长托宁、阿托品联合血液灌流治疗急性有机磷农药中毒伴呼吸衰竭的临床疗效

目的:探讨长托宁、阿托品联合血液灌流治疗急性有机磷中毒伴呼吸衰竭的临床疗效。方法:选取2009年1月至2016年8月在我院治疗的重症有机磷农药中毒伴呼吸衰竭患者68例,随机分为2组,A组35例,B组33例,A组患者接受长托宁联合阿托品常规治疗,B组患者接受长托宁、阿托品联合血液灌流治疗。比较两组患者治疗期间血清乙酰胆碱酶、肌酸激酶的含量以及治疗情况、临床疗效,同时记录治疗期间不良反应的发生情况。结果:治疗期间,B组患者血清Ach E的含量显著高于A组患者(P0.05),血清CK含量显著低于A组患者(P0.05);B组患者的清醒时间、到达阿托品化时间、中毒症状消失时间以及住院时间显著低于A组患者(P0.05);B组患者的病死率以及不良反应的发生率显著低于A组(P0.05);B组患者治疗的总有效率显著高于A组(P0.05)。结论:长托宁、阿托品联合血液灌流可以显著缓解急性有机磷中毒伴呼吸衰竭患者体内胆碱能紊乱的状态,提高临床疗效,并且有效降低治疗期间不良反应的发生率。     

血浆置换联合血液灌流治疗急性重度有机磷农药中毒的疗效及对患者肝功能的影响

目的:探讨血浆置换联合血液灌流治疗急性重度有机磷农药中毒的临床疗效及对患者肝功能的影响。方法:选择我院于2014年1月至2017年9月收治的66例急性重度有机磷农药中毒患者,按照随机原则分为血液灌流组(n=30)、联合治疗组(n=36),两组均接受急性重度有机磷农药中毒常规治疗,在此基础上血液灌流组和联合治疗组分别接受血液灌流、血浆置换联合血液灌流治疗。观察两组治疗效果,治疗前、治疗1周后血浆丙氨酸转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素水平。观察治疗过程中的不良反应发生情况。结果:与血液灌流组比较,联合治疗组胆碱酯酶(CHE)恢复时间较短,而长托宁用量较少,住院时间较短,且抢救成功率较高(P0.05)。治疗1周后联合治疗组血浆ALT、AST、总胆红素显著低于血液灌流组(P0.05)。治疗过程联合治疗组出现1例皮疹,不良反应发生率为2.78%,血流灌注组无不良反应发生,两组不良反应发生率比较无差异(P0.05)。结论:血浆置换联合血液灌流能明显提高急性重度有机磷中毒患者的抢救成功率,同时改善患者肝功能,且安全性良好,值得临床推广。     

Design,synthesis, in silico studies and in vitro evaluation of isatin-pyridine oximes hybrids as novel acetylcholinesterase reactivators

Organophosphorus poisoning caused by some pesticides and nerve agents is a life-threating condition that must be swiftly addressed to avoid casualties. Despite the availability of medical countermeasures, the clinically available compounds lack a broad spectrum, are not effective towards all organophosphorus toxins, and have poor pharmacokinetics properties to allow them crossing the blood-brain barrier, hampering cholinesterase reactivation at the central nervous system. In this work, we designed and synthesised novel isatin derivatives, linked to a pyridinium 4-oxime moiety by an alkyl chain with improved calculated properties, and tested their reactivation potency against paraoxon- and NEMP-inhibited acetylcholinesterase in comparison to the standard antidote pralidoxime. Our results showed that these compounds displayed comparable in vitro reactivation also pointed by the in silico studies, suggesting that they are promising compounds to tackle organophosphorus poisoning.     

