溴己新注射液致肌张力增高

1例63岁男性患者因腹股沟疝修补术后出现咳嗽症状,给予溴己新注射液16 mg静脉滴注.输液过程中,患者出现大汗淋漓,双下肢肌张力增高,足内翻屈曲.停用溴己新注射液,给予10%葡萄糖酸钙20 ml静脉滴注,20 min后症状缓解.3 d后出院.     

哌拉西林钠他唑巴坦钠致骨关节痛1例

1例78岁女性患者,主因反复咳嗽、咳痰50余年,加重1d,诊断为肺部感染入院,入院后根据痰培养结果给予注射用哌拉西林钠他唑巴坦钠抗感染治疗,该药治疗2d后,患者出现四肢及躯干疼痛,骨痛样症状,皮肤肌肉无触痛、无红肿.止痛治疗后,患者症状减轻,停药出院后疼痛症状消失.1个月后,患者再次因为肺部感染入院治疗,给予注射用哌拉...     

丹红注射液致发热及伤口出血

1例47岁男性患者,因左足跟腱修补术后感染给予丹红注射液40 ml加入葡萄糖氯化钠注射液250 ml静脉滴注,1次/d.治疗第9天,输注10 min后,患者出现发热,左下肢伤口呈红、肿、热、痛,之后症状自行消失.再次输注又出现上述症状,且伴有伤口出血,出血量约60 ml.行伤口处理.第12天停用该药,未再出现上述症状.     

氟康唑的不良反应

1　过敏反应患者 ,男 ,34岁 ,因包皮龟头炎给予口服氟康唑片剂 (首剂3片·ｄ 1 ) ,服药次日 ,包皮处出现 0 .7ｃｍ×1 .0ｃｍ大小红斑 ,且在颜面、口唇、颈部出现皮疹 ,继而泛发全身 ,以躯干部较严重 ,瘙痒症状明显 ,停药后经中西药抗过敏治疗 ,1周后红斑全部消退[1 ] 。2　室性早搏患者 ,男 ,71岁 ,因肺炎给予氟康唑 1 0 0ｍｇ加入输液中静脉滴注 ,1 5ｍｉｎ后出现频发性早搏 ,呈二联律 ,给予利多卡因治疗后症状消失 ,次日再次用药时再次出现类似心律失常 ,停药后症状逐渐消失[2 ] 。3　血尿患者 ,男 ,79岁 ,因慢性支气管炎给予氟康唑 0 .2…     

药物所致精神障碍6则

1　阿托品患者 ,女 ,2 3岁 ,因甲胺磷农药中毒给予阿托品静脉推注直至阿托品化后 ,给予阿托品 1ｍｇ ,ｉｍ ,ｑ 2ｈ ,第 4天上午突然出现四肢抽搐、胡言乱语 ,喃喃自语 ,入院后 ,阿托品逐渐减量并给予对症治疗 ,1周后病情基本缓解 ,精神症状完全消失。本例系甲胺磷中毒症状明显缓解后未及时适量地撤阿托品 ,以致长期阿托品化而导致精神症状[1 ] 。2　西咪替丁患者 ,女 ,70岁 ,因慢性胃炎给予西咪替丁 0 .6ｇ加入 5 %葡萄糖溶液 2 50ｍＬ ,静脉滴注 ,当液体滴入 1 50ｍＬ时 ,患者突然胡言乱语 ,双手不自主震颤 ,即停药 ,肌肉注射地西泮 ,症状逐渐缓解 ,次日 ,再次使用西咪替丁 ,二次出现上述症状。本品可通过血脑屏障 ,进入中枢神经系统 ,有一定的神经毒性 ,少数患者可出现精神紊乱等症状 ,且多发生在老年人[3 ] 。3　氧氟沙星例 1 ,患者 ,女 ,45岁 ,因泌尿系统感染给予 5 %葡萄糖注射2 50ｍＬ加氧氟沙星 0 .4ｇ,静脉滴注 ,用药后患者即出现精神异常 ,表现为烦躁不安 ,动作异常 ,并伴有恐惧感 ,拒绝输液 ,给予地西泮 1 0ｍｇ ,ｉｍ ,30ｍｉｎ...     

氟康唑致精神障碍

1例79岁股癣患者,因股骨头置换术后预防真菌感染给予氟康唑200 mg/d静脉滴注.输液完毕后3 h,患者出现面色潮红、多语、失眠,呈轻度兴奋状态.次日症状好转,再次输入氟康唑,上述症状复现,并出现定向障碍、情绪亢奋、思维奔逸、幻视及被害妄想.停用氟康唑,改为伊曲康唑0.2 g,1次/d口服,2 d后症状消失.     

硝苯地平引起牙龈增生2例

2例高血压病患者使用硝苯地平致牙龈增生.例1,43岁男性患者口服硝苯地平10 mg,2次/d.用药5年后患者出现牙龈乳头增大伴有龈缘充血.停用硝苯地平,改为坎地沙坦酯.1个月后症状好转.例2,78岁女性患者因血压控制不佳给予硝苯地平30 mg,1次/d.用药1年后患者出现牙龈乳头增大伴有轻度充血.停用硝苯地平,改为氨氯地平.2周后症状缓解.     

