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[Organ failure in patients with multiple trauma. The effect of early osteosynthesis of fractures on complications]. 多发创伤患者的器官衰竭。骨折早期植骨对并发症的影响[j]。
H Burchardi, M Sydow, T A Crozier, J Burgdorff

The course of 225 multiple traumatized patients in our ICU with a mean age of 35 +/- 16.8 years, a mean ISS of 30 +/- 8.3 and an overall mortality of 18.2% was evaluated retrospectively. For comparable ISS the mortality was higher in patients over 65 years, and increased further with age. The most common causes of death were MOF (41.5%), severe head injury (34.1%), and acute respiratory failure (ARF) (19.5%). The mortality increased when two or more organ failures were present. 105 patients had fractures of the long bones; in 28 of these all fractures were stabilized primarily (during the first 24 hours). Organ failure was seen less frequently in these patients compared to those with secondary stabilization: ARF 10.7% vs. 51.9% (p less than 0.0004), acute renal failure 3.6% vs. 11.7%, liver failure 3.6% vs. 11.7%, sepsis 14.3% vs. 29.9%. Mortality was significantly lower in the patient with primarily stabilized fractures (7.1% vs. 24.7%, p less than 0.05). The study demonstrates that early stabilization of long bone fractures results in a more favourable course, and that this should be carried out whenever feasible.

回顾性分析我院ICU 225例多发性创伤患者的病程,平均年龄35 +/- 16.8岁,平均ISS 30 +/- 8.3,总死亡率18.2%。对于可比的ISS, 65岁以上患者的死亡率更高,并随着年龄的增长而进一步增加。最常见的死亡原因是MOF(41.5%)、严重头部损伤(34.1%)和急性呼吸衰竭(19.5%)。当出现两个或两个以上器官衰竭时,死亡率增加。长骨骨折105例;其中28例骨折在最初24小时内基本稳定。与次要稳定的患者相比,这些患者的器官衰竭发生率较低:ARF 10.7%对51.9% (p < 0.0004),急性肾功能衰竭3.6%对11.7%,肝衰竭3.6%对11.7%,败血症14.3%对29.9%。主要稳定型骨折患者的死亡率明显较低(7.1%比24.7%,p < 0.05)。研究表明,长骨骨折的早期稳定会导致更有利的过程,并且应该在可行的情况下进行。
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引用次数: 0
[Mixed venous versus central venous oxygen saturation in intensive medicine]. [重症医学中混合静脉与中心静脉血氧饱和度]。
M Wendt, T Hachenberg, A Albert, R Janzen

Mixed venous oxygen saturation (SvO2) has been established as a useful guide in observing whole body oxygenation. Since SvO2 provides limited information about adequate tissue oxygenation for a specific organ, the usefulness of central venous saturation (ScvO2) as a guide was analysed, which is a less invasive parameter. In 19 ICU patients 44 pairs of blood samples were drawn from a separate central venous catheter and from the tip of an SG-catheter. The correlation of oxygen partial pressures was 0.687 and the correlation of the saturation reached 0.779. The calculation of venous admixture showed a correlation of 0.901. It is concluded that ScvO2 yields adequate information on the oxygen saturation of venous return.

混合静脉氧饱和度(SvO2)已被确立为观察全身氧合的有用指标。由于SvO2提供的关于特定器官足够组织氧合的信息有限,因此分析了中心静脉饱和度(ScvO2)作为指导的有效性,这是一个侵入性较小的参数。在19例ICU患者中,从单独的中心静脉导管和sg导管尖端抽取了44对血液样本。氧分压的相关系数为0.687,饱和度的相关系数为0.779。静脉掺合量的计算结果显示相关性为0.901。由此得出结论,ScvO2能提供足够的静脉回流血氧饱和度信息。
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引用次数: 0
[Characteristics of the relative humidity and temperature in the inspiratory part of the Dräger circle system and their influence on the function of the ciliary epithelium]. [Dräger循环系统吸气部相对湿度和温度的特点及其对纤毛上皮功能的影响]。
C Anger, T van Bömmel, S Phadana-anek, A Reich, J Büter, H Stahl, T Deitmer

