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1.
靶控输注依托咪酯对围术期肾上腺皮质功能的影响   总被引:11,自引:0,他引:11  
目的 观察利用靶控输注复合依托咪酯及丙泊酚乳剂在麻醉中患者血浆皮质醇含量及血流动力学的变化,比较二者对患者围术期肾上腺皮质功能的影响.方法 选择择期手术的患者60例随机分为两组,每组30例:E组为实验组,使用靶控输注依托咪酯乳剂进行麻醉;P组为对照组,使用靶控输注丙泊酚乳剂进行麻醉.分别于麻醉前5min(T0)、插管时(T1)、插管后5min(T2)、手术结束时(T3)、术后24h(T4)、术后48h(T5)6个时点测定血中皮质醇含量及血流动力学指标的变化.结果 与麻醉前比较,两组患者在麻醉诱导及维持过程中各时点血皮质醇含量均有不同程度的降低,但均在正常范围以内;其中两组患者均以手术结束时(T3)血皮质醇含量降低最明显(P<0.05).两组患者血皮质醇含量在术后24h均可恢复至术前水平.两种药物对患者围术期血流动学的变化均有不同程度的影响,以P组较为明显.结论 靶控输注依托咪酯及丙泊酚乳剂均能较好地抑制患者围术期应激反应;对患者围术期肾上腺皮质功能有不同程度的抑制作用,但没有明显差异,各时点血皮质醇含量均在正常范围以内,术后24h血皮质醇含量均可恢复至术前水平.  相似文献
2.
目的比较异丙酚复合瑞芬太尼或芬太尼在腹腔镜胆囊手术行靶控输注(TC I)全凭静脉麻醉时对血流动力学及恢复情况的影响。方法ASAⅠ~Ⅱ级择期行腹腔镜胆囊切除术患者100例,随机分为瑞芬太尼组和芬太尼组各50例;复合异丙酚行靶控血浆浓度输注并观察记录麻醉诱导、气管插管时心率、血压的变化、术毕停麻醉药后患者自主呼吸恢复、送术后恢复室(PACU)、呼之睁眼、拔管、定向力恢复和离开PACU时间;并根据OAA/S及VRS评分,记录患者意识状态、疼痛评分及副反应情况。结果2组患者在麻醉诱导时、气管插管即刻、气管插管后3 m in、气腹时及术后5 m in、拔管时血压和心率的变化、术毕停药后呼吸恢复时间、送PACU时间、呼之睁眼时间、拔管后时间;拔管后即刻、回病房后1.5 h的OAA/S及VRS评分均有显著差异(P<0.05);术后瑞芬太尼组躁动和高血压发生率明显高于芬太尼组(P<0.05)。结论瑞芬太尼TC I麻醉诱导、气管插管时及术中心血管反应小,术后恢复快,正确处理并发症不失为理想的麻醉镇痛药。  相似文献
3.
目的:构建人端粒酶催化亚单位(hTERT)启动子驱动的增强绿色荧光蛋白(EGFP)真核表达载体,研究其调控EGFP在肿瘤细胞中的靶向表达。方法:从含hTERT启动子序列的重组质粒pGL3-hTERTp上,酶切获取约1100bv的启动子片段,克隆至无启动子的EGFP质粒载体pEGFP-1的多克隆位点中,构建pEGFP-hTERTp真核表达载体。用含有巨细胞病毒(CMV)启动子的质粒pEGFP—N1作为阳性对照,pEGFP-1作为阴性对照,脂质体转染法分别转染人肺癌细胞95D,NCI—H446,A2,A549,LTEP—a-2,YTMLC和人正常细胞MRC-5,荧光显微镜下观察各细胞中EGFP转录表达情况。结果;双酶切和单酶切均显示载体pEGFP—hTERTp构建成功。细胞转染结果显示:在转染了pEGFP-hTERTp质粒的肺癌细胞中EGFP都有不同程度的表达,而在MRC-5中无EGFP表达;转染pEGFP-N1的肺癌细胞和正常细胞中均可清晰地观察到EGFP强荧光表达。结论:hTERT启动子能调控EGFP在肺癌细胞中靶向性转录表达。CMV启动子调控的EGFP在肺癌细胞和正常细胞中的表达不具有特异性。hTERT启动子有可能作为肿瘤靶向性基因治疗的调控元件。  相似文献
4.
