罗哌卡因和布比卡因硬膜外麻醉剖宫产疗效对比

目的：比较0．5％罗哌卡因和0．5％布比卡因行硬膜外阻滞麻醉用于剖宫产术,其镇痛疗效和运动神经受阻滞功能恢复是否优于布比卡因。方法：将60例ASAⅠ-Ⅱ级单胎初产妇,年龄22～35岁,体重55～86kg。随机分为B组和R组,每组30例。B组硬膜外导管中注入0．5％布比卡因,R组硬膜外导管中注入0．5％罗哌卡因,观察比较B组和R组镇痛疗效和运动神经受阻滞功能恢复情况。结果：所有患者麻醉镇痛完善,R组运动神经阻滞恢复快于B组。结论：罗哌卡因用于剖宫产满足麻醉要求,下肢运动恢复快,对产妇的术后运动功能恢复有益。     

0．2％罗哌卡因复合芬太尼镇痛液持续硬膜外给药临床观察

目的观察0．2％罗哌卡因复合芬太尼2、3、4ml／h用于硬膜外术后镇痛（PCEA）对运动神经阻滞后恢复和镇痛效果。方法选择250例择期脊柱手术病例,均采用硬膜外麻醉。以0．2％罗哌卡因复合芬太尼镇痛液（0．2％罗哌卡因150ml＋芬太尼0．3mg）持续硬膜外给药。按给药速度分为3组,A组：2ml／h;B组：3ml／h;C组：4ml／h。全部病例无按压PCEA泵,采用视觉模拟评分对疼痛进行评分。结果术后48h不同阶段VAS评分,B组、C组低于A组（P〈0．05）;B组和C组差异无统计学意义（P〉0．05）。结论0．2％罗哌卡因复合芬太尼（含罗哌卡因6mg/h,芬太尼6μg/h）背景剂量3ml／h是国人PCEA镇痛最佳选择。     

甲磺酸罗哌卡因与盐酸罗哌卡因硬膜外麻醉的临床研究

目的：比较甲磺酸罗哌卡因与盐酸罗哌卡因硬膜外麻醉的Ⅱ期临床效果和安全性。方法：3个中心124例择期在低位硬膜外麻醉下行经腹子宫切除术、膀胱部分切除术等手术的患者随机均分为2组：A组注入0．75％盐酸罗哌卡因15ml．B组注入0．894％甲磺酸罗哌卡因15ml。结果：不论是在感觉和运动阻滞的起效时点分布、效果及效果维持时长方面，还是在维持相对稳定的循环、呼吸、肝肾功能等方面，甲磺酸罗哌卡因均表现出良好的作用，与盐酸罗哌卡因无明显差异，二者均无严重不良反应。结论：甲磺酸罗哌卡因与盐酸罗哌卡因具有相似的硬膜外麻醉的临床效果和安全性。     

不同浓度罗哌卡因硬膜外阻滞行乳腺癌根治术的临床观察

目的通过观察不同浓度罗哌卡因高位硬膜外阻滞行乳腺癌根治术的镇痛效果和对呼吸循环功能的影响,探讨罗哌卡因高位硬膜外阻滞的合适浓度。方法选择45例择期硬膜外阻滞行乳腺癌根治术的患者,随机分为A、B、C三组,各15例,分别注射0．25％、0．375％和0．5％罗哌卡因,观察记录三组的镇痛效果以及MAP、HR、RR和SpO2的变化。结果镇痛效果：B、C组优于A组,三组麻醉后MAP和HR均显著下降,C组RR和SpO2有显著下降,差异有统计学意义。结论0．375％罗哌卡因硬膜外阻滞行乳腺癌根治术对呼吸循环影响小,安全可行。     

罗哌卡因与左布比卡因用于硬膜外分娩镇痛的效果比较

目的比较罗哌卡因与左布比卡因用于分娩镇痛的效果。方法选择足月阴道分娩产妇70例,随机分为罗哌卡因组35例和左布比卡因组35例,每位产妇给予不同浓度罗哌卡因或左布比卡因20mL,每组的第一位产妇给予罗哌卡因或左布比卡因浓度为0．10％,之后的产妇所给予的罗哌卡因或左布比卡因的浓度在上一位产妇的基础上升高0．01％或者降低0．01％,采用双盲法进行视觉模拟镇痛评分（VAS）和下肢运动神经阻滞评分（Bromage改良法）,测定在第一产程中罗哌卡因与左布比卡因的最低有效浓度,比较产妇硬膜外分娩的镇痛效果。结果罗哌卡因的最低有效剂量为0．094％,左布比卡因最低有效剂量为0．093％,罗哌卡因和左布比卡因的效能比为0．99。结论在第一产程中,罗哌卡因与左旋布比卡因的硬膜外镇痛效果相近。     

