原位肝脏移植术中血液保护的临床研究

目的　研究原位肝移植手术中的血液保护。方法　 35例行原位肝移植手术的病人 ,随机为分A、B两组。A组 2 0例 ,术中采用洗涤式自体血回收和大剂量抑肽酶的血液保护措施 ;B组 15例 ,不使用上述血液保护方法。A、B两组均加强血液动力学、体温、凝血功能监测包括活化部分凝血酶时间 (APTT)、凝血酶时间 (TT)、凝血酶原时间 (PT)、纤维蛋白原定量 (FIB)、激活全血凝血时间(ACT)、凝血弹性图 (TEG) (取R值作为观察指标 )。并统计两组术中失血量和输血量、A组回收的血量和回输的洗涤红细胞量。两组病人均在无肝期采用静脉 静脉转流。术中保持正常体温并于新肝期中和肝素。结果　A组平均出血量 (315 2± 16 35 )ml,B组 (4 2 6 5± 15 45 )ml(P <0 0 5 )。A组平均每例回收血量 (2 6 6 2± 1135 )ml,回输洗涤红细胞 (1310± 710 )ml。A组平均输血量 (2 410±95 0 )ml,B组 (2 886± 10 10 )ml(P <0 0 5 )。在凝血功能各项中 ,转流 30、6 0分钟、新肝期 15分钟及术毕时 ,A组各指标均优于B组 (P <0 0 5 ,P <0 0 1)。结论　原位肝移植术中应用相应的血液保护方法能节省用血 ,加强凝血功能的监测并予针对性处理 ,对减少用血与合理用血是有利的     

控制性降压联合自体血回输在特发性脊柱侧凸矫形术中的应用价值

目的:探讨控制性降压联合自体血回输在特发性脊柱侧凸矫形术中的应用价值。方法:对39例特发性脊柱侧凸患者行后路矫形术时均进行术中控制性降压,其中12例未进行自体血回输,作为对照组(A组),全部输异体库存血;另外27例均采用自体血液回输,包括术前预存自体血及术中自体血回输,作为研究组(B组)。观察两组患者失血量及输血情况。结果:A组失血量为763±164ml(400～1000ml),B组为852±386ml(350～2100ml),两组间相比无差异性(P>0.05)。A组输入库存血量为1045±362ml(500～1800ml),B组为511±337ml(0～1300ml),两组间差异有显著性(P<0.01)。结论:控制性降压可减少术中出血量,同时采用自体血回输可明显减少异体库存血的需要量。     

自体血回输对青少年特发性脊柱侧凸患者围手术期细胞免疫功能的影响

目的：探讨自体血回输对青少年特发性脊柱侧凸患者围手术期细胞免疫功能的影响。方法：2002年2月～2005年2月，根据术中输血的方式将特发性脊柱侧凸患者148例分为2组，异体输血组(Ⅰ组)42例：术中全部输异体成分血；自体血回输组(Ⅱ组)106例：术中采用血液回收机将自体血回输给患者，使患者红细胞比容(HCT)≥30％，Hb≥10g／L，如果达不到低限，适量补充异体血。观察两组异体血输入量、过敏反应发生率；并分别于入手术室、术后第1天及第5天抽取静脉血，测定T细胞亚群和NK细胞的数量。结果：Ⅰ组平均异体血输入量850±170ml，Ⅱ组中有58例除了自体血回输外补充了异体血，平均410±150ml。输血反应发生率Ⅰ组为26．2％(11／42)，Ⅱ组为4．7％(5／106)，两组间存在显著性差异(P＜0．01)。两组术后第1天CD3~+、CD4~+、CD4~+／CD8~+、NK细胞较术前显著减少(P＜0．05或P＜0．01)，异体输血组较自体输血组减少更明显(P＜0．05)。术后第5天异体输血组CD3~+、CD4~+、CD4~+／CD8~+、NK细胞仍较术前显著减少，自体输血组基本恢复正常，两组间存在显著差异(P＜0．05)。结论：自体血回输可明显减少脊柱侧凸矫形患者异体血输入量，术后自体输血患者细胞免疫功能的抑制较异体血输入者轻，术后细胞免疫功能恢复快。     

预储自体血和血液稀释回输法在骨科手术中的应用

目的 介绍采用术前预储自体血输血法和血液稀释回输法进行自体输血的初步经验。方法 对45例骨科手术病人采用自体输血技术，方法包括术前预储自体血输血法13例，血液稀释输血法32例，其中观察血液稀释输血组病人术前、术中、术后血液动力学、有形成分和凝血功能变化。结果 术前预储自体血输血组中8例(61．54％)未输异体血，另5例加输异体血；血液稀释输血组中21例(65．63％)未输异体血，另ll例加输异体血，两组都顺利完成手术，无不良反应，其用血量较以往同类手术显著减少。血液稀释输血组术中、术后血液动力学稳定，有形成分和凝血功能虽有变化，但仍在正常范围。结论 在骨科手术采用术前预储自体血输血和血液稀释回输法是安全、可行的方法。     

