喉罩在小儿先天性心脏病介入治疗麻醉中的应用

目的探讨喉罩在小儿先天性心脏病介入治疗麻醉中的优越性。方法选择先天性心脏病介入治疗患儿60例,随机分为喉罩组（L组）和气管插管组（T组）,氯胺酮组（K组）,每组20例。分别观察各组在麻醉诱导前、麻醉诱导后及喉罩或导管置入前、置入后、拔除前、拔除后的血氧饱和度（SpO2）、心率（HR）、平均动脉压（MAP）和术后恢复情况。结果 L组置入喉罩后和拔除喉罩后的MAP、HR低于T组（P〈0.05）,术后呼吸系统并发症L组低于T组（P〈0.05）,术中肢动人数K组高于L组及T组。结论喉罩在小儿先天性心脏病介入治疗的麻醉中安全,可行。     

氯胺酮联合异丙酚和瑞芬太尼在小儿静脉全麻中的应用观察

目的探讨氯胺酮联合异丙酚和瑞芬太尼在小儿静脉全麻中应用中的应用效果。方法选择东莞市桥头医院2008年11月至2010年11月静脉全麻下手术治疗患儿80例。随机分为观察组和对照组。两组均给予氯胺酮诱导,术中维持观察组采用异丙酚和瑞芬太尼,对照组采用氯胺酮和异丙酚。观察两组患者在麻醉诱导前和麻醉过程中的平均动脉血压(MBP)、脉搏血氧饱和(SpO2)、心率(HR)的变化情况。记录两组患者术后麻醉恢复情况。结果观察组术中平均动脉压和心率显著低于对照组,差异有统计学意义(P<0.05);观察组睁眼时间、定向力恢复时间和离开手术室时间显著低于对照组,差异有统计学意义(P<0.05)。结论氯胺酮联合异丙酚和瑞芬太尼在小儿静脉全麻中应用效果良好,术中血流动力学变化较小,术后麻醉恢复快。     

丙泊酚及氯胺酮持续泵注静脉麻醉的效果

目的观察丙泊酚复合氯胺酮静脉泵注应用于静脉全麻的效果。方法20例ASAⅠ～Ⅱ级静脉全麻手术患者随机为Ⅰ、Ⅱ组,每组10例。Ⅰ组为丙泊酚及氯胺酮分次静脉注射组,Ⅱ组为丙泊酚及氯胺酮持续静脉泵泵注组。两组术前3min静脉注射丙泊酚0.6mg/kg,氯胺酮1mg/kg。Ⅰ组术中当麻醉转浅时静脉注射丙泊酚(0.6mg/kg)和(或)氯胺酮(1mg/kg);Ⅱ组术中以微泵泵注丙泊酚眼1～3mg/(kg·h)演,氯胺酮眼2～4mg/(kg·h)演。记录麻醉前至手术进行1h每隔5min测得的平均动脉压(MAP)、心率(HR)、呼吸(R)及脉搏氧饱和度(SpO2);整个手术过程中麻醉药用量,术后苏醒时间。结果麻醉期间Ⅰ组MAP、HR、R波动大,Ⅱ组较平稳;Ⅰ组有4例SpO2下降至88%～94%;Ⅱ组所有患者SpO2为98%～100%。Ⅱ组人均氯胺酮及丙泊酚用量明显多于Ⅰ组,两组患者术后苏醒时间无显著性差异。结论氯胺酮及丙泊酚微泵泵注给药麻醉效果好,术中BP、HR和R平稳,安全性好。     

丙泊酚和芬太尼联合阿曲库铵全身麻醉在小儿先天性心脏病介入中的临床研究

目的探讨阿曲库铵全身麻醉联合呼吸机控制通气用于小儿先天性心脏病介入治疗的可行性与安全性。方法ASAⅠ～Ⅱ级先天性心脏病患儿200例介入治疗。随机分为2组,每组100例。观察组静脉注射芬太尼3μg/kg、丙泊酚2mg/kg、阿曲库铵0.3mg/kg麻醉,气管插管呼吸机辅助通气;对照组氯胺酮50μg·kg-1·min-1、丙泊酚50μg·kg-1·min-1持续微量静脉泵注入,保留自主呼吸。比较2组术中屏气呛咳发生率、血氧饱和度（SpO2）〈90%发生率、苏醒时间、最低SpO2。结果观察组术中无屏气呛咳及SpO2〈90%发生,平均苏醒时间（17±4）min,最低SpO2平均（96±3）min;对照组屏气呛咳20例（20.0%）、SpO2〈90%8例（8.0%）、平均苏醒时间（62±22）min、最低SpO2平均（86±8）min,观察组均优于对照组（P〈0.05）。结论阿曲库铵复合全身麻醉配合呼吸机控制通气用于小儿先天性心脏病介入治疗安全可行。     

异丙酚复合氯胺酮恒速静脉注射用于小儿表浅手术麻醉的临床观察

目的对比观察异丙酚复合氯胺酮恒速静脉注射和单用氯胺酮用于小儿麻醉的临床效果和安全性。方法选择小儿表浅手术60例,随机分为A、B两组,每组30例。A组采用异丙酚复合氯胺酮液(100mg异丙酚加100mg氯胺酮)电子微泵恒速静脉注射麻醉,B组采用间断分次静脉注入氯胺酮的方法麻醉。记录两组手术时间、观察术前、切皮时、术中操作、缝合时的心率(HR)、血压(BP)、血氧饱和度(SpO2)的变化、术中不良反应及苏醒时间。结果术中心率、血压的变化B组较A组明显,差异有统计学意义(P<0.05),术后不良反应B组多于A组,差异有统计学意义(P<0.05)。结论异丙酚复合氯胺酮电子微泵恒速静脉注射给药用于小儿麻醉安全有效、苏醒迅速、可控性强、麻醉过程平稳、不良反应少。     