阿奇霉素静脉滴注治疗急性咽喉炎致失眠

1例35岁女性患者,因患急性咽喉炎给予阿奇霉素0.5 g加入5%葡萄糖注射液250 ml静脉滴注,1次/ d.当晚出现入睡困难.次日静脉滴注后又出现入睡困难,给予安神片5片及地西泮10 mg口服,失眠症状仍未改善.停用阿奇霉素,改用左氧氟沙星100 ml静脉滴注,1次/d,1 d后睡眠恢复正常.追问病史,患者1年前使用阿奇霉素治疗,曾出现过失眠.     

静脉滴注头孢曲松钠致不良反应2例

例1.患者,女,60岁.因咳嗽2d来我院就诊.查体诊断为上呼吸道感染,给予静脉滴注头孢曲松钠2g+0.9%氯化钠注射液250ml,每天1次.10min后出现恶心、呕吐、面部潮红,双眼睑红热水肿,继之背部手臂大片荨麻疹,喉部发痒,胸闷、气促、呼吸困难、全身发抖,立即给予更换液体,吸氧,给予肾上腺素1mg皮下注射,地塞米松10mg静脉注射,30min后患者症状缓解,第2天全部症状消退.     

阿莫西林致血尿和蛋白尿

1例36岁女性患者因患化脓性扁桃体炎给予阿莫西林胶囊0.5 g,5 h后患者出现腹痛、腰痛,伴尿频,尿急,尿痛症状.尿常规:尿暗红色,混浊,RBC(++),WBC 1～2个/HP,Pro(++).停用阿莫西林,改为青霉素.2 d后症状好转,10 d后复查尿常规正常.     

1H-NMR法分析头孢孟多酯钠对照品

目的　测定首批对照品头孢孟多酯钠含量和头孢孟多校正因子。方法　采用 L C/ MSNMR的方法鉴定了样品中所含的主要降解产物为头孢孟多 ;选择合适的溶剂防止降解反应的发生 ,采用 NMR法测定头孢孟多酯钠和头孢孟多的含量 ,计算出头孢孟多相对于头孢孟多酯钠的校正因子 ,同时采用 L C法对测定结果进行了验证。结果　NMR与 L C含量测定及校正因子测定结果一致。结论　NMR法测定含量方法准确、简便、快速 ,NMR测定校正因子方法可行     

踝关节骨折临床路径中抗菌药物应用的优化

目的:筛选踝关节骨折临床路径中预防性应用抗菌药物的合理化用药方案。方法:回顾性分析我院2008-2010年204例踝关节骨折围手术期预防性应用抗菌药物的情况,筛选出磺苄西林钠、头孢呋辛钠、头孢孟多酯钠和头孢美唑钠4种抗菌药物进行成本-效果分析。结果:204例患者预防性应用抗菌药物使用率100%,术前0.5～2h用药44例(21.57%),平均用药时间(6.03±2.51)d。磺苄西林钠、头孢呋辛钠、头孢孟多酯钠和头孢美唑钠的成本分别为1987.20、892.56、3644.28、1241.28元,有效率分别为71.43%、87.50%、88.46%、97.50%,成本-效果比分别为2782.02、1020.07、4119.69、1273.11,头孢孟多酯钠和头孢美唑钠相对于头孢呋辛钠的增量成本-效果比分别是286637.50和3487.20。结论:实施踝关节骨折临床路径需要优化抗菌药物的预防性应用,头孢呋辛钠可作为较佳用药方案。     

HPLC-DAD考察头孢孟多酯钠与卡络磺钠在5%葡萄糖注射液和0.9%氯化钠注射液中的配伍稳定性

目的考察室温(25℃)下,注射用头孢孟多酯钠与注射用卡络磺钠分别在5%葡萄糖注射液和0.9%氯化钠注射液中的配伍稳定性。方法采用反相高效液相色谱法-二极管阵列检测器分别测定0～6 h内配伍液中头孢孟多酯钠和卡络磺钠的含量变化,同时观察配伍溶液的外观和测定其pH值。结果在室温(25℃)下、6 h内,配伍液外观无明显变化,但pH值和含量均变化明显。结论在室温(25℃)下、6 h内,注射用头孢孟多酯钠与注射用卡络磺钠在5%葡萄糖注射液和0.9%氯化钠注射液中配伍均不稳定。     

注射用头孢孟多酯钠与注射用奥美拉唑钠序贯静滴的稳定性研究

目的：研究注射用头孢孟多酯钠与注射用奥美拉唑钠序贯静滴的配伍稳定性。方法：参考临床常用质量浓度,配制头孢孟多酯钠与5%葡萄糖注射液配伍溶液,再取该配伍溶液分别与不同体积的奥美拉唑钠溶液配伍。于0,0.5,1,2,3,4,5,6 h观察各配伍液的外观性状变化,测定pH值和不溶性微粒数,并采用HPLC法测定各配伍液头孢孟多酯钠的相对百分含量。结果：头孢孟多酯钠与5%葡萄糖注射液的配伍液在6 h 内外观无明显变化,与不同体积奥美拉唑钠配伍的配伍液随时间延长出现不同颜色的浑浊,在6 h内各配伍液中不溶性微粒数均符合规定,头孢孟多酯钠的相对百分含量略有下降。结论：在临床上,若注射用头孢孟多酯钠与注射用奥美拉唑钠静滴联用时,最好在两者之间先用0.9%氯化钠注射液清洗输液管道,完毕后再输注另一种药物,或者不将两者连续使用。     