解磷注射液急诊治疗有机磷农药中毒的临床分析

目的：探讨解磷注射液急诊治疗有机磷农药中毒的临床疗效。方法：选取2009年10月-2011年8月于我院进行治疗的216例有机磷农药中毒的患者为研究对象,将所有患者随机分为观察组（解磷注射液组）108例和对照组（阿托品组）108例,后将两组患者治愈率、治愈时间、死亡率和住院天数情况进行统计及比较。结果：观察组患者治愈率和治愈时间显优于对照组,且死亡率和住院天数也明显低于对照组,均P〈0．05,有显著性差异。结论：解磷注射液急诊治疗有机磷农药中毒患者的效果显著,应在有机磷农药中毒的患者中广泛使用。     

液体复苏治疗有机磷中毒对患者血清乳酸水平和CRP的影响

为了探讨在应用目标指导下液体复苏对有机磷农药中毒休克患者的抢救效果影响,本研究选取54例有机磷农药中毒休克患者,平均分成两组,其中27例患者采用基础治疗+目标指导下液体复苏治疗(A组)、另外27例患者采用基础治疗+常规抗休克治疗(B组),对比两组患者的救治效果差异。治疗前,A组和B组患者的SBP、血乳酸、CRP、APACHEⅡ评分、CHE、LDH、淀粉酶、CK、AST差异无统计学意义(p>0.05);治疗后12 h、24 h、48 h,A组患者的SBP显著高于B组(p<0.05),血乳酸显著低于B组(p<0.05);治疗后24 h、48 h,A组的CHE显著高于B组(p<0.05),CRP、APACHEⅡ评分、LDH、淀粉酶、CK、AST均显著低于B组(p<0.05);A组和B组患者的阿托品用量、血清CHE恢复时间、反跳率、治愈率、住院时间差异无统计学意义(p>0.05);A组和B组患者的MODS发生率、呼吸衰竭发生率、肺部感染发生率差异无统计学意义(p>0.05);A组患者的应激性溃疡发生率11.11%显著低于B组的37.04%(p<0.05)。本研究表明,应用目标指导下液体复苏对有机磷农药中毒休克患者的生命体征恢复具有积极意义,同时可以减轻患者并发症的发生,但是并不能显著地提高患者的抢救成功率。     

Poisoning with Organophosphorus Insecticides

Because of an increasing incidence of poisoning with the newer organophosphorus anticholinesterase insecticides, these compounds have been reviewed in terms of their history and pharmacology, relationship with other drugs, factors affecting toxicity, mechanism of action, toxic signs and treatment. The modern organophosphorus pesticide requires metabolic conversion before toxicity develops. Insects have a greater propensity for this conversion than humans. Nevertheless, this conversion does occur in humans and can be potentiated by other drugs. Toxicity also varies with age, sex, route and frequency of administration, and previous exposure. The mechanism of toxicity is inhibition of acetylcholinesterase, causing an intoxicating build-up of acetylcholine. Signs and symptoms consist of the clinical manifestations of unopposed parasympathetic and central activity. Treatment must be initiated early. Respiration must be maintained and the effects of acetylcholine must be counteracted by massive doses of atropine. Metaraminol enhances the antagonistic action of atropine against acetylcholine and may also be given. Once acetylcholinesterase is inactivated, restoration is slow. Recovery can be accelerated by enzyme reactivators like the oxime compounds. Pyridine aldoxime (Pralidoxime, Protopam, P₂S and 2-PAM) can be given in combination with atropine and metaraminol (AMP therapy) and may be the treatment of choice.     

参麦注射液联合阿替普酶治疗急性心肌梗死的临床效果研究

目的:研究参麦注射液联合阿替普酶治疗急性心肌梗死的临床效果。方法:选择2015年1月～2016年12月在我院进行诊治的急性心肌梗死患者98例,随机分为两组,每组各49例。对照组静脉滴注阿替普酶100 mg治疗,于90 min内滴注完毕,先静脉推注15 mg,再于30 min内静脉滴注50 mg阿替普酶,最后于60 min内静脉滴注35 mg,每天1次;观察组联合静脉滴注参麦注射液治疗,每次100 mL,每天1次。比较两组的临床治疗效果,治疗前后左心室射血分数、左心室舒张末期内径、左心室后壁厚度等心功能指标及血清心肌肌钙蛋白I(c TnI)、肌酸激酶同工酶(CK-MB)、超氧化物歧化酶以及(SOD)内皮素1(ET-1)水平的变化。随访半年,观察两组的预后情况(再梗死、梗死后心绞痛、血管再通以及冠脉血栓的发生率)。结果:治疗后,观察组的有效率为91.83%(45/49),明显高于对照组[71.43%(35/49)](P0.05);两组的左心室射血分数、左心室舒张末期内径、左心室后壁厚度均较治疗前明显改善(P0.05),且观察组的改善程度明显优于对照组(P0.05);两组的血清TnI、CK-MB、ET-1水平均较治疗前明显降低(P0.05),血清SOD水平均较治疗前明显升高(P0.05),且观察组以上指标的改善情况较对照组更为明显(P0.05);观察组再梗死、梗死后心绞痛以及冠脉血栓的发生率均明显低于对照组(P0.05),血管再通的发生明显高于对照组(P0.05)。结论:与单独使用阿替普酶对比,参麦注射液联合阿替普酶治疗急性心肌梗死临床疗效和安全性较好。     

