有机磷中毒中间综合征使用呼吸机治疗的护理体会

有机磷中毒中间综合征(IMS)是急性有机磷农药中毒(AOPP)的主要死亡原因之一,其原因主要发生于胆碱能危象高峰之后和诱发神经毒性之前的综合征,临床上以肌无力最为突出表现,涉及部位除屈肌、肢体近端肌、颅脑神经所支配的肌肉外,并可累及呼吸肌,引起中枢性和周围性呼吸衰竭。我科2003年元月至2006年7月使用呼吸机机械通气(MV)方法治疗16例IMS患者,由于护理措施及时,使患者平稳渡过了呼吸肌麻痹阶段,取得较好的治疗效果。现将护理过程及体会报告如下。资料与方法1.一般资料本组16例中男性5例,女性11例,年龄19-40岁,均为口服中毒。其中乐…     

水中贾第鞭毛虫和隐孢子虫检测方法的探讨

本研究参考EPA1623的三个关键步骤:原虫过滤浓缩→分离→染色鉴定,对原虫的检测方法在过滤、浓缩和染色等过程中进行了改进,并用膜过滤-梯度分离-Giem Sa染色、膜过滤-IMS-GiemSa染色及囊过滤-IMS-IFA(EPA1623)三种检测方法对原虫的染色特征,形态结构和回收率的检测进行了方法学的探讨和比较分析。结果显示:三种检测方法G的回收率均在EPA规定的质控范围内,而膜-梯度分离-Giemsa和膜-IMS-Giemsa的C的回收率略低于EPA质控范围。但将EPA方法中的滤囊过滤改成滤膜过滤,免疫荧光染色改成GiemSa染色,能减少成本费用约60%-90%,而且实验条件要求较低,可以用于自来水出厂水和污水(不经膜过滤)中原虫的筛选。     

Acute Combined Revascularization in Acute Ischemic Stroke with Intracranial Arterial Occlusion: Self-expanding Solitaire Stent during Intravenous Thrombolysis

PurposeTo investigate the safety and efficacy of the self-expanding Solitaire stent used during intravenous thrombolysis (IVT) for intracranial arterial occlusion (IAO) in acute ischemic stroke (AIS).Materials and MethodsConsecutive nonselected patients with AIS with IAO documented on computed tomographic angiography or magnetic resonance angiography and treated with IVT were included in this prospective study. Stent intervention was initiated and performed during administration of IVT without waiting for any clinical or radiologic signs of potential recanalization. Stroke severity was assessed by National Institutes of Health Stroke Scale (NIHSS), and 90-day clinical outcome was assessed by modified Rankin scale (mRS), with a good outcome defined as an mRS score of 0–2. Recanalization was rated by thrombolysis in cerebral infarction (TICI) scale.ResultsFifty patients (mean age, 66.8 y ± 14.6) had a baseline median NIHSS score of 18.0. Overall recanalization was achieved in 94% of patients, and complete recanalization (ie, TICI 3 flow) was achieved in 72% of patients. The mean time from stroke onset to maximal recanalization was 244.2 minutes ± 87.9, with a median of 232.5 minutes. The average number of device passes was 1.5, with a mean procedure time to maximal recanalization of 49.5 minutes ± 13.0. Symptomatic intracerebral hemorrhage occurred in 6% of patients. The median mRS score at 90 days was 1, and 60% of patients had a good outcome (ie, mRS score 0–2). The overall 3-month mortality rate was 14%.ConclusionsCombined revascularization with the Solitaire stent during IVT appears to be safe and effective in the treatment of acute IAO.     

124例健康成人吸气肌强度和耐力测定

本文测定了124例健康成人最大吸气压和最大持续吸气压,探讨吸气肌强度和耐力的分布及影响因素。发现最大吸气压和最大持续吸气压受年龄、体重和性别响影,吸气肌张力时间指数0.30可作为检测吸气肌疲劳的临界阈值。     

有创-无创序贯通气治疗急性有机磷中毒致中间期肌无力综合征

目的采用双水平气道正压通气(BiPAP)呼吸机经口/鼻罩正压通气,探讨在急性重度有机磷中毒(AOPP)致中间期肌无力综合征(IMS)有创机械通气后脱机过渡中的应用价值,并与传统方法比较。方法AOPP致IMS患者25例,均行有创机械通气,出现IMS控制窗后,分为常规治疗组(10例)和序贯治疗组(15例)。检测两组患者心肌酶学变化,上BiPAP呼吸机前、2h后测动脉血气,监测HR、BP、SpO2,并计算重新气管插管率。结果两组治疗后心肌酶(CK、CK-MB、AST、LDH)较治疗前均明显下降,有显著差异(P<0·01);序贯治疗组患者拔管前及拔管2h后生命体征及动脉血气分析比较差异无显著性(P>0·05);撤机后序贯治疗组在有创通气时间、总机械通气时间、住ICU/EICU时间明显缩短(P<0·05);VAP的发生率两组相似;序贯治疗组重新气管插管率明显低于对照组(P<0·05)。结论患者对BiPAP呼吸机耐受性好,能够改善AOPP致IMS的通气功能,并能使常规机械通气顺利脱机,减少重新插管率。     

