氯诺昔康、咪达唑仑、芬太尼联合静脉连续输注用于脊柱内固定手术后镇痛效果

目的 探析脊柱内固定手术后镇痛中运用芬太尼、咪达唑仑以及氯诺昔康的临床效果.方法 选择2014年1月～2016年1月期间我院收治的脊柱内固定手术患者80例为研究对象,随机分为两组,其中给予对照组常规镇痛,而观察组则运用氯诺昔康、咪达唑仑、芬太尼联合镇痛,对比分析两组镇痛效果.结果 与对照组相比,观察组的VAS评分和Ramsay评分均较低,组间比较差异明显(P＜0.05);但是两组的不良反应发生率对比无差异(P＞0.05).结论 临床上给予脊柱内固定手术患者咪达唑仑、氯诺昔康以及芬太尼联合镇痛时,再采取有效护理措施,能够减轻患者痛苦,预防不良反应.     

氯诺昔康在甲状腺手术中的应用评价

目的:探讨氯诺昔康用于甲状腺手术麻醉的有效性及安全性.方法:择期甲状腺手术患者56例,麻醉方式以局麻为主,随机分为氯诺昔康组(A组)和对照组(B组).A组在切皮前30min给予氯诺昔康16mg静脉注射,而B组在切皮前30min给予生理氯化钠溶液4mL静脉注射.通过下列指标评价临床效果:① VAS评分;②局麻药和芬太尼的用量;③ Ramsay镇静评分;④患者对术中镇痛效果总体印象评分;⑤术中呼吸循环指标;⑥术后24h内不良反应如恶心呕吐的发生情况.结果:A组术中血流动力学稳定,术中VAS评分较低,局麻药和芬太尼用量及加药次数显著减少,术后恶心呕吐等不良反应少.结论:氯诺昔康用于甲状腺手术可以提供满意的镇痛效果.     

氯诺昔康预防鼻内窥镜手术患者苏醒期躁动与疼痛的效果观察

［摘要］目的观察氯诺昔康对鼻内窥镜手术患者苏醒期躁动及术后疼痛的防治作用。方法选择60例择期行鼻内窥镜手术患者，随机均分为氯诺昔康组和曲马多组各30例。两组患者均用咪达唑仑＋丙泊酚＋芬太尼＋维库溴铵静脉诱导后行气管插管，术中以吸入异氟醚和持续静脉注射丙泊酚麻醉，术毕，氯诺昔康组患者静脉注射氯诺昔康16 mg，曲马多组患者静脉注射曲马多100 mg。观察并记录各组的镇痛效果、躁动评分及不良反应数。结果氯诺昔康组对躁动的控制效果显著强于曲马多组（P＜0.05＝；两组患者各时段视觉模拟（VAS）评分差异无显著性（P＞0.05）；曲马多组呕吐发生例数多于氯诺昔康组。结论氯诺昔康对鼻内窥镜手术患者苏醒期躁动及术后疼痛的有良好的防治作用。     

不同剂量芬太尼联合氯诺昔康用于神经外科患者术后镇痛的疗效分析

目的：探讨不同剂量芬太尼联合氯诺昔康用于神经外科患者术后静脉自控镇痛（PCA）的疗效分析。方法将符合标准的病例随机分为A组（氯诺昔康40 mg＋芬太尼0.7 mg）、B组（氯诺昔康40 mg＋芬太尼0.5 mg）、C组（氯诺昔康40 mg＋芬太尼0.3 mg）,对比分析3组的镇痛情况及不良反应。结果同时段内A、B两组的视觉模拟评分（VAS）无显著性差异,但C组明显高于A、B两组;B、C两组的Ramsay镇静评分无显著性差异, A组镇静评分明显高于B、C两组;A组患者术后镇痛相关不良反应明显多于B、C两组,B、C两组间无显著差异。结论氯诺昔康联合小剂量芬太尼用于神经外科手术PCA,镇痛效果满意,值得推广。     

