腰-硬膜外麻醉与硬膜外麻醉在剖宫产术中的应用

目的：探讨腰麻-硬膜外麻醉（CSEA）与硬膜外麻醉（EA）应用于剖宫产术的临床效果。方法：将80例足月妊娠产妇,随机分为两组,每组40例,实验组采用腰一硬膜外麻醉,对照组采用硬膜外麻醉。结果：两组麻醉效果比较,P〈0．05,差异有统计学意义;两组患者HR、BP比较,P〈0．05,差异有统计学意义;新生儿Apgar评分差异无统计学意义（P〉0．05）。结论：CSEA在剖宫产术中应用效果优于EA。     

腰麻-硬膜外联合麻醉用于急诊剖宫产术的效果观察

目的探讨腰麻-硬膜外联合麻醉应用于急诊剖宫产术的安全性及临床效果观察。方法对50例需急诊剖宫产无妊娠合并症的产妇随机分组施行腰麻-硬膜外联合麻醉和硬膜外麻,每组25例,监测并记录BP、SpO2、EKG、HR,麻醉起效时间,麻醉阻滞效果,脊神经阻滞上界平面时间,新生儿Apgar评分及不良反应。结果腰麻-硬膜外联合麻醉起效时间和脊神经阻滞上界平面时间与硬膜外组比较,腰麻-硬膜外联合组时间短于连续硬膜外麻醉组（P〈0．01）,腰麻．硬膜外联合组麻醉阻滞效果优于连续硬膜外麻醉组,2组新生儿评分及不良反应差异无显著性（P〉0．05）。结论腰麻．硬膜外联合综合腰麻和硬膜外麻的优点,具有诱导快、阻滞完善、对循环呼吸干扰少、母婴安全的优点,用于急诊剖宫产麻醉是安全可行的。     

腰麻联合硬膜外麻醉应用于剖宫产术疗效观察

目的探讨腰麻联合硬膜外麻醉用于剖宫产术的临床麻醉效果。方法随机选择2011年1月—2012年12汉中市中医医院收治的120例需要剖宫产的孕妇，按麻醉方式随机均分为观察组和对照组各60例。对照组给予硬膜外麻醉（CEA）；观察组给予腰麻联合硬膜外麻醉（CSEA），观察两组患者的麻醉时效、不良反情况、母婴健康状况等。结果观察组的时效、术中出血量、Bromage评分以及药物用量情况显著优于对照组（P〈0．05）；MAP及Apgar评分差异比较不显著（P〉0．05），观察组的不良反应率为5％，对照组为13．33％，两组的差异比较显著（P〈0．05）。结论CSEA具备用药少、起效快、麻醉效果优、对母婴的不良影响小等优势，可作为急诊剖宫产手术的首选麻醉办法。     

腰麻-硬膜外联合麻醉在剖宫产术中的临床应用

目的 观察腰麻-硬膜外联合麻醉（CSEA）在子宫下段剖宫产术中应用的临床效果.方法 选择ASA Ⅰ～Ⅱ 级子宫下段剖宫产产妇620例,随机分成腰麻-硬膜外联合麻醉（CSEA）和单纯硬膜外麻醉（EA）两组,每组310例.观察两组产妇的麻醉阻滞效果、血流动力学指标变化、新生儿Apgar评分及麻醉并发症.结果 腰麻-硬膜外联合麻醉（CSEA）组麻醉起效时间、麻醉至胎儿娩出时间和手术时间均短于单纯硬膜外麻醉（EA）组（P＜0.05）,麻醉效果明显好于单纯硬膜外麻醉组（P＜0.05）,但低血压发生率较单纯硬膜外麻醉组高（P＜0.05）.两组新生儿Apgr评分差异无统计学意义（P＞0.05）.结论 腰麻-硬膜外联合麻醉具有起效快、镇痛完全、肌松满意等优点,是一种安全有效的麻醉方法,值得临床推广应用,可作为子宫下段剖宫产术的首选麻醉方法.     

腰麻-硬膜外联合麻醉在剖宫产术中的应用

目的观察比较腰麻一硬膜外联合麻醉与单纯硬膜外麻醉在剖宫产手术麻醉效果的优劣。方法选择单胎孕足月产妇80例,ASAI～Ⅱ级,随机分为2组,每组40例。I组采用腰麻联合硬膜外麻醉（CSEA组）,Ⅱ组采用单纯硬膜外麻醉（EA组）。比较2组产妇的麻醉起效时间、麻醉作用、完全时间、麻醉至胎儿娩出时间、新生儿评分、麻醉效果及围手术期不良反应发生情况。结果腰硬联合麻醉组麻醉起效时间、麻醉作用完全时间、麻醉至胎儿娩出时间均短于单纯硬膜外麻醉组（P〈0．05）,麻醉效果明显优于单纯硬膜外麻醉组（P〈0．05）,但低血压发生率较单纯硬膜外麻醉组高（P〈0．05）。结论腰麻联合硬膜外麻醉因其起效迅速,阻滞完善,在急诊剖宫产手术中比硬膜外麻醉更为优越,但血压下降明显,要提前扩容,加强术中管理。     

