艾司氯胺酮联合丙泊酚对臂丛神经阻滞下小儿上肢手术的镇静效应

目的 探讨艾司氯胺酮联合丙泊酚对臂丛神经阻滞下小儿上肢手术的镇静效果。方法 选择我院2020年4月至2021年5月行上肢骨折手术患儿80例,采用随机数字表法将患儿分为丙泊酚组(P组)和艾司氯胺酮联合丙泊酚组(ESP组),每组40例。P组采用丙泊酚镇静,ESP组采用艾司氯胺酮联合丙泊酚镇静。记录麻醉前、手术开始时、术中0.5 h、手术结束时的平均动脉压(MAP)、心率(HR)和脑状态指数(CSI);记录苏醒时间、麻醉复苏室(PACU)时间、补救镇痛时间、苏醒后1 min修订面部疼痛评分(Faces Pain Scale-Revised,FPS-R)和Ramsay镇静评分;记录不良反应发生率。结果 ESP组患儿不同时点的MAP、HR明显低于P组,CSI高于P组(P<0.05);与麻醉前比较,ESP组各时点的MAP、HR和CSI明显降低(P<0.05);与P组比较,ESP组患儿苏醒时间和PACU时间明显少于P组、补救镇痛时间明显长于P组,丙泊酚用量明显少于P组(P<0.05);患儿苏醒后1 min FPS-R疼痛评分明显低于P组,Ramsay镇静评分明显高于P组(P<0.05)。ESP组患儿丙泊酚注射痛和术后躁动发生率明显低于P组(P<0.05)。结论 艾司氯胺酮联合丙泊酚镇静,可安全用于超声引导下腋路臂丛神经阻滞小儿上肢手术,提高镇静镇痛效果,不良反应少。     

小儿肌间沟臂丛神经超声引导阻滞的解剖学特点及应用价值

目的研究小儿肌间沟臂丛神经超声解剖学特点及超声引导在小儿肌间沟臂丛神经阻滞中的临床应用价值。方法回顾性分析我院收治的行上肢手术的患儿84例,根据不同麻醉方法分为观察组与对照组,各42例,观察组在超声引导下行小儿肌间沟臂丛神经阻滞,对照组在解剖标志引导下进行神经阻滞,比较两组患儿各时间点OAA/S镇静评分、氯胺酮用量、术后初醒时间及不良反应发生情况。结果两组患儿麻醉前、清醒时间OAA/S镇静评分差异无统计学意义(P0.05)。观察组切皮、缝皮时OAA/S镇静评分明显低于对照组(P0.05)。观察组患儿氯胺酮用量、初醒时间、术后镇痛时间分别为(74.26±24.29)mg、(123.23±35.12)min、(30.82±19.12)min,均明显少(短)于对照组的(163.43±34.22)mg、(225.65±36.41)min、(52.23±20.43)min,差异有统计学意义(P0.05)。观察组患儿不良反应发生率为14.29%,明显低于对照组的23.81%,差异有统计学意义(P0.05)。结论超声引导下进行氯胺酮基础麻醉下的罗哌卡因肌间沟臂丛神经阻滞麻醉可明显提高穿刺成功率、缩短初醒时间及术后镇痛时间,减少术中氯胺酮用量、降低苏醒期不良反应发生率,临床疗效可靠,安全性高。     

艾司氯胺酮联合常规镇静药物用于小儿腺样体切除术效果观察

目的 探讨艾司氯胺酮联合常规镇静药物对腺样体切除术患儿血流动力学指标、术后躁动行为和疼痛程度的影响。方法 选取河北省唐山市妇幼保健院2020年1月至2022年12月收治的行腺样体切除术的患儿120例,随机分为对照组和研究组,各60例。两组患儿均予常规镇静药物麻醉,研究组患儿加用艾司氯胺酮麻醉。结果 与麻醉前(T₁)比较,两组患儿麻醉起效时(T₂)的舒张压、收缩压、心率均显著降低(P <0.05);与T₂比较,两组患儿麻醉停止10 min时(T₃)的舒张压、收缩压、心率均显著升高(P <0.05);且研究组患儿的变化幅度均显著低于对照组(P <0.05)。与对照组比较,研究组患儿的睫毛反射消失时间、疼痛反应消失时间、苏醒室停留时间均显著缩短(P <0.05),术后6,12,24 h的视觉模拟评分法(VAS)评分均显著降低(P <0.05),麻醉苏醒后、术后3 d的简易智力状态检查量表(MMSE)评分均显著升高(P <0.05)。研究组患儿的术后躁动发生率为11.67...     

