曲马多、酒石酸布托啡诺与盐酸右美托咪定治疗腰硬联合麻醉剖宫产患者寒战的效果比较

目的观察比较静注曲马多、布托啡诺、右美托咪定对剖宫产腰硬联合麻醉后寒战的治疗效果。方法选择ASAⅡ~Ⅲ级剖宫产腰硬联合麻醉后寒战的子痫前期患者180例,随机分为曲马多、布托啡诺、右美托咪定3组,每组60例。对于发生寒战的患者,待胎儿取出后,分别静注曲马多1.0 mg/kg、布托啡诺0.01 mg/kg或右美托咪定0.5μg/kg,观察寒战改善情况、用药后镇静程度及不良反应发生情况。结果三组治疗寒战的有效率差异无统计学意义(P>0.05)。给药后,曲马多组有9例发生恶心,4例发生呕吐;布托啡诺组有5例发生恶心,无呕吐发生。右美托咪定组有1例发生恶心,无呕吐发生。三组均无呼吸抑制。与曲马多组相比,布托啡诺组、右美托咪定组不良反应发生率均较低(P<0.05)。结论三种药物均可以有效治疗寒战,右美托咪定镇静效果更佳,且不良反应更少。     

右美托咪定复合曲马多用于老年高血压患者术后镇痛的效果

目的观察右美托咪定复合曲马多对原发性高血压老年患者术后镇痛的效果。方法选择择期气管插管静吸复合全身麻醉下行骨折内固定手术患者60例,年龄65～79岁,体重50～75 kg,高血压分级Ⅰ或Ⅱ级。采用随机数字表法,将患者随机分成3组(每组20例):Ⅰ组术毕前30 min静注曲马多50 mg,术后采用曲马多PCIA,配方为曲马多500 mg+托烷司琼5 mg+生理盐水稀释至100 mL,背景输注速率2 mL/h,PCIA0.5 mL,锁定时间15 min;Ⅱ组术毕前40 min缓慢输注右美托咪定0.4μg/kg,术后PCIA同Ⅰ组;Ⅲ组术毕前40min静滴右美托咪定0.4μg/kg,术后采用曲马多400 mg复合右美托咪定100μg行PCIA。记录术后24 h内VAS评分和曲马多用量、Ramsay镇静评分、呕吐和呼吸抑制的发生情况及三组患者的BP、HR和乌拉地尔、麻黄碱和阿托品的使用情况。于术后24 h时行患者满意度评价。结果与Ⅰ组相比,Ⅱ组和Ⅲ组术后24 h内曲马多用量和VAS评分降低,Ramsay镇静评分和满意度评价升高,呕吐发生率和乌拉地尔使用率降低(P<0.05);与Ⅱ组相比,Ⅲ组术后24 h内曲马多用量、VAS评分及乌拉地尔使用率降低,Ramsay镇静评分升高(P<0.05)。结论小剂量右美托咪定复合曲马多PCIA用于老年高血压患者术后镇痛安全、有效,还可预防术后高血压进一步恶化。     

右美托咪定联合曲马多预防瑞芬太尼麻醉后痛觉过敏的临床研究

目的：观察右美托咪定联合曲马多用于预防瑞芬太尼麻醉后痛觉过敏效果及不良反应。方法选择70例妇科择期全麻手术的患者,随机分为2组：A组：全麻插管后静脉泵注右美托咪定1μg·kg -1,10min后改为0．4μg·kg -1·h-1至手术结束前30 min停药,缝皮前静注曲马多1 mg · kg -1;B组：术中泵注等量生理盐水,缝皮前静注曲马多1．5 mg · kg -1。记录所有患者的手术时间、苏醒时间、苏醒室停留时间。于拔管后即刻及术后20,40和60 min对患者进行Ramsay镇静程度评级,并于拔管后即刻、术后30,60和90 min对患者进行疼痛（VAS）评分。结果 A 组患者术后早期镇静评分明显高于B组（P＜0．05）,2组患者术后VAS评分,差异无统计学意义（P＞0．05）,A 组患者术后恶心、呕吐、寒战的发生率低于B组（P＜0．05）。结论右美托咪定联合曲马多可有效预防瑞芬太尼麻醉后痛觉过敏,且不明显增加复苏时间,获得良好的术后镇静,两者合用可减少曲马多用量,减少术后恶心呕吐、寒战的发生。     

