奈替米星的药理作用和临床综述

奈替米星(乙基西索米星)是一种半合成氨基糖苷类抗生素，由西索米星乙酰化而成，其抗菌谱广，活性高，耳肾毒性较其他氨基糖苷类小，已广泛用于国内外临床，现将其药理作用及下呼吸道感染的临床效果及药效等。结果表明，每日1次单用奈替米星组疗效较合用头孢唑林及阿米卡星组好。     

医疗纠纷用药利弊分析——氨基糖苷类药用药纠纷分析

氨基糖苷类抗生素属静止期杀菌药,主要不良反应是肾毒性和耳毒性,尤其儿童和老人更易发生. 1 病例简介[案例1] 庆大霉素、丁胺卡那霉素连续注射导致幼儿耳聋     

庆大霉素的肾毒性反应及应用注意事项

庆大霉素是从放线菌科单孢子菌属发酵培养液中提取的,系碱性化合物,常用硫酸盐,易溶于水,性质稳定,以水针剂供临床使用,因价廉、疗效可靠,是目前常用的氨基糖苷类抗生素.但庆大霉素在氨基糖苷类抗生素中肾毒性最大,出现肾中毒也最常见.肾毒性表现为蛋白尿、管型尿、尿中红细胞,严重时肾功能受损,甚至发生急性肾功能衰竭.所以在临床应用中应注意以下几点:(1)老年人应尽量少用或不用此类抗生素,确因病情需要而使用时,应严密观察尿常规及肾功能变化,每2～3天查一次,早发现可能发生的肾损害并给予及时处理.     

静脉用硫酸小诺霉素与炎琥宁存在配伍禁忌

<正>小诺霉素属于氨基糖苷类抗生素,抗菌谱近似庆大霉素,与其他氨基糖苷的交叉耐药性较轻。本品的特点是对氨基糖苷乙酰转移酶AAC(6ˊ)稳定,因此小诺霉素对产生该酶的耐药菌可有效。临床主要用于大肠杆菌、绿脓杆菌等革兰阴性杆菌引起的感染。由于抗菌谱广、杀菌力强、无需皮试、耳、肾毒性小等优点,是一种较好的替代庆大霉素的新     

氨基糖苷类药物血药浓度监测现状和发展趋势

氨基糖苷类抗生素抗茵谱广，杀菌活性强，与β-内酰胺类抗生紊和非典型结构的β-内酰胺类抗生素有显著的协同作用，特别是具有抗生索后效应，因此在治疗严重的院内感染中具有相当重要的价值，由于氨基糖苷类抗生素的优势与毒性作用都极为突出，为了保证达到有效的治疗浓度和避免潜在的毒性作用，在临床需监测血药浓度，给药方案个体化。虽然测定的方法不少，但测定的成本较高或者效果不理想，不能满足临床上的要求，所以，研究快速、准确、经济的监测方法成为当务之急。现将氨基糖苷类药物的血药浓度监测现状和发展趋势综述如下：     

常用抗生素引起的药物性肾损伤

抗生素引起的肾损害主要是药物或其代谢产物所致的过敏反应,许多抗生素具有潜在肾毒性,其损害作用随剂量增大、疗程延长而加重,尤其是大剂量联合用药、不合理用药、滥用药时尤为突出。抗生素引发肾毒性,主要是指能引起可逆性蛋白尿、血尿、管型尿、氮质血症、少尿、无尿,某些抗生素药物甚至引起肾小管坏死、急性肾功能衰竭。氨基糖苷类抗生素氨基糖苷类抗生素的肾毒性与药物剂量及药物在肾皮质区蓄积有密切关系,血药浓度越高,肾毒性越大,血尿素氮和肌酐水平也愈高。一般剂量时仅出现多尿;较大剂量早期多尿,当肾小管细胞进一步受损,可引起少尿性肾衰,伴有氮质血症;更大剂量早期可见肾脏功能细胞有改变,随后产生细胞坏死。目前按其肾毒     

冠心病与血清胆红素的关系探讨

氨基糖苷类抗生素有不同程度的肾毒性,本院1998年1月到2 0 0 3年3月收治38例应用氨基糖苷类抗生素庆大霉素、妥布霉素、阿米卡星、奈替米星的过程中,出现急性肾功能损害的老年患者,现报告分析如下。1　资料与方法1 1　一般资料　本组38例,男性2 2例,女性16例,年龄6 2～75岁,平均年龄6 8岁。原发疾病为慢性支气管炎或支气管扩张、慢性阻塞性肺气肿、肺原性心脏病合并肺部感染16例,尿路感染5例,慢性胆囊炎伴冠心病5例,急性胃肠炎5例,急性阑尾炎4例,子宫内膜癌3例。38例患者用药前尿常规及肾功能检查在正常范围。1 2　方法　16例静脉滴注庆大霉…     

氨基糖苷类抗生素耳毒性基础研究与临床防制

氨基糖苷类抗生素 (ＡｍＡｎ)临床应用极为普遍 ,其抗菌谱较广、作用强、相对不易耐药 ,对Ｇ-杆菌 ,尤其对不易控制的大肠杆菌、变形杆菌、绿脓杆菌等引起的严重感染以及特种菌如结核杆菌感染起着重要作用 ,5 0年代以来大量的临床和实验研究证实ＡｍＡｎ可损害内耳感受器 ,引起听功能受损和前庭功能障碍 ,其发生率高达 2 0 %～ 30 % [1] 。目前 ,对ＡｍＡｎ耳毒性的机制尚不清楚 ,同时也缺乏有效的治疗方法和药物 ,因此 ,对ＡｍＡｎ耳毒性防制的基础与临床研究极为重要。1　避免在妊娠期使用ＡｍＡｎ类药物ＡｍＡｎ可通过胎盘屏障进入胎儿体…     

服用某些药物宜多喝水

抗生素注射氨基糖苷类抗生素,如链霉素、庆大霉素、卡那霉素等抗感染时,这些药对肾脏毒性大,浓度超高时对肾小管损害较大,故宜多喝水,以稀释并加快药物排泄。     

氨基糖苷的毒性作用

氨基糖苷有肾毒性及耳毒性作用。虽然已有测定其血清水平的设备,肾及听力损伤仍有友生。最近报告了一例疑为细菌性心内膜炎病人,接受一疗程庆大霉素治疗后出现双侧前庭损伤,且为不可逆性。病人不能工作已一年多。用药剂量为5.6mg/kg,共治疗19天。在开始治疗的2周内测定了最低药物浓度,但未测定峰值。 Kapusnik等提出,过去对氨基糖苷的用法可能既未达到最大药效,也     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.