Molecular mechanism of noradrenaline during the stress-induced major depressive disorder

Chronic stress-induced depression is a common hallmark of many psychiatric disorders with high morbidity rate.Stress-induced dysregulation of noradrenergic system has been implicated in the pathogenesis of depression.Lack of monoamine in the brain has been believed to be the main causative factor behind pathophysiology of major depressive disorder（MDD） and several antidepressants functions by increasing the monoamine level at the synapses in the brain.However,it is undetermined whether the noradrenergic receptor stimulation is critical for the therapeutic effect of antidepressant.Contrary to noradrenergic receptor stimulation,it has been suggested that the desensitization of β-adrenoceptor is involved in the therapeutic effect of antidepressant.In addition,enhanced noradrenaline（NA） release is central response to stress and thought to be a risk factor for the development of MDD.Moreover,fast acting antidepressant suppresses the hyperactivation of noradrenergic neurons in locus coeruleus（LC）.However,it is unclear how they alter the firing activity of LC neurons.These inconsistent reports about antidepressant effect of NA-reuptake inhibitors（NRIs） and enhanced release of NA as a stress response complicate our understanding about the pathophysiology of MDD.In this review,we will discuss the role of NA in pathophysiology of stress and the mechanism of therapeutic effect of NA in MDD.We will also discuss the possible contributions of each subtype of noradrenergic receptors on LC neurons,hypothalamic-pituitary-adrenal axis（HPA-axis） and brain derived neurotrophic factor-induced hippocampal neurogenesis during stress and therapeutic effect of NRIs in MDD.

Endoscopic-catheter-directed infusion of diluted(-)-noradrenaline for atypical hemobilia caused by liver abscess:A case report

BACKGROUND Hemobilia occurs when there is a fistula between hepatic blood vessels and biliary radicles,and represents only a minority of upper gastrointestinal hemorrhages.Causes of hemobilia are varied,but liver abscess rarely causes hemobilia and only a few cases have been reported.Here,we present a case of atypical hemobilia caused by liver abscess that was successfully managed by endoscopic hepatobiliary intervention through endoscopic retrograde cholangiopancreatography(ERCP).CASE SUMMARY A 54-year-old man presented to our emergency department with a history of right upper quadrant abdominal colic and repeated fever for 6 d.Abdominal sonography and enhanced computed tomography revealed that there was an abscess in the right anterior lobe of the liver.During hospitalization,the patient developed upper gastrointestinal bleeding.Upper gastrointestinal endoscopy revealed a duodenal ulcer bleeding that was treated with three metal clamps.However,the hemodynamics was still unstable.Hence,upper gastrointestinal endoscopy was performed again and fresh blood was seen flowing from the ampulla of Vater.Selective angiography did not show any abnormality.An endoscopic nasobiliary drainage(ENBD)tube was inserted into the right anterior bile duct through ERCP,and subsequently cold saline containing(-)-noradrenaline was infused into the bile duct lumen through the ENBD tube with no episode of further bleeding.CONCLUSION Hemobilia should be considered in the development of liver abscess,and endoscopy is essential for diagnosis and management of some cases.

Effects of Tetrandine on Cardiac Noradrenaline Release Evoked by Electrical Stimulation

The effects of tetrandine (TD) on endogenous cardiac noradrenaline (NA) release evoked by electrical stimulation were investigated in perfused guinea pig hearts. The overflow of cardiac NA and its intraneuronal metabolite 3 ,4-dihydroxyphenylethyleneglycol (DOPEG) were determined by high pressure liquid chromatography (HPLC). In the presence of TD,the release of NA evoked by either nerve ganglion-stimulation or cardiac field-stimulation was significantly reduced (P<0. 01). The overflow of DOPEG was markedly enhanced (P<0. 01).TD inhibited cardiac endogenous NA release resulting from activation of the sympathetic nerve terminals within the myocardium, and increased the release of DOPEG, indicating that TD could result in a loss of NA from storage vesicles or activate monoamine oxidase in axoplasma, which could be detected by markedly increased DOPEG release. These effects of TD may be associated with its property of calcium antagonist.

