六岁以下患儿气管插管全身麻醉后呼吸系统不良事件的相关因素分析

目的分析6岁以下患儿行气管插管全身麻醉后呼吸系统不良事件的相关影响因素。方法收集普、胸、泌、骨及矫形外科患儿267例,对术前评估中所有可能造成麻醉后呼吸系统不良事件的因素进行定义和记录,包括:性别、年龄6岁、体重、术前住院日、手术实施季节、术前是否合并轻、中度上呼吸道感染症状、手术操作部位是否对呼吸具有潜在影响及麻醉维持时间。不良事件包括:咳嗽多痰、SpO2静息状态下95%、腋窝T38℃、舌后坠、气管导管移位、屏气、喉痉挛、支气管痉挛。对影响不良事件的相关因素进行二元逻辑回归分析OR值。结果年龄1岁的患儿,1种呼吸系统不良事件的发生率增加(OR=2.66,95%CI:1.50~4.71),2种及以上呼吸系统不良事件的发生率增加(OR=2.44,95%CI:1.29~4.60);术前合并上感症状的患儿,1种呼吸系统不良事件的发生率增加(OR=2.81,95%CI:1.47~5.39),2种及以上呼吸系统不良事件的发生率增加(OR=2.57,95%CI:1.31~5.03),而其余因素对发生呼吸系统不良事件的影响无统计学意义。结论年龄1岁及术前合并上感仍是发生麻醉后呼吸系统不良事件的独立危险因素;性别、体重、术前住院日、季节、手术部位及麻醉维持时间等独立因素并不增加不良事件的发生。     

9985例右美托咪定滴鼻镇静行无创检查患儿的回顾性分析

目的回顾性分析患儿使用右美托咪定滴鼻镇静术行无创性检查的安全性和有效性。方法通过提取本院手术麻醉电子病历系统中的数据,回顾性分析2017年6月至2018年4月在本院镇静镇痛中心行无创性检查的患儿9 985例,年龄≥3个月,体重5～10 kg,右美托咪定滴鼻剂量为1.5～2.5μg/kg,体重10 kg的患儿滴鼻剂量为2.5～3μg/kg,如果镇静失败,可追加一次1μg/kg。统计镇静成功率和不良事件的发生率。结果起始剂量镇静成功8 237例(82.49%),总成功率为94.27%。总计有271例(2.71%,95%CI 2.40%～3.03%)患儿发生不良事件,其中心动过缓有231例(2.31%,95%CI 2.02%～2.61%),为主要不良事件,未发生一例心跳呼吸骤停及死亡。结论右美托咪定滴鼻镇静可安全有效地用于患儿无创性检查。     

心包积液患儿围术期不良事件的危险因素分析

目的回顾性分析心包积液患儿围术期不良事件的影响因素。方法我院2009年1月至2014年7月手术治疗的心包积液患儿157例,麻醉期间不良事件定义为诱导后出现低氧、低血压或心律失常。应用单因素和多因素Logistic回归分析不良事件的危险因素。结果有38例(24.2%)患儿发生不良事件(A组),其中一般不良事件31例(81.6%),严重不良事件7例(18.4%)。A组术前合并胸腔积液、呼吸困难、奇脉、心房/心室压迫、较高ASA分级及入手术室时呼吸急促、心动过速、低氧、低血压明显多于无不良事件组(N组)(P0.05)。多因素Logistic回归分析显示,术前呼吸困难(OR=6.8,95%CI 1.4~12.4)、入手术室时低氧(OR=5.5,95%CI 1.1~15.9)、入手术室时低血压(OR=3.4,95%CI 1.2~9.1)及心房/心室压迫(OR=6.3,95%CI 1.8~22.1)是不良事件的独立危险因素。结论对存在危险因素的心包积液患儿应警惕其麻醉期间发生不良事件。     

老年髋部骨折术后脑卒中的发生率及其独立危险因素分析

目的探讨老年髋部骨折术后脑卒中的发生率及其独立危险因素。方法回顾性收集临沂市人民医院2019年6月—2022年6月收治的1 296例择期行髋部骨折手术患者的临床资料, 依据术后30 d内是否发生脑卒中分为脑卒中组(30例)和非脑卒中组(1 266例)。单因素分析两组患者的基线资料、术前实验室资料、麻醉相关资料、骨折及手术相关资料, 将单因素分析中P<0.2的因素纳入多因素logistic回归分析, 探讨老年髋部骨折术后脑卒中的发生率及其独立危险因素。结果本研究共纳入1 296例患者, 其中30例术后发生脑卒中, 发生率为2.3%。多因素logistic回归分析结果显示, 老年髋部骨折术后脑卒中的独立危险因素为美国麻醉医师协会(ASA)分级Ⅲ-Ⅳ级[比值比(OR)4.441, 95%置信区间(CI)1.243～15.861, P=0.022]、术前红细胞分布宽度(RDW)(OR 1.057, 95%CI 1.006～1.110, P=0.027)较高、颈动脉斑块(OR 2.760, 95%CI 1.191～6.395, P=0.018)、术中低血压(OR 2.641, 95%CI ...     

