磨损颗粒诱导基质金属蛋白酶2和基质金属蛋白酶9生成实验研究

[目的]研究和比较氧化铝陶瓷和高分子聚乙烯磨损颗粒在air-pouch动物模型体内诱导基质金属蛋白酶2(MMP-2)和基质金属蛋白酶9(MMP-9)产生及表达变化,探讨在不同磨损颗粒作用下明胶酶表达规律及其在人工假体无菌性松动病理过程中的意义.[方法]构建小鼠air-pouch动物模型.实验组分别注射氧化铝陶瓷颗粒悬液3 ml (A组)和高分子聚乙烯颗粒悬液3 ml (B组) ,对照组注射磷酸盐缓冲盐水3 ml.分别于注射后第3、7、14 d后各处死动物8只取出air-pouch囊壁组织,光镜下细胞计数反映炎性细胞浸润和增殖程度,半定量RT-PCR及免疫组织化学染色法观察MMP-2、MMP-9基因及蛋白表达量的变化.[结果]实验组炎性细胞计数、MMP-2、MMP-9基因表达量和MMP-2、MMP-9阳性细胞率差异均有显著性(P<0.05);且各时间点B组均高于A组(P<0.05);第14 d时,B组明显高于A组(P< 0.01).[结论]两种磨损颗粒均能诱导MMP-2、MMP-9 mRNA及蛋白的表达,并且高分子聚乙烯颗粒组高于氧化铝陶瓷磨损颗粒组.     

镁硅玉人工髋关节假体周围骨溶解与诱导型一氧化氮合酶、过氧亚硝基阴离子的关系

[目的]观察诱导型一氧化氮合酶（iNOS）和过氧亚硝基阴离子（ONOO^-）在假体周围各区的表达和分布变化，各区iNOS和ONOO^-表达与骨溶解程度之间的关系。[方法]临床选取6例镁硅玉人工全髋关节翻修术，手术中按Delee-Charnley髋臼分区法和Gruen股骨分区法，取出松动假体周围各区的假体-骨间界膜，免疫组化法检测iNOS和ONOO^-体内生成标志物硝基酪氨酸（NT）的表达，同时以术前X线片，区分假体周围非骨溶解区和骨溶解区。分析并比较iNOS和NT在各个分区中的阳性表达，与骨溶解程度的关系。[结果]髋臼侧Ⅲ区的iNOS阳性细胞率高于Ⅰ、Ⅱ区，股骨侧1、2、6、7区染色阳性细胞率高于3、4、5区（P〈0．05）；髋臼侧Ⅲ区的NT阳性细胞率明显高于Ⅰ、Ⅱ区，股骨侧阳性细胞率由高到低依次为1、7区，2区，6、4、3、5区（P〈0．05）；骨溶解区界膜组的iNOS和NT阳性细胞率均明显高于非溶骨区界膜组和OA滑膜组（P〈0．01）。[结论]假体周围iNOS和ONOO^-的表达具有一定规律性，并与骨溶解程度密切相关。iNOS和ONOO^-的异常表达可能是磨损颗粒造成界面骨重建受阻和骨溶解的关键环节之一。     

银芷肛肠熏洗剂对大鼠痔相近模型iNOS、VEGF、CD68表达的影响

为观察银芷肛肠熏洗剂对大鼠痔相近模型诱导型一氧化氮合酶（iNOS）、血管内皮生长因子（VEGF）、CD68表达的影响,本实验采用肛门外周注射冰醋酸法建立大鼠痔相近模型,造模成功后将50只大鼠随机分为空白对照组（A组）、马应龙金玄痔科熏洗散对照组（B组）和银芷肛肠熏洗剂低剂量组（C组）、中剂量组（D组）、高剂量组（E组）,每组10只,连续给予相应药物7d,于第8天处死大鼠,通过免疫组化染色法评估大鼠痔相近模型创面组织中iNOS、VEGF、CD68水平。结果显示,（1）iNOS：B～E组大鼠创面组织中iNOS阳性细胞率评分明显低于A组,P〈0．01;D、E组大鼠创面组织中iNOS阳性细胞率评分明显低于B、C组,P〈0．01;而B、C组比较差异无统计学意义,P〉0．05。（2）VEGF：B～E组大鼠创面组织中VEGF阳性细胞率评分明显低于A组,P〈0．05或P〈0．01;D、E组大鼠创面组织中VEGF阳性细胞率评分均低于B、C组,P〈0．01;而B、C组比较差异无统计学意义,P〉0．05。（3）CD68：B～E组大鼠创面组织中CD68阳性细胞率评分明显低于A组,P〈0．05或P〈0．01;C～E组大鼠创面组织中CD68阳性细胞率评分均明显低于B组,P〈0．05或P〈0．01。结果表明,银芷肛肠熏洗剂能明显抑制大鼠痔相近模型iNOS、VEGF、CD68的表达,其对痔的治疗作用可能与抑制iNOS、VEGF、CD68表达有关。     

