Hong Kong Society of Clinical Blood Management recommendations for implementation of patient blood management.

Patient blood management (PBM) is a patient-centred, multidisciplinary approach to optimise red cell mass, minimise blood loss, and manage tolerance to anaemia in an effort to improve patient outcomes. Well-implemented PBM improves patient outcomes and reduces demand for blood products. The multidisciplinary approach of PBM can often allow patients to avoid blood transfusions, which are associated with less favourable clinical outcomes. In Hong Kong, there has been increasing demand for blood in the ageing population, and there are simultaneous blood safety and donor issues that are adversely affecting the blood supply. To address these challenges, the Hong Kong Society of Clinical Blood Management recommends implementation of a PBM programme in Hong Kong, including strategies such as optimising red blood cell mass, improving anaemia management, minimising blood loss, and rationalising the use of blood and blood products.

Implication of Major Adverse Postoperative Events and Myocardial Injury on Disability and Survival: A Planned Subanalysis of the ENIGMA-II Trial.

BACKGROUND: Globally, >300 million patients have surgery annually, and ≤20% experience adverse postoperative events. We studied the impact of both cardiac and noncardiac adverse events on 1-year disability-free survival after noncardiac surgery. METHODS: We used the study cohort from the Evaluation of Nitrous oxide in Gas Mixture of Anesthesia (ENIGMA-II) trial, an international randomized trial of 6992 noncardiac surgical patients. All were ≥45 years of age and had moderate to high cardiac risk. The primary outcome was mortality within 1 postoperative year. We defined 4 separate types of postoperative adverse events. Major adverse cardiac events (MACEs) included myocardial infarction (MI), cardiac arrest, and myocardial revascularization with or without troponin elevation. MI was defined using the third Universal Definition and was blindly adjudicated. A second cohort consisted of patients with isolated troponin increases who did not meet the definition for MI. We also considered a cohort of patients who experienced major adverse postoperative events (MAPEs), including unplanned admission to intensive care, prolonged mechanical ventilation, wound infection, pulmonary embolism, and stroke. From this cohort, we identified a group without troponin elevation and another with troponin elevation that was not judged to be an MI. Multivariable Cox proportional hazard models for death at 1 year and assessments of proportionality of hazard functions were performed and expressed as an adjusted hazard ratio (aHR) and 95% confidence intervals (CIs). RESULTS: MACEs were observed in 469 patients, and another 754 patients had isolated troponin increases. MAPEs were observed in 631 patients. Compared with control patients, patients with a MACE were at increased risk of mortality (aHR, 3.36 [95% CI, 2.55-4.46]), similar to patients who suffered a MAPE without troponin elevation (n = 501) (aHR, 2.98 [95% CI, 2.26-3.92]). Patients who suffered a MAPE with troponin elevation but without MI had the highest risk of death (n = 116) (aHR, 4.29 [95% CI, 2.89-6.36]). These 4 types of adverse events similarly affected 1-year disability-free survival. CONCLUSIONS: MACEs and MAPEs occur at similar frequencies and affect survival to a similar degree. All 3 types of postoperative troponin elevation in this analysis were associated, to varying degrees, with increased risk of death and disability.

A randomised comparison of InnoScope and Macintosh laryngoscope in simulated difficult tracheal intubation in manikins.

