抚触对高胆红素血症新生儿黄疸指数及行为神经发育的影响

目的探讨抚触对高胆红素血症新生儿黄疸指数及行为神经的干预作用.方法将93例高胆红素血症新生儿随机分为A、B、C组各31例.A组采用常规治疗护理;B组在常规治疗护理基础上予抚触干预,2次/d,15 min/次,连续5 d;C组在B组基础上每日增加抚触1次.测量三组干预5 d内黄疸指数及行为神经发育情况.结果干预第2～5天B、C组黄疸指数显著低于A组(均P＜0.01),第4、5天C组黄疸指数显著低于B组(均P＜0.01);干预第5天B、C组新生儿行为神经评分显著高于A组(均P＜0.01),且C组显著高于B组(P＜0.05).结论抚触可降低高胆红素血症新生儿黄疸指数,促进其行为神经发育.     

早期腹部抚触促进新生儿胆红素排泄的研究

目的探讨预防新生儿黄疸有效安全的干预方法。方法将足月行剖宫产的60例新生儿随机分为观察组和对照组，各30例。两组均行常规护理和母乳喂养，观察组在此基础上于新生儿出生后第2、3、4天进行腹部抚触。结果新生儿出生后第2～5天观察组血清胆红素上升幅度显著低于对照组（P〈0．05，P〈0．01）；第3、5天粪胆素显著高于对照组（均P〈0．01）。结论早期腹部抚触能有效促进胆红素的排泄，预防新生儿黄疸的发生。     

游泳及抚触对新生儿体重和黄疸的影响

目的探讨游泳及抚触对新生儿体重、黄疸的影响。方法将100例正常新生儿随机均分为对照组与观察组。对照组仅接受沐浴；观察组沐浴后进行游泳和抚触，游泳分为被动泳操和婴儿自动泳操，1次／d，15min／次；抚触于游泳后按国际通用抚触法（全身按摩法）进行。观察比较两组体重和黄疸情况的差异。结果两组新生儿出生后第5天体重、黄疸指数比较，差异有显著性意义（均P〈0．05）。结论游泳及抚触有益于新生儿体重的增长和黄疸指数的降低。     

人工排便法预防新生儿黄疸

目的 促使新生儿早期排出胎便，预防新生儿黄疸。方法 将133例新生儿随机分为两组，观察组63例，采用腹部按摩加体温表玻璃棒刺激直肠壁的人工排便法促进胎便排出；对照组70例，任其自然排便。结果 出生后1～5d观察组黄疸指数显著低于对照组（P〈0．05，P〈0．01）。结论 采用人工排便法可预防新生儿黄疸。     

早期腹部抚触促进新生儿胆红素排泄的研究

目的 探讨预防新生儿黄疸有效安全的干预方法.方法 将足月行剖宫产的60例新生儿随机分为观察组和对照组,各30例.两组均行常规护理和母乳喂养,观察组在此基础上于新生儿出生后第2、3、4天进行腹部抚触.结果 新生儿出生后第2～5天观察组血清胆红素上升幅度显著低于对照组(P＜0.05,P＜0.01);第3、5天粪胆素显著高于对照组(均P＜0.01).结论 早期腹部抚触能有效促进胆红素的排泄,预防新生儿黄疸的发生.     

不同吸痰方式对呼吸机相关性肺炎的影响

目的探讨不同吸痰方式和吸痰深度对呼吸机相关性肺炎（VAP）的影响，为临床选择最佳吸痰方式提供依据。方法将80例同期行机械通气的患者随机分为A、B、C、D组各20例。A组行开放式深吸痰；B组行开放式改良深吸痰；C组行密闭式深吸痰，吸痰深度同A组；D组行密闭式改良深吸痰，吸痰深度同B组，方法同C组。结果四组VAP发生率比较，差异无显著性意义（P=0，048）；但C、D纽VAP发生时间较A、B组显著延迟（均P〈0．01）。气管插管第5天A组CPIS评分显著高于C、D组（均P〈0．01）：第7天密闭式吸痰组CPIS评分有所升高，与开放式吸痰组比较，差异无显著性意义（均P〉0．05）。结论密闭式吸痰法是否能够降低VAP尚需扩大样本进一步探讨，但在延迟VAP发生时间方面独具优势。     

