不同浓度罗哌卡因术后自控镇痛的临床观察

目的：比较三种不同浓度罗哌卡因的术后自控镇痛效果、运动阻滞及不良反应。方法：选择63例择期妇科手术病人．ASAⅠ～Ⅱ级,随机分为0．15％罗哌卡因（A组）、0．20％罗哌卡因（B组）和0．25％罗哌卡因（C组）,均复合5ng／L芬太尼,以持续剂量4ml／11,PCA剂量4ml,锁定时间30min硬膜外自控镇痛,观察各组镇痛效果、运动阻滞情况及不良反应发生率。结果：术后6、12、24h和48hVAS评分,A组显著高于B、C组;C组Bromage评分显著高于A、B组;镇静及并发症的发生率差异无显著性意义。结论：三组均适合妇科手术的术后镇痛,其中0．2％罗哌卡因术后镇痛效果好,无明显运动阻滞,病人更加舒适。     

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。     

不同浓度舒芬太尼复合罗哌卡因鞘内注射在剖宫产术后镇痛中的应用评价

目的：探讨不同浓度舒芬太尼复合罗哌卡因鞘内注射应用于剖宫产术后镇痛的有效性及安全性。方法：将1460例行剖宫产术患者随机分为A组（489例）、B组（501例）和C组（470例）。所有患者均采用腰硬联合阻滞,分别给予0.3μg/mL、0.4μg/mL、0.5μg/mL舒芬太尼配伍0.1%盐酸罗哌卡因。结果：B组、C组术后2h、8h、12h VAS评分显著低于A组,差异均有统计学意义（P〈0.05）,而该时间点B组、C组VAS评分比较则无显著性差异（P〉0.05）。三组术后24h VAS评分比较均无统计学意义（P〉0.05）。B组、C组术后镇痛泵按压有效率较A组显著升高,差异均有统计学意义（P〈0.05）,而B组、C组比较则无显著性差异（P〉0.05）。A组和B组不良反应的发生率分别8.0%和10.2%,显著低于C组20.2%,差异有统计学意义（P〈0.05）。结论：0.4μg/mL舒芬太尼＋0.1%盐酸罗哌卡因应用于剖宫产术后镇痛,可有效缓解术后早期的疼痛,并减少不良反应。     

罗哌卡因复合舒芬太尼在潜伏期分娩镇痛中的应用效果

目的:探讨罗哌卡因复合舒芬太尼在潜伏期分娩镇痛中的应用效果。方法:择取2015年1月~2016年1月我院收治的产妇102例,随机分为A、B、C组,各组34例,A组产妇宫口开至1 cm时采取罗哌卡因复合舒芬太尼硬膜外自控分娩镇痛,B组产妇宫口开至3 cm时采取罗哌卡因复合舒芬太尼硬膜外自控分娩镇痛,C组产妇未采取分娩镇痛,比较两组第一产程潜伏期、活跃期及第二产程持续时间及宫缩时视觉模拟评分(VAS)评分,比较各组产妇出血量、新生儿体质量及胎儿娩出后1 min、5 min Apgar评分,记录各组治疗30 d后不良反应。结果:A组、B组第一产程潜伏期持续时间明显较C组延长,活跃期持续时间较C组明显缩短,差异有统计学意义(P0.05);A组产妇宫颈口开至2 cm和cm时VAS评分低于B组和C组,差异有统计学意义(P0.05);A组、B组产妇在活跃期、第二产程时VAS评分低于C组,差异有统计学意义(P0.05);各组产妇出血量、新生儿体质量、Apgar评分比较均无统计学意义(P0.05);C组抑郁症发生率均高于较A组和B组,差异有统计学意义(P0.05)。结论:从产妇潜伏期开始应用罗哌卡因复合舒芬太尼进行分娩镇痛的效果较好,具有良好的应用价值。     