小剂量右美托咪定静脉泵注联合丙泊酚对宫腔镜手术的麻醉作用

目的：分析小剂量右美托咪定静脉泵注联合丙泊酚对宫腔镜手术的麻醉作用。方法：选取我院2021年4月～2022年4月收治的98例宫腔镜手术患者作为研究对象,以随机数字表法分组,观察组(49例,0.5μg/kg右美托咪定静脉泵注联合丙泊酚麻醉)与对照组(49例,术前静脉泵注1μg/kg右美托咪定麻醉)。比较两组麻醉情况、不良反应发生率、围术期血流动力学指标、疼痛程度。结果：(1)麻醉情况：观察组患者麻醉起效时间、呼吸恢复时间、睁眼时间、清醒时间、拔管时间、定向力恢复时间、丙泊酚用量、术后镇静评分均低于对照组(P<0.05)。(2)不良反应发生率：观察组不良反应发生率均低于对照组(P<0.05)。(3)围术期血流动力学指标：入室后,MAP水平、HR水平两组比较,无统计学差异(P>0.05);观察组麻醉后、输卵管插管、手术结束后MAP水平、HR水平均高于对照组(P<0.05)。(4)疼痛程度：观察组疼痛评分低于对照组(P<0.05)。结论：对宫腔镜手术患者实行0.5μg/kg右美托咪定静脉泵注联合丙泊酚麻醉方法,能有效调节MAP水平、HR水平,减轻患者疼痛感,降低不...     

右美托咪定用于腰硬联合麻醉妇科手术患者镇静作用的观察

目的探讨右美托咪定用于腰硬联合麻醉下妇科手术的镇静效果。方法选取2013年5月至2014年3月期间在我院进行腰硬联合麻醉下妇科手术的患者116例为研究对象,分为4组,每组29例。观察组A:静脉给予右美托咪定0.25μg/kg;观察组B:右美托咪定0.5μg/kg;观察组C:右美托咪定1.0μg/kg;对照组D为生理盐水组。统计分析四组的OAA/S镇静评分及心动过缓等不良反应情况。结果观察组B和C两组患者镇静评分均明显高于对照组D(P<0.05),而观察组A与对照组D之间差异无统计学意义(P>0.05);与对照组D比较,观察组C的心动过缓等不良反应发生率差异有统计学意义(P<0.05),而观察组B和C两组与D组比较差异无统计学意义(P>0.05)。结论对于腰硬联合麻醉的妇科手术患者辅助应用0.5μg/kg右美托咪定可以较好的发挥镇静作用,并且不良反应较少,具有一定临床应用价值。     

术前及术中泵注右美托咪定对后腹腔镜术后疼痛的影响

目的观察术前及术中持续泵注右美托咪定对后腹腔镜术后疼痛及不良反应发生情况的影响。方法 40例ASAⅠ^Ⅱ级的患者行择期泌尿外科后腹腔镜手术,随机分为两组:对照组(Ⅰ组,n=20)及右美托咪定组(Ⅱ组,n=20)。Ⅱ组诱导前静脉泵注右美托咪定0.5μg/kg,10min泵完,术中持续泵注右美托咪定0.4μg/(kg·h)。观察两组术后2、4、16、24、48h的VAS评分及恶心、呕吐、寒战等不良反应的发生率。结果Ⅱ组术后2、4 h的VAS评分低于对照组Ⅰ组(P<0.05),Ⅱ组术后恶心、呕吐、寒战的发生率低于Ⅰ组(P<0.05)。结论术前及术中持续泵注右美托咪定可以有效缓解后腹腔镜术后疼痛,并减少术后恶心、呕吐、寒战等不良反应的发生率。     