Pralidoxime in Acute Organophosphorus Insecticide Poisoning—A Randomised Controlled Trial

Background

Poisoning with organophosphorus (OP) insecticides is a major global public health problem, causing an estimated 200,000 deaths each year. Although the World Health Organization recommends use of pralidoxime, this antidote''s effectiveness remains unclear. We aimed to determine whether the addition of pralidoxime chloride to atropine and supportive care offers benefit.

Methods and Findings

We performed a double-blind randomised placebo-controlled trial of pralidoxime chloride (2 g loading dose over 20 min, followed by a constant infusion of 0.5 g/h for up to 7 d) versus saline in patients with organophosphorus insecticide self-poisoning. Mortality was the primary outcome; secondary outcomes included intubation, duration of intubation, and time to death. We measured baseline markers of exposure and pharmacodynamic markers of response to aid interpretation of clinical outcomes. Two hundred thirty-five patients were randomised to receive pralidoxime (121) or saline placebo (114). Pralidoxime produced substantial and moderate red cell acetylcholinesterase reactivation in patients poisoned by diethyl and dimethyl compounds, respectively. Mortality was nonsignificantly higher in patients receiving pralidoxime: 30/121 (24.8%) receiving pralidoxime died, compared with 18/114 (15.8%) receiving placebo (adjusted hazard ratio [HR] 1.69, 95% confidence interval [CI] 0.88–3.26, p = 0.12). Incorporating the baseline amount of acetylcholinesterase already aged and plasma OP concentration into the analysis increased the HR for patients receiving pralidoxime compared to placebo, further decreasing the likelihood that pralidoxime is beneficial. The need for intubation was similar in both groups (pralidoxime 26/121 [21.5%], placebo 24/114 [21.1%], adjusted HR 1.27 [95% CI 0.71–2.29]). To reduce confounding due to ingestion of different insecticides, we further analysed patients with confirmed chlorpyrifos or dimethoate poisoning alone, finding no evidence of benefit.

Conclusions

Despite clear reactivation of red cell acetylcholinesterase in diethyl organophosphorus pesticide poisoned patients, we found no evidence that this regimen improves survival or reduces need for intubation in patients with organophosphorus insecticide poisoning. The reason for this failure to benefit patients was not apparent. Further studies of different dose regimens or different oximes are required.

Trial Registration

Controlled-trials.com ISRCTN55264358 Please see later in the article for Editors'' Summary     

优化两步输注美罗培南联合参麦注射液对重症感染患者血清感染指标、细菌清除率和T淋巴细胞亚群的影响

目的:探讨优化两步输注美罗培南联合参麦注射液对重症感染患者血清感染指标、细菌清除率和T淋巴细胞亚群的影响。方法:选取2017年1月-2018年10月在我院重症医学科(ICU)住院的153例重症感染患者,按随机数字表法将患者分为传统输注美罗培南组(A组,54例)、优化两步输注美罗培南组(B组,49例)、优化两步输注美罗培南联合参麦注射液组(C组,50例)。比较治疗后三组患者的总体疗效、血清感染指标和T淋巴细胞亚群水平及不良反应发生情况。结果:B组、C组的临床有效率、细菌清除率、28天生存率高于A组(P<0.05);B组、C组机械通气时间、ICU住院时间、总住院时间少于A组,且C组少于B组(P<0.05);治疗后B组、C组CD3⁺、CD4⁺、CD4⁺/CD8⁺高于A组,且C组高于B组(P<0.05);B组、C组CD8⁺、白细胞计数(WBC)、降钙素原(PCT)、C-反应蛋白(CRP)水平低于A组,且C组低于B组(P<0.05)。三组患者不良反应发生率比较无差异(P>0.05)。结论:优化两步输注美罗培南联合参麦注射液治疗重症感染患者疗效确切,可提高细菌清除率,改善患者免疫状态,促进患者康复。     

