婴幼儿营养不良合并低钾麻痹44例的治疗方法

目的探讨婴幼儿营养不良合并低钾麻痹的治疗方法。方法对44例婴幼儿营养不良合并低钾麻痹的患儿根据血钾浓度给予不同的剂量和浓度静脉补钾联合口服补钾,较高浓度(>0.3%)静脉补钾在心电监护和监测血钾下进行,同时注意补镁。观察神志、呕吐、腹胀及四肢肌力、肌张力恢复情况。结果44例中多数于24h内病情明显好转,呕吐、腹胀缓解,12~48h内四肢肌力、肌张力恢复正常,血钾浓度于入院后48~72h逐渐恢复至3.5 mmol/L以上。4例患儿补钾4d后测血钾仍低于3.5mmol/L,予补镁2d后血钾渐恢复正常,未出现高钾血症及死亡病例。结论营养不良患儿出现低钾血症时易引起四肢骨骼肌,消化道平滑肌、呼吸肌麻痹,并累及心肌,根据血钾调整静脉补钾浓度加口服补钾,注意补镁,加强支持治疗效果良好。     

冠心病心绞痛介入治疗术后血钾浓度改变分析

目的观察冠心病心绞痛患者介入治疗后患者血清钾离子浓度变化情况并初步分析其原因。方法选择接受冠心病心绞痛支架介入治疗患者106例,介入治疗前1d查静脉血钾浓度,术后3h复查血钾浓度,对比手术前后血钾浓度变化。结果 106例接受介入治疗患者,术后29例发生低钾血症,发生率为27.4%。术前血钾3.50～3.99mmol/L者78例,术后26例发生低钾血症;术前血钾≥4.0mmol/L者28例,术后3例发生低钾血症。手术前后血钾浓度变化差异有统计学意义(P<0.05)。结论冠心病心绞痛患者介入治疗后低钾血症发生率较高,术前应将血钾浓度控制于较高水平,术后应监测血钾浓度并酌情补钾。     

Bartter综合征一例报告

1病例报告患者女 ,18岁。主因间断发作四肢麻木、软瘫1个月余 ,加重3d于2002年7月20日收住院。曾于1月前出现上述症状外院急诊就诊 ,查血钾2 8mmol/L ,血钠133.8mmol/L ,血氯102 6 ,临时给予静脉补钾2 5g,后予补达秀1g,每日3次口服。于次日门诊复诊 ,症状好转 ,查血钾上升至4 1mmol/L。入院前半月再次发作 ,外院急诊就诊查血钾3 3mmol/L ,血钠128 2mmol/L ,给予对症治疗后 ,次日再次来我院门诊复查血钾、血钠、血氯均恢复正常范围 ,继续给予10 %KCL口服液3g/d治疗观察。近3d出现四肢麻木发作较前频繁并迅速出现无力软瘫 ,给予静脉补钾后…     

利托君用于早产早期的观察与护理

早产占分娩总数的5％-15％,约15％早产儿于新生儿期死亡。盐酸利托君是一种β2肾上腺素能受体激动剂,作用为抑制子宫平滑肌收缩,减少子宫活动,延长妊娠期,适用于先兆早产。本研究观察盐酸利托君治疗先兆早产孕妇早期血钾的变化及护理,现报告如下。     

探讨心电图在高血钾诊断中的价值

目的:为了探讨心电图对诊断高血钾的临床价值,尽早诊断、治疗高血钾这一临床急症。方法:对24例高血钾患者的心电图与血钾浓度进行对照研究分析。结果:显示血清钾高低与心电图改变并不呈绝对平行关系,不同程度的高血钾在心电图上有不同的特征性改变,而细胞内钾外移所致的高血钾在心电图上无高血钾改变。结论:心电图对高血钾改变的反应比血清钾测定更准确,可作为诊断高血钾、判断其程度和观察疗效的重要指标。     

血钾测定前影响因素例析

<正>血钾测定是临床常见的检查项目,低钾血症的诊断和临床补钾治疗直接依赖于血钾测定结果,然而检测结果是否可信与测定前各种影响因素的控制有关,如标本的采集、采血方法、血标本运输、药物影响等。目前使用真空采血管,如果管内血量不足,管内负压仍存在,血细胞易被挤破,可能会造成不同程度的溶血。人体体液中98%的钾分布于细胞内液,细胞外液只占2%。钾在组     