不同浓度罗哌卡因用于蛛网膜下腔阻滞在剖宫产手术中的效果分析

目的:探讨不同浓度罗哌卡因用于蛛网膜下腔阻滞在剖宫产手术中的效果。方法:选择2015年7月到2017年12月在本院进行剖宫产的初产妇89例作为研究对象,根据随机数字表法分为观察组44例与对照组45例,两组都给予经蛛网膜下腔阻滞麻醉。观察组注入罗哌卡因15 mg,对照组注入罗哌卡因17.5 mg。比较两组麻醉开始前(T0)、麻醉开始后2 min(T1)、10 min(T2)的呼吸频率(Respiration Rate,RR)和心率(Heart Rate,HR),两组的最高感觉阻滞时间、最高阻滞平面、感觉阻滞起效时间,术后2 h、4 h与24 h的VAS疼痛评分,产妇不良反应情况的发生情况并进行新生儿评价。结果:所有产妇在不同时间点的呼吸频率和心率均正常波动,组间与组内对比差异均无统计学意义(P0.05)。两组的感觉阻滞起效时间、最高阻滞平面、最高感觉阻滞时间对比差异无统计学意义(P0.05)。两组术后2 h、4 h与24 h的疼痛评分比较差异无统计学意义(P0.05)。所有新生儿都顺利分娩,1 min和5min Apgar评分都为9-10分;观察组产妇的不良反应发生率为4.5%,显著低于对照组的27.3%(P0.05)。结论:剖宫产手术经蛛网膜下腔阻滞中应用15 mg罗哌卡因也能保持产妇循环功能稳定,具有良好的镇痛与阻滞效果,且安全性更高。     

左旋布比卡因浓度和容量选择对小儿骶管阻滞效果影响

为探究不同浓度和容量左旋布比卡因对小儿骶管阻滞效果的影响,研究人员对我院2013年至2015年收治的90例小儿手术患者病例进行了研究。所有患儿采用左旋布比卡因行骶管阻滞麻醉,按照随机数表法平均分至A~F 6组,分别给予不同浓度和容量的左旋布比卡因:A组(0.25%,1.0 m L/kg)、B组(0.25%,0.7 m L/kg)、C组(0.20%,1.0 m L/kg)、D组(0.20%,0.7 m L/kg)、E组(0.15%,1.0 m L/kg)、F组(0.15%,0.7 m L/kg)。平均动脉压,A组明显低于C组和E组,B组显著低于D组和F组。E组麻醉时间、下肢肌力恢复时间及肛门排气时间明显低于A、C两组,而补充氯胺酮次数及疼痛评分显著高于A、C两组。F组麻醉时间、下肢肌力恢复时间及肛门排气时间明显低于B、D两组,而补充氯胺酮次数及疼痛评分显著高于B、D两组。E、F两组不良反应发生率显著高于其余4组。C组疼痛评分显著低于D组。0.20%的左旋布比卡因1.0 m L/kg用于小儿骶管阻滞既可达到满意麻醉效果,且并发症少,可作为最佳有效浓度。     

右美托咪定联合罗哌卡因腹横肌平面阻滞对老年腹腔镜胃癌根治术患者应激反应、炎症反应及术后谵妄的影响

摘要 目的：探讨右美托咪定联合罗哌卡因腹横肌平面阻滞（TAPB）对老年腹腔镜胃癌根治术患者炎症反应、应激反应及术后谵妄的影响。方法：选择2017年7月~2019年10月期间我院接收的行腹腔镜胃癌根治术的老年患者118例,按随机信封抽签法将其分为A组（n=59,罗哌卡因TAPB麻醉）和B组（n=59,右美托咪定联合罗哌卡因TAPB麻醉）,对比两组血流动力学指标、应激反应、炎症反应、术后疼痛、术后谵妄及不良反应发生率。结果：两组TAPB阻滞即刻（T1）~拔管时（T4）时间点心率（HR）、平均动脉压（MAP）均较麻醉前（T0）时间点升高（P<0.05）,B组T1~T4时间点HR、MAP低于A组（P<0.05）。两组术后3 d、术后5 d皮质醇（Cor）、去甲肾上腺素（NE）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平高于术前,但术后5 d 低于术后3 d（P<0.05）,B组术后3 d、术后5 d的IL-6、TNF-α、Cor、NE水平低于A组（P<0.05）。B组的术后谵妄发生率较A组降低（P<0.05）,两组不良反应发生率对比无差异（P>0.05）。B组术后6 h、术后12 h、术后24 h、术后48 h视觉模拟评分法（VAS）评分低于A组（P<0.05）。结论：老年腹腔镜胃癌根治术患者采用右美托咪定联合罗哌卡因TAPB可维持血流动力学稳定,减轻应激反应、炎症反应,降低术后谵妄发生率,术后镇痛效果良好,且安全性较好。     

