HBeAg阳性与HBeAg阴性慢性乙型肝炎患者的临床和病理对照

目的探讨HBeAg阳性与HBeAg阴性慢性乙型肝炎(CHB)患者的临床和肝组织病理损伤特点。方法经肝活检病理诊断为CHB患者548例,分为HBeAg阳性与HBeAg阴性2组,分别统计患者年龄、肝组织炎症活动度(G分级)、纤维化程度(S分期)、肝活检前后2周肝功能(ALB、GLB、TBil、ALT、AST、GGT)峰值、血清HBVDNA载量、肝组织病理改变与临床之间的关系。结果肝组织G分级、S分期与肝功能改变有相关性(P均0.01),肝功能明显异常者肝组织病理损伤亦重;S分期与G分级有相关性(P0.01),S分期随G分级升高而加重。HBeAg阳性者较HBeAg阴性者平均年龄小,ALT、AST水平及HBVDNA载量高(P均0.01)。HBeAg阴性者肝组织G分级、S分期与患者年龄有相关性(P均0.05),与HBVDNA载量有显著相关性(P均0.01);而HBeAg阳性者G分级、S分期与患者年龄、HBVDNA载量无相关性(P均0.05)。结论CHB肝功能改变可以反映肝脏病理损害程度,S分期随G分级升高而加重。HBeAg阳性与HBeAg阴性CHB患者临床表现有所不同:HBeAg阴性CHB患者年龄较大,ALT、AST水平及HBVDNA载量较低。除肝功能改变外,患者年龄、血清HBVDNA载量可作为HBeAg阴性CHB患者肝脏病变程度的预测指标。     

Prox1基因在原发性肝细胞癌中的表达及其与病理学分级及临床分期的相关性研究

目的检测Prox1(prospero-related homeobox 1)基因在原发性肝细胞癌(HCC)中的表达,探讨其与HCC病理学分级及临床分期的相关性。方法应用RT-PCR方法检测51例肝癌组织、癌旁组织和16例正常肝组织中Prox1基因表达,并分析其与HCC病理学分级和临床分期的相关性。结果 Prox1 mRNA在肝癌、癌旁及正常肝组织中均有表达,但肝癌组织(0.243±0.102)和癌旁组织(0.537±0.235)的表达量均明显低于正常肝组织(0.812±0.372),P<0.01或P<0.05,且肝癌组织中Prox1 mRNA表达量又明显低于癌旁组织(P<0.05)。肝癌组织中Prox1 mRNA的表达量在不同病理学分级(F=97.950,P<0.001)和临床分期(F=228.300,P<0.001)的肝癌组织中差异均有统计学意义,且各病理学分级和临床分期间两两比较,差异也均有统计学意义(P<0.001,P<0.01)。Prox1 mRNA表达与肝癌的病理学分级(r=-0.930,P<0.01)和临床分期(r=-0.980,P<0.01)呈负相关。结论 Prox1 mRNA表达可能与HCC的发生、发展有关,然而其是否为HCC的抑癌基因有待进一步证实。     

肝脏硬度直接测定对肝硬化病理变化程度评估的价值

目的探讨肝脏硬度直接测定对乙肝后肝硬化病理变化程度评估的价值。方法采用邵氏硬度计直接测定因肝脏外科疾病而手术的113例病人的肝脏硬度。据肝脏硬度值(liver stiffness value,LSV)的分布范围将肝脏硬度分为Ⅰ级(LSV:2～6 HC)、Ⅱ级(LSV:7～11 HC)和Ⅲ级(LSV:12～16 HC)。对其中76例乙肝相关的肝癌病人及门静脉高压症病人肝硬化程度以Laennec分级标准进行分级,分析肝脏硬度值与肝硬化病理分级之间的相关性。结果肝脏硬度值与肝硬化病理分级之间存在相关性(r=0.693,P0.05),肝脏硬度值评估轻度、中度和重度肝硬化的AUC分别为0.91、0.81和0.80。结论肝脏硬度值与肝硬化病理改变程度之间呈明显正相关性,肝脏硬度值可以作为判断肝硬化病理程度的有效指标。     

肝硬化患者血清CA125水平与Child-Pugh分级、CHE及腹水量相关性分析

目的探讨肝硬化患者血清CA125水平与Child-Pugh分级CHE及腹水量的相关性。方法选择2013年10月至2014年12月我院收治的82例肝硬化患者为研究对象,分别按Child-Pugh分级、腹水量分组,另外选取同期40例健康体检者为对照组,采用电化学发光法、速率法检测血清CA125,CHE水平,Spearman相关分析CA125与Child-Pugh分级、CHE及腹水量的相关性。结果 CA125水平:Child C级患者Child B级Child A级,三组比较具有统计学意义(P0.05),大量腹水组中量腹水组少量腹水组无腹水组(P0.05)。CHE水平:Child C级患者Child B级Child A级,三组比较具有统计学意义(P0.05)。CA125与CHE呈负相关(r=-0.599,P0.05),与Child-Pugh分级呈正相关(r=0.736,P0.05),与腹水量呈正相关(r=0.779,P0.05)。结论肝硬化患者血清CA125与有无腹水、肝功能损伤程度、CHE有关,血清CA125、CHE的监测可能对评估肝硬化患者的病情有一定的价值。     