自体血液回输在胸腰椎前路手术中的应用

目的　探讨术中血液回输技术安全性和效果 ,评价其在胸腰椎前路手术中的应用价值。方法　 45例胸腰椎骨折行前路手术的病人分为自体血液回输组和非自体血液回输组。对两组病人术中出血量、输血量及手术前后血常规进行观测。结果　两组术中出血量无显著差异 (P>0 .0 5 ) ,自体血回输组所需异体血较对照组明显减少 (P <0 .0 1)。两组术后血常规的变化规律一致。分别比较术前、术后第 1天、第 7天两组间血常规 ,均无显著性差异。但是 ,两组内WBC、中性粒细胞含量在术后有一过性显著增高 ,术后第 7天两组均恢复正常 (P >0 .0 5 )。RBC、HGB、HCT均较术前有显著降低 (P <0 .0 5 )。未发现应用自体血液回输出现的并发症。结论　①术中自体血液回输能有效地减少自体血的丢失和异体血的输入量 ,安全有效 ;②胸腰椎骨折前路手术出血量大 ,术中血液回输在此手术中具有很高的应用价值。     

Sonoclot评价术中自体和异体输血对老年人凝血功能的影响

目的观察老年患者术中回收式自体输血前后凝血参数的变化。方法24例择期手术的老年患者随机分为回收式自体输血组(观察组)或异体输血组(对照组)。观察组12例,回输经血液回收仪洗涤处理的自体血;对照组12例,输异体浓缩红细胞。分别取术前、输血前和输血后的静脉血,测定血常规、凝血酶原时间(PT)、活化的部分凝血活酶时间(APTT),同时Sonoclot仪测定血凝曲线的各项指标。结果两组术前、输血前和输血后Hb、血小板计数(Plt)、纤维蛋白原(FIB)、APTT及PT水平变化趋势相似。观察组的血块凝结速率(CR)值自体血回输前与手术前相比变化明显(P<0.05),但与对照组比差异无统计学意义。两组间Sonoclot仪其他各项指标在各测定点差异也无统计学意义。结论术中回收式自体输血与异体输血相比对老年人凝血功能的影响差异无统计学意义。     

类风湿关节炎手术后自体引流血回输技术的应用

目的评价类风湿性关节炎(RA)患者手术后自体引流血回输的作用和使用安全性。方法93例RA患者随机分为两组。实验组(53例)术后使用自体引流血回输装置,对照组(40例)使用负压吸引瓶。记录引流量、回输血量及输血不良反应。结果实验组平均回输引流血759ml,其中6例平均输入库血165ml;对照组平均术后输库血824ml。两组患者手术前后的血红蛋白差异无显著性。两组中接受异体输血的患者有7例出现输血不良反应:荨麻疹4例(实验组2例,对照组2例),寒战、高热反应3例(均为对照组)。结论自体引流血回输是RA患者术后安全有效的输血方法。在术前没有自体血储备的情况下,该技术减少了输注库血的机会,避免血液传播疾病的发生。     

术中自体血回输与输注异体血对脊柱手术术后血液流变学的影响

目的 对比术中自体血回输和输注异体血对脊柱手术病人血液流变学（凝血功能）的影响,进一步探讨术中血液回收的安全性和可行性。方法 选择2015年1月至2016年12月我院收治的术前实验室检验正常、无凝血功能异常且未接受抗凝治疗、非恶性肿瘤、术中血液无污染的骨科脊柱开放性手术病人100例。严格遵守献血与输血的伦理准则分组：①自体血液回输组（自体组）,即术中回输经洗涤处理的自体血,男22例,女28例;②异体输血组（异体组）,即行异体输血,男23例,女27例。两组病人一般资料比较,差异均无统计学意义（均P＞0.05）。同时进行血液流变学项目监测,并对比输血对病人凝血功能的影响。结果 自体组的术中回输自体血量为（289.4±55.7） ml,少于异体组的异体输血量［（396.5±141.1） ml］,两者比较差异有统计学意义（t=4.992,P＜0.05）。术后第3天两组病人的红细胞压积,自体组为31.00%±5.84%,小于异体组的34.25%±6.15%,两组比较差异具有统计学意义（t=2.710,P=0.007）;两组病人其余血液流变学参数比较,差异均无统计学意义（均P＞0.05）。术后第7、14天,两组病人各项血液流变学参数比较,差异均无统计学意义（均P＞0.05）。结论 自体血回输对血液流变学参数的影响与输注异体血相比无显著差异,可广泛应用于临床。     