We conducted a crossover randomised study to evaluate the performance of a novel optical stylet, the InnoScope, for tracheal intubation in simulated normal and difficult airways. Twenty-five anaesthetists attempted tracheal intubation on a SimMan 3G simulator using the InnoScope first followed by the Macintosh laryngoscope or vice versa. Three airway scenarios were tested: (1) normal airway; (2) difficult airway with swollen pharynx; and (3) limited neck movement. In each scenario, the laryngeal view, duration of and success rate for tracheal intubation were recorded. Compared with the Macintosh laryngoscope, the use of InnoScope increased the percentage of glottic opening seen by 17% in normal airway, 23% in the difficult airway and 32% with limited neck movement, p < 0.01. Despite this better laryngeal view, successful tracheal intubation achieved with the InnoScope (88.0%) was lower than that for the Macintosh laryngoscope (98.7%), p = 0.008. Using the InnoScope, tracheal intubation during the first attempt was only successful in 48% of cases with difficult airway. In this scenario, the median (interquartile range [range]) duration of tracheal intubation was significantly longer with [corrected] InnoScope compared with the Macintosh laryngoscope, (70 (19-120 [15-120)] s vs 30 [21-58 (15-120)] s, [corrected] p = 0.01. We conclude that an improved laryngeal view with the use of the InnoScope did not translate into better conditions for tracheal intubation.

A double-blind randomised comparison of intravenous patient-controlled remifentanil with intramuscular pethidine for labour analgesia.

In a prospective, double-blind, randomised controlled trial, we compared the efficacy of patient-controlled analgesia using remifentanil (25-30 µg per bolus) with intramuscular pethidine (50-75 mg) for labour analgesia in 69 parturients. Parturients receiving patient-controlled analgesia reported less pain than those receiving intramuscular pethidine throughout the study period (p < 0.001), with maximal reduction in visual analogue pain score at 2 h after commencement of analgesia (mean (SD) 20 (17) in the patient-controlled analgesia group and 36 (22) in the intramuscular pethidine group. The median (95% CI) time to the first request for rescue analgesics was significantly longer with patient-controlled analgesia (8.0 (6.8-9.2) h) compared with intramuscular pethidine (4.9 (3.8-5.4) h, p < 0.001). Maternal satisfaction scores were also higher with remifentanil compared with intramuscular pethidine (p= 0.001). There was no report of sedation, aponea or oxygen desaturation in either group, and Apgar scores were similar between groups. We conclude that patient-controlled analgesia with remifentanil provides better labour analgesia and maternal satisfaction than intramuscular pethidine. At this dose, maternal and fetal side effects were uncommon.

Correlation between kidney and peripheral nerve functions in Type 2 diabetes.

BACKGROUND: Although greater impairments in nerve functions parameters are most likely to occur with a lower kidney function, there is a paucity of information on the relationship between the kidney and peripheral nerve functions parameters in Type 2 diabetes. AIM: To address the impact of peripheral nerve functions in Type 2 diabetes patients in different stages of chronic kidney diseases (CKD). DESIGN: This prospective study enrolled 238 patients with Type 2 diabetes at a tertiary medical center. METHOD: We designed composite amplitude scores of nerve conductions (CAS) as a measure of severity of peripheral neuropathy (PN), and used estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) parameters to stage CKD in Type 2 diabetes patients. The intrapersonal mean, standard deviation and coefficient of variation of eGFR for 238 patients were obtained in the 3 years prior to the study. RESULTS: The patients who had lower eGFR and higher UACR were older, with longer diabetes duration, a greater percentage of retinopathy and PN and higher CAS. Multiple linear regression analysis revealed that diabetes duration and eGFR were independently associated with CAS, and a cut-off value of eGFR in the presence of PN was 65.3 ml/min/1.73 m2. CONCLUSION: We observed a close relationship between the severity of kidney and peripheral nerve function in patients with diabetes. If a patient's eGFR value is below 65.3 ml/min/1.73 m2 or the UACR value is above 98.6 mg/dl, caution is needed with the presence of PN even in diabetic patients who are asymptomatic.

The outcomes of statin therapy in patients with acute ischemic stroke in Taiwan: a nationwide epidemiologic study.

