血液稀释法自体输血在脊柱侧凸后路手术中的应用

目的：探讨在脊柱侧凸矫形术中应用血液稀释法自体输血的可行性。方法：３６例脊柱侧凸患者在行后路器械矫形融合术中采用了血液稀释法自体输血。２０例患者术接受了预存自体输血,其中４例患者又应用了术中自体血回输。结果：平均轴血量为６２７ｍｌ（４２５～８３４ｍｌ）,血液稀释后红细胞压积达２９．８％。２０例平均预存血量为６５０ｍｌ。术中术后平均总失血量１８５０ｍｌ,平均异体血输入量７５０ｍｌ。４例应用术中自体血回输患者均未输异体血而安全度过手术期。所有患者在血液稀释采血后血红蛋白、红细胞压积均明显下降,术后１周基本恢复正常,未发现应用血液稀释法采血的相关并发症。结论：血液稀释法自体输血能有效减少异体血的输入量,且安全有效、节约区费;联合应用多种自体输血方法可大大减少甚至无需异体血输入。     

等容血液稀释自体输血对肿瘤病人围术期T淋巴细胞亚群、NK细胞影响的比较

目的：探讨异体输血和等容血液稀释自体输血对围术期T淋巴细胞亚群,NK细胞的变化。方法：选择直肠癌,结肠癌格或胃癌根治术病人30例,随机均分为2组。H组术中输异体全血400ml;A组于手术切皮前放血400ml,同时输入等量羟乙基淀粉。术中自体血回输给病人。分别于术前,输血前,术后第1d,第5d抽取静脉血,用流林细胞仪测定T细胞亚群和NK细胞的数量。结果：两组术后第1dCD3^ ,CD4^ ,CD4^ /CD8^ ,NK细胞较术前显著减少（P＜0．05或0．01）,异体输血组较自体输血组减少更明显（P＜0．05）。术后第5d异体输血组CD3^ ,CD4^ ,CD4^ /CD8^ ,NK细胞仍较术前显著减少,自体输血组基本恢复正常。结论：围术期输异体血严重抑制病人免疫,因液稀释自体输血免疫抑制轻微,且术后免疫功能很快恢复。     

预存自体输血在脊柱侧凸矫形术中的应用

目的：探讨预存自体输血在脊柱侧凸矫形术中应用的可行性。方法：选择９６例行后路器械矫形融合术的脊柱侧凸患者,５０例患者接受了预存自体输血。作为研究员,另４６例患者除术前未行预存自体输血外,其它条件如年龄、手术方式、手术时间等与研究组相似,作为对照组。所有患者术中均常规使用自体血回输。结果：预存自体输血组平均预存血量为６５０ｍｌ,围手术期异体血输入量平均为３５０ｍｌ。对照组围手术期异体血平均输入量为８     

自体血回输在单侧人工全膝关节表面置换术后的临床观察

目的探讨人工全膝关节表面置换术后自体血回输的安全性、有效性及护理特点。方法使用回顾性质量评估设计,比较了2005-2009年本组行单侧人工全膝关节表面置换术患者120例,其中60例采用自体血回输装置（A组）,60例术后伤口采用常规引流袋引流（B组）。根据患者的临床表现和血红蛋白水平决定异体血的输入量,使术后血红蛋白水平维持在10g/dL以上。比较两组患者术后8h内及术后总引流量;比较两组患者术前、术后第1天、术后第7天的血红蛋白变化及术后平均输血量、输异体血比例。观察两组患者输血后不良反应的发生情况。结果两组患者8h内引流量以及术后总引流量比较,差异均无统计学意义（P〉0．05）。两组患者术前、术后第7天血红蛋白的变化无统计学差异（P〉0．05）,术后第1天血红蛋白的变化有统计学意义（P〈0．05）。A组术后自体血回输量平均为382．5ml,术后有9例接受异体血输血,平均异体血输入量134．3ml;A组所有自体血回输未出现输血反应,无感染等并发症。B组术后23例接受异体血输血,平均异体血输入量252．4ml;B组异体血输血过程中有3例出现发热反应。输异体血的比例为A组15．0％,B组38．3％。结论单侧人工全膝关节表面置换术后使用自体血回输是安全有效的,能够节约血源,避免血液传播疾病的发生,临床效果好,值得推广应用。     

骨科术后伤口渗血回吸收的临床研究

目的：检测伤口渗血自体血回输的临床疗效。方法：观测自体血回输组和异体血输入组共20例病人的临床表现、体温、血常规、肝肾功能、出血量及异体血输入量。结果：两组病人在临床表现、体温、血常规、肝肾功能、出血量上对比无差异，即两者均可使术后患者的血像恢复正常，对肝肾功能无影响，但在异体血输入量上对比差异明显，自体输血组可减少异体血输入约60%。结论：术后伤口渗血回输可有效减少血液丢失，减少异体血输入，安全可靠。     

控制性降压联合自体血回输在特发性脊柱侧凸矫形术中的应用价值

目的:探讨控制性降压联合自体血回输在特发性脊柱侧凸矫形术中的应用价值。方法:对39例特发性脊柱侧凸患者行后路矫形术时均进行术中控制性降压,其中12例未进行自体血回输,作为对照组(A组),全部输异体库存血;另外27例均采用自体血液回输,包括术前预存自体血及术中自体血回输,作为研究组(B组)。观察两组患者失血量及输血情况。结果:A组失血量为763±164ml(400～1000ml),B组为852±386ml(350～2100ml),两组间相比无差异性(P>0.05)。A组输入库存血量为1045±362ml(500～1800ml),B组为511±337ml(0～1300ml),两组间差异有显著性(P<0.01)。结论:控制性降压可减少术中出血量,同时采用自体血回输可明显减少异体库存血的需要量。     

