持续静脉泵入呋塞米对严重心力衰竭患者利尿效果的观察

目的：观察比对呋塞米持续静脉泵入与间断静脉注射对严重心力衰竭患者的利尿效果。方法在常规抗心衰治疗的基础上,观察分析42例NYHA心功能IV级患者,分为持续静脉泵入呋塞米组（观察组）21例和间断静脉注射呋塞米组（对照组）21例,2组使用呋塞米剂量相同,监测每日尿量。结果观察组治疗后尿量多于对照组（ P＜0．05）。结论持续静脉泵入呋塞米治疗严重心力衰竭,利尿效果明显优于间断静脉注射法。     

托拉塞米在肾移植病人围手术期的应用

目的:通过对比托拉塞米与呋塞米的利尿作用,探讨托拉塞米在肾移植病人围手术期中的应用价值。方法:肾移植术后病人52例,分为2组。托拉塞米组26例,男性16例,女性10例,年龄(31±s 10)a,围手术期中应用托拉塞米100 mg+氯化钠注射液500 mL,iv,qd;呋塞米组26例,男性15例,女性11例,年龄(29±9)a,围手术期中应用呋塞米400 mg·d~(-1)+氯化纳注射液500 mL,iv,qd。2组均治疗7 d为一个疗程。观察手术前和术后每日尿钾、钠及血钾、钠的含量,血压、血肌酐和24 h尿量变化情况。监测2组病人环孢素全血谷值血药浓度。结果:手术后托拉塞米组24 h尿钠、血钠含量和血肌酐与呋塞米组比较,无显著差异(P>0.05)。托拉塞米组血钾的含量和24 h尿量高于呋塞米组,差异非常显著(P<0.01)。呋塞米组24 h尿钾含量高于托拉塞米组,差异非常显著(P<0.01)。2组血压和环孢素全血谷值血药浓度比较无显著差异(P>0.05)。不良反应发生率托拉塞米组8%(2/26),呋塞米组69%(18/26),差异非常显著(P<0.01)。结论:托拉塞米具有排钠又相对保钾的作用,在增加病人尿量的同时不影响环孢素全血谷值血药浓度,减少了肾移植病人不良反应的发生,是一种比呋塞米更加适合肾移植围手术期利尿药物。     

随机对照观察托拉塞米片治疗水肿性疾病的疗效和安全性

目的观察国产托拉塞米片在水肿性疾病中的利尿效果及安全性。方法采用随机、双盲、多中心对照研究方法。国产托拉塞米片与呋塞米片的用药剂量比为1∶2。结果共观察了214例肾病水肿、心力衰竭和肝硬化腹水患者,其中托拉塞米组106例,呋塞米组108例。用药前托拉塞米组和呋塞米组尿量分别为(1 067.1±514.5)和(1 111.8±528.0)mL.d-1(P=0.428),用药后d 3尿量即增至(1 714.7±760.4)和(1 566.0±643.3)mL.d-1(与用药前比较,P均<0.01);2组利尿有效率分别为90.0%和86.5%(P=0.443)。同时2组患者用药后体重、腹围也显著降低(P<0.05),心力衰竭患者在用药后心功能也得到一定程度改善。血清电解质紊乱是2组患者主要的不良事件,发生率分别达11.3%和10.2%,但没有见到严重不良事件发生。结论国产托拉塞米片治疗水肿性疾病利尿效果显著,不良反应较小,与呋塞米片无显著差异。     

小剂量呋塞米持续静脉泵入联合甘露醇在难治性肝硬化腹腔积液合并低钠血症患者治疗与护理中的应用

目的 探讨持续静脉泵入小剂量呋塞米（速尿）联合甘露醇对难治性肝硬化腹腔积液的疗效.方法 选择2009年7月-2013年3月我院收治的顽固性肝硬化腹腔积液患者58例,将患者随机分为对照组和治疗组,各29例.对照组给予常规治疗基础上每天单次或分次静脉注射呋塞米160mg＋甘露醇125ml,缓慢2h静脉滴注;治疗组在常规治疗的基础上联合小呋塞米持续静脉泵入＋甘露醇125ml,缓慢2h静脉滴注.连续应用14d进行总的疗效判定.结果 治疗14d后,治疗组显效20例,有效5例,无效4例,总有效率 86.21%.对照组显效10例,有效6例,无效13例,总有效率为55.17%.治疗组总有效率高于对照组,差异有统计学意义（P＜0.05）.结论 在常规治疗基础上小剂量呋塞米＋甘露醇对存在利尿剂抵抗的难治性肝硬化腹腔积液疗效显著.     

小剂量呋塞米持续静脉泵入联合小剂量甘露醇治疗难治性肝硬化腹腔积液的疗效观察

目的 探讨持续静脉泵入小剂量呋塞米联合甘露醇治疗难治性肝硬化腹腔积液的疗效.方法 选择2009年1月-2013年1月本院收治的顽固性肝硬化腹腔积液患者58例,将患者随机分为治疗组和对照组,每组29例.治疗组在常规治疗的基础上联合小呋塞米持续静脉泵入＋甘露醇125ml,2～3h内静脉滴注;对照组常规抗治疗基础上每天单次或分次静脉注射呋塞米160mg＋甘露醇250ml,2～3h内静滴.每7d观察一次腹腔积液变化,连续应用14d进行总的疗效判定;观察两组治疗后临床效果.结果 治疗14d后,治疗组显效22例,有效5例,无效4例,有效率 86.21%; 对照组显效10例,有效6例,无效13例,总有效率为55.17%.两组比较差异有统计学意义（P＜0.05）.结论 在常规治疗基础上,小剂量呋塞米联合甘露醇对存在利尿剂抵抗的难治性肝硬化腹腔积液疗效显著.     

