地佐辛与芬太尼、舒芬太尼在纤维支气管镜引导清醒气管插管中的效果比较

摘 要 目的：观察等效剂量的地佐辛、芬太尼、舒芬太尼在纤维支气管镜引导清醒气管插管中的镇痛镇静效果及其对血流动力学的影响。方法: 选择术前预计困难气道拟行纤维支气管镜经鼻插管患者90例,随机分为地佐辛组（D组）、芬太尼组（F组）、舒芬太尼组（S组）。插管前10 min,各组分别静脉给予地佐辛0.15 mg·kg^-1、芬太尼3μg·kg^-1、舒芬太尼0.2 μg·kg^-1等镇痛药。比较3组患者入室后安静5 min（T0）、纤支镜置入前（T1）、气管插管成功后即刻（T2）及插管后5 min（T3）的心率（HR）、平均动脉压（MAP）、氧饱和度（SpO2）,及插管前Ramsay镇静评分,同时观察记录插管过程中药品不良反应发生情况。结果: 与T0时比较,F组和S组在T1时HR明显减慢,MAP明显降低（P＜0.05）;三组在T1时SpO2明显降低,T2时MAP明显升高（P＜0.05）;T1时F组和S组HR、MAP和SpO2明显低D组（P＜0.05）;T2时F组HR、MAP明显高于D组和F组,F组和S组SpO2明显降低（P＜0.05）;T3时S组HR明显降低且明显低于D组和F组,F组MAP明显高于D组和S组（P＜0.05）。T1时3组Ramsay镇静评分明显升高,S组明显高于F组（P＜0.05）。F组恶心、躁动和呼吸抑制发生率明显高于D组（P＜0.05）;F组躁动发生率明显高于S组（P＜0.05）;S组呼吸抑制发生率明显高于D组和F组（P＜0.05）。结论: 地佐辛联合充分的表面麻醉在困难气道患者经纤支镜引导的清醒气管插管过程中对血流动力学影响程度小,插管不良反应事件发生率低于芬太尼和舒芬太尼,安全性更高。     

氢吗啡酮静脉自控镇痛对乳腺癌术后疼痛的控制作用及对患者血清5-HT和hs-CRP的影响

摘 要 目的： 探讨氢吗啡酮静脉自控镇痛（PCIA）对乳腺癌术后疼痛的控制作用和安全性,及其对患者血清5 羟色胺（5-HT）和超敏C反应蛋白（hs-CRP）的影响。 方法: 行改良根治术治疗的乳腺癌患者100例随机分为舒芬太尼组和氢吗啡酮组各50例。术后舒芬太尼组给予舒芬太尼PCIA,氢吗啡酮组给予氢吗啡酮PCIA。分别应用视觉模拟评分法(VAS)、Ramsay评分于术后2,6,12,18,24 h评估观察患者镇痛和镇静效果,记录两组患者24h PCIA泵自动进药量、按压次数、实际有效进药次数,以及两组药品不良反应发生情况;分别于术后2h和术后24h检测血清5-HT和hs-CRP水平。结果: 氢吗啡酮组患者术后12h、18h和24h 的VAS评分和Ramsay评分均明显低于舒芬太尼组(P＜0.05);术后24 h自动进药量、按压次数、实际有效进药次数均明显低于舒芬太尼组(P＜0.05)。两组患者术后24 h血清5-HT和hs-CRP水平均较前显著升高(P＜0.05),而氢吗啡酮组术后24 h血清5-HT和hs-CRP水平低于舒芬太尼组(P＜0.05)。两组患者不良反应发生率差异无统计学意义（P＞0.05）。 结论: 乳腺癌术后应用氢吗啡酮PCIA,具有良好的镇痛和镇静作用,且能有效降低5-HT、hs-CRP水平,安全性较好。     

布托啡诺联合瑞芬太尼用于子宫肌瘤栓塞术患者自控镇痛效果观察

摘 要 目的： 观察布托啡诺联合瑞芬太尼用于子宫肌瘤栓塞术患者自控镇痛的效果。方法: 子宫肌瘤栓塞术患者68例按入院先后顺序分为观察组(n=35)和对照组(n=33),择期行子宫肌瘤栓塞术。对照组予芬太尼自控镇痛,观察组予布托啡诺联合瑞芬太尼自控镇痛,观察两组患者的视觉模拟评分(VAS)、镇静评分、术后疼痛以及药品不良反应等。结果: 术后1,4,12,24 h,观察组患者的VAS评分、镇静评分均明显低于对照组(P＜0.05);观察组术后0级疼痛率达74.3%,明显高于对照组的48.5%(P＜0.05);观察组药品不良反应发生率明显低于对照组(P＜0.05)。结论:子宫肌瘤栓塞术后使用布托啡诺和瑞芬太尼联合自控镇痛,可有效减轻患者术后疼痛,不良反应少,安全可靠,值得临床推广使用。     

