电视胸腔镜下肺叶切除的麻醉管理

目的 总结电视胸腔镜下肺叶切除术的麻醉管理体会.方法 接受电视胸腔镜下肺手术患者20例.病变包括支气管扩张4例、肺大泡3例和肺肿瘤13例.采用支气管内插管静-吸复合全身麻醉.插入Robertshaw双腔支气管导管(F35-39);其中,左侧双腔管13例,右侧7例.结果 单肺通气时间1.5-2h.术中BP、HR均维持在术前基础值的20％以内.SpO2双肺通气期间维持在69％,单肺维持在94％以上.结论 电视胸腔镜手术具有创伤小、对机体内环境干扰轻、手术时间短、术后恢复快、住院时间短和节省医疗费用等优点.其麻醉管理的难度在于单肺通气时维持良好的氧合.需要确保双腔支气管插管定位准确、单肺通气充分,并加强生命指征监测.     

35例胸腔镜手术麻醉处理的体会

目的总结胸腔镜手术的麻醉处理要点及并发症的防治经验。方法对35例胸腔镜手术患者均采用快诱导双腔支气管插管静吸复合全麻。连续监测MV、TV、RR、Paw、SpO2、PETCO2、FiO2及吸入麻醉药浓度,并应用无创连续监测SBP、DBP、MAP、HR,用EJS-Ⅱ型肌肉松弛监测仪监测肌松情况。结果全组麻醉效果满意,发生2例与麻醉有关的并发症,无手术及围麻醉期死亡病例。结论胸腔镜手术的麻醉处理关键是双腔管插管位置准确,加强呼吸管理,避免低氧血症。     

胸腔镜肺大泡手术麻醉中双腔支气管插管的临床应用分析

目的分析胸腔镜肺大泡手术麻醉中双腔支气管插管的临床应用效果。方法选取我院2013年1月至2013年12月收治的81例行胸腔镜肺大泡手术患者,患者手术麻醉时,均采用双腔支气管插管,分析临床应用效果。结果 81例患者通过双腔支气管插管,麻醉效果良好,插管成功率为100%,未出现重插。2例患者出现低氧血症,SpO2降低到80%;通过对症处理,低氧血症得到明显改善,SpO2提升。结论在胸腔镜肺大泡手术中采用双腔支气管插管效果显著,显著提高手术麻醉质量,降低并发症的发生,值得推广使用。     

胸腔镜手术中麻醉的呼吸管理

目的总结和探讨电视胸腔镜(video-assistcd thoracic surgery，VATS)手术的麻醉方法。方法全组患者均静脉快速诱导插入双腔支气管导管，间歇正压通气(IPPV)。用芬太尼、力蒙欣、阿曲库铵或维库溴铵加吸入异氟醚维持麻醉。单肺通气时(Olv)时，采用IPPV加呼气末正压呼吸(PEEP)通气，并调整通气参数。全程监测SpO2、ECG、BP、P、中心静脉压、呼气末二氧化碳分压、尿量及吸入麻醉药浓度。结果全组病例双腔支气管插管初始到位良好，改变体位后调整率为40％。38例患者术中36例肺萎陷满意，手术野显露良好。2例经患侧负压吸引后达到萎陷满意，患者SpO2维持在95％以上，无麻醉手术死亡。术中改小切口开胸手术5例．气胸复发1例，复胀性肺水肿1例。结论电视胸睦镜手术的麻醉关键是双腔气管导管插管要到位．双肺分隔要确切，患侧肺萎陷要满意。单肺通气时通气模式为IPPV加PEEP，并及时调整通气参数是安全有效的麻醉方法。     

肺癌患者不同手术方式围术期与麻醉相关配合136例报道

目的探讨肺癌患者不同手术方式围术期与麻醉相关配合。方法回顾性分析136例早期肺癌患者的手术实践以及麻醉管理。按手术方式分为传统开胸手术组(52例)和胸腔镜手术组(84例)(传统三孔式胸腔镜肺叶切除术50例、单操作孔胸腔镜肺叶切除术26例、单孔胸腔镜肺叶切除术8例)。麻醉插管采用静脉复合全身麻醉双腔支气管导管法或支气管封堵器法,术中单肺通气,监测Sp O2,ECG,BP,Peak,PETCO2,尿量及吸入麻醉药浓度。全组手术均行肺叶切除加纵隔淋巴结清扫。结果全组患者无1例围术期死亡。术中单肺通气效果均较满意,双腔支气管插管法115例,其中4例因困难气道使用纤维支气管镜辅助定位下插管;支气管封堵器法插管21例。全组手术时间及淋巴结清扫数量相当,胸腔镜手术组与传统开胸手术组分别有5例、3例术中出现低氧血症,单操作孔胸腔镜手术有1例因术中出血而中转开胸。术后患者拔管顺利,恢复良好。结论肺癌手术中术者与麻醉师应当密切配合,不同手术方式采用不同处理方法。     

