目的 观察不同浓度肾上腺素与利多卡因混合液头皮浸润注射对开颅术患者血流动力学的影响。方法 选取2010年5月－10月80例颅内肿瘤患者，随机分成4组，行1%利多卡因溶液混合不同浓度的肾上腺素16 mL头皮浸润注射。肾上腺素浓度：A组2.5 μg/mL、B组5.0 μg/mL、C组7.5 μg/mL、D组10.0 μg/mL。记录注射前（T0）、注射后5 min内（T1-10）心率（HR）、平均动脉压（MAP）、收缩压（SBP）、舒张压（DBP），根据各时段的MAP最低值和最高值，计算MAP的降低率和升高率，计数各组MAP下降10%以内、10%～20%和20%以上的例数。 结果 C组的MAP下降例数最多且MAP下降率最高，与其他组间比较差异有统计学意义（P＜0.05）。组内比较，C组MAP、SBP在1.5、2.0、2.5 min时、DBP在2 min时和D组MAP和DBP在1.5、2.0 min时下降差异有统计学意义（P＜0.05）。4组血压下降的同时伴HR增快，但HR组间差异无统计学意义（P＞0.05）。 结论 低浓度的肾上腺素与10%利多卡因混合液用于开颅术患者头皮浸润注射时可导致血压下降。
Objective To discuss the effect of continuous phenylephrine infusion and single-dose phenylephrine injection on puerpera undergoing spinal and epidural combined anesthesia and the infant outcomes. Methods A total of 50 patients scheduled for selective cesarean section under combined spinal and epidural anesthesia were selected as the study subjects between July 2015 and June 2016. They were randomly allocated into two groups with 25 in each. Group CII underwent continuous phenylephrine infusion [0.5 μg/(kg·min)] immediately after anesthesia to adjust the blood pressure, while group CON accepted single-dose phenylephrine injection (50 μg) after anesthesia when systolic pressure was lower than 90 mm Hg (1 mm Hg=0.133 kPa) or when the decrease of mean arterial pressure (MAP) was higher than 20% of the base value. The infusion of phenylephrine was stopped after the fetus was taken out. MAP, cardiac output, cardiac index (CI) at the time when the patient went into the delivery room (T1), before anesthesia (T2), 1 minute after anesthesia (T3), 3 minutes after anesthesia (T4), 10 minutes after anesthesia (T5), and delivery (T6) were recorded. Blood gas analysis of fetal umbilical arterial blood was carried out and neonatal Apgar score was recorded. Results Hemodynamics was more stable in group CII compared with group CON. Heart rate at T4 and T5, and cardiac output at T5 and T6 in group CON were significantly lower than those in group CII (P<0.05). The neonatal umbilical arterial blood pH value, base excess and HCO3－ were all significantly lower, while partial pressure of carbon dioxide was significantly higher in group CON than group CII (P<0.05). Conclusion Compared with single-dose phenylephrine injection, continuous phenylephrine infusion has more stable hemodynamics, and exert less effect on maternal and infant outcomes for patients undergoing cesarean section under combined spinal and epidural anesthesia.
Objective To assess the efficacy of medical expulsive therapy for ureteral calculi with tamsulosin. Methods We searched PubMed, MEDLINE, EMBASE, BIOSIS, International Pharmaceutical Abstracts (IPA) Database, The Cochrane Library and Chinese Journal Full-text Database from 1995 to September 2006, as well as the proceedings of urological scientific conferences from 2000 to 2006. Randomized controlled trials(RCTs) comparing tamsulosin and other therapies for ureteral calculi among adults were included. Data were extracted by two reviewers independently and synthesized by STATA 9.0 software. Results A total of 16 studies involving 1521 patients with distal or juxtavesical ureteral calculi were included. Compared with conservative therapy, tamsulosin showed higher expulsion rate [RR 1.50, 95%CI (1.20 to 1.87), Plt;0.0001], shorter expulsion time [SMD –1.29, 95%CI (–2.27, –0.31)] and fewer patients requiring ESWL or ureteroscopy [RR 0.40, 95%CI (0.27, 0.59), Plt;0.05]. Compared with conservative therapy, the combination of tamsulosin plus deflazacort also showed higher expulsion rate [RR 1.59, 95%CI (1.31, 1.93)], shorter expulsion time [SMD –0.8, 95%CI (–1.18, –0.42)] and fewer patients requiring ESWL or ureteroscopy [RR 0.13, 95%CI (0.06, 0.31), Plt;0.05]. Compared with deflazacort alone, the combination of tamsulosin plus deflazacort demonstrated similar expulsion rate [RR 1.31, 95%CI (0.78, 2.23), P=0.31], but significantly reduced the dosage of analgesics [SMD 15.20, 95%CI (14.98, 15.52)] and decreased the proportion of patients requiring ESWL or ureteroscopy [RR 0.09,, 95%CI (0.02, 0.47), Plt;0.05]. Compared with deflazacort plus nifedipine, the combination of tamsulosin plus deflazacort showed higher expulsion rate [RR 1.20, 95%CI (1.07, 1.35), P=0.002], but similar expulsion time [SMD –1.34, 95%CI (–3.47, 0.79)] and proportion of patients requiring ESWL or ureteroscopy [RR 0.34, 95%CI (0.05, 2.22), Pgt;0.05]. As for side effects, tamsulosin-based treatment and conservative therapy were comparable (Pgt;0.05). Conclusions Tamsulosin has a beneficial effect on the expulsion of ureteral calculi, especially for distal and juxtavesical ureteral calculi. Tamsulosin-based medical expulsive therapy at the dosage of 0.4mg daily is effective and safe for patients with distal ureteral calculi. More large-scale studies are required to define the efficacy of combination therapy of tamsulosin plus deflazacort.
