外科性黄疸对T细胞和NK细胞活性的影响

目的　探讨黄疸对外周血T细胞和自然杀伤 (NK)细胞的活性的影响。方法　通过应用CD系列单克隆抗体对 2 0例术前黄疸患者外周血T细胞和NK细胞的活性进行检测 ,观察免疫功能改变。结果　良性黄疸组CD3 (65 .0 9± 6.5 2 )、CD4(4 0 .5 8± 5 .82 )及NK(16.62± 6.91)细胞活性与对照组相比下降明显 (P <0 .0 5 ) ;CD8(3 5 .40± 6.0 7)细胞活性上升 (P <0 .0 5 )。恶性黄疸组CD3 (62 .44± 7.2 8)、CD4(3 0 .0 1± 6.89)及NK(16.2 3± 7.0 2 )细胞活性同样下降明显 (P <0 .0 5 ) ;且良恶性黄疸组CD4(3 0 .0 1± 6.89)细胞活性比较有显著性意义 (P <0 .0 5 )。而黄疸持续时间仅对CD4(分别为 2 3 .43± 3 .70 ,3 0 .0 1± 6.89)有影响。结论　良恶性黄疸能降低T淋巴细胞和NK细胞的活性 ,对机体免疫功能产生一定的影响。     

肝癌疫苗激活的肿瘤浸润性淋巴细胞治疗原发性肝癌的研究

目的探讨经冷冻的肝癌疫苗激活的肿瘤浸润性淋巴细胞 (s TIL)治疗原发性肝癌的作用。方法 2 6例原发性肝癌患者使用s TIL治疗 ,并检测治疗前后其CD3、CD4、CD8、CD4/CD8比值、自然杀伤细胞 (NKC)活性和血清白细胞介素 2受体 (sIL 2R)水平的变化 ,计算 1、2、3年生存率 ,并与对照组相比较。结果应用s TIL患者 ,其第 19天、30天的CD3、CD4、CD4/CD8比值和NKC活性分别为 5 5± 3、76± 5 ;2 8 3± 1 6、44 6± 2 3;1 19± 0 2 2、2 2 1± 0 36 ;9 8± 1 2、17 4± 2 2。与对照组比较明显升高 (P <0 0 1)。而CD8和血清sIL 2R明显下降 ,分别为 2 4 9± 1 4、2 1 1± 1 2 ;5 6 9± 90、15 0± 31(P <0 0 1)。其 3年生存率为 88% ,与对照组 (5 7% )比较明显升高 (P <0 0 5 )。结论应用s TIL治疗原发性肝癌 ,能明显地提高原发性肝癌患者的免疫功能和远期疗效     

肝动脉插管化疗栓塞联合胸腺素α1治疗原发性肝癌

目的　研究短程连续使用胸腺素α1对肝动脉插管化疗栓塞 (TACE)治疗原发性肝癌辅助治疗作用。方法　选择确诊为原发性肝癌 ,愿意接受在TACE同时使用胸腺素α1的病人 32例 ,男2 7例 ,女 5例。Child分分A级 9例 ,B级 2 0例 ,C级 3例。年龄 34～ 6 8岁 ,平均 5 2 33± 9 6 4岁。在TACE当天开始皮下注射胸腺素α1,1 6mg/次 ,每天 1次 ,10d为一疗程。 结果　肝区疼痛缓解率为 6 3 16 % (12 / 19) ;食欲增加为 6 6 6 7% (18/ 2 7) ;乏力改善为 6 5 6 3% (2 1/ 32 )。AFP逐渐降低 ,由治疗前的 5 12 34± 32 0 75ng/ml降到治疗后 30d的 2 15 12± 4 9 2 2ng/ml(P <0 0 1)。而ALT在TACE后明显升高 ,治疗后 30d恢复到治疗前水平。其他肝功能指标和血白细胞无明显变化。治疗后 30dCD3、CD4由治疗前的 5 3 38± 8 31和 37 5 5± 7 4 7增加到 6 5 74± 8 6 3(P <0 0 5 )和 4 5 34± 9 81;CD8由 34 86± 5 38降到 2 9 2 6± 4 4 9;CD4 /CD8比值和NK细胞活性由 1 0 7± 0 5 6和4 2 38± 10 15增加到 1 5 5± 0 77和 5 1 91± 9 35。无胸腺素相关的并发症。结论　胸腺素α1可提高TACE后原发性肝癌病人的免疫功能 ,是一种安全、可靠的免疫增强剂     

