急性超容性血液稀释法减少手术用血量的研究

目的评价术前急性超容性血液稀释(AHH)应用于术中节约用血的可行性.方法 40例ASA Ⅰ～Ⅱ级肝胆疾病患者随机分为AHH组和对照组.AHH组常规输入乳酸林格液的同时在切皮前输入6%羟乙基淀粉(15 ml/kg,15 ml/min);对照组仅常规输入乳酸林格液.两组均采用异氟醚吸入麻醉.术中持续监测MAP、HR、CVP,分别于稀释前、稀释后、术毕测定Hct、PT、APTT、Na+、K+、pH、PO2;记录术中输液量、输血量并计算出血量.结果 AHH组与对照组MAP和HR平稳;CVP和PT稀释后明显升高和延长(P＜0.01),但在正常范围内;APTT组间比较差异无显著意义(P＞0.05);AHH组Hct在稀释后,明显低于对照组(P＜0.01);术毕两组输液量和出血量差异无显著意义(P＞0.05),但AHH组输血量明显低于对照组(P＜0.05).AHH后动脉血Na+、K+、pH、PO2与对照组相比无明显变化(P＞0.05).结论采用HES行AHH能充分扩容,维持血液动力学及内稳态的稳定,可有效地提高机体对失血的耐受性,大大减少异体输血量.     

缩合葡萄糖氯化钠注射液行急性高容量血液稀释对食管癌患者血流动力学和血乳酸的影响

目的探讨术前缩合葡萄糖氯化钠注射液行急性高容量血液稀释(AHH)对食管癌患者血流动力学和血乳酸的影响。方法 30例ASAI～Ⅱ级的食管癌患者,随机分为研究组(15例)和对照组(15例)。麻醉诱导后行AHH,分别输注缩合葡萄糖氯化钠注射液和乳酸钠林格液,均以15mL/kg的剂量和50mL/min的速度输入。术中监测心电图、平均动脉压、中心静脉压和血氧饱和度,并于AHH前(T0)、AHH后即刻(T1)、30min(T2)、60min(T3)行血气分析和血常规检查。结果两组HR、MAP、CVP在各时点比较差异无统计学意义(P>0.05),但两组AHH后CVP显著升高(P<0.01)。两组红细胞比容(Hct)在AHH后显著降低(P<0.01),血乳酸则无明显改变(P>0.05)。结论缩合葡萄糖氯化钠注射液行AHH对食管癌患者血流动力学、组织氧代谢无明显影响。     

小儿神经外科术中输注不同浓度含糖液对脑糖代谢的影响

目的:探讨不同浓度含糖液输注在小儿神经外科术中对脑糖代谢的影响.方法:将60例颅脑占位性病变择期手术全身麻醉患儿,随机分为3组:A组术中输注乳酸林格液;B组术中输注2.5%葡萄糖乳酸林格液;C组术中输注1%葡萄糖乳酸林格液.记录麻醉全程患儿血流动力学参数、插管前即刻(T_a)、切开硬脑膜后2 h(T_b)和术毕睁眼时(T_c)的血糖及乳酸值,应用微透析技术在切开硬脑膜灌注1 h后开始收集微透析液标本,每间隔1 h收集1次,应用生化分析仪及相应试剂盒测定切开硬脑膜后1 h(T_A)和2 h(T_B)的葡萄糖和乳酸含量.结果:3组患儿心率、平均动脉压和脉搏氧饱和度差异均无统计学意义(均P > 0.05).组间Ta期血糖差异无统计学意义(P > 0.05),T_b和T_c期血糖值B组＞C组＞A组(P < 0.01),组内比较各组T_b和T_c期血糖值均大于T_a期(P < 0.01).3组患儿血乳酸值组内及组间比较差异均无统计学意义(均P > 0.05).3组患儿微透析液葡萄糖值和乳酸值组间及组内比较差异均无统计学意义(均P > 0.05).结论:患儿在神经外科手术期间输注乳酸林格液或低浓度含糖液将增加血糖浓度,对血乳酸、脑组织葡萄糖及乳酸值无不利影响,是相对安全的液体选择.     