右美托咪定复合曲马多用于单纯性肾切除患者术后镇痛的疗效观察

目的探讨右美托咪定复合曲马多对全麻术后躁动、镇痛效果和不良反应的影响。方法纳入132例择期单纯性肾切除术患者,均接受全身麻醉,年龄18~65岁,ASAⅠ~Ⅱ级。随机分为2组:单纯曲马多组(对照组,66例)、曲马多联合右美托咪定组(试验组,66例)。分别记录拔除气管导管前(T0)、拔除气管导管后即刻(T_1)、术后1 h(T_2)和术后2 h(T_3)的血压、心率、血氧饱和度等生命体征变化。在拔管前评估患者躁动评分。在术后2、12、24、48 h各时点评估患者的VAS疼痛评分和Ramsay镇静评分。记录术后24 h、48 h曲马多消耗量,评估患者术后24 h、48 h的镇痛总体满意度和总体睡眠质量评分,记录不良反应发生率。结果试验组在T1时的心率及T0时的躁动评分均低于对照组(P<0.05)。术后24 h,试验组的VAS评分低于对照组(P<0.05);拔管后及术后2 h、24 h,试验组Ramsay评分高于对照组(P<0.05)。术后24 h、48 h,试验组的曲马多消耗量少于对照组(P<0.05);术后24 h,试验组的镇痛总体满意度和总体睡眠评分明显优于对照组(P<0.05),头晕、恶心、呕吐的发生率低于对照组(P<0.05)。结论曲马多和右美托咪定联合应用的循环功能较单独应用曲马多更稳定,镇痛和镇静效果更完善,并且明显降低了恢复期的不良反应发生率。     

右美托咪定与曲马多对椎管内麻醉后寒战治疗效果的比较

目的研究右美托咪定与曲马多在治疗椎管内麻醉后寒战的临床疗效比较。方法将90例2012年1月至2013年1月期间在我院行腹式妇科手术中出现椎管内麻醉后寒战的患者,随机分为D、T、C三组,每组30例,分别采取不同的措施,D组患者注射右美托咪定,T组患者注射曲马多和C组患者注射生理盐水。观察患者在用药后的寒战改善程度以及恶心,呕吐,强化镇静方面的比较。结果 D、T组寒战级别较C组降低(P<0.05),T组恶心呕吐发生率高于D、C两组(P<0.05),D组的镇静评分高于T、C组。结论右美托咪定与曲马多对于椎管内麻醉后寒战的治疗均有一定的作用,但是相对来说右美托咪定的效果更好,且用药后的不良反应更少,值得在临床上推广使用。     

右美托咪定结合曲马多对瑞芬太尼麻醉后痛觉过敏的疗效和不良反应分析

目的:分析右美托咪定结合曲马多对瑞芬太尼麻醉后痛觉过敏的疗效和不良反应.方法:选取应用瑞芬太尼麻醉的患者80例,按照随机数字表法将其分为观察组与对照组两组,每组患者40例,对照组采取右美托咪定用药干预,观察组采取右美托咪定结合曲马多用药干预.结果:观察组患者寒战、恶心、呕吐、出汗等不良反应发生率均低于对照组(P<0.05).结论:右美托咪定结合曲马多在瑞芬太尼麻醉患者应用中,可以对术后患者痛觉过敏现象进行预防,具有较高的临床安全性.     

丙泊酚及右美托咪定在妇产科手术麻醉中的镇静效果对比

目的:探讨丙泊酚及右美托咪定在妇产科手术麻醉中的镇静效果。方法:选取102例妇产科手术患者作为研究对象,并根据麻醉药物不同分成两组:丙泊酚组(n=51)应用丙泊酚治疗,右美托咪定组(n=51)应用右美托咪定治疗,就两组患者不同时间点的血流动力学状态、镇静状态、不良反应发生率进行统计学分析。结果:(1)右美托咪定组的血流动力学状态优于丙泊酚组(P0.05);(2)右美托咪定组患者术后5min、术后15min、术毕的镇静评分均高于丙泊酚组(P0.05);(3)右美托咪定组不良反应发生率是7.84%,低于丙泊酚组的23.53%(P0.05)。结论:相较于丙泊酚,右美托咪定在妇产科手术麻醉中的镇静效果更佳,可改善其血流动力学状态,且不良反应发生率较低,可借鉴。     

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.