舒芬太尼联合氯胺酮术后患者静脉自控镇痛有效性和安全性的Meta分析

摘 要 目的：采用Meta分析方法评价舒芬太尼联合氯胺酮与单用舒芬太尼术后患者静脉自控镇痛（PCIA）的有效性和安全性。方法：计算机检索PubMed、Web of science、ISI、Cochrane database of Systematic Reviews、Embase、中国知网（CNKI）、维普（VIP）数据库、万方数据、中国生物医学文献服务系统（SinoMed）,收集舒芬太尼联合氯胺酮术后静脉自控镇痛的随机对照试验（RCT）,采用RevMan 5.3软件对VAS评分、RSS评分、PCA有效按压次数、药品不良反应进行Meta分析。结果：共纳入19篇中文文献,累计受试者1 746例。Meta分析结果显示：联合用药组在术后12,24,48 h的VAS评分均较单用舒芬太尼组低,差异有统计学意义（P<0.01）;与单用舒芬太尼比较,联合用药组在术后24 h镇静效果即Ramsay评分（WMD=-0.09,95%CI：-0.16~-0.02）和48 h镇静效果（WMD=-0.09,95%CI：-0.12~-0.06）的差异均有统计学意义（P<0.05）;与单用舒芬太尼比较,联合用药组术后12 h的PCA有效按压次数（WMD=-3.48,95%CI：-4.64~-2.31）和48 h的PCA有效按压次数（WMD=-5.05,95%CI：-6.56~-3.54）均较低,差异有统计学意义（P<0.01）;与单用舒芬太尼组相比,联合用药组术后恶心呕吐、皮肤瘙痒、呼吸抑制、精神异常及总发生率明显降低。结论：与单用舒芬太尼组相比,舒芬太尼联合氯胺酮用于PCIA能获得较好的临床镇痛效果,并有效降低不良发应发生率,临床应用更为安全。     

非体外循环冠状动脉旁路移植术患者右美托咪啶联合地佐辛术后镇痛效果及对心肌酶谱影响的回顾性分析

摘 要 目的：回顾性分析非体外循环冠状动脉旁路移植术（OPCABG）患者术后应用右美托咪啶联合地佐辛镇痛对心肌酶谱的影响,并评价其镇痛效果及不良反应情况。方法: 采用回顾性研究方法,收集择期全麻OPCABG患者58例,根据治疗方法分为两组。观察组29例术后予右美托咪啶联合地佐辛镇痛,对照组29例术后予地佐辛镇痛,其余治疗方案两组相同。比较分析两组术前及术后24 h的乳酸脱氢酶（LDH）、肌酸激酶（CK）及肌酸激酶同工酶（CK MB）的数值变化,监测麻醉前、拔管后不同时间点的收缩压（SBP）、舒张压（DBP）、心率（HR）、血氧饱和度（SpO2）的数据,对术后不同时间点的镇静程度进行评分,记录两组患者术后72 h不良反应情况。结果: 两组患者术后LDH、CK及CK MB水平均高于术前(P＜0.05);而观察组患者术后心肌酶水平均低于对照组(P＜0.05)。两组患者麻醉前、拔管后不同时间点（6,12,24,48,72 h）的SBP、DBP、HR和SpO2比较,差异无统计学意义(P＞0.05)。两组患者术后不同时间点（12,24,36,48,72 h）的Ramsay评分、VAS评分及术后24,48,72 h累计有效按压次数比较,差异无统计学意义(P＞0.05)。观察组患者恶心呕吐及躁动发生率明显低于对照组(P＜0.05)。结论: OPCABG患者术后应用右美托咪啶联合地佐辛能够保护心肌,增强镇痛效果,降低不良反应发生率。     

妇科术后帕瑞昔布钠联合舒芬太尼静脉自控镇痛疗效观察

目的：观察帕瑞昔布钠复合舒芬太尼静脉自控镇痛（PCIA）用于妇科术后镇痛的疗效及安全性。方法：66例妇科手术患者随机分为观察组与对照组。两组患者均在拔管后予舒芬太尼PCIA,观察组在缝皮前和术后12h分别静注帕瑞昔布钠40mg,对照组在同一时间静注0.9%氯化钠注射液5ml。观察两组患者术后1h（T1）、2h（T2）、6h（T3）、12h（T4）、24h（T5）的镇痛评分（VAS）与镇静评分（Ramsay）。记录术后24hPCIA按压次数、有效按压次数、舒芬太尼用量、患者镇痛满意度及药品不良反应。结果：观察组患者各时间点镇痛评分及镇静评分均优于对照组（P〈0.05）,24hPCIA总按压次数、有效次数、舒芬太尼用量均少于对照组（P〈0.05）,镇痛满意率优于对照组（P〈0.05）,药品不良反应发生率少于对照组（P〈0.05）。结论：帕瑞昔布钠复合舒芬太尼用于妇科术后PCIA可减少舒芬太尼用量,提高镇痛及镇静效果,药品不良反应少,是一种安全有效的术后镇痛方法。     