BACKGROUND: Acute stroke is the third leading cause of death in Taiwan. Although statin therapy is widely recommended for stroke prevention, little is known about the epidemiology of statin therapy after acute ischemic stroke (AIS) in Taiwan. To investigate the effects of statin therapy on recurrent stroke, intracranial hemorrhage (ICH), coronary artery disease (CAD), cost of hospitalization and mortality, we conducted a nationwide population-based epidemiologic study. METHODS: Cases of AIS were identified from the annual hospitalization discharge diagnoses of the National Health Insurance Research Database with the corresponding International Classification of Diseases, ninth revision codes from January 2001 to December 2010. We divided the AIS patients into three groups: non-statin, pre-stroke statin and post-stroke statin. RESULTS: A total of 422 671 patients with AIS (including 365 419 cases in the non-statin group, 22 716 cases in the pre-stroke statin group and 34 536 cases in the post-stroke statin group) were identified. When compared to the non-statin group, both statin groups had a lower recurrent stroke risk [pre-stroke statin: odds ratio (OR) = 0.84; 95% confidence interval (CI) = 0.82-0.87; P < 0.0001; post-stroke statin: OR = 0.89; 95% CI = 0.86-0.91; P < 0.0001], lower ICH risk (pre-statin: OR = 0.75; 95% CI = 0.69-0.82; P < 0.0001; post-stroke statin: OR = 0.75; 95% CI = 0.71-0.81; P < 0.0001), and a lower mortality rate (pre-stroke statin: OR = 0.56; 95% CI = 0.53-0.59; P < 0.0001; post-stroke statin: OR = 0.51; 95% CI = 0.48-0.53; P < 0.0001). In terms of CAD, only the post-statin group had a lower risk (OR = 0.81; 95% CI = 0.79-0.84; P < 0.0001) than the non-statin group. The post-statin group had the lowest 1-year medical costs after index discharge among the three groups. CONCLUSIONS: Statin therapy reduced the risks of recurrent stroke, CAD, ICH and the first year mortality in patients after AIS. Treatment with statin therapy after AIS is a cost-effective strategy in Taiwan.

Heart Transplantation in a Patient Without a Heart: A Case Report.

We report a heart transplantation in a patient with no heart. A 60-year-old man suffered from severe infective endocarditis, and due to extensive involvement of the myocardium, only minimal myocardium was left after debridement of the necrotic myocardium and aortic annulus. We finally excised the entire heart to eradicate the infection source and employed 2 extracorporeal membrane oxygenations for full life support. The infection was controlled with strong antibiotics. The patient underwent successful heart transplantation 16 days following the excision and the patient fully recovered without any complications.

Outcomes of Heart Transplant Recipients With Preexisting Malignancies.

BACKGROUND: Ensuring careful selection of heart transplant recipients with pretransplant malignancies (PTM) has been suggested in several retrospective studies. However, cancer survival rates continue to increase and we still lack outcomes data on PTM patients who have undergone heart transplantation (HT) within the Asian region. Herein we report pretransplant characteristics and outcomes among PTM patients with HT. METHODS: A total of 354 patients underwent HT from January 2004 to January 2016. Eight of these patients had a history malignancy that was being treated before transplantation. Posttransplant outcomes and clinical characteristics were collected and possible prognostic factors analyzed. RESULTS: The median age of the patients with a preexisting malignancy was 60 years. The PTM group included 5 males and 3 females, with a median duration of follow-up of 43 months. In this group there were 2 patients with lymphoma after chemotherapy, 1 with colon cancer postoperatively, and 1 was on chemotherapy. In the other 4 patients, nasopharyngeal cancer, thyroid cancer, breast cancer, and endometrial cancer were identified, and each had undergone treatment. Only 1 premalignancy patient, with nasopharyngeal cancer, had disease recurrence. The 5-year overall survival of these patients was 50.0 ± 17.7%, but 5-year survival for those without PTM was 68.7 ± 2.0%. CONCLUSION: PTM was 2.3% in our cohort. PTM is associated with an increased risk of all-cause mortality. Thus, our findings suggest careful consideration when selecting PTM patients for HT.

Neuropsychiatric symptoms in Alzheimer's disease: associations with caregiver burden and treatment outcomes.

