低浓度罗哌卡因复合舒芬太尼用于上肢手术后镇痛的效果

目的:观察低浓度罗哌卡因复合舒芬太尼用于上肢手术后的镇痛效果。方法:上肢骨折切开复位术后60例患者随机分为低浓度(0.125%)罗哌卡因复合舒芬太尼留置针自控镇痛(试验组,n=29)与舒芬太尼静脉自控镇痛(对照组,n=31),分别于术后4,8,12,24 h观察VAS疼痛评分和VAS满意度评分,24 h按键次数和24 h药液消耗量以及不良反应。结果:试验组VAS疼痛评分显著低于对照组,VAS满意度评分显著高于对照组,按键次数、24 h消耗量和不良反应发生率均显著低于对照组(P<0.05)。结论:低浓度罗哌卡因用于上肢术后镇痛安全有效。     

罗哌卡因与利多卡因切口逐层浸润麻醉用于脊柱手术后镇痛效果比较

目的 比较罗哌卡因与利多卡因在脊柱手术后局部浸润麻醉的镇痛效果。方法 择期脊柱手术患者40例,按随机数字表法分为罗哌卡因组和利多卡因组各20例。罗哌卡因组手术结束缝皮前,于切口两侧逐层应用0.5%罗哌卡因40ml浸润麻醉,利多卡因组手术结束缝皮前,同法、同量应用利多卡因浸润麻醉。两组术后用静脉自控镇痛泵镇痛。观察两组术后不同时间的静息与活动疼痛视觉模拟评分(VAS),术后各时段自控镇痛(PCA)药液使用量及不良反应。结果 罗哌卡因组术后6、12小时的静息VAS评分,术后4、6、12小时的活动VAS评分均低于利多卡因组,术后4~6、7~1 2小时的P C A药液使用量少于利多卡因组,差异均有统计学意义。两组术后镇痛不良反应发生率相同。结论 罗哌卡因切口浸润用于脊柱手术后镇痛在术后4~12小时的效果优于利多卡因,4小时以内和12小时以上的镇痛效果并无明显优势。     

罗哌卡因局部浸润联合多瑞吉贴膜对腹腔镜胆囊切除术后的镇痛效果及安全性评价

目的探讨联合应用罗哌卡因局部浸润和多瑞吉贴膜对腹腔镜胆囊切除术后的镇痛效果及其安全性。方法纳入81例在我院行腹腔镜胆囊切除术的患者,随机分为3组,每组27例。A组(多瑞吉组)入手术室时,胸前贴多瑞吉透皮贴剂;B组(罗哌卡因组)缝合切口前以0.5%罗哌卡因喷洒胆囊床,再以0.5%罗哌卡因局部浸润每个切口;C组(联合组),胸前贴多瑞吉透皮贴剂,罗哌卡因用法同B组。术中采用瑞芬太尼和丙泊酚静脉维持麻醉,常规监测心率、血压和脉搏氧饱和度。术后进行VAS评分,观察不良反应的发生情况。结果术后4 h,B、C组的VAS评分显著低于A组(P<0.01),疼痛明显缓解。术后4～48 h,A、C组的VAS评分显著低于B组(P<0.01),镇痛效果显著。C组在各个监测点的VAS评分均最低,镇痛效果最为显著。三组患者均无严重的不良反应发生。结论罗哌卡因局部浸润联合多瑞吉贴膜对腹腔镜胆囊切除术后镇痛效果显著,安全可靠,值得临床推广应用。     

罗哌卡因复合地塞米松切口浸润麻醉对胸腔镜手术术后疼痛的影响

目的:探讨罗哌卡因复合地塞米松切口浸润对胸腔镜手术术后疼痛的影响。方法:选取我院2017年6月-2018年11月的80例行胸腔镜手术患者进行研究,随机分为对照组和研究组,对照组实施罗哌卡因切口浸润麻醉,研究组实施罗哌卡因复合地塞米松切口浸润麻醉,比较两组患者术后的静息、活动时疼痛VAS评分。结果:研究组术后2小时、术后12小时、24的静息、活动时疼痛VAS评分与对照组相比具有明显的差异,且明显优于对照组(p0.05)。结论:罗哌卡因复合地塞米松切口浸润麻醉可有效缓解胸腔镜手术患者的术后疼痛,值得进行临床推广。     

罗哌卡因切口浸润麻醉对腹腔镜术后镇痛的疗效观察

目的观察罗哌卡因切口浸润麻醉对腹腔镜术后患者镇痛的疗效。方法收集采用腹腔镜手术方法治疗各种疾患且采用全身麻醉方法麻醉的患者75例,随机分为观察组40例,对照组35例;其中观察组在行全身麻醉方法基础上给予0.5%罗哌卡因切口浸润麻醉,对照组只行全身麻醉不给予其他麻醉药物或手段。观察两组患者术后3,6,12,24h疼痛评分(VAS),以及患者血压和心率变化。结果两组患者在术后3,6h两时间点VAS评分比较无显著性差异P>0.05;在术后12,24h两时间点VAS评分比较有显著性差异P<0.05。两组患者在不同时间点的血压和心率变化无显著性差异P>0.05。结论罗哌卡因切口浸润麻醉对腹腔镜术后患者镇痛的疗效明确,值得推广应用。     