北京地区2077例2型糖尿病患者治疗达标调查   总被引:8,自引:0,他引:8  
目的 调查北京地区2型糖尿病患者治疗达标率.方法 2007年3~4月对北京地区36家医院2077例2型糖尿病患者的血糖、血压、血脂达标情况及其治疗措施和医疗费用进行调查.结果 糖化血红蛋白A1c<6.5%者占24.6%.空腹血糖<6.1mmol/L者占19.7%;收缩压<130mmHg者占40%,舒张压<80mmHg者占41.1%;血清总胆固醇<4.2ramol/L者占25.6%.低密度脂蛋白胆固醇<2.6mmol/L者占40%,甘油三酯<1.7mmol/L者占56.8%,高密度脂蛋白胆固醇>1.04mmol/L者占71.5%.70.6%的患者坚持每月就诊1次.分别有81.4%和67.3%的患者能坚持饮食控制及运动:单纯饮食疗法者占6.5%,使用单药治疗者占31.3%,采用联合药物治疗者占62.3%.在家经常测定血糖的患者占35.1%.平均每周监测2.57次.平均每人每月药费686.69元,治疗费159.15元,检查费147.82元,挂号费11.22元.结论 北京地区2型糖尿病治疗达标率与全国的调查结果相似.  相似文献
5.
Background There are few studies to assess whether the effect-site concentration of propofol can predict anesthetic depth during the target-controlled infusion (TCI) induction in elderly patients. This study aimed to evaluate the relationship between effect-site concentration of propofol and depth of anesthesia during the TCI induction in elderly patients. Methods Ninety patients (60-80 years) with an American Society of Anesthesiologists (ASA) physical status of 1-3, undergoing scheduled abdominal and thoracic surgery under general anesthesia were randomly allocated into one of three groups, Group S1, S2 and S3 (30 patients in each group). The patients in Group S1 received propofol with a target plasma concentration of 4.0 pg/ml; patients in Group S2 received propofol with an initial target plasma concentrations of 2.0 IJg/ml that was raised to 4.0 pg/ml 3 minutes later; patients in Group S3 received an infused scheme of 3 steps; starting from a target plasma concentration of 2.0 pg/ml that was increased stepwised by 1 pg/ml until a target plasma concentration of 4.0 pg/ml was achieved, the interval between the two steps was 3 minutes. When an Observer's Assessment of Alertness/Sedation (OANS) score of 1 was achieved, remifentanil (effect-site concentration (Ce) of 4.0 ng/ml) and rocuronium 0.9 mg/kg were administered. Tracheal intubation was started 2 minutes after rocuronium injection. Changes of propofol Ce, blood pressure (BP), heart rate (HR), and bispectral index (BIS) were recorded. Results When an OAA/S score of 1 was achieved, Ce of propofol were (1.7±0.4) pg/ml, (1.9±0.3) pg/ml, (1.9±0.4) pg/ml and the BIS values were 64±5, 65±8, and 62±8 in Groups S1, S2 and S3. Before intubation, Ce of propofol was (2.8±0.2) pg/ml, (2.8±0.3) pg/ml, (2.7±0.3) pg/ml, and the BIS values were 48±7, 51±7, and 47±5 in Groups S1, S2 and S3. By linear regression analysis, a significant correlation between Ce of propofol and BIS values was found (r=-0.580, P 〈0.01). Systolic blood pressure (SBP) before intubation was significantly lower in Group S1 than in Groups S2 and S3. SBP and HR after intubation in the three groups were significantly increased when compared with pre-intubation values, but they did not exceed baseline values Conclusions During the TCI induction, Ce of propofol with (1.9±0.3) pg/ml may make the elderly patients unconscious. When remifentanil with a Ce of 4.0 ng/ml is added a Ce of propofol with (2.8±0.3) pg/ml is suitable for intubation. The Ce of propofol has a close correlation with the BIS values. Also, a two-step TCI technique seems to be a more suitable method of anesthesia induction in elderly patients compared with the no-stepwise TCI technique and three-step TCI technique.  相似文献
6.
