ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03398.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Increased pulmonary vascular resistance (PVR) and microvascular hyperpermeability resulting in lung edema and arterial hypoxemia are mainstays in the development of adult respiratory distress syndrome (ARDS). The proposed pathophysiologic mechanisms include activation of complement and polymorphonuclear leukocytes secreting lysozomal enzymes, toxic oxygen metabolites (TOM) and eicosanoids. Platelets and coagulation factors are also involved, and in the most severe cases even monocytes are activated as reflected in release of thromboplastin. The latter may elicit disseminated intravascular coagulation (DIG). Under physiologic conditions lung blood flow is diverted from poorly to better oxygenated areas by way of hypoxic pulmonary vasoconstriction (HPV) thereby counteracting a decrease in arterial oxygenation. Many vasoactive substances have been proposed and again refuted as possible mediators of HPV. In this study we have focused on the following: histamine, catecholamines, arachidonates, calcium, phosphoinositides and TOM as well as endothelium‐derived relaxing and constricting factors. Whether HPV is present in ARDS and whether it is advantageous or not seems to depend on the stage and extent of disease. We discuss possible interactions between HPV and ARDS mediators and between HPV and various vasoactive agents tested for therapeutic effects. Out of the abundance of mediators released, prostacyclin, prostaglandin E1, activated complement and platelet activating factor have been shown explicitly to inhibit HPV whereas others are suspected of doing so. In therapeutical use, prostacyclin has proved to reduce PVR and at the same time enhance cardiac output and oxygen delivery. In mild to moderate ARDS, improvement of arterial oxygenation has also been obtained employing almitrine bismesylate, a potentiator of HPV. Experimentally, adenosine effectively reduces increments in PVR and microvascular permeability with modest effects on systemic circulation. However, further investigations are warranted to decide whether adenosine or more specific blockers as, for instance, monoclonal antibodies against tumor necrosis factor should be integrated in ARDS therapy in the futur

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03399.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Morphine, meperidine and ketobemidone used in continuous i. v. infusion for postoperative pain relief were compared in a double‐blind, controlled, prospective study in 81 consecutive consenting adult patients after open‐heart surgery, with permission from the hospital ethics committee. During the first postoperative period, the infusion rates were fixed. Later on, when the infusion rate could be regulated according to individual patient needs, the variation in infusion rate was large, in accordance with earlier studies. No significant differences were demonstrated between the three analgesics with respect to efficacy of analgesia or side effects like shivering, nausea or vomiting. Respiratory depression following extubation was not observed. During shivering, there was a significant increase in the arterio‐mixed venous difference of oxygen in all groups. The amounts of opioids used were relatively small compared to amounts used in patients following abdominal surgery. When interviewed some days after surgery, 18/74 patients remembered moderate pain and 11 severe pain during the stay in th

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03238.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The prospective registration of 200 percutaneous placements of permanent central venous catheters (Hickman catheters and subcutaneous infusion ports) was conducted in 172 patients aged 3 months‐95 years. The insertions were reviewed to assess whether certain groups of patients or physicians were associated with more complications than others. Complications occurred in 16 patients (8. 0%), of which 12 were arterial punctures. Two attempts (1%) at catheter placement failed. None of the complications required treatment. Of the catheter placements, 70% were performed by one of the three authors, and the rest by seven other experienced anesthesiologists. The complication rates were not different between the two groups. Nor was the complication rate significantly higher in small children. Percutaneous placement of permanent central venous catheters thus proved to be a safe and reliable technique, even in small children. The method is easily learnt by physicians experienced in central venous catheterization. Using this method, permanent venous access may be offered to a large number of patient

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03239.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Ten whip‐lash syndrome patients treated with intracutaneous triggerpoint injections with sterile water for pain relief were followed for 2 months. Pain intensity was evaluated with the Visual Analogue Scale (VAS). Eight patients became free from pain (VAS 0) and two patients improved to VAS 2 immediately after the treatment. Nine patients remained free from pain, three of them after one treatment, while six patients needed 2—4 treatments. One patient responded only a few hours after each of three treatments. Remarkably, with the relief of pain mobility was normalised in all patients. The method is suggested to be a first choice in the treatment of not only whip‐lash patients but also for most acute and chronic musculo‐skeletal triggerpoint pain sy

