急性肾衰竭患者血清胆碱酯酶变化的意义

目的通过观察急性肾衰竭（ARF）患者血清胆碱酯酶（CHE）的变化,探讨血清CHE与ARF预后的关系,并分析其临床意义。方法将68例ARF患者分为存活组（A组）及死亡组（B组）,检测其治疗前后血清CHE,并与40例肾功能正常的原发肾小球疾病患者（M组）和30例健康体检者（N组）比较。结果A组和B组患者血清CHE均较M组和N组降低;而M组与N组间无显著性差异;A组患者治疗后血清CHE恢复,与治疗前CHE相比差异有统计学意义;B组患者治疗后血清CHE持续降低。结论血清CHE可作为ARF的检测物之一,对ARF患者的病情监测和预后判断具有重要的临床意义。     

血清胆碱酯酶的变化在临床麻醉中的意义

背景血清胆碱酯酶广泛存在于人体各种组织,尤其以血浆和肝最为丰富,一直以来其作为肝功能监测的常用指标反映肝的合成功能.目前临床医疗活动发现在重症患者的监测治疗过程中,血清胆碱酯酶的变化对判断机体的功能状态有重要的临床意义,且由于其参与体内某些物质和多种药物的分解代谢而直接影响临床治疗用药的选择.目的 主要对血清胆碱酯酶的结构、基因类型和生理功能进行综述,为临床麻醉的评估和管理提供参考依据.内容整理和阐述胆碱酯酶的分类和生理功能,并以血清胆碱酯酶为重点,讨论其变化对麻醉术前的评估和麻醉选药的指导意义.趋向随着对血清胆碱酯酶的深入研究,其将被广泛用于临床医疗活动中.     

血清胆碱酯酶变化与严重多发伤患者病情及转归的关系

血清胆碱酯酶（ChE）活性的降低常用于有机磷中毒和慢性肝病肝功能的评估，但在严重多发伤患者中的变化，国内外少有报道。笔者检测了30例严重多发伤患者伤后7d内血清ChE的动态变化，试探讨其与病情严重度的关系及预测转归的价值。     

急性心肌梗死患者血清甲状腺激素的变化及临床意义

目的:通过观察急性心肌梗死患者血清甲状腺激素的变化,来探讨其临床应用价值.方法:应用放射免疫分析法,对正常对照组、急性心肌梗死组患者血清FT3、FT4、TSH、rT3的浓度进行检测,比较各组间的差异.将急性心肌梗死患者分为两组,A组:经再灌注治疗后病情稳定、无并发症及恶性心脏事件的发生,B组:经再灌注治疗后出现并发症及恶性心脏事件.对两组患者治疗前、治疗后2天及治疗后2周FT3、rT3进行检测,比较治疗前后不同时间FT3、rT3的差异.结果:(1)急性心肌梗死患者的FT3含量较正常对照组明显降低,rT3含量较正常对照组明显升高,差异有统计学意义.(2)与治疗前的A组比较,B组FT3含量明显降低,rT3含量明显增高,差异有统计学意义.(3)A组患者治疗后2周FT3含量较治疗前升高,rT3含量较治疗前降低,差异有统计学意义;(4)B组AMI患者治疗后2天FT3较治疗前降低更明显,rT3含量较治疗前升高更明显,差异有统计学意义;治疗后2用FT3含量较治疗前增高,rT3含量较治疗前降低,差异有统计学意义.结论:AMI患者甲状腺功能处于较低水平,且治疗后甲状腺功能有明显的改善.FT3、rT3可作为心肌梗死发生与发展的预测指标.     

肾病综合征患者血小板参数的变化及临床意义

肾病综合征由于高脂血症、低蛋白血症、高黏质血症等容易形成血栓.近年来国内外研究表明,在血栓性疾病血小板参数有明显变化.为探讨血小板参数在肾病综合征中的变化及其临床意义,我们对62例肾病综合征患者血小板计数(PLT)、血小板体积(MPV)、血小板分布宽度(PDW)、血小板压积(PCT)4项指标进行了回顾性分析,并与正常对照组进行比较.     

