异丙酚复合枸橼酸芬太尼静脉麻醉在人工流产术中的应用

目的观察异丙酚复合枸橼酸芬太尼静脉麻醉用于无痛人工流产手术的临床效果。方法300例拟行无痛人工流产术的早孕妇女,随机分为Ⅰ组和Ⅱ组,各150例。Ⅰ组给予异丙酚＋枸橼酸芬太尼麻醉,Ⅱ组给予异丙酚。观察记录其术前、术中、术后的SBP、HR、RR、SpO2、镇痛效果和不良反应。结果Ⅰ组术中SBP、HR、SpO2均高于Ⅱ组（P〈0.05）,术中、术后RR低于Ⅱ组（P〈0.05）。2组均无明显不良反应。结论异丙酚复合枸橼酸芬太尼静脉麻醉用于人工流产术是一种安全的方法。     

无痛人流术的麻醉用药观察研究

目的探讨异丙酚、芬太尼、利多卡因联合用药无痛人流术中的安全性及有效性。方法ASAⅠ～Ⅱ级人工流产患者50例,随机分为Ⅰ、Ⅱ两组,每组25例,Ⅰ组单纯使用异丙酚,Ⅱ组用异丙酚联合芬太尼、利多卡因。观察两组患者的诱导时间、苏醒时间、离院时间、记录诱导前及诱导后2min,手术结束时,SBP、DBP、HR、SpO2的变化和两组患者的麻醉效果及并发症。结果两组年龄体重及手术时间比较无统计学差异（P〉0．05）,Ⅱ组诱导期异丙酚用量明显少于Ⅰ组（P〈0．01）。Ⅰ组诱导后2min—BP下降,HR减慢SpO2降低（P〈0．01）。Ⅱ组麻醉镇痛效果明显优于Ⅰ组。结论异丙酚联合芬太尼、利多卡因用于人工流产手术的麻醉安全有效镇痛效果好。     

不同联合用药在镇静无痛胃镜检查的效果研究

目的探讨联合应用异丙酚-芬太尼与咪唑安定-芬太尼在胃镜检查中的镇静镇痛效果和安全性。方法将胃镜检查者随机分为异丙酚-芬太尼(Ⅰ组),咪唑安定-芬太尼(Ⅱ组)和对照组,常规胃镜组,Ⅲ组)。观察记录各组受检者术中的反应、胃镜操作时间、麻醉药物作用时间,检查前中后BP、HR、SpO2,及术后问卷调查。结果Ⅰ、Ⅱ组术中不适反应少、100%舒适无痛苦(P<0.05)。Ⅲ组术中BP、HR显著增高,SpO2显著下降(P<0.01),而Ⅰ、Ⅱ组术中BP、HR及SpO2均一过性轻度下降(P<0.01)。与Ⅱ组比较Ⅰ组药物起效更快、苏醒及清醒时间更短、术中不适反应更少(P<0.01)。结论联合应用芬太尼-异丙酚及咪唑安定-异丙酚在镇静无痛苦胃镜检查中是舒适安全的,芬太尼-异丙酚联用起效更快、恢复时间更短、不适反应更少。异丙酚+芬太尼组合较适用于医院规模大、患者量大、有条件配备专职麻醉医师的内镜中心进行清醒镇静胃镜检查,对基层医院、患者量较少、无条件配备专职麻醉医师的医院咪唑安定+芬太尼组合是清醒镇静胃镜检查的更佳的方案     

异丙酚、咪唑安定、芬太尼联合应用于纤维结肠镜检查中的效果观察

目的比较异丙酚、咪唑安定和芬太尼不同配伍,对门诊纤维结肠镜患者的镇静、镇痛的作用以及安全性.方法选择门诊90例行纤维结肠镜检查的患者,ASAⅠ～Ⅱ级.随机分为A组(异丙酚 咪唑安定 芬太尼,n＝30),B组(异丙酚 芬太尼,n＝30),C组(异丙酚,n＝30).A组:首先静脉推注咪唑安定1 mg,5 min后静脉推注芬太尼1 μg/kg,再过1 min异丙酚按1.5 mg/kg以3 mg/s的速度静脉注入,至患者睫毛反射消失.术中患者肢体活动时,以0.5 mg/kg追加异丙酚.B组:静脉推注芬太尼1 μg/kg,1 min后异丙酚按2 mg/kg以3 mg/s的速度静脉注入.C组:单纯静脉给予异丙酚按2 mg/kg以3 mg/s的速度静脉注入.术中均给予面罩吸氧,均待肠镜退至距肛门30 cm时停止给异丙酚,同时静脉给予推注美解眠50 mg,连续监测SBP、DBP、HR、RP、SPO2、EKG和停药后苏醒时间.结果三组间年龄、性别、体重等差异均无显著性(P＞0.05).比较三组的镇静镇痛效果,A组作用更显著,苏醒时间最短(P＜0.01).结论异丙酚与咪唑安定、芬太尼联合应用于门诊纤维结肠镜检查过程中有良好的镇静镇痛效果.     