Changes in relative humidity and temperature of the anaesthetic gases were measured in the inspiratory limb of the Dräger circle system next to the carbon dioxide absorber in 29 patients requiring ENT surgery under general anaesthesia. Immediately following intubation and prior to extubation, nasal and tracheal cytologic samples were taken with a brush technique and ciliary beat frequency was determined. At a fresh gas flow of 6 l/min, relative humidity increased from 57.6 +/- 1.5 to 62.5 +/- 1.8% (p less than 0.05) after 110 minutes. Temperature increased continuously from 21.96 +/- 0.97 degrees C to 23.83 +/- 0.48 degrees C after 200 minutes. The number of vital ciliated cells in the tracheal samples decreased from 24.4% following induction of anaesthesia to 6% at the end of anaesthesia (p less than 0.05), and from 35.7% to 26.8% (p less than 0.05) in the nasal samples. Ciliary beat frequency remained unchanged at the end of anaesthesia as compared to control in tracheal as well as in nasal samples. It is concluded that the output of relative humidity and temperature in the circle system is not sufficient to prevent broncho-epithelial damage. Ciliary beat automaticity appears to behave according to an all or nothing principle.

对29例全麻耳鼻喉科手术患者在二氧化碳吸收体旁Dräger循环系统的吸气肢体中麻醉气体的相对湿度和温度变化进行了测量。插管后和拔管前,立即用毛刷技术采集鼻腔和气管细胞学样本,并测定纤毛搏动频率。当新鲜气体流量为6 l/min时,110 min后相对湿度由57.6 +/- 1.5%上升至62.5 +/- 1.8% (p < 0.05)。200分钟后,温度从21.96 +/- 0.97℃持续上升到23.83 +/- 0.48℃。气管样本中重要纤毛细胞的数量从麻醉诱导后的24.4%下降到麻醉结束时的6% (p < 0.05),鼻腔样本中重要纤毛细胞的数量从35.7%下降到26.8% (p < 0.05)。与气管和鼻腔样本的对照组相比,麻醉结束时纤毛搏动频率保持不变。由此可见,循环系统中相对湿度和温度的输出不足以防止支气管上皮损伤。纤毛搏动自动性似乎遵循全有或全无的原则。
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引用次数: 0
[Total intravenous anesthesia using propofol and alfentanil in comparison with balanced anesthesia in neurosurgery]. [异丙酚和阿芬太尼全静脉麻醉与神经外科平衡麻醉的比较]。
H Van Aken, J Van Hemelrijck, L Merckx, T Möllhoff, J Mulier, H J Lübbesmeyer

Anaesthesia for neurosurgical patients should provide haemodynamic stability, reduce cerebral metabolism, preserve cerebral autoregulation, avoid increases of intracranial pressure and guarantee rapid recovery without respiratory depression. A commonly used Balanced Anaesthesia (BA, n = 20) (thiopental and fentanyl bolus induction and maintenance with repetition boluses of fentanyl and droperidol, thiopental infusion, and isoflurane in N2O/O2) was compared to Total Intravenous Anaesthesia (TIVA, n = 20) with propofol and alfentanil infusion. Pancuronium was employed for muscle relaxation in both groups. The TIVA evinced more haemodynamic stability during induction; notably, there was no increase in blood pressure after intubation, as seen in the BA group. Another advantage of TIVA is that it obviates the use of N2O. Quality of recovery after the procedure was determined by standardised psychometric tests. The time span between awakening of patients to orientation and concentration was significantly shorter in the TIVA group compared to the BA group. There was also a smaller deviation of these parameters in the TIVA group indicating a more predictable recovery.