癌症患者血清胆碱酯酶与琥珀胆碱对呼吸抑制的临床研究

琥珀胆碱 (Ｓｃｈ)是全麻气管插管的首选药物之一 ,在体内由血清胆碱酯酶(ＳｃｈＥ)分解灭活 ,有报道认为癌症患者ＳｃｈＥ浓度降低[1 3 ] ,本文针对这一问题进行癌症患者Ｓｃｈ诱导前后ＳｃｈＥ水平和Ｓｃｈ呼吸抑制时限的研究。资料与方法癌症患者 83例 ,其中男 39例 ,女 44例 ,年龄 31～ 6 8岁 ,体重 49～ 6 8ｋｇ ,ＡＳＡⅠ～Ⅱ级 ,依据肿瘤的原发部位分为三组 :Ⅰ组为肝、胆、胰肿瘤组 (2 8例 ) ,Ⅱ组为肺癌组 (30例 ) ,Ⅲ组为乳腺和颅脑肿瘤组 (2 5例 ) ,2 0例非癌症患者作为对照组 (Ⅳ组 )。麻醉诱导以芬太尼 2 μｇ·ｋｇ-1、2 5 %…     

腹部提压心肺复苏救治心脏外科术后心搏骤停患者的临床研究

目的 探讨腹部提压心肺复苏(AACD-CPR)救治心脏外科术后心搏骤停患者的效果。方法 回顾性分析阜外华中心血管病医院2018-01—2021-01收治的心脏外科术后心搏骤停患者的临床资料。分为AACD-CPR组(78例)和标准心肺复苏(STD-CPR)组(98例)。比较2组患者抢救时间、自主循环恢复(ROSC)率、2周后生存率。统计复苏前及复苏后15 min患者的血氧饱和度(SpO₂)、平均动脉压(MAP)、中心静脉压(CVP)血流动力学指标,以及动脉血氧分压(PaO₂)、二氧化碳分压(PaCO₂)、pH值氧合指标。结果 AACD-CPR组抢救成功时间短于STD-CPR组,差异有统计学意义(P<0.05)。2组患者的ROSC率和2周存活率差异均无统计学意义(P>0.05)。2组ROSC患者复苏后15 min的血流动力学和氧合指标均较复苏前显著改善,其中AACD-CPR组的改善效果均优于STD-CPR组,差异均有统计学意义(P<0.05)。结论 心脏外科术后患者突发心搏骤停时,应用AACD-CPR和ST...     

急性冠脉综合征患者血浆脑钠素水平变化及临床意义

目的：探讨急性冠脉综合征(acute coronary syndrome,ACS)患者血浆脑钠素(brain natriuretic pep- tide,BNP)水平的变化规律及对诊断急性冠脉综合征的临床意义。方法：采用酶联免疫吸附法测定ACS患者和对照组血浆BNP浓度,将55例ACS患者分为急性心肌梗死组(acute myocardial infarction,AM组,n=25),不稳定型心绞痛组(unstable angina,UA组,n=30),分别测定症状发作6h及24h的BNP并和30例正常健康体检者(对照组)作比较。结果：①症状发作6h内,BNP含量AMI组(60．10±1．71)μg/L和UA组(34．80±14．80)μg/ L,均显著高于对照组(10．60±1．70)μg/L(P＜0．01)。②症状发作24h,AMI组BNP(154．00±18．60)μg/L,UA组BNP(70．31±23．30)μg/L,显著高于正常对照组(10．54±1．80)(P＜0．01)。结论：血浆BNP水平升高与ACS有显著相关性,并认为血浆BUN水平升高可作为ACS的早期诊断的有效指标。     

卵巢癌患者手术前后血清糖类抗原125的水平变化及临床意义

本文用放射免疫分析（RIA）对40例卵巢癌患者手术前后血清糖类抗原125（CA125）进行检测，并与正常健康对照组比较，以了解其在卵巢癌的诊断、疗效评价及预后观察中的价值，现报告如下。     

Role of serum cholinesterase in patients treated with salvage radical prostatectomy

Background

Serum cholinesterase (ChE) a serine hydrolase that catalyses the hydrolysis of esters of choline, is involved in cellular proliferation and differentiation, therefore affecting carcinogenesis. The aim of this study was to understand the prognostic role of preoperative serum ChE in patients with radiation-recurrent prostate cancer (CaP) treated with salvage radical prostatectomy (SRP).

Prolonged mivacurium-induced neuromuscular blockade in patients with reduced plasma cholinesterase activity

Mivacurium is a recently released short-acting nondepolarizing muscle relaxant, metabolized by plasma cholinesterase. The short duration of action makes mivacurium an increasingly popular choice for muscle relaxation in ambulatory surgery procedures. Individuals with abnormalities of plasma cholinesterase, however, may have longer than expected duration of action of mivacurium, requiring prolonged mechanical ventilation. We present two cases where this occurred.     

Airway management using the pediatric GlideScope in a child with Goldenhar syndrome and atypical plasma cholinesterase

We report a case of difficult intubation in a child with Goldenhar syndrome and atypical plasma cholinesterase. Intubation attempts by direct laryngoscopy and the Trachlight were unsuccessful. The airway was ultimately secured using the pediatric GlideScope in conjunction with external laryngeal manipulation.     

