护理干预对麻醉后留置尿管患者苏醒期躁动的影响

目的探讨护理干预对全麻后留置尿管患者苏醒期躁动的影响。方法100例全麻手术患者随机分为观察组和对照组各50例,均在全麻后留置尿管,观察组于术前1d及麻醉前分别对患者进行2次护理干预,置尿管前以利多卡因胶浆进行尿道表面麻醉。对照组按常规导尿。观察2组苏醒期躁动情况。结果观察组苏醒期躁动评分为0分患者44例（88%）多于对照组的29例（58%）,且评分为1分、2分、3分的患者例数均少于对照组,差异均有统计学意义（P〈0.05）。结论对全麻后留置导尿的患者进行护理干预并进行局部麻醉有利于减少苏醒期躁动。     

手术患者置尿管时间选择对苏醒期躁动的影响

目的观察手术前不同时间段留置导尿对患者的心理承受和尿道刺激的程度,从而选择最佳的导尿时机。方法对2007年3月至2009年6月对75例需术前留置导尿的患者随机分组,对照组为术晨在病房导尿;试验组A组为手术前日,进行心理护理后,麻醉前在手术室导尿;试验组B组为全麻后由巡回护士导尿。对患者不同时机进行导尿所引起的不舒适感、麻醉苏醒时的躁动情况及术后第1天对尿管适应性进行比较。结果试验组B组患者麻醉苏醒躁动率明显高于对照组、试验组A组。有统计学意义（P〈0.05）。术后第1天患者尿管适应度,试验组A组术后留置尿管的适应度较好。试验组B组患者较差。结论在患者进入手术室后麻醉前进行留置导尿对患者的心理压力比较小,生理不适比较轻,操作方便,且术后导尿管引起的尿道刺激症状较轻。     

手术患者不同时机导尿对苏醒期躁动和适应性比较

目的比较全麻手术患者不同时机导尿后全麻苏醒期躁动和术后1天尿管耐受性。方法将180例全麻手术患者随机分为三组,I组为术晨在病房导尿;II组为手术前1日,由巡回护士访视患者,进行心理护理后,麻醉前在手术室导尿;III组为全身麻醉平稳后由巡回护士导尿。对患者就不同时机进行导尿所引起的不舒适感、麻醉苏醒时的躁动情况及术后1日对尿管适应性进行比较。结果III组患者麻醉苏醒期躁动率明显高于I、II组,有统计学意义（P〈0.05）。术后1日患者尿管适应度,II组术后留置尿管的适应度较好,III组患者较差。结论麻醉前对患者进行心理护理后导尿可提高手术患者对留置尿管的适应度,大大降低麻醉苏醒时的躁动率。     

PPH术静脉麻醉前后留置导尿管舒适度比较

目的 比较PPH术静脉麻醉前后留置导尿管舒适度.方法 将100例PPH手术患者随机分为观察组和对照组各50例.观察组在麻醉后行留置导尿术,对照组在麻醉前行留置导尿术,分别观察2组患者导尿前后的心率、血压变化情况、留置导尿的舒适度及麻醉复苏期躁动情况.结果 2组留置导尿前后心率、收缩压、舒张压变化方面均有显著性差异（P＜0.05）,对照组心率、血压波动范围较观察组大,差异均有统计学意义（P＜0.05）.观察组导尿舒适度优于对照组,差异有统计学意义（P＜0.01）.2组患者复苏期躁动情况比较差异无统计学意义（P〉0.05）.结论 PPH手术留置导尿宜在麻醉后进行.     

