乌拉地尔复合芬太尼对高血压颅脑手术患者气管插管循环反应的影响

目的比较乌拉地尔和芬太尼对颅脑手术合并高血压患者气管插管循环反应的影响。方法选取 4 0例颅脑手术合并高血压的患者 ,随机分成 4组 ,每组 1 0例 ,A组用生理盐水 1 0ml;B组用乌拉地尔 0 .5mg/kg +生理盐水至 1 0ml;C组用芬太尼 2 μg/kg +生理盐水至 1 0ml;D组用乌拉地尔0 .5mg/kg +芬太尼 2 μg/kg +生理盐水 1至 1 0ml,测定插管前后心率 (HR)、收缩压 (SAP)、舒张压(DAP)、并计算心率收缩压乘积 (RPP) ,于相应时点采集动脉血标本测定血浆去甲肾上腺素 (NA)和肾上腺素 (A)的浓度。结果气管插管后 1min和 3minA组患者的SAP、DAP、HR、及RPP均有显著增高 (P <0 .0 5 ) ,B组患者插管后血浆NA浓度明显大于C、D组 (P <0 .0 5 ) ,D组患者气管插管后SAP、DAP、HR和NA、A水平较基础值无明显差异。结论颅脑手术合并高血压患者气管插管时存在明显循环和应激反应 ,单独应用乌拉地尔和单独应用芬太尼 2 μg/kg仅能部分抑制插管反应 ,两者联合能很好抑制高血压患者插管时循环和应激反应     

右美托咪啶对老年患者双腔支气管插管诱发心血管反应的影响

目的为了观察预注右美托咪啶对老年肺癌患者插入双腔气管导管（DLT）诱发心血管反应的影响。方法选择60例年龄65—80岁,体重45～75kg,ASAⅠ～Ⅱ级择期行肺癌手术的患者,随机分为右旋美托咪啶组（D组）和对照组（c组）,每组30例．D组右旋美托咪啶1μg／kg,用生理盐水配制成4μg／L的浓度,麻醉前15min内静脉注射完毕．c组持续输注同等容量生理盐水作对照．麻醉诱导：静脉注射芬太尼4μg/kg,依托咪酯0．3mg／kg,顺阿曲库铵0．15mg／kg,给完药后4分钟行双腔支气管插管,成功后接麻醉机行机械通气。观察患者输注右美托咪啶前（T0）,泵注右美托咪啶或生理盐水结束时（T1）、气管插管前（T2）、气管插管即刻（T3）、气管插管后1min（T4）、3min（T5）及5min（T6）各时间点的动脉收缩压（SAP）、舒张压（DAP）、平均动脉压（MAP）、和心率（HR）的数值。结果两组间T0时SAP、DAP、MAP和HR相比差异无统计学意义（P〉0．05）。T1和T2时,D组SAP、DAP、MAP均较C组升高（P〈0．05）;D组T1时HR比C组降低（P〈0．05）。T3至T6时,D组患者的SAP、DAP、MAP和HR均比c组要低沪〈0．05）。结论全麻诱导前静脉输注右美托咪啶可有效抑制老年肺癌患者双腔支气管插管诱发的心血管反应,维持血流动力学稳定。     

不同剂量右美托咪定抑制气管插管反应的临床研究

目的比较不同剂量右美托咪定抑制气管插管反应,维持血流动力学稳定的临床效果。方法选择60例择期手术全身麻醉气管插管患者,ASAI～Ⅱ级,随机分为C、D,和D：3组,每组20例,诱导前15min分别静脉泵注生理盐水20ml、右美托咪定0．5μ/kg和1肛g／kg,10min内完成。结果与T0时比较,c组MAP和HR在L和T1时升高,血浆AD和NA浓度在T4时升高（P〈0．05）。三组MAP、HR、血浆AD和NA浓度在Tn时比较,差异均无统计学意义（P〉0．05）。结论应用0．5μg／kg和1μg／kg右美托咪定静脉泵注均能抑制儿茶酚胺的释放,有效抑制插管应激反应,有助于围插管期血流动力学的稳定,且1μg/kg的效果更优。     

