全麻诱导期丙泊酚、依托咪酯、咪唑安定对血液动力学的影响

目的研究全麻诱导前单纯使用等效剂量的丙泊酚、依托咪酯、咪唑安定[1,7]时对患者镇静程度、脑电图（EEG值）、心排量（CO）和血液动力学的影响。方法共60例年龄18~60岁患者,ASAⅠ~Ⅱ级,采用丙泊酚（P组20例）2.0mg/kg,依托咪酯（E组20例）0.3mg/kg,咪唑安定（M组20例）0.25mg/kg诱导剂量静脉输注,监测记录诱导前基础值（P0,E0,M0）,输注后1、3、5、7、10min（P1~P5,E1~E5,M1~M5）时的EEG值、CO、HR、MAP以及意识消失的时间。结果分别静脉输注丙泊酚、依托咪酯、咪唑安定后EEG、CO、HR、MAP均有不同程度的下降[1-2]（与P0,E0,M0相比,P〈0.01）;依托咪酯组对血液动力学影响〈丙泊酚组（P〈0.05）〈咪唑安定组（P〈0.05）,即依托咪酯对患者血液动力学影响小,丙泊酚次之,咪唑安定影响相对较大。结论全麻诱导前单纯使用丙泊酚,依托咪酯,咪唑安定其中一种时,三组药物均可使EEG、CO、HR、MAP有所下降,相比之下依托咪酯对血液动力学的影响最小,丙泊酚次之,咪唑安定较大。全麻诱导后血液动力学表现更为稳定。     

依托咪酯加咪唑安定与依托咪酯或异丙酚全麻时心血管反应比较

依托咪酯、咪唑安定和异丙酚是目前国内外普遍使用的新型速效静脉麻醉药,它们均有起效快,维持时间短,恢复迅速完全等优点,但均有不同的缺点.作者经临床应用依托咪酯加咪唑安定取得了良好的麻醉诱导效果,现报道如下:1 资料和方法1.1 一般资料:60例手术病人,ASA I～Ⅱ级,男17例,女43例.年龄12～71岁.A组依托咪酯加咪唑安定组20例,B组依托咪酯组20例,C组异丙酚组20例.三组病人的性别、年龄、体重无明显差异.1.2 方法:全部病人麻醉前1小时肌注苯巴比妥钠0.1g和阿托品0.5mg,入室后均开放外周静脉,A组依托咪酯0.3～0.4mg/kg加咪唑安定0.2mg/kg,B组依托咪酯0.3～0.4mg/kg,C组异丙酚2～2.5mg/kg静注,三组病人均用芬太尼0.1mg和卡肌宁0.6～0.8mg/kg静注复合麻醉诱导.面罩供氧充分去氮,明视下经口气管插管成功,接DragerSA2全能麻醉机或欧美达110全能麻醉机机械控制呼吸,安氟醚或异氟醚加笑气吸入麻醉维持,长肌宁维持肌松.HP78352C监护HR、NIBP、SPO_2,欧美达5250麻醉气体监护仪监测麻醉气体和通气功能,记录诱导前、诱导时、插管时、插管后5分钟HR和平均动脉压(MAP).全部病人术毕苏醒迅速,完全,顺利拔出气管导管安返病房,术后随访均无特殊麻醉并发症.2 结果三组病例HR和MAP的测定值为均值 标准差,用T检验统计学     

依托咪酯用于心脏手术全麻诱导的临床观察

目的 观察依托咪酯乳剂复合咪唑安定、芬太尼、万可松对心脏手术全麻诱导、气管插管前后循环系统的影响.方法 静脉注射咪唑安定0.1～0.15 mg/kg、依托咪酯乳剂0.2～0.6 mg/kg、芬太尼2～5 μg/kg、万可松0.1 mg/kg.呼吸抑制后面罩紧闭给予辅助呼吸,待肌肉松弛后行气管插管,之后以静脉＋吸入异氟醚复合维持麻醉,诱导中观察诱导前（用药前）、用药入睡后、气管插管操作中、气管插管后3 min内平均动脉压（MAP）、心率（HR）变化.结果 88例患者麻醉诱导平稳,气管插管顺利,血流动力学稳定,各项监测指标与诱导前相比差异无显著意义（P＞0.05）.结论 依托咪酯乳剂复合上述药物对循环系统无明显抑制,用于心脏手术的全麻诱导是安全的,不良反应是可以防治的.     

