Comparative study between ephedrine infusion vs. CO/post loading of fluids for prevention of hypotension in emergency cesarean section under spinal anesthesia

IntroductionMaternal hypotension is the most common complication during cesarean section under spinal anesthesia. The aim of this study was to compare the effectiveness of CO/post loading of fluids versus immediate post spinal infusion of ephedrine in prevention of hypotension.MethodsNinety healthy pregnant patients ASA I with single term fetus arrived to the operating room with nonlife threatening cause for emergency cesarean section under spinal anesthesia. The patients were allocated randomly into 3 groups, Group R: started the CO/post loading at the time of spinal injection and continued after it with 0.5 ml/kg/min Lactated Ringer's solution until delivery of the fetus. Group V: started the CO/post loading with 0.5 ml/kg/min Voluven at the same period. Group E: started ephedrine infusion at 1 mg/min via the infusion pump immediately after spinal anesthesia until delivery of the fetus.ResultsThe systolic blood pressure changes were statistically significant but they failed to reach clinical significant values in the three groups. The total dose of ephedrine was significantly higher in Ephedrine group than the other two groups. Intraoperative heart rate increased in the first 30 min in Ephedrine group without any clinical significance. All fetal data were within normal range and comparable between groups. Apger score of the fetuses was not less than 8 in the three groups. The incidence of nausea and vomiting was higher in group R and group V compared to group E.ConclusionIntravenous infusion of ephedrine 1 mg/min immediately after spinal anesthesia for emergency cesarean sections, even if there is no enough time for proper prehydration, can control effectively the hypotension without episodes of hypertension or significant tachycardia, and it had no effect on fetal well-being. It could be as effective as CO/post loading of 0.5 ml/kg/min lactated Ringer or Voluven in controlling systolic blood pressure with fewer incidences of post operative complications.     

中药复方液对麻黄素仔鼠肝组织结构和抗氧化酶活性的影响

目的 探讨中药复方液对麻黄素致损伤的影响。 方法 采用递增剂量连续腹腔注射浓度为2.0g/L、3.0g/L和4.0g/L的麻黄素溶液,在注射麻黄素1h 后再分别灌胃,浓度为20.0g/L、30.0g/L和40.0g/L的中药复方液。分别于灌胃中药5、10、15d后,用比色法测定仔鼠肝组织中超氧化物歧化酶（SOD）、过氧化氢酶（CAT）活性和丙二醛（MDA）含量,用显微镜观察肝组织结构,用免疫组织化学法检测肝组织c-Fos蛋白的表达。 结果 麻黄素组仔鼠10d、15d 时肝组织SOD、CAT的活性低于对照组,MDA含量高于对照组 (P<0.05或 P<0.01),肝组织有不同程度的损伤,肝组织c-Fos蛋白表达强度高于对照组 (P<0.05或P<0.01);中药组仔鼠肝组织SOD、CAT活性升高,MDA含量降低(P<0.05或P<0.01),肝组织损伤明显减轻,肝组织c-Fos蛋白的阳性表达强度减弱(P<0.05或P<0.01)。结论 麻黄素对肝组织有明显的损伤效应,中药复方液可提高细胞抗氧化活性,具有抗炎、抗氧化和保护肝细胞等作用,能有效减轻麻黄素对肝组织的损伤。     

HPLC法同时测定扑麻滴鼻液中2成分的含量

目的:建立同时测定扑麻滴鼻液中盐酸麻黄碱和马来酸氯苯那敏含量的HPLC方法。方法:采用:PurospherSTAR RP18色谱柱(150 mm×4.6 mm,5μm),以磷酸盐缓冲液(p H 3.0±0.1)-乙腈(82∶18)为流动相,流速为1.0 ml·min-1,在210nm波长处同时检测盐酸麻黄碱和马来酸氯苯那敏,柱温35℃,进样量20μl。结果:盐酸麻黄碱和马来酸氯苯那敏分别在19.81~118.85μg·ml-1和6.21~37.25μg·ml-1浓度范围内线性关系良好,r分别为0.999 6和0.999 8。平均回收率分别为100.39%(RSD=0.69%,n=9)和100.11%(RSD=0.60%,n=9)。结论:该方法快速简便、重复性、准确性好,可用于该制剂中盐酸麻黄碱和马来酸氯苯那敏的含量测定。     

The Severity of Toxic Reactions to Ephedra: Comparisons to Other Botanical Products and National Trends from 1993–2002

