传染病和寄生虫病

中国医学文摘·内科学1996年第17卷第5期·377· 963538流感引起气道过敏所致严重咳嗽”例治疗体会/李怀勇//广东医学.二1996,17(l)一51 男43例,女55例,咳嗽病程10天~3个月,用各种抗生素(红霉素除外)治疗无效。改用下列方法治疗:①红霉索0.3或氟呱酸。.2;②红霉素 博利康尼2.smg或氯喘smg十氨茶碱0.2;③博利康尼2.smg或氯喘smg十氨茶碱0.2;④心痛定10~Zomg 氨茶碱o·2。均日3次共3天。结果:4组无效者分别为14、O、2、1例,余有效率分别为46写、100%、91%、90%,后3组均优于第1组(尸<0.01),后3组间无显著性差异。,咳嗽完全控制时间平均10.3、5…     

吡喹酮对华支睾吸虫糖原代谢影响的研究

0.1ug/ml吡喹酮对华支睾吸虫体外作用6小时后,用组织化学方法观察到虫体内的糖原颗粒非常显著地减少;作用时间延长至24小时,大部分虫体的糖原基本消失。吡喹酮浓度提高到0.5ug/ml以上时,其对糖原的影响与0.1ug/ml相比,无明显差别。提示体外实验吡喹酮浓度为0.1ug/ml时,其抑制华支睾吸虫吸收葡萄糖、促使虫体内糖原减少的作用已达到最大限度。     

布洛芬引起急性可逆性肾功能不全

患者80岁,因头痛软弱及尿少而入院。曾因关节痛服布洛芬600mg/d,分3次服,连服12日。服药3天后关节痛消失,继而无尿。经服速尿24小时后尿量200～250ml,血压由110/60升至175/100mmHg,心功过速。血常规无异常,尿蛋白0。96‰,偶见白细胞和红细胞。肾小球滤过率(GFR)30ml/min,血肌酐(Scr)0.41mmol/min,诊断为急性药物性肾功能不     

老年肺心病静脉使用氨茶碱血药浓度与安全性评价

目的 监测老年慢性肺心病治疗中氨茶碱的血药浓度与毒副反应.方法 12例老年慢性肺心病患者.给予氨茶碱0.25 g,静脉滴注,每日1次.每例患者在治疗结束采用高效液相色谱仪进行氨茶碱血药浓度检测.结果 氨茶碱0.25 g静脉滴注,每日1次,有9例(75%)分布在4～14μg/ml,2例(16.7%)14μg/ml以上,有1例(8.3%)在4μg/ml以下.无毒性反应发生.结论 老年肺心病患者在应用氨茶碱治疗时,静脉应用0.25 g,每日1次是安全、有效的.     

氨茶碱治疗小儿喘息临床体会

小儿顽固喘息在临床上治疗颇为棘手 ,我科自 2 0 0 0年以来对收治的喘息患儿 ,应用氨茶碱治疗 ,疗效较好 ,现分析如下。一、临床资料 :我科对诊断明确 ,年龄、病情程度相近喘息患儿并经综合治疗 (抗感染、平喘、吸氧 )严重者吸入喷雾剂 ,2 4小时～ 4 8小时后咳喘仍无好转或反复者共 32 2例。随机抽样分为两组 :对照组仍用原药 ;用药组加口服氨茶碱4ｍｇ ｋｇ～ 6ｍｇ ｋｇ次。每日 3次～ 4次 ,重者加静注氨茶碱 ,首次 5ｍｇ ｋｇ～ 10ｍｇ ｋｇ ,以后每 6小时用 4ｍｇ ｋｇ～ 6ｍｇ ｋｇ维持。毛细支气管 (毛支 )与喘息性支气管 (喘支 ) 3天…     

硫酸镁治疗哮喘持续状态疗效观察

1987年以来,我院收治的哮喘持续状态病例46例。随机分为两组,治疗组22例,病程1～22年;对照组24例,病程6个月至20年。两级的性别、年龄及病程均无显著性差异。对照组给予氨茶碱、舒喘灵、皮质激素及吸氧等常规治疗,伴感染者给抗生素;治疗组除给上述常规治疗外,另给25％硫酸镁20ml加入5％葡萄糖500ml中静滴,35～40滴/min,每日1次,连用3天后评定疗效。     