低温对颅脑损伤大鼠脾淋巴细胞转化功能及自然杀伤细胞活性的影响

目的　研究低温对颅脑损伤大鼠脾免疫活性细胞功能的影响。方法　雄性SD大鼠液压颅脑损伤后随机分为低温 2 7℃组、低温 33℃组和常温 37℃组 ,另设未致伤假手术常温正常对照组。分别采用3H TdR掺入法及乳酸脱氢酶同功酶 (LDH)释放法检测不同温度组颅脑损伤大鼠脾脏T、B淋巴细胞增殖转化功能和自然杀伤 (NK)细胞活性的动态变化。结果　颅脑损伤常温 37℃组大鼠脾T淋巴细胞转化率 [(4 5 .6± 5 .6 )× 10 3/min]及NK细胞活性 [(17.19± 3 .83) % ]降低 ,在此基础上 ,2 7℃组T、B淋巴细胞转化率 [分别为 (4 4.0± 4.5 )× 10 3/min和 (2 5 .4± 3 .6 )× 10 3/min]及NK细胞活性 [(13 .2 1± 4.6 2 ) % ]进一步降低 ,33℃组B淋巴细胞转化率 [(2 5 .0± 4.9)× 10 3/min]降低。结论　 2 7℃低温对颅脑损伤大鼠脾脏T、B淋巴细胞功能及NK细胞活性有进一步损害作用。 33℃亚低温可以抑制颅脑损伤大鼠脾脏B淋巴细胞功能。     

七氟醚增强个培养鼠背根神经节细胞γ—氨基丁酸调控的氯电流

目的　观察七氟醚 ( 0 38至 3× 10 -3 mol/L)对单个培养SD鼠背根神经节细胞 3× 10 -6mol/Lγ 氨基丁酸 (GABA)调控的氯电流影响。方法　采用膜片钳全细胞记录和“Y型管”技术。结果　0 38× 10 -3 ,0 76× 10 -3 ,1 5 2× 10 -3 ,2 2 8× 10 -3 ,3 0 4× 10 -3 mol/L七氟醚分别增强氯电流峰值高度至对照值的 149%± 2 5 % ,2 0 3%± 2 7% ,32 7%± 79% ,331%± 10 9% ,2 43%± 71%。结论　相关临床麻醉浓度的七氟醚能增强培养鼠背根神经节细胞 3× 10 -6mol/LGABA调控的氯电流     

血液净化在肝移植围手术期的应用

目的探讨血液净化在肝移植围手术期患者中的应用价值。方法回顾性分析42例肝移植围手术期患者进行血液净化包括血浆置换(plasma exchange,PE)和持续肾脏替代治疗(continuous renal replacement therapy,CRRT)的结果。结果29例肝移植患者移植前后行PE治疗(其中5例联合血液灌流),25例患者顺利过渡到肝移植,移植后的25例患者1年存活率为68%。PE治疗前后CD3~+分别为70．5%±9．3%及53．9%±6．4%,CD8~+(29．7%±8．1%,18．9%±7．3%)和CD25~+(12．3%±6．4%,9．6%±5．9%)下降,CD20~+(10．9%±6．9%,22．0%±8．6%)上升,IgG [(16．9±2．4)g/L,(12．2±1．5)g/L]和IgA[(6．4±1．5)g/L,(3．6±0．8)g/L)]下降,补体C3 [(0．35±0．17)g/L,(0．60±0．19)g/L)]和CH50[(9．6±3．0)×10~4U/L,(15．7±1．3)×10~4U/L]增高。19例患者移植前后进行CRRT治疗,9例肾功能恢复,移植后存活7例。移植后需要CRRT支持的17例患者1年存活率为41．2%。7例患者既行PE又行CRRT治疗,移植后4例存活。治疗期间无严重并发症发生。结论血浆置换可以改善患者凝血功能及一般情况;肝移植加人工肝支持系统是治疗肝衰竭的有效方法;以CRRT为基础的综合疗法能有效治疗肝移植术后急性肾衰竭的患者。     

创伤早期患者外周血树突状细胞的变化及临床意义

目的　探讨创伤后早期患者外周血树突状细胞 (DC)变化及临床意义。方法　分离创伤患者 ( 2 7例 ,创伤组 )和健康人 ( 12例 ,对照组 )外周树突状细胞 ;通过流式细胞仪检测各组的DC数量 (CMRF 44标记法 )及DC表面HLA DR、CD80、CD86表达水平以及DC诱导的T细胞反应性增殖。检测各组外周血上清中白细胞介素 6(IL 6)、IL 10的浓度。结果　创伤组DC细胞数( 7.9± 3 .2 )× 10 6/L明显低于对照组DC ( 14 .9± 5 .1)× 10 6/L(P <0 .0 1)。创伤组DC表面HLA DR及CD80、CD86的表达水平与对照组相比明显下调 (P <0 .0 1)。DC诱导的T细胞增殖能力对照组明显强于创伤组 (P <0 .0 1)。在创伤组中血清IL 6、IL 10的浓度 ( 2 .42± 0 .3 3 ) μg/L和( 1.49± 0 .2 7) μg/L显著升高 ,与对照组比较差异有非常显著性 (P <0 .0 1)。 结论　创伤早期患者外周血DC数量少 ,功能低下 ,与创伤后的免疫功能低下关系密切。     