不同浓度国产盐酸罗哌卡因在产科临床分娩镇痛中的应用分析

目的:研究不同浓度下国产盐酸罗哌卡因用于硬膜外分娩镇痛中的镇痛效果分析,探讨分娩镇痛中国产盐酸罗哌卡因的最佳浓度以及对母婴影响程度分析.方法:将96例符合要求的初产妇平均分作Ⅰ、Ⅱ、Ⅲ组.Ⅰ组用0.075％国产盐酸哌卡因、Ⅱ组用0.01％国产盐酸哌卡因、Ⅲ组用0.15％国产盐酸哌卡因,并在该3组中均加入芬太1 ug/ml,硬膜外分别注入不同浓度的国产盐酸罗哌卡因.观察Ⅰ、Ⅱ、Ⅲ组镇痛起效和维持时间.并对注药前、后各时间的VAS记录、评分.记录Ⅰ、Ⅱ、Ⅲ组产妇的运动阻滞、分娩方式、产程用时等;对新生儿Apgar评分.结果:Ⅲ组起效时间最佳;Ⅲ组维持时间最佳;Ⅱ、Ⅲ组镇痛有效率最佳;新生儿脐静脉血气、Apgar无差异.结论:国产盐酸罗哌卡因用量在0.075％-0.15％浓度范围时,对产妇及新生儿无不良影响.其中,国产盐酸罗哌卡因在0.1％浓度时,临床应用效果最佳.     

不同剂量罗哌卡因复合地佐辛硬膜外自控镇痛应用于无痛分娩的效果观察

目的:探讨不同剂量罗哌卡因复合地佐辛硬膜外自控镇痛(PCEA)应用于无痛分娩的临床价值。方法:选择2019年1月~12月于北京协和医院拟行自然分娩的初产妇180例,按随机数余数法分为A、B、C三组,每组60例,分别采用0.75%罗哌卡因0.33 m L(2.50 mg)、0.50 m L(3.75 mg)、0.67 m L(5.0 mg)复合地佐辛PCEA分娩镇痛,宫口开至2~3 cm时进行无痛分娩,L2~L3间隙穿刺,头侧置管行PCEA,宫口开全时停止PCEA。比较三组镇痛前(T0)、镇痛15 min(T1)、宫口全开(T2)、胎儿娩出(T3)、胎盘娩出(T4)及缝合会阴(T5)视觉模拟评分(VAS),采用改良Bromage评分评估下肢运动神经阻滞效果,统计各组镇痛起效时间、镇痛开始至宫口全开时间、第一产程、第二产程和第三产程时间,统计各组达目标麻醉平面时镇痛药物用量及产妇镇痛泵按压次数,记录各组产后出血量及最终分娩方式,采用新生儿阿氏评分法(Apgar)评定新生儿窒息情况,并行脐血血气分析,统计各组分娩期间不良反应发生情况。结果:T1~T5时点三组VAS评分均较T0时点降低(P<0.05),B、C组T1~T5时点VAS评分均低于A组(P<0.05);三组改良Bromage分级分布比较差异有统计学意义(P<0.05);B、C组镇痛起效时间较A组更快,第二产程时间、第三产程时间较A组缩短,达目标麻醉平面镇痛药物用量、镇痛泵按压次数、有效按压次数均较A组减少(P<0.05),B、C组以上指标对比差异无统计学意义(P>0.05);三组产后出血量、最终分娩方式、新生儿出生1 min、5 min Apgar评分、pH值、血氧分压(PO2)、二氧化碳分压(PCO2)和不良反应发生率比较差异无统计学意义(P>0.05)。结论:0.75%罗哌卡因0.50 m L(3.75 mg)复合地佐辛PCEA分娩镇痛在无痛分娩中镇痛效果满意,对产程、宫缩、母婴影响小,具有运动神经阻滞、感觉神经阻滞分离优势,不良反应少,安全性高。     

