局麻药高浓度低容量坐骨神经阻滞和低浓度高容量腰丛阻滞的临床研究

目的 比较局麻药高浓度低容量坐骨神经阻滞和低浓度高容量腰从阻滞的临床麻醉效果.方法 观察组坐骨神经给予10 ml l.50％利多卡因、10 ml 0.75％罗哌卡因,腰丛神经给予15ml 1.00％利多卡因、25 ml 0.30％罗哌卡因.对照组坐骨神经和腰丛神经均给予0.60％利多卡因和0.30％罗哌卡因混合液25 ml.记录两组患者麻醉前（T1）、麻醉后即刻（T2）、麻醉后10 min（T3）和手术结束时（T4）的SBP、DBP和HR,并评价麻醉效果.结果 观察组各时点的SBP、DBP和HR与T1时点差异无统计学意义（P＞0.05）.观察组T2、T3、T4时点的SBP显著高于对照组（P＜0.05）,T2、T3时点的DBP显著高于对照组（P＜0.05）;两组各时点的HR差异无统计学意义（P＞0.05）.观察组优秀、良好和无效例数分别有23、25和2例,麻醉成功率为96.0％.对照组麻醉成功率为82.0％,显著低于观察组（χ2=24.476,P＜0.001）.结论 相比于低浓度高容量腰从阻滞麻醉,高浓度低容量坐骨神经阻滞麻醉对患者的SBP、DBP和HR影响更小,麻醉效果更好,值得在临床中推广运用.     

罗哌卡因与布比卡因用于颈丛神经阻滞的临床对比

目的用布比卡因作对照,研究罗哌卡因对甲状腺切除术中颈丛神经阻滞的临床效果及对血流动力学的影响。方法将124例甲状腺手术患者随机分为A、B两组,A组0.375%盐酸罗哌卡因组(n=62),B组0.375%盐酸布比卡因组(n=62),记录麻醉前后两组患者的SBP、DBP、HR及麻醉满意度。结果麻醉后即刻15′、30′两组SBP、DBP、HR均明显增加(P<0.05)麻醉后各时点B组较A组SBP、HR变化显著,两组DBP变化无显著差异(P>0.05)。结论0.375%罗哌卡因颈丛麻醉效果确切,较0.375%布比卡因对循环影响小。     

罗哌卡因与布比卡因用于用于颈丛神经阻滞的麻醉效果比较

目的评价罗哌卡因与布比卡因用于颈丛神经阻滞的麻醉效果。方法择期甲状腺肿块手术40例,ASAⅠ~Ⅱ级,随机分成罗哌组(A组)和布比组(B组),每组各20例,分别用0.375%罗哌卡因和0.375%布比卡因各20 m l行双侧颈丛神经阻滞。评价麻醉效果,记录并发症以及麻醉过程中的HR、SBP、DBP的变化。结果两组麻醉效果、并发症发生情况差异无显著性(P>0.05),但麻醉后HR、SBP、DBP均明显升高(P<0.05)。A组病人抬头肌力影响低于B组(P<0.01)。结论0.375%罗哌卡因和0.375%布比卡因用于颈丛神经阻滞均能取得满意的麻醉效果,由于罗哌卡因颈丛神经阻滞时对颈项运动功能影响较轻,故较布比卡因有一定优势。     

芬太尼复合罗哌卡因肌间沟臂丛神经阻滞的临床应用

目的 探讨芬太尼复合罗哌卡因肌间沟臂丛神经阻滞的临床应用.方法 50例ASA I-II级肌间沟臂丛神经阻滞行上肢手术的患者随机分成对照组（A组）：0.25%罗哌卡因30ml＋静脉注射生理盐水1ml,观察组（B组）：0.25%罗哌卡因30ml＋芬太尼1μg/kg,记录麻醉起效时间、痛觉开始恢复时间、麻醉持续时间;观察手术开始、10、20、30、60min的生命体征（BP、HR、SPO2）;术后2、6、12、24h的VAS疼痛评分.结果 B组麻醉起效时间明显短于A组,痛觉开始恢复时间、麻醉持续时间明显长于A组（P〈0.05）,B组术中BP、HR比A组更平稳（P〈0.05）,SPO2两组差异无统计学意义.B组术后不同时点VAS明显低于A组（P〈0.05）.结论 芬太尼复合罗哌卡因用于肌间沟臂丛神经阻滞可以缩短麻醉起效时间,延长麻醉持续时间,完善镇痛效果,患者血压、心率更平稳.     

