关节镜下半月板损伤修复的治疗方法

目的探讨关节镜下半月板损伤缝合修复术的治疗方法和效果。方法1998年6月~2003年5月,收治110例膝半月板损伤患者。其中男78例,女32例。年龄14~66岁,平均27.5岁。半月板滑膜缘纵裂93例,横裂12例,潜行撕裂5例。半月板损伤部位侧缘损伤78例,近前角部损伤23例,近后角部损伤9例。术前Lysholm评分为57±12分。均在关节镜下应用可吸收缝线缝合修复损伤的半月板,其中2针91例,4针13例,6针4例,8针2例。术后行康复训练及随访观察效果。结果术后关节无血肿、伤口期愈合。全部获随访12~67个月,平均26个月。3例患者劳累后出现膝关节胀痛,1例半月板损伤症状再出现,再手术探查见半月板缝合处未完全愈合,行半月板部分切除,术后痊愈。其余患者症状消失,关节功能良好。术后Lysholm评分为92±7分。结论关节镜下半月板损伤缝合修复术安全、可靠、操作简便。缝线吸收后,避免对半月板的制约,使愈合的半月板更好地发挥其生理和生物力学功能。     

膝关节半月板损伤的手术修复疗效观察

目的探讨切开直视下及关节镜下缝合修复半月板损伤的疗效及术后并发症发生情况。方法1988年1月～2004年6月采用切开直接缝合法和关节镜下缝合修补方法修复半月板损伤168例170个。关节镜下方法包括穿刺打磨修复法、可吸收半月板箭复位固定法、Outside-In缝合法、Inside-Out缝合法、Elite肩袖缝合器缝合法、T-Fix固定技术和FasT-Fix固定技术。通过症状、体征、Tegner和Lysholm评分对半月板缝合修复的临床效果进行评价,并对术后的并发症进行观察。对有明显症状及体征的患者进行关节镜探查。结果所有患者获得6个月～9．5年(平均49．3±28．8个月)随访发现,Tegner评分：术前3．3±2．3,术后6．8±2．1(p＜0．05)。Lysholm评分：术前30．1±18．2,术后87．5±22．5(P＜0．01)。按Molster对Lysholm评分的分级方法,优98个,良57个,可10个,差5个,优良率为91．2%。对术后症状和体征明显的19例患者进行关节镜再探查,发现5例术愈合,6例部分愈合。术后并发症包括Outside-In缝线打结处疼痛3例,外侧半月板前角Outside-In缝合后未愈合导致后关节囊牵拉痛1例,半月板箭固定处的后关节囊刺痛5例。无严重血管、神经损伤,术后并发症的总发生率为5．3%。结论选择适当方法对损伤半月板进行修复可明显改善膝关节的症状和功能评分,并且具有较高的手术成功率和较少的术中、术后风险。     

关节镜下可吸收性半月板箭治疗半月板损伤的初步报告

目的关节镜下应用可吸收性半月板箭治疗半月板损伤并评价其近期疗效。方法2002年2～10月,关节镜下采用半月板箭缝合固定12例12侧半月板损伤,男5例,女7例;年龄18～58岁,平均33.2岁。左膝4例,右膝8例。内侧半月板损伤4例,外侧半月板损伤8例;前角损伤2例,体部损伤3例,后角损伤7例。红区损伤10例,红-白区损伤2例。病程3d～5个月,平均2.3个月,其中急性损伤(病程<1个月)9例。关节镜下采用新型全内半月板箭技术固定,共使用25枚半月板箭(平均每例2.1枚)。5例同时施行其它类型手术。结果所有病例术后均无早期并发症发生。全部患者均获得随访,随访时间7～13个月,平均10.2个月。随访时所有患者膝关节稳定,无疼痛、绞锁等症状,6周后关节活动度全面恢复。Lysholm评分由术前的平均(45.6±13.4)分增加到术后平均(82.4±16.3)分,差异有显著性(P< 0.05)。2例分别于术后8个月和9个月出现关节积液,考虑为滑膜炎,经治疗后消失。结论对于半月板损伤,如撕裂类型和部位适当,可选择可吸收性半月板箭治疗。半月板箭技术是一种简便快捷、安全有效的半月板缝合方法。     

