大环内酯类抗生素的几种代表性药物

大环内酯类抗生素自发现至今，已经历了40多年的发展，至今仍在各种感染性疾病中得到了广泛的应用。红霉素(Erythromycin EM)是第一个开发成功的大环内酯类抗生素，也是其代表药物。传统的大环内酯类抗生素对绝大多类革兰氏阳性菌、奈瑟球菌、嗜血菌、革兰氏阳性和阴性厌氧菌具有抗菌活性，但对革兰氏阴性菌作用较差，易产生耐药性，药物稳定性较差，对胃肠道产生副作用，因此，相继开发了许多新的红霉素衍生物。其中较具代表性的有克拉霉素(clarithromycin，CLM)、地红霉素(Dirithromycin，DRM)、罗红霉素(Roxithromycin，RXM)，琥乙红霉素(Erythromycin ethylsuccinatis)、阿奇霉素(Azithromy cin)。本文仅就上述药物的体外抗菌活性，人体药代动力学和临床应用作简要综述。     

阿奇霉素细粒剂口服与静脉滴注治疗小儿细菌性呼吸道感染的疗效观察

阿奇霉素是新一代大环内酯类抗生素,对葡萄球菌、肺炎链球菌、链球菌、流感嗜血杆菌、奈瑟菌、肠球菌及支原体、衣原体、嗜肺军团菌等有较强的抗菌活性.我科应用阿奇霉素细粒剂口服治疗小儿细菌性呼吸道感染,并与阿奇霉素静脉滴注进行对照,现将临床应用结果报告如下.……     

阿奇霉素的不良反应

阿奇霉素为大环内酯类抗生素，通过阻碍细菌转肽过程，抑制细菌蛋白质合成而致细菌死亡。它具有广谱抗菌作用，对下列细菌具有良好的抗菌作用：革兰氏阳性球菌如金黄色葡萄球菌、肺炎球菌、α溶血性链球菌、A组β溶血性链球菌及其他链球菌；革兰氏阴性杆菌如流感杆菌、副流感杆菌、卡他菌、嗜肺军团菌、百日咳杆菌、副百日咳杆菌、副溶血性杆菌及志贺菌属、霍乱弧菌等；     

林可霉素类抗生素的临床应用

林可霉素类抗生素的临床应用谢惠民１０００１０北京隆福医院１抗菌范围林可霉素类抗生素包括林可霉素（洁霉素）和克林霉素（氯洁霉素、氯林霉素）两个品种。二者的抗菌范围和红霉素相似，但比红霉素更窄，对革兰氏阴性菌，如肺炎链球菌、化脓性链球菌、绿色链球菌、白喉...     

阿奇霉素临床过敏反应1例报告

阿奇霉素(Azitromycin)，又名阿红霉素，阿齐红霉素，为半合成的十五员大环内酯类抗生素，其作用与红霉素相近，作用较强，对流感嗜血杆菌、淋球菌的作用比红霉素强4倍，对军团菌强2倍，对肺炎链球菌、卡他球菌、螺旋杆菌、百日咳杆菌、肺炎支原体、梅毒支原体等也有较强杀菌作用，由于临床副作用较少，应用较为广泛，但其胃肠道反应及神经毒副作用亦有报道，最近，我们收治的1例门诊病例，就因滴注阿奇霉素发生较重副作用，现报告如下，供临床警示。     

甲磺酸加替沙星注射液治疗呼吸系统疾病过敏反应48例分析

加替沙星（gatifloxacin，GFLX）是国外近年开发并应用于临床的新一代氟喹诺酮类抗菌药物，C8位用甲氧基取代后，抗菌谱扩大，抗菌活性增强，不但对革兰氏阴性菌有较好的抗菌活性，而且对革兰氏阳性球菌包括葡萄球菌属、肺炎链球菌、肠球菌属等及厌氧菌如脆弱拟杆菌、消化链球菌等也有较好的抗菌活性，     

52株肺炎链球菌耐药性分析

目的调查分析临床标本分离到肺炎链球菌对青霉素等17种抗生素的体外抗菌活性，为临床治疗肺炎链球菌感染提供参考。方法对我院从2003年1月至2005年7月临床标本分离到的52株肺炎链球菌．用美国DADE—BEHRING公司的MICro STREP Plus链球菌药敏测定板检测肺炎链球菌对17种不同抗菌药物的MIC值。结果52株肺炎链球菌对红霉素、心环素的耐药率最高达71．2％，5株对青霉素耐药（9．6％），18株对青霉素低度耐药（34．6％），29株对青霉素敏感（55．8％），对阿奇霉素、克林霉素的耐药率为63．5％。对万古霉素、阿莫西林，棒酸、加替沙星的耐药率为0．00％。青霉素不敏感菌株对红霉素、阿奇霉素、克林霉素、氯霉素、头孢克洛、头孢峡辛的耐药率显著高于敏感株。结论肺炎链球菌对大环内酯类和凹环素耐药率高。对青霉素以低度耐药为主，喹喏酮类药物和阿莫西林，棒酸对肺炎链球菌抗菌活性较高，可作为首选药物。     