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03240.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The effects of clonidine, a central alpha2‐adrenoreceptor agonist, on haemodynamic and catecholamine changes were assessed during emergence from anaesthesia, a period which is associated with increased sympathetic nervous discharge, hypertension and tachycardia. According to a double‐blind randomized design, 32 patients received either clonidine, preoperatively given by oral route (3. 5 μg kg‐1) and postoperatively by i. v. infusion (0. 3 μg‐kg‐1‐h‐1), or a placebo. Perioperative management was similar in both groups. Measurements were made in the recovery room, before starting clonidine or placebo infusions for evaluation of clonidine premedication, and then during infusion as follows: when core temperature reached 37°C; then 2 h, and 6 h later. Prior to starting infusions, mean blood pressure (88 ± 15vs103± 14 mmHg) (11. 7 ± 2. 0vs13. 7 ± 1. 9 kPa), heart rate (67 ±8vs87 ± 17 beats min‐1) and plasma norepinephrine levels (462 ±393vs615 + 361 pg‐ml‐1) were lower in the clonidine group. Only at the latest measurement (6 h after core temperature reached 37°C) did clonidine elicit significant effects. The values during clonidine infusion compared to placebo were at this time: mean blood pressure (73 ± 10vs86 ± 13 mmHg) (9. 7 ± 1. 3vs11. 5 ± 1. 7 kPa), heart rate (71±6vs93± 13 beats‐min‐1) and plasma norepinephrine levels (240 ± 224vs451 ± 111 pg‐ml‐1). Our results suggest that: 1) preoperative clonidine may improve the haemodynamic profile associated with anaesthetic discontinuation, but 2) i. v. infusion (0. 3 μg · kg‐1. h‐1) did not prolong this effect during the early postoperative period in the f

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03241.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03400.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

This review encompasses a description of the main pathophysiological events leading to disseminated intravascular coagulation (DIC). Emphasis has been put on microcirculatory disturbances and endothelial dysfunction. The normal hemostatic functions of the vascular endothelium are described. The close connection between endothelium and superimposed immuno‐modulators is stressed as is the interrelation between the proteolytic cascade systems in the blood. The importance of differentiating local and systemic events is discussed. Organ dysfunction in multiple organ failure (MOF) is exemplified by pulmonary insufficiency in the adult respiratory distress syndrome (ARDS). Essential laboratory tests of DIC are described as are the cornerstones of treatmen

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03401.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Effects of toxic oxygen metabolites (TOM) on the pulmonary vascular bed and airways were studied in isolated, plasma‐perfused rat lungs. TOM were generated by xanthine oxidase (XO) (0. 1 or 0. 25 unit– ml‐1) and hyopxanthine (HX) (1 mol. l‐1).In vitromeasurements by chemiluminescence indicated that the major oxygen metabolite generated by XO and HX was H2O2. Measurements of Po2in the perfusate as an indicator of O2–consumption suggested that production of TOM by XO and HX was finished, within 30 min. XO and HX induced an early dose‐dependent bronchoconstriction and a late increase in transpulmonary pressure (Ptp). Pulmonary arterial pressure (Ppa) increased gradually and levelled off within 30 min with low‐dose XO, but not with high‐dose XO. As judged by weight increase of the lungs, interstitial edema occurred regularly. Allopurinol, an inhibitor of XO, blocked the lung responses caused by XO and HX. Catalase attenuated all lung responses induced by XO and HX, while superoxide dismutase had no effect. The hydroxyl radical scavenger dimethylsulfoxide abolished the increase in Ptp and attenuated the increase in Ppa, but did not consistently protect the lungs from edema development. This study shows that TOM induce vasoconstriction, bronchoconstriction and lung edema in plasma‐perfused rat lungs, mainly due to generation of H2O2and the

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03243.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Fourteen patients undergoing open‐heart surgery received intermittent or continuous postoperative autotransfusion of shed mediastinal blood (minimum 400 ml during 6 h after surgery) collected in the cardiotomy reservoir. Haemotologic variables and changes in the coagulation, fibrinolytic and plasma kallikrein‐kinin systems were investigated in the reservoir blood at the beginning and after 6 h of autotransfusion, and in patient blood during and after surgery and before and after autotransfusion. Autotransfusion volume ranged from 400 to 1200 ml per patient (median 482 ml). The reservoir blood had a median haemoglobin level of 93 and 74 g/1, a platelet count of 71 and 119times 109/1, and plasma haemoglobin level of 3110 and 4100 mg/1 before and after 6 h of autotransfusion, respectively: Further examination of the reservoir blood showed that it had undergone extensive coagulation and fibrinolysis as well as a moderate activation of the kallikrein‐kinin system. Despite these extensive alterations in the reservoir blood, no major change could be found in the circulating blood after autotransfusion, except for a moderate increase in plasma haemoglobin from 180 mg/1 to 430 mg/1. The clinical safety and simplicity of this technique were confirmed for autotransfusion of shed mediastinal blood up to 12

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03244.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY