盐酸戊乙奎醚治疗脓毒性休克的临床分析

目的:分析盐酸戊乙奎醚治疗脓毒性休克临床疗效.方法:40例脓毒性休克住院患者随机分为对照组(n=20)和盐酸戊乙奎醚治疗组(PH组,n=20)),对照组予山莨菪碱(654-2)治疗;PH组予盐酸戊乙奎醚治疗.观察患者治疗效果及末梢转暖时间,给药后2h、6h、12h时点患者心率、平均动脉压、瞳孔、动脉血氧饱和度、肠鸣音及血乳酸含量变化.结果:PH组、对照组总有效率比较,差异无统计学意义(P0.05).PH组末梢转暖持续时间明显延长,两组差异有统计学意义(P0.05).与治疗前比较,治疗后两组患者血乳酸含量下降、动脉氧饱和度明显改善;PH组心率、平均动脉压、瞳孔、肠鸣音变化差异无统计学意义.两组间比较,PH组血乳酸水平下降更明显,差异有统计学意义(P<0.05),且两组在2h、6h时点心率、瞳孔、肠鸣音变化比较,差异有统计学意义(P<0.05).治疗后,两组的APCACHE Ⅱ评分、SOFA评分较治疗前减少(P<0.05),且PH组评分减少比对照组更明显(P<0.05).结论:盐酸戊乙奎醚可明显改善休克患者微循环,无明显增加心率、抑制肠蠕动副作用,是脓毒性体克患者较理想的血管活性药.     

盐酸戊乙奎醚与丙泊酚联合用于无痛人工流产术的临床研究

目的:评价盐酸戊乙奎醚联合丙泊酚减轻人工流产术后疼痛的效果.方法:ASAⅠ-H级人工流产术患者100例,随机分为观察组和对照组.处理组先缓慢静脉注射盐酸戊乙奎醚注射剂1mg,30min后静脉注射丙泊酚2.5mg/kg;;对照组单独静脉注射丙泊酚2.5mg/kg.两组丙泊酚静注速率均为5mg/s.结果:处理组苏醒即刻苏醒后15min和30min宫缩痛的VAS评分分别为(3.13±0.15)、(2.02±0.11)和(0.87±0.09)分,明显低于对照组的(4.47± 0.35)、(3.54± 0.14)及(2.01±0.12)(P＜0.01).结论:盐酸戊乙奎醚联合丙泊酚镇痛能减轻人工流产术后的疼痛.     

阿托品与盐酸戊乙奎醚注射液联合治疗重度急性有机磷农药中毒的疗效分析

目的探讨阿托品联合盐酸戊乙奎醚注射液治疗重度急性有机磷农药中毒(AOPP)的临床疗效。方法选择2014年3月~2017年2月我院收治的116例重度AOPP患者为研究对象,随机均分为两组,对照组予以常规阿托品治疗,观察组在对照组的基础上联合盐酸戊乙奎醚注射液治疗,观察比较两组患者的临床疗效及用药安全性。结果观察组患者的阿托品化时间、中毒症状消退时间、CHE活力恢复70%以上时间、住院时间均短于对照组,差异有统计学意义(P0.05)。观察组患者的阿托品中毒率、中毒反跳率均低于对照组,差异有统计学意义(P0.05)。结论阿托品联合盐酸戊乙奎醚注射液治疗重度AOPP的临床疗效确切,可快速达到阿托品化,有助于短期内恢复CHE,促进中毒症状消退,减少抗胆碱药的毒副作用。     

