右美托咪定两种麻醉方式用于下肢骨折手术麻醉的效果及安全性比较

目的:分析在下肢骨折患者手术麻醉中右美托咪定的两种不同麻醉方式的应用价值。方法:对照组患者术中采取右美托咪定联合常规腰硬联合麻醉,观察组患者行右美托咪定联合腰丛神经阻滞麻醉。结果:观察组患者术中麻醉显效率为98.57%,显著高于对照组患者的91.43%(P0.05);观察组患者麻醉中的不良反应率为3.57%,显著低于对照组的15.71%(P0.05)。结论:下肢骨折手术中采取右美托咪定联合腰丛神经阻滞麻醉具有麻醉效果好和安全性高等优势,值得临床应用与推广。     

右美托咪定辅助腰丛坐骨神经阻滞对老年股骨干骨折患者的阻滞作用分析

目的：研究老年股骨干骨折患者手术治疗期间采用右美托咪定辅助腰丛坐骨神经阻滞麻醉的临床效果。方法：选择2019年1月—2022年12月在我院接受手术治疗的60例老年股骨干骨折患者,根据手术期间麻醉方法的不同将其分成对照组和研究组。对照组中30例患者手术期间单纯接受全身麻醉;研究组中30例患者手术期间在全身麻醉基础上接受右美托咪定辅助腰丛坐骨神经阻滞。对比两组研究对象麻醉阻滞效果相关评价指标。结果：研究组麻醉效果优于对照组(P<0.05);研究组麻醉不良反应发生率少于对照组(P<0.05);研究组麻醉起效、完全阻滞、术后完全苏醒、住院时间短于对照组(P<0.05);麻醉组麻醉前后生命体征、应激反应相关指标、精神状态、谵妄量表相关评分水平变化幅度小于对照组(P<0.05)。结论：老年股骨干骨折患者手术治疗期间采用右美托咪定辅助腰丛坐骨神经阻滞麻醉,可以减小对心率、血压等生命体征的影响,减轻应激反应,防止术后出现麻醉不良反应,缩短术后苏醒和住院时间,使麻醉效果得到提高。     

右美托咪定两种给药模式在老年膝关节镜手术腰硬联合麻醉中的应用效果及安全性分析

目的 观察老年膝关节镜手术腰硬联合麻醉中静脉泵注和自控镇静模式应用右美托咪定的效果及安全性.方法 选取解放军188医院于2015年1月-2016年6月行膝关节镜手术患者80例,采用随机数字表法将其分为两组,均行腰硬联合麻醉,常规组术中应用静脉泵注右美托咪定,研究组则采用电子自控镇静模式应用右美托咪定,观察两组患者感觉、运动阻滞的起效和恢复时间,镇静效果,不良反应及术后遗忘情况.结果 研究组感觉及运动阻滞的起效时间明显短于常规组(P＜0.01),且恢复时间明显长于常规组(P＜0.01).研究组达适宜镇静时间明显长于常规组(P＜0.01),达适宜镇静和术毕时右美托咪定用量明显少于常规组(P ＜0.05,P＜0.01).两组术中均未出现寒战、低血压、心动过缓等不良反应.两组术后躁动和遗忘程度比较差异无统计学意义(P＞0.05).结论 老年膝关节镜手术腰硬联合麻醉中应用右美托咪定自控镇静模式可达到静脉泵注的镇痛效果,维持时间较长且用药剂量较少,不良反应少且轻微,是一种较为理想的镇静模式.     

右美托咪定两种麻醉方式在下肢骨折手术中的麻醉效果及安全性比较

目的：探讨右美托咪定在腰丛-坐骨神经阻滞在下肢骨折手术中的麻醉效果及安全性。方法：选取2021年1月—2022年5月我院收治的600例下肢骨折患者作为研究对象，采用随机数字表法分为两组，其中麻醉(1)组（300例）实施右美托咪定腰硬联合麻醉，麻醉(2)组（300例）实施右美托咪定腰丛-坐骨神经阻滞麻醉。比较两组临床麻醉效果优良率、Ramsay镇静评分、术后24h收缩压、舒张压、心率及不良反应发生率。结果：麻醉(2)组临床麻醉效果优良率为99.33%，高于麻醉(1)组的96.00%(P<0.05)；麻醉(2)组Ramsay镇静评分高于麻醉(1)组（P<0.05）；麻醉(2)组术后24 h收缩压、舒张压高于麻醉(1)组，心率低于麻醉(1)组（P<0.05）；麻醉(2)组不良反应发生率低于麻醉(1)组（P<0.05）。结论：下肢骨折手术中实施右美托咪定腰丛-坐骨神经阻滞麻醉，可获得更佳的麻醉、镇静效果，稳定血流动力学水平，降低不良反应发生率。     

