Supreme与ProSeal喉罩用于腹腔镜胆囊切除术患者气道管理比较

目的 观察 Supreme 喉罩与 ProSeal 喉罩用于腹腔镜胆囊切除术患者气道管理效果.方法 选择全身麻醉下行腹腔镜胆囊切除术患者80例,ASAⅠ~Ⅱ级,随机分为ProSeal喉罩组(P组)和Supreme喉罩组(S组),每组40例.记录麻醉诱导前(T0)、麻醉诱导后(T1)、喉罩置入即刻(T2)、喉罩置入后3min(T3)、气腹前、气腹后5 min和20 min、拔除喉罩前(T4)、拔除喉罩即刻(T5)、拔除喉罩后3 min(T6)MAP、HR、SpO2、气道峰压(Ppeak)和呼气末二氧化碳分压(PETCO2),以及喉罩置入成功率、一次放置成功时间和喉罩密封压,并观察拔除喉罩时表面是否有血丝及术后咽喉部等并发症.结果S组平均置入时间明显短于P组(P＜0.05),一次置入成功率和气道密闭压明显优于P 组.两组各时点MAP、HR、SpO2 、Ppeak 、PETCO2比较差异无统计学意义(P＞0.05).P组拔除喉罩后罩面沾血和咽痛发生率低,优于S组(P＜0.05).结论 Supreme 与 ProSeal 喉罩在腹腔镜胆囊切除术中通气效果良好,气道密封效果可靠,术后咽喉部并发症少.两者比较,Supreme 喉罩置入更便捷.     

喉罩通气复合颈丛阻滞麻醉在甲状腺手术中的应用

目的 探讨喉罩应用于颈丛加静脉麻醉甲状腺手术的临床效果.方法 80例甲状腺手术的择期手术患者,随机分成气管插管组(T组)和喉罩置入组(L组),每组40例,气管插管用喉镜明视插入法,喉罩置入按顺行盲探置入口底.记录麻醉诱导前(T0)、诱导后(T1)气管插管后1min(T2)、3min(T3)、拔除气管导管或喉罩后1 mi...     

探讨Supreme喉罩在妇科肿瘤手术中的应用

目的比较Supreme喉罩与气管插管在妇科肿瘤术中对血流动力学和通气的影响,并评估Supreme喉罩应用的安全性。方法选择妇科肿瘤手术168例,其中子宫肌瘤全子宫切除术104例,宫颈癌根治术36例,卵巢癌根治术18例,子宫内膜癌根治术10例,年龄26～70岁,体质量46～78kg,ASA分级Ⅰ～Ⅱ级,随机均分为Supreme喉罩组(L组)和气管插管组(M组)。排除咽喉疼痛、呼吸系统疾病等禁忌证的患者。所有患者入手术室后建立静脉通路,常规监测血压(BP)、心电图(ECG)、脉搏血氧饱和度(SpO2),记录入室后、置入喉罩/气管导管前(T0),置入喉罩/气管导管即刻(T1),通气30min(T2)、术毕(T3)和苏醒拔喉罩/气管导管时(T4)的收缩压(SBP)、舒张压(DBP)、心率(HR)、脉搏血氧饱和度(SpO2)和气道峰压(Ppeak)。并观察拔除喉罩/气管导管后并发症的发生情况。术中维持呼气末二氧化碳分压(PETCO2)在35～45mmHg。结果 L组T1、T4的血压、心率较T0轻度升高,但差异无统计学意义(P>0.05),M组T1、T4的血压、心率较T0和L组明显升高有统计学意义(P<0.05)。两组T1、T2、T3、T4各时间点的SpO2、Ppeak比较无明显差异(P>0.05)。L组苏醒期拔喉罩过程平稳,呛咳、呕吐、躁动及术后咽喉痛发生率明显低于M组(P<0.05),两组均无反流、误吸发生。结论 Supreme喉罩全麻通气在妇科肿瘤手术中使用能更好地控制血流动力学、安全性好、并发症少。     

