Sequence analysis and feeding responses evoked by the large molecular form of gastrin releasing peptide (GRP) in the rat GRP-29

Microisolation techniques utilizing several reverse phase high performance liquid chromatography (HPLC) steps have resulted in the purification of two rat gastrin releasing peptide (GRP) forms suitable for microsequence and mass spectral analysis. The sequence of the larger form is APVSTGAGGGTVLAKMYPRGSHWAVGHLM-amide and the smaller form is GSHWAVGHLM-amide which is the carboxyl terminal decapeptide of the larger peptide. The peptides were synthesized and their feeding patterns e.g. first meal size (MS), intermeal interval (IMI) and satiety ratio (SR, IMI/MS) were determined in overnight food-, but not water deprived, male Sprague Dawley rats. The peptides were administered in the femoral vein (0, 0.21, 0.41 and 1.03 nmol/kg) immediately before presenting the rats with a 10% sucrose solution. We found that (1) GRP-10 (all doses) and GRP-29 (0.41 nmol/kg) reduced first MS, (2) both peptides prolonged IMI length and (3) both peptides increased the SR to similar extents. In conclusion, GRP-10 and GRP-29 are the two endogenous forms of GRP in the rat intestine and they reduce short term feeding to similar extents when administered intravenously.     

Capacity of the manufacturing process of Flebogamma DIF, a new human high purity intravenous immunoglobulin, to remove a TSE model-agent

The variant Creutfeldt-Jakob disease (vCJD) is a transmissible spongiform encephalopathy (TSE) associated with the ingestion of cattle derived products affected with bovine spongiform encephalopathy. vCJD emerged in the UK, where most of the cases occurred (170 of 217 cases worldwide). Manufacturers of biological products must investigate the ability of their production processes to remove TSE agents. Two manufacturing steps (polyethylene glycol-PEG precipitation and nanofiltration down to 20 nm) of Flebogamma^® DIF, were evaluated by western blot and bioassay to measure the prion protein (PrP^Sc) and infectivity clearance capacity, respectively. A laboratory scale model representative of the industrial process and a (experimentally) spiked TSE model-agent (hamster scrapie strain 263 K) were employed. Both steps showed a significant capacity to clear the TSE model-agent used since no PrP^Sc signal or infectivity was detected in the resulting product of each step. PEG precipitation and nanofiltration provided reduction factors of ≥6.19 log₁₀ID₅₀ and ≥5.45 log₁₀ID₅₀ respectively. Both steps showed consistency between western blot and bioassay results. These results demonstrate the ability of the Flebogamma^® DIF manufacturing process to clear TSE agents beyond the limit of detection of the assays, by several orders of magnitude.     

电子胃镜检查使用镇静麻醉药的护理研究

目的探讨电子胃镜检查时应用镇静麻醉药的临床护理效果。方法抽取300例患者随机分为观察组和对照组,观察组使用镇静麻醉药加多种护理配合,对照组作常规胃镜检查加多种护理配合,在两组之间进行检查和护理效果比较。结果观察组胃镜检查成功率为100%,全部患者插管均无发生任何合并症或危重症状,仅11%的患者出现恶心呕吐,7.5%的患者对麻醉药非常敏感。对照组成功率为100%,全部患者插管也无发生任何合并症或危重症状,但有21%的患者出现恶心呕吐,多数患者情绪稳定较差,诊断的准确性也比较差。结论电子胃镜检查时使用静脉镇静药,其检查效果非常理想,而多种护理配合对这种效果起着重要作用。     

Daily rhythms in blood and milk lead toxicokinetics following intravenous administration of lead acetate to dairy cows in summer

The objective of this study was to investigate circadian variations of blood and milk lead toxicokinetics in dairy cows in summer. Twenty lactating Holstein animals were randomly assigned to four treatments corresponding to different hours after onset of light (HALO): 2, 8, 14, and 20. Cows received a single intravenous administration of 2.5 mg/kg lead as lead acetate. Blood and milk samples were taken and analyzed by atomic absorption spectrophotometry. For each toxicokinetic parameter, a one-way analysis of variance (ANOVA) was performed to outline the existence of daily variations. Significant blood differences as a function of HALO were found for the hybrid constant of distribution (α), hybrid constant of elimination (β), elimination half-life (), area under the curve (AUC), volume of distribution at steady state (V_ss) and clearance (Cl_B) (p<0.05). Half-life of elimination presented two peaks at 2 and 14 HALO. Milk data showed significant differences for maximum concentration and AUC (p<0.05). The ratio AUC_milk/AUC_blood was utilized to estimate penetration of lead in milk. It differed significantly throughout the day (p<0.05). Milk data for the significant parameters could be fitted to circadian rhythms. No circadian rhythms were detected in blood parameters or in the ratio AUC_milk/AUC_blood.     

