右美托咪啶与芬太尼联合对ICU 腹部外科术后机械通气患者镇静镇痛的效果比较

目的:探讨右美托咪啶与芬太尼联合在ICU腹部外科术后机械通气患者中的应用效果及对镇静、镇痛作用的影响。方法:选择2018年5月—2019年6月ICU腹部外科术后机械通气患者62例,随机分为对照组(n=31例)和观察组(n=31例)。两组均采用芬太尼持续静脉泵入,对照组采用咪达唑仑镇静镇痛,观察组采用右美托咪啶镇静镇痛,比较两组镇痛镇静效果、镇静剂使用剂量、苏醒及达到镇静所需时间、血流动力学水平及安全性。结果:两组T2、T3时间点VAS评分分别为(2.40±0.31 vs 2.43±0.32和2.01±0.12 vs 2.05±0.15)、Ramsay量表评分分别(3.21±0.35 vs 3.20±0.33和3.01±0.25vs 3.00±0.24)均低于T1时间点(VAS评分2.94±0.69 vs 2.96±0.71;Ramsay量表评分3.57±0.61 vs 3.58±0.62)(P0.05);观察组右美托咪啶联合芬太尼镇痛镇静达到镇静所需时间(34.29±3.56) min长于对照组(23.63±3.21)(t=5.535,P=0.043);观察组镇静剂使用剂量(220.59±15.25)μg、苏醒时间(3.29±0.69)min均少(短)于对照组镇静剂使用剂量(386.44±18.92)μg、苏醒时间(7.56±1.21)min(t=6.294、6.092,P=0.023、0.025);两组T1、T2时间点心率[观察组T1(88.47±9.76)次/min、T2(86.41±9.43)次/min;对照组T1(89.53±10.41)次/min、T2(87.46±9.58)次/min]均高于T0时间点[观察组(78.78±4.35)次/min、对照组(79.12±4.41)次/min](P0.05);观察组T1、T2时间点MVP(79.58±5.71、87.53±6.76)mmHg高于对照组(74.12±4.69、75.26±5.61)mmHg(t=9.613、7.223,P=0.011、0.016);观察组的不良反应发生率为6.45%,与对照组的12.90%差异无统计学意义(χ~2=1.214, P=0.643)。结论:将右美托咪啶联合芬太尼用于ICU腹部外科术后机械通气患者中能获得良好的镇痛、镇静效果,缩短苏醒及达到镇静所需时间,血流动力学相对稳定,药物安全性较高,值得推广应用。     

Validation of a Flow-Through Diffusion Cell for Use in Transdermal Research

A flow-through finite-dose diffusion cell has been designed for use in transdermal drug delivery research. The diffusion cell consists of an upper donor chamber and a lower receiver compartment through which a continuous supply of fresh solvent flows. The flow is directed to an automatic fraction collector. To validate the flow-through cell, its performance was compared directly against that of a conventional single-reservoir Franz cell. Homologous alkyl p-aminobenzoates were diffused through dimethylpolysiloxane membranes, and permeability coefficients increased with increasing chain length, reaching a plateau at the butyrate ester for both types of cells. This behavior suggests a shift from membrane-controlled diffusion to boundary layer control. Permeation of the butyrate and valerate compounds was significantly faster when the flow-through cell was used, suggesting that better mixing is obtained through the flow-through cell design. Considering the advantages offered in terms of time and labor saved through its use, the flow-through cell with automatic fraction collector appears to be a viable alternative to the conventional Franz cell.     

两性霉素B微乳的制备及体外经皮渗透研究

 目的制备水包油型两性霉素B微乳,并对其进行体外经皮渗透性能考察。方法用相转变温度法制备两性霉素B微乳,用光散射粒度仪测定微乳的粒径,电子透射电镜观察微乳的形态。用药物渗透扩散仪进行两性霉素B透皮吸收研究,高效液相色谱法测定两性霉素B含量。结果用相转变温度法制备了Tween80和异丙醇重量比为1∶1,IPM和混合表面活性剂之比为1∶9,水含量64.6%,载药量为0.247%的两性霉素B微乳。所制微乳符合微乳特征,调节pH值有助于两性霉素B由分散介质向微乳表面转移。水性月桂氮酮对两性霉素B的促渗效果最好,pH值为5.12,月桂氮酮浓度为1%时,两性霉素B微乳经离体兔皮的JS为4.627μg·cm^-2·h^-1,经离体大鼠皮肤的JS为4.484μg·cm^-2·h^-1。结论开发微乳透皮给药制剂有望提高两性霉素B的疗效,降低其毒副作用。     

银杏内酯B柔性纳米脂质体的制备及体外透皮研究

目的：制备银杏内酯B(GB)柔性纳米脂质体，并对其体外透皮规律进行研究。方法：采用薄膜分散法制备银杏内酯B柔性纳米脂质体，并对其形态及粒径大小进行分析；采用改良的 Franz 扩散池进行体外透皮吸收试验，比较银杏内酯B醇溶液、银杏内酯B柔性纳米脂质体及普通银杏内酯B纳米脂质体的经皮累积渗透量及渗透速率。结果：此方法制得的脂质体平均包封率为(89.52±1.76)%，平均粒径为(208.3±25.49) nm，Zata电位为-49.2 mV。柔性纳米脂质体8 h的累积透过量为189.97 μg·cm^-2，8 h的渗透速率为23.75 μg·cm^-2·h^-1。结论：柔性纳米脂质体包封率较高，稳定性良好，可显著促进银杏内酯B的透皮吸收。     