Background Target-controlled infusion (TCI) has been recently developed and successfully implemented in clinical practice. This study was conducted to determine the pharmacokinetics of TCI administered sufentanil in Chinese surgical patients. Methods The pharmacokinetics of sufentanil was investigated in 12 adult patients, aged 23-76 years, scheduled for prolonged surgery under general anesthesia. Anesthetic induction was carried out with propofol, rocuronium and TCI administered sufentanil aiming for target effect-site concentration of sufentanil 4 or 6 ng/ml. Sufentanil TCI lasted for 30 minutes. Frequent arterial blood samples (1.5 ml) were drawn during and up to 24 hours after sufentanil TCI. Plasma sufentanil concentrations were measured by liquid chromatography-tandem mass spectrometry; limit of sensitivity of mass spectrometry was 5 pg/ml. The data were analyzed with the nonlinear mixed-effect model program. Results The pharmacokinetics of TCI administered sufentanil were optimally described by a three-compartment model with the following parameters: the central volume of distribution (V1) = 5.4 L, the volume of distribution at steady-state (Vdss) = 195.4 L, systemic clearance (CI1) = 1.10 L/min, and elimination half-life (t1/2 Y) = 271.8 minutes. Both age and gender affected the pharmacokinetic parameters. The rapid distribution clearance (012) was negatively correlated with patient age, and the volume of slowly equilibrating compartment (V3) was positively correlated with age. The Cl2 and the volume of rapidly equilibrating compartment (V2) were influenced by gender with male patients showing higher values of Cl2 and V2 than female patients. There was no relationship of body weight, lean body mass, plasma albumin, or target effect-site concentration of sufentanil with any of the pharmacokinetic parameters studied. Conclusions The pharmacokinetics of TCI administered sufentanil in Chinese patients can be adequately described by a three-compartment model. Pharmacokinetics adjusted to the individual patient should improve the accuracy of TCI systems.  相似文献
7.
鼻咽癌治疗的研究进展   总被引:6,自引:0,他引:6       下载免费PDF全文
 调强放射治疗技术提高了鼻咽癌的局部区域性控制率和总生存率,并改善了生存质量, 而准确勾画靶区是保证鼻咽癌调强疗效的前提&;#65377;近年临床研究结果逐渐支持以同步放化疗作为局部晚期鼻咽癌的标准治疗方式,但诱导化疗和辅助化疗的价值尚有待明确&;#65377;鼻咽癌的分子靶向药物治疗主要处在Ⅰ&;#65380;Ⅱ临床试验阶段,为今后的综合治疗模式提供了更多的选择&;#65377;本文就这三方面的研究进展作一综述&;#65377;  相似文献
8.
天麻素鼻用原位凝胶脑靶向性研究   总被引:6,自引:0,他引:6  
目的研究天麻素离子敏感鼻用原位凝胶在大鼠体内血液与脑组织中的药物分布,并评价其脑靶向性。方法大鼠静注天麻素溶液或经鼻给予天麻素鼻用原位凝胶后,采用HPLC法分别测定血浆中的天麻素及脑组织中天麻苷元的浓度。结果与静注天麻素溶液组相比,鼻用原位凝胶组大鼠脑组织中的药物分布显著增加(P<0.01),大脑、小脑及嗅球的药时同线下面积分别增加1.16、0.77及3.34倍,脑靶向指数分别为:2.66、2.18及5.34,药物平均滞留时间增加近4倍。结论天麻素鼻用原位凝胶具有一定的脑靶向性与缓释作用。  相似文献
9.
老年原发性高血压患者动态血压分析   总被引:5,自引:5,他引:3  
目的探讨老年高血压患者动态血压参数变化的临床意义。方法选择58例老年高血压患者进行24 h动态血压监测,分析其24 h、白昼、夜间平均血压和平均脉压、血压变异性,并与正常老年人比较。结果老年单纯高血压(EH)组和高血压伴靶器官损害(EH TOD)组24 h、白昼、夜间平均血压、平均脉压和血压变异系数显著高于对照组(P<0.01)。EH TOD组夜间平均血压、24 h平均脉压、血压变异系数与EH组比较有显著差异(P<0.05)。结论老年高血压患者存在明显节律紊乱,脉压和血压变异性增大,并与TOD密切相关。  相似文献
10.
新型抗凝药物研发进展   总被引:5,自引:0,他引:5       下载免费PDF全文
摘 要:静脉血栓形成及栓塞是严重危害人类健康的疾病,是继急性冠脉综合征与脑卒中之后第三大心血管疾病。随着对凝血与血栓形成机制、静脉栓塞发病机制,及普通肝素、低相对分子质量肝素、华法林等传统用药研究与了解的进一步深入,以凝血因子靶点Ⅹa、Ⅱa、Ⅸa,以及Ⅲ(TF)/Ⅶa特异性抑制为基础的新抗凝药物研发取得了很大进展。同时,理想的抗凝药物标准为新型药物研发提出了更高的要求,靶点选择、获益与风险、效应与毒性评价等许多问题更值得关注。综述静脉血栓形成原因与机制,传统用药,以及新药研发靶点与研发进展、研发注意事项。  相似文献
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