氯诺昔康联合小剂量氯胺酮 预防开颅患者术后疼痛的疗效观察

［摘要］目的探讨氯诺昔康联合小剂量氯胺酮对开颅患者术后镇痛疗效和安全性。方法将择期开颅患者42例随机均分为Ⅰ、Ⅱ、Ⅲ组，每组14例。3组患者均用咪达唑仑+异丙酚+芬太尼+维库溴铵静脉诱导后行气管插管，术中以吸入异氟醚和持续静脉注射异丙酚，间断给维库溴铵麻醉。Ⅰ组患者术前静脉注射氯诺昔康8 mg，同时静脉注射氯胺酮0.2 mg·kg 1，术后追加氯诺昔康8 mg；Ⅱ组患者只在术后给氯诺昔康8 mg；Ⅲ组患者未行镇痛。记录各患者的手术时间、全麻苏醒时间；观察并记录手术后3，6，18，24 h各时点的视觉模拟（VAS）评分及镇静评分；记录各组患者术后恶心、呕吐程度和发生率。结果3组患者手术时间、全麻苏醒时间无显著差别；Ⅰ、Ⅱ组患者镇痛优良率分别为85.2%，72.3%（P＜0.05），术后3，6 hⅠ组与Ⅱ组VAS评分差异无显著性，但Ⅰ组术后18 h VAS评分明显低于Ⅱ组（P＜0.05）；术后3，6，18 hⅠ组、Ⅱ组术后VAS评分均显著低于Ⅲ组（P＜0.05），但术后24 h各组患者VAS评分差异无显著性；术后各组恶心、呕吐程度及发生率差异无显著性；各组镇静评分差异无显著性。结论氯诺昔康伍用小剂量氯胺酮具有良好的镇痛作用，且不影响意识状态，是用于开颅患者的一种较理想的术后镇痛方法。     

镇静镇痛方案在ICU清醒危重症患者机械通气的临床比较观察

目的在芬太尼镇静镇痛的基础上,观察对比咪达唑仑和丙泊酚两种镇静镇痛方案对清醒危重症患者机械通气的临床疗效。方法筛选我科ICU危重症患者56例,随机分为咪达唑仑组和丙泊酚组,每组28例,比较两组的NRS镇痛评分、Ramsay镇静评分、唤醒时间及不良情绪事件发生情况。结果两组患者NRS镇痛评分比较差异无统计学意义（P〉0．05）;Ramsay镇静评分比较,咪达唑仑组高于丙泊酚组,差异具有统计学意义（P〈0．05）,唤醒时间比较,咪达唑仑组高于丙泊酚组,差异具有统计学意义（P〈0．05）;咪达唑仑组疼痛、躁动、谵妄等不良情绪事件发生率明显高于丙泊酚组,比较差异具有统计学意义（P〈0．05）。结论危重症患者机械通气的同时要根据患者具体病情,采取合理的个体化镇静镇痛方案。     

咪达唑仑联合芬太尼对重症机械通气患者镇静效果的研究

目的探讨咪达唑仑联合应用芬太尼对重症机械通气患者镇静效果的影响。方法将40例使用机械通气的重症患者,随机分为咪达唑仑组（对照组,n=20）和咪达唑仑加芬太尼组（实验组,n=20）,记录镇静前2组呼吸循环指标。镇静开始前2组均给予咪达唑仑0.05mg/kg静注,直至患者镇静达Ramsay3～4级（采用Ramsay镇静评分）,对照组给予咪达唑仑（咪达唑仑50mg＋生理盐水至50ml）,以0.1mg/kg/h微量注射泵持续泵入;实验组选用咪达唑仑和芬太尼（咪达唑仑50mg＋芬太尼0.5mg＋生理盐水至50ml）,以0.1ml/kgh微量注射泵持续泵入,观察2组患者镇静1、6、12、24h呼吸频率、脉搏、平均血压、末梢血氧饱和度、氧合指数及镇静评分。结果镇静后2组呼吸频率、血氧饱和度、氧合指数均较镇静前明显改善（P〈0.01）;镇静后实验组各时点脉搏均低于对照组（P〈0.05）,RS评分均高于对照组（P〈0.05）,各组镇静后平均血压、脉搏、RS评分均较镇静前明显改善（P〈0.01）。结论对重症机械通气的患者,咪达唑仑联合应用芬太尼能显著提高患者的镇静效果,增加人机顺应性。     

