可乐定对2型糖尿病患者围手术期应激反应的影响

目的探讨可乐定对2型糖尿病患者围手术期应激反应的影响。方法将40例2型糖尿病患者随机分成治疗组和对照组各20例，治疗组术前90 min给予可乐定肌内注射，4.5 μg·kg 1；对照组术前90 min给予等量0.9%氯化钠注射液。所有患者麻醉诱导前和术中根据血糖水平使用胰岛素，术中使血糖浓度维持在5.5 ～11.1 mmol·L 1。 麻醉诱导前(S1)、气管插管后(S2)、术中(S3)、气管拔管时(S4)、术后3 h(S5)和6 h(S6)分别采样测量血浆儿茶酚胺浓度；测定诱导前、术中和手术结束后6 h内血糖浓度。结果 S1、S5、S6时治疗组血浆儿茶酚胺浓度明显低于对照组，两组比较，S1时P＜0.01，S5、S6时均P＜0.05；手术开始后45～120 min和手术结束后1～4 h，治疗组血糖浓度明显低于对照组(分别为P＜0.05和P＜0.01)。手术过程中治疗组胰岛素平均用量明显少于对照组(P＜0.01)。治疗组围手术期血压、心率平稳。结论可乐定可明显减少2型糖尿病患者围手术期儿茶酚胺的释放，改善血糖水平，降低胰岛素用量。     

可乐定对CO2气腹时应激的影响

目的观察术前口服可乐定对CO2气腹时应激的调节作用.方法选择无心血管和内分泌系统等合并症,择期腹腔镜胆囊切除术病人22例,随机分为两组,可乐定组(A)和对照组(B),每组11例.可乐定组病人在麻醉前90分钟口服可乐定5μg-kg-1,其余用药两组均同.气管插管静吸复合全身麻醉.记录麻醉前90分钟(T1)、诱导前即刻(T2)、气腹前即刻(T3)、气腹压达14mmHg时(T4)、气腹压平衡(达14mmHg)后5分钟(T5)各时点心率(HR)、平均动脉压(MAP);并于T1、T3及T5各时点自上肢静脉留置针抽取血标本,测定血糖(Glu)、皮质醇(Cor)、内皮素(ET)、一氧化氮(NO).结果(1)HR、MAP可乐定组在气腹压平衡后5分钟较气腹前(T3)HR、MAP均有显著升高(P＜0.01),但与麻醉前90分钟相比,无显著差异(P＞0.05).可乐定组在麻醉期间HR、MAP维持一相对稳定的水平.对照组在气腹时HR、MAP均较可乐定组上升显著.(2)内分泌激素及血糖、血糖、皮质醇;可乐定组T5时血糖和皮质醇显著高于T3和T1(P＜0.01),但均明显低于对照组(P＜0.01).Et气腹后5分钟(T5)两组均上升明显(P＜0.01),而可乐定组明显低于对照组(P＜0.01).NO可乐定组T5较T1显著升高(P＜0.05),而对照组T5明显低于T1(P＜0.05).NO/ET可乐定组各时点变化不显著,对照组有明显下降趋势,气腹后5分钟最为明显(P＜0.01).结论术前应用可乐定可以稳定术中血流动力学,较好地降低CO2气腹时的应激反应,抑制血糖、皮质醇、内皮素的上升,使NO/ET比值维持稳定.     

右美托咪定对高血压全麻患者围拔管期应激反应的影响

目的:观察右美托咪定(dexmedetomidine,Dex)对高血压全麻患者围拔管期应激反应的影响。方法:选择既往有高血压病史,血压控制稳定,择期行胃癌根治手术的患者60例。随机分成右美托咪定0.5μg/kg组(D1组)、右美托咪定1μg/kg组(D2组)和生理盐水对照组(C组),每组20例。均采用静吸复合全麻,手术结束前60min分别静脉微泵注射右美托咪定0.5μg/kg、1μg/kg、生理盐水20mL,输注时间30min。于麻醉前、拔管前、拔管后1、3、5、10min记录血流动力学参数,测定血浆肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(COR)、血糖(GLU)、血乳酸(LAC)浓度,并记录手术麻醉时间、唤醒时间、拔管时间。结果:三组患者围拔管期间平均动脉压(MAP)、心率(HR)数值和血浆E、NE、COR、GLU、LAC浓度均比麻醉前明显增高(P<0.01或P<0.05);与D1组、D2组比较,C组的MAP、HR、E、NE、COR、GLU、LAC明显增高(P<0.01或P<0.05);D2组的唤醒时间、拔管时间明显长于C组和D1组(P<0.05)。结论:右美托咪定能明显抑制气管拔管期引起的应激反应,以0.5μg/kg更为合适。     

