复方利多卡因乳膏气管内麻醉用于腭咽成形术的临床观察

【摘要】 目的 观察复方利多卡因乳膏用于腭咽成型术术中及术后保留气管导管患者的临床效果。方法：选择60例接受腭咽成型术患者（ASA II-III级）,随机分为观察组（复方利多卡因组）和对照组（石腊油组）各30例,2组均采用丙泊酚和芬太尼诱导及维持麻醉,监测围术期血压、心率、血氧饱和度（Sp02）及体征的变化。结果：观察组气管导管耐受性优于对照组,包括血压、心率波动和肢动,皱眉、吞咽和呛咳反应频率显著降低（P<0．05）。结论：复方利多卡因乳膏用于气管内麻醉可显著减轻腭咽成型术患者术中及术后血流动力学反应,气管插管耐受良好。     

SLIPA喉罩与气管插管在颅内动脉瘤栓塞术中的应用观察

目的比较SLIPA喉罩与气管插管用于颅内动脉瘤栓塞术时血压、心率的影响。方法择期行颅内动脉瘤栓塞术患者62例,随机分为SLIPA喉罩组和气管插管组。记录麻醉诱导前(T0)、麻醉诱导后(T1)、喉罩置入或气管插管后即刻(T2)、插入后5min(T3)、拔除喉罩或气管导管即刻(T4)、拔除后5min(T5)各时点血压、心率的变化;记录患者拔管时呛咳、躁动以及咽痛等并发症的发生情况。结果喉罩组围术期血压、心率平稳,气管插管组T2～T5时血压、心率均显著高于喉罩组,差异有统计学意义;拔管时呛咳、躁动以及咽痛等并发症均显著高于喉罩组,差异有统计学意义。结论喉罩通气操作简单,刺激小,通气可靠,术中血压、心率平稳,且不良反应少,可安全用于颅内动脉瘤栓塞术。     

喉罩与气管导管全麻应用于小儿腹腔镜疝修补术中的效果对比

目的 比较分析喉罩与气管导管全麻应用于小儿腹腔镜疝修补术中的效果.方法 选取我院收治的腹腔镜腹股沟斜疝修补术患儿82例作为研究对象,随机分为观察组和对照组,观察组置入喉罩,对照组置入气管导管,比较两组围术期血流动力学及并发症发生率.结果 观察组各时点收缩压、舒张压及心率的波动不大(P>0.05),而对照组在置入气管导管(T1)和拔除气管导管(T2)时的收缩压、舒张压及心率均有较大波动(P<0.05).观察组并发症总发生率低于对照组并(P<0.05).结论 与传统气管插管相比,喉罩全身麻醉应用于小儿腹腔镜疝修补术中对血压及心率的影响较小,能够有效维持血流动力学的稳定,且并发症发生率更低,安全可靠.     

欧普乐喉罩在乳腺癌根治术病人全身麻醉中的应用

目的比较气管插管或放置欧普乐喉罩全身麻醉下行乳腺癌根治术对血流动力学的影响,探讨欧普乐喉罩(Oro-Pharyngeal Airway CapOPLAC)在乳腺手术全麻中的应用。方法选择ASAⅠ-Ⅱ级择期乳腺手术患者60例,随机分为欧普乐喉罩组(H组)和气管导管组(Q组),每组30例,记录每组麻醉诱导前(T0),麻醉诱导后(T1),气管导管/喉罩置入即刻(T2),气管导管/喉罩置入后5min(T3),气管导管/喉罩拔出即刻时(T4)的心率(HR)、血压(收缩压/舒张压)。结果气管导管组在T2、T4时的心率、血压均明显高于欧普乐喉罩组。结论欧普乐喉罩置入简便,放置、拔出时应激反应轻,,血流动力稳定,在乳腺癌根治术病人全身麻醉值得推广。     

