肺保护通气策略对妇科腹腔镜患者呼吸力学及肺氧合功能的影响

目的观察保护性肺通气策略对妇科腹腔镜患者呼吸力学及肺氧合功能的影响。方法选取择期实施妇科腹腔镜患者40例,ASAⅠ~Ⅱ级,年龄20~50岁,随机均分为VLP组即VT=6 m L/kg+PEEP=5 mm Hg组,呼吸频率(f)=16次/分;VN组即VT=10 m L/kg,f=12次/分。记录气管插管后(T0)、气腹后5 min(T1)、头低位后30 min(T2)、气腹后60 min(T3)时的呼气末CO2分压(PETCO2)、气道峰压(PPeak)、平均气道压(Pmean),分别在T0、T3、气管导管拔除后15 min(T4)时刻抽取动脉血行血气分析;计算肺动态顺应性(Cdyn)、肺泡动脉血氧分压差(A-a DO2)、氧合指数(OI)、呼吸指数(RI)。结果两组患者各时点HR、MAP、Sp O2及机械通气时间差异无统计学意义(P>0.05);与VN组比较,T2、3时点VLP组PPeak和Pmean上升(P<0.05),T2、3时点VLP组Cdyn下降(P<0.05);与T0比较,T2、3时点VN组PETCO2升高(P<0.05),VLP组升高更显著(P<0.05);与机械通气时(T1~3)比较,2组T4时点OI及RI(P<0.05)降低,VLP组较显著(P<0.05)。结论小潮气量低水平呼吸末正压通气改善肺顺应性,降低术中气道压,保证肺部氧合功能,是一种安全有效妇科腹腔镜术中机械通气模式。     

不同通气方法对全麻俯卧位脊柱手术老年患者围术期呼吸功能的影响

目的观察不同通气方法对老年全麻俯卧位脊柱手术患者围术期呼吸功能的影响。方法选择拟在全麻俯卧位下行腰骶椎手术的老年患者60例,ASAⅠ或Ⅱ级,性别不限,年龄65~75岁,体重50~80 kg,体重指数≤25 kg/m2;采用随机法,将其分为3组,每组20例:C组(Vt:10 m L/kg)、LV组(Vt:6 m L/kg)和LV+PEEP组(Vt:6 m L/kg,PEEP:5 cm H2O)。记录麻醉前(T0)、气管插管后仰卧位机械通气10 min(T1)、气管插管后俯卧位机械通气10 min(T2)、气管插管后俯卧位机械通气60 min(T3)、气管拔管后脱氧30 min(T4)的血流动力学指标、血气分析指标及呼吸力学指标。结果三组患者HR、MAP比较差异无统计学意义(P>0.05);与LV组同时点比较,C组及LV+PEEP组机械通气期间Ppeak、Pmean较高(P<0.05),但LV+PEEP组与C组比较,差异无统计学意义(P>0.05);LV组及LV+PEEP组Cldyn明显高于同时点C组(P<0.05),但三组患者Cldyn均随着通气时间延长呈下降趋势,其中LV组与LV+PEEP组差异无统计学意义(P>0.05);在T4时点,LV+PEEP组Pa O2/Fi O2明显高于C组及LV组,A-a DO2低于C组及LV组,差异有统计学意义(P<0.05)。结论小潮气量联合低水平PEEP(6 m L/kg+5 cm H2O PEEP)通气能够有效改善全麻俯卧位脊柱手术老年患者术后氧合,提高肺的顺应性,有利于此类手术老年患者呼吸功能的恢复,而且对血流动力学无明显影响。     