不同药物用于可行走硬膜外分娩镇痛对母婴影响的比较

目的：比较不同药物用于可行走硬膜外分娩镇痛对母婴的影响。方法160例拟行硬膜外分娩镇痛的初产妇随机分为4组,舒芬太尼混合罗哌卡因组（S组）,芬太尼混合罗哌卡因组（F组）,单纯罗哌卡因组（R组）,未行任何镇痛处理的为对照组（D组）。记录4组产妇的镇痛起效时间,镇痛效果和运动神经阻滞分级、产程、分娩方式、出血量、新生儿Apgar评分、脐动脉血气分析及不良反应等。结果 S、F、R组VAS评分小于D组（ P ＜0 x．05）;S、F、R组均无运动阻滞。活跃期S、F、R组短于D组（ P ＜0．05）;S、F、R组的出血量、助产率、剖宫产率与D组比较差异无统计学意义（ P ＞0．05）,4组新生儿1、5 min Apgar评分、脐动脉血气分析差异无统计学意义（ P ＞0．05）。结论罗哌卡因联合舒芬太尼用于硬膜外分娩镇痛,具有起效快,镇痛作用强,维持时间长的特点。     

0.1%罗哌卡因联合舒芬太尼在分娩镇痛中的应用

目的探讨低浓度罗哌卡因伍用舒芬太尼用于硬膜外分娩镇痛的效果浓度。方法100例同意接受硬膜外镇痛的足月初产妇,随机分为两组,每组50例。第一、二产程所有产妇均于硬膜外腔持续输注镇痛药。RS组（研究组）所用镇痛药物配方为：0．1％罗哌卡因,内含0．0002％舒芬太尼;R组（对比组）所用镇痛药物配方为单纯0．2％罗哌卡因。结果在第一产程中,RS组完全无疼痛者（58％）明显较R组多（32％）（P（0．01）;RS组产妇中出现轻度运动阻滞者（74％）明显比R组（32％）多（P〈0．01）,而中度运动阻滞者（22％）明显少于R组（62％）（P〈0．01）,两组间比较差异有显著意义。结论第一、二产程于硬膜外腔持续输注0．1％罗哌卡因＋0．0002％舒芬太尼,镇痛效果优于单纯0．2％罗哌卡因;对运动神经的阻滞发生率低于后者,阻滞程度也较轻,是一种较理想的分娩镇痛方法。     

右美托咪定复合罗哌卡因在中低位硬膜外麻醉的临床效果研究

目的比较右美托咪定复合罗哌卡因中低位硬膜外麻醉与静脉泵注右美托咪定联合罗哌卡因中低位硬膜外麻醉临床效果,分析两种不同给药途径的优劣点,以期指导临床用药。方法选择某院2018年7月~2019年7月行中低位硬膜外麻醉的手术患者120例,随机分为三组:A组(罗哌卡因硬膜外麻醉组)、B组(右美托咪定复合罗哌卡因硬膜外麻醉组)、C组(罗哌卡因硬膜外麻醉+静脉泵注右美托咪定组)。由专门的麻醉医师实施临床麻醉,监测记录患者麻醉实施过程中生命体征的变化,记录感觉阻滞起效时间、最高阻滞平面和感觉阻滞时间。于硬膜外给药后30 min时记录改良Bromage分级、Ramsay镇静评分。结果右美托咪定复合罗哌卡因硬膜外麻醉组的感觉阻滞起效时间和维持时间好于其他两组,且差异具有统计学意义(P<0.05)。B组的Ramsay镇静评分高于其他两组,VAS评分低于其他两组,差异具有统计学意义(P<0.05)。结论右美托咪定复合罗哌卡因硬膜外麻醉能够提高镇痛效果,提高患者的麻醉满意度。     

低浓度罗哌卡因用于分娩镇痛的临床疗效

目的探讨低浓度罗哌卡因硬膜外镇痛对产妇及新生儿的影响。方法40例足月分娩产妇随机分为2组,镇痛组（n=20）采用0．15％罗哌卡因硬膜外患者自控分娩镇痛,对照组（n=20）自然分娩。记录产妇的疼痛视觉模拟评分（VAS）,运动神经阻滞程度改良Bromage评分及心率、呼吸和血压的变化,比较两组的剖宫产率、产钳助产率、宫缩时间及产后出血量。对新生儿进行Apgar评分。结果与对照组相比,罗哌卡因组报告无痛的产妇病例数明显增加（P〈0．01）,且无运动阻滞。两组的剖宫产率、产钳助产率、宫缩时间及产后出血量差异均无统计学意义,新生儿Apgar评分差异也无统计学意义。结论低浓度罗哌卡因硬膜外阻滞用于分娩镇痛安全、有效,值得更进一步研究。     