可乐定对CO2气腹时应激的影响

目的观察术前口服可乐定对CO2气腹时应激的调节作用.方法选择无心血管和内分泌系统等合并症,择期腹腔镜胆囊切除术病人22例,随机分为两组,可乐定组(A)和对照组(B),每组11例.可乐定组病人在麻醉前90分钟口服可乐定5μg-kg-1,其余用药两组均同.气管插管静吸复合全身麻醉.记录麻醉前90分钟(T1)、诱导前即刻(T2)、气腹前即刻(T3)、气腹压达14mmHg时(T4)、气腹压平衡(达14mmHg)后5分钟(T5)各时点心率(HR)、平均动脉压(MAP);并于T1、T3及T5各时点自上肢静脉留置针抽取血标本,测定血糖(Glu)、皮质醇(Cor)、内皮素(ET)、一氧化氮(NO).结果(1)HR、MAP:可乐定组在气腹压平衡后5分钟较气腹前(T3)HR、MAP均有显著升高(P＜0.01),但与麻醉前90分钟相比,无显著差异(P＞0.05).可乐定组在麻醉期间HR、MAP维持一相对稳定的水平.对照组在气腹时HR、MAP均较可乐定组上升显著.(2)内分泌激素及血糖、血糖、皮质醇;可乐定组T5时血糖和皮质醇显著高于T3和T1(P＜0.01),但均明显低于对照组(P＜0.01).Et:气腹后5分钟(T5)两组均上升明显(P＜0.01),而可乐定组明显低于对照组(P＜0.01).NO:可乐定组T5较T1显著升高(P＜0.05),而对照组T5明显低于T1(P＜0.05).NO/ET:可乐定组各时点变化不显著,对照组有明显下降趋势,气腹后5分钟最为明显(P＜0.01).结论术前应用可乐定可以稳定术中血流动力学,较好地降低CO2气腹时的应激反应,抑制血糖、皮质醇、内皮素的上升,使NO/ET比值维持稳定.     

喉麻喷雾管在老年腹腔镜胆囊切除术中的应用

目的:观察喉麻喷雾管在老年病人中预防气管插管和拔管引起的应激反应的作用。方法:选择ASAⅠ～Ⅲ级,行腹腔镜胆囊手术的老年病人20例,全麻诱导后用麻醉咽喉镜挑起会厌,见声门后用喉麻喷雾管喷入2%利多卡因2～3ml行气管黏膜表面麻醉,并随机选择同类病人20例作为对照,对照组全麻诱导后用喉麻喷雾管给予等量生理盐水,两组麻醉诱导和维持用药相同。分别记录入室后基础值,麻醉诱导后气管插管前,气管插管即刻,插管后1、5、10min以及拔管时、拔管后5min各时间点的心率(HR)、收缩压(SBP)、舒张压(DBP);记录插管前、插管后5、10min、拔管后5min血糖、术后拔管时间以及有无拔管时呛咳、拔管后咽喉痛。结果:对照组病人HR、SBP、DBP在气管插管即刻,插管后1、5min以及拔管时、拔管后5min均较入室后基础值增快和升高,血糖在插管后5、10min、拔管后5min较插管前升高,差异有显著性(P<0.05);观察组病人HR、SBP、DBP在除诱导后插管前外各时间点均较入室后基础值变化不大,差异无显著性(P>0.05),血糖在拔管后5min较插管前升高,差异有显著性(P<0.05);两组比较HR、SBP、DBP在气管插管即刻,插管后1、5min以及拔管时、拔管后5min差异有显著性,血糖在插管后5、10min、拔管后5min差异有显著性,均为对照组高于观察组;两组术后拔管时间以及拔管时呛咳、拔管后咽喉痛比较差异显著(P<0.05)。结论:喉麻喷雾管使用利多卡因气管内表面麻醉能有效的减轻老年手术病人气管插管和拔管引起的心血管应激反应,并可安全预防这种应激反应。     

丙泊酚复合芬太尼麻醉对胃镜检查应激反应的影响

目的观察丙泊酚复合芬太尼麻醉对胃镜检查应激反应的影响。方法胃镜检查患者50例,分为观察组与对照组,观察组采用丙泊酚加芬太尼麻醉,对照组采用常规局部表面麻醉法。以两组患者检查前血浆皮质醇和血糖作为基础值,并于检查后即刻抽血测定血浆皮质醇及血糖值。用放免法测定血浆皮质醇含量。结果胃镜检查前两组患者血浆皮质醇均高出正常范围,观察组血浆皮质醇检查后较检查前显著降低(P<0.01),对照组血浆皮质醇检查后较检查前则显著增高(P<0.01);两组血糖检查后均增高,对照组增高较观察组明显(P<0.05),但均在血糖正常值范围内。结论丙泊酚复合芬太尼能在一定程度上抑制胃镜检查操作中的应激性反应,使胃镜检查更加安全。     