术中不同时期呼气末正压通气对全身麻醉老年患者血气指标和肺顺应性的影响

目的 探讨术中低潮气量复合不同时期呼气末正压通气(PEEP)的保护性肺通气策略对开腹手术全身麻醉老年患者动脉血气分析指标和肺顺应性的影响. 方法 选择接受开放性腹部手术的老年全身麻醉患者60例,随机分为常规通气组、中期PEEP组和后期PEEP组.常规通气组未复合PEEP,中期PEEP组在手术开始后1 h 复合PEEP,后期PEEP组在拔管前1h复合PEEP,各组PEEP设定为10cmH2O,持续1h.3组均采用间歇性正压通气(IPPV)模式,潮气量为6mL/kg,吸呼比为1∶1.5~2,调节呼吸频率,维持呼气末二氧化碳分压(PETCO2) 在35~45mmHg(1mmHg=0.133kPa).分别于术前、术后1h、术后24h抽取动脉血行血气分析,并记录气管插管后30min、术中90min和拔管前30min的潮气量、PEEP值、气道峰压(Ppeak),计算肺顺应性(CL). 结果 与术前比较,术后1h各组PaCO2明显升高(P<0.05),常规通气组和后期PEEP组氧合指数(OI)明显降低(P<0.05),常规通气组和中期PEEP组肺泡-动脉氧分压差(A-aDO2)明显升高(P<0.05);与术后1h比较,术后24h中期PEEP组PaCO2明显降低(P<0.05),常规通气组OI明显升高(P<0.05),常规通气组和中期PEEP组A-aDO2明显下降(P<0.05),其余差异无统计学意义(P>0.05). 结论 低潮气量复合术中1h PEEP或拔除气管导管前1h复合PEEP均能改善术后血气指标,前者可以改善术后1h和术后24h的氧合功能.     

等潮气量单肺或双肺通气对开胸食管癌患者的影响

目的 探讨等潮气量单肺通气(OLV)与双肺通气(TLV)模式对开胸食管癌患者围术期的影响.方法 40例择期行食管癌根治手术患者,随机分为单肺通气(O组)和等潮气量双肺通气(T组)两组,每组20例.潮气量(VT)均为5～6 ml/kg.气管插管后(T1)、手术45 min(T2)和120min(T3),术毕2 h(T4)测血气、丙二醛(MDA)、超氧化物歧化酶(SOD)及白细胞介素6(IL-6).结果 T组手术时间、出血量多于O组(P<0.05).O组术中气道峰压(Ppeak)和气道阻力(Raw)比T组高(P<0.05).T组T3和T4时点的MDA高于O组,而SOD低于O组(P<0.05),T2～T4时点IL6值明显高于T1和O组(P<0.05).结论 与TLV比较,等潮气量OLV开胸食管癌手术,虽有气道阻力增加,但可减轻肺损伤.     

乌司他丁联合肺保护性通气策略对腹腔镜结直肠癌根治术患者的肺保护作用分析

目的分析乌司他丁联合肺保护性通气策略对腹腔镜结直肠癌根治术患者的肺保护作用。方法88例行腹腔镜结直肠癌根治术的患者,按照随机分组的原则分为对照组和观察组,每组44例。两组患者的通气模式以及麻醉维持基本一致,对照组患者采取单纯的肺保护性通气策略干预,观察组患者采取乌司他丁联合肺保护性通气策略干预。比较两组患者不同时间点[气腹前(T1)、气腹2 h(T2)、拔管前(T3)]肺动态顺应性(Cdyn)、气道峰压(Ppeak)、气道平均压(Pmean)水平,不同时间点[麻醉诱导前(T0)、T1、T2、T3、术后24 h(T4)]动脉血氧分压(PaO2)和氧合指数(OI)水平。结果两组T1时Pmean、Ppeak水平比较差异均无统计学意义(P>0.05),T2、T3时,观察组Pmean、Ppeak水平显著低于对照组,差异具有统计学意义(P<0.05)。观察组T1、T2、T3时Cdyn分别为(47.87±2.38)、(44.13±3.87)、(41.92±2.30)ml/cm H2O(1 cm H2O=0.098 kPa),均高于对照组的(44.23±2.03)、(37.28±2.43)、(35.95±8.12)ml/cm H2O,差异具有统计学意义(P<0.05)。两组T0、T1、T2时PaO2和OI水平比较,差异均无统计学意义(P>0.05);T3、T4时,观察组PaO2和OI水平均显著高于对照组,差异具有统计学意(P<0.05)。结论乌司他丁联合肺保护性通气策略对腹腔镜结直肠癌根治术患者的肺部保护作用相对较好,能够改善患者的肺顺应性和氧合功能,值得推广。     