地塞米松复合罗哌卡因臂丛神经阻滞对儿童肱骨髁上骨折患儿术后镇痛的影响

摘要 目的：探讨地塞米松复合罗哌卡因臂丛神经阻滞（BPB）对儿童肱骨髁上骨折患儿术后镇痛效果的影响。方法：择期行肱骨髁上骨折手术的患儿140例，随机分组为对照组70例与试验组70例。麻醉后两组均于超声引导下实施BPB，其中对照组予以0.25%罗哌卡因药液，试验组予以0.25%罗哌卡因、0.1 mg/kg地塞米松所组成的混合药液。记录两组患儿痛觉阻滞时间；于患儿苏醒后10 min、术后2 h、术后6 h、术后12 h及术后24 h，采用FLACC评分对患儿疼痛程度进行评估；记录两组患儿术后24 h内镇痛药物使用情况；记录两组患儿术后首次下床活动时间和术后住院时间；记录两组术后24 h内不良反应发生情况。结果：与对照组相比，试验组痛觉阻滞时间显著延长（P<0.05）。与对照组相比，试验组术后2~24 h的疼痛评分均显著降低（P<0.05）。试验组术后24 h布洛芬混悬液使用次数显著少于对照组（P<0.05），曲马多使用率显著低于对照组（P<0.05）。与对照组相比，试验组下床活动时间提前（P<0.05），术后住院时间缩短（P<0.05）。两组不良反应发生率无统计学差异（P>0.05）。结论：地塞米松复合罗哌卡因行BPB能够为肱骨髁上骨折患儿提供良好术后镇痛效果，利于患儿术后恢复。     

A Unique Protease Cleavage Site Predicted in the Spike Protein of the Novel Pneumonia Coronavirus (2019-nCoV) Potentially Related to Viral Transmissibility

正Dear Editor,In December 2019, a novel human coronavirus caused an epidemic of severe pneumonia(Coronavirus Disease 2019,COVID-19) in Wuhan, Hubei, China(Wu et al. 2020; Zhu et al. 2020). So far, this virus has spread to all areas of China and even to other countries. The epidemic has caused 67,102 confirmed infections with 1526 fatal cases     

Curcuminoids as inhibitors of thioredoxin reductase: A receptor based pharmacophore study with distance mapping of the active site

Curcumin is the yellow pigment of turmeric that interacts irreversibly forming an adduct with thioredoxin reductase (TrxR), an enzyme responsible for redox control of cell and defence against oxidative stress. Docking at both the active sites of TrxR was performed to compare the potency of three naturally occurring curcuminoids, namely curcumin, demethoxy curcumin and bis-demethoxy curcumin. Results show that active sites of TrxR occur at the junction of E and F chains. Volume and area of both cavities is predicted. It has been concluded by distance mapping of the most active conformations that Se atom of catalytic residue SeCYS498, is at a distance of 3.56 from C13 of demethoxy curcumin at the E chain active site, whereas C13 carbon atom forms adduct with Se atom of SeCys 498. We report that at least one methoxy group in curcuminoids is necessary for interation with catalytic residues of thioredoxin. Pharmacophore of both active sites of the TrxR receptor for curcumin and demethoxy curcumin molecules has been drawn and proposed for design and synthesis of most probable potent antiproliferative synthetic drugs.     