酗酒引起可逆性3°房室传导阻滞

患者男性,49岁。3小时前饮高度白酒半斤,感头晕,胸闷、眼前阵阵发黑。每天饮白酒150—250ml已11年。BP19/12KPa(142/90mmHg)。心率48次/分,齐,无杂音。心电图(图ⅠⅡ导联)示3°房室传导阻滞,室性逸搏心律。给予异丙肾上腺素1mg和1％葡萄糖500ml,以2ug/分速度静脉滴注。1天后再记心电图(图1左侧V1)未完全性右束支传导阻滞。4天后记录心电图(图1右侧V1)右束支阻滞已消失。住院期间X线胸片、二维超声心动图及心肌酶谱检查皆无异常。戒酒后随访一年,未见复发     

胺碘酮、硫酸镁联合治疗难治性心律失常37例疗效观察

1989～1991年用胺碘酮硫酸镁联合治疗难治性心律失常37例,结果如下:一般资料 37例曾用多种抗心律失常药物未获明显疗效。原发病:冠心病18例,风心病9例,心肌炎6例,陈旧性心肌梗塞3例,先心病1例。持续性房颤12例,频发室性早搏9例,多源性早搏8例,偶发室性早搏8例。病程:2～24月。方法及疗效①25％硫酸镁液12～24ml,加入半量～全量极化液中静点,10～15天后停用硫酸镁及极化液。②口服胺碘酮0.2一日3次,第四天起改为1日1次维持。个别患者给予综合治疗措施。显效(心律失常完全控制)30例(82.1％);有效(发作频率减少1/2以上)4例(10.8％)。无效(发作频率减少低于1/2)3例(8.1％)。总有效率91.9％。用药见效最短时间20小时,平均70小时。讨论 (1)镁是体内重要的阳离子,主要存在     

邪毒致鸭肝血瘀阻证动物模型的初步研究(摘要)

目的:研制一种较为实用的邪毒致肝血瘀阻证的动物模型。方法:将80只1日龄武汉麻鸭,随机分成正常对照组、病理造模组、秋水仙碱防治组、解毒软肝汤小剂量及大剂量防治组。后4组用DHBV阳性血清攻击雏鸭造模,每周1次,剂量0.1ml/只,从第10周起剂量加大为0.2ml/只,且后3组第11日分别用秋水仙碱、解毒软肝汤小剂量及大剂量灌胃,至第112     

临床药学

&27氟唆诺酮对长效茶碱药代动力学影响的研究/钟淑卿…/’/中国实用内科杂志一1995,15(10),一597~599 30例慢阻肺患者分为3组,每组10例。茶喘平胶囊0. 259,每12小时服1次,连服3天达稳态后3组分别加服氟呱酸胶囊0.29,每天3次;环丙氟呱酸片0.59,每天2次,氟嗦酸片0. 39,每天2次,连服3天。结果:3组茶碱稳态谷浓度分别延长16·7%、20.5%和7.7环;药时曲张下面积分别增大19·6环、22·4线和5.7写;消除率分别下降19·4写、25·8%和1.44%。提示环丙氟呱酸均降低茶碱消除率,使血清茶碱浓度增高。两者合用时应监测血药浓度,适当调整剂量。而氟呱酸对…     

C-反应蛋白对脐静脉内皮细胞凋亡和P选择素表达的影响

目的:观察C-反应蛋白(C-reactive protein,CRP)对人脐静脉内皮细胞(Human Umbilical Vein Endothelial Cells,HUVECs)凋亡和P选择素(P-selectin)表达的影响。方法:将HUVECs与不同浓度CRP(0ug/ml、5ug/ml、25ug/ml、50ug/ml、100ug/ml)在培养基中孵育24h后为CRP剂量效应组;0ug/ml、50ug/mlCRP作用3h、6h、12h、24h为时间效应组;分别收集细胞和上清液。采用流式细胞仪检测细胞凋亡率,用酶联免疫吸附试验检测上清液中的P选择素含量。结果:(1)与对照组(0ug/mlCRP)相比,5ug/ml的CRP培养内皮细胞24h细胞凋亡率显著增加(12.16±3.69%,P0.01),50ug/ml时细胞凋亡率到达顶峰(27.91±3.11%,P0.01);50ug/mlCRP孵育不同时间,细胞凋亡率从3h明显增加(2.71±0.93%,P0.01),24h时细胞凋亡率达顶峰(27.91±3.11%,P0.01)。(2)与对照组(0ug/mlCRP)相比,5ug/ml的CRP即可显著增加内皮细胞P选择素表达(15.93±3.77ng/ml,P0.01),100ug/ml时P选择素表达到达顶峰(86.35±7.35ng/ml,P0.01);50ug/mlCRP孵育不同时间,P选择素表达从3h明显增加(34.33±5.01ng/ml,P0.01),6h时P选择素表达达顶峰(79.28±7.63ng/ml,P0.01)。结论:CRP以剂量及时间依赖的方式促进内皮细胞凋亡及P选择素的表达。     