注射用头孢孟多酯钠在4种常用液体中的稳定性考察

目的考察注射用头孢孟多酯钠在25℃下与0．9％氯化钠注射液、5％葡萄糖注射液、10％葡萄糖注射液和5％葡萄糖氯化钠注射液4种常用输液液体配伍的稳定性。方法将注射用头孢孟多酯钠与输液配伍,采用高效液相色谱法测定头孢孟多酯钠的含量变化,并考察配伍液的外观和pH变化。结果注射用头孢孟多酯钠与0．9％氯化钠及5％葡萄糖氯化钠在室温下（25％）配伍,0～8h内其外观、pH值及含量无明显变化。而与5％葡萄糖注射液、10％葡萄糖注射液配伍稳定性欠佳。结论注射用头孢孟多酯钠与输液配伍时应选择0．9％氯化钠注射液或5％葡萄糖氯化钠注射液,不宜与5％葡萄糖注射液和10％葡萄糖注射液配伍。     

Electrochemical analysis of the cephalosporin cefamandole nafate.

The polarographic assays for cefamandole sodium and its formyl ester, cefamandole nafate, are described. Controlled potential coulometry is used as an absolute method for the assignment of purity of these compounds without the need for a reference material. The precision, accuracy, and selectivity of these assays were better than for the microbiological autoturbidimetric and automated iodometric assays. NMR, TLC, GC, and polarography are used to detect and quantitate likely impurities and degradation products.     

Conversion of cefamandole nafate to cefamandole sodium.

The rate of hydrolysis of the formyl moiety of cefamandole nafate was determined as a function of pH, temperature, and concentration of added sodium carbonate or tromethamine. The reaction rate was sensitive to hydroxide ion in the pH 5.5-8.0 range with half-life values of hours to minutes. Hydrolysis was rapid upon the addition of sodium carbonate or tromethamine. Chirality in the 7-D-mandelamido side chain was unaffected by hydrolysis.     

Stability of clindamycin phosphate and ceftizoxime sodium, cefoxitin sodium, cefamandole nafate, or cefazolin sodium in two intravenous solutions

The stability and compatibility of clindamycin phosphate and ceftizoxime sodium, cefoxitin sodium, cefamandole nafate, or cefazolin sodium in two intravenous solutions were studied. Each antibiotic alone as well as each of the four two-drug combinations were examined when mixed in duplicate 100-mL glass bottles of 5% dextrose and 0.9% sodium chloride injections. Antibiotic concentration, pH, and visual appearance were recorded at the time of preparation and at 1, 4, 8, 12, 24, and 48 hours. Antibiotic concentrations were assessed with drug-specific high-performance liquid chromatographic assays. Decreases in concentration of 10% or more from the original concentration were considered to indicate instability. All the single antibiotic solutions were stable for 48 hours. Clindamycin was stable in all combinations except with ceftizoxime in 0.9% sodium chloride injection, which measured 89.3% of its original clindamycin concentration at 48 hours. All the cephalosporins mixed with clindamycin were stable for 48 hours. Clindamycin is stable for at least 48 hours when mixed with cefoxitin sodium, cefamandole nafate, or cefazolin sodium in either 5% dextrose or 0.9% sodium chloride injections and for at least 24 hours when mixed with ceftizoxime sodium in 0.9% sodium chloride injection.     

Antibiotic delivery polyurethanes containing albumin and polyallylamine nanoparticles

Nano-structured polymers delivering an antibiotic for the prevention of medical device-related infections were developed. Systems consisted of bovine serum albumin or polyallylamine nanoparticles alone or entrapped in a polyurethane and then loaded with cefamandole nafate, chosen as a drug model. Results showed that nanoparticles alone were able to adsorb high antibiotic amounts due to their high surface/volume ratio. However, they released cefamandole in an uncontrolled fashion, leading to a rapid loss of antibacterial activity. Improvements in the release control were obtained when CEF loaded and non-loaded nanoparticles were entrapped in a carboxylated polyurethane. For these systems the drug delivery was at least of 50% with respect to nanoparticles alone with a prolonged antimicrobial activity up to 9 days.     

用差示扫描量热法测定头孢菌素类药物的热降解稳定性

本文用差示扫描量热法(DSC)试验了十二个常用的有代表性的头孢菌素的热降解稳定性,用Kissinger和Ozawa方程求各头孢菌素的热降解动力学参数(主要为活化能)。在所有头孢菌素的DSC曲线中均未见有熔点峰,故不能用量热法测定其纯度,但它们的放热峰均甚陡直、明锐,而且峰温的重现性良好,可供鉴别这些头孢菌素用。