大剂量呋塞米微泵连续输注治疗急性肾功能衰竭的疗效观察和护理

目的探讨大剂量呋塞米微泵连续输注治疗急性肾功能衰竭少尿期的临床疗效。方法将76例急性肾功能衰竭的患者采用随机数字表分为两组,微泵维持组(A组)和分次静脉注射组(B组),A组予呋塞米200mg加生理盐水至50mL,采用微泵5～10mL/h速度静脉内维持,B组予呋塞米5～10mg/(kg·d)分4次/d静脉注射。分别观察两组治疗后的疗效、治疗后第1天每2h尿液流量及治疗时低血压的发生率和治疗后需要行透析治疗的例数。结果 A组利尿效果明显优于B组;每2h尿液流量A组明显比B组平稳;低血压的发生率A组低于B组;需要行透析的例数A组明显少于B组。结论大剂量呋塞米微泵连续输注治疗急性肾功能衰竭的利尿效果明显优于传统的分次静脉推注,缩短了急性肾功能衰竭的少尿期,遏制了急性肾功能衰竭的发展,提高了危重症的抢救成功率,值得推广。     

瓣膜置换术后持续静脉微量注射呋塞米疗效观察

目的：观察对比瓣膜置换术后患者持续静脉微量注射呋塞米或间断注射呋塞米的疗效,及呋塞米剂量和对血脑钠肽浓度的影响。方法：126例瓣膜置换患者随机分为观察组与对照组,观察组63例持续微量注射呋塞米,对照组63例间断注射呋塞米。根据常规术后处理,保持合理尿量和血液动力学指标水平,比较两组患者平均每日呋塞米总剂量,记录术后4,12 h尿量,测定两组术前和术后第3天血脑钠肽浓度。结果：观察组呋塞米日剂量低于对照组（P〈0.05）;两组均未发生严重不良反应（P〉0.05）;两组术前术后血脑钠肽浓度差异无统计学意义（P〉0.05）;观察组术后4,12 h尿量均明显高于对照组（P〈0.05）,两组术后24 h尿量差异无统计学意义（P〉0.05）。结论：瓣膜置换术后患者持续静脉微量注射呋塞米可减少呋塞米用量,利尿效果优于间断注射呋塞米,且不影响血脑钠肽浓度,无严重并发症。     

呋噻米治疗难治性充血性心力衰竭疗效评价

晚期心力衰竭患者出现严重水钠潴留,不同种类利尿剂合用和(或)大剂量呋噻米应用可增加利尿效应[1],部分患者效果仍差.等剂量的呋噻米持续静脉滴注较静脉注射在体内及肾小管内维持更长时间的高水平,利尿效应强于静脉注射[2,3].本研究旨在介绍静脉注射呋噻米效果欠佳时静脉滴注呋塞米的方法和临床效果.     

托拉塞米与呋塞米治疗儿童肾病综合征伴高度水肿的疗效评价

目的:观察托拉塞米与呋塞米治疗儿童肾病综合征引起水肿的临床疗效。方法:选取54例儿童肾病综合征患儿,将54例患儿分为托拉塞米组、呋塞米加口服补钾组、呋塞米组各18例。三组患儿在激素及一般治疗的基础上,托拉塞米组给予静脉注射托拉塞米1 mg/(kg·d),每次不超过20 mg;呋塞米加口服补钾组给予静脉注射呋塞米2 mg/(kg·d),每次不超过40 mg,并口服补钾;呋塞米组给予静脉注射呋塞米2 mg/(kg·d),每次不超过40 mg。三组患儿分别于治疗前1 d、治疗后每天记录24 h尿量,治疗前及治疗后第4天抽外周血查电解质的变化情况,并记录不良反应。结果:三组患儿治疗后尿量较治疗前均显著增多,但治疗后前3 d平均尿量三组比较差异无统计学意义(P>0.05);呋塞米组治疗后第4天血钾浓度较其余两组降低明显(P<0.05);托拉塞米组和呋塞米加口服补钾组患儿治疗后第4天血钾浓度比较差异无统计学意义(P>0.05)。结论:临床上对于儿童肾病综合征引起的水肿应用托拉塞米或呋塞米治疗效果显著。应用呋塞米时同时口服补钾可减轻其致低血钾的不良反应。     

持续静脉微量注射呋塞米对严重充血性心力衰竭患者治疗效果

目的观察对比持续静脉微量注射呋塞米对严重充血性心力衰竭（CHF）患者疗效是否优于传统的间断注射疗效。方法在常规防重构、强心、扩血管的基础上,观察分析72例NYHA心功能Ⅲ-Ⅳ级患者,分为持续静脉微量注射呋塞米组（观察组）35例和间断注射呋塞米组（对照组）37例,两组使用呋塞米剂量大致相同,比较两组治疗前后尿量、血压波动、血液电解质浓度、超声心动图心功能指标、症状缓解时间和水肿消退时间的差别。结果观察组治疗后尿量多于对照组,心功能指标FS和LVEF改善显著优于对照组,症状缓解时间和水肿消退时间短于对照组（P〈0.01或0.05）;血压和血液电解质浓度无显著差异（P〉0.05）。结论持续静脉微量注射呋塞米治疗严重CHF,疗效明显优于传统的间断静脉注射法。     

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.     

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.