瑞芬太尼对小儿七氟烷麻醉自主呼吸的影响

目的 研究不同剂量瑞芬太尼持续输注对小儿七氟烷麻醉下自主呼吸的影响。方法 选择3～6岁七氟烷麻醉下斜视手术患儿120例,根据术中给予瑞芬太尼的剂量,将患儿随机分为四组（n=30）:C组（生理盐水）、L组（瑞芬太尼0.03μg?kg-1?min-1）,M组（瑞芬太尼0.06μg?kg-1?min-1）和H组（瑞芬太尼0.09μg?kg-1?min-1）,每组30例。观察记录喉罩置入后（T1）、静注负荷量后（T2）、持续输注10min（T3）、持续输注15min（T4）、拔出喉罩（T5）时患儿呼吸频率（RR）、潮气量（VT）、分钟通气量（MV）、呼末CO2浓度（PETCO2）、呼末七氟烷浓度(PETSev)以及平均动脉压（MBP）、心率（HR）等循环指标,记录手术、麻醉、苏醒时间和术中不良反应情况。结果 四组患儿的基本情况和循环指标无统计学差异,四组患儿术中均无体动和低氧血症的发生。H组T3、T4时点RR和MV明显低于其他三组（P<0.05）,PETCO2则高于其他三组;M组与L组RR和MV比较无统计学差异,但均显著低于C组（P<0.05）;四组VT比较无统计学差异。结论 0.03～0.09μg?kg-1?min-1瑞芬太尼持续输注对小儿七氟烷麻醉下自主呼吸具有抑制作用,但不会造成低氧血症的发生。呼吸抑制作用主要表现为患儿RR的降低,0.09μg?kg-1?min-1剂量抑制作用最明显,0.03～0.06μg?kg-1?min-1剂量间差异不显著。根据手术需要,选择中低剂量瑞芬太尼持续输注,既可保留患儿自主呼吸,又可减少对呼吸的抑制作用。      

右美托咪啶联合瑞芬太尼在经鼻清醒气管内插管中的应用

目的评价右美托咪啶联合瑞芬太尼在经鼻清醒气管内插管中的可行性。方法选择张口困难的口腔颌面部择期手术患者44例,ASAⅠ或Ⅱ级,随机分为A组(表麻+咪达唑仑+瑞芬太尼组)和B组(表麻+右美托咪啶+瑞芬太尼组),A组患者静脉注射咪达唑仑0.05 mg.kg-1,同时经静脉注射瑞芬太尼0.1μg.kg-1负荷量,然后以3μg.kg-1.h-1的速度泵入瑞芬太尼;B组患者静脉泵入右美托咪啶1μg.kg-1,继而以0.2μg.kg-1.h-1维持,右美托咪啶负荷量输注完后即经静脉注射瑞芬太尼0.1μg.kg-1负荷量,然后以3μg.kg-1.h-1的速度泵入瑞芬太尼。两组患者在瑞芬太尼开始泵入即用1%丁卡因对鼻腔深部、舌根部、咽喉部及声门上进行表面麻醉,再行环甲膜穿刺,以2%利多卡因进行气管内表面麻醉。记录患者表麻前、插管前、插管成功即时,插管后1,3,5 min各时间点的心率,、血氧饱和度(SO2)、平均动脉压(MAP)指标,插管前后Ramsay评分;观察患者气管插管舒适程度。结果在清醒气管插管前后,B组循环变化明显小于A组,镇静程度及舒适度B组也明显优于A组。结论右美托咪啶联合瑞芬太尼可使患者较舒适地耐受经鼻清醒气管内插管。     

瑞芬太尼用于下肢骨科术后静脉自控镇痛效果观察

目的 观察瑞芬太尼用于下肢骨科术后静脉自控镇痛(PCIA)的临床效果.方法 选择2006～2008年下肢骨科手术后使用PCIA的住院患者96例,随机分为4组(n=24).A组: PCIA给予瑞芬太尼0.15μg·kg-1·h-1;B组:PCIA给予瑞芬太尼0.25μg·kg-1·h-1;C组:PCIA给予瑞芬太尼0.35μg·kg-1·h-1;D组:PCIA给予瑞芬太尼0.45μg·kg-1·h-1,各组均加曲马多500mg、地塞米松 10mg,然后加生理盐水至 100ml.比较4组镇痛效果,术后按压PCIA自控键的次数;恶心呕吐、皮肤瘙痒、呼吸抑制、胸肌强直等不良反应.结果 C、D组患者术后镇痛效果及PCIA按压次数与 A、B组比较差异有显著性意义(P<0.05),但 D组发生恶心呕吐例数略多于 C组.结论 瑞芬太尼0.35μg·kg-1·h-1用于下肢骨科术后镇痛安全有效,而且不良反应少.     

