绝经后女性骨密度与腰椎间盘退变的相关性分析

目的:观察绝经后女性腰椎和髋部骨密度与腰椎间盘退变的关系。方法:回顾性统计2017年12月～2018年12月因腰痛在我院脊柱外科门诊及住院的229例绝经后女性患者,记录患者年龄、身高、体重、糖尿病史、高血压病史、饮酒史、吸烟史等,采用双能X线骨密度测量仪检查患者腰椎椎体(L1～L4)骨密度和髋部平均骨密度,记录相应的T值,每例患者同时行腰椎MRI检查。根据骨密度T值≥-1.0为正常,-2.5 T值-1.0为骨量减少,T值≤-2.5诊断为骨质疏松,将患者分为骨质疏松组(n=78)、骨量减少组(n=73)和正常组(n=78)。每个节段腰椎间盘退变程度用Pfirrmann分级系统进行评分,用协方差和Spearman相关性分析来分析腰椎和髋部骨密度与腰椎间盘退变的关系。结果:骨质疏松组、骨量减少组和骨量正常组的年龄分别为67.17±9.99岁、65.66±10.71岁、55.29±12.35岁,骨质疏松组、骨量减少组年龄显著大于骨量正常组(P0.05);骨质疏松组的体重指数小于正常组(23.38±2.37kg/m~2 vs 24.72±2.96kg/m~2,P0.05);其余一般资料各组间无显著性差异(P0.05)。上腰椎(L1、L2)中,骨质疏松组腰椎间盘退变评分均较正常组低(2.24±0.82 vs 2.60±0.95,2.79±0.95 vs3.18±0.94,P0.05),而与骨量减少组比较无显著性差异(P0.05);下腰椎(L3、L4)椎体和髋部不同骨密度组之间椎间盘退变程度无显著性差异(P0.05)。各腰椎椎体骨密度分别与腰椎间盘平均退变程度呈正性相关(L1:r=0.185;L2:r=0.157;L3:r=0.180;L4:r=0.132;L1～L4:r=0.180;均P0.05),髋部骨密度与腰椎间盘退变的严重程度无统计学相关性。结论:绝经后女性腰椎间盘退变的严重程度与腰椎骨密度存在正相关关系,提示绝经后女性腰椎骨密度较高者椎间盘退变可能更严重,有必要进一步做腰椎CT或者MRI检查;股骨颈骨密度检查对骨质疏松诊断更有帮助。     

绝经后女性腰椎T值评分与椎体骨折的关系

目的探讨绝经后女性腰椎骨密度的T值评分与发生椎体骨折的关系。方法选择原发性骨质疏松症女性患者共74例,其中发生椎体骨折患者37例,无椎体骨折患者37例,所有受检者均行正侧位胸腰椎X线摄片证实。两组女性的出生年月、身高、体重、绝经年限等无显著性差异。用双能X线吸收仪(DXA)分别检测正位腰椎(L1-L4)及一侧股骨近段股骨颈的骨密度(BMD)值及T值,统计腰椎部位的T值评分(T-Score),以腰椎T值评分达≤-2.5可入选,并对两组腰椎的T值评分进行统计分析。结果骨折组腰椎T值评分明显低于非骨折组腰椎T值评分(P0.05)。结论绝经后女性发生椎体压缩性骨折与腰椎骨密度的T值评分降低相关。     

绝经后女性膝关节骨性关节炎与胫骨软骨下骨骨密度的相关性研究

目的评价绝经后女性膝关节骨性关节炎与胫骨软骨下骨骨密度的相关性。方法选取2017年7月至2017年10月就诊于新疆医科大学第一附属医院的绝经后膝关节骨性关节炎女性80例,年龄45~92(65.2±10.9)岁。按照KellgrenLawrence诊断标准将Ⅰ、Ⅱ、Ⅲ、Ⅳ级KOA分为A、B、C、D等4个组。将胫骨内侧及外侧选为感兴趣区(regions of interest,ROI)分别标记为ROI 1,ROI 2。采用GE Lunar Prodigy型双能X线骨密度仪分别测量两个ROI骨密度,同时测量股骨颈及腰椎骨密度。结果共纳入骨性关节炎患者80例。ROI 1平均骨密度值0.66±0.24 g/cm~2,ROI 2平均骨密度值0.46±0.19 g/cm~2,腰椎平均骨密度值0.76±0.15 g/cm~2,股骨颈平均骨密度值0.75±0.14 g/cm~2。ROI 1、ROI 2、股骨颈及腰椎骨密度值与KOA分级比较后发现,ROI 1、ROI 2、股骨颈骨密度值在4组间差异有统计学意义(P0.05),腰椎骨密度差异没有统计学意义(P0.05)。胫骨软骨下骨骨密度与KOA分级、年龄、腰椎骨密度、股骨颈骨密度进行相关性分析后发现,胫骨软骨下骨骨密度与KOA分级、年龄呈负相关,与腰椎及股骨颈骨密度呈正相关。结论随KOA的进展,胫骨软骨下骨皮质终板硬化,但其下方的松质骨骨密度减低。     

