不同麻醉方法用于腹腔镜胆囊切除术的临床观察

目的:观察全麻与全麻复合硬膜外麻醉用于腹腔镜胆囊切除术(LC)时的血流动力学、呼气末二氧化碳分压(PetCO2)和术毕清醒质量的影响.方法:40例LC患者随机分为全麻组(A组,n=20)和全麻复合胸段硬膜外麻醉组(B组,n=20),连续监测SBP、DBP、MAP、HR、ECG、SpO2、BIS、PetCO2,记录两组患者麻醉前(T1)、插管后(T2)、气腹后10min(T3)、气腹后20min(T4)和放气后10min(T5)的SBP、DBP、MAP、HR、PetCO2,以及全麻用药量和拔管时间.结果:在T2、T3、T4、T5时,A组SBP、DBP、MAP值明显升高,B组较基础值下降,组间差异显著(P＜0.05);气腹期间A组心率明显升高(P＜0.05),B组无明显变化(P＞0.05);气腹20min后PetCO2值两组都较术前升高,以A组明显(P＜0.05);组间比较差异显著(P＜0.05);术毕拔管时间B组较A组时间明显缩短(P＜0.05).结论:LC时,全麻复合胸段硬膜外麻醉使循环、呼吸更稳定,清醒质量高;术中需加强PetCO2的检测,尤其是气腹解除后.     

舒芬太尼复合异丙酚用于腹腔镜胆囊手术麻醉的效果分析

目的:探讨舒芬太尼复合异丙酚在腹腔镜胆囊手术中的麻醉效果.方法:将腹腔镜胆囊手术患者随机分为舒芬太尼组和芬太尼组各40例,观测并记录麻醉前、诱导后、插管后、气腹后和手术毕的心率(HR)、收缩压(SBP)、舒张压(DBP)、脉搏氧饱和度(SpO2)等;记录两组患者苏醒及拔管的时间.结果:两组患者诱导后HR、SBP、DBP明显低于麻醉前(P＜0.05),芬太尼组插管后的HR、SBP、DBP有所升高,高于诱导后(P＜0.05);舒芬太尼组患者诱导后、插管后、气腹后和手术毕的HR、SBP、DBP均明显低于芬太尼组(P＜0.05);两组患者SpO2无差异.舒芬太尼组患者在苏醒及拔管时间上明显少于芬太尼组(P＜0.05).结论:舒芬太尼用于腹腔镜胆囊手术患者麻醉血流动力学及麻醉过程平稳程度优于芬太尼.     

瑞芬太尼对全麻气管内插管心血管反应的影响

目的观察不同剂量瑞芬太尼全麻诱导气管内插管对血压心率的影响.方法 92例择期手术全麻患者,随机分为3组,Ⅰ组(n=40)、Ⅱ组(n=40)、Ⅲ组(n=12),全麻诱导用咪唑安定0.08 mg/kg、异丙酚1.5 mg/kg、瑞芬太尼和阿曲库铵,瑞芬太尼剂量是:Ⅰ组1 μg/kg、Ⅱ组2 μg/kg、Ⅲ组为生理盐水对照组.记录麻醉诱导前(T0)、诱导后置入喉镜前(T1)、导管插入即刻(T2)、气管插管后1 min(T3)、3 min(T4)、5 min(T5)、10 min(T6)的血压(SBP、DBP、MAP)和心率(HR)变化.结果 (1)与麻醉前相比,T1时Ⅰ组和Ⅱ组的HR、SBP、DBP、MAP均明显下降(P＜0.01),Ⅲ组的HR和SBP较低(P＜0.05);T2时除Ⅱ组的SBP较低外(P＜0.05),Ⅰ组和Ⅱ组的血压、心率恢复至T0时水平(P＞0.05);Ⅲ组的血压、心率增高(P＜0.01或P＜0.05),需瑞芬太尼加深麻醉.(2)Ⅰ、Ⅱ组与Ⅲ组相比,诱导后的SBP和从T2到T3,SBP、DBP、MAP、HR的变化差异均非常显著(P＜0.01).(3)Ⅰ、Ⅱ组间比较,在各时点, SBP、DBP、MAP、HR的变化差异无显著性(P＞0.05).结论 1～2 μg/kg瑞芬太尼麻醉诱导对血压、心率影响较小,能较好抑制气管插管引起的心血管反应.     