肺保护性通气策略在创伤性颅脑损伤 45例围术期中的应用

目的 探讨肺保护性通气策略在创伤性颅脑损伤围术期呼吸管理机械通气中的作用.方法 选择2018年6月至2019年6月鹤山市人民医院创伤性中、重型颅脑损伤行颅骨开窗减压颅内血肿清除手术病人90例,按随机数字表法分为常规容量控制通气组(CV组)和肺保护性通气策略组(PV组),每组45例.两组均采用气管插管全麻机械通气,呼吸参数设置:CV组:潮气量10 mL/kg,呼吸频率10～12次/分,吸呼比1:2,吸入氧浓度(FiO2)60％,氧流量1～2 L/min;PV组潮气量6～8 mL/kg,呼吸频率10～15次/分,吸呼比1:2,呼气末正压(PEEP)5 cmH2o,FiO260％,氧流量1～2 L/min,每隔6 h予手法肺复张3次.记录麻醉诱导前(T0)、机械通气开始(T1)、首次颅内压(ICP)监测时(T2)、术毕关颅(T3)、术后12 h(T4)、术后24 h(T5)、术后48 h(T6)、术后72 h(T7)、术后5 d(T8)的平均动脉压(MAP)、脉搏血氧饱和度(SPO2)、呼气末二氧化碳分压(PETCO2),T2～T8时ICP,计算脑灌注压(CPP);记录各时段动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO2)变化,计算肺氧合指数(OI)、肺泡-动脉血氧分压差(PA-aDO2)的数值;观察记录手术时间、失血量、机械通气时间、术后肺部并发症及术后脑梗死的情况.结果 与CV组比较,PV组T6～T8时SPO2升高(P<0.05),T1～T5时PETCO2显著升高(P<0.05),T3～T8时PaO2显著升高(P<0.05),T1～T4时PaCO2较高(P<0.05),T6～T8时PaCO2下降,T3～T8时OI显著增大(P<0.05),T2～T8时PA-aDO2降低(P<0.05),机械通气时间缩短[(9.1±2.5)d比(13.0±4.2)d]、术后肺部并发症及术后脑梗死[4.5％(2/45)比17.8％(8/45)]显著较少(P<0.05).两组病人MAP、ICP、CPP、手术时间、失血量,均差异无统计学意义(P>0.05).结论 肺保护性通气策略具有预防肺不张、肺损伤,改善肺氧合功能,减少术后肺部并发症发生,是创伤性颅脑损伤围术期呼吸管理机械通气的理想方法 .     

低氧血症老年患者术后应用机械通气的临床观察

目的　探讨机械通气在低氧血症的老年患者术后应用的效果。方法　将 4 0例腹部手术的老年患者随机分为两组 : 组为术后给予继续机械通气组 ; 组为术后拔除气管导管给予常规治疗组。观察两组患者术后一段时间内的动脉血气的变化。结果　 组患者 2 4 h后 Pa O2 明显高于 组 ,Pa CO2 明显低于 组。 组患者中 ,4例再次气管插管 (2 0 % ) ,3例出现 ARDS(1 5 % )。1例死亡。结论　术后短时间给予有低氧血症的老年患者应用机械通气可以改善低氧状况 ,有利于预防 ARDS的发生     

合理营养治疗对AECOPD行机械通气患者的影响

目的探讨合理营养支持对AECOPD行机械通气治疗患者肺功能级预后的影响。方法选择60例因AECOPD行机械通气入我院内科ICU的患者,随机分为对照组和观察组。观察两组患者治疗后第1、7天的营养指标:白蛋白、前白蛋白、三酰甘油;肺功能指标:Pa CO2、Pa O2/Fi O2、顺应性(C);呼吸力学指标:最大吸气负压(MIP)、浅快呼吸指数(SBI)、口腔闭合压(P0.1);并记录预后相关指标:机械通气时间、脱机拔管例数、住ICU时间及出院时APACHEⅡ评分。结果营养指标:观察组白蛋白、前白蛋白、三酰甘油明显高于对照组(P<0.05);肺功能指标:观察组Pa CO2、Pa O2/Fi O2、顺应性(C)明显高于对照组(P<0.05);呼吸力学指标:观察组最大吸气负压(MIP)、浅快呼吸指数(SBI)、P0.1明显高于对照组(P<0.05);预后相关指标:机械通气时间、脱机拔管例数、住ICU时间及出ICU前4 h时APACHEⅡ评分亦明显优于对照组(P<0.05)。结论合理营养支持可以改善AECOPD行机械通气患者的营养状况、肺功能进而改善预后。     