Effects of succinylcholine in an organotypic spinal cord-skeletal muscle coculture of embryonic mice

Intoxication with organophosphorus compounds is an important clinical problem worldwide. Although the core treatments – atropine, oximes and diazepam – are defined, high case fatalities were reported for intoxication with organophosphorus insecticides. In particular the role of oximes is not completely understood since they might benefit only patients poisoned by specific pesticides or patients with moderate poisoning and few randomised trials of such poisoning have been performed. This justifies the need for new in vitro test-systems like cocultures of spinal cord and muscle tissue, which have been recently introduced. However this test-system is not yet fully characterized. In order to estimate the applicability of cocultures of spinal cord and muscle tissue their sensitivity to succinylcholine (di-acetylcholine), a depolarizing muscle relaxant in clinical use, was tested.     

Investigation of kinetic interactions between approved oximes and human acetylcholinesterase inhibited by pesticide carbamates

Carbamates are widely used for pest control and act primarily by inhibition of insect and mammalian acetylcholinesterase (AChE). Accidental or intentional uptake of carbamates may result in typical signs and symptoms of cholinergic overstimulation which cannot be discriminated from those of organophosphorus pesticide poisoning. There is an ongoing debate whether standard treatment with atropine and oximes should be recommended for human carbamate poisoning as well, since in vitro and in vivo animal data indicate a deleterious effect of oximes when used in combination with the N-methyl carbamate carbaryl. Therefore, we performed an in vitro kinetic study to investigate the effect of clinically used oximes on carbamoylation and decarbamoylation of human AChE. It became evident that pralidoxime and obidoxime in therapeutic concentrations aggravate the inhibition of AChE by carbaryl and propoxur, with obidoxime being substantially more potent compared to 2-PAM. However, obidoxime had no impact on the decarbamoylation kinetics. Hence, the administration of 2-PAM and especially of obidoxime to severely propoxur and carbaryl poisoned humans cannot be recommended.     

乌司他丁与沐舒坦治疗严重烧伤伴吸入性损伤的疗效分析

目的:探讨严重烧伤伴中重度吸入性损伤患者早期联合使用大剂量乌司他丁与沐舒坦的临床疗效。方法:选择2003年5月~2013年5月在我院接受治疗的185例严重烧伤伴中重度吸入性损伤患者,随机分为两组,治疗组93例,对照组92例。两组患者在确诊为中重度吸入性损伤后,立即给予传统常规治疗:吸氧、视情尽早预防性气管切开、湿化气道及气道灌洗、翻身拍背吸痰、呼吸机辅助呼吸等。治疗组在常规治疗的基础上给予乌司他丁40万单位,每隔8h静脉滴注,沐舒坦450 mg,每隔12h微泵静推;对照组给予乌司他丁10万单位,每隔8h静滴,沐舒坦30 mg,每隔8h静滴,疗程为10天,比较两组患者急性肺损伤(ALI)的发生率、急性呼吸窘迫综合征(ARDS)的发生率、呼吸机使用时间、死亡率。结果:治疗组93例患者,治愈92例,死亡1例,死亡率为1.08%(1/93),治疗过程中发生ALI34例,ARDS12例,呼吸机使用时间为(4.2±2.1)d。对照组92例患者治愈88例,死亡4例,死亡率率为4.35%(4/92),治疗过程中发生ALI43例,ARDS17例,呼吸机使用时间为(8.2±2.7)d。两组患者ALI发生率、ARDS发生率、呼吸机使用时间、治愈率差异均有统计学意义(P0.05)。结论:对于严重烧伤伴中重度吸入性损伤的患者,在气管切开的前提下,给予常规传统治疗的同时,采用大剂量乌司他丁与沐舒坦早期联合使用给药,能够明显的提高治愈率,降低并发症,值得在临床上广泛推广应用。     

Brain neuronal RNA metabolism during acute soman toxication: Effects of antidotal pretreatments

