地塞米松布比卡因东莨菪碱混气液硬膜外术后镇痛的临床效果观察

临床上,硬膜外镇痛是术后镇痛常用的方法之一,而其效果因药物的配方不同而异.作者自1999年至2000年采用地塞米松、布比卡因及东莨菪碱混气液用于硬膜外腔术后镇痛与同一剂量单独使用地塞米松、布比卡因、东莨菪碱镇痛进行了临床比较,现将结果报告如下: 1临床资料 手术结束前15～20min,从硬膜外腔缓慢注入镇痛复合液0.75%布比卡因3ml+地塞米松10mg+东莨菪碱0.3mg+0.9%生理盐水4ml,作为观察组(Ⅰ),以地塞米松10mg+0.9%生理盐水8ml为Ⅱ组,0.75%布比卡因3ml+0.9%生理盐水为Ⅲ组,东莨菪碱0.3mg+0.9%生理盐水9m1为Ⅳ组,Ⅱ、Ⅲ、Ⅳ组为对照组.所有病例均在出手术室前拔除硬膜外导管后送回病房,术后30h内观察各组镇痛效果及副作用.其选择患者180例,随机分到Ⅰ、Ⅱ、Ⅲ、Ⅳ组(见表1).     

老年人上腹部手术硬膜外超前镇痛的疗效与安全性

目的：探讨手术前硬膜外注射氯胺酮、吗啡、布比卡因术后镇痛的疗效和安全性。方法：将45例ASAⅠ-Ⅱ级择期实施上腹部手术的65岁以上老年病人,随机分为三组：Ⅰ组（对照组n=15);Ⅱ组（吗啡加布比卡因M＋B组n=15);Ⅲ组（氯胺酮－吗啡－布比卡因;K＋M＋B组n=15)。Ⅰ、Ⅱ、Ⅲ组术前30min分别经硬膜外导管注入0．9％生理盐水6－7ml,0.5%布比卡因6－7ml加吗啡1mg混合液;0．5％布比卡因6－7ml加氯胺酮20mg和吗啡1mg混合液。三组术后均行病人自控硬膜外镇痛（PCEA）治疗。结果：Ⅲ组术后72h吗啡总用量最少、VAS评分最低,与Ⅰ、Ⅱ组比较P＜0．05－0．01,未见明显的不良反应和呼吸循环抑制。结论：术前硬膜外预先注小剂量氯胺酮、吗啡、布比卡因混合液有良好的术后镇痛作用,不良反应少,而且安全。     

国产0.125%左旋布比卡因与0.2%罗哌卡因用于术后硬膜外镇痛效果比较

目的:研究0.125%左旋布比卡因行病人硬膜外自控镇痛(PCEA)临床效果,并于0.2%罗哌卡因比较。方法:选择40例择期下腹部手术患者,ASA～级,采用随机双盲法分为两组:左旋布比卡因组(L组,n=20)、罗哌卡因组(R组,n=20)。两组术后分别采用0.125%左旋布比卡因、0.2%罗哌卡因复合小剂量吗啡(0.005%)和地塞米松10mg行病人自控硬膜外镇痛(PCEA),观察两组术后镇痛效果、运动阻滞程度和副作用的发生情况。结果:两组术后视觉模拟评分(VAS)、改良Bromage评分和病人自评镇痛效果满意度比较差异均无显著性(P>0.05)。两组不良反应发生率差异无显著性(P>0.05)。结论:0.125%左旋布比卡因复合小剂量吗啡和地塞米松用于病人术后硬膜外自控镇痛可取得和罗派卡因同样的镇痛效果。     

低浓度左旋布比卡因复合芬太尼用于剖宫产术后硬膜外腔镇痛的效应

目的 观察0.125%左旋布比卡因复合芬太尼用于剖宫产术后硬膜外腔镇痛的效果及安全性,并与0.125%布比卡因比较.方法 采用随机双盲法,将择期行剖宫产手术的足月,单胎孕妇90例,分为左旋布比卡因组(L组,n=45)和布比卡因组(B组,n=45).术后分别采用0.125%左旋布比卡因及0.125%布比卡因复合小剂量的芬太尼行病人自控硬膜外镇痛(PCEA).观察两组术后镇痛效果、运动阻滞情况及恶心呕吐、尿潴留等副作用的发生情况.结果 两组产妇术后镇痛效果、运动阻滞情况及不良反应发生率差异均无显著性(P＞0.0 5).结论 0.125%左旋布比卡因复合芬太尼可用于产科术后硬膜外镇痛.     