Disciplined sleep for healthy living: Role of noradrenaline

Sleep is essential for maintaining normal physiological processes. It has been broadly divided into rapid eye movement sleep(REMS) and non-REMS(NREMS); one spends the least amount of time in REMS. Sleep(both NREMS and REMS) disturbance is associated with most altered states, disorders and pathological conditions. It is affected by factors within the body as well as the environment, which ultimately modulate lifestyle.Noradrenaline(NA) is one of the key molecules whose level increases upon sleep-loss, REMS-loss in particular and it induces several REMS-loss associated effects and symptoms. The locus coeruleus(LC)-NAergic neurons are primarily responsible for providing NA throughout the brain. As those neurons project to and receive inputs from across the brain, they are modulated by lifestyle changes, which include changes within the body as well as in the environment. We have reviewed the literature showing how various inputs from outside and within the body integrate at the LC neuronal level to modulate sleep(NREMS and REMS) and vice versa. We propose that these changes modulate NA levels in the brain, which in turn is responsible for acute as well as chronic psychosomatic disorders and pathological conditions.

Release of myocardial noradrenaline during acute hibernation in the isolated rat heart

Objective： To explore the release of myocardial noradrenaline during acute hibernation. Methods： The hearts were gained from rats and set up as modified Langendorf preparations beating isometrically. They were perfused with modified Krebs-Henseleit buffer under controlled pressure. Mechanical measurements and coronary effluent were recorded simultaneously at 30min intervals for 150min. Lactate dehydrogenase in coronary effluent was assayed at the beginning, 60min and 120min low-flow ischemia. Noradrenaline in coronary effluent was determined at the beginning of low-flow and 120min of low-flow ischemia and also in control, during hibernation and after 30min reperfusion during stimulation, myocardial noradrenaline response on tyramine was investigated in absence or presence of desipramine after 30min reperfusion. Results： In the control, there was nosignificant chant in noradrenaline overflow during 120min perfusion; In the acute myocardial hibernation group, there was also nosignificant difference in noradrenaline overflow between the beginning and 120min low-flow ischemia. The electrical field stimulation-induced overflow of noradrenaline during hibernation myocardium was significantly less than preischemia or after reperfusion, but there was nosignificant difference between preischemia and reperfusion group. Tyramine induced significant noradrenaline release in absence of desipramine after 30min reperfusion, but this increase in noradrenaline release had nosignificant in the presence of desipramine. These studies indicated that there was not significant spontaneous noadrenaline overflow during acute myocardial hibernation in isolated rat hearts, the stimulation-induced noradrenaline overflow decreased during hibernation and restored to the level of preischemia after reperfusion, myocardial noradrenaline response to tyramine remained after 30min reperfusion. Conclusion： Myocardial noradrenaline overflow may not contribute to the development of acute myocardial hibernation and the function of sympathetic nerve may also maintain in hibernation as myocardium does during acute myocardial hibernation, reperfusion of myocardium may contribute to restoring the function of sympathetic nerve.

Quantitative Determination of Adrenaline Hydrochloride Injection and Noradrenaline Bitartrate Injection by a New HPLC Method via Substitute for Reference Substance

An HPLC method for quantitative determination of adrenaline hydrochloride injection and noradrenaline bitartrate injection was established and validated with a substitute for the reference substance.Phenylephrine hydrochloride was selected as the substitute for the reference substance of adrenaline and noradrenaline bitartrate.The correction factor of phenylephrine hydrochloride with respect to the reference substance of adrenaline and noradrenaline bitartrate was determined under defined conditions.Adrenaline hydrochloride injection and noradrenaline bitartrate injection were quantified by assaying phenylephrine hydrochloride and a correct factor.The results indicate that the HPLC method with the substitute for reference substance was reliable and feasible for quantitative determination of drugs.

Effects of serotonin and noradrenaline on neuronal activities of the solitary tract nucleus and its alteration after ketanserin

Effects of serotonin(5-HT)and noradrenaline(NA)on neuronal activities of the sol-itary tract nucleus(NTS)were investigated in rat medullary slice preparations.After perfusingthe slice with 5-HT,the spontaneous discharge was significantly increased in 25(of 43,58.1%)NTS neurons,reduced in 13(30.2%)and not changed in 5(11.7%).After perfusingthe slice with NA,the spontaneous discharge was significantly reduced or even completelyceased in 27(62.8%)neurons,increased in 13(30.2%)and not changed in 3(7%).Therewere 38(88.4%)neurons responding to both 5-HT and NA.From the 38 neurons,21 wereselected for studying the effect of ketanserin.It was found that ketanserin potentiated the ef-fect of NA on spontaneous discharge in 10(47.6%)neurons and attenuated it in 4(19.0%)neurons.These results suggest that there is an interaction between 5-HT receptorand α-adrenoceptor at the NTS level.This interaction may be helpful in explaining themechanism of the central antihypertensive action of ketanserin.

