酚苄明和新斯的明联合用药对硬膜外吗啡术后止痛所致尿潴留的预防和治疗作用

硬膜外吗啡术后止痛可导致尿潴留,而长期给尿潴留患者留置导尿管可引起尿道感染和尿路损伤。因此,如何预防尿潴留的发生及发生尿潴留后如何及时解除是硬膜外吗啡术后止痛亟待解决的关键问题[1]。本研究术前给患者口服酚苄明,术后出现尿潴留时给患者肌注新斯的明,观察两药对尿潴留的预防及治疗作用。　　资料和方法腹部择期手术患者80例,年龄17～56岁;男34例,女46例;ASA分级Ⅰ～Ⅱ级,无明显的心脏病、高血压病和呼吸系统疾病,无泌尿系统疾病所致的排尿困难病史。其中胆囊手术36例,胃大部切除术25例,阑尾切除术19例。将患者随机…     

新斯的明对百草枯中毒大鼠全身炎症反应和肺损伤的影响

目的 观察胆碱酯酶抑制剂——新斯的明对百草枯中毒大鼠全身炎症反应和肺损伤的影响.方法 96只SD大鼠随机分为3组(n=32).NES组:腹腔注射百草枯(paraquat,PQ)溶液20 mg/kg后2h腹腔注射新斯的明300 μg/kg;PQ组:腹腔注射等量PQ溶液后2h腹腔注射生理盐水300μg/kg;对照组:以等量生理盐水代替PQ溶液腹腔注射.在6、24、72h3个时间点观察大鼠血清及肺组织TNF-α、IL-6、IL-10变化;分批处死大鼠进行肺组织病理学观察以及测量肺湿/干质量(W/D);Real-Time PCR检测肺组织SOCS1、SOCS3 mRNA表达.结果 PQ染毒后,大鼠血清和肺组织TNF-α、IL-6、IL-10均显著升高,NES组在染毒后各时间点血清和肺组织TNF-α水平低于PQ组(P＜0.05),在染毒后24、72 h血清及肺组织IL-6水平低于PQ组(P＜0.05).染毒后各时间点NES组IL-1O水平高于PQ组(P＜0.05).染毒后72 h,病理学观察可见NES组大鼠肺损伤程度较PQ组轻.NES组24、72 h肺湿干质量比低于PQ组(P＜0.05).PQ染毒后各时间点SOCS1、SOCS3 mRNA表达水平高于对照组(P＜0.05).NES组SOCS3 mRNA表达水平高于PQ组,但SOCS1 mRNA表达水平与PQ组差异无统计学意义(P＞0.05).结论 新斯的明能减轻PQ中毒大鼠的全身炎症反应和肺损伤程度,其机制可能涉及激活胆碱能抗炎途径     

Comparison of reversal with neostigmine of low‐dose rocuronium vs. reversal with sugammadex of high‐dose rocuronium for a short procedure

Some short procedures require deep neuromuscular blockade, which needs to be reversed at the end of the procedure. Forty‐four patients undergoing elective laryngeal micro‐surgery were randomly allocated into two groups: rocuronium 0.45 mg.kg^?1 with neostigmine (50 μg.kg^?1 with glycopyrrolate 10 μg.kg^?1) reversal (moderate block group) vs. rocuronium 0.90 mg.kg^?1 with sugammadex (4 mg.kg^?1) reversal (deep block group). The primary outcome was the intubating conditions during laryngoscopy secondary outcomes included recovery of neuromuscular block; conditions for tracheal intubation; satisfaction score as determined by the surgeon; onset of neuromuscular block; and postoperative sore throat. The onset of neuromuscular block was more rapid, and intubation conditions and ease of intra‐operative laryngoscopy were more favourable, and the satisfaction score was lower in the moderate block group compared with the deep block group. No difference was found in the incidence of postoperative sore throat. In laryngeal micro‐surgery, the use of rocuronium 0.9 mg.kg^?1 with sugammadex for reversal was associated with better surgical conditions and a shorter recovery time than rocuronium 0.45 mg.kg^?1 with neostigmine.     

