聚焦超声联合不同药物治疗慢性宫颈炎的疗效对比分析

目的探讨聚焦超声联合聚甲酚磺醛溶液治疗慢性宫颈炎与聚焦超声加西瓜霜喷剂治疗慢性宫颈炎的疗效对比分析。方法390例确诊的中、重度宫颈糜烂患者根据就诊先后顺序随机分为治疗组A（聚焦超声联合聚甲酚磺醛溶液治疗）、治疗组B（聚焦超声联合西瓜霜喷剂治疗）和对照组（聚焦超声治疗）各130例,对3组的疗效进行对比分析。结果治疗2个月后,对照组总有效率为79．23％,治疗组A总有效率为90．00％。治疗组B总有效率为81．54％。3组总有效率比较差异有统计学意义（P〈0．05）。治疗3个月后,对照组总率为85．38％,治疗组A总有效率98．46％,治疗组B总有效率为86．92％,3组总有效率比较差异有统计学意义（P〈0．05）。且治疗3个月后3组的总有效率均较治疗2个月后的疗效明显增加。结论聚焦超声联合聚甲酚磺醛溶液或联合西瓜霜喷剂治疗慢性宫颈炎疗效均优于单纯聚焦超声治疗,且聚焦超声联合聚甲酚磺醛溶液治疗慢性宫颈炎疗效显著,能明显改善患者的症状,值得临床推广。     

宫颈炎临床治疗体会

目的观察微波联合安达芬栓治疗宫颈炎的临床疗效。方法将收治的114例宫颈炎患者随机分为两组,对照组给予微波治疗,观察组在对照组治疗的基础上,再予安达芬栓治疗,10d为1个疗程,治疗2个疗程后观察效果。结果观察组总有效率为93．62％,对照组总有效率为82．46％,观察组疗效明显优于对照组（P〈0．05）。结论微波联合安达芬栓治疗宫颈炎疗效确切,值得广泛应用。     

宫颈环形电极切除术与微波治疗慢性宫颈炎的疗效比较

目的：比较宫颈环形电极切除术（ LEEP ）与微波治疗宫颈炎的临床疗效。方法选择慢性宫颈炎患者77例,采取数字表法将患者随机分为两组,对照组37例接受微波治疗,观察组40例接受LEEP治疗,比较两组临床疗效。结果两组轻度慢性宫颈炎治愈率（100．0％比93．3％）、总有效率（100．0％比100.0％）差异均无统计学意义（均P＞0．05）;两组中重度慢性宫颈炎治愈率（87．5％比63．6％）、总有效率（100．0％比86．4％）差异均有统计学意义（χ^2＝13．6、14．3,均P＜0．05）;观察组术中出血量、术后阴道排液时间分别为（5．3±3．2）mL、（8．1±3．5）d,均显著低于对照组的（11．2±3．7）mL、（14．8±4．3）d,差异均有统计学意义（t＝11．9、12．6,均P＜0．05）;观察组术后创面感染发生率、宫颈外翻、宫颈瘢痕率、脱痂出血多、复发等发生率分别为0．0％、2．5％、2．5％、2．5％、2．5％,对照组分别为5．4％、5．4％、13．5％、16．2％、10．8％,两组差异均有统计学意义（χ^2＝11．3、10．4、14．9、15．8、13．0,均P＜0．05）。结论与微波相比,LEEP应用于中重度糜烂的慢性宫颈炎疗效确切,副作用小,具有较好的临床应用价值。     

LEEP刀治疗慢性宫颈炎的临床观察

目的探讨LEEP刀治疗慢性宫颈炎的效果及临床价值。方法将169例慢性宫颈炎患者,按照患者意愿随机分为LEEP刀治疗组（观察组269例）和光谱治疗组（对照组100例）。比较两组的疗效及并发症。结果 LEEP刀治疗重度慢性宫颈炎的治愈率为98.6%,对照组治愈率为72.4%,两组比较差异有统计学意义（P〈0.05）。结论 LEEP刀治疗慢性宫颈炎疗效显著,是治疗慢性宫颈炎的有效方法 。     

交沙霉素配伍干扰素栓治疗支原体衣原体性宫颈炎疗效观察

目的探讨女性生殖道支原体、衣原体感染治疗的最佳方法。方法将120例患者随机分为治疗组（56例）和对照组（64例）。治疗组口服交沙霉素400mg，3次／d，10d为1疗程；对照组口服阿奇霉素分散片500mg，1次／d，10d为1疗程，两组均同时予干扰素栓（奥平栓）1枚置阴道深部，隔日1次，共7次为1疗程。结果治疗组有效率达85．7％，对照组有效率70．3％，两组比较有显著性差异（P〈0．05）。结论交沙霉素治疗支原体、衣原体性宫颈炎效果优于阿奇霉素，交沙霉素配伍干扰素栓不失为一种治疗支原体、衣原体性宫颈炎的有效方法。     

宫颈炎康栓联合微波治疗宫颈炎的临床效果观察

目的：探讨宫颈炎康栓联合微波治疗宫颈炎的临床效果。方法选取我院妇科2012年2月—2013年2月收治的100例宫颈炎患者，根据患者意愿分为观察组和对照组，每组50例。比较两组患者的临床治疗效果、阴道清洁度及随访12个月的复发情况。结果对照组患者的总有效率（72％）低于观察组（96％），差异有统计学意义（P 〈0.05）。观察组清洁度优于对照组，差异有统计学意义（P 〈0.05）。随访12个月，观察组复发1例（2％），对照组复发8例（16％），两组比较差异有统计学意义（P 〈0.05）。结论宫颈炎康栓联合微波治疗宫颈炎的疗效显著，复发率低。     