硬膜外阻滞复合全麻在老年人上腹部手术中的应用观察

目的:探讨硬膜外阻滞复合全麻在老年人上腹部手术中应用的有效性及安全性。方法:46例患者随机分为单纯全麻组(A组)和全麻复合硬膜外阻滞组(B组)。分别记录围手术期血压、心率、全麻用药量、术毕至苏醒拔出气管导管时间及术后躁动情况。结果:两组年龄、性别、体重、手术时间、手术方式差异无统计学意义。血压、心率、麻醉用药量、术毕至苏醒拔出气管导管时间及术后躁动情况两组间差异有显著性(P<0.05)。结论:硬膜外阻滞复合全麻可以有效、安全地在老年人上腹部手术中应用。     

低剂量右美托咪定对全麻高血压手术患者血流动力学和麻醉效果的影响

目的探讨分析低剂量右美托咪定对全身麻醉高血压手术患者的血流动力学及术后麻醉效果的影响。方法选择2014年2月至2015年1月择期在全麻下行腹部手术的患者60例,随机分为观察组和对照组,每组30例,均采用静吸复合全身麻醉。观察组给予静脉泵入右美托咪定0.3μg/(kg·h),对照组给予相等量的0.9%生理盐水泵入。分别观察注药前(T0)、气管插管前1 min(T1)、气管插管时(T2)、气管插管后1 min(T3)、拔管前1 min(T4)、拔管后1 min(T5)时的血压、心率(HR)、术后镇静评分Ramsay及不良反应。结果两组患者手术时间、术中出血量等一般情况,以及拔管时间、麻醉时间、苏醒时间和不良反应发生率比较差异无统计学意义(P>0.05)。观察组患者T1~T5时的血压及心率比T0时明显下降,差异有统计学意义(P<0.05);对照组患者T1时的血压、心率较T0时明显下降,但T2~T5时血压及心率较T0时升高(P<0.05)。两组患者T0、T1时血压、心率比较差异无统计学意义(P>0.05),但观察组T2~T5时血压、心率低于对照组(P<0.05),T1~T5时RSS评分高于对照组(P<0.05)。结论低剂量右美托咪定对全身麻醉的高血压患者可产生明显的镇静、镇痛效应,有助于保持血流动力学稳定。     

喉罩替代气管导管对腹腔镜手术围拔管期应激反应的影响

目的 探讨全麻腹腔镜手术即将结束麻醉深度减浅前,喉罩替代气管导管通气预防围拔管期应激反应的效果.方法 选择择期行全麻腹腔镜手术患者60例,随机分为更换喉罩组(A组,30例)和继续保留气管导管组(B组,30例).记录每组患者入室诱导前(T0)、减浅麻药前(T1)、停药后3 min (T2)、5 min (T3)、拔除气管导管或喉罩时(T4)、拔除气管导管或喉罩后3 min (T5)、5 min (T6)的BP、HR、SpO2和PET CO2,并计算各时点心肌耗氧间接指标(RPP,收缩压与HR的乘积)及采集各时间点外周静脉血检测血糖及血浆皮质醇水平;A组记录麻醉深度减浅前即拔管前(t1)、拔管时(t2)、插入LMP时(t3)的HR、BP变化;观察围拔管期两组患者呛咳和躁动发生情况及术后1天咽部不适的发生率.结果 A组在更换喉罩期间,血流动力学平稳;T2、T3、T4、T5时,B组的SBP、DBP、HR、RPP及血糖和血浆皮质醇均明显高于T0时,差异有统计学意义(P＜0.05),而A组的相应各指标波动不明显(P＞0.05),且两组间比较差异有统计学意义(P＜0.05);在各时间点,两组患者SpO2、PET CO2差异无统计学意义(P＞0.05).围拔管期,B组呛咳、躁动及术后咽部不适的发生率均高于A组(P＜0.05).结论 全麻腹腔镜手术手术即将结束麻醉深度减浅前,拔除气管导管、更换喉罩通气预防围拔管期过度应激反应,安全有效.     