氯诺昔康对心内直视手术后患者自控镇痛效应的影响

目的：观察氯诺昔康对心内直视手术后患者自控镇痛效应的影响。方法：将30例心内直视手术患者随机分为氯诺昔康组和吗啡组,每组各15例。镇痛药为吗啡1mg/mL,参数设置为：负荷剂量1mg,持续输注剂量0.5mg/h,单次给药剂量1mg,锁定时间10min,每4h最大限量20mg。应用PCA泵的同时,氯诺昔康组静脉注射首剂氯诺昔康8mg,首剂药物后12、24和36h,静脉注射氯诺昔康8mg;吗啡组在四时间点均注射生理盐水。镇痛开始后12、24、36和48h记录疼痛VAS评分,PCA需求按压次数和有效按压次数,药物用量,镇静程度评分;术后各种并发症及不良反应发生率;记录镇痛满意度NRS评分。结果：两组患者各时间点安静痛和咳嗽痛评分差异无统计学意义（P〉0.05）。镇静程度评分、PCA需求按压次数、有效按压次数及药物用量氯诺昔康组显著低于吗啡组（P〈0.05）。两组患者氯诺昔康组恶心发生率显著低于吗啡组（P〈0.05）,其他术后各种并发症及不良反应发生率差异无统计学意义（P〉0.05）。两组患者对镇痛满意度评分、在ICU停留时间及手术后住院时间差异无统计学意义（P〉0.05）。结论：氯诺昔康可安全有效地应用于心内直视手术后患者术后镇痛,并减少吗啡用量。     

氯诺昔康与布托啡诺用于腹腔镜胆囊切除术后镇痛效果

目的：对比观察氯诺昔康和布托啡诺用于腹腔镜胆囊切除术（LC）后镇痛的临床效果。方法：90例ASAⅠ-Ⅱ级择期在全麻下行腹腔镜胆囊切除术的患者，随机分为氯诺昔康、布托啡诺和生理盐水3组，每组30例。各组患者于术毕伤口疼痛时，分别静注氯诺昔康8mg、布托啡诺1mg和生理盐水2mL，观察并记录各组注药后1、6、12、24h的疼痛视觉模拟评分（VAS值）、镇静评分、舒适评分、生命体征的变化和不良反应的发生情况。结果：氯诺昔康、布托啡诺组术后各时点VAS评分、镇静评分、舒适评分与生理盐水组比较差异有统计学意义（P〈0．01），术后镇痛期间生命体征变化组间比较差异无统计学意义（P〉0．05），氯诺昔康组术后恶心、呕吐发生率低于生理盐水组（P〈0．05），注药后1h布托啡诺组头晕和嗜睡的发生率明显高于氯诺昔康组（P〈0．05）。结论：氯诺昔康和布托啡诺对LC患者均具有良好的术后镇痛效果，术后不良反应发生率低。     

氯诺昔和合小剂量芬太尼用于术后静脉镇痛的效果分析

目的探讨氯诺昔康复合小剂量芬太尼用于术后静脉镇痛的效果。方法 2009年2月至2010年2月进行术后静脉镇痛患者268例分为观察组138例,对照组130例,对两组进行术后4、8、12、24、48h进行疼痛评分、镇静评分和不良反应发生情况观察。结果两组术后4、8、12、24、48h进行疼痛评分、镇静评分比较P>0.05无显著差异性。观察组共出现不良反应12例,不良反应发生率8.69%;对照组共出现不良反应35例,不良反应发生率26.92%。经统计学分析,观察组与对照组不良反应发生率比较P<0.05有显著差异性。结论氯诺昔康复合小剂量芬太尼可增强氯诺昔康的镇痛作用,镇痛效果比单用氯诺昔康效果好,可以减少芬太尼的用量,减少芬太尼不良反应。     

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.