右旋美托咪啶镇静治疗对严重创伤后炎症因子的影响

 目的：探讨右旋美托咪啶（DEX）在严重创伤患者短期镇静治疗中对严重创伤后炎症因子的影响。方法：随机将60例入住重症监护病房（ICU）的严重创伤患者分为3组：DEX镇静组（DEX组,n=20）、咪达唑仑（MDZ）镇静组（MDZ组,n=20）和不用镇静剂的对照组（n=20）。DEX组：先静脉注射DEX负荷量1~2 μg/kg（>10 min）,继以微量注射泵持续静脉泵注维持量0.2~0.7 μg·kg^-1·h^-1。MDZ组：先静脉注射MDZ负荷量0.03~0.3 mg/kg,继以微量注射泵持续静脉泵注维持量0.03~0.2 mg·kg^-1·h^-1。镇静2组均以Ramsay氏镇静评分分级Ⅱ~Ⅳ级为镇静目标,根据Ramsay评分调整用量,实施2 d的短程镇静治疗。分别检测患者在入院时、24 h和48 h血清中白细胞介素1（IL-1)、IL-6、肿瘤坏死因子α（TNF-α）和C反应蛋白（CRP）水平。结果：3组患者TNF-α、IL-1、IL-6和CRP水平在入住ICU时均明显高于正常值,3组差异无统计学意义（P>0.05）;对照组TNF-α、IL-1、IL-6和CRP在24 h和48 h逐步升高,而DEX组和MDZ组的上述指标有所下降,分别与对照组比较差异有统计学意义（P<0.05）;DEX组和MDZ组TNF-α、IL-1、IL-6和CRP水平在24 h无显著差异（P>0.05）,但在48 h差异显著（P<0.05）。结论：右旋美托咪啶可在一定程度上降低创伤后过度应激反应,阻止炎症介质的进一步产生和释放,有助于严重创伤患者的稳定和恢复。     

丙泊酚复合瑞芬太尼靶控输注对高血压患者脑电双频指数的影响

目的：研究丙泊酚复合瑞芬太尼靶控输注对高血压患者脑电双频指数的影响。方法：选择2015年1月至2016年3月在我院行丙泊酚复合瑞芬太尼靶控输注麻醉的高血压患者105例,根据使用瑞芬太尼靶控输注的浓度将患者分为3组,Ⅰ组浓度为2.0 ng/mL、Ⅱ组浓度为3.0 ng/mL、Ⅲ组浓度为4.0 ng/mL,其三组丙泊酚的靶浓度均为4μg/mL,每组各35例患者。观察比较三组患者在入室5 min(T0)、插管前(T1)、插管后1 min(T2)、插管后3 min(T3)以及插管后5 min(T4)各时间点的平均动脉压、心率以及脑电双频指数的变化,并比较其苏醒的时间。结果：Ⅰ组患者在T2、T3时间点的平均动脉压与心率均明显的高于T1时间点,Ⅱ组患者在T2时间点的平均动脉压与心率均明显的高于T1时间点,比较差异具体统计学意义(P<0.05);在T2、T3与T4时间点上,Ⅲ组患者的脑电双频指数明显的低于Ⅱ组患者与Ⅰ组患者,比较差异具有统计学意义(P<0.05);Ⅲ组患者的苏醒时间明显的长于Ⅰ组、Ⅱ组患者,比较差异显著(P<0.05)。结论：使用丙泊酚复合瑞芬太尼靶控输注麻醉高血压患者,其脑电双频指数会随着瑞芬太尼的浓度而降低,减低插管应激反应,并能够维持血流动力学的平稳。     