急性高容量血液稀释在老年颅脑手术患者的应用

目的:探讨急性高容量血液稀释(AHH)对老年患者血流动力学及对脑水肿和脑氧合的影响.方法:40例ASA Ⅰ～Ⅱ级择期颅内病变老年患者,随机分为对照组(C组)和稀释组(A组),A组在麻醉诱导前以25 mL/min的速度输注6%羟乙基淀粉.血液稀释的预期目标为红细胞比容(Hct)达0.30.2组分别于麻醉诱导前即刻(T0),气管插管前即刻(T1),气管插管后即刻(T2)、5 min(13)、10 min(T4)、15 min(T5)记录平均动脉压(MAP)、心率(HR)、中心静脉压(CVP).于AHH前后测定总血浆渗透压、动脉血氧含量(SO2)、颈内静脉血氧饱和度(SjvO2)和动静脉乳酸含量,并计算出动脉颈内静脉血氧含量差(DA-JVO2)、脑氧摄取率(CERO2=DA-JVO2/CaO2)和动脉颈内静脉血乳酸含量差(DA-JVL).结果:A组AHH后Hb浓度和Hct降低(P<0.05).A组患者AHH前后血流动力学较C组稳定.2组患者AHH前后总血浆渗透浓度无明显改变(P>0.05).与AHH前比较,A组在AHH后SjvO2升高,DA-JVO2和CERO2均有降低(P<0.05).C组AHH前后SjvO2、DA-JVO2、CERO2和DA-JVL变化差异无统计学意义(P>0.05).结论:老年颅脑手术患者麻醉诱导前实施适度的AHH可维持麻醉诱导期血流动力学稳定,不引发脑水肿.     

血液稀释对老年腹部手术患者血流动力学和氧代谢的影响

目的 探讨术前急性高容血液稀释（AHH）对老年腹部手术患者术中血流动力学和组织器官氧代谢的影响.方法 选择60岁以上老年择期腹部手术48例,ASA分级Ⅰ-Ⅲ级,随机分为2组,Ⅰ组：林格氏液组;Ⅱ组：6%羟乙基淀粉急性AHH组,每组24例.所有患者均行全身麻醉,Ⅱ组在麻醉诱导插管时开始静脉输注6%羟乙基淀粉,速率为10-15 ml·kg-1·h-1 ,1 h内输完.2组患者均以8-10 ml·kg-1·h-1的速度持续输注乳酸钠林格氏液.监测平均动脉压（MAP）、心率（HR）、血氧饱和度（SpO2）、中心静脉压（CVP）、心电图（ECG）等血流动力学指标,分别于稀释前（T0）、稀释后即刻（T1）、稀释后1 h（T2）、术后即刻（T3）分别采集混合静脉血和动脉血,测定各时点的动脉血气包括Hb、Hct、动脉血氧含量（CaO2）和离子、乳酸,混合静脉血氧饱和度（SvO2）、血氧含量（CvO2）.计算动静脉血氧含量差C（a-v）O2=CaO2-CvO2和氧摄取率ERO2=（CaO2-CvO2）/CaO2.结果 Ⅱ组在血液稀释后,CVP明显增高;Hct和Hb显著下降（P〈0.05）,但术后Ⅱ组Hb和Hct明显高于Ⅰ组（P〈0.05）,Ⅰ组在T2时点HR增快（P〈0.05）;随着血液的稀释,Ⅱ组CaO2和CvO2逐渐降低,C（a-v）O2 也降低,而SvO2和ERO2未见异常,在2组间各时点差异均无统计学意义（P＞0.05）.2组患者在术中各时点pH值、K＋、Na＋始终在正常范围,与术前差异无统计学意义（P＞0.05）,Ⅱ组血液稀释后组乳酸值未见明显增高（P＞0.05）.结论 高容血液稀释能够使老年人腹部手术术中血流动力学更稳定,减少术中血液有形成分的丧失,对酸碱平衡、K＋、Na＋、Ca2＋以及组织灌注氧供需平衡无影响,可安全用于老年腹部肿瘤手术.     

