七氟醚和丙泊酚对HIV感染患者外周静脉血T淋巴细胞亚群的影响

目的探讨七氟醚和丙泊酚全身麻醉对HIV感染患者外周静脉血T淋巴细胞亚群的影响。方法选择全麻下接受妇科及结肠肿瘤手术的HIV感染患者28例,男16例,女12例,年龄28～65岁,体重50～75 kg,ASAⅠ—Ⅲ级。随机分为两组:七氟醚组(S组)和丙泊酚组(P组),每组14例。S组术中持续吸入2%～4%七氟醚,P组持续静脉注射丙泊酚3～6 mg·kg~(-1)·h~(-1),两组均泵注瑞芬太尼0.4～0.6μg·kg~(-1)·min~(-1),调节麻醉深度,维持术中BIS值在40～60。分别于麻醉前30 min(T_0)、气管插管时(T_1)、切皮时(T_2)、手术结束时(T_3)及拔管时(T_4)记录患者生命体征和BIS值以及手术时间和术中出入量。分别于T_0、T_3、术后24 h(T_5)及术后3 d(T_6)抽取患者外周静脉血,检测T淋巴细胞亚群(CD3~+,CD4~+,CD8~+)的含量,计算CD4~+/CD8~+比值,并检测T_0、T_5和T_6时HIV病毒载量。结果与T_0时比较,T_3时两组外周静脉血CD3~+、CD4~+含量和CD4~+/CD8~+比值明显降低,CD8~+含量明显增加(P0.05)。与P组比较,T_3、T_5时S组CD3~+、CD4~+含量和CD4~+/CD8~+比值明显增高,CD8~+含量明显降低(P0.05)。两组HIV病毒载量差异无统计学意义。结论相同麻醉深度下,与丙泊酚比较,七氟醚全身麻醉对HIV感染患者T淋巴细胞亚群抑制较轻且恢复较快。     

异丙酚后处理对颅内动脉瘤夹闭术患者脑缺血再灌注时脑组织抗氧化作用的影响

目的 探讨异丙酚后处理对颅内动脉瘤夹闭术患者脑缺血再灌注时脑组织抗氧化作用的影响.方法 择期拟行颅内动脉瘤夹闭术患者30例,年龄26～64岁,体重53～73 ks,ASA Ⅰ或Ⅱ级,随机分为2组(n=15):对照组(C组)和异丙酚后处理组(P组).C组吸入0.5%～2.0%七氟烷,P组在开放载瘤动脉前吸入0.5%～2.0%七氟烷,开放载瘤动脉即刻靶控输注异丙酚至术毕,血浆靶浓度设为1.2μg/ml,同时下调七氟烷吸人浓度,维持BIS 40～60.于麻醉诱导前即刻(T_0)、阻断载瘤动脉即刻(T_1)、开放载瘤动脉即刻(T_2)、开放载瘤动脉后30min(T_3)、1 h(T_4)及术毕(T_5)时测定脑脊液压力,于T_0、T_3、T_5及术后24 h(T_6)时测定脑脊液F_2-异前列腺素(F_2-IsoPs)、α-生育酚(α-T)及γ-生育酚(γ-T)的浓度.结果 与T_0时比较,L_(4,5)时C组脑脊液压力降低,T_(3～5)时P组脑脊液压力降低,T_(3,5,6)时两组脑脊液α-T及γ-T的浓度降低,F_2-IsoPs浓度升高(P＜0.05);与C组比较,P组T_(3,4)时脑脊液压力降低,T_(3,5,6)时γ-T浓度升高,F_2-IsoPs浓度降低(P＜0.05).结论 异丙酚后处理可增强颅内动脉瘤夹闭术患者脑缺血再灌注时脑组织的抗氧化作用.     

