乌头中毒的诊断与救治

乌头是毛莨科植物乌头的块根。野生品称为草乌，栽培品称川乌；川乌的块根主根名为乌头，旁生块根（子根）称附子，独根称天雄，均含有毒成分乌头碱等。     

抢救乌头碱中毒45例临床报告

抢救乌头碱中毒４５例临床报告闫卫民（广西灵川县人民医院灵川县５４１２００）关键词乌头碱；中毒；预后乌头碱毒性剧烈，其结晶体２～４ｍｇ即可致人死亡。它是临床常用的中草药川乌、草乌、附子等的重要成份，其毒性常为患者忽视。用药过量和用药过量中毒在临床上时有...     

乌头及其制剂中乌头生物碱的测定方法进展

乌头及附子为常用中药，有止痛、强心、利尿、促进代谢等作用。药用乌头有草乌和川乌两种，草乌为毛莫科植物北乌头的干燥块根，川乌为植物乌头的干燥块根。附子为植物乌头的干燥侧根。乌头及附子的主要有效成分是生物碱，其中的乌头碱、中乌头碱及次马头碱为剧毒性双酯类生物碱。故临床上一般不用生乌头及附子，而是经过加工炮制使生药减毒后提供药用，但不同的植物品种，不同产地或是不同方法加工的炮制品中乌头生物碱的含量及组成变化很大，故药材炮制后，应采用适当的分析方法定量测定其中的总生物碱和双酯型毒性生物碱，以便控制药物质…     

应用大鼠体外胚胎培养模型研究生草乌对胚胎发育的影响

目的探讨生草乌对胚胎发育的毒性作用及机制。方法应用大鼠着床后体外全胚胎培养模型,将9.5dSD大鼠胚胎与含不同浓度(终浓度分别为:0、0.63、1.25、2.5、5mg生药/mL)生草乌的大鼠即刻离心血清共培养48h,观察其对大鼠胚胎生长发育和组织器官形态分化的影响。结果随着生草乌剂量增加,胚胎生长发育和器官分化的各项指标均呈现下降趋势,有一定的剂量-效应关系。生草乌最大无作用剂量为1.25mg生药/mL,2.5mg生药/mL以上剂量可诱发卵黄囊生长和血管分化不良、生长迟缓及形态分化异常,严重者出现体节紊乱、小头、心脏发育迟滞(心小,停留在心管期)及心脏空泡等。结论较高剂量生草乌对体外培养大鼠胚胎具有一定的毒性作用,建议孕妇妊娠期间(特别是妊娠前3个月)慎用或禁用草乌。     

乌头炮制品煎煮前后生物碱含量变化的初步研究

采用薄层扫描法（ＴＬＣＳ）测定乌头炮制品（制川乌、创草乌）煎煮前后乌头生物碱含量变化及其在复方的煎煮液中含量，结果表明制川乌和制草乌在常规水煎煮２．５ｈ后，乌头生物碱量降低２～５倍和１．５～４倍。复方水煎液中乌头生物碱（乌头碱、中乌头碱、次乌头碱）含量为０．００５３％～０．０３９７％。     

急性乌头碱中毒的抢救及护理

乌头类植物其有毒成分为乌头碱，毒性极强，易溶于乙醇及醚等有机溶剂，其生药经炮制之后分解为低毒的苯甲酰乌头碱。用于治疗风湿病、外伤及各种关节疼痛等症［１］。但服药过量或炮制不善均可中毒。现将我院１９９６年２月～２００１年１月１０例急性乌头碱中毒的抢救及护理体会总结如下。１ 临床资料１．１ 一般情况 本组１０例，男６例，女４例，年龄２４～８９岁。制草乌常用量０．０５～０．２ｇ［２］。８例用生草乌泡酒，饮用４０～１８０ｍｌ，含量约０．２～０．７ｇ；２例用生草乌泡水煎服１０ｍｉｎ，饮用 １００～１５０ｍｌ，…     

药酶诱导剂对生附子急性毒性的影响

目的：考察典型肝脏细胞色素氧化酶P450酶系（肝药酶）诱导剂苯巴比妥钠干预给药对生附子毒性的影响,评价生附子毒性表现过程中的CYP450因素。方法：（1）测定小鼠单独给予生附子水煎液后的LD50;（2）测定苯巴比妥钠干预3天后,小鼠给予生附子水煎液的LD50;（3）Wistar大鼠经苯巴比妥钠（PB）干预给药3天后,十二指肠给予生附子水煎液,以出现频发室性早搏为其心脏毒性指标,观察PB干预及未干预的大鼠给予生附子后频发室性早搏发生率、出现时间及恢复率情况。结果：（1）小鼠给予生附子水煎液的LD50值为7.15g/kg,95%可信限为6.19～8.29g/（kg·d）;（2）苯巴比妥钠诱导后,小鼠给予生附子水煎液的LD50〉12.08g/（kg·d）;（3）与单用生附子水煎液相比,苯巴比妥钠诱导后可显著减少生附子水煎液致大鼠频发室性早搏的发生率（P〈0.01）,延长出现时间（P〈0.01）,缩短持续时间（P〈0.01）。结论：肝药酶诱导剂可显著降低生附子的毒性。     

参麦注射液预防乌头碱中毒时的心律失常观察

乌头碱中毒所致心律失常是比较棘手的急危重症之一，我们采用参麦注射液预防乌头碱中毒时的心律失常，取得较好疗效。报告如下。１临床资料１．１病例　乌头碱中毒患者６８例均为我院１９８９～１９９７年住院病人，随机分为２组，对照组３６例，男２７例，女９例；年龄１８－５６岁，平均３４．５岁。１６例用川乌等泡酒饮，２０例用川乌、附子煨肉食所致。所含川乌、附子剂量９－４０ｇ不等。服药至发病时间＜１ｈ者２１例，１－２ｈ者１５例。发病至就诊＜１ｈ者１９例，＞１ｈ时者１７例。治疗组３２例，男２１例，女１１例；年龄１９～…     

附子,川乌,草乌中毒12例辨析

附子是毛茛科植物乌头的子根,川乌为干燥母根,草乌为毛茛科植物北乌头的干燥块根,均为乌头类中药。三者所含的生物碱基本相同,其毒性主要由它们共有的乌头碱类生物碱引起。自1990至1998年,我们共收治12例附子、川乌、草乌中毒的患者,现回顾整理报道如下:1　临床资料本组年龄16～65岁;男7例,女5例;附子中毒9例,川乌2例,草乌1例;服用附子均为煎剂,量为10～40g;川乌为煎剂,量为2～4g;草乌为粉剂,量为3g;发病时间在服药后0.1～2.0h,8例在1h之内,就诊多在10h之内;主要症状为口唇、四肢麻木,恶心呕吐,腹痛腹泻,头昏,胸闷心悸,主要体征为意识障碍、…     

1例乌头碱类药物中毒的急救与护理

川乌、草乌、附子及雪上一枝蒿等中草药,广泛用于腰腿痛、关节炎、风湿痛等多种疾病.其中含有主要生物碱为乌头碱,为剧毒的双酯型生物碱,具有剧烈的毒性,摄入0.2毫克就能使人中毒,3-5毫克即达致死量.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.