麻醉诱导前不同剂量盐酸戊乙奎醚对老年腹腔镜胆囊切除术患者氧化应激和血清S100β、NSE、BDNF的影响

摘要 目的：探讨麻醉诱导前不同剂量盐酸戊乙奎醚对老年腹腔镜胆囊切除术（LC）患者氧化应激和血清S100β、神经元特异性烯醇化酶（NSE）、脑源性神经营养因子（BDNF）的影响。方法：根据随机数字表法将2019年1月~2022年12月期间在我院择期行LC的150例老年患者分为高剂量组（盐酸戊乙奎醚0.015 mg/kg）、中剂量组（盐酸戊乙奎醚0.01 mg/kg）和低剂量组（盐酸戊乙奎醚0.005 mg/kg）,每组各50例。对比三组血流动力学指标[心率（HR）、平均动脉压（MAP）]、氧化应激指标[超氧化物歧化酶（SOD）、丙二醛（MDA）和总抗氧化能力（T-AOC）]和血清S100β、NSE、BDNF水平、术后认知功能障碍（POCD）发生率及不良反应发生率。结果：中剂量组喉罩置入后5 min（T1）~停止气腹10 min后（T4）HR、MAP低于低剂量组、高剂量组（P<0.05）。中剂量组术后1d MDA低于低剂量组、高剂量组,SOD、T-AOC高于低剂量组、高剂量组（P<0.05）。中剂量组术后1d S100β、NSE低于低剂量组、高剂量组,BDNF高于低剂量组、高剂量组（P<0.05）。三组不良反应发生率对比未见统计学差异（P>0.05）。中剂量组POCD发生率低于低剂量组、高剂量组（P<0.05）。结论：老年LC患者麻醉诱导前应用0.01 mg/kg盐酸戊乙奎醚,可有效维持血流动力学稳定,减轻氧化应激和脑损伤程度。     

盐酸戊乙奎醚（长托宁）抑制脑缺血／再灌注时谷氨酸的释放及受体机制研究

目的：观察盐酸戊乙奎醚对全脑缺血／再灌注大鼠易损区海马谷氨酸（Glu）及其受体（NMDAR1）的影响,探讨盐酸戊乙奎醚脑保护作用机制。方法：雄性Wistar大鼠60只,随机分为3组（n=20）：假手术组（A组）;缺血再灌注对照组（B组）;盐酸戊乙奎醚干预组,采用Pulsinelli-Brierley四血管阻断法制备全脑缺血模型,实验分两部分进行,各组随机选择10只大鼠于全脑缺血15min再灌注1h、3h、6h,采用脑微透析技术结合高效液相色谱（HPLC）检测大鼠海马细胞外Glu水平的变化,其余10只大鼠于再灌注3h后灌流固定断头取脑,采用免疫组织化学方法,检测海马CA1区NMDAR1蛋白表达。结果：与缺血／再灌注组各对应时点相比较,盐酸戊乙奎醚干预组大鼠海马细胞外Glu含量明显降低,统计结果差异均有显著性（P〈0．05或P〈0．01）;海马CA1区NMDAR1表达明显受抑制,积分光密度、阳性细胞面积、平均灰度值均存在显著性差异（P〈0．05或P〈0．01）。结论：脑缺血／再灌注早期应用盐酸戊乙奎醚不仅减少兴奋性氨基酸释放,还能抑制NMDAR1的高表达而产生脑保护作用。     

盐酸戊乙奎醚治疗有机磷中毒重度中间综合症临床研究

目的:探讨分析盐酸戊乙奎醚在急性有机磷中毒重度中间综合症治疗中的效果。方法:选取急性有机磷中毒并发重度中间综合症患者34例,依治疗方案分为对照组和观察组,各17例。2组患者基础治疗相同,对照组给予氯解磷定+阿托品+机械通气治疗;观察组采用氯解磷定+盐酸戊乙奎醚+机械通气治疗。观察比较2组患者肌无力症状消失时间、机械通气时间以及住院时间。结果:观察组患者肌无力症状消失时间、机械通气时间以及住院时间均明显低于对照组,经比较,差异均有统计学意义(P0.01)。结论:盐酸戊乙奎醚可快速有效缓解急性有机磷中毒重度中间综合症患者的临床症状,显著缩短病程。     