全医嘱静脉药物配置中心配送时效的优化

目的 运用现代物流管理方法,对运输人员进行工作量分析和运送人力分析,以满足静脉药物配置中心长期医嘱和临时医嘱的药品配送需求。方法 根据自身硬件和软件条件,利用统计学方法对运输工作量和运输人员的人力等方面进行分析,再利用现代物流管理理念和方法对药品配送中的硬件准备和路径选择拟定PIVAS所配药品的运送需求。结果 从硬件准备到路径选择,同时结合统计学计算运输工作量和运输人员的人力分析,从实际出发使医院内部物流能满足PIVAS所配药品的运送需求。结论 PIVAS配置长期医嘱,同时也能承接临时医嘱的配置,完善的物流配送是保证其正常动作的基础。     

帕瑞昔布钠超前镇痛对妇科腹腔镜手术全凭静脉麻醉效果的影响

目的:评价帕瑞昔布钠超前镇痛对妇科腹腔镜手术异丙酚-芬太尼静脉麻醉效果的影响。方法:选择在我院行妇科腹腔镜手术的患者60例,ASA分级为Ⅰ级或Ⅱ级,年龄分布在21-53岁,体重为41-72 kg。将所有患者随机分为帕瑞昔布钠组(P组)和生理盐水组(NS组),每组各30例。在麻醉诱导前15 min,对P组患者采取静脉注射帕瑞昔布钠40 mg,NS组患者则采取静脉注射等容积的生理盐水。两组麻醉诱导方法相同,术中以脑电双频指数(bispectral index,BIS)为麻醉深度指标,根据BIS值调节异丙酚血浆靶浓度以维持麻醉。记录拔管期间患者的心率(HR),平均动脉压(MAP)变化情况,苏醒时间,拔管时间,苏醒期不良反应及拔管后5 min疼痛VRS评分。结果:①两组患者血流动力学平稳,P组在T3至T6各时点的MAP和T3至T5各时点的HR均明显低于NS组,差异有统计学意义(P0.05);②两组苏醒时间和拔管时间无明显差别(P0.05);P组苏醒期躁动发生率为10%,明显低于NS组的26.7%,差异有统计学意义(P0.05);③P组拔管后5 min疼痛VRS评分为2.0,明显低于NS组的3.6,差异有统计学意义(P0.05)。结论:帕瑞昔布钠超前镇痛能减轻异丙酚-芬太尼静脉麻醉下妇科腹腔镜手术过程中血流动力学波动,减少苏醒期躁动的发生和疼痛VRS评分。     

臂丛神经阻滞复合静脉全麻进行锁骨骨折手术对患者疼痛阈值和术后谵妄的影响

摘要 目的：探讨臂丛神经阻滞复合静脉全麻进行锁骨骨折手术对患者疼痛阈值和术后谵妄的影响。方法：选取本院2018年4月-2021年5月收治的100例锁骨骨折患者作为研究对象,随机将其分为观察组（n=50）和对照组（n=50）。观察组采用臂丛神经阻滞复合静脉全麻进行手术,对照组单独采用静脉全麻进行手术,对比两组患者手术时间、住院时间以及唤醒时间;不同时间生命体征;麻醉效果和术后疼痛阈值;术后谵妄发生率、谵妄持续时间以及每天睡眠时间。结果：观察组患者的术后住院时长以及唤醒时间明显低于对照组（P＜0.05）。观察组T₁到T₄时间血氧饱和度（SPO₂）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）无明显波动,对照组T₁到T₄时间上述指标波动明显,且两组患者T₂、T₃时间SPO₂、SBP、DBP、MAP、HR对比差异显著（P＜0.05）;观察组患者的COR、NE在T₂、T3明显下降,而对照组的COR在T₂、T₃呈上升趋势（P＜0.05）。观察组运动神经阻滞时间以及感觉神经阻滞时间明显高于对照组（P＜0.05）,术后2 h、12 h、24 h疼痛阈值明显低于对照组（P＜0.05）。观察组术后谵妄发生率和谵妄持续时间明显低于对照组（P＜0.05）。结论：对锁骨骨折手术患者进行臂丛神经阻滞复合静脉全麻,有效降低患者手术时间、住院时间以及唤醒时间,同时稳定患者生命体征,提升麻醉效果,降低术后疼痛阈,并且谵妄发生率、谵妄持续时间以及每天睡眠时间相对较低。     