超声评价维生素C静脉输注对原发性高血压病患者肱动脉内皮功能的影响

目的应用高分辨力超声测量反应性充血前后肱动脉内径的百分变化率,评价维生素C静脉输注对原发性高血压病患者肱动脉内皮功能的影响。方法分别于维生素C静脉输注前后,应用高分辨力超声测量50例原发性高血压病患者静息状态下、反应性充血后、舌下含服硝酸甘油后的肱动脉内径,并计算反应性充血和硝酸甘油诱发的内径百分变化率。结果维生素C静脉输注后,原发性高血压病患者反应性充血前后肱动脉内径百分变化率(16.8%±2.9%)明显高于静脉输注前(5.8%±2.7%,P<0.001),硝酸甘油诱发的肱动脉内径百分变化率(23.1%±4.6%)与静脉输注前(22.3%±4.2%,P=0.29)差别无统计学意义。结论维生素C静脉输注可以恢复原发性高血压病患者肱动脉内皮功能。     

静脉注射L-NAME对肉鸡肺动脉压的影响

目的：观察静脉注射一氧化氮合酶抑制剂L-NAME对肉鸡肺动脉压的影响。方法：AA肉鸡40羽随机等分为A、B、C、D组,按常规条件饲养至44 d龄进行实验。A组为对照组,B、C、D组分别为静脉注射一氧化氮合酶抑制剂L-NAME 1、2、4 h的3个实验组。应用右心导管技术逐羽测定肺动脉压,并采集血样作一氧化氮 （nitric oxide,NO）和内皮素（endothelin-1,ET-1）水平测定。结果：与A组相比,静注L-NAME 1-2 h后肉鸡血浆NO含量低于A组（P<0.05）,肺动脉压高于A组 （P<0.05）,血浆ET-1未见明显差异;静注4 h后血浆NO含量、肺动脉压与A组水平无明显差异但血浆ET-1水平明显高于A、B、C组（P<0.05）。结论：L-NAME可能通过抑制NO的合成从而促进了肉鸡肺动脉高压的形成。     

Effect of corticosteroids on phlebitis induced by intravenous infusion of antineoplastic agents in rabbits

Purpose: Phlebitis caused by intravenous infusion of antineoplastic agents is one of the critical problems when anticancer therapy is prolonged. We have already reported that both rapid infusion and dilution of the injection solution were effective methods for reducing phlebitis caused by vinorelbine (VNR) in rabbits. The aim of this study was to explore other practical methods for preventing phlebitis caused by VNR and doxorubicin (DXR) in a rabbit model. VNR is often used with cisplatin, and dexamethasone (DEX) has been co-administered for prevention of cisplatin-induced nausea. DXR is used with prednisolone (PSL) in the CHOP regimen for the treatment of non-Hodgkin''s lymphoma. Therefore, the present study investigated the prevention of phlebitis due to VNR with DEX and that due to DXR with PSL.Methods: VNR and DXR were diluted with normal saline to prepare test solutions at concentrations of 0.6 mg/mL and 1.4 mg/mL, respectively. Each test solution was infused into the auricular veins of rabbits. Two days after VNR infusion and three days after DXR infusion, the veins were evaluated histopathologically. The effect of DEX on VNR-induced phlebitis was evaluated by infusion of DEX before or after VNR. The effect of PSL on DXR-induced phlebitis was similarly evaluated by co-infusion of PSL.Results: The histopathological features of phlebitis caused by the antineoplastic agents differed between VNR and DXR: VNR did not cause the loss of venous endothelial cells, but caused inflammatory cell infiltration, edema, and epidermal degeneration. In contrast, DXR caused the loss of venous endothelial cells and chrondrocyte necrosis. Pre-treatment and post-treatment with DEX significantly decreased VNR-induced phlebitis compared with the control group and pre-treatment was particularly effective. Co-infusion of PSL also significantly decreased phlebitis caused by DXR, but its effect was less marked.Conclusion: The present findings suggested that pre-treatment with DEX may be a useful method for preventing phlebitis due to VNR, and that co-infusion of PSL has the potential to prevent phlebitis caused by DXR.     

