地氟醚、异氟醚和氟烷通过膜式氧合器应用的药代动力学研究

选择10例行心脏瓣膜置换手术的成年患者,心肺转流术（CPB）开始后通过氧合器应用地氟醚、异氟醚和氟烷。结果在摄取与排出阶段,三种药物的动脉血麻醉药分压（Pa）、静脉血麻醉药分压（Pv）变化速率在各个时间点比较均有显著性差异（P〈0．05）,动脉血分压、静脉血分压与排出气分压的关系均有良好的相关性．但以动脉血分压的相关性更好。Bentley膜式氧合器具有快速转运吸入麻醉药的性能;地氟醚、异氟醚和氟烷通过氧合器应用后摄取和排出速率随药物血／气分配系数的增高而减慢;通过监测氧合器排气口中吸入麻醉药分压可以快速、准确地估计血液中吸入麻醉药分压。     

体外循环主动脉阻断前后心室颤动原因和预防方法的探讨

对180例体外循环手术患者进行观察,发现在阻断循环前后易引起心室颤动(简称室颤)的原因有,预充液温度>血温10℃,含钾浓度过高或过低;预充液及患者血的pH值<7.35;部分转流时静脉引流过多;血流降温过快;心停跳液温度高及灌注速度慢等。预防室颤发生的方法有:预充液温度在30℃左右,pH7.45,钾4mEq左右;经动脉管先灌注100～150ml预充液,再部分转流,腔静脉引流逐渐增加;鼻咽温30℃左右时阻断循环;冷停跳液快速灌注。     

不同浓度异氟烷吸入对大鼠炎症反应的影响

目的探讨吸入不同浓度异氟烷对大鼠肺脏炎性因子水平及其基因表达的影响。方法将32只Wistar大鼠随机分为对照组及异氟烷1—3组各8只,各组均吸入40％O2,在此基础上异氟烷1—3组分别吸入0．7％、1．5％、2．0％的异氟烷。实验8h时测定各组肺组织IL—1βmRNA和IL-10mRNA表达和支气管肺泡灌洗液（BALF）中IL-1β和IL—10水平。结果异氟烷2组BALF中IL-1β和IL-10及肺组织中IL-1βmRNA和IL-10mRNA表达显著高于对照组和异氟烷、3组（P均〈0．05）。结论吸入1．5％的异氟烷可上调大鼠肺脏炎性因子水平及其基因表达,吸入2．0异氟烷则对上述指标无明显影响;此为临床应用异氟烷提供了理论依据。     

异氟醚和七氟醚对脑缺血再灌注损伤大鼠大脑皮层诱发电位的影响

目的 探讨异氟醚和七氟醚对脑缺血再灌注损伤大鼠大脑皮层诱发电位( CSEP)的影响.方法 选择健康Wistar大鼠54只,随机分为对照组、异氟醚组、七氟醚组各18只,分别给予900 mL/L O2、1倍最低肺泡有效浓度(1 MAC)的异氟醚(15 mL/L异氟醚+900 mL/L O2)、1 MAC的七氟醚(24 mL/L七氟醚+900 mL/L O2)预处理1.5h.各组随机抽取10只采用线栓法制备大鼠大脑中动脉阻闭模型,阻闭2h后恢复再灌注,48 h后记录各组大鼠CSEP.其余8只行股动脉穿刺置管,预处理前后检测平均动脉压(MAP)和血气分析.结果 各组预处理前MAP和血气分析比较均无统计学意义;异氟醚组MAP及七氟醚组PaCO2、PaO2预处理前后比较有统计学意义(P均＜0.05).与对照组比较,异氟醚组、七氟醚组CSEP正、负波潜伏期均明显缩短(P均＜0.05),峰峰值明显升高(P均＜0.05).结论 七氟醚和异氟醚均能明显减轻大鼠脑缺血再灌注损伤,改善大脑皮层的电生理功能状态.     