Effects of various antidotal treatments on neuronal RNA contents and on soman induced RNA and acetylcholinesterase (AChE) depletion were monitored using quantitative cytochemical techniques. In rats treated only with antidotes, atropine depressed whereas pralidoxime (2-PAM) elevated RNA contents of both caudate and cerebrocortical (Layer V) neurons. Soman produced a virtually complete inhibition of AChE activity and a moderate decline in neuronal RNA contents. Atropine pretreatment partially restored neuronal RNA levels. Atropine+2-PAM prophylaxis eventuated in a complete restoration of RNA levels but no reactivation of AChE. Addition of physostigmine to the atropine +2-PAM treatment regimen resulted in appreciable AChE reactivation but reduced RNA levels. The overall data indicate that: (1) soman-induced neuronal RNA depletion can be completely reversed by antidotal pretreatment; (2) no precise relationship exists between the extents of antidote-induced restoration of RNA and AChE levels; and (3) 2-PAM exerts marked effects on the brain neuronal network which are unrelated to AChE reactivation. It is postulated that effects of soman and antidotes on neuronal RNA metabolism may signify alterations in acetylcholine (ACh) sensitivity and that pharmacologic manipulation of ACh responsiveness during organophosphate cholinesterase poisoning may be a mechanism for additional therapeutic intervention.     

头孢哌酮舒巴坦联合莫西沙星治疗老年肺部感染的临床效果研究

目的:研究头孢哌酮舒巴坦联合莫西沙星治疗老年肺部感染的临床效果。方法:以2014年1月至2016年12月于我院就诊的200例老年肺部感染患者为研究对象,将其随机分为观察组与对照组,每组各100例。两组患者均采用叩背吸痰、化痰、吸氧、营养支持等常规治疗方案。对照组静脉滴注头孢哌酮/舒巴坦钠进行治疗,每次3.0 g,每12 h给药1次;观察组联合静脉滴注莫西沙星治疗,每次0.4 g,每天给药1次。两组患者疗程均为2周。观察和比较两组患者的临床疗效、退热时间、止咳时间、肺部啰音消散时间和肺CT病灶吸收时间,治疗前后的血清超敏C反应蛋白水平以及白细胞计数的变化。结果:观察组的治疗总有效率为97.00%(97/100),明显高于对照组[83.00%(83/100)](P0.05);观察组的退热时间、止咳时间、肺部啰音消散时间以及肺CT病灶吸收时间均明显低于对照组(P0.05);两组治疗后的血清超敏C反应蛋白水平以及白细胞计数均较治疗前明显降低,且观察组以上指标显著低于对照组(P0.05);两组患者的不良反应发生率比较无明显差异(P0.05)。结论:头孢哌酮舒巴坦联合莫西沙星治疗老年肺部感染的临床效果明显优于单纯给予头孢哌酮舒巴坦治疗,不仅可以有效改善患者的临床症状、控制炎症,且具有较高的安全性。     

Optimizing Hospital Use of Intravenous Insulin Therapy: Improved Management of Hyperglycemia and Error Reduction With a New Nomogram

ObjectiveTo assess the efficacy and safety of intravenous (IV) insulin administration with use of our institution’s old protocol (pre-nomogram phase) as compared with our new insulin nomogram (post-nomogram phase), which titrates insulin dose based on the rate of change of plasma glucose values and uses multipliers to determine the new insulin infusion rate.MethodsHospitalized adults receiving an IV insulin infusion in our tertiary care medical center were enrolled in this study after informed consent was obtained. The study was an observational analysis conducted before and after implementation of the new insulin infusion nomo-gram. Measurements included episodes of hypoglycemia and incidence of the following errors in the insulin infusion process: (1) episodes of documented failure to increase insulin infusion rate despite persistent hyper-glycemia and (2) number of times the IV infusion was stopped without subcutaneous administration of insulin.ResultsOverall, 66 patients were analyzed (38 in the pre-nomogram phase and 28 in the post-nomogram phase). The new nomogram reduced by nearly 3-fold (from 0.89 ± 0.68 to 0.36 ± 0.49 occurrence per patient per 24 hours; P < 0.001) the mean incidence of failure to give insulin subcutaneously before discontinuation of IV insulin infusion. Moreover, the nomogram nearly eliminated the error of caregiver nonresponsiveness to persistent hyperglycemia: mean incidence 0.39 ± 0.65 occurrence per patient per 24 hours before implementation of the new nomogram versus 0.02 ± 0.09 afterward (P < 0.002). There was no statistically significant difference in episodes of hypoglycemia between the 2 study groups.ConclusionSafe IV administration of insulin through error prevention is essential. Implementation of a new IV insulin infusion nomogram, which adjusts insulin infusion using multipliers, reduces errors and improves glycemic control without increasing hypoglycemic episodes. (Endocr Pract. 2005;11:240-253)     