52株肺炎链球菌耐药性分析

目的调查分析临床标本分离到肺炎链球菌对青霉素等17种抗生素的体外抗菌活性,为临床治疗肺炎链球菌感染提供参考.方法对我院从2003年1月至2005年7月临床标本分离到的52株肺炎链球菌,用美国DADE-BEHRING公司的MICro STREP Plus链球菌药敏测定板检测肺炎链球菌对17种不同抗菌药物的MIC值.结果52株肺炎链球菌对红霉素、四环素的耐药率最高达71.2%,5株对青霉素耐药(9.6%),18株对青霉素低度耐药(34.6%),29株对青霉素敏感(55.8%),对阿奇霉素、克林霉素的耐药率为63.5%,对万古霉素、阿莫西林/棒酸、加替沙星的耐药率为0.00%.青霉素不敏感菌株对红霉素、阿奇霉素、克林霉素、氯霉素、头孢克洛、头孢呋辛的耐药率显著高于敏感株.结论肺炎链球菌对大环内酯类和四环素耐药率高,对青霉素以低度耐药为主,喹喏酮类药物和阿莫西林/棒酸刘肺炎链球菌抗菌活性较高,可作为首选药物.     

肺炎链球菌192株对新喹诺酮类体外耐药性测定

目的：调查192株肺炎链球菌对青霉素、红霉素和环丙沙星等的耐药现状，并与新喹诺酮类进行比较。方法：根据美国国家I临床实验室标准委员会(NCCLS)2002年标准使用微量肉汤稀释法检测192株肺炎链球菌对青霉素、红霉素、克林霉素和喹诺酮类抗菌药物的最低抑菌浓度(MIC)。结果：肺炎链球菌对青霉素的耐药率(中介率 耐药率)已达42．7％，对红霉素的耐药率为77．6％，克林霉素、白霉素和环丙沙星的耐药率分别为66．7％、65．6％和57．3％，新喹诺酮类抗菌药物对之有较好的抗菌活性，敏感率皆大于90％；并与是否对青霉素、红霉素耐药无关。结论：在我国，肺炎链球菌对青霉素、红霉素的耐药率较高，新喹诺酮类抗生素有较好的抗菌活性。     

溶脲脲原体对大环内酯类药物的敏感性分析

目的：检测溶脲脲原体(Uu)对14环(红霉素和罗红霉素)、15环(阿奇霉素)和16环(交沙霉素和吉他霉素)大环内酯类药物的敏感性，为临床合理用药提供参考依据。方法：采用微量肉汤稀释法检测了5种大环内酯类药物对203株Uu的最低抑菌浓度(MIC)。结果：203株Uu对红霉素、罗红霉素、阿奇霉素、交沙霉素和吉他霉素的耐药率分别为：11．8％、7．4％、6．9％、3．9％和3．5％。在5种药物中，交沙霉素和吉他霉素抗Uu活性最强，MIC50分别为0．125mg／L和0．5mg／L，MIC90分别为0．5mg／L和1mg／L，其次为阿奇霉素，MIC50和MIC90分别为2mg／L和4mg／L，红霉素和罗红霉素抗Uu活性较弱，MIC50均为4mg／L，MIC90均为8mg／L.结论：Uu对大环内酯类药物存在不同程度的耐药；16环大环内酯类药物交沙霉素和吉他霉素抗Uu活性强于14环和15环大环内酯类药物。     

儿童肺出血导管灌注药物治疗(附5例报告)

通过对5例儿童肺出血行血管及导管灌注药物治疗观察，作者认为：（1）选择性支气管动脉及肺动脉造影是诊断肺出血定位、定性和局部有效治疗的重要手段。（2）立止血（Reptilase）用于肺出血导管区域性灌注止血，其疗效较血管加压素（Vasopressin）更为安全可靠。（3）免疫抑制剂在“特发性肺含铁血黄素沉着症”出血期应用可明显增强治疗效果。     

Drug metabolism and disposition in children

Key factors undergoing maturational changes accounting for differences in drug metabolism and disposition in the pediatric population compared with adults are reviewed. Gastric and duodenal pH, gastric emptying time, intestinal transit time, bacterial colonization and probably P-glycoprotein are important factors for drug absorption, whereas key factors explaining differences in drug distribution between the pediatric population and adults are membrane permeability, plasma protein concentration and plasma protein characteristics, endogenous substances in plasma, total body and extracellular water, fat content, regional blood flow and probably P-glycoprotein, mainly that present in the gut, liver and brain. As far as drug metabolism is concerned, important differences have been found in the pediatric population compared with adults both for phase I enzymes [oxidative (e.g. cytochrome CYP3A7 vs. CYP3A4 and CYP1A2), reductive and hydrolytic enzymes] and phase II enzymes (e.g. N-methyltransferases and glucuronosyltransferases). Finally, key factors undergoing maturational changes accounting for differences in renal excretion in the pediatric population compared with adults are glomerular filtration and tubular secretion. It would be important to generate information on the developmental aspects of renal P-glycoprotein and of other renal transporters as done and still being done with the different isozymes involved in drug metabolism.     

