瑞芬太尼复合丙泊酚用于老年人诱导及维持麻醉的临床研究

目的 分析瑞芬太尼复合丙泊酚用于老年患者手术麻醉的疗效和安全性.方法 选择笔者所在医院2007～2009年择期行手术的老年患者68例,随机分为观察组和对照组,组采用瑞芬太尼、咪达唑仑、丙泊酚和维库溴铵诱导麻醉,气管插管后微量泵持续输注瑞芬太尼0.2 μg/(kgomin)、丙泊酚2 mg/(kgoh)、维库溴铵60～80 μg/(kgomin);对照组应用芬太尼、咪达唑仑、丙泊酚和维库溴铵进行麻醉诱导,插管后微量泵持续输注芬太尼0.2 μg/(kgomin)、丙泊酚2 mg/(kgoh)、维库溴铵60～80 μg/(kgomin)以维持麻醉.评估两组患者的麻醉效果和安全性,结果 麻醉诱导后两组患者MAP、HR均较诱导前有所下降(P<0.05),但是组间对比无统计学意义.自主呼吸恢复时间、苏醒时间、拔管时间对照组均明显高于观察组,P<0.01,不良反应发生率两组差异不明显.结论 瑞芬太尼复合丙泊酚用于老年患者手术的麻醉诱导和维持麻醉安全可靠,值得临床推广.     

全麻苏醒拔管期间维持小剂量瑞芬太尼靶控输注可改善苏醒拔管质量

目的探讨丙泊酚联合瑞芬太尼全凭静脉麻醉患者全麻苏醒期间维持小剂量瑞芬太尼靶控输注对苏醒拔管质量的影响。方法择期脊柱侧弯后路矫形手术患者40例,随机分为对照组(全麻苏醒期间停用所有药物,n=20)和瑞芬太尼组(全麻苏醒期间维持瑞芬太尼小剂量靶控输注,n=20)。记录两组患者苏醒时间、拔管时间,并观察苏醒拔管质量评分。结果对照组患者苏醒时间为(12.76±3.56)min,拔管时间为(13.98±4.06)min;瑞芬太尼组患者苏醒时间为(13.14±3.87)min,拔管时间为(14.21±4.77)min,组间比较无显著差异。但对照组患者苏醒拔管质量评分为1、2、3、4和5分的患者例数分别为1、10、5、3和1例;瑞芬太尼组患者苏醒拔管质量评分为1、2、3、4和5分的患者例数分别为5、12、3、0和0例,组间比较有显著差异(P0.05)。结论丙泊酚联合瑞芬太尼全凭静脉麻醉全麻苏醒拔管期间维持小剂量瑞芬太尼靶控输注可以改善苏醒拔管质量,且不延长苏醒拔管时间。     

瑞芬太尼在小儿外科麻醉中的可行性研究

目的：探讨瑞芬太尼静脉输注在小儿外科手术麻醉中的有效性及安全性。方法选择ASA(美国麻醉医师协会分级法)玉~Ⅱ级患儿60例,患者年龄1.5~8岁。随机分为试验组瑞芬太尼组(REM组)和对照组芬太尼组(Fen组),各30例。其中,先天性腭裂修补手术患儿24例,腺样体扁桃体切除患儿36例。麻醉诱导采用静脉注射丙泊酚、维库溴胺、地塞米松、瑞芬太尼或芬太尼。麻醉维持院两组均采用持续静脉泵注丙泊酚,间断静脉注射维库溴铵维持肌松;试验组持续静脉泵注瑞芬太尼,对照组持续静脉泵注芬太尼。记录麻醉时间,苏醒时间和拔管时间。结果两组患儿麻醉效果均满意,生理参数两组之间比较无明显差异,并发症发生率低,无统计学差异(>0.05)。试验组比对照组苏醒快,拔管时间短。结论瑞芬太尼比芬太尼镇痛作用强,术中血流动力学稳定,并且术后苏醒快,拔管时间短,恢复迅速,无蓄积作用,是小儿外科手术的一种较好麻醉。     

咪达唑仑或丙泊酚联合瑞芬太尼对机械通气重症患者镇静效果观察

目的:观察咪达唑仑或丙泊酚联合瑞芬太尼对机械通气重症患者的镇静效果.方法:选择2018年9月至2020年9月本院收治的72例接受机械通气治疗的重症患者作为研究对象,按照镇静用药不同分为咪达唑仑组和丙泊酚组,各36例.观察两组镇静效果及麻醉并发症的发生.结果:咪达唑仑组达理想镇静时间、镇静苏醒时间久于丙泊酚组,瑞芬太尼用量低于丙泊酚组(P<0.05);咪达唑仑组并发症发生率低于丙泊酚组(P<0.05).结论:咪达唑仑或丙泊酚联合瑞芬太尼均可作为机械通气重症患者的镇静管理方案使用,瑞芬太尼联合丙泊酚起效快、患者苏醒时间短,但瑞芬太尼联合咪达唑仑瑞芬太尼用量更少,并发症较少发生.     