神经外科患者的麻醉应保证血流动力学稳定,减少脑代谢,保持大脑自身调节,避免颅内压升高,保证快速恢复,无呼吸抑制。将一种常用的平衡麻醉(BA, n = 20)(硫喷妥钠和芬太尼丸诱导和维持,芬太尼和哌啶醇重复剂量,硫喷妥钠输注,异氟醚在N2O/O2中)与丙泊酚和阿芬太尼输注全静脉麻醉(TIVA, n = 20)进行比较。两组均应用泮库溴铵进行肌肉松弛。在诱导过程中,TIVA表现出更强的血流动力学稳定性;值得注意的是,与BA组相比,插管后血压没有升高。TIVA的另一个优点是它避免了N2O的使用。手术后的恢复质量由标准化心理测试确定。与BA组相比,TIVA组患者对定向和集中的觉醒时间间隔明显缩短。在TIVA组中,这些参数的偏差也较小,表明恢复更可预测。
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引用次数: 0
[The effect of staged lavages in peritonitis on the vital functions]. [腹膜炎分期灌洗对肺脏功能的影响]。
E Götz, S Bogosyan, D Loose

In 16 consecutive patients with diffuse peritonitis 93 staged lavages were undertaken. In a retrospective study the changes of some vital functions due to transport in the operating room and staged lavage were evaluated. 9 patients (56%) survived the diffuse peritonitis. The vital parameters showed no significant changes following staged lavages. Intraabdominal specimen cultures were positive in 62% of cases, showing no correlation of the underlying disease and mortality. Only an elevation of C-reactive protein and rise of thrombocyte count correlated significantly with the outcome of diffuse peritonitis.

对16例连续的弥漫性腹膜炎患者进行了93次分阶段灌洗。在一项回顾性研究中,我们评估了由于在手术室中转运和分阶段洗胃而导致的一些重要功能的变化。弥漫性腹膜炎存活9例(56%)。分阶段灌洗后,重要参数无明显变化。62%的病例腹腔内标本培养呈阳性,表明潜在疾病与死亡率无相关性。只有c反应蛋白的升高和血小板计数的增加与弥漫性腹膜炎的预后显著相关。
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引用次数: 0
[Fresh gas flow and artificial respiration in anesthesia. Technical requirements for the adequate use of rebreathing systems]. 麻醉中的新鲜气流和人工呼吸。充分使用再呼吸系统的技术要求]。
J Baum, G Sachs

The majority of modern anaesthetic machines is designed for the rebreathing method. But frequently high fresh gas flows are employed, thus minimising the rebreathing fraction of expiratory gases. However, only by reducing the fresh gas flow substantially, the advantages of the rebreathing technique can be obtained. To evaluate the practicability of flow reduction, minimal flow anaesthesia was carried out with four different anaesthetic machines: AV 1 (Drägerwerk AG, Lübeck), ELSA (Gambro Engström AB, Bromma, Sweden), SULLA 808 V (Drägerwerk AG, Lübeck) und VIVOLEC (Hoyer Medizintechnik, Bremen). Fresh gas flow was reduced to 0.5 l/min after an initial phase of 15-20 min, during which the fresh gas flow was kept at a high level of 4.4 l/min. The minute volumes before and after fresh gas flow reduction were compared. The minute volume decreased markedly and significantly in the SULLA 808 group, whereas it remained nearly unchanged in the AV 1, the ELSA, and the VIVOLEC groups. The differences result from different modes of fresh gas delivery into the breathing circuit. If anaesthetic apparatus that maintain their tidal volume with different fresh gas flow rates are employed, rebreathing systems may be used judiciously by changing the fresh gas flow according to the individual uptake or any particular clinical requirement.

