靶控输注瑞芬太尼复合丙泊酚对中老年颅内动脉瘤夹闭术患者血液动力学的影响

摘 要 目的：观察靶控输注瑞芬太尼复合丙泊酚静脉麻醉对中老年颅内动脉瘤夹闭术患者血流动力学的影响。方法: 行颅内动脉瘤夹闭术的中老年患者40例随机分为复合组和丙泊酚组。复合组行瑞芬太尼复合丙泊酚靶控静脉麻醉,丙泊酚组采用丙泊酚静脉输注降压。观察两组患者麻醉诱导前（T1）、气管插管前（T2）、动脉瘤夹闭前（T3）、动脉瘤夹闭后（T4）、拔除气管时（T5）等时间点的平均动脉压（MAP）、心率（HR）、心排血量（CO）和心指数（CI）;比较两组患者麻醉维持时间、拔管时间、术后唤醒时间和术后不良反应情况。结果:两组患者各时间点MAP、HR差异均无统计学意义（P＞0.05）,复合组T2、T3、T4时MAP、HR、CO和CI均显著低于T1时,且CO和CI均显著低于丙泊酚组同时点。术后复合组拔管时间、唤醒时间和不良反应发生率均显著低于丙泊酚组（P＜0.05）。结论:TCI瑞芬太尼复合丙泊酚有助于颅内动脉瘤夹闭术患者保持血流动力学稳定,缩短拔管时间和唤醒时间,减少不良反应发生。     

纳布啡联合丙泊酚用于无痛人工流产术麻醉的最适剂量选择

摘 要 目的： 探讨在无痛人工流产术中异泊酚复合纳布啡静脉麻醉时纳布啡的最适剂量。方法：自愿实施无痛人工流产术患者300例随机分成纳布啡Ⅰ组(N1组,纳布啡0.10 mg·kg-1）、纳布啡Ⅱ组（N2组,纳布啡0.15 mg·kg-1）、纳布啡Ⅲ组（N3组,纳布啡0.20 mg·kg-1）。各组患者分别静注相应剂量纳布啡,5 min后再缓慢注入丙泊酚,而后实施人工流产术。比较各组患者不同时点的收缩压(SBP)、心率（HR)、脉搏血氧饱和度(SpO2)变化,记录各组术中丙泊酚用量、手术时间、停药后苏醒时间、离院时间,以及术中辅助呼吸、术后恶心呕吐、离院时眩晕比例,苏醒5 min后腹痛VAS评分及麻醉效果。 结果：3组患者麻醉后SBP均较前明显下降（P<0.05）,苏醒后SBP均恢复正常;HR及SpO2则未见明显变化。3组患者各时点SBP、HR及SpO2组间比较差异均无统计学意义（P>0.05）。N2组、N3组患者术后中重度腹痛比例显著低于N1组（P<0.05）,麻醉效果优良率显著优于N1组（P<0.05）。N1组患者术中丙泊酚用量与苏醒时间均明显高于N2组和N3组患者（P<0.05）;N1组、N2患者的离院时间、离院时眩晕者比例等明显低于N3组患者（P<0.05）。结论：丙泊酚联合适宜剂量的纳布啡（0.15 mg·kg-1）用于无痛人工流产术具有一定的安全性、有效性。     

