依托咪酯复合瑞芬太尼在现代无抽搐电休克治疗中的应用

目的观察依托咪酯复合瑞芬太尼用于现代无抽搐电休克治疗(MECT)的效果及安全性。方法将拟行MECT的80例精神疾病患者随机分为A组和B组各40例,两组MECT前30 min均予阿托品0.5 mg肌肉注射,入室后开放静脉通路分别静注依托咪酯0.15～0.2 mg/kg、依托咪酯0.15～0.2 mg/kg+瑞芬太尼2μg/kg,两组均在眼睑反应消失后静注琥珀胆碱1 mg/kg,并于1.5 min后行MECT。分别记录麻醉前、电刺激前、电刺激后1 min、电刺激后5 min患者的收缩压(SBP)、舒张压(DBP)、HR;观察患者癫痫发作时间、自主呼吸恢复时间、肌抽搐发作情况及术后不良反应。结果两组麻醉后SBP、DBP、HR均较麻醉前明显下降,电刺激后1 min各指标均较麻醉前明显升高,尤以B组为著(P<0.05或0.01),电刺激后5 min两组各指标均与基础值相似(P均>0.05);两组癫痫发作时间、自主呼吸恢复时间差异均无显著性,B组肌抽搐发生率显著低于A组(P<0.05);B组术后头痛、肌肉痛发生例数明显少于A组(P均<0.05)。结论依托咪酯复合瑞芬太尼用于MECT可减轻电刺激引起的心血管反应,并减少肌抽搐及不良反应发生。     

依托咪酯作用机制的研究和临床应用现状

依托咪酯是咪唑类衍生的非巴比妥类短效静脉全身麻醉药,有较好的镇静作用,无镇痛作用,尤其适用于休克、有心血管危险因素、血流动力学不稳定、低血容量及气道高反性患者的全麻诱导。但其对肾上腺皮质功能的抑制作用不同程度上限制了其在临床上的应用,尤其在对长时间镇静和病情危重免疫力低下患者的应用中倍受争议。     

茯芩总三萜抗惊厥作用的实验研究

目的观察茯苓总三萜（TTP）对小鼠最大电休克模型、戊四唑模型以及大鼠皮层定位注射青霉素诱发癫痫模型的对抗作用。方法采用最大电休克和戊四唑惊厥模型,灌胃小鼠不同剂量茯苓总三萜,以拉莫三嗪（LTG）为对照,观察其抗惊厥作用;建立大鼠皮层定位注射青霉素诱发癫痫模型,以拉莫三嗪为阳性对照,观察两种剂量茯苓总三萜灌胃给药对青霉素诱发癫痫发作和海马区痫性放电的潜伏期、痫波发放频率及痫波最高波幅的影响。结果不同剂量TTP对MES模型均有对抗作用,且量效呈正相关性．但最大效能较拉莫三嗪弱。两种剂量TTP（80mg/kg．160mg／kg）均可延长MET发作潜伏期,与对照组比较均有统计学意义（P〈0．01）,且作用较拉莫三嗪强。两种剂量茯苓总三萜（140mg／kg,280mg／kg）和拉莫三唾（180mg／kg）均可延长大鼠癫痫发作潜伏觏减轻发作的程度．延长痫性放电的潜伏期（P〈0．01）,减少痫波发放频率,减小放电最高波幅,与模型组比较,均有统计学意义（P〈0．05）。结论茯苓总三萜可明显对抗小鼠最大电休克和戊四唑惊厥,抑制大鼠皮层定位注射青霉素诱发的癫痫发作和痫性放电。产生抗癫痫作用,但抗MES作用较拉莫三嗪弱而抗MET和青霉素惊厥作用较拉莫三嗪强。     

茯苓总三萜抗惊厥作用的实验研究1)

