瑞芬太尼静吸复合快通道麻醉在妇科腹腔镜手术中的应用

目的比较瑞芬太尼、七氟醚静吸复合麻醉与瑞芬太尼、丙泊酚全凭静脉麻醉,用于妇科腹腔镜手术的临床效果。方法 60例择期行腹腔镜妇科手术病人,随机分为静吸复合组(Ⅰ组)与全凭静脉组(Ⅱ组)。观察麻醉诱导,气腹前后及术毕的血压、心率、睁眼应答时间、拔管时间、苏醒期恶心呕吐、烦燥等并发症的发生情况与麻醉药用量。结果两组患者麻醉诱导前后,气腹前、术毕的血压、心率变化差异无统计学意义。气腹后3minⅡ组血压升高、心率增快、与气腹前比较差异有统计学意义。Ⅰ组变化不明显,两组间比较差异有统计学意义。术毕两组均迅速苏醒、及时拔管。Ⅰ组瑞芬太尼与丙泊酚的用量明显低于Ⅱ组。结论妇科腹腔手术应用瑞芬太尼、丙泊酚、七氟醚静吸复合麻醉,术中循环稳定,术毕苏醒迅速,不良反应少,是临床实施快通道麻醉的一种较好选择。     

瑞芬太尼-丙泊酚对腹部手术患者麻醉复苏的影响

目的探讨丙泊酚复合瑞芬太尼靶控输注全凭静脉麻醉对腹部手术患者麻醉复苏的影响。方法选取90例腹部手术患者按照麻醉方法的不同分为对照组和观察组,对照组采用丙泊酚复和瑞芬太尼靶控输注全凭静脉麻醉,观察组采用芬太尼复合丙泊酚静吸复合麻醉。比较两组患者的苏醒效果和术后镇痛效果。结果苏醒效果比较:观察组患者自主呼吸时间、呼唤睁眼时间、指令反应恢复时间及拔管时间均快于观察组,两组比较差异有统计学意义(P<0.05);VAS评分比较:在苏醒30min和苏醒1h两个时间点组间比较差异有统计学意义(P<0.05),其他时间点比较差异无统计学意义(P>0.05)。结论靶控输注丙泊酚复合瑞芬太尼是一种较为安全的麻醉方法。     

不同浓度瑞芬太尼靶控输注在腹腔镜手术中的应用

目的：观察不同靶控浓度瑞芬太尼复合丙泊酚静脉麻醉在腹腔镜手术中的应用。方法：29例择期腹腔镜手术病人随机分为3组,分别接受4ng/ml,6ng/ml,8ng/ml的瑞芬太尼复合丙泊酚3μg/ml靶控输注静脉麻醉。观察并记录插管前、插管后5分钟,建立气腹前及建立气腹后1、3、5、10和15分钟的心率和动脉收缩压数值。同时测量并记录气腹前和气腹后5分钟的血糖。结果：R1组建立气腹后血糖明显低于建立气腹前数值（P〈0.05）,并且建立气腹后各时点的血压和心率与建立气腹前相比有明显差异。R2与R3组建立气腹前后血糖无显著变化。其中R2组病人的心率和血压在建立气腹前后无显著变化,但R3组病人心率在建立气腹后较气腹前显著减慢。结论：靶控输注瑞芬太尼复合丙泊酚静脉麻醉可以应用于腹腔镜手术麻醉,而瑞芬太尼的最佳靶控血浆浓度为6ng/ml。     

瑞芬太尼靶控静脉麻醉用于妇科腹腔镜手术的临床观察

目的 比较不同靶控浓度瑞芬太尼复合丙泊酚全凭静脉麻醉与传统的静吸复合麻醉对机体应激反应的影响和血流动力学变化.方法 ASAⅠ～Ⅱ级妇科腹腔镜手术患者45例,随机分为静吸复合麻醉组(Ⅰ组),不同靶控浓度(4、6ng/ml)瑞芬太尼全凭静脉麻醉组(Ⅱ、Ⅲ组).每组15例.观察和测定麻醉前(T1),插管后1 min(T2),气腹后20 min(T3),气腹结束后20 min(T4)时的血压、心率、血糖和皮质醇.观察术毕停药后患者呼之睁眼时间、拔管时间,观察恶心呕吐等副反应,记录术中知晓的发生率和患者满意度等.结果 ①Ⅲ组皮质醇含量在T3、T4时点与Ⅰ组比较明显下降(P<0.01).②Ⅲ组血糖在T4时点同麻醉前比较升高(P<0.05),但同Ⅰ组比较差异有统计学意义(P<0.05).③Ⅲ组HR在T2、T3时点同Ⅰ组比较明显下降(P<0.01),Ⅲ组MAP在T2时点同Ⅰ组比较下降(P<0.05).④Ⅱ、Ⅲ组睁眼时间及拔管时间同Ⅰ组比较缩短(P<0.05).结论 在妇科腹腔镜手术中,丙泊酚3 μg/ml靶控瑞芬太尼6ng/ml全凭静脉麻醉比传统的静吸复合麻醉能更有效地抑制二氧化碳气腹所致的应激反应,苏醒快,且能获得血流动力学的稳定性.     

