抑肽酶剂量对体外循环炎性反应的作用及影响

目的：观察不同剂量抑肽酶对体外循环（ＣＰＢ）心脏手术炎性反应的作用及差异。方法：３２例拉膜置换病人,随机双盲分为３组：对照组、抑肽酶小剂量组、抑肽酶大剂量组,分别于ＣＰＢ前、ＣＰＢ结束、停机后２h取桡动脉血,测定中性粒细胞ＣＤ１１b表达及细胞因子ＴＮＦ－α、ＩＬ－６血浆清凉,:凶肽酶大剂量组中性粒细胞ＣＤ１１b的表达,细胞因子ＴＮＦ－α血浆水平各时间点无明变化,且ＩＬ－６释放减少,小剂量抑肽酶只在停机后２h部分下调ＣＤ１１b表达及降低ＴＮＦ－α血浆水平,两组相比,小剂量抑肽酶作用明显减弱,结论：抑肽酶的抗赕作用存在量效关系,大剂量抑肽酶的效能好于小剂量抑肽酶。     

氨甲环酸减少体外循环心脏手术后失血的作用及与抑肽酶的比较研究

目的 观察氨甲环酸减少体外循环（ＣＰＢ）心脏手术后失血的作用,探讨其其作用机制,并与抑肽酶比较。方法 随机选取ＰＣＢ心脏手术病人３０例,分为氨甲环酸用药组（ＴＡ组,１０例）,抑肽酶用药组（ＡＰ组,１０例）和对照组（Ｃ组,１０例）。于ＣＰＢ前、中、后２ｈ分别测定ｔ－ＰＡ和ＰＡＩ－Ｉ活性、ＴＸＢ２和６－ｋｅｔｏ－ＰＧＦ１α含量、ＡＤＰ诱导的血小板最大聚集率和血小板超微结构变化,记录各组术后纵隔心包引流     

体外循环中小剂量抑肽酶对血栓素及血小板功能与结构的作用

体外循环中小剂量抑肽酶对血栓素及血小板功能与结构的作用李建华＊孙继领＊高小环＊王京庆＊王红卫＊表１两组血小板计数聚集功能粘附功能ＴＸＢ２ＰＧＦ１α及ＴＸＡ２／ＰＧＦ１α变化（ｘ±ｓ）组别麻醉后ＣＰＢ１０ｍｉｎＣＢＰ４０ｍｉｎ术终术后２ｈ术后１２ｈ术后...     

心脏瓣膜置换术围术期动脉血及冠脉血TNF-α、SOD、LPO及CK-MB的变化

目的 观察进行体外循环（ＰＢ）病人围术期动脉血和冠脉血肿瘤坏死因子（ＴＮＦ－α）、超氧化物歧化酶（ＳＯＤ）、脂质过化物（ＬＰＯ）及肌酸激酶－ＭＢ（ＣＫ－ＭＢ）的变化。方法 １３例病人分别于ＣＰＢ前、升主动脉开放后５ｍｉｎ、３０ｍｉｎ、术毕、术后６ｈ、术后１８ｈ采集动脉和冠状窦血样本,测定血浆ＴＮＦα、ＬＰＯ的浓度及ＳＯＤ、ＣＫ－ＭＢ的活性和动脉血气,测算不同时间点的肺泡动脉氧分压差（ＰＡ－ａＤＯ２）,心肌ＴＮＦ－α的净释出量（冠状窦内血液ＴＮＦα含量减去动脉血含量）。结果 血液的ＴＮＦα水平在开放升主动脉后至术毕前明显增高（Ｐ〈０．０５）,ＣＰＢ期间心肌ＴＮＦα净释出量明显增高（Ｐ〈０．０５）;ＬＰＯ在开放升主动脉后明显升高且持续到术后６ｈ（Ｐ〈０．０５）,其峰值在开放升主动脉后５ｍｉｎ;ＳＯＤ含量逐渐下降并在     

大剂量抑肽酶对体外循环导致凝血机制紊乱的作用

３０例行心脏直视手术病人随机分为对照组和抑肽酶用药组。于麻醉后、主动脉阻断开放时、体外循环结束后１０ｍｉｎ、２ｈ和术后２４ｈ，分别观察血小板计数、血小板聚集率、ＴＸＢ２、６－ｋｅｔｏ－ＰＧＦ１α、ⅧＲ：Ａｇ、ＡＴⅢ：Ａ与ＦＤＰ，并记录术后２４ｈ纵隔心包引流量。结果表明，大剂量抑肽酶可增加术后血小板功能、抑制纤溶、提高术后凝血因子含量等，从而减少了术后出血。     