依托咪酯与异丙酚用于老年患者全麻诱导血液动力学变化比较

目的比较依托咪酯与异丙酚用于老年患者全麻诱导期间的血液动力学变化。方法选择年龄在60~75岁、ASAⅠ~II级的择期行腹腔镜胆囊摘除手术的老年病人40例,随机分为E、P两组(各20例)。E组:麻醉诱导给予咪唑安定0.06 mg.kg-1、芬太尼4μg.kg-1、阿曲库铵0.6 mg.kg-1、依托咪酯0.3 mg.kg-1;P组麻醉诱导给予咪唑安定0.06 mg.kg-1、芬太尼4μg.kg-1、阿曲库铵0.6 mg.kg-1、异丙酚0.5 mg.kg-1。结果E组诱导后2 min血压及脉率与麻醉前比较无明显变化(P>0.05),P组诱导后2 min血压及脉率较麻醉前下降明显(P<0.05)。插管后2 min与诱导后2 min相比,二组SBP上升明显(P<0.01~0.05),E组DBP和HR明显上升(P<0.05)。结论依托咪酯有益于血液动力学的稳定,尤其利于老年患者,但在抑制气管插管所致的心血管反应方面明显弱于异丙酚。     

不同静脉麻醉药对老年患者气管插管时循环功能影响的比较

目的比较异丙酚、依托咪酯、咪唑安定全麻诱导插管对老年患者循环系统的影响。方法选择年龄65～78岁择期全麻手术患者60例,ASAⅡ～Ⅲ级,随机分为异丙酚组(A组)、依托咪酯组(B组)、咪唑安定组(C组)。麻醉诱导:全部病例先静注芬太尼3μg/kg、维库溴铵0.1mg/kg,然后A组异丙酚1.5mg/kg、B组依托咪酯0.2mg/kg、C组咪唑安定0.1mg/kg,诱导后5min进行气管插管。连续监测和记录麻醉诱导前后各时点BP、HR及脉搏氧饱和度SpO_2。结果诱导后三组患者血压和心率均下降,至插管前下降幅度最大,A、C组下降明显,差异有统计学意义,B组差异无统计学意义。插管后三组血压和心率均上升,A、C组与插管前比较差异有统计学意义,三组血压与基础值比较差异无统计学意义。结论对于老年患者进行静脉全麻诱导时,选用依托咪酯有利于减轻对患者循环功能的干扰,保持循环功能的相对稳定,优于异丙酚和咪唑安定。     

小剂量氯胺酮在失血性休克患者全麻诱导期的应用

目的探讨小剂量氯胺酮对失血性休克患者全麻诱导时循环的影响。方法选择失血性休克患者60例,随机均分为2组,Ⅰ组麻醉采用咪达唑仑0.03mg/kg,氯胺酮0.5mg/kg,丙泊酚1mg/kg,万可松0.1mg/kg诱导插管;Ⅱ组麻醉采用咪达唑仑0.03mg/kg,芬太尼0.05mg/kg,丙泊酚1mg/kg,万可松0.1 mg/kg诱导插管。监测并记录麻醉诱导前、麻醉诱导后的心率(HR)、收缩压(SBP)、舒张压(DBP)。结果Ⅰ组麻醉诱导后HR、SBP、DBP变化不大,无统计学差异(P>0.05)。Ⅱ组麻醉诱导后SBP、DBP显著下降,有统计学差异(P<0.05);HR增快显著,有统计学差异(P<0.05)。结论小剂量氯胺酮在失血性休克患者全麻诱导时,循环相对稳定,麻醉效果满意。     

氟哌利多预防依托咪酯术后恶心呕吐的临床观察

目的:观察氟哌利多在预防依托咪酯,术后恶心呕吐(PONV)的效果。方法:择期妇科腹腔镜手术病人80例,ASAⅠ￣Ⅱ级,随机分为2组:对照组麻醉诱导咪唑安定0.1￣0.2mg/kg加维库溴铵0.08￣0.12mg/kg加芬太尼3￣4#g/kg加依托咪酯0.1￣0.2mg/kg;观察组在对照组诱导前2分钟静脉注射氟哌利多2mg。全凭靶控静脉依托咪酯0.6￣0.8mg/(kg·h)维持镇静,其间静脉注射芬太尼,维库溴铵维持镇痛和肌松。结果:观察组PONV发生率明显低于对照组(P<0.05)。结论:诱导前静脉注射氟哌利多能预防依托咪酯麻醉下腹腔镜术后PONV。     