硬膜外腔注射生理盐水在剖宫产麻醉中的应用

目的研究硬膜外腔注射生理盐水对剖宫产患者行腰麻一硬膜外联合麻醉（CSEA）的影响，并探讨其临床应用价值。方法60例ASA Ⅰ～Ⅱ级急诊剖宫产患者，均分为生理盐水观察组和对照组，实施针套针法CSEA，待注入腰麻药后分别经硬膜外穿刺针向硬膜外腔注射10ml生理盐水或未用药直接置入导管，观测并记录感觉阻滞起效时间、最高阻滞平面、最高阻滞平面的出现时间、最大运动阻滞程度、最大运动阻滞出现时间、感觉阻滞持续时间及运动阻滞持续时间。结果两组患者的感觉阻滞起效时间、最高阻滞平面的出现时间、最大运动阻滞程度及最大运动阻滞出现时间无显著性差异（P〉0．05）；观察组最高阻滞平面比对照组升高1．5～2．0个节段（P〈0．05）；观察组感觉阻滞持续时间小于对照组，但无显著性差异（P〉0．05）；观察组运动阻滞持续时间小于对照组，且有显著性差异（P〈0．05）。结论硬膜外腔注射10ml生理盐水不影响剖宫产患者CSEA腰麻的感觉和运动阻滞的起效时间和效果，但可扩展腰麻平面，且能缩短感觉及运动阻滞的持续时间。     

腰麻一硬膜外联合阻滞和硬膜外麻醉在剖宫产术中的效果观察

目的观察腰麻一硬膜外联合阻滞（CSEA）和硬膜外麻醉（EA）在剖宫产术中的临床效果,探讨CSEA在剖宫产术中的可行性。方法选择ASAI-Ⅱ级足月剖宫产产妇90例,随机分成A组（CSEA组）45例和B组（EA组）45例,记录两组椎管内麻醉阻滞情况、术中呼吸循环功能、麻醉效果及不良反应情况。结果两组SBP、DBP、HR麻醉后均有一过性降低,正确处理后呼吸循环功能趋向稳定,不良反应、新生儿Apgar评分差异无统计学意义（P〉0．05）,A组的麻醉效果明显优于B组（P〈0．05）。结论剖宫产手术使用CSEA麻醉效果确切,肌松良好．起效时间快,并发症少．手术的可行性、舒适性明显优于EA法。     

腰硬联合阻滞麻醉在基层医院急诊剖宫产的应用价值

目的探讨腰硬联合阻滞麻醉在急诊剖宫产中的应用价值及安全性。方法选择60例急诊剖宫产ASA分级为Ⅰ~Ⅱ级单胎足月妊娠产妇,随机分为CSEA组(n=30)采用腰硬联合阻滞麻醉和EA组(n=30)采用连续硬膜外阻滞麻醉。比较两组术中血流动力学参数、麻醉起效时间、阻滞完善时间、麻醉效果、新生儿娩出Apgar评分、麻醉合并症及副反应。结果两组血流动力学组间和组内比较差异无统计学意义(P>0.05);CSEA组的起效时间、阻滞完善时间明显比EA组短(P<0.05);CSEA组麻醉效果明显优于EA组(P<0.01);两组新生儿Apgar评分比较差异无统计学意义(P>0.05);两组间合并症及副反应发生率差异无统计学意义(P>0.05)。结论 CSEA起效快,麻醉效果确切,肌肉松驰好,副反应发生率低,是基层医院急诊剖宫产手术理想和安全的麻醉方法。     

腰-硬联合麻醉在剖宫产术中的临床应用分析

目的比较分析硬膜外麻醉(EA)与腰-硬联合麻醉(CSEA)下行剖宫产手术的临床麻醉效果,探讨剖宫产手术理想的麻醉方法。方法 ASAI-II级100例剖宫产,随机分为腰麻-硬膜外联合麻醉(CSEA组),单纯硬膜外麻醉(EA组)各50例,观察麻醉效果,记录麻醉起效时间、手术时间、麻醉至胎儿娩出时间、最大运动阻滞程度,并记录新生儿娩出1～5min的Apgar评分。结果 CSEA组麻醉起效时间、手术时间、麻醉至胎儿娩出时间均短于EA组(P<0.05),而Bromage评分高于EA组(P<0.05)。两组间Apgar评分比较差异无统计学意义(P>0.05)。CSEA组有3例心动过缓,均有不同程度血压下降。结论 CSEA相对于EA具有用药量少、起效快、成功率高且损伤小等特点,缩短了娩出胎儿的时间,是剖宫产手术的一种较理想的麻醉方法。     

妊娠高血压综合征患者手术时的麻醉处理

目的观察腰硬联合麻醉（CSEA）应用于妊高征产妇剖宫产术的安全性及临床效果。方法对109例妊高征剖宫产产妇随机分为腰硬联合麻醉组（CSEA组）57例和硬膜外麻醉组（EA组）52例。比较两组麻醉起效时间、麻醉阻滞效果、新生儿Apgar评分及不良反应。结果 2组麻醉起效时间、达最高阻滞平面时间及切皮至胎儿娩出时间分别比较,差异均有统计学意义（P均〈0.05）;2组麻醉效果的优良率比较,差异有统计学意义（P〈0.05）;两组新生儿1min和5min Apgar评分差异均无统计学意义（P均〉0.05）;2组患者不良反应发生率差异无统计学意义（P〉0.05）。结论 CSEA具有用药量少、起效快、镇痛完全、阻滞完善、肌松满意、对循环、呼吸干扰小、并发症少、不受时间限制及对母婴安全等优点,用于妊高征产妇剖宫产术安全可行。     

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.