盐酸戊乙奎醚作为全麻术前用药的安全性研究

目的对比研究盐酸戊乙奎醚与阿托品作为全麻术前用药的安全性。方法40例拟在全麻下行择期手术的患者,美国麻醉医师(ASA)分级Ⅰ～Ⅱ级,随机均分为4组,Ⅰ、Ⅱ、Ⅲ组分别肌内注射盐酸戊乙奎醚0．005、0．010和0．014 mg／kg,Ⅳ组肌内注射阿托品0．01 mg／kg。分别记录患者进入手术室后的基础口干程度视觉模拟评分和基础唾液分泌量,以及在注射药物30 min后的相应变化。记录各组患者注射药物后30、45、60和120 min的心率、平均动脉压、脉搏血氧饱和度和心电图的变化。结果肌内注射0.005和0．010 mg／kg盐酸戊乙奎醚后30 min唾液的分泌量无明显变化(P值均>0．05),而肌内注射0．014 mg／kg盐酸戊乙奎醚能明显抑制唾液分泌(P<0．01),平均抑制程度为56％。Ⅳ组注射阿托品后30 min的心率明显增快(P<0．05),Ⅰ、Ⅱ、Ⅲ组的心率无明显变化(P值均>0．05)。结论盐酸戊乙奎醚可以替代阿托品作为全麻术前用药,且特别适用于需要避免心动过速的患者。     

长托宁在颈、颌面部肿瘤手术前应用的临床观察

 目的 观察长托宁在颈、颌面部肿瘤手术前应用对腺体分泌的临床效果。方法 选择60例颈、颌面部肿瘤手术患者，术前30min肌注长托宁1mg。常规气管插管全身麻醉。观察插管、拔管及术后患者口腔、上呼吸道分泌物量及镇静作用。结果 插管、拔管时患者口腔、上呼吸道分泌物均减少，其中48例气管插管时口腔无明显分泌物；54例术毕气管拔管时口腔分泌物明显减少。麻醉苏醒时大部分病人较安静，无明显烦躁。术后不需追加抗胆碱药，90％患者不需追加镇静药。结论 长托宁对M受体的亚型具有高度选择性、强大的腺体抑制作用和一定的中枢镇静作用，更适用颈、颌面部肿瘤手术患者术前用药。     

戊乙奎醚预处理对内毒素性脑损伤大鼠CD14和TLR4mRNA的影响

【摘要】 目的 探讨盐酸戊乙奎醚预处理对内毒素性脑损伤大鼠CD14和TLR4mRNA的影响。方法 将40只Wistar大鼠随机分为生理盐水对照组（NS组）,内毒素性脑损伤模型组（LPS组）,低剂量戊乙奎醚干预组（PL组）,高剂量戊乙奎醚干预组（PH组）4组,每组各10只,实验大鼠注射内毒素4h后处死,留取脑组织标本。光镜下观察脑组织病理变化,RT PCR法检测CD 14和TLR4 mRNA表达,ELISA法测定TNF a的含量。结果 光镜下LPS组脑细胞损伤严重,PL组、PH组与LPS组对比脑损伤减轻。与NS组相比较,LPS组、PL组及PL组脑组织TLR4和CD14 mRNA表达水平均升高（P＜005）;与LPS组比较,PL组和PH组脑组织TLR4和CD14 mRNA表达水平均降低（P＜005）;与PL组比较,PH组TLR4和CD14 mRNA表达水平降低（P＜005）。与NS组相比较,TNF α含量升高（P＜005）;与LPS组比较,PL组和PH组脑组织TNF α含量降低（P＜005）;与PL组比较,PH组TNF α降低（P＜005）。结论 盐酸戊乙奎醚预处理可减轻大鼠内毒素的脑损伤,机制可能与降低CD14及TLR4mRNA的表达,阻断炎症信号传导通路,减轻炎症介质的释放有关。     

Effect of penehyclidine hydrochloride on β-arrestin-1 expression in lipopolysaccharide-induced human pulmonary microvascular endothelial cells

