右美托咪定及丙泊酚复合瑞芬太尼用于神经外科术中唤醒的比较

目的：观察比较右美托咪定及丙泊酚复合瑞芬太尼用于神经外科术中唤醒的效果。方法选择神经外科手术治疗的64例患者为研究对象,随机分为观察组和对照组各32例,观察组患者术中应用右美托咪定维持麻醉实施术中唤醒,对照组患者应用丙泊酚复合瑞芬太尼维持麻醉实施术中唤醒,观察记录两组患者血流动力学[平均动脉血压（MAP）、心率（HR）、血氧饱和度（SpO2）和收缩压（SBP）]、苏醒时间及唤醒期间不良事件发生情况。结果观察组患者的MAP、HR、SpO2和SBP等各项指标较对照组更趋于稳定,观察组患者唤醒时间短于对照组,且呛咳、体动、呼吸抑制等不良反应发生率显著低于对照组,两组比较差异有统计学意义（P＜0.05）。结论右美托咪定用于神经外科术中唤醒安全、有效,与丙泊酚复合瑞芬太尼比较有一定优势,患者血流动力学影响小、患者苏醒质量高,不良事件发生率低。     

右美托咪定复合丙泊酚静脉麻醉对人工流产术后恶心呕吐发生率的影响

目的 研究右美托咪定复合丙泊酚静脉麻醉是否可以影响人工流产术后恶心呕吐的发生率.方法 选择2012年至2014年江门市中心医院同一手术组医生施行的无痛人流手术患者,采用随机数字表法分为DP组(右美托咪定复合丙泊酚静脉麻醉组)和FP组(芬太尼复合丙泊酚静脉麻醉组).DP组予右美托咪定及丙泊酚静脉推注;FP组予芬太尼及丙泊酚静脉推注.记录两组患者心率、平均动脉压、血氧饱和度变化;两组丙泊酚的用量和阿托品、麻黄素的用量;及两组患者术后恶心呕吐(PONV)的发生率.结果 ①两组患者在麻醉前(T1)、丙泊酚注射完毕时(T2)、扩张宫颈时(T3)、手术结束时(T4)、患者送入恢复室时(T5)及患者离院时(T6)心率、平均动脉压、血氧饱和度变化比较差异无统计学意义(P＞0.05).②两组患者麻醉过程中各种药物用量比较差异无统计学意义(P＞0.05).③在术后恶心呕吐发生率的比较中,FP组术后恶心呕吐的发生率明显高于DP组(P＜0.05).结论 ①右美托咪定复合丙泊酚静脉麻醉能提供安全的人工流产麻醉与镇痛.②右美托咪定复合丙泊酚静脉麻醉用于人工流产麻醉与镇痛,其术后恶心呕吐发生率下降.     

右美托咪定靶控输注在髋关节置换术中对血流动力学和术后苏醒时间的影响

目的:探讨右美托咪定靶控输注在髋关节置换术中对血流动力学和术后苏醒时间的影响.方法:选取46例在我院行全髋关节置换术的患者,按治疗方法分为观察组和对照组,每组23例.均采用全身麻醉手术.观察组术中采用右美托咪定联合丙泊酚靶控输注,对照组采用丙泊酚联合芬太尼麻醉,比较两组血流动力学指标和术后苏醒时间.结果:观察组输注8min、10min后血压、心率、BIS值均低于对照组(P＜0.05),5min时血压高于对照组(P＜0.05);与对照组相比,BIS70、BIS80、睁眼时间均缩短(P＜0.05).结论:在全髋关节置换术中采用右美托咪定靶控输注可有效维持血流动力学的稳定,缩短术后苏醒时间.     

右美托咪定与芬太尼对无痛人流的临床安全性及效果观察

目的探讨右美托咪定与芬太尼对无痛人流的临床安全性和效果分析观察。方法选取自2015年2月至2016年2月于大连市中心医院手术室接受无痛人流患者60例,试验组与对照组均应用信封法随机分组,对照组30例,应用芬太尼联合丙泊酚麻醉,试验组30例,应用右美托咪定联合丙泊酚麻醉方案,观察两组患者手术时间、苏醒时间、丙泊酚总剂量、低血压、呼吸抑制、心动过缓及恶心呕吐情况。结果试验组手术及苏醒时间、丙泊酚总剂量、不良反应发生情况均低于对照组,有统计学差异(P<0.05)。结论右美托咪定联合丙泊酚可明显提高麻醉效果,降低丙泊酚用量,缩短手术及苏醒时间,减轻不良反应发生率,安全性较高,临床麻醉效果优异,值得临床推广。     