氯胺酮联合瑞芬太尼、丙泊酚用于小儿全凭静脉麻醉的效果比较

目的探讨氯胺酮联合瑞芬太尼用于小儿全凭静脉麻醉的疗效。方法选自2009年1月至2010年5月我院收治ASAI-II患儿100例,随机双盲分为瑞芬太尼联合氯胺酮组（A组）与丙泊酚联合氯胺酮组（B组）。A组用微量泵输注瑞芬太尼与氯胺酮混合剂（瑞芬太尼0.1mg、氯胺酮100mg溶解于20ml生理盐水）,B组用微量泵输注丙泊酚与氯胺酮混合剂（丙泊酚100 mg加氯胺酮50mg）,监测患者BP、RR、HR、SPO2及MBP,记录两组氯胺酮用量及患儿苏醒时间。观察手术中患儿有无体动、分泌物量及有无呕吐症状。结果 A组氯胺酮用量、患儿苏醒时间、分泌物多发生率小于B组,但A组呼吸抑制发生率高于B组,差异有统计学意义（P〈0.05）。结论氯胺酮联合瑞芬太尼用于小儿全凭静脉麻醉,可以减少术中用药量,患儿苏醒时间短,不良反应发生率低,麻醉效果好,但在术中须注意患儿呼吸抑制的发生。     

异丙酚复合雷米芬太尼全凭静脉麻醉在临床工作中的应用

目的 观察异丙酚复合雷米芬太尼全凭静脉麻醉的临床效果.方法 60例ASA I-II级全身麻醉患者,随机分成A组(静吸复合组)异氟醚,芬太尼,维库溴铵30例,B组(全凭静脉组) 异丙酚,雷米芬太尼,维库溴铵30例.麻醉诱导均为咪达唑仑,芬太尼,维库溴铵,依托咪酯.分别记入患者血流动力学变化及停药后患者清醒时间,拔管时间.结果 两者术中MAP、HR与术前无明显变化.全凭静脉组清醒时间,拔管时间均快于静吸复合组.结论 异丙酚复合雷米芬太尼全凭静脉组患者血流动力学稳定,术后恢复快,苏醒完全,同时可以减少手术室污染,是一种较为理想的麻醉方法.     

瑞芬太尼、舒芬太尼全凭静脉麻醉在妇科腹腔镜手术中的应用

目的对比瑞芬太尼或舒芬太尼全凭麻醉应用于妇科腹腔镜手术的麻醉特点。方法选择妇科腹腔镜手术患者80例,分为2组,瑞芬组40例实施全凭瑞芬太尼静脉麻醉,舒芬组40例实施全凭舒芬太尼静脉麻醉,比较2组在诱导前、诱导后、插管、气腹、术毕5个阶段心率、平均动脉压的变化情况,记录2组在苏醒时间、拔管时间、术后24 h疼痛、排气时间及术后并发症等方面的差异。结果患者心率、平均动脉压变化趋势和幅度无明显差别(P0.05),患者苏醒时间、拔管时间瑞芬组优于舒芬组(P0.01),术后24 h疼痛舒芬组较瑞芬组轻(P0.01),排气时间、不良反应无明显差异(P0.05)。结论舒芬太尼和瑞芬太尼用于妇科腹腔镜手术均能取得良好的麻醉效果,两者对血流动力学的影响基本一致,瑞芬太尼在恢复方面优于舒芬太尼,而舒芬太尼具有更强的术后镇痛。     

氯安酮复合瑞芬太尼和咪达唑仑用于小儿全凭静脉麻醉

目的探讨氯胺酮复合瑞芬太尼和咪达唑仑在小儿全凭静脉麻醉中的应用。方法选择56例ASAⅠ~Ⅱ级择期手术患儿,入手术室后分别静注负荷剂量氯胺酮0.3mg.kg-1、瑞芬太尼0.1μg.kg-1、咪达唑仑0.05mg.kg-1。然后根据镇静深度调节以上三种药物注药速度。不行气管内插管,面罩吸氧2L.min-1。术中观察患儿的生命体征、镇静评分(SS)和不同时间点的血气分析,记录术中有无低氧血症、呼吸暂停以及术后24h精神反应、恶心呕吐的发生。结果患儿术中安静入睡,镇痛完善(镇静评分在5分以上)。术中分泌物少,呼吸循环功能稳定,咽喉反射存在,无躁动、喉痉挛及恶心、呕吐,无明显呼吸抑制现象。术毕苏醒时间缩短。结论氯胺酮复合瑞芬太尼和咪达唑仑用于小儿全凭静脉麻醉是一种较好的麻醉方法。     