大剂量使用糖皮质激素时预防补钾现状及建议

目的 分析大剂量使用糖皮质激素治疗患者血钾水平变化,为临床预防性补钾提供建议。方法 选取2019年1月至2021年5月在郑州市第二人民医院进行大剂量甲泼尼龙琥珀酸钠冲击治疗的患者447例,通过卡方检验分析预防补钾组和非预防补钾组血钾水平下降的发生率是否有差异,通过SPSS线性回归分析初始血钾值为多少应预防补钾。结果447例患者中371例（83.00%）患者给予补钾治疗、76例（17.00%）未给予补钾治疗;预防补钾组42例（11.32%）发生血钾值减低、非预防补钾组6例（7.89%）发生血钾值减低。大剂量使用激素前后两组血钾值减低的发生率差异无统计学意义（P>0.05）,血钾的变化值与血钾的初始值存在的线性回归关系：Y=2.105-0.512X。结论 血钾的降低与是否预防性补钾不相关。当初始血钾值大于4.11 mmol/L时,预防补钾反而导致血钾下降,不建议初始血钾值大于4.11 mmol/L的患者预防性补钾。     

血钾检测结果呈季节性波动的原因分析

目的分析不同季节时血钾检测结果波动的原因。方法统计分析2010-2011年每月临床血钾检测结果的均值与同期质控血钾的均值,另采集空腹37例志愿者静脉血,每例分3份,第1份即刻分离出血清,另外2份分别保存于30℃、10℃下150min后分离血清,用离子选择电极法检测血钾浓度并比较三组结果的差异性。结果2010．2011年间每月临床血钾冬季整体偏高,夏季整体偏低;同期室内质控双水平血钾结果冬季与夏季间无区别,10℃下放置后的血钾结果为（4．512±0．267）mmol／L,显著高于即刻检测的（3．890±0．195）mmol／L（t=11．445,P〈0．05）,而30℃下放置后检测的结果与即刻检测结果差异无统计学意义（t=1．643,P〉0．05）。结论血钾检测存在季节性波动,低温下保存血标本可导致血钾检测结果假性偏高,应该设法控制好检测前样本的贮存条件,保证检测结果的准确性。     

个体化钾浓度透析的临床观察与应用

目的 调查维持性血液透析患者的透析前血钾水平,了解个体化钾浓度透析治疗对病人心血管功能及机体内环境的影响.方法 选取56例行维持性血液透析治疗的患者,观察其透析前血清电解质尤其是血钾水平,将患者分为高钾血症组(血钾＞ 5.5 mmol/L)和低钾血症组(血钾＜ 3.0 mmol/L),改变传统透析液钾离子浓度:对高钾血症患者使用3.0 mmol/L低钾透析液,对低钾血症患者使用4.0 mmol/L正钾透析液,观察血液透析前后患者血清钾水平变化.结果 应用钾浓度调整后的透析液治疗后,高、低钾血症患者血钾水平分别由治疗前的(5.9±0.4)mmol/L、(3.2±0.2)mmol/L调整至治疗后的(4.6±0.5)mmol/L、(4.1±0.3)mmol/L.患者在透析治疗过程中心血管功能状态稳定,未出现明显不良反应.结论 对于维持性血液透析治疗的患者,应监测透析前的血钾浓度,根据检测水平配制个体化钾浓度透析液,将患者血钾水平控制于理想水平,减少心血管并发症的发生.     

不同补钾途径纠正小儿先天性心脏病术后重度低钾血症的研究

目的研究经中心静脉联合胃肠道双重途径高浓度快速补钾治疗小儿先天性心脏病术后重度低钾血症的临床效果。方法将240例小儿先天性心脏病术后发生重度低钾血症患儿随机分为2组,对照组120例,试验组120例。对照组单纯经中心静脉微量泵补钾,试验组经中心静脉和胃肠道双重补钾。分别于补钾后30 m in采集静脉血,监测血钾浓度,比较2组血钾恢复正常值时所需时间及平均尿量。结果试验组血钾恢复正常值时所需时间低于对照组（P〈0.05）,2组血钾恢复正常值时平均尿量比较差异无统计学意义（P（0.05）。结论经中心静脉联合胃肠道双重补钾是快速、及时纠正小儿先天性心脏病术后重度低钾血症的有效方法,并且保证了高浓度快速补钾的安全性和可靠性。     

