两种不同的麻醉方法在单肺通气时对肺内分流影响的比较

目的　比较异丙酚、芬太尼静脉麻醉和异氟醚氧化亚氮吸入麻醉在电视胸腔镜手术(vid-eo-assistedthoracoscopic surgery,VATS)单肺通气(OLV)时对肺内分流(Qs/Ot)的影响。方法　60例行VATS,随机分为异丙酚静脉麻醉组(Ⅰ组,n=30)和异氟醚吸入麻醉组(Ⅱ组,n=30)。全部病例以静注芬太尼2μg/kg、异丙酚2~3 mg/kg、阿曲库铵0.25~0.5 mg/kg诱导插双腔气管导管,然后Ⅰ组用微泵持续注射异丙酚8~10 mg·kg-1·h-1,30~45 min间断静注阿曲库铵0 25~0 5 mg/kg维持,根据患者的麻醉深度作调整。Ⅱ组吸入0 8%~2 0%异氟醚和50%氧化亚氮氧气维持麻醉。OLV 30 min、OLV 60 min 测定血气。结果　OLV期间PaO2Ⅰ组高于Ⅱ组,PaCO2Ⅱ组高于Ⅰ组(P<0.05)。结论　在OLV期间异丙酚静脉麻醉比异氟醚吸入麻醉对肺内分流的影响较小,异氟醚吸入麻醉对机体HPV明显抑制。     

舒芬太尼-丙泊酚全凭静脉麻醉对单肺通气肺内分流的影响

目的拟观察舒芬太尼．丙泊酚全凭静脉麻醉对单肺通气肺内分流的影响。方法选择单肺通气（OLV）食管癌手术患者加例,将患者随机分为两组,舒芬太尼．丙泊酚组（S组）,异氟醚．芬太尼组（I组）,每组20例。S组选择舒芬太尼-丙泊酚全凭静脉麻醉,I组选择异氟醚-芬太尼静吸复合麻醉。分别在双肺通气后15min（To）,OLV15min（T1）,OLV30rain（T2）,OLV60min（13）及OLV90min（T4）采集动脉血和混合静脉血行血气分析,并计算肺内分流率（Qs／Qt）。结果两组患者PaCO2、pH均在正常范围,组问比较无明显差异;S组单肺通气后各时点PaO2均高于I组（P〈0．05）,Qs／Qt值低于I组。结论与异氟醚静吸复合麻醉相比,舒芬太尼异丙酚全凭静脉麻醉可减少OVL时的肺内分流,提高动脉氧分压,有利于单肺通气时低氧血症的预防。     

七氟醚复合瑞芬太尼在剖宫产手术中的效果观察

目的探讨七氟醚复合瑞芬太尼在剖宫产手术中的麻醉效果,并与异氟醚复合芬太尼比较。方法将需剖宫产手术的ASAI～Ⅱ级的足月产妇40例（23～32岁）随机分为七氟醚复合瑞芬太尼组（I组）和异氟醚复合芬太尼组（Ⅱ组）各20例。诱导：I组面罩吸入3．5％七氟醚、2～4L／min流量的氧气、静脉输入瑞芬太尼1μg／kg、丙泊酚1mg／kg、顺苯阿曲库铵0．1mg／kg;Ⅱ组静脉注芬太尼0．02mg／kg、丙泊酚2mg／kg、顺苯阿曲库铵0．1mg／kg。维持：I组吸入1．5％～3．5％七氟醚,胎儿娩出后输注瑞芬太尼0．15μg／（kg·min）;I组吸人1％～2．5％异氟醚,胎儿娩出后静脉注芬太尼0．02mg／kg。取新生儿脐动脉（UA）血样1ml行血气分析。分别记录两组麻醉期间血流动力学的参数、血氧饱和度（SpO2）的变化、麻醉复苏的时间、术中知晓情况以及新生儿Apgar评分、脐动脉血气分析。结果I组诱导后和手术时心率、血压基本保持平稳沪〉0．05）。II组在诱导后心率和血压下降较I组明显（p〈0．05）,术后产妇拔管时间【（10．3±3．2）mini和睁眼时间[（15．4±2．3）min】I组明显早于Ⅱ组[（18．5±6．3）min,（25．6±3．5）min],差异有显著性垆〈0．05）。两组新生儿1、5、10minApgar评分均大于7分,脐动脉血气分析差异无显著性垆〉0．05l两组均未见新生儿呼吸抑制及产妇术中知晓发生。结论吸入七氟醚联合瑞芬太尼在剖宫产手术中的麻醉平稳、效果确切、苏醒快、新生儿无呼吸抑制。     