磨损颗粒刺激巨噬细胞引起人工关节松动的作用机制

目的探讨来源于人外周血的单核／巨噬细胞对直径1μm以下超高分子聚乙烯（UHMWPE）磨损颗粒的反应及其机制。方法从因无菌性人工髋关节松动而需要行翻修手术的患者假体周围组织中提取UHMWPE磨损颗粒。从10名健康志愿者分别抽取50ml外周血，梯度离心获得外周血中的单核／巨噬细胞。将细胞分为6组：A：单核／巨噬细胞＋UHMWPE磨损颗粒；B：单核／巨噬细胞＋UHMWPE磨损颗粒＋100μM Rotenone；C：单核／巨噬细胞＋UHMWPE磨损颗粒＋10μM U0126；D：单核／巨噬细胞＋UHMWPE磨损颗粒＋10ng／ml Cerivastatin；E：单核／巨噬细胞；F：单核／巨噬细胞＋脂多糖（LPS）。检测各组细胞的TNFα表达。结果UHMWPE磨损颗粒明显刺激单核／巨噬细胞分泌TNFα。Rotenone、U0126和Cerivastatin均可抑制UHMWPE磨损颗粒刺激单核／巨噬细胞分泌TNFα，且以U0126明显（P〈0．01）。结论UHMWPE磨损颗粒刺激单核／巨噬细胞产生TNFα可通过NF—κB和MAPK通路，但以MAPK通路为主。     

米非司酮对早孕胎盘绒毛诱导型一氧化氮合酶和细胞凋亡的影响

目的了解米非司酮对早孕绒毛诱导型一氧化氮合酶（iNOS）及滋养层细胞凋亡的影响,进一步探讨米非司酢早孕药物流产机理。方法选择40例早孕药物流产患者（实验组）,采用原位杂交及免疫组化方法检测绒毛中iNOS的表达,细胞凋亡采用3＇-OH末端缺口标记法（TUNEL）显示绒毛滋养细胞中原位凋亡细胞的表达。利用计算机图象分析系纺（CMIAS）,iNOS表达指标以数密度（N／S）及阳性单位（Pu）计算,细胞凋亡以每个统计场凋亡细胞个数（N）、凋亡细胞平均噘光度（OD）、凋亡细胞面密度（凋亡细胞面积／统计场面积,DS／TS）表示,并与40例正常人工流产的绒毛和蜕膜组织（对照组：比较。结果实验组绒毛组织iNOS原位杂交结果显示N／S、Pu分别为0．12±0．010、15．3±2．6,对照组分别为0．02±0．003、3．1±0．5,两组有极显著性差异（P〈0．01）;免疫组化结果显示实验组和对照组N／s、Pu分别为0．09±0．01、10．24±1．55及0．016±0．002、1．26±0．33,差异有显著性。实验组绒毛滋养细胞凋亡指数显著增高,各指标两组比较差异显著。结论米非司酮早孕药物流产与绒毛组织iNOS活性及滋养细胞凋亡有关。     

RNA干扰树突细胞主要组织相容性复合物1表达后诱导抑制性T细胞对小肠移植耐受的影响

目的探讨RNA干扰树突细胞（Dc）组织相容性复合物1（MHC-1）表达后获得的CD8＋CD28-抑制性T细胞（Ts）对小肠移植免疫耐受的的影响。方法通过siRNA干扰DC MHC—I表达后,诱导获得CD8^＋CD28^-Ts。建立由Wistar大鼠移植到SD大鼠的小肠移植模型36例,随机分为A组（转染实验组）、B组（未转染组,注射普通T细胞）和C组（移植对照组,注射生理盐水）。术后14d,每组各随机挑选6例,取移植大鼠小肠和血液标本行移植小肠组织病理学检查．并检测移植大鼠血清TGF-β、IFN-γ水平及回肠黏膜Na^＋-K^＋-ATP酶活性,观察移植大鼠的存活时间。结果术后第14天,A组移植大鼠血清中TGF—β和IFN-γ表达水平高于B、C组（P〈0．05）。A组大鼠肠黏膜Na^＋-K^＋-ATP酶活性为（6．3±1．0）kU／g,明显高于B组的（3．6±0．9）kU／g和C组的（2．9±1．3）kU／g（P〈0．05）。A组移植小肠病理Parks评分分级明显低于B组和C组（P〈0．05）。A、B和C组移植后大鼠中位生存时间分别为32．0、17．5和21．0d,A组存活时间明显优于B组和C组（P〈0．05）。结论将RNA干扰DCMHC—I表达所获得的CD8^＋CD28^-Ts过继小肠移植大鼠．可以减轻移植大鼠的损伤程度．抑制免疫排斥反应．     

