彩色多普勒超声检测门静脉血流动力学改变在门静脉高压症分期中的意义

目的探讨彩色多普勒超声在门静脉高压症临床分期中应用的意义.方法应用彩色多普勒超声对38例肝硬化门静脉高压症患者和20例健康体检者门静脉血流动力学进行检测,指标包括门静脉最大内径、门静脉血流速度和血流量.比较在不同肝功能分级、有无腹水和有无胃底食管静脉曲张等的差异.结果门静脉血流速度和血流量随Child-Pugh A,B 和C级而逐渐降低,分别为(18.5±3.02) cm/s和(1358.48±384) ml/min,(16.0±3.89) cm/s和(1142.23±390) ml/min,(12.25±1.67) cm/s和(788.59±234) ml/min;腹水组较无腹水组低,分别为(13.0±1.72) cm/s和(1078±533) ml/min,(18.6±2.60) cm/s和(1394±354) ml/min,以上差异均具有显著性.而在食管胃底静脉曲张轻、重度组之间却无显著性差异(P＞0.05).门静脉内径在所有组间均无显著性差异(P＞0.05).结论肝硬化患者肝功能分级越差,门静脉血流速度和血流量则越低.超声学检测门静脉血流速度可以较敏感反映肝功能损害和门静脉高压症的进程和代偿状态,可作为门静脉高压症临床分期的重要指标.     

用适时超声容量血流计同时测量肝动脉和门静脉血流

目前已有多种测量肝血流的技术,各有其缺陷,常用的电磁血流计不能同时精确测量门静脉血流.本文介绍用适时超声容量血流计同时测定肝动脉和门静脉血流的结果.资料和方法:15例病人,平均年龄54.5岁(40～75岁),均在全麻下行腹部内脏癌肿手术.将超声血流探子植入肝动脉适当处,用适时超声容量血流计(T201型超声系统公司)测量血流.先取得基础血流量,暂时阻断门静脉,观察肝动脉血流的变化,继而阻断肝动脉,观察门静脉血流的变化.7例暂时阻断肝总动脉,了解肝动脉和门静脉血流的影响.结果:(1)肝动脉、门静脉和全肝血流量的基础值分别为267.3±21.2、746.4±41.3和1010.7±52.7ml/min;按每公斤体重计算,则分别为4.9±     

无创性血流动力学检查在腹腔镜胆囊切除术中的应用

目的探讨彩色多普勒超声在腹腔镜胆囊切除术围手术期股静脉血流动力学检测中的作用及意义。方法采用二维灰阶超声、彩色多普勒血流显像及脉冲多普勒超声技术相结合,对28例腹腔镜胆囊切除术患者围手术期及手术期间股静脉横截面积、流速及流量的变化进行测定。结果(1)与术前麻醉状态(BASELINE期)相比,单纯给予气腹(PP期)后,股静脉横截面积由(0.72±0.31)cm2增至(1.08±0.31)cm2(P=0.004),流速由(14.23±11.96)cm/s降至(5.50±2.63)cm/s(P=0.017),流量由(596.49±477.95)ml/min降至(340.41±166.14)ml/min(P=0.018);与PP期相比较,气腹及头高脚低位(PP和RT期)时,股静脉横截面积增大[(1.32±0.14)cm2,P=0.039]、流速降低[(4.40±1.75)cm/s,P=0.034],流量[(346.69±142.66)ml/min,P=0.067]则未见明显降低;与BASELINE期相比,手术后(PO期)股静脉横截面积恢复至术前状态[(0.86±0.15)cm2,P=0.222],股静脉流速[(11.35±8.02)cm/s,P=0.412]、流量[(566.94±348.55)ml/min,P=0.840]也基本得以恢复。(2)彩色多普勒血流结合脉冲多普勒的检测结果显示,28例患者中21例可见股静脉内的血流停滞,其中15例出现返流现象。结论腹腔镜胆囊切除术中由于气腹和头高脚低位体位(reverse Trendelenburg position,RT)的双重作用,股静脉内血流缓慢,甚至会出现短暂的血流停滞、返流等现象,因此,腹腔镜手术围手术期可应用彩色多普勒超声检查以利早期检出下肢深静脉血栓性病变。     