七氟醚吸入或丙泊酚静脉麻醉对单肺通气期肺内分流的影响

目的 观察七氟醚、丙泊酚对对单肺通气(OLV)期出现的低氧性肺血管收缩(HPV)和肺内分流(Qs/Qt)的影响.方法 ASA Ⅱ～Ⅲ级行OLV的肺癌、食管患者36例,年龄30～61岁,随机均分为两组,分别采用吸入七氟醚(A组)或静脉丙泊酚诱导(B组),快速行双腔支气管导管插管.术中以吸入3% ～5% 的七氟醚或静脉靶控2.0～3.0μg/ml 丙泊酚维持麻醉.于双肺通气(TLV)15 min、OLV 15 min,OLV 30 min、恢复TLV 15 min时,取动脉血和混合静脉血行血气分析,计算Qs/Qt值.记录血流动力学指标.结果 与TLV时相比,两组OLV期的PaO_2显著下降,Qs/Qt明显增加(P<0.01).两组OLV时的Qs/Qt无明显差异.结论 七氟醚吸入或丙泊酚静脉麻醉OLV时均有一定程度的PaO_2下降和Qs/Qt增加.     

七氟醚吸入麻醉对单肺通气患者的药动学影响

目的观察七氟醚吸入麻醉中单肺通气(OLV)对其药物代谢动力学的影响。方法选择食管癌根治术患者15例(OLV组)和胃癌根治患者15例(TLV组),分别于全麻诱导后插入双腔支气管导管或单腔气管导管控制呼吸,行七氟醚吸入麻醉,记录每组患者各个时点的脑电双频指数(BIS)、七氟醚吸入气浓度(Fi)和呼出气浓度(Et),并计算Et/Fi,进行组间及组内各时间点的比较。结果组间:OLV组BIS高于TLV组(P<0.05);OLV组Et/Fi高于TLV组(P<0.01)。OLV组:BIS呈逐渐下降趋势,5 min达到临床麻醉水平(60),5~120 min维持在临床麻醉深度(40~60);Et呈逐渐上升趋势,30 min达到稳态。Et/Fi呈逐渐升高趋势,50 min达到稳态,50~120 min变化无统计学意义(P>0.05)。TLV组:BIS呈逐渐下降趋势,2 min达到临床麻醉水平,2~70 min维持在临床麻醉深度,70~120min低于40;Et呈逐渐上升趋势,20 min达到稳态。Et/Fi呈逐渐升高趋势,2 min达到稳态,2~120 min变化无统计学意义(P>0.05)。结论七氟醚吸入麻醉中OLV对其摄取有一定影响,摄取总量少于TLV,2~50 min摄取速率高于TLV。在七氟醚吸入浓度为3%vol,氧流量为2 L/min的条件下,OLV与TLV均可达到满足手术要求的麻醉深度,但TLV组在70 min后应调整吸入浓度以避免麻醉过深。相同时点OLV麻醉深度较浅,达到稳定麻醉状态的时间较长(30 min/20 min)。     

地氟醚与丙泊酚的不同配伍对单肺通气时肺内分流的影响

目的探讨地氟醚与丙泊酚的不同配伍在食管癌根治术单肺通气(One lung ventilation,OLV)期间对肺内分流的影响。方法选择择期行食管癌左侧开胸切除术患者45例,ASAⅠ～Ⅱ级,随机均分为3组(每组15例):丙泊酚组(P组)、地氟醚-丙泊酚组(DP组)和地氟醚组(D组),分别于平卧位双肺通气15min(T0),右侧卧位双肺通气15 min(T1),单肺通气15 min(T2)、30 min(T3)、60 min(T4)、90 min(T5)进行动脉血及混合静脉血血气分析,计算肺内分流率(Qs/Qt)。结果 TLV(T0)时,Qs/Qt组间比较,差异无统计学意义(P>0.05);OLV期间(T2～T5)Qs/Qt与TLV(T0)时相比,有明显增高(P<0.05),且D组明显高于P组和DP组(P<0.05),P组与DP组相比,差异无统计学意义(P>0.05)。三组OLV各时的PaO2较TLV时下降(P<0.05),但仍在安全范围内。结论临床剂量[3 mg/(kg.h)]丙泊酚复合低浓度地氟醚(<0.83MAC)对OLV的患者更安全有效。     

双侧肺同期手术中保护性单肺通气策略定容和定压通气的比较

目的探讨双侧肺同期手术单肺通气（OLV）期间采用定容（VCV）和定压（PCV）不同通气模式对呼吸力学及动脉血气的影响,并评价其临床效果。方法9例双侧肺同期手术患者,双肺通气（TLV）期间均采用VCV模式（TLV—VCV）,OLV后通气侧肺先采用传统方法大潮气量（10ml／kg）通气（OLV—VCV1）,30min后改为单肺保护通气：小潮气量（6～8ml／kg）＋PEEP的通气模式（OLV—VCV2）;或PCV＋PEEP的通气模式（OLV—PCV）。用旁气流通气监测法（SSS）监测呼吸力学参数：气道峰压（Ppeak）、气道平台压（Pplat）、气道阻力（Raw）、动态胸肺顺应性（Cdyn）、分钟通气量（MV）等。同时抽动脉血做血气分析。结果单肺保护通气时,Ppeak、Pplat、Raw较低,Cdyn相对较好（P均〈0．05）。PaO2及PaCO2显著升高（P〈0．05）,但PaCO2的升高在临床允许范围内。结论双侧肺同期手术在实行单肺保护通气策略时,OLV—PCV和OLV—VCV2通气模式均可改善肺泡氧舍,预防和减轻单肺通气造成的低氧血症,还可以有效地降低气道压力、气道阻力,但PCV模式控制气道压更有效,更有利于减少气道损伤。     