戊乙奎醚与咪唑安定作为妇科腹腔镜手术麻醉前用药对患者血流动力学的影响

目的:戊乙奎醚与咪唑安定作为妇科腹腔镜手术麻醉前用药对患者血流动力学的影响.方法:将150例美国麻醉师协会(ASA)分级Ⅰ～Ⅱ级妇科腹腔镜手术患者(病种包括子宫肌瘤、宫外孕、单纯卵巢囊肿)随机分为2组,每组75例.于麻醉诱导前10分钟分别静注戊乙奎醚0.01 mg/kg (A组)、咪唑安定0.01 mg/kg (B组).记录并比较注药后5分钟,10分钟,20分钟患者口干程度的视觉模拟评分(visual analogue scale,VAS);记录并比较患者注药前10分钟(P1)、注药后10分钟(P2)、患者意识消失时(P3)、手术开始时(P4)、手术开始后1小时(P5)、手术结束时(P6)、苏醒后1小时(P7)时的脉搏血氧饱和度(SpO2)、心率(HR)、收缩压(SBP)、舒张压(DBP);记录并比较术后气管及口腔内分泌物量、动脉血乳酸(ABL)含量.结果:对两组患者于麻醉诱导前分别注射0.01 mg/kg戊乙奎醚和0.01 mg/kg咪唑安定,结果显示B组患者在给药后5分钟,10分钟,20分钟心率较A组相同时间点心率有显著升高(P＜0.05),口干程度VAS评分B组显著高于A组.手术期间两组血液动力学变化为B组注药后血压、心率均较基础值显著降低(P＜0.05);两组患者注药前后脉搏氧饱和度均无显著变化(P＞0.05).B组气管及口鼻腔分泌物的量明显多于A组,且术后测定动脉血乳酸含量B组显著高于A组(P＜0.05).结论:于麻醉诱导前20分钟静注戊乙奎醚0.01 mg/kg可以有效减少患者术中及术后口腔、呼吸道分泌物,而不致心率增加和血压升高,对患者血流动力学无显著影响;对患者微循环有明显改善作用.     

蝮蛇抗栓酶对微循环作用的实验与临床研究

对实验性失血性休克的４０只大鼠和１５只家兔静注不同剂量的抗栓酶,用激光多普勒微循环血流计测定肾表面固定部位的微循环血流量,发现用药后血流量显著增加且与尿量相一致;阻断６０只沙鼠颈动脉造成脑缺血模型,在颅顶开窗用微循环显微镜观察用药后软脑膜微循环的变化,发现微循环血流速度加快并显示一定的冲击力,且能减少白细胞数及贴壁滚动;用２０只家兔做成ＤＩＣ模型,给抗栓酶后观察肠系膜微循环,发现毛细血管开放数增多,微循环流态改善。观察３３例脑血栓形成期病人用抗栓酶治疗前后甲襞微循环的变化,发现治疗后微循环总积分值改善,流态改善更明显     

HPC联合深呼吸法可有效抑制芬太尼诱发的咳嗽反应

为了研究盐酸戊乙奎醚(HPC)联合深呼吸法对芬太尼诱发的咳嗽反应(FIC)的抑制作用,本研究选择2015年9月至2016年9月期间于我院接受手术治疗的患者220例,随机分为H组、P组、M组和N组4组,每组55例。在进行芬太尼静脉注射前10 min,用生理盐水将0.01 mg/kg的盐酸戊乙奎醚稀释成10 m L并给予H组和M组患者静脉注射,同时M组在注射芬太尼前还需完成3次深呼吸;P组患者接受静脉注射芬太尼前,完成3次深呼吸;N组按照一定诱导顺序给予静脉快速诱导。通过记录和分析,本研究发现M组、H组和P组之间在咳嗽程度方面无显著差异(p0.05);咳嗽发生时间无组间差异(p0.05);H组FIC发生率为14.5%(8例)、P组为12.7%(7例)、M组为7.3%(4例),明显低于N组的30.9%(17例)(p0.05),M组FIC发生率明显低于H组和P组(p0.05);4组患者的心率(HR)、脉搏血氧饱和度(Sp O2)及平均动脉压(MAP)在T0、T1、T2时逐渐降低,T2时HR和MAP比T0时降低(p0.05);各组患者的不良反应发生率无显著差异(p0.05)。本研究表明,HPC联合深呼吸法不仅可有效抑制FIC的发生,效果上优于单独使用HPC和深呼吸法,且对患者血流动力学影响小,安全性高。     