超声引导下腹横肌平面阻滞与静脉镇痛在腹股沟疝气手术中的应用价值

摘要 目的：分析超声引导下腹横肌平面阻滞与静脉镇痛在腹股沟疝气手术中的应用价值。方法：选择2019年1月～2020年12月我院的120例腹股沟疝气手术患者为研究对象,按照麻醉镇痛方法的差异分为两组,对照组采用静脉镇痛,观察组采用腹横肌平面阻滞。记录两组患者术中丙泊酚、麻黄碱以及芬太尼的使用剂量以及手术后不同时间的VAS评分和芬太尼追加次数;比较两组术后恶心呕吐的发生率,并比较进食时间、肠道功能恢复时间以及下床活动时间。结果：观察组患者丙泊酚、麻黄碱以及芬太尼的使用剂量均显著少于对照组(P<0.05);观察组疝气手术后1 h(T0)、5 h(T1)、10 h(T2)、1d (T3)、2 d(T4)的VAS评分均明显低于对照组(P<0.05);观察组的芬太尼追加次数为4次/人,明显低于对照组的11次(P<0.05);观察组疝气手术后恶心呕吐的发生率（6.67%）、进食时间、肠道功能恢复时间以及下床活动时间均明显低于对照组(P<0.05)。结论：腹横肌平面阻滞对腹股沟疝气手术后患者的镇痛效果明显优于静脉镇痛,且更有助于促进术后恢复。     

肌间沟臂丛神经阻滞复合静脉全麻对肩关节镜手术患者麻醉效果、MAP、HR以及血清Cor、NE的影响

目的:分析B超指引下实施肌间沟臂丛神经阻滞复合静脉全麻对肩关节镜手术患者麻醉效果、心率(HR)、平均动脉压(MAP)以及血清皮质醇(Cor)、去甲肾上腺素(NE)水平的影响。方法:选择本院2016年3月至2019年12月收治的80例肩关节镜手术患者,以随机数字表法作为分组原则(每组样本容量40例),对照组实施单纯全凭静脉麻醉,实验组实施B超指引下肌间沟臂丛神经阻滞复合静脉全麻,对比两组不同时点MAP、HR、血清Cor、NE水平以及瑞芬太尼、尼群地平(NIT)、丙泊酚使用剂量,并对比两组并发症发生情况。结果:实验组T1-4时点MAP、HR、血清Cor、NE水平均明显低于对照组(P0.05),瑞芬太尼、NIT以及丙泊酚使用剂量实验组均明显较对照组减少(P0.05);两组并发症发生率比较未见统计学差异(P0.05)。结论:B超指引下肌间沟臂丛神经阻滞复合静脉全麻应用于肩关节镜手术中可抑制患者体内应激物质释放,将MAP及HR维持在稳定范围内,极大地减少了麻醉药物、NIT使用剂量,麻醉效果理想、确切。     

股神经阻滞自控镇痛用于全膝置换术后镇痛和功能恢复的疗效观察

目的:观察股神经阻滞自控镇痛用于全膝置换(total knee arthoplasty,TKA)术后镇痛和功能恢复的疗效。方法:选择2017年8月～2019年6月院骨科收治的膝关节骨性关节炎患者122例,根据随机数字表法将其分为观察组与对照组,每组61例患者。所有患者均采用静吸复合全身麻醉,观察组给予股神经阻滞自控镇痛,对照组给予静脉自控镇痛,记录和比较两组患者术后镇痛效果与功能恢复情况。结果:观察组术后1 d、3 d与7 d的疼痛视觉模拟评分法(Visual Analogue Scale/Score,VAS)评分、血清白细胞介素(Interleukin,IL)-6和C-反应蛋白(C-reactive protein,CRP)含量都显著低于对照组(P0.05),患肢膝关节活动度明显高于对照组(P0.05),术后7 d的恶心、头晕、嗜睡、心动过缓等并发症发生率(4.9%)显著低于对照组(21.3%,P0.05),术后1 d、1个月与3个月的患肢膝关节活动度显著高于对照组(P0.05)。结论:股神经阻滞自控镇痛用于TKA可提高术后镇痛效果,促进膝关节功能恢复,减少术后并发症的发生,可能与其有效抑制IL-6和CRP的释放有关。