门静脉高压症血流动力学改变及冠状静脉脾静脉壁NOS2、VEGF表达与出血的关系

目的研究门静脉高压症病人门静脉系统血流动力学改变与食管胃底静脉曲张破裂出血的关系,及不同出血史病人门静脉系统血管壁NOS2、VEGF的表达.方法 43例门静脉高压症病人依照出血病史分为两组,A 组(无上消化道出血史或1次出血史)26例,B组(>1次出血史)17例行门静脉系统超声血流检查,术中测压,取冠状静脉脾静脉血管壁免疫组化NOS2、VEGF染色(S-P法).结果门静脉主干内径(PVD)(14.56±1.69)mm,最大血流速度(PVMAX)(19.47±5.35) cm/s,血流量(PVBF)(840.66±211.81)L/min,门静脉压(PVP)(33.2±7.07) cmH2O.A、B两组病人门静脉最大血流速度及门静脉压(PVP)无统计学意义.A组病人门静脉直径及门静脉血流量显著高于B组.43例中28例(65.1%)有冠状静脉逆流(离肝血流).脾静脉血流量(422.5±139.4)L/min,脾静脉平均血流量与门静脉平均血流量之比为0.503,B组病人脾静脉血流量低于A组.脾静脉NOS2阳性率A组为30.8%,B组为52.9%.冠状静脉VEGF阳性率A组为38.5%,B组为58.8%.门静脉系统血管内皮的NOS2和VEGF均有高表达.结论门静脉系统高血流动力学是引起出血的基本条件,初期高血流动力学是机体代偿机制;多次出血史病人门静脉脾静脉血流量明显下降;脾静脉主动充血在门静脉高压症的发生中起重要作用;血管结构改变是影响出血的重要抑或直接因素;门静脉系统血管内皮NOS2高表达在维持高血流动力学中起重要作用;门静脉系统血管内皮VEGF高表达与血管结构改变紧密关联,并因此影响出血情况.     

腹腔镜胆囊切除术围手术期股静脉血流动力学的变化

目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)围手术期股静脉血流动力学的变化及其意义。方法通过彩色多普勒超声诊断仪对28例手术前后4个不同的时期(BL、PP、PP&RT、PO)的股静脉横截面积、流速及流量等指标进行测定。结果①与术前麻醉状态(BASELINE)相比,单纯给予气腹(PP)后,股静脉横截面积由(0.72±0.31)cm2增至(1.08±0.31)cm2(P=0.004),流速由(14.23±11.96)cm/s降至(5.50±2.63)cm/s(P=0.017),流量由(596.49±477.95)ml/min降至(340.41±166.14)ml/min(P=0.018);与PP期相比较,气腹及头高脚低位(PP&RT)时,股静脉横截面积增大[(1.32±0.14)cm2,P=0.039]、流速降低[(4.40±1.75)cm/s,P=0.034)],流量则未明显降低[(346.69±142.66)ml/min,P=0.067]与BASELINE期相比,手术后(PO)股静脉横截面积恢复至术前状态[(0.86±0.15)cm2,P=0.222],股静脉流速[(11.35±8.02)cm/s,P=0.412]、流量[(566.94±348.55)ml/min,P=0.840]也基本得以恢复。②脉冲多普勒的检测结果显示,21例可见股静脉内的血流停滞,其中15例出现反流现象。结论LC术中由于气腹和头高脚低位体位(reversetrendelenburgposition,RT)的双重作用,股静脉内血流缓慢,甚至会出现短暂的血流停滞、反流等现象。     

经尿道等离子体双极电切术治疗老年女性膀胱颈梗阻(附37例报告)

目的 探讨治疗老年女性膀胱颈梗阻的有效治疗方法.方法 采用经尿道等离子体膀胱颈双极电切术治疗老年女性膀胱颈梗阻37例.结果 37例平均手术时间17min(10～57min),失血＜10ml,无水中毒及尿失禁发生.治疗后生活质量评分由4.0±1.0降至1.6±0.3(t=4.21,P＜0.01),最大尿流率由(9.7±2.1)ml/s升至(21.4±4.2)ml/s(t=3.74,P＜0.01),残余尿量由(82.0±17.0)ml降至(12.7±7.7)ml(t=2.92,P＜0.01). 结论 经尿道等离子体双极电切术是治疗老年女性膀胱颈梗阻有效的腔内治疗方法.     

肝硬化变门静脉高压症患者血浆内皮素水平内毒素血症的临 …

目的　肝硬变患者血浆内皮素含量究竟升高还是降低 ,学术界还有争论 ,鉴于内皮素的强大血管活性作用 ,因此有必要进一步探讨。方法　我们用放射免疫法测定了 12 1例肝硬变患者和5 0例年龄、性别相称的对照者血浆内皮素水平 ,并探讨了与合并腹水者内毒素血症的关系。结果　肝硬变患者血浆内皮素水平比对照组明显增高〔股动脉 :(82± 2 0 )pg/ml,(30± 8)pg/ml,P <0 0 1;股静脉 :(90± 2 3)pg/ml,(34± 8)pg/ml,P <0 0 1;贵要静脉 :(87± 2 3)pg/ml,(33± 8)pg/ml,P <0 0 1〕。此外 ,合并腹水的肝硬变患者股静脉血内皮素含量比无腹水患者增高明显〔(10 6± 17)pg/ml,(90±2 3)pg/ml,P <0 0 1)。股静脉血浆内皮素含量与内毒素血症的严重程度呈正相关 (rs=0 6 1,P =0 0 34 )。结论　肝硬变门静脉高压症患者血浆内皮素水平的增高可能对肝硬变患者门静脉血管阻力的增加有重要影响 ,内毒素是内皮素合成和释放的强烈刺激因子。     