ObjectiveTo systematically evaluate the correlation between type-2 diabetes mellitus (T2DM) and T/C polymorphism in 190 locus ofβ3-adrenergic receptor (β3-AR) gene in Chinese population. MethodsThe following databases such as CNKI, VIP, CBM, PubMed, EMbase, the Cochrane Library (Issue 8, 2012) and WanFang Data were searched to collect case-control studies on the correlation between T2DM and T/C polymorphism in 190 locus of β3-AR gene. The retrieval time was from October 1980 to October 2013. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data and assessed the quality. Then the meta-analysis was conducted by using RevMan 5.0 and Stata 12.0 software, and the publication bias was analyzed by means of Egger's linear regression. ResultsA total of 11 studies involving 1 602 T2DM patients and 1 773 healthy volunteers were included. The results of meta-analyses showed that, for Chinese population, TC genotype in case group was more than that in control group[OR=1.19, 95%CI (1.01, 1.40), P=0.04]. CC+TC genotype in case group was more than that in control group[OR=1.23, 95%CI (1.05, 1.45), P=0.01]. Allele C in case group was more than that in control group[OR=1.24, 95%CI (1.08, 1.43), P=0.003]. ConclusionsThe allele C in 190 locus of β3-AR gene in Chinese population is significantly associated with T2DM. For the quantity and quality limitation of the included studies, this conclusion has to be further proved by more studies.
To quantitatively measure the α1-adrenergic receptors and select the suitable conditions of receptor-ligand binding assay. Radioligand binding analysis was used to measure the concentration of α1-adrenergic receptors, and the measuring conditions were selected, respectively. Under the selected conditions, the α1-adrenergic receptors in lier plasma membranes of 8 nonhepatopathy subjects were measured.Under such suitable conditions as ３H-prazosin concentration 0.1-2.0nmol/L, incubating temperature 37℃, reaction time 20 minutes and seperating free ligand from system with double layer of filter paper, the binding of 3H-prazosin to α1receptors from 8 nonhepatopathy subjects were saturable with a high affinity. The Bmax, Kd, RMC and Hill coefficient were 142.1±14.1 fmol per milligram of protein, 0.2382±0.0548 nM, 739.0±167.6 fmol per gram of liver and 0.90±0.03, respectively.The suitable conditions may be very important for measuring α1-adrenergic receptors in human liver plasma membranes, which should be considered in hepatopathy studies.
Objective To evaluate the effects of low-dose epinephrine on cerebral oxygen saturation (rScO2) and awakening time during one-lung ventilation (OLV) for thoracic surgery. Methods Thirty consecutive patients undergoing lobectomy from March to July 2016 in our hospital were randomly divided into an epinephrine group (n=15, 8 males and 7 females at an average age of 58.70±11.40 years) or a saline group (n=15, 7 males and 8 females at an average age of 57.00±11.40 years). They were continuously infused with 0.01 μg/(kg·min) epinephrine or saline after general induction. Hemodynamics was maintained ±20% of the baseline value. All patients were ventilated by a pressure control mode during OLV with tidal volume of 5-8 ml/kg and end-tidal carbon dioxide tension (EtCO2) of 35-45 mm Hg. Regional cerebral oxygen saturation (rScO2) was monitored using near-infrared spectroscopy (NIRS) continuously. Results Compared with the saline group, the epinephrine group had a high rScO2 during OLV, with a statisitical significance at OLV 40 min and 50 min (67.76%±4.64% vs. 64.08%±3.07%, P=0.016; 67.25%±4.34% vs. 64.20%±3.37%, P=0.040). In addition, the awakening time of patients in the epinephrine group was shorter than that of the saline group (P=0.004), and the awakening time was associated with the duration of low-dose rScO2 (r=0.374). Conclusion Continuous infusion of 0.01 μg/(kg·min) could improve the rScO2 during OLV and shorten awakening time in thoracic surgery.
ObjectiveTo explore the influence of norepinephrine on the prediction of fluid responsiveness by passive leg raising (PLR) during septic shock. MethodsForty-six septic shock patients in intensive care unit of Nanjing Drum Tower Hospital were prospectively observed from September to November 2012. Among which 36 septic shock patients were enrolled with a positive PLR test (defined by an increase in stroke volume index ≥10%). A PLR test was performed at baseline (PLR1). A second PLR test (PLR2) was performed at returning to supine position for 10 min and the dose of norepinephrine was increased to maintain MAP ≥65 mmHg for 20 min. The changes of heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),cardiac index(CI),stroke volume index(SVI),index of systemic vascular resistance(SVRI),global end-diastolic volume index(GEDVI),and cardiac function index(CFI) were monitored by transpulmonary thermodilution technique (PiCCO). ResultsPLR1 significantly increased SVI by (20.54±9.63)%,CI by (20.57±9.89)%,MAP by (7.64±5.77)%,and CVP by (25.83±23.39)%. As the dose of norepinephrine increased,SVI was increased by (16.97±9.06)%,CI by (16.78±8.39)%,GEDVI by (9.08±4.47)%,MAP by (28.07±12.48)%,and CVP by (7.86±8.52)%. PLR2 increased SVI by (13.74±8.79)%,CI by (13.79±9.08)%,MAP by (2.93±5.06)%,and CVP by (13.36±14.74)%. The PLR2 and the dose increase of norepinephrine augmented SVI to a significantly lesser extent than the PLR1 performed at baseline (both P<0.05). However,SVI increased by <10% in 6 patients while the baseline PLR was positive in these patients. ConclusionIn septic patients with a positive PLR at baseline,norepinephrine increases cardiac preload and cardiac output and influences the fluid responsiveness.