急性左心衰竭患者应用双水平正压通气呼吸机辅助通气后的临床疗效分析

目的分析急性左心衰竭患者应用双水平正压通气呼吸机辅助通气后的临床疗效。方法从本院2017年1至2018年11月接受的急性左心衰竭患者中,抽取58例,随机将其分为对照组与观察组,均29例,对照组采用常规综合处理方案进行治疗,观察组在此基础上应用双水平正压通气呼吸机辅助治疗,观察两组患者血气指标。结果观察组标氧分压(PaO_2)、二氧化碳分压(PaCO_2)、心率(HR)、呼吸频率(RR)等各项指标均显著由于对照组(P <0.05)。结论对急性左心衰竭患者应用双水平正压通气呼吸机辅助通气治疗能够有效改善患者血气指标,促进其康复。     

无创正压机械通气治疗急性重度左心衰竭的临床价值

摘要 目的：探讨双水平式呼吸道正压无创通气治疗急性重度左心力衰竭的可行性。方法：急性重度左心衰竭42例,在常规抗心力衰竭药物治疗的基础上。随机分成两组：BiPAP无创通气组、有创通气组,分别应用双水平式呼吸道正压无创呼吸机和有创呼吸机治疗,比较每组治疗前后、两组之间血压、心率、动脉血气变化和临床疗效。结果： BiPAP无创通气组和有创通气组治疗后心率、动脉血气均较治疗前好转,两组之间血压、心率、动脉血气变化和临床疗效在治疗前和治疗后差异无统计学意义(P>0．05)。结论：及早使用双水平式呼吸道正压通气结合抗心力衰竭药治疗急性重度左心衰竭,能及时有效地改善病人症状及低氧血症,对心功能改善有明显疗效。     

呼吸机正压通气治疗在急性心肌梗死并左心衰竭中的应用价值

目的 探讨呼吸机无创正压通气在老年人急性心肌梗死并左心衰竭中的临床应用价值.方法 将70例急性心肌梗死并左心衰竭患者随机数字表法分为观察组和对照组,对照组患者接受常规治疗,观察组患者在其基础上应用无创正压通气,比较两组患者治疗后相关指标及两组患者转为气管插管比例、病死率和住院时间.结果 与对照组比较,观察组患者二氧化碳分压(PaCO2)、呼吸频率(RR)、心率(HR)及收缩压(SBP)改善更显著,氧分压(PaO2)及氧饱和度(SaO2)升高更显著(t=4.2588、5.144、7.127、4.2814、6.4719、6.2629,均P＜0.05)；观察组患者心搏量(SV)、射血分数(EF)升高更显著,中心静脉压(CVP)降低更显著(t=12.0527、14.0937、14.6425,P＜0.05)；观察组患者转为气管插管及死亡比例均显著低于对照组,平均住院时间显著短于对照组(x2 =4.6289、4.2000,t=6.3892,均P＜0.05).结论 在急性心肌梗死并左心衰竭的治疗中,无创正压通气能够明显改善患者心脏功能、肺通气及换气功能,提高治疗效果.     

无创机械通气治疗急性心肌梗死并发急性左心衰竭20例治疗体会

目的：观察无创机械通气治疗急性心肌梗死合并急性左心衰竭的疗效。方法：将40例急性心肌梗死合并急性左心衰竭患者分为治疗组20例、对照组20例,两组均常规抗心力衰竭治疗,但治疗组同时应用无创机械通气治疗,观察两组治疗前后PaO2、SaO2、心率、呼吸频率、肺部哕音及临床症状变化情况并进行分析。结果：治疗组呼吸困难明显改善,总有效率95％,对照组呼吸困难改善者75％,治疗组优于对照组,差异有统计学意义,P〈0．05。结论：无创机械通气治疗急性心肌梗死合并急性左心衰竭时,效果显著。     

无创呼吸机在急性左心衰竭治疗中的应用分析

目的 观察无创呼吸机在急性左心衰竭中的应用效果.方法 将47例急性左心衰竭患者随机分为治疗组及对照组.治疗组在常规治疗同时接受双水平无创正压通气辅助呼吸,观察治疗前、后1 h的临床症状、动脉血气分析参数、血压、心率、呼吸频率,并与对照组进行比较.结果 治疗组治疗后1 h的RR、HR、PaO2、SaO2均较对照组明显改善（P 〈 0.05）,治疗组有效率高于对照组（P 〈 0.05）.结论 在急性左心衰竭患者中早期使用无创正压通气可快速减轻临床症状,是一种有效的辅助治疗方法.     

