Effect of pneumatic leg compression on post-induction hypotension in elderly patients undergoing robot-assisted laparoscopic prostatectomy: a double-blind randomised controlled trial

Post-induction hypotension is common and associated with postoperative complications. We hypothesised that pneumatic leg compression reduces post-induction hypotension in elderly patients undergoing robot-assisted laparoscopic prostatectomy. In this double-blind randomised study, patients were allocated randomly to the pneumatic leg compression group (n = 50) or control (n = 50). In the intervention group, pneumatic leg compression was initiated before induction of anaesthesia. In the control group, pneumatic leg compression was initiated 20 min after anaesthesia induction. The primary outcome was the incidence of post-induction hypotension in these groups. Post-induction hypotension was defined as systolic blood pressure < 90 mmHg during the first 20 min after induction. Haemodynamic variables and area under the curve of post-induction systolic blood pressure over time were assessed. Complications associated with pneumatic leg compression were recorded, including: peripheral neuropathy; compartment syndrome; extensive bullae beneath the leg sleeves; and pulmonary thromboembolism. The incidence of post-induction hypotension decreased in the pneumatic leg compression group compared with that in the control group; 5 (10%) vs. 29 (58%), respectively, p < 0.001. In the pneumatic leg compression group, the lowest systolic, diastolic and mean blood pressures 20 min after induction of anaesthesia were significantly greater than the control group. Pneumatic leg compression resulted in an increased area under the curve of systolic blood pressure in the first 20 min after induction, p = 0.001. There were no pneumatic leg compression-related complications. Pneumatic leg compression reduced post-induction hypotension in elderly patients undergoing robot-assisted laparoscopic prostatectomy, suggesting that it is an effective and safe intervention to prevent post-induction hypotension among elderly patients undergoing general anaesthesia.     

Efficacy of botulinum toxin injection before pneumatic dilatation in patients with idiopathic achalasia

Graded pneumatic dilatation (PD) is an appropriate long-term therapy and botulinum toxin injection (BT) is a relatively short-term therapy in idiopathic achalasia. Their combination has not been previously scrutinized. This study aimed to evaluate the role of BT in enhancing the efficacy of PD with 30 mm balloons. Patients who underwent PD with 30 mm balloons after botulinum toxin injections and a group of age- and sex-matched controls who were treated only with PD were enrolled in the study. Symptom scores were taken before, 1 month after and then every 3 months after PD. There were no significant differences between the two groups in gender, duration or severity of symptoms. One of the 12 patients in the case group relapsed 30 months after PD but the others were in remission for an average of 25.6 months. In the control group, all the patients relapsed after a mean of 12.6 months and needed a 35-mm PD. The cumulative remission rate was significantly higher in the case group compared with the control group (P < 0.01). The mean symptom score decreased by 76% in the case group (P < 0.001) and 53% in the controls (P < 0.01) at the end of the first month. Neither age, sex, nor duration or severity of symptoms were predictive of patients' responses to treatment. It seems that BT may be a meaningful enhancing factor in long-term efficacy of PD. PD with a 30 mm balloon after a BT session may resolve the need for the future higher grade PD.     

尿石症住院患者1100例分析

目的了解近年来尿石症住院患者情况的变化。方法对1998年~2003年间的尿石症住院患者1100例进行分析。结果本组中,肾结石251例(22.8%)、输尿管结石742例(67.5%)、膀胱结石97例(8.8%)、尿道结石10例(0.9%)。上、下尿路结石的比例为9.28∶1。高钙尿患者27例(13.0%)、高钙血症91例(9.1%)、高尿酸血症167例(17.8%)。结石成分分析结果:草酸钙168例(62.7%);磷酸钙59例(22.0%);尿酸及尿酸盐25例(9.3%);磷酸镁铵10例(3.7%);碳酸盐5例(1.7%);胱氨酸1例(0.4%)。治疗:ESWL658例(59.8%)、肾切开取石术35例、肾切除术6例、输尿管切开取石术92例(占8.4%)、输尿管镜加气压弹道碎石52例(4.7%)、膀胱切开取石53例(其中前列腺摘除术加膀胱切开取石术26例);膀胱镜加气压弹道碎石20例;前列腺电切术加气压弹道碎石7例;膀胱镜加大力钳碎石术9例。尿道切开取石术1例;经尿道镜取石术2例;尿道镜加气压弹道碎石3例。结论本组尿石症患者以上尿路结石为主,含钙结石占绝大多数。尽管微创手术的普遍开展,ESWL仍不失为一种创伤小、效果好的治疗方法。     