肝癌合并肝硬化患者肝癌切除后机体免疫状态的变化

目的探讨肝癌合并肝硬化患者癌灶切除前后机体免疫状态的变化。方法以肝硬化患者为对照组 ,采用流式细胞技术 (FCM)及ELISA方法分析 18例中晚期肝癌合并肝硬化患者癌灶切除前后外周血T细胞亚群CD4、CD8、CD4 /CD8及Th1/Th2细胞因子IFN γ、IL2、IL10蛋白水平的变化。结果　肝癌切除术后CD4 (33± 3) %、CD4 /CD8(1 1± 0 1)、IL2 (71± 11)pg/ml、IFN γ(90± 15 )pg/ml回升 ,高于术前水平〔CD4 (2 9± 4 ) %、CD4 /CD8(0 9± 0 3)、IL2 (5 7± 15 )pg/ml、IFN γ(78± 13)pg/ml〕 ,但仍低于肝硬化组〔CD4 (37± 4 ) %、CD4 /CD8(1 3± 0 2 )、IL2 (82± 15 )pg/ml、IFN γ(10 4± 2 2 )pg/ml〕(P <0 0 1或P <0 0 5 ) ;CD8(32± 3) %、IL10 (70± 9)pg/ml下降 ,低于术前〔CD8(35± 6 ) %、IL10(81± 15 )pg/ml〕水平但高于肝硬化组〔CD8(2 9± 2 ) %、IL10 (6 1± 10 )pg/ml〕(P <0 0 5 )。结论　癌灶切除后 ,机体免疫功能有明显改善。但仍未恢复到肝硬化患者的水平。     

聚丙烯酰胺水凝胶注入兔体的免疫效应研究

目的　观察注射性聚丙烯酰胺水凝胶 (PAMHG)注入实验兔体的免疫效应。方法　采用间接免疫荧光法或双抗体夹心ELISA法 ,监测PAMHG注入兔体前后T淋巴细胞亚群、NK细胞活性、IL 2和sIL 2R表达水平。结果　PAMHG注入兔体前 ,CD3+ 和CD4 + T淋巴细胞表达水平分别为(17.8± 5 .9) %和 (9.6± 3.5 ) % ;PAMHG注入兔体后 3个月 ,表达水平分别为 (2 4 .3± 5 .6 ) %和 (15 .8± 4 .7) %。注入前后比较有显著差异 (P <0 .0 1)。 3个月后表达水平逐渐下降 ,与术前比较差异无显著意义 (P >0 .0 5 )。PAMHG注入兔体前 ,CD8+ T淋巴细胞表达水平为 (6 .2± 2 .4 ) % ,与注入后 3个月为 (8.5± 4 .2 ) %比较仅略有上升 ,两者比较P >0 .0 5。注入兔体前、后CD4 + CD8+ 比值均在正常范围(1～ 2 )。NK细胞活性仅于注入兔体 1个月为 (2 5 .3± 6 .8) % ,较注入前 (18.0± 9.7) %升高 (P <0 .0 5 ) ,俟后NK细胞活性逐渐下降 ,与注入前比较差异无显著性意义 (P >0 .0 5 )。IL 2和sIL R表达水平于注入兔体前后差异无显著性意义 (P >0 .0 5 )。结论　PAMHG用作软组织填充剂 ,仅在机体内引起短时异物排斥 ,可渐与组织相容 ,不会引起严重免疫功能失调     

CD3AK细胞过继治疗对肝癌患者T淋巴细胞亚群及功能活性的影响

目的　探讨CD3AK细胞过继治疗对原发性肝癌 (PLC)患者T淋巴细胞亚群及功能活性的影响。方法　5 8例PLC患者分为CD3AK细胞治疗组 (n =3 7)及对照组 (n =2 1) ,另取同期 11例献血员为正常对照组。治疗组术后第 1天开始输注CD3AK细胞 ,每天 1次 ,每次输注 2× 10 9个细胞 ,输注前 3 0min静脉注射IL 2 10 0u ,连续 5天为一疗程 ;对照组只给予与治疗组相同的保肝治疗。观察两组T淋巴细胞亚群、IL 2R、细胞增殖功能、NK及LAK活性。结果　治疗组CD4/CD8比值、NK活性、LAK活性及IL 2R表达水平和细胞增殖活力与治疗前和对照组比较 ,差异均有显著性意义。结论　过继输注CD3AK细胞治疗能够补充肝癌患者有效抗肿瘤活性细胞数量的不足 ,并能够使T淋巴细胞亚群比例失调和功能低下的状况获得不同程度的改善     

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.     

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.