早期强直性脊柱炎骨密度分析

目的探讨早期强直性脊柱炎(ankylosing spondylitis,AS)患者骨密度(bone mineral density,BMD)及BMD与其他临床指标的相关性。方法回顾性研究调查2006年3月至2014年12月中日友好医院中医风湿病科确诊为早期AS患者120例,其中女性57例,平均年龄(31.02±5.94)岁;男性63岁,平均年龄(29.79±6.87)岁。健康人107例,其中女性48例,平均年龄(32.97±6.47)岁;男性59例,平均年龄(29.58±6.65)岁。双光能X线法检测腰椎、股骨颈、股骨粗隆的BMD与年龄、病程、疾病活动性指标、影像学指标进行相关分析。结果 (1)早期AS男性患者各部位的BMD均较健康人减低(P0.01),而女性患者则和健康人无统计学差异。(2)早期AS患者骨质疏松(osteoporosis,OP)6例(5%),骨量减少(osteopenia,OT)36例(21.67%)。其中男性早期AS患者腰椎OP者5例(7.93%),OT者29例(46.03%)。早期AS患者中,男性腰椎部位OP、OT发生率较女性高(P0.05),股骨颈及股骨粗隆部位OP/OT发生率无差异。(3)中、低年龄组中,早期AS患者的腰椎和股骨颈BMD较健康人显著减低,差异有统计学差异(P0.01)。(4)男性早期AS患者腰椎BMD与年龄呈显著负相关(P0.01)。结论早期AS男性患者即可出现显著BMD下降,OP发生率为7.93%,OT发生率为46.03%。其中腰椎部位BMD减低及OT发生率更为突出。早期AS患者BMD的下降与疾病活动指标无关联。对于男性AS患者,在疾病早期即需要重视OT及OP的诊断与防治。     

男女强直性脊柱炎骨密度对比分析

目的探讨男性和女性强直性脊柱炎(Ankylosing Spondylitis,AS)患者骨密度（Bone mineral density,BMD)及BMD与其 他临床指标的相关性。方法回顾性调查2006年3月至2014年12月中日友好医院中医风湿病科确诊为AS的患者,其中女 性168例,男性587例,年龄在20岁~45岁,双光能X线法检测腰椎、股骨颈、股骨粗隆的BMD,并与年龄、病程、疾病活动性 指标、影像学指标进行相关分析。结果①男性AS患者腰椎BMD较女性腰椎BMD显著减低（P < 0. 01);男性AS患者骨质 疏松（Osteoporosis,OP)及骨量减少（Osteopenia,OT)总发生率为"71. 04%,显著高于女性AS患者的42. 86% ( P < 0. 05),且在 腰椎、股骨颈、股骨粗隆部位的OP、OT发生率均显著高于女性AS患者(P <0. 01);②中年龄组(30 ~ 39岁）及高年龄组(40? 45岁）的AS患者中男性腰椎丽D较女性显著降低（P < 0. 01);高年龄组AS患者中男性股骨颈丽D较女性显著降低（P < 0. 01);病程5 ~ 10年及大于10年的AS患者中男性腰椎、股骨颈丽D较女性显著降低（P <0. 01、P <0. 01、P <0. 01、尸<05)③相关性分析显示男性与女性AS患者BMD与疾病活动指标ESR、CRP,体征、骶髂关节炎分级等有相关性,而男性AS 患者丽D与年龄、病程尚呈显著负相关(P <0. 05)。结论男女AS患者均有较高的OT、OP的发生率,且男性OT及OP的较 之女性更为显著,特别是腰椎BMD男性AS患者减低更为突出。此外年龄越大、病程越长的男性AS患者BMD减低程度越明 显。男性与女性AS患者丽D的下降均与疾病程度、病情的活动性、肢体活动功能、HLA427相关联。对于男性AS患者更需 要重视OT及OP的诊断与防治。     