β-arrestins are expressed proteins that were first described, and are well-known, as negative regulators of G protein-coupled receptor signaling. Penehyclidine hydrochloride (PHC) is a new anti-cholinergic drug that can inhibit biomembrane lipid peroxidation, and decrease cytokines and oxyradicals. However, to date, no reports on the effects of PHC on β-arrestin-1 in cells have been published. The aim of this study was to investigate the effect of PHC on β-arrestin-1 expression in lipopolysaccharide (LPS)-induced human pulmonary microvascular endothelial cells (HPMEC). Cultured HPMEC were pretreated with PHC, followed by LPS treatment. Muscarinic receptor mRNAs were assayed by real-time quantitative PCR. Cell viability was assayed by the methyl thiazolyl tetrazolium (MTT) conversion test. The dose and time effects of PHC on β-arrestin-1 expression in LPS-induced HPMEC were determined by Western blot analysis. Cell malondialdehyde (MDA) level and superoxide dismutase (SOD) activity were measured. It was found that the M₃ receptor was the one most highly expressed, and was activated 5 min after LPS challenge. Furthermore, 2 μg/mL PHC significantly upregulated expression of β-arrestin-1 within 10 to 15 min. Compared with the control group, MDA levels in cells were remarkably increased and SOD activities were significantly decreased in LPS pretreated cells, while PHC markedly decreased MDA levels and increased SOD activities. We conclude that PHC attenuated ROS injury by upregulating β-arrestin-1 expression, thereby implicating a mechanism by which PHC may exert its protective effects against LPS-induced pulmonary microvascular endothelial cell injury.     

不同药物治疗有机磷农药中毒的临床比较

目的:探讨长托宁抢救有机磷农药中毒(AOPP)的安全有效性。方法:将120例纳入研究的AOPP患者随机分成两组:观察组60例,应用长托宁治疗;对照组60例,应用阿托品治疗。比较两组的解毒恢复效果及不良反应。结果:观察组AOPP患者的总有效率93.33%,对照组AOPP患者的总有效率80.00%,观察组的疗效明显高于对照组(P<0.05);观察组AOPP患者的M样症状持续时间(1.70±0.45)h、N样症状持续时间(6.38±2.09)h和中枢神经系统症状持续时间(12.50±3.22)h均显著性短于对照组的(2.31±0.52)h、(10.25±4.88)h、(18.37±3.16)h(P<0.05);观察组AOPP患者所需的意识障碍恢复时间(23.46±11.30)h、Ch E活性恢复时间(46.81±13.27)h、住院天数(7.03±2.85)d均显著性少于对照组的(40.58±12.35)h、(63.50±18.94)h、(11.52±3.06)d(P<0.05);观察组的AOPP患者出现心动过速、躁动、视力模糊、尿潴留等不良反应的概率均明显低于对照组(P<0.05)。结论:长托宁治疗AOPP比阿托品更安全有效。     

盐酸戊乙奎醚对肺叶切除术患者单肺通气时血清炎性因子和气道黏蛋白MUC5AC表达的影响

目的 评估盐酸戊乙奎醚对肺叶切除术患者单肺通气（OLV）时血清炎性因子和气道黏蛋白MUC5AC表达的影响。方法 择期行胸腔镜下肺叶切除术患者48例,男28例,女20例,年龄40~75岁,BMI 18~25 kg/m²,ASA Ⅰ或Ⅱ级,采用随机数字表法分为两组：对照组（C组）和盐酸戊乙奎醚组（P组）,每组24例。P组于麻醉诱导前10 min静脉注射盐酸戊乙奎醚0.01 mg/kg,C组于相同时点静脉注射等容量生理盐水3 ml。分别于OLV前（T1）、OLV 60 min（T2）、术毕（T3）、术后24 h（T4）采集中心静脉血,采用ELISA法测定血清IL-1β、IL-6、TNF-α、NF-κB浓度;肺叶切除后即刻取肺组织,HE染色观察病理学结果;采用Image-Pro Plus图像分析软件进行图像分析,取平均积分光密度值表示气道黏蛋白MUC5AC含量。记录术后72 h内肺炎、肺不张、低氧血症等并发症及住院时间。结果 与T1时比较,T2—T4时两组血清中IL-1β、IL-6、TNF-α、NF-κB浓度明显升高（P＜0.05）。与C组比较,T2—T4时P组血清中IL-1β、IL-6、TNF-α、NF-κB浓度明显降低（P＜0.05）,肺组织病理损伤明显减轻,气道黏蛋白MUC5AC含量明显下降（P＜0.05）。两组术后72 h内肺炎、肺不张、低氧血症等并发症及住院时间差异均无统计学意义。结论 盐酸戊乙奎醚可下调肺叶切除术患者OLV时血清炎性因子和气道黏蛋白MUC5AC的表达,减轻炎症反应和肺损伤。     