大多数现代麻醉机都是为再呼吸法设计的。但通常采用高新鲜气体流量,从而尽量减少呼气气体的再呼吸部分。然而,只有大幅度减少新鲜气体流量,才能获得再呼吸技术的优点。为了评估流量减少的实用性,使用四种不同的麻醉机进行最小流量麻醉:AV 1 (Drägerwerk AG, l beck), ELSA (Gambro Engström AB,瑞典Bromma), SULLA 808 V (Drägerwerk AG, l beck)和VIVOLEC (Hoyer Medizintechnik,不来梅)。初始阶段15-20 min后,新鲜气体流量降至0.5 l/min,在此期间新鲜气体流量保持在4.4 l/min的高位。比较了新鲜气体减少前后的分钟体积。sula 808组的分钟体积明显下降,而av1、ELSA和VIVOLEC组的分钟体积几乎保持不变。这种差异是由于新鲜气体进入呼吸回路的方式不同造成的。如果使用的麻醉装置以不同的新鲜气体流速保持其潮汐量,则可根据个人摄取或任何特定的临床要求,明智地通过改变新鲜气体流量来使用再呼吸系统。
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引用次数: 0
[Computer-assisted documentation and performance data processing in the intensive care unit. Description of a custom development]. 重症监护病房的计算机辅助文件和性能数据处理。自定义开发的描述]。
H N Herden, A Tecklenburg

Computer-aided documentation of medical and performance data processing seems to be imperative for every intensive-care unit in the future. It is the rational approach to deal with therapy-related information management as well as organizational and administrative tasks. This custom-made program is based on data collected from 3600 intensive-care patients. It serves 3 objectives: 1. documentation of relevant therapeutic data, 2. information exchange with other departments, 3. thorough analysis of topics related to intensive-care medicine. Based on a microsoft disc operating system, the programme contains not only the data base but also word processing and statistical capacities. Optional choice by menu guarantees easy handling and helps to create a high acceptance.

计算机辅助的医疗记录和性能数据处理在未来似乎是每个重症监护室必不可少的。这是处理治疗相关信息管理以及组织和管理任务的合理方法。这个定制的程序是基于从3600名重症监护患者中收集的数据。它有三个目标:1。2.相关治疗资料的记录;2 .与其他部门的信息交流;深入分析与重症监护医学相关的主题。该程序基于微软光盘操作系统,不仅具有数据库功能,而且具有文字处理和统计功能。菜单的可选选项保证易于处理,并有助于创建一个高接受度。
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引用次数: 0
[High-frequency ventilation: side effects and dangers]. 【高频通气:副作用和危险】。
J L Theissen, K Redmann, P P Lunkenheimer, G Grosskopff, R E Zimmermann, P Lawin

Dangers of high-frequency ventilation result from the lack of a sensitive monitoring technique. Mucosal lesions of the trachea and the bronchi as well as cooling of the patient can be prevented by adequate humidification and heating of the gas flow. It is still controversial whether HFV leads to increased mucus production or secretolysis, and whether it prevents or promotes aspiration. The influence of mobilisation or immobilisation of a pulmonary focus on its recovery is not well understood. Interferences of HFV with the autonomic nervous system and endocrine system, like an increased release of PGI2, an antidiuretic and narcotic effect, with the coagulation system and the acid-base balance are inconsistent and therefore need particular clinical observation.

高频通气的危险源于缺乏灵敏的监测技术。气管和支气管的粘膜病变以及患者的冷却可以通过适当的加湿和加热气流来防止。目前仍有争议的是,HFV是否会导致粘液产生或分泌增加,以及它是否会阻止或促进误吸。活动或固定肺病灶对其恢复的影响尚不清楚。HFV对自主神经系统和内分泌系统的干扰,如PGI2释放增加,抗利尿和麻醉作用,与凝血系统和酸碱平衡不一致,因此需要特别的临床观察。
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引用次数: 0
[Continuous intragastric pH measurement in intensive care patients treated with ranitidine and tube feeding]. [雷尼替丁加管饲重症患者连续胃内pH测定]。
C Krier, H Böhrer, G Jürs, S Warth, O H Just

