慢性肺心病急性加重期血气变化及酸碱失衡分析

目的探讨慢性肺心病急性加重期患者血气变化及酸碱失衡类型的特点、判断和治疗。方法 69例慢性肺心病急性加重期患者216例次动脉血气及同步静脉血清电解质,经计算代偿预计值、AG值、潜在HCO3-,结合临床综合分析,做出酸碱失衡类型的判断。结果 216例次中,单纯酸碱紊乱107例次(49.5%),双重酸碱紊乱85例次(39.4%),三重酸碱紊乱24例次(11.1%)。结论单纯呼吸性酸中毒由原发病引起,呼吸性碱中毒由机械过度通气引起,代谢性酸中毒由严重缺氧、肝肾功能障碍、重度感染、休克引起。代谢性碱中毒由医源性因素引起。治疗中要纠正最主要的病理生理改变,对pH过高或过低者酌情补充酸性或碱性药。对于TABD,因病死率高,治疗更要慎重,仅pH>7.50或<7.10时才考虑适当补充酸或碱性药。对于慢性呼吸性酸中毒,只要pH>7.10,不需补碱,即使pH<7.10,也只能少量补碱。     

修正酸碱失衡预计代偿公式的初步研究

目的 编制更为合理的单纯性酸碱失衡预计代偿范围计算公式.方法 采纳Hamm公式的最大代偿系数及周寿生公式的代偿范围,编制成修正代偿公式.结果 修正酸碱失衡预计代偿公式(修正公式)有A、B两种表达式,其最后计算结果完全一致,A表达式:代谢性酸中毒:PaCO2＝40-1.4×△[HCO3-]↓+(0～5);代谢性碱中毒:PaCO2＝40+0.9×△[HCO3-]↑-(0～5);急性呼吸性酸中毒:[HCO3-]＝24+0.175×△PaCO2↑-(0～3);慢性呼吸性酸中毒:[HCO3-]＝24+0.55×△PaCO2↑-(0～3);急性呼吸性碱中毒:[HCO3-]＝24-0.25×△PaCO2↓+(0～3);慢性呼吸性碱中毒:[HCO3-]＝24-0.5×△PaCO2↓+(0～3).B表达式与周寿生公式形式类似(略).结论 修正公式推理成立,无过度代偿,可减少双重性失衡的误判或漏判,且应用方便.     

重症监护86例新生儿血气及阴离子间隙状态分析和临床意义

目的　探讨新生儿重症监护室 (NICU)中新生儿血液酸碱失衡和阴离子间隙 (AG)的特点。方法　对NICU中 86例新生儿进行血气分析、血电解质测定及AG测定。应用单纯性酸碱失衡代偿预期公式判断混合性酸碱失衡。对AG和血气的关系进行t检验。结果　 83例 ( 96 5 1% )存在酸碱紊乱 ,其中以代谢性酸中毒合并呼吸性酸中毒为最多见 ( 6 1 6 3% )。本组未见三重酸碱紊乱的病例。高AG4 9例 ( 5 6 98% ) ,为新生儿特点。AG与血气关系显示 ,高AG组与正常AG组的血液pH、氧分压 (PO2 )、氧饱和度 (SO2 )之间差异无显著性 (P >0 0 5 ) ,而与二氧化碳分压 (PCO2 )差异有显著性 (P <0 0 5 ) ,与剩余碱 (BE)、碳酸氢根 (HCO3 ) -差异有高度显著性 (P <0 0 1) 。结论　NICU中新生儿以代谢性酸中毒合并呼吸性酸中毒为最多见。危重新生儿存在高AG现象 ,对高AG酸中毒应以综合治疗     

修正酸碱失衡预计代偿公式的初步研究

目的编制更为合理的单纯性酸碱失衡预计代偿范围计算公式。方法采纳Hamm公式的最大代偿系数及周寿生公式的代偿范围,编制成修正代偿公式。结果修正酸碱失衡预计代偿公式（修正公式）有A、B两种表达式,其最后计算结果完全一致,A表达式：代谢性酸中毒：PaCO2=40-1.4×△[HCO3-]↓＋（0-5）;代谢性碱中毒：PaCO2=40＋0.9×△[HCO3-]↑-（0-5）;急性呼吸性酸中毒：[HCO3-]=24＋0.175×△PaCO2↑-（0-3）;慢性呼吸性酸中毒：[HCO3-]=24＋0.55×△PaCO2↑-（0-3）;急性呼吸性碱中毒：[HCO3-]=24-0.25×△PaCO2↓＋（0-3）;慢性呼吸性碱中毒：[HCO3-]=24-0.5×△PaCO2↓＋（0-3）。B表达式与周寿生公式形式类似（略）。结论修正公式推理成立,无过度代偿,可减少双重性失衡的误判或漏判,且应用方便。     

重症监护室2078例新生儿酸碱失衡临床分析

目的 探讨新生儿重症监护室（NICU）中新生儿酸碱失衡的特点。方法 对NICU中2078例新生儿行血气及电解质检测共3910例次,运用酸碱平衡代偿预期公式对新生儿酸碱失衡进行研究分析。结果 3422例次（87．52％）发生酸碱平衡紊乱,其中单纯型酸碱紊乱1591例次（46．49％）,双重酸碱紊乱1790例次（52．31％）,三重酸碱紊乱41例次（1．20％）。结论 NICU中新生儿酸碱失衡以代谢性酸中毒合并呼吸性碱中毒（19．80％）居首位,其次是单纯型呼吸性酸中毒（16．29％）,应重视三重酸碱紊乱及其处理。     