纳美芬超前镇痛在小儿腹腔镜疝修补术后的临床应用

目的 研究纳美芬超前镇痛在小儿腹腔镜疝修补术后的应用效果.方法 选择在静脉复合全麻下行腹腔镜疝修补术的60例患儿,采用随机数字表法分成纳美芬超前镇痛组(A组)和对照组(B组).A组手术开始前10 min缓慢静脉注射纳美芬0.2 μg/kg,B组手术开始前10 min缓慢静脉注射生理盐水2 mL.收集患儿诱导前、手术前10 min、手术开始时、手术结束时、苏醒时、拔除气管导管时的收缩压、舒张压和心率数据;观察术后即刻、4、8 h的视觉模拟评分法(VAS)、改良目的疼痛评分法(MOPS)和镇静-躁动评分(SAS);记录各时段的不良反应.结果 两组收缩压、舒张压和心率均在正常范围内.两组患儿手术时间、自主呼吸恢复时间、呼之睁眼时间、拔管时间比较差异无统计学意义(P>0.05).A组术后各时间段的VAS评分、MOPS评分和SAS评分均低于B组(P<0.05).两组均未出现不良反应.结论 纳美芬超前镇痛用于小儿腹腔镜疝气手术,可减轻患儿的术后疼痛,降低躁动的发生,无明显不良反应.     

术前静滴酮咯酸氨丁三醇预防小儿全麻苏醒期躁动的临床观察

目的观察预先静脉滴注酮咯酸氨丁三醇对小儿全麻苏醒期躁动的影响。方法选择60例择期静吸复合全麻下行骨折内固定物取出术患儿,随机分为试验组和对照组,每组30例。全麻诱导前10 min试验组静脉滴注酮咯酸氨丁三醇0.5 mg/kg,对照组静脉滴注相同容量的生理盐水。记录两组患儿手术时间、麻醉时间、拔除喉罩时间、苏醒室停留时间,患者在入室及拔除喉罩时(T1)、到达苏醒室后5 min(T2)、15 min(T3)、30 min(T4)各时点的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)值以及T1～T4的疼痛、躁动和镇静评分(分别为FLACC评分、PAED评分和Ramsay评分),并观察恶心呕吐、低氧血症、呼吸抑制、反流误吸、瘙痒等不良反应发生情况。结果试验组在T1、T2、T3时点HR低于对照组,在T1、T2时点MAP低于对照组;试验组的疼痛评分在T1、T2、T3时点均低于对照组,躁动评分在4个时点均低于对照组,镇静评分在T1、T2、T3时点均高于对照组,差异有统计学意义(P<0.05)。结论在骨折内固定物取出术患儿全麻诱导前预先静脉滴注酮咯酸氨丁三醇0.5 mg/kg,可获得良好的镇痛效果,减少苏醒期躁动,无明显不良反应的发生。     

七氟醚吸入全麻加骶管阻滞在小儿单孔腹腔镜疝气手术中的应用

目的 观察七氟醚吸入全麻加骶管阻滞在小儿腹股沟斜疝单孔腹腔镜手术麻醉中的临床应用,及其术后早期苏醒及镇痛效果.方法 选择腹股沟斜疝手术患儿60例,随机数字表法分为观察组和对照组（n=30）.观察组面罩吸入七氟醚麻醉诱导后插入气管导管,采用骶管阻滞加七氟醚吸入全麻维持,对照组采用七氟醚吸入复合静脉全麻维持.观察两组患儿术中心率、血压及脉搏血氧饱和度、苏醒时间以及出室时哭闹评分及术后30 min疼痛评分.结果 两组切皮时均表现出良好的麻醉效果、术中生命体征较稳定;观察组术毕苏醒时间[（5.8±3.6）min]与对照组[（15.6±8.5）min]比较差异有统计学意义（P＜0.001）,在出室时表现出更好的镇痛效果.结论 七氟醚吸入全麻加骶管阻滞在小儿腹股沟斜疝单孔腹腔镜手术有利于患儿的术中麻醉管理和术后快速苏醒,并且能提供良好的术后镇痛效果.     

