年龄与成年人肾细胞癌临床分期的相关性分析

目的 探讨年龄与成年人肾细胞癌（renalcell carcinoma，RCC）临床分期的相关性。方法 回顾性分析310例病理确诊的成年RCC患者的临床资料，按年龄大小分为10岁以下组（≤40岁）、40-60岁组、60岁以上组（≥60岁），对三组患者的症状表现、病理学特点、淋巴结转移进行比较，以此了解年龄与成年人RCC临床分期的相关性。结果 40岁以下组偶发癌所占的比例明显低于10-60岁组（X^2=3．294，P=0．070），60岁以上组则显著低于40-60岁组（X^2=3．950，P=0．047）；分化不良RCC的发生率随年龄增长逐渐降低（11．6％vs．5．2％vs．2．7％），且40岁以下组与60岁以上组相比较差异有显著性意义（P=0．038）；淋巴结转移的发生率同样随年龄的增长而降低，且40岁以下组与其他两组相比较差异均有显著性意义（P〈0．05）；三组临床分期的构成比差异有显著性意义（P〈0．01）．Ⅰ期所占的比例随年龄增长逐渐降低，Ⅱ期在10岁以下组中所占的比例明显低于其他两组．而Ⅰ期＋Ⅱ期在40-60岁组中的比例则明显高于其他两组。结论 偶发癌在各年龄组的不同比例值是导致不同年龄组患者临床分期出现差异的主要因素；淋巴结转移及分化不良RCC是导致这种差异的次要因素。     

不同人群腹直肌后鞘Ⅰ、Ⅲ型胶原蛋白含量初步研究

目的 初步分析不同人群腹直肌后鞘Ⅰ、Ⅲ型胶原蛋白含量、胶原总量及Ⅰ／Ⅲ型胶原比例变化。方法 切取104例开腹手术患者腹直肌后鞘组织，应用免疫组织化学SABC方法进行染色，比较胶原含量在不同性别、体力劳动组和非体力劳动组、吸烟组和不吸烟组间的差异，并分析胶原含量与年龄、体重指数及身高的相关性。结果 ①男性和女性间胶原比较：Ⅰ型胶原含量及Ⅰ／Ⅲ型胶原比例男性均低于女性（P〈0．01）；Ⅲ型胶原含量及胶原总量差异无统计学意义（P〉0．05）。②体力劳动组与非体力劳动组间胶原含量及比例差异无统计学意义（P〉0．05）。③吸烟组和不吸烟组间胶原比较：胶原总量及Ⅲ型胶原含量差异无统计学意义（P〉0．05）；Ⅰ型胶原含量及Ⅰ／Ⅲ型胶原比例在吸烟组较低（P〈0．01，P〈0．05）。④胶原含量随年龄增加变化趋势：胶原总量、Ⅰ型胶原含量及Ⅰ／Ⅲ型胶原比例降低（r=0．341、0．392、0．212，P〈0．001，P〈0．05）；III型胶原含量无明显变化（r=0．089，P〉0．05）。⑤胶原含量及比例与体重指数及身高均无明显关系（P〉0．05）。结论 吸烟、性别和年龄均影响组织胶原含量及比例。     

儿童紫癜性肾炎血清、尿液巨噬细胞移动抑制因子水平及临床意义

目的：探讨过敏性紫癜肾炎（HSPN）患儿血、尿巨噬细胞移动抑制因子（MIF）的水平及临床意义。方法：采用酶联免疫吸附（ELISA）法检测33例HSPN、21例HSP患儿以及20例健康对照组儿童血清和尿液MIF水平，进行比较并分析其与24h尿蛋白（TUP）、尿红细胞的关系。其中11例HSPN患儿进行肾穿刺活检术获得肾组织标本，比较不同病理程度血、尿MIF水平的变化。结果：HSPN组尿液MIF水平显著高于HSP组及对照组（P〈0．05，P〈0．01）；3组血MIF水平比较差异无统计学意义（P〉0．05）。HSPN患儿中尿MIF水平随蛋白尿水平增加而逐渐增加，TUP≥1．0g组显著高于0．15g≤TUP〈1．0g组和TUP≤0．15g组（P均〈0．01）；3组之间血MIF水平差异无统计学意义（P〉0．05）。肉眼血尿组尿液MIF水平高于镜下血尿组，差异有统计学意义（P〈0．01），两组血MIF水平比较差异无统计学意义（P〉0．05）。HSPN病理Ⅲ～Ⅳ级组的尿MIF水平显著高于I～Ⅱ级组及对照组（P〈0．05，P〈0．01），病理I～Ⅱ级组的尿MIF水平显著高于对照组（P〈0．01）；病理Ⅲ～Ⅳ级组的血MIF水平高于正常对照组（P〈0．05），但与I～Ⅱ级组相比差异无统计学意义（P〉0．05）。结论：MIF表达上调可能是HSPN肾损害的重要机制之一，尿MIF水平能反映肾病理损伤程度，动态监测其变化可作为判断HSPN病情的一个非侵入性指标。     