靶控输注瑞芬太尼在腹腔镜胆囊切除术中的应用

目的观察不同靶控浓度的瑞芬太尼复合丙泊酚全凭静脉麻醉，有效抑制腹腔镜胆囊切除手术所致的应激反应及血流动力学变化，探讨靶控输注瑞芬太尼的合适靶控浓度。方法ASAⅠ～Ⅱ级择期行胆囊腹腔镜切除手术患者45例，随机分为3组，每组15例。Ⅰ组瑞芬太尼靶控浓度4ng／ml；Ⅱ组瑞芬太尼靶控浓度6ng／ml；Ⅲ组瑞芬太尼靶控浓度8ng／ml；3组丙泊酚靶控浓度均为3g／ml。观察麻醉前10min（T1）、插管后lmin（T2）、气腹后20min（T3）、术毕解除气腹后20min（T4）时的血压、心率、血糖；术毕停药后患者呼之睁眼时间，拔管时间，气腹时间；术后伤口疼痛程度（VAS评分：0级不同，1级轻微疼痛，2级中都疼痛，3级非常疼痛，4级剧痛）；恶心、呕吐等不良反应。结果插管后1min、气腹后20min、术毕解除气腹后20minMAP、HR3组组间比较差异无统计学意义（P〉0．05）；3组MAP在捕管后1min同麻醉前比较均下降（P〈0．01）；3组HR在插管后1min、气腹后20min同麻醉前比较均下降，差异有统计学意义（P〈0．01）。血糖在术毕解除气腹后20min组间比较差异有统计学意义（P〈0．05），3组血糖较麻醉前均增高，但I组同麻醉前相比血糖升高显著（P〈0．01）。术后睁眼时间、拔管时间3组组间比较差异无统计学意义（P〈0．05）。3组的恶心、呕吐发生率稍高。Ⅰ、Ⅱ、Ⅲ组VAS评分在拔管后即刻不痛和轻微疼痛所占比例分别为79％、100％、94％，而拔管后24h不痛和轻微疼痛所占比例分别为74％、86％、93％。结论瑞芬太尼可控性好，持续输注半衰期短，消除快。     

靶控输注丙泊酚全凭静脉麻醉与静吸复合麻醉在腹腔镜胆囊切除术中的效果比较

目的：比较靶控输注丙泊酚全凭静脉麻醉与静吸复合麻醉在腹腔镜囊切除术中的效果。方法选取本院2012年5月-2013年5月收治的行腹腔镜胆囊切除术患者78例,将其随机分成两组,其中试验组39例,对照组39例,试验组行靶控输注丙泊酚全凭静脉麻醉,对照组行静吸复合麻醉。然后分析比较两组患者平均睁眼时间、术后平均拔管时间、诱导前、气腹后收缩压及舒张压、血氧饱和度、不良反应发生率等。结果试验组患者术后平均拔管时间、睁眼时间均少于对照组,差异有统计学意义（P ＜0.05）;两组患者舒张压、收缩压及血氧饱和度诱导前、气腹后比较差异无统计学意义（P ＞0.05）;试验组患者不良反应发生率低于对照组,差异有统计学意义（ P ＜0.05）。结论靶控输注丙泊酚全凭静脉麻醉对腹腔镜胆囊切除术患者具有极佳的麻醉效果,较静吸复合麻醉更安全可靠。     

舒芬太尼靶控输注在腹腔镜辅助下阴式子宫切除术中的效果

目的：探讨舒芬太尼复合丙泊酚靶控输注全凭静脉麻醉在腹腔镜下阴式子宫切除术中的应用效果。方法行腹腔镜下阴式子宫切除术患者60例,随机分为对照组（D组）和舒芬太尼组（S组）,每组30例。D组麻醉诱导采用靶控输注瑞芬太尼6 ng/ml及丙泊酚4μg/ml, S组麻醉诱导采用靶控输注舒芬太尼0.6 ng/ml及丙泊酚4μg/ml,患者意识消失后静脉注射罗库溴铵0.6 mg/kg。D组麻醉维持采用靶控输注瑞芬太尼4 ng/ml及丙泊酚3μg/ml, S组麻醉维持采用靶控输注舒芬太尼0.3 ng/ml及丙泊酚3μg/ml。结果 D组患者在插喉罩后1 min、拔管时HR及MAP与基础值比较差异有统计学意义（P〈0.05）。S组患者在插喉罩后1 min、气腹后15 min、拔喉罩时的HR及MAP低于D组（P〈0.05）。2组患者术后睁眼时间及拔管时间比较差异无统计学意义（P〉0.05）。S组患者术后镇痛满意度为87%, D组镇痛满意度为37%,组间比较差异有统计学意义（P〈0.05）。结论舒芬太尼复合丙泊酚靶控输注麻醉方法在腹腔镜辅助下阴式子宫切除术中应用患者血流动力学稳定、术后镇痛效果好。     

