RP-HPLC法测定脊柱结核病椎组织中异烟肼的浓度

目的建立反相高效液相色谱法（RP-HPLC）测定脊柱结核患者患椎组织中异烟肼的浓度。方法色谱柱为Hypersil ODS C18（150am×4．6mm），以0．02mol／LKH2PO4（pH=4．0）-乙腈（70：30，V／V）为流动相，流速为1．0mL／min，检测波长为340nm。结果在0．024～0．75μg／g骨匀浆（相当于骨浓度0．24～7．5μg／g）范围内异烟肼峰面积与骨样本浓度呈良好线性关系（r=0．9993），提取回收率为82．69％～89．94％（n=5），方法回收率为97．60％～104．55％（n=5），13内、13间相对标准偏差分别为2．34％～4．28％，2．76％～5．83％（n=5）。结论本方法准确、精密度高、重复性好，是一种可靠的测定骨中异烟肼浓度的方法，适用于脊柱结核患者体内患椎骨组织中异烟肼浓度的定量分析，以便于判定和调整化疗方案以及指导手术病灶清除范围。     

利福平在脊柱结核患者不同组织分布的实验研究

目的:探讨脊柱结核患者应用利福平化疗时体内不同组织中的药物分布规律。方法:15例应用2SHRZ/3HRZ化疗方案 手术治疗的脊柱结核患者术前连续服药4周后手术,RFP每日顿服剂量为600mg,于术晨服药后120～130min、240～250min手术中分别取血浆、髂骨、病椎硬化骨、病椎非硬化骨、死骨及坏死干酪组织,采用高效液相色谱法测定样本中的药物浓度。结果:利福平的血药浓度最高,髂骨与椎体非硬化骨次之,死骨及坏死干酪组织则未检出利福平。被测组织中,硬化骨中利福平浓度仅为髂骨中的10%(P<0.05),病椎非硬化骨及自身对照髂骨的利福平浓度相近(P>0.05)。结论:利福平可在脊柱结核化疗强化期正常髂骨及病椎非硬化骨组织中达到有效杀菌浓度,而在硬化骨中仅相当于最低抑菌浓度,死骨及硬化包壳内的坏死干酪中基本无利福平分布。     

反相高效液相色谱-二极管阵列检测法测定驱白马日白热斯丸中槲皮素和山奈酚的含量*

目的建立反相高效液相色谱-二极管阵列检测(RP-HPLC-PAD)法测定维吾尔成药驱白马日白热斯丸中槲皮素和山奈酚含量。方法色谱柱:安捷伦HC-C18柱(250 mm×4.6 mm,5 μm);流动相:甲醇-0.4%磷酸溶液(47:53);检测波长:365 nm;柱温:30℃;流速:1.0 mL·min-1。结果槲皮素和山奈酚分别在0.5～30.0 μg·mL-1(r＝0.999 9)和0.5～20.0 μg·mL-1 (r＝0.999 8)浓度范围内呈良好的线性关系, 平均回收率分别为102.2% (RSD＝1.18%,n＝ 5)和96.9% (RSD＝1.22% , n＝5)。结论该方法简便、快速、准确,具有良好的重复性和回收率,可作为该药物的定量分析方法,为进一步开发利用维药资源提供了参考依据。     

高效液相色谱法测定新肾炎胶囊中蒽醌类化合物的含量*

目的建立高效液相色谱法(HPLC)测定新肾炎胶囊中蒽醌类化合物大黄酸、大黄素、大黄酚的含量。方法采用Phenomenex C18柱(4.6 mm×250 mm,5 μm),以甲醇-1%醋酸(70:30)为流动相,检测波长254 nm,柱温25 ℃;流速 1 mL·min-1。结果大黄酸、大黄素、大黄酚检测浓度分别在4.96～24.80 μg·mL-1 (r＝0.999 6)、6.58～32.91 μg·mL-1(r＝0.999 9)、15.11～75.55 μg·mL-1(r＝0.999 9)范围内与峰面积呈良好的线性关系,平均加样回收率分别为100.78%,98.13%,99.29%。结论制剂制备工艺稳定,建立的含量测定方法简便、可靠,可用于制定主要治疗成分大黄素、大黄酚的含量下限以及非主要治疗成分大黄酸的含量上限,进一步保障制剂安全。     

用双异丙酚、阿芬太尼和利多卡因不注肌松药给患儿气管插管

选90例(ASAⅠ～Ⅱ级)患儿其中1～3岁(n=45)和4岁以上(n=45)。术前服咪唑安定0.5mg·kg~(-1)和阿托品0.03mg·kg~(-1),然后随机各分为三组(每组15例)。(1)A_(20)+L组,先静注阿芬太尼20μg·kg~(-1),1min后注双异丙酚和利多卡因(1mg·kg~(-1));     