Alterations in gills of Lepomis gibbosus,after acute exposure to several xenobiotics (pesticide,detergent and pharmaceuticals): morphometric and biochemical evaluation

In recent decades, scientific research about the effects of anthropogenic xenobiotics on non-target organisms has increased. Among the likely effects, some studies reported the evaluation of biochemical and morphological changes in specific tissues or organs of fishes, such as gills, which are key organs for the direct action of pollutants in the aquatic environment. This work intended to assess biochemical [oxidative stress/phase II conjugation isoenzymes glutathione S-transferase (GSTs)] and morphological [secondary lamellar length (SLL), secondary lamellar width (SLW), interlamellar distance (ID), basal epithelial thickness (BET) and proportion of the secondary lamellae available for gas exchange (PAGE)] changes in gills, after acute exposure to the pesticide chlorfenvinphos, the detergent sodium dodecylsulphate (SDS) and to the anticholinesterasic pharmaceuticals (neostigmine and pyridostigmine). Our results point to a significant, eventually hormetic, effect in the activity of GSTs following exposure to chlorfenvinphos that significantly increased the activity of GSTs at concentration of 0.2?mg/L. The activity of GSTs increased significantly after exposure to 100?mg/L of neostigmine. Considering the morphometric analysis of the gills, the data obtained showed that chlorfenvinphos exerted mainly minor architectural alterations in gills, with the exception of the highest tested concentration of chlorfenvinphos that produced also a slight decrease of the PAGE. The overall conclusions point to a null or negligible toxicity of the selected toxicants towards L. gibbosus, which may be reverted if exposure is withdrawn.     

Acute colonic pseudo-obstruction: rapid correction with neostigmine in the emergency department

Ogilvie's syndrome, now known as acute colonic pseudo-obstruction, is characterized by massive dilatation of large bowel in the absence of mechanical obstruction. It is found in a variety of patients, although elderly and immobile patients make up a large portion of the afflicted population. This article discusses the case of a 64-year-old bedridden, paraplegic, male nursing home resident who presented to the Emergency Department with a chronic history of abdominal distention that acutely worsened on the day of his arrival. A diagnosis of acute colonic pseudo-obstruction was made and 2 mg of intravenous neostigmine was administered, with resolution of the patient's condition allowing for subsequent Emergency Department discharge. This report discusses the utilization of neostigmine, an acetylcholinesterase inhibitor, for patients with colonic pseudo-obstruction. We also briefly review the literature on this condition and other therapeutic options.     

胃肠安丸不同提取部位对小鼠肠推进、胃排空作用研究

目的:探讨胃肠安丸及其不同极性部位对小鼠胃排空和小肠推进的影响。方法 :采用酚红排空方法,观察胃肠安丸及其不同极性部位对正常和新斯的明小鼠模型的胃排空和小肠各段推进的影响。结果:胃肠安丸在400mg/kg对胃排空无影响,800mg/kg时能够抑制正常小鼠胃排空,与对照组比较差异显著(77.80±3.45 vs.93.45±0.94%,P<0.01),同时能够促进小肠推进,使得酚红集中在小肠的后段。而对于新斯的明小鼠模型,随着剂量的增加,胃肠安丸与新斯的明共同促进胃排空,但是和模型组比较并无显著性意义,而且其使得小肠中酚红的含量趋于正常。胃肠安丸的石油醚层抑制了胃排空,其它部位促进了胃排空,但是均和空白组对比无显著性差异(P>0.05),并且石油醚层和水层能够促进小肠的推进。不同的极性部位对新斯的明小鼠模型随着极性的增大,胃排空作用亦增加,但是均弱于新斯的明模型组(P>0.05),同时石油醚层和水层表现出抑制小肠的推进作用。结论:胃肠安丸对胃肠动力有一定的调节作用,并且其发挥作用的活性部位为石油醚层。     

Does esomeprazole prevent post‐operative nausea and vomiting?