手术室麻醉苏醒护理对减少腹部手术患者全麻苏醒期躁动的作用分析

目的分析手术室麻醉苏醒护理对减少腹部手术患者全麻苏醒期躁动的作用。方法选取110例全麻腹部手术患者,将其随机分为观察组与对照组,对照组给予手术室常规护理,观察组给予手术室麻醉苏醒护理,比较两组患者的苏醒期心率、血压以及躁动发生情况。结果苏醒期,观察组心率、收缩压、舒张压等指标均低于对照组(P<0.05);且观察组患者苏醒期躁动发生率低于对照组(P<0.01)。结论给予腹部手术全麻苏醒期患者麻醉苏醒护理,可有效降低患者全麻苏醒期躁动发生率,值得推广。     

全麻诱导前后置尿管对麻醉苏醒期的影响

全麻手术患者由于手术相对较大,时间较长,为了观察尿量及解除尿潴留需实施导尿术。以往我院多在全身麻醉后进行留置尿管,这样在一定程度上使患者手术时更轻松、舒适。但工作中我们发现全身麻醉后进行留置尿管的患者麻醉苏醒期心率、血压变化明显,尿道刺激症状较严重．并且发生躁动的几率较大。     

手术室预见性护理减少全麻手术留置导尿管患者苏醒期躁动的效果观察

目的:探讨全麻手术留置导尿管患者实施手术室预见性护理对苏醒期躁动的影响。方法:选择2015年6月-2017年8月期间在商丘市第一人民医院手术室治疗的60例全麻手术留置导尿管患者作为研究对象,随机分成两组,各30例。对照组行常规护理,观察组行手术室预见性护理,比较两组干预前后疼痛程度及躁动情况。结果:护理干预后,观察组疼痛评分与躁动评分均低于对照组,差异有统计学意义(P0.05)。结论:手术室预见性护理在全麻手术留置导尿管患者的应用效果显著,可降低全麻苏醒期疼痛程度,减少全麻苏醒期躁动的发生。     

预防性护理对全麻下留置导尿管患者苏醒时尿道舒适度的影响

目的采用预防性护理对全麻下留置导尿管患者术后麻醉苏醒时舒适度的影响。方法选取140例老年男性全麻手术患者随机分为两组(各70例),对照组患者采用全麻手术留置导尿管常规护理,观察组患者采用全麻手术留置导尿管预防性护理,主要包括术前1 d访视及麻醉诱导前进行心理护理、健康宣教,插管时间选择在麻醉诱导后,选择14号导尿管、插入合适的深度、气囊内注入10～12 ml生理盐水等,观察比较两组患者术后麻醉苏醒后及术后2 d时的尿道舒适度。结果观察组术后尿道刺激症状0级、Ⅰ级比例为85.71%,对照组为71.42%,观察组高于对照组(P<0.05);观察组Ⅱ级、Ⅲ级比例为14.19%,对照组为28.58%,观察组低于对照组(P<0.05)。观察组术后2 d尿道刺激症状0级、Ⅰ级比例为91.43%,对照组为75.72%,观察组高于对照组(P<0.05),观察组Ⅱ级、Ⅲ级比例为8.57%,对照组为24.28%,观察组低于对照组(P<0.05)。结论对全麻下留置尿管的患者实施预防性护理,可减轻患者尿道不适感,促进患者术后恢复,体现了人性化护理服务。     

导尿前应用利多卡因胶浆减少全麻患者的苏醒期躁动

目的探讨男性全麻患者在麻醉前行导尿时盐酸利多卡因胶浆的局部应用对减少患者苏醒期躁动的效果。方法选择60例在全麻下施行手术的患者,随机分为两组,常规组30例于全麻诱导后行常规方法导尿术,利多卡因组30例在全麻前清醒状态下用盐酸利多卡因胶浆作尿道表面麻醉下行导尿术。观察患者置管过程中血流动力学指标的变化以及麻醉苏醒期躁动的发生率。结果常规组与利多卡因组的一次性置尿管成功率无明显差异。两组患者的血压和心率在导尿管置入前、置入即刻、置入后1min、5min均无明显改变。利多卡因组患者麻醉苏醒期躁动的发生率显著低于常规组(P<0.05)。结论全麻前用盐酸利多卡因胶浆用于男性患者导尿可减少患者苏醒期躁动的发生。     