电视胸腔镜二尖瓣置换术93例麻醉体会

目的 探讨电视胸腔镜手术的麻醉处理要点.方法 回顾性分析93例电视胸腔镜二尖瓣置换术患者的临床资料,麻醉均采用左侧双腔支气管插管行左肺单肺通气.结果 手术顺利,无麻醉及手术死亡,无复张性肺水肿及肺不张.结论 二尖瓣病变患者在电视胸腔镜行二尖瓣置换术,麻醉管理要点为术前充分准备,术中保持良好的双肺隔离,心脏复跳后使用血管活性药物,加强手术期间的呼吸和循环监测.     

胸腔镜下肺大泡切除术的麻醉体会

目的探讨电视胸腔镜手术的麻醉处理要点。方法回顾分析16例胸腔镜下肺大泡切除术患者的临床资料,麻醉采用双腔支气管插管行单肺通气。结果无麻醉及手术死亡,无复张性肺水肿及肺不张。结论肺大泡患者在胸腔镜下行切除术。麻醉管理要点为术前充分准备,术中保持良好的双肺隔离,加强手术期间的呼吸和循环监测。     

Coopdech支气管阻塞导管在胸腔镜单肺通气手术中的应用

目的 观察Coopdech支气管阻塞导管用于胸腔镜手术实现单肺通气的效果.方法 选择单肺通气行胸腔镜手术患者50例,完全随机分为双腔支气管导管组(A组)和支气管阻塞导管组(B组)各25例.B组经单腔气管导管插入Coopdech支气管阻塞导管实现单肺通气,A组通过插入双腔支气管导管实现单肺通气.记录指标:①单肺通气前、单肺通气后30 min、60 min的PaO2、PaCO2、pH、呼气末二氧化碳分压(PETCO2)、气道峰压(PAW)、脉搏血氧饱和度(SpO2);②插管和定位时间;③单肺通气时肺萎陷质量和外科暴露程度;④术后声音嘶哑和咽喉痛发生情况.结果 ①2组PaO2、PaCO2、pH、PET CO2、SpO2差异无统计学意义(P＞0.05),单肺通气后30 min、60 min的PAW A组分别为(22.1±2.0)cm H2O(1 cm H2O =0.098 kPa)、(21.7±1.8)cm H2O,明显高于B组(18.1±2.1)cm H2O、(18.2 ±2.1)cm H2O(P ＜0.05);②A组的插管和定位时间分别为(2.8±0.7)min、(4.2±1.6) min,较B组[(1.0±0.3)min、(1.1 ±0.2)min]明显长(P＜0.05);③单肺通气肺萎陷质量和外科术野暴露程度在2组间差异无统计学意义(P＞0.05);④A组术后声音嘶哑和咽喉痛发生率分别为44.0％ (11/25)、48.0％(12/25),较B组[16.0％(4/25)、24.0％( 6/25)]明显升高(P＜0.05).结论 双腔支气管和Coopdech支气管阻塞导管在胸腔镜手术单肺通气的应用均安全、有效,应用支气管阻塞导管插管和定位方便快捷,可降低患者术后声音嘶哑及咽喉疼痛的发生率,在适应证范围内的胸腔镜手术中可以优先选用Coopdech支气管阻塞导管.     

完全胸腔镜下心脏手术的麻醉管理

目的 总结和探讨完全胸腔镜下心脏手术的麻醉管理方法及特点.方法 完全胸腔镜下心脏手术4例,采用单腔气管导管插管全麻,术中配合手术操作随时调整呼吸参数或改为手控呼吸,密切观察脉搏血氧饱和度(SpO2)和呼气末二氧化碳分压(PETO2)的变化.结果 麻醉效果基本满意,有2例出现SpO2下降至94％,PFTCO2分别上升至52-55mmHg(1 mmHg=0.133 kPa),经加强通气后均于5 min内恢复正常 结论 完全胸腔镜下心脏手术的麻醉管理要求麻醉医生熟悉胸腔镜下心脏手术的特点与步骤,术中注重呼吸管理与呼吸配合.     