探讨罗哌卡因联合奥布卡因对40例全麻鼻内镜术中的麻醉控制效果及术中应激反应

目的:探讨罗哌卡因联合奥布卡因对全麻鼻内镜术中的麻醉控制效果及术中应激反应的影响.方法:选择80例行鼻内镜术治疗患者随机为观察组和对照组各40例.对照组局部使用肾上腺素加用利多卡因局部浸润联合丁卡因表面麻醉,观察组局部使用肾上腺素加用罗哌卡因局部浸润联合奥布卡因表面麻醉;比较术后苏醒时间以及不同时刻的视觉疼痛模拟评分(VAS)及术中应激反应;检测术前及术中的血糖和去甲肾上腺素水平.结果:观察组术后苏醒时间显著短于对照组;苏醒即刻时两组VAS评分差异不显著,其余各时刻观察组VAS评分均显著低于对照组;两组术中血糖水平均较术前显著上升但观察组术中血糖显著低于对照组,对照组术中去甲肾上腺素水平显著上升且显著高于观察组(P<0.05).结论:观察组的麻醉方法有助于增加麻醉可控性和安全性,减轻患者术中应激反应及术后疼痛.     

股骨近端防旋髓内钉与股骨近端锁定钢板治疗股骨转子间骨折疗效比较

目的探讨股骨近端防旋髓内钉与股骨近端锁定钢板治疗股骨转子间骨折的疗效。方法选择2016年1月~2017年6月本院收治的股骨转子间骨折患者100例,按照随机数字表法分为两组,各50例,对照组行股骨近端锁定钢板治疗,观察组行股骨近端防旋髓内钉治疗,对所有入组者进行3个月随访,比较术后3个月,患者10米步行速度、5次坐立运动耗时,手术前后Harris髋关节功能评分,比较两组总住院时间、拄拐行走时间和弃拐行走时间。结果术后3个月,观察组10米步行速度大于对照组(P<0.05),5次坐立运动耗时短于对照组(P<0.05),观察组术后3个月Harris髋关节运动评分显著高于对照组(P<0.05),观察组总住院时间短于对照组(P<0.05),拄拐行走时间快于对照组(P<0.05),弃拐行走时间快于对照组(P<0.05)。结论针对股骨转子间骨折行股骨近端防旋髓内钉治疗,其术后髋关节功能恢复快,住院时间短,更利于患者术后康复。     

舒芬太尼联合罗哌卡因对剖宫产患者术后镇痛的影响

目的探讨剖宫产患者应用舒芬太尼联合罗哌卡因对术后镇痛的影响,以丰富临床麻醉经验。方法选取2014年3月至2015年10月在我院收治的剖宫产患者70例,根据入院治疗顺序分成对照组与观察组,每组35例。对照组给予罗哌卡因联合吗啡镇痛,观察组则使用舒芬太尼联合罗哌卡因予以镇痛。经镇痛后,统计两组的镇痛效果、VAS评分情况以及不良反应发生情况等,并进行对比。结果经镇痛后,观察组的镇痛效果显著优于对照组,差异显著(P<0.05);观察组的术后24 h以及术后48 h的VAS评分均显著低于对照组,差异显著(P<0.05);观察组的不良反应发生率显著低于对照组,差异显著(P<0.05)。结论剖宫产患者应用舒芬太尼联合罗哌卡因镇痛具有较好的镇痛疗效,使VAS评分显著降低,且更加的安全,值得推广。     

股骨近端防旋髓内钉在老年股骨粗隆骨折患者中的运用分析

目的分析比较股骨近端防旋髓内钉与股骨近端解剖型钢板在老年股骨粗隆骨折患者中的运用效果。方法选取2010年8月至2013年2月入住我科老年股骨粗隆骨折患者83例为研究对象,根据当时手术方式的不同,分为试验组(n=42例)和对照组(n=41例),试验组给予股骨近端防旋髓内钉微创治疗,对照组采用股骨近端解剖型钢板给予髓外固定,术后比较两组患者骨折愈合时间及下地负重时间、并发症发生情况及髋关节Harris评分情况,并作分析讨论。结果试验组骨折愈合时间为(9.3±1.5)周,明显低于对照组的(15.73±1.3)周,下地负重时间(3.5±0.6)d,明显短于对照组的(9.2±5.9)d,差异有统计学意义(P<0.05);试验组仅出现3例感染,无其他并发症出现,并发症发生率为7.14%(3/42),明显低于对照组的31.71%(13/41),差异具有统计学意义(P<0.05);试验组Harris评分优良率为92.86%(39/42),对照组Harris评分优良率为78.05%(32/41),差异有统计学意义(P<0.05)。结论老年股骨粗隆骨折患者采用股骨近端防旋髓内钉微创治疗,操作简单,愈合快速,效果明显,同时也降低了并发症发生率,优于股骨近端解剖型钢板髓外固定。     

罗哌卡因用于妇科腹腔镜手术后肩痛的临床分析

目的分析罗哌卡因在妇科腹腔镜术后肩痛中的应用。方法选取100例行妇科腹腔镜手术患者,随机分为对照组(50例)与观察组(50例)。对照组不给予其他处理,观察组给予罗哌卡因,对比两组镇痛情况。结果观察组肩部疼痛发生率为20.00%,对照组为38.00%,观察组明显低于对照组(P<0.05)。观察组术后4 h、8 h、12 h VAS评分低于对照组(P<0.05)。结论对行妇科腹腔镜手术患者,腹腔内给予罗哌卡因表面麻醉,能减少术后肩痛发生,缓解疼痛程度。     

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.

     

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.     

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.     

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.