瑞芬太尼合用异丙酚麻醉高龄患者的临床观察

目的评价瑞芬太尼复合异丙酚静脉麻醉对高龄患者麻醉诱导和苏醒的影响。方法手术患者40例,随机平分为瑞芬太尼(R)组和芬太尼(F)组。观察全麻诱导及气管插管时的血压、心率,术毕停药后患者自主呼吸恢复、呼之睁眼、定向力恢复和离开恢复室(PACU)的时间。结果R组诱导时低血压和插管应激反应发生率低于F组,两组有显著性差异(P<0.05)。R组术后自主呼吸恢复、呼之睁眼、拔管、定向力恢复、离开恢复室的时间明显短于F组,两组有显著性差异(P<0.01)。结论与芬太尼比较,瑞芬太尼用于高龄患者麻醉诱导更加平稳,苏醒时间短。     

瑞芬太尼复合异丙酚全凭静脉麻醉与静吸复合麻醉的比较

目的观察瑞芬太尼复合异丙酚全凭静脉麻醉临床应用的优越性。方法ASAI～Ⅱ级,择期行鼻内窥镜鼻窦开放术的病人50例,年龄<60岁,随机分成静吸复合组(C组),瑞芬太尼—异丙酚组(R组),每组25例。观察麻醉诱导及气管插管时的血压、心率,记录术毕停药后病人自主呼吸恢复的时间、呼之睁眼时间、拔管时间、定向力恢复时间和离开手术室时间。同时观察病人拔管时的意识及躁动情况。结果①两组诱导后MAP和HR值较诱导前基础值下降(P<0.05),R组插管前后血压和心率无显著变化,无1例插管反应;C组病人则插管前后血压和心率较基础值上升(P<0.050),插管反应发生率高。②两组病人术后自主呼吸恢复时间、呼之睁眼时间、拔管时间、定向力恢复时间和离开手术室时间R组早于C组(P<0.01),R组病人离开手术室时的意识状态、认知功能测试评分高于C组,且病人拔管时安静,躁动小。结论与常规静吸复合麻醉下行鼻内窥镜行鼻窦开放术比较,瑞芬太尼复合异丙酚全凭静脉麻醉诱导更加平稳,术中血流动力学稳定,术后苏醒质量更优良,同时可以减少手术室的环境污染。但术毕须及时应用镇痛药。     

瑞芬太尼复合丙泊酚与芬太尼复合丙泊酚在腹腔镜手术中麻醉效果比较

目的探讨瑞芬太尼复合丙泊酚在腹腔镜手术中的临床效果和意义。方法将90例腹腔镜手术患者随机分为观察组和对照组各45例,观察组给予瑞芬太尼复合丙泊酚,对照组给予芬太尼复合丙泊酚,观察比较两组患者麻醉诱导前、插管后1min、气腹后3min、术毕各时点血压、心率;记录术毕后呼吸恢复时间、睁眼时间、拔管时间、恶心、呕吐发生率。结果观察组呼吸恢复时间、睁眼时间、拔管时间、恶心、呕吐发生率均低于对照组,组间比较差异有统计学意义(P<0.05);观察组插管后1min、气腹后3min时SBP、DBP、HR低于对照组(P<0.05)。结论瑞芬太尼复合丙泊酚具有苏醒迅速、起效快等诸多优点,值得临床推广应用。     

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.     

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.

     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

Gender-related symptoms and correlates of alcohol dependence among men and women with a lifetime diagnosis of alcohol use disorders

This study explored gender-related symptoms and correlates of alcohol dependence in a crosssectional study of 150 men and 150 women with a lifetime diagnosis of alcohol use disorders (AUD). Participants were recruited in equal numbers from treatment settings, correctional centres and the general community. Standardized measures were used to determine participants' use of substances, history of psychiatric disorders and psychosocial stress, their sensation seeking and family history of substance use and mental health disorders. Multivariate analyses were used to detect patterns of variables associated with gender and the lifetime severity of AUD. Men had a longer history of severe AUD than women. Women had similar levels of alcohol dependence and medical and psychological sequelae as men, despite 6 fewer years of AUD. More women than men had a history of severe psychosocial stress, severe dependence on other substances and antecedent mental health problems, especially mood and anxiety disorders. There were differences in family history of alcohol-related problems approximating same-gender aggregation. The severity of a lifetime AUD was predicted by its earlier age at onset and the occurrence of other disorders, especially anxiety, among both men and women. The limitations in the generalizability of these findings due to sample idiosyncrasies are discussed.     

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.