We studied 22 critically ill patients on long-term mechanical ventilation using continuous intragastric pH monitoring with an antimony electrode. Intragastric pH profiles were established for the duration of mechanical ventilation (mean: 7 days). The aim of our study was to achieve a gastric pH between 3.0 and 4.5 utilizing the H2-receptor antagonist ranitidine and nasogastric feeding with Nutricomp F. Patients were divided into three groups which were given (A) ranitidine boluses, (B) continuous ranitidine infusions, or (C) continuous ranitidine infusions together with enteral nutrition via the nasogastric tube. In group B we were able to obtain a pH value between 3.0 and 4.5 only in 11.6% of the observation period. With ranitidine boluses, there were even less measurements (9.3%) in the "optimal" pH range. The combination of continuous ranitidine application together with enteral alimentation made our attempts slightly more successful (20.0%). This failure to achieve the desired pH range encourages airway colonisation and nosocomial pneumonia at gastric pH greater than 4.5. At pH less than 3.0 there is a significantly higher incidence of acute stress ulcerations. Other therapeutic regimens e.g. the application of pirenzepine and sucralfate offer adequate protection of the gastric mucosa without raising the pH level.

我们研究了22例长期机械通气的危重患者,使用锑电极连续监测胃内pH值。在机械通气期间(平均:7天)建立胃内pH谱。我们的研究目的是利用h2受体拮抗剂雷尼替丁和Nutricomp f的鼻胃喂养使胃pH值在3.0到4.5之间。患者被分为三组,分别给予(a)雷尼替丁大剂量,(B)连续雷尼替丁输注,或(C)连续雷尼替丁输注并通过鼻胃管进行肠内营养。在B组中,只有11.6%的观察期pH值在3.0到4.5之间。使用雷尼替丁丸,在“最佳”pH范围内的测量值更少(9.3%)。雷尼替丁联合肠内营养治疗的成功率略高(20.0%)。当胃pH值大于4.5时,未能达到预期的pH值范围会促进气道定植和医院性肺炎。当pH值小于3.0时,急性应激性溃疡的发生率显著增高。其他治疗方案,如使用吡仑西平和硫糖酸盐,在不提高pH值的情况下,对胃黏膜有足够的保护。
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引用次数: 0
[The effects of incremental PEEP on atrial natriuretic peptide, right atrial pressure and the size of the right atrium in anesthetized patients]. [增加PEEP对麻醉患者心房钠素肽、右心房压及右心房大小的影响]。
J Scholz, F Bednarz, N Roewer, R Schmidt, J Schulte am Esch

8 ASA class II-III patients (50-67 years) undergoing traumatic-surgical procedures were studied. Since the release of atrial natriuretic peptide (ANP) is stimulated by volume loading and increased right atrial pressure (RAP), the effects of incremental positive end-expiratory pressure (PEEP) on ANP-concentration, RAP and right atrial dimensions were investigated. Anaesthesia was induced with intravenous etomidate and vecuronium and maintained after endotracheal intubation with 66% N2O in O2 and ethrane (0.4-0.6 Vol.-%). A catheter was inserted into the A. radialis for blood sampling and determination of mean arterial pressure (MAP). For determining endsystolic (RAESA) and end-diastolic (RAEDA) areas of the right atrium a 5 MHz transoesophageal echocardiographic (TEE)-probe was positioned at the level of the foramen ovale. Under TEE-control a catheter was placed into the right atrium for measurement of RAP. The method for ANP determination was based on a direct radioimmunoassay that is specific for human ANP (ANP-J125). PEEP was incrementally raised from 0 to 16 mbar in 4 mbar steps each for 5 min and thereafter reduced to 0 mbar. During the investigation no significant differences were detectable for MAP, heart rate, end-expiratory CO2 partial pressure and the arterial O2 saturation. However, 16 mbar PEEP ventilation increased plasma ANP concentrations (from 44.3 +/- 9.7 to 58.1 +/- 8.7 pg/ml) and RAP (from 4.4 +/- 0.9 to 10.7 +/- 0.9 mmHg) whereas the right atrial dimensions RAESA (from 9.4 +/- 1.0 to 4.6 +/- 0.6 cm2) and RAEDA (from 5.9 +/- 1.2 to 3.2 +/- 0.4 cm2) decreased.(ABSTRACT TRUNCATED AT 250 WORDS)