高渗氯化钠羟乙基淀粉40注射液预防经尿道前列腺电切综合征的临床观察

目的 观察高渗氯化钠羟乙基淀粉40注射液用于经尿道前列腺切除术(TURP)的可行性及其预防经尿道前列腺电切综合征的效果.方法 选择90例择期行TURP患者,完全随机分为乳酸林格液组(R)、6％羟乙基淀粉组(H)和高渗氯化钠羟乙基淀粉40组(S).3组均用L3～４腰-硬联合麻醉,麻醉平面控制在T10以下.手术开始后每隔15 min记录各时点(T0、T15、T30、T45、T60、T75、T90/Tend)的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP).每隔30 min抽取动脉血检测Na+、K+、Hct、Hb,记录手术时间及术中冲洗液用量.结果 3组术前HR、MAP、CVP差异无统计学意义(均P＞0.05).T30之后R组HR、MAP明显下降(P＜0.05),CVP明显升高.T60之后H组HR、MAP明显下降(P＜0.05),CVP明显升高(P＜0.05).各时点S组HR、MAP、CVP差异无统计学意义(P＞0.05).3组术前Na+、K+、Hct、Hb差异无统计学意义(P＞0.05).3组各时点K+差异无统计学意义(P＞0.05).T30之后R组Na+、Hct、Hb明显下降(P＜0.05).T60之后H组Na+、Hct、Hb明显下降(P＜0.05),S组Hct、Hb明显下降(P＜0.05).R组有6例患者发生经尿道前列腺电切综合征,经输入高渗盐水及呋塞米后得到纠正.H组和S组均无一例发生.R组有12例、H组有7例患者发生低血压需要注射麻黄碱纠正,S组无一例发生严重低血压.全部病例均未发生低血钾、过敏反应等不良反应.结论 TURP术中应用高渗溶液安全可行,预防经尿道电切综合征的效果较6％羟乙基淀粉优越.     

急性高容血液稀释联合控制性降压在骨科手术中应用的观察

目的 观察急性高容量血液稀释(AHH)联合控制性降压(CH)对骨科手术患者血液动力学、氧代谢的影响.方法 择期骨科手术患者48例,ASA Ⅰ-Ⅱ级,随机分为2组,每组24例:A组为对照组;B组为AHH联合CH组.两组患者均采用全身麻醉,术中连续监测平均动脉压(MAP)、中心静脉压(CVP)、心率(HR)、心电图(ECG)、脉搏血氧饱和度(SPO2)和尿量.分别于稀释前插管后(T0)、稀释后即刻(T1)、稀释后l h(T2)、术毕(T3)测定血红蛋白(Hb)、红细胞压积(Hct)、乳酸、动脉血氧含量(CaO2)及凝血指标等变化,并计算氧摄取率(ERO2),术中记录输血量、输液量和失血量.结果 与A组比较,B组术中失血量、平均输血量以及输血例数减少(P＜0.01),尿量增多(P＜0.01).与T0比较,B组AHH后CVP升高(P＜0.01);两组AHH后Hb、Hct、CaO2均明显下降(P＜0.01),但两组间同期比较差异无显著性意义.两组ERO2、乳酸各时点及组间比较变化无显著性差异(P＞0.05).B组PLT、FIB在AHH后、术毕均显著降低(P＜0.01),但两组间差异无显著性意义.两组患者其他凝血机能指标(PT、TT、APTT)手术前后均无明显变化.结论 术前急性高容量血液稀释联合控制性降压能较好维持骨科手术患者机体血液动力学和氧代谢的相对稳定,显著减少出血量和异体输血.     