舒芬太尼对腹腔镜手术患者术中应激反应的影响

摘 要 目的: 探讨舒芬太尼对腹腔镜手术患者血流动力学、血清皮质醇及β-内啡肽水平的影响。方法: 将68例腹腔镜胆囊切除术患者随机分为舒芬太尼组与芬太尼组,分别使用舒芬太尼与芬太尼静脉麻醉。观察两组患者各时点血流动力学、血清皮质醇及β-内啡肽水平变化。结果:芬太尼组气腹后20 min 平均动脉压（MAP）较麻醉前明显上升(P<0.05),高于同时点舒芬太尼组(P<0.05),解除气腹后60 min MAP降到麻醉前水平;两组气腹后20 min、解除气腹后60 min血清皮质醇及β 内啡肽均较麻醉前明显上升(P<0.05),而舒芬太尼组上升幅度明显低于芬太尼组(P<0.05);舒芬太尼组和芬太尼组发生药物不良反应的例数分别为6例和9例（P>0.05),症状均较轻微。结论:舒芬太尼静脉麻醉较芬太尼麻醉能更好抑制CO2气腹刺激引起的机体应激反应,维持血流动力学的稳定,不良反应轻,安全性较好。     

术后重度疼痛患者使用镇痛药物的经济学评价

摘 要 目的：对两种术后镇痛方案进行药物经济学评价,为临床合理用药提供指导。 方法：回顾性分析胸外科开胸术后重度疼痛患者使用静脉自控镇痛泵（patient controlled intravenous analgesia,PCIA）治疗的情况,87例病例根据镇痛药物分为A组（地佐辛+右美托咪定+托烷司琼）和B组（地佐辛+布托啡诺+托烷司琼）,用药48 h后观察镇痛疗效和药品不良反应,并采用成本 效果分析方法对两组治疗方案进行药物经济学评价。结果：A、B两组疼痛缓解率分别为97.78%,97.62%,差异无统计学意义（P>0.05）。各组均无严重药品不良反应出现,药品不良反应发生率分别为13.33%,4.76%,差异无统计学意义（P>0.05）。A、B组人均成本分别为1 092.14,729.91元,成本 效果比分别为11.17,7.48。 结论：手术48 h后,两组方案疼痛缓解率相当,B组花费较低,且药品不良反应发生率也较低。     

地佐辛注射液联合硫酸镁治疗肾绞痛48例临床分析

摘 要 目的: 观察地佐辛注射液联合硫酸镁应用于肾绞痛患者的镇痛效果。方法: 肾绞痛患者96例随机分成两组,治疗组48例,给予地佐辛注射液5 mg im,同时予25%硫酸镁4 g加入0.9%氯化钠注射液250 ml ivd;对照组48例,给予曲马多注射液100 mg im,同时予山莨菪碱10 mg,加入0.9%氯化钠注射液250 ml ivd。观察两组疗效、药物起效时间,以及药物不良反应。结果:治疗组症状显著改善、起效时间明显缩短,镇痛、镇静效果均明显优于对照组(P<0.05),不良反应发生率也明显低于对照组(P<0.05)。结论:地佐辛联合硫酸镁治疗肾绞痛,镇痛、镇静效果佳,不良反应少,值得临床推广使用。     

喷他佐辛联合舒芬太尼在全髋关节置换术后早期功能锻炼的运用

目的：观察喷他佐辛、舒芬太尼在全髋关节置换术后静脉镇痛对早期功能锻炼的影响。方法将40例ASAⅠ-Ⅱ择期行全髋关节置换术患者,随机分为喷他佐辛组（P组）、舒芬太尼（S组）两组,每组20例,术后行PCIA。配方为P组：喷他佐辛1.5mg/kg＋舒芬太尼1μg/kg＋托烷司琼5mg加生理盐水稀释到100ml;S组：舒芬太尼2.5μg/kg＋托烷司琼5mg加生理盐水稀释到100ml。手术结束前10min给予两组预注的配置夜10ml作为术后镇痛的负荷量,随即连接静脉镇痛泵镇痛。记录患者术后镇痛、镇静评分及不良反应、早期功能锻炼医师满意度等。结果两组配方均能为患者提供良好的术后镇痛,P组患者早期功能锻炼医师满意度显著优于S组（P〈0.05）,且不良反应少。结论喷他佐辛联合舒芬太尼静脉镇痛在全髋关节置换术后静脉镇痛效果确切可靠且不良反应少,减少患者早期功能锻炼疼痛。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.