不同类型肝硬化患者肝功能和免疫功能的对比分析

目的:对比乙型肝炎肝硬化、酒精性肝硬化和混合型(乙型肝炎+酒精性肝炎)肝硬化患者的肝功能和免疫功能指标,并分析其与Child-Pugh分级的相关性,为临床评估患者免疫状态及采取相关治疗提供参考。方法:选取2019年3月—2020年7月贵州医科大学附属医院收治的肝硬化患者128例,其中乙型肝炎肝硬化44例,酒精性肝硬化48例,混合型肝硬化36例。采用全自动生化分析仪检测肝功能指标,免疫比浊法检测免疫球蛋白,流式细胞术(FCM)检测外周血淋巴细胞亚群百分比。结果:乙型肝炎肝硬化患者谷草转氨酶/谷丙转氨酶(AST/ALT)、免疫球蛋白A(Ig A)、γ-谷氨酰转肽酶(γ-GT)、CD3+CD4+细胞百分比显著低于酒精性肝硬化患者和混合型肝硬化患者(P均0.05),而酒精性肝硬化患者和混合型肝硬化患者相应指标间的差异无统计学意义(P0.05)。乙型肝炎肝硬化患者及混合型肝硬化患者Child-Pugh分级与AST、AST/ALT、总胆红素(TBIL)、免疫球蛋白G(Ig G)、Ig A均呈正相关(r=0.464、0.469、0.705、0.540、0.540和0.555、0.563、0.782、0.424、0.515,P0.05),与白蛋白(ALB)、白蛋白/球蛋白(A/G)均呈负相关(r=-0.772、-0.642和-0.623、-0.470,P0.01);酒精性肝硬化患者Child-Pugh分级与AST、TBIL呈正相关(r=0.375、0.573,P0.05),与ALB呈负相关(r=-0.451,P0.01)。结论:酒精性肝硬化和混合型肝硬化患者相比乙型肝炎肝硬化患者,肝功能和免疫功能受损更为严重,且不同类型肝硬化患者的Child-Pugh分级与肝功能生化指标和免疫球蛋白存在显著相关性。     

tPSA4～10μg/L患者前列腺穿刺标本炎症分级与前列腺癌相关性分析

目的:分析血清tPSA 4～10μg/L患者前列腺穿刺活检标本中前列腺组织学炎症分级与前列腺癌间的相关性。方法:回顾性分析2015年1月至2017年12月200例行前列腺穿刺活检患者的临床资料,对穿刺标本组织学炎症的范围、位置及程度进行评估,探讨前列腺组织学炎症分级与前列腺癌的相关性。结果:200例前列腺穿刺活检标本,病理学诊断为BPH 169例(84.5%),前列腺癌31例(15.5%)。活检组织学炎症分级1、2、3级位置中前列腺癌阳性率分别为19.3%、25.8%、54.8%(P0.01),炎症范围中前列腺癌阳性率分别为77.4%、19.4%、3.2%(P0.01),炎症程度中前列腺癌阳性率分别为51.6%、29.0%、19.4%(P0.01);而组织学分级炎症位置、范围和程度中BPH阳性率均无统计学意义。Logistic多因素回归分析发现,组织学炎症程度分级与前列腺癌无相关性(95%CI 0.796～4.193,OR=1.804,P=0.215),而炎症位置(95%CI 0.052～0.407,OR=0.113,P=0.001)及炎症范围(95%CI 0.068～0.819,OR=0.231,P=0.023)分级与前列腺癌风险呈显著负相关(r=-2.078、-1.526)。同时运用炎症位置及范围联合预测模型区分前列腺癌和BPH的阳性、阴性预测值、敏感性及特异性分别为51.2%、90.3%、91.5%、50.8%。结论:前列腺组织炎症程度与前列腺癌无相关性;炎症位置及范围与前列腺癌呈负相关,进行前列腺炎症位置和范围的分级描述可以减少一定比例的重复穿刺活检。     

肝组织内性甾体激素受体与慢性乙型肝炎肝组织病理状态的相关性

目的探讨肝组织内性雄激素受体(AR)m RNA和雌激素受体-α(ERα)m RNA表达水平对慢性乙型肝炎(CHB)肝组织病理学状态的影响。方法收集135例CHB患者,其中HBe Ag阳性患者80例,HBe Ag阴性患者55例。肝组织内AR m RNA和ERαm RNA采用反转录定量PCR检测。结果 HBe Ag阳性患者的平均年龄在肝组织不同炎症分级和纤维化分期之间的差异均具有统计学意义(P均0.01);肝组织内平均AR m RNA和ERαm RNA含量在肝组织不同炎症分级和纤维化分期之间的差异均有统计学意义(P均0.01)。HBe Ag阴性患者的平均年龄在肝组织不同炎症分级之间的差异无统计学意义(P均0.05),在不同纤维化分期之间的差异具有统计学意义(P均0.01);肝组织内平均AR m RNA和ERαm RNA含量在不同炎症分级和纤维化分期之间的差异均有统计学意义(P均0.05)。根据有序Logistic回归分析结果,HBe Ag阳性患者,只有肝组织内AR m RNA含量有预测肝组织炎症分级和纤维化分期的意义(P均0.01);HBe Ag阴性患者,仅肝组织内AR m RNA含量有预测肝组织炎症分级的意义(P均0.01)。结论肝组织内AR m RNA含量是影响CHB肝组织病理学状态的一个独立因素。     