Noradrenaline as a putative neurotransmitter mediating hypotension-induced Fos-like immunoreactivity inthe supraoptic nucleus of the rat

Hemorrhage or hypotension induces extensive Foslike immunoreactivity in the magnocellular neurosecretory cells in the supraoptic nucleus of the hypothalamus in rat, especially in the vasopressin neurons. The present study was to explore the neurotransmitter mediating this effect. Microinfusion of the alpha-adrenergic blocker into the supraoptic nucleus reduced the hypotension-induced Fos, whereas beta-antagonist did not affect it significantly. Alpha1- and alpha2-antagonist, prazosin and yohimbine,both reduced the Fos-positive cell counts. However, the effective dosage of yohimbine was much larger. Alpha1-agonist, methoxamine, induced abundant Fos-like immnnoreactivity in the vasopressin cells in this nucleus,while beta-and alpha2-agonist did not elicit such effect.Administration of the noradrenergic re-uptake inhibitor,desipramine, to this nucleus to locally accumulate the spontaneously released noradrenaline from the nerve terminals also induced Fos expression, mostly in the vasopressin cells.

Management of Arterial Hypotension Induced by Spinal Anesthesia during Cesarean Section at the Parakou University Hospital in Benin in 2020: Ephedrine versus Noradrenaline

Background: Spinal anesthesia (SA) is a preferred anesthetic technique for childbirth through caesarean section. It causes a sympathetic block responsible for low blood pressure which can be prevented or treated with vasopressors. Aim: This research aims to compare the effect of Noradrenaline with that of Ephedrine in the management of arterial hypotension caused by SA during Caesarean act. Study method: It was a cross-sectional study with two comparative settings which took place at the Teaching hospital of Parakou from April 15th to August 15th 2020. It included all parturients who underwent a caesarian act and received spinal anesthesia. To prevent hypotension two groups were formed. The first group parturient received Noradrenaline (10 γ) as prophylactic and the second group received Ephedrine (10 mg) before anesthesia. The main evaluation criteria were the time before the hypotension occurs and, the secondary endpoint was the number of hypotension episode. The two groups were compared using the usual statistical tests. The study received the approval of the Local Ethical committee of University of Parakou. Results: Two hundred and four parturients were compiled with 102 in each group. The mean age was 28.37 ± 6.15 years with extremes of 16 and 45 years. The main indications for Caesarean section were respectively iterative Caesarean section (46.57%) for scheduled Caesarean section and acute fetal distress (15.69%) for emergency Caesarean section. The incidence of hypotension was 38.24%. The mean delay of occurrence of hypotension was significantly longer in adrenaline group (19.90 min) than ephedrine group (12.53 min) with P = 0.001. According to the secondary endpoint the number of episodes of hypotension, number of tachycardia, and the total doses of each vasopressor were significantly lower in adrenaline group than in the ephedrine group. Conclusion: The use of Noradrenaline according to the established protocol demonstrated its efficiency compared with Ephedrine in the management of hypotension after spinal anesthesia.

艾司洛尔联合去甲肾上腺素对脓毒症休克患者心功能及预后的影响

目的:探讨艾司洛尔联合去甲肾上腺素对脓毒症休克患者心功能及预后的影响。方法:回顾性分析2020年12月至2023年1月该院收治的74例脓毒症休克患者的临床资料,根据治疗方案不同将其分为对照组与研究组各37例。两组均予以常规抗感染、抗炎、液体复苏等治疗,在此基础上对照组采用重酒石酸去甲肾上腺素注射液治疗,研究组在对照组基础上加用盐酸艾司洛尔注射液治疗。比较两组治疗前后血流动力学指标[心率、平均动脉压(MAP)]水平、病情危重度[急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)、序贯器官衰竭评估量表(SOFA)]评分、心功能指标[每搏指数(SVI)、心脏指数(CI)]水平、心肌损伤标志物[高敏肌钙蛋白T(hs-cTnT)、N末端B型脑钠肽前体(NT-proBNP)]水平、血清炎性因子[高迁移率族蛋白B1(HMGB1)、白细胞介素-6(IL-6)]水平、血乳酸水平、不良反应发生率及28 d生存率。结果:治疗后研究组心率,APACHEⅡ、SOFA评分,血清hs-cTnT、NT-proBNP、HMGB1、IL-6、血乳酸水平均低于对照组,SVI、CI水平均高于对照组,差异有统计学意义(P<0.05);治疗6 h后,两组MAP水平均高于治疗前,但组间比较差异无统计学意义(P>0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05);研究组28 d生存率为78.39%(29/37),对照组28 d生存率为67.57%(25/37),差异无统计学意义(P>0.05)。结论:艾司洛尔联合去甲肾上腺素治疗脓毒症休克患者可促进心率恢复正常,且不影响血压水平,并减轻心肌损伤,提高心功能,降低血清炎性因子和血乳酸水平,从而加快病情缓解,效果优于单用去甲肾上腺素。

