不同剂量舒芬太尼在腹部术后镇痛中的应用

目的探究不同剂量舒芬太尼在腹部手术术后静脉镇痛中的应用。方法择取2018年6月-2019年2月期间本院收治的92例腹部手术患者,随机分为对照组与观察组,每组46例。对照组行小剂量舒芬太尼给药,观察组行大剂量舒芬太尼给药,比较两组患者术后不同时间点疼痛视觉模拟评分(VAS)以及不良反应发生率。结果术后8h两组患者VAS评分差异无统计学意义(P> 0.05);术后12 h、术后24 h以及术后48 h观察组患者VAS评分均低于对照组,不良反应发生率6.52%低于对照组23.91%,差异有统计学意义(P <0.05)。结论腹部手术患者术后静脉镇痛使用大剂量舒芬太尼具有更理想的麻醉镇痛效果,且安全性高。     

Changes in respiratory pattern after repeated doses of diazepam and midazolam in healthy subjects

Changes in respiratory pattern and arterial PCO2 after three repeated intravenous sedative doses of midazolam 0.05 mg/kg or diazepam 0.15 mg/kg were studied in eight healthy male volunteers in a randomized double-blind crossover design. In order to reduce the influence of the measuring equipment, we utilized a noninvasive computerized technique to measure respiratory variables. Both drugs caused equal changes in breathing pattern with a decrease in tidal volume, an increase in respiratory rate and an unaltered minute ventilation. These alterations in breathing pattern were associated with CO2 retention. Respiratory changes were mainly induced by the first injection of either drug. Despite increased plasma drug concentrations, subsequent doses did not cause further changes in respiratory variables except for an increase in PCO2 after the second dose of midazolam. The clinical significance of these changes in PaCO2 in otherwise healthy individuals is probably limited. The duration of the subjective sensation of sedation was longer after diazepam than after midazolam.     

Estimated ultraviolet doses to psoriasis patients during climate therapy

Background/purpose: Psoriasis is a chronic inflammatory disease affecting about 2–3% of the population. Sun exposure has a positive effect on most lesions, but ultraviolet (UV) radiation also constitutes a carcinogenic potential. Climate therapy is frequently used to treat patients, with the consequence that they may receive high doses of UV. This paper explores UV doses to patients treated in Gran Canaria.
Methods: Patient UV doses have been estimated for 20 psoriasis patients during a 15-day climate therapy study and compared with the predetermined exposure schedule and doses reported from other studies. Estimates were based on UV measurements and the patients' diaries with information on the time spent in the sun.
Results: On the first day of exposure, the patients received on average 5.1 standard erythema doses (SED) estimated to the skin. The average dose for the 15-day study was 166 SED (250 SED for a regular 3-week treatment period). We found no significant correlation between the reduction in psoriasis area severity index scores and UV doses.
Conclusion: The UV doses were higher than if they had followed the prescribed exposure schedule and also higher than those reported from other climate therapy studies. It seems beneficial to focus on following the prescribed exposure schedule.     

Dynamic aspects on acute tolerance to hexobarbital evaluated with an anesthesia threshold

Induction of acute tolerance was studied with hexobarbital in male rats. A threshold technique utilizing an EEG-criterion consisting of a burst suppression of 1 second or more (the SS) was used both to induce and maintain anesthesia. Hexobarbital was infused with an optimal dose rate of 15 mg/kg/min. The infusion was stopped at the criterion and restarted when no SS had been seen for 1 min. The doses of hexobarbital needed to maintain anesthesia were fairly constant around 3.5 mg/kg/min up to durations of 120 min which indicates that redistribution of hexobarbital is of minor importance in the present experiments. After different predetermined times of this fairly stable anesthesia, the rats were sacrificed, and concentrations in the cortex of the brain were determined with a HPLC-method. Maximal induction of acute tolerance was seen as a 45 percent increase in cortex concentration after 60 min of anesthesia, but already after 10 min a slight acute tolerance was recorded.     