快速锁定装置在膝关节半月板损伤中的应用

目的 探讨采用可吸收快速锁定缝合装置(Rapidloc-PDS)在关节镜下缝合治疗膝半月板损伤的治疗效果.方法 30例33侧半月板损伤在关节镜下应用Rapidloc-PDS可吸收缝合装置缝合撕裂的半月板.术后由专科治疗师指导康复训练.结果 术后平均随访7.4个月(3～12个月).2例在缝合部有轻度疼痛,1例膝关节屈曲活动受限,1例伸直活动受限;其余患者症状消失,无关节弹响,功能良好.Lysholm评分术前(58.0±13.0)分,术后末次(93.0±7.0)分(t=2.628,P＜0.01);IKDC2000评分术前(49.0±11.5)分,术后末次(90.0±8.6)分(t=1.375,P＜0.05).结论 Rapidloc-PDS可吸收缝合装置关节镜下缝合半月板,具有安全、可靠、操作简便等优点.它采用all-inside技术,不需辅助切口,避免了血管、神经的损伤,特别适合于半月板后角及体部与后角交界区的损伤处理.     

膝关节镜下半月板缝合术18例临床分析

目的　评价膝关节镜下半月板缝合术的效果。　方法　 18例半月板损伤行关节镜下半月板损伤缝合手术 ,应用关节内 -外技术 ,对 16例红区损伤、2例红 -白区损伤病人行缝合术。　结果　随访 2年～ 6年 (平均 4年 ) ,病人疼痛缓解 ,16例交锁症状消失 ,根据JOA半月板损伤治疗成绩判断标准 ,手术前JOA为 (6 5 .0± 11.3)分 ,手术后JOA为 (87.0± 13.9)分 ,术前、术后比较有统计学差异 (t=5 .2 1,P <0 .0 1)。　结论　关节镜下半月板缝合手术具有损伤小 ,愈合率高等优点。     

可吸收缝线联合克氏针固定治疗腱性锤状指

2017年6月~2018年12月,我科采用可吸收缝线联合克氏针固定治疗16例腱性锤状指患者,疗效满意,报道如下。1材料与方法1.1病例资料本组16例,男12例,女4例,年龄21~53岁。开放损伤2例,闭合损伤14例。受伤至手术时间1 h~8 d。1.2治疗方法指根麻醉下手术。做└┐形切口,两侧弧度均大于90°(开放损伤首先彻底清创,根据创口灵活改良切口形状),暴露肌腱断端。3-0 Ethicon可吸收缝线采用Kessler缝合法缝合近侧断端,两侧预留足够长度,进针侧缝线尾端穿入圆针,2枚缝针紧贴末节指骨两侧向指尖穿出,同时将远侧指间关节背伸5°~10°调整,1枚克氏针纵行固定中、远指间关节,外露部分做∽形折弯,两侧缝线在预留克氏针尾端弯曲处打结固定,4-0 Ethicon可吸收缝线进行断端褥式缝合。术后无需外固定,开放损伤患者加强抗感染1周。术后6周拔除克氏针并剪断外露部分可吸收缝线,在康复师指导下进行功能锻炼。     

关节镜下可吸收缝线修复治疗半月板边缘撕裂的近期疗效报道

目的探讨关节镜下可吸收缝线修复半月板边缘撕裂的手术方法及疗效。方法2010年12月~2012年12月,本组共收治56例经关节镜证实的半月板损伤患者,其中21例膝关节半月板边缘撕裂患者,采用关节镜下PDS-Ⅱ线U型缝合,左膝7例,右膝14例,内侧半月板8例,外侧半月板13例,前角6例,体部12例,前角及体部混合撕裂5例,术后指导患者功能锻炼并进行随访,评估其方法的疗效。结果本组患者术后均获随访,时间平均12（8~32）个月,根据术后12个月Lysholm评分情况,把疗效分为4级：优：87分以上;良：74~86分;中：60~73分;差：60分以下。术前平均56（49~64）分,术后12个月Lysholm评分提高平均88分（72~96分）,优16例,良3例,中2例,总优良率90.4%。结论利用自制套管针、钩线器及PDS-Ⅱ线U型缝合半月板,操作简单方便,稳定牢靠,疗效满意,且费用较低,利于基层医院推广使用。     

