胺碘酮静脉给药治疗心房纤维颤动患者引致休克的临床特点

目的：探讨胺碘酮静脉给药治疗心房纤维颤动患者引起休克的临床特点。方法：收集2003年至2007年中文医学文献关于胺碘酮静脉给药治疗心房纤维颤动患者引致休克的临床资料，包括患者的基础心脏病，心房纤维颤动发作时的心律、心率、血压、心功能状态、心电图以及胺碘酮的用法用量。对胺碘酮输液的浓度、静脉滴注速度和总剂量以及休克发生的时间、表现和处理进行分析。结果：共收集7例胺碘酮所致休克患者的临床资料，其中2例来自本院。胺碘酮溶于5％葡萄糖注射液100ml中，浓度为1．5～7．5mg／ml，静脉给药速度为2．5～10mg／min。用药后休克发生的时间，4例为2min内，3例为5～20min内，持续时间为3～120min。2例休克患者伴有意识障碍，5例患者休克时仍有心房纤维颤动。结论：胺碘酮静脉给药可能引起休克，临床表现危重，及时对症治疗可缓解。     

我院盐酸胺碘酮药品不良反应39例分析

目的:分析胺碘酮所致不良反应的特点及相关因素,为临床合理用药提供参考.方法:收集2015年我院药品不良反应报告,对使用胺碘酮的用量、注射速度、浓度和口服时间等项目进行统计分析.结果:共收集盐酸胺碘酮药品不良反应39例分析,其中30例是静脉给药,9例口服给药.静脉给药有2例发生休克,口服给药有2例发生肺纤维化.休克患者停药并给予抢救好转,肺纤维化患者药物治疗,病情得到一定控制,未治愈.结论:胺碘酮的不良反应尤其是严重不良反应,应引起临床注意,临床药师在预防和减少药物不良反应上有积极作用.     

胺碘酮与毛花苷治疗心衰伴快速房颤短时疗效比较

目的:比较静脉应用胺碘酮与毛花苷治疗充血性心力衰竭(CHF)伴快速心室率心房颤动(Af)患者的短时疗效.方法:60例CHF伴快速心室率Af患者,随机分为胺碘酮组30例、毛花苷组30例,在常规治疗基础上,两组分别静脉应用胺碘酮及毛花苷,观察用药后不同时刻的心室率变化、药物平均起效时间及不良反应.结果:两组患者用药后心室率均明显下降,与用药前比较均有统计学差异,用药2 h后胺碘酮组心室率下降幅度明显大于毛花苷组(P<0.05);胺碘酮、毛花苷组平均起效时间分别为(26.5±12.7)min和(48.9±14.2)min(P<0.01);胺碘酮、毛花苷组治疗总有效率分别为80.0%和70.0%(P＞0.05).结论:静脉应用胺碘酮治疗CHF伴快速心室率Af短时效果显著,患者安全性好.     

急诊科应用胺碘酮治疗快速性心律失常的临床分析

目的探讨急诊科应用胺碘酮治疗快速性心律失常的临床效果。方法选取我院2012年1月至2012年7月收治的62例快速性心律失常患者作为研究对象。首次剂量150mg加入5%葡萄糖20mL中20min内缓慢静脉泵入,1.5mg/min持续静脉滴注。给药后未好转者10～15min后再次给予75～150mg,20min缓慢静脉推注;观测患者用药24h内心律失常纠正情况。结果 62例患者中有效58例,无效4例,有效率为93.57%。无恶性心律失常、心力衰竭等并发症发生。结论胺碘酮治疗快速性心律失常,疗效确切,适用于快速性心律失常急救,值得进一步探究和临床推广应用。     

胺碘酮致肺毒性20例文献分析

目的:总结应用胺碘酮致肺毒性的一般规律与特点,为临床合理使用胺碘酮及避免相关不良反应发生提供参考。方法:检索中国知网(CNKI)、中文科技期刊数据库(VIP)、万方数据库收录的1990-2016年间发表的胺碘酮致肺毒性相关个案报道文献,对符合要求的病例进行统计和分析。结果:共收集到19篇相关文献,涉及20例应用胺碘酮致肺毒性的患者。其中,年龄>60岁的患者占75.0%,男女比例为3∶1;75.0%的患者肺毒性发生时的用药时间>1个月;17例患者胺碘酮的口服维持量为200~400mg/d;6例患者死亡,占30.0%。结论:胺碘酮致肺毒性可能与患者的性别、年龄、用药时间、用药剂量等因素有关,其致死率相对较高,应引起广大医务工作者的关注,定期监测,以便及时发现和处理。     

