硫酸镁配合中药辨证施治胎儿生长受限效果观察

目的探讨胎儿生长受限(FGR)的治疗方法。方法将128例住院FGR孕妇随机分为对照组(61例)和观察组(67例)。对照组采用硫酸镁静脉滴注辅以营养饮食,观察组在此基础上根据患者气血虚弱、脾肾阳虚、肝肾阴虚等不同类型采用不同中药辨证施治,1个疗程后评价效果。结果两组治疗前后脐动脉血流阻力指数比较,差异有显著性意义(P<0.05、P<0.01);治疗后观察组疗效显著优于对照组(P<0.05)。结论硫酸镁配合中药辨证施治是治疗FGR的有效方法之一。     

中药红纱条治疗压疮效果观察

目的 探讨硫酸镁湿热敷治疗产后痔的效果。方法 将分娩后发生产后痔的135例产妇随机分为观察组（80例）和对照组（55例），观察组采用50％硫酸镁湿热敷治疗，对照组采用0．5％碘伏外洗。结果 观察组治疗总有效率显著高于对照组（P〈0．01），止痛时间显著短于对照组（P〈0．01），止痛率显著高于对照组（P〈0．01）。结论 50％硫酸镁湿热敷治疗产后痔效果较好。     

硫酸镁联合特布他林雾化吸入辅助治疗发作期哮喘患者

目的 探讨硫酸镁作溶煤雾化吸入特布他林辅助治疗发作期哮喘患者的效果。方法选择哮喘中、重度发作期患者50例，随机分成观察组和对照组各25例。对照组采用生理盐水加特布他林雾化吸入，观察组采用7．5％硫酸镁联合特布他林雾化吸入，两组均治疗7d。结果 观察组肺通气功能各指标改善情况显著优于本组治疗前及对照组治疗后（P〈0．05，P〈0．01），而治疗前后两组心率、血压、呼吸比较，差异无显著性意义（均P〉0．05）。结论 硫酸镁联合特布他林雾化吸入辅助治疗发作期哮喘效果较好。     

不同时间中药内服治疗溃疡性胃脘痛效果观察

目的探讨不同时间中药内服治疗溃疡性胃脘痛的效果。方法将312例需中药内服治疗的溃疡性胃脘痛患者随机分为对照组（157例）和观察组（155例），分别予中药餐后服药（对照组）和餐前服用（观察组）。结果观察组止痛效果显著优于对照组（P〈0．05．P〈0．01）。结论于饭前服用中药时溃疡性胃腕痛止痛效果更好。     

中药保留灌肠辅助治疗慢性肾衰竭效果观察

目的观察中药保留灌肠辅助治疗慢性肾衰竭的效果。方法将91例慢性肾衰竭患者随机分为观察组（55例）及对照组（36例）。对照组采用常规口服中药治疗，观察组在此基础上加用中药保留灌肠治疗。结果观察组治疗后症状评分及血肌酐、尿素氮显著低于对照组（均P〈0．05），总有效率显著高于对照组（P〈0．01）。结论中药保留灌肠辅助治疗有利于排出体内毒素，能提高慢性肾衰竭患者的疗效。     

硫酸镁联合硝酸甘油治疗重度子痫前期心力衰竭的临床价值

目的探讨硫酸镁联合硝酸甘油治疗重度子痫前期心衰的临床价值。方法选择80例患者,分为两组,各40例,对照组使用硫酸镁,观察组则在对照组的基础上使用硝酸甘油,比较两组患者治疗后不同时间点平均动脉压变化,检测血小板凝集率及24h尿蛋白量变化,并统计两组发生的产科并发症。结果治疗后观察组15min、30min、1h及3h,其平均动脉压均显著低于对照组（P〈0．05）,观察组血小板凝集率显著低于对照组（P〈0．05）,24h尿蛋白量值显著少于对照组（尸〈0．05）,发生宫内窒息、新生儿窒息及产后出血的比率显著低于对照组（P〈0．05）。结论硝酸甘油联合硫酸镁治疗重度子痫前期在预防和治疗心衰方面能有效降低平均动脉压,保护凝血功能和肾功能,减少产科并发症,具有显著疗效。     

中药辨证治疗骨科术后非感染性发热的临床观察

目的研究探讨使用中药辨证法治疗非感染性发热（骨科术后）的f临床治疗效果。方法将本院92例骨科术后出现非感染性发热患者随机分为两组，每组46例，治疗组根据临床分型采用中药辨证治疗；对照组不服用中药，予以冰敷头部或酒精拭浴等处理，患者无法耐受，给予解热镇痛药物。结果治疗第一天、第二天治疗组的体温下降幅度大于对照组（P〈0．05）；并且治疗组体温恢复正常的时间少于对照组体温恢复至正常的时间，两组相比差异具有统计学意义（P〈0．05）；两组均未见不良反应。结论中药辨证治疗骨科术后非感染性发热的临床疗效好，安全性高，值得进一步推广。     

健脾清化方改善慢性肾脏病2—3期患者微炎症状态的研究

目的观察健脾清化方治疗慢性肾脏疾病（CKD）2—3期脾虚湿热型患者微炎症状态的作用。方法将156例中医辨证为脾虚湿热的CKD2—3期患者随机分成中药组和对照组各78例,并设20例健康体检患者为正常组。对照组予以纠正水、电解质紊乱,现代营养治疗等治疗。中药组在对照组治疗基础上加用健脾清化方治疗,疗程为8周,观察两组患者治疗前后肾功能、微炎症指标的变化。结果最终中药组有74例、对照组有73例完成研究。治疗前,两组的超敏CRP（hs—CRP）、白介素－17（IL－17）、干扰素－7（IFN-7）比正常组显著升高（P〈0．05）。8周治疗后,中药组中医症候积分、血清肌酐（Scr）、尿素氮（BuN）、24小时尿蛋白定量均有明显下降且优于对照组（P〈0．05或P〈0．01）,中药组hs-CRP平均下降了26．4％（P〈0．05）,而对照组有上升的趋势。中药组IL-17平均下降了73．5％（P〈0．05）,对照组平均下降了25．6％。中药组IFN-7平均下降了48．3％,P〈0．05）,而对照组平均下降了23．3％。结论CKD2—3期的脾虚湿热型患者存在微炎症状态,健脾清化方能改善患者的微炎症状态,延缓肾功能进展,降低蛋白尿,延长非透析治疗时间,是一种安全、有效且容易被患者接受的治疗方法,适用于CKD早中期中医辨证为脾虚湿热的患者。     

自制银丹膏外敷治疗输液性静脉炎

目的探讨自制中药银丹膏外敷治疗输液性静脉炎的疗效。方法将240例输液性静脉炎患者随机分为观察组160例和对照组80例，观察组采用自制银丹膏局部外敷，对照组采用50％硫酸镁溶液湿热敷，均连续治疗3d。结果观察组治疗后不同时间的治疗效果优于对照组（均P〈0．01）。结论中药银丹膏外敷可有效治愈输液性静脉炎。     

情志五行生克理论辅助治疗郁证效果观察

目的探讨情志五行生克理论辅助治疗郁证的效果。方法将138例郁证患者随机分为两组，对照组（60例）仅行辨证施治，观察组（78例）辨证施治外。依据情志间五行生克理论进行心理护理。结果1个疗程内显效率观察组为87．18％，对照组为66．67％。两组比较。差异有显著性意义（P〈0．01）。结论结合情志五行生克理论辅助心理护理治疗郁证疗效显著优于单纯辨证施治。     

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.