芳冰鼻吸剂对大鼠镇静助眠的药效研究与评价

目的：开展芳冰鼻吸剂对大鼠镇静助眠的药效研究,评价其可能的作用机理。方法：采用改良多平台水环境法造模。观察大鼠造模前后行为、体重、血常规等变化,并采用ELISA测定给药后大鼠血清、海马区5-HT、DA、NA的含量变化。结果：睡眠剥夺后给予药物治疗,低剂量组可显著缩短大鼠入睡时间,同时与环境对照组比较,造模后大鼠血清中的5-HT 及海马中的DA含量均降低,中剂量组血清中DA及NA的含量明显低于阳性对照组;与模型组比较,环境对照组、阳性对照组和高剂量组海马中DA的含量显著增加。结论：芳冰鼻吸剂具有较好的镇静助眠的疗效,其作用机理主要是通过升高大鼠血清中5-HT、NA的含量,降低海马中NA含量来达到镇静助眠的功效。     

Utilization of analgesics, sedatives, and pain scores in infants with a prolonged hospitalization: A prospective descriptive cohort study

Aim

Describe the utilization of analgesic and sedative medications and documentation of pain scores in a cohort of critically ill infants in a neonatal intensive care unit.

Method

A prospective, longitudinal, cohort study of infants with a predicted length of stay ≥28 days. Dosages and routes of administration of analgesic and sedative medications and documentation of pain scores were collected on a daily basis.

Results

55 infants were enrolled into the study. Oral sucrose was administered to all 55 infants, 51 infants (93%) were administered enteral acetaminophen and 50 (91%) infants were administered morphine during their hospitalization. Sedatives were administered to 42 infants (76%); 36 (65%) were administered chloral hydrate and 32 (58%) were administered intravenous midazolam. With the exception of the first week of admission, when there was highest utilization of opioids and lower use of sucrose, acetaminophen and sedatives, the pattern of administration of analgesic and sedative agents remained relatively constant throughout the hospitalization. Pain scores were documented for 36 (65%) infants during their hospitalisation, however for these 36 infants, pain scores were infrequently recorded.

Conclusion

There was substantial and varied analgesic and sedative use in this cohort of infants, yet infrequent documentation of pain assessment scores. These practices highlight important clinical implications for sick infants requiring careful consideration of pain and distress management.     

咪达唑仑和丙泊酚镇静用于结肠镜检查的比较(前瞻性随机对照研究)

目的借助脑电双频指数（bispectral index,BIS）监测,随机前瞻性比较咪达唑仑和丙泊酚用于结肠镜检查的镇静深度、镇静效果和安全性。方法接受无痛结肠镜检查患者60例,用随机数字表分为3组,每组20例：Ⅰ组,咪达唑仑首次剂量0．06mg／kg;Ⅱ组,丙泊酚首次剂量1．0mg／kg;Ⅲ组,丙泊酚首次剂量1．5mg／kg。于丙泊酚给药后1min、眯达唑仑给药后2min进镜。病人出现不良反应且影响操作时追加丙泊酚20～30mg。监测血压、心率、血氧饱和度值（SpO,）、BIS值,以BIS值反映镇静深度。结果进镜时镇静深度由浅到深依次为Ⅰ、Ⅱ、Ⅲ组（F=25．40,P=0．000）,检查中的BIS最低值无统计学差异。进镜时三组患者均无不良反应,丙泊酚追加剂量Ⅰ组明显少于Ⅱ、Ⅲ组,清醒时间Ⅰ组明显长于Ⅱ、Ⅲ组。Ⅰ组有1例心率〈60次／min,Ⅲ组有1例血压〈90／60inmHg,均为一过性,三组SpO2均大于90％。结论咪达唑仑0．06mg／kg和丙泊酚1．0mg／kg作为首次剂量用于结肠镜检查,检查中适时追加丙泊酚镇静深度,镇静效果满意且安全。     

氯甲西泮的合成工艺研究

目的 对氯甲西泮的合成工艺进行研究.方法 以2-氨基-2′,5-双氯二苯甲酮为原料,经过成肟反应、扩环反应、甲基化反应、乙酰化反应、碱解反应,再通过两次乙醇精制得到氯甲西泮成品.结果与结论 目标化合物的结构经核磁共振氢谱(1H-NMR)、核磁共振碳谱(13C-NMR)、质谱(MS)等确定,总收率达到20%.该合成工艺原料易得,操作简单,各步中间体质量收率稳定,适用于大工业生产.     