地佐辛与芬太尼、舒芬太尼在纤维支气管镜引导清醒气管插管中的效果比较

摘 要 目的：观察等效剂量的地佐辛、芬太尼、舒芬太尼在纤维支气管镜引导清醒气管插管中的镇痛镇静效果及其对血流动力学的影响。方法: 选择术前预计困难气道拟行纤维支气管镜经鼻插管患者90例,随机分为地佐辛组（D组）、芬太尼组（F组）、舒芬太尼组（S组）。插管前10 min,各组分别静脉给予地佐辛0.15 mg·kg^-1、芬太尼3μg·kg^-1、舒芬太尼0.2 μg·kg^-1等镇痛药。比较3组患者入室后安静5 min（T0）、纤支镜置入前（T1）、气管插管成功后即刻（T2）及插管后5 min（T3）的心率（HR）、平均动脉压（MAP）、氧饱和度（SpO2）,及插管前Ramsay镇静评分,同时观察记录插管过程中药品不良反应发生情况。结果: 与T0时比较,F组和S组在T1时HR明显减慢,MAP明显降低（P＜0.05）;三组在T1时SpO2明显降低,T2时MAP明显升高（P＜0.05）;T1时F组和S组HR、MAP和SpO2明显低D组（P＜0.05）;T2时F组HR、MAP明显高于D组和F组,F组和S组SpO2明显降低（P＜0.05）;T3时S组HR明显降低且明显低于D组和F组,F组MAP明显高于D组和S组（P＜0.05）。T1时3组Ramsay镇静评分明显升高,S组明显高于F组（P＜0.05）。F组恶心、躁动和呼吸抑制发生率明显高于D组（P＜0.05）;F组躁动发生率明显高于S组（P＜0.05）;S组呼吸抑制发生率明显高于D组和F组（P＜0.05）。结论: 地佐辛联合充分的表面麻醉在困难气道患者经纤支镜引导的清醒气管插管过程中对血流动力学影响程度小,插管不良反应事件发生率低于芬太尼和舒芬太尼,安全性更高。     

喷他佐辛对全身麻醉上肢手术患者苏醒期躁动的影响

摘 要 目的：观察喷他佐辛对全麻上肢手术苏醒期躁动的影响。方法: 全麻下行择期上肢手术患者60例随机分为两组。Ⅰ组（观察组,n=30）患者在手术结束缝皮前以喷他佐辛0.25 mg·kg-1稀释至10ml缓慢静注（超过3 min）;Ⅱ组（对照组,n=30）在手术结束缝皮前以同样速度静注0.9%氯化钠注射液10 ml。监测比较两组患者诱导前（T0）、拔管前（T1）、拔管即刻（T2）、拔管后5 min（T3）、拔管后10 min（T4）、拔管后15 min（T5）等时点的血压、心率变化;比较两组患者的苏醒时间、拔管时间,拔管后15 min的躁动情况和躁动评分,以及患者恶心呕吐发生情况等。结果: Ⅱ组在T3～T5时点血压、心率明显高于Ⅰ组（P<0.05）;两组间苏醒时间和拔管时间差异无统计学意义（P>0.05）;Ⅰ组患者拔管后15 min躁动情况和躁动评分均明显低于Ⅱ组（P <0.05）,Ⅰ组患者恶心呕吐发生率和严重程度明显高于Ⅱ组（P <0.05）。结论: 在缝皮前应用喷他佐辛0.25 mg·kg-1可维持拔管时患者循环稳定,减少全麻苏醒期躁动发生,使患者安全、舒适地度过苏醒期。     

右美托咪定与丙泊酚联用于老年患者无痛胃镜麻醉的临床观察

摘 要 目的： 观察右美托咪定与丙泊酚联用在老年患者无痛胃镜麻醉中的效果及安全性。方法: 拟行无痛胃镜检查的老年患者70例随机分为观察组（35例）和对照组（35例）;观察组给予右美托咪定联合丙泊酚麻醉,对照组给予丙泊酚麻醉。比较两组患者的麻醉诱导时间、苏醒时间,患者不同时点的生命体征,术中并发症、药品不良反应等指标。结果: 观察组麻醉诱导时间、苏醒时间均短于对照组（P<0.01）。两组患者平均动脉压（MAP）在T2、T3、T4阶段均明显低于T1阶段（P<0.05或P<0.01）;对照组的HR在T3阶段、R在T2阶段均低于T1阶段（P<0.05）;观察组的RR在T2阶段明显低于T1阶段（P<0.05）;观察组MAP在T2、T3阶段明显高于对照组（P<0.01）,在T4阶段低于对照组（P<0.05）;观察组的HR在T3阶段明显高于对照组（P<0.05）。观察组患者术中并发症显著低于对照组（P<0.05）。结论:右美托咪定联合丙泊酚的麻醉效果与安全性均高于单用丙泊酚,值得临床推广应用。     

