气道湿化方式对气管切开患者肺炎发生率的影响

目的探讨气管切开术后痰液粘稠度Ⅲ度患者不同气道湿化方式对肺炎发生率的影响。方法选取气管切开术后痰液粘稠Ⅲ度患者60例,随机分为试验组与对照组,试验组给予微量泵持续滴入气道湿化液,对照组给予传统的气管内间歇滴入,湿化液均为O．45％氯化钠溶液。试验组36h内气道湿化量为16ml／h,36—48h逐渐过渡为12ml／h;对照组给予间歇气管内滴入,使用注射器每2小时向气管内滴入0．45％氯化钠溶液4～6ml／h。结果试验组气管切开后第3天吸痰次数、吸痰时、吸痰后3min、吸痰后5min血氧饱和度均高于对照组（P〈0．05）;气管切开后72h肺炎发生率明显少于对照组（P〈0．05）。结论应用持续气道内滴药的湿化方法,对气道刺激性小,能减少吸痰次数及肺炎发生率。     

微量输液泵在破伤风患者气管切开湿化中的临床效果

目的探讨破伤风患者气管切开气道湿化的最佳方法。方法实验组(21例)气道内持续滴入湿化液为0.9%盐水加α糜蛋白酶、地塞米松及庆大霉素,对照组(21例)用传统50ml注射器加0.9%盐水加α糜蛋白酶、地塞米松及庆大霉素、进行气道滴注,比较两种湿化方法对病人湿化的效果观察。结果两种湿化方法比较,实验组在减少患者气道刺激性咳嗽、痰阻、气道黏膜损伤出血及肺部感染等方面明显优于对照组(P<0.05)。结论气管切开后用微量输液泵滴入湿化液,对气道刺激微小,不引起刺激性咳嗽,且保持生理湿化功能,稀释痰液,防止痰阻,减少吸痰次数,减少黏膜损伤出血,对预防肺部感染有显著效果。     

3种气道湿化液用于气管切开患者气道湿化的临床应用研究

目的了解人工气道湿化过程中,不同湿化液的选择对湿化效果的影响。方法 将140例气管切开患者以便利分组法分为对照组46例、实验A组50例和实验B组44例。对照组采用0.45%氯化钠溶液为湿化夜,实验A组采用0.45%氯化钠溶液加盐酸氨溴索作为湿化液,实验B组采用1.5%碳酸氢钠溶液作为湿化液。观察3组气道湿化效果和并发症的发生情况。结果实验A组患者刺激性咳嗽、痰阻次数、气道黏膜损伤出血、肺部感染等并发症的发生率明显低于对照组,湿化效果明显优于对照组。差异有统计学意义(P<0.01)。实验B组患者痰阻次数、肺部感染等优于对照组(P<0.05),而气道黏膜损伤出血、刺激性咳嗽及湿化效果与对照组比较无差异。结论 0.45%氯化钠溶液加盐酸氨溴索作为气管切开患者微量泵持续气道湿化液效果优于0.45%氯化钠溶液和1.5%碳酸氢钠溶液,值得在临床推广使用。     

颅脑损伤气管切开患者气道湿化不佳相关因素分析与护理

目的分析和总结颅脑损伤气管切开患者气道湿化不佳的影响因素,探寻效果较好的护理方法。方法收集2010年6月至2011年9月进行气管切开手术的颅脑损伤患者20例．随机分为气道湿化不足组和气道湿化过度组,每组各10例,其中气道湿化不足组再随机分为两组,每组各5例．分别行传统法（即采用一次性注射器将药物滴入患者气道中,传统组）及雾化湿化处理（即采用生理盐水加入糜蛋白酶及庆大霉素配成雾化液行雾化处理,雾化组）。气道湿化过度组再随机分为两组,每组各5例,分别行低渗盐水（0．45％氯化钠溶液）湿化及生理盐水（0．9％氯化钠溶液）湿化。观察各组患者在气道湿化不足和气道湿化过度两种情况下并发症发生情况。结果在气道湿化不足患者中．传统组发生痰痂1例、血痂2例、气管阻塞2例;雾化组并发痰痂1例、血痂2例。在气道湿化过度患者中．生理盐水组发生痰液黏稠1例,刺激性咳嗽1例,气道黏膜出血2例;低渗盐水组发生痰液黏稠2例,无刺激性咳嗽和气道黏膜出血者。低渗盐水组并发症发生情况较生理盐水组低。结论采用传统方法对颅脑损伤气管切开患者行气道湿化容易引起痰痂、血痂吸水后膨胀、阻塞气管等症状,在临床治疗中用药剂量很难控制。而采用雾化方法发生上述症状的患者较少：选择低渗盐水,进入支气管内不会蒸发太快,造成支气管水肿,有利于体内气体交换。     

0.45%氯化钠溶液与碳酸氢钠溶液用于气道湿化的效果比较

目的 比较碳酸氢钠溶液和0.45%氯化钠溶液的气道湿化效果.方法 人工气道患者80例,随机分为4组,每组20例.分别以1.5%(A组)、2.0%(B组)、2.5%碳酸氢钠(C组)和0.45%氯化钠(D组)作为湿化液.观察气道湿化效果、气管黏膜出血水肿及肺部感染情况.结果 4组患者痰液粘稠度、日吸痰次数及气道出血相似.与D组比较,三个碳酸氧钠湿化组肺部感染发生率明显下降(P<0.05).结论 与0.45%氯化钠溶液比较,对人工气道患者实施碳酸氢钠溶液气道湿化可有效降低肺部感染.     