目的 观察茯苓总三萜(TTP)对小鼠最大电休克模型、戊四唑模型以及大鼠皮层定位注射青霉素诱发癫痫模型的对抗作用.方法 采用最大电休克和戊四唑惊厥模型,灌胃小鼠不同剂量茯苓总三萜,以拉莫三嗪(LTG)为对照,观察其抗惊厥作用;建立大鼠皮层定位注射青霉素诱发癫痫模型,以拉莫三嗪为阳性对照,观察两种剂量茯苓总三萜灌胃给药对青霉素诱发癫痫发作和海马区痫性放电的潜伏期、痫波发放频率及痫波最高波幅的影响.结果 不同剂量TTP对MES模型均有对抗作用,且量效呈正相关性,但最大效能较拉莫三嗪弱.两种剂量TTP(80 mg/kg ,160 mg/kg)均可延长MET发作潜伏期,与对照组比较均有统计学意义(P<0.01),且作用较拉莫三嗪强.两种剂量茯苓总三萜(140 mg/kg ,280 mg/kg)和拉莫三嗪(180 mg/kg)均可延长大鼠癫痫发作潜伏期,减轻发作的程度,延长痫性放电的潜伏期(P<0.01),减少痫波发放频率,减小放电最高波幅,与模型组比较,均有统计学意义(P<0.05).结论 茯苓总三萜可明显对抗小鼠最大电休克和戊四唑惊厥,抑制大鼠皮层定位注射青霉素诱发的癫痫发作和痫性放电, 产生抗癫痫作用,但抗MES作用较拉莫三嗪弱而抗MET和青霉素惊厥作用较拉莫三嗪强.     

依托咪酯在颅脑手术麻醉诱导与维持的应用

目的探讨依托咪酯用于颅脑手术麻醉的可行性与安全性。方法选择204例采用依托咪酯麻醉的颅脑手术患者,分别记录麻醉前（T0）及插管（T1）、切皮（T2）、切开硬脑膜（T3）、缝皮（T4）时的血压、脉搏变化,并进行分析比较。结果依托咪酯麻醉中各时点患者血压、心率平稳,血流动力学稳定。麻醉后血压、心率回升,与术中比较有统计学差异（P〈0.05）;与麻醉前相比,麻醉后各时点患者血压、心率显著下降（P〈0.05）。未出现围麻醉期顽固性低血压现象。结论依托咪酯在颅脑手术麻醉诱导与维持中对血流动力学有良好的稳定性,具有较好的麻醉效果。     

依托咪酯复合芬太尼全凭静脉麻醉在胸科手术中的应用

目的 观察依托咪酯复合芬太尼全凭静脉麻醉(TIVA)在胸科手术中的应用效果及安全性.方法 将择期拟行肺叶切除术患者60例随机分为观察组和对照组各30例.两组均采用芬太尼、咪唑安定、维库溴铵行麻醉诱导及维持,在此基础上,观察组和对照组分别加用依托咪酯、异丙酚.分别于术前(T1)、术中(T2)、术毕(T3)及术后24、48 h(T4、T5)观察两组平均动脉压、心率和血糖变化;采静脉血应用放射免疫法测定血浆皮质醇(GC)、醛固酮(ALD)、促肾上腺皮质激素(ACTH)水平;记录两组术中芬太尼和维库溴铵用量,停药后苏醒时间、恢复时间及术中知晓、满意度.结果 两组术中血流动力学均维持稳定,且相关指标比较无显著差别.观察组T3时GC水平低于T1 (P＜ 0.05) ,T4基本恢复至术前水平,T5较术前明显升高(P＜0.05);T3时ACTH水平高于T1 (P＜ 0.05) ,T4基本恢复至T1水平.对照组各时点GC及ACTH水平均无显著变化.观察组苏醒时间长于对照组相(P＜ 0.05).结论 依托咪酯复合芬太尼静脉TIVA可安全用于胸科手术.     