男性强直性脊柱炎患者骨密度与血尿酸水平相关性研究

目的分析强直性脊柱炎(ankylosing spondylitis,AS)男性患者骨密度(bone mineral density,BMD)与血尿酸(serum uric acid,SUA)的相关关系。方法回顾性分析2013年9月到2018年9月在中日友好医院确诊的143名男性AS患者,按腰椎、股骨颈、股骨粗隆BMD水平各分为正常骨量组和骨量减少组。比较两组间患者临床基本资料、疾病活动程度指标等的差异;使用多元回归分析评估SUA水平与男性AS患者各部位BMD的关系;使用Logistic回归模型预测SUA与各部位BMD之间的风险概率;构建列线图预测男性AS患者腰椎及股骨粗隆发生骨量减少的风险。结果两组间比较结果显示,身高、腰椎、股骨颈、股骨粗隆BMD比较差异均有统计学意义(均P<0.05)。多元线性回归分析提示SUA水平与腰椎、股骨粗隆的BMD呈正相关。Logistic回归分析结果提示,SUA每降低78 mmol/L发生腰椎和股骨粗隆骨量减少的风险分别升高18%和17%。通过构建的列线图可预测男性AS患者发生腰椎及股骨粗隆骨量减少的风险。结论SUA水平低可能会增加男性AS患者腰椎和股骨粗隆骨量减少的风险,SUA具有反映男性AS患者骨量减少风险的潜力。     

强直性脊柱炎患者血清TNF-a、BGP和CTX水平与骨密度的关系

目的探讨强直性脊柱炎(AS)患者骨质疏松(OP)的发病机制。方法分别测定36例男性AS患者血清肿瘤坏死因子-a(TNF-a)、骨钙素(BGP)I、-型胶原C末端肽(CTX)水平及腰椎和股骨颈的骨密度(BMD)值,并与20例健康者对照。结果AS早期腰椎和股骨颈BMD均低于对照组,晚期股骨颈BMD更低于对照组。AS血清TNF-a、CTX水平较对照组显著增高(P<0.01;P<0.05),而血清BGP水平较对照组无显著差差异(P>0.05)。AS患者中OP组TNF-a、CTX水平较NOP组显著增高(P<0.01;P<0.05),OP组中血清TNF-a与CTX呈正相关,与股骨颈密度呈负相关;与BGP无明显相关性。结论AS患者主要是由于骨吸收增加而导致骨质疏松的发生。血清TNF-α水平的增高可促进骨吸收加强,是AS骨质疏松的重要原因之一。降低血清TNF-a水平,对AS患者骨质疏松的防治可能有积极的意义。     

昆明地区中老年人群定量CT骨密度测定及骨质疏松症患病率调查

目的 采用定量CT（quantitative computed tomograph,QCT）分析昆明地区中老年人群腰椎和髋部骨密度(bone mineral density,BMD)及骨质疏松（osteoporosis,OP）情况。方法 选取2021年3月至11月于云南省第一人民医院自愿接受腰椎和髋部QCT扫描的昆明地区50岁及以上中老年人,并记录其身高、体重和病史。将受检者以10岁为1个年龄层,按照不同性别,各分为3组（50~59岁,60~69岁,70岁及以上）。分别测量腰1~2椎体平均骨密度（L1-2 BMD）及全髋面积骨密度（TH aBMD）、全髋体积骨密度（TH vBMD）、股骨颈面积骨密度（FN aBMD）、股骨颈体积骨密度（FN vBMD）、股骨大粗隆面积骨密度（TR aBMD）、股骨大粗隆体积骨密度（TR vBMD）、股骨粗隆间面积骨密度（IT aBMD）、股骨粗隆间体积骨密度（IT vBMD）等参数。结果 共纳入555例受检者（男性180例,女性375例）,基于腰椎、全髋及二者任一部位BMD测量获取的OP总体患病率分别为33.51 %、12.79 %和36.04 %,其中任一部位的OP检出率与腰椎检出率差异无统计学意义（P＞0.05）,腰椎和任一部位的OP检出率均明显高于髋部（P均＜0.001）。50~59岁年龄组,男性与女性L1-2 椎体BMD差异无统计学意义（P>0.05）,60~69岁及70岁以上年龄组女性L1-2 椎体BMD均小于男性（P<0.001）。男性髋部各部位BMD与年龄无关（P>0.05）,女性则与年龄呈负相关（P<0.05）。50~59岁年龄组男女TH vBMD、FN vBMD、TR aBMD、IT vBMD差异有统计学意义（P<0.05）,除女性TR aBMD低于男性外,其余均高于男性;60~69岁年龄组男性TH aBMD、FN aBMD、TR aBMD、TH vBMD、IT aBMD均大于女性（P<0.05）;70岁以上年龄组男性髋部各部位BMD均大于女性（P<0.05）。结论 昆明地区中老年人群腰椎测量OP总体患病率为33.51 %,全髋为12.79 %。60岁以上女性OP患病率显著高于男性,女性髋部BMD较男性更低。     

