右美托咪啶与哌替啶预防腰硬联合麻醉期间寒战的效果比较

目的:探讨右美托咪啶与哌替啶预防腰硬联合麻醉期间寒战的效果比较。方法:选取2013年2月至2014年3月期间需行腰硬联合麻醉60例患者,随机分为观察组(右美托咪啶组)、对照组(哌替啶组),各30例,观察两组患者的临床效果和不良反应。结果:(1)观察组的寒战发生率(91.7%)明显高于对照组(73.3%);(2)观察组在腰硬联合麻醉期间用药后的恶心、呕吐以及暂时性血压升高等不良反应率(4.4%)明显低于对照组患者的不良反应率(15.6%),两组间的差异具有统计学意义。结论:哌替啶和右美托咪定均可以减少腰硬联合麻醉期间出现寒战的概率,但是右美托咪比哌替啶的效果更好,副作用更少,值得在临床上推广使用。     

右美托米定对慢性阻塞性肺疾病急性加重期患者镇静效果的临床观察

目的:探讨右美托咪定对慢性阻塞性肺疾病急性加重期(AECOPD)患者机械通气的镇静效果和安全性。方法:选取2012年6月-2014年9月在我院接受气管插管呼吸机辅助通气治疗的AECOPD患者62例,并将其随机分为实验组和对照组。其中,对照组患者给予常规治疗,实验组在常规治疗的基础上给予右美托咪镇痛。观察和比较两组患者机械通气持续时间、ICU停住时间、呼吸机相关性肺炎(VAP)、心动过缓和谵妄的发生率。结果:实验组患者机械通气时间及ICU停住时间均明显短于对照组,VAP、心动过缓及谵妄的发生率均显著低于对照组,差异均具有统计学意义(P0.05)。结论:右美托咪定对行机械通气慢性阻塞性肺疾病急性加重期患者良好的镇静效果,且安全性高,值得临床推广。     

右美托咪定与咪达唑仑用于肠镜检查患者镇静效果比较

目的:比较右美托咪定与咪达唑仑用于肠镜检查患者效果比较。方法:肠镜检查的患者60例,随机分为两组:D组静脉输注右美托咪定0.6μg/kg,M组静脉输注咪达唑仑0.08 mg/kg,均用生理盐水10 mL稀释,10 min输注完毕后进行肠镜检查。观察患者血流动力学指标及呼吸指标的变化,是否完成肠镜,患者的满意度以及检查过程中的不良反应。结果:右美托咪定组所有患者镇静满意,均能很好耐受肠镜检查,并且检查过程中MAP、HR和SpO2稳定(P0.05)。咪达唑仑组镇静时有轻度呼吸抑制,肠镜检查过程中MAP和HR升高(P0.05),插管耐受率低于右美托咪定组(P0.05)。结论:右美托咪定用于肠镜镇静有效,无呼吸抑制,血流动力学稳定,是理想的辅助药。     

右美托咪定治疗老年精神病患者无抽搐电休克的临床效果分析

目的:探讨右美托咪定治疗老年精神病患者无抽搐电休克的临床效果。方法:选择2015年9月～2019年2月在徐州医科大学(本院)进行无抽搐电休克治疗的老年精神病患者60例,根据随机数字表法将其分为右美托咪定组与对照组,每组各30例。两组都给予丙泊酚静脉注射麻醉,电休克治疗前10 min右美托咪定组缓慢推注右美托咪定0.2μg/kg(20 mL),对照组推注20 mL的生理盐水,记录和比较两组的麻醉效果与患者生命体征的波动情况。结果:右美托咪定组的丙泊酚用量、意识恢复时间与定向力恢复时间都显著低于或短于对照组(P0.05)。两组麻醉前、无抽搐电休克治疗20 min的收缩压、舒张压、心率都处于正常范围内,组内与组间对比差异均无统计学意义(P0.05)。两组治疗前后血清IgA、IgM值变化比较差异均无统计学意义(P0.05)。右美托咪定组治疗期间的烦躁、惊恐发作、苏醒延迟、头痛、恶心呕吐等不良反应发生率为6.7%,显著低于对照组(36.7%,P0.05)。结论:右美托咪定用于治疗老年精神病患者无抽搐电休克治疗不会对机体的生命体征与免疫功能产生负面影响,且能减少丙泊酚用量,提高麻醉效果,安全性更高。     