针刺治疗卒中后抑郁的临床观察研究

目的客观评价针刺调节脑卒中后抑郁(Post-stroke depression,PSD)患者情绪的临床疗效与安全性,并探索针刺干预的可能作用靶点。方法将76例PSD患者随机分为治疗组和对照组,对照组采用脑卒中常规治疗措施,治疗组在此基础上加用针刺治疗,以上星、百会、神庭、风池、率谷为主穴,辅以太冲、合谷、曲池、内关、阳陵泉、足三里、太溪进行针刺,每周5次,连续治疗4周,在治疗结束后的第90天进行随访。比较治疗前、治疗后以及随访后患者17项汉密尔顿抑郁量表评分(HAMD)、改良版Barthel指数(MBI)和治疗前、后血清5-羟色胺、去甲肾上腺素水平以及肠道菌群变化。结果两组患者治疗后、随访后的HAMD评分、MBI指数均低于本组治疗前(P<0.01),且治疗组患者治疗后、随访后的汉密尔顿量表评分显著低于对照组(P<0.01);治疗组治疗后患者5-羟色胺、去甲肾上腺素水平优于本组治疗前(P<0.01),且显著高于对照组(P<0.01)。针刺后患者的优势菌群拟杆菌、厚壁菌、布劳特菌有上升趋势(P>0.05)。治疗前后的差异菌群主要富集与ECM-受体相互作用等信号通路上,差异具有统计学意义(P<0.01)。结论针刺可以帮助患者提升日常生活能力,还能在一定程度上改善PSD患者肠道菌群的相对丰度,从而调节5-HT、NE水平以缓解患者的抑郁情绪,在临床上值得推广。

NE激活Nrf2/HO-1信号通路调节人子宫内膜上皮细胞的氧化应激

目的明确去甲肾上腺素(NE)是否能通过核因子E2相关因子2(Nrf2)和血红素加氧酶-1(HO-1)调控培养的人子宫内膜上皮细胞(hEECs)的氧化应激状态。方法培养hEECs,通过逆转录多聚酶链式反应(RT-PCR)检测α和β肾上腺素能受体在hEECs的表达;细胞计数试剂盒-8(CCK-8)实验确定NE处理对细胞活性的影响,根据结果将细胞分为处理组和对照组,选择合适浓度进行处理;通过Western blot实验,检测闭锁蛋白(Occludin),闭锁小带蛋白-1(ZO-1),凋亡相关蛋白B细胞淋巴瘤-2蛋白(Bcl-2),Bcl-2相关X蛋白(Bax),抗氧化应激蛋白Nrf2、HO-1的表达,流式细胞术检测NE处理后细胞凋亡的情况;酶联免疫吸附试验试剂盒(ELISA)检测丙二醛(MDA)、超氧化物歧化酶(SOD)的水平。结果在hEECs上检测到α1 a、α1 b、α2 a、α2 b、α2 c、β1、β3肾上腺素能受体的表达。NE处理后,在低浓度(5、10μmol/L)不明显影响细胞活力,而15、20μmol/L NE处理细胞6 h或24 h均明显增加细胞活性。紧密连接蛋白ZO-1和Occludin在15μmol/L 24 h处理组显著升高。ZO-1在6 h处理组下降,15μmol/L处理显著下降,同时Occludin在6 h处理组升高。NE处理后与对照相比,细胞凋亡率升高,15μmol/L NE处理细胞6 h凋亡率显著升高,处理24 h后细胞凋亡率有所下降,凋亡相关蛋白Bcl-2/Bax>1。NE处理后,上调Nrf2及HO-1,细胞培养基上清液中的MDA水平没有明显升高,同时SOD水平明显上调。结论NE处理细胞后可通过激活Nrf2/HO-1信号,上调SOD,发挥抗氧化应激、抗凋亡的作用。

