艾司洛尔对腹腔镜手术CO2气腹致心血管副反应治疗作用的临床观察

目的 本文旨在观察艾司洛尔在腹腔镜手术中对心血管副反应的防治作用。方法 腹腔镜胆囊切除术患者50例随机分为试验组和对照组，试验组以艾司洛尔1mg／kg静脉注射后，以微量泵连续静脉注射艾司洛尔200μg／kg．min维持。结果 试验组在心率(HR)和平均动脉压(MAP)与对照组相比明显平稳。结论 艾司洛尔可有效地对抗腹腔镜手术中CO2气腹所致的血压升高和心率增快，保证病人围麻醉期的安全。     

艾司洛尔与尼卡地平对气管插管时心血管反应的预防

目的探讨单独或联合应用艾司洛尔和尼卡地平预防气管插管时心血管反应的效果。方法选择全麻择期手术患者80例,ASA为I～Ⅱ级,随机分为4组,于全麻诱导后按组静脉注射不同药物：即对照组（A组）为生理盐水5ml;艾司洛尔组（B组）为1mg/kg;尼卡地平组（C组）为10μg/kg;艾司洛尔＋尼卡地平组（D组）为艾司洛尔0.5mg/kg和尼卡地平5μg/kg,分别于诱导前、后,插管时,以及插管后1、2、3min监测记录MAP和HR的变化情况。结果A组插管时MAP和HR分别较基础值上升。B组插管后MAP的升高幅度与A组无显著性差异,但HR无明显增快。C组插管后MAP无显著性变化,但HR明显增快。D组插管后MAP和HR均无升高反应。结论全麻诱导后单独应用艾司洛尔可有效抑制心率增快,但不能防止血压升高;单独应用尼卡地平可抑制血压升高,但不能控制心率增快,二者联合应用可有效抑制气管插管时心血管反应。     

小剂量艾司洛尔预防全麻拔管时的心血管反应

目的:观察全身麻醉拔管时应用小剂量艾司洛尔时的心血管反应.方法:择期腹部手术64例患者,随机等分成两组,均用异丙酚静吸复合麻醉,拔管前5 min,试验组给予盐酸艾司洛尔0.3 mg/kg,30～60 s内静脉注射,并记录拔管前5 min(给药时),拔管前3 min(给药后2min)、拔管时、拔管后1,3,5 min的心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP),并进行统计学处理.结果:试验组在给药后各时间点的各项指标均有不同程度地降低,而对照组则明显增高,尤其在拔管时较明显(p＜0.05).结论:在全身麻醉拔出气管导管时应用小剂量艾司洛尔能有效地防止心率增快、血压升高等心血管反应.     

羟甲唑啉在鼻腔内窥镜手术中的应用

目的：探讨羟甲唑啉作为减充血剂在鼻腔鼻窦手术中的应用。方法：将165例鼻窦炎患者随机分为2组。治疗组90例，将局麻药丁卡因加入羟甲唑啉；对照组75例，将局麻药丁卡因加入肾上腺素。术中心电监测，记录心率，血压及术中出血情况。结果：治疗组，心率血压变化幅度小，与对照组比较差异有显著性。结论：作为减充血剂，羟甲唑啉可以替代肾上腺素。     

硝普钠复合艾司洛尔控制性降压在鼻内窥镜手术中的应用

目的 分析微量泵静脉注射硝普钠-艾司洛尔控制性降压在鼻内窥镜手术中的临床效果,为临床合理用药提供参考.方法 选取40例慢性鼻窦炎,鼻息肉患者随机分为全麻对照组(A)组和全麻控制性降压组(B组),每组20例,2组患者均为ASAⅠ～Ⅱ级.比较两组术中出血量,输液量、手术时间,平均动脉压(MAP),心率(HR).结果 与对照组比较2组术中出血量,输液量、手术时间,平均动脉压(MAP),心率(HR)差异有显著性(P＜0.05).结论 硝普钠复合艾司洛尔控制性降压用于鼻内窥镜手术效果显著,安全可靠,无单用硝普钠降压的副作用,出血量减少,手术时间缩短,具有较高的临床应用价值.     

利多卡因和艾司洛尔预防七氟醚诱导插管反应的研究

目的 比较在单纯吸入七氟醚诱导插管期间,利多卡因和艾司洛尔对患者心血管反应的影响.方法 选择全麻下行择期非心脏手术患者60例,ASA分级Ⅰ～Ⅲ,年龄20～65岁,随机分为3组(n=20); Ⅰ组(对照组),Ⅱ组(艾司洛尔组),Ⅲ组(利多卡因组).麻醉诱导前2 min,Ⅰ组静脉注射生理盐水1 ml,Ⅱ组静脉注射艾司洛尔2 mg/kg,Ⅲ组静脉注射利多卡因1.5 mg/kg.然后进行麻醉诱导插管,在插管过程中连续监测患者血压(SBP,DBP)和心率(HR).记录麻醉诱导前(T0基础值),气管插管即刻(T1),气管插管后即刻(T2),1 min(T3),3 min(T4),5 min(T5)时上述指标.结果 Ⅲ组患者的SBP,DBP较Ⅰ组低,但心率增加与Ⅰ组无差异,Ⅱ组患者的SBP,DBP andHR与Ⅰ组相比均明显降低.结论 利多卡因能够抑制七氟醚麻醉诱导插管期间血压升高,但不能有效抑制心率增快.艾司洛尔对血压、心率的升高均有明显抑制作用.     

