小切口手术与MED治疗腰椎间盘突出症的疗效比较

目的：比较椎板拉钩法的小切口手术与显微内窥镜下椎间盘切除术(microendoscopic discetomy，MED)治疗腰椎间盘突出症的手术疗效。方法：采用椎板拉钩法的小切口手术治疗腰椎间盘突出症50例，MED治疗腰椎间盘突出症58例。将二者的手术疗效行统计学分析。结果：小切口组手术出血量略多于MED组，手术时间少于MED组。术后恢复正常工作／生活时间两组无显著性差异。按照Macnab评定标准，小切口手术组：优28例，良18例；MED组：优30例，良24例，二组优良率无显著性差异。结论：小切口手术与MED治疗腰椎间盘突出症的疗效相当．且操作方便。二者可根据具体情况选用。     

应用腰椎间盘镜手术系统(MED)结合区域定位治疗腰椎间盘突出症

目的：探讨应用腰椎间盘镜手术系统（MicroEndoscopic Discectomy system,MED)结合腰椎间盘突出症区域定位提高腰椎间盘突出症治疗效果。方法：对应用MED治疗腰椎间盘突出症病人。术前进行腰椎间盘突出症区域定位分析。根据分析效果。方法：对应用MED治疗腰椎间盘突出症病人。术前进行腰椎间盘突出症区域定位分析。根据分析结果，指导MED置入和操作。清除椎间盘突出症区域内卡压因素。结果：本组45例。47个椎间盘，术前进行区域定位分析；层面：Ⅰ层面：30个，Ⅰ-Ⅲ层面：15个；Ⅰ-Ⅱ-Ⅲ层面；2个；区：1-2区：41个；2-3区；2个；2-1-2区；3个；1-2-3区：1个：域：b域：P44个；c域：3个。疗效评估分三次进行；第一次评估，优：37例，良：8例，差：0例，第二次评估。优：41例，良：3例，差：1例。第三次评估。优：43例。良：1例，差：1例。结论：MED治疗腰椎间盘突出症，术前进行腰椎间盘突出症区域定位分析。对提高MED疗效有重要意义。     

MED系统下治疗脱垂型腰椎间盘突出症中期随访

目的：探讨MED系统下治疗脱垂型腰间盘突出症的中期效果。方法：回顾性分析2001-2003年问用MED系统治疗的共31例脱垂型腰椎间盘突出症的中期疗效。结果：随访年限8～11年,据国家中医药管理局《中医病证诊断及疗效标准》腰椎间盘突出症疗效标准评定,本组31例病人中：优者24例;良者5例;可者2例。结论：MED系统治疗腰椎间盘突出症是一种有效的治疗手段,中期评价疗效更佳。     

应用椎旁阻滞治疗腰椎间盘脱出症的疗效观察

腰椎间盘脱出症是疼痛治疗临床上常见的病症，为观察腰椎旁阻滞治疗腰椎间盘脱出症的疗效，我们随机选择100例腰椎间盘脱出症病人，分别应用腰椎旁阻滞与硬膜外阻滞进行对照治疗，并对治疗效果及副反应进行比较，现将结果报告如下。     

腰椎间盘突出症手术前后的护理

腰椎间盘突出症又称腰椎间盘纤维环破裂髓核脱出症。本院１９９４年至２０００年期间，共手术治疗腰椎间盘突出病人５１例。现将护理体会报告如下。临床资料本组５１例，男３６例，女１５例；年龄最小３１岁，最大６８岁，平均４９．５岁。所有病例均行CT扫描，其中L３～４腰椎间盘突出２例，L４～５腰椎间盘突出３２例，L５～S１腰椎间盘突出１７例。均经保守治疗后效果不佳或无效而行手术治疗。本组随访６～６８个月，除１例症状未改善外，其余症状明显改善，恢复正常生活。护理体会１．术前护理：（１）心理护理：有针对性地与患者及…     

椎间盘内窥镜髓核摘除术治疗急性发作腰椎间盘突出症

目的探讨椎间盘内窥镜髓核摘除(MED)手术治疗急性发作腰椎间盘突出症的意义。方法对21例青壮年急性重症腰椎间盘突出患者在入院4h内采用MED手术摘除突出椎间盘髓核。结果21例患者术后即刻优良18例。经4～18个月随访,无一例复发腿痛,20例恢复工作。结论急诊MED手术能尽快解除急性发作腰椎间盘突出症脱出髓核对神经的急性压迫,防止神经损伤进行性加重,达到最佳治疗效果。     

