含抑肽酶低温灌注液减轻体外循环肺损伤

目的;研究体外循环期间低温保护液肺动脉灌注对肺脏的保护作用。方法;１２只杂种犬随机均分为２组。主动脉阻断后,对照组右肺动脉灌注４℃乳酸林格液,实验组灌注４℃肺保护液。开放主动脉后和停ＣＰＢ后５,３０,６０,９０分钟;分别取各组肺静脉血标本行生化分析,测定肺功能,并行组织学检查。     

左旋精氨酸对离体兔肺脏保存质量的影响

目的　观察左旋精氨酸（ＬＡｒｇｉｎｉｎｅ,ＬＡｒｇ） 对离体兔肺脏保存的保护作用。　方法　３０ 只健康家兔随机分成对照组和左旋精氨酸组（ＬＡｒｇ 组） ,每组１５ 只,对照组兔肺脏给予Ｅｕｒｏｃｏｌｌｉｎｓ 液进行灌注,ＬＡｒｇ 组给予含ＬＡｒｇ的Ｅｕｒｏｃｏｌｌｉｎｓ 液进行灌注,灌注总量６０ｍｌ／ｋｇ ,灌注压力１ ．９６ｋＰａ（２０ｃｍ Ｈ２ Ｏ） ,灌注完毕整取下心肺组织浸入４ ℃保存液中冷藏,７ 小时后取肺进行离体复灌,测定肺血管阻力、血气分析、肺血管对乙酰胆碱舒血管反应性、肺组织湿／ 干重比例及肺组织电子显微镜检查等指标。　结果　对照组肺血管阻力、肺组织湿／ 干重比例均高于ＬＡｒｇ 组（ Ｐ＜ ０ ．０５） ,肺血管对乙酰胆碱反应性对照组较ＬＡｒｇ 组差, 血气分析肺静脉血氧分压对照组下降明显（ Ｐ ＜ ０－０１） ,ＬＡｒｇ 组肺组织形态轻微改变,而对照组肺组织水肿明显、渗出严重。　结论　ＬＡｒｇ具有改善离体兔肺脏的保存效果。     

钾通道开放剂心脏超极化停搏保护效果的研究

目的 对比观察大量三磷酸腺苷（ＡＴＰ）敏感性钾通道开放剂吡那地尔对常温／低温体外循环（ＣＰＢ）心脏超极化停跳缺血心肌的保护作用。方法 １８只犬随机分３组,每组６只,低温超极化组（ＬＨ）：阻断升主动脉后,心脏灌注４℃含吡那地尔停跳液,ＣＰＢ血温为２６～２８℃,开放前复温至３７℃,全心缺血６０ｍｉｎ,恢复灌注３０ｍｉｎ;常温超极化组（ＷＨ）：ＣＰＢ血温３５～３７℃,心脏灌注３７地７０含吡那地尔（５０μｍｏｌ／Ｌ）停跳液,余同ＬＨ组;对照组（Ｃ）;无吡那地尔的标准Ｓｔ、Ｔｈｏｍａｓ停跳液,余３７℃含昆那地尔（５０ｕｍｏｌ／Ｌ）停跳液,余同ＬＨ组;对照组（Ｃ）：无吡那地尔的标准Ｓｔ．Ｔｈｏｍａｓ停跳液,余同ＬＨ组,对比观察吡那地尔心脏超极化停跳不同时相各项指标的变化。结果 （１）停复跳情况：ＬＨ组、Ｃ组灌注后心脏停跳较     

常温充氧晶体和氧合血停搏液持续灌注对心肌能量代谢的影响

我们从能量代谢角度探讨常温体外循环（ＣＰＢ）时,常温充氧晶体和氧合血停搏液持续灌注的心肌保护效果,报告如下。方法健康犬１５条,随机均分３组,建立体外循环主动脉根部连接灌注装置后,对照组在低温ＣＰＢ下灌注４℃Ｓｔ．Ｔｈｏｍａｓ液（钾浓度１６ｍｍｏｌ／Ｌ...     

