IFN-γ和TNF-α诱导的骨髓间充质干细胞的免疫抑制作用及环孢素A对其的影响

目的 观察γ干扰素(IFN-γ)和肿瘤坏死因子α(TNF-α)诱导的骨髓问充质干细胞(MSC)的免疫抑制作用及环孢素A(CsA)对其的影响.方法 取Balb/c小鼠骨髓,分离、培养、纯化及扩增MSC,分别以IFN-γ、TNF-α和IFN-γ+TNF-α(终浓度均为20 ng/ml)预处理MSC 12 h,然后与Balb/c小鼠脾细胞共培养,脾细胞以刀豆蛋白A激活72 h.混合细胞培养实验分8组进行:(1)脾细胞组;(2)MSC组,MSC+脾细胞;(3)IFN-γ处理组,IFN-γ预处理的MSC+脾细胞;(4)TNF-α处理组,TNF-α预处理的MSC+脾细胞;(5)联合处理组,IFN-γ与TNF-α联合预处理的MSC+脾细胞;(6)CsA组,CsA+脾细胞;(7)CsA联合预处理组:IFN-γ与TNF-α联合预处理的MSC+CsA+脾细胞;(8)1400W组,IFN-γ与TNF-α联合预处理的MSC+脾细胞+1400W[诱导型-氧化氮合酶(iNOS)抑制剂].各组脾细胞数量均为5000个,MSC与脾细胞按1:10混合,CsA浓度为10μg/ml.培养72 h后,以四甲基偶氮唑盐法检测脾细胞增殖情况,同时以碘化丙啶和Annexin-V凋亡双染试剂盒检测脾细胞的凋亡情况;以实时聚合酶链反应法检测经炎症因子处理的MSC的iNOS mRNA表达情况,观察CsA对MSC的iNOS mRNA表达的影响.结果 MSC组、IFN-γ处理组和TNF-α处理组的MSC对脾细胞的增殖无明显抑制作用(P>0.05),而联合处理组的脾细胞增殖明显受到抑制,CsA组的脾细胞增殖同样受到抑制,但IFN-γ与TNF-α联合预处理MSC产生的这种免疫抑制作用却可以被CsA所抑制(CsA联合预处理组,P<0.05).联合处理组、CsA组和CsA联合预处理组的脾细胞凋亡率明显高于脾细胞组、MSC组、IFN-γ处理组和TNF-α处理组(P<0.05),而联合处理组和CsA组的脾细胞凋亡率又明显高于csA联合预处理组(P<0.05).野生型MSC、分别以IFN-γ或TNF-α单独刺激的MSC均不表达iNOS mRNA,而以IFN-γ和TNF-a联合处理的MSC则高表达iNOS mRNA,但这种高表达可被CsA所抑制(P<0.05).1400W组的脾细胞增殖受到明显抑制(P<0.05).结论 IFN-γ和TNF-α联合预处理的MSC在体外可抑制脾细胞的增殖,促进脾细胞凋亡,CsA可抑制该种MSC的这一作用,其机制可能与CsA下调lFN-7和TNF-α联合预处理的MSC的iNOS表达有关.     

脂肪干细胞免疫学性状的初步实验观察

目的初步研究脂肪干细胞(Adiposederivedstemcells,ADSC)表面免疫分子的表达以及体外免疫调节功能,以期为组织工程提供同种异体种子细胞来源。方法体外培养人脂肪抽吸术中获取的脂肪干细胞,体外培养至第二代,流式细胞仪检测免疫分子HLA、HLA、B7-1、B7-2、CD40的表达。1×105个/孔ADSC细胞分别刺激单一异体淋巴细胞或混合双向淋巴细胞反应,观察淋巴细胞增殖情况。同时观察ADSC经IFN-γ作用后,免疫分子表达与淋巴细胞增殖的调节情况。结果ADSC表达HLA类分子,但未检测到HLA类分子阳性表达。B7-1(CD80)、B7-2(CD86)、CD28、CD40未见明显阳性表达。人IFN-γ刺激48h后,HLA类分子表达明显增高,HLAI表达未见明显增高。异体或经IFN-γ作用的ADSC均未能刺激异体淋巴细胞增殖。同样数量的ADSC可明显抑制双相混合淋巴细胞增殖,经IFN-γ作用后抑制作用未见明显减弱。结论ADSC具有一定的体外调节淋巴细胞反应的能力,有可能成为组织工程同种异体细胞来源。     

