鞘内镇痛在顽固性癌痛患者的应用

目的探讨鞘内镇痛用于顽固性癌痛患者的临床效果及安全性。方法晚期顽固性癌痛患者50例采用持续鞘内镇痛,镇痛药物分别为吗啡+布比卡因(A组,25例)和吗啡(B组,25例)。比较治疗前后静息/运动VAS疼痛评分,记录吗啡用量,评估生活质量和不良反应。结果与治疗前相比,两组患者镇痛期间VAS疼痛评分均降低(P<0.05),A组患者的运动VAS疼痛评分较B组更低(P<0.05)。A组每日吗啡用量为(4.17±1.25)mg,少于B组的(8.34±1.48)mg(P<0.05)。A组患者的生活质量总评分为(80.24±6.71)分,高于B组的(67.82±6.03)分(P<0.05)。A组镇痛相关的不良反应发生率低于B组(4.00%vs.20.00%)(P<0.05)。结论与单一吗啡比较,持续鞘内输注吗啡联合布比卡因对顽固性癌痛的镇痛效果较好,能减少吗啡的用量和不良反应。     

肝动脉内栓塞并持续时辰灌注治疗肝转移瘤

目的 探讨肝动脉内栓塞并持续时辰灌注治疗肝转移瘤的临床疗效。方法 38例肝转移瘤根据治疗方式不同分为二组，A组采用肝动脉内栓塞加腹腔干或脾动脉持续时辰灌注5-FU，5-Fu使用时间为连续5天，灌注时间为10PM-10AM，B组单纯行肝动脉内栓塞化疗术。两组治疗间隔时间均为30-40天。结果 A，B两组有效率分别为61．1％和45．0%，A组1年，2年生存率分别为66.7%和27．6%，B组1年，2年生存率分别为35.0和10．0％，两组毒副反应无明显差别。结论 肝动脉内栓塞并持续时辰灌注治疗肝转移瘤可提高生存率而不影响生存质量。     

硫酸吗啡缓释片应用于中孕引产镇痛

本文采用路泰（硫酸吗啡缓释片）应用与中孕引产的妇女,对引产所致疼痛进行镇痛。患者随机分成三组,A组口服硫酸吗啡缓释片10mg,B组口服硫酸吗啡缓释片30mg,C组给于口服安慰剂。结果A、B组获得良好镇痛效果,值得临床推广。     

氟哌啶、胃复安、氯胺酮配伍吗啡用于硬膜外腔术后镇疼作用的比较与麻醉学研究

目的研究分析氟哌啶、胃复安、氯胺酮与吗啡配伍用于硬膜外腔术后镇痛是否可提高镇痛并减少不良反应与临床意义。方法160例腰段硬膜外腔麻醉下行下肢手术的患者,随机分为4组,每组40例。A组为对照组:吗啡2 mg;B组:氟哌啶2.5 mg+吗啡2 mg;C组:胃复安10 mg+吗啡2 mg;D组:氯胺酮30 mg+吗啡2 mg。于术后记录疼痛评分(VAS)及不良反应发生情况。结果①B\C两组镇痛效果与A组无显著差异(P>0.05),D组镇痛效果强于A组(P<0.01)。镇痛时间各组间比较均无显著差异(P>0.05)。②恶心呕吐发生率B、C组明显低于A组(P<0.01)。D组与A组比较无显著差异(P>0.05)。皮肤瘙痒B、C、D组比A组明显减少(P<0.05)。尿潴留B、C组比A组明显减少(P<0.01)。D组与A组比较无显著差异(P>0.05)。结论氟哌啶与胃复安并不增强吗啡的镇痛效果及镇痛时间,但可明显减少吗啡所致恶性呕吐、皮肤瘙痒、尿潴留的发生率。氯胺酮伍用吗啡可提高镇痛效果,镇痛时间无明显延长,氯胺酮可明显减少吗啡所致皮肤瘙痒的发生率,但并不能减少恶心呕吐、尿潴留的发生率。     

