咪达唑仑复合舒芬太尼硬膜外麻醉对行腹腔镜阑尾切除术患者术中内脏牵拉反应及镇静效果的影响

目的 探讨咪达唑仑复合舒芬太尼硬膜外麻醉对行腹腔镜阑尾切除术患者术中内脏牵拉反应及镇静效果的影响.方法 选取2014年1 1月至2016年10月在本院进行腹腔镜阑尾切除术患者67例,按照随机数字表法分为两组,对照组33例予以单一舒芬太尼硬膜外麻醉,观察组34例予以舒芬太尼+咪达唑仑硬膜外麻醉,观察比较两组镇静效果(镇静起效时间、镇静持续时间)及对患者内脏牵拉反应的影响,并统计两组不良反应发生情况.结果 观察组镇静起效时间为(5.28±1.12) min,小于对照组(11.36±2.94) rin,镇静持续时间为(3.50±0.29)h,大于对照组(1.44±0.35)h,差异有统计学意义(t1=1 1.249,t2=26.266,P1=0.000,P2=0.000);观察组内脏牵拉反应较对照组轻微,差异有统计学意义(P＜0.05);观察组不良反应发生率为17.65％(6/34),对照组为12.12％(4/33),组间比较差异无统计学意义(x2=0.085,P=0.771).结论 咪达唑仑复合舒芬太尼硬膜外麻醉应用于行腹腔镜阑尾切除术患者,镇静效果显著,可有效缓解腹腔镜阑尾切除术患者术中内脏牵拉反应,且安全性高.     

舒芬太尼、咪达唑仑辅助硬膜外腔阻滞麻醉用于胆囊切除术的临床观察

目的观察舒芬太尼、咪达唑仑辅助硬膜外腔阻滞麻醉用于胆囊切除手术时镇静和抑制内脏牵拉反应的效果,并观察其对循环及呼吸功能的影响。方法40例择期行胆囊切除手术患者在知情同意情况下,按数字表法随机分为A组和B组各20例,两组均常规进行硬膜外腔阻滞麻醉,平面形成后,于切皮前5min静脉注射辅助药物：A组：首剂静脉注射（1—2min内）舒芬太尼0．1μg/kg十咪达唑仑0,02mg／kg,随后微量泵持续输注舒芬太尼0．2μg·kg^-1·h^-1＋咪达唑仑0．04mg·kg^-1·h^-1,于手术关闭腹腔时停药。B组：哌替啶1mg／kg＋氟哌利多0．05mg／kg单次缓慢静脉滴注。观察并记录两组血压、心率、血氧饱和度变化情况及Ramsay镇静程度和内脏牵拉反应分级情况。结果两组患者麻醉后血压、心率、血氧饱和度等均有不同程度下降,但组间差异均无统计学意义（均P〉0．05）;Ramsay镇静分级：A组达Ⅱ、Ⅲ、Ⅳ级分别为3例、8例、9例,与B组的4例、13例、3例相比较,差异有统计学意义（u=3．75,P〈0．05）;A组内脏牵拉反应（0～Ⅲ级）分别为9例、9例、1例、1例,与B组的4例、5例、7例、4例比较,差异有统计学意义（u=4．01,P〈0．01）。结论舒芬太尼、咪达唑仑辅助硬膜外腔阻滞麻醉用于胆囊切除术中,可明显改善镇静程度,防治内脏牵拉反应,对呼吸循环干扰小。     

两种不同剂量舒芬太尼硬膜外预注对全子宫切除术患者麻醉效果的影响

目的 观察不同剂量舒芬太尼硬膜外预注对全子宫切除术患者麻醉效果的影响.方法 选择全子宫切除术患者60例随机分为A、B、C组各20例,均行腰—硬联合麻醉,分别经硬膜外腔注入舒芬太尼10μg、20μg生理盐水各3ml,同时各组患者静注咪达唑仑0.04 mg/kg,记录患者不同时段BP、HR、SpO2,术中镇静、牵拉反应、遗...     

咪达唑仑复合舒芬太尼在腰硬联合麻醉镇静中的应用

目的观察咪达唑仑复合舒芬太尼在腰硬联合麻醉镇静中的应用效果。方法将100例需行手术治疗的患者随机分为观察组和对照组各50例。观察组应用咪达唑仑联合舒芬太尼麻醉镇静,对照组单用咪达唑仑麻醉镇静,观察2组术中麻醉镇静效果及遗忘程度,并进行QAA／S评分观察术中、术后的不良反应。结果观察组给药30、60min和90min的QAA／S评分均低于对照组,遗忘程度高于对照组,术中体动发生率（0）低于对照组的（30．0％）,差异均有统计学意义（P〈0．05）,术后2组患者均有程度不同的恶心呕吐反应,差异无统计学意义（P〉0．05）。结论咪达唑仑复合舒芬太尼在腰硬联合麻醉镇静中有良好的应用效果,保持患者的麻醉深度,促进手术顺利进行,值得临床推广应用。     

