地佐辛复合丙泊酚用于宫腔镜诊刮手术的临床观察

目的:观察地佐辛复合丙泊酚用于宫腔镜诊刮手术的临床效果.方法:90例患者随机均分为P组、PR组和PD组.P组静注丙泊酚2mg/kg;PR组静注瑞芬太尼0.5μg/kg,1min后静注丙泊酚2mg/kg;PD组静注地佐辛0.1mg/kg,15min后静注丙泊酚2mg/kg.观察三组不同时间点MAP、HR和SpO2的变化,观察三组麻醉起效时间、苏醒时间、手术完成时间、丙泊酚总用量、苏醒后5min疼痛程度(VAS评分)以及不良反应.结果:三组麻醉后MAP有不同程度下降(P<0.05或P<0.01);三组HR麻醉后有不同程度下降(P<0.05或P<0.01),PR组和PD组低于P组(P<0.05或P<0.01),P组在扩宫颈时明显上升(P<0.05),高于其他两组(P<0.05或P<0.01);麻醉后PR组SpO2明显下降(P<0.05);三组麻醉起效时间、手术时间、苏醒时间无明显差异.结论:地佐辛联合丙泊酚用于宫腔镜诊刮手术,麻醉平稳,不良反应少,麻醉效果满意.     

地佐辛复合利多卡因用于预防丙泊酚注射痛的临床观察

目的观察预先注射地佐辛复合利多卡因预防丙泊酚注射痛的价值。方法择期无痛人流患者400例,按随机序列数字法分为4组,对比4组注射前后患者的疼痛指标变化情况。结果 L、D、DL组的丙泊酚注射痛发生率显著低于C组(P<0.01),DL组的丙泊酚注射痛发生率显著低于L、D组(P<0.05)。结论预先注射地佐辛复合利多卡因能有效地抑制或减轻丙泊酚注射痛,减少不良反应,其效果优于预先注射地佐辛或利多卡因。     

舒芬太尼与地佐辛用于无痛人工流产麻醉的对比观察

目的 探讨舒芬太尼与地佐辛用于无痛人工流产麻醉的临床效果.方法 80例早期妊振要求行无痛人工流产的孕妇随机分为舒芬太尼+丙泊酚组和地佐辛+丙泊酚组各40例.记录麻醉前即刻、术中、苏醒后的MAP、HR、RR、SpO2;观察术中麻醉效果、呼吸抑制情况;观察术后清醒时间、VAS评分及不良反应等情况.结果 2组患者麻醉前MAP、HR、RR及SpO2比较差异均无统计学意义(P>0.05).舒芬太尼+丙泊酚组术中各观察指标均低于麻醉前,且RR和SpO2低于地佐辛+丙泊酚组,苏醒后MAP、HR及SpO2低于麻醉前(P<0.05).地佐辛+丙泊酚组术中RR及SpO2均低于麻醉前(P<0.05),苏醒后各观察指标与麻醉前比较差异无统计学意义(P>0.05).舒芬太尼+丙泊酚组和地佐辛+丙泊酚组麻醉镇痛总有效率比较差异无统计学意义(P>0.05).2组术后VAS评分、呼吸抑制、恶心呕吐及头晕发生率比较差异亦无统计学意义(P>0.05),但地佐辛+丙泊酚组术后清醒时间明显短于舒芬太尼+丙泊酚组(P<0.05).结论 舒芬太尼与地佐辛复合丙泊酚用于无痛人工流产镇痛效果相似,但地佐辛术后清醒较快,用于无痛人工流产效果满意..     

地佐辛复合丙泊酚用于人工流产手术麻醉的效果观察

目的 观察地佐辛复合丙泊酚静脉麻醉行无痛人工流产手术的麻醉效果.方法 拟行人工流产术患者60例,ASA Ⅰ～Ⅱ级.按随机数字表法分为两组:地佐辛复合丙泊酚组(A组),丙泊酚组(B组).记录麻醉前(T1)、术中扩宫颈时(T2)、术后苏醒时(T3)生理参数变化及不良反应发生率,记录患者丙泊酚用量及术后宫缩痛的情况.结果 T2时两组平均动脉压(MAP)、心率(HR)均低于T1时(P＜0.05).丙泊酚的用量A组显著少于B组[(2.5±0.4)mg/kg与(4.6±0.7)mg/kg,P＜0.05],呼吸抑制发生率显著低于B组(20％与30％,P＜0.05),A组术后宫缩痛好于B组(P＜0.05).结论 地佐辛复合丙泊酚静脉麻醉是一种安全、可控、有效的人工流产手术麻醉方法.     