柱前衍生化HPLC法测定人血清中丙戊酸钠的浓度

目的:建立测定人血清中丙戊酸钠浓度的方法.方法:采用2-溴-对硝基苯乙酮为衍生化试剂,以高效液相色谱法进行测定.色谱柱为大连依利特Hypersil ODS2色谱柱(4.6mm×150mm,5μm),流动相为甲醇-水(80:20),流速为1mL.min-i,检测波长为265nm,柱温为30℃,内标为环己烷羧酸.结果:丙戊酸钠血药浓度在8.96～134.4mg.L-1范围内线性关系良好(r=0.9992,n=6),最低检测浓度为2 mg.L-1;平均回收率为99.8％～102.4％,日内与日间RSD均＜6.7％(n=5).结论:本方法快速、简便、准确,适用于临床丙戊酸钠的血药浓度监测.     

HPLC法测定三黄片中大黄素及大黄酚的含量

目的:建立高效液相色谱法同时测定三黄片中大黄素和大黄酚含量的方法。方法:高效液相色谱法测定,色谱柱为Dikma DiamondsilC18柱,流动相为甲醇-0.2%磷酸溶液(85:15),检测波长为254nm,流速为1.0ml/min,柱温35℃。结果:大黄素在20.25～101.26μg范围内与峰面积呈良好线性关系(r=0.9999),平均回收率为98.2%(RSD=1.45%,n=6);大黄酚在21.85～109.24μg范围内与峰面积呈良好线性关系(r=0.9999),平均回收率为97.9%(RSD=1.51%,n=6)。结论:该方法简便、准确、重复性好,可用于三黄片的质量控制。     

建立HPLC-ESI-SIM法测定盐酸多奈哌齐在血浆中的含量

目的:研究盐酸多奈哌齐口服制剂在健康人体的药动学特征及生物等效性,建立HPLC-ESI-SIM方法测定血浆中的盐酸多奈哌齐浓度。方法:以乙哌立松为内标,待测血浆经碱化处理后,经乙酸乙酯进行液-液萃取,采用ODS-2C18柱(250mm×2.0mm,5μm),以甲醇-20mmol/L醋酸溶液(60:40)为流动相,流速0.8mL/mi n,柱温35℃。采用质谱电喷雾离子源正源(ESI+)将样品离子化,选择性离子监测(SIM)准分子离子峰。结果:多奈哌齐在0.10～20.0ng/mL内线性关系良好(r=0.9997),最低定量限为0.1ng/mL。方法回收率为92.9%～98.4%,提取回收率均大于80%,批内与批间RSD均小于10%。结论:该方法简单、快速、灵敏度高、专属性强,适用于人血浆中多奈哌齐浓度的测定及药动学研究。     

HPLC法测定吉祥草中β-胡萝卜素

目的:建立吉祥草中β-胡萝卜素的高效液相色谱测定方法.方法:以丙酮-石油醚(1∶1v/v)的混合溶液浸提吉祥革中β-胡萝卜素.色谱条件:色谱柱为DiamonsilC18柱(200mm×4.6mm,5μm),流动相:乙腈-甲醇-乙酸乙酯-三乙胺(80∶10∶10∶0.05);流速:1.0ml·min-1;柱温20℃;检测波长为450nm.进行了线性关系、精密度、稳定性、重复性、回收率等项的考察.结果:β-胡萝卜素的质量浓度在0.0074～0.0666μg范围内线性关系良好(r=0.9999),平均回收率(n=6)为99.33%,稳定性400分钟内RSD=1.94%.结论:该法专属性强,结果准确,重现性好,可用作吉祥草中β-胡萝卜素的含量测定方法.     

脊柱结核椎骨缺损的两种不同修复方法效果对比

目的 对比研究不同椎骨缺损修复方案在脊柱结核治疗中的临床疗效。方法 选取2012-02-2013-02在我院通过钛笼修复椎骨缺损的脊柱结核患者42例,髂骨块植骨修复椎骨缺损的脊柱结核患者40例,分成钛笼组和髂骨块组。比较两组患者植骨融合时间,术前及术后CRP、ESR、ODI、VAS、Cobb角和椎间高度矫正及丢失及并发症。结果 随访两组患者20~58个月,随访患者术后植骨全部融合,且两组均未发现结核复发病例。钛笼组和髂骨块组CRP、ESR、ODI、VAS较术前降低,术后与术前比较差异具有统计学意义(P0.05),两组组间比较不具有差异(P0.05)。髂骨块组椎间高度及Cobb角丢失多于钛笼组,差异具有统计学意义(P0.05)。主要并发症包括钛笼组2例窦道形成,1例脑脊液漏,髂骨块组2例窦道形成,1例术区椎间隙感染。结论 钛笼和髂骨块植骨修复椎骨缺损均具有良好效果,钛笼植骨修复椎骨缺损椎间高度及Cobb角丢失更小。     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.     