咪唑安定复合异丙酚用于老年患者无痛肠镜的效果观察

目的 观察咪唑安定复合异丙酚用于老年患者行无痛肠镜的效果.方法 将60例患者分为两组,Ⅰ组:异丙酚 眯唑安定;Ⅱ组异丙酚 芬太尼.结果 Ⅱ组术中SBP、DBP、SPO2有所下降与Ⅰ组比较有差异(P＜0.05),但麻醉效果及清醒时间相同.结论 小剂量咪唑安定复合异丙酚及芬太尼均可用于老年患者无痛肠镜检查.     

咪达唑仑、异丙酚复合芬太尼用于结肠镜检查的临床观察

目的比较两种不同给药方法在结肠镜检查中的镇静、镇痛作用及对呼吸、循环的影响。方法将结肠镜检查患者80例随机均分为两组，Ⅰ组静脉注射异丙酚2mg／kg＋芬太尼1、5μg／kg，Ⅱ组静脉注射咪唑安定0．03mg／kg＋异丙酚1mg／kg＋芬太尼1μg／kg。结果Ⅰ组心率（HR）、收缩压（SBP）、舒张压（DBP）及脉搏血氧饱和度（SPO2）比Ⅱ组明显下降，有显著性差异（P〈0．05），Ⅱ组术中镇静、镇痛效果明显优于Ⅰ组（P〈0．05），而两组术后苏醒时间无显著性差异（P〉0．05）。结论咪唑安定、异丙酚复合芬太尼辅助结肠镜检查是安全有效的。     

异丙酚合用芬太尼在无痛人流术中的疗效观察

目的:观察异丙酚合用芬太尼在无痛人流中对患者呼吸、循环的影响及麻醉效果、并发症情况。方法:ASAⅠ-Ⅱ级无痛人流术患者60例,随机分成异丙酚组(A组)、异丙酚合用芬太尼组(B组),观察两组患者注药后2min及术毕的脉搏氧饱和度(SpO2)、呼吸频率(RR)、收缩压(SBP)、舒张压(DBP)、心率(HR)、麻醉效果及其他并发症情况。结果:A组注药后2min及术毕的SpO2,RR,SBP,DBP,HR变化较B组明显(P<0.05),B组比A组麻醉效果好,并发症少。结论:静脉注射异丙酚及芬太尼在无痛人流中的麻醉效果较单用异丙酚好、并发症少、呼吸循环抑制轻微。     

胃镜检查中异丙酚复合芬太尼或咪唑安定的对比

目的观察异丙酚-芬太尼、异丙酚-咪唑安定在无痛胃镜检查中的麻醉效果及苏醒过程。方法40例ASAⅠ~Ⅱ级,年龄20~65岁,自愿接受无痛胃镜检查患者,随机分为A、B两组,每组各20例。A组为异丙酚-芬太尼组,B组为异丙酚-咪唑安定组,A组芬太尼1μg/kg、B组咪唑安定0.03mg/kg静脉注射后2m in,两组均以异丙酚1.6mg/kg静注。记录:①用药前、睫毛反射消失进镜前、胃镜过咽时、胃镜检查中各时点的HR、SBP、DBP、SpO2。②胃镜操作时间、苏醒时间、定向力恢复时间。结果①胃镜经过咽腔时,B组有4例体动、2例屏气、2例咳嗽。此时点HR、SBP、DBP均升高,SpO2下降,与A组比较差异有统计学意义(P<0.01),而其余各时点无统计学意义。②胃镜检查时间两组无差异,苏醒时间A组低于B组(P<0.01),定向力恢复时间A组低于B组(P<0.01),差异有统计学意义。结论异丙酚-芬太尼用于无痛胃镜检查经过平顺、效果满意、苏醒时间短,是较为理想的麻醉选择。     

异丙酚配伍不同药物在无痛人工流产术中的麻醉效果分析

目的探讨异丙酚联合应用不同药物在无痛人工流产术中的麻醉效果与安全性。方法ASAⅠ～Ⅱ级人工流产患100例，等分为2组，A组异丙酚配伍芬太尼和麻黄碱，B组异丙酚配伍芬太尼。分析判断对循环、呼吸功能的影响，记录两组患者的MAP、HR、SpO2的变化及苏醒时间、恢复正常行走时间。结果B组麻醉后MAP、SpO2值显著小于麻醉前；两组清醒时间、恢复正常行走时间无明显差异。结论异丙酚联合芬太尼和麻黄碱用于人工流产手术的麻醉安全、可靠，术中镇痛效果好。     