Objective. Ephedra is a botanical product widely used to enhance alertness, as a weight loss aide, and as a decongestant. Its reported adverse effects led the Food and Drug Administration (FDA) to ban ephedra-containing products in the United States in 2004. This study's purpose was to compare toxicity from botanical products containing ephedra to nonephedra products. Methods. The Toxic Exposure Surveillance System (TESS), a national poison center database, was utilized to determine the number and outcomes of cases involving botanical products reported from 1993–2002. Cases listing both a botanical product and any other drugs or chemicals were excluded a priori. Ten-year hazard rates (moderate outcomes + major outcomes + deaths per 1000 exposures) were used to compare botanical product categories. Results. There were 21,533 toxic exposures with definitive medical outcomes reported over the 10 yrs where a botanical product was the only substance involved. Of these, 4,306 (19.9%) had moderate or major medical outcomes and there were two deaths, for an overall hazard score of 200 per 1000 exposures. The number of ephedra reports to poison centers increased 150-fold over the 10-yr period. The hazard rate for products that contained only ephedra was 250 per 1000 exposures and 267 per 1000 exposures for products that contained ephedra and additional ingredients; whereas the hazard score for only nonephedra botanical products was 96 per 1000 exposures. The rate ratios for multibotanical products with ephedra (RR 1.33; 95% C.I. 1.27–1.40) and for single-ingredient ephedra products (RR 1.25; 95% C.I. 1.11–1.40) were both two to six times higher than those of other common botanical products. Yohimbe-containing products had the highest hazard score (417) and rate ratio (2.08; 95% C.I. 1.59–2.80). Conclusion. Ephedra-containing botanical products accounted for a significant number of toxic exposures with severe medical outcomes reported to poison centers. Hazard rate analysis suggests poison center–reported events involving ephedra-containing botanical products were much more likely to result in severe medical outcomes than those involving nonephedra-containing botanical products. These data support recommendations by policymakers that the sale of ephedra should be prohibited to protect consumers. Our data suggest that the botanical product, yohimbe, may also be associated with unacceptably high risks of toxicity and should receive close scrutiny from health policymakers.     

HPLC梯度洗脱法同时测定鼻炎喷剂中3种组分的含量

目的:建立同时测定鼻炎喷剂中盐酸麻黄碱、环丙沙星、醋酸泼尼松龙3种组分含量的方法。方法:采用高效液相色谱梯度洗脱法。色谱柱为SHIMADZU Shim-pack VP-ODS,流动相为甲醇-乙腈-0.05 mol/L磷酸二氢钾(含0.25%三乙胺,pH 3.0),流速为1.0 ml/min,变换紫外检测波长分别为207、278、247 nm,柱温为40℃。结果:盐酸麻黄碱、环丙沙星、醋酸泼尼松龙检测质量浓度线性范围分别为99.93⁷99.44、46.38799.44、46.38³71.00、5.39371.00、5.39⁴3.12μg/ml(r=0.999 643.12μg/ml(r=0.999 6⁰.999 8),平均回收率为100.4%(RSD=1.2%,n=3)、101.1%(RSD=1.3%,n=3)和101.0%(RSD=1.5%,n=3)。结论 :建立的方法简便、灵敏、准确,可用于制订鼻炎喷剂的质量标准并为产品质量控制提供支持。     

HPLC法测定复方愈酚麻黄糖浆中四种成分的含量

目的建立测定复方愈酚麻黄糖浆中盐酸麻黄碱、愈创甘油醚、马来酸氯苯那敏、双氯芬酸含量的HPLC方法。方法采用Insteril ODS-3C18色谱柱,梯度洗脱,流速：1．0mL·min^-1,柱温：30℃,检测波长：257nm。结果盐酸麻黄碱、愈创甘油醚、马来酸氯苯那敏、双氯芬酸分别在0．4018～6．4287μg（r=0．9999）、3．1836～50．9379μg（r=0．9999）、0．1610～2．5762μg（r=1．0000）、0．1485～2．3759μg（r=0．9999）范围内线性关系良好,平均回收率分别为99．589／6（RSD=0．39％）、99．58％（RSD=0．30％）、99．36％（RSD=0．29％）、99．40％（RSD=0．46％）（n=9）。结论本方法经方法学验证可用于复方愈酚麻黄糖浆中盐酸麻黄碱、愈创甘油醚、马来酸氯苯那敏、双氯芬酸的含量检测。     

