EMR技术在炎症性肠病诊治中的应用

目的探讨内镜下黏膜切除术(EMR)在炎症性肠病诊治中的应用方法及效果。方法回顾性分析300例炎症性肠病患者临床资料,对EMR技术诊治效果进行评价。结果溃疡性结肠炎与克罗恩病的确诊率分别为97.3%、84.2%。治疗后随访1年,溃疡性结肠炎与克罗恩病的临床治疗有效率分别为90.4%、87.5%。结论 EMR技术诊治炎症性肠病效果确切,值得临床推广使用。     

炎症性肠病的药物治疗

1什么是炎症性肠病？ 炎症性肠病（inflammatory bowel diseases,IBD）是一种特殊的慢性肠道炎症性疾病,主要包括克罗恩病和溃疡性结肠炎。克罗恩病可发生于消化道任何部位,为慢性、反复发作的肠壁全层性炎症,常见于回肠末端和结肠。溃疡性结肠炎为发生于结肠的弥漫性、浅表性、局限于黏膜层的炎症,常见于直肠和乙状结肠。     

溃疡性结肠炎和克罗恩病临床特点的比较分析

目的：比较分析溃疡性结肠炎和克罗恩病的临床特点。方法：将本院2009年2～11月收治的48例炎症性肠病患者按照疾病种类分为溃疡性结肠炎组33例和克罗恩病组15例,总结两组患者的临床特点,并进行比较。结果：溃疡性结肠炎患者明显多于克罗恩病患者,前者的发病年龄及并发症发生率均明显高于后者,组间差异均具有统计学意义（P〈0.001或P〈0.05）,且两组患者的临床症状间差异也有统计学意义（P〈0.05）。结论：炎症性肠病中,溃疡性结肠炎更为常见,其发病年龄及并发症发生率高于克罗恩病,两种疾病的临床表现多样。     

枯草杆菌二联活菌肠溶胶囊联合美沙拉嗪在溃疡性结肠炎患者中的应用及对炎症因子的影响研究

<正>研究表明~([1]):枯草杆菌二联活菌肠溶胶囊(美常安)联合美沙拉嗪在溃疡性结肠炎患者中的应用,取得了良好的临床治疗效果,但是,关于枯草杆菌二联活菌肠溶胶囊联合美沙拉嗪在溃疡性结肠炎患者中的应用及对炎症因子的影响研究较少~([2])。因此,本文以溃疡性结肠炎患者作为对象开展研究,     

炎症性肠病认识误区多

炎症性肠病是肠道炎症性疾病的总称．包括溃疡性结肠炎和克罗恩病。这种疾病通常反复发作,迁延不愈。我国炎症性肠病的发病高峰年龄为15—25岁．亦可见于儿童或老年人。     

临床药师对1例溃疡性结肠炎合并慢性乙肝患者的SOAP模式药学监护

摘要：炎症性肠病是一种慢性非特异性肠道炎症性疾病,包括溃疡性结肠炎和克罗恩病。肝炎病毒感染是炎症性肠病患者中常见的病毒感染之一。炎症性肠病合并乙肝病毒感染的患者由于接受免疫抑制药或生物制剂治疗可能会导致乙肝病毒复制活跃、肝功异常,甚至肝衰竭的风险。临床药师结合溃疡性结肠炎及慢性乙肝的治疗原则和诊疗方案,运用SOAP工作模式参与1例溃疡性结肠炎合并慢性乙肝患者的治疗药物调整,并对药物疗效及不良反应等实施全程药学监护,及时发现药物治疗问题,向医师提出合理建议保证患者用药安全性和有效性。     

儿童克罗恩(Crohn)病12例临床诊断体会

克罗恩病((crohn病),是一种慢性、复发性、原因不明的肠道炎症性疾病,本病和慢性非特异性溃疡性结肠炎统称为炎症性肠病(IBD),但克隆病腹泻一般不如慢性溃疡性结肠炎严重,以腹痛、腹泻、肠梗阻为主要症状,且有发热、营养障碍等肠外表现。本文将对儿童克罗恩(Crohn)病是我临床诊治经验做一汇总。     

英夫利西单抗治疗克罗恩病的护理

炎症性肠病是一种病因尚不明确的慢性非特异性肠道炎症性疾病,包括溃疡性结肠炎和克罗恩病,病程长,患者心理压力大,易复发,严重影响患者的生活质量。注射用英夫利西单抗（Infliximab,商品名为类克）,为单克隆抗体,2008年我国炎症性肠病诊治共识意见中推荐用于激素和免疫抑制剂治疗无效的重度克罗恩病[1]。有国内学者进行了英夫利西单抗治疗     

38例炎性肠病的药物治疗

炎症性肠病（IBU）本病包括克罗恩病（CD）和非特异性溃疡性结肠炎（UC）。溃结（UC）病因虽未完全阐明，但多数学者认为与遗传因素、免疫功能障碍、感染及精神因素有关。现将38例炎症性肠病的药物治疗介绍如下。     

克罗恩病的个案治疗讨论

克罗恩病:克罗恩(crohn)病是一个病因未明,主要累及末端回肠和临近结肠的慢性炎症性急病,但整个消化道均可累及,呈节段性分布。本病与溃疡性结肠炎统称为炎症性肠病。临床以腹痛、腹泻、腹部包块、发热及肠瘘等为特点,常伴有肠外损害。发作与缓解交替出现。重症者迁延不愈,常有各种并发症,愈后不良。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

基层医院护士在临床合理用药中的作用

目的充分利用护士在医师和患者间的特殊地位和作用,促进基层临床合理用药。方法从护士的工作性质出发,论述护士参与促进合理用药的方便和优势。结果通过实践,护士在促进合理用药中的作用得到有效发挥,基层合理用药环境得到极大改善。结论充分利用护士与医师和患者间的特殊桥梁作用,在基层医院促进合理用药,规范医师用药行为,防止药物滥用,引导患者安全用药,降低药源性疾病。