Comparison of Oral Bambuterol and Terbutaline in Elderly Patients with Chronic Reversible Airflow Obstruction

Bambuterol, a carbamate prodrug of terbutaline, is the first once-daily oral β₂-agonist. The effect/side effect ratio of bambuterol oral solution was compared with terbutaline mixture in elderly patients with chronic reversible obstructive airways disease. The study was of a double-blind, crossover, randomized design and consisted of a 4-7-day run-in period followed by four consecutive treatment periods each of 2 weeks. The treatments were bambuterol solution 20 mg nocte (B20), 10 mg nocte (B10), terbutaline mixture 3 mg t.i.d., (T), and placebo solution (P). Patients measured daily peak expiratory flow rate (PEFR), asthma symptoms, use of inhaled β₂-agonist, and tremor. Of 84 patients, 66 completed all periods. Mean age was 67 years (60-90), basal FEV₁1.49 L, and reversibility of FEV¹ 30%. Ninety-four percent of the patients used inhaled/oral steroids in constant dosage. All treatments were significantly more effective than placebo. B20 resulted in higher morning PEFR than T (306 × 2.9 L/min vs. 297 × 2.9 L/min), while B10 gave equivalent results to T. No differences were seen in the use of inhaled β-agonist. Less shortness of breath was experienced during the night with B20 and during the day with B10 compared with placebo. Both B20 and T produced more tremor than B10 and P. In elderly patients with chronic reversible airways obstruction once-daily bambuterol (10-20 mg) has a better effect/side effect ratio than 3 mg terbutaline thrice daily.     

坎地沙坦与福辛普利对高血压疗效的观察

目的前瞻性评估坎地沙坦治疗原发性高血压的降压疗效和安全性。方法130例轻中度原发性高血压患者随机服用坎地沙坦4~8mg或福辛普利10~20mg共20周,服药前后行动态血压监测(ABPM),观察24h收缩压(SBP)和舒张压(DBP)、谷峰比值、下一次给药前6h血压变化、降压有效率和不良反应。结果坎地沙坦和福辛普利均能有效降低血压,20周治疗有效率分别为74%和73%(P>0.05),坎地沙坦谷峰比值较福辛普利高(SBP:79%VS63%,P<0.05;DBP:79%vs62%P<0.05;),且较福辛普利具有更强的减低清晨2:00~8:00血压的作用(P<0.05)。坎地沙坦不良反应发生率较少。结论坎地沙坦治疗轻中度原发性高血压安全有效,耐受性好,可持续24h理想的控制血压。     

Inspired gas relative humidity affects systemic to pulmonary bronchial blood flow in humans

To our knowledge, the effects of humidity of inspired air on bronchial blood flow in humans are unknown. During total cardiopulmonary bypass, we measured systemic to pulmonary bronchial blood flow (Qbr[s-p]) which is the volume of blood accumulating into the left side of the heart in the absence of pulmonary and coronary flow. A cannula was introduced into the right upper pulmonary vein and advanced into the lowermost portion of the left side of the heart. From this cannula Qbr(s-p) was vented by gravity and measured. Inspired gas (10 L/min, endotracheal tube, 50 percent O2 + 50 percent N2O) relative humidity was less than 20 percent and greater than 85 percent in group A (n = 25) and in group B (n = 25), respectively. Mean (+/- SE) Qbr(s-p) was 40.7 +/- 0.06 ml/min or 1.32 +/- 0.12 ml/min (percent cardiac output) in group A and 21.7 +/- 1.8 ml/min or 0.68 +/- 0.06 ml/min in group B. These data indicate that under these conditions Qbr(s-p) is increased by dry gas lung inflation in humans.     