衣达拉奉对重度一氧化碳中毒脑神经功能改善作用的探讨

目的探讨依达拉奉对重度一氧化碳中毒患者脑神经功能的改善作用。方法选取2010年1月～2013年2月本院收治的重度一氧化碳中毒患者76例为临床研究对象,按照治疗方法分为对照组与观察组,每组各38例。对照组使用一般临床治疗方法,实验组在对照组治疗的基础上使用依达拉奉治疗,比较两组患者的昏迷时间、迟发性脑病的发生率、治疗效果、不良反应。结果实验组的昏迷时间为（3．77±1．32）h,短于对照组的（6．29±1．04）h（P〈0．05）;实验组的总有效率为89．47％,高于对照组的65．79％（P〈0．05）;实验组迟发性脑病的发生率低于对照组（P〈0．05）。结论对重度一氧化碳中毒患者使用依达拉奉治疗可以有效改善患者的脑神经功能,提高治疗效果,是一种有效的临床治疗方法。     

窄谱中波紫外线单一治疗重度银屑病

目的评价窄谱中波紫外线（NB—UVB）单一治疗重度银屑病的临床疗效。方法按照治疗方案规律接受NB—UVB治疗的斑块型银屑病患者83例,根据病情严重程度分为轻中度组[银屑病面积及皮损严重指数（PASI）评分〈15,33例）和重度组（PASI评分≥15,50例）。治疗第2…468、12周对患者进行疾病严重程度评价（PASI评分）,并记录不良事件及合并用药。研究结束后对治疗的有效性和安全性进行统计分析及评价,第8周作为主要疗效分析终点。结果治疗第8周轻中度组的PASI的下降比例为68．2（60．0％,78．6％）,重度组为77．5％（51．0％,88．4％）,均明显优于第4周。轻中度组PASI75、PASI90的比例为45．5％（15例）、21．2％（7例）,而重度组PASI75、PASI90的比例为56．0％（28例）、28．0％（14例）。第2周时,轻中度组PASI下降比例22．8％（10．0％,46．3％）及PASI75的比例（12．1％）均明显高于重度组[13．4％（0．0％,27．1）,0％]。不良反应主要为轻度红斑及水肿,轻中度组轻度红斑4例（12．1％）,共11例次（1．9％）;重度组轻度红斑5例（10．0％）,共16例次（1．4％）,重度红斑l例（2．0％）,共1例次（0．1％）。轻中度组轻度水肿1例（3．0％）,共7例次（1．2％）;重度组3例（6．0％）,共12例次（1．1％）。重度组发生治疗后轻度瘙痒1例（2．0％）,共1例次（0．1％）。结论NB—UVB单一治疗对轻中度及重度寻常型银屑病均具有叮靠的疗效,重度银屑病患者对NB—UVB的治疗反应并不亚于轻中度患者。轻中度银屑病在治疗早期改善速度快于重度银屑病患者。     

超高频电波刀联合阴道镜在慢性宫颈炎治疗中的应用

目的观察超高频电波刀联合阴道镜在慢性宫颈炎治疗中的应用价值，为临床治疗提供依据。方法选择慢性宫颈炎患者72例，采用数字表法随机将其分成治疗组36例和对照组36例，治疗组采用超高频电波刀联合阴道镜治疗；对照组采用传统方法治疗。对两组患者治疗效果、手术时间和手术出血量进行比较。结果治疗组治愈33例，好转2例，无效1例，总有效率97．2％；对照组治愈18例，好转10例，无效8例，总有效率77．8；治疗组总有效率明显优于对照组（x^2=6．22，P〈0．05）。治疗组手术时间（5．1±2．6）min，显著短于对照组的（7．5±2．4）min，治疗组手术出血量（61．5±9．6）mL，显著少于对照组的（94．2±20．5）mL，差异均有统计学意义（t=3．31、57．62，均P〈0．05）。结论超高频电波刀联合阴道镜治疗慢性宫颈炎疗效优于传统治疗方法，患者痛苦小，值得在临床中推广应用。     

双额叶重度脑挫裂伤并发中央型脑疝的早期救治观察和预后分析

目的：探讨双额叶重度脑挫裂伤并发中央型脑疝的早期治疗效果。方法选取双额叶重度脑挫裂伤并发中央型脑疝患者54例,采用随机数字表法分为观察组和对照组,观察组采用早期手术治疗,对照组则不接受手术治疗。比较两组临床疗效及预后。结果经过治疗后,观察组GCS评分（12．98±3．85）分,显著高于对照组的（11．35±4．12）分（t＝2．354,P＜0．05）,观察组ICU时间及总入院时间明显短于对照组（t＝10．007,P＜0．01;t＝19．278,P＜0．01）;观察组恢复良好率（40．74％）显著高于对照组（14．81％）（χ2＝4.523,P＜0．05）,观察组中残率、重残率、植物生存率及病死率（33．33％、14．81％、7．41％、3．70％）均低于对照组（44．44％、22．22％、11．11％、7．41％）,但差异均无统计学意义（χ2＝2．587、2．135、2．268、2．189,均P＞0.05）。结论对双额叶重度脑挫裂伤并发中央型脑疝患者进行早期诊断,采用手术治疗方法进行开颅减压,能明显提高治愈率,有效改善预后。     

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。     

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.     

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.     

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。