吸入不同浓度异氟烷对大鼠肺脏肿瘤坏死因子-α表达的影响

目的探讨大鼠自主吸入异氟烷对肺脏肿瘤坏死因子-α(TNF-α)表达的影响。方法2005年2月至12月北京大学人民医院将实验用Wistar大鼠随机分为空气对照组(C组)、氧气对照组(O2C组)、0·7%和1·5%异氟烷吸入组,O2C组及异氟烷组又分为吸入4h、8h、吸入8h停药2h亚组。采用分子生物学方法测定TNF-α浓度及其基因表达和肺组织髓过氧化物酶(MPO)含量。结果各组间MPO含量差异无统计学意义(P(0·05)。1·5%异氟烷组吸入4h和8h后支气管肺泡灌洗液(BALF)中TNF-α浓度及肺组织TNF-α信使核糖核酸(TNF-αmRNA)均高于C组(P<0·05),停药2h恢复。吸入异氟烷4h和8h时,1·5%异氟烷组BALF中TNF-α浓度和肺组织TNF-αmRNA表达高于O2C组(P<0·05),与0·7%异氟烷组相比差异无统计学意义(P(0·05)。结论吸入较高浓度的异氟烷可逆性的增加大鼠肺脏TNF-α表达,但不会造成中性粒细胞的聚集。     

异氟醚间断预处理对非停跳冠状动脉移植患者的心肌保护作用

目的:在非停跳冠状动脉移植术(OPCABG)患者中,比较异氟醚间断预处理与丙泊酚持续静脉麻醉,对患者血流动力学及cTnI和CK-MB的影响情况。方法:本研究为随机-对照前瞻性临床研究。入组患者随机分为持续丙泊酚麻醉组(P组,n=30)和间断异氟醚预处理静吸复合组(Iso组,n=30)。P组中,术中持续静脉输注丙泊酚3～5 mg·kg~(-1)·h~(-1)维持麻醉深度。Iso组中,于切皮前5 min,间断吸入洗出1MAC异氟醚2次循环。术中常规时刻点记录血流动力学指标(平均动脉压、中心静脉压、体循环阻力和心率等)。在术前和术后留取患者血样监测心肌损伤指标(cTnI和CK-MB)。结果:所有入组患者均成功完成手术,术后未发生严重的不良反应;丙泊酚组和异氟醚间断吸入预处理组患者的基本资料以及各指标、参数的基线值均不存在明显的统计学差异(P>0. 05);两组患者基础cTnI和CK-MB比较,差异无统计学意义(P>0. 05)。结果提示,两组患者的cTnI和CK-MB在术后都明显升高,峰值出现在术后4 h。在术后4 h,Iso组患者血样中的cTnI和CK-MB值明显低于P组(P<0. 05)。结论:在OPCABG术中使用异氟醚间断预处理降低了cTnI和CK-MB的表达,减轻了患者的心肌损伤。     

N_2O对地氟醚摄取及排出影响的研究

目的观察氧化亚氮（N2O）对地氟醚摄取和排出的影响,探讨第二气体效应及反第二气体效应。方法将24例ASAⅠ~Ⅱ级全麻患者随机均分为3组,A组为O2（3 L/min）＋4%地氟醚;B组为O2（1 L/min）＋N2O（2 L/min）＋4%地氟醚;C组是在O2（1 L/min）的吸入达平衡后再复合吸入4%地氟醚。监测3组地氟醚在20 min吸入过程中的呼气末浓度（FA）和吸入浓度（FI）。20 min后,再将B组分为2个亚组,B1组停止吸入地氟醚,B2组同时停止地氟醚与N2O,O2的流量由1 L/min改为3 L/min,监测地氟醚洗出时2组的吸入气体在90 s中的FA,计算FA/FA0（FA0为开始停止吸入气体时地氟醚的FA）。结果吸入3 min之后,A组地氟醚的FA/FI低于B、C组,而后两者间无差异。B1、B2组洗出时地氟醚的FA/FA0在90 s过程中始终无差异（P〉0.05）。结论在3 min以后表现出第二气体效应,但并未出现反第二气体效应。     