胸腔镜下交感神经链切除术治疗手汗症的麻醉处理

目的分析手汗症患者胸腔镜下双侧胸交感神经链切断术的麻醉处理,总结其特殊性。方法对手汗症患者胸腔镜下双侧胸交感神经链切断术73例采用全凭静脉麻醉,术中以丙泊酚、瑞芬太尼维持麻醉深度。分别采用单腔及双腔支气管导管插管,行血流动力学及呼吸监测。结果手术时间45～60min,术中SPO2保持在98%以上。单腔及双腔导管插管支气管均能保证术中血流动力学稳定。结论单腔管插管全凭静脉麻醉可安全有效地用于胸腔镜下双侧胸交感神经链切断术。     

Allosteric interaction of zinc with recombinant alpha(1)beta(2)gamma(2) and alpha(1)beta(2) GABA(A) receptors

In a recent study we have provided evidence that inhibition of native GABA(A) receptors by zinc depends primarily on the allosteric modulation of receptor gating. Both the kinetics and the sensitivity of the GABA(A) receptor to zinc depend on subunit composition, especially on the presence of the gamma(2) subunit. To analyze the mechanism of action of zinc its effects have been tested on recombinant alpha(1)beta(2)gamma(2) and alpha(1)beta(2) receptors expressed in HEK 293 cells. The currents produced by ultrafast application of GABA have been measured to assess the impact of zinc ions on GABA(A) receptor gating with resolution corresponding to the time scale of synaptic currents. While, as expected, zinc markedly reduced the peak amplitude of alpha(1)beta(2)-mediated currents, its effect on kinetics was significantly different from that observed for alpha(1)beta(2)gamma(2). In particular, unlike alpha(1)beta(2)gamma(2), zinc did not affect the onset of alpha(1)beta(2)-mediated responses. Moreover, zinc increased the extent of desensitisation of alpha(1)beta(2)gamma(2) receptors and reduced desensitisation of alpha(1)beta(2) ones. Quantitative analysis suggests that zinc exerts an allosteric modulation on both alpha(1)beta(2)gamma(2) and alpha(1)beta(2) receptors. Zinc effects on alpha(1)beta(2)gamma(2) were qualitatively similar to those reported for native receptors.     

(S)-(-)-氨磺必利-D-(-)-酒石酸盐的合成

目的研究（S）-（-）-氨磺必利-D-（-）-酒石酸盐的制备方法。方法以4-氨基-2-甲氧基-5-巯基苯甲酸为原料,经乙基化、氧化得4-氨基-2-甲氧基-5-乙基磺酰基苯甲酸（4）,另由1-乙基-2-氨甲基吡咯烷经D-（-）-酒石酸拆分得S-（-）-1-乙基-2-氨甲基吡咯烷（6）,4与6缩合制得S-（-）-氨磺必利（7）,再与D-（-）-酒石酸成盐制得目标物S-（-）-氨磺必利-D-（-）-酒石酸盐（1）。总收率达25%（以4-氨基-2-甲氧基-5-巯基苯甲酸计算）。结果所得产物经元素分析,红外光谱、核磁共振谱及质谱确证了结构。结论本方法原料易得,反应条件温和,产品质量易控制。     

alpha-glucosidase (CHO) (Genzyme)

Genzyme General is developing recombinant human alpha-glucosidase, produced in mammalian cell culture, as a potential treatment for Pompe disease. By July 2004, enrollment was completed in two clinical trials and an observational study in adults. Genzyme was planning to file for regulatory approval in Europe during 2004, followed by filings in the US and Japan in mid-2005.     

Developmental toxicity of di-(C(7)-C(9) alkyl) phthalate and di-(C(9)-C(11) alkyl) phthalate in the rat

Two phthalate esters, di-(C(7)-C(9) alkyl) phthalate (D79P) and di-(C(9)-C(11) alkyl) phthalate (D911P), have been assessed for their potential to cause developmental toxicity in the rat. Groups of 22 timed-mated Sprague-Dawley rats were administered 250, 500, or 1000 mg/kg D79P or D911P daily by oral gavage (5 ml/kg) between gestation days (GD) 1 and 19. Control animals received the vehicle (olive oil) alone. On GD20, the animals were sacrificed and the fetuses examined. Treatment resulted in no signs of maternal toxicity, as assessed by adjusted maternal bodyweight gain throughout gestation and clinical examinations, and no effects upon litter size, fetal survival or bodyweight. Pups of the high dose D79P and intermediate and high dose D911P groups showed increased incidences of supernumerary lumbar ribs. There was a significant increase in dilated renal pelves in pups of the low dose D79P and high dose D911P groups, but only for D911P was there a significant trend. Consequently, the no observed adverse effect level (NOAEL) for maternal toxicity for both D79P and D911P is 1000 mg/kg/day. The NOAEL values for developmental toxicity are 500 mg/kg/day D79P and 250 mg/kg/day D911P.     