非体外循环冠状动脉旁路移植术患者右美托咪啶联合地佐辛术后镇痛效果及对心肌酶谱影响的回顾性分析

摘 要 目的：回顾性分析非体外循环冠状动脉旁路移植术（OPCABG）患者术后应用右美托咪啶联合地佐辛镇痛对心肌酶谱的影响,并评价其镇痛效果及不良反应情况。方法: 采用回顾性研究方法,收集择期全麻OPCABG患者58例,根据治疗方法分为两组。观察组29例术后予右美托咪啶联合地佐辛镇痛,对照组29例术后予地佐辛镇痛,其余治疗方案两组相同。比较分析两组术前及术后24 h的乳酸脱氢酶（LDH）、肌酸激酶（CK）及肌酸激酶同工酶（CK MB）的数值变化,监测麻醉前、拔管后不同时间点的收缩压（SBP）、舒张压（DBP）、心率（HR）、血氧饱和度（SpO2）的数据,对术后不同时间点的镇静程度进行评分,记录两组患者术后72 h不良反应情况。结果: 两组患者术后LDH、CK及CK MB水平均高于术前(P＜0.05);而观察组患者术后心肌酶水平均低于对照组(P＜0.05)。两组患者麻醉前、拔管后不同时间点（6,12,24,48,72 h）的SBP、DBP、HR和SpO2比较,差异无统计学意义(P＞0.05)。两组患者术后不同时间点（12,24,36,48,72 h）的Ramsay评分、VAS评分及术后24,48,72 h累计有效按压次数比较,差异无统计学意义(P＞0.05)。观察组患者恶心呕吐及躁动发生率明显低于对照组(P＜0.05)。结论: OPCABG患者术后应用右美托咪啶联合地佐辛能够保护心肌,增强镇痛效果,降低不良反应发生率。     

舒芬太尼对腹腔镜手术患者术中应激反应的影响

摘 要 目的: 探讨舒芬太尼对腹腔镜手术患者血流动力学、血清皮质醇及β-内啡肽水平的影响。方法: 将68例腹腔镜胆囊切除术患者随机分为舒芬太尼组与芬太尼组,分别使用舒芬太尼与芬太尼静脉麻醉。观察两组患者各时点血流动力学、血清皮质醇及β-内啡肽水平变化。结果:芬太尼组气腹后20 min 平均动脉压（MAP）较麻醉前明显上升(P<0.05),高于同时点舒芬太尼组(P<0.05),解除气腹后60 min MAP降到麻醉前水平;两组气腹后20 min、解除气腹后60 min血清皮质醇及β 内啡肽均较麻醉前明显上升(P<0.05),而舒芬太尼组上升幅度明显低于芬太尼组(P<0.05);舒芬太尼组和芬太尼组发生药物不良反应的例数分别为6例和9例（P>0.05),症状均较轻微。结论:舒芬太尼静脉麻醉较芬太尼麻醉能更好抑制CO2气腹刺激引起的机体应激反应,维持血流动力学的稳定,不良反应轻,安全性较好。     

不同剂量乌拉地尔对急性缺血性脑卒中患者血压及尿激酶溶栓预后的影响

摘 要 目的：比较不同剂量乌拉地尔对急性缺血性脑卒中（AIS）患者降压效果和预后的影响,为其临床合理应用提供依据。方法: 62例AIS患者随机分为高剂量组20例、中剂量组21例和低剂量组21例,均行乌拉地尔降压和尿激酶溶栓治疗,乌拉地尔首剂量分别为25,15,5 mg。观察患者入院至溶栓结束收缩压（SBP）与舒张压（DBP）变动水平;随访6～12个月,比较各组患者美国国立卫生院卒中量表（NIHSS）、改良Rankin量表（mRS）及日常生活能力量表（ADL）评分。结果: 中剂量组和低剂量组血压达标时间均高于高剂量组,低剂量组血压达标时间高于中剂量组,差异均有统计学意义（P<0.05）。治疗后,各组患者溶栓前（T1） SBP与DBP水平显著低于治疗前(T0),溶栓5 min（T2）与溶栓结束时（T3）时SBP与DBP水平显著低于T1,差异有统计学意义（P<0.05）;高剂量组患者T1、T2、T3的SBP与DBP水平均低于中剂量组和低剂量组;中剂量组低于小剂量组,差异有统计学意义（P<0.05）。中剂量组NIHSS、mRS及ADL评分低于低剂量组和高剂量组（P<0.05）,低剂量组和高剂量组之间差异无统计学意义（P>0.05）。结论: 乌拉地尔首剂量为15 mg时,能够在有效降压的前提下保障较好的预后。     

