生理盐水肠道冲洗辅助治疗真菌性肠炎效果观察

目的 探讨生理盐水肠道冲洗辅助治疗真菌性肠炎的疗效。方法 将72例真菌性肠炎患者随机分为观察组和对照组各36例，对照组行常规治疗，观察组在此基础上予以温生理盐水（38～41℃）500～7000ml持续肠道冲洗，3～6h／次，1次／d，治疗1～3次。结果 观察组治疗后肠道pH值显著低于治疗前及对照组治疗后（均P〈0．01），治愈率显著高于对照组（P〈0．01）。结论 对真菌性肠炎腹泻患者在常规治疗的基础上，辅以温生理盐水肠道冲洗可显著改善肠道环境，提高治愈率。     

生理盐水冷敷辅助治疗压疮的效果观察

目的 探讨生理盐水冷敷辅助治疗压疮的效果.方法 将42例(80处)Ⅱ～Ⅳ期压疮患者随机分为对照组20例(38处)和观察组22例(42处),对照组按常规处理压疮疮面,观察组在常规治疗基础上采用20～23℃生理盐水冷敷患处.观察压疮直径大小、分泌物变化及结痂情况.结果 观察组总有效率95.24%,对照组总有效率71.05%,两组比较,差异有显著性意义(P＜0.01).观察组压疮直径缩小速度、分泌物减少程度、结痂情况显著优于对照组(P＜0.05,P＜0.01).结论 生理盐水冷敷压疮患处可提高压疮治疗效果.     

应用生理盐水冲洗深静脉营养导管效果观察

目的 探讨应用生理盐水冲洗深静脉营养导管的效果.方法 将31例行深静脉营养治疗患者随机分为观察组(15例)和对照组(16例).对照组常规采用肝素钠盐水冲洗深静脉营养导管,观察组在应用常规法的同时加用生理盐水冲管.结果 两组导管留置时间比较,差异无显著性意义(P＞0.05),置管后第6～10天液体滴注速度、导管堵塞率比较,差异有显著性意义(均P＜0.01).结论 用生理盐水冲洗深静脉营养导管是预防导管堵塞的有效方法.     

放射性肠炎患者保留灌肠法的改进

目的 探讨改良保留灌肠法治疗放射性肠炎的效果.方法 将40例放射性肠炎患者随机分为观察组和对照组各20例,对照组按照常规方法 保留灌肠,观察组采用增加药液剂量和插管深度等改良方法,比较两组治疗效果.结果 观察组治愈率显著高于对照组(P＜0.05).结论 改良保留灌肠法可提高放射性肠炎治疗效果.     

多频振动治疗仪辅治呼吸道感染患儿效果观察

目的 探讨多频振动治疗仪在呼吸道感染患儿排痰中的辅助治疗作用.方法 将呼吸道感染住院患儿152例随机均分为观察组和对照组,在常规治疗护理的基础上,观察组给予多频振动治疗仪治疗,对照组患儿给予常规排痰治疗.两组均治疗10～15 min/次,3次/d.结果 观察组排痰量及治疗效果显著优于对照组(P＜0.05,P＜0.01)...     

聚乙二醇电解质散溶液用于胃癌术前肠道清洁的临床观察

目的 探讨胃癌患者术前肠道清洁的有效方法.方法 将120例术前需肠道清洁的胃癌患者随机分为观察组和对照组各60例,观察组术前口服聚乙二醇电解质散溶液,对照组常规口服甘露醇溶液.结果 观察组灌肠次数显著少于对照组(P＜0.01),肠道清洁获佳率显著高于对照组(P＜0.05),术后首次排气、排便时间显著早于对照组(均P＜0.01).结论 口服聚乙二醇电解质散溶液用于术前肠道清洁效果理想,且胃肠功能恢复快,无并发症发生.     

糜蛋白酶溶液膀胱保留灌注治疗膀胱积血疗效观察

目的 探讨α-糜蛋白酶溶液膀胱保留灌注治疗膀胱积血的疗效.方法 将40例膀胱积血患者随机均分为观察组和对照组,两组均用生理盐水行膀胱冲洗,在此基础上观察组每天给予α-糜蛋白酶溶液行膀胱保留灌注;而对照组采用生理盐水行膀胱保留灌注.保留30 min,连续3 d,观察两组血块体积变化、尿色转清时间及患者不适症状.结果 观察组患者保留膀胱灌注后B超测量膀胱血块体积显著小于对照组(P＜0.05);且泌尿道不适程度、尿液中血色转清时间显著低于对照组(均P＜0.01).结论 α-糜蛋白酶溶液膀胱保留灌注治疗膀胱积血能快速有效清除膀胱积血,且可减轻患者泌尿道不适症状.     

变速关节腔冲洗治疗化脓性膝关节炎效果观察

目的 提高关节腔冲洗治疗化脓性膝关节炎的疗效.方法 将72例化脓性膝关节炎患者随机分为观察组与对照组各36例.观察组先以80～120 gtt/min关节腔冲洗2 h后改为60 gtt/min冲洗1 h,再改为80～120 gtt/min冲洗2h,用此方法行24 h循环持续冲洗;对照组以60 gtt/min的速度行持续匀速关节腔冲洗.结果 观察组体温下降时间及关节腔积液、肿胀消退,疼痛消失时间显著短于对照组(P＜0.05,P＜0.01).结论 持续变速关节腔冲洗有利于关节腔内杂质、沉淀物的清除,其效果明显优于持续匀速关节腔冲洗.     

西瓜霜联合芝麻油外搽治疗压疮

目的 探讨西瓜霜联合芝麻油外搽治疗压疮的疗效.方法 将神经内科67例压疮患者随机分成观察组39例和对照组28例,两组同法对创面清创、消毒后,观察组用西瓜霜与芝麻油混合剂均匀涂抹创面,对照组用表皮生长因子涂抹创面,每日2～3次.结果 观察组压疮治愈率显著高于对照组,压疮愈合时间显著短于对照组(P＜0.05,P＜0.01).结论 西瓜霜联合芝麻油外搽治疗压疮疗效显著.     

清开灵氧气驱动雾化辅助治疗慢性阻塞性肺疾病效果观察

目的 探讨清开灵氧气驱动雾化辅助治疗慢性阻塞性肺疾病(COPD)急性加重期的疗效.方法 将80例COPD加重期患者随机分为两组各40例,对照组行常规治疗,观察组在此基础上辅以清开灵氧气驱动雾化,2次/d,15 min/次.连续7 d后评价疗效.结果 临床症状改善情况,PaO2及白细胞计数观察组显著优于对照组(P＜0.05,P＜0.01).结论 清开灵氧气驱动雾化吸入可有效改善COPD患者症状.     

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.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

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.     

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.     

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.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.