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Discharging patients home from the intensive care unit:A new trend

World Journal of Clinical Cases 2024年第23期12卷 5313-5319页

作者： Esraa M Hassan Abbas B Jama Ahmed Sharaf Asim Shaikh Mohamad El Labban Salim Surani Syed A Khan Department of Critical Care Medicine Mayo Clinic Health systemMankatoMN 56001United States Department of Internal Medicine Baptist Hospital of Southeast TexasBeaumontTX 77701United States Department of Medicine Aga Khan UniversityKarachi 74200SindhPakistan Department of Internal Medicine Mayo Clinic Health SystemMankatoMN 56001United States Department of Medicine and pharmacology Texas A&M UniversityCollege StationTX 77843United States Department of anaesthesiology Mayo Clinic Health SystemRochesterMN 55905United States

Discharging patients directly to home from the intensive care unit(ICU)is becoming a new *** review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU *** analyzing available evidence and healthcare professionals'experiences,the review explores the potential impacts on patient outcomes and healthcare *** practice of direct discharge from the ICU presents both opportunities and *** it can potentially reduce costs,enhance patient comfort,and mitigate complications linked to extended hospitalization,it necessitates meticulous patient selection and robust post-discharge support *** this strategy successfully mandates the availability of home-based care services and a careful assessment of the patient's readiness for the *** critical evaluation of existing literature,this review underscores the significance of tailored patient selection criteria and comprehensive post-discharge support systems to ensure patient safety and optimal *** insights provided contribute evidence-based recommendations for refining the direct discharge approach,fostering improved patient outcomes,heightened satisfaction,and streamlined healthcare ***,the review seeks to balance patientcentered care and effective resource utilization within ICU discharge strategies.

关键词： Intensive care unit Critical care Early discharge Cost effective critical care Patient comfort Early recovery

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高浓度曲马朵通过内皮依赖与非依赖机制诱导家兔主动脉舒张(英文)

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Acta Pharmacologica Sinica 2003年第5期24卷 3-7+95页

作者： Tijen KAYA,Sinan GURSOY,Baris KARADAS,Bulent SARAC,Haluk KAFALI,Ahmet Serdar SOYDAN Department of pharmacology Department of anaesthesiology Cumhuriyet University Faculty of Medicine Sivas 58140 Turkey Department of pharmacology Department of pharmacology Department of anaesthesiology Cumhuriyet University Faculty of Medicine Sivas 58140 Turkey Department of pharmacology

AIM: The mechanism of tramadol-induced vasodilation was investigated using isolated rabbit thoracic aortic rings. METHODS: Aortic rings from 8 rabbits were placed in organ bath and precontracted with phenylephrine(10-5mol/L) before addition of tramadol. Relaxation responses by tramadol were evaluated in the presence and absence of endothelium, indomethacin （an inhibitor of cyclooxygenase）, NG-nitro-L-arginine methyl ester （L-NAME, a specific inhibitor of nitric oxide synthase）, glibenclamide （an inhibitor of ATP-sensitive potassium channels）, tetraethylammonium chloride （TEA, an inhibitor of calcium-sensitive potassium channels）, and naloxone （an antagonist of opioid receptors）. RESULTS: Tramadol(10-4mol/L and 3×10-4mol/L) caused significant vasodilation in endothelium-intact and endothelium-denuded aortic rings （P<0.05）. The relaxation response to tramadol was significantly greater in endothelium-intact rings than in endothelium-denuded rings. Pretreatment of aortic rings with indomethaci

关键词：曲马朵胸主动脉内皮血管舒张

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Liver dysfunction markedly decreases the inhibition of CYP1A2-mediated theophylline metabolism by fluvoxamine

Liver dysfunction markedly decreases the inhibition of CYP1A...

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第十五届国际药理学大会

作者： P. Palatini S. De Martin P. Piccoli R. Padrini R. Orlando Department of pharmacology and anaesthesiology Department of pharmacology and anaesthesiology Department of pharmacology and anaesthesiology Department of pharmacology and anaesthesiology Department of Medical and Surgical Sciences University of PadovaItaly.

