经鼻型肠梗阻导管治疗急性肠梗阻的临床效果观察

目的:探讨经鼻型肠梗阻导管治疗急性肠梗阻的临床效果。方法:64例急性单纯性肠梗阻患者,按治疗方法不同分成观察组(经鼻型肠梗阻导管减压治疗)32例,对照组(普通鼻胃管减压治疗)32例,观察两组症状体征缓解情况及中转手术率。结果:观察组肠梗阻症状缓解率93.8%,而对照组为25.0%。观察组急症中转手术率为6.2%,而对照组为56.2%。结论:将肠梗阻导管应用于急性单纯性肠梗阻的治疗中,可有效缓解梗阻症状,减少急诊手术机会。     

肠内全程导管减压法用于术后早期炎性肠梗阻治疗的研究

目的评价经鼻置入导管行肠内全程减压在术后早期炎症性肠梗阻保守治疗中的作用。方法回顾性分析北京大学第三医院2005年3—8月收治的8例腹部手术后早期炎症性肠梗阻的病人，使用鼻胃管减压等常规保守治疗无效后，经鼻置入导管行肠内全程减压，并进行胃肠减压治疗，观察其治疗效果。结果与鼻胃管相比，使用肠内全程导管减压后，病人的胃肠减压量明显增加、腹围和腹腔内压力明显降低；通过3～10d的经鼻置入导管减压等保守治疗后，8例病人的肠梗阻症状均缓解，未再接受手术治疗。结论经鼻肠内全程导管减压用于治疗术后早期肠梗阻安全有效，且可能使病人免于再次急诊手术。     

肠梗阻导管在结直肠癌性肠梗阻治疗中的应用研究

目的 探讨肠梗阻导管治疗结直肠癌性肠梗阻的临床效果.方法 对我院2005年12月至2008年12月期间收治的32例结直肠癌性肠梗阻患者先行经鼻和经肛两种途径置入肠梗阻导管,通过导管减压、引流等治疗后,再行一期根治切除吻合术.结果 32例患者中19例经鼻及经肛型肠梗阻导管双侧同时性置入成功,另13例仅完成经鼻型肠梗阻导管置入.置管12～36 h后所有患者腹痛、腹胀症状明显缓解;26例于48～96 h后腹痛、腹胀症状完全消失.比较所有患者置管前、后腹围缩小程度,置管24 h后为(81.3±19.6)%,明显小于置管前的100%(t=3.586,P=0.02).32例患者经肠梗阻导管治疗5～7 d后,均成功施行一期根治切除吻合术,术后无腹腔感染、吻合口漏等严重并发症发生.结论 经肠梗阻导管减压、引流等治疗后再行一期根治切除吻合术,是治疗结直肠癌性肠梗阻的有效方法.     

经鼻肠梗阻导管小肠内排列术与传统手术治疗急性小肠梗阻临床对比研究

目的 比较经鼻肠梗阻导管小肠内排列术与传统手术治疗急性肠梗阻的临床疗效。 方法 回顾性分析大连医科大学附属第一医院普外三科2005年4月至2010年12月手术治疗并获得随访的129例机械性小肠梗阻病人的临床资料。其中行经鼻肠梗阻导管小肠内排列术组41例,传统手术组88例。 结果 两组术后排气、排便时间、术后并发症发生率、术后病死率差异均无统计学意义（P>0.05）;经鼻肠梗阻导管小肠内排列术组术后5年复发率为5.0%（2/40）,明显低于传统手术组［18.8%（16/85）,P<0.05］,且复发时间（42.5±7.8）个月明显晚于传统手术组［（20.3±11.8）］个月（P<0.05）］。 结论 经鼻肠梗阻导管小肠内排列术防治肠梗阻复发效果良好。     

经肛门肠梗阻导管在结直肠癌性梗阻治疗中的应用

目的探讨肠梗阻导管治疗急性结直肠癌性梗阻的可行性与临床疗效。俩方法在X线辅助下,经内镜放置肠梗阻导管治疗21例急性结直肠癌性梗阻的患者。结果 19例放置肠梗阻导管成功,成功率为90.5%,19例术后1~2 d梗阻症状缓解或消除,13例经内镜治疗解除梗阻后5~7 d行I期肿瘤切除吻合术,术后均恢复顺利,无感染及吻合口漏等并发症发生。2例因病变部位过度狭窄导管无法通过而治疗失败,2例术后1~3 d导管滑脱再次置管。结论肠梗阻导管治疗急性结直肠癌性梗阻,能够有效缓解患者的梗阻症状,显著降低患者的创伤和痛苦,增加手术安全性,提高患者的生活质量。     