hIL-10基因修饰骨髓间充质干细胞对异种T淋巴细胞增殖的影响及机制研究

目的 研究hIL-10基因修饰的MSCs(骨髓间充质干细胞)对异种混合T淋巴细胞增殖的影响及机制.方法 RT-PCR克隆hIL-10基因并将构建慢病毒hIL-10/pLOX-cwGFPs,然后将慢病毒转导hIL-10入豚鼠MSCs;ELISA测定hIL-10-MSCs培养上清hIL-10含量;CCK-8法检测hIL-10基因修饰的骨髓间充质干细胞对体外混合淋巴细胞培养的影响;ELISA测定其培养上清对外周血单个核细胞分泌IFN-γ的影响.结果 成功构建慢病毒hIL-10/pLOX-cwGFP,hIL-10-MSCs培养上清的IL-10水平明显高于未转染(P<0.05);hIL-10-MSCs能抑制异种T淋巴细胞混合培养的增殖反应(P<0.05);加入IL-2能逆转MSCs的抑制作用(P<0.05);hIL-10-MSCs培养上清组能抑制PHA刺激的PBMC分泌IFN-γ(P<0.05).结论 hIL-10-MSCs对混合异种淋巴细胞培养有显著的抑制作用,能抑制PHA刺激的PBMC分泌IFN-γ.     

红活麻有效部位抗皮肤移植排斥反应研究

目的 观察湖北民族药红活麻有效部位对小鼠皮肤移植排斥反应的影响.方法 采用小鼠同种异体皮肤移植模型,通过皮肤移植物存活时间、受体脾淋巴细胞增殖实验、细胞因子分泌水平测定及CD4+CD25+T细胞亚群分析研究红活麻有效部位抗皮肤移植排斥反应的作用及机制.结果 与模型对照组平均皮肤移植物存活时间(14.4±0.9)d比较,红活麻有效部位中剂量组、高剂量组皮肤移植物存活时间分别为(25.9±1.8)和(41.2±2.8)d,提示红活麻有效部位呈剂量依赖性延长小鼠皮肤移植物存活时间;中剂量组、高剂量组对非特异性刺激(ConA)的脾淋巴细胞增殖反应强度均低于模型对照组(P＜0.05);同时高剂量组抑制脾细胞分泌IL-2、IFN-γ水平明显(P＜0.01),刺激IL-10的分泌水平明显(P＜0.01).结论 红活麻有效部位通过刺激淋巴细胞表面CD4+ CD25+分布,调节IL-2、IL-10和IFN-γ等细胞因子的合成,抑制T淋巴细胞转化功能,诱导宿主细胞免疫耐受,从而有效抑制皮肤移植排斥反应.     

大鼠肝移植排斥反应时γ干扰素及白细胞介素10的表达及意义

目的 探讨大鼠肝移植排斥反应时γ干扰素(IFN-γ)及白细胞介素10(IL-10)的表达及意义.方法 采用改良的Kamada"二袖套法"制备大鼠原位肝移植模型,同系移植组供、受者均为SD大鼠;同种异体移植组的供者为Wistar大鼠,受者为SD大鼠;另设假手术组.术后7 d处死动物,观察移植肝脏的组织学变化,检测血清IFN-γ和IL-10的含量,以及移植肝脏内IFN-γ和IL-10 mRNA的表达.结果 同种异体移植组移植肝脏有较多坏死肝细胞,汇管区及中央静脉周围可见以淋巴细胞为主的炎症细胞浸润,胆管上皮细胞可见胞浆空泡变性、核固缩或碎裂,整个肝小叶结构紊乱.同系移植组肝脏组织结构仅有轻度缺血再灌注损伤表现,汇管区有较少炎症细胞浸润,胆管上皮细胞结构和肝小叶结构基本正常.同种异体移植组血清IFN-γ为(386.7±14.4)Pg/ml,明显高于同系移植组的(159.8±16.5)pg/ml(P<0.05);同种异体移植组血清IL-10为(126.3±13.1)pg/ml,明显低于同系移植组的(288.3±17.1)pg/ml(P<0.05).同种异体移植组移植肝组织内IF-γ mRNA表达水平明显高于同系移植组(P<0.05),而IL-10 rnRNA表达水平明显低于同系移植组(P<0.05).结论 大鼠肝移植排斥反应时IFN-γ表达明显升高,IL-10表达明显降低;T_H1/T_H2型细胞因子的动态平衡可能在大鼠肝移植排斥反应中起着重要作用.     