喉罩替代气管导管对腹腔镜手术围拔管期应激反应的影响

目的 探讨全麻腹腔镜手术即将结束麻醉深度减浅前,喉罩替代气管导管通气预防围拔管期应激反应的效果.方法 选择择期行全麻腹腔镜手术患者60例,随机分为更换喉罩组(A组,30例)和继续保留气管导管组(B组,30例).记录每组患者入室诱导前(T0)、减浅麻药前(T1)、停药后3 min (T2)、5 min (T3)、拔除气管导管或喉罩时(T4)、拔除气管导管或喉罩后3 min (T5)、5 min (T6)的BP、HR、SpO2和PET CO2,并计算各时点心肌耗氧间接指标(RPP,收缩压与HR的乘积)及采集各时间点外周静脉血检测血糖及血浆皮质醇水平;A组记录麻醉深度减浅前即拔管前(t1)、拔管时(t2)、插入LMP时(t3)的HR、BP变化;观察围拔管期两组患者呛咳和躁动发生情况及术后1天咽部不适的发生率.结果 A组在更换喉罩期间,血流动力学平稳;T2、T3、T4、T5时,B组的SBP、DBP、HR、RPP及血糖和血浆皮质醇均明显高于T0时,差异有统计学意义(P＜0.05),而A组的相应各指标波动不明显(P＞0.05),且两组间比较差异有统计学意义(P＜0.05);在各时间点,两组患者SpO2、PET CO2差异无统计学意义(P＞0.05).围拔管期,B组呛咳、躁动及术后咽部不适的发生率均高于A组(P＜0.05).结论 全麻腹腔镜手术手术即将结束麻醉深度减浅前,拔除气管导管、更换喉罩通气预防围拔管期过度应激反应,安全有效.     

右美托咪定对颅内动脉瘤患者围拔管期应激反应和苏醒质量的影响

目的：观察右美托咪定（Dexmedetomi—dine,Dex）对颅内动脉瘤患者围拔管期应激反应和苏醒质量的影响。方法：选择Hunt／Hess分级为I～II级的施行颅内动脉瘤夹闭术患者50例。随机分成右美托咪定（A组）和生理盐水对照组（B组）,每组25例。A组麻醉前10min微泵静脉注射右美托咪定0．5μg／kg,术中0．4／g·kg-1·h-1持续泵注,B组给予等容量的0．9％的氯化钠注射液。两组均采用静吸复合全麻。记录入手术室时（T2）、拔管即刻（T1）、拔管后5rain（T1）、10min（T4）的血压（BP）、心率（HR）变化,抽外周静脉血测定皮质醇（COR）、血糖（GI．U）、血乳酸（LAC）浓度,并记录麻醉恢复时间,苏醒期躁动评分、拔管后30min视觉模拟（VAS）镇痛评分和Ramsay镇静程度评分。结果：B组的MAP、HR、COR、GLU、LAC较A组增高更为明显（P〈0．01或P〈0．05）;B组苏醒期躁动评分和拔管后30rainVAS评分高于A组,而Ramsay镇静程度评分低于A组（P〈0．05）。结论：右美托咪定有效抑制了围拔管期的应激反应,能提高麻醉苏醒质量,不延迟苏醒时间。     

右美托咪定辅助全身麻醉手术对术中应激反应与术后疲劳程度的影响

目的:探讨右美托咪定辅助全身麻醉手术对术中应激反应与术后疲劳程度的影响.方法:选择140例择期行全身麻醉手术的患者作为研究对象,随机将其分为观察组和对照组,各70例,观察组采用右美托咪定辅助麻醉,对照组采用等量生理盐水辅助麻醉;比较两组麻醉前(T0),气管插管时(T1),切皮后(T2),拔管即刻(T3),拔管后5 min(T4)的血浆去甲肾上腺素、肾上腺素以及皮质醇水平以及术前1 d、术后1 d、术后2 d、术后3 d的疲劳严重度评分(FSS).结果:T1～T4时,两组的应激反应指标(去甲肾上腺素、肾上腺素、皮质醇)均高于T0时(均P<0.05),且观察组T1～T4时应激反应指标均低于对照组(均P<0.05).术后1d～3d的FSS评分均高于术前1d(均P<0.05),且观察组术后1d～3 d的FSS评分均低于对照组(均P<0.05).结论:右美托咪定辅助全身麻醉手术可以有效减轻患者术中应激反应,缓解患者术后疲劳程度.     

盐酸右美托咪定对全麻患者围拔管期应激反应的影响

目的 探讨盐酸右美托咪定对全麻患者围拔管期应激反应的抑制作用.方法 全凭静脉麻醉下行上腹部手术患者42例随机均分为两组,A组拔管前输注盐酸右美托咪定0.2～0.7μg·kg-1·h-1,B组不用盐酸右美托咪定作为对照.记录拔管前、拔管时、拔管后10 min以及20 min的平均动脉压(MAP)、心率(HR),并采集静脉血,测定血浆皮质醇(Cor)和血糖(BG)浓度.结果 与拔管前比较,B组拔管期MAP和HR均明显升高(P＜0.05),A组拔管时和拔管后10 min的MAP和HR均低于B组(P＜0.05).A组拔管后10 min的Cor明显低于B组[(253.2±33.7)mg/Lvs.(278.5±45.2)mg/L],BG亦低于B组[(5.18±0.59) mmol/L vs.(5.58±0.58)mmol/L](P＜0.05).结论 盐酸右美托咪定能有效减轻上腹部手术患者拔管期的应激反应.     

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.     

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.     

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.     

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.