瑞芬太尼微泵输注复合丙泊酚用于无痛人流术的临产观察

目的探讨如何达到无痛人流的效果。方法采用静脉麻醉,一组先缓慢推注瑞芬太尼0.15ug/kg/min(30s注完),继以微泵瑞芬太尼0.15ug/kg/min(Graseby3500型微泵)持续输注,同时静注丙泊酚1￣1.5mg/kg至睫毛反射消失,手术结束前30s停用瑞芬太尼;另一组先静注芬太尼1ug/kg,2min后静注丙泊酚1.5￣2.0mg/kg至睫毛反射消失,给药速度为50￣80mg/min。结果诱导时间瑞芬太尼组较芬太尼组缩短2min。瑞芬太尼组手术结束后(65.12±15.66)呼之能睁眼,3min之内均可自行站立,术后行走恢复时间比芬太尼组(7.20±1.64)min显著提早。结论瑞芬太尼独特的药理学特点与丙泊酚配合应用于人工流产术的临床麻醉,可加强镇痛,减少丙泊酚用量,达到了镇痛、镇静完全,苏醒迅速,不良反应少的目的,为患者减轻了痛苦。     

瑞芬太尼、芬太尼复合丙泊酚在无痛人流术中应用的临床对比分析

目的 对丙泊酚复合瑞芬太尼在人流术中的情况进行系统的观察研究,以评价其镇痛效果和安全性.方法 需行人流术患者105例,随机分为三组:①芬太尼组;②瑞芬太尼1.5ng组;③瑞芬太尼2.5ng组.每组35例,观察麻醉和手术中丙泊酚的用量、术中体动、呼吸抑制和术后苏醒时间、腹痛情况等.结果 术中丙泊酚的用量芬太尼组＞瑞芬太尼1.5ng组＞瑞芬太尼2.5ng组,各组均有显著差异;术后苏醒时间瑞芬太尼1.5ng组最快;呼吸抑制在芬太尼组和瑞芬太尼1.5ng组相似,瑞芬太尼2.5ng组发生率较高;体动发生情况无显著差异;术后腹痛瑞芬太尼组相仿,芬太尼组发生率较高.结论 靶控输注瑞芬太尼在人流术中有较大的优点,但需注意管理呼吸,从综合效应看效应部位浓度1.5ng优于2.5ng.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.     

Der Einfluß von Nahrungsmitteln und Rauchen auf die klinisch-chemische Diagnostik von Phäochromozytom,Neuroblastom und Karzinoid-Syndrom

Zusammenfassung Der Einfluß von verschiedenen Nahrungsmitteln auf Methoden zur Bestimmung von Adrenalin (AD), Noradrenalin (NA), Vanillinmandelsäure (VMS), Metanephrinen (MN), Homovanillinsäure (HVS) und 5-Hydroxyindolessigsäure (5-HIE) im 24 h-Harn zur Diagnose des Phäochromozytoms bzw. Karzinoid-Syndroms wurde untersucht. Die in die Untersuchung einbezogenen Nahrungsmittel waren: Tee, Kaffee, Mandeln, Ananas, Käse, Walnüsse, Vanillepudding, Bananen, Tomaten und Milchschokolade. Außerdem wurde der Einfluß des Zigarettenrauchens auf die Bestimmung von AD, NA, VMS und MN untersucht.Walnüsse führten zu einer starken Erhöhung der 5-HIE-Ausscheidung. Bananen erhöhten die Ausscheidung von AD, NA, VMS, MN und 5-HIE. Kaffee und Ananas bewirkten eine geringe Zunahme der MN-Werte. Rauchen von 20–30 Zigaretten/Tag beeinflußte keine der vier Variablen.Wenn die beschriebenen Methoden benutzt werden, sollte lediglich auf den Verzehr von Bananen und Walnüssen vor und während der Harnsammelperioden verzichtet werden, da die oberen Normgrenzen im Harn überschritten werden könnten. Ein Verzicht auf Kaffee und Ananas in normalen Mengen ist nicht erforderlich. Es besteht kein Anlaß, weiterhin die bisherigen umfangreichen Restriktionen der übrigen Nahrungsmittel beizubehalten.