依达拉奉对单肺通气患者围术期细胞因子IL-6、IL-8及其mRNA表达的影响

目的：观察依达拉奉对单肺通气患者围术期炎性细胞因子IL-6、IL-8及其mRNA表达的影响。方法：择期拟行肺叶切除术肺癌患者24例,ASAⅠ级或Ⅱ级,年龄48～67岁,随机分为2组：对照组（C组）和依达拉奉组（E组）,每组12例。麻醉诱导：两组均静脉注射咪唑安定0．03mg／kg、芬太尼3μg／kg,吸入8％七氟醚。麻醉诱导后,E组给予依达拉奉0．5mg／kg;C组给予等量生理盐水。麻醉维持：间断静脉注射维库溴铵0．04～0．08mg／kg、芬太尼0．05～0．1mg,七氟醚呼气末浓度维持在1．8％～2．7％。两组均在麻醉后切皮前（T1）、膨肺后60min（T2）、术后1h（T3）采取血样测定白细胞介素IL-6、IL-8血浆浓度及其mRNA表达。结果：与T4比较,两组IL-6、IL-8血浆浓度及其mRNA表达于T2—3明显上升（P〈0．05）;与C组相比,E组IL-6、IL-8血浆浓度及其mRNA表达于T2-3显著低于C组（P〈0．05）。结论：依达拉奉应用于单肺通气患者可有效抑制机体促炎细胞因子的生成和释放。     

七氟醚麻醉深度对单肺通气时肺顺应性的影响

目的 观测不同最低肺泡有效浓度(MAC)七氟醚对单肺通气(OLV)时肺顺应性的影响.方法 选择45例择期左开胸手术患者,ASA Ⅰ~Ⅱ级,随机分为七氟醚0.5 MAC组(Ⅰ组)1.0 MAC(Ⅱ组)和1.5 MAC(Ⅲ组)三组,每组15例.三组均用芬太尼2 μg/kg,依托米脂0.2 mg/kg和琥珀胆碱(司可林)1.5 mg/kg进行麻醉诱导,然后经口插入右双腔支气管导管控制呼吸,术中七氟醚分别以0.5 MAC、1.0 MAC和1.5 MAC,瑞芬太尼以0.5 μg/(kg·h),维库溴铵以0.05 mg/(kg·h)维持麻醉.在MAC值稳定后分别记录侧身双肺通气0、3 min单肺通气2、3、4、5、15 min的气道压、气道压峰值(Ppeak)、气道平台压(Pplat)、血氧饱和度(SaO2)、平均动脉压(MAP)、呼气末二氧化碳(PETCO2)和顺应性.结果 OLV后3组患者的顺应性明显降低(P<0.05),其他参数均无差异;OLV后Ⅲ组与其他两组之间差异有统计学意义(P<0.05).结论 1.5 MAC七氟醚在右侧单肺通气时对顺应性有明显增强效应,0.5 MAC和1.0 MAC 七氟醚影响轻微.     

瑞芬太尼复合异丙酚用于电视腹腔镜手术麻醉的临床观察

目的比较瑞芬太尼或芬太尼复合异丙酚用于腹腔镜手术麻醉的临床效果。方法ASAⅠ。Ⅱ级择期行腹腔镜胆囊切除术的患者100例，随机均分为瑞芬太尼＋异丙酚组（RP组）和芬太尼＋异丙酚组（FP组）。RP组以异丙酚2mg／kg、瑞芬太尼1μg／k、维库溴铵0．1mg／kg诱导，术中以异丙酚2mg／（kg·h）、瑞芬太尼0．2μgJ（kg·min）维持麻醉；FP组以异丙酚2mg／kg、芬太尼3μg／kg、维库溴铵0．1mg／kg诱导，术中以异丙酚2mg／（kg·h）、芬太尼0．03μg/（kg·min）维持麻醉，同时吸入1％异氟醚。观察血流动力学、麻醉苏醒时间及不良反应情况。结果两组麻醉效果无显著差异，患者诱导后血压均明显降低（P〈0．01），心率减慢（P〈0．05），RP组心率减慢持续到术毕（P〈0．05）；RP组作用强于FP组，术毕苏醒快，拔管早。结论异丙酚复合瑞芬太尼比芬太尼更优越、安全。     

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.

     

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.     

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.     

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.