两种湿化液在铜绿假单胞阳性患者气道护理的应用和意义

目的:探讨两种湿化液在痰培养铜绿假单胞菌阳性患者气道护理的应用和意义。方法:将64例重度颅脑损伤患者气管切开患者痰培养铜绿假单胞菌阳性病人随机分成对照组和实验组,对照组采用1.25%NaHCO_3 135ml使用微量可调节输液器持续气道滴入进行湿化方法,实验组乳酸环丙沙星注射液使用微量可调节输液器持续气道湿化的方法进行气道湿化,比较两组痰的粘稠度、痰液的气味、痰培养是否存在铜绿假单胞菌。结果:两组病人在治疗前均无差异,在用药7天后实验组及对照组痰粘稠度明显降低,无明显差异。实验组痰的气味消失病例数明显高于对照组,痰培养致病菌检出率两组比较实验组明显低于对照组,实验组通过气道湿化起到了控制呼吸道病原菌的效果。结论:采用微量可调节输液器,持续滴入乳酸环丙沙星注射液进行气道持续湿化,能减轻铜绿假单胞菌感染。     

微量注射泵在气管切开湿化中的应用

目的 对气管切开术后病人采用微量注射泵进行气道湿化取得满意效果。方法 将115例气管切开病人用微量注射泵推注湿化液,实验组(115例)气道内推注湿化液为0.45%盐水加a-糜旦白酶、庆大霉素、维生素B2,对照组(115例)用传统50ml注射器加0.45%盐水加a-糜旦白酶、庆大霉素、维生素B2进行气道滴注,比较两种湿化方法对病人湿化效果观察,结果 两种湿化方法比较,对减少气道刺激性咳嗽、痰阻、气道粘膜损伤出血、肺部感染、早期封管、撤机,实验组明显优于对照组(P〈0.05〉.结论 气管切开后用微泵推注湿化液,由于每滴湿化液量极少,且沿内管壁缓流入气道,对气道刺激微小,不引起刺激性咳嗽,且保持生理湿化功能,稀释痰液,防止痰阻,减少吸痰次数,减少粘膜损伤出血,从而降低肺部感染率,对提早封管、撤机有显著效果。     

两种不同气道湿化方法用于脑梗死患者气管切开术后疗效比较

目的比较两种不同气道湿化方法用于脑梗死患者气管切开的疗效。方法60例脑梗死气管切开患者按数字表法随机分为观察组及对照组各30例,观察组采用以输液泵持续滴注0．45％氯化钠溶液气道湿化法,对照组采用以注射器间断滴入0．45％氯化钠注射液气道湿化法,比较两组患者刺激性咳嗽、痰痂形成、气道黏膜出血、肺部感染等发生情况。结果观察组刺激性咳嗽、痰痂形成、气道黏膜出血、肺部感染等发生率明显低于对照组,差异有统计学意义（均P〈0．05）。结论应用输液泵持续滴注0．45％氯化钠溶液气道湿化法能明显减少肺部感染及痰痂形成,预防刺激性咳嗽与气道黏膜出血,值得临床推广应用。     

细辛脑联合碳酸氢钠注射液湿化气管切开患者气道的疗效观察

目的：观察细辛脑联合碳酸氢钠注射液湿化气管切开患者气道的疗效。方法：将80例气管切开患者随机分为观察组40例、对照组40例,观察组采用细辛脑和碳酸氢钠交替湿化气道,对照组采用α-糜蛋白酶和生理盐水进行气道湿化,用药后观察痰液粘稠度、痰液性状、细菌培养、肺部感染等呼吸道并发症发生率。结果：观察组湿化效果显著优于对照组（P〈0．01）,并发症发生率显著低于对照组（P〈0．05）。结论：碳酸氢钠联合细辛脑湿化气道可提高湿化效果,降低并发症发生。     

间断氧气驱动雾化吸入气道湿化在食管癌术后患者中的应用观察

目的:观察间断氧气驱动雾化吸入气道湿化在食管癌术后患者中的应用效果。方法:将80例食管癌术后患者随机分为两组,观察组40例给予氧气驱动湿化气道吸入疗法,对照组40例常规氧气驱动雾化吸入BID或TID进行对比研究;对痰液粘稠、需吸痰、血氧饱和度低、呼吸道感染等指标进行观察。结果:观察组痰液粘稠、需吸痰、血氧饱和度低、呼吸道感染指标明显优于对照组(P0.05)。结论:间断氧气驱动雾化吸入湿化气道疗法在降低痰液粘稠度,提高排痰效果方面疗效满意,有效预防食管癌术后患者肺部并发症的发生     

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.

     

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.     

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.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.