8例ASA II-III级患者(50-67岁)接受创伤性外科手术。由于容积负荷和右心房压(RAP)升高刺激心房利钠肽(ANP)的释放,我们研究了呼气末正压(PEEP)增加对ANP浓度、RAP和右心房尺寸的影响。静脉滴注依托咪酯和维库溴铵麻醉,气管插管66% N2O (0.4-0.6 Vol.-%)加入O2和乙烷维持麻醉。将导管插入桡足刺进行采血并测定平均动脉压(MAP)。为了确定右心房收缩末期(RAESA)和舒张末期(RAEDA)区域,在卵圆孔水平放置5 MHz经食管超声心动图(TEE)探针。在tee控制下,将导管置入右心房测量RAP。测定ANP的方法是基于对人ANP (ANP- j125)具有特异性的直接放射免疫分析法。PEEP以4毫巴的速度递增,每次5分钟,从0毫巴增加到16毫巴,然后减少到0毫巴。在调查期间,MAP、心率、呼气末CO2分压和动脉O2饱和度没有明显差异。然而,16 mbar PEEP通气增加血浆ANP浓度(从44.3 +/- 9.7到58.1 +/- 8.7 pg/ml)和RAP(从4.4 +/- 0.9到10.7 +/- 0.9 mmHg),而右心房尺寸RAESA(从9.4 +/- 1.0到4.6 +/- 0.6 cm2)和RAEDA(从5.9 +/- 1.2到3.2 +/- 0.4 cm2)下降。(摘要删节250字)
{"title":"[The effects of incremental PEEP on atrial natriuretic peptide, right atrial pressure and the size of the right atrium in anesthetized patients].","authors":"J Scholz,&nbsp;F Bednarz,&nbsp;N Roewer,&nbsp;R Schmidt,&nbsp;J Schulte am Esch","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>8 ASA class II-III patients (50-67 years) undergoing traumatic-surgical procedures were studied. Since the release of atrial natriuretic peptide (ANP) is stimulated by volume loading and increased right atrial pressure (RAP), the effects of incremental positive end-expiratory pressure (PEEP) on ANP-concentration, RAP and right atrial dimensions were investigated. Anaesthesia was induced with intravenous etomidate and vecuronium and maintained after endotracheal intubation with 66% N2O in O2 and ethrane (0.4-0.6 Vol.-%). A catheter was inserted into the A. radialis for blood sampling and determination of mean arterial pressure (MAP). For determining endsystolic (RAESA) and end-diastolic (RAEDA) areas of the right atrium a 5 MHz transoesophageal echocardiographic (TEE)-probe was positioned at the level of the foramen ovale. Under TEE-control a catheter was placed into the right atrium for measurement of RAP. The method for ANP determination was based on a direct radioimmunoassay that is specific for human ANP (ANP-J125). PEEP was incrementally raised from 0 to 16 mbar in 4 mbar steps each for 5 min and thereafter reduced to 0 mbar. During the investigation no significant differences were detectable for MAP, heart rate, end-expiratory CO2 partial pressure and the arterial O2 saturation. However, 16 mbar PEEP ventilation increased plasma ANP concentrations (from 44.3 +/- 9.7 to 58.1 +/- 8.7 pg/ml) and RAP (from 4.4 +/- 0.9 to 10.7 +/- 0.9 mmHg) whereas the right atrial dimensions RAESA (from 9.4 +/- 1.0 to 4.6 +/- 0.6 cm2) and RAEDA (from 5.9 +/- 1.2 to 3.2 +/- 0.4 cm2) decreased.(ABSTRACT TRUNCATED AT 250 WORDS)</p>","PeriodicalId":7813,"journal":{"name":"Anasthesie, Intensivtherapie, Notfallmedizin","volume":"25 Suppl 1 ","pages":"20-4"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13293070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Anasthesie, Intensivtherapie, Notfallmedizin
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