去白细胞血液预防家兔缺血心肌再灌注损伤的实验研究

用涤纶纤维滤器去除再灌注血液中的白细胞，旨在检验其对缺血心肌再灌注损伤的保护效应。３２只家兔随机分成对照组和实验组，分别用全血和去白细胞血再灌注－离体心脏在２８℃下缺血６０ｍｉｎ后再灌注２０ｍｉｎ。结果表明：对照组白细胞计数、ＣＶＲ、ＣＰＫ及ＣＰＫ－ＭＢ显著高于实验组（Ｐ〈０．００１～Ｐ〈０．０５）；ＳＯＤ活性下降，ＭＤＡ含量明显增高与实验组相比有显著差异，分别为Ｐ〈０．０２及Ｐ〈０．０５。线粒体     

缺血预处理对犬单肺移植后血液动力学的影响

目的 观察供肺缺血预处理对犬肺移植后血液动力学的影响。方法 健康家犬１６条，随机分为供肺犬和受肺犬各８条，供肺均经４℃Ｅｕｒｏ－Ｃｏｌｌｉｎ氏液冷灌并保存３小时，其中４条给予左肺门阻断１０分钟再灌注１５分种的缺血预处理（实验组）。另外４条无肺门阻断作为对照组。并于移植前后定期观察受体犬血液动力学变化及血浆ＴＸＢ２和６－ｋｅｔｏ－ＰＧＦ１α含量变化。结果肺移植后３０分种内两组肺动脉压均明显升高（Ｐ〉     

BQ123对肺移植早期缺血再灌注损伤保护作用的实验研究

目的　研究内源性内皮素（ Ｅ Ｔ）１ 对肺移植早期缺血再灌注损伤的影响及 Ｅ Ｔ Ａ 受体阻断剂 Ｂ Ｑ１２３ 对其病理过程的保护作用。方法　以家犬（ 保存８ 小时） 左肺移植模型观察缺血再灌注。损伤过程中内源性 Ｅ Ｔ１ 产生及 Ｂ Ｑ１２３ 对其血流动力学、肺功能的作用。结果　 Ｂ Ｑ１２３ 组和对照组的平均动脉压、左房压、中心静脉压及组织形态学差异无显著性; Ｂ Ｑ１２３ 组平均肺动脉压、肺血管阻力指数及血清 Ｅ Ｔ１ 浓度明显低于对照组（ Ｐ ＜ ０ ．０１） ,心脏指数、动脉血氧分压明显高于对照组（ Ｐ ＜ ０ ．０１） ,而动脉二氧化碳分压明显低于对照组（ Ｐ ＜ ０ ．０１） ; Ｂ Ｑ１２３ 组肺组织含水百分比明显低于对照组（ Ｐ ＜０ ．０１） 。结论　 Ｂ Ｑ１２３ 对肺移植早期出现的缺血再灌注损伤具有保护作用。     

抑肽酶在心肺转流术中对肺损伤的保护

目的 探讨心肺转流术（ｃａｒｄｉｏｐｕｌｍｏｎａｒｙ ｂｙｐａｓｓ,ＣＰＢ）导致肺缺血－再灌注损伤,抑肽酶对肺损伤保护的作用。方法 将２４例心内直视手术的患者随机分为对照组和实验组,每组１２例,实验组给予抑肽酶处理。检测ＣＰＢ前后左、右心房血中性粒细胞和血小板计数,围手术期各时段桡动脉血浆中内皮素、血栓素Ｂ２、６－酮－前列腺素Ｆ１α和呼吸指数的变化。结果 对照组ＣＰＢ后左、右心房血中血小板和中性粒细胞计数差异有显著性（Ｐ〈０．０５）;实验组ＣＰＢ前后则差异无显著性;内皮素、血栓素Ｂ２、呼吸指数在ＣＰＢ中、ＣＰＢ后两组比较均差异有显著性（Ｐ〈０．０１）。结论 ＣＰＢ致肺损伤,血小板和中性粒细胞在肺内聚集,内皮素、血栓素Ｂ２、６－酮－前列腺素Ｆ１α在其病理过程中起重要作用。抑肽酶能通过干预这些因素而达到保护肺功能的     