瑞芬太尼对全麻气管内插管心血管反应的影响

目的观察不同剂量瑞芬太尼全麻诱导气管内插管对血压心率的影响.方法 92例择期手术全麻患者,随机分为3组,Ⅰ组(n=40)、Ⅱ组(n=40)、Ⅲ组(n=12),全麻诱导用咪唑安定0.08 mg/kg、异丙酚1.5 mg/kg、瑞芬太尼和阿曲库铵,瑞芬太尼剂量是:Ⅰ组1 μg/kg、Ⅱ组2 μg/kg、Ⅲ组为生理盐水对照组.记录麻醉诱导前(T0)、诱导后置入喉镜前(T1)、导管插入即刻(T2)、气管插管后1 min(T3)、3 min(T4)、5 min(T5)、10 min(T6)的血压(SBP、DBP、MAP)和心率(HR)变化.结果 (1)与麻醉前相比,T1时Ⅰ组和Ⅱ组的HR、SBP、DBP、MAP均明显下降(P＜0.01),Ⅲ组的HR和SBP较低(P＜0.05);T2时除Ⅱ组的SBP较低外(P＜0.05),Ⅰ组和Ⅱ组的血压、心率恢复至T0时水平(P＞0.05);Ⅲ组的血压、心率增高(P＜0.01或P＜0.05),需瑞芬太尼加深麻醉.(2)Ⅰ、Ⅱ组与Ⅲ组相比,诱导后的SBP和从T2到T3,SBP、DBP、MAP、HR的变化差异均非常显著(P＜0.01).(3)Ⅰ、Ⅱ组间比较,在各时点, SBP、DBP、MAP、HR的变化差异无显著性(P＞0.05).结论 1～2 μg/kg瑞芬太尼麻醉诱导对血压、心率影响较小,能较好抑制气管插管引起的心血管反应.     

依托咪酯与咪唑安定在老年患者麻醉诱导中的应用

目的比较依托味酯与咪唑安定在老年患者全麻诱导中的应用。方法选择年龄在60～75岁,ASAⅡ～Ⅲ级,择期行全麻手术的患者90例,随机分为依托咪酯组(A组)、咪唑安定组(B组),每组各45例。麻醉诱导:全部病例先静注舒芬太尼0.5～1μg/kg,维库溴铵0.1～0.2mg/kg,然后A组给予依托咪酯0.1～0.2mg/kg,B组给予咪唑安定0.1～0.2mg/kg,诱导后5min进行气管插管,观察记录麻醉诱导前、后及气管插管前、后两组患者的血流动力学变化。结果麻醉诱导后两组患者的血压和心率均较诱导前下降,至插管前下降幅度最大,各组与诱导前比较,差异有统计学意义,两组相比较差异无统计学意义。插管后两组患者的血压和心率均较插管前上升,各组与插管前比较差异有统计学意义,两组相比较差异无统计学意义。结论依托咪酯与咪唑安定用于老年患者静脉全麻诱导时,对患者循环功能的干扰均较小,有利于保持患者血流动力学功能的相对稳定。     

依托咪酯复合瑞芬太尼在老年结肠镜检查中的应用

目的观察依托咪酯复合瑞芬太尼在老年人结肠镜检查中的效果和安全性。方法 140例纤维结肠镜检查患者,年龄60⁸2岁,ASAⅠ82岁,ASAⅠ^Ⅱ级,随机分为A、B两组,每组75例,采用注射泵以2.0 ng/mL为效应部位靶浓度输注瑞芬太尼,3 min后,A组缓慢静注依托咪酯0.1Ⅱ级,随机分为A、B两组,每组75例,采用注射泵以2.0 ng/mL为效应部位靶浓度输注瑞芬太尼,3 min后,A组缓慢静注依托咪酯0.1⁰.2 mg/kg,B组缓慢静注丙泊酚1.00.2 mg/kg,B组缓慢静注丙泊酚1.0¹.5 mg/kg,术中有肢动,A组追加依托咪酯0.1 mg/kg,B组追加丙泊酚0.51.5 mg/kg,术中有肢动,A组追加依托咪酯0.1 mg/kg,B组追加丙泊酚0.5¹ mg/kg,记录两组检查前、中、后的HR、SpO2、MAP、RR、苏醒时间、不良反应及麻醉满意度。结果两组均取得了联合镇静镇痛效果,A组镇痛效果较B组更显著(P<0.05);B组术中MAP和HR较术前显著降低(P<0.05),术后均恢复到术前水平(P>0.05),两组间SpO2无差异。结论依托咪酯联合瑞芬太尼与丙泊酚联合瑞芬太尼均有良好的镇静镇痛效果,依托咪酯联合瑞芬太尼效果更显著、更适应于有心血管疾患及老年患者。     

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.