Effect of intravenous infusion of hypertonic glucose solutions on pancreatic HCO3 secretion

To examine why intravenous infusion of hypertonic non-electrolyte solutions inhibit pancreatic HCO₃^- secretion, the relationship between pancreatic HCO₃^- secretion and plasma pH was examined before and following intravenous infusion of hypertonic glucose to 5 anesthetized, secretin infused (2.7 C.U./kg b. wt. h^-1) pigs. Hyperglycemia (plasma glucose 103±6 mmol/l) did not significantly change plasma pH, NaM⁺, K⁺, Cl^- and HCO₃^- concentrations. Hyperglycemia reduced pancreatic water flux by 48±5% and raised pancreatic juice HCO₃^- concentration by 43±4 mmol/l. Concurrently, HCO₃^- secretion fell by 34±5%. Acidosis, produced through intravenous HC1 infusion and CO₂ addition to inspired air, reduced HCO₃^- secretion by 40±6 ±mol/min and 30±5 ±mol/min per 0.1 pH unit reduction in plasma pH before and during hyperglycemia, respectively, and abolished HCO₃ secretion at an estimated plasma pH of 6.51 ±0.06 before and a pH of 6.63±0.05 during hyperglycemia. We conclude that hypertonic glucose infusions inhibit pancreatic water flux and cause an increase in pancreatic juice HCO₃^- concentration which may inhibit HCO₃^- secretion through an effect on acid-base balance in secretory cells.     

Potential therapeutic application of intravenous autologous bone marrow infusion in patients with alcoholic liver cirrhosis

The present study was conducted to evaluate the application and efficacy of autologous bone marrow infusion (ABMi) for improvement of liver function in patients with alcoholic liver cirrhosis (ALC). Five subjects and 5 control patients with ALC who had abstained from alcohol intake for 24 weeks before the study were enrolled. Autologous bone marrow cells were washed and injected intravenously, and the changes in serum liver function parameters, and the level of the type IV collagen 7S domain as a marker of fibrosis, were monitored for 24 weeks. The distribution of activated bone marrow was assessed by indium-111-chloride bone marrow scintigraphy. The number of cells infused was 8.0±7.3×10(9) (mean±standard error). The serum levels of albumin and total protein and the prothrombin time were significantly higher during the follow-up period after ABMi than during the observation period in treated patients, whereas no such changes were observed in the controls. In the patients who received ABMi, the Child-Pugh score decreased in all 3 who were classified as class B; the serum levels of type IV collagen 7S domain improved in 4 of the 5 patients; and bone marrow scintigraphy demonstrated an increase of indium-111-chloride uptake in 3 of the 4 patients tested. ABMi for patients with ALC helps improve liver function parameters in comparison with observation during abstinence and ameliorates the degree of fibrosis in terms of serum markers and bone marrow activation in most cases.     

Effect of continuous intravenous infusion of zidovudine (AZT) in children with symptomatic HIV infection

To produce concentrations of zidovudine (AZT) in plasma and cerebrospinal fluid that would provide constant inhibition of the replication of human immunodeficiency virus (HIV), we gave AZT by continuous intravenous infusion to 21 children ranging in age from 14 months to 12 years who had acquired HIV infection through transfusions or perinatally. All patients were symptomatic before AZT treatment (Class P2 of the Centers for Disease Control); 13 (62 percent) had evidence of neurodevelopmental abnormalities. The mean CD4/CD8 ratio was 0.18; 11 patients had CD4 counts below 0.2 x 10(9) per liter. We administered AZT at four dose levels: 0.5, 0.9, 1.4, and 1.8 mg per kilogram of body weight per hour. The plasma drug concentrations achieved at the respective dose levels were 1.9 +/- 0.3, 2.8 +/- 1.4, 3.1 +/- 1.1, and 4.5 +/- 1.0 microM. The steady-state cerebrospinal fluid:plasma ratio was 0.24 +/- 0.07. The only evidence of toxicity was bone marrow suppression. Transfusion was required in 14 patients because of low levels of hemoglobin (5 mmol per liter [less than 8 g per deciliter]). Dose-limiting neutropenia (less than 0.5 x 10(9) polymorphonuclear leukocytes per cubic millimeter) occurred in most patients who received doses of 1.4 mg per kilogram per hour or more. Improvement in neurodevelopmental abnormalities occurred in all 13 children who had presented with encephalopathy before treatment. Serial measurements of IQ before therapy and after three and six months of continuous therapy with AZT showed that IQ scores, including those for verbal and performance IQ, rose in these 13 patients and in 5 other children who had no detectable evidence of encephalopathy before treatment. Most patients also had increased appetite and weight, decreased lymphadenopathy and hepatosplenomegaly, decreased immunoglobulin levels, and increased numbers of CD4 cells. In some patients the improvement in the features of encephalopathy occurred despite the absence of immunologic improvement. We conclude that AZT is beneficial in children with symptomatic HIV infection, especially those with encephalopathy (which may be subclinical), and that the optimal continuous intravenous dose of AZT in children is between 0.9 and 1.4 mg per kilogram per hour.     