MED治疗腰椎间盘突出症时对神经根变异的探查

目的：观察显微内窥镜下椎间盘切除术（microendoscopic discectomy，MED）治疗腰椎间盘突出症时神经根变异情况，防止出现术中神经根损伤。方法：回顾分析自1999年10月至2003年12月应用MED治疗的腰椎间盘突出症患者724例，其中男452例，女272例。对术中发现存在腰骶神经根变异患者的临床特点及术中所见进行统计分析。结果：724例腰椎间盘突出症患者有37例神经根变异，发生率为5.1％。与术前的临床表现吻合，全部神经根变异患者均在MED下完成手术，无一例出现神经根损伤。结论：仔细探查及分离突出髓核周围神经根发出情况．确定有无神经根变异是防止MED治疗腰椎间盘突出症时发生神经根损伤的重要环节之一。     

急诊内窥镜下椎间盘切除术治疗重症腰椎间盘突出症

重症腰椎间盘突出症系椎间盘突出或脱垂压迫马尾神经及神经根，导致大小便功能障碍、鞍区麻木、剧烈腰腿痛、活动困难等，常需急诊手术治疗。我院于2002年1月．2003年6月，应用后路显微内窥镜下髓核摘除术(microendoscopic discectomy．MED)治疗腰椎间盘突出症358例，其中43例为合并马尾神经压迫的重症腰椎间盘突出症，急诊行MED，获得满意效果，报告如下。     

显微内窥镜下椎间盘切除术治疗钙化型腰椎间盘突出症初步探讨

目的：介绍经显微内窥镜下椎间盘切除术（MED）治疗椎体后缘突出的钙化型椎间盘的手术方法。并总结其治疗效果。方法：2000年5月至2002年2月采用脊柱后路MED治疗经CT诊断并在术中证实的钙化型腰椎间盘突出症患者16例。结果：随访3-9个月，平均5.6个月，16例患者下肢痛，间歇性跛行全部消失，恢复了原工作和正常生活，但其中2例足趾，小腿外侧麻木未完全消失，参照陆裕朴评定标准，优良率为87.5%。结论：显微内窥镜下腰椎间盘摘除术治疗病史较短的钙化型腰椎间盘突出症有较好的效果。     

显微内窥镜下椎间盘切除术与传统开放术式治疗腰椎间盘突出症的疗效比较

目的：比较显微内窥镜下椎间盘切除术（MED）与传统开放式腰椎间盘切除术治疗腰椎间盘突出症的临床疗效。方法：2001年1月～2004年3月采用临床同期、随机化、病例对照研究。将97例单纯性腰椎间盘突出症患者分为2组，治疗组50例采用后路MED治疗，对照组47例采用传统开放手术方式治疗，分析比较两组患者的手术时间、术中出血量、术后住院时间、术后下地活动时间、恢复日常生活时间、住院费用及术后并发症情况，按1994年中华医学会骨科分会脊柱外科学组制定的手术疗效标准评价术后出院时疗效，并按照腰痛疗效评分方法评价其术后6、12和24个月时的临床效果。结果：MED组有2例发生脑脊液漏，对照组有2例定位错误、3例脑脊液漏和1例马尾神经损伤。MED组比对照组手术时间缩短1／3，术中出血量减少100ml，术后住院时间缩短5．8d。术后下地活动时间缩短9d，恢复日常生活时间减少24．2d，住院费用减少737元。MED组患者出院时的优良率为92．0％，对照组为91．5％，差异无显著性（P〉0．05）。MED组术后6、12和24个月时临床疗效评价优良率分别为88．0％、86．0％和84．0％，对照组分别为91．5％、91．5％和89.4％，各时间点两组之间差异无显著性（P〉0．05）。结论：两种手术方法在术后2年内效果相近，但MED安全可靠，具有术中出血少、手术时间和住院时间短、术后下地活动时间以及恢复日常生活时间早、且费用较少的优点，是治疗单纯腰椎间盘突出症的较好方法。     

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.     

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.     

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.