Effects of inhaled and intravenous furosemide on bronchial hyperresponsiveness in patients with chronic congestive heart failure]

We studied the effects of inhaled and intravenous furosemide (40 mg) on bronchial responsiveness to acetylcholine (ACh) in patients with chronic congestive heart failure. The measurement of bronchial responsiveness was performed by inhaling doses of ACh and calculating the provocative concentration of ACh needed to cause a 20% fall in FEV1.0 (PC20-ACh). Intravenous furosemide (N = 11) had a marked diuretic effect (urine output 1014 ml (SEM 156) in 2 hours), but had no effect on resting pulmonary function and PC20-ACh. In contrast, inhaled furosemide (N = 10) had no effect on urine output and resting pulmonary function, but caused significant increase in PC20-ACh from 2.74 (GSEM 1.28) to 8.47 (GSEM 1.22) mg/ml (p less than 0.05). We conclude that inhaled furosemide, but not intravenous furosemide reduces bronchial hyperresponsiveness to ACh in patients with chronic congestive heart failure. The mechanism of this effect appears to be related to the ion transport system of airway epithelium.     

Bronchial hyperresponsiveness to inhaled methacholine in subjects with chronic left heart failure at a time of exacerbation and after increasing diuretic therapy

Cough and wheezing are common findings in left heart failure. However, it is still questionable whether nonallergic bronchial hyperresponsiveness, the hallmark of asthma, is also associated with this condition. In 12 subjects with acute decompensation of chronic postischemic LV failure, we assessed the PC20 methacholine during an episode of acute LV failure and after five to 15 days of intensive diuretic therapy. Weight, arterial blood gases, plethysmographic lung volumes, and expiratory flows were also measured on both visits. Extravascular lung water was estimated indirectly with a radiologic score. During acute decompensation, six subjects had significant airway obstruction and eight had a PC20 less than or equal to 16 mg/ml (significant bronchial hyperresponsiveness). After diuretic therapy, subjects improved significantly, losing an average of 2.2 kg, but they still had chronic LV failure and evidence of an obstructive breathing defect. Although mean PC20 was unchanged, three subjects had significantly improved PC20 after treatment. We conclude that: (1) left ventricular failure is often associated with mild bronchial hyperresponsiveness, although it is not excluded that smoking and the resulting possibility of bronchial obstruction can also play some role; and (2) acute treatment does not generally alter bronchial responsiveness to methacholine, suggesting that chronic LV failure can cause chronic changes to the airways.     

无血浆的血浆置换术治疗特发性血小板减少性紫癜的临床研究

目的观察一种新的血浆置换组合液（o．9％生理盐水500ml＋低分子右旋糖酐500ml＋6％羟乙基淀粉500ml＋5％白蛋白生理盐水溶液500m1）,在特发性血小板减少性紫癜（ffP）患者血浆置换术中的临床效果及安全性。方法应用这种置换组合液对60例ITP患者进行血浆置换,每位患者在1周左右进行1—2次血浆置换,每次间隔时间为2～3天。同时加用地塞米松（10mg／d）静滴,每1～2次血浆置换为1个疗程,治疗结束后复查血浆血小板抗体、血小板和凝血功能。结果ITP患者血浆置换治疗1个疗程后血浆血小板抗体下降（P〈0．05）,凝血酶原时间、活化部分凝血活酶时间、凝血酶时间和纤维蛋白原与治疗前相比,无明显变化（P〉0．05）。血小板较治疗前上升（P〈0．01）。血浆置换术中枸橼酸盐中毒和低血容量反应等不良反应发生率较低,未出现其它并发症。结论这种新的置换组合液经济、安全、有效,并且未使用血浆,不会发生过敏反应,也不会因血源紧张而妨碍血浆置换的进行,从而为ITP的患者赢得了治疗的时间,达到尽快提升血小板、减少出血的目的。     

Interleukin-17 in sputum correlates with airway hyperresponsiveness to methacholine