131I治疗甲亢Graves病剂量效应研究

目的 研究^131I治疗甲亢Graves病的合适剂量。方法 40例既往未接受^131I治疗甲亢Graves病患者，随机接受以下四种^131I治疗剂量计算方法。固定低剂量111MBq(3mCi)、固定高剂量222MBq(6mCi)、根据24h摄碘率调节后低剂量，1．85MBq(50μCi)／g甲状腺、根据24h摄碘率调节后高剂量3．70MSq(100μCi)／g甲状腺。随访评估以下临床结果：需要再次^131I治疗的甲亢、须长期服用甲状腺素的甲减、甲状腺功能正常。结果 各治疗组平均剂量相似，临床结果亦无显著差异。结论 用固定剂量简化了治疗程序，节约了治疗费用，值得推广。     

Cardio-Respiratory Toxicity of Propoxyphene and Norpropoxyphene in Conscious Rabbits*

Abstract The toxic effects of α-d-propoxyphene (P) and its primary metabolite α-d-norpropoxyphene (NP) were compared by intravenous infusions (100 min.) of equimolar doses of P and NP (80 μmol/kg equivalent to 30 mg/kg P HCl) in conscious rabbits. During P infusion severe respiratory depression and convulsions were seen in all the animals, and six of the nine animals died. During NP infusion, however, only minimal respiratory depression was seen and all the animals survived. Considerable prolongation of the QRS complex and cardiac arrhythmias like intermittent A-V block and ventricular extrasystoles were seen in the ECG during both P and NP infusion, while the arterial blood pressure was unchanged. In P injection experiments (6 mg/kg P HC1), ECG changes preceded reduction in respiratory rate and during NP infusion only minor changes were seen in arterial blood gases, demonstrating that the ECG changes produced by P and NP are independent of respiratory depression. The ECG changes were found to be similar to those reported in quinidine intoxication. The QRS prolongation was markedly correlated with plasma concentrations during and after P and NP infusions. The results of the present investigation favour the hypothesis that the contribution of NP to the toxicity of oral P overdosage in man is ascribed to its cardiotoxic action whereas P is responsible for the CNS toxicity (respiratory depression and convulsions) as well as cardiotoxicity.     

Role of Alternaria and Penicillium spores in the pathogenesis of asthma

The ability to harvest spore-rich isolates of molds permitted quantitative studies of their role in the pathogenesis of asthma. Alternaria and Penicillium were selected as examples of ubiquitous molds that readily induce IgE antibodies and are of contrasting sizes. Extracts from those spores were prepared for skin tests and aerosol bronchial challenges. Intact spores were used in the same subjects in bronchial challenges delivered by a Spinhaler. Seven patients with a history of mild asthma received a total of 16 bronchial challenges with the mold to which they had been sensitized. Provocative doses in spore equivalents for a 35% drop in SGaw, 20% drop in FEV1, or 25% drop in PEFR were sought for each challenge. Density dependence-flow rates were also determined. Environmental spore survey data were obtained and compared with the challenge doses for these spores. It was found that immediate-type asthma was readily provoked by both whole spores and by their extracts, in some subjects fewer intact than extracted spores were required, delayed-type asthma occurred only after whole spore challenges, SGaw was the most sensitive and equally specific of the pulmonary function tests, and provocative doses of spore equivalents were within natural exposure ranges. The study confirmed that Alternaria and Penicillium spores in relatively natural states and numbers were potent immunopathogens for asthma.     

Haloperidol in large doses reduces the cataleptic response and increases noradrenaline metabolism in the brain of the rat

The neurochemical basis for the clinical observation that some patients receiving a large dose of haloperidol exhibit no extrapyramidal side effects was investigated in rats. Haloperidol at doses of 1, 2.5, 5, 7.5 and 10 mg/kg (i.p.) caused a dose-dependent decrease in the duration of catalepsy. Haloperidol at a dose of 10 mg/kg induced catalepsy lasting for only 20% of that obtained with 1 mg/kg. Haloperidol decreased the content of noradrenaline in the frontal cortex and thalamus in a dose-dependent manner, while the content of 3-methoxy-4-hydroxyphenylglycol (MHPG) showed a dose-dependent increase in the same areas of the brain. Thus, there was an inverse relationship between the duration of catalepsy and the ratio of 3-methoxy-4-hydroxyphenylglycol to noradrenaline in the frontal cortex or thalamus. The concomitant administration of 20 mg/kg of phenoxybenzamine with 10 mg/kg of haloperidol induced a long-lasting catalepsy. The result may indicate that the increased metabolism of noradrenaline by large doses of haloperidol was not secondary to the blocking of dopaminergic receptors. In contrast, haloperidol caused a dose-dependent decrease in the content of homovanillic acid and 3,4-dihydroxyphenylacetic acid in the striatum and mesolimbic area. These results indicate that noradrenergic hyperfunction in the frontal cortex or thalamus induced by large doses of haloperidol may reduce the cataleptogenic effect of the drug via indirect stimulation of a dopaminoceptive neuron in the striatum or mesolimbic area.