I-gel 喉罩与 LMA-Superme 喉罩在全麻中耳炎手术中应用效果的比较

目的：比较 I-gel 喉罩与 LMA-Superme 喉罩用于全麻中耳炎手术中的气道管理效果。方法全麻下行中耳炎手术患者100例,ASAⅠ或Ⅱ级,随机均分为 I-gel 喉罩组（I 组）和 LMA-Superme 喉罩组（S 组）。记录喉罩置入成功率、置入时间、气道密封压、纤维支气管镜检查分级情况;记录喉罩置入即刻（T0）、头侧旋位即刻（T1）、手术开始即刻（T2）、手术开始后1 h（T3）、拔除喉罩即刻（T4）的心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）和气道峰压（Ppeak）;记录手术时间、苏醒时间、拔除喉罩时间及拔除喉罩后相关并发症的发生情况。结果气道密封压 I 组（27．8±4．6）cmH2 O,高于 S 组（21．9±4．3）cmH2 O （P ＜0．05）;纤维支气管镜评级 I 组优于 S 组（P ＜0．05）。两组患者的手术时间、苏醒时间、拔除喉罩时间及各时点的 HR、MAP、SpO2和 Ppeak 差异无统计学意义（P ＞0．05）;S 组有5例（10％）,I 组有1例（2％）在 T1时患者出现口咽部漏气现象,差异显著（P ＜0．05）。结论I-gel 喉罩在全麻中耳炎手术中的气道管理效果优于 LMA-Superme 喉罩。     

SLIPA喉罩与气管内插管用于夹层主动脉瘤腔内隔绝术中血流动力学比较

目的 比较应用SLIPA喉罩与气管导管两种气道管理方式对夹层主动脉瘤腔内隔绝术患者术中血流动力学影响,评价SLIPA喉罩在该手术中应用的安全性与优越性.方法 选取夹层主动脉瘤腔内隔绝术患者40例,随机均分喉罩观察组和气管插管对照组,记录诱导后喉罩/气管插管前(T0),置入喉罩/气管导管即刻(T1),置入喉罩/气管导管后5 min(T3),拔除喉罩/气管导管前(T4),拔除喉罩/气管导管后5 min(T5)HR、MAP的变化值.结果 对照组在T1、T3、T4时点HR、MAP明显增高,与T0相比差异有统计学意义(P<0.05),对照组在T1、T3、T4时点与观察组同时点HR、MAP比较,差异有统计学意义(P<0.05).结论 在夹层主动脉瘤腔内隔绝术中使用SLIPA喉罩优于气管内插管,麻醉诱导与苏醒期患者的血流动力学更稳定,应激反应轻,安全性好,是一种值得推荐的麻醉气道管理新途径.     

I-gel喉罩在小儿外科手术中的临床应用

目的对比观察I-gel喉罩在小儿外科麻醉中的应用效果。方法 40例小儿外科手术患儿,随机分为I组(I-gel喉罩全麻组)和Ⅱ组(气管插管全麻组),各20例。两组患儿使用相同的麻醉药物。比较两组各时间节点血流动力学参数及术后不适发生情况。结果Ⅱ组置入喉罩或气管导管即刻(T2)、拔除喉罩或气管导管即刻(T4)时段的平均动脉压、心率均高于Ⅰ组,差异具有统计学意义(P<0.05)。麻醉苏醒期及术后,两组患儿均出现了躁动、呕吐等症状,但是Ⅱ组出现不适症状的总例数明显多于Ⅰ组(P<0.05)。结论 I-gel喉罩安全、有效,在小儿外科手术麻醉的气道管理中更为合适,值得在临床实践上推广。     

Supreme双管喉罩用于术前置入鼻胃管的腹腔镜手术患者气道管理的可行性

目的评价Supreme双管喉罩用于术前置入鼻胃管的腹腔镜手术患者气道管理的可行性。方法择期全麻下拟行腹腔镜胆囊切除手术患者60例,ASAⅠ～Ⅱ级,年龄24～62岁,体重52～75 kg,MallampatiⅠ～Ⅱ级,将患者随机分为经Supreme喉罩引流管放置胃管组(I组,29例)和术前经鼻放置胃管组(Ⅱ组,31例)。Ⅰ组放置胃管后经胃管引流胃内容物,Ⅱ组于术前经鼻放置胃管,麻醉诱导前充分吸引后再置入喉罩。喉罩置入成功后行纤维支气管镜检查评分。记录喉罩置入时间、首次置入成功率和气道密封压情况。记录置入喉罩后和气腹后气道峰压(Ppeak)和呼气末二氧化碳分压(PETCO2)的变化。拔除喉罩后观察罩体内是否有血液或反流物,记录患者围术期不良反应的发生情况。结果两组喉罩置入时间、首次置入成功率和气道密封压比较差异无统计学意义(P>0.05);置入喉罩后和气腹后两组患者Ppeak和PETCO2均可维持在正常范围内;纤维支气管镜视野显露评分、咽部不良反应发生率、罩体内带血和有反流物的发生率两组比较差异均无统计学意义(P>0.05)。结论 Supreme喉罩可安全有效地应用于术前置入鼻胃管的腹腔镜手术患者。     