布托啡诺联合瑞芬太尼用于子宫肌瘤栓塞术患者自控镇痛效果观察

摘 要 目的： 观察布托啡诺联合瑞芬太尼用于子宫肌瘤栓塞术患者自控镇痛的效果。方法: 子宫肌瘤栓塞术患者68例按入院先后顺序分为观察组(n=35)和对照组(n=33),择期行子宫肌瘤栓塞术。对照组予芬太尼自控镇痛,观察组予布托啡诺联合瑞芬太尼自控镇痛,观察两组患者的视觉模拟评分(VAS)、镇静评分、术后疼痛以及药品不良反应等。结果: 术后1,4,12,24 h,观察组患者的VAS评分、镇静评分均明显低于对照组(P＜0.05);观察组术后0级疼痛率达74.3%,明显高于对照组的48.5%(P＜0.05);观察组药品不良反应发生率明显低于对照组(P＜0.05)。结论:子宫肌瘤栓塞术后使用布托啡诺和瑞芬太尼联合自控镇痛,可有效减轻患者术后疼痛,不良反应少,安全可靠,值得临床推广使用。     

罗哌卡因不同给药方式对妊高症产妇分娩镇痛的影响观察

摘 要 目的：观察罗哌卡因连续硬膜外麻醉或腰硬联合麻醉用于妊高症产妇分娩镇痛的效果及安全性。方法：行分娩镇痛妊高症产妇164例按入院时间顺序分为E组(硬膜外镇痛组)和SE组（腰硬联合镇痛组）,每组82例。记录两组产妇分娩镇痛前即刻(T0)、镇痛后5 min(T1)、镇痛后10 min(T2)、镇痛后30 min(T3)、镇痛后1 h(T4)、镇痛后2 h(T5)、宫口开全(T6)时的疼痛视觉模拟评分(VAS)评分及平均动脉压（MAP）。比较两组产妇的产程时间、分娩方式、催产素使用率、降压药使用率、产后出血率、镇痛起效时间、镇痛时间、产妇满意度、改良Bromage评分、新生儿Apgar 评分、新生儿体重及脐带血罗哌卡因浓度。结果：两组产妇T1～T6时VAS评分均较T0时下降（P＜0.05）,SE组T1～T6时MAP较T0时下降（P＜0.05）。SE组T1、T2时VAS评分低于E组（P＜0.05）,T1、T2、T3时MAP低于E组（P＜0.05）。两组产妇第一和第二产程时间、分娩方式、降压药使用率、产后出血率差异均无统计学意义（P＞0.05）。SE组催产素使用率高于E组（P＜0.05）。SE组镇痛起效时间短于E组(P<0.05);两组镇痛时间、产妇满意度及改良Bromage 评分≤1分比例差异无统计学意义（P＞0.05）。两组新生儿1 min Apgar 评分和5 min Apgar 评分,新生儿体重及脐带血罗哌卡因浓度等差异无统计学意义（P＞0.05）。两组产妇药品不良反应发生率差异无统计学意义(P＞0.05),均无严重不良反应发生。结论：连续硬膜外麻醉和腰硬联合麻醉均可提供满意、安全的镇痛效果。与腰硬联合麻醉相比,连续硬膜外麻醉用于妊高症产妇的分娩镇痛,对血流动力学和子宫收缩的影响较小。     

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.