(S)-oxybutynin (Sepracor)

Sepracor is developing (S)-oxybutynin, a single-isomer version of Alza's Ditropan (racemic oxybutynin), a muscarinic acetylcholine receptor antagonist, as a potential treatment for urinary incontinence.     

Psychopharmacological profile of 1-(m-(trifluoromethyl) phenyl) piperazine (TFMPP)

The effect of TFMPP, an agonist of the 5-HT1b receptors, was studied in mice on several psychopharmacological parameters. In contrast to imipramine-like drugs, TFMPP neither antagonized reserpine-induced hypothermia nor increased yohimbine-induced toxicity. Similarly to imipramine-like drugs, TFMPP antagonized oxotremorine-induced hypothermia and was active in the behavioural despair test. In addition, TFMPP normalized a social behavioural deficit induced by isolation. The effects of TFMPP on oxotremorine-induced hypothermia in the behavioural despair test and in the isolation-induced social behavioural deficit are all antagonized by d-1 propranolol. It is concluded that TFMPP seems to possess psychotropic activity resembling only in part that of imipramine-like drugs and that these actions may be mediated through 5-HT1b receptors.     

Two-generation reproduction toxicity studies of di-(C(7)-C(9) alkyl) phthalate and di-(C(9)-C(11) alkyl) phthalate in the rat

Di-(C(7)-C(9) alkyl) phthalate (D79P) and di-(C(9)-C(11) alkyl) phthalate (D911P), based on high-normality linear oxo-alcohols, have been assessed for their impact upon reproductive performance in Sprague-Dawley rats. Rats were continuously exposed to either D79P or D911P at dietary levels of 0%, 0.1%, 0.5%, or 1.0% over two generations. Selected F(0) offspring (F(1) generation) were exposed to the same dietary concentration of D79P or D911P as the respective F(0) animals, and were mated to produce F(1) offspring. Both D79P and D911P markedly reduced body weight gain in F(0) and F(1) adult males at the highest dose, but females were affected to a lesser extent. There was no impairment of fertility, fecundity, or development in either generation, but body weights of offspring in the 1.0% D79P and 1.0% D911P groups were slightly and transiently reduced over the weaning period. Although decreases in the weight of several organs were accounted for by depressed body weight, ovary weights were reduced in both generations exposed to 1.0% D79P, and epididymidal weights were slightly reduced in adults of both generations exposed to 1.0% D911P. However, ovarian function-assessed by the oestrus cycle and mating behaviour-and epididymidal sperm concentration, motility, and morphology were unaffected by either substance. Treatment resulted in liver changes, particularly in males, characterised by increased liver weight in young animals, histopathologic changes and reduced organ weight in mature animals, and an increase in palmitoyl CoA oxidase activity. In conclusion, neither D79P nor D911P impaired reproductive function in rats when administered in the diet at levels that induce systemic toxicity, and the NOAEL for effects on reproduction in the rat is 0.5% for both D79P and D911P.     

（S）—（＋）—2—氨基丙醇制备新工艺

(S) - ( ) - 2 -氨基丙醇 ( 1 )是合成左氧氟沙星的重要中间体 [1] ,随着左氧氟沙星作为国家基本药物在国内上市 ,开发适合我国国情的制备 1的简便新工艺显得很有必要。文献报道 [2 ,3 ] ,采用 Li Al H4 还原 L-丙氨酸 ( 2 )可以制得 1 ,该法的优点是反应过程简单 ,缺点是Li Al H4 价格昂贵 ,并且比较危险 ,同时后处理也比较复杂。另有文献报道 [4 ] ,先将 2酯化 ,然后采用较为便宜的 KBH4 还原制备 1 ,该法收率太低而不能用于工业化。为了提高收率 ,降低成本 ,我们对后一条合成路线进行了工艺研究 ,在将 2酯化得 L-丙氨酸乙酯 ( 3)…