＜正＞ Objectives: To evaluate the effect of cirrhosis on the inhibition by fluvoxamine of theophylline metabolism, to assess whether liver dysfunction has any influence of drug interaction involving CYP1A2. Methods: The study was carried out in 10 healthy volunteers, 10 patients with Child A, and 10 with Child C cirrhosis, according to a randomized, double - blind, 2 - phase, crossover design. Results: Fluvoxamine - induced inhibition of theophylline clearance decreased from 62 %. in controls, to 52% and 12% in Child A and C cirrhotics, respectively. CYP1A2 - mediated formations of 3 - methylxanthine and 1 - methyluric acid were totally inhibited in controls, but reduced by only one third in Child C cirrhotics . Inhibition of 1,3 - dimethyluric acid formation decreased from 58% , in controls, to 43% and 7% in patients with Child grade A and C cirrhosis, respectively. Conclusions: Two mechanisms are proposed to explain the attenuating effect of cirrhosis on CYP1A2 inhibition: decreased sensitivity to fluvoxamine of CYP1A2 - mediated biotransformations. probably due to reduced uptake of the inhibitory drug by the cirrhotic liver;reduced hepatic expression of CYP1A2, which makes its inhibition less important.

关键词： theophylline - fluvoxamine interaction liver disease

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Amnesia induced by halothane is related with an increase of the 5-HMA and galanin receptors function in the limbic areas of the rat brain.

Amnesia induced by halothane is related with an increase of ...

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第十五届国际药理学大会

作者： Bellido I Gomez -Luque A Bellido MV Sanchez de la Cuesta F pharmacology and Clinical Therapeutics pharmacology and Clinical Therapeutics.anaesthesiology Medicine School Nursering School Malaga pharmacology and Clinical Therapeutics

＜正＞ The effect of halothane’ anaesthesia in the memory and in the rat brain 5 - HT1A and galanin （GAL） receptors were determined. Rats （n = 12. adult male Sprague- Dawley） were anaesthetized with halothane （HAL）（3-5 mmHg in 50% O2- 50 % O2N,30 min）. The memory capacity （8 - arm labyrinth） and brain 5 -HT1A and GAL receptors （ autoradiography techniques with 3H - 8OH - DPAT and 125I - human - porcine galanin） were determined 24 h after. HAL increased the time spent in: the first choice （ + 50 % ）,in the first 1 and 8 accuracy choices （ + 53%,+ 67% ）, and the error choices total number （ + 136% ）. HAL diminished the time spent eating （ - 26% ）. and the accuracy choices total number （ - 44 %） and the first 8 choices accuracy choices number （ -42%）（p＜0. 05）. HAL increased the affinity of GAL receptors in hippocampus and amygdala （Ki increment 82 % and 151 % ）（p ＜ 0.01）. HAL increased the 5 - HT1A receptors affinity of fronto - parietal cortex, hippocampus CA1 and amygdala （Kd reduction - 66% , - 88% and - 63% ） while reduced receptors affinity of dorsal raphe （Kd increment +224%）（p＜0.0l）. Amnesia induced by halothane in rats are linked to an increased neurotransmission of the galanin and the 5 - HT1A receptors in limbic areas.

关键词： halothane brain. 5-HT1A galanin

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5-ASA colonic mucosal concentrations resulting from different pharmaceutical formulations in ulcerative colitis

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World Journal of Gastroenterology 2013年第34期19卷 5665-5670页

作者： Renata D’Incà Martina Paccagnella Romilda Cardin Surajit Pathak Vincenzo Baldo Maria Cecilia Giron Giacomo Carlo Sturniolo Department of Surgical Oncological and Gastroenterological SciencesUniversity of Padua Department of Environmental Medicine and Public Health Institute of HygieneUniversity of Padua Department of pharmacology and anaesthesiology University of Florence