HPLC法测定链麻滴鼻液中硫酸链霉素和盐酸麻黄碱的含量

目的建立测定链麻滴鼻液中硫酸链霉素和盐酸麻黄碱含量的高效液相色谱法,消除焦亚硫酸钠对硫酸链霉素含量测定的影响。方法色谱柱为Diamonsil C18柱(250mm×4.6mm,5μm);流动相为0.014mol·L-1庚烷磺酸钠的0.05mol·L-1磷酸二氢钾溶液-乙腈(78∶22);检测波长硫酸链霉素195nm,盐酸麻黄碱207nm;流速1.0mL·min-1。结果硫酸链霉素质量浓度在44.40³10.80μg·mL-1范围内,与其峰面积呈良好的线性关系。(r=0.999 8,n=7),平均回收率为103.4%(RSD=3.4%);盐酸麻黄碱质量浓度在20.224310.80μg·mL-1范围内,与其峰面积呈良好的线性关系。(r=0.999 8,n=7),平均回收率为103.4%(RSD=3.4%);盐酸麻黄碱质量浓度在20.224⁸0.896μg·mL-1范围内,与其峰面积呈良好的线性关系(r=0.999 9,n=7),平均回收率为99.5%(RSD=1.0%)。结论该方法专属性强、测定结果准确、精密度高、线性好,加入甲醛能够消除辅料中焦亚硫酸钠对硫酸链霉素含量测定的影响。     

麻黄素对卵巢组织结构的影响

目的探讨麻黄素对雌鼠血液雌二醇(E2)、肾上腺素(EPI)浓度和卵巢组织结构及超氧化物歧化酶(SOD)活性、丙二醛(MDA)含量的影响。方法受孕雌鼠分别腹腔注射(2g/L、4g/L、6g/L)麻黄素溶液和等量的生理盐水,采用ELISA法检测15d、20d、25d雌鼠血浆中EPI与E2浓度的变化,用比色法检测卵巢SOD活性及MDA含量的变化,称量检测卵巢的重量变化,用生物显微技术观察卵巢组织结构的变化,统计卵巢各级卵泡的数量。结果实验组雌鼠血浆中的E2含量降低,EPI含量显著升高,并呈现剂量依赖性,卵巢SOD活性降低,MDA含量显著升高;实验组卵巢的重量明显低于对照组,初级卵泡、次级卵泡和闭锁卵泡数量均增多;黄体数量减少;实验组卵巢固缩,结构不完整,卵母细胞萎缩,颗粒细胞变性、降解,排列疏松、紊乱,黄体结构模糊,颗粒黄体细胞核固缩。结论麻黄素影响雌鼠卵巢的组织结构和功能,这可能与卵巢中SOD活性下降有关。     

反相-高效液相色谱法测定黄龙止咳颗粒中盐酸麻黄碱和盐酸伪麻黄碱的含量

目的：建立反相-高效液相色谱法（RP-HPLC）测定黄龙止咳颗粒中盐酸麻黄碱和盐酸伪麻黄碱含量的方法.方法：色谱柱：AgilentZORBAXSB-C18色谱柱（4.6mm×250mm,5μm）;流动相：乙腈-磷酸二氢钾溶液（4∶96）（取磷酸二氢钾6.8g,加水1000ml溶解后,加三乙胺1ml,用磷酸调节pH值至3.0）;检测波长：210nm;柱温：35℃.结果：盐酸麻黄碱、盐酸伪麻黄碱进样量分别在0.0040～0.0480μg（r=0.9996）、0.0237～0.2844μg（r=0.9999）范围内线性关系良好;平均回收率分别为96.2％、97.5％,RSD分别为1.97％、1.81％.结论：本方法简便、准确,适用于黄龙止咳颗粒中盐酸麻黄碱和盐酸伪麻黄碱的含量测定.     

预注不同血管活性药对重度子痫前期患者腰硬联合麻醉剖宫产母儿的影响

目的观察预注不同血管活性药对重度子痫前期患者腰硬联合麻醉剖宫产母儿的影响。方法择期拟联合阻滞麻醉下剖宫产术的重度子痫前期产妇60例,随机均分为3组,E组泵入麻黄素(2 mg/min),P组泵入去氧肾上腺素(25μg/min),C组泵注同等容量的生理盐水。调整药物输注量维持血压接近术前基础值的80%。记录三组药物的使用容量、输注血管收缩药后1、3、5、7、10、12、15 min的MAP、HR,同时记录产妇恶心、呕吐的情况。在胎儿娩出即刻,进行产妇动脉血、新生儿脐动脉和脐静脉血气分析,对新生儿进行1 min和5 min Apgar评分。结果母体术中HR变化:用药后5 min,P组与E组比较差异有统计学意义;用药后3 min,P组与C组比较差异有统计学意义;用药后3、5 min,E组与C组比较差异有统计学意义。母体术中MAP变化:用药后3、5、7 min,P组与C组、E组与C组比较差异有统计学意义。C组产妇中恶心呕吐的发生率与P组、E组比较差异有统计学意义。C组麻黄碱追加次数与P组、E组比较差异有统计学意义。结论 CSEA麻醉前预先给予去氧肾上腺素、麻黄碱等血管活性药物并维持一定的血药浓度,对维持重度子痫患者的血流动力学稳定、改善患者及胎儿的预后有一定意义。