血小板活化因子及其受体拮抗剂对脊髓损伤后脊髓血流量的影响

实验采用鞘内注射血小板活化因子（ＰＡＦ）及静脉注射ＰＡＦ受体拮抗剂ＢＮ５２０２１，观察其对猫脊髓损伤后伤区和邻近脊髓（Ｌ２－Ｌ４）血流量及血浆血栓素Ｂ２（ＴＸＢ２）、６－酮－前列腺１α（６－ｋｅｔｏ－ＰＧＦ１α）比值（Ｔ／Ｋ值）的影响。     

体外循环时小剂量抑肽酶对纤溶系统和血小板的影响

心脏直视手术体外循环时应用小剂量抑肽酶，观察其对纤溶系统和血小板的影响。３０例随机分为对照组和抑肽酶用药组。用药组仅一次在预充液中加入小剂量抑肽酶２×１０６ＫＩＵ。分别于转流前、转流３０分钟、转流结束时及转流停止后２小时测定ＰＬＧ、ＦＤＰ、ＰＫ、ＴＸＢ２、ｔ－ＰＡ、６－ｋｅｔｏ－ＰＧＦ１α，ＴＸＢ２／６－ｋｅｔｏ－ＰＧＦ１α浓度。术后２４小时纵隔心包引流量用药组较对照组减少出血４１．７％，Ｐ＜０．０１。电镜观察用药组血小板改变不明显；对照组呈现破碎、脱颗粒、微管扩张、聚集。作者认为小剂量抑肽酶能有效地抑制高纤溶活性，可保护血小板功能，减少术后出血。     

体外循环复温期间的应激反应及预防

目的 探讨体外循环（ＣＰＢ）中降温期、稳定低温期及复温期机体应激反应的变化及加入异丙酚的作用。方法 ３１例心内直视手术病人随机分成异丙酚组（Ａ组）１６例和对照组（Ｂ组）１５例。芬太尼－安另于ＣＰＢ前（Ｔ１），降温３３℃（Ｔ２）、３０℃（Ｔ３），低温期（Ｔ４），复温３０℃（Ｔ５）、３３℃（Ｔ６）及ＣＰＢ后１５ｍｉｎ（Ｔ７）７个时点测定平均动脉压（ＭＡＰ），血浆肾上素（Ｅ）、去甲肾上腺素（ＮＥ）及血糖     

抑肽酶抑制体外循环期间血小板激活反应

为研究体外循环期间抑肽酶对血小板激活的抑制，将４０例心脏手术病人随机分为对照组和观察组。观察组加抑肽酶于预充液中，取围术期５个时段检测血小板计数（ＰＴＣ）、血栓烷Ｂ２（ＴＸＢ２）、血小板表面α颗粒膜蛋白（ＧＭＰ１４０）、β血小板球蛋白（βＴＧ）、血小板第４因子（ＰＦ４）、５羟色胺（５ＨＴ）、术后出血量。结果表明对照组ＰＴＣ明显下降，ＴＸＢ２、ＧＭＰ１４０、βＴＧ、ＰＦ４、５ＨＴ均显著升高；观察组以上各项指标及术后出血量均较对照组明显好转（Ｐ＜０．０５或Ｐ＜０．０１）。作者认为，抑肽酶通过抗纤溶等作用可抑制体外循环期间血小板的激活，减少术后出血量。     

阿魏酸钠对犬心脏停跳复苏后脑组织TXB_2、6-keto-PGF_(1a)及MDA含量的影响

研究了阿魏酸钠对犬心脏停跳１０分钟复苏后４小时脑组织中血栓素Ｂ２（ＴＸＢ２）、６－酮－前列腺素Ｆ１ａ（６－ｋｅｔｏ－ＰＧＦ１ａ）及丙二醛（ＭＤＡ）含量的影响。１７只犬随机分为非缺血对照组（Ａ组）、缺血再灌注常规治疗组（Ｂ组）及缺血再灌注阿魏酸钠治疗组（Ｃ组）。结果发现，Ｂ组ＴＸＢ２、ＭＤＡ含量及ＴＸＢ２／６－ｋｅｔｏ－ＰＧＦ１ａ比值均较 Ａ组明显升高（Ｐ＜０． ０１）。 Ｃ组 ＴＸＢ２、ＭＤＡ含量及 ＴＸＢ２／６－ｋｅｔｏ－ＰＧＦ１ａ比值升高幅度均较Ｂ组明显低（Ｐ＜０．０１）。表明阿魏酸钠可明显抑制犬心脏停跳复苏后脑组织花生四烯酸代谢及脂质过氧化反应。     

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.     

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.