AIM:To compare the mucosal concentrations of 5-aminosalicylic acid(5-ASA)resulting from different pharmaceutical formulations and analyse the influence of inflammation on the mucosal ***:The study included 130 inflammatory bowel disease(IBD)patients receiving 5-ASA as pH-dependent-release formulations(73 patients),time-dependent-release formulations(11 patients),or pro-drugs(18patients).In addition,28 patients were receiving topical treatment(2-4 g/d)with pH-dependent-release *** biopsies were obtained from the sigmoid region during the *** 5-ASA concentrations(ng/mg)were measured in tissue homogenatesusing high-pressure liquid chromatography with electrochemical *** t test and Mann-Whitney test,when appropriate,were used for statistical ***:Patients receiving pH-dependent-release formulations showed significantly higher mucosal concentrations of 5-ASA(51.75±5.72 ng/mg)compared with patients receiving pro-drugs(33.35±5.78 ng/mg,P=0.01)or time-dependent-release formulations(38.24±5.53 ng/mg,P=0.04).Patients with endoscopic remission had significantly higher mucosal concentrations of5-ASA than patients with active disease(60.14±7.95ng/mg vs 35.66±5.68 ng/mg,P=0.02).Similar results were obtained when we compared patients with the histological appearance of remission and patients with active histological inflammation(67.53±9.22 ng/mg vs 35.53±5.63 ng/mg,P<0.001).Significantly higher mucosal concentrations of 5-ASA were detected in patients treated with both oral and topical treatments in combination compared with patients who received oral treatment with pH-dependent-release formulations alone(72.33±11.23 ng/mg vs 51.75±5.72 ng/mg,P=0.03).CONCLUSION:IBD patients showed significant variability in mucosal 5-ASA concentrations depending on the type of formulation,and the highest mean concentration was achieved using pH-dependent-release formulations.

关键词： 5-aminosalicylic acid Inflammatory bowel diseases Mucosal concentration

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腹腔镜手术时腹腔内注射哌替啶和罗哌卡因后的药物分布与临床作用

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麻醉与镇痛 2009年第1期5卷 68-76页

作者： Michael J. Paech Kenneth F. Itett Peter Hackett Madhu Page-Sharp Richard W. Parsons 邢军(译) 李成辉(校) pharmacology and anaesthesiology unit School of Medicine and Pharmacology The University of Western Australia Perth Clinical pharmacology and Toxicology Laboratory PathWest Laboratory Medicine Nedlands Western Australia Australia Independent Biostatistician PerthWestern Australia Australia 不详

背景目前，支持腹腔内注射哌替啶或局部麻醉药以提供有效手术后镇痛的证据尚为有限。本研究的目的旨在探讨腹腔内注射哌替啶和罗哌卡因后镇痛的有效性，并测定药物的血浆浓度。本研究的无效假设为：各组患者接受腹腔镜腹部大手术后24小... 详细信息

背景目前，支持腹腔内注射哌替啶或局部麻醉药以提供有效手术后镇痛的证据尚为有限。本研究的目的旨在探讨腹腔内注射哌替啶和罗哌卡因后镇痛的有效性，并测定药物的血浆浓度。本研究的无效假设为：各组患者接受腹腔镜腹部大手术后24小时内活动时疼痛程度无统计学差异。方法本研究采用随机、双盲和空白对照的方法，在2个医学中心将250例拟行腹腔镜手术的女性患者分为5组：腹腔内注射哌替啶50或100mg（M50和M100组）、罗哌卡因150mg（R150组）、哌替啶50mg复合罗哌卡因150mg（M50R150组）和哌替啶肌肉注射50mg（对照组）。所有患者均肌肉注射生理盐水或腹腔内注射生理盐水，以保证各组处理方法的一致性。在恢复期间，将疼痛作为基本的观察指标，此后还要测定药代动力学参数。结果各组患者在手术后恢复室中及离开后的活动疼痛评分均数差异无统计学意义[对照组、M50组、M100组、R150组和M50R150组分别为2．2（2．8）、2．5（3．3）、1．6（2．5）、2．6（3．2）和2．7（3．2），P=0．50]。各组问静息疼痛评分、吗啡静脉用量、恢复指标和患者满意度的差异无统计学意义。腹腔内给予哌替啶50mg后，其血浆浓度（中位数55～60ug/L）相当于肌肉注射等量哌替啶后血浆浓度的一半（中位数113ug/L）。结论与全身注射阿片类药物相比，腹腔内注射哌替啶和罗哌卡因（单独使用或联合使用）并不能更好地缓解腹腔镜手术后的疼痛或减少阿片类药物的使用量。