氯胺酮复合右美托咪啶在烧伤切痂植皮麻醉中的应用

目的探讨氯胺酮复合右美托咪啶在烧伤切痂植皮术非气管插管麻醉中的效果。方法 60例择期切痂植皮手术患者,ASAⅠ-Ⅱ级,随机均分为氯胺酮复合右美托咪啶组(KD组)和氯胺酮复合丙泊酚组(KP组)。术中均保留自主呼吸,并用面罩给氧。记录心率、血压、脉搏血氧饱和度、心肌耗氧指数、氯胺酮用量、手术时间、苏醒时间、围术期镇静评分及出现的不良反应。结果与KP组相比,KD组右美托咪啶给药后10min收缩压增高(P<0.05),氯胺酮给药后5、10min降低(P<0.05),在氯胺酮给药后5、10、15min心率-收缩压乘积(RPP)降低(P<0.05),术后1h镇静评分增高(P<0.05),苏醒时间缩短(P<0.05)。结论烧伤切痂植皮术用氯胺酮复合右美托咪啶麻醉较复合丙泊酚能更好的维持血流动力学稳定,减少术中心肌氧耗,促进早期苏醒。     

比较单次负荷剂量右美托咪啶和咪唑安定注射对鼻内镜手术全麻的影响

目的观察比较单次负荷剂量右美托咪啶和咪唑安定注射对鼻内镜手术全麻的影响效果。方法将60例行鼻内镜手术患者,随机分成右美托咪啶组(D组)和咪唑安定组(C组)。D组病人诱导前缓慢静脉注射右美托咪啶1μg/kg,M组诱导前静脉注射咪达唑仑2 mg。静脉注射丙泊酚和芬太尼、阿曲库铵进行全麻诱导,丙泊酚、芬太尼、阿曲库铵维持麻醉,术中观察血压、心率,根据病人的应激反应调节丙泊酚输注速度,记录维持异丙酚用量。记录插管期、术中及拔管期的血流动力学变化及苏醒拔管时间和苏醒时有无躁动。结果与C组比较,D组麻醉维持异丙酚用量明显减少(P<0.05)。苏醒时间、拔管时间无统计学意义(P>0.05)。D组术中收缩压、心率均较C组降低,苏醒时躁动明显少于C组(P<0.05)。结论静脉注射右美托咪啶,麻醉中可节省异丙酚的用量,术中血流动力学平稳,苏醒期躁动少,并具有良好的安全性。     

丙泊酚及右美托咪定在妇产科手术麻醉中的镇静效果对比

目的:探讨丙泊酚及右美托咪定在妇产科手术麻醉中的镇静效果。方法:选取102例妇产科手术患者作为研究对象,并根据麻醉药物不同分成两组:丙泊酚组(n=51)应用丙泊酚治疗,右美托咪定组(n=51)应用右美托咪定治疗,就两组患者不同时间点的血流动力学状态、镇静状态、不良反应发生率进行统计学分析。结果:(1)右美托咪定组的血流动力学状态优于丙泊酚组(P0.05);(2)右美托咪定组患者术后5min、术后15min、术毕的镇静评分均高于丙泊酚组(P0.05);(3)右美托咪定组不良反应发生率是7.84%,低于丙泊酚组的23.53%(P0.05)。结论:相较于丙泊酚,右美托咪定在妇产科手术麻醉中的镇静效果更佳,可改善其血流动力学状态,且不良反应发生率较低,可借鉴。     

右美托咪定复合小剂量丙泊酚用于无痛纤维支气管镜检查的有效性及安全性

目的探讨右美托咪定复合小剂量丙泊酚用于无痛纤维支气管镜检查的麻醉效果及安全性。方法选择2017年1月至2017年12月在我科进行无痛纤维支气管镜检查的患者200例,随机分为对照组和观察组,每组患者100例。观察组患者泵注右美托咪定0.8μg/kg复合静脉注射0.8 mg/kg丙泊酚进行麻醉;对照组患者泵注等剂量0.9%氯化钠注射液后静脉注射2 mg/kg丙泊酚麻醉;观察2组患者在入室时(T0)、麻醉诱导后(T1)、进入声门时(T2)、到达隆突时(T3)、检查完成时(T4)时的血流动力学指标及警觉/镇静(OAA/S)评分;并比较2组患者的丙泊酚总用量、镜检时间、苏醒时间及不良反应情况。结果观察组患者在T1、T2、T3及T4时刻的心率明显低于对照组(P<0.05);T1、T2、T3及T4时刻观察组患者平均动脉压(MAP)水平均明显高于对照组(P<0.05);观察组患者在T2时刻血氧饱和度(SpO2)水平明显低于对照组(P<0.05);观察组患者在T4时刻OAA/S评分明显高于对照组(P<0.05);2组患者的检查时间差异无统计学意义(P>0.05),观察组患者的苏醒时间及丙泊酚用量均明显少于对照组(P<0.05);观察组患者的不良反应发生率为8%,明显低于对照组的33%(P<0.05)。结论右美托咪定复合小剂量丙泊酚用于无痛纤支镜检查较单独使用丙泊酚麻醉具有更高的安全性,且能够保证更佳的镇静镇痛作用及稳定的血流动力学,减少丙泊酚的用量。     