异丙酚对体外循环下冠状动脉搭桥术病人的脑保护作用

目的观察异丙酚对体外循环(CPB)下冠状动脉搭桥术(CABG)病人的脑保护作用。方法择期CPB下行CABG病人40例,年龄50～65岁,ASAⅡ或Ⅲ级,随机分为2组(n=20)：异丙酚组(P组)和芬太尼组(F组)。两组常规麻醉诱导,麻醉诱导后即刻P组持续静脉输注异丙酚4～6 mg·kg~(-1)·h~(-1),F组持续静脉输注芬太尼0．7～10μg·kg~(-1)·h~(-1)。P组术中间断静脉注射芬太尼,F组间断静脉注射咪唑安定,两组术中均间断静脉注射维库溴铵及吸入异氟烷维持麻醉。桡动脉、右颈内静脉穿刺球部置管,用于监测平均动脉压、中心静脉压和采集血液标本。分别于麻醉诱导后30 min(T_1)、CPB开始5 min(T_2)、降温结束后5 min(T_3)、复温结束后5 min(T_4)、CPB结束(T_5)采集颈内静脉球部血,进行血气分析。分别于,T_1、T_2、T_5、术后4 h(T_6)、24 h(T_7)、48 h(T_8)、72 h(T_9)采集颈内静脉球部血,测定血浆S-100B浓度。术后10 d内进行精神状态量表(MMSE)评分,MMSE评分1～24分为有精神神经系统并发症(POMD)组,MMSE评分大于24分为对照组(C组)。结果P组、F组血浆S-100B浓度在T_(6,8)时高于,T_1,T_7时P组血浆S-100B浓度低于F组(P＜0．05)；术后P组POMD发生率(2／20)低于F组(6／20)(P＜0．01),但是两组脑损伤症状均于术后10 d恢复正常；与T_1比较,P组与F组SjvO_2在T_3时升高,T_4时下降(P＜0．05),T_4时P组颈静脉血氧饱和度(SjvO_2)高于F组(P＜0．05)；与T_1比较,POMD组、C组SjvO_2在T_3时升高,T_4时下降(P＜0．05),T_4时C组SjvO_2高于POMD组(P＜0．05)。结论异丙酚可减轻CPB下CABG病人脑损伤。     

乌司他丁复合帕瑞昔布钠对老年患者髋关节置换术后早期细胞免疫及认知功能的影响

目的探讨乌司他丁联合帕瑞昔布钠对老年患者单侧髋关节置换术后早期细胞免疫及认知功能的影响。方法选择择期行单侧髋关节置换术患者100例,性别不限,年龄65~80岁,随机分为四组:乌司他丁组(W组)、帕瑞昔布钠组(P组、乌司他丁联合帕瑞昔布钠组(WP组)和生理盐水对照组(C组),每组25例。W组于切皮前、手术结束即刻分别给予乌司他丁5 000U/kg;P组于麻醉诱导前给予帕瑞昔布钠40mg,之后40mg/12h,共6次;WP组于切皮前、手术结束即刻分别给予乌司他丁5 000U/kg,30min内泵注完毕,并于麻醉诱导前给予帕瑞昔布钠40mg,之后40mg/12h,共6次;C组于相同时点给予等量生理盐水。记录患者手术时间、术中出血量、自体血输注量和芬太尼总用量;于入室前(T_0)、术毕(T_1)、术后6h(T_2)、24h(T_3)及72h(T_4)采集外周静脉血,采用流式细胞术检测血T淋巴细胞(CD3~+、CD4~+、CD8~+),计算CD4~+/CD8~+值,同时采用ELISA法测定各时点血清IL-6、TNF-α、神经元特异性烯醇化酶(NSE)浓度和S100β蛋白含量。分别于T_0、T_4和术后7d(T5)时对患者进行简易智能状态量表(MMSE)评分。结果与T_0时比较,C、W和P组T_1~T_4时CD3~+、CD4~+细胞含量及CD4~+/CD8~+值明显降低,IL-6和TNF-α浓度明显升高,T_2、T_3时NSE浓度和S100β蛋白含量明显升高(P0.05);T_2、T_3时W和P组,T_1~T_4时WP组CD3~+、CD4~+细胞含量及CD4~+/CD8~+值明显高于,IL-6、TNF-α、NSE浓度和S100β蛋白含量明显低于C组(P0.05);T_2、T_3时WP组CD3~+、CD4~+细胞含量及CD4~+/CD8~+值明显高于,IL-6、TNF-α、NSE浓度和S100β蛋白含量明显低于W和P组(P0.05)。与T_0时比较,T_4、T5时C组MMSE评分明显降低(P0.05);T_4时W、P和WP组MMSE评分明显高于C组(P0.05);T_4时WP组患者MMSE评分明显高于W和P组(P0.05)。结论乌司他丁联合帕瑞昔布钠可改善老年患者单侧髋关节置换术细胞免疫功能及认知功能,较单独使用效果更好。     

丙泊酚对肺癌患者外周血IL-12、IFN-γ及IL-4的影响

目的探讨丙泊酚对肺癌患者外周血细胞因子白细胞介素(IL)-12、γ-干扰素(IFN-γ)、IL-4的影响。方法30例行非小细胞型肺癌肺叶切除术患者随机分为丙泊酚(IV)组和异氟醚(IH)组,每组15例。分别于麻醉诱导前(T0)、麻醉诱导后10min(T1)、切皮后1h(T2)、停药即刻(T3)、术后1h(T4)及术后24h(T5)采集肘静脉血,测定血清IL-12、IFN-γ、IL-4及皮质醇(Cor)浓度。结果与T0时比较,IV组T5时IL-12、IFN-γ/IL-4及T4、T5时IFN-γ明显增高(P<0.05或P<0.01);且T5时IL-12、IFN-γ/IL-4及T4、T5时IFN-γ均高于IH组(P<0.05)。两组IL-4均有增高趋势,但组内、组间差异无显著意义。与T4时相比,T5时IV组IFN-γ、IFN-γ/IL-4增高明显(P<0.05)。结论丙泊酚可以促进外周血IL-12、IFN-γ的分泌,升高IFN-γ/IL-4比值,诱导围术期Ⅰ型辅助性淋巴细胞(Th1)反应,有利于抗肿瘤、抗感染免疫。     

