Efficacy, results, and complications of mechanical ventilation in children with status asthmaticus.

We have conducted a retrospective survey of 79 children out of a total hospital asthmatic patient population of 2,412, admitted over a 32 month period to the ICU for the management of severe status asthmaticus. All patients were in severe respiratory distress with CO2 retention; 19 required mechanical ventilation due to increasing fatigue and worsening bronchospasm, having failed to respond to either inhaled or IV bronchodilator therapy. All patients were ventilated at slow rates (less than 12 min) and their airway pressure (Paw) was deliberately kept below 45 cmH2O, while accepting a PaCO2 in the 45-60 mmHg range, as long as the pH was compensated. Although two patients developed pneumothoraces while on positive pressure ventilation, these were resolved without incidents. Five patients who had mediastinal or subcutaneous air leaks prior to intubation did not develop pneumothoraces. Following the initiation of mechanical ventilation, IV beta-agonist therapy was increased in order to reverse the bronchospasm and reduce the duration of mechanical ventilation. Mean duration of intubation was 42 hours. Fourteen of the 19 patients were weaned and extubated within 48 hours. All patients survived without sequelae. We conclude that a degree of controlled "hypoventilation" by deliberately choosing Paw less than 45 cmH2O can be successfully used to ventilate children with severe status asthmaticus with a reduced rate of pressure-related complications.     

Pharmacokinetics of intravenous chloramphenicol sodium succinate in adult patients with normal renal and hepatic function

The pharmacokinetics of chloramphenicol (CAP) and total chloramphenicol succinate (CAPS) were studied in eight hospitalized adult patients with normal renal and hepatic function receiving intravenous chloramphenicol sodium succinate therapy. The steady-state peak concentrations of CAP (8.4–26.0 g/ml) occurred at an average of 18.0 min (range 5.4–40.2) after cessation of the chloramphenicol sodium succinate infusion. Unhydrolyzed CAPS prodrug, representing 26.0±7.0% of the dose, was recovered unchanged in the urine indicating that the bioavailability of CAP from a dose of intravenous chloramphenicol succinate is not complete. A pharmacokinetic model was developed for simultaneous fitting of CAP and CAPS plasma concentration data. Pharmacokinetic parameters determined by simultaneous fitting were: V, 0.81±0.18 liters/kg; t_1/2, 3.20 ±1.02 hr; CL_B, 3.21±1.27 ml/min/kg for chloramphenicol; and V, 0.38±0.13 liters/kg; t_1/2, 0.57±0.12hr; CL_B, 7.72±1.87 ml/min/kg for total chloramphenicol succinate.Supported in part by Faculty Research Council Grant VF648 from the University of North Carolina.     

Pharmacokinetics of methyldopa in healthy man

Summary The pharmacokinetics of 2-¹⁴C-L--methyldopa have been investigated in five healthy volunteers following intravenous and oral administration. In the intravenous study a bi-phasic plasma concentration curve was found both for chemically determined -methyldopa and for radioactivity. The plasma level of radioactivity differed significantly from chemically determined drug, a pattern which was also found in urine. This suggests the presence of unidentified metabolite(s). The difference between plasma disappearance and urine recovery of -methyldopa and radioactivity during the first 4 h after injection suggests distribution to an extravascular compartment. Plasma half-lives of total radioactivity and of unchanged drug were calculated. In three subjects, pharmacokinetic parameters for a two-compartment open body model were calculated from urine and plasma data. Urinary recovery of radioactivity was almost complete within 48 h after intravenous administration. After oral administration, however, only about 40 per cent of the radioactive dose was recovered in the urine, and it contained approximately equal amounts of unconjugated methyldopa, acid-labile conjugated methyldopa and unidentified metabolite(s). The acid-labile conjugate was found only after oral administration, which supports the theory of a mucosal conjugation process. The lack of acid-labile conjugated drug either in the plasma or urine after intravenous injection indicates that there is no enterohepatic circulation of this drug.     

High-dose immunoglobulin therapy for Guillain−Barré syndrome in Japanese children

BACKGROUND: Guillain-Barré syndrome (GBS) is an acute acquired demyelinating polyneuropathy, presumed to be immune-mediated. Intravenous immunoglobulin (IVIg) has been used to treat GBS and was found to be effective. However, a well-controlled study of pediatric GBS has not been conducted in Japan. Therefore, to evaluate the efficacy of IVIg in the treatment of GBS, an open-labeled study was performed in pediatric patients. METHODS: Participants in the study were required to be younger than 15 years old, and diagnosed as having moderate or severe GBS. IVIg (400 mg/kg per day) was administered to patients for five consecutive days. Predefined outcome measures were defined on a seven-point scale of motor function (Hughes' functional grade [FG]). RESULTS: Eleven patients were treated with IVIg. The median time taken to improve by one grade on the FG scale was 10.0 days after initial treatment. Two weeks after initial treatment, 72.7% of patients treated with IVIg improved by one or more grades, and 36.4% improved by two or more grades, measured on the FG scale. After 4 weeks an improvement by one or more grades was observed in 81.8% of patients, and two or more grades in 63.6% of patients. These improvement rates were markedly greater than would occur with the natural course of GBS1. Adverse events (subjective symptoms or abnormal laboratory findings) were observed in four patients, although all were temporary and mild. CONCLUSIONS: The authors conclude that IVIg is a safe and effective treatment for childhood GBS, which shortens the time to recovery.     