盐酸羟考酮与硫酸吗啡直肠给药治疗癌痛的对比研究

目的比较盐酸羟考酮缓释片(商品名：奥施康定,简称羟考酮)和硫酸吗啡缓释片(商品名：美施康定,简称吗啡)治疗晚期恶性肿瘤重度疼痛的疗效及患者不良反应。方法将2011年1月至2014年12月经我院或外院经病理和影像学确诊的、在我院就治的晚期恶性肿瘤患者72例纳入研究,随机分为羟考酮组和吗啡组,每组36例,对两组分别给予羟考酮控释片和吗啡控释片直肠给药治疗癌痛,观察比较两两组的镇痛起效时间、镇痛效果及不良反应。结果吗啡控释片组,平均剂量为每12h 60mg,平均用药时间42.5（7-133）d,27例(75.00%)患者需要增加剂量;羟考酮控释片组首剂为每12h 10mg,平均用药时间32.7(6-77)d,有25例(69.44%)患者需要增加剂量。两组增加剂量者比较无显著差异(χ2=0.28,P＞0.05)。羟考酮组有效率80.55%(29/36),吗啡组有效率75.00%(27/36),两组疼痛控制效果差异无统计学意义(χ2=0.32,P＞0.05)。0.5-1h起效,羟考酮组为50.00%（18/36）,比吗啡组25.00%（9/36）对疼痛控制的起效时间更快(χ2=4.8,P＜0.05)。两组缓解疼痛的起效时间比较差异有统计学意义(χ2=22.916,P＜0.05)。羟考酮组总不良反应发生率为61.11%(22/36),吗啡组为94.44%(34/36),两组间差异有统计
　　学意义(χ2=11.57,P＜0.05)。结论羟考酮和吗啡均可作为中重度癌痛治疗的首选药物,两者疗效相当,但羟考酮作为新型阿片类镇痛药,优势更明显,因此,我们建议,对于癌痛较剧较频的患者可以考虑首选吗啡,如吗啡不良反应较重,可以转用羟考酮。     

舒芬太尼联合罗哌卡因硬膜外麻醉在剖宫产术中的应用价值

目的 探讨不同剂量舒芬太尼联合罗哌卡因硬膜外麻醉用于剖宫产术的效果与不良反应.方法 120例剖宫产产妇随机分为A、B、C组,每组40例,均采用硬膜外麻醉.A组予舒芬太尼10 μg(1 rrl)加0.75％罗哌卡因(12 ml),B组予舒芬太尼20 μg(1 ml)加0.75％罗哌卡因(12 ml),C组给予0.75％罗哌卡因(12 ml)加0.9％氯化钠溶液l ml.观察术中胎儿娩出后Apgar评分,起效时间、无痛平面时间、镇痛持续时间,改良Bromage评分,视觉模拟评分(VAS)以及不良反应.结果 与C组比较,A、B组起效时间、无痛平面时间、感觉阻滞达最高平面时间缩短[起效时间:(6.1±1.7),(5.4±1.5)min比(13.6±1.9)min,无痛平面时间:(8.1±1.8),(7.6±2.1)min比(17.3±2.2) min,感觉阻滞达最高平面时间:(14.3±2.4),(12.8 ±2.7)min比(19.9 ±2.8)min];镇痛持续时间延长[(289±33),(308±34) min比(203±42) min],差异有统计学意义(P＜0.01).3组在切皮时的VAS评分差异无统计学意义(P＞0.05).B组在探查、取胎时的VAS评分明显低于A组、C组[(10±11)比(35 ±25),(18±10)分](P＜0.05或P＜0.01).C组寒颤的发生率与A组、B组比较[22.5％ (9/40)比10.0％ (4/40),2.5％ (1/40)],差异有统计学意义(P＜0.05或P＜0.01),A组和B组比较差异有统计学意义(P＜0.05).结论 罗哌卡因麻醉加入舒芬太尼可增强罗哌卡因麻醉效果,20μg舒芬太尼复合罗哌卡因硬膜外麻醉可减轻探查取胎时内脏牵拉不适症状,减少术中寒颤的发生.     

急诊肝切除术及肝动脉栓塞治疗原发性肝癌自发性破裂的临床疗效观察

目的 比较急诊肝切除、肝动脉插管栓塞(TAE)及两者联合治疗原发性肝癌自发破裂出血的疗效.方法 选取我院2012年3月至2015年3月收治的原发性肝癌自发破裂出血患者105例,并根据患者情况及出血治疗方法的不同分成四组.分别为急诊TAE后择期部分肝切除组(A组)、急诊TAE治疗组(B组)、急诊肝切除治疗组(C组)和保守治疗组(D组),通过比较A、B、C、D四组的止血成功率、并发症发生率、住院病死率和1、3年生存率来比较哪种治疗方式更有利于原发性肝癌自发破裂出血的治疗.结果 相对于D组,A、B、C三组患者的止血成功率为100％,明显高于D组的45％(P＜0.05).三组的住院病死率分别为0％、7.4％和13.0％,明显低于D组55.0％ (P ＜0.01).A组1年生存率为77.1％,3年生存率为54.3％,明显高于B组的48.1％、33.3％和C组的43.4％、34.8％ (P＜0.05).D组没有生存超过1年的患者,与A、B、C三组相比,生存质量明显下降(P＜0.01).结论 无论是TAE还是急诊肝部分切除术,都是治疗原发性肝癌自发性破裂出血的的有效安全方法.对于可切除病例,选择在TAE后择期进行切除手术时治疗效果更好,可作为临床治疗该类疾病的首选治疗方法.     