原发性骨质疏松症不同部位骨密度测量分析

目的 探讨原发性骨质疏松症患者腰椎及股骨颈骨密度的改变,了解不同部位的测量结果对原发性骨质疏松症诊断的检出率.方法 对2008年3月至2009年2月首次来我院就诊行骨密度检测患者,用双能X线吸收仪(DXA)分别检测正位腰椎(L1～L4)及一侧股骨近段股骨颈的骨密度(BMD)值,其中任一部位T值评分达≤-2.5可诊断骨质疏松症,并对其各部位的T值评分(T-Score)进行统计分析.结果 腰椎T值评分≤-2.5有81例,对原发性骨质疏松检出率为81.0%;股骨颈T值评分≤-2.5有47例,对原发性骨质松检测率为47.0%.将原发性骨质疏松症按Ⅰ型和Ⅱ型分为≤70岁和≥71岁2组,按T值评分结果,腰椎比较P>0.05差异无显著性,股骨颈比较P<0.001差异有非常显著性.结论 在诊断原发性骨质疏松症中正位腰椎的检出率明显高于股骨颈部,但对年龄>70岁患者,股骨颈部检出率反而高于正位腰椎.     

绝经后不同骨关节退行性疾病与骨质疏松程度的相关性研究

目的探讨绝经后女性不同骨关节退行性疾病的临床特点及与骨密度的关系,为防治绝经后骨关节退行性疾病提供依据。方法选取2013年9月至2016年3月在我院收治的959例绝经后女性患者,取腰椎和股骨颈处的最大的骨密度值及T值作为研究对象,按不同骨关节退行性疾病分为脆性骨折组、腰椎退行性病变组、膝骨关节炎组及无明显骨关节疾病对照组。采用SPSS 19.0软件进行统计学分析。结果 (1)各组间腰椎BMD值及T值的差异具有统计学意义(P0.05),其中腰椎退行性病变组患者的腰椎骨密度值和T值均比其他3组明显减低(P0.05),膝骨关节炎组骨密度值和T值均高于其他3组(P0.05);(2)各组间股骨颈BMD值及T值的差异具有统计学意义(P0.05),其中脆性骨折组患者的股骨颈骨密度值和T值均比其他3组明显减低(P0.05),膝骨关节炎组骨密度值和T值均高于其他3组(P0.05)。结论在绝经后女性患者中,脆性骨折与骨质疏松的关系最为密切,而其他骨关节疾病也在不同程度上与骨质疏松程度存在显著相关性,在治疗骨关节疾病的同时也要重视骨质疏松症的防治。     

肌肉强度和肌肉质量与绝经后女性骨密度的相关性研究

目的探索绝经后女性肌肉强度和肌肉质量与骨密度相关性。方法分析了2014年3月至2017年8月在我院就诊的340名绝经后妇女。使用双能量X射线吸收测定法检测股骨颈和腰椎骨密度(bone mineral density,BMD)、全身骨密度和附肢骨骼肌肌肉量(appendicular skeletal muscle,ASM)。ASM指数(ASMI,kg/m~2)按照ASM(kg)除以高度的平方(m~2)计算。测量握力(kg)作为肌肉力量的指标。结果调整ASMI和年龄后(股骨颈标准化偏回归系数β=0. 105,腰椎=0. 116),握力强度与几个骨骼部位BMD呈显著性正相关(P0. 05)。股骨颈和腰椎骨密度的调整平均值显示出握力强度从最低到最高三分位数的显著增加趋势。本研究结果表明肌肉强度与绝经后妇女肌肉量的几个位点的BMD密切相关。无论肌肉大小如何,肌力强健的绝经后妇女都有健康的骨骼状态。结论绝经后女性骨密度和肌肉强度密切相关,与肌肉质量无明显相关性。     

年龄和维生素D状态对绝经后女性骨质疏松患者握力的影响

目的观察年龄和维生素D状态对绝经后女性骨质疏松患者握力的影响。方法对123例绝经后女性骨质疏松患者进行血清25(OH)D检测和手握力测量,25(OH)D检测采用电化学发光法。手握力测量使用手持式Jamar测力计,取优势侧握力最大值作为分析数据。观察患者年龄与最大握力的相关性和患者年龄与血清25(OH)D的相关性,研究血清25(OH)D与最大握力的相关性。结果年龄44~91岁,平均(65.55±10.66)岁。最大握力6~34 kg,平均(22.24±6.05)kg,年龄与最大握力呈显著负相关;25(OH)D为6.32~52.23 ng/ml,平均(24.35±8.23)ng/ml,年龄与血清25(OH)D呈显著负相关,25(OH)D与最大握力无显著相关性,当25(OH)D≤10 ng/ml时,最大握力显著降低。结论在绝经后骨质疏松女性中,年龄是导致握力和25(OH)D水平下降的重要因素,维生素D缺乏时可致握力下降。     