不同抗凝药物对全膝关节置换术后失血量的影响

[目的]对比利伐沙班和那曲肝素对人工膝关节表面置换术(TKA)术后失血量的影响。[方法]接受初次单侧TKA手术的骨性关节炎患者79例,随机分为利伐沙班组(n=53)和那曲肝素组(n=26)。记录术后切口总引流量、自体血回输量和异体血输血量。测量术前及术后1、3、5 d血常规,通过Gross方程计算TKA术后隐性失血量和总失血量。[结果]利伐沙班组总引流量、回输量分别为(784.34±367.78)ml,(561.89±305.86)ml,与那曲肝素组相当[引流量和回输量分别为(713.46±356.94)ml和(479.62±259.85)ml,P=0.42和0.24]。术后5 d利伐沙班组Hb为(90.68±11.89)g/L,显著低于那曲肝素组(98.77±12.01 g/L,P=0.01)。两种抗凝药的应用对于患者术前、术后1、3、5 d的Hb及Hct总体的影响均不具备组间统计学差异(P>0.05)。隐性失血量、总失血量分别为(1 361.46±601.01)ml,(2 207.40±651.95)ml,与那曲肝素组相当[隐性失血量、总失血量分别为(1135.01±755.35)ml,(1 917.09±811.30)ml;P=0.15,P=0.09]。异体血输注率54.72%,输血量(307.55±329.25)ml,与那曲肝素组均无组间显著性差异(异体血输血率38.46%,输血量[(230.77±323.44)ml,P=0.17和P=0.28)]。[结论]相对于那曲肝素,利伐沙班并不增加术后失血量和异体血输血率。     

急性等容血液稀释结合术中自体血回输在脊柱手术中的应用

目的 探讨急性等容血液稀释结合术中自体血回输在脊柱手术中临床应用的可行性。方法 38例腰椎滑脱行后路减压、椎弓根螺钉内固定加椎体间Cage融合术患者,随机分为三组,急性等容血液稀释结合术中自体血回输组(组Ⅰ,n=12);自体血回输组(组Ⅱ,n=12);对照组(组Ⅲ,n=14)。术中均采用控制性低血压,记录术前、术中、回输前、回输后、术后的血红蛋白和红细胞比容,分别记录回输的血量和输异体血量。结果 急性等容血液稀释结合术中自体血回输组术中输异体血量约100ml,自体血回输组输异体血量约400ml,对照组输异体血量约800ml,经统计学检验有显著差异(P<0.05)。结论急性等容血液稀释结合术中自体血回输在脊柱手术中临床应用是一种安全有效、节约血源的方法,可减少异体血输入,避免其并发症。     

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.     

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.     

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.     

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.     

Intraoperative autotransfusion is associated with modest reduction of allogeneic transfusion in prosthetic hip surgery

Background: The efficacy of intraoperative salvage and washing of wound blood and the predictors of allogeneic red cell transfusions in prosthetic hip surgery are insufficiently known.
Methods: In 96 patients, undergoing primary or revision surgery, salvaged and washed red cells and, if necessary, allogeneic blood were used to keep haematocrit not lower than 33%. The bleeding of red cells during hospital stay was calculated from the red cell balance. The preoperative red cell reserve (millilitres of red cells in excess of a haematocrit of 33%) was estimated and the difference between this volume and the total bleeding of red cells was retrospectively used to classify patients with regard to the need for red cells. Stepwise regression analysis was used to define patient-related variables associated with allogeneic blood transfusion.
Results: Preoperative knowledge of the type of operation (primary, revision), the preoperative red cell reserve, and the body mass could predict roughly half of the need for banked blood (r²=0.45). Only one-third of the total bleeding of red cells was retransfused. For complete avoidance of allogeneic blood, autotransfusion was most effective in patients with a moderate need (0–4 u). However, 32% of such patients required allogeneic blood.
Conclusions: Autotransfusion has a limited efficacy to decrease the need for allogeneic blood, and other blood-saving methods should be added for this purpose. It is difficult to predict the need for allogeneic blood preoperatively.     