靶控输注异丙酚在全麻复合硬膜外阻滞中的应用

目的观察靶控输注(TCI)异丙酚在全麻复合硬膜外阻滞中诱导、术中维持血流动力学变化以及术后苏醒时间、术中有无知晓,指导临床用药。方法30例择期行腹腔镜胆囊切除术患者在全麻复合硬膜外阻滞中采用TCI异丙酚,在硬膜外注药后麻醉平面满意的基础上,设定诱导时异丙酚的效应室浓度为1．5μg/ml,复合咪唑安定2mg、罗库溴铵0．6mg／kg、瑞芬太尼1．0μg／kg行气管插管。术中维持异丙酚效应室浓度仍为1．5μg/ml,瑞芬太尼0．1μg·min-1·kg-1持续泵入,记录麻醉前、诱导前、插管前、插管即刻、插管后4min、气腹前、气腹后收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)、停药后苏醒时间及术中有无知晓。结果插管即刻HR、DBP、SBP、MAP比麻醉前有所上升(P<0．05)、气腹后DBP、MAP比麻醉前也有差异(P<0．05)、平均苏醒时间为(6±4)min,所有患者术后随访均无术中知晓。结论在全麻复合硬膜外阻滞中采用TCI异丙酚诱导及术中维持血流动力学相对平稳,术后苏醒安静迅速,术中无知晓。     

瑞芬太尼异丙酚对气管插管血管反应的影响

目的 比较不同剂量瑞芬太尼复合异丙酚麻醉诱导对气管插管时的心血管反应的影响.方法 ASA I～Ⅱ级择期全麻手术患者60例按瑞芬太尼剂量不同随机分为3组:1μg/kg(Ⅰ组)、2μg/kg(Ⅱ组)、3μg/kg(Ⅲ组),各组麻醉诱导用药依次静注异丙酚2μg/kg,维库溴胺0.1μg/kg,瑞芬太尼1μg/kg(Ⅰ组)、2μg/kg(Ⅱ组)、3μg/kg(Ⅲ组)后,经口气管内插管.观察诱导前、诱导后、插管后1、3、5、10min的血压(SBP、DBP、MAP)和心率(HR)变化,对所得数据进行统计学分析.结果 各组患者诱导后及插管后1、3、5、10min的血压(SBP、DBP、MAP)与诱导前相比有显著性降低(P＜0.05或P＜0.01);组间比较,第Ⅲ组比第Ⅰ、Ⅱ组有显著性差异(P＜0.05).各组心率(HR)无显著性差异(P＞0.05).结论 1、2μg/kg瑞芬太尼复合异丙酚能有效抑制气管插管引起的心血管不良反应.     

腹腔镜胆囊切除术静吸复合麻醉的临床观察

目的 观察异丙酚、瑞芬太尼靶控输注(TCI)与N2O吸入复合麻醉在腹腔镜胆囊切除术(LC)中的应用效果.方法 将择期LC手术患者40例随机分为静吸组和全静脉组各20例.静吸组采用吸复合麻醉,全静脉组采用全凭静脉麻醉.记录麻醉诱导前、气腹前和气腹后10min、气腹毕、术毕的收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SpO2)、停止麻醉至拔管时间、拔管时的清醒程度和随访结果.结果 全静脉组气腹后10min HR、SBP、DBP及术毕HR水平明显高于麻醉诱导前(P＜0.05或P＜0.01).静吸组气腹后10min、气腹结束、术毕后HR均明显低于静吸组(P＜0.05).2组患者手术时间、拔管时间比较差异无统计学意义(P＞0.05).静吸组拔管时清醒程度及术后随访情况均优于全静脉组,差异有统计学意义(P＜0.05).结论 异丙酚、芬太尼靶控输注与N2O吸入复合麻醉用于LC具有麻醉效果满意、血流动力学稳定、苏醒快速、术后恶心呕吐发生率低等特点,增加了手术安全性,同时有效减少了静脉给药量,降低成本,可供临床借鉴应用.     

艾司洛尔复合利多卡因对老年病人气管插管时血流动力学的影响

目的 观察艾司洛尔复合利多卡因预防气管插管引起血流动力学变化的效果.方法 50例择期全麻手术病人随机分为实验组、对照组(n=25),两组病人诱导方法相同:咪唑安定0.05 mg·kg-1,依托咪酯0.2 mg·kg-1,舒芬太尼0.4 μg·kg-1,维库溴铵0.1 mg·kg-1,实验组病人在诱导后静脉注射艾司洛尔0.5 mg·kg-1和利多卡因1 mg·kg-1,对照组病人则静脉注射生理盐水.分别记录诱导前(T0)、诱导后1 min(T1)、插管后即刻(T2)、插管后1 min(T3)、3 min(T4)、5 min(T5)各时点的收缩压(SBP)、舒张压(DBP) 、心率(HR)及脉搏氧饱和度、呼气末二氧化碳浓度及心电图变化.结果 实验组病人SBP、DBP、HR插管后较基础值有短时间轻度升高(P＞0.05);对照组病人在插管后HR较基础值明显增快(P＜0.01),明显高于实验组(P＜0.05);插管后即刻、1 min、3 min SBP、DBP较基础值明显升高(P＜0.01),明显高于实验组(P＜0.05).结论 艾司络尔复合利多卡因在老年病人全麻诱导时应用可有效缓解气管插管时的心血管反应,使血流动力学更加平稳,这在老年病人可减少心肌氧耗,降低麻醉风险,提高围手术期安全性.     

