异丙酚预处理诱导PC12细胞缺氧耐受作用研究

目的 观察异丙酚预处理对PC12细胞缺氧损伤的影响.方法 对数生长期的PC12细胞分为四组:对照组(C组),普通培养箱内常规培养;脂肪乳剂组(F组),在细胞培养基中加入10%脂肪乳剂,置普通培养箱内常规培养;缺氧组(H组),细胞置三气培养箱内培养,设置培养条件为2% O2、5% CO2;异丙酚+缺氧组(PH组),在细胞培养基中加入终浓度为2 mmol/L的异丙酚,再置入三气培养箱培养,条件设置同H组.四组细胞均在培养4 h后行细胞活力和细胞凋亡检测.结果 C组与H组之间细胞活力和细胞凋亡率的差异有统计学意义(P<0.05);与H组相比,PH组细胞活力明显增高(P<0.05),细胞凋亡率明显降低(P<0.05).结论 异丙酚预处理改善PC12细胞活力,通过抑制细胞凋亡诱导PC12细胞缺氧耐受.     

浅麻醉下犬脑组织对异丙酚的摄取及其分布

目的:研究异丙酚浅麻醉时在犬脑不同区域的摄取及分布。方法:6条成年雄犬,静脉注射异丙酚4.5mg/kg,达到有效麻醉深度后3min,取颈内动脉和颈内静脉血并断头法将犬处死,解剖犬脑,分别取额叶、顶叶、颞叶、海马、扣带回、丘脑、中脑、桥脑、小脑组织。高效液相色谱-紫外线法测定血浆浓度及组织浓度。结果:各个脑区药物浓度分布呈桥脑>中脑>丘脑>小脑>扣带回>额叶>颞叶>顶叶>海马的趋势,动脉血药浓度明显高于静脉血药浓度。结论:异丙酚浅麻醉时在犬脑不同区域分布不同,其中以脑干和丘脑最高,可能在异丙酚静脉麻醉中发挥着重要作用。     

The relationship between abuse and depression

Very strong links exist between abuse and depression in clinical practice. Abuse and depression often coexist in the victims and perpetrators of abuse. In nursing practice, responding to patients, particularly women, presenting with depression or depressive symptoms requires an understanding of the underlying and perhaps hidden issues of abuse and violence. Women who have experienced trauma often are diagnosed with depression, when in fact they have symptoms more consistent with posttraumatic stress disorder. Furthermore, depression often improves over time, when women manage to escape the abuse and violence in the relationship.     

Prevalence of alcohol use disorders in Shiraz,Iran

Aims To assess the prevalence of alcohol use disorders in Shiraz, Iran. Setting and Participants A household survey of a nationally representative sample of 1400 subjects (aged 15 years or older). Measurements The researchers administered a semistructured interview by a questionnaire and a structured interview based on DSM-IV Criteria for alcohol dependence and alcohol abuse. Findings Of the participants, 373 (26.6%) admitted the use of alcohol once or more during their lives (39.6% of men and 13.7% of women); 159 (11.4%) were occasional alcohol abusers (17.3% of men and 5.4% of women); and 102 (7.3%) were alcohol dependent (11.9% of men and 2.7% of women). Use of alcohol was significantly related to gender. There was nonsignificant difference between single and married alcohol users. The most common reasons given for initial alcohol use were curiosity, modelling, and seeking pleasure and for current regular use were: seeking pleasure, release of tension, and need to avoid withdrawal symptoms. There were significant differences between occupations and alcohol use and also between level of education and alcohol use.     

Religiousness, Current Substance Use, and Early Risk Indicators for Substance Abuse in Nursing Students

Nursing students have been targeted by the American Nurses' Association (ANA) for efforts focused on the prevention of substance abuse. This study surveyed 241 nursing students enrolled in their first year of nursing courses at seven faith-based colleges and universities. The purposes were to investigate the prevalence of current substance use and the number of early risk indicators for substance abuse and dependence among nursing students, and to examine the relationships among religiousness, current substance use, and early risk indicators for substance abuse. Efinger's Alcohol Risk Survey, the CAGE Questionnaire, and the Intrinsic/Extrinsic-Revised Scale were used to collect data. Twenty-four percent of respondents reported current substance use, 15% scored in the probable abuse/dependence category: those who were more religious tended to have lower prevalence rates of substance use as well as fewer numbers of early risk indicators.     