右美托咪定在神经刺激仪下的下肢神经阻滞中的镇静作用

目的 观察右美托咪定用于辅助神经刺激仪下的下肢手术神经阻滞麻醉的镇静效果.方法 40例膝关节置换手术患者随机分为2组(每组20例),于神经刺激仪下行神经阻滞麻醉.在操作前10 min,试验组静脉泵注右美托咪定1 μg· kg-1,后以0.5 μg·kg-1 ·h-1维持;对照组,则静脉注射咪达唑仑2.5 mg和芬太尼0.05 mg.用神经刺激仪进行定位,用腰丛联合坐骨神经阻滞.记录不同时间点患者的心率、血压及血氧饱和度(SpO2),并进行Ramsay镇静评分.结果 试验组的Ramsay评分明显高于对照组(P＜0.05);对照组SpO2明显低于试验组(P＜0.05).试验组患者用药后心率明显减慢(P＜0.05),对照组则无明显变化.结论 用右美托咪定麻醉,对清醒患者具有镇静时易唤醒、无呼吸抑制等特点.     

右美托咪啶联合地佐辛在腰丛-坐骨神经阻滞中的应用效果

目的研究分析在腰丛神经下肢麻醉过程中使用右美托咪定以及地佐辛联合麻醉的效果。方法选取在赤壁市人民医院接受手术治疗行腰丛-坐骨神经阻滞麻醉的患者,选取时间段为2017年2月至2017年12月,病例数为60例。通过随机数字表格法分组,平均分成对照组和观察组各30例。对照组中患者接受地佐辛麻醉,观察组中患者接受右美托咪定以及地佐辛联合麻醉,分析两组麻醉效果差异。结果观察组中患者的麻醉起效时间、痛觉消失时间以及持续镇痛时间均显著优于对照(P<0.05)。在麻醉前半小时、手术开始后1h以及手术后6h观察组的SpO_2、HR均显著比对照组更稳定(P<0.05),术后观察组VAS分数显著低于对照组(P<0.05)。结论临床上在实施腰丛-坐骨神经阻滞麻醉时,运用右美托咪定以及地佐辛联合的方式效果良好,患者能够获得显著的镇痛、镇静效果。     

腰丛、坐骨神经阻滞复合喉罩全麻用于老年全膝关节置换术的临床作用分析

目的探讨腰丛、坐骨神经阻滞复合喉罩全麻用于老年全膝关节置换术的临床作用。方法将2016年4月至2017年10月90例老年全膝关节置换术患者随机数字表法分组。对照组用气管插管全身静脉麻醉,观察组进行腰丛、坐骨神经阻滞复合喉罩全麻。比较两组老年全膝关节置换术麻醉的效果;呼吸抑制等不良反应率;干预前后患者相关血流指标。结果观察组老年全膝关节置换术麻醉效果、不良反应率和生命体征优于对照组,P <0.05。结论腰丛、坐骨神经阻滞复合喉罩全麻在老年全膝关节置换术麻醉中的效果确切,稳定血流动力学,减少对呼吸的影响,安全性高。     