高龄患者术后严重并发症的危险因素分析

目的 探讨高龄患者择期手术后严重并发症的危险因素。
方法 选择行骨科、妇科、胃肠外科手术的患者332例，男123例，女209例，年龄≥80岁。根据患者是否发生术后严重并发症分为两组：严重并发症组和对照组。记录一般情况、术前合并症、实验室检查、手术和麻醉情况。采用多因素Logistic回归分析术后发生严重并发症的危险因素。
结果 有43例（13.0%）患者发生术后严重并发症。与对照组比较，严重并发症组BMI和术中最低MAP值明显降低，ASA分级、改良Goldman分级、合并控制不良糖尿病比例明显升高，手术开始时间明显延迟（P<0.05）。Logistic回归分析显示，术后严重并发症的危险因素为BMI降低（OR=1.145，95%CI 1.042～1.261，P=0.016）、ASA分级升高（OR=3.587，95%CI 1.210～10.632，P=0.021）、改良Goldman分级升高（OR=7.175，95%CI 2.355～21.861，P=0.001）、控制不良的糖尿病（OR=2.202，95%CI 1.041～4.657，P=0.039）、手术开始时间延迟（OR=2.611，95%CI 1.242～5.491，P=0.011）和术中最低MAP值降低（OR=1.068，95%CI 1.116～1.119，P=0.009）。
结论 高龄患者择期手术后严重并发症发生的独立危险因素为BMI降低、ASA分级和改良Goldman分级升高、控制不良的糖尿病、手术开始时间延迟、术中最低MAP值降低。     

芬太尼抑制七氟醚复合瑞芬太尼麻醉恢复期间患儿躁动的药效学

目的 探讨芬太尼抑制七氟醚复合瑞芬太尼麻醉恢复期间患儿躁动的药效学.方法 择期拟行鼻内镜下增殖体刮除术的息儿26例,年龄5～8岁,体重15～30 kg,ASA Ⅰ或Ⅱ级.麻醉诱导:吸入8%七氟醚(氧流量6 L/min),静脉注射瑞芬太尼1 μg/kg(经30 s注射完),气管插管后行机械通气,随后静脉注射芬太尼抑制麻醉恢复期间患儿躁动,采用改良的序贯法确定静脉注射芬太尼的剂量.第1例患儿静脉注射芬太尼的剂量为4μg/kg,相邻剂量差值为0.5μg/kg,以患儿苏醒后易激惹且难以安慰作为判断躁动发生的标准.麻醉维持:吸人2%七氟醚(氧流量1 L/min),静脉输注瑞芬太尼0.2μg·kg-1·min-1.术毕停用七氟醚和瑞芬太尼,带气管导管回麻醉恢复室,待患儿苏醒.记录术后4h内患儿躁动、恶心、呕吐、呼吸抑制等的发生情况及苏醒时间.计算芬太尼抑制50%、95%患儿七氟醚复合瑞芬太尼麻醉恢复期间躁动的剂量(ED50、ED95)及其95%可信区间.结果 芬太尼抑制七氟醚复合瑞芬太尼麻醉恢复期间患儿躁动的ED50及其95%可信区间为3.01(2.52～3.40)μg/kg,En95及其95%可信区间为3.81(3.41～6.22)μg/kg.术后4h内未发生明显恶心、呕吐及呼吸抑制.苏醒时间(11.3±2.6)min.结论 芬太尼抑制七氟醚复合瑞芬太尼麻醉恢复期间患儿躁动的ED50为3.01μg/kg,ED95为3.81μg/kg.     