丙泊酚、瑞芬太尼、麻黄碱在胃镜检查中的应用

目的观察丙泊酚、瑞芬太尼、麻黄碱配合应用于胃镜检查时对循环、呼吸功能及麻醉效应的影响。方法患者120例，随机分为3组，A组单用丙泊酚；B组合用丙泊酚与瑞芬太尼；C组合用丙泊酚、瑞芬太尼及麻黄碱。观察患者药物用量、苏醒时睁眼、对答和自行离去时间、循环呼吸功能及不良反应。结果B、C组丙泊酚用量比A组明显减少（P〈0．05），呼之睁眼及自如对答时间比A组缩短（P〈0．05），而C组患者自行离开时间要短于A、B两组（P〈0．05）；A、B两组患者用药后及呼之睁眼时MAP均较检查前明显降低、HR减慢（P〈0．05），而C组患者检查前、用药后及呼之睁眼时MAP和HR均没有显著性差异（P〉0．05）；3组患者用药后及呼之睁眼时RR均减慢，SpO2降低（P〈0．05）；B、C组的注射部位疼痛及检查时肢体活动发生率比A组显著降低（P〈0．05）。结论瑞芬太尼伍用于丙泊酚可减少丙泊酚用量，降低注射部位疼痛及检查时肢体活动发生率，但并不减轻对循环呼吸的抑制作用；丙泊酚、瑞芬太尼、麻黄碱伍用则既能减少丙泊酚用量，循环功能亦较稳定，但不能减轻对呼吸的抑制作用。     

异丙酚静脉麻醉在人工流产术中的应用

目的探讨异丙酚静脉麻醉下行人工流产手术的临床效果。方法选择自愿要求终止妊娠的早孕妇女,分异丙酚组300例、利多卡因组300例及对照组200例进行对比分析。结果异丙酚组用药后收缩压（SBP）、舒张压（DBP）、心率（HR）、呼吸（R）、血氧饱和度（SpO2）等指标较用药前均呈下降趋势,但差异无显著性（P〉0.05）。异丙酚组镇痛有效率为100%,显著高于利多卡因组（69.67%）和对照组（26.00%）,3组的镇痛有效率比较,差异有显著性（P〈0.01）。异丙酚组无1例人工流产综合征发生,而利多卡因组发生率为4.67%,对照组为34.50%,3组比较差异有显著性（P〈0.01）。3组在出血量上差异无显著性（P〉0.05）。结论异丙酚静脉麻醉用于人工流产术镇痛效果明显,可降低人工流产综合征的发生率,且无明显呼吸抑制作用,不增加出血量,值得临床推广应用。     

宫颈旁阻滞复合丙泊酚用于宫腔镜检查的研究

目的观察宫颈旁阻滞复合丙泊酚用于宫腔镜检查的效果。方法行宫腔镜检查的患者60例,随机分为观察组和对照组,手术开始前静脉注射丙泊酚至脑电双频指数（BIS）到60,观察组术前于左右宫颈旁各注射1%利多卡因5ml,对照组注射等剂量生理盐水。观察患者苏醒时间、丙泊酚用量,观察麻醉前（T1）、手术开始后5min（T2）,患者苏醒后（T3）的心率（HR）、收缩压（SBP）和舒张压（DBP）,术中低血压、心动过缓、低氧血症的发生率及术中体动次数。结果与观察组比较,对照组苏醒时间长,丙泊酚用量大,术中低血压、低氧血症发生率高,术中体动次数多（P〈0.05）,对照组T2时点SBP、DBP低于同组其他时点和观察组同时点（P〈0.05）。结论利多卡因宫颈旁阻滞复合丙泊酚,可有效镇痛镇静,对呼吸循环干扰小,苏醒迅速。     