Bispyridinium Compounds Inhibit Both Muscle and Neuronal Nicotinic Acetylcholine Receptors in Human Cell Lines

Standard treatment of poisoning by organophosphorus anticholinesterases uses atropine to reduce the muscarinic effects of acetylcholine accumulation and oximes to reactivate acetylcholinesterase (the effectiveness of which depends on the specific anticholinesterase), but does not directly address the nicotinic effects of poisoning. Bispyridinium molecules which act as noncompetitive antagonists at nicotinic acetylcholine receptors have been identified as promising compounds and one has been shown to improve survival following organophosphorus poisoning in guinea-pigs. Here, we have investigated the structural requirements for antagonism and compared inhibitory potency of these compounds at muscle and neuronal nicotinic receptors and acetylcholinesterase. A series of compounds was synthesised, in which the length of the polymethylene linker between the two pyridinium moieties was increased sequentially from one to ten carbon atoms. Their effects on nicotinic receptor-mediated calcium responses were tested in muscle-derived (CN21) and neuronal (SH-SY5Y) cells. Their ability to inhibit acetylcholinesterase activity was tested using human erythrocyte ghosts. In both cell lines, the nicotinic response was inhibited in a dose-dependent manner and the inhibitory potency of the compounds increased with greater linker length between the two pyridinium moieties, as did their inhibitory potency for human acetylcholinesterase activity in vitro. These results demonstrate that bispyridinium compounds inhibit both neuronal and muscle nicotinic receptors and that their potency depends on the length of the hydrocarbon chain linking the two pyridinium moieties. Knowledge of structure-activity relationships will aid the optimisation of molecular structures for therapeutic use against the nicotinic effects of organophosphorus poisoning.     

Chromium Infusion In Hospitalized Patients with Severe Insulin Resistance: A Retrospective Analysis

ObjectiveTo investigate the effects of intravenous chromium on serum glucose and insulin infusion rates in hospitalized patients with severe insulin resistance.MethodsIn this retrospective study, we reviewed hospital records from January 1, 2008, to December 1, 2008, to identify patients for whom intravenous chromium was ordered at our academic medical center. To be included, patients were required to demonstrate profound insulin resistance and uncontrolled hyperglycemia (defined as the inability to achieve a blood glucose value less than 200 mg/ dL during the 12 hours before chromium was given despite administration of continuous insulin infusion at a rate of 20 or more units/h) and to have received a continuous infusion of chromium chloride at 20 mcg/h for 10 to 15 hours for a total dose of 200 to 240 mcg.ResultsFourteen patients met our inclusion criteria. Over the hour preceding intravenous chromium infusion, the mean ± standard deviation rate of insulin infusion was 31 ± 15 units/h, and blood glucose was 326 ± 86 mg/dL. Twelve hours after the initiation of chromium, these values were 16 ± 16 units/h and 162 ± 76 mg/dL, respectively (P = .011 for difference in mean insulin rate from baseline, P <.001 for difference in mean blood glucose from baseline) and 24 hours after, these values were 12 ± 15 units/h and 144 ± 48 mg/dL, respectively (P <.001 for both).ConclusionsIntravenous chromium decreases insulin needs and improves glucose control at 12 and 24 hours compared with baseline values. Chromium appears to improve hyperglycemia and insulin resistance in acutely ill patients and represents a potential new therapy. Future prospective randomized controlled trials are needed to confirm these results. (Endocr Pract. 2012;18:394-398)     