红景天镇静催眠作用的实验研究

目的探讨中药红景天(Rhodiola rosea)的镇静催眠作用。方法取雄性SD大鼠30只,设正常对照组(不灌服任何药物)、阴性对照组(灌服羧甲基纤维素钠溶液)、地西泮组(灌服地西泮溶液)、红景天低剂量组(灌服低剂量红景天)、红景天中剂量组(灌服中剂量红景天)和红景天高剂量组(灌服高剂量红景天),每组5只。灌服药物1h后,各组动物按照55mg/kg的剂量腹腔注射0.1%戊巴比妥钠溶液,记录每只大鼠从腹腔注射戊巴比妥钠到翻正反射消失的时间为睡眠潜伏期,翻正反射消失的到翻正反射开始出现的时间为睡眠时间,观察灌服不同剂量红景天对大鼠睡眠潜伏期及睡眠时间的影响。结果与正常对照组(3.24±0.22、93.96±2.25)相比,灌服中剂量及高剂量的红景天可以缩短大鼠的睡眠潜伏期(2.42±0.33,P<0.01;2.16±0.13,P<0.01),亦可延长大鼠的睡眠时间(102.54±3.15,P<0.05;107.10±7.75,P<0.05)。结论中剂量及高剂量的的红景天对大鼠具有镇静催眠作用。     

Dexmedetomidine use and mortality in mechanically ventilated patients with severe burns: A cohort study using a national inpatient database in Japan

BackgroundDexmedetomidine is an alpha 2-adrenergic receptor agonist. Apart from its sedative effects, dexmedetomidine can potentially reduce mortality through its anti-inflammatory effect. However, the impact of dexmedetomidine on in-hospital outcomes of patients with severe burns remains unclear. Therefore, we aimed to elucidate the association between dexmedetomidine use and mortality in mechanically ventilated patients with severe burns, using a Japanese nationwide database of in-hospital patients.MethodsWe included adults with severe burns (burn index ≥ 10) who were registered in the Japanese Diagnosis Procedure Combination national inpatient database from 2010 to 2018, started mechanical ventilation within 3 days of admission, and received any sedative drug (dexmedetomidine, midazolam, or propofol). One-to-one propensity score matching was performed between patients who received dexmedetomidine on the day of mechanical ventilation initiation (dexmedetomidine group) and those who did not receive dexmedetomidine (control group). The primary outcome was all-cause 30-day in-hospital mortality. Secondary outcomes were length of hospital stay and duration of mechanical ventilation in patients and survivors.ResultsEligible patients (n = 1888) were classified into the dexmedetomidine group (n = 371) or the control group (n = 1517). After one-to-one propensity score matching, we compared 329 patients from both groups. No significant difference was observed in the 30-day mortality between patients in the dexmedetomidine and control groups (22.8% vs. 22.5%, respectively; odds ratio, 1.02; 95% confidence interval, 0.71–1.46). Moreover, there were no significant differences between patients in the dexmedetomidine and control groups in terms of the length of hospital stay or the duration of mechanical ventilation.ConclusionsWe found no significant association between dexmedetomidine use and in-hospital outcomes (mortality, length of hospital stay, and length of mechanical ventilation) in mechanically ventilated patients with severe burns. Dexmedetomidine use may not improve the aforementioned outcomes; therefore, its selection should be based on the patient’s general condition and the target level of sedation.     

Alfentanil/promazine versus meperidine/promazine as a sedative regimens during local analgesia for cataract operation

The influence of two intravenous (IV) sedative regimens on intra-ocular pressure (IOP) was investigated in conjunction with retrobulbar local analgesia. Forty patients of either sex, and similar age with body weight within 40–90 kg were allocated equally and randomly to two groups: Group A (alfentanil/promazine) and group M (meperidine/promazine). Measurement of IOP, systolic pressure, pulse rate, respiratory rate, PaCO₂, PaO₂ and O₂ saturation were made before operation, after premedication, after IV sedation and post-operatively. In the Alfentanil group there was significantly stronger decrease of IOP (p < 0.001). In group A the IOP dropped from 18.1 ± 3.2mm Hg to 10.3 ± 2.7mm Hg, i.e. 43%, while in group M the reduction IOP was from 17.6 ± 3.5 mm Hg to 12.6 ± 1.9 mm Hg, i.e. 28.4%. Meperidine caused a significant increase in PaCO₂ (4.2 ± 0.3 mm Hg), however this increase was not sufficient to cause the IOP alterations. The oxygen saturation was lower in group M (decreased by 1.5 ± 1% in group M versus decrease by 1.0 ± 1.2% in group A). Cardiovascular parameters were more stable in group A. In conclusion the alfentanil regimen produced a better reduction of the IOP with excellent sedation, operative condition and least anaesthetic side effects.     