吸入不同麻醉剂对上腹部手术支气管哮喘患者围麻醉期呼吸动力学的影响

目的观察吸入不同麻醉剂对行上腹部手术支气管哮喘患者围麻醉期呼吸力学特性的影响。方法63例择期行上腹部手术患者随机分为A、B、C组,各21例,均在以相同方式麻醉诱导后,分别以异氟醚、地氟醚、七氟醚维持麻醉。分别于插管后（T1）、手术开始时（T2）、术中60min时（,13）、手术结束时（T4）,测量患者呼吸道静态顺应性（Cst）、气道峰压、平台压（PpIat）和平均气道压（Pawn）以及动脉血气变化。结果A、B组T3、T4时呼吸道Cst、气道峰压、PpIat和Pawn明显高于T1时和C组T4时（P均〈0．05）。三组各时点血气分析结果无显著差异。结论七氟醚对行上腹部手术支气管哮喘患者围麻醉期患者呼吸力学影响最小;吸入麻醉药对三组患者动脉血气指标均无影响。     

异丙肾上腺素对异氟醚犬心血管效应的影响

目的 :探讨异丙肾上腺素 （ ISP）对异氟醚的心血管效应的影响。方法 :本实验分为异氟醚低浓度 [0 .85 % ,0 .6MAC（最小肺泡有效浓度 ） ]和高浓度 （ 1.70 % ,1.2 MAC）两部分。每部分实验选择 3 2只健康杂种犬 ,随机分为 4组（每组 8例 ） :对照组 ,异氟醚组 ,ISP组和 ISP+异氟醚组。监测有创动脉血压、肺动脉压、肺动脉楔嵌压、中心静脉压、心排出量和心率。记录上述参数在用药 2 0 m in后的变化。结果 :在硫喷妥钠麻醉犬上静脉滴注 0 .0 2 μg· kg- 1· min- 1 的 ISP和 0 .6MAC及 1.2 MAC异氟醚的心血管效应之间均没有交互作用。结论 :ISP对临床浓度的异氟醚的心血管效应没有显著影响。目的 :探讨异丙肾上腺素 （ ISP）对异氟醚的心血管效应的影响。方法 :本实验分为异氟醚低浓度 [0 .85 % ,0 .6MAC（最小肺泡有效浓度 ） ]和高浓度 （ 1.70 % ,1.2 MAC）两部分。每部分实验选择 3 2只健康杂种犬 ,随机分为 4组（每组 8例 ） :对照组 ,异氟醚组 ,ISP组和 ISP+异氟醚组。监测有创动脉血压、肺动脉压、肺动脉楔嵌压、中心静脉压、心排出量和心率。记录上述参数在用药 2 0 m in后的变化。结果 :在硫喷妥钠麻醉犬上静脉滴注 0 .0 2 μg· kg- 1· min- 1 的 ISP和 0 .6MAC及 1.2 MAC异氟醚的心血管效应之间均没有交互     

七氟醚吸入和丙泊酚靶控输注对老年冠心病患者全麻诱导期血流动力学及HRV的影响

老年冠心病患者心血管系统的调节能力较差,在麻醉诱导时,手术应激反应非常明显,容易发生心脑血管意外.如何使老年冠心病患者在手术过程中安全渡过麻醉关,是临床工作中的重要问题[1].七氟醚具有血/气分配系数小、麻醉诱导过程迅速、平稳、不刺激呼吸道、抑制循环系统轻微等特点,且只要术前访视告知七氟醚的特殊气味,使其做好心理准备,仍有大部分成年患者愿意选择吸入诱导,但不能忽视其对心脏的抑制作用[2,3].丙泊酚是目前应用最为广泛的静脉麻醉药,但可引起循环抑制、血压下降、丙泊酚靶控输注,能够维持适宜的麻醉深度,保持血流动力学稳定,抑制气管插管引起的应激反应[4].     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.