关节镜下射频汽化仪治疗半月板损伤的应用

目的探讨关节镜下射频汽化仪与常规器械治疗半月板损伤术后近期疗效.方法将38例膝关节半月板损伤患者按纳入和剔除标准分为常规器械(CI)和射频汽化仪(RF)组,比较和分析两组手术时间、术后关节积液、膝关节屈伸度改善程度、术后临床症状改善程度和膝关节功能恢复程度.结果射频汽化仪组的手术时间为(28.50±2.97)min,明显少于常规器械手术组的(41.00±7.49)min,且RF组术后关节积液发生较少,为(6.0±1.41)ml,RF组术后膝关节活动度改善程度为(25.61±12.62)°,膝关节功能恢复程度为(40.0±10.55)分,均优于CI组的(15.55±10.01)°和(32.35±5.71)分结论使用射频汽化仪在关节镜下行半月板成形具有手术操作更加简单易行、创伤小和术后膝关节功能恢复良好的优点.     

囊肿切除联合撕裂半月板缝合术治疗半月板囊肿的临床研究

[目的]探讨关节镜下半月板囊肿切除后联合半月板撕裂全关节内缝合技术的临床应用特点.[方法]2006年8月～2008年5月共收集19例外侧半月板囊肿病例,其中男7例,女12例,通过MRI检查:其中半月板撕裂合并半月板囊肿14例,单纯滑膜囊肿5例,最终关节镜下诊断半月板撕裂合并半月板囊肿15例,单纯滑膜囊肿4例,通过关节镜将囊肿切除后,利用肩关节镜缝合器械将损伤的半月板缝合,继而进行有效的康复计划.然后应用Lysholm评分系统对术前术后的关节功能进行比较.[结果]平均随访20.5个月,所有病例恢复了正常的运动,没有发现关节内或关节外的术后并发症的产生.Lysholm scores 术前平均(64±5)分,术后平均(94±3)分.应用Studeng-t检验术前和术后的关节功能评分有显著的差异(P＜0.001).其中13例镜下随访发现11例完全愈合,2例不完全愈合.[结论]关节镜下半月板囊肿切除后联合半月板撕裂全关节内缝合技术(all-inside)无论在操作方面还是半月板的愈合方面都是一种简单有效的方法,是关节镜技术的一项创新和发展.     

关节镜下肩袖缝线过线器捆扎缝合半月板撕裂伤疗效观察

目的:探讨采用肩袖缝线过线器进行关节镜下半月板撕裂捆扎缝合的临床疗效。方法:自2015年7月至2019年5月采用关节镜下肩袖缝线器捆扎缝合半月板撕裂损伤患者40例,其中男27例,女13例;年龄20～55(36.0±1.4)岁。观察术后并发症情况,术前及术后12个月采用Lysholm膝关节评分标准评价临床疗效,采用疼痛视觉模拟评分(visual analogue scale,VAS),膝关节屈伸活动范围评估疼痛与功能恢复情况。结果:所有患者获得随访,时间12～15(12.6±0.7)个月。未出现关节积液、缝合失效等并发症。2例患者末次随访时膝关节存在轻度疼痛,但临床查体无异常;1例患者中度疼痛合并关节间隙局部按压痛,其余患者均无异常。Lysholm膝关节评分由术前的(49.55±1.21)分提高到术后12个月的(98.95±0.42)分,VAS评分由术前的(5.18±0.78)分降至术后12个月的(1.03±0.77)分,膝关节屈伸活动范围由术前的(50.63±9.20)°提高到术后12个月的(130.38±4.99)°,差异有统计学意义(P0.05)。结论:关节镜下使用肩袖缝线过线器捆扎缝合适用于大部分的半月板损伤,包括内侧半月板后角撕裂,及外侧半月板体部、后角撕裂。此项技术解决了缺乏专用半月板缝合器情况下的半月板全内缝合需求,且具有手术操作方便,并发症少,术后功能好等优点。     

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.