Regulatory Decision‐Making in the United States Based on a Single Pivotal Clinical Study: Principles and Precedents

The concept of regulatory approval in the United States based on substantial evidence from a single adequate and well‐controlled clinical study is not a new or radical concept. Appropriate discussions and developmental milestone meetings between sponsors and U.S. Food and Drug Administration (FDA) have provided a means to reach a shared understanding of specific situations where a single adequate and well‐controlled study may yield substantial evidence to enable a regulatory approval in the United States. FDA's issuance of its final guidance document on evidence of clinical effectiveness brought additional attention to this topic. The basis in US law, regulations, and guidance for regulatory decision making based on a single adequate and well‐controlled trial is reviewed. Further, to illustrate practical implementation of these provisions, this paper summarizes a number of examples of situations in which a single clinical study was the basis for approval by FDA. These examples were grouped into categories for the purpose of illuminating the patterns of established regulatory precedents. Sufficient examples were available to show logical groupings of experiences to demonstrate circumstances in drug development where there are reasonable precedents for use of a single adequate and well‐controlled trial for regulatory decision making. Regulatory decision‐making based on a single adequate and well‐controlled trial appears to be a well‐accepted approach to attaining approval for 1) use of a product for a new indication where patients attain a significant reduction in morbidity or mortality (or both) with treatment with a drug that was previously approved for a related indication, 2) a new dosage regimen for a previously approved product, and 3) a Supplemental Application seeking traditional approval of a product based on confirmatory evidence of clinical efficacy for a product subject to accelerated approval. Not surprisingly, reliance on a single adequate and well‐controlled trial as the basis for approval of an original NDA or BLA for a new chemical entity or new biologic has been infrequent and typically limited to special situations where patients are refractory to other available therapies or where no alternative therapy exists. The examples presented here illustrate a range of practical experiences where a single adequate and well‐controlled trial has successfully provided the primary basis for regulatory approval in the United States. This information should assist developers of drugs and biologics in their consideration of alternative approaches to development and registration of new products and new indications.     

Pre-clinical methods for detecting the hypersensitivity potential of pharmaceuticals: regulatory considerations

Immune-based systemic hypersensitivities account for a significant number of adverse drug reactions. There appear to be no adequate nonclinical models to predict systemic hypersensitivity to small molecular weight drugs. Although there are very good methods for detecting drugs that can induce contact sensitization, these have not been successfully adapted for prediction of systemic hypersensitivity. Several factors have made the development of adequate models difficult. The term systemic hypersensitivity encompases many discrete immunopathologies. Each type of immunopathology presumably is the result of a specific cluster of immunologic and biochemical phenomena. Certainly other factors, such as genetic predisposition, metabolic idiosyncrasies, and concomitant diseases, further complicate the problem. Therefore, it may be difficult to find common mechanisms upon which to construct adequate models to predict specific types of systemic hypersensitivity reactions. There is some reason to hope, however, that adequate methods could be developed for at least identifying drugs that have the potential to produce signs indicative of a general hazard for immune-based reactions.     

Currently used oxytocin regimen outcome measures at term & postterm. I: Outcome indicators in relation to parity & indication for induction

INTRODUCTION: Although induction of labour with oxytocin is a daily practice at public as well as private health institutions, to the best of our knowledge, there is no published study on induction in Ethiopia. OBJECTIVE: To assess the oxytocin dose required to achieve adequate uterine contraction, the time interval between initiation of oxytocin and adequate contraction achieved and the time lapsed between initiation of induction and vaginal delivery. METHODOLOGY: A two-year retrospective case-series study was done to evaluate the currently used oxytocin regimen outcome measures at Gandhi and St. Paul's hospitals. Oxytocin level in milliunit/minute to achieve adequate uterine contraction, time lapsed to establish labour and deliver vaginally, Bishop Score, and indications for induction were some of the variables included. RESULTS: Five hundred fifty two women induced at term and post term (55.8% nulliparas and 44.2% multiparas) were reviewed with overall elective to emergency induction ratio about 1:1. The first three indications for induction were post term (P < 0.05), term premature rupture of fetal membranes and hypertension (P = 0.005). Spontaneous vertex delivery (46.4%), caesarean section for failed induction (28.4%) and fetal distress (9.6%) were the top modes of delivery in both nulliparas and multiparas. Equal proportion of nulliparas and multiparas established labour (84.1% vs 84.8%) with mean oxytocin level in mu/min 33.6 +/- 21.9 and 17.2 +/- 11.4 and mean time lapsed in hours 2:10 +/- 1:30 and 2:10 +/- 1:10 between initiation of induction and adequate uterine contraction, respectively. More than two-thirds of multiparous and half of nulliparous women achieved adequate uterine contractions with 20-mu/min and less oxytocin infusion among the total women (84.4%) who were diagnosed to have adequate uterine contractions. CONCLUSION: Although the starting, increment and maximum oxytocin regimen for nulliparas and multiparas were different but with parallel Bishop Score, the induction initiation to vaginal delivery time was almost comparable. Very high oxytocin dose for nulliparas wasn't superior to multiparas dose.     