p38MAPK抑制剂对急性肺损伤大鼠肺组织核因子-κB表达的影响

目的 观察p38丝裂原活化蛋白激酶（p38MAPK）抑制剂预处理对大鼠内毒素型急性肺损伤（Au）核因子-κB（NF-κB）的影响。方法 腹腔内注射＋气管内给内毒素复制大鼠ALI模型，用免疫组化方法测定肺组织NF-κB的表达。结果实验组、预处理组NF-κB的表达高于对照组（P〈0．05或P〈0．01），且实验组高于预处理组（P〈0．05）。结论 p38MAPK抑制剂可减轻大鼠细胞的NF-κB表达，减轻肺组织的病理损害。     

细胞生长因子联合诱导ES细胞向肾脏前体细胞分化的实验研究

目的：探讨细胞生长因子联合诱导胚胎干细胞（embryonicstemcell,Es细胞）向肾脏前体细胞定向分化的实验技术,为应用胚胎干细胞进行肾脏再生提供实验基础。方法：小鼠ES细胞悬浮培养2d制备成拟胚体,RA、activin—A、Bmp7三种生长因子诱导培养5d设为A组,不加生长因子培养设为对照（B组）,生长因子培养5天后继续以肾脏上皮细胞生长培养液培养7d设为c组,免疫荧光检测Pax2、Bry、wTl蛋白表达情况,流式细胞技术检测Pax2、Bry、cD24阳性细胞比例,realtimePcR检测Pa]（2、Bry、0srl、Liml、wTl、six2、salll、AQPl、CD24、PDGFR基因表达情况。结果：免疫荧光染色结果显示A组细胞Pax2、Bry、WTl的表达明显高于B组;流式细胞技术检测显示A组Pax2、Bry、cD24阳性细胞比例较B组增加,C组表达Pax2、Bry的阳性细胞比例较A组明显升高;realtimePcR检测显示A组Pax2、Bry、0srl、Ijml、wTl表达较B组明显增加（P〈0．05或P〈0．01）,C组表达CD。基因较A组明显升高（P〈0．05）。结论：胚胎干细胞在体外生长因子联合诱导条件下能够分化为早期肾脏前体细胞,并表达部分成熟肾脏细胞的标记物。     

饮酒对大鼠生精细胞iNOS,Bcl-2基因表达的影响

目的 探讨酒精对大鼠睾丸诱导型一氧化氮合酶（iNOS）、Bcl-2基因表达和生精细胞凋亡的影响。方法30只成年健康SD雄性大鼠随机均分为对照组、低剂量组和高剂量组，用不同剂量的酒精灌胃成年大鼠26d（两个生精周期）后，免疫组织化学法（SP法）检测睾丸iNOS、BCl-2基因表达的变化；原位缺口末端标记法（TUNEL法）检测细胞凋亡指数（A1）的变化。结果 与对照组相比，低剂量组大鼠睾丸iNOS、Bcl-2基闪表达强度和细胞凋亡指数（A1）无明显变化（P〉0．05）：而高剂量组与对照组和低剂量组相比，iNOS表达显著增强（P〈0．01），Bcl-2基因表达明显减弱（P〈0．01，P〈0．05），细胞凋亡指数则增加（P〈0.01）。结论 长期大量饮酒可以诱导睾丸生精细胞凋亡增加，iNOS与Bcl-2基因表达的改变是重要原因之一。     

磨损颗粒诱导细胞外基质金属蛋白酶诱导因子表达及机制研究

[目的]观察磨损颗粒诱导EMMPRIN产生及PDTC对EMMPRIN表达影响,探讨EMMPRIN在炎症反应中的作用及其调节机制。[方法]构建小鼠air-pouch动物模型,实验组囊腔内注射颗粒悬液3 ml(B、C组),对照组注射磷酸盐缓冲盐水3 ml(A组),即日起A组、C组每天腹腔注射0.1 ml PDTC溶液,B组注射等量生理盐水,给药后第3、7、14 d后各处死动物8只取出air-pouch囊壁组织,行大体、组织学观察,半定量RT-PCR、免疫组织化学、western-blot检测。[结果]在B组、C组小鼠背部可见一白色、质脆椭圆形囊壁组织,光镜下可见大量炎性细胞浸润,A组背部皮下可见一透明壁薄囊腔,磨损颗粒均能诱导囊壁组织EMMPRINmRNA及蛋白的表达,且呈时间依赖性。7、14 d C组EMMPRIN mRNA、蛋白及NF-κBP65的表达少于B组(P<0.05),A组明显少于C组(P<0.01)。[结论]磨损颗粒可以刺激EMMPRIN的产生,EMMPRIN的生成可能受NF-κB的调节。     

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.     

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.