尼卡地平联合异丙酚预处理对沙鼠缺血后再灌注神经细胞凋亡的影响

目的　探讨尼卡地平联合异丙酚预处理对缺血后再灌注神经细胞凋亡的影响 ,并检测经尼卡地平和异丙酚联合预处理后的沙土鼠脑组织中抑凋亡基因Bcl 2的表达。方法　采用夹闭沙土鼠双侧颈总动脉造成脑缺血模型。 5 0只健康成年沙土鼠随机分成五组 ,每组各 1 0只 :假手术对照组 (A组 ) ;脑缺血对照组 (B组 ) ,全脑缺血 5min后再灌注 72h ;尼卡地平预处理组 (C组 ) ;异丙酚预处理组 (D组 ) ;尼卡地平联合异丙酚预处理组 (E组 )。C、D、E三组缺血前 30min分别静脉给予尼卡地平 0 2mg/kg、腹腔注射异丙酚 1 0 0mg/kg以及两者同时联合处理 ,缺血 5min后分别再灌注 72h。实验终末 ,断头取脑 ,石蜡切片 ,采用DNA末端标记技术 (TUNEL法 )观察各组脑细胞凋亡的变化情况并采用免疫组化染色评定Bcl 2蛋白反应强度。结果　E组的凋亡细胞百分数明显低于其他各组 ,而Bcl 2蛋白免疫反应强度高于其它各组(P <0 0 5 )。结论　短暂性脑缺血再灌注后有细胞凋亡发生 ,脑缺血前经尼卡地平联合异丙酚预处理后 ,能明显减少细胞凋亡的发生 ,此与Bcl 2蛋白表达增强有关。     

Acute Hyponatremia,Seizure, and Rhabdomyolysis After Ecstasy Use

Abstract

Objective.?Inhalant misuse is the intentional inhalation of volatile substances in order to obtain euphoric, disinhibiting, and exciting effects. Solvents, glues, adhesives, paints, varnishes, paint removers, dry cleaning agents, spray paints, nail polish removers, typewriter correction fluids, and aerosol propellants are common sources of volatile substance abuse. In recent years the abuse of inhalant substances, not only among those who abuse other drugs but also in teenagers and younger children, has been reported. We reviewed retrospectively the cases of inhalant misuse reported to the Spanish Poison Control Center. Methods.?Human intoxications from abuse of inhalant substances registered by our service from 1991 to 2000 were studied. Data analyzed were relative to age, gender, signs and symptoms, drug dependence antecedents, and severity of symptoms of the patients. The type of product and composition were also investigated. Results.?During the study period 109 cases of patients aged from 8 to 50 years were collected. A percentage of 36.6% was less or equal to 20 years old. Seventy percent corresponded to males. Of the patients, 11% presented dependence antecedents to other abuse drugs and 72.5% were symptomatic. In the symptomatic exposures clinical features affected the following systems: CNS (62.8%), gastrointestinal (8.1%), cardiovascular (8.1%), respiratory (2.9%), peripheral nervous system (1.1%), renal (1.1%), haematological (1.1%), hepatic (1.7%), and other (13.1%). The commercial products more frequently inhaled were solvents (34.9%) and glues/adhesives (22.9%). We noted the use of medicines with ethyl chloride–local anaesthetic (8.3%), three cases with aerosol bronchodilator (with fluorocarbons as propellants), and one case of xylazine inhalation. The composition most often involved was aromatic hydrocarbons (46.9%), halogenated hydrocarbons (16.5%), aliphatic hydrocarbons (11.4%), ketones (10.1%), local anaesthetic (ethyl chloride) (8.4%), ethers (2.5%), nitrous oxides (2.5%), and aliphatic nitrites (1.7%). The calls received were 59.6% from health care units and 22% from general public. Only 14% of cases were at home and 48% had moderate to severe clinical effects. Acute intoxications occurred in 82% of cases. Conclusions.?Inhalation of volatile substance as abuse drugs has been detected in different age groups, including very young people. Although the principal source was industrial products, the use of drugs such as local anaesthetics and aerosol broncodilators was also detected. Based on epidemiological studies in the Spanish population (essentially adolescents and childhood) together with the ability of a Poison Center to detect sentinel‐events, the community and authorities should develop strategies to prevent these exposures and the later use of other substances of abuse. In fact, recently a Law on Drug Dependences and Other Addictive Alterations has been approved in Madrid in order to take precautionary measures.     