酮咯酸氨丁三醇预防性镇痛对乳腺癌改良根治术患者镇痛效果及免疫功能的影响

目的探讨酮咯酸氨丁三醇预防性镇痛应用于乳腺癌改良根治术患者的镇痛效果及对免疫功能的影响。方法选择择期乳腺癌改良根治术患者70例,年龄36~65岁,体重45~75kg,ASAⅠ或Ⅱ级,根据患者是否接受镇痛分为预防性镇痛组(A组)和对照组(C组),每组35例。两组患者均采用气管插管全麻,预防性镇痛组在麻醉诱导前30min给予酮铬酸氨丁三醇60mg入壶静滴,对照组同时给予等量生理盐水。记录两组患者麻醉诱导前(T_0)、术后30min(T_1)、1h(T_2)、4h(T_3)和24h(T_4)时疼痛VAS评分。在T_0、T_4时测量患者血浆T_淋巴细胞亚群(CD3~+、CD4~+、CD8~+)及白细胞介素(IL)~(-1)β、IL-6、IL~(-1)0水平。结果 T_1~T_4时C组患者VAS评分明显高于T_0时和A组(P0.05);T_4时C组T_淋巴细胞亚群CD3~+、CD4~+及CD8~+明显低于T_0时和A组(P0.05),两组CD4~+/CD8~+组间组内差异无统计学意义;T_4时C组IL~(-1)β和IL-6水平明显高于T_0时和A组,T_4时A组IL~(-1)0水平明显高于T_0时和C组(P0.05)。结论酮咯酸氨丁三醇预防性镇痛应用于乳腺癌改良根治术患者能取得较好的镇痛效果,同时能够保护患者免疫功能,抑制炎性反应,减轻手术及麻醉对患者免疫功能的抑制作用。     

术后加速康复对腹腔镜肝部分切除术患者免疫功能的影响

目的探讨术后加速康复(enhanced recovery after surgery,ERAS)对腹腔镜肝部分切除术患者免疫功能的影响。方法选择2014年6月至2015年10月择期行腹腔镜肝部分切除手术的患者60例,男34例,女26例,年龄38~57岁,ASAⅠ或Ⅱ级,随机分为两组,每组30例。E组实施ERAS,C组实施常规围术期处理及麻醉方法。记录患者手术方式及时间、术中出血量、芬太尼总用量、补液量,以及术前、术毕时CVP和体温;于麻醉前(T_0)、术毕(T_1)、术后第1天(T_2)、第3天(T_3)及第7天(T_4)采集外周静脉血,采用流式细胞术检测外周血T_淋巴细胞亚群CD3~+、CD4~+和CD8~+T细胞百分比,并计算CD4~+/CD8~+值,采用ELISA法测定各时点血清IgA、IgM、IgG浓度。记录患者术后4、8、24、48h的VAS疼痛评分和Ramsay镇静评分。结果 E组芬太尼总用量、补液量和术毕时CVP明显低于C组,而术毕时体温明显高于C组(P0.05);与T_0时比较,T_1~T_3时E组CD3~+、CD4~+T_细胞百分比、CD4~+/CD8~+值、IgA、IgM和IgG浓度明显降低,T_1~T_4时C组CD3~+、CD4~+T_细胞百分比、CD4~+/CD8~+值、IgA、IgM和IgG浓度明显降低(P0.05);T_1~T_4时E组CD3~+、CD4~+T细胞百分比、CD4~+/CD8~+值、IgA、IgM和IgG浓度明显高于C组(P0.05);术后4、8、24hE组的VAS评分明显低于C组(P0.05),术后各时点两组Ramsay评分差异无统计学意义。结论 ERAS可减少肝部分切除术患者芬太尼用量,防止术中低体温的发生,且提供满意的术后镇痛,可显著改善患者免疫功能。     

丙泊酚对肺癌根治术患者T淋巴细胞可诱导协同刺激分子的影响

目的 观察丙泊酚复合雷米芬太尼麻醉对肺癌根治术患者T淋巴细胞可诱导协同刺激分子(ICOS)的影响.方法 择期行肺叶切除术肺癌患者20例,年龄40～70岁.随机均分为丙泊酚组(P组)和异氟醚组(Ⅰ组).于麻醉诱导前即刻(T0)、诱导后10 min(T1)、切皮后1 h(T2)、术后1h(T3)及24 h(T4)采集静脉血,用流式细胞仪测定血浆CD4+ICOS+和CD8-ICOS+表达率,用放射免疫法测定血清白细胞介素(IL)-6、IL-10的浓度.结果 与T0时比较,P组T3时CD4+ICOS+、CD8+ICOS+、IL-6浓度升高,T2～T4时IL-10浓度均升高(P＜0.05);与Ⅰ组比较,P组在T4时CD4+ICOS+、CD8+ICOS+升高,T3时IL-10升高(P＜0.05).结论 丙泊酚可以促进ICOS的表达,可以增强肺癌根治术患者的细胞免疫功能.     