广州地区1 403例成年女性骨密度测定分析

目的了解本地区成年女性人群腰椎、股骨近端各部位骨密度(Bone mineral density BMD)随年龄、绝经年限、体重、身高的变化规律、各部位骨密度的偏相关分析和多元线性回归分析及骨质疏松患病率情况,为骨质疏松的诊断及预防提供科学依据.方法采用美国NORLAND公司的XR-46系列双能X线骨密度仪测量1 403例成年女性人群腰椎(L2-L4前后位及L3侧位)、非优势(左)股骨近端各部位(股骨颈、大粗隆及Ward's三角)BMD值,按10岁一个年龄组分7组对数据进行统计分析.结果广州地区成年女性腰椎骨峰含量出现在30～39岁组,而股骨近端骨峰含量出现在20～29岁组,腰椎及股骨近端各部位BMD值均随年龄增长而下降,腰椎和Ward's三角部位在50～59岁和60～69岁两年龄组骨量呈快速丢失现象.各部位骨密度的偏相关分析显示各部位的骨密度均呈相关性(P＜0.01).多元线性回归分析显示年龄和体重对绝经前女性股骨颈的骨密度有影响(P＜0.01),而绝经后女性腰3侧位骨密度除了年龄和体重的影响外,身高和绝经年限均对其有影响(P＜0.01).成年女性在达到峰值骨量后随着年龄的增加,各部位骨质疏松的患病率都呈上升趋势.结论女性机体BMD随年龄而变化,年龄、体重、绝经年限及身高等对机体BMD均有一定的影响,保持合适的体重和体型,有利于BMD的增加与维持.对不同年龄段的成年女性人群,预防骨质疏松的发生应以测量不同部位的BMD作为评价手段.     

强直性脊柱炎患者腰椎定量CT骨密度测定及分析

目的 测定强直性脊柱炎患者腰椎骨密度(BMD),分析骨量变化相关因素,指导治疗。方法 选取强直性脊柱炎患者66例为实验组,26例健康查体者为对照组,登记一般资料及病程、ESR、CRP、BASFI及HLA-B27等指标,应用定量CT测定腰1-5椎体BMD,进行两组间BMD比较及危险因素相关分析。结果 实验组腰椎皮质骨及松质骨BMD均显著低于对照组（269.1±39.8 vs 308.2±49.3 mg/mL,140.8±18.6 vs 190.1±15.7 mg/mL,P<0.01）,实验组腰椎松质骨BMD丢失百分率显著高于皮质骨（25.9±10.3% vs 12.7±13.2%,P<0.01）,实验组骨量减少和骨质疏松发生率分别为45.5%和39.4%。病程及骶髂关节破坏程度与骨密度负相关,身高、体重、BMI、BASFI、ESR和/或CRP是否升高及HLA-B27阳性与否均与骨密度无相关性。结论 强直性脊柱炎患者腰椎BMD显著降低,骨质疏松发生率高,应早期评估BMD,及时应用生物制剂等防治骨量丢失。     