探讨不同年龄无痛胃镜检查丙泊酚用量

目的探讨丙泊酚在不同年龄无痛胃镜检查时的用量。方法选择门诊行胃镜检查的患者120例,按年龄分为四组,Ⅰ组（18～40岁）,Ⅱ组（40～55岁）,Ⅲ组（55～70岁）,Ⅳ组（70～85岁）,每组30例。记录丙泊酚用量、MAP、HR、RR、SpO2及检查时间。结果Ⅰ、Ⅱ组MAP、HR、RR、SpO2与基础值棚比差异无统计学意义,两组丙泊酚用量差异无统计学意义。Ⅲ、Ⅳ组MAP、RR、SpO2与基础值比较有所下降,差异有统计学意义（P〈0.05）,HR变化不明显;丙泊酚用量明显比Ⅰ、Ⅱ组少,且Ⅳ组比Ⅲ组少,差异有统计学意义（P〈0．05）。结论丙泊酚在无痛胃镜检查中的用量,青壮年在2．0mg／kg以上,老年人随着年龄的增大而减少,在2.0mg/kg以下。     

丙泊酚靶控输注麻醉在瓣膜置换术中的应用

目的：比较丙泊酚靶控输注(TCI)静脉麻醉和异氟醚静吸复合全麻在瓣膜置换术中的临床效果。方法：24名患者随机分成两组。丙泊酚组(n=12)气管插管后经右颈内静脉泵入丙泊酚，靶浓度2μg／ml，体外循环(CPB)期间0．8μg／ml，CPB后1μg／ml；异氟醚组(n=12)采用大剂量芬太尼复合吸入异氟醚全麻。以收缩压(SBP)≤80％基础值为反馈指标。监测SBP、心率(HR)、中心静脉压(CVP)等指标，比较术后恢复情况。结果：两组围术期血流动力学稳定，丙泊酚组清醒快，气管导管拔除早，在抑制心肌应激方面优于异氟醚组。结论：在瓣膜置换术中应用靶控输注丙泊酚辅以喉麻和硫酸镁，可大幅减少芬太尼用量，术后恢复快，该方法值得临床推广应用。     

异氟醚和异丙酚对高血压手术患者血压的影响

目的比较异氟醚和异丙酚麻醉对高血压手术患者麻醉中的安全性和有效性。方法择期行全麻手术的高血压患者60例,ASAⅠ或Ⅱ级,随机分成I组(异丙酚组)和Ⅱ组(异氟醚组),每组30例。诱导麻醉后,Ⅰ组异丙酚TCI维持麻醉,Ⅱ组异氟醚、氧化亚氮低流量吸入维持麻醉。记录诱导前2 min(T0)诱导前(T1)、插管后5 min(T2)、麻醉30 min(T3)、术毕拔管5 min(T4)时收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)的变化。结果两组T1、T2、T3时点与T0时点比较SBP、DBP、MAP、HR都下降,以Ⅰ组下降比较明显(P0.05),但差异无统计学意义(P0.05)。Ⅰ组相对与Ⅱ组而言其苏醒时间稍长,但是其平稳性较好。结论从麻醉效果总体而言,高血压手术麻醉中应用异丙酚静脉麻醉优于异氟醚吸入麻醉。     

丙泊酚短小麻醉中患者梦境的观察

目的探讨丙泊酚短小麻醉患者梦境发生率、梦的特征,以及对患者麻醉满意度和情绪的影响。方法选择ASAI~II级无痛胃镜检查患者160例,静脉推注丙泊酚复合小剂量芬太尼,待患者睫毛反射消失,OAA/S评分0分时开始进镜。检查结束后待患者苏醒、OAA/S评分达5分时开始问卷调查,内容包括Brice问卷表、麻醉满意度视觉模拟评分(VAS)、焦虑视觉模拟评分(AVAT)等。结果梦境发生率为49.7%。大多数患者的梦境都是令人愉快、生动、不陌生的。做梦者和未做梦者麻醉恢复时间差异有统计学意义(P<0.05),VAS和AVAT评分差异无统计学意义(P>0.05)。结论丙泊酚短小麻醉中患者梦境发生率高。梦境大多给患者带来愉快的、无害的体验。梦的性质与生理状态下相似。做梦与否并不影响患者对麻醉的满意度,也不会产生焦虑的负面情绪。     

丙泊酚和芬太尼静脉麻醉在肩周炎治疗中的应用

目的:比较丙泊酚和芬太尼静脉麻醉在肩周炎粘连松解术中的应用。方法:肩周炎患者300例,分成B、F两组,B组仅用丙泊酚,F组使用丙泊酚和芬太尼。分别记录各组患者从注药到睫毛反射消失时间、呼之睁眼时间、能回答问题时间、术后VAS评分。结果:F组患者的呼之睁眼时间及能回答问题时间均长于B组,差异有显著性。F组和B组的睫毛反射消失时间、VAS评分差异无显著性。结论:在静脉麻醉下进行肩关节粘连松解术,使用芬太尼并不能减少术后患者的疼痛程度,反而延长了术后唤醒的时间。     