小剂量复合用药麻醉在神经外科手术中的临床应用

目的 探讨小剂量咪唑安定、异丙酚、瑞芬太尼复合用药麻醉在神经外科手术中的临床应用价值.方法 将43例美国麻醉师协会（ASA）分级Ⅰ~Ⅲ级神经外科手术病人按病情随机分为两组,A组以咪唑安0.02~0.03 mg·kg-1,异丙酚1 mg·kg-1,瑞芬太尼2 μg·kg-1,维库溴胺0.1 mg·kg-1静脉快速诱导,气管插管后,以异丙酚1 mg·kg-1·h-1,瑞芬太尼2 μg·kg-1·h-1静脉泵入维持.B组以咪唑安0.02~0.03 mg·kg-1,异丙酚1 mg·kg-1,瑞芬太尼2 μg·kg-1,维库溴胺0.1 mg·kg-1静脉快速诱导,气管插管后,立即以异丙酚2~3 mg·kg-1·h-1、瑞芬太尼2~3 μg·kg-1·h-1静脉泵入维持,记录血压、心率、心电图、动脉血氧饱和度变化,术后随访气管拔管时间、清醒时间,有无术中知晓.结果 B组与A组插管后的平均动脉压（SBP）和心率（HR）有明显下降（P〈0.05）,随访无术中记忆、无疼痛.结论 应用小剂量咪唑安定、异丙酚、瑞芬太尼加肌松剂可以明显减少气管插管反应,可以提前拔除气管导管.术后随访均无术中知晓,镇痛效果满意.     

颈浅丛阻滞下甲状腺手术中镇静镇痛药物的运用

目的:观察双侧颈浅丛阻滞下甲状腺手术中辅助镇静、镇痛药物应用的效果。方法:甲状腺择期手术75例,随机分为3组,在双侧颈浅丛阻滞麻醉完善后:P组(异丙酚组,n=25)先注入异丙酚0.6mg.kg-1,随后用微量泵以2mg/(kg.h)持续输注;R组(瑞芬太尼组,n=25)持续输注瑞芬太尼0.1～0.2μg/(kg.min);RP组(异丙酚加瑞芬太尼组,n=25)先注入异丙酚0.3mg.kg-1,随后以1～1.5mg/(kg.h)泵入,瑞芬太尼以0.05～0.10μg/(kg.min)持续输注。观察呼吸、循环变化、镇静程度、镇痛质量、配合评分等。结果:PR组对循环呼吸影响较小,P组和R组术中血压升高与基础值比较差异有显著性(P<0.05),部分患者有呼吸抑制,以R组最为明显;R组和P组重度镇静患者数高于PR组,与PR组比较差异有统计学意义(P<0.05);3组配合良好率组间差异无显著性;P组视觉模拟(VAS)评分分别与R组和PR组比较差异有显著性(P<0.05),R组和PR组镇痛质量好于P组。结论:双侧颈浅丛阻滞麻醉下甲状腺手术中辅助微量泵持续输注异丙酚加瑞芬太尼镇静效果好,镇痛质量高,循环稳定,无呼吸抑制,患者手术过程中配合良好。     

不同麻醉维持方式对小儿 OSAS手术后苏醒期躁动影响比较

目的：探讨瑞芬太尼复合异丙酚全凭静脉麻醉与瑞芬太尼复合七氟醚静吸复合麻醉对阻塞性睡眠呼吸暂停综合征（ OSAS）患儿苏醒期躁动（ EA）的影响。方法选择40例4～11岁择期行扁桃体切除和（或）腺样体刮除手术的患儿,随机分为全凭静脉麻醉（I）组与静吸复合麻醉组（S）组,每组20例。2组均以咪唑安定0．1 mg/kg,瑞芬太尼1μg/kg,异丙酚1．5～2 mg/kg,和罗库溴铵0．6 mg/kg麻醉诱导插管,I组麻醉维持应用瑞芬太尼0．4～0．5μg· kg-1· min-1＋异丙酚4～6 mg· kg-1· h-1,手术结束同时停止输注。 S组麻醉维持以瑞芬太尼0．4～0．5μg· kg-1· min-1＋吸入七氟醚1．2～1．8 MAC,手术结束同时停药。 EA按照5点法进行评估。结果 I组EA评分平均低于S组（P＜0．05）,EA发生率（25％）明显低于S组（60％）。结论 OSAS手术患儿瑞芬太尼异丙酚全凭静脉麻醉后EA的发生率低于七氟醚异丙酚静吸复合麻醉。     