胺碘酮治疗急性冠脉综合征伴快速房颤临床分析

目的 观察静脉滴注胺碘酮在急性冠状动脉综合征(ACS)伴快速房颤患者的临床疗效。方法 20例ACS患者伴新近发生快速房颤,静脉应用胺碘酮,先静脉注射负荷量后,继以静脉滴注维持观察房颤转复及心室率控制及不良反应。结果 20例患者心率用药后较用药前明显下降(P<0.01)。其中14例患者(70%)在24 h内转为窦性心律,3例用药后出现长R-R间期,3例出现窦性心动过缓,经停药或减药后恢复。结论静脉应用胺碘酮治疗ACS伴快速房颤是有效及安全的。     

盐酸胺碘酮导致严重的低血压休克、心搏骤停1例

本科于2010年8月收治1例静脉注射胺碘酮导致严重低血压休克、心搏骤停患者。确诊为特发性室性心动过速,使用前患者血压正常,经给予胺碘酮150 mg加生理盐水(NS)40 mL静脉注射,突然出现面色苍白、烦躁不安、意识模糊、血压下降、休克,经多巴胺及肾上腺素、电除颤等治疗,抢救成功1例。提示胺碘酮静脉注射出现休克与胺碘酮有关,应仔细查找原因,积极处理,从而挽救患者的生命。     

老年心功能不全伴心房颤动患者静脉用胺碘酮治疗的评估与观察

目的探讨老年心功能不全伴心房颤动患者静脉用胺碘酮治疗的用药安全。方法对76例老年心功能不全伴心房颤动患者静脉用胺碘酮时进行用药前评估;用药方案正确实施;用药后疗效判断;用药后不良反应观察与处理4个方面进行评估与观察。结果76例老年心功能不全伴心房颤动患者静脉用胺碘酮治疗,阵发性心房颤动52例,持续心房颤动24例。复律成功55例(72%),未转复为窦性心律21例(28%)。13例(17%)患者出现低血压,立即停止静脉用胺碘酮并使用升压药物多巴胺干预后恢复正常。7例(9%)患者应用胺碘酮转为窦性心律后,出现窦性心动过缓,4例患者出现快慢综合征,3例患者出现间歇性的慢心室率(长R-R间期)。7例(9.21%)患者停静脉用胺碘酮后给予阿托品药物治疗,4例患者心率恢复正常,有3例患者安装永久性心脏起搏器。结论加强对老年心功能不全伴心房颤动患者,静脉用胺碘酮治疗的评估与观察。早期发现不良反应及时处理,对患者用药安全有重要的意义。     

胺碘酮治疗急性冠脉综合征伴快速房颤

目的 观察静脉滴注胺碘酮在急性冠状动脉综合征(Acs)伴快速房颤患者的临床疗效.方法 23例ACS患者伴新近发生快速房颤,静脉应用胺碘酮,先静脉注射负荷量后,继以静脉滴注维持观察房颤转复及心室率控制及不良反应.结果 23例患者用药后15min、1h、2h、24h心室率分别为(141.3±18.7)次/min、(128.1±17.2)次/min、(105.3±15.9)次/min、(82.5±20.1)次/min,较用药前(149.2±19.3)次/min明显下降(P＜0.01).其中17例患者(73.9%)在24h内转为窦性心律,2例用药后出现长R-R间期,3例出现窦性心动过缓,经停药或减药后恢复.结论 静脉应用胺碘酮治疗ACS伴快速房颤是有效及安全的.     

胺碘酮治疗急性心肌梗死后室性心律失常的疗效分析

目的:观察胺碘酮治疗急性心肌梗死后室性心律失常的疗效分析。方法:我院2016年9月至2017年9月接收的66例急性心肌梗死后室性心律失常患者为本次研究对象,按照是否给予胺碘酮治疗将所有患者均分为实验组(33例)与对照组(33例),对照组给予利多卡因治疗,实验组给予胺碘酮治疗,观察比较两组患者临床疗效。结果:实验组给药3天后共有32例患者病情好转,多于对照组,P0.05.实验组患者发生不良反应率与对照组相比,P0.05。结论:对于急性心肌梗死后室性心律失常患者联合胺碘酮可有效改善个体症状,可行性高。     

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.