咪达唑仑复合舒芬太尼用于腰硬联合麻醉镇静的效果观察

目的对比咪达唑仑复合舒芬太尼和单纯使用咪达唑仑用于腰硬联合麻醉镇静的效果观察。方法选择40例妇科手术患者随机分为两组,观察术中体动、恶心、呕吐、呃逆等不良反应及记录患者OAA/S(改良警觉/镇静观察法)评分及遗忘程度。结果 MS组所有患者在术中均未发生体动,M组中有8例患者在术中发生不同程度的体动,两组患者均能达到良好的遗忘作用,无统计学差异。结论咪达唑仑复合舒芬太尼用于腰硬联合麻醉的镇静效果优于单纯使用咪达唑仑,有效预防术中内脏牵拉引起的不良症状。     

全麻诱导期舒芬太尼分两次外周静脉注射对其诱发呛咳反应的影响

目的观察全身麻醉诱导期舒芬太尼分两次外周静脉注射对其诱导期诱发呛咳反应的影响。方法 100例25～55岁ASA分级Ⅰ～Ⅱ级的择期行腹部手术患者随机为观察组和对照组:50例在全身麻醉诱导时先静注0.2μg·kg-1舒芬太尼,1min后按顺序静注咪达唑仑0.05 mg·kg-1、舒芬太尼0.3μg·kg-1、依托咪酯0.2 mg·kg-1、维库溴铵0.1 mg·kg-1(观察组,n=50);50例在全麻诱导期一次性静脉注射舒芬太尼诱导期给药总量的给药组(对照组,n=50),即在全身麻醉诱导期按顺序静注咪达唑仑0.05 mg·kg-1、舒芬太尼0.5μg·kg-1、依托咪酯0.2 mg·kg-1、维库溴铵0.1 mg·kg-1;两组患者舒芬太尼的静脉注射速度相同,总的诱导期舒芬太尼的静注时间均在5 s内。对比两组患者诱导期呛咳发生率和强度。结果观察组患者诱导期呛咳显著低于对照组,且发生同级别呛咳的人数显著少于对照组。结论全身麻醉诱导期分两次外周静脉注射舒芬太尼能显著降低舒芬太尼诱导期的呛咳反应。     

不同剂量咪达唑仑与芬太尼联合用于老年患者术中镇静的疗效比较

目的观察不同剂量咪达唑仑和芬太尼联合用于老年患者术中镇静的效果及不良反应。方法在硬膜外麻醉下手术的老年患者280例，随机分成A、B、C、D 4组各70例，手术前静脉注射咪达唑仑和芬太尼。A组：咪达唑仑0.03 mg·kg-1+芬太尼0.75μg·kg-1；B组：咪达唑仑0.03 mg·kg-1+芬太尼1.0 μg·kg-1； C组：咪达唑仑0.05 mg·kg-1+芬太尼0.75 μg·kg-1；D组：咪达唑仑0.05 mg·kg-1+芬太尼1.0 μg·kg-1。观察患者术中镇静评分及不良反应的发生情况。结果B、C、D 3组的镇静效果明显优于A组（P＜0.05），D组呼吸抑制发生率明显高于A、B、C组（P＜0.05），C、D组血压下降患者明显较A、B组多（P＜0.05）。结论老年患者术前静脉注射咪达唑仑0.03 mg·kg-1和芬太尼1.0 μg·kg-1可达到理想的术中镇静效果，且不良反应相对较少。     

咪达唑仑复合芬太尼用于臂丛神经阻滞的临床观察

目的:探讨在臂丛神经阻滞下不同剂量咪达唑仑复合芬太尼对患者的镇静遗忘作用。方法:选取90例拟行单侧上肢手术的患者随机分成3组:Ⅰ组,咪达唑仑0.04mg·kg-1+芬太尼1μg·kg-1;Ⅱ组,咪达唑仑0.06mg·kg-1+芬太尼1μg·kg-1;Ⅲ组为对照组,穿刺前不给予任何药物。比较3组穿刺后的血压、心率、脉搏氧饱和度的变化、镇静程度和遗忘程度。结果:Ⅰ、Ⅱ组在不同时间的镇静程度均优于Ⅲ组(P<0.05),Ⅱ组在给药后30、120min遗忘程度优于Ⅰ组(P<0.05)。3组患者的术中生命体征无显著性变化(P>0.05)。结论:咪达唑仑复合芬太尼在臂丛神经阻滞下对患者可产生有效的镇静遗忘作用,提高麻醉质量和患者满意度。     

咪达唑仑复合舒芬太尼在腰硬联合麻醉的镇静效果分析

目的探讨咪达唑仑复合舒芬太尼在腰硬联合麻醉中的镇静效果。方法 88例腰硬联合麻醉患者随机分为对照组(咪达唑仑复合芬太尼麻醉)和观察组(咪达唑仑复合舒芬太尼麻醉),每组44例。于给药后10、30、60、90 min,通过改良警觉/镇静观测评分法,观察和比较两组QAA/S评分;并对两组遗忘程度、不良反应等指标进行观察和比较。结果与对照组相比,观察组于给药后30、60 min,QAA/S评分明显降低,而遗忘程度显著提高,体动不良反应发生率显著降低(P<0.05)。结论咪达唑仑复合舒芬太尼用于腰硬联合麻醉镇静作用明显,不良反应少。     