依托咪酯乳剂全凭静脉全麻在心脏手术中的临床应用

目的 探讨依托咪酯乳剂全凭静脉全麻在心脏手术中的可行性、安全性及麻醉效果.方法 选择ASAⅡ～Ⅳ,拟行心脏手术的患者100例,以咪达唑仑0.05～0.10 mg/kg、依托咪酯0.15～0.20mg/kg、维库溴胺0.15mg/kg、舒芬太尼0.4～0.5μg/kg进行麻醉诱导,依托咪酯0.3～0.5 mg·kg-1·h-1持续输注维持全身麻醉,间断静注舒芬太尼(总量:2～3 μg/kg)、持续输注阿曲库胺0.5～0.8 mg·kg-1·h-1维持镇痛及肌松,缝皮结束后停止药物输入.记录患者诱导前(T1)、诱导后(T2)、气管插管后5 min(T3)、停体外循环时(T4)、关胸时(T5)患者的有创血压(IBP)、心率(HR);记录患者的清醒时间、拔管时间,术后随访有无术中知晓的发生.结果 本组患者麻醉诱导后IBP、HR轻度下降,气管插管后IBP回复插管前水平.插管后5 min患者IBP维持平稳,体外循环前无1例患者需要使用正性肌力药物维持血压.本组患者麻醉效果满意,无术中知晓的发生.患者术后2～4h清醒,拔管时间为(21±3.5)h.本组无死亡病例.结论 依托咪酯乳剂全凭静脉全麻不仅能满足心脏手术的麻醉需求,且血流动力学稳定,可安全应用于心脏手术患者.     

舒芬太尼复合依托咪酯在无痛胃镜检查中的应用

目的：观察舒芬太尼复合依托咪酯在无痛胃镜检查中的应用效果。方法将100例行无痛胃镜检查的患者随机分为E组和P组各50例,E组缓慢静推舒芬太尼0．1μg/kg、依托咪酯0．1～0．2 mg/kg,P组缓慢静推舒芬太尼0．1μg/kg、丙泊酚1～2 mg/kg。分别于麻醉前（T1）、麻醉后1 min（T2）、置入胃镜后1 min（T3）,苏醒后1 min（ T4）,记录两组的SBP、DBP、HR、RR。记录两组诱导后眼睑反射消失时间、胃镜检查时间、恢复时呼之睁眼时间,用药过程中出现的不良反应及麻黄碱和阿托品的应用情况。结果两组T2、T3时点SBP、DBP、HR均显著低于T1时点,P组下降更明显,P均＜0．05。两组眼睑反射消失时间、胃镜检查时间、苏醒时间及麻黄碱、阿托品使用情况比较,P均＞0．05。 E组发生注射痛1例、肌颤4例、呛咳3例、体动4例、SpO2＜90％1例、恶心呕吐2例,P组分别为19、0、2、3、1、1例;两组注射痛、肌颤发生率比较,P均＜0．05。结论在无痛胃镜检查中,舒芬太尼复合依托咪酯麻醉对患者心率和血压的影响较小,安全性较好。     

依托咪酯与异丙酚在围插管期心血管反应比较

不同静脉麻醉药对全麻诱导时循环的影响不尽相同，本研究拟比较依托咪酯与异丙酚快速诱导围插管期心血管反应。     

The use of etomidate for rapid sequence induction in septic patients

There is continued debate about the clinical ramifications of single-dose etomidate for rapid sequence induction (RSI) in patients with sepsis. This history of this debate includes early studies identifying an association between etomidate infusions and mortality with adrenal suppression as a hypothesized mechanism. More recent data describing the high prevalence of adrenal insufficiency in patients with sepsis has prompted additional investigation as to the clinical effects of single-dose etomidate when utilized as an agent in RSI. Acknowledging the small number and heterogeneity of studies on this topic, we feel that the recent meta-analysis by Gu et al. provides an accurate and complete assessment of the existing literature on this topic. We continue to utilize etomidate for the purposes of RSI in this critically ill patient population and feel that the current data supports this position.     

