Gehring H
Klinik fur Anasthesiologie, Med. Universitat, Lubeck.
Anasthesiol Intensivmed Notfallmed Schmerzther. 2000 Feb;35(2):82-5. doi: 10.1055/s-2000-235.
A main basis of this habilitation thesis is the development of a portable, mains-free measurement device for determining breath ethanol concentrations (BrEC) both during spontaneous breathing and in mechanically ventilated patinets undergoing inhalation anaesthesia, for detecting and quantifying irrigation fluid absorbed during endourological surgical interventions. Here a respired gas has to be measured which compared to other usually measured gases 1) is present in substatially smaller concentrations, 2) is subject to significant influences by temperature and humidity in the expired air, and 3) can only be measured discontinuously in the alveolar air due to technical limitations of the sensor. The basis for investigating accuracy of measurement was not just evaluation of the device using different lung models, but also a comparison with the target parameter "absorbed irrigation fluid" using another further-developed reference procedure, i.e. direct measurement of sorbitol and mannitol concentrations in serum. This has the added advantage that even when ethanol monitoring is not available, another laboratory procedure is indeed available for directly evaluating the absorption of irrigation fluid. In the clinical aspects of this thesis, ethanol monitoring helped show that during transurethral resection of the prostate (TURP) in spontaneously breathing patients undergoing regional anaesthesia, irrigation fluid was intravascularly absorbed not more often, but more rapidly and in larger quantities than it was in mechanically ventilated patients undergoing inhalation anaesthesia. A possible reason for this was the significantly reduced central venous pressure observed in the group of patients undergoing regional anaesthesia. The diagnosis of a delayed extravascular absorption of irrigation fluid during percutaneous nephrolithotripsy (PNL), made with the assistance of the ethanol monitoring, was associated with a significantly prolonged period of hospitalization in the clinic and an increase in opioid requirements. This finding can be explained pathophysiologically by an increased trauma to the kidney with injury to bordering organ structures. As a result of close co-operation with several departments of the Medical University of Lubeck, we now have at our disposal an excellent BrEC-measuring device for detecting and quantifying absorbed irrigation fluid during urosurgical procedures. The results of the clinical studies presented here underscore the value of the newly-developed AlcoMed 3011.
本habilitation论文的一个主要基础是开发一种便携式、无需 mains的测量设备,用于在自主呼吸期间以及接受吸入麻醉的机械通气患者中测定呼气乙醇浓度(BrEC),以检测和量化腔内泌尿外科手术干预期间吸收的冲洗液。在这里,必须测量呼出气体,与其他通常测量的气体相比,呼出气体 1)浓度要小得多,2)受呼出空气中温度和湿度的显著影响,3)由于传感器的技术限制,只能在肺泡气中进行间断测量。研究测量准确性的基础不仅是使用不同的肺模型对设备进行评估,还包括使用另一种进一步开发的参考程序与目标参数“吸收的冲洗液”进行比较,即直接测量血清中山梨醇和甘露醇的浓度。这还有一个额外的优点,即即使没有乙醇监测,也确实有另一种实验室程序可用于直接评估冲洗液的吸收情况。在本论文的临床方面,乙醇监测有助于表明,在接受区域麻醉的自主呼吸患者进行经尿道前列腺切除术(TURP)期间,冲洗液血管内吸收的频率并不更高,但比接受吸入麻醉的机械通气患者吸收得更快、量更大。一个可能的原因是在接受区域麻醉的患者组中观察到中心静脉压显著降低。在乙醇监测的帮助下诊断经皮肾镜碎石术(PNL)期间冲洗液的血管外吸收延迟,与临床住院时间显著延长和阿片类药物需求量增加有关。这一发现可以从病理生理学角度解释为肾脏创伤增加,邻近器官结构受损。由于与吕贝克医科大学的几个部门密切合作,我们现在拥有了一种出色的 BrEC测量设备,用于在泌尿外科手术期间检测和量化吸收的冲洗液。此处呈现的临床研究结果强调了新开发的AlcoMed 3011的价值。