老年患者脑脊液及血清分子标记物与术后早期认知功能障碍的关系

目的 研究老年患者脑脊液及血清分子标记物与术后早期认知功能障碍(POCD)的关系.方法 选择腰麻下择期行全髋置换术患者43例,年龄65-85岁.患者于蛛网膜下腔穿刺成功后抽取脑脊液1ml,行Tau、Aβ淀粉样蛋白42(Aβ-42)、IL-1β及脑源性神经营养因子(BDNF)测定;于术后第7天行血清IL-1β及BDNF测定.术前及术后第7天采用简易精神状态量表(MMSE)评定认知功能,并以此将患者分为有POCD(A组)13例和无POCD(B组)30例.结果 术后第7天13例有POCD,发生率为30.2％.与B组(30例)相比,A组术前脑脊液中IL-1β明显高于B组[(800±87) pg/mlvs.(654±56) pg/ml],而Aβ-42明显低于B组[(322±52) pg/ml vs.(427±67) pg/ml](P＜0.05);两组脑脊液中Tau和BDNF及血清中IL-1β和BDNF差异无统计学意义(P＞0.05).结论 老年患者术前脑脊液IL-1β升高及Aβ-42降低可能与术后早期POCD发生有关.     

舒芬太尼联合罗哌卡因硬膜外麻醉在剖宫产术中的应用价值

目的 探讨不同剂量舒芬太尼联合罗哌卡因硬膜外麻醉用于剖宫产术的效果与不良反应.方法 120例剖宫产产妇随机分为A、B、C组,每组40例,均采用硬膜外麻醉.A组予舒芬太尼10 μg(1 rrl)加0.75％罗哌卡因(12 ml),B组予舒芬太尼20 μg(1 ml)加0.75％罗哌卡因(12 ml),C组给予0.75％罗哌卡因(12 ml)加0.9％氯化钠溶液l ml.观察术中胎儿娩出后Apgar评分,起效时间、无痛平面时间、镇痛持续时间,改良Bromage评分,视觉模拟评分(VAS)以及不良反应.结果 与C组比较,A、B组起效时间、无痛平面时间、感觉阻滞达最高平面时间缩短[起效时间:(6.1±1.7),(5.4±1.5)min比(13.6±1.9)min,无痛平面时间:(8.1±1.8),(7.6±2.1)min比(17.3±2.2) min,感觉阻滞达最高平面时间:(14.3±2.4),(12.8 ±2.7)min比(19.9 ±2.8)min];镇痛持续时间延长[(289±33),(308±34) min比(203±42) min],差异有统计学意义(P＜0.01).3组在切皮时的VAS评分差异无统计学意义(P＞0.05).B组在探查、取胎时的VAS评分明显低于A组、C组[(10±11)比(35 ±25),(18±10)分](P＜0.05或P＜0.01).C组寒颤的发生率与A组、B组比较[22.5％ (9/40)比10.0％ (4/40),2.5％ (1/40)],差异有统计学意义(P＜0.05或P＜0.01),A组和B组比较差异有统计学意义(P＜0.05).结论 罗哌卡因麻醉加入舒芬太尼可增强罗哌卡因麻醉效果,20μg舒芬太尼复合罗哌卡因硬膜外麻醉可减轻探查取胎时内脏牵拉不适症状,减少术中寒颤的发生.     

多模式镇痛复合不同浓度罗哌卡因切口浸润在加速康复外科术后镇痛的效果

目的 探讨在多模式镇痛中复合不同浓度罗哌卡因切口浸润在加速康复外科(ERAS)行开腹结直肠手术术后镇痛的效果.方法 选择择期加速康复外科开腹结直肠手术患者62例,随机分为2组,每组31例.R1组:0.5％罗哌卡因20 mL术毕切口局部浸润;R2组:0.375％罗哌卡因20 mL术毕切口局部浸润.术后均行舒芬太尼静脉自控镇痛(PCIA).分别观察并记录手术结束0、2、4、6、24、48 h各组静息视觉模拟评分(VAS)、Prince-Henry疼痛评分;记录术后首次追加舒芬太尼时间,术后6、24、48 h舒芬太尼消耗量及患者实际按压PCIA泵次数;记录患者术后首次排气排便、离床活动时间及术后住院时长;记录患者术后48 h内不良反应的发生情况.结果 两组患者的一般情况、手术时间、切口长度、手术方式及术中补液量比较,差异均无统计学意义.两组术后备时间点VAS、Prince-Henry评分及不良反应发生情况比较,差异无统计学意义.R1组与R2组比较,首次追加舒芬太尼时间延长[(60.97±20.79) min vs.(37.74±33.14) min],6h舒芬太尼消耗量减少[(16.80±1.74) μg vs.(21.62±2.62) μg],6h镇痛泵按压次数减少[2(1 ～3)次vs.12(10～ 14)次];术后首次排气排便时间提前[(21.47±2.45)h vs.(27.47±3.10)h],差异均有统计学意义(P＜0.05).结论 在多模式镇痛中复合0.5％罗哌卡因20 mL术毕切口局部浸润,可为开腹行结直肠手术患者提供早期良好的术后镇痛,同时减少术后早期PCIA舒芬太尼使用量,加速胃肠功能恢复.     