自体血回输对全髋关节置换术患者免疫功能的影响

目的 比较回收式自体血回输和异体血输血对全髋关节置换手术患者免疫功能的影响. 方法 选择50例全髋关节置换手术,随机数字表法分为自体血回输组(A组)和异体血输血组(B组),每组25例.术中根据血容量丢失情况分别用自体血回输及异体血输血,于麻醉前、输血后第2天和输血后第5天采用流式细胞仪测定血浆CD4+T淋巴细胞(CD4+)、CD8+T淋巴细胞(CDx+)、自然杀伤细胞(natural killer cell,NK)的比例以及白细胞介素(interleukin,IL)-2(IL-2)和白细胞介素-6(IL-6)的值.结果 B组输血后CD4+、CD8+、NK细胞、IL-2的值在第2天[(35±6)、(22±6)、(7±3)％、(523±407) ng/L]和第5天[(35±6)、(26±8)、(6±4)％、(442±376) ng/L]均低于术前[(40±8)、(28±9)、(9±4)％、(839±472)ng/L] (P＜0.05);A组输血后CD4+、CD8+的值在第5天[(39±8)、(27±9) ng/L]、NK细胞、IL-2的值在第2天[(8±4)％、(807±534) ng/L]和第5天[(8±4)％、(821±437) ng/L]均较术前有所下降,但差异无统计学意义(P＞0.05);IL-6的值在第2天[(3198±698) ng/L]和第5天[(3076±703) ng/L]均较术前[(2593±784) ng/L]有所升高(P＜0.05). 结论 自体血回输对全髋关节置换手术患者细胞和体液免疫功能均无明显抑制作用,是安全、可靠的血液保护方式.     

贮存式自体成分输血对胃肠肿瘤患者围术期免疫功能的影响

目的观察贮存式自体成分输血与异体输血对胃肠恶性肿瘤患者围术期细胞免疫和体液免疫的影响。方法选择择期全麻下行胃肠肿瘤根治手术患者60例,男33例,女27例,年龄53~69岁,体重47~70 kg,ASAⅠ或Ⅱ级。术中出血200~400 ml,Hb70 g/L时启动输血,将患者随机分为两组,每组30例。贮存式自体成分输血组(P组):术中输血时采用贮存式自体成分输血;异体输血组(A组):输血时采用异体输血。测定入室时、术毕即刻、术后1、3、7 d外周血中T淋巴细胞亚群、NK细胞百分比和IL-2、IL-10、TNF-α、穿孔素(perforin,PF)浓度。结果与入室时比较,术毕即刻至术后7 d A组CD3~+、CD4~+、NK细胞百分比和CD4~+/CD8~+比值明显降低(P0.05);术后3、7 d A组CD3~+、CD4~+、NK细胞百分比和CD4~+/CD8~+比值明显低于P组(P0.05);术后1~7 d A组IL-2浓度明显低于,IL-10浓度明显高于P组(P0.05)。与入室时比较,术毕即刻至术后3 d A组Ig G、Ig A含量明显降低(P0.05);术毕即刻P组Ig G、Ig A含量明显降低(P0.05),术后1、3 d恢复至术前水平。结论围术期异体输血可降低肿瘤患者T细胞亚群和NK细胞百分比并延长其恢复时间,也可一过性降低血浆中免疫球蛋白Ig G、Ig A含量,从而影响患者的免疫功能,而贮存式自体成分输血对肿瘤患者术后免疫功能的影响轻微。     

术中自体血回输在脊柱外科手术中的应用及其并发症

目的 探讨术中自体血回输在脊柱外科手术中的应用及并发症.方法 应用国产自体-3000P型血液回输机对115例脊柱手术术中失血进行回输.结果 115例脊柱外科手术回输浓缩红细胞75 900 ml,平均每人术中出血(1250±862)ml,回输自体血(670±445)ml,异体输血(520±212)ml.除1例并发凝血功能障碍外,无输血及免疫调节反应,无术后感染.结论 术中自体血回输能减少脊柱手术异体血用量,并发症少,使用安全有效.     

双侧全髋关节置换术中自体血回输作用探讨

目的 双侧全髋关节置换术病人经常需要输入大量术中及术后异体血,其危险性包括溶血反应、感染乙肝或丙肝、感染HIV或梅毒等.减少异体血输入的最常用方法是采用术中自体血回输.该回顾性研究旨在评价术中自体血回输能否具有减少双侧全髋关节置换术围手术期异体输血总量的作用.方法 自2003年1月至2007年6月期间,行双侧首次全髋关节置换术51例,其中26例采用术中自体血回输(A组),25例未用术中自体血回输(B组),回顾性比较两组病人的性别、年龄、体重、身高、疾病、手术医生、手术时间,术前血红蛋白及红细胞压积,术中出血量、自体血回输量、异体血使用量,术后引流量、异体血使用量,术后1、3、7天血红蛋白和红细胞压积.结果 A组术中自体血回输330.7±122.7ml (100～557ml).术中异体血输入量在A组为661.5±437.3ml,B组为888.0±483.3ml(P=0.085).术后异体血输入量在A组为607.7±672.9ml,B组为328.0±423.8ml(P=0.082).两组之间术中和术后异体血总输入量无统计学差异(A组1269.2±807.8ml,B组1216.0±706.9ml,P=0.804).两组之间术后第1天血红蛋白和红细胞压积无统计学差异,而术后第3天血红蛋白和红细胞压积有统计学差异(P=0.020和P=0.013),术后第7天血红蛋白和红细胞压积又无统计学差异.结论 双侧全髋关节置换术术中自体血回输能够减少术中异体输血量,但不能减少围手术期异体输血总量.     

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.     

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.     

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.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.