盐酸左旋布比卡因复合液用于硬膜外持续泵注术后镇痛的临床研究

目的观察国产盐酸左旋布比卡因注射液用于硬膜外持续泵注术后镇痛的效果,探讨其用于硬膜外镇痛的可行性和最佳浓度,评价其安全性.方法选择ASA Ⅰ～Ⅱ级、妇产科手术患者96例,随机分为4组:Ⅰ组:0.125%左旋布比卡因组,Ⅱ组0.15%左旋布比卡因组,Ⅲ组:0.2%左旋布比卡因组,Ⅳ组:0.125%布比卡因组.观察术毕即刻、术后4 h、8 h、12 h、24 h、48 h各时间点的VAS评分、MBS评分以及MAP、SpO2、HR、RR变化、不良反应发生情况,注射局麻药前和术后24 h抽血测定AST、LDH、BDH、CK的变化.结果VAS评分Ⅰ、Ⅱ、Ⅳ组相比差异无显著性,而Ⅲ组与Ⅰ、Ⅱ、Ⅳ比较差异有显著性(P＜0.05),MBS评分Ⅲ组高于Ⅰ、Ⅱ、Ⅳ组,但差异无显著性(P＞0.05),各组术后24 h AST、LDH、BDH、CK均有增高,与术前比较差异有显著性(P＜0.05),组间比较除CK、BHD外均无差异(P＞0.05),Ⅳ组术后BDH变化高于Ⅰ、Ⅱ、Ⅲ组(P＜0.05).各组术后24 h CK,与术前相比差异有非常显著性(P＜0.01).结论采用浓度为0.125%～0.2%的左旋布比卡因复合4μg/ml的芬太尼,以4 ml/h的速度持续榆注能提供良好的术后镇痛效果,0.2%的左旋布比卡因组运动神经恢复时间较长,盐酸布比卡因组安全性高于盐酸左旋布比卡因组.     

罗哌卡因混合曲马多、氟哌利多用于老年人腹部术后硬膜外镇痛的效应

目的研究硬膜外用罗哌卡因复合曲马多、氟哌利多对老年人腹部术后镇痛的效果和不良反应.方法选择65～86岁腹部手术患者186例分三组,每组62例,术后分别采用0.125%罗哌卡因(R组)、0.125%左旋布比卡因(L组)及0.125%布比卡因(B组)复合0.5%曲马多 0.005%氟哌利多行硬膜外镇痛.以VAS及D1/D2衡量镇痛效果,观察肛门排气时间及恶心、呕吐、头痛、下肢麻木等不良反应.结果三组老年人VAS、D1/D2对PCEA满意率均无显著性差异(P＞0.05),肛门排气时间R组早于L组及B组,下肢麻木的发生率R组无而L组及B组都有(P＜0.05).结论0.125%罗哌卡因 0.5%曲马多 0.005%氟哌利多对老年人腹部术后硬腹外镇痛效果确切且安全.     

地佐辛增强布比卡因硬膜外患者自控镇痛的效果

目的 观察地佐辛用于增强患者术后镇痛的效果.方法 经腹子宫全切术的患者60例,随机均分为基本资料相仿的三组,采用腰-硬联合麻醉,术后行0.125％布比卡因硬膜外患者自控镇痛(PCEA).Ⅰ组术前静注地佐辛0.15 mg/kg;Ⅱ组术毕将地佐辛0.15mg/kg加入0.125％布比卡因镇痛药液中;Ⅲ组不用地佐辛.记录术后3 h(T1)、6 h(T2)、12 h(T3)、24 h(T4)、48 h(T5) VAS疼痛评分、BCS舒适度评级和Ramsay镇静评分.结果 三组术后镇痛效果均良好,术后48 h的VAS均＜3分.Ⅰ、Ⅱ两组的VAS评分均低于Ⅲ组(P＜0.05),且Ⅰ组低于Ⅱ组(P＜0.05);Ⅰ、Ⅱ两组的BCS评级和Ramsay镇静评分均高于Ⅲ组(P＜0.05),且Ⅰ组高于Ⅱ组(P＜0.05);Ⅰ、Ⅱ组的自控按压次数明显少于Ⅲ组(P＜0.05).结论 地佐辛能明显增强子宫全切术患者布比卡因PCEA作用,改善术后舒适度,有良好镇静效果;术前应用地佐辛效果更好.     

