阿扎司琼联合地塞米松预防腹腔镜胆囊切除恶心呕吐的疗效观察

目的:观察阿扎司琼联合地塞米松对预防腹腔镜胆囊切除术后恶心呕吐(post-operative nausea and vomiting,PONV)的疗效.方法:选择腹腔镜胆囊切除手术患者80例,随机分为4组,每组20例.A组:麻醉诱导前静脉注射生理盐水2 mL,手术缝皮时静脉注射阿扎司琼10 mg,B组:麻醉诱导前静脉注射地塞米松10 mg,手术缝皮时静脉注射生理盐水2 mL;C组:麻醉诱导前静脉注射地塞米松10 mg,手术缝皮时给予阿扎司琼10 mg;D组:麻醉诱导前和手术缝皮时均给予生理盐水4 mL.观察并记录四组患者术后24小时恶心呕吐发生的例数、程度与不良反应.结果:术后24小时内,A、B、C三组恶心呕吐发生率较D组低,差异有统计学意义(P<0.05),A B两组问的恶心呕吐发生率差异无显著性(P>0.05),C组术后恶心呕吐发生率较A、B两组低,差异有显著性(P<0.05).结论:阿扎司琼联合地塞米松能有效预防腹腔镜胆囊切除术患者术后恶心呕吐,效果较单用阿扎司琼或地塞米松更佳.     

不同时机静注阿扎司琼对术后静脉镇痛恶心呕吐的预防效果

目的:探讨阿扎司琼不同时机给药对术后静脉镇痛恶心呕吐(PONV)的预防效果。方法:120例ASAⅠ～Ⅱ级全麻下行腹部手术、术后自愿接受静脉镇痛的患者,随机分为A、B、C、D四组,每组30例:A组麻醉诱导前静脉注射阿扎司琼10mg;B组进腹探查后静脉注射阿扎司琼10mg;C组手术结束接镇痛泵之前静脉注射阿扎司琼10mg;D组作为对照组,不使用阿扎司琼。四组镇痛泵药物配方均为芬太尼按20μg/kg加生理盐水至100mL,背景剂量、单次追加剂量、锁定时间均相同。分别于术后4、8、12、24、48h观察并记录患者的疼痛视觉模拟评分(VAS)及Ramsay镇静状态评分、恶心呕吐评分及PONV发生率。结果:各组镇痛后12～48h的VAS与4h相比较差异有统计学意义(Ρ<0.01或Ρ<0.05);无嗜睡或镇静过深;PONV发生率,镇痛后A组各时段与D组相比较差异有统计学意义(Ρ<0.01或Ρ<0.05),C组仅0～4h和4～24h与D组相比较差异有统计学意义(Ρ<0.05),B组各时段与D组相比较差异均无统计学意义(Ρ>0.05)。结论:全麻诱导前静注阿扎司琼能有效地预防术后静脉镇痛恶心呕吐的发生。     

氟比洛芬酯在乳腺癌术后镇痛中的应用

目的探讨氟比洛芬酯在乳腺癌术后患者自控静脉镇痛(PCIA)中的作用。方法选择行乳腺癌手术患者50例,随机分为A、B两组,A组于手术开始前静脉给予氟比洛芬酯50mg,术后镇痛配方为芬太尼0.6mg+氟比洛芬酯150mg+阿扎司琼10mg/100mL;B组未用氟比洛芬酯,术后镇痛配方为芬太尼1.0mg+阿扎司琼10mg/100mL。PCIA的设置均为:维持量2mL/h,单次负荷量0.5mL,锁定时间15min,观察两组术后6h、12h、24h的镇静、镇痛评分及不良反应。结果两组术后各时点的VAS评分(视觉模拟评分),镇静评分差异无显著意义,A组术后芬太尼用量明显少于B组,A组术后恶心、呕吐、嗜睡等不良反应率低于B组。结论氟比洛芬酯用于乳腺癌术后PCIA镇痛效果好,且明显降低了芬太尼的用量,术后恶心、呕吐、嗜睡等不良反应发生率明显减少。     

昂丹司琼复合氟哌利多预防妇科腹腔镜术后恶心呕吐的临床观察

目的:探讨昂丹司琼复合氟哌利多对妇科腹腔镜手术后恶心呕吐的预防作用.方法:选用120例妇科腹腔镜手术病人随机分成A、B、C、D四组,分别给予氟哌利多2 mg、昂丹司琼4mg、昂丹司琼4mg 氟哌利多2mg、生理盐水于诱导前10分钟静脉注射,观察术后24小时恶心、呕吐发生情况.结果:四组病人恶心发生率情况:A、B、C组恶心发生率明显低于D组(P<0.05),与A、B组比较,C组的恶心发生率明显降低(P<0.05).四组病人呕吐发生率情况:A、B、C组呕吐发生率明显低于D组(P<0.05),与A、B组比较,C组的呕吐发生率明显降低(P<0.05).结论:预注昂丹司琼联合小剂量氟哌利多可较好地预防腹腔镜妇科手术后恶心呕吐的发生率,比单独使用效果更好.     