阿仑膦酸钠对类风湿关节炎合并骨质疏松患者骨强度的影响

目的 分析阿仑膦酸钠对类风湿关节炎（rheumatoid arthritis,RA）合并骨质疏松（osteoporosis,OP）患者骨强度的影响。方法 选取华北理工大学附属医院骨质疏松门诊2012年6月至2020年6月诊治的OP患者120例,分为RA+OP组（60例）和OP组（60例）,且均口服阿仑膦酸钠联合骨化三醇、钙尔奇D持续12个月。比较治疗前后表征髋部力学结构强度的参数值CSA、CSMI、Z、CT和BR值（分别代表股骨颈抗轴向压缩力、骨骼刚度、抗屈曲负荷系数、皮质骨厚薄及屈曲比）、骨密度（BMD）、骨折发生率、炎性指标及临床体征。结果 经治疗6月、12月后,除RA+OP组全髋部位BMD外,OP组全髋、两组患者腰椎、股骨颈BMD、CSA、CSMI、Z、CT值均高于治疗前（P＜0.05）,BR值均低于治疗前（P＜0.05）;治疗12月后,RA+OP组股骨颈、全髋BMD、CSA、CSMI、Z值均低于OP组（P＜0.05）,腰椎BMD、CT、BR值无差异;治疗6至12月期间,RA+OP组股骨颈、全髋BMD增长率低于OP组（P＜0.05）;RA+OP组治疗前骨折发生率显著高于OP组,所有RA患者疾病活动性控制良好。结论 阿仑膦酸钠联合骨化三醇和钙剂可明显提升RA患者骨密度及髋部骨强度,提高骨骼稳定性,这种提升随疗程延长比正常骨质疏松患者缓慢。     

强直性脊柱炎合并髋关节累及患者骨质疏松症发病概况及相关因素分析

目的研究强直性脊柱炎(ankylosing spondylitis,AS)合并髋关节累及患者骨质疏松症的发病概况、特点及相关因素。方法收集有髋关节受累的AS患者82例,并以80名健康体检者作为对照。收集患者的临床资料,包括胸腰椎及骨盆X线、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白水平(C-reactive protein,CRP)、HLA-B27、强直性脊柱炎疾病活动指数(bath ankylosing spondylitis disease activity index,BASDAI)、强直性脊柱炎Bath功能指数、强直性脊柱炎放射学指数及治疗情况等。双能X线检测骨密度(bone mineral density,BMD),测量部位为腰椎1~4和股骨颈部位。结果 AS合并髋关节累及的患者骨量减少或骨质疏松发生率(78.05%)明显高于健康对照组(32.5%);与正常对照组比较,AS组表现出更高的骨量减少(46.3%VS 27.5%)和骨质疏松发生率(31.7%VS 5.0%)。但AS患者骨密度检测率及抗骨质疏松治疗率极低。合并髋关节受累的AS患者腰椎及股骨颈部位骨密度水平均明显低于正常对照组。相关性分析结果显示,ESR升高是AS患者腰椎骨丢失的危险因素;而身高、体重、BASDAI及CRP水平与股骨颈部位骨密度明显相关。结论 AS合并髋关节累及患者腰椎及股骨颈部位骨密度水平均明显降低;ESR及CRP水平升高、高疾病活动度是AS患者骨丢失的危险因素;AS合并髋关节累及患者骨质疏松发生率高,但骨密度检测率及抗骨质疏松治疗率极低。     

老年男性骨密度与踝肱指数的相关性探讨

目的探讨老年男性骨质疏松(OP)与外周动脉疾病(PAD)间的相关性。方法选取我院查体的老年男性222例,年龄53～94岁,平均76.65±9.48岁,采用双能X线吸收法(DXA)测定正位腰椎、股骨颈、粗隆、全股骨的骨密度,测定踝肱指数(ABI)。按ABI0.9者入选PAD组(87例),ABI≥0.9者为非PAD组(135例)。记录两组患者收缩压(SBP)、舒张压(DBP)、总胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)等指标。结果 PAD组与非PAD组除年龄有显著性差异外,血压、血脂、骨密度异常检出率及各部位骨密度二组间无统计学差异,股骨颈,粗隆,全股骨与踝肱指数呈正相关(r=0.258,0.208,0.247,P0.001)。髋部各部位BMD与身高、年龄、体重、ABI、DBP、LDL-C有显著相关性(P0.001)。结论 老年男性PAD与非PAD患者间骨密度无显著差异,但髋部BMD指标与ABI密切相关,并同时受增龄等其他因素影响,提示骨质疏松与外周动脉疾病间存在共同病理生理机制。     

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.