右美托咪啶与咪达唑仑在重症破伤风患者镇静中效果比较

目的:比较右美托咪啶与咪达唑仑用于重症破伤风患者镇静中效果。方法:选取2012年1月~2015年12月间在我院治疗的重症破伤风患者72例,通过随机数表法分为右美托咪啶组与咪达唑仑组,各36例,给予右美托咪啶组静脉泵入右美托咪啶1μg/kg持续时间为10 min,之后以0.3~0.6μg/kg进行维持,咪达唑仑组静脉泵入咪达唑仑0.05 mg/kg,持续时间为1 min,之后以0.02~0.1/kg·h进行维持。监测两组患者用药前及用药12 h后平均动脉压(MAP)、呼吸频率(RR)、血氧饱和度(SpO_2)和心率(HR)深用Ramasy评分法评估镇静程度。结果:两组患者治疗后HR、RR、MAP水平明显降低而SpO_2明显上升且右美托咪啶组HR、RR、及SpO_2改善更显著差异均有统计学意义(P0.05);两组用药后4 h、8 h、12 h时Ramasy评分在组间、组内比较差异均无统计学意义(P0.05);右美托咪啶组不良反应发生率为5.56%,低于咪达唑仑组的16.67%,差异有统计学意义(P0.05)。结论右美托咪啶有助于维持患者血流动力学的稳定减少重症破伤风患者心动过速、心率增快、呼吸抑制等不良反应情况的发生。     

盐酸右美托咪定及丙泊酚用于乳腺癌根治术中的镇静作用比较

比较盐酸右美托咪定及丙泊酚用于全凭静脉麻醉乳腺癌根治术患者术中镇静作用及对围术期炎症因子的影响。选择择期行乳腺癌根治术患者60名,用随机数字表法分为两组:盐酸右美托咪定组(C组)和丙泊酚组(E组)(n=30),两组均采用全凭静脉麻醉(TIVA)。其中C组在麻醉中采用盐酸右美托咪啶静脉维持;E组在麻醉中采用丙泊酚静脉维持。记录患者术中镇静程度BIS监测评分、术中知晓率、术后呼吸抑制发生率(术后SPO_294%)、恶心呕吐发生率、寒战不适发生率和术后镇痛的满意率,分别比较麻醉诱导前10 min(T1)、术后30 min(T2)2时间点外周血中TNF-α、IL-6、CRP的变化情况。两组患者术中镇静程度BIS监测评分及术中知晓率无显著差异(p0.05),C组术后呼吸抑制发生率明显小于E组(p0.01),且恶心呕吐及寒战不适的发生率也显著低于E组患者(p0.05);同时,与E组相比,C组的术后镇痛满意率显著提高(p0.05)。两组患者T1时刻的TNF-α、CRP、IL-6水平比较,差异无统计学意义(p0.05)。组间比较,C组T2时刻TNF-α、CRP、IL-6水平低于E组,差异有统计学意义(p0.05)。盐酸右美托咪定较丙泊酚更适用于全凭静脉麻醉乳腺癌根治术的镇静,且有利于降低围术期应激反应,提高患者舒适度。     

右美托咪定复合丙泊酚在清醒气管插管中的麻醉效果及对呼吸和循环的影响

目的:探讨右美托咪定复合丙泊酚应用于清醒气管插管的麻醉效果及对呼吸和循环的影响。方法:选择我院2015年1月~2016年12行清醒气管插管患者80例,按麻醉方式分组,每组40例,对照组采用丙泊酚麻醉诱导,研究组麻醉诱导予以右美托咪定复合丙泊酚。比较两组麻醉效果、呼吸和循环的变化及并发症的发生情况。结果:研究组插管时间、Ramsay评分、耐受良好、插管成功率、呼吸次数、分钟通气量、心率、平均动脉压均显著高于对照组(P0.05),潮气量、去甲肾上腺素、皮质醇、并发症总发生率均明显低于对照组(P0.05)。结论:右美托咪定复合丙泊酚用于清醒气管插管的麻醉效果确切,可使有效减轻对呼吸和循环的影响。     