长托宁与阿托品治疗急性有机磷农药中毒的临床观察

有机磷农药是农村日常接触的有毒化学品之一,急性有机磷农药中毒(AOPP)为基层医院急诊科最常见的急危重症之一,病死率高达l5%左右[1]。长托宁(盐酸戊乙奎醚)是一种新型胆碱受体阻断药,对外周M受体和中枢M、N受体均有作用。但选择性作用于M受体亚型,对M受体作用橄弱,对心率无明显影响,较阿托品作用强,有效剂量小,作用时间(半衰期6~8小时)长,不良反应少[2]。     

Testicular blood flow and microcirculation in rats after treatment with ethane dimethyl sulfonate

The effects of ethane dimethyl sulfonate (EDS) on total testicular blood flow, microcirculation, and the testicular interstitial fluid volume (IFV) in rats were studied. In agreement with previous studies, treatment of control rats with human chorionic gonadotropin (hCG) induced an increase in IFV and total testicular blood flow as measured with radioactive microspheres. These effects of hCG were completely abolished in rats pretreated with EDS; in EDS-treated rats not receiving any hCG, there were decreases in IFV when compared with untreated control rats. Furthermore, the pulsatile pattern of testicular microcirculation registered with laser-Doppler flowmetry was abolished after EDS treatment, and this effect was not influenced by hCG treatment. The hCG-induced increase in IFV is associated with an increased accumulation of polymorphonuclear leukocytes locally in the testis, but this accumulation of leukocytes was not observed in rats pretreated with EDS. It was concluded from the present study that hCG-induced changes in total testicular blood flow and testicular microcirculation require functionally intact Leydig cells.     

The estimation of microcirculation state in cerebrovascular disorders by data of laser Doppler flowmetry and hemorheological parameters

The study was aimed to evaluate microvascular blood flow and theological blood properties in healthy volunteers (n = 27) and patients with cerebral accident (n = 30). To study cutaneous blood flow we used the multifunctional laser analyzer of blood microcirculation LAKK (LAZMA, Moscow) with spectrophotometric channel and wavelet analysis of blood flow oscillations. Viscosity of the whole blood, plasma, RBC aggregability and deformability were assessed. Results: microcirculation index was by 25% (p < 0.05) lower in patients compared to the control group. Computing amplitude-frequency range of blood flow oscillations revealed notable changes in the blood flow regulation mechanisms under cerebrovascular accident: the amplitudes of all active rhythms (endothelial, neurogenic and myogenic ones) were increased. In spite of such activization of regulatory mechanisms, aimed to keep essential blood supply to tissue, index of specific oxygen consumption by tissue was decreased by 21% (p < 0.05) under cerebrovascular disorders. Blood rheological properties in patients group were impaired compared to the healthy group: blood viscosity was increased because of elevated plasma viscosity, increased RBS aggreagation and decreased erythrocyte deformability. Thus, our results demonstrated the decrease of tissue perfusion, activization of vasodilating mechanisms, impaired blood rheology and the decrease of oxygen supply to tissue in patients with cerebrovascular accident. Statistical analysis revealed a number of significant correlations between the hemorheological parameters and passive rhythms of microcirculation in norm. In patients blood viscosity correlated to the amplitude of active regulatory rhythms (endothelial, neurogenic and myogenic oscillations). Close interralations between rheological and microcirculation parameters testified the important role of hemorheological factors in maintenance of microvascular blood flow and oxygen delivery to tissue.     