关键词：腹腔内注射腹腔镜手术罗哌卡因哌替啶药物分布临床作用手术后镇痛注射生理盐水

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中低速率输注瑞芬太尼不改变脑电双频指数监测下维持麻醉所需靶控输注丙泊酚的浓度

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麻醉与镇痛 2008年第2期4卷 46-52页

作者： Lars P. Wang Peter McLoughlin Michael J. Paech Irina Kurowski Emma L. Brandon 包睿(译) 邓小明(校) Department of Anaesthesia and Pain Medidne Royal Perth Hospital Perth Western AustraliaAustralia pharmacology and anaesthesiology unit School of Medicine and PharmacologyUniversity. of Western Australia Perth Western Australia Australia 不详

背景本文旨在观察不同速率输注瑞芬太尼是否会降低使脑电双频指数（bispectral index，BIS）≤50的丙泊酚EC50（半数有效浓度）值。方法将72例ASA分级Ⅰ或Ⅱ级拟行气管内插管并靶控输注（TCI）丙泊酚维持麻醉的成人患者，随机分为6组。... 详细信息

背景本文旨在观察不同速率输注瑞芬太尼是否会降低使脑电双频指数（bispectral index，BIS）≤50的丙泊酚EC50（半数有效浓度）值。方法将72例ASA分级Ⅰ或Ⅱ级拟行气管内插管并靶控输注（TCI）丙泊酚维持麻醉的成人患者，随机分为6组。瑞芬太尼输注速率分别为：B组0．1μg·kg^-1·min^-1,C组0．15μg·kg^-1·min^-1,D组0．2μg·kg^-1·min^-1,E组0．3μg·kg^-1·min^-1,F组0．4μg·kg^-1·min^-1,A组作为对照组不使用瑞芬太尼。在同一浓度瑞芬太尼组中，以第1例患者对TCI4μg/ml丙泊酚的反应决定岳一例患者的效应室浓度（Dixon的“序贯法”）。如果BIS〉50，后一例患者TCI丙泊酚的效应室浓度增加，如果BIS≤50，后一例患者TCI丙泊酚的效应室浓度则减少。同时研究了联合用药的血流动力学效应。结果EC50变化范围为2．4-2．9μg/ml.未发现瑞芬太毫对丙泊酚EC50的累加效应。但是未使用瑞芬太尼的空白对照组对丙泊酚的反应差异较大。使用瑞芬太尼组患者心率下降。结论瑞芬太昆输注不会减少无刺激麻醉患者丙泊酚需求量。在联合输注瑞芬太尼时不应当降低丙泊酚TCI浓度．

关键词：脑电双频指数监测半数有效浓度瑞芬太尼靶控输注维持麻醉丙泊酚低速率效应室浓度

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Assessment of regional ventilation distribution:Comparison of vibration response imaging with electrical impedance tomography

Assessment of regional ventilation distribution:Comparison o...

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中国毒理学会第六届全国毒理学大会

作者： SHI Chang Stefan BOEHME Alexander H BENTLEY Erik K HARTMANN Klaus U KLEIN Marc BODENSTEIN Roman ULLRICH Klaus MARKSTALLER Department of anaesthesiology Medical Centre of the Johannes Gutenberg-University Mainz National Beijing Center for Drug Safety Evaluation and Research Beijing Institute of Pharmacology and Toxicology

＜正＞OBJECTIVE Vibration response imaging（VRI） is a new bedside technology to monitor ventilation by detecting lung sound *** is currently unknown whether VRI is able to accurately monitor the local distribution of ventilation within the *** therefore compared VRI to electrical impedance tomography（EIT）,an established technique used for the assessment of regional ventilation. METHODS For peer review,simultaneous EIT and VRI measurements were performed in the healthy and injured lungs（ALI;induced by saline lavage） at different PEEP levels（0,5,10,15 mbar） in nine *** energy amplitude（VEA） by VRI,and amplitudes of relative impedance changes（rel. AZ） by EIT,were evaluated in seven regions of interest（ROIs）.To assess the distribution of VT by VRI and EIT,absolute values were normalized to the VT obtained by simultaneous spirometry measurements. RESULTS Redistribution of ventilation by ALI and PEEP was detected by VRI and *** linear correlation between pooled VT by VEA and *** was R =***-Altman analysis showed a bias of -1.07±24.71 ml and limits of agreement of -49.05 to +47.36 *** the different ROIs, correlations of VT - distribution by EIT and VRI ranged between R values ofO.29 and *** and PEEP did not alter the agreement of VT between VRI and *** Measurements of regional ventilation distribution by VRI are similar to those obtained by EIT.