中药透皮吸收促进剂的研究进展

中药透皮吸收促进剂具有起效快、效果好、副作用小、无污染等优点,总结近年来常用中药透皮吸收促进剂的研究进展,中药透皮吸收促进剂主要包括单一中药透皮吸收促进剂和含中药PE多元透皮吸收促进剂,并对存在的问题及今后的研究前景进行了思考和展望。     

芬太尼透皮贴剂预防脾栓塞后疼痛的临床观察

目的 观察芬太尼透皮贴剂预防脾栓塞术后疼痛的疗效. 方法 29例接受脾栓塞治疗的血液病患者（治疗组）,在术前10～12 h应用芬太尼透皮贴剂5 mg,观察其镇痛效果［采用视觉模拟评分（VAS）评分］及不良反应.同时回顾性分析14例接受脾栓塞治疗而未应用芬太尼透皮贴剂（对照组）的情况.结果 治疗组疼痛完全缓解9例(31.03%),疼痛部分缓解16例(55.17%),疼痛未缓解4例（13.8%）,镇痛满意率86.2%,VAS评分（1.93±1.77）分;对照组VAS评分（6.43±2.90）分,两组间差异有极显著性 (P<0.01).芬太尼透皮贴剂不良反应发生率低,主要有恶心、呕吐、食欲减退、便秘等,1例发生了肠麻痹及腹胀. 结论 芬太尼透皮贴剂预防脾栓塞术后疼痛的效果好,使用方便,不良反应发生率低，建议作为脾栓塞治疗前的常规用药.     

Inhaled fentanyl as a method of analgesia

A study was undertaken to investigate the use of fentanyl by aerosol for postoperative analgesia. Seven patients had placebo, six received fentanyl 100 micrograms and seven were given fentanyl 300 micrograms. A significant improvement in postoperative pain, as assessed by linear visual analogue scale, was achieved in the higher dose group, and in both fentanyl groups the time to alternative analgesia was significantly longer than in the control group. Serum fentanyl levels after inhalation of 100 micrograms reached a plateau around 0.04 ng/ml and after 300 micrograms at around 0.1 ng/ml after 15 minutes. Inhaled fentanyl may have a useful analgesic effect despite these low serum levels; this supports the hypothesis that the mode of analgesia from inhaled opioids may be different from that after other routes of administration. There were no adverse effects such as respiratory depression, bronchospasm, nausea or drowsiness.     

Cerebral blood flow, cerebral metabolic rate of oxygen and relative CO2 reactivity during neurolept anaesthesia in patients subjected to craniotomy for supratentorial cerebral tumours

In 10 patients subjected to craniotomy for supratentorial cerebral tumours in neurolept anaesthesia, cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) were measured twice peroperatively by a modification of the Kety & Schmidt technique, using 133Xe. The relative CO2 reactivity was assessed indirectly as the % change of the arteriovenous oxygen difference (AVDO2) per mm change in PaCO2. The patients were premedicated with diazepam 10-15 mg perorally. For induction, thiopentone 4-6 mg/kg, droperidol 0.2 mg/kg and fentanyl 5 micrograms/kg were used, and for maintenance N2O 67% and fentanyl 4 micrograms/kg/h. During the first flow measurement the median and range of CBF was 30 ml/100 g/min (range 17-45), of AVDO2 8.0 vol % (range 4.1-9.5), and of CMRO2 2.28 ml O2/100 g/min (range 1.57-2.84). During the second CBF study, AVDO2 increased to 9.3 vol % (range 3.4-11) (P less than 0.05), and CMRO2 increased to 2.51 ml O2/100 g/min (range 1.88-3.00) P less than 0.05, while CBF was unchanged. The CO2 reactivity was present in all studies, median 1.8%/mmHg (range 0.5-15.1). The correlation coefficients between jugular venous oxygen tension/saturation, respectively, and CBF were high at tensions/saturations exceeding 4.0 kPa and 55%, indicating that hyperperfusion is easily unveiled by venous samples from the jugular vein during this anaesthesia.     

Mechanisms of tolerance during treatment with nitroglycerin patches for 24 h

Objective: We examined the relationship between tolerance development, counterregulatory responses and arterial vasodilating effects evaluated by digital pulse plethysmography. Methods: Twenty patients with stable angina pectoris were exercise tested before, after 2 and after 24 h of open nitrate patch treatment. Results: The effects observed after 2 h of treatment on exercise duration, ST-segment depression, blood pressure and heart rate were lost in most individuals after 24 h. In contrast, the effects on the arterial pulse curves persisted after 24 h, with a mean change from baseline of 29%, compared to 33% at 2 h. After 24 h, a significant decrease in haematocrit and an increase in body weight were observed. The haematocrit changes correlated with the loss of clinical efficacy (r =0.57 for ST-segment depression, and r =0.54 for exercise duration). Conclusion: Clinical nitrate tolerance may be observed despite maintenance of the arterial vasodilating effects, and tolerance is more related to plasma volume expansion as a counterregulatory mechanism. Received: 28 February 1996/Accepted in revised form: 5 July 1996