Partnership in care: parents' views of participation in their hospitalized child's care

• ? This paper describes parents' experiences of participation in their hospitalized child's care on a general surgical paediatric ward.
• ? The findings indicate that parents chose to participate because of concern for the child's emotional welfare. Influencing- factors included sense of parental duty, past experiences with hospitals, and concern for consistency of care.
• ? Parents' readiness to care was encouraged by a supportive family network, support from other parents, familiarity and experience with care.
• ? Parents were willing to adapt their parenting skills in order to be able to care for their child at home and were willing to perform more care provided it did not cause pain for the child, had the nurses' approval and increased their confidence and competence as carers.
• ? Lack of information, non-negotiation of roles, inadequate facilities, feelings of anxiety and loneliness were the difficulties parents experienced.

     

准分子激光原位角膜磨镶术护理安全问题与管理对策

目的探讨如何提高准分子激光原位角膜磨镶术的护理质量管理。方法分析234例准分子激光原位角膜磨镶术患者术前、术中、术后易出现的护理问题,提出针对性管理措施。结果通过行使有效的护理管理措施,准分子激光原位角膜磨镶术护理达到满意效果,97.8%的患者达到术前的预期矫正视力,护理问题得到解决。结论提高护士对准分子激光原位角膜磨镶术护理安全的认识,采取针对性护理管理措施,是保证准分子激光原位角膜磨镶术安全开展的基础。     

The Conduction System in Sudden Death in Alaskan Sled Dogs During the Iditarod Race and/or During Training

Using serial section examination, we studied the conduction system in five Alaskan sled dogs that died suddenly: four during the Iditarod race and one during training. We compared our findings with the conduction system of three sled dogs of similar age that died of natural causes unrelated to the cardiovascular system. The conduction system of sudden death dogs revealed marked fibrosis of the sinoatrial (SA) node and/or its approaches and narrowing of the SA nodal artery in 3 dogs, fibrosis and marked fatty infiltration in and around the AV node in all 5, total isolation and/or tenuous connection of the AV node with its approaches in 4, fat and fibrosis in the A V bundle and bundle branches to a varying degree in all, and focal fibrotic scars in the left ventricle with fat and/or some disarray in 3. The control group revealed mild fibro-fatty changes in the conduction system without fibrotic scar areas in the heart. These findings are similar to the pathological findings in and around the conduction system in cases of sudden death in humans, especially trained athletes. These changes may form an anatomical substrate for an arrhythmic event in susceptible dogs during an altered physiological state.     

精神科三班护士心理健康状况的调查研究

目的:了解精神科三班护士的心理健康状况。方法:应用症状自评量表(SCL-90)调查100名三班护士,其中精神科70人、非精神科30人(包括精神科门诊),将两组评分进行相互比较,并分别与中国成人常模比较。结果:精神科三班护士与常模比较,所有指标都差于常模,除阳性症状均分、人际关系敏感因子两指标为显著性差异(0.05>P>0.01)外,其余统计指标均有高度显著性差异(P<0.01),与非精神科三班护士比较,全部指标都差于非精神科三班护士,有高度显著性差异(P<0.01)。45.71％的精神科三班护士有心理问题,尤以抑郁、强迫症状、焦虑和人际关系敏感为突出。结论:精神科三班护士心理健康状况欠佳,应对她们加强心理卫生保健工作,努力提高她们的心理健康水平。     

ICU护士与病房护士对工作满意度的调查与分析

目的:了解二级医院ICU护士与病房护士对护理工作的满意度,从而找出护理管理工作中存在的不足,制定改进措施,调动护士的积极性,更好地为患者服务。方法:采用问卷调查法,分别对病房和ICU各42名护士进行了调查。结果:①两组在每日工作时间长短、对周末工作的补偿、专业提升机会、对工作环境的支配和控制等方面存在着显著差异,P<0.05。②84名护士总体满意度低于均数指标3.03。体现在家庭与工作平衡、工作中的控制和决策、福利待遇、排班制度、专业发展机会5个方面。建议:①合理编制护理人员,合理排班,设立奖励机制。②重视专业发展,提高整体素质。③建立激励机制,提高福利待遇。     

Exploring relationships in teenage pregnancy

The aim of this paper is to report a study exploring aspects of teenage pregnant women relationships with the fathers of their unborn children within the context of two contrasting demographic areas of the UK. The perceptions of teenage pregnant women on how they view their relationship with the fathers of their unborn babies has not been fully investigated. Three major categories emerged from the perspectives of 47 teenage pregnant women: (i) age of baby's father; (ii) education and employment status of baby's father; and (iii) ability of baby's father to provide financial support. Teenage pregnant women living in the south-east were more likely to maintain the relationship with fathers of their babies than those living in the north-west. This was found to be statistically significant. The age, employment status and education of the baby's father can influence the continuance of the partnership between the participant and of the father of her baby. The statistical difference in the maintenance of the relationship between the prospective parents may be associated with the continuing demographic and cultural characteristics of the north-west, where teenage pregnancy remains high and the south-east where the rates are low.