BACKGROUND: Caregivers play a major role in providing care for patients with Alzheimer's disease (AD) and are themselves at higher risk of health comorbidities. AIM: To address the impact of neuropsychiatric symptoms of patients in different stages of AD on their caregivers' burden. DESIGN: This prospective study enrolled 260 AD patients with clinical dementia rating (CDR) of 0.5, 1 and 2 at a tertiary medical center. METHODS: All patients were tested using the mini-mental state examination (MMSE), the cognitive abilities screening instrument (CASI), the neuropsychiatric inventory (NPI) and the CDR scale. Data regarding therapeutic outcomes of anti-Alzheimer's drugs were also collected. Caregivers were tested using NPI. RESULTS: The mean follow-up interval was 25.0 ± 12.2 months, and two patients died during follow-up. NPI-burden was positively correlated with NPI-sum ( r = 0.822, P < 0.001) but negatively correlated with years of education ( r = -0.140, P = 0.024), CASI score ( r = -0.259, P < 0.001) and MMSE score ( r = -0.262, P <0.001). Multiple linear regression analysis showed that only NPI-sum was independently associated with mean NPI-burden. Both higher mean CASI and MMSE scores had better therapeutic outcome of anti-Alzheimer's drugs ( P = 0.001 and P = 0.005, respectively). CONCLUSIONS: The severity of neuropsychiatric symptoms in patients with AD was positively associated with caregiver's stress, and patients with better cognitive functions, under treatment with anti-Alzheimer's drugs, had better therapeutic outcomes. To reduce the impact of neuropsychiatric symptoms, it is crucial to detect dementia in its early phases and provide early intervention with anti-Alzheimer's drugs, which might help decrease the caregiver burden, thereby improving their quality of life.

Successful outpatient treatment of renal vein thrombosis by low-molecular weight heparins in 3 patients with nephrotic syndrome.

Renal vein thrombosis (RV Thromb) is a serious complication ofnephrotic syndrome. Anticoagulation is usually recommended as the treatment of choice. This study reports 3 nephrotic patients diagnosed to have RVThromb combined with thromboembolic events. Low-molecular weight heparin (LMWHep) was given subcutaneously every 12 hours following the diagnosis of RVTromb, which continued at the outpatient clinic after an average of 11 in-hospital days. The patients visited the nephrology outpatient clinic every other week and underwent magnetic resonance image (MRI) studies at 6-week intervals for follow-up of patency of the involved renal vein. LMWHep was discontinued when MRI showed this patency. The average outpatient treatment period was 74 days. There was no recurrent RVThromb in the follow-up course of 6 months after discontinuation of LMWHep. Kidney function was preserved, as indicated by image studies and serial renal function tests. LMWHep produced a more predictable anti-coagulant effect, a superior bioavailability, a longer half-life and a dose-independent effect than unfractionated heparin and coumadin. These benefits made the outpatient treatment of RVThromb possible. Our report recommends outpatient treatment of RVThromb by LMWHep because it is feasible, effective and safe.

Long-term results of coronary artery bypass grafting in patients with dialysis-dependent renal failure.

AIM: Coronary artery disease is the main cause of mortality and morbidity in dialysis-dependent renal failure patients. Both the prevalence and incidence of renal failure are high in Taiwan. However, there were few reports exploring the outcome of coronary aortic bypass grafting (CABG) in these patients. The aim of this study was to determine the survival outcome and risk factors for mortality from CABG in this population. METHODS: The operative, early postoperative and late results of 170 dialysis patients undergoing isolated coronary artery bypass grafting from January, 2000 to January, 2012 were retrospectively reviewed. Operative mortality, long-term survival, and risk factors were analyzed. RESULTS: One hundred and seventeen patients (68.8%) were male, and the mean age was 61.5±10.3 years (range, 34-86 years). Follow-up was 40.3±32.1 months. Operative mortality was 8.2%. Actuarial survival, including operative mortality, was 81±3% at 1 year, 68±4% at 3 years, 58±5% at 5 years and 49±6% at 10 years, better than the natural course of dialysis-dependent renal failure patients. Age, emergent operation, postoperative ventricular tachycardia or fibrillation, postoperative intra-aortic balloon pump insertion, gastrointestinal bleeding, and left internal mammary artery graft were significant predictors of operative or long term mortality. Most causes of late death were due to infection or cardiac events. CONCLUSION: CABG in dialysis patients is associated with a higher incidence of complications, but has acceptable mortality. CABG is beneficial in this population. Internal mammary artery grafting may provide more favorable long term outcomes.