不同通气方式在妇科腹腔镜手术中的麻醉观察

目的观察喉罩和传统的气管插管对妇科腹腔镜手术临床麻醉效果。方法选择择期行妇科腹腔镜手术患者48例随机分为喉罩组（H组）和气管插管组（T组）。两组均采用静-吸复合麻醉,监测并记录麻醉药物注入前（T0）、置入喉罩或气管插管后即刻（T1）、气腹后3 min（T2）、拔除喉罩或气管导管后（T3）MAP（平均动脉）、HR（心率）、PETCO2（呼气末二氧化碳分压）及气道峰压（Ppeak）等情况。结果 T组在T1、T3时的MAP、HR明显高于H组（P〈0.05）,两组PETCO2及气道峰压（Ppeak）均在正常范围,两组通气效果无差别。结论喉罩可以安全应用于静吸复合全身麻醉下的妇科腹腔镜手术的气道管理。     

一次性双腔无囊喉罩I-gel在烧伤手术麻醉中的应用

目的 一次性双腔无囊喉罩I-gel与气管插管在成人烧伤患者麻醉中的应用观察及优缺点比较.方法 选择50例择期手术成人烧伤患者随机数字表法分成两组,喉罩组采用I-gel喉罩行麻醉(n=25)、插管组采用气管插管行麻醉(n=25),麻醉方法均选用全凭静脉麻醉,用药剂量及种类差异无统计学意义.记录麻醉诱导后(T1),插入I-gel喉罩或气管导管后(T2),术毕停止输注麻醉药物后5 min(T3),拔出I-gel喉罩或气管导管后(T4),患者各时段平均动脉压(MAP),心率(HR),脉搏血氧饱和度(SpO2),及T2、T3、T4时间点呼气末二氧化碳分压(PETCO2),分别计算两组中每位患者使用丙泊酚、瑞芬太尼、顺阿曲库铵的总量,并记录苏醒时间和拔管后的并发症.结果 插管组T2、T4时段MAP、HR分别为(89.4±8.3) mmHg、(96.0±7.7)mmHg、(99.4±4.9)次/分钟、(100.6±5.6)次/分钟明显高于喉罩组(P＜0.05),与T1,T3时段比较,捶管组MAP、HR数值则明显升高(P＜0.05),喉置组则无明显变化(P＞0.05).两组不良反应包括苏醒躁动、呛咳屏气、术后咽痛喉罩组少于插管组(喉罩组比插管组依次为4.0％比28.0％、0.0％比20.0％、4.0％比28％,均P＜0.05).而喉罩组丙泊酚与顺阿曲库铵的用量也明显少于插管组(P＜0.05),喉罩组苏醒时间(4.1±2.2)min明显快于插管组(8.1±3.0)min(P＜0.05).结论 与气管插管全麻相比,I-gel喉罩在成人烧伤患者的应用有血流动力学更稳定,麻醉平稳,患者舒适度高的优势.     

SLIPA喉罩与气管插管在乳腺癌根治术中的应用比较

目的 比较SLIPA喉罩与气管插管在乳腺癌根治术中的应用效果,并评价其有效性和安全性.方法 随机选取60例乳腺癌患者分为SLIPA喉罩组(S组)和气管插管组(T组).分别记录插管或置罩成功率及所需时间,记录患者入室时(T0)、置罩或插管即刻(T1)、置罩或插管后3 min( T2)、拔罩或管前(T3)、拔罩或管即刻(T4)、拔罩或管后3 min(T5)的平均动脉压(MAP)、心率(HR))、脑电双频指数(BIS)变化.记录气道建立成功后10 min、30 min、60 min的气道峰压(Ppeak)、呼气末二氧化碳分压(PetCO2)和血氧饱和度( SpO2).并记录术中及术后并发症的发生情况.结果 T组气管插管所需时间明显长于S组置入SLIPA喉罩所需时间(P＜0.05).T1、T2、T4、T5时T组MAP明显高于T0及S组,HR明显快于T0及S组(均P＜0.05).S组在各时点MAP、HR差异均无统计学意义(均P＞0.05).两组患者各时点Ppeak、PetCO2、BIS均在正常范围内,差异均无统计学意义(均P＞0.05).术后咽痛、呛咳及躁动人数S组少于T组(均P＜O.05),两组均无反流、误吸发生.结论 SLIPA喉罩操作简捷,对血流动力学影响小,术后并发症少,能安全有效地用于乳腺癌根治术的麻醉.     

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.