不同剂量地佐辛抑制舒芬太尼呛咳反应的临床观察

目的 观察不同剂量地佐辛对全麻诱导期舒芬太尼诱发呛咳反应的影响.方法 择期选择全麻手术患者60例,ASA Ⅰ或Ⅱ级,随机分为3组(n=20),分别于麻醉诱导前静注地佐辛0.05mg/kg (D1组)、0.1mg/kg (D2组)、0.15mg/kg(D3组),10min后3组患者均在3s内快速静注舒芬太尼0.4μg/kg,1min后行麻醉诱导.记录舒芬太尼注射后1min内发生呛咳反应的例数和强度.记录地佐辛静注前(T0)、地佐辛静注后10min (T1)、舒芬太尼静注后1min(T2)时的心率(HR)、平均动脉压(MAP)、脉搏氧饱和度(SpO2)和镇静评分(OAA/S).结果 3组患者舒芬太尼静注后1min内均未发生呛咳反应.与T0时比较,T1、T2时D3组HR、MAP、Sp02及OAA/S评分均降低(P＜0.05);与D1、D2组比较,D3组T1、T2时MAP、SpO2及OAA/S评分降低,T2时HR降低,差异有统计学意义(P＜0.05).结论 全麻诱导前静脉注射地佐辛0.05mg/kg、0.1 mg/kg、0.15mg/kg均可有效抑制舒芬太尼诱发的呛咳反应,以0.05mg/kg、0.1mg/kg应用较为安全.     

喷他佐辛复合异丙酚在无痛人工流产手术的临床观察

目的：比较异丙酚与喷他佐辛复合异丙酚用于人工流产手术的麻醉效果。方法宫内妊娠初孕妇女160例,随机分为异丙酚组和喷他佐辛+异丙酚组,每组80例。两组均以异丙酚2mg/kg静注作麻醉诱导,复合组在常规消毒铺巾前给予喷他佐辛0.5mg/kg加生理盐水稀释至5ml静注。观察两组的HR、MAP、SpO2、意识消失时间、清醒时间、异丙酚用药量及术后宫缩痛的程度。结果两组之间MAP、HR、SpO2比较差异无统计学意义(P>0.05)。两组意识消失时间比较无显著差异(P>0.05);复合组清醒时间明显短于单纯组,异丙酚用量明显少于单纯组,比较有显著统计学意义(P<0.05)。而且复合组较单纯组术后宫缩痛明显减轻(P<0.05)。结论喷他佐辛复合异丙酚静脉麻醉应用于人工流产手术,麻醉效果满意,术后宫缩痛程度减轻,而且减少了异丙酚的用量,是一种安全可靠的选择。     

地佐辛在急诊饱胃患者全麻诱导中的应用效果观察

目的观察地佐辛在急诊饱胃患者全麻诱导中的应用效果。方法选择2017年1月-2018年12月南昌大学第四附属医院普外科饱胃患者需急诊行剖腹探查术患者60例,按照随机数字表法分为地佐辛组和生理盐水组各30例。2组均采用全麻气管插管,快速诱导:地佐辛组予咪达唑仑0.1 mg/kg、地佐辛0.1 mg/kg(2 ml)、芬太尼2μg/kg、注射用苯磺顺阿曲库铵0.1 mg/kg、丙泊酚2 mg/kg;生理盐水组予咪达唑仑0.1 mg/kg、生理盐水2 ml、芬太尼2μg/kg、注射用苯磺顺阿曲库铵0.1 mg/kg、丙泊酚2 mg/kg。比较2组患者麻醉诱导前(T0)、注药后1 min(T1)、2 min(T2)、5 min(T3)平均动脉压(MAP)、心率(HR)、血氧饱和度(Sp O2)及呛咳发生情况。结果2组患者T0、T1、T2、T3时点MAP、HR和Sp O2比较差异均无统计学意义(P>0.05);地佐辛组患者呛咳发生率低于生理盐水组(P<0.05),呛咳控制良好率高于生理盐水组(P<0.05)。结论地佐辛可显著减少饱胃患者麻醉诱导时呛咳反射,减少呕吐反流误吸的风险,保证麻醉诱导平稳。     