罗哌卡因复合舒芬太尼臂丛神经阻滞麻醉体会

目的探讨罗哌卡因复合舒芬太尼臂丛神经阻滞麻醉效果。方法选择ASAⅠ～Ⅱ级,18～65岁择期或急诊行上肢手术患者60例,随机分为两组,实验组30例:0.33%罗哌卡因30mL+舒芬太尼10μg,对照组30例:0.33%罗哌卡因30mL。比较麻醉后两组患者生命体征、镇静及麻醉效果。结果两组患者麻醉后10、20、30、60、120min BP、HR、SPO2差异无统计学意义(P>0.05);镇静评分在麻醉20min后实验组高于对照组(P<0.05);麻醉效果两组比较有显著性差异(P<0.01)。结论罗哌卡因复合舒芬太尼用于臂丛神经阻滞麻醉,具有镇静镇痛效果好,安全可靠。     

右美托咪定复合罗哌卡因用于臂丛神经阻滞的临床观察

目的观察右美托咪定复合罗哌卡因用于臂丛神经阻滞的临床效果。方法择期在臂丛神经阻滞下行上肢手术患者60例,年龄18-45岁,ASA分级Ⅰ-Ⅱ级,采用随机数字表法,将患者随机均分为两组：右美托咪定复合罗哌卡因组（D组）和单纯罗哌卡因对照组（C组）。D组以0.375%罗哌卡因复合右美托咪定1μg/kg共20ml,C组以0.375%罗哌卡因20ml行肌间沟臂丛神经阻滞。分别于麻醉前（T0）、手术开始时（T1）、手术开始30min时（T2）和手术结束时（T3）记录患者心率（HR）、平均动脉压（MAP）、脉搏氧饱和度（SpO2）、OAA/S及Ramsay镇静评分,并记录两组患者麻醉起效时间、镇痛持续时间、运动恢复时间及患者满意度。结果与C组比较,D组T1-T3时HR、MAP降低,OAA/S评分及Ramsay镇静评分升高,麻醉起效时间缩短,镇痛持续时间和运动恢复时间延长,患者满意度升高（P〈0.05）,心动过缓、恶心及呕吐等不良反应发生率差异无统计学意义（P〉0.05）。结论右美托咪定复合罗哌卡因较单纯罗哌卡因用于臂丛神经阻滞可显著缩短麻醉起效时间,延长镇痛时间。     

羟乙基淀粉预扩容对腰麻剖宫产母体循环功能影响的研究

目的观察羟乙基淀粉和乳酸钠林格氏液预扩容对剖宫产妇腰-硬联合麻醉后循环功能的影响。方法择期剖宫产妇120例,随机分为两组,每组60例,麻醉前分别输入分子量130000羟乙基淀粉（130/0.4）氯化钠注射液（Ⅰ组）和乳酸林格氏液（Ⅱ组）。左侧卧位,L3～4间隙穿刺,见脑脊液后,注入含糖0.75%罗哌卡因10mg立即改平卧,手术床面左倾15°,鼻导管吸氧4ml/min,控制麻醉平面于T6以下。于麻醉前、麻醉3、5、10min记录收缩压（SBP）、舒张压（DBP）、HR、SpO2。结果I组麻醉后3、5、10min各时点SBP、DBP也较术前下降（P〈0.01）,但术毕时SBP、DBP与术前比较差异无显著性意义（P〉0.05）;II组产妇麻醉后3、5、10min、术毕各时点SBP、DBP仍低于麻醉前（P〈0.01）。组间比较,I组麻醉后3、5、10min、术毕时SBP、DBP均高于Ⅱ组（P〈0.05）。两组产妇麻醉后心率各时点与术前比较差异无显著性,组间比较差异无显著性（P〉0.05）。结论羟乙基淀粉预扩容可有效预防剖宫产妇腰麻后血压下降,有利于维持循环功能稳定。     