盐酸戊乙奎醚注射液联合阿托品治疗急性有机磷中毒的效果观察

目的 探讨盐酸戊乙奎醚注射液联合阿托品治疗急性有机磷中毒的临床效果.方法 选取本院收治的42例急性有机磷中毒患者,随机均分为对照组和观察组,对照组患者给予阿托品治疗,观察组患者给予盐酸戊乙奎醚注射液联合阿托品治疗.比较两组患者的中毒症状维持时间、胆碱酯酶（ChE）恢复时间、用药次数、住院时间、死亡率和不良反应发生率的差异.结果 观察组患者中毒症状维持时间、ChE恢复时间、用药次数和住院时间均显著短于对照组（P＜0.05）;观察组死亡率为4.8％,与对照组的14.3％比较,差异无统计学意义（P＞0.05）;观察组心率增快、视力模糊和尿潴留等不良反应发生率均显著低于对照组（P＜0.05）.结论 盐酸戊乙奎醚注射液联合阿托品治疗急性有机磷中毒效果确切.     

长托宁在老年ERCP麻醉前用药的临床观察

目的：探讨长托宁作为老年患者ERCP麻醉前用药的可行性,临床效果及安全性。方法：选取2009年5月-2013年2月本院90例在静脉麻醉下行ERCP手术老年患者,随机数字表法分为三组,长托宁组30例,阿托品组30例,生理盐水组30例,三组分别以长托宁,阿托品,生理盐水作为麻醉前用药。比较三组患者在麻醉给药后不同时间点SBP、DBP、HR以及唾液分泌量的变化,并比较三组患者在术中术后出现的不良反应情况。结果：三组患者血压变化均平稳,长托宁组患者心率变化较阿托品组平稳,和生理盐水组比较变化无统计学差异,长托宁组患者唾液分泌量明显少于阿托品及生理盐水组。阿托品组患者在给药前后心率变化差异有统计学意义（P〈0.05）。结论：长托宁在应用于老年ERCP术前麻醉时,对老年患者的循环血流动力学影响小,在抗胆碱作用时比阿托品效果更持续,并能够有效的控制围术期间呼吸道分泌物,是一种更为理想的老年患者麻醉前用药。     

Role of penehyclidine in acute organophosphorus pesticide poisoning

BACKGROUND:Penehyclidine is a newly developed anticholinergic agent.We aimed to investigate the role of penehyclidine in acute organophosphorus pesticide poisoning(OP)patients.METHODS:We searched the Pubmed,Cochrane library,EMBASE,Chinese National Knowledge Infrastructure(CNKI),Chinese Biomedical literature(CBM)and Wanfang databases.Randomized controlled trials(RCTs)recruiting acute OP patients were identifi ed for meta-analysis.Main outcomes included cure rate,mortality rate,time to atropinization,time to 60%normal acetylcholinesterase(AchE)level,rate of intermediate syndrome(IMS)and rate of adverse drug reactions(ADR).RESULTS:Sixteen RCTs involving 1,334 patients were identifi ed.Compared with the atropineor penehyclidine-alone groups,atropine combined with penehyclidine significantly increased the cure rate(penehyclidine+atropine vs.atropine,0.97 vs.0.86,RR 1.13,95%CI[1.07–1.19];penehyclidine+atropine vs.penehyclidine,0.93 vs.0.80,RR 1.08,95%CI[1.01–1.15])and reduced the mortality rate(penehyclidine+atropine vs.atropine,0.015 vs.0.11,RR 0.17,95%CI[0.06–0.49];penehyclidine+atropine vs.penehyclidine,0.13 vs.0.08,RR 0.23,95%CI[0.04–1.28]).Atropine combined with penehyclidine in OP patients also helped reduce the time to atropinization and AchE recovery,the rate of IMS and the rate of ADR.Compared with a single dose of atropine,a single dose of penehyclidine also signifi cantly elevated the cure rate,reduced times to atropinization,AchE recovery,and rate of IMS.CONCLUSION:Atropine combined with penehyclidine benefi ts OP patients by enhancing the cure rate,mortality rate,time to atropinization,AchE recovery,IMS rate,total ADR and duration of hospitalization.Penehyclidine combined with atropine is likely a better initial therapy for OP patients than atropine alone.