异丙酚·芬太尼全凭静脉麻醉在LC术中的应用

目的　研究异丙酚和芬太尼全凭静脉麻醉在LC中的应用及效果评价。方法　择期LC手术患者80例,随机等分成静吸复合麻醉组(静吸组)和全凭静脉麻醉组(全静脉组),两组均以咪唑安定0.15mg/kg,异丙酚2mg/kg和维库溴铵0.1mg/kg诱导后作气管插管、麻醉维持;静吸组用安氟醚吸入,全静脉组将异丙酚8mg/kg·h和芬太尼4μg/kg·h混合液用微量泵注入,记录麻醉诱导前、气腹前和气腹后10min,气腹毕和术毕的SBP、DBP、HR 和SPO2,停止麻醉至拨管的时间,拨管时的清醒程度和随访结果。结果　两组间的拨管时间、清醒程度无显著性差异。静吸组在气腹后10min的HR、SBP、DBP及术HR明显高于基础值(P<0.05),而全静脉组术中无明显变化,此外,全静脉组的术后恶心呕吐发生率明显低于静吸组。结论　异丙酚和芬太尼全凭静脉麻醉用于LC手术,具有麻醉效果满意,血液动力学稳定,苏醒快速,术后恶心呕吐率低等优点,且无吸入麻醉的手术室空气污染,可供临床借鉴。     

瑞芬太尼复合异丙酚全凭静脉麻醉在腹腔镜胆囊切除术中的应用

目的研究瑞芬太尼复合异丙酚全凭静脉麻醉在腹腔镜胆囊切除术的应用及其效果评价。方法选择择期行腹腔镜胆囊切除手术患者100例,随机等分为静吸复合组(静吸组)和全凭静脉麻醉组(全静脉组),两组均以咪达唑仑0.1mg/kg、异丙酚2mg/kg、芬太尼2μg/kg和维库溴胺0.08~0.12mg/kg诱导后作气管插管。麻醉维持:静吸组用异氟醚吸入,间断辅以芬太尼静注;全静脉组将瑞芬太尼0.2μg/(kg.min)和异丙酚70μg/(kg.min)混合抽入50mL注射器中,用微量泵持续输注。记录麻醉诱导前、气腹前和气腹后10min、气腹毕和术毕的SBP、DBP、HR和SPO2及停止麻醉至拔管时间,拔管时的清醒程度和随访结果。结果两组间的拔管时间、清醒程度无显著性差异。静吸组在气腹后10min的HR、SBP、DBP、术毕HR明显高于基础值(P<0.05),而全静脉组术中无明显变化。全静脉组的术后恶心、呕吐发生率明显低于静吸组。结论瑞芬太尼复合异丙酚全凭静脉麻醉用于腹腔镜胆囊切除手术,具有麻醉效果满意、血流动力学稳定、苏醒快速、术后恶心呕吐率低、无空气污染等优点。     

瑞芬太尼丙泊酚全凭静脉麻醉与静吸复合麻醉用于腹腔镜胆囊切除术的比较

目的:评价瑞芬太尼-丙泊酚全凭静脉麻醉与静吸复合麻醉应用于腹腔镜胆囊切除术(LC)的临床疗效及不良反应。方法:择期LC手术40例,随机分为静吸复合麻醉组(对照组)和全凭静脉麻醉组(试验组),每组20例。2组均以咪达唑仑0．1 mg·kg～(-1),丙泊酚2 mg·kg～(-1),瑞芬太尼2μg·kg~(-1)和维库溴铵0．1 mg·kg~(-1)诱导后气管插管。麻醉维持,对照组用2%异氟醚吸入,试验组按丙泊酚6 mg·kg～(-1)·h~(-1)和瑞芬太尼0．5μg·kg～(-1)·min~(-1)的速度用微量泵输入。记录麻醉诱导前、气腹前和气腹后5 min、气腹毕和术毕的收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SPO_2)、呼之睁眼时间、拔管时间和清醒程度及不良反应。结果:2组患者拔管时间和清醒程度均无显著性差异;试验组镇静评分(OAAS评分)明显高于对照组(P＜0．05);对照组在气腹后5min的HR,SBP,DBP及气腹后5min、气腹结束、术毕的HR显著高于麻醉诱导前的基础值(P＜0．05),试验组术中无明显变化;气腹后5min、气腹结束及术毕对照组的HR和SBP均明显高于试验组(P＜0．05);气腹后5min、气腹结束时对照组的DBP明显高于试验组(P＜0．05);试验组的术后恶心呕吐发生率显著低于对照组(P＜0．05)。结论:与常规静吸复合麻醉下行LC手术比较,丙泊酚复合瑞芬太尼全凭静脉麻醉围术期麻醉更平稳,并发症较少。     

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.

---

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.     

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.