输尿管镜气压弹道碎石治疗输尿管结石86例

目的：观察输尿管镜下气压弹道碎石治疗输尿管结石的临床疗效。方法：自1998年5月至1999年4月采用输尿管尿镜下气压弹道碎石治疗86例输尿管结石,一次碎石成功73例,2例再次碎石成功,0达满意疗效,5例改行ESWL术,6例改行开放手术。结论：输尿管镜下气压弹道碎石是治疗输尿管结石的有效手段,具有疗效好,治疗快速、病人痛苦小、费用低、可以门诊治疗等优点。     

间歇性气囊挤压大鼠腿部对挤压部位和远端骨骼肌一氧化氮合酶mRNA表达的影响

目的:为了进一步了解间歇性气囊挤压法(Intermittent pneumatic compression, IPC)挤压大鼠腿部与一氧化氮(NO)的关系.方法:检测了大鼠骨骼肌中3种一氧化氮合酶(NOS)同工酶:神经型NOS(nNOS);诱导型NOS(iNOS)和内皮细胞型NOS(eNOS)mRNA在IPC作用后的表达变化.25只SD大鼠被随机分为3个模拟实验组和4个IPC实验组.每只鼠取右侧胫前肌(AT)和提睾肌(CM)作为正常对照.IPC组挤压0.5,1,和5h,及挤压5h加等待4h,模拟实验组除不挤压外,其他操作均与实验组相同,然后分离左侧AT和CM作为处理后样品.所有样品应用RT-PCR进行NOS mRNA测定.以样品中看家基因2,3-二羟基丙醛-3-磷酸脱氢酶(GAPHD)cDNA为内参,与NOS cDNA 共同扩增.PCR产物电泳条带密度用NIH图像分析软件定量,并以与正常对照的对比值作为变化比率.结果:在IPC作用0.5、1和5h后,eNOS mRNA显著上升,在AT中分别达到正常对照的1.2,1.8和2.6倍;在CM中分别达到1.2,1.8和2.7倍,而其他NOS,除5hIPC组的nNOS外,总体表现下调.在IPC作用1h加等待4h组中,eNOS mRNA回复至正常对照水平.结论:该结果证实了IPC产生的机械压力至少部分增加了血管壁的剪切压,使内皮细胞增加了NO产物的释放量,导致了挤压部位及远端肌肉的血管扩张和改善了微循环.     

异丙酚复合芬太尼维持麻醉对脑代谢的影响

观察异丙酚复合芬太尼维持麻醉对脑代谢的影响。方法： 择期手术病人８ 例, 芬太尼、硫贲妥钠、维库溴铵诱导插管, 静脉联接Ｇｒａｓｅｂｙ 微泵异丙酚８ ｍｇ／ （ｋｇ·ｈ） , 芬太尼１ μｇ／ （ｋｇ·ｈ）维持麻醉。连续监测ＭＡＰ、心电图、脉搏氧饱和度和呼气末二氧化碳分压, 同步采集动脉血和颈内静脉血作血气分析, 计算动－ 静脉氧含量差（Ｄａ － ｖＯ２） 和脑氧摄取率（ＥＲＯ２） 。结果： 异丙酚麻醉维持平稳, Ｄａ － ｖＯ２ 和ＥＲＯ２ 在给药３０ ｍｉｎ 、６０ ｍｉｎ 较气管插管后５ ｍｉｎ 无明显改变, 有平均动脉压下降和心动过缓。结论： 异丙酚复合芬太尼维持麻醉可保持脑氧供需平衡稳定。     