右美托咪定联合丙泊酚在脊柱侧弯矫形术麻醉唤醒中的应用

目的：探讨右美托咪定联合丙泊酚麻醉用于脊柱侧弯矫形术唤醒中的可行性,比较不同剂量右美托咪定联合丙泊酚麻醉在脊柱侧弯矫形术唤醒中的效果。方法选择60例脊柱侧弯矫形手术患者,按数字表法随机分成A、B、C三组,每组20例,三组在麻醉诱导前10 min内给予右美托咪定1μg/kg,丙泊酚血浆靶浓度设为3～4μg/mL,靶控丙泊酚待患者意识消失后,芬太尼6μg/kg,顺式阿曲库胺2 mg/kg,且脑电双频指数（BIS）值达到40～60时行气管插管,A组靶控丙泊酚复合右美托咪定0．2μg· kg-1· h-1维持,B组靶控丙泊酚复合右美托咪定0．4μg· kg-1· h-1维持,C组靶控丙泊酚复合右美托咪定0．6μg· kg-1· h-1维持,顺式阿曲库胺按照2μg· kg-1· min-1维持,比较三组患者的血流动力学变化、唤醒时间以及不良反应。结果三组患者在唤醒期间均完成运动和感觉测试,苏醒后三组MAP、HR差异均无统计学意义（均P＞0.05）;A、B、C三组唤醒时间分别为（10．0±1．8）min、（11．0±2．4）min、（15．0±2．1）min,A、B两组在短时间内唤醒患者,C组唤醒时间长于A、B组,差异均有统计学意义（t＝2．97、2．69,均P＜0．05）。结论右美托咪定联合丙泊酚麻醉应用于脊柱侧弯矫形术唤醒中,以0．4μg· kg-1· h-1右美托咪定唤醒效果最佳,可提供稳定的血流动力学,无呼吸抑制且不延长苏醒时间,是良好的唤醒麻醉镇静镇痛用药。     

右美托咪定与芬太尼复合丙泊酚用于无痛人流的麻醉效果比较研究

目的比较盐酸右美托咪定注射液与枸橼酸芬太尼注射液复合丙泊酚注射液用于无痛人流的麻醉效果。方法选取2015年12月—2016年6月在天津医科大学总医院滨海医院进行无痛人流术的患者200例,按照麻醉方式的不同分为对照组(113例)和治疗组(87例)。对照组静脉泵注枸橼酸芬太尼注射液,1μg/kg稀释至20 m L,泵注时间8 min。治疗组静脉泵注盐酸右美托咪定注射液,0.5μg/kg稀释至20 m L,泵注时间8 min。而后两组以1 m L/6 s静脉注射丙泊酚注射液。观察两组麻醉效果,比较两组的手术时间、苏醒时间、丙泊酚用量、心率(HR)、平均动脉压(MAP)、血氧饱和度(Sp O2)和不良反应。结果治疗后,对照组和治疗组的麻醉的优良率分别为74.34%、89.66%,两组比较差异有统计学意义(P0.05)。在术中,治疗组丙泊酚用量显著低于对照组,两组比较差异有统计学意义(P0.05)。在注射丙泊酚后(T2)、扩宫时(T3)、刮宫时(T4)时,两组HR和MAP水平明显低于同组泵注右美托咪定或芬太尼后注射丙泊酚前(T1)时,同组比较差异有统计学意义(P0.05);且在T3、T4时,治疗组这些观察指标的下降程度明显优于对照组,两组比较差异具有统计学意义(P0.05)。对照组和治疗组的不良反应发生率分别为32.74%、13.79%,两组比较差异有统计学意义(P0.05)。结论盐酸右美托咪定注射液复合丙泊酚注射液用于无痛人流的麻醉效果优于枸橼酸芬太尼注射液复合丙泊酚注射液,可减少丙泊酚用量,改善术中HR和MAP水平,安全性较好,具有一定的临床推广应用价值。     

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.     

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.     

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.