效。方法：41例CAPD腹膜透析伴有高磷血症患者,口服醋酸钙片治疗,观察8周。检测治疗前、治疗2周、4周和8周血磷、血钙、碱性磷酸酶和全段甲状旁腺激素等。结果：与治疗前比较,治疗2周、4周、8周血磷明显下降,差异有统计学意义（P值〈0.05）;与治疗前比较,治疗2、4、8周校正血钙、白蛋白、血红蛋白、血肌酐、全段甲状旁腺激素和碱性磷酸酶差异均无统计学意义（P〉0.05）。醋酸钙片治疗高磷血症总有效率82.93％,轻度不良反应发生率4.88％,高钙血症2例,发生率4.88％。结论：醋酸钙片治疗腹膜透析患者高磷血症具有明显疗效且安全。     

小剂量维生素D受体激活剂(骨化三醇)对血液透析患者血管紧张素Ⅱ和微炎症的影响

目的 探讨小剂量维生素D受体激活剂(骨化三醇)对血液透析患者血压、血管紧张素Ⅱ和微炎症的影响.方法 20例血液透析患者应用骨化三醇(0.25μg/d)治疗,分别于用药前、用药4、8周观察患者收缩压、舒张压、血浆血管紧张素Ⅱ、超敏C反应蛋白和白细胞介素6水平.结果 治疗4周后,患者收缩压与治疗前比较差异有统计学意义(P＜0.05)；治疗4周后,患者血浆血管紧张素Ⅱ水平与治疗前比较差异有统计学意义(P＜0.05)；治疗8周后,患者血浆超敏C反应蛋白水平与治疗前比较差异有统计学意义(P＜0.01)；治疗4、8周后,患者血浆白细胞介素6水平与治疗前比较差异有统计学意义(P＜0.01).结论 小剂量维生素D受体激活剂(骨化三醇)对维持性血液透析患者可以明显降血压、抑制血管紧张素Ⅱ和抗炎症作用.     

烟酰胺治疗血液透析患者高磷血症的疗效观察

目的观察烟酰胺治疗血液透析患者高磷血症的疗效和安全性。方法30例维持性血液透析患者经停用其他磷结合剂2周后,患者（血磷〉1．5mol／L）每天口服烟酰胺500-750mg,观察8周。分别比较治疗前和治疗后4周和8周患者血磷、血钙、钙磷乘积、碱性磷酸酶、血常规、肝功能、。肾功能和血脂的变化。结果与治疗前相比,烟酰胺治疗4周后血磷水平、钙磷乘积和血全段甲状旁腺素明显下降,8周达到最低水平,8周后碱性磷酸酶明显减低（P〈0．05）。治疗前、后血清钙、白细胞数、肝酶、血糖和血脂均无显著变化。结论烟酰胺可有效控制维持性血液透析患者的高磷血症,降低钙磷乘积和碱性磷酸酶,而且无明显毒副作用。     

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.     

帕立骨化醇在透析患者继发性甲状旁腺功能亢进中的疗效分析

目的:探讨帕立骨化醇治疗骨化三醇或拟钙剂效果不佳的维持性血液透析患者继发性甲状旁腺功能亢进的疗效。方法:选取四川大学华西医院雅安市人民医院维持性血液透析伴继发性甲状旁腺功能亢进(iPTH>300 pg/ml),且对骨化三醇或拟钙剂疗效不佳的患者16例。检测其使用帕立骨化醇前及治疗后4、8、12周血钙、磷、甲状旁腺激素、碱性磷酸酶水平。结果:使用帕立骨化醇12周后,iPTH由1159.0(740.05,2104.50)pg/ml下降至738.35(462.58,944.58)pg/ml(P=0.002),并且37.50%(6/16)的患者iPTH水平下降≥30%,31.25%(5/16)的患者iPTH水平下降≥50%。血钙由(2.09±0.19)mmol/L上升至(2.38±0.13)mmol/L(P<0.001),血清ALP由(179.38±107.61)mmol/L下降至(99.58±21.37)mmol/L,差异具有统计学意义(P=0.009)。血磷在治疗前后差异无统计学意义。结论:帕立骨化醇对骨化三醇或拟钙剂疗效不佳的维持性血液透析患者的继发性甲状旁腺功能亢进仍然有效...     

西那卡塞治疗血液透析患者继发性甲状旁腺功能亢进的临床观察

目的探讨西那卡塞治疗维持性血液透析(MHD)患者继发性甲状旁腺功能亢进(SHPT)的临床疗效。方法选择武汉市第五医院收治的98例并发SHPT的MHD患者,采用随机数字表法随机分为观察组(n=49)与对照组(n=49)。对照组给予磷结合剂、维生素D类似物等常规治疗,观察组在对照组基础上给予西那卡塞治疗。对比2组患者SHPT的临床疗效,并比较2组患者治疗前后尿素氮、血肌酐、尿素清除指数的变化。结果观察组的治疗有效率为87.8%,显著高于对照组的67.3%(P0.05)。与治疗前比较,2组患者治疗后血钙、血磷、碱性磷酸酶、全段甲状旁腺素均显著降低(P0.05);治疗后组间比较,观察组血钙水平、血磷、碱性磷酸酶、全段甲状旁腺素也显著低于对照组,差异具统计学意义(P0.05)。2组患者治疗前后尿素氮、血肌酐、尿素清楚指数无统计学意义(P0.05);治疗后2组甲状旁腺体积均较治疗前显著减小(P0.01),且观察组治疗后显著小于对照组(P0.01)。对照组不良反应发生率为40.8%,显著高于观察组的14.3%(P0.01)。结论西那卡塞用于MHD患者SHPT具有理想疗效,能够显著降低甲状旁腺素水平,同时缩小甲状旁腺体积,值得临床推广。     

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.