BACKGROUND: Esomeprazole is a potent proton pump inhibitor (PPI), reducing acid production as well as gastric juice volume. This study evaluated the possible beneficial effect of esomeprazole on reducing post-operative nausea and vomiting (PONV). METHODS: Patients undergoing laparoscopic or open gynaecological surgery, or laparoscopic cholecystectomy were randomized to receive three peri-operative doses double blindly of either esomeprazole 40 mg or placebo, given intravenously or orally. All patients were given a standardized anaesthesia regimen including fentanyl and sevoflurane/nitrous oxide. RESULTS: The study population consisted of 284 patients. Demographic data and known PONV risk factors were similar for the two treatment groups. PONV was observed in 77% of patients on esomeprazole vs. 81% on placebo (NS) and rescue antiemetic medication was needed in 56% vs. 53%, respectively (NS). The proportion of patients that vomited during 0-24 h was lower on esomeprazole than placebo (38% vs. 49%; NS), and the mean amount of vomit was significantly lower (52 vs. 86 g; P < 0.05). The use of neostigmine, use of opioids and type of surgery were significant risk factors for PONV (P < 0.05). The 24-h incidence of PONV was 63% after laparoscopic gynaecology, 80% after laparoscopic cholecystectomy and 88% after open gynaecological laparotomy, whereas laparoscopic cholecystectomy had the lowest risk when corrected for other risk factors of PONV. CONCLUSION: Esomeprazole had no clinically relevant effect on the overall 24-h incidence of PONV. However, esomeprazole significantly reduced the total amount of vomit during 24-h post-operatively. This may be of value in patients with an increased risk of pulmonary aspiration.     

2例剖宫产术后注射新斯的明不良反应的护理

新斯的明注射液常用于手术后腹胀，不良反应较少，使用安全，但由于存在个体差异，临床上偶尔也会出现不良反应。2008年我科收治2例剖宫产术后注射新斯的明引起不良反应的患者，现将护理报告如下。     

Efficacy of intrathecal neostigmine for the relief of postinguinal hemiorrhaphy pain

BACKGROUND: Intrathecal administration of various doses of neostigmine has been reported to produce analgesia without neurotoxicity in both animal and human studies. The present study was undertaken to evaluate the efficacy and safety of intrathecal neostigmine for the relief of pain for patients having undergone inguinal herniorrhaphy surgery. METHODS: Sixty men scheduled for elective inguinal herniorrhaphy with spinal anaesthesia were randomly allocated to three groups: group I (n=20) received intrathecal (IT) tetracaine 15 mg, group II (n=20) received IT tetracaine 15 mg+ neostigmine 50 microg, and group III (n=20) received IT tetracaine 15 mg+neostigmine 100 microg. The onset of anaesthesia, duration of analgesia, time to use of first rescue analgesics, the overall 24 h VAS pain scores and the incidence of adverse effects were recorded for 24 h postdrug administration. RESULTS: Onset of anaesthesia (time to T6 sensory block) was significantly faster for group II and III patients compared with group I patients. Motor block (time to lift leg) was greatly prolonged for group III patients, with an average of 6.4 h, compared with 4.1 h for group II patients. Group III patients also showed a later onset of postsurgical pain, lower overall 24-h VAS pain score and prolonged time to first rescue analgesics than did group II patients. There was a significantly greater incidence of adverse effects associated with IT neostigmine, especially nausea and vomiting. CONCLUSION: Our study showed that intrathecal neostigmine at 50 pg or 100 microg enhanced the onset of tetracaine anaesthesia and provided analgesia lasting for 6-9 h, although increased incidences of prolonged motor blockade and nausea or vomiting were noted.