依托咪酯联合丙泊酚镇静应用于超重患者无痛胃镜检查的效果观察

[目的]比较超重患者无痛胃镜检查中依托咪酯联合丙泊酚与单独使用丙泊酚的效果。[方法]将60例患者随机分为丙泊酚组(P组)和依托咪酯联合丙泊酚组(EP组)。P组在胃镜检查前首次给予1%丙泊酚(1 mg/kg),EP组给予1%丙泊酚(0.5 mg/kg)加依托咪酯(0.1 mg/kg)。后重复给予P组10~20 mg丙泊酚或EP组5~10 mg丙泊酚加1~2 mg依托咪酯,以维持足够的镇静水平。[结果]与T0比较,T1及T2时刻2组患者的收缩压、舒张压、平均动脉压、心率均明显降低,且与EP组相比,P组下降更为显著,差异有统计学意义(P<0.05),EP组麻醉后循环波动较小。与P组相比,EP组患者从静脉注入麻醉药物到患者意识消失的时间更长(P<0.05)。EP组低血压、呼吸抑制以及注射痛的发生例数低于P组,差异有统计学意义(均P<0.05)。[结论]依托咪酯联合丙泊酚对超重患者无痛胃镜检查中的呼吸和循环影响不大,患者苏醒质量高,不良反应少,比单用丙泊酚更安全有效。     

羟考酮与舒芬太尼复合依托咪酯用于老年男性患者无痛膀胱镜检查效果的比较

目的比较羟考酮与舒芬太尼复合依托咪酯用于老年男性患者无痛膀胱镜检查的效果。方法选择2017年10月至2018年5月于保定市第一中心医院全麻下行膀胱镜检查的老年男性患者60例,年龄66～78岁,体质量52～74 kg,美国麻醉医师协会(ASA)分级Ⅱ～Ⅲ级,分为2组(每组n=30):羟考酮组(O组)及舒芬太尼组(S组)。O组静脉注射羟考酮0.05 mg/kg,S组静脉注射舒芬太尼0.05μg/kg,3 min后静脉注射依托咪酯0.2 mg/kg。术中出现皱眉或体动反应时,静脉追加依托咪酯0.1 mg/kg。观察指标:膀胱镜检查过程中患者发生皱眉或体动、呼吸抑制的情况;膀胱镜检查时间及依托咪酯用量;苏醒时间及发生苏醒后头晕、恶心呕吐的情况。采用SPSS 17.0统计软件对数据进行分析。组间比较采用t检验或χ~2检验。结果与S组比较,O组皱眉或体动[10%(3/30) vs 47%(14/30)]及依托咪酯用量[(13.2±2.1) vs (20.7±3.6)mg]减少(P0.05);与S组比较,O组恶心、呕吐[3%(1/30) vs 20%(6/30)]及呼吸抑制[0%(0/30) vs 13%(4/30)]的发生率均降低(P0.05);2组头晕[10%(3/30) vs 13%(4/30)]发生率差异无统计学意义(P0.05)。结论羟考酮复合依托咪酯可有效用于老年患者膀胱镜检查,效果优于舒芬太尼。     

Sedation with a 1:1 mixture of etomidate and propofol for gastroscopy in hypertensive elderly patients

We hypothesized that the combined use of etomidate and propofol for endoscopic sedation in elderly hypertensive patients could reduce adverse reactions while providing ideal sedation. To validate our hypothesis, we conducted a prospective, randomized, controlled, double-blinded study. A total of 360 elderly hypertensive patients scheduled for gastroscopy at our hospital were enrolled in the study, of whom 328 completed the trial. The patients were randomly assigned to one of three groups: the propofol group (group P), the etomidate group (group E), or the propofol-etomidate combination group (mixed at a ratio of 1:1, group PE). We collected and analyzed the cardiopulmonary effects and side effects in each group. Regardless of the sedation drug used, the systolic blood pressure, mean blood pressure, and heart rate of involved patients were significantly affected. Oxygen desaturation and injection pain were more common in group P compared to groups E (33.6% vs. 14.8%, 31.8% vs. 2.7%, both P < 0.01) and group PE (33.6% vs. 13.6%, 31.8% vs. 6.4%, both P < 0.01). The incidence of myoclonus in the PE group was lower than that in the E group (10.9% vs. 61.2%, P < 0.01). Our results indeed demonstrated that the combined use of etomidate and propofol appeared to maintain cardiopulmonary stability with minimal side effects in older hypertensive patients scheduled for gastroscopy, which further implied that this sedation strategy could be a safe and pain-free option for managing patients undergoing gastroscopy, particularly those at a higher risk of adverse cardiovascular events.     