Effect of intravenous infusion of growth hormone-releasing hormone on the morphology of rat pituitary somatotrophs

The effect of GRH infusion on rat adenohypophysial morphology was studied by light microscopy, immunocytochemistry, in situ hybridization, and electron microscopy. Synthetic rat GRH was intravenously administered by osmotic minipumps at 14.4, 72, 360 and 720 μg/ day/rat for 1 week. In one group treated for 1 week with a daily dose of 720 μg GRH, the rats were killed 7 days after withdrawal of GRH. Control rats in which GRH was replaced by excipient, or those that received no treatment, were included as well. GRH infusion with daily doses of 360 and 720 μg resulted in a significant increase in pituitary weight and weaker GH immunoreactivity compared with other groups. Ultrastructurally, the somatotrophs were increased in size and became sparsely granulated, and the organelles involved in hormone sythesis were very prominent. The intensity of the GH mRNA signal did not differ from control animals, suggesting the desensitization of somatotrophs to GRH. The highest GRH dose induced an increased number of nuclei immunoreactive for proliferation cell nuclear antigen (PCNA). One week after GRH withdrawal, shrinkage of cytoplasm, involution of RER and Golgi complex, and a decrease of cell attachment sites indicated the reversibility of changes induced by GRH. In conclusion, GRH infusion induced, within days, hypertrophy and proliferation of somatotrophs with ultrastructural features of highly stimulated, sparsely granulated cells. Morphological changes were reversible.Endocr Pathol 4:131–139, 1993.     

Effect of intravenous infusion of Polyosm on diuresis and parameters of systemic and cerebral hemodynamics

The effect of 30-min infusion of Polyosm (a polyethylene oxide 400 solution) is studied on anesthetized cats. The preparation stimulates diuresis and has no effect on arterial and venous pressure and cardiac and stroke indices. By the 30th min of infusion, the total peripheral and cerebral vascular resistance significantly decrease, while cerebral blood flow increases. Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 123, No. 3, pp. 299–301, March, 1997     

The complications of intravenous Corynebacterium parvum infusion.

100 intravenous infusions of Corynebacterium parvum were given to thirty-six patients at a dose of 5 mg/m2. Fever and rigors occurred in all patients but these acute side effects were acceptable to all but two patients. Seventeen patients suffered a delayed fall in blood pressure, which was marked in eight of them but was generally well tolerated. One patient died 18 hr after infusion from extensive myocardial infarction. Herpes labialis complicated the first infusion in nine instances, which may reflect transient immunosuppression following immunotherapy.     

小儿静脉输液常见问题原因及预防对策

目的：探讨小儿静脉输液常见问题的原因,针对其中存在的问题,采取有效的预防措施,从而提高静脉输液的成功率。方法：对2011年1～3月我院收治的617例患儿在小儿静脉输液时所遇到的问题进行回顾性分析,结合临床实践经验,总结出小儿静脉输液常见问题的原因及几点护理对策。结果：在617例患儿中,穿刺失败（包括穿刺两针及以上）67例（10.85%）,输液渗漏34例（5.51%）,针头堵塞27例（4.38%）,针头脱出46例（7.46%）,输液速度过快致不良反应9例（1.46%）,静脉炎2例（0.32%）。结论：掌握小儿静脉输液失败的原因并提出预防对策,可以保证患儿用药安全,提高患儿和家长的满意度。