骨髓间充质干细胞的吲哚胺2,3-双加氧酶活性抑制T淋巴细胞的增殖

目的探讨骨髓间充质干细胞(MSCs)的吲哚胺2,3-双加氧酶(IDO)活性对T淋巴细胞免疫应答反应的影响。方法从人骨髓中分离培养MSCs,以不同浓度的干扰素(IFN-γ)对MSCs诱导18h,检测MSCs上IDO的mRNA表达以及IDO活性。将经过200U/ml IFN-γ诱导的MSCs预先接种在培养板中,再建立混合淋巴细胞培养(MLC)体系,利用四甲基偶氮唑盐检测T淋巴细胞增殖率,并用反相高效液相色谱法检测IDO活性。结果IFN-γ能诱导MSCs上IDO mRNA的表达和IDO活性,mRNA的表达量和IDO活性与IFN-γ浓度呈现明显的剂量依赖关系;MSCs的IDO活性能抑制MLC体系中T淋巴细胞增殖率。结论MSCs在体外可抑制异体T淋巴细胞的免疫应答,IDO活性参与了这种免疫抑制作用。     

去细胞异体神经移植后T细胞亚群及细胞内细胞因子的实验研究

目的 为化学去细胞同种异体周围神经移植的临床应用提供进一步的免疫学实验依据.方法 128只BALB/C小鼠分随机分为假手术组、自体神经移植组、新鲜异体神经移植组和化学去细胞异体神经移植组,每组32只.对各实验组分别进行相应的手术.分别在术后3、7、14、28 d将各组8只小鼠脾淋巴细胞进行分离,特异性荧光标记的单克隆抗体作用后,经流式细胞仪检测T淋巴细胞亚群及细胞内细胞因子的水平及其变化趋势. 结果 在各时间点中,化学去细胞神异体经移植组CD3+、CD4+、CD8+、CD25+阳性细胞率以及IL-2、IFN-γ、TNF-α阳性细胞率与假手术组、自体神经移植组相比差异均无统计学意义(P＞0.05).而新鲜异体神经移植组与其他三组比较差异有统计学意义(P＜0.05). 结论 化学去细胞处理的同种异体神经的免疫源性等于或接近于自体神经,明显低于新鲜同种异体神经.     

抗IL-2R单克隆抗体在肾脏移植中的应用

IL 2和IL 2R的相互作用在T细胞活化、增殖中起关键作用。IL 2Rα单克隆抗体可以对被同种异体移植物激活的T细胞克隆选择性地产生免疫抑制作用 ,从而达到预防急性排斥反应的目的。Ⅲ期临床试验结果表明 ,IL 2Rα单抗da clizumab(Zenapax)和basiliximab(Simulect)可将同种异体移植肾急性排斥反应的发生率降低 2 7～ 40 % ;并未见明显的毒副作用。     

异体手移植术后细胞因子的动态观察

目的 探讨手移植患者术后细胞因子血清水平的变化和意义。方法 采用ELISA的方法动态检测2例同种异体手移植患者血清中IL-2,IL-10,IFN-γ,TNF-α水平。结果 术后IL-2,IFN-γ,TNF-α血清水平术后lw内明显降低,lw后恢复至术前水平,随后逐渐降低并维持在低水平。IL-10在术后lw内明显升高,随后逐渐降低并维持在低水平,5个月后又中度升高。结论 同种手移植术后细胞因子谱系由Th_1向Th_2的转换提示术后免疫抑制方案十分有效,利于移植物的存活。同种异体手移植后患者无明显的排斥反应与临床观察相符,提示细胞因子的监测有助于同种异体手移植预后的判断和排斥反应的诊断。     

IFN-γ上调MHC-Ⅱ分子表达对KC免疫原性的影响

目的观察在炎症因子IFN-γ的作用下,角质形成细胞（Keratinocyte,KC）免疫原性的变化情况。方法 KC体外传代培养,按不同的INF-γ浓度分组后作用于传代的KC。将高表达MHC-Ⅱ分子的KC与异体淋巴细胞混合培养后,观察淋巴细胞的增殖情况;同时,将KC植入异体小鼠皮下,观察免疫排斥迹象。结果在6 000 U/mL IFN-γ的作用下,MHC-Ⅱ+的KC超过90%。高表达MHC-Ⅱ分子的传代KC无明显刺激异体淋巴细胞增殖的作用,植入异体小鼠皮下后也无明显淋巴细胞浸润现象。结论传代后的KC在IFN-γ作用下高表达MHC-Ⅱ分子,表达MHC-Ⅱ分子的KC无明显免疫原性。     

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.     

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.     

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.