艾司洛尔预防气管插管时心血管副反应的临床观察

目的　探讨艾司洛尔预防气管插管时心血管副反应的效果。方法　将ASA - 级无呼吸、心血管或内分泌系统疾病择期手术患者4 0例,随机分为观察组(用艾司洛尔)和对照组(未用艾司洛尔)。采用咪唑安定-异丙酚-芬太尼-罗库溴胺-艾司洛尔快速静脉诱导气管插管,插管后机械通气,吸入异氟醚维持麻醉。监测无创血压(NIBP)、心率(HR)、血氧饱和度(Sp O2 ) ,并记录给药前,插管即刻,插管后1min,5 min平均动脉压(MAP) ,心率(HR)指标。结果　观察组插管后1min MAP同对照组差异有非常显著性(P<0 .0 1) ,插管后1m inНR差异也有显著性(P<0 .0 5 )。结论　全麻诱导时使用艾司洛尔能有效预防气管插管心血管副反应。     

舒芬太尼鼻腔内给药的镇痛效应及安全性研究

目的:研究经鼻腔内滴入舒芬太尼的镇痛效应和安全性.方法:60例局麻下行甲状腺手术患者,随机分为两组,每组30例,观察组切皮前10 min经鼻滴入舒芬太尼20 ug,以0.5%利多卡因局部浸润后开始手术,对照组用注射用水作为安慰剂,切皮前10 min用同样方法向鼻腔内滴入注射用水后,以0.5%利多卡因局部浸润后开始手术.术中采用语言评分法(Verbal rating scale,VRS)双盲评估镇痛效果,记录两组患者在给药前、给药后5,10,20,40,60 min的NBP、HR、SpO2和呼吸次数.统计术中所用局麻药的总量、术中追加局麻药的次数、手术时间和甲状腺大小.观察术后恶心呕吐、皮肤瘙痒的发生情况.结果:两组患者均顺利完成手术,观察组患者在给药后10,20,40 min较给药前呼吸次数有明显减慢(P＜0.01),60 min时恢复至给药前水平(P＞0.05),在剥离甲状腺时,观察组患者的VRS评分明显低于对照组,有显著性差异(P＜0.01).手术过程中患者要求追加局麻的次数和所用局麻药总量在两组问比较有显著性差异(P＜0.05).结论:经鼻滴入舒芬太尼镇痛安全有效.     

复合用药与单纯用药对控制性降压效果的临床探讨

目的 探讨用硝酸甘油与硝酸甘油 艾司洛尔对内窥镜鼻窦手术患者行控制性降压的效果比较。方法38例择期内窥镜鼻窦手术患者,常规在静吸复合全麻下行内窥镜鼻窦手术。麻醉手术期控制降压以期减少术中出血的危险。降压药物分为硝酸甘油(Ⅰ组)及硝酸甘油 艾司洛尔(Ⅱ组)。术中控制降压,将平均动脉压(MAP)降至并维持在60~65mmHg,监测降压期间MAP和HR的变化。结果Ⅰ组降压后HR明显增快,超过110次／min(P<0.05),停止降压后10min仍高于降压前值(P<0.05)。Ⅱ组合并使用艾司洛尔50ug／kg／min,可减慢心率及减少硝酸甘油的用量30％(P<0.05)。结论 内窥镜鼻窦手术病人单纯使用硝酸甘油控制性降压,效果较差,反射性心率加快,联合使用硝酸甘油-艾司洛尔降压效果具有更优越的效果。     

硝酸甘油复合艾司洛尔控制性降压在鼻内窥镜手术中的应用

目的探讨硝酸甘油复合艾司洛尔控制性降压技术在鼻内窥镜手术申减少出血量、缩短手术时间的效果.方法选择择期行鼻内窥镜手术病人60例,随机分成三组.Ⅰ组为对照组;Ⅱ组为硝酸甘油控制性降压组;Ⅲ组为硝酸甘油复合艾司洛尔控制性降压组,每组20例.所有病人均用咪唑安定、丙泊酚、芬太尼、阿曲库铵行麻醉快速诱导,经口腔气管内插管,接麻醉机控制通气;用异氟醚、芬太尼、阿曲库铵维持麻醉;术中监测平均动脉血压(MAP)、HR、SpO,、ECG、出血量、手术时间、尿量.结果Ⅱ、Ⅲ组出血量和手术时间少于Ⅰ组,差异有显著性(P＜0.05);Ⅱ组的心率明显高于术前,差异有显著性(P＜0.05),Ⅰ、Ⅲ组的心率较术前无明显差异.结论硝酸甘油复合艾司洛尔控制性降压技术应用于鼻内窥镜手术,明显减少出血量、缩短手术时间,防止反射性的心率增快,降低心肌耗氧量,是鼻内窥镜手术较为理想的麻醉方法.     

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.     

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.     

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.     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

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.