关键词： electrical impedance lung injury ventilation vibration imaging

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手术前口服普瑞巴林用于缓解妇科小手术术后疼痛的随机安慰剂对照实验

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麻醉与镇痛 2008年第5期4卷 49-53页

作者： Michael J. Paech Raymond Goy Sebastian Chua Karen Scott Tracey Christmas Dorota A. Doherty 彭宇(译) 蒋宗滨(校) pharmacology and anaesthesiology unit School of Medicine and Pharmacology The University of Western Australia Department of Anaesthesia and Pain Medicine King Edward Memorial Hospital for Women Research Design and Biostatistics unit Women and Infants Research Foundation Perth Western Australia Australia 不详

背景尽管普瑞巴林能有效治疗神经病理性疼痛，但是否能有效控制手术后疼痛仍证据不足。我们的研究目的是调查分析普瑞巴林对发生急性内脏痛的日间手术患者的镇痛效果。假设是普瑞巴林和安慰剂的镇痛效果差异无显著性。方法对90例行子宫... 详细信息

背景尽管普瑞巴林能有效治疗神经病理性疼痛，但是否能有效控制手术后疼痛仍证据不足。我们的研究目的是调查分析普瑞巴林对发生急性内脏痛的日间手术患者的镇痛效果。假设是普瑞巴林和安慰剂的镇痛效果差异无显著性。方法对90例行子宫手术的妇科小手术妇女进行随机双盲平行安慰剂对照试验。患者在手术前约1小时口服普瑞巴林100mg（PG组）或安慰剂（C组）。观察结果是患者在恢复室和手术后24小时的疼痛评分。结果两组患者在恢复室的疼痛评分（PG组的中位数、四分位间距分别为16和0～36；C组中位数、四分位间距分别为10和6．5—36，P=0．80）和此后所经历的疼痛差异无显著性；两组患者恢复室内芬太尼用量（PG组为42％，C组为27％，P=0．12）或手术后24小时恢复质量（PG组和c组的中位数、四分位间距分别为17、17—18小时和18、16．5～18，P=O．75）差异也无显著性。出院后轻度头晕、视觉障碍和行走困难的发生率普瑞巴林组明显高于安慰剂组。结论只进行单纯子宫操作的妇科小手术患者，手术前服用单次剂量普瑞巴林100mg不能减轻其手术后急性疼痛以及改善其恢复质量。

关键词：手术后疼痛随机安慰剂妇科小手术普瑞巴林术前口服对照实验神经病理性疼痛缓解

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术后恶心与呕吐的治疗近年取得了较好的数据资料和疗效

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英国医学杂志中文版 2004年第6期7卷 330-331页

作者： Martin R Tramér 裴丽坚 Division of anaesthesiology Department of Anaethesiology Pharmacology and Surgical Intensive Care Geneva University Hospitals CH-1211 Geneva 14 Switzerland

手术后出现恶心和呕吐让人不适，麻醉医师常常因此而受到指责。事实上，目前有证据表明：引起手术后恶心与呕吐的因素有多种，其中，一些与麻醉医师有关，一些与手术有关，另一些则与病人本身有关。由于手术后恶心呕吐为自限性，不会慢... 详细信息

手术后出现恶心和呕吐让人不适，麻醉医师常常因此而受到指责。事实上，目前有证据表明：引起手术后恶心与呕吐的因素有多种，其中，一些与麻醉医师有关，一些与手术有关，另一些则与病人本身有关。由于手术后恶心呕吐为自限性，不会慢性化，

关键词：术后恶心呕吐治疗数据资料麻醉 5-羟色胺

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