异丙酚配伍瑞芬太尼用于人工流产术的临床评价

目的观察异丙酚复合芬太尼用于无痛人工流产术的麻醉效应和对呼吸、循环系统的影响以及临床效果和安全性。方法选择行无痛人工流产术的早孕妇女60例,随机分为瑞芬太尼组（P＋R组）和芬太尼组（P＋F组）各30例。P＋R组：瑞芬太尼1.0μg/kg,异丙酚2～3mg/kg。P＋F组：芬太尼1.0μg/kg,异丙酚2～3mg/kg。分别记录术前、扩宫时、吸宫时和术后的HR、SBP、DBP和SpO2及麻醉效果,异丙酚总量、手术时间、苏醒时间以及术后并发症（恶心、呕吐、宫缩痛）,并观察麻醉满意率。结果两组药物用于人工流产手术静脉麻醉,起效迅速,效果确切,术后恢复迅速且平顺,无严重不良反应,两组病例扩宫时HR、SBP、DBP和SpO2均较术前下降（P〈0.01）,苏醒时间P＋R组短于P＋F组（P〈0.05）,麻醉满意率两组均为100%。结论瑞芬太尼和芬太尼复合异丙酚用于无痛人工流产术效果好,安全可行,以瑞芬太尼复合异丙酚更优,但术中需严密监测呼吸、循环和加强管理。     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Polymorphisms in genes involved in neurotransmission in relation to smoking

Smoking behavior is influenced by both genetic and environmental factors. The genetic contribution to smoking behavior is at least as great as its contribution to alcoholism. Much progress has been achieved in genomic research related to cigarette-smoking within recent years. Linkage studies indicate that there are several loci linked to smoking, and candidate genes that are related to neurotransmission have been examined. Possible associated genes include cytochrome P450 subfamily polypeptide 6 (CYP2A6), dopamine D₁, D₂, and D₄ receptors, dopamine transporter, and serotonin transporter genes. There are other important candidate genes but studies evaluating the link with smoking have not been reported. These include genes encoding the dopamine D₃ and D₅ receptors, serotonin receptors, tyrosine hydroxylase, trytophan 2,3-dioxygenase, opioid receptors, and cannabinoid receptors. Since smoking-related factors are extremely complex, studies of diverse populations and of many aspects of smoking behavior including initiation, maintenance, cessation, relapse, and influence of environmental factors are needed to identify smoking-associated genes. We now review genetic polymorphisms reported to be involved in neurotransmission in relation to smoking.     

Genotoxic effects of chlorophenoxy herbicide diclofop-methyl in mice in vivo and in human lymphocytes in vitro

Diclofop-methyl (DM) is a chlorophenoxy derivative used in large quantities for the control of annual grasses in grain and vegetable crops. In this study, the genotoxic effects of DM were investigated by measuring chromosomal aberrations (CAs) in mouse bone-marrow cells and CA and the comet assay in human peripheral lymphocytes. Mice were treated with 15.63, 31.25, 62.5, and 125?mg/kg body weight of DM intraperitoneally for 24 hours, and 15.63-, 31.25-, 62.5-, 125-, and 250-µg/mL concentrations were applied to human lymphocytes for both 24 and 48 hours. In in vivo treatments, DM significantly, but not dose dependently, increased the total chromosome aberrations, compared to both negative and solvent controls. Cell proliferation was significantly, but not dose dependently, affected by all doses. In in vitro treatments, DM (except 15.63 µg/mL) significantly and dose dependently increased the frequency of chromosome aberrations. Also, 250 µg/mL of 48-hour treatment was found to be toxic. Cell proliferation was significantly and dose dependently affected by DM applications, when compared to negative control. In in vitro treatments, DM significantly decreased the mitotic index only at the highest concentration for 24 hours, and 62.5- and 125-µg/mL concentrations for 48 hours. In the comet assay, a significant and dose-dependent increase in comet-tail intensity was observed at 62.5-, 125-, and 250-µg/mL concentrations. The mean comet-tail length was significantly increased in all concentrations. Our results demonstrate that DM is genotoxic in mammalian cells in vivo and in vitro.     

Tramadol concentrations in blood and in cerebrospinal fluid in a neonate

Based on blood and cerebrospinal fluid samples collected in a full-term neonate, the penetration of tramadol in the central nervous system is described. Following intravenous administration of tramadol, a lag time of about 4 h was observed until full blood–brain equilibration was achieved. This pharmacokinetic observation is in line with a recent pharmacodynamic evaluation of the central opioid effects of tramadol in adults.     

2010调脂治疗领域进展

2010年在调脂治疗领域针对他汀治疗心血管病的防治又进行了许多探索。本文通过综述他汀类药物的国际大规模临床试验结果,重新评价了他汀类药物在冠心病一级预防和冠心病二级预防中的地位,阐明了强化他汀治疗的意义;对他汀的心肾保护作用和安全性新证据进行了说明。