右美托咪啶对高血压患者全麻围插管期应激反应的影响

目的 观察右美托咪啶对高血压患者全麻围插管期应激反应的影响.方法 60例高血压患者随机均分为三组:A组诱导前用右美托咪啶(1.0μg/kg,10min泵完,继以0.5 μg·kg-1·h-1泵至气管插管后5 min)复合舒芬太尼0.5 μg/kg;B组静注舒芬太尼0.5 μg/kg;C组舒芬太尼1.0μg/kg.记录入室(T0)、诱导前(T1)、插管前(T2)、插管后1 min(T3)、5 min(T4)的血压(BP)、心率(HR);同时检测血浆去甲肾上腺素(NE)、肾上腺素(E)和多巴胺(DA)值.结果 A组围插管期BP和HR均较B、C组稳定(P<0.01).A组T1时血浆NE、E、DA值均明显低于B、C两组(P<0.01);B组T3时血浆NE、E、DA值均明显高于T0(P<0.01).结论 右美托咪啶复合舒芬太尼能维持高血压患者全麻诱导及气管插管期间循环功能稳定,抑制气管插管引起的应激反应.     

地佐辛抑制全麻气管插管期应激反应的效果

目的观察地佐辛抑制全麻插管应激反应的效果。方法 80例全麻患者随机均分为两组:D组,给予地佐辛0.2 mg/kg;F组,给予芬太尼3μg/kg。两组诱导均用咪唑安定0.05～0.10mg/kg、丙泊酚1～2 mg/kg和顺式阿曲库铵0.15～0.25 mg/kg,气管内插管。记录用药前5 min(T0)、插管前即刻(T1)、插管后1 min(T2)、5 min(T3)和10 min(T4)平均动脉压(MAP)和心率(HR),并于T0、T2和T4时采集桡动脉血,测定血浆肾上腺素(E)和去甲肾上腺素(NE)浓度。结果 D组围插管期MAP和HR无显著变化(P>0.05)。F组T1、T4时HR明显慢于T0和D组;而T2、T3时明显加快,并快于D组(P<0.05)。两组气管插管后血浆E和NE浓度均有所升高;但D组气管插管前后比较差异无统计学意义(P>0.05),而F组T2时血浆E和NE浓度均明显高于T0(P<0.05)。结论地佐辛比芬太尼更能有效抑制全麻气管插管的应激反应。     

雷米芬太尼复合丙泊酚诱导行经鼻气管插管的临床效果

目的 研究雷米芬太尼复合丙泊酚在非肌松药诱导下经鼻气管插管的可行性及合适剂量.方法 下颌角良性肥大行磨削术女性美容患者60例,随机均分为三组.全麻诱导:静注咪唑安定0.08 mg/kg、丙泊酚2mg/kg和雷米芬太尼2μg/kg(A组)、3μg/kg(B组)或4 μg/kg(C组),每组20例.喉镜明视下经鼻气管插管.评价插管条件,记录围插管期MAP和HR变化.结果 B、C两组气管插管条件满意率明显高于A组(75%、85%vs.50%)(P<0.05).B、C两组导管过鼻腔时和插管后2 min时的HR及MAP明显低于TO(P<0.05);C组1例应用用麻黄碱和阿托品各一次,迅速恢复.结论 雷米芬太尼3～4 μg/kg复合丙泊酚可提供较好的插管条件.     

乌拉地尔预防高血压病人气管插管时心血管反应的观察

目的 观察乌拉地尔（URA）预防高血压病人全麻气管插管期间心血管反应的效果。方法 40例确诊高血压病择期全麻手术病人,术前血压控制在21．3／13．3kPa以下。随机分成A组（URA组,n=20)和B组（对照组,n=20.A组于麻醉诱导前5分钟静注URA0．5mg/kg,B组静注生理盐水。两组均以芬太尼、安定、维库溴铵和丙泊酚静脉诱导后气管插管。记录诱导前、静注URA后5分钟、诱导后及插管后1分钟、3分钟、5分钟SBp、DBp、MAPey HR,并计算RRP。结果A组静注URA后5分钟SBp、DBp、及MAP显著下降（P＜0．01）,诱导插管期间SBp、DBp、MAP及RPP无明显变化,插管后1分钟HR显著加快（P＜0．05）。B组诱导后SBp、DBp及MAP显著下降（P＜0．01）;插管后1分钟、3分钟SBp、DBp、MAP及HR显著高于诱导前（P＜0．05,P＜0．01）,插管后1分钟、3分钟及5分钟RPP均显著升高（P＜0．01）,与A组同期比较差异有极显著意义（P＜0．01）。结论 应用URA能有效预防高血压病人气管插管时的心血管反应。     