血液透析治疗急性肾功能衰竭24例

本文探讨运用血液透析疗法治疗各种病因所致的急性肾功能衰竭(ARF)患者24例,结果治愈22例(治愈率91.67%)。总结了血液透析疗法是治疗ARF的主要措施,对ARF患者进行早期预防性,充分的透析治疗,可以减轻ARF引起的并发症,有利于肾功能的恢复,并能预防其他系统脏器功能衰竭的发生,尤其对ARF并发多脏器功能衰竭(MSOF)者,早期充分地透析,可以提高救治成功率,减少病死率。     

Influence of iron and zinc status on cadmium accumulation in Bangladeshi women

Cadmium is a widespread environmental contaminant present in food. The absorption in the intestine increases in individuals with low iron stores, but the effect of zinc deficiency is not clear. The aim of the present study was to assess the influence of iron and zinc status on cadmium accumulation in pregnant Bangladeshi women. We measured cadmium in urine from 890 women using inductively coupled plasma mass spectrometry (ICPMS). Further, we also measured ferritin and zinc in plasma. The median cadmium concentration in urine was 0.59 microg/L (adjusted to mean specific gravity of 1.012 g/mL). Analysis of covariance (ANCOVA) showed that urinary cadmium was associated with plasma ferritin and plasma zinc via a significant interaction between dichotomized plasma ferritin and plasma zinc. The analysis was adjusted for age and socioeconomic status. Women with low iron stores and adequate zinc status had significantly higher urinary cadmium compared to women with both adequate iron stores and zinc status. There was no difference in urinary cadmium between women with both low iron stores and zinc status compared to those with both adequate iron stores and zinc status. In conclusion, low iron stores were associated with increased cadmium accumulation, but only at adequate zinc status.     

A dose-ranging, placebo-controlled, randomized trial of alosetron in patients with functional dyspepsia

BACKGROUND: Functional dyspepsia is characterized by upper abdominal pain or discomfort. AIM: To assess the benefit of the 5-HT3-receptor antagonist alosetron in a pilot, dose-ranging, placebo-controlled, multicentre, randomized clinical trial. METHODS: A total of 320 functional dyspepsia patients received placebo (n=81), or alosetron 0.5 mg b.d. (n=77), 1.0 mg b.d. (n=79) or 2.0 mg b.d. (n=83) for 12 weeks, followed by 1 week of follow-up. Primary efficacy was the 12-week average rate of adequate relief of upper abdominal pain or discomfort. Secondary endpoints assessed pain and upper gastrointestinal symptoms. RESULTS: Twelve-week average rates of adequate relief of pain or discomfort were 46% (95% CI: 37-54%), 55% (95% CI: 46-63%), 55% (95% CI: 47-64%) and 47% (95% CI: 38-55%) in the placebo, 0.5 mg, 1.0 mg and 2.0 mg alosetron groups, respectively. Alosetron 0.5 mg or 1.0 mg showed potential benefit over placebo for early satiety and postprandial fullness. Females showed greater responses compared to males. Patients with adequate relief had significantly (P < 0.001) greater reductions in severity and frequency of functional dyspepsia symptoms than those without adequate relief. Constipation was the most commonly reported adverse event. CONCLUSIONS: Alosetron showed potential benefit in relieving functional dyspepsia symptoms compared to placebo. Patients with adequate relief of upper abdominal pain or discomfort showed improvements in multiple functional dyspepsia symptoms.     