高血压病人术毕喉罩通气替换气管导管的临床观察

目的比较高血压病人全麻术后,拔除气管导管置入喉罩,与保留气管导管,预防心血管反应的效果。方法选择择期高血压全麻手术病人40例,ASA分级II~III。术毕停止给麻药前将气管导管拔出,插入普通型喉罩为喉罩通气组（L组n=20）和继续保留气管导管通气组（T组n=20）。记录每组病人入室诱导前,停止麻醉前,停药后1、3、5min,拔管或喉罩时,拔管或喉罩后1、3min的心率,血压、RPP。L组记录拔管前、拔管后插入LMP即刻、插入LMP后心率、血压。比较两组病人麻醉诱导期和苏醒期高血压、心率、呛咳、躁动的发生及情况。结果 L组在术毕拔出气管导管置入喉罩期间,血流动力学平稳。TT组与诱导前比较在停止麻醉后1、3、5min拔管时,拔管后1、3minBP、DP、HR、RPP升高（P〈0.05）。L组与诱导前比较在停止麻醉后1、3、5min,拔除后1、3min,BP,HR,RPP,无统计学差异（P〉0.05）,与T组比较有统计学差异（P〈0.05）。结论高血压病人全麻术毕后,喉罩通气替代气管导管发生高血压、呛咳、躁动等不良反应的几率降低,有利于血流动力学的稳定。     

心理干预对全麻患者苏醒期气管拔管时合作程度的影响（附40例分析）

目的观察术前心理干预对接受气管内全麻患者在苏醒期气管拔管时合作程度的影响。方法选择拟行气管内全麻下进行乳癌根治术的成年患者40例(ASAⅠ~Ⅱ级),随机分为两组,即观察组和对照组,每组20例。对照组常规进行麻醉前访视和会诊。观察组在手术前一天由麻醉医师和手术室护士进行术前访视及心理准备,系统讲解此类手术特点和麻醉相关知识;在手术当日麻醉前30分钟再次对观察组患者进行麻醉苏醒期相关知识宣教;重点观察患者在麻醉苏醒期及气管导管拔出前后是否合作及合作程度,手术后24小时随访。结果在麻醉苏醒期及气管导管拔出前后观察组患者合作程度评分明显高于对照组(P<0.05);患者对麻醉过程满意度,观察组明显高于对照组(P<0.05)。结论术前心理干预可以提高气管内全麻患者苏醒期气管拔管时的合作程度。     

光棒导索芯引导下更换双腔气管导管临床效果观察

目的:观察开胸手术术毕,利用光棒装置中导索芯引导将双腔气管导管更换为单腔气管导管的临床效果。方法:开胸手术患者86例,随机分为两组:喉镜组40例,导索芯组46例,并记录以下数据:换管前1 min(T1)、双腔气管导管拔出时(T2)、喉镜或导索芯经口插入时(T3)、单腔气管导管插入气管时(T4)、成功插入后3 min(T5)的收缩压(SBP)、舒张压(DBP)和心率(HR);导管更换时间;术后48 h随访咽痛、声音嘶哑、插管创伤的发生率。结果:T3时喉镜组与导索芯组SBP,DBP,HR比较,差异有统计学意义(P<0.05);T3与T2比较,喉镜组SBP,DBP,HR有统计学意义(P<0.05),而导索芯组差异无统计学意义(P>0.05),两组导管更换时间差异无统计学意义(P>0.05),术后24 h咽痛、声音嘶哑发生率,导索芯组较喉镜组低(P<0.05)。喉镜组发生2例插管创伤导致出血,喉镜组3例插管2次,而导索芯组均一次性成功。结论:利用光棒导索芯引导更换双腔气管导管,不仅具有安全、损伤小、廉价和血流动力学稳定等优点,而且术后气道并发症少。     

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.     

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.     

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.