氧氟沙星加双黄连注射液静脉滴注致肝损害1例

氧氟沙星 (ｏｆｌｏｘａｃｉｎ)和双黄连 (Ｓｈｕａｎｇｈｕａｎｇｌｉ ａｎ)已成为临床常用的抗菌药 ,但其不良反应亦不可忽视。我们曾遇见 1例用该 2药治疗上呼吸道感染引起严重肝功能损害 ,报道如下。病人男性 ,2 1ａ。主要因咽痛、咯痰、发热 2ｄ入院。病人于入院前 2ｄ出现咽痛、咯黄痰、胸痛、发热 (Ｔ38.9℃ )。诊断为上呼吸道感染。在当地卫生所给予氧氟沙星注射液(四川科伦大药厂生产 ,规格 :1 0 0ｍＬ :0 .2ｇ批号 0 1 30 1 2 )0 .2ｇ(1 0 0ｍＬ) +双黄连注射液 (齐齐哈尔第二制药厂生产 ,规格 :每支 2 0ｍＬ批号 30 0 1 32 ) 2 0…     

中药制剂所致药物不良反应分析

目的：了解中药制剂引起药物不良反应的发生情况。方法：对152例中药制剂所致的不良反应进行了分析。结果：共涉及中药制剂59种，在180例次不良反应中变态反应占57.78%(104/180)，其次为呼吸系统反应，占13.89%(25/180）,其他类型反应占28.33%(51/180）。由静脉给药引起的不良反应最多。占75.00%。结论：中药制剂也可引起许多不良反应。其中静脉给药时发生不良反应的可能性最大，应加强对中药不良反应的认识。     

静脉输注地尔硫治疗冠状动脉搭桥术前不稳定性心绞痛

目的 :评价静脉输注地尔硫治疗冠状动脉搭桥 (CABG)术前不稳定性心绞痛的疗效和安全性。方法 :68例CABG术前不稳定性心绞痛病人停服肾上腺素 β受体阻滞剂、钙通道阻滞剂及抗血小板药物 ,静脉给予地尔硫 ,以 33～ 167μg·min- 1,持续微泵注入 72h以上。观察心绞痛症状、心电图、血压、心率及不良反应。结果 :65例 (96% )病人有效。与用药前相比 ,心绞痛发作平均次数减少 (5 .4±s 1.8)次·d- 1(P <0 .0 1) ,发作持续时间缩短 (7.6± 2 .5 )min(P <0 .0 1)。心肌耗氧指数降低。心电图异常者ST T明显改善 ,4 9例病人在病情稳定后 1wk内接受CABG。无严重不良反应。结论 :静脉输注地尔硫为CABG术前不稳定性心绞痛提供了一种较为安全有效的药物治疗手段     

丙泊酚及氯胺酮持续泵注与间断静注的静脉全麻比较

目的比较丙泊酚复合氯胺酮静脉泵注与间断静注的静脉全麻效果及安全性。方法　20例ASA　I～II级静脉全麻手术患者随机为I、II组,每组10例,I组为丙泊酚及氯胺酮分次静注组,II组为丙泊酚及氯胺酮持续静脉泵注组。两组术前3分钟静注丙珀酚0.6mg/kg,氯胺酮1mg/kg。I组术中当麻醉转浅时静注丙泊酚(0.6mg/kg)和(或)氯胺酮(1mg/kg),Ⅱ组术中以微泵泵注丙泊酚(1～3mg·kg-1·h-1),氯胺酮(2～4mg·kg-1·h-1)。记录麻醉前至手术进行1小时每隔5分钟测得的平均动脉压(MAP)、呼吸(R)及脉搏氧饱和度(SpO);整个手术过程中麻醉药用量。结果2麻醉期间I组MAP、R波动大,Ⅱ组较平稳;I组有4例SpO下降至88%～94%;Ⅱ组所有病人SpO达98%～100%以上,22两组比较差异有显著性。Ⅱ组人均氯胺酮及丙泊酚用量显著多于Ⅰ组。结论　氯胺酮及丙泊酚微泵泵注给药麻醉效果好,术中BP和R平稳,麻醉药用量少,安全性好。     

乐沙定为基础的化疗方案治疗晚期胃癌临床研究

评价乐沙定与氟尿嘧啶、四氢叶酸钙联合治疗晚期胃癌的疗效和耐受性。 1999年 5月～ 2 0 0 2年 3月住院的晚期胃癌患者 2 0例 ,进行乐沙定 5 FU 四氢叶酸钙联合用药 ,对其临床资料进行统计分析。全组CR为 2例 ,PR为 7例 ,SD为 8例 ,PD为 3例 ,有效率 45 0 % ( 9/2 0 )。主要的副反应为恶心、呕吐、骨髓抑制和神经感觉障碍 ,大多数为Ⅰ～Ⅱ度。中位缓解期 5 1个月 ,平均生存期 8 9个月。乐沙定联合氟尿嘧啶、四氢叶酸钙是治疗晚期胃癌的一种有效安全的化疗方案     

持续滴注异长春花碱联合异环磷酰胺治疗难治性非霍奇金淋巴瘤

目的：临床研究持续性静脉滴注诺维本(Navelbine，NVB)联合异环磷酰胺(Ifosfamide，IFO)治疗难治性非霍奇金淋巴瘤(NHL)的近期疗效与毒副反应。方法：入组22例经CHOP治疗失败的NHL患，给予持续性静脉滴注NVB联合IFO化疗，至少2个周期，疗效及毒性判定按照WHO标准。结果：完全缓解(CR)6例，部分缓解(PR)13例，稳定(NC)1例，进展(PD)2例，总有效率86．4％。主要毒副作用为骨髓抑制。结论：持续静脉滴注NVB联合IFO治疗难治性NHL有较高的疗效，并较为安全，患可耐受。