X线下置管肠排列对慢性放射性肠炎早期合并小肠梗阻的治疗探讨

目的 探讨在X线监视下经鼻置入肠梗阻导管行小肠内减压与支撑排列,治疗早期放射性肠炎合并小肠梗阻的临床效果.方法 选择7例慢性放射性肠炎早期合并小肠梗阻的患者,在X线监视下经鼻置入300 cm减压导管至空肠上段20 cm以上,边抽吸减压边随肠蠕动前行,可达回肠末端,行全小肠减压.留置导管作为肠内支架,起到小肠内置管支撑排列的作用.结果 7例患者梗阻均顺利解除.随访9个月至2年,除1例10个月后再次梗阻外,其余6例均未再出现梗阻.结论 X线下经鼻置入肠梗阻导管行小肠内减压与支撑排列,治疗慢性放射性肠炎早期合并小肠梗阻简便无创、安全有效.     

X线下置管肠排列对慢性放射性肠炎早期合并小肠梗阻的治疗探讨

目的 探讨在X线监视下经鼻置入肠梗阻导管行小肠内减压与支撑排列,治疗早期放射性肠炎合并小肠梗阻的临床效果.方法 选择7例慢性放射性肠炎早期合并小肠梗阻的患者,在X线监视下经鼻置入300 cm减压导管至空肠上段20 cm以上,边抽吸减压边随肠蠕动前行,可达回肠末端,行全小肠减压.留置导管作为肠内支架,起到小肠内置管支撑排列的作用.结果 7例患者梗阻均顺利解除.随访9个月至2年,除1例10个月后再次梗阻外,其余6例均未再出现梗阻.结论 X线下经鼻置入肠梗阻导管行小肠内减压与支撑排列,治疗慢性放射性肠炎早期合并小肠梗阻简便无创、安全有效.     

X线下置管肠排列对慢性放射性肠炎早期合并小肠梗阻的治疗探讨

目的 探讨在X线监视下经鼻置入肠梗阻导管行小肠内减压与支撑排列,治疗早期放射性肠炎合并小肠梗阻的临床效果.方法 选择7例慢性放射性肠炎早期合并小肠梗阻的患者,在X线监视下经鼻置入300 cm减压导管至空肠上段20 cm以上,边抽吸减压边随肠蠕动前行,可达回肠末端,行全小肠减压.留置导管作为肠内支架,起到小肠内置管支撑排列的作用.结果 7例患者梗阻均顺利解除.随访9个月至2年,除1例10个月后再次梗阻外,其余6例均未再出现梗阻.结论 X线下经鼻置入肠梗阻导管行小肠内减压与支撑排列,治疗慢性放射性肠炎早期合并小肠梗阻简便无创、安全有效.     

术后粘连性肠梗阻应用经鼻肠梗阻导管置入术的治疗体会

目的探讨经鼻肠梗阻导管置入术治疗术后粘连性肠梗阻的效果。方法对43例术后粘连性肠梗阻患者采取经鼻肠梗阻导管置入术,观察治疗效果。结果本组患者腹部症状缓解时间(2.08±0.46)d,恢复排气排便时间(3.65±1.96)d,气液平面消失时间(5.29±1.96)d。依据疗效评判标准本组总有效率95.35%(41/43)。结论经鼻肠梗阻导管置入术治疗术后粘连性肠梗阻,解除梗阻成功率高,症状改善明显。     

X线下置管肠排列对慢性放射性肠炎早期合并小肠梗阻的治疗探讨

目的 探讨在X线监视下经鼻置入肠梗阻导管行小肠内减压与支撑排列,治疗早期放射性肠炎合并小肠梗阻的临床效果.方法 选择7例慢性放射性肠炎早期合并小肠梗阻的患者,在X线监视下经鼻置入300 cm减压导管至空肠上段20 cm以上,边抽吸减压边随肠蠕动前行,可达回肠末端,行全小肠减压.留置导管作为肠内支架,起到小肠内置管支撑排列的作用.结果 7例患者梗阻均顺利解除.随访9个月至2年,除1例10个月后再次梗阻外,其余6例均未再出现梗阻.结论 X线下经鼻置入肠梗阻导管行小肠内减压与支撑排列,治疗慢性放射性肠炎早期合并小肠梗阻简便无创、安全有效.     

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.     

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.     

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.     

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.