超声引导下腰丛-坐骨神经阻滞麻醉对行人工膝关节置换术老年患者血流动力学水平的影响

目的：探讨分析行人工膝关节置换术治疗的老年患者采用超声引导下腰丛-坐骨神经阻滞麻醉对其血流动力学水平的影响。方法：将在我院进行人工膝关节置换术的80例老年患者进行研究分析,按照麻醉方式分为参照组和实验组,每组40例。参照组以常规引导腰丛-坐骨神经阻滞麻醉,实验组行超声引导下腰丛-坐骨神经阻滞麻醉,观察两组患者的血流动力学水平。结果：血流动力学水平在麻醉前(T0)两组患者比较无显著差异,P>0.05;在麻醉后5min(T1)、30min(T2)组间数据比较均显示P<0.05。实验组患者感觉神经的阻滞时间和维持时间以及运动神经的阻滞时间和维持时间,麻醉效果均优于参照组患者,P<0.05。实验组不良反应发生率低于参照组(P<0.05)。结论：行人工膝关节置换术的老年患者采用超声引导下腰丛-坐骨神经阻滞麻醉,其应用效果较为理想,对其血流动力学水平基本不影响,具有较高的安全性。     

右美托咪定不同给药途径用于超声引导下腰丛?坐骨神经阻滞在踝关节手术的疗效观察

目的探讨右美托咪定不同给药途径用于超声引导下腰丛 ?坐骨神经阻滞在踝关节手术的临床疗效。方法选取英山县人民医院 2018年 3月至 2019年 3月踝关节手术病人 90例,采用随机组字表法分为三组,每组 30例:罗哌卡因组(R组),右美托咪定联合罗哌卡因组(VDR组),右美托咪定混合罗哌卡因组(PDR组)。三组均使用超声引导下腰丛 ?坐骨神经阻滞;腰丛阻滞时, R组注射 0.5%罗哌卡因 20 mL,VDR组注射 0.5%罗哌卡因 20 mL后立即静脉注射右美托咪定 0.5 μg/kg,泵注 30 min,PDR组注射含右美托咪定 0.5 μg/kg的 0.5%罗哌卡因 20 mL;坐骨神经阻滞时,各组分别注射相应药物 10 mL。记录感觉、运动神经阻滞起效时间和持续时间, Ramsay评分评估镇静程度,麻醉效果,镇静过度及心血管不良事件的发生情况。结果三组感觉、运动神经阻滞起效时间和运动神经阻滞持续时间差异无统计学意义(P＞0.05);与 R组［坐骨神经(390.5±114.9)min,腰丛(458.2±196.7)min］相比, VDR组［坐骨神经(762.8±264.2)min,腰丛(863.3±304.0)min］和 PDR组［坐骨神经(788.2±291.5)min,腰丛(889.0±312.2)min］感觉神经阻滞持续时间延长(F＝26.596、22.988,P＜0.001)感觉神经阻滞持续时间 PDR组与VDR组比较,差异无统计学意义(P＞0.05);与 R组 70.0%比较, VDR组 96.7%和 PDR组 96.7%,镇静满意率高,差异有统计学意义(P＝0.012);镇静满意率 PDR组与 VDR组相比,差异无统计学意义(P＞0.05);三组均未发生镇静过度,心血管不良事件差异无统计学意义(P＞0.05)。结论右美托咪定联合罗哌卡因腰丛 ?坐骨神经阻滞用于踝关节手术具有良好的镇静镇痛效果,并可明显延长镇痛时间且不增加不良事件风险。     

盐酸右美托咪定用于膝关节镜手术患者腰硬联合麻醉的临床效果

目的:对盐酸右美托咪定应用于膝关节镜手术患者腰硬联合麻醉的效果探讨和研究。方法:按数字法将我院受治的54例行膝关节镜手术的患者进行分组:分别为对照组和治疗组(各27例)。采用盐酸右美托咪定对治疗组进行静脉注射,对照组未采用盐酸右美托咪定,观察与分析两组患者的疗效。结果:对照组的Ramsay镇静评分低于治疗组,VAS和Scale运动神经阻滞评分高于治疗组,对比发现,治疗组的效果较为理想,且P0.05,差异具有统计学意义。结论:盐酸右美托咪定用于膝关节镜手术腰硬联合麻醉中效果理想,镇静镇痛效果显著,适合推广和使用。     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.     

Trichinellosis in immigrants in Switzerland

We describe a case of trichinellosis diagnosed at the Division of Infectious Diseases, Hospital of Lugano, in January 2009. This case was associated with a cluster of cases and was traced to the consumption of contaminated meat after a wild boar hunt in Bosnia.