艾司氯胺酮用于患儿术前镇静的半数有效剂量

目的 应用改良序贯法研究艾司氯胺酮在患儿术前镇静的半数有效剂量（ED50）。
方法 选择2021年1—2月择期全麻下行短小手术（＜1 h）的患儿23例,男12例,女11例,年龄2～6岁,ASA Ⅰ或Ⅱ级。术前于手术准备间内静脉注射艾司氯胺酮,待起效后与家属分离,行麻醉诱导,评估用药后镇静效果。采用改良序贯法测定其用于患儿术前有效镇静的剂量,起始剂量为0.5 mg/kg,剂量梯度设定为0.05 mg/kg,当患儿Ramsay镇静评分≥2分、Funk神经行为评分≥3分且麻醉诱导评分为4分时为镇静成功（阳性）,则下一例患儿在上一例患儿给药剂量基础上降低0.05 mg/kg,反之任一指标达不到相应评分时则为镇静失败（阴性）,下一例患儿在上一例患儿给药剂量基础上升高0.05 mg/kg,直至出现连续7个阳性和阴性拐点交替之后研究结束。采用概率单位回归分析法计算其术前用药的ED50、95%有效剂量（ED95）和95%可信区间（CI）。记录患儿术后苏醒时间和麻醉期间恶心呕吐、喉痉挛、支气管痉挛、呼吸道梗阻、呼吸抑制等不良反应的发生情况。
结果 艾司氯胺酮用于患儿术前有效镇静的ED50为0.580 mg/kg（95%CI 0.559～0.602 mg/kg）,ED95为0.618 mg/kg（95%CI 0.598～0.678 mg/kg）。患儿无一例发生恶心呕吐、喉痉挛、支气管痉挛、呼吸道梗阻、呼吸抑制等不良反应。
结论 艾司氯胺酮静注用于2~6岁患儿入手术室前镇静的ED50为0.580 mg/kg（95%CI 0.559～0.602 mg/kg）。     

胫骨平台骨折切开复位内固定术后短期不良结果的影响因素分析

目的分析影响胫骨平台骨折切开复位内固定术后短期不良结果的因素。方法回顾性分析自2009-07—2013-12采用切开复位内固定治疗的186例SchatzkerⅣ型胫骨平台骨折,记录术后短期不良事件、住院时间延长、30 d内再住院及感染发生情况,并采用Poisson回归模型分析年龄、性别、BMI、ASA分级、合并症、吸烟史、功能状态、开放性骨折、骨折移位程度、手术时间对术后短期不良结果发生率的影响。结果 23例(12.4%)术后出现严重不良事件,11例(5.9%)出现轻微不良事件,14例(7.5%)出现感染并发症,39例(20.9%)住院时间延长,9例(4.8%)30 d内再住院。多元分析得出,严重不良事件发生率与男性(RR=2.2,P=0.015)、ASA≥3级(RR=3.6,P0.001)显著相关,轻微不良事件发生率与ASA≥3级(RR=3.8,P0.001)、糖尿病(RR=1.9,P=0.012)、吸烟史(RR=1.8,P=0.016)显著相关,术后感染发生率与男性(RR=3.0,P=0.010)、ASA≥3级(RR=3.3,P=0.005)、肺部疾病(RR=2.9,P=0.018)、吸烟史(RR=2.8,P=0.012)独立相关,住院时间延长与年龄≥60岁(RR=2.1,P=0.014)、ASA≥3级(RR=2.0,P=0.001)、肺部疾病(RR=1.8,P=0.001)、糖尿病(RR=1.6,P=0.025)、手术时间≥178 min(RR=1.6,P=0.031)独立相关,30 d内再住院与ASA≥3级(RR=3.9,P=0.024)、糖尿病(RR=2.9,P=0.030)、非独立功能状态(RR=8.1,P=0.001)独立相关。结论高ASA分级是导致胫骨平台骨折切开复位内固定术后短期发生不良结果的高危因素,男性、吸烟史及肺部疾病也是影响术后短期结果的危险因素。     

区域麻醉和全身麻醉用于老年下肢骨折患者术后康复的比较

目的比较区域麻醉和全身麻醉对老年单侧下肢骨折术后康复的影响。方法回顾本院2017年5月至2018年4月间行单侧下肢骨折手术的老年患者116例,男35例,女81例,年龄65～98岁,ASAⅠ—Ⅳ级。根据麻醉方式分为区域麻醉组(RA组,n=50)和全身麻醉组(GA组,n=66),记录两组患者性别、年龄、ASA分级、骨折部位、术前1 d Barthel评分和分级等术前基线资料;术式、手术时间和失血量等手术相关资料,ICU停留时间、术毕至下床活动时间、术后住院时间、术后3 d Barthel评分和分级等术后康复相关资料,建立3个Logistic回归模型记录2种麻醉方式老年单侧下肢骨折术后Barthel的评分。结果 RA组年龄明显大于GA组(P0.05)。两组性别、ASA分级、骨折部位、术式、手术时间和失血量、ICU停留时间、术毕至下床活动时间、术后住院时间,术前1 d Barthel评分和分级等差异均无统计学意义。术后3 d RA组Barthel评分明显高于GA组(P0.05),Barthel分级为III或IV级的比例明显低于GA组(P0.05)。采用二元Logistic回归进一步调整潜在混杂因素,分析麻醉方式与术后3 d Barthel分级的关联强度,建立3个回归模型以去除潜在混杂因素影响后,RA组患者出现术后3 d Barthel分级为Ⅲ级或Ⅳ级的危险明显低于GA组(P0.05)。按照模型1调整年龄因素后OR=0.235, 95%CI 0.103～0.538,P=0.001;按照模型2调整年龄和性别因素后OR=0.207, 95%CI 0.087～0.490,P0.001;按照模型3调整年龄、性别和ASA分级因素后OR=0.210, 95%CI 0.088～0.498,P0.001。结论老年患者行单侧下肢骨折手术时,与全身麻醉比较,区域麻醉更有助于患者提高Barthel评分,有助于早期康复。     