门静脉高压症血流动力学变化的临床研究

目的：探讨脾脏体积大小与门静脉系统高动力循环状态及手术前后门静脉体循环分流率，血流动力学变化的关系。方法：利用彩色多普勒复合装置、CT及公式法测量22例肝硬变门静脉高压症行脾切除、贲门周围血管离断术（下简称门静脉奇静脉断流术）患者的血流动力学变化参数、脾体积及门静脉体循环分流率。结果：（1）门静脉血流量（PVF）：对照组为785±144ml/min；实验组为966±125ml/min（t=3.56,P=0.002)。其中实验组的脾静脉血流量／门静脉血流量（SVF／PVF）为77％±17％，实验组的肠系膜上静脉血流量／门静脉血流量（SMVF／PVF）为28％±8％。（2）脾体积与脾静脉血流量、流速、直径显著相关（r=0.793,P<0.001,r=0.471,P<0.05,r=0.494,P<0.02)。（3）术后PVF减少187±87ml/min,SMVF增加100±40ml/min，门静脉体循环分流率减少26％±15％。结论：门静脉高压症时，门静脉系统处于高动力循环状态，对门静脉高压的形成和维持有重要意义。脾脏的高动力循环是门静脉系统产生高动力循环的主要因素。门静脉奇静脉断流术后、门静脉血流量的变化取决于术前脾脏的高动力循环状态，胃脾区的分流程度及术后肠系膜上静脉的代偿能力。     

肝阻抗血流图评价门静脉高压症患者贲门周围血管离断术前后肝血流灌注的改变

目的利用肝阻抗血流图探讨肝硬化门静脉高压症患者的肝脏血流灌注改变和贲门周围血管离断术对肝血流灌注的影响.方法选取22例肝硬化门静脉高压症患者,分别在术前1周、术后2周检测其肝血流阻抗的改变,同时用Doppler彩超检测门静脉血流动力学的变化.结果肝阻抗血流图测定结果表明,门静脉高压症患者的肝动脉、门静脉向肝血流灌注明显下降,总肝灌注血流降低[(0.053±0.011)比(0.031±0.009)、(0.033±0.011)比(0.018±0.008)、(7.7±3.0)比(3.5±1.7),P<0.05];断流术后门静脉高压症患者的门静脉向肝灌注增加[(0.018±0.008)比(0.026±0.006),P<0.05],肝动脉向肝灌注无显著改变.结论肝硬化患者肝动脉、门静脉向肝有效血流灌注都降低,肝脏总血流量下降;贲门周围血管离断术能增加大部分患者的门静脉向肝血流灌注,但对肝动脉的向肝灌注无显著影响;肝阻抗血流图对于评价肝硬化患者的肝脏血流及手术对肝脏血流动力学的影响有一定的价值.     

选择性消化道灭菌对急性胰腺炎肠源性内毒素血症的预防作用

目的探讨选择性消化道灭菌(SDD)对肠源性内毒素血症的预防作用.方法 Wistar大鼠60只,胰管逆行灌注法复制急性坏死性胰腺炎(ANP)模型,设立正常对照组、假手术组、ANP组和SDD治疗组(ANP后喂服三联抗生素),记录发病72小时组织学、血清TNFα、IL-1β、肠道菌群、血浆D-乳酸(肠通透性指标)和内毒素含量及病死率. 结果 SDD使ANP胰腺和小肠病理改变减轻,TNFα水平下降(P<0.01).ANP时肠道大肠杆菌等条件致病菌过度繁殖,双歧杆菌数量减少,SDD抑制了致病菌的繁殖,双歧杆菌数量不变,双歧杆菌/大肠杆菌比值(B/E值)回升(P<0.01).SDD组血浆D-乳酸由(8.05±3.05) mg/L降至(3.95±1.83) mg/L(P<0.01),门静脉内毒素由(0.423±0.155) EU/ml下降至(0.227±0.084) EU/ml(P<0.01).ANP组72小时病死率为58.8%,SDD组为14.3%(P=0.005).结论 SDD可减少肠道革兰氏阴性菌含量,保护正常菌群,维护肠屏障,减轻了ANP时肠源性内毒素血症,有助于提高ANP的生存率.     

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.     

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.     

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.