Cerebral infarction in perinatal and childhood bacterial meningitis.

BACKGROUND: Cerebral infarction is an important neurological complication of childhood bacterial meningitis, but little is known about its epidemiology and outcomes. AIM: To determine the predictive factors, clinical features, causative pathogens, and outcomes of cerebral infarction secondary to perinatal and childhood bacterial meningitis. DESIGN: Retrospective analysis METHODS: Over the period 1986-2001, 166 perinatal and childhood patients were identified as having culture-proven bacterial meningitis, of whom 14 had cerebral infarction at admission. The clinical and CSF data of patients with and without cerebral infarctions on admission were compared. RESULTS: Cerebral infarction patients accounted for 10% (14/166) of bacterial meningitis cases, mostly in the first year of life (11/14, 79%). Salmonella species (n = 4) and Streptococcus pneumoniae (n = 4) were the most frequent causative pathogens, accounting for 57% (8/14) of episodes. Single infarctions were found in four patients and multiple infarctions in 10. At 1 year follow-up, outcome was good in three, but poor in 11. Significant differences between the two patient groups at admission included age bands, presence of seizures, hydrocephalus, disturbed consciousness on admission, and CSF lactate concentration. DISCUSSION: There was a high prevalence of cerebral infarctions when the disease was caused by S. pneumoniae and Salmonella species. Occurrence was highest in the first year of life, and the prognosis in this patient group is poor. Risk factors associated with cerebral infarction in our patients included age 28-365 days, seizures, hydrocephalus, disturbed consciousness on admission, and high CSF lactate concentrations.

Biomechanical evaluation of translaminar facet joint fixation. A comparative study of poly-L-lactide pins, screws, and pedicle fixation.

STUDY DESIGN: Nine sheep cadaveric spines were used in this acute postoperative model. OBJECTIVES: To compare the biomechanical performance of translaminar facet joint fixation techique with that of cortical screws and bioabsorbable poly-L-lactide pins and with that of rigid pedicle screw fixation in the lumbar spine. SUMMARY OF BACKGROUND DATA: Among numerous posterior spine fixation techniques, pedicle screw fixation has been reported to be the most rigid construct and to provide high fusion rate. Translaminar facet joint screw fixation is an alternative to pedicle screw fixation and is the lowest profile construct that achieves stabilization. The authors have developed a new concept involving application of bioabsorbable poly-L-lactide pins to translaminar facet joint fixation. Degradation in the stiffness of the implants with time may be advantageous for fusion mass remodeling. METHODS: A total of nine sheep L2-L6 cadaveric spines were used. Each intact spine was nondestructively tested in flexion-extension bending (+/- 5-Nm peak bending moment with 100-N axial compression) on a modified testing machine. Loads were applied for 10-second periods using sinusoid waveforms. After testing the intact spine, bilateral fenestration was performed between L4 and L5 and the medial aspect of the facet capsule was resected. The L4-L5 functional spinal unit was than stabilized by five methods: translaminar facet joint fixation with smooth poly-L-lactide pins; translaminar facet joint fixation with cortical screws; pedicle screw fixation with the Texas Scottish Rite Hospital system; and without instrumentation, in that order. Linear displacement of L4 inferior and L5 superior articular processes in the sagittal plain (delta facet) and L4-L5 intervertebral rotation in the sagittal plain (theta sagittal) were measured by the extensometers mounted to the spine. Ranges of motion (delta facet and theta sagittal), neutral zones, linear elastic zone stiffness, and the total energy absorption during the load-unload cycle (hysteresis) were calculated. RESULTS: By resecting the facet joint capsules and ligamentum flavum, delta facet and theta sagittal were not increased significantly, whereas the increase of neutral zones and hysteresis were statistically significant. Compared with the intact spine, delta facet was significantly reduced to 41% of normal with translaminar facet joint fixation with poly-L-lactide pins, to 9% with translaminar facet joint fixation with screws, and to 11% with the Texas Scottish Rite Hospital system. Neutral zones of delta facet showed a similar pattern, and these differences were significant. Regarding linear elastic zone stiffness, translaminar facet joint fixation with screws provided a stiffer construct than did pedicle screw fixation in the flexion loading mode, whereas pedicle screw fixation yielded higher values for stiffness in extension loading. Translaminar facet joint fixation with poly-L-lactide pins increased linear elastic zone stiffness in extension loading, but the increase was less than was achieved with the other constructs. CONCLUSIONS: The facet joint is the only true articulation in the lumbosacral spine. It is logical to fix this part directly to achieve spine fixation. Translaminar facet joint fixation with screws show similar biomechanical performance to pedicle screw fixation. Translaminar facet joint fixation with poly-L-lactide pins is significantly less stiff than either type of screw fixation, but it also restricts the facet joint and intervertebral motions significantly when compared with the intact spine.

