重症急性胰腺炎的早期营养支持治疗

目的分析重症急性胰腺炎的早期营养支持治疗方法及效果。 方法选取了2013年10月至2016年10月收治的122例重症急性胰腺炎患者作为研究对象,随机分为肠内营养组(EN组)和肠外营养组(TPN组),使用SPSS19.0统计软件进行分析,两组患者的并发症发生率采用χ²检验;各项营养指标、APACHEⅡ评分和Ranson评分采用( ±s)表示,独立t检验。P<0.05差异具有统计学意义。 结果两组患者治疗前的营养指标以及APACHEⅡ评分和Ranson评分相比差异无统计学意义(P>0.05),治疗后,肠内营养组患者的各项营养指标均明显优于肠外营养组(P<0.05),且肠内营养组患者的APACHEⅡ评分和Ranson评分明显低于肠外营养组(P<0.05);肠内营养组患者的肾衰、腹腔感染等并发症发生率明显低于肠外营养组(P<0.05)。 结论应用早期肠内营养治疗可以有效改善重症急性胰腺炎患者的身体营养状况,从而提高患者的免疫力,降低了患者的APACHEⅡ、Ranson评分以及并发症发生率,宜广泛应用于临床治疗中。     

全胃切除患者术后早期强化免疫营养的临床效果分析

目的观察术后早期强化肠内免疫营养对全胃切除术患者的临床效果。方法全胃切除术后胃癌患者120例,所有患者均曾合并术前营养不良,其中60例患者术后早期接受普通肠内营养(EN组),另外60例接受强化的肠内免疫营养(EIN组)。分别于术前1天、术后第1天、术后第8天检测两组患者的营养指标(血清白蛋白、前白蛋白和转铁蛋白)及免疫指标(血清IgA、IgG、IgM和外周血T淋巴细胞亚群),并观察术后感染性的发生率。结果术前两组问各营养指标比较无显著性差异(P0.05);两组患者术后第1天的各项营养指标和免疫指标较术前均显著下降(P0.05);两组患者术后第8天的营养指标和免疫指标较术后第1天均有改善,且EIN组患者的各项免疫指标均高于EN组(P0.05),两组间营养指标比较无统计学差异(P0.05);EIN组术后感染性的发生率较EN组低(P0.05)。结论术后早期肠内免疫营养能更好地改善全胃切除术后患者的免疫状态,并降低术后感染性发生率。     

合理营养支持对重症急性胰腺炎治疗作用的研究

目的　探讨合理营养支持对重症急性胰腺炎治疗的作用。方法　将 96例重症急性胰腺炎病人随机分为全胃肠外营养组和肠内与肠外营养结合组。分别检测血清内毒素、尿L/M值、CD4 /CD8比值和IgG水平以监测肠黏膜通透性和免疫状态的改变 ,同时观察TNF α和IL 6血清病人感染率和死亡率。结果　肠内与肠外结合营养组病人血清IgG和CD4 /CD8明显高于全胃肠外营养组 (P <0 0 5 ) ,而内毒素、尿L/M值以及TNF α、IL 6水平则明显低于全胃肠外营养组 (P <0 0 5 ) ,病人感染率和死亡率亦明显降低 (P <0 0 5 )。结论　合理应用肠外与肠内营养相结合的营养支持方式可缓解炎性细胞因子及炎性介质的释放 ,从而对重症急性胰腺炎具有积极的治疗作用。     

早期鼻肠管肠内营养治疗急性重症胰腺炎的临床研究

目的 探讨早期鼻肠管肠内营养在减轻急性重症胰腺炎(ASP)急性炎症反应和改善疾病转归中的作用.方法 对2000年6月至2006年6月78例ASP前瞻性的随机分成两组,38例接受全肠外营养(TPN)组成TPN组,40例早期鼻肠管肠内营养,组成EN组,检测78例ASP病人APACHEⅡ评分、C反应蛋白、血清白蛋白指标,按随机接受肠内、肠外营养7 d后再检测上述指标;同时观察MOF的发生率、胰周脓肿感染率、外科手术干预率.结果 肠内营养组7 d后急性炎症反应指标:C反应蛋白、APACHEⅡ明显改善(P＜O.05),TPN组上述指标无明显改变;MOF的发生率、胰周脓肿感染率、外科手术干预率,肠内营养组明显降低(P＜0.05).结论 早期鼻肠管肠内营养可缓和急性重症胰腺炎病人的急性炎症反应;明显减少MOF的发生率、胰周脓肿感染率、外科手术干预率,能改善疾病的愈后,SAP病人,血液流动学稳定,肠功能基本恢复时营养支持优先考虑鼻肠管肠内营养.     