山茛菪碱防治肺动脉高压患者心肌 再灌注损伤的临床研究

目的探讨山茛菪碱（６５４－Ⅱ）对肺动脉高压（ＰＨ）患者心肌再灌注损伤防治机制和心功能保护作用。方法３０例先天性心脏病（ＣＨＤ）合并ＰＨ患者随机分为２组,用药组：在常规心肌保护液中加入６５４－Ⅱ０．５ｍｇ／ｋｇ;对照组：使用常规心肌保护液作为对照。分别测定不同手术时期２组冠状窦血中乙酰胆碱（Ａｃｈ）、Ｃａ２＋、脂质过氧化物（ＬＰＯ）和乳酸（ＬＡ）含量,并经Ｓｗａｎ－Ｇａｎｚ导管测定手术前后心排血量（ＣＯ）及平均肺动脉压（ＭＰＡＰ）的改变。结果再灌注即刻和停机前,对照组冠状窦血中Ａｃｈ,Ｃａ２＋,ＬＰＯ和ＬＡ含量均较用药组明显增加（Ｐ＜０．０５和Ｐ＜０．０１）;转流后用药组ＭＰＡＰ较对照组显著下降（Ｐ＜０．０１）;手术结束时ＣＯ显著增加（Ｐ＜０．０５）。结论在ＣＨＤ合并ＰＨ患者的心肌保护液中加入６５４－Ⅱ可抑制迷走神经活动,增加ＣＯ和早期降低肺动脉压力,从而防治心肌再灌注损伤,保护心脏功能     

磷脂酶A2抑制剂溴苯乙酮对大鼠急性失血性休克复苏后早期肺损伤的保护作用

目的观察磷脂酶Ａ_２抑制剂４－二溴苯乙酮（４－ＢＰＢ）对大鼠急性失血性休克复苏后早期肺损伤的保护作用。方法纯种ＳＤ大鼠３６只,随机分为假手术组（对照组）、乳酸林格氏液复苏组（ＬＲ组）、乳酸林格氏液＋４－ＢＰＢ复苏组（保护组）。两复苏组动物放血并维持低血压（ＭＡＰ ４～５．３ｋＰａ） ６０分钟,其后１０分钟内分别输入全部自体抗凝血或同时静注４－ＢＰＢ（２５μｍｏｌ）;２０分钟内输入２倍放血量的乳酸林格氏液,观察６０分钟。实验结束时收集血清、肺组织标本或作支气管肺泡灌洗。双缩脲法测定支气管肺泡灌洗液（ＢＡＬＦ）及血清中蛋白的浓度;放免法检测血清中ＴＮＦａ、ＩＬ－１β、ＩＬ－６及ＩＬ－８水平。光镜下比较观察各组大鼠肺组织形态学改变。结果保护组血清ＴＮＦα水平明显低于 ＬＲ组（Ｐ＜０． ０１）,而与对照组无明显差异。三组血清ＩＬ－１β,ＩＬ－６及ＩＬ－８水平除ＬＲ组ＩＬ－６与对照组比较有明显差别外,其余则均无明显差异。保护组肺通透指数与对照组比较无显著性差异,而ＬＲ组明显高于其它两组（Ｐ＜０．０１）。支气管肺泡灌洗液中蛋白含量ＬＲ组明显高于其它两组,保护组明显高于对照组（Ｐ＜０．０１）。各组支气管肺泡灌洗液中细胞数及ＰＭ     

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.