富氢盐水对高压电烧伤大鼠微循环内红细胞流速及组织病理损伤的影响

目的:探讨富氢盐水对高压电烧伤大鼠微循环内红细胞流速及组织病理损伤的影响。方法:80只大鼠随机分为四组,分别为烧伤组、治疗组、对照组和阳性对照组,治疗组烧伤后给予富氢盐水治疗,阳性对照组给予罂粟碱溶液治疗。每组分成三个亚组用于血气分析,肺组织形态学观察和红细胞流动速度检测。结果:治疗组和阳性对照组大鼠肺组织湿干重比均显著低于烧伤组(P0.05),治疗组和阳性对照组大鼠肺组织湿干重比差异不显著(t=0.585,P0.05)。治疗组和阳性对照组大鼠生存时间均显著高于烧伤组(P0.05),治疗组和阳性对照组大鼠生存时间差异不显著(t=0.448,P0.05)。治疗组和阳性对照组氧分压均显著高于烧伤组(P0.05);治疗组和阳性对照组氧分压差异不显著(t=0.424,P0.05)。治疗组和阳性对照组二氧化碳分压均显著低于烧伤组(P0.05);治疗组和阳性对照组二氧化碳分压差异不显著(t=1.285,P0.05)。治疗组和阳性对照组大鼠红细胞流动速度分压均显著高于烧伤组(P0.05);治疗组和阳性对照组之间大鼠红细胞流动速度差异不显著(P0.05)。结论:富氢盐水能够促进烧伤大鼠微循环内红细胞的流动,改善微循环,恢复受损肺组织,在高压电烧伤患者的治疗方面具有较好的应用前景。     

高压氧联合地塞米松治疗突发性耳聋的疗效及对血液流变学的影响

目的:研究高压氧联合地塞米松治疗突发性耳聋的疗效及对血液流变学的影响。方法:选择2012年6月至2015年1月在我院接受治疗的突发性耳聋患者90例(124耳)进行研究。根据数字法随机分成观察组(45例,60耳)及对照组(45例,64耳),两组均给予常规的改善内耳微循环及神经营养类制剂治疗,对照组另给予地塞米松治疗,观察组在对照组基础上另给予高压氧治疗,治疗1个疗程后对比两组疗效,听力改善程度以及血液流变学指标变化。结果:观察组的总有效率是98.33%,显著高于对照组的89.06%,差异有统计学意义(P0.05)。治疗后观察组的听力损失程度显著优于对照组,纯音听阈显著低于对照组,差异有统计学意义(P0.05)。治疗后观察组的高切粘度、中切粘度、低切粘度、红细胞聚集指数均分别显著低于对照组,红细胞变形指数显著高于对照组,差异均有统计学意义(均P0.05)。结论:高压氧联合地塞米松治疗突发性耳聋患者具有更为显著的疗效,且可有效改善患者的血液流变学指标,值得临床推荐。     

Estimation of the microcirculation state in cerebrovascular disorders using laser doppler flowmetry data and hemorheological parameters

The microcirculation state was assessed in the group of patients with ischemic stroke (n = 30) and the control group of healthy individuals (n = 27) using laser Doppler flowmetry and the wavelet analysis of the amplitude-frequency range of microvascular blood flow oscillations combined with absorption spectroscopy. The hemorheological parameters (blood and plasma viscosity, the degree of red blood cell aggregability and deformability) were assessed in both groups, as were their correlations with the microcirculation parameters. Decreased tissue perfusion (by 25%) and specific oxygen consumption (by 21%) were revealed in a cerebrovascular accident. Changes in the tone-forming regulatory mechanisms of microcirculation of vasodilating nature (decreased microvascular tone, activation of the secretory function of endothelium) may be regarded as a compensatory reaction aimed at maintaining the blood supply of organs and tissues in stroke. The blood viscosity increase in patients due to the plasma viscosity increase and increased red blood cell aggregability and their decreased deformability cause the blood flow to slow down and the wall shear stress to increase, which activates the endothelial secretory function and vasodilation of microvessels. Correlation between the rheological parameters and the passive (respiratory and cardiac) rhythm amplitudes was observed in the control group. In patients, the hemorheological parameters were correlated with the characteristics of the active factors of microvascular blood flow modulation (endothelial, neurogenic, and myogenic), which confirms the role of changed blood properties and regulatory tone-forming mechanisms in the maintenance of tissue perfusion in cerbrovascular accidents.     