Mivacurium-induced neuromuscular blockade in patients with atypical plasma cholinesterase

The duration of action of mivacurium was evaluated during a modified neurolept anaesthesia in 17 patients heterozygous for the usual and the atypical plasma cholinesterase (pChe) gene (E^a₁E^a₁) and in five patients homozygous for the atypical gene (E^a₁E^a₁). The response to train-of-four nerve stimulation was recorded using a Myograph 2000. Five heterozygous patients were given a small dose of mivacurium 0.03 mg kg bw^-1 intravenously (Group 1). The mean (range) suppression of the first twitch in the train-of-four response (T₁) was 91% (69–100%). The time to 90% T₁ recovery was 23.9 min (14.0–31.3 min). Twelve other heterozygous patients (Group 2) received mivacurium 0.2 mg kg bw^-1 (2.5 * ED₉₅). In these patients the time to 100% T₁ suppression was 1.4 min (1.1–2.0 min). The time to reappearance of the T₁ response, to 90% T₁ recovery, and the recovery index (25.3 min (14.5–34.5), 45.5 min (30.9–59.2), and 9.8 min (6.8–19.6), respectively) were significantly longer than reported in phenotypically normal patients. Five patients homozygous for the atypical gene (Group 3) were given 0.03 mg kg bw^-1 mivacurium. The time to reappearance of T₁ response following this low dose of mivacurium ranged from 26–128 min. In all five patients the neuromuscular block was successfully antagonized with neostigmine preceded by atropine. In conclusion, mivacurium-induced neuromuscular blockade was moderately prolonged in patients heterozygous for the usual and the atypical gene for plasma cholinesterase. Patients homozygous for the atypical plasma cholinesterase gene appear to be markedly sensitive to mivacurium.     

Postoperative decline in plasma aspirin-esterase and cholinesterase activity in surgical patients

We studied preoperative and postoperative plasma hydrolysis of aspirin and plasma cholinesterase activity in surgical patients. Postoperative aspirin esterase and cholinesterase activities fell sharply (119 ± 32 μg ml h^-1 and 3746 ± 1068 U I^-1 respectively; P<0.01) in comparison to basal preoperative values (157 ± 33 μg ml h^-1 and 4620 ± 940 U I^-1 respectively, P ± 0.01). We suggest that alterations in plasma esterase during the postoperative period may be related to the metabolic response to anesthesia- and surgery-induced stress.     

Recurarisation following a suxamethonium–alcuronium sequence in patients with atypical cholinesterase

Alcuronium 10 mg was administered to maintain muscle relaxation in two patients before recovery from suxamethonium neuromuscular blockade to facilitate tracheal intubation. This sequence resulted in a markedly prolonged block which could not be antagonised adequately by neostigmine 0.05 mg/kg; initial antagonism was followed rapidly by prolonged recurarisation. Estimation of plasma cholinesterase activity revealed that the two patients were homozygous for the atypical and silent genes. respectively.     

Post-cardiac arrest intensive care in Sweden: A survey of current clinical practice

Background

European guidelines recommend targeted temperature management (TTM) in post-cardiac arrest care. A large multicentre clinical trial, however, showed no difference in mortality and neurological outcome when comparing hypothermia to normothermia with early treatment of fever. The study results were valid given a strict protocol for the assessment of prognosis using defined neurological examinations. With the current range of recommended TTM temperatures, and applicable neurological examinations, procedures may differ between hospitals and the variation of clinical practice in Sweden is not known.

Aim

The aim of this study was to investigate current practice in post-resuscitation care after cardiac arrest as to temperature targets and assessment of neurological prognosis in Swedish intensive care units (ICUs).

Methods

A structured survey was conducted by telephone or e-mail in all Levels 2 and 3 (= 53) Swedish ICUs during the spring of 2022 with a secondary survey in April 2023.

Results

Five units were not providing post-cardiac arrest care and were excluded. The response rate was 43/48 (90%) of the eligible units. Among the responding ICUs, normothermia (36–37.7°C) was applied in all centres (2023). There was a detailed routine for the assessment of neurological prognosis in 38/43 (88%) ICUs. Neurological assessment was applied 72–96 h after return of spontaneous circulation in 32/38 (84%) units. Electroencephalogram and computed tomography and/or magnetic resonance imaging were the most common technical methods available.

Conclusion

Swedish ICUs use normothermia including early treatment of fever in post-resuscitation care after cardiac arrest and almost all apply a detailed routine for the assessment of neurological prognosis. However, available methods for prognostic evaluation varies between hospitals.