2010年至2011年中国东部和西部地区成人单发跖骨骨折的流行病学对比分析北大核心CSCD

目的对比分析我国东部地区与西部地区成人单发跖骨骨折的流行病学特征。方法回顾性比较分析2010年1月至2011年12月我国东部地区和西部地区63所医院诊治的成人单发跖骨骨折患者资料,记录患者的性别、年龄及骨折分型等。将东部地区35所医院的患者资料定义为A组,西部地区28所医院的患者资料定义为B组,对比分析两组患者的性别、年龄、骨折分型和骨折部位。结果A组4779例,B组1708例,A组成人单发跖骨骨折占同期成人足部骨折的21．28％（4779／22455）,低于B组的26．88％（1708／6354）;A组成人单发跖骨骨折占同期成人全身骨折的2．48％（4779／192991）,高于B组的2．10％（1708／81143）,以上差异均有统计学意义（P〈0．05）。A、B组男女比分别为1．21：1和1．48：1,差异有统计学意义（χ2=11．768,P=0．001）。A组患者中位数年龄（43岁）大于B组（40岁）,差异有统计学意义（Z=-6．275,P〈0．001）。A组21～30岁（19．02％）、31～40岁（18．62％）年龄段患者跖骨骨折构成比低于B组（22．66％、21．60％）,51—60岁（21．09％）年龄段患者跖骨骨折构成比高于B组（14．64％）;A组患者87．A型（40．18％）、87-C型（5．52％）骨折构成比低于B组（44．38％、8．20％）,而87-B型（54．30％）骨折构成比高于B组（47．42％）,以上差异均有统计学意义（P〈0．05）。两组跖骨骨折部位分布构成比比较差异无统计学意义（P〉0．05）。结论东、西部地区均以第5跖骨的发病率最高,跖骨近端骨折构成比最高,西部地区单发跖骨骨折的构成比、男性骨折的构成比均高于东部地区。     

电针治疗膝骨关节炎临床对照试验

目的：探讨电针对骨关节炎的治疗作用。方法：将40例膝骨关节炎患者按就诊顺序随机分为2组，每组20例。电针组男8例，女12例，平均年龄（62．50±9．23）岁，平均病程（9．85±8．17）年，采用电针治疗；对照组男7例，女13例，平均年龄（61.15±6．75）岁，平均病程（8．60±6．89）年，口服双氯芬酸钠治疗。采用Lysholm膝关节评分标准评定治疗前后膝关节功能。结果：电针组除支撑外，其余各项评分与疗前比较差异均有统计学意义（P〈0．01或P〈0．05）；对照组疼痛度及交锁、膝软与疗前比较差异有统计学意义（P〈0．01或P〈0．05），其余各项差异无统计学意义（P〉0．05）。两组疗后评分在交锁、膝软、肿胀、爬楼梯和下蹲方面差异有统计学意义（P〈0．05），而跛行、支撑和疼痛度评分差异无统计学意义（P〉0．05）。结论：针刺能有效改善膝骨关节炎患者的临床症状、体征及膝关节活动度，疗效优于口服双氯芬酸钠．是治疗骨关节炎的有效手段。     

青年与老年直肠癌临床对比分析

目的探讨青年与老年直肠癌的临床、病理及预后差异。方法中国医学科学院肿瘤医院自1990年1月至2000年1月收治40岁以下直肠癌患者138例（青年组），65岁以上者163例（老年组），对这组患者的病例资料进行生存分析和预后的多因素分析。结果青年组Ⅲ期直肠癌患者比例（53．6％，74／138）明显高于老年组（34.3％，55／163）；P=0．001；青年组中黏液腺癌和低分化腺癌患者比例（28．2％，39／138）也高于老年组（10．4％，17／163）P〈0．001。青年组和老年组5年生存率分别为50．4％和64．1％．两组比较差异有统计学意义（P〈0．05）；而按照TNM分期进一步分析显示．同期别两组的生存率差异均无统计学意义（P〉0．05）。多因素分析结果显示，肿瘤T分期（P=-0．001）和淋巴结转移（P〈0．05）是影响两组患者预后的独立因素。结论与老年直肠癌相比，青年直肠癌患者的病期较晚、肿瘤分化程度较低，影响其预后；但相同病期者生存率相似。早期诊疗是提高直肠癌总体生存率的关键。     