直肠癌术后严重并发症的危险因素分析

目的探究直肠癌保肛术后30d严重并发症的危险因素。方法回顾性分析中山大学附属第六医院2010年1月至2014年10月间接受直肠癌保肛手术的956例病人的临床病理及并发症资料,采用单因素和多因素Logistic回归模型分析直肠癌保肛手术术后30d内严重并发症(Clavien-Dindo分级≥Ⅲ级)的危险因素。结果 956例病人中严重并发症发生率为6.3%(60/956)。按Clavien-Dindo并发症分级:Ⅲa级36例,Ⅲb级12例,Ⅳa级5例,Ⅳb级5例,Ⅴ级2例。单因素Logistic回归分析显示,术前合并症(OR=1.781、95%CI为1.04~3.048、P=0.035),术前白蛋白(OR=6.979、95%CI为3.057~15.930、P0.001),术中估计出血量(OR=2.386、95%CI为1.375~4.138、P=0.002),术中输血(OR=2.698、95%CI为1.088~6.695、P=0.032)与直肠癌术后严重并发症的发生有关。Logistic多因素回归分析显示,术前存在合并症(OR=2.051、95%CI为1.160~3.627、P=0.014),术前白蛋白(≤35g/L)(OR=4.652、95%CI为1.776~12.182、P=0.002),术中估计出血量(150ml)(OR=2.131、95%CI为1.190~3.816、P=0.011)是直肠癌术后严重并发症发生的独立危险因素。结论术前存在合并症、低白蛋白血症及术中出血量大是直肠癌术后30d内发生严重并发症的危险因素。     

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.     

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.     

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.     

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.     

Intraoperative autotransfusion is associated with modest reduction of allogeneic transfusion in prosthetic hip surgery

Background: The efficacy of intraoperative salvage and washing of wound blood and the predictors of allogeneic red cell transfusions in prosthetic hip surgery are insufficiently known.
Methods: In 96 patients, undergoing primary or revision surgery, salvaged and washed red cells and, if necessary, allogeneic blood were used to keep haematocrit not lower than 33%. The bleeding of red cells during hospital stay was calculated from the red cell balance. The preoperative red cell reserve (millilitres of red cells in excess of a haematocrit of 33%) was estimated and the difference between this volume and the total bleeding of red cells was retrospectively used to classify patients with regard to the need for red cells. Stepwise regression analysis was used to define patient-related variables associated with allogeneic blood transfusion.
Results: Preoperative knowledge of the type of operation (primary, revision), the preoperative red cell reserve, and the body mass could predict roughly half of the need for banked blood (r²=0.45). Only one-third of the total bleeding of red cells was retransfused. For complete avoidance of allogeneic blood, autotransfusion was most effective in patients with a moderate need (0–4 u). However, 32% of such patients required allogeneic blood.
Conclusions: Autotransfusion has a limited efficacy to decrease the need for allogeneic blood, and other blood-saving methods should be added for this purpose. It is difficult to predict the need for allogeneic blood preoperatively.     