绝经前女性系统性红斑狼疮患者骨密度和骨代谢指标测定

目的 探讨绝经前女性系统性红斑狼疮(SLE)患者骨密度(BMD)和骨代谢指标的变化.方法 采用双能x线骨密度吸收仪(DEXA)测定178例绝经前女性SLE患者以及60例正常对照组的腰椎、股骨颈的骨密度以及T值,血钙、磷浓度,血清碱性磷酸酶(AKP)、血清骨钙素(BGP)、尿I型胶原交联氨基末端肽(NTX)水平,并将SLE组患者分为SLE初诊组与治疗组,分别对其数据进行统计分析.结果 SLE初诊组的腰椎BMD,股骨颈BMD及T值,血清AKP、尿NTX较正常对照组均无明显差异,而腰椎骨密度T值、血清BGP较正常对照组低(P＜O.05);SLE治疗组的腰椎BMD、T值和股骨颈1值,血清BGP低于正常对照组,但股骨颈BMD、血清AKP、尿NTX较正常对照组差异未达统计学意义;SLE治疗组的腰椎、股骨颈BMD与T值均显著低于SLE初诊组.SLE组的骨质疏松及骨量减少率分别为6.74%、16.85%.结论 绝经前SLE患者较同年龄正常女性易发生骨质疏松,血清BGP和腰椎骨密度可能较早反映骨质疏松的发生.     

南京地区成年女性衰老过程中各部位骨密度的变化

目的 探讨南京地区成年女性骨质疏松的患病情况,及衰老过程中各部位骨密度的变化。方法 对南京地区成年女性,20-29岁,共计388人,均排除继发性骨质疏松症,运用双能X线骨密度仪,对所有患者进行腰椎及髋部骨密度测定。结果 1.南京地区成年女性,骨量正常者占33.5%,骨量低下者占48.5%,骨质疏松者占18%;其中绝经前成年女性骨量正常者占52.7%,骨量低下者占47.3%,无骨质疏松患者;绝经后女性骨量正常者占12%,骨量低下者占49.7%,骨质疏松患者占38.3%;2. 20~39岁年轻女性,随年龄增加,各部位骨密度均无明显下降;但自40岁开始至49岁,股骨颈骨密度首先开始下降,而此时腰椎及总髋部骨密度无明显变化;到50岁开始,各部位骨密度均明显下降;其中50~69岁时,腰椎骨密度T值与股骨颈骨密度T值之间的差异消失,但均低于总髋部骨密度T值。结论 1.南京地区年轻女性骨量低下者患病率较高,随年龄增加,绝经后女性骨量低下者进一步增多,且骨质疏松患病率高达38.3%;2.在女性50岁前,股骨颈骨密度下降最早,诊断骨质疏松最敏感,而50岁后,腰椎骨密度与股骨颈骨密度均明显下降,诊断骨质疏松同样敏感。     

绝经后股骨颈骨折股骨头骨铁含量、血清铁蛋白与骨密度相关性研究

 目的 探讨女性绝经后股骨颈骨折股骨头骨铁含量、血清铁蛋白与髋部骨密度的相关性。方法 2010年6月至2013年3月,收集156例股骨颈骨折行髋关节置换的绝经后女性患者资料,年龄56~92岁,平均(72.40±8.97)岁;按每10岁年龄段分组,共分5组,即≤ 60岁组、61~70岁组、71~80岁组、81~90岁组、≥91岁组。患者入院后第2天留空腹血清标本测定血清铁蛋白和骨代谢指标;对髋关节置换术后留取的股骨头组织行骨铁含量检测和骨铁染色,术后第10天行髋部和腰椎骨密度(DXA)检测。结果 5组之间骨铁、血清铁蛋白、转铁蛋白、总铁结合力、Ⅰ型原胶原氨基端延长肽、Ⅰ型胶 原C端肽β降解产物、髋部和L1~4骨密度存在组间差异。髋部和L1~4骨密度随年龄增加而下降,骨铁和血清铁蛋白随年龄增 加而升高,骨铁和血清铁蛋白检测值均在81~90岁年龄组达到峰值,156例患者的平均骨铁量为96.81 μg/g,平均血清铁蛋白为235.66 μg/L。156例患者中,血清铁蛋白＞200 μg/L的患者为100例(100/156,64.1%)。骨铁、血清铁蛋白、年龄、体重指数可进入髋部骨密度回归模型,股骨颈R2=0.443,Wards三角R2=0.397,大转子R2=0.322,全股骨R2=0.379;控制年龄、体重、体重指数等因素,骨铁和血清铁蛋白与髋部骨密度呈负相关,与腰椎骨密度无明显相关性。结论 发生股骨颈脆性骨折的绝经后女性患者体内存在铁蓄积,股骨头骨铁含量随年龄增加而升高,骨铁增加和血清铁蛋白升高可能是髋部骨密度下降的独立危险因素,铁蓄积与绝经后骨质疏松症存在相关性。     

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.     

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.