环泊酚和丙泊酚在老年患者纤维结肠镜治疗中镇静效果比较

目的 比较环泊酚和丙泊酚在老年患者纤维结肠镜治疗中的镇静效果。

方法 选择行纤维结肠镜治疗的老年患者330例,男179例,女151例,年龄65～84岁,BMI 18～29 kg/m²,ASA Ⅰ或Ⅱ级。随机分为两组：环泊酚组（C组,n=160）和丙泊酚组（P组,n=162）。C组麻醉诱导给予环泊酚0.4 mg/kg,麻醉维持泵注环泊酚1～1.5 mg·kg^-1·h^-1,P组麻醉诱导给予丙泊酚2 mg/kg,麻醉维持泵注丙泊酚4～6 mg·kg^-1·h^-1。记录镇静成功率、诱导时间、完全清醒时间,麻醉诱导前（T0）、进镜时（T1）、进镜后10 min（T2）、完全清醒时（T3）时SBP、DBP、BIS,术中心动过缓、低血压、低氧血症、注射痛、体动,气道干预、术中追加镇静和术后恶心呕吐发生情况。

结果 与P组比较,C组T2时SBP、DBP明显升高（P<0.05）,T2和T3时BIS明显降低（P<0.05）,术中低氧血症和注射痛发生率明显降低（P<0.05）。两组镇静成功率、诱导时间、完全清醒时间,术中心动过缓、低血压、体动发生率,气道干预、术中追加镇静和术后恶心呕吐发生率差异无统计学意义。

结论 与丙泊酚比较,环泊酚在老年患者纤维结肠镜治疗中有同样的镇静效果,且有着更低的低氧血症和注射痛发生率,值得临床推广。     

右美托咪定用于腰硬联合麻醉下肢手术的镇静效果及剂量探讨

摘 要 目的： 评估并比较在腰硬联合麻醉下肢手术中应用不同剂量右美托咪定的镇静效果。方法: 选择120例拟择期实施腰硬联合麻醉下肢手术的患者,随机分为不同剂量右美托咪定镇静组（0.25 μg·kg^-1剂量组为D₅组,0.5μg·kg^-1为D₂组,0.75μg·kg^-1剂量组为D₃组）、咪达唑仑镇静组（M 组）和 生理盐水空白对照组（C组）,每组24例。记录各组给药前即刻（T₃）、给预充负荷量结束即刻（T₁）,预充负荷量后10 min（T₂）,30 min（T₃）,60 min（T₄）,90 min（T₅）和术毕（T₆）时的心率（HR）、平均动脉压（MAP）、麻醉意识深度指数（CSI）及Ramsay 镇静评分;术后24 h 随访,评估患者用药后至术毕期间的遗忘程度。结果: 与T₃比较,D₅～D₃及M组在T₃～T₅时HR均显著降低（P<0.05）,D₅、D₃组在T₃~T₅时HR 显著低于C组（P<0.05）;与T₃比较,D₅～D₃及M组在T₁、T₂时MAP均显著升高（P<0.05）,D₅、D₃组在T₃、T₄时MAP 与C组比较有显著差异（P<0.05）;D₅～D₃组及M组在T₂～T₅时的CSI明显低于T₃时（P<0.05）,D₅～D₃组及M组的CSI均分别低于同一时间点的C组（P<0.05）;D₅～D₃组及M组在T₃～T₅时的Ramsay评分明显高于T₃时（P<0.05）,D₅~D₃组及M组在T₃～T₅的Ramsay评分均高于C组（P<0.05）;术后24 h回访,D₅～D₃组及M组患者对手术过程的遗忘程度I级例数明显少于C组（P<0.05）,Ⅲ级例数明显多于C组（P<0.05）。结论: 对于腰硬联合麻醉下肢手术患者,术前10 min内给予右美托咪定负荷量0.5μg·kg^-1后以0.5μg·kg^-1·h^-1的速度恒速维持,具有较好的镇静效果,对心率、血压无明显影响,可作为临床腰硬联合麻醉的适宜镇静剂量。     

右美托咪定在功能神经外科手术麻醉中的应用效果研究

目的探讨右美托咪定在功能神经外科手术麻醉中的应用效果。方法选取2013-02—2014-02于我院行外科手术的患者共150例,按入院顺序号随机将患者分为观察组与对照组各75例。在手术结束前30min,观察组微量泵注入右美托咪定0.4μg/kg。对照组注入等容量的0.9%氯化钠溶液。比较2组静注右美托咪定(或生理盐水)10min后的Ramsay镇静评分,记录术中血流动力异常情况,苏醒时间、清醒拔管时间及不良反应发生情况等。结果观察组静注右美托咪定10min后的Ramsay镇静评分为(2.7±0.6)分,苏醒时间和拔管时间分别为(25.5±12.4)min、(30.4±5.6)min,显著好于对照组(t=5.269、4.735、4.381,P0.05)。观察组切口缝合时、术后1h、术后2h的脑氧摄取率及动脉-颈内静脉球部血样差均显著好于对照组(P0.05)。观察组不良反应发生率为1.33%,显著低于对照组(χ~2=9.058,P0.05)。结论右美托咪定是功能外科手术麻醉的较佳选择,其在临床上的应用具有美好的前景,值得大力推广。