布托非诺、芬太尼、曲马多混合布比卡因在剖宫产术后硬膜外镇痛的效应

目的：比较布托非诺、芬太尼及曲马多复合布比卡因用于剖宫产术后硬膜外镇痛的效果和不良反应.方法：60例剖宫产手术的足月、单胎孕妇,VSAⅠ～Ⅱ级,随机分为3组：布托非诺4 mg＋0.75%布比卡因15 mg组（Ⅰ组）,芬太尼（0.2 mg＋0.75%布比卡因15 mg组（Ⅱ组）,曲马多400mg＋0.75%布比卡因15mg组（Ⅲ组）,每组20例.术后硬膜外导管接PCEA镇痛泵,以持续量2 mL·h^-1,自控量每次0.5 mL,琐定时间15 min.术后48 h内进行随访并记录疼痛评分、镇静评分以及呼吸抑制、恶心呕吐、皮肤瘙痒等不良反应的发生率.结果：镇痛效果,Ⅰ组与Ⅱ组各时点VAS评分差异无显著性（P＞0.05）,Ⅰ组、Ⅱ组镇痛效果明显优于Ⅲ组（P＜0.05）.镇静效果,镇静评分Ⅰ组高于Ⅱ组,Ⅱ组高于Ⅲ组差异有显著性（P＜0.05）.不良反应,3组产妇术后心率、脉搏血氧饱和度（HR、SpO2）均在正常范围,无呼吸抑制发生,恶心呕吐的发生率Ⅰ组低于Ⅱ组、Ⅲ组（P＜0.05）.结论：布托非诺混合布比卡因用于剖宫产手术后硬膜外镇痛可获得满意的镇痛及镇静效果,且无明显的不良反应.     

剖宫产术后镇痛几种方法的比较

目的探讨适合割宫产术后镇痛的理想方案。方法360例孕妇需剖宫产者分为静脉镇痛组和硬膜外镇痛组(吗啡组、芬太尼组),随机分为三组,每组120例,静脉镇痛组(Ⅰ组):芬太尼0.8mg+氟哌利多2.5mg+NS至100mL,2mL/h;硬膜外镇痛组(芬太尼组) (Ⅱ组):芬太尼0.8mg+0.75%左旋布比卡因10mL+NS至100mL,2mL/h;硬膜外镇痛组(吗啡组)(Ⅲ组):吗啡6mg+0.75%左旋布比卡因10mL+盐酸异丙嗪12.5mg+NS至60mL,1mL/h,手术结束前10min硬膜外腔给饱和量(吗啡1.5mg+盐酸异丙嗪5mg+NS至10mL,根据产妇情况一次注入7～10mL)。结果各组镇痛效果差异明显,硬膜外镇痛吗啡组>硬膜外镇痛芬太尼组>静脉镇痛组,不良反应发生率Ⅰ组稍高于Ⅱ组,Ⅱ组稍高于Ⅲ组(P<0.05),皮肤搔痒发生率Ⅲ组稍大于Ⅰ、Ⅱ组(P>0.05),锥体外系发生率Ⅰ组大于Ⅱ、Ⅲ组(P<0.05).结论硬膜外吗啡镇痛组效果优良,不良反应发生率低,易于产妇接受,适宜制宫产术后镇痛.     

3种局麻药用于分娩镇痛的临床观察

目的观察低浓度罗哌卡因、布比卡因、利多卡因加小剂量芬太尼用于产妇自控硬膜外分娩镇痛(PCEA)的临床效果.方法90例单胎、足月、头位、初产妇随机分成3组Ⅰ组0.2%罗哌卡因,Ⅱ组0.125%布比卡因,Ⅲ组0.4%利多卡因,均加0.002%芬太尼配成镇痛混合液,按LCP[负荷剂量(L)、持续注入计量(C)、产妇自控计量(P)]给药模式实施无痛分娩.观察镇痛效果[视觉模拟评分(VAS)]、运动能力[药疗研究理事会评分(MRC)]、行走状况、产程时间、分娩方式以及不良反应的发生.结果产妇均获得满意的镇痛效果,VAS评分镇痛后明显降低,与镇痛前相比差异有显著性(P＜0.01).Ⅰ组MRC评分,产妇第一产程行走率、自然分娩率、产妇综合满意度均高于Ⅱ、Ⅲ组,组间相比差异有显著性(P＜0.01).Ⅰ组第一产程时间明显缩短,与Ⅱ、Ⅲ组相比差异有显著性(P＜0.01).产妇产程中没有发生并发症和其他不良反映.结论低浓度罗哌卡因是较理想的无痛分娩局麻药.     

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.     

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.