右美托咪定对生理功能的影响和在临床中的应用

盐酸右美托咪定(dexmedetomidine hydrochloride,Dex))是一种新型α2肾上腺受体激动剂,该药可明显减少麻醉药和阿片类药用量,减轻气管插管及外科手术刺激的血流动力学反应,抑制交感神经反应,增加麻醉期间的循环稳定性,减少麻醉恢复期激动和恶心,是很有前途的麻醉辅助药。该药对缺血的心肌具有保护作用,对呼吸的影响较小,具有镇静、镇痛及抗焦虑作用,还可以降低危重患者的炎症反应以及抗抽搐等作用。右美托咪定还可以对颅内肿瘤切除术期间语言区定位提供良好的镇静作用,在临床中的应用越来越广泛。     

盐酸右美托咪定联合瑞芬太尼在骨科手术中的镇静效果及对患者血流动力学和呼吸功能的影响

目的:探讨盐酸右美托咪定联合瑞芬太尼在骨科手术中的镇静效果及对患者血流动力学和呼吸功能的影响。方法:选择2016年3月至2017年5月在我院186例行骨科手术的患者,根据数表法随机分为对照组(93例)和观察组(93例),对照组采用丙泊酚联合瑞芬太尼进行麻醉,观察组采用盐酸右美托咪定联合瑞芬太尼进行麻醉,比较两组用药前(T_1)、联合用药后10 min(T_2)、联合用药后20 min(T_3)、联合用药后30 min(T_4)和患者清醒后(T_5)等时间点的镇静效果以及血流动力学和呼吸功能指标变化,并比较两组不良反应发生率。结果:T_3、T_4时间点两组警觉/镇静(OAA/S)评分低于组内其他时间点,且观察组OAA/S评分低于对照组(P0.05)。两组T_1、T_5时间点呼吸频率(RR)、血氧饱和度(SpO_2)比较差异无统计学意义(P0.05);在T_2、T_3、T_4时间点观察组RR、SpO_2高于对照组(P0.05);T_3、T_4时间点两组的RR水平均低于组内其他时间点(P0.05)。两组各时间点平均动脉压(MAP)、心率(HR)水平比较差异均无统计学意义(P0.05)。观察组呼吸抑制、呼吸道梗塞和恶心呕吐的发生率低于对照组(P0.05)。结论:盐酸右美托咪定联合瑞芬太尼在骨科手术中镇静效果良好,对患者血流动力学的影响较小,呼吸抑制程度轻,安全性好。     

不同浓度罗哌卡因复合右美托咪定在肛肠疾病日间手术中的麻醉效果研究

目的:研究不同浓度罗哌卡因复合右美托咪定在肛肠疾病日间手术中的麻醉效果。方法:选取2016年5月～2018年5月期间于我院行肛肠疾病日间手术的患者123例为研究对象。根据随机数字表将患者分成A、B、C三组,每组各41例,其中A组麻醉时注入右美托咪定复合0.375%罗哌卡因20 m L,B组麻醉时注入右美托咪定复合0.5%罗哌卡因20 m L,C组注入右美托咪定复合0.75%罗哌卡因20 m L。比较三组患者麻醉后镇痛效果,比较三组麻醉前、麻醉30 min后的呼吸循环指标,比较三组患者感觉神经、运动神经阻滞情况,记录三组患者术后不良反应发生情况。结果:B组、C组镇痛优良率显著高于A组(P0.05),但B组、C组镇痛优良率组间比较差异无统计学意义(P0.05)。三组患者麻醉前、麻醉30 min后心率(HR)、收缩压(SBP)、舒张压(DBP)、血氧饱和度(SPO2)整体比较差异均无统计学意义(P0.05)。B组、C组感觉神经阻滞起效时间均较A组短,且C组短于B组(P0.05),而B组、C组感觉神经阻滞持续时间均较长,且C组长于B组(P0.05);B组、C组Bromage评分1分人数均较A组少,且C组少于B组(P0.05),B组、C组Bromage评分2分人数均较A组多,但C组较B组少(P0.05),C组Bromage评分3分人数较A组和B组多(P0.05),三组Bromage评分4分人数整体比较差异均无统计学意义(P0.05)。C组患者术后不良反应总发生率高于A组、B组(P0.05),但A组、B组不良反应总发生率组间比较差异无统计学意义(P0.05)。结论:0.5%、0.75%罗哌卡因复合右美托咪定应用于肛肠疾病日间手术的镇痛效果、麻醉效果优于0.375%罗哌卡因复合右美托咪定,但是0.75%罗哌卡因复合右美托咪定的不良反应发生率偏高,0.5%罗哌卡因复合右美托咪定是肛肠疾病日间手术中更为合适的麻醉方案。     