导尿时机对男性全麻患者苏醒期躁动的影响

目的在麻醉前后不同时机留置尿管,观察其对全麻男性患者苏醒期躁动的影响,从而选择最佳导尿时机。方法将80例全麻男性导尿患者(无泌尿系统及精神疾病)随机分为两组。观察组40例,在麻醉前清醒状态下并联合应用2%利多卡因行导尿术;对照组40例,全麻插管后行导尿术。结果观察组在全麻苏醒期躁动情况非常明显优于对照组。结论麻醉清醒状态下导尿并联合应用利多卡因能明显减轻患者的尿路刺激疼痛和不适,而且苏醒期躁动明显少于全麻后导尿,生命体征比较平稳。故应选择清醒状态下麻醉前留置尿管。     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Polymorphisms in genes involved in neurotransmission in relation to smoking

Smoking behavior is influenced by both genetic and environmental factors. The genetic contribution to smoking behavior is at least as great as its contribution to alcoholism. Much progress has been achieved in genomic research related to cigarette-smoking within recent years. Linkage studies indicate that there are several loci linked to smoking, and candidate genes that are related to neurotransmission have been examined. Possible associated genes include cytochrome P450 subfamily polypeptide 6 (CYP2A6), dopamine D₁, D₂, and D₄ receptors, dopamine transporter, and serotonin transporter genes. There are other important candidate genes but studies evaluating the link with smoking have not been reported. These include genes encoding the dopamine D₃ and D₅ receptors, serotonin receptors, tyrosine hydroxylase, trytophan 2,3-dioxygenase, opioid receptors, and cannabinoid receptors. Since smoking-related factors are extremely complex, studies of diverse populations and of many aspects of smoking behavior including initiation, maintenance, cessation, relapse, and influence of environmental factors are needed to identify smoking-associated genes. We now review genetic polymorphisms reported to be involved in neurotransmission in relation to smoking.     

Tramadol concentrations in blood and in cerebrospinal fluid in a neonate

Based on blood and cerebrospinal fluid samples collected in a full-term neonate, the penetration of tramadol in the central nervous system is described. Following intravenous administration of tramadol, a lag time of about 4 h was observed until full blood–brain equilibration was achieved. This pharmacokinetic observation is in line with a recent pharmacodynamic evaluation of the central opioid effects of tramadol in adults.     

Genotoxic effects of chlorophenoxy herbicide diclofop-methyl in mice in vivo and in human lymphocytes in vitro

Diclofop-methyl (DM) is a chlorophenoxy derivative used in large quantities for the control of annual grasses in grain and vegetable crops. In this study, the genotoxic effects of DM were investigated by measuring chromosomal aberrations (CAs) in mouse bone-marrow cells and CA and the comet assay in human peripheral lymphocytes. Mice were treated with 15.63, 31.25, 62.5, and 125?mg/kg body weight of DM intraperitoneally for 24 hours, and 15.63-, 31.25-, 62.5-, 125-, and 250-µg/mL concentrations were applied to human lymphocytes for both 24 and 48 hours. In in vivo treatments, DM significantly, but not dose dependently, increased the total chromosome aberrations, compared to both negative and solvent controls. Cell proliferation was significantly, but not dose dependently, affected by all doses. In in vitro treatments, DM (except 15.63 µg/mL) significantly and dose dependently increased the frequency of chromosome aberrations. Also, 250 µg/mL of 48-hour treatment was found to be toxic. Cell proliferation was significantly and dose dependently affected by DM applications, when compared to negative control. In in vitro treatments, DM significantly decreased the mitotic index only at the highest concentration for 24 hours, and 62.5- and 125-µg/mL concentrations for 48 hours. In the comet assay, a significant and dose-dependent increase in comet-tail intensity was observed at 62.5-, 125-, and 250-µg/mL concentrations. The mean comet-tail length was significantly increased in all concentrations. Our results demonstrate that DM is genotoxic in mammalian cells in vivo and in vitro.     

2010调脂治疗领域进展

2010年在调脂治疗领域针对他汀治疗心血管病的防治又进行了许多探索。本文通过综述他汀类药物的国际大规模临床试验结果,重新评价了他汀类药物在冠心病一级预防和冠心病二级预防中的地位,阐明了强化他汀治疗的意义;对他汀的心肾保护作用和安全性新证据进行了说明。