静脉注射利多卡因对丙泊酚全麻诱导浓度的影响

目的观察丙泊酚靶控输注(TCI)诱导时,静脉注射不同剂量利多卡因对丙泊酚TCI诱导浓度和气管内插管血流动力学的影响,探讨其全麻诱导期应用的最适剂量。方法选择80例拟在全麻下行甲状腺择期手术的患者,随机分为4组,每组20例。对照组静脉推注生理盐水3 m L(A组),实验组分别静脉推注利多卡因0.5 mg/kg(B组)、1 mg/kg(C组)、1.5 mg/kg(D组),1 min后开始丙泊酚TCI诱导,每30 s观察意识反应,初始血浆浓度设定为4μg/m L,5 min后意识仍未消失的每分钟增加0.5μg/m L,直至意识消失。之后给予舒芬太尼0.4μg/kg、罗库溴铵0.6 mg/kg,面罩辅助通气2 min后,完成气管插管。记录患者静脉注射利多卡因前(T0)、丙泊酚TCI开始(T1)、意识消失时(T2)、插管前(T3)、插管后(T4)各时点的心率(HR)、平均动脉压(MAP),效应室浓度(Ce)、脑电双频指数(BIS)值。询问患者丙泊酚TCI诱导开始后是否有注射痛。结果 T2时,B、C、D组的效应室浓度低于A组,而B、C、D组间差异无统计学意义。T2时,各组MAP、HR比较差异无统计学意义(P>0.05);B、C、D组气管插管前后MAP变化明显小于A组(P<0.05);T4时,C、D组HR明显低于A组(P<0.05)。静脉注射利多卡因1 min后,B、C、D组BIS值下降(P<0.05);T2时,各组BIS值比较差异无统计学意义(P>0.05);插管前后,B、C、D组的BIS值变化小于A组(P<0.05)。与A组比较,C、D组注射痛的发生率降低(P<0.05),C、D组间比较差异无统计学意义(P>0.05)。结论全麻诱导前静脉注射利多卡因有明显镇静作用,可显著降低丙泊酚诱导浓度,减轻气管插管的应激反应和丙泊酚的注射痛。诱导期静脉应用利多卡因的最适剂量为1 mg/kg。     

舒芬太尼与地佐辛用于无痛人工流产麻醉的对比观察

目的探讨舒芬太尼与地佐辛用于无痛人工流产麻醉的临床效果。方法 80例早期妊振要求行无痛人工流产的孕妇随机分为舒芬太尼+丙泊酚组和地佐辛+丙泊酚组各40例。记录麻醉前即刻、术中、苏醒后的MAP、HR、RR、SpO2;观察术中麻醉效果、呼吸抑制情况;观察术后清醒时间、VAS评分及不良反应等情况。结果 2组患者麻醉前MAP、HR、RR及SpO2比较差异均无统计学意义(P>0.05)。舒芬太尼+丙泊酚组术中各观察指标均低于麻醉前,且RR和SpO2低于地佐辛+丙泊酚组,苏醒后MAP、HR及SpO2低于麻醉前(P<0.05)。地佐辛+丙泊酚组术中RR及SpO2均低于麻醉前(P<0.05),苏醒后各观察指标与麻醉前比较差异无统计学意义(P>0.05)。舒芬太尼+丙泊酚组和地佐辛+丙泊酚组麻醉镇痛总有效率比较差异无统计学意义(P>0.05)。2组术后VAS评分、呼吸抑制、恶心呕吐及头晕发生率比较差异亦无统计学意义(P>0.05),但地佐辛+丙泊酚组术后清醒时间明显短于舒芬太尼+丙泊酚组(P<0.05)。结论 舒芬太尼与地佐辛复合丙泊酚用于无痛人工流产镇痛效果相似,但地佐辛术后清醒较快,用于无痛人工流产效果满意。。     

预先注射地佐辛联合地塞米松在宫腔镜手术中的应用及对患者术后的镇痛效果

目的探讨预先注射地佐辛联合地塞米松在宫腔镜手术中的应用效果及其对患者术后的镇痛效果。方法选取2014年1月至2017年12月我院收治的245例拟行无痛宫腔镜手术治疗的患者,随机分为研究组(122例)和对照组(123例)。两组均采用静脉注射丙泊酚进行麻醉,研究组术前15 min注射地佐辛+地塞米松,对照组静脉注射等量的生理盐水。记录两组患者麻醉效果、VAS/Ramsay评分、HR和MAP的变化,统计两组不良反应发生情况。结果与对照组比较,研究组丙泊酚用量、输液量减少(P<0.01),睁眼时间及定向力恢复时间缩短(P<0.01)。从术前20 min至术后30 min的4个时间点,患者HR、MAP比较差异均无统计学意义(P>0.05),且各时间点两组比较差异亦无统计学意义(P>0.05)。术后8、12、24 h,研究组患者VAS评分低于对照组,且增加镇痛药物使用的患者少于对照组(P<0.01)。术后12 h,研究组Ramsay评分为1分的患者比例低于对照组(P<0.01),2～4分患者比例高于对照组(P<0.01)。研究组不良反应总发生率低于对照组(P<0.01)。结论宫腔镜手术中预先注射地佐辛联合地塞米松具有较好的术后镇痛、镇静效果,降低了丙泊酚的用量,减少了不良反应的发生,麻醉效果显著。     

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.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

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.