采用药物利用指数和人均限定疗程分析剖宫产围术期抗菌药物预防性应用

目的调查本院剖宫产围术期抗菌药物应用情况,评价用药合理性。方法回顾性调查2012年1～12月剖宫产病历528例,采用药物利用指数和人均限定疗程进行抗菌药物应用合理性评价。结果剖宫产围术期抗菌药使用率为100%,68.2%单用抗菌药,24.2%二联使用抗菌药,7.6%先后换用抗菌药。主要使用抗菌药品种为头孢唑啉（56.1%）、头孢美唑（27.3%）及奥硝唑（24.2%）。选用的9种抗菌药中,有3种抗菌药利用指数（DUI）〉1,2种抗菌药DUI〈1,4种抗菌药DUI等于或接近1;6种抗菌药的人均限定疗程〉3d。结论本院剖宫产围术期抗菌药使用剂量存在较大问题,且术后预防性用药疗程长,提示应采取一定的干预措施,促进其合理使用。     

腹外疝患者围术期预防性应用抗菌药物分析

目的:了解广西柳州柳钢医院腹外疝患者围术期预防性应用抗菌药物情况,并对其合理性进行分析及评价。方法:对2009—2010年我院腹外疝患者围术期预防性应用抗菌药物进行回顾性调查分析。结果:109例腹外疝患者中有86例围术期预防性应用抗菌药物,使用率为78.9%;术前0.5～2 h内给药的有86例,合理率为100.0%;术后平均用药疗程为4.3 d。结论:我院腹外疝患者围术期预防性应用抗菌药物仍存在不合理现象,临床医师须规范抗菌药物的应用,确保患者用药的安全、有效、经济。     

人均限定疗程和药物利用指数比较研究

目的:提出人均限定疗程的概念,并以围术期抗菌药物应用为例,探讨药物利用监测指标的合理选择。方法:收集我院2009年12月-2010年4月147例Ⅰ类切口围术期患者抗菌药物的应用情况,计算所用药品的药物利用指数(DUI)和人均限定疗程,比较2个指标对抗菌药物应用情况的评价结果。结果:我院Ⅰ类切口抗菌药物的DUI和人均限定疗程对不规范用药的阳性检出率分别为61.3%和83.9%(P=0.016);以2d为界的分组统计结果为:疗程≤2d组2项指标对不规范用药检出率比较差异无统计学意义(P>0.05),疗程>2d组2项指标对不规范用药检出率差异有统计学意义(P=0.016),人均限定疗程检出率较高。结论:人均限定疗程是一个比DUI更敏感、易得的药物利用监测指标。     

小儿腹外疝手术围术期预防性应用抗菌药物调查分析

目的评价医院外科小儿腹外疝手术围术期预防性应用抗菌药物情况。方法回顾性调查医院外科2008年9月至2010年9月558例腹外疝手术患儿预防性应用抗菌药物情况。结果 558例患儿中,抗菌药物预防性应用率达100%;采用术前0.5~2 h给药者558例次,占100%,其中累计应用抗菌药物时间最短者为24 h,最长者达7 d。预防性应用抗菌药物涉及3类7种,种类最多的为青霉素类(67.20%),其次为头孢菌素类(32.07%)。结论医院小儿腹外疝手术围术期抗菌药物使用中存在使用率高、用药时间过长、抗菌药物选择档次偏高等问题,清洁手术围术期抗菌药物合理使用有待提高。     

195例Ⅰ类切口手术预防性应用抗菌药物分析

目的：了解Ⅰ类切口手术围术期抗菌药物应用情况,为抗菌药物的合理应用及其监督管理提供参考依据。方法：回顾性调查分析甲状腺手术、乳腺手术、腹外疝术共计195例患者抗菌药物的使用情况。结果：195例患者围术期抗菌药物使用率为71.8%（140/195）;使用较多的抗菌药物为头孢菌素类,其中使用频次居首位的为头孢唑林钠,有126例患者使用该药,占90.0%（126/140）。术前0.5～2 h内给药者121例,术前15 min给药者2例,术后给药者17例;术后1 d内停药者44例,术后2 d内停药者10例,术后〉2 d停药者76例。结论：195例Ⅰ类切口手术围术期预防性应用抗菌药物存在不合理用药情况,主要表现为用药指征掌握不严、选药不当、给药时间不适宜、用药疗程过长等。     