不同浓度罗哌卡因复合布托啡诺行硬膜外分娩镇痛的量效观察

目的：探讨罗哌卡因复合布托啡诺行硬膜外分娩镇痛时布托啡诺的半数有效剂量（ED50）和罗哌卡因的最佳有效浓度。方法：121例初产妇接受L2—3硬膜外分娩镇痛,前31例患者中第一个患者接受0．15％罗哌卡因＋20μg／mL布托啡诺复合液,随后的产妇运用改良序贯法确定布托啡诺的ED50。另90例患者按硬膜外用药不同随机分为0．08％罗哌卡因＋16μg／mL布托啡诺（B1组）、0．10％罗哌卡因＋16μg／mL布托啡诺（B2组）及0．12％罗哌卡因＋16μg／mL布托啡诺（B3组）。监测分娩镇痛过程中阻滞平面和运动阻滞（Bromage评分）、镇静镇痛评分及宫缩胎心;记录麻醉起效时间、产程时间、分娩方式、缩宫素使用增加例数以及新生儿Apgar评分,记录恶心、呕吐、瘙痒、胎心减速等副作用发生率。结果：布托啡诺的E耽。值及ED50值分别为14．79（95％CI13．91～15．61）和16．84（95％CI15．86～20．97）μg／mL。B1组镇痛起效时间明显长于B2、B3组（P〈0．05）,给药后30、60和90min时的VAS评分明显高于B2、B3组,停药时VAS评分明显高于B3组（P〈0．05）;B1组在镇痛后第4～6次宫缩时的VAS评分明显高于B2、B3组（P〈0．05）。B3组运动神经阻滞发生的例数明显高于B1、B2组（P〈0．05）。结论：0．10％罗哌卡因复合16μg／mL布托啡诺行分娩镇痛时镇痛效果好、无运动阻滞、安全性高,值得临床推广。     

Could low dead-space syringes really reduce HIV transmission to low levels?

Studies published by Zule and colleagues have suggested that use of low dead-space syringes (LDSS) instead of high dead-space syringes (HDSS) by injecting drug users (IDUs) could dramatically reduce HIV transmission. However, evidence is limited because experiments have considered a small range of syringe types and have been unable to reliably estimate the efficacy of using LDSS for reducing HIV transmission. We critically appraise available evidence to determine whether using LDSS is likely to dramatically reduce HIV transmission.We systematically review the literature on the dead-space volume of syringes and estimate the factor difference in blood volume transferred from sharing LDSS or HDSS. Existing data on the relationship between host viral load and HIV transmission risk is used to evaluate the likely efficacy of using LDSS instead of HDSS. An HIV transmission model is used to make conservative impact projections for switching to using LDSS, and explore the implications of heterogeneity in IDU transmission risk and syringe preferences.Although highly variable, reviewed studies suggest that HDSS have on average 10 times the dead-space volume of LDSS and could result in 6/54/489 times more blood being transferred after 0/1/2 water rinses. Assuming a conservative 2-fold increase in HIV transmission risk per 10-fold increase in infected blood inoculum, HDSS use could be associated with a mean 1.7/3.6/6.5-fold increase in transmission risk compared to LDSS for 0/1/2 rinses. However, even for a low efficacy estimate, modelling suggests that partially transferring to LDSS use from using HDSS could dramatically reduce HIV prevalence (generally >33% if LDSS use is 50%), but impact will depend on IDU behavioural heterogeneity and syringe preference.Indirect evidence suggests that encouraging HDSS users to use LDSS could be a powerful HIV prevention strategy. There is an urgent need to evaluate the real life effectiveness of this strategy.     

Very low calorie diets

In the UK, over 50% of adults are overweight (body mass index [BMI] of 25-29.9 kg/m(2)) or obese (BMI 30 kg/m(2) or more); it is thought that over half of the UK population could be obese by 2050 because of the increasing availability of calorie-dense food and sedentary lifestyles.(1-3) Interventions to achieve weight loss include diets, increased physical activity, behavioural modification strategies, drugs (e.g. orlistat) and bariatric surgery.(4) Dietary interventions include low-calorie diets (LCDs; 1,000-1,200 kcal/day for women and 1,200-1,600 kcal/day for men), very low calorie diets (VLCDs; including Very Low Energy Diets [VLED]; below 800 kcal/day) and Low Energy Liquid formula diets (LELD; above 800 kcal/day).(4,5) However, drop-out rates from such interventions are often high. Here we consider the safety and effectiveness of VLCDs and practical issues about their use.     