Intravenous endotoxin does not increase tissue extravasation of albumin in rats

Background : It is unclear whether activation of the inducible nitric oxide synthase (iNOS) increases or decreases the extravasation of plasma.
Methods : Chloralose anaesthetised male Wistar rats received E. coli lipopolysacharide (LPS), 3 mg kg^-1 i.v., or the corresponding volume of saline, 3 or 5 h before the end of the experiment. Mean arterial pressure (MAP) and heart rate (HR) were recorded. Tissue clearance of radio-labelled albumin, during the last 2 h of each experiment, was determined by a double-isotope method. In separate animals, the serum concentration of nitrite and nitrate was determined, 5 h after LPS or the solvent.
Main Results : LPS initially decreased MAP and lastingly increased HR. In the 3-h LPS animals (n=8), tissue plasma clearance was lower in the heart and calf muscle and increased only in diaphragm, compared to corresponding control animals (n=8). In the 5-h LPS rats, clearance was lowered (n=8) in the entire gastrointestinal tract and in testes, compared to controls (n=8). The serum nitrite/nitrate concentration was higher in animals given LPS (n=6) than in controls (n=6).
Conclusion : After LPS, tissue clearance of albumin was not increased in any major tissue, in spite of increased serum levels of NO end products. Apparently, after activation of iNOS, the augmented release of NO is not necessarily associated with increased albumin extravasation.     

Adrenaline markedly improves thoracic epidural analgesia produced by a low-dose infusion of bupivacaine, fentanyl and adrenaline after major surgery: A randomised, double-blind, cross-over study with and without adrenaline

Background: Basic pharmacological research indicates that there are synergistic antinociceptive effects at the spinal cord level between adrenaline, fentanyl and bupivacaine. Our clinical experience with such a mixture in a thoracic epidural infusion after major surgery confirms this. The objectives of the present study were to evaluate the effects on postoperative pain intensity, pain relief and side effects when removing adrenaline from this triple epidural mixture. Methods: A prospective, randomised, double-blind, cross-over study was carried out in 24 patients after major thoracic or abdominal surgery. Patients with only mild pain when coughing during a titrated thoracic epidural infusion of about 10 ml · h^?1 of bupivacaine 1 mg · ml^?1, fentanyl 2 μg · ml^?1, and adrenaline 2 μg · ml^?1 were included. On the 1^st and 2^nd postoperative days each patient was given a double-blind epidural infusion, at the same rate, with or without adrenaline. The effect was observed for 4 h or until pain when coughing became unacceptable in spite of a rescue analgesic procedure. Rescue analgesia consisted of up to two epidural bolus injections per hour and i.v. morphine if necessary. All patients received rectal paracetamol 1 g, every 8 h. Fentanyl serum concentrations were measured with a radioimmunoassay technique at the start and end of each study period. Main outcome measures were extent of sensory blockade and pain intensity at rest and when coughing, evaluated by a visual analogue scale, a verbal categorical rating scale, the Prince Henry Hospital pain score, and an overall quality of pain relief score. Results: The number of hypaesthetic dermatomal segments decreased (P <0.001) and pain intensity at rest and when coughing increased (P <0.001) when adrenaline was omitted from the triple epidural mixture. This change started within the first hour after removing adrenaline. After 3 h pain intensity when coughing had increased to unacceptable levels in spite of rescue analgesia (epidural bolus injections and i.v. morphine). Within 15–20 min after restarting the triple epidural mixture with adrenaline, pain intensity was again reduced to mild pain when coughing. Serum concentration of fentanyl doubled from 0.22 to 0.45 ng · ml^?1 (P <0.01), and there was more sedation during the period without adrenaline. Conclusions: Adrenaline increases sensory block and improves the pain-relieving effect of a mixture of bupivacaine and fentanyl infused epidurally at a thoracic level after major thoracic or abdominal surgery. Serum fentanyl concentrations doubled and sedation increased when adrenaline was removed from the epidural infusion, indicating more rapid vascular absorption and systemic effects of fentanyl.     

The multiply injured child

Blunt trauma is the principal cause of childhood death in many developed countries. This review outlines the differences between adults and children with respect to resuscitation and treatment of orthopaedic injuries in a child with polytrauma. Recent advances in techniques of fracture stabilization are reported.     

Utilisation des médicaments prokinétiques en réanimation : indications et limites ?

Enteral feeding is often limited by gastric and intestinal motility disturbances in critically ill patients, particularly in patients with shock. So, promotility agents are frequently used to improve tolerance to enteral nutrition. This review summaries the pathophysiology, presents the available pharmacological strategies, the clinical data, the counter-indications and the principal limits. The clinical data are poor. No study demonstrates a positive effect on clinical outcomes. Metoclopramide and erythromycin seems to be the more effective. Considering the risk of antibiotic resistance, the first line use of erythromycin should be avoided in favor of metoclopramide.