盐酸美沙酮片与硫酸吗啡缓释片治疗73例晚期癌症患者疗效比较

目的:比较盐酸美沙酮片与硫酸吗啡缓释片在治疗晚期重度癌痛患者的疗效和不良反应。方法:对73例晚期癌症伴重度疼痛患者随机分为2组,其中A组(36例)采用盐酸美沙酮片治疗,B组(37例)采用硫酸吗啡缓释片治疗,观察镇痛效果和不良反应。结果:镇痛效果A组患者总体缓解率为90.3%,B组患者总体缓解率为90.5%(P>0.05);不良反应主要包括恶心呕吐、便秘、头昏、嗜睡,不良反应的严重程度、发生率相似(P>0.05)。结论:盐酸美沙酮片与硫酸吗啡缓释片用于治疗晚期癌症重度癌痛疗效接近。对于吗啡耐受晚期重度癌痛患者,推荐使用盐酸美沙酮片。     

盐酸羟考酮缓释片与硫酸吗啡缓释片治疗中重度癌症疼痛患者的效果比较

目的 探究盐酸羟考酮缓释片与硫酸吗啡缓释片治疗中重度癌症疼痛患者的临床效果。方法 102例中重度癌症疼痛患者为研究对象,随机分为研究组和对照组,每组51例。对照组应用硫酸吗啡缓释片进行镇痛治疗,研究组患者则使用盐酸羟考酮缓释片进行镇痛治疗。对比两组患者的镇痛效果、治疗过程中不良反应发生情况以及镇痛前后生活质量评分。结果 研究组患者镇痛总有效率为98.04%(50/51),显著高于对照组患者的82.35%(42/51)(P<0.05)。研究组患者不良反应发生率9.80%(5/51)显著低于对照组患者的45.10%(23/51)(P<0.05)。镇痛前两组患者生活质量评分组间差异无显著性(P>0.05);镇痛后两组患者生活质量评分较镇痛前明显降低,且研究组患者生活质量评分(12.23±5.13)分低于对照组的(16.59±4.81)分(P<0.05)。结论 对中重度癌症疼痛患者使用盐酸羟考酮缓释片镇痛价值肯定,相较于硫酸吗啡缓释片镇痛效果更好,安全性更高,有助于提高患者的生活质量。     

急性高容量血液稀释并低中心静脉压对肝叶切除患者失血和肝肾功能的影响

目的 观察急性高容量血液稀释(AHHD)联合低中心静脉压(LCVP)应用于肝叶切除术患者的血液保护效果以及对肝肾功能的影响.方法 择期行肝叶切除术的肝癌患者60例,随机分为三组(n=20);对照组(A组)、LCVP组(B组)和LCVP联合AHHD组(C组).三组均采用复合全麻.A组维持正常中心静脉压;B组控制CVP在2～5 cmH2O,切肝后快速扩容使CVP维持在6～ 12 cmH2O;C组麻醉后行(AHHD),使Hct维持在25％～30％,应用LCVP技术,在肝叶切除后10 min输注6％羟乙基淀粉50 mg/kg·h使CVP回复正常水平.测定各时段血红蛋白(Hb)、红细胞压积(Hct)、凝血功能指标(PT)、谷丙转氨酶(ALT)和肾功能尿素氮(BUN)、肌酐Cr)指标,并记录各组输液量、尿量、术中失血、输血情况及术后并发症的发生情况.结果 三组患者肾功能均在正常范围,与B组相比,C组BUN的波动更小(P＜0.05),与A组相比,B组和C组ALT术后七天恢复更好(P＜0.05);与A组(1193.00±443.05)ml比较,B组(875.00±415.01)ml、C组(769.00±405.57) ml失血量显著减少(P＜0.05)、C组少于B组(P＜ 0.05);与A组(642.00±69.10) ml比较,B组(435.50±59.43)ml、C组(491.00±64.70) ml尿量明显减少(P＜0.05),C组尿量较B组增加(P＜0.05).结论 肝叶切除术中AHHD联合LCVP能显著减少术中失血量和异体输血,并且较单纯LCVP有更好的肝肾功能保护,具有良好的安全性.     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.