尼莫地平对急性脑梗死患者血浆内皮素1的影响

目的 探讨尼莫地平对急性脑梗死患者血浆内皮素1(ET-1)水平的影响。方法 83例急性脑梗死患者随机分为尼莫地平组(A组)42例和常规治疗组(B组)41例,并以35例健康体检人群作为正常对照组(C组)。采用放射免疫法测定血浆ET-1水平。结果 治疗前,A、B组患者血浆ET-1水平均高于C组[(89.45±12.75)pg/ml、(92.35±11.88)pg/ml vs.(68.99±10.03)pg/ml](P<0.01);治疗后,A、B组患者血浆ET-1水平均较治疗前降低[(72.29±8.46)pg/ml vs.(89.45±12.75)pg/ml、(83.01±10.51)pg/ml vs.(92.35±11.88)pg/ml](P<0.05),且A组较B组血浆ET-1降低更明显(P<0.01)。结论 尼莫地平可改善急性脑梗死患者的血管内皮功能,对急性脑梗死具有良好的治疗作用。     

阴道试产失败中转剖宫产术前碘伏冲洗阴道+术中碘伏及甲硝唑冲洗宫腔预防术口愈合不良的效果

目的 研究阴道试产失败中转剖宫产术前碘伏冲洗阴道+术中碘伏及甲硝唑冲洗宫腔的效果。方法 90例阴道试产失败中转剖宫产产妇作为研究对象,根据消毒方式不同分为A组、B组和C组,每组30例。A组采用抗生素+术前应用0.5%碘伏液冲洗阴道+术中用0.5%碘伏及2%甲硝唑注射液冲洗宫腔, B组采用抗生素+术中用0.5%碘伏及2%甲硝唑注射液冲洗宫腔, C组采用抗生素+术中用2%甲硝唑注射液冲洗宫腔。比较三组术后24 h体温、白细胞计数(WBC)、C反应蛋白(CRP)水平及术后切口感染率。结果 A组术后24 h体温、WBC、CRP分别为(37.15±0.23)℃、(10.13±0.51)×109/L、(15.61±1.18)mg/L, B组分别为(37.69±0.28)℃、(11.42±0.56)×109/L、(17.02±1.21)mg/L,C组分别为(38.42±0.62)℃、(12.61±0.59)×109/L、(18.72±1.29)mg/L;三组术后24 h体温、WBC、CRP水平比较差异有统计学意义(P<0.05);A组术后24 h体温、WBC、CRP水平均明显低于B组与C组,且...     

生大黄治疗急性胰腺炎的临床观察

目的 探讨生大黄治疗急性胰腺炎(AP)的疗效.方法 69例AP患者随机分成两组:对照组33例,仪采用常规治疗;治疗组36例,同时经胃管加用生大黄颗粒剂.于治疗前和治疗第7天检测血自细胞(WBC)、C-反应蛋白(CRP)和血清淀粉酶(AMS),并行APACHEⅡ评分;记录住院大数及费用.结果 治疗组第7天WBC、CRP、AMS及APACHEⅡ评分均明显低于对照组[(8.0±3.7)×109/L vs.(11.3±4.3)×109/L,(20.0±6.7)mg/L VS.(56.2±16.3)mg/L,(124.0±35.4)U/L vs.(256.0±67.6)U/L和(6.3±0.8)分vs.(8.6±1.1)分](P<0.05).与对照组比较.治疗组平均住院日少[(14.2±6.3)d vs.(11.2±4.4)d]、住院费用低(P<0.05).结论 在常规治疗基础上加用生大黄颗粒剂治疗急性胰腺炎具有显著疗效.     