甲状腺切除术后的药物镇吐效果对比

目的 分别评价阿扎司琼和胃复安应用于甲状腺切除术后的镇吐效果.方法 随机将ASA Ⅰ-Ⅱ级120例择期行甲状腺切除术的病人分为3组(各40例):阿扎司琼(A组)于术毕静注阿扎司琼10mg(2ml);胃复安(B组)于术毕静注胃复安10mg(2ml);安慰剂(C组)于术毕静注生理盐水2ml.观察术后24h内病人的恶心、呕吐情况.结果 A组恶心呕吐发生率为20.0%,明显低于B组37.5%)P＜0.05;与C组(52.5%)比较P＜0.01;B.组(37.5%)的恶心呕吐发生率与C组(52.5%)比较明显较低,P＜0.05.结论 阿扎司琼和胃复安均能减少甲状腺切除术后的恶心、呕吐发生率,但在镇吐效果上阿扎司琼明显优于胃复安.     

阿扎司琼、格拉司琼预防腹腔镜胆囊切除术后恶心呕吐的疗效观察

目的比较阿扎司琼和格拉司琼预防腹腔镜胆囊切除术后恶心呕吐的临床疗效。方法选择120例ASAⅠ～Ⅱ级择期腹腔镜胆囊切除术病人,随机将病人分为三组,在开始缝皮前静注格拉司琼(G组,n=40)3mg、阿扎司琼(A组,n=40)10mg、生理盐水(对照组,C组,n=40)。结果在术后6小时内和24小时内恶心呕吐的发生率G组(175%、325%)和A组(125%、175%)明显低于C组(400%、675%)(P<001),A组在术后6小时内恶心呕吐与G组比较差异无显著性(P>005),但在术后7～24小时内恶心呕吐的发生率明显低于G组(50%vs15.0%)(P<005)。结论阿扎司琼和格拉司琼均可显著减少腹腔镜胆囊切除术术后恶心呕吐发生率,对于预防早期恶心呕吐两者疗效相当,但阿扎司琼对晚期恶心呕吐的预防作用要优于格拉司琼。     

阿扎司琼联合小剂量地塞米松预防无痛人流术后恶心呕吐临床观察

目的 观察阿扎司琼联合小剂量地塞米松预防无痛人流术后恶心、呕吐的作用.方法 选择ASA Ⅰ一Ⅱ级择期行无痛人流术患者270例,随机分为A、B、C 3组,每组90例;分别静脉注射生理盐水、阿扎司琼及阿扎司琼+地塞米松,3组患者均注射丙泊酚(3 mg/kg)及芬太尼(0.6μg/kg),手术24 h后电话询问恶心、呕吐发生...     

托烷司琼与昂丹司琼预防单髋关节置换患者术后恶心呕吐的比较

目的:比较不同剂量托烷司琼和昂丹司琼在预防术后恶心呕吐(PONV)发生的效果,为临床应用提供参考。方法:选择单髋关节置换术患者178例,18~65岁,ASAⅠ或Ⅱ,随机分为4组。术毕均使用患者自控静脉镇痛(PCIA),PCIA药物配方为舒芬太尼2μg·kg-1+氟比洛芬酯4 mg·kg-1(最大至300 mg),加生理盐水至100 m L。其中,泵中止吐药方案,A组:托烷司琼10 mg,B组:托烷司琼15 mg,C组:昂丹司琼12 mg,D组:昂丹司琼16 mg。分别于6、12、24、48 h观察患者恶心、呕吐及相关并发症的发生情况。结果:术后6 h内,A组和B组呕吐发生率及呕吐程度明显低于C组;术后6~12 h内,A组恶心发生率明显低于C组和D组,A组呕吐发生率和呕吐程度明显低于C组(P<0.05)。结论:在单髋关节置换术后PCIA泵中持续输注托烷司琼10 mg可有效预防恶心呕吐。     

不同剂量阿扎司琼预防硬膜外吗啡术后镇痛所致恶心呕吐

目的探讨阿扎司琼预防硬膜外吗啡术后镇痛所致恶心、呕吐的有效剂量。方法选择硬膜外麻醉下妇科手术患者200例,分为5组,每组40例。取L_(1-2)或T_(12)-L_1间隙穿刺置管,予2%利多卡因,首次剂量13～15mL,手术结束前30min,A2.5组、A5组、A7.5组和A10组分别给予阿扎司琼2.5、5、7.5、10mg,D组给予氯化钠注射液。手术结束时皆硬膜外注入镇痛负荷量(0.25%罗哌卡因8mL+吗啡2mg),连接镇痛泵(0.15%罗哌卡因100mL+吗啡5mg)。观察并记录术后24h内恶心、呕吐发生情况。结果 A5组术后恶心呕吐发生率45%,低于D组(68%),差异有显著意义(P<0.05)。A10组和A7.5组术后恶心呕吐发生率均为10%,显著低于D组(P<0.05),A10组和A7.5组组间比较无显著差异(P>0.05)。结论手术结束前给予阿扎司琼对硬膜外吗啡术后镇痛所致恶心、呕吐有预防效果,推荐剂量为5～7.5mg。     

阿扎司琼降低患者吗啡镇痛中并发恶心呕吐的效果观察

目的评价阿扎司琼降低吗啡镇痛致恶心呕吐的疗效。方法205例硬膜外麻醉患者随机分成2组。对照组硬膜外腔注入吗啡2.0 mg(生理盐水稀释至5 ml)。实验组术后镇痛同对照组,手术结束前静脉给予阿扎司琼10 mg。结果实验组恶心发生率25.63%,呕吐发生率18.75%,对照组分别为48.89%,44.44%,两组比较有统计学差异(P<0.01)。结论阿扎司琼能有效降低吗啡镇痛引起的恶心呕吐。     

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.     

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.     

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.