Variation In Surface Proteins In Tetrahymena*

SYNOPSIS. Surface proteins of Tetrahymena were identified by lactoperoxidase iodination, and comparisons were made between a number of strains and species within the genus. an adequate procedure for strain comparisons was found to be solubilization of whole cells following iodination, separation of total cell protein using polyacrylamide gel electrophoresis, and identification of surface proteins by autoradiography of dried gels. the results obtained in the present study show the existence of both interspecific and intraspecific variation in surface proteins of Tetrahymena, but the differences tend to be small within species and large between species. the relation of these cell surface fingerprints to the present taxonomic designations within the genus is discussed. Questions are raised about the functional significance of these surface proteins.     

C-Myc Expression In Exfoliated Cells In Serous Effusions

In an attempt to improve the discrimination between benign and malignant cells in pleural and peritoneal fluids, 32 effusions were investigated for c-myc expression. Smears were prepared from cells harvested from the fluids for immunocytochemical staining to identify the presence of c-myc protein. Recombinant DNA technology (Northern blotting, slot blotting and in situ hybridization) was used to detect c-myc mRNA. No significant difference in expression of c-myc was noted in benign or malignant effusions. Although the results are inconclusive, the recombinant DNA technology developed for this research could be used to investigate the expression of other oncogenes in cytological material.     

In Appreciation

Marine animals can induce metallothioneins (MTs) in their responses to exposure to certain trace metals in the environment. MTs generally function as metal storage/detoxification or homeostatic regulation of both essential and non-essential metals. This review discusses the important roles of MTs in metal biokinetics other than metal detoxification and homeostasis in marine animals. Recent studies have revealed the complicated cellular and biochemical processes involving intracellular ligands (cytosolic proteins and insoluble deposits) during metal uptake and elimination. The responses of metal biokinetics to MT induction are metal- and organism-specific. Depending on the different marine animals and metals, all biokinetic parameters such as dissolved metal uptake rate, dietary assimilation efficiency and elimination (efflux) rate can be significantly impacted by MT induction. Among the different metal biokinetic parameters, dietary assimilation efficiency and elimination rate appear to be most impacted by MT induction. MT turnover kinetics can also significantly affect metal uptake kinetics, but again, such influence is also dependent on the organism, particularly its predominant pathway of metal detoxification. Even though the total MT pool in aquatic animals may remain constant, the turnover of MTs, involving MT synthesis and breakdown, can potentially lead to a major change of metal accumulation biokinetics. We propose several issues that need to be further addressed in studying the interaction between MT induction and metal accumulation biokinetics.     

In memoriam

Microcosm experiments were performed to identify the influence of bacterial cell surfaces on the morphology, mineralogy, size and solubility of CaCO₃ precipitated in response to the enzymatic hydrolysis of urea in an artificial groundwater (AGW) by the ureolytic bacteria, Bacillus pasteurii. In each microcosm, B. pasteurii were contained within a cellulose dialysis membrane (10 K Dalton MWCO), resulting in bacteria-inclusive and bacteria-free AGW solution. Urea hydrolysis by B. pasteurii resulted in the production of ammonium and an increase in pH in the whole AGW solution. This initiated predominantly rhombohedral calcite precipitation at the same critical saturation state ( S _critical = 12) in the B. pasteurii-inclusive and bacteria-free zone of the AGW, indicating the mineralogy and morphology of CaCO₃ precipitation is not controlled by B. pasteurii surfaces. However, the temporal evolution of distinctly different lognormal crystal-size-distributions in the B. pasteurii-inclusive and bacteria-free zone of the AGW resulted from identical changes in bulk solution chemistry. Specifically, B. pasteurii increased the size and size variance of crystals, and led to a greater crystal growth rate throughout the experiments, relative to bacteria-free AGW. Calculated crystal solubility (ln K _S0 ) was lower for crystals > 4000 nm in diameter, reflecting smaller molar surface areas. This suggests that the larger crystals generated in the presence of B. pasteurii have a lower affinity for re-dissolution than those generated in the bacteria-free AGW, which may act as a positive feedback to maintain larger crystal sizes in the presence of B. pasteurii. During ureolysis, higher bacterial concentrations may therefore generate larger and less soluble carbonate crystals. This has important implications for the adaptation of bacterial ureolysis as a method for precipitating calcium carbonate and co-precipitating metals and radionuclides in contaminated aquifers.