BACKGROUND: Interleukin-17 (IL-17) is a novel cytokine secreted by activated human memory CD4+ T cells. In vivo IL-17 recruits neutrophils into the airways via the release of CXC chemokines (interleukin-8) from bronchial epithelial cells. Since neutrophils are implicated in pathogenesis of chronic obstructive pulmonary disease (COPD) chronic bronchitis (CB) and asthma, we hypothesized that there would be increased concentration of IL-17 in the airways of these patients. To test this hypothesis, we measured levels of IL-17 in induced sputum of COPD patients, chronic bronchitis and asthmatics and compared them with healthy controls. METHODS: Levels of IL-17 in induced sputum were measured via ELISA method in 19 COPD, 16 CB, 10 asthma and 11 control subjects. Airway responsiveness to methacholine was performed in people with FEV1 higher than 70% of predicted. RESULTS: There were no significant differences in IL-17 levels between control group and the other groups. However, levels of IL-17 in sputum of COPD patients were significantly lower than in asthma (P=0.004) and in CB (P=0.01) groups. Medians and (ranges) were as follows: asthma--37.6 pg/ml (18.8-55.7 pg/ml), CB 293 pg/ml (18.8-49.7 pg/ml) and COPD 24.6 pg/ml (0-34.1 pg/ml). Comparison of healthy control subjects (PC20 > 8 mg/ml) to a group with bronchial hyperreactivity, which consisted of asthmatics and CB patients, whose PC20 was less than 8 mg/ml, revealed that levels of IL-17 were significantly increased in the second group (P=0.02). Also, levels of IL-17 were significantly increased (P=0.02) in the asthmatic patients with bronchial hyperreactivity compared to healthy subjects. Moreover levels of IL-17 in sputum of all studied subjects correlated negatively with PC20 (r=-0.51, P=0.002). CONCLUSIONS: According to our results IL-17 is probably not involved in pathogenesis of stable COPD, but it may play a role in people with airway hyperresponsiveness.     

白细胞介素12重组腺病毒气道内应用对哮喘豚鼠治疗作用的研究

目的　探讨激发前气道内应用白细胞介素 12 (IL 12 )重组腺病毒对过敏性气道高反应的调节作用。方法　以C5 7BL/ 6小鼠经鸡卵蛋白 (OVA)免疫建立哮喘模型 ,实验分 6组 ,每组 6只。激发前气管内单次使用IL 12重组腺病毒 (10 8pfu/mouse) ,观察抗原激发后反应的变化。结果　 (1)小鼠气道内应用IL 12重组腺病毒在肺内可有效表达 ,48h血浆及肺泡灌洗液IL 12分别为 (5 40± 6 0 )U/ml和 (470 0± 80 0 )U/ml,对照病毒和PBS组未检出 ,两组比较差异有显著性 (P <0 0 1)。 (2 )在抗原激发阶段使用IL 12重组腺病毒 ,可明显抑制肺内IL 4[(3 5± 2 0 )ng/ml∶85 0± 2 5 0 )ng/ml]和IL 5[(6 5± 4 5 )ng/ml∶(5 4 0± 14 0 )ng/ml];γ干扰素 (IFN γ)的产生增加 [(6 90 0± 32 0 )ng/ml∶(12 5±3 2 )ng/ml];并明显抑制气道高反应性 [(36 0± 30 )cmH2 O∶(810± 5 0 )cmH2 O];抑制外周血 [(0 7±0 1) %∶(9 2± 0 5 ) % ]及肺泡灌洗液 [(3 5± 0 7)∶(2 1 6± 4 7)× 10 4 /ml]中的嗜酸细胞的水平 ;与对照组比较 (t分别 =7 97、7 92、5 1 6、18 9、9 33、47 1,P均 <0 0 1) ;但与总IgE[(6 5± 9) μg/ml∶(6 7± 10 )μg/ml]及抗原特异性IgE[(32± 8)∶(33± 8)U/ml]比较无明显影响 (P均 >0 0 5 )。     

Serum levels and bronchodilatation after intravenous administration of theophylline in asthmatic patients

Forced expiratory volume in the first second (FEV1) and serum theophylline levels were measured comparatively in 26 patients with stable bronchial asthma after a 240 mg theophylline infusion. The mean (+/- s.e.m.) elimination half-life and clearance of theophylline were 6.37 +/- 2.03 hours and 0.78 +/- 0.31 ml/min/kg respectively. A bronchodilator response (more than 20% increase in FEV1) was obtained in 17 patients whose pretreatment FEV1 was less than 30% of predicted normal values. No significant bronchodilator response was obtained in the other patients. There was no relationship in responders between changes in FEV1 and simultaneous serum theophylline levels. Maximal ventilatory response was apparent 1 to 2 hours only after the theophylline peak concentration.