羟基丁酸钠、氯胺酮静脉复合麻醉用于失血性休克患者的观察

失血性休克是外科、妇产科临床常见的急重症,病情较危急,为迅速根除休克的病因,多数在抗休克的同时行急诊手术。这类休克患者对麻醉的要求较择期手术患者高。     

重症胰腺炎术后并发症6例的护理体会

重症胰腺炎是一种极为严重的外科急腹症，其来势凶猛、病情严重，发展迅速，并发症多，不仅可引起急性腹膜炎，而且常因并发休克、多器官功能衰竭而危及生命，死亡率高。现将收治的6例中4例术后有效的防治及重视护理全部治愈，现报告如下：     

外科手术联合腹腔动脉灌注给药治疗急性重症胰腺炎22例

重症胰腺炎是外科常见的急腹症之一,起病急,进展快,并发症多,病死率高,目前一般行手术治疗。我院自2005年3月至2008年10月采用外科手术及术后联合腹腔动脉灌注治疗急性重症胰腺炎,取得良好效果,报道如下：     

产科失血性休克危急重症患者51例临床特点及救治体会

目的总结产科失血性休克危急重症患者临床特点及救治体会。方法对产科收治的失血性休克病例51例临床资料进行回顾分析。结果 51急重症产妇经密切观察、积极抗休克及防治功能衰竭等救治后,所有产妇均脱离危险,休克得到纠正,抢救成功率100%。产妇一般状况改善,皮肤红润温暖,血气分析、血压均恢复正常,尿量均在30mL/h以上。结论分析患者失血性休克发病原因、特点并进行针对性抢救,对确保抢救成功具有重要作用。     

老年急重症胆囊炎48例应用局麻胆囊切开取石造瘘术疗效观察

<正>老年急重症胆囊炎多需紧急手术处理,传统方式为胆囊切除术,但老年人全身状况较差,脏器功能不全,且多伴有内科疾病,往往难以耐受麻醉及手术风险,甚至有术中术后死亡之可能。因此探讨其手术治疗方法历来为临床外科医师所关注。我院2005年至2008年应用局麻急诊胆囊切开取石造瘘术治疗老年急性重症胆囊炎48例,现报道如下:     

低温高渗盐液对创伤失血性休克大鼠血清TNF-α、IL—1β的影响

创伤失血性休克是外科常见的急危重病,创伤失血性休克后各脏器处于缺血、缺氧状态,心肌、肺、肾对缺血缺氧特别明显,早期复苏、如何复苏、复苏后如何避免缺血再灌注损伤至为重要。本文建立创伤失血性休克大鼠动物模型,观察低温高渗液对大鼠不同时段生命征、血浆TNF-α、IL-1β水平及肺脏超微结构的改变的影响。     

介入止血在急诊科的临床应用探讨

目的探讨介入止血术在急诊科急救中的临床疗效。方法 12例经内科保守治疗无效的骨盆骨折合并盆腔出血患者,16例外伤性脾脏破裂患者,15例肾脏损伤性出血患者,8例不明原因下消化道出血患者,2例颅底骨折鼻腔大出血,来院后2h内急诊行选择性动脉造影及损伤血管栓塞止血治疗,栓塞剂采用明胶海绵。再予相应外科处理和其他综合救治措施。结果 53例患者均成功进行选择或超选择性损伤血管栓塞止血。经短时间继续扩容后所有病人血压迅速回升,1例死亡,1例栓塞治疗后未能有效止血而开腹行脾切除手术,1例出现脾脓肿行脾切除术。其余50例病人未出现严重的并发症,痊愈出院。结论介入止血是救治急重症大出血、失血性休克的快速、安全、有效的方法。     

小儿急腹症合并感染性休克的麻醉管理

<正>小儿急腹症发病急、进展快,重症者随病情发展继发感染性休克。感染性休克又称脓毒性休克,是指脓毒症诱导的组织低灌注和心血管功能障碍[1]。急腹症合并感染性休克患儿确诊后应在治疗休克的同时进行紧急麻醉和手术祛除感染病灶。正确进行围术期麻醉管理,可减轻手术和麻醉创伤,促进患儿疾病转归。2014年1月至2015年3月,我院对23例感染性休克急腹症患儿行手术治疗,现回顾总结如下。1资料与方法     

重症急性胰腺炎外科治疗术后68例的护理

目的：探讨重症急性胰腺炎外科治疗术后护理的效果。方法：回顾性总结了68例重症急性胰腺炎患者的术后护理,包括心理护理,引流管护理,健康教育等。结果：68例重症急性胰腺炎均全部治愈,无一例出现腹痛、腹泻。结论：重症急性胰腺炎术后各种引流管的护理是SAP患者术后康复的重要措施之一。     

新生儿感染性休克血糖及电解质变化的临床分析(附113例报告)

感染性休克是严重威胁新生儿生命的急重症.本文通过对113例新生儿感染性休克时血糖、电解质进行总结,探讨新生儿感染性休克时血糖与电解质变化的临床特点及其与病情的关系.     

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.