参附注射液对慢性阻塞性肺疾病机械通气患者呼吸力学的影响

目的 观察参附注射液时慢性阻塞性肺疾病机械通气患者的呼吸力学影响.方法 将48例慢性阻塞性肺疾病呼吸衰竭的机械通气患者随机分为两组,均行机械通气,对照组根据患者病情需要给予常规内科治疗,治疗组在对照组治疗措施的基础上加用参附注射液60 mL加入0.9%氯化钠注射液中静脉滴注,每日1次,10d为1个疗程.比较两组患者机械通气10 d后呼吸力学参数及脱机率.结果 治疗组的气道峰压(PIP)、平台压(Pplat)、平均气道压(Pmean)和吸气阻力(Ri)均显著低于对照组(P<0.05),动态顺应性(Cd)显著高于对照组(P<0.05).两组治疗10 d后脱机率无显著性差异.结论 参附注射液能显著改善慢性阻塞性肺疾病机械通气患者的呼吸力学参数.     

单腔气管导管和双腔气管导管行单肺通气在食管癌根治术中应用的临床观察

目的比较单腔气管导管和双腔气管导管用在经左胸路径食管癌根治术中单肺通气的临床特点。方法选择拟行经左胸径路食管癌根治术患者100例,随机分为单腔气管导管组(S组)和双腔气管导管组(D组),每组50例。插管成功后接麻醉机并机控呼吸吸入麻醉。观察并记录麻醉诱导前(T1)、插管定位成功后(T2)、开胸时(T3)、开胸后术侧肺萎陷30min(T4)、关闭膈肌时(T5)、术毕(T6)时平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)和气道峰压值(Ppeak);观察并记录术中肺萎陷优良例数、记录插管次数、导管定位时间、术中肺泡萎陷快慢、术中调整为双肺呼吸的例数、随访术后声音嘶哑和咽喉疼痛情况、术中吸痰确切性、随访术后在纤维支气管镜引导下气管隆突或右支气管黏膜水肿情况。结果 2组患者诱导前和插管前血压及心率差异无统计学意义(P>0.05),插管后S组血压低于D组,心率慢于D组(P<0.05)。2组SpO2在各时间点均差异无统计学意义(P>0.05)。S组Ppeak在T4、T5点小于D组(P<0.05),在T2、T6点与D组差异无统计学意义(P>0.05)。S组定位时间和一次插管成功例数长(多)于D组,术中肺萎陷优良例数2组差异无统计学意义(P>0.05),术后声音嘶哑和咽喉疼痛例数少于D组(P<0.05)。S组肺泡萎陷慢于D组(P<0.05),一般多需辅助,吸痰精确性S组差于D组(P<0.05)。结论单腔、双腔气管导管行单肺通气用于左侧开胸手术都安全可靠。相比于双腔管,单腔管具有经济、省时,对患者呼吸、循环影响小等优点,但肺泡萎陷速度慢,多需辅助,吸痰缺少精确性。双腔管能吸引且吸痰彻底,不但能使两肺分别单肺通气,而且通气形式多样化,术中肺萎陷良好。     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Gender-related symptoms and correlates of alcohol dependence among men and women with a lifetime diagnosis of alcohol use disorders

This study explored gender-related symptoms and correlates of alcohol dependence in a crosssectional study of 150 men and 150 women with a lifetime diagnosis of alcohol use disorders (AUD). Participants were recruited in equal numbers from treatment settings, correctional centres and the general community. Standardized measures were used to determine participants' use of substances, history of psychiatric disorders and psychosocial stress, their sensation seeking and family history of substance use and mental health disorders. Multivariate analyses were used to detect patterns of variables associated with gender and the lifetime severity of AUD. Men had a longer history of severe AUD than women. Women had similar levels of alcohol dependence and medical and psychological sequelae as men, despite 6 fewer years of AUD. More women than men had a history of severe psychosocial stress, severe dependence on other substances and antecedent mental health problems, especially mood and anxiety disorders. There were differences in family history of alcohol-related problems approximating same-gender aggregation. The severity of a lifetime AUD was predicted by its earlier age at onset and the occurrence of other disorders, especially anxiety, among both men and women. The limitations in the generalizability of these findings due to sample idiosyncrasies are discussed.