大鼠双侧肾动脉后支结扎术制作肾性高血压模型

目的探讨一种经背双侧切口入路行大鼠双侧肾动脉后支结扎术制作颅内动脉瘤模型的手术入路新方法。方法选用70只雌性SD大鼠，实验组35只采用经背双侧手术入路双侧肾动脉后支结扎术；对照组35只采用传统经腹手术入路双侧肾动脉后支结扎术。两组同时作左颈总动脉结扎，手术1周后，用2％盐水替代饮水喂养3个月。比较实验终结时两组的血压，切肾、感染、死亡和总失败率。结果两组血压差异无统计学意义（t=-0．10，P〉0．50）；两组的切肾率（χ^2=4．79，P〈0．05）和感染率（χ^2=4．20，P〈0．05）差异有统计学意义，对照组高于差异有统计学意义（χ^2=6．63，P〈0．01），对照组明显高于实验组。结论 经背双侧手术入路行大鼠双侧肾动脉后支结扎术是一种安全性较高和手术操作简便的新方法。     

酪氨酸激酶受体B在前列腺癌组织中的表达分析

目的酪氨酸激酶B（TrkB）在前列腺癌、前列腺增生中的表达和临床病理特征及其与生物学行为的关系。方珐前列腺肿瘤标本60例，其中前列腺增生标本14例，前列腺癌标本46例，均为存档石蜡切片，应用免疫组织化学（SP法）研究TrkB表达。结果TrkB在前列腺增生组织表达为14．29％，在前列腺癌组织为80．43％，两者之间差异有统计学意义（X^2=12．26，P〈0．01）。TrkB表达水平在与Gleason评分之间呈正相关（r=0．672，P〈0．001），在不同临床TNM分期组间，在血清PSA浓度≤20ng／mL与〉20ng／mL组间差异无统计学意义（P〉0．05）。结论TrkB很可能是前列腺发病过程中起重要作用的分子，并有可能作为判断前列腺癌患者诊断和治疗的靶基因。     

不同性别原发性IgA肾病随增龄的临床病理特点

目的：了解不同性别原发性IgA肾病（IgAN）患者随增龄的临床病理特点。方法：回顾性分析我科2003年1月～2006年12月经肾活栓确诊的757例原发性IgAN患者的临床病理资料，根据年龄分成四组：A组（青年组，≤24岁，n=172例）、B组（中青年组，25岁～39岁，n=318）、C组（中年组，40岁～54岁，n=189）及D组（中老年组，≥55岁，n=78），分别比较不同性别组随增龄及同一年龄段男性与女性的临床病理特点。结果：A、B、C组男性多于女性，而D组女性多于男性。男、女性原发性IgAN中肾功能中度受损（eGFR〈60 ml／min）、高血压、高甘油三酯血症的比例均与年龄有关（P〈0．05）。A组最低，男性中B、C、D组均显著高于A组（P〈0．007），而女性中仅D组显著高于A组（P〈0．007），B、C组与A组无差异。另外，B、C组中男性肾功能中度受损、高血压及高甘油三酯血症的比例均显著高于女性（P〈0．05），而A、D组均无此趋势。B、C组男性的肾小管间质病变、肾内血管病变及血管壁透明样变性程度均重于同年龄段的女性（P〈0．05），而A、D组均无此趋势。女性患者肾功能中度受损的独立相关因素有年龄、高尿酸血症、肾小管间质损害、蛋白尿〉1g／d、肾内动脉病变5个参数。男性的独立相关因素为年龄、高尿酸血症、肾小管间质损害、全球硬化这4个参数。结论：中青年及中年女性IgAN患者的临床表现、慢性化病理改变显著轻于同年龄段男性，而55岁以上及24岁以下女性多个临床病理预后指标与同年龄段男性基本一致。     

凋亡相关基因Bax和bcl-2在骨关节炎软骨中的作用

目的探讨原发性骨关节炎与继发性骨关节炎发病机制的异同。方法收集原发性骨关节炎、继发性骨关节炎的关节软骨各8例，并以9例正常关节软骨作对照，采用RT—PCR和免疫组化方法分别检测Bax和bcl-2的mRNA和蛋白的表达，应用细胞核荧光染色的方法进行软骨细胞凋亡的检测。结果1．原发性骨关节炎组BaxmRNA表达明显升高，与继发组、对照组差异均有统计学意义（P〈0．01，P〈0．01），而继发性骨关节炎组Bax mRNA的表达与对照组之间的差异没有统计学意义（P〉0．05）；bcl-2mRNA在两类骨关节炎中的表达较对照组均升高（P〈0．01，P〈0．05），而两组间差异没有统计学意义（P〉0．05）。2．免疫组化发现两类骨关节炎中Bax、bcl-2蛋白表达水平与其mRNA表达相一致。3．原发性骨关节炎组、继发性骨关节炎组和正常对照组细胞凋亡率分别为10％～20％，8％～13％，2％～5％。原发性骨关节炎组细胞凋亡比例最高。结论软骨细胞凋亡是骨关节炎发病的重要原因，受Bax和bcl-2的共同调节；Bax表达水平的升高可能是原发性骨关节炎发病的重要原因。     

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.