Ion mobility spectrometry as a high-throughput technique for in vitro transdermal Franz diffusion cell experiments of ibuprofen

Rapid, low-cost and sensitive analytical methods are needed to analyse the large number of samples that are generated when investigating the absorption profile of drugs through the skin using Franz diffusion cell experiments (FDC). The goal of this study was to evaluate the potential of ion mobility spectrometry (IMS) for the quantitative analysis of active pharmaceutical ingredients (API) in transdermal research. Ibuprofen was used as a model drug and the optimal IMS parameters were determined using a Doehlert experimental design. To assess the usefulness of the IMS method, FDC experiments using human skin were conducted, covering a concentration range of 0.32-69.57μg/ml. The resulting analytical samples were analysed using IMS and subsequently compared to HPLC as a reference method. No significant differences were found between the results obtained using both analytical methods, with a mean skin permeability coefficient (K(p)) value of 0.013cm/h. The combination of fast detection times, sensitivity, low costs and easy maintenance of IMS instruments makes this technique an attractive alternative for HPLC in this type of experiments.     

Efficacy of Peripheral Interventional Radiologists Performing Endovascular Stroke Therapy Guided by CT Perfusion Triage of Patients

PurposeTo assess safety and efficacy of intraarterial mechanical thrombectomy for treatment of ischemic stroke in a community hospital by peripheral interventional radiologists employing computed tomography (CT) perfusion imaging for patient selection.Materials and MethodsForty patients, 11 men (27.5%) and 29 women (72.5%), were treated between February 2008 and October 2011. Eligible patients had a National Institutes of Health Stroke Scale (NIHSS) score greater than 8 and diagnosis of large-vessel ischemic stroke by head CT angiogram, and met previously reported CT perfusion imaging triage criteria.ResultsThe baseline NIHSS score was 18.0 ± 7.9 (range, 8–35). Sixteen patients (40%) had a baseline NIHSS score greater than 20. Symptom onset was unknown in five patients. Symptom onset to device time in the remaining 35 patients was 254.8 minutes ± 150.9 (range, 75–775 min). A total of 65% of patients showed thrombolysis in cerebral infarction (TICI) 2a, 2b, or 3 flow following the procedure. Symptomatic intracranial hemorrhage was seen in four patients (10.0%). At 90 days, 32 patients (80%) were alive and eight (20%) had died. The modified Rankin scale (mRS) score at 90 days was no more than 2 in 20 patients (50.0%). The mean mRS score at 90 days was 2.9 ± 2.0 (range, 0–6). NIHSS score at 90 days was 5.1 ± 6.1 (range, 0–24). In patients with successful recanalization (ie, TICI 2 or 3 flow), a good clinical outcome (ie, mRS score ≤ 2) was achieved in 65.3% of patients (mean, 2.4 ± 1.9; range, 0–6), and 90-day mortality rate was 15.4%, compared with 28.6% in patients with TICI 0/1 flow.ConclusionsPeripheral interventional radiologists who use CT perfusion imaging for patient triage can have good neurologic outcomes and provide sustainable, safe, and complete around-the-clock coverage for endovascular stroke treatment.     

Mitochondria and reactive oxygen and nitrogen species in neurological disorders and stroke: Therapeutic implications

Mitochondria represent both the main source and target of reactive oxygen and nitrogen species (RONS). In view of the large energy expenditure made by neurons during neurotransmission, an intact mitochondrial function is of paramount importance for the correct function of the brain. Accordingly, the search of therapeutic strategies against situations in which there is an abnormal brain function, such as neurological disorders and stroke, should be focused towards mitochondria. Here, we have reviewed the normal and abnormal mitochondrial bioenergetics and dynamics, highlighting the relevance that, for these processes in the brain RONS exert. Evidence suggests that disruption of mitochondrial bioenergetics and dynamics may have a critical role in the pathogenesis of these brain diseases. Drug therapies directed toward providing safer mitochondria are currently under both pre- and clinical investigations.