乌司他丁对非体外循环冠状动脉旁路移植术病人围术期炎性反应的影响

目的观察乌司他丁对非体外循环冠状动脉旁路移植术(OPCABG)病人围术期炎性反应的影响。方法拟行OPCABG的病人24例,采用随机、双盲方法分为对照组(C组)和乌司他丁组(U组),每组12例。静脉注射咪达唑仑0.1mg/kg、芬太尼10～20μg/kg、哌库溴铵0.1mg/kg麻醉诱导后气管插管,机械通气,吸入1%～2%异氟烷、间断静脉注射芬太尼(2～5μg/kg,总量最高为50μg/ kg)、持续静脉输注哌库溴铵0.03～0.05mg·kg~(-1)·h~(-1)维持麻醉。U组麻醉诱导后开始恒速静脉输注乌司他丁6 000U/kg(30min内输完),然后以1 000 U·kg~(-1)·h~(-1)的速率持续静脉输注至手术结束。C组采用的同样方法输注等容量的生理盐水。分别在切皮前即刻(T_1)、冠状动脉全部吻合结束后0.5h (T_2)、术后2h(T_3)、6h(T_4)、18h(T_5)采集静脉血,测定血浆白细胞介素-6(IL-6)、IL-10、终末补体复合物(TCC)的浓度及CD11b/CD18的表达。结果与T_1比较,C组在T_(3,4)时IL-6浓度、T_3时IL-10浓度升高,T_(2-4)时CD11b/CD18表达升高,2组在T_2时TCC浓度均升高(P<0.05或0.01);与C组比较,U组在T_3时IL-6、IL-10浓度降低,在T_(2～4)时CD11b/CD18表达降低(P<0.05或0.01)。结论乌司他丁可在一定程度上抑制OPCABG病人围术期IL-6、IL-10浓度及CD11b/CD18表达的升高,具有减轻炎性反应的作用。     

不同血浆靶浓度瑞芬太尼复合异丙酚对肺癌根治术病人细胞免疫功能的影响

目的 评价不同血浆靶浓度瑞芬太尼复合异丙酚对肺癌根治术病人细胞免疫功能的影响.方法 择期肺癌根治术病人24例,ASAⅠ或Ⅱ级,年龄45～64岁,体重指数<30 ks/m2.随机分为3组(n=8),麻醉诱导:R1组、R2组和R3组靶控输注瑞芬太尼,血浆靶浓度分别为4、6、8 ng/ml,靶控输注异丙酚,血浆靶浓度为3μg/ml,待病人意识消失时静脉注射维库溴铵0.1 mg/kg,3 min后行气管插管,机械通气.各组术中瑞芬太尼血浆靶浓度维持不变,调整异丙酚血浆靶浓度维持脑电双频谱指数45～55,间断静脉注射维库溴铵0.05 mg/kg维持肌松,术后均行病人白控静脉镇痛.于入室后5min(T0)、切皮后1 h(T1)、术毕即刻(T2)、术后24 h(T3)和术后72 h(T4)抽取外周静脉血,采用流式细胞仪检测CD3+、CIM+、CD8+及NK细胞水平,计算CD4+/CD8+;采用ELISA法测定血清干扰素γ(IFN-γ)和白细胞介素4(IL-4)浓度,计算IFN-γ/IL-4.结果 与T0时比较,R3组T2时血清IFN-γ浓度、IFN-γ/IL-4降低,R1组T1时血清IL-4浓度、T3,4.时IFN-γ/IL-4降低,R1组、R2和R3组分别于T3、T2,3和T1～3时CD3+细胞水平降低,R3组T1,2时CD8+、NK细胞水平降低(P<0.05或0.01);R3组T2时血清IFN-γ浓度、IFN-γ/IL-4较R1组和R2组降低(P<0.05);与R1组比较,R3组T1～3时CD3+、T1,2时CD8+、NK细胞水平降低(P<0.05或0.01);与R2组比较,R3组T1,2时CD3+、NK细胞水平降低(P<0.05或0.01).结论 靶控输注瑞芬太尼(血浆靶浓度8 ng/ml)复合异丙酚(血浆靶浓度3 μg/ml)可抑制肺癌根治术病人细胞免疫功能,但呈可逆性.     

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.