Biomechanical comparison of posterior cervical fixation.

STUDY DESIGN: Biomechanical stability using four different posterior cervical fixation techniques was evaluated in human cadaveric spine. OBJECTIVES: To introduce an alternative interspinous fixation technique using wavy-shaped rods, and to compare its in vitro biomechanical stability with that of other posterior cervical fixation techniques. SUMMARY OF BACKGROUND DATA: Fixation of the posterior cervical spine with interspinous wiring is well known as Rogers' or Bohlman's technique. Recently, several plate fixation techniques have been used for posterior cervical stabilization. Since 1983, the authors have developed the wavy-shaped rod system as an alternative to the interspinous fixation technique. This unique technique has been proven clinically useful in Japan. However, the authors are not aware of any prior biomechanical studies. METHODS: Seven fresh frozen cervical human spines were tested at the C5-C6 motion segment. Nondestructive static biomechanical testing was performed with flexion-extension, lateral bending, and axial rotation for the following stabilization techniques: intact spine, creation of a Stage 3 distractive-flexion injury followed by fixation with the wavy-shaped rods bounded by three multistrand cables, interspinous wiring with a multistrand cable, triple wiring technique using multistrand cables with a pair of unicortical grafts from the ilium, and lateral mass plate fixation with Magerl's screw technique. Testing was performed on a material testing machine (MTS 858 Bionix test system, MTS, Minneapolis, MN), and load displacement curves were obtained using four linear extensometers and one rotatory extensometer across the C5-C6 motion segment. RESULTS: In axial compression loading, the reconstructed specimens showed significant differences in range of motion measured at the anterior and posterior positions, and statistical analysis was performed using one-way analysis of variance. In a comparison of the four fixation techniques, the construct with the wavy-shaped rod indicated significantly less motion both anteriorly and posteriorly than with the other fixation techniques. Also in flexion-extension loading, all the techniques significantly limited the intervertebral motion below the level of the intact motion segment. Particularly, the construct with the wavy-shaped rod showed the smallest mobility, 49.9% anteriorly and 9.3% posteriorly, compared with that of the intact spine. In lateral bending, the lateral mass plate provided the greatest stability, which was superior to the intact segment, but the difference was not statistically significant. In axial rotation, all the reconstruction techniques limited the angular motion below the intact level (wavy rod, 68.0%; Rogers' wiring, 75.2%; Bohlman's triple wiring, 59.8%; lateral mass plate, 71.7%), but no significant differences were observed using one-way analysis of variance, as compared with the intact segment. CONCLUSIONS: All four reconstruction techniques restored the stability of the cervical motion segment to at least the level of the intact motion segment before destabilization. An alternative cervical posterior fixation technique, the Wavy Rod system, was considered the most effective technique in stabilizing a cervical motion segment, particularly in axial compression and flexion extension loading.