Comparative morphology of the carpel in the Liliaceae: Hewardieae, Petrosavieae, and Tricyrteae

The young pistils in the melanthioid tribes, Hewardieae, Petrosavieae and Tricyrteae, are uniformly tricarpellate and syncarpous. They lack raphide idioblasts. All are multiovulate, with bitegmic ovules. The Petrosavieae are marked by the presence of septal glands and incomplete syncarpy. Tepals and stamens adhere to the ovary in the Hewardieae and the Petrosavieae but not in the Tricyrteae. Two vascular bundles occur in the stamens of the Hewartlieae and Tricyrtis latifolia. Ventral bundles in the upper part of the ovary of the Hewardieae are continuous with compound septal bundles and placental bundles in the lower part. Putative ventral bundles occur in the alternate position in the Tricyrteae and putative placental bundles in the opposite. position in the Petrosavieae. The dichtomously branched stigma in each carpel of the Tricyrteae is supplied by a bifurcated dorsal bundle.     

Enterovirus 71 3C proteolytically processes the histone H3 N-terminal tail during infection

Highlights
1. The N-terminal tail of histone H3 is specifically cleaved during EV71 infection.
2. Viral protease 3C is identified as a protease responsible for proteolytically processing the N-terminal H3 tail.
3. Our finding reveals a new epigenetic regulatory mechanism for Enterovirus 71 in virus-host interactions.     

Detection of EBV and HHV6 in the Brain Tissue of Patients with Rasmussen’s Encephalitis

Rasmussen’s encephalitis (RE) is a rare pediatric neurological disorder, and the exact etiology is not clear. Viral infection may be involved in the pathogenesis of RE, but conflicting results have reported. In this study, we evaluated the expression of both Epstein-Barr virus (EBV) and human herpes virus (HHV) 6 antigens in brain sections from 30 patients with RE and 16 control individuals by immunohistochemistry. In the RE group, EBV and HHV6 antigens were detected in 56.7% (17/30) and 50% (15/30) of individuals, respectively. In contrast, no detectable EBV and HHV6 antigen expression was found in brain tissues of the control group. The co-expression of EBV and HHV6 was detected in 20.0% (6/30) of individuals. In particular, a 4-year-old boy had a typical clinical course, including a medical history of viral encephalitis, intractable epilepsy, and hemispheric atrophy. The co-expression of EBV and HHV6 was detected in neurons and astrocytes in the brain tissue, accompanied by a high frequency of CD8⁺ T cells. Our results suggest that EBV and HHV6 infection and the activation of CD8⁺ T cells are involved in the pathogenesis of RE.     

Perinatal Vertical Transmission of Chikungunya Virus in Ruili,a Town on the Border between China and Myanmar

正Dear Editor,Chikungunya virus (CHIKV), an arbovirus in the family of Togaviridae, genus Alphavirus, is transmitted by the A.aegyptii or A. albopictus mosquito, and causes disease in humans characterized by fever, rash, and arthralgia (Silva and Dermody 2017; Suhrbier 2019). It was first reported in 1953 in Tanzania, and caused only a few outbreaks and sporadic cases in Africa and Asia in last century. However, in the epidemic in 2004, CHIKV acquired mutations that conferred enhanced transmission by the A. albopictus mosquito(Schuffenecker et al. 2006). Since then, it has successively caused outbreaks in Africa, the Indian Ocean, South East Asia, the South America, and Europe (Zeller et al. 2016).     

Development of a Novel Reverse Transcription Loop-Mediated Isothermal Amplification Method for Rapid Detection of SARS-CoV-2

In conclusion, the novel visual RT-LAMP assay is a simple, rapid, and sensitive approach for detection of SARS-CoV-2, and it is ready for application in primary care and community hospitals or health care centers, and even patients' own houses in response to the current SARS-CoV-2 epidemic because the assay does not require sophisticated equipment and skilled personnel. Furthermore, it is also ready to be used in fields for screening samples from wild animals and environments to facilitate the identification of potential intermediate hosts that mediate the cross-species transmission of SARS-CoV-2 from bats to humans.