Noradrenaline regulates substance P release from rat dorsal root ganglion neurons in vitro

Objective To determine whether activation and/or inhibition of α-adrenoreceptors influences substance P （SP） release from dorsal root ganglion （DRG） primary sensory neurons in vitro. Methods DRGs were dissected from 15-day embryonic Wistar rats. DRG neurons were dissociated and cultured for 2 d and then exposed to noradrenaline （NA） alone （1×10-4 mol/L）, or along with the α1-adrenoreceptor antagonist prazosin （1×10-6 mol/L） or the α2-adrenoreceptor antago- nist yohimbine （1×10-5 mol/L） for 4 d. Then, RT-PCR was used to determine the levels of preprotachykinin （PPT） mRNA encoding for SP and Western blot to assess the protein levels of SP. Basal and capsaicin （CAP）-evoked SP release were measured by enzyme-linked immunosorbent assay （ELISA）. Results CAP-evoked SP release was sensitized by NA and this effect was inhibited by pre-incubation with prazosin but not with yohimbine. The levels of PPT mRNA, SP peptide, and basal SP release did not change significantly in any of the experimental conditions. Conclusion NA may significantly increase CAP-evoked SP release through activation of α-adrenoreceptors, which may contribute to noradrenergic pain modulation.

感染性休克液体复苏完成时限对病情转归的影响

目的 探究感染性休克液体复苏完成时限对患者病情转归的影响。方法 选取2020年7月—2023年7月收治的感染性休克156例,根据液体复苏完成时限分为<1 h组68例、1~2 h组57例、≥2 h组31例。比较3组液体复苏前后急性生理和慢性健康状况评分(APACHEⅡ)、序贯器官衰竭评分(SOFA)、血流动力学指标[中心静脉压(CVP)、心指数、外周血管阻力指数(SVRI)、每搏量指数(SVI)]、血乳酸、pH值、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、血管外肺水指数(ELWI)、肺血管通透性指数(PVPI)、血肌酐、液体复苏量,以及去甲肾上腺素应用剂量、重症监护病房(ICU)住院时间、机械通气时间、28 d生存率。结果 <1 h组、1~2 h组复苏后APACHEⅡ、SOFA评分低于≥2 h组(P<0.05);≤1 h组、1~2 h组复苏后APACHEⅡ、SOFA评分无明显差异(P>0.05);<1 h组、1~2 h组复苏后CVP、心指数、SVI高于≥2 h组,SVRI低于≥2 h组(P<0.05);<1 h组、1~2 h组复苏后CVP、心指数、SVRI、SVI比较无明显差异(P>0.05)。<1 h组、1~2 h组复苏后血乳酸低于≥2 h组(P<0.05);<1 h组、1~2 h组复苏后血乳酸比较无明显差异(P>0.05);3组复苏后血pH值、PaO_(2)、PaCO_(2)比较无明显差异(P>0.05)。<1 h组复苏后ELWI、PVPI、血肌酐高于复苏前,并高于1~2 h组、≥2 h组(P<0.05);3组1 h液体复苏量比较无明显差异(P>0.05),<1 h组、1~2 h组、≥2 h组3 h液体复苏量呈依次降低趋势(P<0.05)。≥2 h组去甲肾上腺素剂量高于<1 h组、1~2 h组(P<0.05);<1 h组ICU住院时间、机械通气时间长于1~2 h组、≥2 h组(P<0.05)。1~2 h组、≥2 h组28 d生存率高于<1 h组(P<0.05,P<0.01)。结论 感染性休克患者初始液体复苏应在1~2 h内完成,能有效改善器官功能障碍和病情,维持血流动力学水平,加快恢复进程,促进病情良好转归。