Protective effect and mechanism of MST1inhibition on kidney tissue in diabetic rats induced by streptozotocin

<正>Objective To investigate the protective effect and mechanism of MST1 inhibition on kidney tissue in diabet-ic rats,and to find a new therapeutic target for diabetic nephropathy.Methods Total of 54 male SD rats enrolled in this study were divided into 3 groups including normal control(group A,n=18).MST1 inhibition group(Group     

Changes in brain amino acids and nitric oxide after melatonin administration in rats with pentylenetetrazole-induced seizures

We examined the effect of melatonin on brain levels of amino acids and nitric oxide (NO) after pentylenetetrazole (PTZ)-induced seizures in rats. Animals were treated with melatonin (10-160 mg/kg, i.p.) 30 min before PTZ administration (100 mg/kg, s.c.), and were killed 3 hr later. At the dose of 80 mg/kg, melatonin significantly increased the latency (5.7-12.7 min) and decreased the duration (31.2-18.4 s) of the first seizure, reducing PTZ induced mortality from 87.5 to 25%. After kill, brains were removed and neurotransmitters and nitrite levels measured in prefrontal cortex (PF), parieto-temporal cortex (PF), striatum (ST), hippocampus (HP) and brain stem (BS) by high performance liquid chromatography. PTZ treatment increased glutamine levels in all brain areas studied, without changes in glutamate, gamma-amino butyric acid (GABA) and glycine. Aspartate and taurine increased in PF and PT and in HS and PT, respectively. Melatonin administration displayed a dose-dependent effect. At doses of 10-40 mg/kg, melatonin counteracted the PTZ-induced glutamine increase and reduced both glutamate and aspartate levels in the studied areas, with minor changes in GABA and glycine content. At doses of 80 and 160 mg/kg, the levels of glutamine, and glutamate, and to a lesser extent aspartate increased, whereas serine levels did not change. These two doses of melatonin also increased taurine, GABA and glycine in most brain areas studied. Treatment with melatonin (40-160 mg/kg) significantly decreased nitrite content in PT cortex, ST and BS areas of epileptic rats, without changes in the other brain regions. The results suggest that the anticonvulsant property of melatonin involves a modulation of both brain amino acids and NO production.     

Effects of metyrapone and etomidate on adrenal function and growth rate in female rats

Two inhibitors of adrenal steroidogenesis were examined to determine whether the growth rate of female rats could be improved by lowering circulating plasma corticosterone concentrations. The first inhibitor, etomidate, is a potent narcotic agent and was found to have no effect on plasma corticosterone and deoxycorticosterone (DOC) concentrations at sub-narcotic doses. Growth rate, food intake, food conversion efficiency and adrenal weight were also unaffected by the drug. The second inhibitor, metyrapone, was shown in acute studies to have two distinct actions. In 6-week-old female rats moderate doses of metyrapone (50 mg/kg) had a stimulatory action resulting in increased plasma DOC and corticosterone concentrations. Higher doses of metyrapone (150-300 mg/kg) were increasingly less selective, causing an increase in plasma concentration of DOC, but attenuating the increase in corticosterone concentration, presumably by inhibiting the 11 beta-hydroxylase enzyme which allows the conversion of DOC to corticosterone. In adult rats (greater than 12 weeks old) the classical response to metyrapone was observed. Plasma DOC concentrations were increased, while corticosterone levels were reduced in a dose-dependent manner. In 5-week-old rats treated chronically, metyrapone (300 mg/kg) had no effect on plasma corticosterone, but increased plasma DOC concentration, depressed food intake and reduced growth rate. In 8-week-old rats treated chronically, the high dose of metyrapone (300 mg/kg) required to lower peak plasma corticosterone concentrations produced toxic effects resulting in the death of three animals. The remaining animals recovered rapidly, and gained more weight than controls over the final 6 days of the experiment. However, this experiment was terminated before the treated animals were able to catch up with the controls.(ABSTRACT TRUNCATED AT 250 WORDS)     