丙泊酚与咪达唑仑辅助硬膜外麻醉镇静效果的比较

目的探讨丙泊酚与咪达唑仑辅助硬膜外麻醉镇静效果的比较。方法选取2010年3月~2011年3月期间在我院行硬膜外麻醉的88例患者作为临床研究对象,随机将其分为丙泊酚组(P组)和咪达唑仑组(M组),每组患者44例,P组给予丙泊酚辅助硬膜外麻醉,M组给予咪达唑仑辅助硬膜外麻醉,并对两组患者的Ramsay镇静评分情况、内脏牵拉反应情况、遗忘程度进行比较和分析。结果与P组患者相比,M组Ramsay镇静评分为Ⅰ级和Ⅱ级的比率显著增高,而Ⅲ级和Ⅳ级的比率则显著减少,差别均具有统计学意义(P<0.05);M组内脏牵拉反应为0级的比率明显提高,而Ⅰ级和Ⅱ级的比率则明显降低,差别均呈现出统计学意义(P<0.05);M组遗忘程度为完全遗忘的比率显著提高,而无遗忘和不全遗忘的比率则显著降低,差别均具有统计学意义(P<0.05)。结论咪达唑仑被认为比丙泊酚更适合于辅助硬膜外麻醉镇静。     

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.

     

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.     

2-(Acetoxyphenyl)-(Z)-styryl sulfides as cyclooxygenase inhibitors

2-(Acetoxyphenyl)-(Z)-styryl sulfides are described as selective cyclooxygenase-2 (COX-2) inhibitors, useful for treating inflammation and COX-2-mediated disorders including neoplasia. 2-(Acetoxyphenyl)-(Z)-styryl sulfide is claimed to be the most potent COX inhibitor in the series with a COX-2 selectivity ratio of 33. This compound is also claimed to be superior to celecoxib (Celebrex^®, Pfizer) in inhibiting cell growth of colorectal carcinoma cells. In this evaluation, the COX inhibitory activity of this compound is compared to that previously disclosed for diarylheterocycles and 2-(acetoxyphenyl)alkyl sulfides. The validity of the DLD-1 cell line in the growth inhibition studies is questioned based on recent literature reports indicating the lack of COX-2 expression in this cell line.     

Sleep-disordered breathing with chronic opioid use

Chronic opioid use for pain relief or as substitution therapy for illicit drug abuse is prevalent in our societies. In the US, retail distribution of methadone and oxycodone has increased by 824 and 660%, respectively, between 1997 and 2003. μ-Opioids depress respiration and deaths related to illicit and non illicit chronic opioid use are not uncommon. Since 2001 there has been an emerging literature that suggests that chronic opioid use is related to central sleep apnoea of both periodic and non-periodic breathing types, and occurs in ～ 30% of these subjects. The clinical significance of these sleep-related abnormalities are unknown. This review addresses the present knowledge of control of ventilation mechanisms during wakefulness and sleep, the effects of opioids on ventilatory control mechanisms, the sleep-disordered breathing found with chronic opioid use and a discussion regarding the future research directions in this area.     

Drug targets for cognitive enhancement in neuropsychiatric disorders

The investigation of novel drug targets for treating cognitive impairments associated with neurological and psychiatric disorders remains a primary focus of study in central nervous system (CNS) research. Many promising new therapies are progressing through preclinical and clinical development, and offer the potential of improved treatment options for neurodegenerative diseases such as Alzheimer's disease (AD) as well as other disorders that have not been particularly well treated to date like the cognitive impairments associated with schizophrenia (CIAS). Among targets under investigation, cholinergic receptors have received much attention with several nicotinic agonists (α7 and α4β2) actively in clinical trials for the treatment of AD, CIAS and attention deficit hyperactivity disorder (ADHD). Both glutamatergic and serotonergic (5-HT) agonists and antagonists have profound effects on neurotransmission and improve cognitive function in preclinical experiments with animals; some of these compounds are now in proof-of-concept studies in humans. Several histamine H3 receptor antagonists are in clinical development not only for cognitive enhancement, but also for the treatment of narcolepsy and cognitive deficits due to sleep deprivation because of their expression in brain sleep centers. Compounds that dampen inhibitory tone (e.g., GABA_A α5 inverse agonists) or elevate excitatory tone (e.g., glycine transporter inhibitors) offer novel approaches for treating diseases such as schizophrenia, AD and Down syndrome. In addition to cell surface receptors, intracellular drug targets such as the phosphodiesterases (PDEs) are known to impact signaling pathways that affect long-term memory formation and working memory. Overall, there is a genuine need to treat cognitive deficits associated with many neuropsychiatric conditions as well as an increasingly aging population.