Hamm和Carroll公式计算酸碱平衡紊乱预计代偿范围的差别

目的 探讨Hamm和Carroll公式计算酸碱平衡紊乱预计代偿范围的差别.方法 将739份实测异常血气分析结果同时用Hamm和Carroll公式判断酸碱失衡类型,研究两组公式的一致性.结果 两组公式判断代谢性酸中毒一致率为83.78%(Kappa值0.67,P＜0.01),判断代谢性碱中毒一致率为54.17%(Kappa值0.21,P＜0.01),判断急性呼吸性酸中毒一致率为81.36%(Kappa值0.53,P＜0.01),判断急性呼吸性碱中毒一致率为43.93%(Kappa值0.15,P＜0.05),判断慢性呼吸性酸中毒一致率为78.08%(Kappa值0.56,P＜0.01),判断慢性呼吸性碱中毒一致率为54.72%(Kappa值0.25,P＜0.01).结论 用Hamm和Carroll公式判断酸碱失衡类型存在明显差别.     

重型颅脑损伤酸碱及血气监测分析

通过对资料较完整的80例重型颅脑损伤患者作回顾性分析;筛选病程各阶段血气及酸碱主要异常类型,了解其改变原因。结果发现,呼吸性碱中毒是伤后主要异常类型,但早期也常见呼吸性碱中毒和并代谢性酸中毒,中后期则可出现呼吸性酸中毒改变。碱血症明显多于酸血症,以低碳酸血症多见。结论:以脑内酸中毒为主要诱因的过度通气是酸碱失调主要的基础。病情的严重程度决定了酸碱血气异常的发展程度。在合并有低氧血症和低碳酸血症;呼吸性碱中毒合并代谢性酸中毒及三重酸碱失调等情况时危害较大,应注意防治。     

Hamm和Carroll公式计算酸碱平衡紊乱预计代偿范围的差别

目的探讨Hamm和Carroll公式计算酸碱平衡紊乱预计代偿范围的差别。方法将739份实测异常血气分析结果同时用Hamm和Carroll公式判断酸碱失衡类型,研究两组公式的一致性。结果两组公式判断代谢性酸中毒一致率为83.78%（Kappa值0.67,P〈0.01）,判断代谢性碱中毒一致率为54.17%（Kappa值0.21,P〈0.01）,判断急性呼吸性酸中毒一致率为81.36%（Kappa值0.53,P〈0.01）,判断急性呼吸性碱中毒一致率为43.93%（Kappa值0.15,P〈0.05）,判断慢性呼吸性酸中毒一致率为78.08%（Kappa值0.56,P〈0.01）,判断慢性呼吸性碱中毒一致率为54.72%（Kappa值0.25,P〈0.01）。结论用Hamm和Carroll公式判断酸碱失衡类型存在明显差别。     

合并两组酸碱失衡预计代偿公式的可行性研究

目的 合并Hamm和Carroll单纯性酸碱平衡紊乱预计代偿公式,形成新的预计代偿公式,提高判断准确性.方法 ①计算Hamm及Carroll公式6种酸碱失衡预计代偿范围;②合并两组公式预计代偿范围:慢性呼吸性碱中毒(呼碱)时,合并预计最大代偿值=Hamm预计最大代偿值-0.200×(Hamm-Carroll)预计最大代偿值,慢性呼吸性酸中毒(呼酸)时,合并预计最大代偿值=Hamm预计最大代偿值+0.125×(Carroll-Hamm)预计最大代偿值,慢性呼碱(酸)时,预计最小代偿值=(Hamm+Carroll)预计最小代偿值/2,其他酸碱失衡预计最大(最小)代偿值的合并预计代偿值=(Hamm+Carroll)预计代偿值/2;③用直线回归方程还原合并预计代偿公式;④软件模拟酸碱失衡数据.对3组公式判断的酸碱失衡类型进行Kappa一致性检验.结果 新合并公式:代谢性酸中毒(代酸)PaCO2=(39.0-1.30×△[HCO3-]↓)～(41.0-1.10×△[HCO3-]↓),代谢性碱中毒(代碱)PaCO2=(37.5+0.65×△[HCO3-]↑)-(42.5+0.90×△[HCO3-]↑),急性呼酸[HCO3-]=(23.26+0.046×△PaCO2↑)～(24.80+0.120×△PaCO2↑),慢性呼酸[HCO 3-]=(22.50+0.325×△PaCO2 ↑)～(25.50+0.475×△PaCO2↑),急性呼碱[HCO3-]=(22.75-0.225×△PaCO2 ↓)～(25.25-0.200×△ PaCO2 ↓),慢性呼碱[HCO,-]=(22.75-0.500×APaCO2↓)～(25.25-0.450×△PaCO2↓).结论 合并公式与Hamm及Carroll公式配对的Kappa值及判断一致率,均明显高于Hamm与Carroll公式配对(P<0.01).合并公式可应用于临床.     

机械通气下危重患儿的血气分析

目的观察机械通气下危重患儿的血气及酸碱紊乱的发生状况,指导机械通气。方法本院内科重症监护室2001年1月～2005年1月上机及改变呼吸机参数后1h查动脉血气分析及静脉血生化、血尿素氮、血糖共532例,发生紊乱200例．结果各种血气酸碱失衡改变的发生率极高,代谢性酸中毒合并呼吸性碱中毒占18．5％,单纯性呼吸性酸中毒占12、5％,单纯性代谢性酸中毒占11％,三重酸碱紊乱的比例达20％、结论从纠正原发病入手,加强纠正酸中毒,稳定惠儿内环境;精通呼吸生理,掌握危重患儿病理状态;熟悉呼吸支持原理,精确调节呼吸机参数。     

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.     

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.