A comparison of the effects of photodynamic therapy on normal and tumor blood vessels in the rat microcirculation

The effects of light activation of the tumor photosensitizer dihematoporphyrin ether (DHE) were studied in the microcirculation of the rat cremaster muscle. Arterioles and venules in an implanted chondrosarcoma were studied by in vivo television microscopy and were compared to normal vessels of the same size elsewhere in the preparation and in control preparations. Activation with green light (530-560 nm, 200 mW/cm2, 120 J/cm2) 48 h after intraperitoneal injection of DHE (10 mg/kg body wt) resulted in significant narrowing of diameters of red blood cell columns in tumor arterioles and venules. The response in normal and control arterioles and venules was not significantly different from that seen in the tumor vessels except that the control arterioles did not remain significantly constricted during the treatment period. Treatment resulted in stasis of blood flow in 90% of tumor and normal arterioles at the completion of light activation. In venules, stasis of blood flow was observed in 75% of tumor and 70% of normal vessels. Vasoconstriction was the primary response in arterioles, while thrombosis predominated in venules. Morphologic assessment of light-activated vessels in the cremaster preparation by transmission electron microscopy revealed platelet aggregation with damage to endothelial cells and smooth muscle cells. Perivascular effects observed included interstitial edema and damage to skeletal muscle cells. In the tumor-bearing preparation, no direct cytotoxic effect on the tumor cells was shown. The surrounding vessels exhibited similar vascular stasis, but the lining cells appeared minimally affected. Photoactivation of DHE results in significant changes in the microcirculation which lead to stasis of blood flow. In this model, the response was similar for the normal microvasculature and for the microcirculation of an implanted chondrosarcoma. These effects may account, in part, for the mechanism of action of photodynamic therapy.     

原发性肝癌患者Th1/Th2 亚群研究*

目的:探讨原发性肝癌患者血清中淋巴细胞亚群中Th1/Th2的变化,为分析肝癌的发生发展状症和临床治疗提供免疫学指标。方法:应用放射免疫分析及酶联免疫分析法(ELISA),测定46例肝癌患者,及43例正常对照组进行比较。以IL-2、INF-γ和TNF-α水平代表Th1型细胞因子,以IL-4,IL-6、IL-8、IL-10的水平代表Th2型细胞因子。结果:肝癌患者IL-2、TNF-γ、IL-6的水平明显低正常对照组,P<0.01。IL-4、IL-8、IL-10、TNF-α的水平明显高于正常对照组,P<0.01。结论:肝癌患者体内存在Th1/Th2细胞因子失衡,其中Th1亚群功能抑制,Th2亚群功能亢进,其与肿瘤在宿主体内生长密切相关。通过纠正这些免疫失调将成为肝癌治疗的重要手段。     

电磁水对血白细胞、红细胞、血小板及血管内皮细胞影响的研究

血管中白细胞等的粘附、聚集问题能够影响微循环的血流速度,是损伤血管内皮细胞乃至形成血栓的主要因素之一。在内毒素注射大白鼠的随机、对照实验中,发现电磁水能够减轻内毒素所致的炎症刺激,并能够降低白、红细胞和血小板的粘附、聚集,能降低白细胞的渗出,能提高红细胞的电泳率,能抑制血流速度的减慢和能够减轻血管内皮细胞的损伤。t检验,差异显著(P<0.01)以及差异明显(P<0.05)。揭示电磁水能够提高血细胞和血管内皮细胞的表面负电荷密度,并可以减轻外因(如,内毒素)对体内细胞和血管的损伤。说明电磁水能够改善微循环,维系正常血流和防止血栓形成。     

Study of endothelium-dependent blood oscillations in the human skin microcirculatory bed

Cutaneous microcirculation parameters were studied with laser Doppler flowmetry in healthy volunteers. To investigate endothelial-dependent peripheral blood flow oscillations the iontophoresis of 1% acetylcholine solution was carried out. To estimate the contribution of rhythmical components in blood flow signal the continuous wavelet-transform spectral analysis was used. To reveal correlation between microcirculation parameters under study the correlation analysis was used. The microcirculation index was shown to be the factor producing cross-correlation dependences. The only positive significant correlation between the blood flow oscillation amplitude in the range of endothelial activity normalized to mean microcirculation index at rest and maximal microcirculation index during the iontophoresis of acetylcholine was revealed.