腹部创伤患者术后肠内与肠外营养支持对肠道通透性及全身炎性反应的影响

目的测定腹部创伤患者术后甘露醇 (mannitol,M)和乳果糖 (lactulose ,L)吸收的浓度变化 ,观察肠内营养 (EN)、胃肠外营养 (PN)对肠道通透性及全身炎性反应影响。方法 30例患者随机分为PN和EN组 ,每组 15例 ,计算手术第 1、3、5、7天L M和APACHEⅡ评分。结果PN组L M第5天最高 (0 0 6 1± 0 0 0 2 ) ,与手术第 1天比较 ,差异有显著意义 (P <0 0 5 ) ,APACHEⅡ评分在第 3天最高 ,为 (17 6± 1 8)分 ,较手术第 1天差异有显著意义 (t=2 316 ,P <0 0 5 ) ,L M与APACHEⅡ评分正相关 (r=0 745 ,t=2 2 35 ,P <0 0 5 )。EN组L M第 3天 (0 0 47± 0 0 0 4) ,较手术第 1天差异有显著意义(t=2 35 2 ,P <0 0 5 ) ,APACHEⅡ评分第 3天最高 ,为 (15 9± 2 3)分 ,较术后第 1天差异有显著意义(t=2 35 2 ,P <0 0 5 ) ,L M比值与APACHEⅡ评分正相关 (r =0 730 ,t=2 375 ,P <0 0 5 )。结论与PN相比 ,EN能改善肠道粘膜通透性 ,降低创伤后全身炎性反应     

重症急性胰腺炎患者实施肠内营养支持治疗对免疫及营养状态指标的影响

目的探讨重症急性胰腺炎(SAP)患者经鼻空肠管肠内营养治疗的临床效果。方法回顾性收集符合病例纳入条件、2015年6月至2018年12月期间在河南省直第三人民医院治疗的76例SAP患者的临床病理资料。根据治疗过程中采用的营养支持治疗方式分为肠内营养组(n=44)和肠外营养组(n=32),肠内营养组给予经鼻空肠管肠内营养治疗,肠外营养组给予常规肠外营养治疗,观察2组患者治疗前及治疗后2周时的急性生理与慢性健康评估Ⅱ(APACHEⅡ)和序贯器官功能衰竭(SOFA)评分、营养状态及免疫功能变化。结果 2组患者的性别、年龄、体质量指数等一般资料比较差异均无统计学意义(P0.050)。①APACHEⅡ和SOFA评分在2组患者治疗后2周时均较治疗前明显降低(P0.050),且在治疗后2周时肠内营养组明显低于肠外营养组(P0.050);②白蛋白和前白蛋白在2组患者治疗后2周时均较治疗前明显升高(P0.050)而Hb较治疗前降低(P0.050),且在治疗后2周时肠内营养组均明显高于肠外营养组(P0.050);③CD4、CD8、CD4/CD8和IgG、IgM、IgA在2组患者治疗后2周时较治疗前均明显降低(P0.050),但在治疗后2周时肠内营养组均明显高于肠外营养组(P0.050);④内毒素、D-乳酸、二胺氧化酶和血清高迁移率族蛋白B1水平在2组患者的治疗后2周时均较治疗前明显降低(P0.050),且在治疗后2周时肠内营养组均明显低于肠外营养组(P0.050)。⑤肠内营养组总并发症发生率明显低于肠外营养组[20.45%(9/44)比53.13%(17/32),χ~2=8.786,P=0.003]。结论 SAP患者经鼻空肠管肠内营养治疗有较好的效果,有助于患者免疫及营养状态改善。     