3.0T磁共振扩散加权成像技术无创评估肝硬化分级

目的：探讨不同b值表观扩散系数（ADC）值、指数化表观扩散系数（eADC）值以及灌注ADC值和eADC值在肝硬化分级及肝功能损害评估方面的价值。方法：对53例肝硬化患者肝脏进行DWI扫描,并计算低（100 s/mm2、200 s/mm2和300 s/mm2）、中（400 s/mm2和600 s/mm2）和高（800s/mm2、1 000 s/mm2和1 200 s/mm2）b值时肝组织的ADC值和eADC值,然后根据低、高b值时ADC和eADC值的差异计算灌注ADC和eADC值。分析DWI各测量参数与Child-Pugh分级及与临床肝功能血清检测指标之间的关系。结果：低b值ADC值、中b值的ADC和eADC值以及灌注ADC值在Child-Pugh分级之间均见统计学差异（P〈0.05）,其余测量值未见统计学差异（P〉0.05）。低b值ADC值与AST负相关（P=0.040,r=-0.554）,中b值ADC值分别与TP、ALB正相关（P=0.006,r=0.814;P=0.034,r=0.570）,但与GLO负相关（P=0.017,r=-0.601）,灌注ADC值也与AST负相关（P=0.021,r=-0.643）,其余参数之间均未见相关性（P〉0.05）。结论：利用DWI技术可对肝硬化的程度进行分级,ADC值相关参数也可在一定程度上反映肝硬化时肝功能情况。     

肝硬化脾功能亢进患者肝组织中铁过载及铁调素mRNA表达的意义

目的 探讨肝硬化合并不同程度脾功能亢进(脾亢)患者肝组织中铁过载及铁调素(hepcidin)mRNA表达的意义.方法 收集肝硬化合并轻、中及重度脾亢患者肝活检标本各10例,共30例(肝硬化组),外伤性肝破裂手术标本10例(对照组),采用原子分光光度计检测肝组织铁元素含量;采用化学发光法检测血清铁蛋白的含量;采用逆转录-聚合酶链反应(RT-PCR)检测肝组织hepcidin mRNA的表达.结果 肝硬化脾亢患者按脾功能亢进程度分为轻、中及重度3组,其肝组织中铁元素含量明显递增,分别为(0.1205±0.0021)、(0.1624±0.0028)和(0.1716±0.0032)mmol/g,均明显高于正常肝组织(0.0639±0.0025)mol/g(P<0.05),表现为铁过载;肝硬化组血清铁蛋白的含量为(436.2±51.6)μg/L,显著高于对照组的(152.5±38.7) μg/L(P<0.01);肝硬化组hepcidin mRNA的表达水平为1.73±0.26,明显高于对照组的0.68±0.22(P<0.01);而且各组的hepcidin mRNA表达水平与血清铁蛋白含量之间具有显著相关性(肝硬化组r=0.735,对照组r=0.648,P<0.01).结论 肝硬化脾亢患者的肝组织中存存铁过载,并随脾亢程度加重而明显增加;hepcidinmRNA是调节铁代谢平衡并影响肝硬化进程的重要因素.     

剪切波弹性成像对食管静脉曲张的诊断价值

目的探讨剪切波弹性成像技术(SWE)对食管静脉曲张(EV)严重程度和破裂出血的诊断价值。方法对临床确诊的103例肝硬化患者行超声、内镜及实验室检查,分析性别、年龄、体质量指数(BMI)、肝功能Child-Pugh分级、肝硬度(LS)、LS×脾长径与血小板(PLT)比值指数(LSPS)、血小板与天冬氨酸氨基转移酶比值指数(APRI)、脾硬度(SS)对有无EV、低危和高危EV、有无EV破裂出血的预测价值,并进行相关性分析。结果有EV与无EV肝硬化患者之间,Child-Pugh分级、LSPS、APRI、LS、SS差异均有统计学意义(P均0.05),LS、SS是诊断EV的独立影响因素。LSPS、APRI、LS、SS诊断EV的AUC为0.84、0.79、0.83和0.89。低危和高危EV患者Child-Pugh分级、LS、SS差异有统计学意义(P均0.05);有无EV破裂出血患者SS差异有统计学意义(P0.01),SS为预测高危EV及有无EV破裂出血的独立影响因素。有无EV与Child-Pugh分级相关性较弱(r=0.35,P0.05),与LSPS、APRI、LS相关性中等(r=0.52、0.45、0.51,P均0.05),与SS相关性较强(r=0.61,P0.05)。结论 SWE对肝硬化患者EV严重程度和破裂出血有较高价值,可作为预测EV分级和破裂出血的无创检查技术。SS对EV的诊断价值高于LS。     

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.     

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.