Colon replacement from esophagus. Clinical experience from 240 cases.

The clinical experience in the colon replacement of the esophagus in 240 cases is reported. The overall operative morbidity was 17.5%; the incidence of the anastomotic leaks was 10.4%; and the mortality was 2.80%. The points in surgical technique were: 1) utilizing the left colic artery as the supporting vessel if possible, based on the anatomy of the colon vessel; 2) using the colon segment in an isoperistaltic position, which has been proved much physiological; 3) single-layer anastomosis which is simple and reliable, with minimal inflammation and quick healing; and 4) choosing the channel of the colon transplant according to the disease condition, the age, and the function of the heart and the lung of the patients.

Recall of preoperative anaesthesia information in Hong Kong Chinese patients.

OBJECTIVE: To evaluate the ability of patients to recall information provided during a preoperative visit. DESIGN: Qualitative study. SETTING: Regional hospital, Hong Kong. PATIENTS: Sixty patients scheduled for elective surgery under general anaesthesia or central neuro-axial block. MAIN OUTCOME MEASURES: Satisfactory recall of preoperative information, defined as the ability to remember at least 75% of adverse effects described. RESULTS: Fifty-nine (98.3%) patients were satisfied with the preoperative information. Forty-two (70%) patients rated anaesthetic complications as important. At the interview on the day of the operation, 57 (95%) patients had satisfactory recall of the information provided. Eighty-five percent of patients remembered that the information was provided by an anaesthesiologist. After the operation, of those who experienced adverse effects, 48 (96%) patients remembered being told to anticipate the adverse anaesthetic event. Univariate analysis found that age, sex, education level, occupation, and the modality of anaesthesia did not affect patient recall of preoperative information on the day of surgery or 1 day postsurgery. CONCLUSION. There was satisfactory recall of preoperative information by the majority of patients in the study. Most patients expressed satisfaction with the information provided.

[Observation of therapeutic effect by combined administration of Salvia miltiorrhiza, ligustrazine and Panax notoginseng on late hemorrhagic shock of rabbits].

OBJECTIVE: To explore the therapeutic mechanism of Salvia miltiorrhize, ligustrazine and Panax notoginseng in treating late hemorrhagic shock in rabbit. METHODS: Rabbit hemorrhagic shock models (MPA 5.3 kPa) were set up according to Wiggers' method and administrated Salvia miltiorrhiza, ligustrazine, Panax notoginseng. The values of blood RBC superoxide dismutase (SOD) and blood lactate (BL), plasma malondialdehyde (MDA) and magnesium (Mg++) were continuously monitored before shock, 120 minutes after shock, 60 and 120 minutes after hydraulic dilatation. RESULTS: (1) In 120 minutes after shock, the level of SOD decreased and the concentrations of MDA, BL, Mg++ were markedly increased, which indicated that the cell membrane damage caused by oxygen free radicals in rabbit hemorrhagic shock. (2) Salvia miltiorrhiza, Ligustrazine or Panax notoginseng could alleviate lipidperoxidation injury to tissue. Compared with the single drug administration groups, the effects of oxygen free radicals scavangers by combined administration with half dose of 2 drugs were better than the single drug with full dose alone and the side effects such as depression of blood pressure and heart rates would be alleviated. CONCLUSION: Combined administration of Salvia miltiorrhiza, ligustrazine and Panax notoginseng would half the dosage, the blood pressure depression and heart rate reduction alleviated and better result obtained.