等容血液稀释性自体血回输在肝癌手术中的应用

目的研究等容血液稀释自体输血（ANH）对肝癌手术患者围术期机体内环境和凝血功能的影响,探讨ANH的节血效果和安全性。方法选择肝癌手术患者40例,随机分为2组。等容血液稀释性自体输血组（I组）：于麻醉后手术切皮前经桡动脉放血400-600 ml,同时经静脉输入相当容量的万汶血浆替代品,手术后半阶段将自体血回输。未做血液稀释组（II组）：分别于麻醉诱导前（T1）、ANH后30 min及术始（T2）、输血后（T3）、术毕（T4）和术后24 h（T5）测定pH值、HCO3-、K＋、Na＋、PT、APTT、PLT和血浆蛋白。结果 II组有8例输异体血而I组只有2例,2组在输异体血后pH值和HCO3-下降较未输异体血者明显（P〈0.05）。PT、APTT在各测定点2组变化一致,2组间均无显著性差异（P〉0.05）,I组PLT在T3后回升明显而II组继续下降。I和II 2组血浆蛋白在T2都下降明显（P〈0.05）,但I组在T3后回升。结论等容血液稀释自体输血（ANH）对肝癌手术患者的围术期机体内环境和凝血功能影响较小,节血效果明显,安全有效,更具优越性。     

等容血液稀释自体输血对患者围术期凝血功能的影响

目的观察术中等容血液稀释自体输血对肿瘤患者围术期凝血功能的影响。方法回顾性分析我院入院治疗的胃癌、结肠癌根治手术的44例患者,将手术过程中异体输全血400 mL的22例患者为异体输血组(对照组);将手术前22例患者切皮放血400 mL,为自体输血组,同时等量输入羟乙基淀粉,术中患者再输回自体血,比较两组患者实验室血常规变化和凝血指标的变化。结果自体输血组患者输血1 h至术后24 h Hct及Hb较异体输血组降低明显(P0.05);两组患者输血前PT及APTT较术前明显增加(P0.05),且在输血前后均发生延长同时PLT和FIB发生减少(P0.05)。结论等容血液稀释自体输血与异体输血对肿瘤患者围术期凝血功能的影响差异性不显著。     

术前急性等容血液稀释联合术中自体血回收在神经外科手术中的应用

【摘要】　目的:探讨术前急性等容血液稀释联合术中自体血回收在颅脑择期手术中对患者凝血功能的影响以纠正贫血的作用。方法:选择16例神经外科择期手术患者,分别比较患者术前、血液等容稀释后、止血基本完成时、回输机采自体血以及术前采集自体血后的APTT、PT、PLT、HB、HCT;结果:等容稀释后和术前相比患者凝血功能无明显变化,HB、HCT明显下降;止血基本完成时和术前相比患者APTT、PT延长,PLT、HB、HCT明显下降,输机采血后和止血基本完成时相比患者的PLT下降,APTT、PT延长,同时HCT及HB明显升高;输术前采集自体动脉血后和输机采血后相比患者的APTT及PT明显缩短,PLT、 HCT、HB明显升高。结论:在出血量较大的神经外科手术中使用术前急性等容血液稀联合术中自体血回收对改善纠正患者贫血,保证患者术后正常凝血功能,增加手术安全性方面是非常有益的。     

急性高容量血液稀释联合自体血回输技术在脊柱侧弯手术中的应用

目的观察急性高容量血液稀释联合自体血回输技术用于脊柱侧弯手术的临床效果。方法将28例择期行脊柱侧弯矫形术的患者随机分为急性高容量血液稀释组(Ⅰ组)和对照组(Ⅱ组)。Ⅰ组患者麻醉诱导后输注羟乙基淀粉130/0.4氯化钠注射液(亿汶)扩容,Ⅱ组不额外扩容。记录手术前(T1)、手术开始后120 min(T2)、手术结束后(T3)的血红蛋白(Hbg)、血细胞比容(Hct)、活化部分凝血活酶时间(APTT)及血浆凝血酶原时间(PT),记录术中出血量、输血量及尿量。结果两组患者T2、T3的Hbg和Hct均较T1降低(P<0.05),两组比较,差异无统计学意义(P>0.05)。Ⅰ组失血量、输血量均明显少于Ⅱ组(P<0.05),两组患者尿量比较,差异无统计学意义(P>0.05)。两组患者T2、T3的APTT、PT与T1比较均有所延长,差异无统计学意义(P>0.05),两组同一时间点比较,差异无统计学意义(P>0.05)。结论急性高容量血液稀释联合自体血液回输技术用于脊柱侧弯矫形术,可以减少术中出血、减少异体血的使用,对凝血功能影响小,可以有效地进行血液保护,具有较高的临床应用价值。     