中药泡洗佐治新生儿黄疸疗效观察

目的观察中药泡洗佐治新生儿黄疸的疗效。方法将70例新生儿黄疸患儿随机分为观察组（30例）和对照组（40例），观察组采用蓝光照射结合中药泡洗综合治疗，对照组仅采用蓝光照射治疗。结果总有效率观察组为100％，对照组为80％，两组比较，差异有显著性意义（P〈0．01）；胆红素降至正常所需时间，观察组为5d，对照组为7d。结论在常规治疗的基础上采用中药泡洗的方法可促进新生儿血清胆红素吸收，缩短住院时间。     

不同用药方法对盖诺疗效及不良反应的影响

目的 研究不同用药方法对盖诺疗效及不良反应的影响。方法 将60例患者按入院顺序分为A、B、C、D四组各15例，A组采用盖诺静脉滴注；其他三组行静脉注射，B组推注时间〈5min；C组5～10min；D组〉10min。结果 四组疗效差异无显著性意义（均P〉0．05）；静脉炎发生率B组显著低于A、C、D组（P〈0．01，P〈0．05）；四组全身不良反应比较，差异无显著性意义（均P〉0．05）。结论 0．9％氯化钠注射液40ml加盖诺25mg／m^2．静脉注射,5min注射完毕．可显著降低静脉炎的发生率。其疗效及全身不良反应与其它3种用药方法无区别。     

梗阻性黄疸患者全身和门静脉血流动力学变化及消炎痛的调节作用

为探讨梗阻性黄疸和胆囊结石患者全身和门静脉的血流动力学变化及消炎痛的调节作用，作者将73例梗阻性黄疸患者（A组）分为＜60岁非消炎痛组（A1组）、消炎痛术前组（A2组）、消炎痛术后组（A3组）和老年梗阻组（A6组），检测其全身和门静脉血流动力学变化，并与胆囊结石（B组）患者比较。结果：梗阻性黄疸各亚组每搏量、心输出量和心脏指数均显著高于B组（P＜0．01）；平均动脉压、周围血管阻力和门脉血流显著低于B组（P＜0．01）；A2、A3两组与其余各亚组比较，其平均动脉压、周围血管阻力和门脉血流虽有显著改善，但与B组比较仍有极显著性差异（P＜0．01）。提示消炎痛有改善梗阻性黄疸患者循环功能、门脉血流和肝功能的作用。     

应激状态下胃黏膜损伤与胃排空及胃酸分泌的关系

目的研究胃黏膜损伤的确切原因和具体过程，为临床防治胃黏膜损伤、胃炎、胃溃疡及胃癌提供新的理论依据。方法以水浸-束缚应激（WRS）大鼠的方法，将144只Wistar大鼠随机分为9组，每组16只，A、B、C3组用放射性核素99m^Tc灌胃测定大鼠胃液相排空率；D、E、F3组采用手术清除胃内容物并幽门结扎测定胃酸分泌率；G、H、I3组为手术不清除胃内容物并幽门结扎，评估胃黏膜损伤溃疡指数（uI）；分析胃排空率、胃酸分泌和胃黏膜损伤之间的关系。结果随着WRS时间延长，大鼠胃排空速率明显下降，B组（WRS2h）和C组（WRS4h）的胃排空速率与A组（正常对照组）相比，差异均有统计学意义（P〈0．01）；C组与B组比较，差异有统计学意义（P〈0．01）。大鼠胃酸分泌受到显著抑制，E组（WRS2h）和F组（WRS4h）的胃酸分泌率与D组（正常对照组）相比，差异均有统计学意义（P〈0．01）；F组与E组比较，差异无统计学意义（P〉0．05）。胃黏膜损伤随着应激时间的延长而加重，清除胃内容物可以有效防治应激引起的胃黏膜损伤，手术对本实验无明显影响。B、C组与A组的胃黏膜损伤UI比较，差异有统计学意义（P〈0．01）；C组与B组比较，差异也有统计学意义（P〈0．01）；A、D、E、F、G组大鼠未出现胃黏膜损伤。H与E组比较，差异有统计学意义（P〈0．01）；I与F组比较，差异也有统计学意义（P〈0．01）；A、D、E、F、G组间比较，差异无统计学意义（P〉0．05）。H组与B组之间和I组与c组之间比较。差异有统计学意义（P〈0．01）。结论WRS可导致胃排空障碍、胃酸分泌减少和胃黏膜损伤。     

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.     

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.     

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.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.