纳布啡超前镇痛用于日间腹腔镜疝修补术患儿的效果

目的 观察纳布啡超前镇痛用于日 间腹腔镜疝修补术患儿的效果.方法 行日间腹腔镜疝修补术患儿80例随机分为观察组和对照组,每组40例.观察组在麻醉诱导前静脉注射纳布啡0.2 mg/kg行超前镇痛,对照组静脉注射生理盐水作为对照.记录进入麻醉恢复室后即刻(T0)、5 min(T1)、15 min(T2)和30 min(T3)时MAP、HR和RR.采用儿童疼痛行为量表(FLACC)评分和Ramsay镇静评分评估镇痛效果.记录手术时间、丙泊酚和雷米芬太尼用量、术后苏醒时间.观察术后呼吸抑制、心动过缓、恶心呕吐和谵妄躁动等不良反应的发生情况.结果 T0～T3时两组患儿MAP、HR和RR差异无统计学意义(P＞0.05).与对照组比较,观察组患儿在T0～T3时的FLACC评分降低(P＜0.05),Ramsay镇静评分升高(P＜0.05).观察组苏醒时间短于对照组(P＜0.05),雷米芬太尼用量少于对照组(P＜0.05).观察组患儿术后谵妄躁动的发生率较对照组下降(P＜0.05).结论 纳布啡超前镇痛可以缩短日间腹腔镜疝修补术患儿的苏醒时间,增强术后镇痛、镇静效果,减少患儿谵妄躁动的发生率.     

地佐辛超前镇痛在泌尿外科腹腔镜手术中的应用

目的探讨地佐辛超前镇痛应用于泌尿外科腹腔镜手术的有效性和安全性。方法全麻下泌尿外科腹腔镜手术患者4O例,随机分为地佐辛组和对照组,每组20例。地佐辛组在切皮前静脉注射地佐辛0.2 mg/kg。对照组注射等量生理盐水。采用VAS和Ramsay评分评估两组术后镇痛和镇静程度;观察比较两组不良反应发生情况。结果地佐辛组术后VAS评分显著低于对照组(P<0.05),术后10 min和30 min Ramsay评分明显高于对照组(P<0.05)两组间不良反应发生率相比较差异无统计学意义(P>0.05)。结论泌尿外科腹腔镜手术使用地佐辛超前镇痛作用明显且无严重不良反应。     

探究艾司氯胺酮复合丙泊酚静脉麻醉对小儿腹腔镜手术的应用效果

目的：探究艾司氯胺酮复合丙泊酚静脉麻醉对小儿腹腔镜手术的应用效果。方法：将我院(2021年10月—2023年02月)收治以小儿腹腔镜手术治疗疾病患儿120例,以随机数字表法分成两组,各60例。以氯胺酮全身麻醉为对照组,以艾司氯胺酮复合丙泊酚静脉麻醉为研究组。比较两组患儿在麻醉手术过程中的生命指标、患儿麻醉相关指标,不良反应发生情况及躁动发生率。结果：两组患儿在麻醉诱导开始、建立二氧化碳气腹、手术开始10min及手术结束后的生命指标比较,无统计学差异(P>0.05)。研究组自主呼吸恢复、拔管、指令性睁眼、PACU停留时间均短于对照组,存在统计学差异(P<0.05)。研究组患儿在麻醉后的不良反应发生率及躁动发生率相比更低,两组相比存在统计学差异(P<0.05)。结论：小儿腹腔镜手术选择艾司氯胺酮复合丙泊酚静脉麻醉,对于患儿为围手术期相关生命指标影响较小,缩短麻醉后自主呼吸恢复、拔管、指令性睁眼、PACU停留时间,减少麻醉后不良反应及躁动的发生率,效果理想。     

儿童扁桃体切除术氟比洛芬酯、曲马多和芬太尼超前镇痛效果的比较

目的比较氟比洛芬酯、曲马多和芬太尼超前镇痛对扁桃体切除术儿童术后疼痛的影响,确定适合小儿较为安全、有效的麻醉超前镇痛方法。方法选择择期行扁桃体切除患儿90例,随机分成3组,每组30例。患儿分别术毕前30min静脉注射芬太尼组1μg/kg（Ⅰ组）、曲马多2.0mg/kg（Ⅱ组）、氟比洛芬酯1.0mg/kg（Ⅲ组）。手术结束后观察患儿拔管时间、清醒时间和术后30min、2h和6h疼痛评分及恶心、呕吐、躁动等并发症发生情况。结果 3组患儿手术时间和术后各时点疼痛评分差异无统计学意义。Ⅰ组的停药到气管拔管时间和清醒时间明显较Ⅱ组和Ⅲ组延长（P〈0.05）,Ⅱ组术后恶心呕吐6例,发生率明显大于Ⅰ组和Ⅲ组（P〈0.05）,且Ⅱ组患儿术后发生1例认知功能障碍和5例术后出汗。3组患儿术后躁动发生率组间比较,差异无统计学意义。结论氟比洛芬酯作用时间长、能有效缓解小儿扁桃体切除术术后疼痛,无明显不良反应,可作为小儿中小手术超前镇痛的安全用药。     

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.     

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.     

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.