连续全遮盖法治疗双眼屈光参差性弱视的有效性与安全性分析

目的:探讨连续q全遮盖法治疗双眼屈光参差性弱视的有效性与安全性。方法:选择2014年2月到2016年9月在我院诊治的126例双眼屈光参差性弱视患儿作为研究对象,根据治疗方法的不同分为阿托品组60例与遮盖组66例,遮盖组采用连续全遮盖法治疗,阿托品组给予阿托品治疗,两组都治疗观察3个月。比较两组治疗期间不良反应的发生情况、治疗后的总有效率、最佳矫正视力、电位潜伏期、波幅。结果:两组治疗期间都无严重不良反应发生。治疗后,遮盖组与阿托品组的总有效率分别为98.5%和88.3%,遮盖组的总有效率明显高于阿托品组(P0.05)。两组治疗后的最佳矫正视力都高于治疗前,且遮盖组治疗后的最佳矫正视力也明显高于阿托品组(P0.05)。两组治疗后的电位潜伏期都较治疗前明显缩短,而波幅明显增强(P0.05),且遮盖组治疗后的潜伏期明显短于阿托品组,而波幅显著强于阿托品组(P0.05)。结论:连续全遮盖法治疗双眼屈光参差性弱视具有很好的安全性,能提高患儿的治疗效果,改善视力,促进神经元的兴奋性。     

Protective effects of pretreatment with Fe2+, Cu2+, and Rb+ on phoxim poisoning in silkworm,Bombyx mori

BackgroundPhoxim is a widely used organophosphorus pesticide in agriculture. People are paying more and more attention to its toxicity. At present, there is no appropriate way to solve the phoxim poisoning of silkworm, which severely affected the development of sericulture. Fe²⁺, Cu²⁺, Rb⁺ exerted their biological effects through various forms in vivo.MethodsTo evaluate the effect of Fe²⁺/Cu²⁺/Rb⁺ on phoxim poisoning in silkworm, Bombyx mori were treated with fresh mulberry leaves soaked in 2.5 mg/L phoxim for 2 min with 50 mg/L FeCl₂, 150 mg/L CuCl₂, or 0.5 mg/L RbCl from 5 days of the fifth-instar silkworm.ResultsFe²⁺, Cu²⁺, and Rb⁺ pretreatments significantly inhibited the phoxim-induced reduction of survival rate and alleviated the phoxim-induced poisoning symptoms. The protective effects of Fe²⁺, Cu²⁺, and Rb⁺ on phoxim poisoning might be due to their enhancement of superoxide dismutase (SOD), catalase (CAT), and carboxylesterase (CarE) in the hemolymph and fat body of silkworm. This enhancement might reduce reactive oxygen species (ROS) accumulation and oxidative stress (OS) caused by phoxim poisoning. Thereby it reduced the damage to silkworm tissues and cells.ConclusionsThese results showed that Fe²⁺, Cu²⁺, and Rb⁺ treatments protected the silkworm from phoxim poisoning by directly enhancing the activity of SOD, CAT, and CarE enzymes and reducing oxidative stress, but not dependent on the high expression of CYP genes. The use of Fe²⁺, Cu²⁺, and Rb⁺ to enhance the activity of SOD, CAT, and CarE enzymes may be an underlying effective way to solve phoxim poisoning in the silkworm industry.     

非阿片类镇痛复合静脉全麻在鼾症手术患者中的疗效

目的:观察三重措施预防为基础,联合非阿片镇痛药复合静脉全麻在行鼾症手术患者术后恶心呕吐的应用效果。方法:选择择期行鼾症手术男性病人80例,随机分为两组:吸入麻醉组(inhalation group, IHLA组)和静脉麻醉组(intravenous group, TIVA组),每组40例,两组均采用三重措施预防恶心呕吐,IHLA组采用以舒芬太尼为基础复合七氟烷吸入麻醉,TIVA组以氯胺酮和右美托咪定镇痛基础上丙泊酚全凭静脉麻醉。评估两组病人恶心呕吐危险系数,采用李克特量表(Likert scale),记录并分析两组患者术后6~8 h在麻醉后监测治疗室(post anesthesia care unit, PACU)及病房24 h恶心呕吐发生情况及补救用药用量。结果:两组患者一般临床资料、恶心呕吐风险评分、手术时间、术后恢复期补救用药量人数无显著差异(P>0.05);IHLA组在PACU恶心呕吐发生率为39.5%,TIVA组发生率为18.9%,两者相比有显著性差异(P<0.05);IHLA组病房24 h恶心呕吐严重程度高于TIVA组,两组术后需要补救应用抗呕吐药物用量无显著差异(P>0.05)。结论:以三重措施预防为基础,与吸入麻醉相比,非阿片类镇痛药复合静脉麻醉可以减少肥胖病人鼾症手术术后恶心呕吐发生率和严重程度,降低围术期风险,有利于患者早期恢复。