草果知母汤对学习记忆功能的影响及与抗癫痫作用的关系

目的探讨草果知母汤对学习记忆功能的影响及与抗癫痫作用的关系。方法选择昆明种小鼠90只和P77-PMC大鼠,即听源性发作(AGS)易感大鼠90只。小鼠分为正常A组、草果知母汤A组和苯巴比妥A组,大鼠分为癫痫模型组、草果知母汤B组和苯巴比妥B组,每组30只,Wistar大鼠30只为正常B组。采用跳台法,按学习记忆的3个过程:获得、巩固、重现分为3大部分观察,测定草果知母汤对正常小鼠和癫痫大鼠学习记忆功能的影响。另选AGS大鼠20只,分为无惊厥组12只和惊厥组8只,测定抗癫痫作用。结果与正常A组和苯巴比妥A组比较,草果知母汤A组明显提高记忆成绩(P<0.05,P<0.01)。与苯巴比妥B组比较,草果知母汤B组明显延长小鼠记忆获得和重现过程的触电潜伏期、提高记忆成绩(P<0.01)。与癫痫模型组比较,草果知母汤B组对癫痫大鼠的获得及重现障碍有明显的翻转作用,能明显延长大鼠记忆获得和重现过程的触电潜伏期(P<0.01),提高学习和记忆成绩(P<0.05)。无惊厥组与惊厥组大鼠学习记忆各项指标差异无统计学意义(P>0.05)。结论草果知母汤有一定的益智作用,但与其抗癫痫作用无相关关系,为其本身所具有。     

Effects of systemic and local administration of etomidate on adrenocortical steroidogenesis in male rats

A method for focal dialysis of the adrenal cortex is introduced allowing determination of adrenal steroid local release rates in conscious, freely moving rats. Etomidate, an anaesthetic drug known to interfere with adrenal steroid synthesis, blocks not only corticosterone but also aldosterone and, to a lesser degree, progesterone release. Intra-adrenal application of the drug via the dialysis system for a defined time resulted in low release rates of corticosterone without inducing sedation of the animals or even anaesthesia. Remaining low steroid concentrations during the next 5 h after cessation of the dialysis with drug-containing medium indicate that the inhibition of steroid synthesis lasted for several hours. It is concluded that the inhibitory effect of etomidate on steroid biosynthesis can be explained on the basis of an interaction of the drug with adrenocortical enzymes without the involvement of hypothalamic or hypophyseal mechanisms.     

The additive effect of opioids and nitric oxide in increasing pentylenetetrazole-induced seizure threshold in cholestatic mice

BACKGROUND: Accumulation of endogenous opioids and overproduction of nitric oxide has been reported in cholestatic mice. It is well known that endogenous opioids and nitric oxide alter the susceptibility of experimental animals to different models of seizure. METHODS: The alterations in clonic seizure thresholds, induced by pentylenetetrazole from 1 to 6 days after bile duct ligation, were evaluated in mice. Whether the pretreatment of cholestatic mice with different doses of opioid receptor antagonist naltrexone, or nitric oxide inhibitor N(omega)-nitro-L-arginine methyl ester would have changed the clonic seizure threshold was also examined. RESULTS: While in sham-operated mice the clonic seizure threshold was similar to that of the thresholds in unoperated controls, a time-dependent increase in the threshold was observed in cholestatic mice, reaching a peak on day 3 after bile duct ligation and declining partially after the 4th day. Chronic pretreatment with naltrexone (2, 5 and 10 mg/kg, i.p.) reversed the increased threshold in cholestatic mice on day 3 after operation in a dose-dependent manner with the highest doses used restoring the threshold to that of the control animals. A similar reversal of the increased threshold was observed after acute (1, 3 and 10 mg/kg, i.p.) or chronic (10 mg/kg, i.p. for 4 days) pretreatment with N(omega)-nitro-L-arginine methyl ester. Moreover, concurrent administration of doses of N(omega)-nitro-L-arginine methyl ester and naltrexone that each separately induced a partial reversal of increased seizure threshold in cholestasis caused a complete restoring of the threshold to the control level. CONCLUSIONS: Based on these findings, both opioid receptors and nitric oxide may be involved in the dramatic increase in pentylenetetrazole-induced seizure threshold in cholestasis.