羟乙基淀粉不同输注方法对麻醉患者的血流动力学影响

目的观察不同方法输注羟乙基淀粉对麻醉患者的血流动力学影响。方法选择下腹部手术患者100例,均行腰硬联合麻醉,麻醉平面控制在T6～S,之间,观察组麻醉前预输羟乙基淀粉（200／0．5）8ml／kg,20min内输注完毕后输注乳酸林格氏液500ml。对照组麻醉前预输乳酸林格氏液500ml,输注完毕后输注羟乙基淀粉（200／0．5）8ml／kg,20min。观察两组输液前、预输液后、麻醉后的红细胞比积（Hct）、凝血功能（（PT,APTT）、SBP、DBP、HR、SpO2变化。结果观察组血压波动在5％之间,对照组在20％以上。两组的Hct、PT、APTT无显著变化,且组内均与术前无明显变化。结论羟乙基淀粉（200／0．5）用于麻醉前预输液对维持患者的血流动力学平稳效果是确切有效的,且无凝血功能及血液的携氧能力改变。     

6%羟乙基淀粉200/0.5急性高容量血液稀释对2型糖尿病患者血液流变学的影响

目的:探讨6%羟乙基淀粉(HES)200/0.5术前急性高容量血液稀释(AHH)对2型糖尿病患者血液流变学的影响。方法:拟在全麻下行择期骨科手术2型糖尿病患者20例,随机分为两组,每组10例。麻醉诱导后H组先以15 mL.kg-1.h-1速度给予乳酸钠林格液500 mL,继之等速输入HES 200/0.5 500 mL,R组以同样速度输入乳酸钠林格液1000 mL,分别于AHH前即刻(T0)、AHH结束后即刻(T1)采集静脉血样5 mL,测定全血黏度高切变率、全血黏度低切变率、血浆黏度、红细胞压积、红细胞聚集指数和变形指数,并记录平均动脉压(MAP)、心率(HR)和动脉血氧饱和度(SpO2)。记录术中输液量和出血量。结果:AHH前、后2组血液动力学指标均在正常范围内。与R组比较,H组AHH后即刻全血黏度高切变率、全血黏度低切变率和红细胞聚集指数降低,红细胞变形指数升高(P<0.01)。结论:HES 200/0.5术前AHH改善2型糖尿病病人血液流变学的状态优于乳酸钠林格氏液,可改善该类病人血液流动缓慢和血液高凝状态。     

急性高血容量血液稀释联合控制性降压和自体血液回收在腰椎手术中的应用

目的 探讨急性高血容量血液稀释(AHH)联合控制性降压和自体血液回收在腰椎手术中的临床应用效果及安全性.方法 将72例腰椎减压内固定患者按数字表法随机分为两组,观察组36例给予AHH联合控制性降压和自体血液回收,对照组36例仅给予AHH,比较两组手术时间、术中失血量和异体血输注量,观察两组患者AHH后血红蛋白(Hb)、红细胞比容(Hct)、纤维蛋白原(FIB)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、心率(HR)、平均动脉压(MAP)及中心静脉压(CVP)变化情况.结果 患者均手术成功,无肺水肿、心衰、创面异常出血等并发症.观察组手术时间为(162.19±25.27) min,与对照组的(157.36±27.40) min比较,差异无统计学意义(P＞0.05);观察组术中失血量为(755.56±124.39)ml,未输注异体血,显著少于对照组术中失血量的(1121.47±115.86)ml和异体血输注量的(602.93±157.25)ml,差异均有统计学意义(t=-12.986、-23.005,均P＜0.01).两组AHH后至术毕,各项指标变化均处于正常范围,其中Hb、Hct和FIB与术前相比显著降低(t=7.434、4.205、5.633,均P＜0.01),PT和APTT与术前相比显著延长(t =3.894、5.406,均P＜0.05或0.01),HR与术前无显著改变(P＞0.05),MAP和CVP与术前相比均显著升高(P＜0.05或0.01),但观察组AHH后60 min MAP和CVP显著低于对照组(t=3.950、6.552,均P＜0.01).结论 AHH联合控制性降压和自体血液回收可有效减少腰椎手术患者术中失血量和异体血输注量,且有利于维持血流动力学稳定.     

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.

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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.