缺氧对肾小管上皮细胞分泌外泌体的影响

目的    观察缺氧对肾小管上皮细胞分泌外泌体的影响,探讨外泌体在缺氧致肾脏损伤中的作用及机制。 方法    （1）常氧（21% O₂）及缺氧（1% O₂）分别处理大鼠肾小管上皮细胞（NRK-52E）48 h,收集细胞上清液并使用高速梯度离心法分离外泌体。采用透射电镜、纳米示踪分析、Western印迹、蛋白浓度定量鉴定并比较两组外泌体的基本特性。（2）在共培养实验中,以不同浓度（1、10、50、100、300 mg/L）的常氧外泌体、缺氧外泌体分别干预脂多糖（LPS）诱导的大鼠原代腹腔巨噬细胞,使用实时荧光定量PCR与酶联免疫吸附试验（ELISA）法分别检测巨噬细胞白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、诱导型氮氧化物合酶（iNOS）水平;使用Western印迹法检测巨噬细胞磷酸化（p）STAT/STAT及细胞因子信号传导抑制蛋白1（SOCS1）的蛋白表达;最后,使用实时荧光定量PCR法检测常氧外泌体与缺氧外泌体中炎性反应相关微RNA（microRNA,miR）的表达差异。 结果    （1）离心得到的囊泡具有外泌体典型的结构,粒径小于150 nm,表达外泌体标志蛋白CD63,说明分离得到外泌体。缺氧对肾小管上皮细胞分泌的外泌体形态、粒径分布比例无明显影响,但提高了外泌体的分泌量。（2）缺氧外泌体相比于常氧外泌体促进了LPS诱导的M1型巨噬细胞IL-6、TNF-α、iNOS 的表达和分泌（均P＜0.01）,同时提高STAT的磷酸化水平并减少SOCS1的蛋白表达（均P＜0.01）;对炎性反应相关microRNA检测发现缺氧外泌体中miR-155、miR-27a表达量较常氧外泌体明显升高（P＜0.05）。 结论    缺氧可改变外泌体的生物学功能,表现为协同促进LPS诱导的M1型巨噬细胞的表型转化,这可能是慢性肾脏病微炎性反应状态持续的原因之一。     

In Vitro Function and Durability Assessment of a Novel Polyurethane Heart Valve Prosthesis

Abstract While flexible-leaflet, central-flow prosthetic heart valves promise relief from anticoagulation therapy, they continue to be restricted by inadequate durability. In consequence, a novel trileaflet valve, made entirely from polyurethane, has been developed. A batch of 6 consecutively manufactured polyurethane valves was subjected to hydrodynamic function and accelerated fatigue testing. Computerized data acquisition and control systems have been introduced to improve valve testing methodologies. In terms of hydrodynamic function, the polyurethane valve demonstrates transvalvular pressure gradients similar to those for a bioprosthetic valve (Carpentier-Edwards) and levels of retrograde flow significantly less than those for either the bioprosthetic valve or a bileaflet mechanical valve (St Jude Medical). The equivalent of 10 years of cycling without failure has been exceeded by all 6 polyurethane valves in accelerated fatigue tests with 2 valves remaining intact after 674 million cycles (equivalent to approximately 17 years) in continuing tests. Highspeed photography revealed considerable differences in leaflet motion between valves cycled at accelerated and physiological rates.     

Negative pressure ventilation vs. spontaneous assisted ventilation during rigid bronchoscopy: A controlled randomised trial

Background: Ventilation during interventional rigid bronchoscopy (IRB) under general anaesthesia (jet ventilation, positive pressure ventilation and spontaneous assisted ventilation) may offer some difficulties. This study compares the effectiveness during IRB of intermittent negative pressure ventilation (INPV) and spontaneous assisted ventilation (SAV). Methods: Thirty-eight patients submitted to IRB were randomised into two groups: SAV or INPV. All patients received a total intravenous anaesthesia; INPV patients were paralysed. Pre-and intra-operative arterial blood gases and O₂ flow through a rigid bronchoscope were assessed. The endoscopist applying a subjective score evaluated the operating conditions. Results: Patients of the INPV group, as compared to the SAV group, required a lower dosage of fentanyl (2.6 ± 1.8 (μg · kg^?1· h^?1 vs. 6.6 ± 4.8 μg · kg^?1· h^?1), a lower O₂ supply (3.3 ± 2.8 1/min vs. 11.6 ± 3.4 1/min), a shorter recovery time (5.4 ± 2.9 min vs. 9.8 ± 7.1 min) and no manually assisted ventilation (0 ± 0 vs. 1 ± 1.1 nd?/procedure). Intraoperative PaCO₂ was higher in the SAV (8.1 ± 1.3 kPa) than in the INPV group (5.0 ± 1.6 kPa) and intraoperative pH differed in the two groups (7.26 ± 0.05, SAV vs. 7.47 ± 0.08, INPV). Operating conditions, as assessed by a subjective score, were considered better with INPV than with SAV (4.9 vs. 4.3). Conclusions: As compared to SAV, INPV in paralysed patients during IRB reduces administration of opioids, shortens recovery time, prevents respiratory acidosis, excludes the need for manually assisted ventilation, reduces 02 need and affords optimal surgical conditions. INPV appears a safe, non-invasive and effective ventilatory management during IRB.