中药材冲击摩擦超细气流粉碎方法研究

目的 :针对中药材粉碎特性 ,提出一种“中药材冲击摩擦超细气流粉碎”方法 ,该方法可有效解决现有中药材超细粉碎方法中关于超细粉碎效率的问题 ,特别是现有气流粉碎装置对不同物性的中药材粉碎适用性较差的缺点。方法 :将喷射气流的高速冲击粉碎作用和旋转靶的高速摩擦粉碎作用复合用于中药材的超细气流粉碎中 ,并经分级获得中药材超细粉体。结果 :通过几种典型中药材的超细粉碎实验表明 ,粉碎平均粒径分别为 2～12. 7μm。结论 :该方法具有适用性强、超细粉碎效率高的优点 ,是一种微米化中药材的有效制备手段。     

Impact of intermittent pneumatic foot pumps on delay to surgery following ankle fracture

BackgroundAnkle fractures requiring open reduction and internal fixation (ORIF) are common and place considerable burden on inpatient beds. ORIF cannot be performed once the associated swelling is too excessive to permit tension-free wound closure. Where ORIF cannot be performed before the onset of swelling in the first 24–48 h, patients typically require up to 7 days of inpatient bed-rest and elevation to reduce swelling to an acceptable level for ORIF.The primary aim of this study was to determine whether delay to ORIF could be reduced with the pre-operative application of an intermittent pneumatic foot pump (IPF). These devices were designed as anti-embolic adjuncts, but have also been shown to be effective in the reduction of swelling.We compared 12 patients managed with an IPF to 12 matched historical controls who were not.No previous studies have addressed this question in unselected patients requiring ankle ORIF.MethodsWe performed a retrospective, controlled, before and after study of 24 patients who underwent ankle ORIF at our orthopaedic unit. Foot pumps were applied in the Accident and Emergency Department to ankle fracture patients requiring admission, and kept in place until ORIF.Data was collected from patient case notes for all patients.Patients were matched for age, gender, American Society of Anaesthesiologists (ASA) Grade, and pre-injury mobility. The primary outcome measure was time to surgery. We also recorded total hospital stay, and calculated cost savings.ResultsPatients managed with IPFs had a statistically significant 50% reduction in time from presentation to surgery compared to those managed without (p = 0.024), and had a reduced hospital stay (p = 0.116). This resulted in a net saving of £10,480 (£953 per patient).ConclusionsWe conclude that foot pumps reduce the time to surgery and total hospital stay of patients requiring ankle ORIF, and are cost effective.     

输尿管封堵器联合气压弹道碎石治疗输尿管结石的临床研究

目的探讨输尿管封堵器联合气压弹道碎石在输尿管结石治疗中的临床疗效。方法将该院收治的78例输尿管结石患者随机分为观察组40例和对照组38例,对照组采用气压弹道碎石术,观察组采用输尿管封堵器联合气压弹道碎石术。对比两组患者手术疗效、手术时间、住院时间、血尿时间以及治疗后BUN、Cr水平变化和两组患者不良反应发生情况。结果两组一次性碎石率比较χ2=5.5038(P=0.0190);两组1个月结石排净率比较χ2=8.6771(P=0.0032);两组需再次手术患者例数比较χ2=11.9114(P=0.0006);两组有效患者例数比较χ2=14.4866(P=0.0001)。两组患者手术时间比较t=7.9142(P=0.0000);两组患者住院时间比较t=6.0797(P=0.0000);两组患者血尿时间比较t=5.2690(P=0.0000);两组BUN水平比较t=1.3569(P=0.1788);两组Cr水平比较t=4.3967(P=0.0000)。两组患者术后恶心、呕吐例数比较χ2=6.7818(P=0.0092);两组患者术后发热例数比较χ2=8.2611(P=0.0041);两组患者术后血尿例数比较χ2=8.6771(P=0.0032);两组患者术后肾绞痛例数比较χ2=14.5142(P=0.0001)。结论输尿管封堵器联合气压弹道碎石治疗输尿管结石,能提高碎石成功率,值得临床上广泛应用。