血浆BNP检测在急性呼吸困难原因鉴别中的价值

目的 探讨B型脑钠肽(BNP)检测在急性呼吸困难(AD)病因鉴别中的价值.方法 AD患者68例,采用床旁快速免疫分析仪检测血浆BNP值,心脏彩超检测左室射血分数(LVEF)、左室舒张末期容积(LVEDV)、周边短轴缩短率(FS)和心肌酶谱.68例分为LVEF≤50％组(A组,49例)和LVEF＞50％组(B组,19例)或血浆BNP＞500 pg/L组(C组,35例)和血浆BNP＜100 pg/L组(D组,33例).以同期健康体检志愿者20名为对照(E)组.结果 A组患者血浆BNP明显高于B组[(6685.9±2666.3) pg/L vs.(3001.5±3583.5) pg/L](P＜0.05).C组FS大于D组[(37.6±2.1)％vs.(31.8±8.0)％](P＜0.05).C组肌酸激酶(CK)高于D组[(158.6±171.3) U/L vs.(80.1±60.7)U/L](P＜0.05).C组肌酸激酶同工酶(CK-MB)高于D组[(23.1±9.3) U/L vs.(15.3±5.6)U/L](P＜0.05).结论 检测血浆BNP值对AD患者可以初步鉴别心源性呼吸困难和肺源性呼吸困难,且可以作为心功能评价指标.     

替米沙坦联合阿托伐他汀对早期糖尿病肾病微炎症状态的影响

目的 替米沙坦联合阿托伐他汀对早期糖尿病肾病(DN)微炎症状态的影响.方法 早期DN患者40例均分为A组(替米沙坦80 mg/d,口服)、B组(替米沙坦80 mg/d+阿托伐他汀20mg/d,口服),疗程20周,采用ELISA检测核转录因子cB(NF-cB) p65亚基活性,生化检测仪检测血清炎症因子水平,RT-PCR和Western blot检测肾组织中NF-кBmRNA及蛋白表达情况.结果 治疗后,两组各项检测指标均较治疗前明显降低(P＜0.05),B组NF-кB p65亚基活性(0.56±0.03vs.1.31±0.05)、超敏C反应蛋白[(3.31±1.95) mg/L vs.(5.48±2.06) mg/L]、IL-1[(11.45±1.71) pg/mlvs.(14.48±1.75) pg/ml]、IL-6[(14.15±2.13) pg/mlvs.(16.19±2.15) pg/ml]、TNF-α[(20.69±4.45) pg/ml vs.(28.89±3.86) pg/ml]、NF-кBmRNA(0.546±0.013 vs.0.780±0.012)及蛋白(0.451±0.021 vs.0.743±0.031)表达水平改善均较A组更为明显(P＜0.05).结论 替米沙坦联合阿托伐他汀可延缓早期DN的进展.     

氨甲环酸联合乌司他丁对心肺转流心脏手术患者出血量及IL-6的影响

目的 探讨氨甲环酸(TA)加乌司他丁(U)对心肺转流(CPB)术中出血量及白细胞介素6(IL-6)的影响.方法 60例CPB下行二尖瓣膜置换术患者随机均分为三组.切皮前,A组静注TA 20 mg/kg和U 1×10<'6>IU,B组静注TA 50 mg/kg和U 1×10<'6> IU,C组静注生理盐水作为对照.记录术中出血量和输血量、术后12 h心包及纵隔引流量,检测CPB前后血细胞压积和IL-6水平.结果 与C组比较,A、B两组术后12 h心包及纵隔引流量[(259.5±82.6)ml vs.(121.0±87.2)ml、(109.6±78.2)ml]、红细胞输入量[(1.2±0.3)U vs.(0.8±0.2)U、(0.8±0.1)U]及停机后IL-6水平[(54.8±15.5)pg/ml vs.(31.2±8.7)pg/ml、(32.1±9.0)Pg/ml]均明显减少(P<0.05).结论 瓣膜置换术患者CPB前联合应用TA和U可有效减少术中、术后的出血量和输血量,减轻炎症反应.     

依达拉奉对大鼠烧伤休克性急性肺损伤的保护作用

目的 探讨依达拉奉在烧伤休克导致急性肺损伤大鼠的抗氧自由基作用.方法 24只大鼠随机分为烧伤休克组(A组)、烧伤休克+依达拉奉给药组(B组)和对照组(C组),每组8只.休克6 h后检测血浆丙二醛(MDA)、超氧化物歧化酶(SOD)、谷光甘肽(GSH)及谷光甘肽过氧化物酶(GSH-px)含量,评定氧自由基水平.结果 B组MDA[(3.35±0.28)nmol/L vs.(3.88±0.28)mml/L]明显低于A组,而SOD[(76.12±11.25)U/ml vs.(72.32±9.36)U/ml]、GSH[(132.41±22.42)mg/L vs.(120.23±24.15)mg/L]、GSH-px[(754.54±101.23)mg/L vs.(685.56±102.37)mg/L]水平明显高于A组(P<0.05).结论 依达拉奉对烧伤休克所致大鼠的急性肺损伤有保护作用.     

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.     

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.     

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.     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.