Sedation in PACU: indications, monitoring, complications

The aim of the present article is to review the indications, the monitoring and the complications of sedation in the post-anaesthesia care unit (PACU). In this setting, sedation is often an unwanted side effect of anaesthetic drugs that delay discharge, however it could be specifically indicated. Such indications include postoperative anxiety and agitation, airway management and mechanical ventilation, protection against myocardial ischaemia and intracranial hypertension control. Whenever sedation is used, an appropriate monitoring is useful to achieve an adequate level for the specific indication. Methods for sedation monitoring in PACU may be subjective (clinical scales) or objective (lower oesophageal sphincter contractility measurement, heart rate variability, evoked potentials and parameters derived from the electroencephalogram). The target score of the most common clinical scales has been reviewed according to the specific indication. An adequate monitoring is fundamental to avoid the complications of sedation including bradycardia, hypotension, prolonged mechanical ventilation and increased risk of respiratory tract infection as pointed out by many recent data. Therefore, sedation should be used carefully and with an adequate monitoring in post-operative patients not to affect negatively morbidity and mortality.     

Application of urine proteomics for biomarker discovery in drug-induced liver injury

The leading cause of hepatic damage is drug-induced liver injury (DILI), for which currently no adequate predictive biomarkers are available. Moreover, for most drugs related to DILI, the mechanisms underlying the adverse reaction have not yet been elucidated. Urinary protein biomarker candidates for DILI have emerged in the past few years and correlate well with clinical studies for serum DILI biomarkers. The goal of this review was to investigate the use of urine as a source of protein biomarkers for drug-induced liver injury. Finally, we discuss some of the current strategies required to advance the field of biomarker discovery for DILI with respect to appropriate clinical biobanking and adequate translational research.     

The impact of medication resistance and continuation pharmacotherapy on relapse following response to electroconvulsive therapy in major depression

After clinical response to electroconvulsive therapy (ECT), 58 patients with major depressive disorder were followed for 1 year or until relapse. The rate of relapse was substantially higher in patients who had failed adequate antidepressant medication trials prior to ECT than in patients not determined to be medication resistant. Adequacy of post-ECT pharmacotherapy was only marginally related to likelihood of relapse. The subgroup of patients who appeared to benefit from adequate post-ECT pharmacotherapy were those who did not receive an adequate medication trial prior to ECT. The findings call into question the common practice of administering as continuation pharmacotherapy following ECT the same class of medications that patients had failed with during the acute episode prior to ECT. The findings also indicate that resistance to antidepressant medication is a strong predictor of relapse following response to ECT.     

Modelling of the Sedative Effects of Propofol in Patients undergoing Spinal Anaesthesia: A Pharmacodynamic Analysis

Sedation can increase patient comfort during spinal anaesthesia. Understanding the relationship between the propofol effect‐site concentration (Ce) and patient sedation level could help clinicians achieve the desired sedation level with minimal side effects. We aimed to model the relationship between the propofol Ce and adequate and deep sedation and also incorporate covariates. Thirty patients scheduled for orthopaedic surgery received spinal anaesthesia with 0.5% bupivacaine. Propofol was administered via an effect‐site target‐controlled infusion device using the Schnider pharmacokinetic model. The pharmacodynamic models for both adequate sedation [Observer's Assessment of Alertness/Sedation (OAA/S) scores of 3–4] and deep sedation (OAA/S scores of 1–2) were developed using nonlinear mixed‐effects modelling. Increments in the propofol Ce were associated with increased depths of sedation. In the basic model, the estimated population Ce₅₀ values for adequate and deep sedation were 0.94 and 1.52 μg/ml, respectively. The inclusion of the patient's age and sensory block level for adequate sedation and of age for deep sedation as covariates significantly improved the basic model by decreasing the objective function's minimum value from 10696.72 to 10677.92 (p = 0.0003). The simulated Ce₅₀ values for adequate sedation in 20‐year‐old patients with a T₁₂ sensory level and in 80‐year‐old patients with a T₄ level were 1.63 and 0.53 μg/ml, respectively. Both age and sensory block level should be considered for adequate sedation, and the propofol concentration should be reduced for elderly patients with a high spinal block to avoid unnecessarily deep levels of sedation.