缺氧对肾小管上皮细胞分泌外泌体的影响

目的    观察缺氧对肾小管上皮细胞分泌外泌体的影响,探讨外泌体在缺氧致肾脏损伤中的作用及机制。 方法    （1）常氧（21% O₂）及缺氧（1% O₂）分别处理大鼠肾小管上皮细胞（NRK-52E）48 h,收集细胞上清液并使用高速梯度离心法分离外泌体。采用透射电镜、纳米示踪分析、Western印迹、蛋白浓度定量鉴定并比较两组外泌体的基本特性。（2）在共培养实验中,以不同浓度（1、10、50、100、300 mg/L）的常氧外泌体、缺氧外泌体分别干预脂多糖（LPS）诱导的大鼠原代腹腔巨噬细胞,使用实时荧光定量PCR与酶联免疫吸附试验（ELISA）法分别检测巨噬细胞白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、诱导型氮氧化物合酶（iNOS）水平;使用Western印迹法检测巨噬细胞磷酸化（p）STAT/STAT及细胞因子信号传导抑制蛋白1（SOCS1）的蛋白表达;最后,使用实时荧光定量PCR法检测常氧外泌体与缺氧外泌体中炎性反应相关微RNA（microRNA,miR）的表达差异。 结果    （1）离心得到的囊泡具有外泌体典型的结构,粒径小于150 nm,表达外泌体标志蛋白CD63,说明分离得到外泌体。缺氧对肾小管上皮细胞分泌的外泌体形态、粒径分布比例无明显影响,但提高了外泌体的分泌量。（2）缺氧外泌体相比于常氧外泌体促进了LPS诱导的M1型巨噬细胞IL-6、TNF-α、iNOS 的表达和分泌（均P＜0.01）,同时提高STAT的磷酸化水平并减少SOCS1的蛋白表达（均P＜0.01）;对炎性反应相关microRNA检测发现缺氧外泌体中miR-155、miR-27a表达量较常氧外泌体明显升高（P＜0.05）。 结论    缺氧可改变外泌体的生物学功能,表现为协同促进LPS诱导的M1型巨噬细胞的表型转化,这可能是慢性肾脏病微炎性反应状态持续的原因之一。     

In Vitro Function and Durability Assessment of a Novel Polyurethane Heart Valve Prosthesis

Abstract While flexible-leaflet, central-flow prosthetic heart valves promise relief from anticoagulation therapy, they continue to be restricted by inadequate durability. In consequence, a novel trileaflet valve, made entirely from polyurethane, has been developed. A batch of 6 consecutively manufactured polyurethane valves was subjected to hydrodynamic function and accelerated fatigue testing. Computerized data acquisition and control systems have been introduced to improve valve testing methodologies. In terms of hydrodynamic function, the polyurethane valve demonstrates transvalvular pressure gradients similar to those for a bioprosthetic valve (Carpentier-Edwards) and levels of retrograde flow significantly less than those for either the bioprosthetic valve or a bileaflet mechanical valve (St Jude Medical). The equivalent of 10 years of cycling without failure has been exceeded by all 6 polyurethane valves in accelerated fatigue tests with 2 valves remaining intact after 674 million cycles (equivalent to approximately 17 years) in continuing tests. Highspeed photography revealed considerable differences in leaflet motion between valves cycled at accelerated and physiological rates.     

Negative pressure ventilation vs. spontaneous assisted ventilation during rigid bronchoscopy: A controlled randomised trial

Background: Ventilation during interventional rigid bronchoscopy (IRB) under general anaesthesia (jet ventilation, positive pressure ventilation and spontaneous assisted ventilation) may offer some difficulties. This study compares the effectiveness during IRB of intermittent negative pressure ventilation (INPV) and spontaneous assisted ventilation (SAV). Methods: Thirty-eight patients submitted to IRB were randomised into two groups: SAV or INPV. All patients received a total intravenous anaesthesia; INPV patients were paralysed. Pre-and intra-operative arterial blood gases and O₂ flow through a rigid bronchoscope were assessed. The endoscopist applying a subjective score evaluated the operating conditions. Results: Patients of the INPV group, as compared to the SAV group, required a lower dosage of fentanyl (2.6 ± 1.8 (μg · kg^?1· h^?1 vs. 6.6 ± 4.8 μg · kg^?1· h^?1), a lower O₂ supply (3.3 ± 2.8 1/min vs. 11.6 ± 3.4 1/min), a shorter recovery time (5.4 ± 2.9 min vs. 9.8 ± 7.1 min) and no manually assisted ventilation (0 ± 0 vs. 1 ± 1.1 nd?/procedure). Intraoperative PaCO₂ was higher in the SAV (8.1 ± 1.3 kPa) than in the INPV group (5.0 ± 1.6 kPa) and intraoperative pH differed in the two groups (7.26 ± 0.05, SAV vs. 7.47 ± 0.08, INPV). Operating conditions, as assessed by a subjective score, were considered better with INPV than with SAV (4.9 vs. 4.3). Conclusions: As compared to SAV, INPV in paralysed patients during IRB reduces administration of opioids, shortens recovery time, prevents respiratory acidosis, excludes the need for manually assisted ventilation, reduces 02 need and affords optimal surgical conditions. INPV appears a safe, non-invasive and effective ventilatory management during IRB.