瑞芬太尼复合异丙酚静脉麻醉在肝癌I125粒子植入术中的应用

目的:探讨瑞芬太尼复合异丙酚静脉麻醉在肝癌I125粒子植入术中应用是否安全、有效。方法:选择拟行I125粒子植入术的肝癌患者50例,随机分为瑞芬太尼复合异丙酚(R组)组与芬太尼复合异丙酚(F组)组,每组各25例。R组静脉滴注瑞芬太尼1μg·kg-1,再用微量泵输注瑞芬太尼0.1μg·kg-1·min-1,F组单次静脉滴注芬太尼1.5μg·kg-1。两组均以异丙酚微量泵注1～2μg·kg-1·min-1维持麻醉。观察并记录患者术前、手术开始时、手术开始后10min及术后苏醒时的平均动脉压、心率、脉搏氧饱和度及呼吸频率。记录术中体动、呼吸暂停的次数。结果:R组患者的清醒时间(6.5±1.8)min显著短于F组(12.7±2.4)min;术中R组的平均动脉压下降明显低于F组(P<0.05);术中体动R组(5例)少于F组(11例),呼吸暂停R组(12例)多于F组(6例)。结论:瑞芬太尼复合异丙酚静脉麻醉在肝癌I125粒子植入术中应用效果确切、安全,但必须加强循环呼吸监测。     

右美托咪啶对瑞芬太尼抑制切皮体动反应量效关系的影响

目的评价右美托咪啶对瑞芬太尼抑制切皮体动反应量效关系的影响。方法 150例行择期乳房肿瘤切除术患者随机分为3组:瑞芬太尼组(R组)、右美托咪啶0.5μg.kg-1+瑞芬太尼组(D1R组)和右美托咪啶1.0μg.kg-1+瑞芬太尼组(D2R组),每组50例,D1R和D2R组分别输注右美托咪啶0.5和1.0μg.kg-1,持续时间为15 min,R组则泵注生理盐水。将每组患者随机分为5个亚组,每亚组10例,在输注右美托咪啶或生理盐水结束后效应室靶控不同浓度的瑞芬太尼。所有患者在靶控瑞芬太尼的同时效应室靶控输注丙泊酚3mg.L-1,3 min后切开乳房皮肤3 cm,观察患者有无体动反应。用Probit法计算抑制体动反应瑞芬太尼的5%有效效应室浓度(EC5),半数有效效应室浓度(EC50)和95%有效效应室浓度(EC95)及其各自95%可信区间(95%CI)。结果D1R和D2R组EC5、EC50和EC95均低于R组(P<0.0167),D2R组EC5、EC50和EC95低于D1R组(P<0.0167)。结论右美托咪啶剂量依赖性的减少抑制体动反应所需的瑞芬太尼剂量。     

阿片类药物瑞芬太尼在小儿先天性心脏病手术中的麻醉方案研究

目的评价瑞芬太尼在小儿先天性心脏病手术麻醉中的可行性及最适宜的剂量。方法 150例先天性心脏病患儿随机分为3组,每组50例。A组:瑞芬太尼0.5μg/kg静脉注射(>30s),随后0.25μg.kg-1.min-1持续输注。切皮前追加瑞芬太尼1μg/kg,体外循环前再次单次缓慢静脉注射瑞芬太尼2μg/kg。B组、瑞芬太尼1μg/kg静脉注射(>30s),随后0.5μg.kg-1.min-1持续输注。C组:手术开始时芬太尼用量达20μg/kg,体外循环前追加至30μg/kg。分别监测记录不同时段的收缩压(SBP)、舒张压(DBP)、心率(HR)、中心静脉压(CVP)、血氧饱合度(SpO2)、呼吸末二氧化碳分压(PETCO2),血糖、血乳酸、血浆皮质醇(COR)、促肾上腺皮质激素(ACTH)。结果 3组患儿手术时间、体外循环时间比较差异无统计学意义(P>0.05)。术后气管拔管时间A组和B组明显短于C组(P<0.05)。入室至术毕3组间血液动力学指标无明显差异(P>0.05)。瑞芬太尼人均总用量A组(1532±121)μg,B组(2348±160)g有明显差异(P<0.01)。体外循环期间COR和ACTHB组高于A组(P<0.05)和C组(P<0.05),拔管后COR和ACTH比较A组与B组高于C组(P<0.05)。3组患儿的血糖值以体外循环30min为最高,体外循环30min、停机前、拔管后与插管后、锯胸骨后,比较显著升高(P<0.01),但组间比较差异无统计学意义(P>0.05)。结论瑞芬太尼0.25μg.kg-1.min-1持续输注并于切皮前追加瑞芬太尼1μg/kg,体外循环前再次单次缓慢静脉注射瑞芬太尼2μg/kg能更有效的抑制应激反应。是适宜的小儿麻醉方案。     

瑞芬太尼联合异丙酚预防硬麻下阑尾手术牵拉反应的效果

目的 观察瑞芬太尼联合异丙酚用于预防阑尾手术牵拉反应的临床效果.方法 选择硬膜外麻醉下拟行阑尾切除术患者88例,随机分为瑞芬太尼组(Ⅰ组)和芬太尼组(Ⅱ组),每组各44例.Ⅰ组于切开腹膜时先静注瑞芬太尼0.1μg·kg-1、异丙酚1mg·kg-1,然后特续泵注瑞芬大尼0.03～0.04μg/(kg·min)及至异丙酚0...     

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.