罗哌卡因腋路臂丛神经阻滞在前臂手术中的临床应用

目的:比较0.375%罗哌卡因与利布合剂腋路臂丛神经阻滞在前臂手术中的应用。方法:将ASAⅠ～Ⅱ级40例行前臂手术的患者,随机分为两组:Ⅰ组(罗哌卡因组,n=20)腋路臂丛麻醉,用0.375%罗哌卡因30ml,Ⅱ组(利多卡因与布比卡因合剂组,n=20)用(0.75%布比卡因15ml加2%利多卡因15ml)30ml。麻醉过程中连续监测心率(HR),平均动脉压(MAP)和运动、感觉神经情况,脉搏血氧饱合度(SpO2),记录麻醉前、手术开始、麻醉开始后10分钟、30分钟、60分钟、术后1小时的HR及MAP和运动、感觉神经麻醉起效及恢复时间、麻醉维持时间及效果。结果:Ⅰ组与Ⅱ组麻醉起效时间相似,麻醉维持时间Ⅰ组明显长于Ⅱ组。Ⅰ组麻醉中和麻醉后各记时点心率和MAP与麻醉前后差异无显著性,而Ⅱ组麻醉开始后30分钟及术后60分钟的HR和MAP比麻醉前增高。结论:0.375%罗哌卡因用于前臂手术的麻醉安全有效可行。     

相同浓度不同容量罗哌卡因在长期吸烟史患者肌间沟臂丛神经阻滞麻醉中的应用

目的 分析相同浓度不同容量罗哌卡因在长期吸烟史患者肌间沟臂丛神经阻滞麻醉中的应用价值。方法 80例有长期吸烟史的上肢手术患者,随机分为观察组及对照组,各40例。两组均行肌间沟臂丛神经阻滞麻醉。对照组在臂丛的后外侧缓慢贴近臂丛神经,回抽无血后注入0.375%罗哌卡因5 ml,后将退针调整,将针尖推进至臂丛的前上方贴近臂丛神经,回抽无血后注入0.375%罗哌卡因5 ml,共10 ml。观察组在臂丛的后外侧缓慢贴近臂丛神经,回抽无血后注入0.375%罗哌卡因10 ml,后将退针调整,将针尖推进至臂丛的前上方贴近臂丛神经,回抽无血后注入0.375%罗哌卡因10 ml,共20 ml。比较两组阻滞30 min后臂丛神经阻滞效果、膈肌麻痹发生率,两组术前(T0)、起效即时(T1)、麻醉后4 h(T2)、麻醉后8 h(T3)、麻醉后12 h(T4)血氧饱和度(SpO2)及肺功能指标[每分钟最大通气量(MVV)、第1秒用力呼气容积占预计值的百分比(FEV1%pred)、FEV1/用力肺活量(FVC)],肺部并发症发生率。结果 阻滞30 min后,观察组正中神经、肌皮神经、桡神经、尺神经感觉阻滞有效率分别...     

咪唑安定降低颈丛神经阻滞时心血管反应的临床观察

目的 评价颈丛神经阻滞术中应用咪唑安定能否减少血压和心率的变化.方法 将60例甲状腺肿瘤切除手术病人,随机分为A、B两组.A组:静注咪唑安定0.05mg/kg 芬太尼0.0015mg/kg;B组:静注氟哌利多0.05mg/kg 芬太尼0.0015mg/kg.两组均选用0.25%罗哌卡因,左右各10ml行颈丛神经阻滞.观察阻滞前、阻滞后5min、15min、30min时的SBP、DBP、HR及SPO2.结果 B组血压和心率均明显高于阻滞前(P＜0.05),B组血压和心率在15min、30min明显高于A组(P＜0.05).SPO2都无显著性差异(P＞0.05).结论 颈丛神经阻滞术中应用咪唑安定能减少血压和心率的变化.     

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.     

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.     

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.