急性等容血液稀释用于脑膜瘤切除术的临床研究

目的观察脑膜瘤切除手术患者应用急性等容血液稀释(ANH)自体输血的临床效果。方法择期脑膜瘤切除术患者40例，随机分为Ⅰ组(血液稀释组，n=20)和Ⅱ组(对照组，n=20)，两组患者均采用相同的麻醉方法全麻气管插管，Ⅰ组术前进行等容血液稀释。比较两组患者输异体血量和术后血红蛋白变化。结果Ⅰ组12例患者未输异体血，8例输异体血200～400ml，Ⅱ组每例患者均需异体血输入，输血量400800ml。结论急性等容血液稀释可使脑膜瘤切除术患者明显减少异体输血或不输异体血。     

急性腹腔内出血自体血回输31例观察

目的评估自体血回输在血液保护中的作用及安全。方法运用自体血液回收机对31例急性腹腔内出血患者进行自体血液回输。记录手术前后HR、MAP、HB、HCT、PLT的变化和凝血功能的变化（FIB、PT、AFIT变化）。结果31例患者出血回输和自体血回输均成功,回输血液66931ml,平均每例2159ml,洗涤浓缩红细胞平均893ml,患者手术结束后HR、MAP、HB、HCT、PT、APIT、FBI值,与手术前比较差异有统计学意义（P〈0．01）,PLT无明显变化。结论自体血回输在改善急性腹腔内出血患者生命体征,节约用血,避免输血并发症有很好的作用。     

急性非等容血液稀释自储血回输技术的临床应用

目的：探讨急性非等容血液稀释（ANIH）自储血回输技术的临床应用效果。方法：选取46例择期手术患者,按血液稀释方法不同分为观察组和对照组,两组各23例。观察组行急性非等容血液稀释,对照组行急性高容血液稀释。观察两组患者不同时段生命体征、血红蛋白（Hb）、血细胞比容（Hct）变化。结果：观察组各时段中心静脉压（CVP）、心率（HR）均较对照组低,*P＜0.05;观察组采血后、稀释后平均动脉压（MAP）均较对照组低,*P＜0.05。两组CO稀释后均高于术前,#P＜0.05。观察组稀释后Hct、Hb均较对照组低,*P＜0.05。结论：ANIH自储血回输技术可有效避免患者经历低Hct窗口期,避免高容量负荷,有效减少心血管事件风险。还可减少异体输血,节约血源,值得推广。     

自体血回输在骨科手术中的运用与护理

<正>自体血回输是指采集患者自己的血液或术中的失血再回输给本人的方法。自体血回输主要分为3种方法:贮血式自体输血、急性等容血液稀释和回收式自身输血。本文将主要讨论回收式自身输血在骨科手术如脊柱侧弯、腰椎滑脱、胸腰椎骨折、骨盆骨折等手术中的运用与护理。1资料与方法1.1临床资料:2011年我院一共完成自体血回输166例,包括脊柱侧弯8例,腰椎滑脱66例,胸腰椎骨折64例,骨盆骨折等创伤手术28例,年龄12～72岁,其中Rh阴性血     

血液回输在腹腔内出血手术中的应用

目的探讨血液回输在腹腔内出血手术中的应用效果。方法将2017年4月至2018年3月腹腔内出血手术患者90例数字表法分组为对照组47例和观察组43例。对照组进行异体血输入,观察组进行自体血液回输。比较两组疗效;回输血总量;手术前后患者凝血功能指标、电解质指标;手术并发症率。结果观察组疗效高于对照组,P <0.05;观察组回输血总量优于对照组,P <0.05;手术前两组凝血功能指标、电解质指标无明显差异,P> 0.05;手术后观察组凝血功能指标、电解质指标优于对照组,P <0.05。观察组手术并发症率低于对照组,P <0.05。结论腹腔内出血手术患者行自体血液回输疗效明显,可更好维持凝血功能指标、电解质指标稳定,加速康复。     

脊柱手术血液保护的临床研究

目的观察评价术前急性高容血液稀释联合术中控制性降压和自体血回输在脊柱手术中的血液保护作用。方法择期80例脊柱手术患者,连续分为2组,每组40例,组Ⅰ CH+自体血回输,组Ⅱ AHH+CH+自体血回输。分别于麻醉前、术毕30min、术后第2天,测定Hb、Hct、PT、APTT,计算失血量、输血量(自体、异体)、尿量。结果组Ⅱ术中失血量显著减少,无异体输血,术中尿量高于组Ⅰ,组Ⅰ7例(18%)患者需要异体输血,平均输血(1.1±2.3)ml,两组术毕PT、APTT,差异无统计学意义(P>0.05)。结论我院采用的多途径血液保护措施,可减少异体输血起到节约用水的作用。     

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.