右美托咪啶用于高血压病人全麻拔管期间血液动力学变化的观察

目的观察右美托咪啶用于预防和降低高血压病人气管拔管心血管应激反应的有效性和安全性。方法选择患有原发性高血压1～2期择期在气管插管全麻下行经腹腔镜胆囊切除术ASAⅡ～Ⅲ级病人72例,随机分为右美托咪啶组（D组）和对照组（N组）,每组各36例,术前所有病人血压控制在160/90mmHg以下,分别于手术结束后拔管前静脉微泵右美托咪啶0.5μg/kg或等剂量生理盐水。观察麻醉前、用药后、拔管前、拔管即刻、拔管后3、5、10min病人HR、MAP、心肌氧耗指数（RPP）、血浆去甲肾上腺素（NE）、肾上腺素（E）浓度。结果①与麻醉前相比,N组在T2、T3、T4 MAP、HR均明显升高（P〈0.05）,而D组在上述时间点MAP、HR上升幅度较小,组间比较差异有统计学意义（P〈0.05）;②RPP、NE、E在T2、T3、T4、T5 D组均低于N组,组间比较有显著性差异（P〈0.05）。结论手术结束后静脉微泵注射右美托咪啶0.5μg/kg能有效预防高血压病人全麻拔管期间的心血管应激反应,维持血液动力学稳定,可安全用于高血压病人的全麻气管拔管。     

舒芬太尼复合依托咪酯对经鼻盲探气管插管应激反应的影响

目的 观察舒芬太尼复合依托咪酯对经鼻盲探气管插管时心血管反应的影响.方法 需行经鼻盲探气管插管术患者60例,随机均分三组:A、B组插管前应用舒芬太尼0.2、0.3μg/kg;C组应用芬太尼2 μg/kg.麻醉诱导均用咪达唑仑0.1mg/kg和依托咪酯0.15 mg/kg静脉注射.记录麻醉前(T0)、插管前即刻(T1)、插管后即刻(T2)、5 min(T3)和10 min(T4)时SBP、DBP、HR、SpO2和RR;检测T0、T2和T3时的血清肾上腺素浓度.结果 三组诱导期SBP、DBP和HR均较麻醉前明显降低(P＜0.05),但组间比较均无统计学差异.三组T3时血清肾上腺素浓度均较T2时明显升高(P＜0.05),但组间比较均无统计学差异.C组呼吸抑制发生率明显低于A组和B组(5％ vs.35％和30％)(P＜0.01).结论 舒芬太尼0.2、0.3μg/kg和芬太尼2μg/kg复合依托咪酯均能有效抑制气管插管应激反应.     

芬太尼和瑞芬太尼对老年患者依托咪酯肌阵挛的预防作用

目的研究芬太尼和瑞芬太尼预处理在老年患者依托咪酯气管插管全麻诱导中对肌阵挛发生及血流动力学参数剧烈波动的预防作用。方法选取择期行全麻气管插管手术患者90例,年龄>65岁,ASAⅠ~Ⅱ级,按随机数字法分为芬太尼组(F组)、瑞芬太尼组(R组)和生理盐水组(C组),每组30例。麻醉诱导开始静脉注射0.2 mg/kg依托咪酯前,C组注射生理盐水10 mL,F组注射芬太尼3.0μg/kg,R组给予瑞芬太尼2.0μg/kg,注射时间至少30s,随后R组0.3μg/(kg·min)持续泵注,记录肌阵挛的发生情况和严重程度。待患者意识消失,睫毛反射消失,BIS值低于50,注射顺式阿曲库铵0.2 mg/kg后2 min进行气管插管。记录基础值(T_0)、诱导即刻(T_1)、插管即刻(T_2)及插管后1 min(T_3)、3 min(T_4)的MAP、HR。结果 F组、R组及C组的肌阵挛发生率分别为10%、3.3%、50%。F组、R组发生肌阵挛的频率和严重程度均显著低于C组(P<0.05),而F组与R组比较差异无统计学意义(P>0.05)。气管插管后,R组血流动力学的稳定性优于其他两组(P<0.05)。结论 3.0μg/kg芬太尼和2.0μg/kg瑞芬太尼均可降低老年患者依托咪酯全麻诱导期引起的肌阵挛发生率和严重程度,而2.0μg/kg瑞芬太尼预处理在麻醉诱导期可起到更好的血流动力学作用。     

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.     

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.