Bicelles at low concentrations

Bilayered detergent-lipid assemblies known as bicelles have been widely used as model membranes in structural biological studies and are being explored for wider applications, including pharmaceutical use. Most studies to date have involved the use of concentrated bicelle mixtures, such that little is known about the capacity of bicellar mixtures to be diluted without unwanted transitions to nonisotropic phases. Here, different detergent/lipid mixtures have been explored, leading to the identification of two different families of bicelles for which it is possible to lower the total amphiphile (detergent + lipid) concentration to <1% (w/v) while retaining isotropic assemblies. These include a novel family of bicelles based on mixtures of 6-cyclohexyl-1-hexylphosphocholine (Cyclofos-6) and the lipid dimyristoylphosphatidylcholine (DMPC). Bicelles formed by these mixtures can be diluted to <0.5% and also have attractive biochemical properties. However, a caveat of our results is that the diffusion coefficients measured for the lipid component of the different bicelles tested were seen to be dependent on sample history, even though all samples were optically transparent. This suggests that the phase behavior of bicelles at low lipid-to-detergent ratios may be more complex than previously appreciated.     

Suppression of neoplastic transformation in vitro by low doses of low LET radiation

A major concern of exposure to low doses of radiation is the risk of cancer induction. Epidemiologic data are rarely powerful enough to accurately discriminate this risk at doses <10 cGy. In order to gain insight into events at these low doses, laboratory-based studies of relevant endpoints are required. One such endpoint is radiation-induced neoplastic transformation in vitro. Such studies can provide quantitative dose-response data, as well as insights into underlying cellular and molecular mechanisms. Data are presented that indicate that low doses of low LET radiation can suppress neoplastic transformation in vitro to levels below those seen spontaneously. Mechanisms involved include both the death of a subpopulation of cells prone to spontaneous neoplastic transformation and the induction of DNA repair. The relative contributions of these mechanisms is dose-dependent. The relevance of these observations to radiation risk estimation is discussed.     

小剂量罗红霉素对免疫低下小鼠的免疫调节作用

目的:研究小剂量罗红霉素对免疫低下小鼠免疫功能的影响。方法:与模型对照组比较,小剂量罗红霉素可明显提高免疫低下小鼠的κ(0.068±0.016 vs. 0.081±0.020)和α(5.43±0.61 vs. 6.07±0.53)值,增强巨噬细胞的吞噬功能(P<0.05);加重由DNCB诱发的耳肿胀(9.1±3.8 vs. 17.0±6.5),增强迟发型超敏反应(P<0.05);提升免疫功能低下小鼠的HC50值(96.8±38.1 vs. 152.3±59.1),促进抗体的生成(P<0.05)。结论:小剂量罗红霉素对环磷酰胺所致免疫功能低下的小鼠有免疫增强作用,显著提高免疫功能低下动物的特异性及非特异性免疫功能。     

低铁与低热量饮食延缓糖尿病肾病的进展

目的探讨低铁与低热量饮食是否能延缓糖尿病肾病的进展。方法以168例Ⅱ型糖尿病肾病患者为研究对象,随机分为两组,对照组予以常规治疗,治疗组在进行同样常规治疗的同时,予低铁、低热量饮食。结果平均随访37±22个月,治疗组患者血清铁水平显著降低,与对照组比较,有显著差异(P<0.01);治疗组血清肌酐189±78μmmol/L,对照组257±115μmmol/L,两组比较,有显著差异(P<0.01)。治疗组有6例患者达到终止随访目标,血红蛋白低于80g/L和或红细胞压积<33%,需进行促红素治疗,占17.6%;对照组有10例达到终止目标,占35.7%,两组比较,有显著差异(P<0.01)。结论低铁饮食治疗能显著降低糖尿病肾病患者铁负荷,配合低热量饮食治疗,能明显延缓糖尿病肾病的进展。     

Neurotrophin-like low molecular weight compounds

A large number of compounds have been reported to prevent ischemia-induced neuronal death, whereas there are few described to enhance recovery of brain functions. Since neurotrophins do not only prevent neuronal death but also protect neuronal circuits, they may be potential candidates. However, their poor penetration of the blood-brain-barrier hampers their development as therapeutic agents. In this context, low-molecular-weight compounds that possess neurite outgrowth- and neuronal survival-promoting activities may be alternative candidates. Neurite outgrowth-promoting prostaglandins, which were recently-synthesized based on the chemical structure of anti-tumor cyclopentenone prostaglandin derivatives, have been characterized by their neurotrophic effects on neurons in the central nervous system. In this paper, we present a review of these compounds as therapeutic agents against several neurodegenerative diseases.