异丙酚与氯胺酮静脉复合麻醉在小儿手术中的应用

目的 对比观察异丙酚复合氯胺酮静脉滴注给药和单用异丙酚静脉给药用于小儿麻醉的临床效果.方法 选择小儿手术麻醉82例,随机分为观察组和对照组,每组4 例.观察组采用异丙酚与氟胺酮复合麻醉,对照组单用异丙酚静脉麻醉.记录两组手术时间、异丙酚的用量,观察术前、切皮时、探查时、缝合时的心率(HR)、平均动脉压(MAP)、血氧饱和度(Sp02)的变化,手术过程中的不良反应及苏醒时间.结果 观察组异丙酚每公斤体重的平均用量明显少于对照组(P＜0.001).观察组的手术时间及苏醒时间均明显短于对照组(P＜0.05或P＜0.001).术中心率、血压和血氧饱和度的变化对照组较观察组明显(P＜0.05或P＜0.001).结论 异丙酚与氯胺酮静脉复合麻醉用于小儿手术安全有效,麻醉过程平衡,优于单用异丙酚静脉给药.     

丙泊酚及氯胺酮持续泵注与间断静注的静脉全麻比较

目的比较丙泊酚复合氯胺酮静脉泵注与间断静注的静脉全麻效果及安全性。方法　20例ASA　I～II级静脉全麻手术患者随机为I、II组,每组10例,I组为丙泊酚及氯胺酮分次静注组,II组为丙泊酚及氯胺酮持续静脉泵注组。两组术前3分钟静注丙珀酚0.6mg/kg,氯胺酮1mg/kg。I组术中当麻醉转浅时静注丙泊酚(0.6mg/kg)和(或)氯胺酮(1mg/kg),Ⅱ组术中以微泵泵注丙泊酚(1～3mg·kg-1·h-1),氯胺酮(2～4mg·kg-1·h-1)。记录麻醉前至手术进行1小时每隔5分钟测得的平均动脉压(MAP)、呼吸(R)及脉搏氧饱和度(SpO);整个手术过程中麻醉药用量。结果2麻醉期间I组MAP、R波动大,Ⅱ组较平稳;I组有4例SpO下降至88%～94%;Ⅱ组所有病人SpO达98%～100%以上,22两组比较差异有显著性。Ⅱ组人均氯胺酮及丙泊酚用量显著多于Ⅰ组。结论　氯胺酮及丙泊酚微泵泵注给药麻醉效果好,术中BP和R平稳,麻醉药用量少,安全性好。     

静脉泵注丙泊酚复合氯胺酮麻醉在小儿斜视手术中的应用

目的观察小儿斜视手术中应用静脉泵注丙泊酚复合氯胺酮麻醉的效果及术后恢复情况,并与单纯氯胺酮麻醉对比。方法选择60例ASAⅠ～Ⅱ级择期手术患儿,随机分为两组：Ⅰ组为单纯氯胺酮麻醉组,Ⅱ组为丙泊酚―氯胺酮复合麻醉组。两组采用不同的麻醉维持方法,Ⅰ组单纯用氯胺酮维持麻醉,Ⅱ组用异丙酚-氯胺酮复合麻醉维持静脉全麻。记录术中血流动力学改变,术后清醒时间及各种不良反应发生率。结果Ⅰ组术中循环波动大,而Ⅱ组血压、心率平稳。麻醉苏醒时间两组间差异无显著意义。Ⅰ组术后1例躁动,1例术后呕吐。结论静脉泵注丙泊酚复合氯胺酮的全身麻醉不延长苏醒时间,术中循环稳定术后恢复好。     

氯胺酮复合异丙酚在小儿麻醉中的临床应用

目的:探讨氯胺酮复合异丙酚应用于小儿麻醉的特点及对呼吸循环的影响.方法:以用氯胺酮复合异丙酚麻醉者为研究组(100 例),术前静注2mg/kg 氯胺酮,术中用异丙酚8～12mg/kg 持续静脉泵注维持至手术结束前10～15min,若术中患儿对手术刺激有反应酌情追加氯胺酮1～2mg/kg,以单纯用氯胺酮者为对照组(100 例),分别观察用药量和作用时间及HR、MBP、SPO2、PETCO2的变化.结果:氯胺酮复合异丙酚组的氯胺酮用量显著少于单纯氯胺酮组,并且手术平稳、恢复快捷、无不良反应发生.结论:氯胺酮复合异丙酚在小儿麻醉中是安全有效的,值得推广应用.     

瑞芬太尼复合氯胺酮用于小儿全凭静脉麻醉

目的:探讨瑞芬太尼复合氯胺酮用于小儿全麻醉的临床疗效.方法:将80例ASAⅠ～Ⅱ级患儿随机分为A、B两组,每组各40例.两组均静脉给予咪唑安定0.02mg/kg,单次推注氯胺酮2mg/kg,A组:氯胺酮95靏/kg/min持续泵注维持;B组:氯胺酮60靏/kg/min配合瑞芬太尼0.06靏/kg/min持续泵注.术中监测患儿血压、心率,及SPO2,并记录术后苏醒时间.结果:A、B两组患儿血压和SPO2均较平稳,但B组心率较术前明显减慢(p＜0.05),而A组心率较术前明显增快(p＜0.05),B组术后麻醉苏醒明显快于A组(p＜0.05),且术中氯胺酮用量明显少于A组(p＜0.05).结论:瑞芬太尼复合氯胺酮用于小儿全麻醉既满足手术需要,又减少各自用药量,降低并发症发生率,使患儿麻醉苏醒时间明显缩短,麻醉更平稳.     

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.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

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.