The use of propofol for sedation of critically ill patients undergoing haemodiafiltration

Objective To assess the requirement for propofol to provide sedation in critically ill patients in established renal failure during the commencement of haemodiafiltration.Design Prospective clinical study.Setting ICU, University Hospital.Patients 10 adult patients. All were mechanically ventilated, had acute oliguric renal failure which necessitated continuous veno-venous haemodiafiltration and were receiving a continuous intravenous infusion of propofol for sedation. Sedation was assessed using a scoring system.Intervention Veno-venous haemodiafiltration.Measurements and results Connection of the extracorporeal circuit produced a reduction in plasma propofol concentration in 7 out of 9 patients (one sample misplaced) with subsequent awakening in 3 of these 7 patients. The commencement of haemodiafiltration itself did not significantly influence the requirement for propofol (8 out of 10 patients).Conclusion Haemodiafiltration does not substantially influence the requirement for propofol but the initial introduction of the extracorporeal circuit will reduce plasma concentrations in the majority of patients. This may be due to haemodilution alone or absorption of plasma albumin (with propofol) onto the membrane.     

Types of abuse

The four most common types of abuse are physical, sexual, emotional, and economic. Abuse is often further categorized into child abuse, intimate partner violence, and elder abuse. This article describes the important role that nurses and health care providers play in detecting, assessing, and reporting abuse. Armed with increased knowledge about signs and symptoms of abuse, nurses can guide patients to the appropriate resources.     

The use of propofol sedation in a paediatric intensive care unit

Background: The aim of this study was to prospectively evaluate and report the experience of the use of continuous intravenous propofol sedation in a paediatric intensive care unit (PICU). Methods: All children younger than 16 years who were admitted to the PICU at a University Hospital for slightly more than a year and received propofol infusion were included prospectively and data were recorded before and within 6 h after completion of the propofol infusion. Results: A total of 174 out of 955 children (18·2%) received propofol infusion for sedation. The median age was 2 years 10 months (range: 2 months to 16 years), duration of propofol infusion 13 h (range: 1·6–179 h) and dose of propofol 2·9 mg/kg/h (range: 0·3–6·5 mg/kg/h). No one developed signs of the propofol infusion syndrome (PRIS). Neither dose >3 mg/kg/h, duration of infusion >48 h nor both were found to be related to adverse metabolic derangements or circulatory failure. Eight children increased their lactate concentration ≥1·8 mmol/L during propofol infusion. All had a favourable outcome. One child who had received propofol infusion for 10 h died, but this occurred 14 h after the infusion ceased and was without doubt attributed to a multiple organ failure not related to the propofol infusion. Conclusion: Propofol infusion was used in this population at low risk of PRIS with no metabolic or circulatory adverse effects. These findings indicate that the occurrence of adverse effects may not be directly related to dose or duration of infusion, but emphasizes the risk that sporadic factors may be involved, such as genetic mutations. Guidelines are presented.     

瑞芬太尼复合静脉麻醉与异氟醚静吸复合麻醉的比较

目的:研究瑞芬太尼复合异丙酚全凭静脉麻醉与异氟醚静吸复合全身麻醉对患者气管插管及苏醒期血流动力学变化和拔管条件的影响.方法:60例择期全麻手术的患者随机分为瑞芬太尼+异丙酚静脉麻醉(R)组和异丙酚+异氟醚静吸复合麻醉(C)组,每组30例.观察麻醉诱导、气管插管及术后恢复过程的血压、心率.记录术毕停药后病人清醒时间、拔管时间,记录病人拔管后即刻、离开手术间及术后3和24 h疼痛评分(VRS).观察恶心、呕吐等副反应.结果:麻醉诱导后气管插管1～5 min内血流动力学变化幅度R组明显小于C组(P＜0.05);术后清醒时间及拔管时间R组早于C组(P＜0.05),并且恶心、呕吐发生率低;术后VRS评分R组高于C组.结论:瑞芬太尼复合异丙酚静脉麻醉在气管插管和麻醉苏醒期的血流动力学稳定,拔管条件优,并发症少,但应注意尽早实施术后镇痛.