肠内、外营养支持治疗重症急性胰腺炎的临床疗效对比研究

目的比较肠内及肠外营养在支持治疗重症急性胰腺炎（SAP）时的不同临床效果,探讨肠内营养（EN）的应用价值。方法将58例SAP患者随机均分为肠外营养（PN）组和EN组,分别观察入院时及营养支持治疗后第7、14d的血淀粉酶（AMS）和免疫指标（WBC、IgA、IgM和IgG）,并比较2组患者的并发症发生情况、体重降低比率、死亡率、住院时间和治疗费用。结果给予营养支持后,EN组的AMS、WBC、并发症发生率、体重降低比率、住院时间和治疗费用均较PN组有显著下降（P〈0.05）;APACHEⅡ积分和CT评分也均低于PN组（P〈0.05）。结论对于适合给予EN的SAP患者,尽早给予EN较PN有更好的临床治疗效果。     

早期肠内免疫营养在重症急性胰腺炎治疗中的应用

目的 比较免疫营养配方(EIN)与标准配方肠内营养(EN) 对重症急性胰腺炎(SAP)炎症反应和患者感染预后的影响.方法 所有患者均符合SAP诊断标准,APACHE Ⅱ评分8分以上.随机分为两组:免疫营养组22例(研究组),给予EIN;对照组22例,给予标准型EN.共30d.两组患者的一般情况和病情严重度相似,并给予相同的处理,在发病1周左右,通过内镜放置鼻空肠管或经胃镜胃造瘘术行EIN 及EN.观察全身炎症反应、营养指标的变化,比较感染等并发症发生率和病死率.结果 ①研究组死亡1例,对照组死亡2例;②两组的胰周感染发生率差异有统计学意义(P＜0.05);③两组治疗前后C反应蛋白、白细胞计数均明显下降(P＜0.05),血小板计数均有所升高,差异有统计学意义(P＜0.01);④平均住院时间两组差异有统计学意义(P＜0.05).结论 早期EIN与普通EN都能明显减轻SAP患者的炎症反应,改善营养状况,但EIN在预防SAP患者继发感染反应方面优于普通EN.     

肠外营养与肠内营养结合治疗重症急性胰腺炎的体会(附200例报道)

目的总结肠外营养结合肠内营养对重症急性胰腺炎患者疗效的影响。方法回顾性分析笔者所在医院近10年收治的200例重症急性胰腺炎患者的临床资料,其中88例患者采用传统的营养支持治疗(传统营养组),其余112例患者采用由早期的肠外营养到中后期逐步结合肠内营养的综合治疗策略(综合营养组)。结果综合营养组患者的APACHEⅡ评分和血清C-反应蛋白(CRP)水平均显著低于传统营养组(P0.05),而血清白蛋白水平则显著高于传统营养组(P0.05)。综合营养组患者的并发症发生率、死亡率、平均住院时间和住院总费用均明显低于或短于传统营养组(P0.05),治愈率明显高于传统营养组(P0.05)。结论将肠外营养与肠内营养的有机结合的营养支持模式,不仅能够缩短病程,减轻患者负担,而且可以降低并发症发生率和死亡率。     

理气通下合剂对急性胰腺炎患者肠屏障功能障碍的影响

目的 观察理气通下合剂对急性胰腺炎患者肠屏障功能障碍的影响.方法 按随机数字表法将40例急性胰腺炎患者随机分为理气通下组(n＝20)和硫酸镁组(n＝20).记录入院时、入院后24 h、48 h、72 h及第5天的APACHEⅡ评分和胃肠功能评分,测定入院时、入院后72 h和第5天的尿乳果糖/甘露醇(L/M)比值、血浆二胺氧化酶(DAO)活性、血浆内毒素水平、血清TNF-α和IL-6水平.结果 2组重症急性胰腺炎病例构成的差异无统计学意义(P＞0.05).治疗后第5天,2组APACHEⅡ评分、胃肠功能评分以及理气通下组L/M比值、DAO、内毒素、TNF-α和IL-6水平较入院时均有所降低,硫酸镁组上述指标升高;2组APACHEⅡ评分差异无统计学意义(P＞0.05);治疗后第5天,理气通下组胃肠功能评分、L/M比值、DAO、内毒素、TNF-α和IL-6水平改善较硫酸镁组明显,差异有统计学意义(P＜0.05,P＜0.01).结论 理气通下合剂能明显改善急性胰腺炎患者的肠屏障功能.     

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.