荆门地区19家医院2011年腹外疝围术期预防用抗菌药物调查分析

目的:了解荆门地区医院腹外疝围术期预防用抗菌药物情况。方法:回顾性整群抽取荆门地区2011年19家医院(三级医院2所,二级医院8所,一级医院9所)腹外疝手术患者病历768份,对围术期抗菌药物应用率、抗菌药物选用频度、病原学送检率、首剂给药时间、平均给药疗程和联合用药情况进行统计、分析。结果:抗菌药物应用率三级医院达70.6%,二级医院达92.4%,一级医院达100%;人均用药种类为三级医院1.03种,二级医院1.15种,一级医院1.55种;病原学送检率三级医院为28.7%,二级医院为13%,一级医院为8.8%;首剂给药时机合理率三级医院为40.2%,二级医院为33.2%,一级医院为10%;平均给药疗程三级医院为3.5d,二级医院为4.7d,一级医院为6.2d;联合用药比例三级医院为10.1%,二级医院为31.8%,一级医院为65.9%。结论:各级医院腹外疝围术期均存在不合理应用抗菌药物的情况,二级、一级医院更为严重,亟待加强监管。     

剖宫产患者围术期抗菌药物应用的调查分析

目的了解本院剖宫产患者围术期的抗菌药物使用的情况。方法抽取本院2011年共200例剖宫产手术患者出院病历,对患者的抗菌药物使用情况进行回顾性分析。结果剖宫产患者围术期抗菌药物使用率100%,给药途径均采用静脉滴注,疗程3⁵ d,抗菌药物使用频率最高的是头孢呋辛,其次是头孢硫脒,再次为头孢他啶,单用抗菌药物152例(76%),二联48例(24%),均为术后给药。结论本院剖宫产患者围术期抗菌药物应用存在不合理用药情况,主要表现在药物的选择不当、用药剂量过大、给药时机不当及用药疗程过长,临床医护人员应当增强意识,按围术期抗菌药物应用原则加以干预,促进抗菌药物的合理应用。     

80例疝修补术患者预防用抗菌药物分析

目的 分析疝修补术预防性使用抗菌药物的情况.方法 对2011年8月-2012年12月收治的80例疝修补术患者使用抗菌药物资料进行回顾性分析.结果 80例疝修补术患者中,预防性使用抗菌药物的有47例,使用率为58.75%;第二代头孢类抗菌药物频率最高,依次为B-内酰胺类以及酶制剂、青霉素、第三代头孢类抗菌药物、第一代头孢类抗菌药物、林可霉素;用药指征合理性为89.4%,用药时机合理性为68.1%,药物选择合理性为78.7%,用药疗程合理性为63.8%;首次给药时间合理性为65.9%,持续性给药时间合理性68.1%.结论 对疝修补术围术期患者预防性使用抗菌药物时,必须对其用药类型、用药时间及用药指征等进行充分考虑,以保证抗菌药物合理使用.     

我院肝胆外科手术患者围术期抗菌药物应用情况调查

目的 研究我院肝胆外科手术患者围术期抗菌药物的应用情况.方法 采集我院肝胆外科2010年1～6月手术患者病历212份,以限定日剂量(DDD)、药物利用指数(DUI)及用药时间、药品费用等作为指标,对围术期抗菌药物应用情况进行分析、评价.结果 本组治疗过程中共使用过5类抗菌药物、14个品种;8种抗菌药物的DUI≤1.0;74.53%的患者抗菌药物使用时间≤3 d;联合用药时存在重复用药现象.结论 我院肝胆外科围术期抗菌药物使用存在一些不合理现象,抗菌药物使用亟须加强规范化管理.     

Ⅰ类切口手术140例围术期抗菌药物应用情况分析

目的 分析Ⅰ类切口手术围术期抗菌药物应用情况.方法 回顾性分析140例三种Ⅰ类切口手术(乳腺、甲状腺、腹股沟疝)患者的临床资料,对抗菌药物的使用率、药物的种类、给药时机、疗程等进行统计分析.结果 140例三种Ⅰ类切口手术围术期抗菌药物预防应用使用率达100％;抗菌药物使用频次居前3位的分别是头霉素类(116例)、头孢菌素类(18例)、氨基糖苷类(8例);术前给药127例、术后给药13例;抗菌药物总的用药时间不超过24h为56例、48 h为42例、72 h为36例、96h为6例;单一品种用药136例、两种联便用药4例.结论 Ⅰ类切口手术围术期抗菌药物预防应用存在不合理现象,应进一步加强抗菌药物的使用管理.     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.