血必净注射液联合去甲肾上腺素对感染性休克患者血流动力学、血清炎症因子和免疫功能的影响

目的探究血必净注射液联合去甲肾上腺素对感染性休克患者血流动力学、血清炎症因子和免疫功能的影响。方法选取2022年10月至2023年9月浙江省金华市人民医院重症医学科就诊的98例感染性休克患者作为研究对象。按照随机数字表法将其分为对照组和观察组,每组49例。对照组采用去甲肾上腺素治疗,观察组采用血必净注射液联合去甲肾上腺素治疗,疗程为2周。比较两组治疗前后血流动力学指标[中心静脉压(CVP)、平均动脉压(MAP)、心脏指数(CI)、混合静脉血氧饱和度(SvO_(2))、脉搏血氧饱和度(SpO_(2))]、血清炎症因子指标[白细胞介素(IL)-6、IL-8、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、B型脑钠肽(BNP)]、免疫功能指标[CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、自然杀伤(NK)细胞]水平。结果治疗后,两组CVP、MAP、CI、SvO_(2)、SpO_(2)水平高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。治疗后,两组IL-6、IL-8、PCT、TNF-α、BNP水平低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平高于治疗前,NK细胞水平低于治疗前,且观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平高于对照组,NK细胞水平低于对照组,差异有统计学意义(P<0.05)。结论血必净联合去甲肾上腺素能够更好地改善感染性休克患者的血流动力学反应,减少炎症机制,提高免疫力,值得推广。

围术期目标导向液体治疗在妇科腔镜手术患者围术期的应用效果

目的:探讨围术期目标导向液体治疗(GDFT)在妇科腔镜手术患者围术期的应用效果。方法:选取2022年1月至2022年10月蚌埠市第三人民医院收治的行妇科腔镜手术患者80例作为研究对象,按照随机数字表法随机分为观察组和对照组,每组40例。观察组围术期基于心排量监测技术予以患者GDFT,对照组围术期常规补液。比较2组术中胶体、晶体的输入量、总输液量以及尿量、去甲肾上腺素(NE)使用量和低血压发生数,匹兹堡睡眠质量指数(PSQI)评估量表评价2组睡眠质量。结果:观察组晶体输入量、胶体输入量、总输液量、NE使用量、低血压发生率低于对照组,(P<0.05);尿量多于对照组(P<0.05)。观察组术后第1天PSQI评分高于对照组(P<0.05)。结论:围术期予以妇科腔镜手术患者GDFT可以获得较常规补液更满意的容量状态,对改善患者术后早期睡眠质量也可能具有积极作用。

Simultaneous Determination of Epinephrine, Noradrenaline and Dopamine in Human Serum Samples by High Performance Liquid Chromatography with Chemiluminescence Detection

A simple, rapid and accurate high performance liquid chromatographic （HPLC） technique coupled with chemiluminescence （CL） detection was developed for the simultaneous determination of epinephrine （E）, noradrenaline （NA） and dopamine （DA）. It was based on the analyte enhancement effect on the CL reaction between luminol and potassium ferricyanide. The effects of various parameters, such as potassium ferricyanide concentration, luminol concentration, pH value and component of the mobile phase on chromatographic behaviors of the analytes （E, NA and DA） were investigated. The separation was carded out on C18 column using the mobile phase of 0.01 mol/L potassium hydrogen phthalate solution and methanol （92 ： 8, V/V）. Under the optimum condi- tions, E, NA and DA showed good linear relationships in the range of 1 × 10^-8 -5 × 10^-6, 5.0× 10^-9 -1.0× 10^-6 and 5.0×10^-9-1.0× 10^-6 g]mL respectively. The detection limits for E, NA and DA were 4.0×10^-9, 1.0× 10^-9 and 8.0 × 10^-10 g/mL. The proposed method has been applied successfully to the analysis of E, NA and DA in human serum samples.

去甲肾上腺素联合垂体后叶素治疗感染性休克的临床效果

目的探讨去甲肾上腺素联合垂体后叶素治疗感染性休克的临床效果。方法选取2017年9月至2023年5月扬州市中医院ICU收治的62例感染性休克患者作为研究对象,按照随机数字表法分为观察组和对照组,每组各31例。对照组在常规的补液、抗感染等治疗的基础上加用去甲肾上腺素维持血压,观察组在对照组的基础上加用垂体后叶素,统计两组治疗后第6、24、48及72 h血乳酸和尿量变化情况,统计两组6 h内的液体复苏成功率、28 d病死率以及不良反应状况。结果治疗后观察组6、24、48及72 h血乳酸下降水平高于对照组,差异有统计学意义(P<0.05);治疗后观察组6、24、48及72 h尿量高于对照组,差异有统计学意义(P<0.05);同时观察组6 h内液体复苏成功率高于对照组,且观察组28 d病死率低于对照组,差异有统计学意义(P<0.05);两组不良反应总发生率的比较,差异无统计学意义(P>0.05)。结论去甲肾上腺素联合垂体后叶素治疗感染性休克能改善患者的血乳酸及尿量,提高6 h内的液体复苏成功率,并且降低28 d死亡率,安全性有保障。