正压机械通气模式在急性左心衰抢救中的应用分析

目的探讨不同机械通气模式在抢救急性左心衰竭病人的临床疗效。方法将87例急性左心衰竭伴意识障碍病人分为三组，对照组应用常规治疗，治疗组I常规治疗基础上加用气管插管接呼吸机CPAP（持续正压通气continued positive air—pressure），治疗组Ⅱ常规治疗基础上加用气管插管接呼吸机SIMV＋PEEP模式通气。观察各组治疗2小时后心率、血压、动脉血气分析等指标和临床表现的变化。结果与对照组比较，其它两组pH值、PaO2、PaO2／FiO2均明显改善（P〈0．05），而心率、血压和PaCO2却无明显变化（均P〉0．05）。治疗组Ⅱ对PaO2／FiO2的改善较治疗组Ⅰ显著（P〈0．05），Ⅰ组和Ⅱ组临床表现有效率分别为86．2％和96．5％（P〈0．05）。结论根据病情选择合适的正压机械通气方式抢救急性左心衰疗效显著，值得推广。     

无创双水平正压通气治疗慢性阻塞性肺疾病合并急性左心衰的疗效观察

目的观察无创双水平气道正压通气治疗慢性阻塞性肺疾病（COPD）合并急性左心衰竭的疗效。方法将40例COPD合并急性左心衰竭患者随机分为两组：对照组用常规治疗；治疗组在常规治疗同时加用无创双水平气道正压通气。观察治疗前后动脉血气分析、左心室射血分数（LVEF）变化及患者的临床变化。结果治疗组经无创双水平气道正压通气后患者呼吸频率减慢，心率下降，呼吸困难缓解，LVEF增加，总有效率90％；对照组总有效率仅55％，两组比较差异有统计学意义（P〈0．05）。结论无创双水平气道正压通气是治疗COPD合并急性左心衰竭快速有效的方法。     

无创正压通气在急性左心衰竭治疗中的应用研究

目的 探讨无创正压通气在急性左心衰竭治疗中的应用价值.方法 46例急性左心衰竭患者随机分为治疗组和对照组各23例,两组均给予常规抗心衰药物治疗,对照组给予鼻面罩吸氧,治疗组应用BiPAP无创通气治疗,对比两组的疗效以及血气分析等指标情况.结果 治疗组明显优于对照组,差异有统计学意义(P＜0.05).治疗组的心率、呼吸频率、PaO2、PaCO2、pH指标均较治疗前和对照组治疗后比较,均有统计学差异(P＜0.05或0.01).结论 无创正压通气治疗急性左心衰竭安全有效,可降低病死率,提高抢救成功率.     

无创正压通气对老年急性左心衰竭患者血浆N端脑钠肽前体浓度及左室射血分数的影响

目的 探讨无创正压通气对老年急性左心衰竭患者血浆N端脑钠肽前体(NT-proBNP)浓度及左室射血分数(LVEF)的影响.方法 选取72例老年急性左心衰竭患者为研究对象,随机分为两组,每组各36例.对照组给予高流量面罩或鼻导管给氧,治疗组在对照组治疗基础上给予无创正压通气.比较两组的短期治疗效果、治疗前后的NT-proBNP浓度和LVEF变化情况.结果 治疗后,治疗组的总有效率高于对照组(P＜0.05),NT-proBNP浓度下降较对照组更明显(P＜0.01),LVEF改善情况优于对照组(P＜0.05).结论 无创正压通气能显著改善老年急性左心衰竭患者的临床疗效、降低NT-proBNP浓度以及改善LVEF,是治疗老年急性左心衰竭的良好方法.     

心功能综合指数评价无创正压通气对急性左心衰竭患儿心功能影响的研究

目的应用多普勒心功能综合指数（Tei指数）评价无创正压通气对急性左心衰竭患儿心脏整体功能的影响。方法32例急性左心衰竭患儿,在常规治疗不能有效控制的基础上加用双水平正压通气（bi-level positive airway pressure,BiPAP）呼吸机治疗,观察治疗前和治疗后2h血气分析、血压、心率及呼吸频率等指标的变化,并在机械通气前后均采用超声心动图测定左心室射血分数、左心房室瓣舒张早期与舒张晚期血流峰值速度比值及Tei指数。结果经口鼻面罩BiPAP呼吸机治疗后,29例患儿血气分析、血压、心率及呼吸明显改善,治疗有效率为90．6％。BiPAP治疗前后Tei指数差异有统计学意义（分别为0．72±0．05．0．60±0．02,P〈0．05）。结论BiPAP可明显改善急性左心衰竭患儿的心功能,改善低氧血症;Tei指数是一种无创、敏感、准确、综合评价心脏整体功能的重要指标。     

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.