健脾熄风汤治疗脾虚风动型儿童抽动障碍疗效及对血清神经递质、T淋巴细胞亚群水平的影响

目的 探讨健脾熄风汤治疗脾虚风动型儿童抽动障碍的临床疗效及对神经递质、T淋巴细胞亚群水平的影响。方法 回顾性选取大庆市中医医院2021年1月至2022年1月收治的80例脾虚风动型抽动障碍患儿作为研究对象,根据治疗方案的不同将其分为对照组和观察组,每组40例。对照组给予硫必利片进行治疗,观察组采用健脾熄风汤联合硫必利片进行治疗,两组均连续治疗8周。比较两组耶鲁综合抽动严重程度量表(YGTSS)评分和临床疗效;比较两组治疗前、后中医证候评分及血清神经递质[多巴胺(DA)、去甲肾上腺素(NE)、5-羟色胺(5-HT)]、T淋巴细胞亚群(CD3^(+)T淋巴细胞、CD4^(+)T淋巴细胞、CD4^(+)T淋巴细胞/CD8^(+)T淋巴细胞)比值水平,统计两组不良反应发生情况。结果 治疗后,两组患儿的运动抽动评分、发声抽动评分、社会受损程度评分和YGTSS总分均低于治疗前,且观察组明显低于对照组,差异均有统计学意义(P<0.05)。观察组治疗总有效率为97.50%,明显高于对照组的85.00%(P<0.05)。治疗后,观察组各项中医证候评分均低于对照组(P<0.05)。重复测量方差分析结果显示,两组DA、NE水平及CD4^(+)T淋巴细胞百分比、CD8^(+)T淋巴细胞百分比、CD4^(+)T淋巴细胞/CD8^(+)T淋巴细胞比值均存在交互效应、时间效应和组间效应(P<0.05),5-HT、CD3^(+)T淋巴细胞水平存在时间效应和组间效应(P<0.05)。进一步进行单独效应分析发现,观察组治疗后第4周、第8周CD4^(+)T淋巴细胞百分比和CD4^(+)/CD8^(+)T淋巴细胞比例高于对照组,血清DA、NE水平及CD8^(+)T淋巴细胞百分比均低于对照组,差异均有统计学意义(P<0.05);两组治疗后第8周后血清DA、NE水平及CD8^(+)T淋巴细胞百分比明显低于治疗后第4周,CD4^(+)T淋巴细胞百分比和CD4^(+)T淋巴细胞/CD8^(+)T淋巴细胞比值均高于治疗后第4周,差异均有统计学意义(P<0.05)。治疗期间,两组均未出现明显不良反应。结论 健脾熄风汤治疗脾虚风动型儿童抽动障碍疗效明确,可显著改善患儿各项临床症状,可能与抑制DA、NE分泌水平及调节机体免疫功能有关。

超声引导神经阻滞联合咪达唑仑对胫骨骨折手术患者的麻醉效果

目的:探讨超声引导神经阻滞联合咪达唑仑对胫骨骨折手术患者的麻醉效果。方法:选取我院2018年10月-2020年10月我院收治的164例胫骨骨折手术患者为研究对象,按随机数字表法分为对照组和观察组,各82例。对照组采用超声引导神经阻滞进行麻醉,观察组在对照组基础上增加咪达唑仑进行麻醉。比较2组呼吸循环指标、应激指标、镇静及疼痛程度、麻醉满意度、并发症发生情况。结果:拔管后15min,观察组镇静评分高于对照组,疼痛评分低于对照组,组间差异有统计学意义(P<0.05)。观察组麻醉总满意度为95.12%,高于对照组的84.15%,差异有统计学意义(P<0.05)。观察组并发症总发生率为2.50%,低于对照组的10.98%,差异有统计学意义(P<0.05)。结论:胫骨骨折手术患者采用超声引导神经阻滞联合咪达唑仑麻醉效果显著,安全性更高,可有效缓解患者应激反应。